Gender-affirming hormone therapy improves gender dysphoria and supports gender euphoria by helping people achieve the embodiment goals that best align with their gender identity, said Dr. Halley Crissman of Planned Parenthood of Michigan.
For transgender and nonbinary people who need medical interventions, this is “really critical, life-affirming and live-saving care,” said the organization’s gender affirming care director, who has seen first-hand resulting gains in self-confidence and self-image.
There are, however, often long wait lists for such therapy, not offered by all because, among other reasons, providers are not well educated in such care, she said. It could take months for a patient to see a provider in Michigan.
To address the need, Planned Parenthood of Michigan announced this week it had begun offering in May gender-affirming hormone care, including testosterone-blocking medications and estradiol (estrogen), and testosterone medications, for transmasculine, transfeminine, nonbinary and gender expansive people 18 and older.
The therapy is now available through Planned Parenthood in Marquette and Lansing.
The aim is to provide the care throughout the state by the end of the year.
To cover patient costs, Planned Parenthood will work with insurers. If individuals are uninsured or feel unsafe using the health plan that covers them, Planned Parenthood administers services for fees that vary based on ability to pay.
“This care falls firmly under the scope of the type of care that Planned Parenthood of Michigan provides. It fits really as a core with our values of bodily autonomy and trusting our patients, and it is care that we are well-positioned to provide,” said Crissman, also associate medical director.
Transgender and nonbinary people have for decades gone to Planned Parenthood for birth control, sexually transmitted infection treatment and screening and abortion and other care, and this is an expansion of those services, said Crissman, who emphasized the need for a gender-affirming, trusting and nonjudgmental approach to all health care.
The organization has also upgraded electronic medical records to accurately capture patient identities and pronouns, trained staff on gender-inclusive care and hired a full-time gender-affirming care navigator.
Hormone therapy is new to the Michigan affiliates, but not new to the national organization. As of the start of the year, more than 320 Planned Parenthood health centers across the United States offered gender affirming hormone care.
Planned Parenthood of Michigan, guided by an advisory board of 19 transgender and nonbinary community members and allies, started small to work out any technical details, such as scheduling, and to robustly train staff, Crissman said.
Lansing was selected as a central location in the Lower Peninsula, and Planned Parenthood knew a couple gender-affirming hormone providers recently left the area, she said. The therapy is available in Marquette because people in rural areas, particularly northern Michigan, have less access to such care or general sexual and reproductive care.
To remove barriers, Planned Parenthood providers will follow an “informed consent model” for hormone therapy. Patients will not be required to see a therapist or obtain an outside referral. Instead, they will discuss the risks and benefits with a clinician and determine the appropriate course of care, Planned Parenthood said in the statement.
Trans and nonbinary people, faced with hurdles to health care as well as violence and discrimination, have at times been asked to have a letter of mental health support, Crissman said.
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It is now widely accepted, she said, that being transgender or nonbinary is not a “mental health pathology.”
The informed consent approach “recognizes that patients are the only ones who are best positioned, in the context of their lived experience, to assess and judge beneficence,” notes the American Medical Association Journal of Ethics.
Improving access to gender-affirming care is an important means of improving health outcomes for the transgender population, reports the association. It has been linked to reductions in rates of suicide attempts, depression and anxiety, and harmful self-prescribed hormone use as well as decreased substance use and improved HIV medication adherence, the association says.
The expansion and announcement comes at a time when transgender patients and people face what Crissman called mounting political attacks.
State legislatures in several states have advanced bills that restrict healthcare for transgender youth, prohibit using restrooms or facilities that match gender identities or exclude transgender youth from athletics. In some areas of the country, it is law. Public school teachers in Florida are banned from classroom instruction on sexual orientation or gender identity. In Alabama, it is a felony to provide gender-affirming medical treatment to transgender youth.
Concurrently, the U.S. Supreme Court is seemingly poised to overturn Roe vs. Wade, the 1973 decision that made abortion a constitutional right, according to a leaked draft opinion published this month by Politico.
This could have “huge implications” for trans and nonbinary people and for marginalized communities, Crissman said. “And it’s not a coincidence that we’re seeing attacks on health care in terms of gender-affirming health care and abortion care simultaneously.”
It is a critical time for physicians and providers to speak up and stand in solidarity with patients. “And fight back against the interference in evidence-based compassionate medical care,” Crissman said. “There’s just no place for a politician in the exam room.”
Crissman, an obstetrician and gynecologist who also works as an adjunct clinical assistant professor at Michigan Medicine, has provided hundreds of patients with gender-affirming hormone care, and she sees how it can make a significant difference in, among other benefits, the ability to engage with the world in a way that feels more authentic.
“To see people blossom and live to their full potential, it’s just, it’s incredibly inspiring and positive care. It is a joy and an honor to see somebody back, who has been on gender affirming care for a few months, or a few years, and is thriving,” Crissman said.
“I wish the folks that are preventing or making it so hard for people to get care could have some compassion for the incredible benefit that this care can have.”
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