Planned Parenthood may be most well known for its reproductive health care and most controversial for its abortion services, but the organization offers much more. Affiliates in 21 states -- including Alaska and Hawaii -- now offer gender-affirming hormone therapy to transgender patients. This summer, the Planned Parenthood League of Massachusetts (PPLM) became one of the affiliates offering this service as part of a larger initiative to better serve the needs of transgender patients. An accompanying media campaign called "My Care, My Way" explains through six personal stories just how hard it can be for transgender people to access health services.
Before launching the services and campaign, PPLM convened focus groups with members of the transgender community who said it was hard find providers offering hormone therapy and stressed their need for nonjudgmental, inclusive care. Focus group participants also said they had experienced systematic discrimination and that providers often had insufficient understanding of transgender identities.
This is not surprising, as traditional health care environments can seem at best unwelcoming to transgender patients. A poll conducted last year by NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health found that 31% of LGBTQ people said that, where they live, transgender people "often" experience discrimination when going to doctor's offices or clinics. Findings from a 2015 survey by the National Center for Transgender Equality were even more alarming, with a full third (33%) of transgender respondents who had themselves seen a health care provider reporting at least one negative experience related to being transgender, such as being verbally harassed or refused treatment because of their gender identity. The fear for being mistreated was enough to keep many transgender people from seeking health care; almost a quarter of respondents (23%) reported skipping needed care for this reason within the year they took the survey.
The need for safe and accessible health care is a message that all five of the patients featured in the "My Care, My Way" campaign touch on as they tell their story. Briar, a 19 year old who describes themselves as non-binary tells viewers of feeling different at age 13 when they were still attending Catholic school: "As soon as I got out, I learned what trans was, and I thought, oh, I'm one of them." Their ability to access help in transitioning was thwarted by rules that required a therapist to sign off -- and a therapist who didn't believe anyone could be non-binary. Of the many gatekeepers put in place before someone can transition, Briar says, "They have this perception that transition and being trans is this awful thing that you want to make sure is not the case, when really what we just want is for someone to tells us that we can make decisions about our body."
Renee, who is 25 and has been on hormone therapy for the past nine months, explains in their video how hard it can be for transgender people to access the treatment they need, both because of expense and because trans people just don't know where to go to get these services. Renee tells viewers: "Trans community accessing health care is a social justice issue because we are literally fighting for something that is a basic fundamental right."
For the campaign -- which is designed to get the word out about PPLM's new services -- the agency partnered with Amir Now, Inc., a Boston-based visual design and strategy firm. Amir Dixon, the firm's CEO and creative director, told TheBody that this campaign was very important and personal: "I am a black queer man. Many of my friends, family, and people are trans, and this campaign in many ways is my form of visual activism. To be able to work and support trans folks in shaping their own narrative and centering trans [people of color] in this campaign about having control over their health, to make decisions about their body -- especially in the current political climate -- is disruptive and necessary."
PPLM is offering gender-affirming hormone therapy with informed consent services at its health centers in Boston, Fitchburg, Marlboro, Springfield, and Worcester. "Informed consent" means that the agency is trusting individuals to know what they need; it does not require referrals from a therapist or any other health care provider. The agency has also made its health centers more trans-friendly by upgrading electronic medical records to better capture patients' gender identity and gender pronouns, training staff on transgender-inclusive care, and installing gender-inclusive bathroom signs. Health center staff have begun to wear lapel pins displaying their preferred pronouns, as well.
While many transgender patients may come to the health center because it is offering gender-affirming hormone therapy, the agency sees this as an entry point not just to Planned Parenthood but also to the larger health care system.
"During a visit for gender-affirming hormone therapy, we provide our patients with a packet of statewide resources for medical and community support for transgender, gender-nonconforming, and non-binary individuals," said Danielle Roncari, M.D., M.P.H., medical director of PPLM, in an email to TheBody. "Patients who come to us for gender-affirming hormone therapy can learn about and receive testing and treatment for sexually transmitted infections, rapid HIV testing, [pre-exposure prophylaxis] (PrEP), contraception, cancer screenings, and any other reproductive health care services they may need."
Related: Amida Care's Health Plan for Transgender New Yorkers Offers a National Model
The good news is that similar services are available at Planned Parenthood affiliates across the country, which can be especially important in places where the political environment or geography makes accessing transgender-friendly health care difficult. Transgender care is being offered by affiliates that serve Alaska, Arkansas, Florida, Hawaii, Kansas, Missouri, New York, and Oklahoma, among others. An affiliate in Nebraska was the first to provide transgender health services, according to Maureen Kelly, vice president for programming and communications at Planned Parenthood of the Southern Finger Lakes (PPSFL).
Kelly's affiliate was the first in New York state to do so, and it is heading into its sixth year of providing transgender care. She noted the challenges of transgender people in rural areas: "[We] currently have more than 500 patients that can now get excellent, compassionate, and skilled transgender hormone care in their home community -- or closer at least. Many of our patients were traveling three-plus hours to get this care previously. It's a unique problem in rural areas, and [Planned Parenhood] is so ideally positioned to help reduce barriers to care to serve the trans community!"
Like the other Planned Parenthood affiliates that have taken on transgender care, PPSFL takes a comprehensive approach. It has a transgender patient navigator on staff and tries to train all staff on related issues. The agency offers free legal clinics a couple of times a year to help patients with paperwork associated with name and gender-marker changes. And it wrote a layperson's guide to the process in New York.
Kelly recently trained staff at several affiliates that have added care for transgender people, and she offered a large-scale training of trainers at a Planned Parenthood Health Summit in June, where she and colleagues trained 7,200 people.
"There has been a steady flow of new affiliates offering care over the last couple years; it's been wonderful to watch," she said. "It's been important and exciting to work to be engaged in!"
Jennifer Childs-Roshak, M.D., M.B.A., the president and CEO of PPLM, summed up the reasoning behind this trend in a press release: "All people need and deserve quality health care, and should be treated with dignity and respect. Transgender people are no exception. As political attacks make it harder for our patients to lead healthy, safe lives, Planned Parenthood League of Massachusetts is proud to serve as a partner in combatting barriers to care and to reaffirm our commitment to the health and rights of the transgender community."
Renee made the message even simpler in their "My Care, My Way" video: "It's very important for Planned Parenthood to provide these services and resources to the community because we are looking for them."