by Spectrum Medical Care Center

Nurse Practitioner Ari Kravitz

When I started medical transition at 20 years old, it was very difficult to get the care I needed for hormone replacement therapy because there are very few providers trained in starting hormones for trans people, even though it’s very similar to the hormones that we prescribe to women in menopause or cisgender men with low testosterone.

I hope more providers get trained in LGBTQ+ healthcare, so they can support patients along their individual gender journey, and provide the info needed to make informed decisions about their body. I’ve personally seen my trans patients find hope and experience a better quality of life through hormone replacement therapy.

If you don’t have a primary care physician who specializes in LGBTQ+ care in your community, you may need to educate yourself (and your provider). But, before you seek such therapy, here are five things you should know!

  1. Monitor closely. At Spectrum Medical Care Center, we screen patients for certain risks before starting anyone on hormones. We frequently monitor patients in the first year to ensure there are no adverse reactions and lab results are within safe ranges. Follow-up care is also important to assess your comfort with the transition as well as the social impact and social support you’re experiencing.
  2. Some changes are permanent, some temporary. For transmasculine individuals going on testosterone, they’ll experience these permanent changes: deepened voice, clitoral enlargement (also known as bottom growth), more body, facial hair, and male pattern baldness. Reversible changes include cessation of menses, increased muscle mass and strength, body fat redistribution, and skin oiliness or acne. For those going on estrogen therapy, the most permanent change is breast growth. Feminizing hormone therapy can also cause atrophy (shrinkage) of the genitals and loss of erectile function that may not be reversible. Estrogen will thin body hair, soften the skin, can increase scalp hair, and decrease muscle mass and strength, all of which are reversible.
  3. You can’t pick and choose results. Unfortunately, you can’t pick and choose the physical changes you want, which may feel challenging. Some of my patients will say, ‘Okay, ‘I’ve seen the permanent changes I want, and I don’t want it to go any further,’ and so at that point, we stop therapy. Low-dose hormone therapy can slow down the rate of changes, allowing for a more gradual physical transition. We counsel patients in advance about the common changes, and it’s up to the individual as to when they’d like to scale back and determine whether some benefits are worth the potential risks.
  4. Be aware of risks. Like any medical treatment, there are potential risks involved. Some risks with testosterone therapy include increased red blood cell mass, acne, hypertension, sleep apnea, weight gain, and dyslipidemia (increases the chance of clogged arteries). Cardiovascular disease is likely increased with additional risk factors for testosterone and estrogen therapy. Transfeminine patients going on estrogen therapy may experience weight gain, thromboembolic disease (when a blood clot breaks off and blocks another blood vessel), and a high level of triglycerides in the blood.
I love hearing my patients come back after starting hormones and say: ‘I feel more like myself,’ and ‘I feel like I am connected to my body again.’ If you’re interested in hormone replacement therapy, remember to work alongside the guidance of a provider, be patient and be aware of the changes and risks.
Ari Kravitz, is a Family Nurse Practitioner at Spectrum Medical Care Center, a Phoenix-based clinic that specializes in state-of-the-art, competent, and compassionate primary care for LGBTQ+ patients and is a leading provider of primary care, preventative care, HIV care, as well as PrEP, PEP, and STI testing services
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As an LGBTQ+ patient, you should be able to expect the same high-quality care provided to all patients. Unfortunately, this doesn’t necessarily always prove to be the case. There remains a notoriously significant disparity in healthcare outcomes for LGBTQ+ patients, often related to issues with discrimination among providers.

Even when you find a good physician, this doesn’t mean that everyone interacting with your healthcare information will be as respectful or responsible. It is, therefore, important to be vigilant about how your data is handled. You have a right to privacy just as you have an expectation of fair treatment.

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Photo courtesty of Cecilie Johnsen on Unsplash

LGBTQ+ Healthcare Issues

The Dobbs decision, otherwise known as the court case that overturned Roe v. Wade, has resulted in confusing medical situations for many patients. On top of affecting access to abortions for straight, cisgender women, it presents heightened risks for LGBTQ+ healthcare as a whole. Flipping the switch on reproductive rights and privacy rights is a far-reaching act that makes quality care harder to find for an already underserved community.

As the fight against the Dobbs decision continues, it’s important to shed light on the full breadth of its impact. We’ll discuss specific ways that the decision can affect LGBTQ+ healthcare and offer strategies for overcoming these challenges.

How the Right to Bodily Privacy Affects LGBTQ+ Healthcare

When the original Roe v. Wade decision was made, the bodily privacy of people across the United States was protected. Now that bodily autonomy is no longer guaranteed, the LGBTQ+ community must brace itself for a potential loss of healthcare rights beyond abortions. This includes services like feminizing and masculinizing hormone therapy (particularly for transgender youth) that conservative lawmakers have been fighting against this year, as well as transition-related procedures. Without privacy, gender-affirming care may be difficult to access without documentation of sex as “proof” of gender.

As essential services for the LGBTQ+ community become more difficult to access, perhaps the most immediate effect we’ll see is eroding trust between healthcare providers and LGBTQ+ patients. When providers aren’t working in the best interest of patients — just like in cases of children and rape victims denied abortions — patients may further avoid preventative care in a community that already faces discrimination in doctor’s offices.

The Dobbs Decision Isn’t Just a Women’s Issue

While the Dobbs decision is often framed as a women's issue — specifically, one that affects cisgender women — it impacts the transgender and non-binary community just as much. All people who are capable of carrying a pregnancy to term have lost at least some ability to choose whether or not to give birth in the U.S.

For transgender and non-binary individuals, this decision comes with the added complexity of body dysmorphia. Without abortion rights, pregnant trans men and some non-binary people may be forced to see their bodies change, and be treated as women by healthcare providers and society as a result.

The Dobbs decision also opens up the possibility for government bodies to determine when life begins — and perhaps even to add legal protections for zygotes and embryos. This puts contraceptives at risk, which could make it more difficult to access gender-affirming care while getting the right contraceptives based on sex for LGBTQ+ individuals.

Overturning Reproductive Rights Puts IVF at Risk

Queer couples that dream of having their own children often have limited options beyond adoption. One such option is in vitro fertilization, or IVF, which involves implanting a fertilized egg into a uterus.

While IVF isn’t directly affected by the Dobbs decision, it could fall into a legal gray area depending on when states determine that life begins. Texas, for example, is already barring abortions as early as six weeks. To reduce embryo destruction, which often occurs when patients no longer want more children, limits could be placed on the number of eggs that can be frozen at once.

Any restrictions on IVF will also affect the availability of surrogacy as an option for building a family.

How Can LGBTQ+ Individuals Overcome Healthcare Barriers?

While the Dobbs decision may primarily impact abortion rights today, its potential to worsen LGBTQ+ healthcare as a whole is jarring. So how can the community be prepared?

If you’re struggling to find LGBTQ+-friendly providers near you, using telemedicine now can be an incredibly effective way to start developing strong relationships with far-away healthcare professionals. Telemedicine eliminates the barrier of geography and can be especially helpful for accessing inclusive primary care and therapy. Be sure to check if your insurance provider covers telemedicine.

If you’re seriously concerned about healthcare access in your area — especially if the Dobbs decision affects your whole state or you need regular in-person services that may be at risk — it may be time to consider moving now. While not everyone has the privilege to do so, relocating gives you the ability to settle in areas where lawmakers better serve your needs. However, this decision shouldn’t be taken lightly, so preparing and making progress on a moving checklist now can help you avoid issues later.

The Dobbs Decision Isn’t LGBTQ+-Friendly

The Supreme Court of the United States has proven the power of its conservative majority with the overturning of Roe v. Wade. However, the effects of the Dobbs decision don’t stop at affecting cisgender women’s abortion rights. In states with bans, it also leads to forced birth for trans men and non-binary individuals. Plus, the Dobbs decision increases the risk of other rights, like hormone therapy and IVF, being taken away.

Taking steps now, whether it’s choosing a virtual provider or considering a move, can help you improve your healthcare situation in the future.