Miles Harris, NP, treating a patient at The Mount Sinai Hospital Center for Transgender Surgery. Mount Sinai Health System follows current precaution guidelines from public health officials. Image was taken before current mask and eye protection policies were implemented.
Gender-affirming care for transgender and gender-diverse people has advanced over the past decade, but connecting patients to this care efficiently remains a challenge, hindered by a lack of awareness.
“Patients worry about what they need to know even before being able to speak to a doctor for gender-affirming care,” said Joshua Safer, MD, Executive Director of the Center for Transgender Medicine and Surgery at Mount Sinai.
Even health providers can be unsure of what gender-affirming care entails. Many once believed that they would have to run a series of tests before even being able to refer their transgender patients for specialized care, Dr. Safer said. “It’s a misconception that they have to do anything,” he noted. “There are some tests that they could run that would make their patients’ lives easier, but it is fine to send patients along even without those tests.”
As part of efforts to raise awareness about transgender care, Dr. Safer weighs in on common misconceptions about gender-affirming care and shares tips for patients and providers on how to make the experience seamless.
For patients
Seeking gender-affirming care can be overwhelming for transgender and gender-diverse patients, Dr. Safer said. With care that can stretch across multiple specialties, including endocrinology, gynecology, urology, and various surgical subspecialties, patients sometimes think they need to do a bunch of research before even speaking with a provider.
However, speaking with your primary care doctor could be part of that care journey, Dr. Safer said: “Providers can help guide patients with what they need to align their bodies with their gender identities.”
- It might be helpful for transgender patients to consider their fertility goals when seeking gender-affirming care. That would help outline what medical or surgical options make sense.
- Letters of support from mental health and primary care providers are required to be eligible for gender-affirming surgery. Obtaining those letters isn’t necessarily complicated, and our Center provides templates for them.
- Out-of-state patients seeking surgical care in New York City need to be housed within a 90-minute travel distance of the surgery office for at least two weeks. Additionally, the accommodation cannot be a walkup apartment, and a caretaker must be present to assist with cleaning and daily activities.
The Center for Transgender Medicine and Surgery at Mount Sinai has set up a hotline to help patients with appointments, or even direct them to “champion providers” within the Health System—providers trained in gender-affirming care, Dr. Safer said.
For patients, click here to learn more about accessing transgender care
For providers
Gender-affirming care in a primary care setting doesn’t need to be complicated, Dr. Safer said. It is fine to refer transgender patients after initial assessments without needing a bunch of tests.
However, should the provider choose to order baseline testing for patients, it would make the patients’ care experience more convenient. Here are some typical tests a provider can consider:
- For trans masculine patients (female to male), typical tests include a testosterone profile, estradiol level, hematocrit, and possibly a luteinizing hormone/follicle-stimulating hormone (LH/FSH)
- For trans feminine patients (male to female), typical tests include a testosterone profile, estradiol level, possible LH/FSH testing, and baseline tests for potassium and prolactin
- For patients seeking hysterectomy, a current Pap smear is recommended.
There is also a misconception that because insurance companies categorize gender-affirming surgery as a treatment for gender dysphoria, patients need to be seen by a mental health provider, Dr. Safer said.
“If there are underlying mental health concerns, do refer those patients for treatment,” he noted. “But there are many transgender patients who have no mental health concerns and are merely seeking gender-affirming care.”
Providers within the Mount Sinai Health System would already be connected within the Epic system for referrals to any needed specialist, expediting the process, Dr. Safer said. For providers outside the Health System, a dedicated hotline team from the Center for Transgender Medicine and Surgery is there to assist, he added.
For providers, click here to learn more about connecting transgender patients to care