Providing Transgender- Affirming Primary Care By Allison Fox, FNP, RN, BA and Margot Presley, FNP, MN-RN, BA, DNP-S
|
|
- Coral Henderson
- 6 years ago
- Views:
Transcription
1 Providing Transgender- Affirming Primary Care By Allison Fox, FNP, RN, BA and Margot Presley, FNP, MN-RN, BA, DNP-S Lecture Objectives Care Coverage in OR and the US Best-practice customer service Hormones: Readiness, Informed Consent, Initiation and Monitoring Health Maintenance & Lifespan Considerations Referrals for surgery and gender non-conforming children and adolescents Overview of OHP Coverage and Medicaid Landscape in the US 1
2 11 States Include Transition Related Care in Medicaid (Transgender Law Center, 2016) Turning Point In Oregon: 2012 Insurance Division Bulletin Expanded the Oregon Equality Act of 2008: A health insurer may not deny or limit coverage or deny a claim for a procedure provided for GI/GD* if the same procedure is allowed in the treatment of another non-gi/gd- related condition. STAY UP TO DATE WITH WHAT OHP COVERS (Insurance Division, 2012) BRO PUBLISHES FAQ SHEETS OHP Coverage: Gender Dysphoria ICD-10 In 2015, Oregon Health Plan expanded coverage for transition-related medical care Puberty suppression in adolescents (Tanner stage 2) Gender-affirming hormones in adolescents and adults Top/Chest surgeries (feminizing and masculinizing) Bottom/genital gender confirmation surgeries + necessary hair removal (FamilyCare Health Provider Toolkit, 2015) 2
3 Basic Customer Service Principles in Working with Trans Patients 3
4 Gender-Affirming Clinic Processes Gather and Use Pertinent Patient Data Collect sexual orientation and gender identity (SOGI) info at intake Follow guidelines for verbiage (Deutsch et al., 2013) Sex Assigned at Birth Current Gender Identity Insurance gender marker Put info in a helpful place in EMR (banner, flag) Create a protocol for noting correct names, pronouns, in EMR, letters and voice message instructions Collaborate with your friends in IT Most Importantly: Create a Positive Space Hormones: Readiness, Informed Consent, Initiation and Monitoring 4
5 Assessing Readiness Gender Dysphoria replaces gender identity disorder in DSM V To diagnose GD- there must be: gender identity is not congruent with gender assigned at birth desire to live or be treated as the other gender strong conviction that one has feelings and reactions typical of the other gender must be present for at least 6 months DSM notes GD is not in itself a mental disorder Informed Consent No longer need a MH letter! Like any informed consent: make sure patient understands, risks, alternatives, unknowns, limitations, risks of not treating WPATH, 7th version Informed Consent Fenway Health me: foxal@ohsu.edu take time to read them over- they can be long reiterate important topics, things that can t be changed, fertility, T doesn t prevent pregnancy, estrogen can carry higher risk for blood clot 5
6 Initiating Hormones Know your resources! UCSF Transgender guidelines Initiating Hormones Endocrine Society, 2009 Initiating Hormones: UCSF, feminizing 6
7 Initiating Hormones: UCSF, masculizing Monitoring Hormones: UCSF Goal Estrogen level: <200 pg/ml Goal Testosterone level: <55 ng/dl Monitoring Hormones: UCSF Goal Testosterone Level: no higher than 700 7
8 Health Maintenance & Lifespan Considerations Collecting a Health History Obtain a thorough medical, mental health, and surgical history Ask about previous preventive screenings Document anatomy inventory If already on hormone therapy, request pt records that include baseline labs Preventive Care and Screening Nat l screening guidelines for organ systems unaffected by hormone therapy are appropriate for trans patients Vision, dental, dermatology, lung cancer Adapting nat l guidelines to trans patients is difficult w/o sufficient evidence: cardiovascular bone health hormone sensitive cancers (WPATH, 2007) 8
9 Slide 24 1 reword this slide Margot Presley,
10 Cardiovascular Risk and HT CV risk is similar for transmen (female at birth) on testosterone compared to cisgender women Evidence regarding transwomen (male at birth) taking estrogen is less clear Some studies find increased morbidity and mortality from MI and stroke compared with cisgender men (UCSF Primary Care Protocol, 2016) Cardiovascular Risk and HT Calculating Risk: Currently there is no guidance on whether to use natal sex or affirmed gender in risk calculators Depends on age at which hormones are begun, total length of exposure Providers may use the risk calculator for the natal sex, affirmed gender, or an average of the two Reducing Risk: For trans women with CV risk factors or established CVD, using the transdermal route of estrogen may be preferred due to lower rates of VTE and lack of associated changes in lipid profile or markers of coagulation (UCSF Primary Care Protocol, 2016) Diabetes Screening Recommendations for DM screening in trans patients (regardless of hormone status) do not differ from current national guidelines Weak evidence about hormones and insulin resistance Estrogen may increase resistance Testosterone may decrease resistance Young people who seek out healthcare for hormone therapy Opportunity to provide comprehensive primary care and identify risk factors/disease (obesity, PCOS, metabolic syndrome, impaired fasting glucose, or diabetes) (UCSF Primary Care Protocol, 2016) 9
11 Bone Health Trans people (regardless of natal sex) should begin bone density screening at age 65 Screening in ages should be considered for those with risk factors for osteoporosis Transwomen (male at birth): low T use after gonadectomy, androgen blockers w/o adequate estrogen, GnRH analogues w/o hormones Transmen (female at birth): oophorectormy before age 45 w/o optimal hormone replacement No studies determine whether to use natal sex or affirmed gender for assessment of osteoporosis, e.g., FRAX tool Case by case basis considering age of hormone initiation (before or after peak bone mass) and length of exposure (UCSF Primary Care Protocol, 2016) Bone Health Trans patients (regardless of natal sex) who have undergone gonadectomy and have a history of at least 5 years without hormone replacement should also be considered for bone density testing Prevention: Vit D supplementation, weight bearing exercise, adequate calcium intake, smoking cessation, and moderate alcohol intake (UCSF Primary Care Protocol, 2016) HIV and STIs Trans patients should undergo universal HIV screening consistent with recommendations for the general public Effective risk assessment (for HIV and other STIs) requires the ability to obtain an accurate sexual history that includes anatomy-specific sexual behavior Condoms and PReP encouraged for prevention There are no known drug-drug interactions or contraindications between concomitant use of PReP and gender affirming hormones (UCSF Primary Care Protocol, 2016) 10
12 Slide 28 2 reword slide about Frax and give example of hormonal mileu Margot Presley,
13 Suggested Questions for Sexual Health History (Fenwway Health) Are you having sex? How many sex partners have you had in the past year? Who are you having sex with? (including anatomy and gender of partners) What types of sex are you having? What parts of your anatomy do you use for sex? How do you protect yourself from STIs? (How often do you use condoms/barriers? Any use of PrEP?) What STIs have you had in the past, if any? When were you last tested for STIs? Has your partner(s) ever been diagnosed with any STIs? Do you use alcohol or any drugs when you have sex? Do you exchange sex for money, drugs, or a place to stay? Approach to STI Specimen Collection and Exam Chaperoned Trauma-Informed Approach: Greet patients while they are dressed Explain what you plan to do and why Provide information, choices, and decision-making ability Offer self-collection of specimen Self-collected vaginal and rectal swabs and urine specimens have equivalent sens/spec to providercollected samples for gonorrhea, chlamydia, and trichomonas Self-insertion of speculum (UCSF Primary Care Protocol, 2016) 11
14 Fertility and Reproduction It is recommended that prior to transition all transgender people be counseled on the effects of transition on their fertility and options for fertility preservation and reproduction. Hormone therapy is not a contraception. Any person with gonads who engages in sexual activity that can lead to pregnancy should be counseled about contraception. (UCSF Primary Care Protocol, 2016) Cancer Screening If an individual has a particular body part or organ and otherwise meets criteria for screening based on risk factors or symptoms, screening should proceed regardless of hormone use. (UCSF Primary Care Protocol, 2016) (UCSF Primary Care Protocol, 2016) Breast Cancer Transwomen: Screening mammography criteria: patient age of 50+ AND 5-10 years of feminizing hormone use Every 2 years Risk score calculators (e.g. GAIL method) may be unreliable. Obtain thorough family history. Transmen: Transmen w/o bilateral mastectomy or with breast reduction should undergo screening according to current guidelines for ciswomen Evaluation of palpable lesion may require MRI or u/s No evidence to guide screening in transmen who underwent complete mastectomy (no breast tissue remaining) Obtain good surgical history (UCSF Primary Care Protocol, 2016) 12
15 Prostate and Testicular Cancers Screening for prostate cancer in transwomen should be made based on guidelines for cismen. Removal of gonads + estrogen likely reduces risk for prostate cancer and benign prostatic hypertrophy PSA less relevant If testing PSA of transwomen with low T, may be appropriate to reduce the ULN to 1.0ng/ml If prostate exam is indicated: Via neovagina or DRE Routine testicular cancer screening is not recommended in cismen and there is no evidence to screen in transwomen. Transwomen adherent to therapeutic doses of estrogen plus an androgen blocker who have persistent testosterone elevations should be evaluated for testicular tumors by physical exam and labs. (UCSF Primary Care Protocol, 2016) Cervical Cancer Cervical cancer screening for transmen follows recommendations for ciswomen as endorsed by the ACS, WHO, and USPSTF. Transmen have lower rates of screening Inadequate screening is linked to the barriers trans patients face in accessing culturally sensitive care Trauma-informed approach to exam Use non-gendered, culturally sensitive language Remember testosterone effects on vaginal tissue (atrophy-use extra lube, smaller speculum) (UCSF Primary Care Protocol, 2016) Some evidence to support self-collection Review of 18 studies with 5441 participants found self-swab to be as sensitive as provider collected sample (Petignat, Faltin, Bruchim, Tramèr, Franco, & Coutlée, 2007) Mental Health Three primary MH needs in trans care: 1. Exploration of gender identity. 2. Coming out and social transition. 3. General mental health issues, possibly unrelated to gender identity (routine screening for depression, GAD, SA). Primary care providers who are experienced in working with transgender patients may feel comfortable initiating hormone therapies without an initial mental health assessment using an informed consent model. (UCSF Primary Care Protocol, 2016) 13
16 Brief overview of surgical referral Surgery Referral OHP Requirements: Cross-sex hormone therapy for 12 months Top surgery: one letter from a mental health provider Bottom surgery: two letters from mental health providers Pearls: Letter templates available online (Transline and OHP Provider Tool Kit) Start referral process early wait lists can be months long + time for hair removal Discuss access to post-op care OHSU Currently Offers: Chest surgery (FTM and MTF) Facial feminization surgery Oophorectomy/hysterectomy Orchiectomy Metoidioplasty Vaginoplasty Phalloplasty (summer/fall 2016) 14
17 Surgery Referral Chest Surgery: Juliana Hansen, OHSU Hema Thakar, Legacy Facial Feminization: Myrian Loyo Li, OHSU Jens Berli, OHSU Bottom Surgery/Gender Confirming Surgeries: Daniel Dugi, OHSU (orchi, vaginoplasty, metoidioplasty, later this year: phalloplasty) Jens Berli, OHSU (phalloplasty) Bottom/Genital Surgery Male-to-Female: Orchiectomy, Vaginoplasty Female-to-Male: Metoidioplasty, Phalloplasty Post-operative satisfaction generally high, low incidence of regret (<4%) Slides adapted from Dr. Dugi s lecture Orchiectomy Surgical removal of testicles Benefit: stop spironolactone, any dysphoria related to testes Risk: loss of fertiliy potential, loss of endogenous sex hormone Outpatient procedure 15
18 Vaginoplasty Goals: removal of male external genitalia, natural appearing external female genitalia, sensate clitoris, vagina for receptive intercourse. Does not remove prostate Most are penile inversion: use of penile, scrotal and perineal skin to create vagina, clitoris and vulva Sigmoid vaginoplasty: usually revision Need permanent hair removal: scrotum, perineum, base of penis 5-7 day stay in hospital, foley cath 1-2 wks, post operative edema normal Complications: wound healing, loss of vaginal depth/width (need for long term dilation), cosmetic dissatisfaction, fistula >90% satisfied, and 85% achieve orgasm post op Metoidioplasty Clitoris as analog of penis: grows with testosterone exposure Release of suspensory ligament of clitoris and mobilization of clitoris, lengthening of urethra Goals: stand to void, male genital appearance Not likely to allow penetrative intercourse No change in clitoral sensation May be followed by phalloplasty Ideal for slender patients/near ideal body weight Mean length after release 5.6 cm (microphallus) Hospital stay 2-3 days, suprapubic cath 3 wks Rate stricture/fistula 6% Metoidioplasty 16
19 Metoidioplasty Metoidioplasty 17
20 Phalloplasty Multiple techniques Goals: appearance of normal penis, ability to stand to urinate, maintain erogenous sensation, penetrative intercourse Radial forearm free flap: thin supple skin, potentially sensate however has donor site scar Hospital stay 5-7 days, suprapubic cath ~3 wks Implant for stiffening Complications: wound, minor (common), urethral (40-80%), implant (40-60%) Radial forearm free flap phalloplasty Radial forearm free flap phalloplasty 18
21 Criteria for puberty suppression and adolescent referrals Criteria for Puberty Suppression (WPATH SoC, 2011) Working with Children and Adolescents GI develops early, may socially transition prior to puberty Medical transition: Puberty suppression can start at Tanner Stage 2 with or followed by gender-affirming hormones Lupron/Lueprolide 7.5mg IM monthly most common regimen GnRH Agonist (turns off pulsatile action to stim LH & FSH) Consult with pediatric endocrinology Portland-based Pediatric Trans* Specialists: OHSU Kara Connelly, MD & Lindsey Nicol, MD and Trans Active Gender Center Legacy Trans Clinic Karin Selva, MD & Valerie Tobin, PMHNP Engage parents, assist w/ social support, collaborate with MH (OHSU Trans Health Program, 2015; UCSF Protocol: Youth Considerations, 2015) 19
22 Resources & Conferences Trans* Healthcare Resources Prescribing Guidelines & Support UCSF Center of Excellence for Transgender Health Primary Care Protocol International Endocrine Society Guideline OHP Provider Tool Kit Project Health: Transline WPATH Standards of Care Trans* Education and Advocacy National LGBT Health Education Center (a lot of free webinars on working with trans* patients) TransActive Gender Center (Youth Organization) Gay & Lesbian Alliance Against Defamation (GLAAD) An Ally s Guide to Terminology National Center for Transgender Equality (has IDs Document Center and more) Conferences LGBTQ Meaningful Care Conference Portland, OR Biannual spring conference National Transgender Health Summit Oakland, CA Biannual conference National Transgender HIV Testing Day (First Annual 4/18/16) Toolkit Available Philadelphia Trans Health Conference Philadelphia, PA 15th Annual Conference June 9-11,
23 References Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J.,... & Monstrey, S. (2012). Standards of care for the health of transsexual, transgender, and gendernonconforming people, version 7.International Journal of Transgenderism, 13(4), Retrieved from Deutsch, M. B., Green, J., Keatley, J., Mayer, G., Hastings, J., Hall, A. M.,... & Fennie, K. (2013). Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group. Journal of the American Medical Informatics Association, 20(4), FamilyCare Health. (2015). Trans health provider tool kit. [pdf]. Retrieved from Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K.,... & Coyne-Beasley, T. (2015). Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. American journal of public health, 105(12), e60-e76. Retrieved from Hembree, W. C., Cohen-Kettenis, P., Delemarre-van de Waal, H. A., Gooren, L. J., Meyer III, W. J., Spack, N. P.,... & Montori, V. M. (2009). Endocrine treatment of transsexual References, cont d Legacy Health. (n.d.) Transgender clinic. Retrieved from Oregon Department of Consumer and Business Services. (2012, December 19). Oregon insurance division bulletin ins Retrieved from Oregon Health & Science University. (n.d.) Transgender health program. Retrieved from Petignat, P., Faltin, D. L., Bruchim, I., Tramèr, M. R., Franco, E. L., & Coutlée, F. (2007). Are self-collected samples comparable to physician-collected cervical specimens for human papillomavirus DNA testing? A systematic review and meta-analysis. Gynecologic oncology, 105(2), Transgender Law Center. (n.d.). Healthcare laws and policies. Retrieved on May 16, 2016 from Transline. (2012). Summary tables labs and hormone doses. [pdf]. Retrieved from University of California, San Francisco. (2016). Center of excellence for transgender h lth i t l f t d ti t R t i d f THANK YOU! Contact Us: Allison Fox, FNP-C foxal@ohsu.edu Margot Presley, FNP-C presley@ohsu.edu 21
Pharmacists' role in pharmacotherapy management of transgender patients
Pharmacists' role in pharmacotherapy management of transgender patients Ashley Floyd, Pharm.D. PGY1 Community Pharmacy Residency Program H-E-B Pharmacy The University of Texas at Austin 1 Objectives Recognize
More informationEvidence Based Approach to Screening Transgender and Gender-diverse (TGD) Adults. Denise Rizzolo, PhD, PA-C
Evidence Based Approach to Screening Transgender and Gender-diverse (TGD) Adults Denise Rizzolo, PhD, PA-C Overview of Terms, Definitions, and Statistics Statistics/Terms An estimated 1.4 million adults
More informationTransgender Medicine: Essentials for the Primary Care Provider BENJAMIN J. BOH, DO, MS
Transgender Medicine: Essentials for the Primary Care Provider BENJAMIN J. BOH, DO, MS ASSISTANT PROFESSOR OF MEDICINE SECTION OF ENDOCRINOLOGY GEISEL SCHOOL OF MEDICINE AT DARTMOUTH Disclosure I will
More informationTransgender Sexual Health. Dr Tara Suchak CliniQ / 56 Dean Street
Transgender Sexual Health Dr Tara Suchak CliniQ / 56 Dean Street Contents Introduction to Transgender Issues Introduction to CliniQ Trans Men Trans Women The Future.. https://cliniq.org.uk Every Wednesday
More information10/07/18. Conflict of interest statement
Care: principles, best practices in Europe and how reproductive/sexual health care providers might contribute Petra De Sutter University Hospital Gent Conflict of interest statement My department occasionally
More informationCase Studies in Primary care
Case Studies in Primary care Holistic care of Transgender and Gender-nonconforming People Katy Kropf DO Ohio University Heritage College of Osteopathic medicine pronouns she/her/hers kropf@ohio.edu My
More informationPharmacy Policy. Adult transgender hormonal therapy may be approved when all of the following criteria are met:
Pharmacy Policy Class: Transgender Hormonal Treatment for Adults Line of Business: Medi-Cal Effective date: February 15, 2017 Revision date: February 15, 2017 This policy has been developed through review
More informationGender Health Center, Hormone Clinic th St #201 Sacramento, CA 95817
MTF Clinical Approach and Protocols Gender Health Center, Hormone Clinic Sacramento, CA Katherine Gardner, MD Revised 11/6/2015 Name and Pronouns: Preferred names and pronouns are used at all times when
More informationTrans Affirming Letter Writing: Best Practices and Challenges for BHP. Justin Wheeler, LISW-S Michelle Pride, Ph.D.
Trans Affirming Letter Writing: Best Practices and Challenges for BHP Justin Wheeler, LISW-S Michelle Pride, Ph.D. Disclosures The speakers and members of the planning committee do not have a conflict
More informationHormone Therapy Overview for the Behavioral Health Provider. Julie Thompson, PA Fenway Health
Hormone Therapy Overview for the Behavioral Health Provider Julie Thompson, PA Fenway Health Continuing Medical Education Disclosure Program Faculty: Julie Thompson, PA Current Position: Physician s Assistant,
More informationState of California, California Health and Human Services Agency, Department of Managed Health Care 2013:
This policy has been developed through review of medical literature, consideration of medical necessity, generally accepted medical practice standards, and approved by the IEHP Pharmacy and Therapeutics
More informationGuidelines for the Clinical Care of Persons with Gender Dysphoria
Guidelines for the Clinical Care of Persons with Gender Dysphoria Friday, May 27, 2016 2:15 5:00 PM 25 th Annual Scientific and Clinical Congress American Association of Clinical Endocrinologist Orlando,
More informationTHE YEAR IN REVIEW: SURGERY. Marta Bizic Faculty of Medicine, University of Belgrade, Serbia Belgrade Center for Genital Reconstructive Surgery
THE YEAR IN REVIEW: SURGERY Marta Bizic Faculty of Medicine, University of Belgrade, Serbia Belgrade Center for Genital Reconstructive Surgery Conflict of interest I have no potential conflict of interest
More informationCancer in the LGBTQ Community. Katie Imborek, MD Clinical Assistant Professor University of Iowa Department of Family Medicine
+ Cancer in the LGBTQ Community Katie Imborek, MD Clinical Assistant Professor University of Iowa Department of Family Medicine + Objectives Discuss the possible reasons that LGBTQ people have a disproportionate
More informationCITY AND COUNTY OF SAN FRANCISCO
CITY AND COUNTY OF SAN FRANCISCO Department of Public Health Transgender Health Services 50 Lech Walesa Street San Francisco, CA 94102 Telephone: (415) 355-7498 FAX: (415) 355-7407 transgenderhealthservices@sfdph.org
More informationTransgender Medicine beyond the guidelines.
Transgender Medicine beyond the guidelines. Rachel Hopkins, MD Assistant Professor of Medicine SUNY Upstate Medical University Division of Endocrinology and Metabolism Overview Definitions and history
More informationGuidelines for Preventative Health Care in LGBT Populations
+ Guidelines for Preventative Health Care in LGBT Populations Katie Imborek, MD Department of Family Medicine Co-Director UI LGBTQ Clinic April 2 nd, 2014 + Objectives n Understand CDC screening guidelines
More informationSexual Health History: Talking Sex with Gender Non-Conforming & Trans Patients
Sexual Health History: Talking Sex with Gender Non-Conforming & Trans Patients Timothy Cavanaugh, MD Co-Medical Director of the Fenway Trans Health Program Fenway Health Continuing Medical Education Disclosure
More informationPrimary and HIV Care for Our Transgender Patients
Primary and HIV Care for Our Transgender Patients James Hekman, MD FACP AAHIVS Clinical Assistant Professor Community Internal Medicine CWRU/Cleveland Clinic. Who are our TG patients? Demographics Those
More informationPatient education for transgender feminizing hormone therapy
Date name DOB Patient education for transgender feminizing hormone therapy o Some transsexual, transgender, and gender non-conforming people choose to take hormone therapy to treat gender dysphoria and
More informationJamie Feldman M.D., Ph.D. Dept. of Family Medicine/Program in Human Sexuality University of Minnesota
Jamie Feldman M.D., Ph.D. Dept. of Family Medicine/Program in Human Sexuality University of Minnesota University of Illinois, Urbana-Champaign Urbana, IL February 9, 2016 } MSP from 1984-1993 PhD in Anthropology
More informationCoding... 4 Benefit Application... 6 Description of Services... 7 Clinical Evidence... 8
Title: TABLE OF CONTENTS Product Variations.... 1 Policy Statement.... 1 Related Policies.... 3 Policy Guidelines..... 3 Coding.... 4 Benefit Application........ 6 Description of Services..... 7 Clinical
More informationSEXUAL HEALTH FOR TRANSGENDER WOMEN. Asa Radix, MD, MPH, FACP
SEXUAL HEALTH FOR TRANSGENDER WOMEN Asa Radix, MD, MPH, FACP April 10, 2018 Learning Objectives 1. Describe the unique sexual health needs of transgender women 2. Describe best practices for sexual health
More informationPrimary Care of LGBT Patients
Primary Care of LGBT Patients Basics Primary care of LGBT patients is primary care of a population with unique barriers to care Like any patient population there are population specific disease risks concerns
More informationPatient education for transgender masculinizing hormone therapy
Date name DOB Patient education for transgender masculinizing hormone therapy o Some transsexual, transgender, and gender non-conforming people choose to take hormone therapy to treat gender dysphoria
More informationMedi-Cal, Healthy Workers, Healthy Kids
Disclaimer: Criteria may change as the state and Medi-Cal update current regulations for transgender services Department Owner: Lines of Business Affected: Utilization Management Medi-Cal, Healthy Workers,
More informationTransgender Health Cases from the Transgender and Intersex Specialty Care Clinic
Transgender Health Cases from the Transgender and Intersex Specialty Care Clinic Caroline Davidge-Pitts, MD Todd B Nippoldt, MD Department of Endocrinology, Diabetes, Nutrition Mayo Clinic, Rochester 2017
More informationWhat to Know a 21 st Century Approach to Transgender Medical Care
What to Know a 21 st Century Approach to Transgender Medical Care Joshua Safer, MD Transgender Medicine Research Group Center for Transgender Medicine and Surgery Patient / Mental Health Provider Gatekeeper
More informationMEDICAL POLICY No R1 GENDER REASSIGNMENT SURGERY
GENDER REASSIGNMENT SURGERY Effective Date: January 1, 2017* Review Dates: 8/15, 8/16, 11/16 Date Of Origin: August 12, 2015 Status: Current *Note: For fully funded commercial (individual or group), this
More informationHarold Husovsky, MD. Associate Professor of General Medicine at SUNY Health Science Center
Harold Husovsky, MD Associate Professor of General Medicine at SUNY Health Science Center Care of the Transgendered Syracuse University, 1/09/07 Goals Introductions Definitions Statistics Evaluation Treatments
More informationDetermining a Client s Readiness for Gender Transition:
Determining a Client s Readiness for Gender Transition: Clinical Evaluation and Recommendation VARUNEE FAII SANGGANJANAVANICH, PHD, LPCC-S THE UNIVERSITY OF AKRON Session Overview Identify DSM 5 diagnostic
More informationArti Barnes MD MPH Tuesday AM series ENCOMPASSING THE MARGINALIZED: CARE FOR THE TRANSGENDER COMMUNITY
Arti Barnes MD MPH Tuesday AM series 9-29-2015 ENCOMPASSING THE MARGINALIZED: CARE FOR THE TRANSGENDER COMMUNITY Disclosures None Objectives Increase awareness of HIV and STD epidemiology among Transgenders
More informationDisclosures. Overview: How did I get Here? Pfizer Safe Medical Designs (SMD) MLM Medicus, LLC. Current Concepts in Caring for Transgender Patients
Disclosures Pfizer Safe Medical Designs (SMD) MLM Medicus, LLC Current Concepts in Caring for Transgender Patients No financial relationships relevant to this presentation to disclose UCSF Controversies
More informationHorizon BCBSNJ Uniform Medical Policy Manual Policy Number: 115 Effective Date: 01/01/2017
Horizon BCBSNJ Uniform Medical Policy Manual Section: Surgery Policy Number: 115 Effective Date: 01/01/2017 Original Policy Date: 05/25/2010 Last Review Date: 05/10/2016 Date Published to Web: 06/23/2010
More information8/17/2015. Objectives. Disclosures
NPANY Annual Conference Niagara Falls, NY October 2015 Laura Markwick, DNP, FNP C Associate Professor Wegmans School of Nursing St Joh Fisher College Objectives The learner will gain an understanding of
More information# 051. Maurice Garcia M.D., MAS. Department of Urology University of California San Francisco
# 051 Building an Academic Medical Center Multidisciplinary Genital Gender Affirming Surgery Program: The UCSF Experience-- Initial Outcomes and Lessons Learned Maurice Garcia M.D., MAS. Department of
More informationFeminising hormone treatment for trans women and non-binary people: Information for primary care professionals
1 Feminising hormone treatment for trans women and non-binary people: Information for primary care professionals Introduction The following information has been produced by the Nottingham Centre for Transgender
More informationDISCLOSURES LEARNING OBJECTIVES. 21st Century Strategies: Transgender Hormone Care. Patient/PCP. Medical model
21st Century Strategies: Transgender Hormone Care DISCLOSURES Joshua Safer, MD Center for Transgender Medicine and Surgery No conflicts of interest Just about the entire talk is "off label" LEARNING OBJECTIVES
More informationPlease note that this should only be used for feedback and comments specifically related to this particular medical policy.
E-Mail Us Close Please note that this email should only be used for feedback and comments specifically related to this particular medical policy. Horizon BCBSNJ Uniform Medical Policy Manual Section: Surgery
More informationPrimary Care for Transgender Pa5ents. Objec5ves. Transgender 2/22/17. Charleston APRN Conference February 2017
Primary Care for Transgender Pa5ents Charleston APRN Conference February 2017 Marty Player MD MS MUSC Department of Family Medicine Objec5ves Review terminology related to transgender people Review screening
More informationEndocrinology and the Transgender Patient
Endocrinology and the Transgender Patient Matthew Leinung MD Professor of Medicine Albany Medical College This project is supported by the Health Resources and Services Administration (HRSA) of the U.S.
More informationThere are four areas where you can expect changes to occur as your hormone therapy progresses. 1) Physical
You are considering taking feminizing hormones, so you should learn about some of the risks, expectations, long term considerations, and medications associated with medical transition. It is very important
More informationMedical Necessity Guidelines: Transgender Surgical Procedures
Medical Necessity Guidelines: Transgender Surgical Procedures Effective: September 13, 2017 Clinical Documentation and Prior Authorization Required Applies to: Coverage Guideline, No Prior Authorization
More informationMEDICAL TREATMENTS OF GENDER DYSPHORIA
Medical Policy MP 2.01.501 Last Review: 01/30/2018 Effective Date: 01/30/2018 Section: Medicine Related Policies 5.01.501 Guidelines for Prior Authorization of Pharmacologic Therapies 5.01.23 Testosterone
More informationGENder Education and Care Interdisciplinary Support (GENECIS) Feminizing Medications for Patients with Gender Dysphoria
GENder Education and Care Interdisciplinary Support (GENECIS) Feminizing Medications for Patients with Gender Dysphoria Patient Information and Informed Consent and Assent for Minors Before using medications
More informationTrust Women Seattle Client Information for Informed Consent MASCULIZING MEDICATIONS FOR TRANSGENDER CLIENTS
Client Information for Informed Consent MASCULIZING MEDICATIONS FOR TRANSGENDER CLIENTS Before using medications to transition and Masculinize, you need to know the possible advantages, disadvantages and
More informationPrimary Care and Preventive Health Needs of Transgender Patients. Julie Thompson, PA-C Fenway Health
Primary Care and Preventive Health Needs of Transgender Patients Julie Thompson, PA-C Fenway Health Continuing Medical Education Disclosure Program Faculty: Julie Thompson, PA-C Current Position: Physician
More informationGender Identity Services
Gender Identity Services www.sandyford.org 2 Contents Welcome to Sandyford....... 4 The Gender Identity Clinic...... 4 Treatment Options for Transsexual Women Male to Female (MTF)........ 6 Treatment Options
More informationAddressing Primary Care Preventive Needs of Transgender Patients. Julie Thompson, PA Fenway Health
Addressing Primary Care Preventive Needs of Transgender Patients Julie Thompson, PA Fenway Health 1 Continuing Medical Education Disclosure Program Faculty: Julie Thompson, PA Current Position: Physician
More informationOrganic. TransSEXualism has nothing to do with sex but everything with gender identity... (NATURE) Psychological (NURTURE)
University Hospital Ghent (Belgium) TRANSGENDER CARE introduction TransSEXualism has nothing to do with sex but everything with gender identity... Stan Monstrey Gender dysphoria Gender Identity Disorder
More informationAll service users will benefit from having the information on these forms. The consent forms may be read in conjunction with the NHS booklet
INFORMED CONSENT FORMS The following forms are intended to protect both service users and clinicians by ensuring that proper information has been given to service users, and that this is fully understood,
More informationGuidelines for the Clinical Care of Persons with Gender Dysphoria
Guidelines for the Clinical Care of Persons with Gender Dysphoria Friday, May 27, 2016 2:15 5:00 PM 25 th Annual Scientific and Clinical Congress American Association of Clinical Endocrinologist Orlando,
More informationClient Information for Informed Consent FEMINIZING MEDICATIONS FOR TRANSGENDER CLIENTS
Client Information for Informed Consent FEMINIZING MEDICATIONS FOR TRANSGENDER CLIENTS Before using medications to transition and feminize, you need to know the possible advantages, disadvantages and risks
More informationTransgender Medical Benefits
Transgender Medical Benefits The following Transgender Medical Benefits are based on the Standards of Care published by the World Professional Association for Transgender Health (WPATH). All transgender
More informationHEALTH CARE FOR TRANSGENDER PERSONS
HEALTH CARE FOR TRANSGENDER PERSONS Tim Cavanaugh, MD Medical Director for the Trans Health Program Fenway Health 1 TRANSGENDER refers to a person who is born with the genetic traits of one gender but
More informationInformation on Feminizing Medications
201 Plageman Building 108 SW Memorial Place Corvallis, Oregon 97331 P 541-737-9355 F 541-737-9694 studenthealth@oregonstate.edu Information on Feminizing Medications Persons in the male-to-female spectrum
More informationCare for Transgender Patient: Providing Competent and Compassionate Care During a Time of Transition
Care for Transgender Patient: Providing Competent and Compassionate Care During a Time of Transition Jessica Francis, MD Assistant Professor Department of Obstetrics and Gynecology Froedtert and the Medical
More informationCorporate Medical Policy
Corporate Medical Policy Gender Confirmation Surgery and Hormone Therapy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: gender_confirmation_surgery_and_hormone_therapy 7/2011 5/2018
More informationAsk at Least Annually. Ask Older Adults. Have you been sexually active in the last year? Have you ever been sexually active?
Essential Sexual Health Questions to Ask Adults Ask all of your adult patients the sexual health questions on this card. They will help you assess the patient s level of sexual risk and determine whether
More informationValues Accountability Integrity Service Excellence Innovation Collaboration
n05586 Transgender and Gender Dysphoria /Gender Incongruence Services Values Accountability Integrity Service Excellence Innovation Collaboration Abstract Purpose: Network Health Plan/Network Health Insurance
More informationAndroderm patch, AndroGel packets and pump, Axiron solution, First- Testosterone, First-Testosterone MC, Fortesta gel, Testim gel, Vogelxo
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.31 Subject: Testosterone Topical Page: 1 of 9 Last Review Date: September 23, 2016 Testosterone topical
More informationDivision: Medical Management Department: Utilization Management
Retired Date: Page 1 of 1 1. POLICY DESCRIPTION: Gender Reassignment Surgery 2. RESPONSIBLE PARTIES: Medical Management Administration, Utilization Management, Integrated Care Management, Pharmacy, Claims
More informationInformation About Hormonal Treatment for Trans men
Information About Hormonal Treatment for Trans men Leighton J Seal PhD FRCP Consultant Endocrinologist, Gender Identity Clinic, (Charing Cross) West London Mental Health NHS Trust 12/12/2016 Introduction...
More informationSex Talk for Self-Advocates #3 Safe Sex Practices - Sexually Transmitted Infections (STIs)
Sex Talk for Self-Advocates #3 Safe Sex Practices - Sexually Transmitted Infections (STIs) Self-Advocacy Educator - Max Barrows Sex Educator - Katherine McLaughlin www.elevatustraining.com Sex Educator
More informationInformed Consent Form for Feminizing Medications
Student Health Services Oregon State University, 201 Plageman Building, Corvallis, Oregon 97331-8567 Tel 541-737-9355 General Fax 541-737-4530 Medical Fax 541-737-9665 http://studenthealth.oregonstate.edu/
More informationDisclosures. Endocrine Care of the Transgender Patient. Objectives. Start where you are. Use what you have. Do what you can. Vocabulary.
Disclosures Endocrine Care of the Transgender Patient Kathryn Tierney, MSN, APRN, FNP-BC Medical Director, Middlesex Hospital Transgender Medicine Program Middlesex Multispecialty Group Division of Endocrinology
More informationNHS MEDICAL POLICY. Transgender Surgical Procedures Procedure
Effective Date: 12/13/2017 NHS MEDICAL POLICY Transgender Surgical Procedures Procedure 2017-003 Transgender surgical procedures may be indicated when ALL of the following are present: 1 The member is
More informationA Guide to Hormone Therapy for Trans People available at
INFORMED CONSENT FORMS The following forms are intended to protect both service users and clinicians by ensuring that proper information has been given to service users, and that this is fully understood,
More informationProtocol. Gender Reassignment Surgery
Protocol Gender Reassignment Surgery Medical Benefit Effective Date: 07/01/18 Next Review Date: 03/19 Preauthorization Yes Review Dates: 03/15, 03/16, 03/17, 03/18, 05/18 Preauthorization is required.
More informationPhoto: Sharon Kilgannon
Photo: Sharon Kilgannon Photo: Paul Grace Photo: Marie Claire of trans and gender variant people have a non-binary gender identity McNeil et al. (2012) Trans Mental Health Study 2012, GIRES Dmitry
More informationTransgender Populations
Treating HIV in Transgender Patients: A Clinical Update Tonia Poteat, PhD, MPH, PA-C Physician Assistant, JHMI Assistant Professor, JHSPH 18 November 2016 Transgender Populations Transgender (trans): people
More informationCLIENT INFORMATION and INFORMED CONSENT TESTOSTERONE THERAPY
CLIENT INFORMATION and INFORMED CONSENT TESTOSTERONE THERAPY This form explains the use of testosterone for someone who wishes to become more masculine as part of a gender transitioning process. Testosterone
More information2. Does the member have a diagnosis of central precocious puberty? Y N
Pharmacy Prior Authorization AETA BETTER HEALTH PESLVAIA & AETA BETTER HEALTH KIDS Leuprolide (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review
More informationPrior Authorization Criteria Update: Androgens, Topical and Parenteral
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationDepartment of Pediatrics
Page 1 of 5 What is testosterone? Consent Form: MASCULINIZING MEDICATIONS You want to take testosterone to masculinize your body. Before taking it, there are several things you need to know about. They
More informationTransgender: A broad spectrum of individuals who transiently or persistently identify with a gender different from their natal gender.
POLICY TITLE: Gender Reassignment Surgery POLICY STATEMENT: Gender reassignment surgery is one treatment option for extreme cases of Gender Dysphoria Disorder. Gender dysphoria disorder (formerly termed
More informationPrEP Basics: A Patient-Centered Approach to Providing PrEP
www.med-iq.com www.projectinform.org 12/18/2017 1 Incidence data help inform the need for local and state HIV services. However, individuals may be more vulnerable to HIV beyond what incidence data indicate.
More informationInformation on Testosterone Therapy
Information on Testosterone Therapy 201 Plageman Building 108 SW Memorial Place Corvallis, Oregon 97331 P 541-737-9355 F 541-737-9694 studenthealth@oregonstate.edu Persons in the female-to-male spectrum
More informationToday s Webinar will be approximately 1 hour long including breaks for Q and A one in the middle, and one at the end. In order to receive Continuing
1 Today s Webinar will be approximately 1 hour long including breaks for Q and A one in the middle, and one at the end. In order to receive Continuing Nursing Education, participants must attend the entire
More informationEndocrine Treatment of Gender-Dysphoric/ Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. Education Module June, 2017
Endocrine Treatment of Gender-Dysphoric/ Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline Education Module June, 2017 Introduction Wylie C. Hembree, MD Associate Attending Physician
More informationPOLICIES AND PROCEDURE MANUAL
POLICIES AND PROCEDURE MANUAL Policy: MP307 Section: Medical Benefit Policy Subject: Gender Dysphoria and Gender Confirmation Treatment I. Policy: Gender Dysphoria and Gender Confirmation Treatment II.
More informationPosition Statement on Medical Necessity of Treatment, Sex Reassignment, and Insurance Coverage in the U.S.A.
21 December 2016 Position Statement on Medical Necessity of Treatment, Sex Reassignment, and Insurance Coverage in the U.S.A. The World Professional Association for Transgender Health (WPATH) is an international,
More informationTestosterone Oral Buccal Nasal. Android, Androxy, Methitest, Natesto, Striant, Testred. Description
1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.32 Subject: Testosterone Oral Buccal Nasal Page: 1 of 10 Last Review Date: March 17, 2017 Testosterone Oral Buccal Nasal Description
More informationHIV PREVENTION WITH PRE-EXPOSURE PROPHYLAXIS: A PRIMER FOR PHARMACISTS. Speaker: Susan MK Lee, PharmD, BCPS, CDE
Clinical Education Initiative Support@ceitraining.org HIV PREVENTION WITH PRE-EXPOSURE PROPHYLAXIS: A PRIMER FOR PHARMACISTS Speaker: Susan MK Lee, PharmD, BCPS, CDE 12/13/2016 HIV Prevention with Pre-Exposure
More informationThere are four areas where you can expect changes to occur as your hormone therapy progresses.
You are considering taking testosterone, so you should learn about some of the risks, expectations, long term considerations, and medications associated with medical transition. If is very important to
More informationAnswers to those burning questions -
Answers to those burning questions - Ann Avery MD Infectious Diseases Physician-MetroHealth Medical Center Assistant Professor- Case Western Reserve University SOM Medical Director -Cleveland Department
More informationSexual health screening
Sexual health screening This guideline provides screening recommendations that are based on anatomy and is inclusive of genderaffirming surgeries and hormone therapy. All patients should be screened according
More informationNational Gender Identity Clinical Network for Scotland (NGICNS)
National Gender Identity Clinical Network for Scotland (NGICNS) Endocrine Management of Adult Transgender Patients Revised 7 th July 2016 (First published 11 August 2015) This guidance is based on the
More informationTRANSGENDER HEALTHCARE Barry Zevin, MD Conrad Wenzel, MSW
TRANSGENDER HEALTHCARE Barry Zevin, MD Conrad Wenzel, MSW Disclosures Dr. Zevin is an employee of the San Francisco Department of Public Health There are no other relevant financial or personal relationships
More informationPreventive Care Guideline for Asymptomatic Low Risk Adults Age 18 through 64
Preventive Care Guideline for Asymptomatic Low Risk Adults Age 18 through 64 1. BMI - Documented in patients medical record on an annual basis. Screen for obesity and offer intensive counseling and behavioral
More informationReproductive Health and Obstetric Care in Transgender Patients. Rebekah P. Viloria, MD Obstetrician & Gynecologist Fenway Health
Reproductive Health and Obstetric Care in Transgender Patients Rebekah P. Viloria, MD Obstetrician & Gynecologist Fenway Health Continuing Medical Education Disclosure Program Faculty: Rebekah P. Viloria,
More informationTransgender. Transgender Health and HIV. Transgender Terminology. Gender Identity & Sexual Orientation 12/8/17
Transgender Transgender Health and HIV Madeline B. Deutsch, MD, MPH Associate Professor of Clinical Family & Community Medicine Director, UCSF Transgender Care Center of Excellence for Transgender Health
More informationTransitions E M M A G O L D M A N C L I N I C.
www.emmagoldman.com Transitions Affirming health care for individuals with diverse expressions of gender and sexuality. E M M A G O L D M A N C L I N I C NONJUDGMENTAL, QUALITY HEALTH CARE Since 1973 Transitions
More informationNCHA and NIU Data Dashboards 2011, 2013, 2015 Sexual Health. Evelyn Comber January 31, 2017
NCHA and NIU Data Dashboards 2011, 2013, 2015 Sexual Health Evelyn Comber January 31, 2017 NIU Male Participants and Female Participants Report Health Exam Behaviors Regardless of gender, a majority of
More informationReproductive System. Testes. Accessory reproductive organs. gametogenesis hormones. Reproductive tract & Glands
Reproductive System Testes gametogenesis hormones Accessory reproductive organs Reproductive tract & Glands transport gametes provide nourishment for gametes Hormonal regulation in men Hypothalamus - puberty
More informationIntegrating Transgender Health Care Into Our Medical Culture
Integrating Transgender Health Care Into Our Medical Culture JOHN F. RANDOLPH, JR., MD DIVISION OF REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY DEPARTMENT OF OBSTETRICS AND GYNECOLOGY UNIVERSITY OF MICHIGAN
More information5/3/2016 SEXUALITY: KNOWLEDGE OPENS THE DOOR OBJECTIVES DEFINITIONS CONT. DEFINITIONS
SEXUALITY: KNOWLEDGE OPENS THE DOOR TO COMMUNICATION JILL LIBBESMEIER BSN, RN, OCN OBJECTIVES Understand the differences between sexuality, intimacy, sexual health, and sexual dysfunction Identify how
More informationTestosterone Oral Buccal Nasal. Android, Androxy, Methitest, Natesto, Striant, Testred. Description
1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.30.32 Subject: Testosterone Oral Buccal Nasal Page: 1 of 10 Last Review Date: November 30, 2018 Testosterone Oral Buccal Nasal
More informationHuman Papillomavirus (HPV) in Patients with HIV.
Human Papillomavirus (HPV) in Patients with HIV www.hivguidelines.org Purpose of the Guideline Increase the numbers of NYS residents with HIV who are screened for HPV-related dysplasia and managed effectively.
More information