Gender and Sexual Minorities

Sex workers and gender sexual minorities (GSM) often feel ostracized by healthcare workers (HCW), therefore gender-sexual minorities experiencing the sex trade are often twice marginalized by HCW. This section of the toolkit is intended to acknowledge gender and sexual minorities’ specialized health needs. 

Below are the powerful words of a trans individual who worked in the sex trade that explains the double stigmatization and extra challenges that individuals face who work in the sex trade and are part of a gender and sexual minority. 

“As a trans individual, I was hesitant to go to the clinics as you never know the criticisms you might get from staff or doctors. For one, you never know who you are going to get—one week you could get a real positive person and another you could be getting someone that is real sex negative or transphobic. Once I started sex work I put it off or avoided getting checked because I just don’t want to deal with the judgement from the staff. If I got this much grief and negative attitude just for being trans and getting an STI check, I could only imagine what would be the judgements if I told them I am a sex worker. Today, I still have not told my family doctor for the same reason” (Roche and Keith, 2014). 

Gender and sexual minority individuals who work in the sex trade are frequently overlooked and under-reported by law enforcement and HCW due to underlying stigma and beliefs (Martinez & Kelle, 2013). Those at highest risk for entering the sex trade are GSM individuals due to systems of bias and oppression in place within our culture and society (Martinez & Kelle, 2013). The literature shows that because of the high amount of rejection from families and communities gender and sexual minorities live on the edges of our society and make up a disproportionate number of homeless, unemployed, drug sellers, and sex workers (Winter et al., 2016; Stepleman et al., 2019; Rodriguez, Agardh, & Asamoah, 2018). Marginalization and discrimination take a significant toll on the health and wellbeing of the GSM population. In addition, as these populations are often hesitant to seek medical care, they frequently experience worse health conditions that leave them vulnerable to treatable STIs and infections (James et al., 2016; Smith, 2015; Winter et al., 2016; Stepleman et al., 2019).  

• 31% of transgender sex workers (TSW) felt “disrespected” by HCW and 28% delayed treatment because of fear of discrimination (Roche & Keith, 2014).  

• 60% of respondents to the National Transgender Discrimination Survey, reported that they had attempted suicide. This is nearly 37 times the rate of the general population (Fitzgerald, Patterson, Hickey, Biko, & Tobin, 2015). 

Vocabulary from the community (Killermann, 2020)

It is helpful to understand the language that is commonly used in the GSM community. However, it is also regularly changing and evolving. Here are some common terms that are used at this time: 

• Binder/binding: Wearing an undergarment that achieves the purpose of altering the appearance of an individual’s breasts 

• Bottom surgery: Surgery done on one’s genitals as part of gender reassignment  

• CIS-gendered: When someone’s sex assigned at birth corresponds with their gender identity in an expected way 

• FTM (female to male): Transgender man, assigned female at birth and is changing or has changed their body and/or gender role from female assigned at birth to a more masculine body or role 

• Folx: Umbrella term for people with a gender-neutral sexual orientation or identity 

• Gaff: Underwear designed specifically for tucking the penis to create a femme and or gender neutral crotch

• Gender affirming surgery: A surgery to affirm a person’s gender identity that changes primary and/or secondary sex characteristics that helps to mitigate gender dysphoria 

• Gender dysphoria: Current term in the DSM-5 used to describe distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics). This term has a history of being weaponized to discriminate against GSM individuals and should only be used in medical paperwork when necessary for insurance coverage of gender affirming care

• Gender expression: The external display of one’s gender via clothes, hair, etc. 

• Gender identity: A person’s intrinsic sense of being male (boy or man), female (girl or woman), or an alternative gender (ie boygirl, girlboy, transgender, genderqueer, eunuch) 

• Gender-nonconforming: A term used to describe people who do not conform to the traditional gender binary of male and female. One may identify as male, female, or trans or as gender non-conforming 

• GSM: Gender/Sexual Minority is used in place of LGBTQ, to be inclusive of
  all individuals 

• Intersexed-person/intersex: One whose biological sex includes a combination of chromosomes, hormones, internal sex organs, and genitals that are different than that expected of a male or female 

• MTF (male to female): Transgender woman, assigned male at birth and is changing or has changed their body and/or gender role from male assigned at birth to a more feminine body or role 

• Natal sex: The sex that a person was assigned at birth based on observable genitalia. Also commonly known as “sex assigned at birth”

• Otherkin: People who identify as something other than human

• Organ inventory: A medical assessment tool that allows providers to document, for health purposes, the organs an individual is born with and acquires to ensure that appropriate preventative care is given

• Queer: An umbrella term to describe individuals who don’t identify as straight and/or cisgender. This term was historically used as a derogatory term and is still considered a slur in many communities. It is not universally embraced by all GSM individuals, and thus it should not be used unless the individual gives permission 

• Transition(ing): Referring to the process of a transgender person changing aspects
  of themselves 

• Transgender: An umbrella term that refers to individuals whose sex at birth and sexual identity do not align 

• Tucking: A method to hide the bulge from the penis and testicles so that they cannot be seen through clothing 

• Sexual orientation: The type of sexual attraction one has the capacity to feel for others, generally labeled based on the gender relationship between the person and the people they are attracted to. Often confused with sexual preference (Comprehensive List, 2020) 

• Sexual preference: The types of sexual intercourse, stimulation, and gratification one likes to receive and participate in. Generally, when this term is used, it is being mistakenly interchanged with “sexual orientation,” creating an illusion that one has a choice (or “preference”) in who they are attracted to (Comprehensive List, 2020) 

• Ze/Xer: Pronounced “zee” and “zer” a non-gendered pronoun, for example:
  Ze loves zemself

Do’s and don’ts:
Caring for GSM individuals in the sex trade 

Do 

• Ask and use the individual’s pronouns when communicating 

• Ask permission before touching any body part or performing any procedure to limit discomfort and fear  

• Be welcoming and non-judgmental to promote a healthy trusting relationship between HCW and patient 

• Keep communication professional 

• Provide holistic trauma informed care 

• Self-reflect on personal biases, strive to improve character, and reserve judgment

• Provide staff training on transgender competency, barriers of care, and bodily boundaries 

• Treat whatever organs the patient comes with, using an organ inventory, a supportive tool of care, while respecting their gender identity 

• Watch for signs of dissociation. If your patient appears to be inattentive, emotionally absent, or physically frozen, verbally check in and take a break which allows the patient extra time to become grounded 

• If corrected while using incorrect pronouns, apologize, move on, and use the
  correct pronouns 

• Ensure that the patient is aware of their rights and can refuse to answer questions and refuse treatment . This gives individuals autonomy and choice which isn’t always given in sex work

• Explain to the patient the reasons for the questions you ask—open communication is key

• Lead the way to the clinic room—it feels safer to follow the HCW and not have someone behind them

Don’t 

• Ask questions that are not relevant to the health care visit 

• Bring personal judgments or prior experience into the professional relationship between a HCW and patient 

• Forget about screening for health issues based on the individual’s organs or hormones (ex: breast, prostate or menses) in a transgender patient. Existing organs or hormones, even if not aligned with gender identity/presentation, could potentially cause
  health issues  

• Use the term homosexual when describing a queer patient

• Make statements about patient’s appearance or attire (e.g. “you’re so pretty” or “I could never tell you were a male/female,” as this reinforces belief that a person is only valued for their body/appearance) 

• Express frustration with your patient on their change in pronouns, gender identity, gender expression

Create an inclusive clinic

Ensure that your physical clinical space is welcoming for GSM individuals by:

• Providing gender neutral bathrooms or bathrooms that are open to the identified gender with signage supporting (“Gender Neutral Bathroom” on single stall restrooms or “You’re welcome to use the restroom that best fits your gender identity” on traditional, multi-stall Male/Female designated bathrooms)

• Displaying statements that this space is a safe space for all and discrimination is not tolerated and action is taken to protect the safety and dignity of all in the space.

• Providing chairs and exam tables that work for all bodies/sizes

• On all intake paperwork, providing a space to fill in their gender (to include non-binary and other gender identities) and pronouns

• Avoiding overly gendered environment for sexual health clinics

• Providing gender diverse images in patient education documents and in clinic spaces (avoid stereotypical pictures of “nuclear families” and/or “gay/lesbian” individuals looking pristine/perfect. Find pictures that represent the community you serve)

• Training everyone in the clinic, from front desk staff to providers, about how to care for GSM patients in respectful, non-judgmental, and culturally appropriate ways. Asking questions and inviting consent is noted as a safe place for GSM folx

• Ensuring that from the time of check-in and throughout the patient visit, the patient is referred to by their name and pronoun they have expressed to HCWs

• Putting HCW pronouns on employee name badges—this gesture goes a long way 

What to do when you make a pronoun mistake

Learning to use pronouns properly when providing care to GSM patients takes some work. Mistakes will likely happen as a part of the learning process about this community. Acknowledging your mistake and apologizing are crucial. Here are some general guidelines that can help.

Example 1: You use the wrong pronouns when speaking about someone. 

“She said she’s been on birth control for six months. I’m sorry, I meant to say that he has been on birth control for six months. He can’t quite remember the prescription, but said he’d bring it next time.” 

Don’t make a big deal out of a pronoun slip-up. Simply apologize and move on to use the correct pronoun throughout the rest of the discussion. The bigger deal you make it, the more uncomfortable it is for everyone. Also, this is something that occurs and should be noted but not doted on. We make mistakes and it’s ok. 

Example 2: You publicly use the wrong pronoun. You’re speaking about someone who uses “they/them” pronouns. 

“He said he would....” 

When publicly using the wrong pronoun, try not to draw everyone’s attention to it. Simply start using the correct pronoun when you realize you’ve made a mistake. If you realize later you’ve made a mistake, apologize quickly in person and in private by saying “I’m sorry for using the wrong pronouns earlier. I know you prefer ____, and I’ll work hard to get it right next time.” Don’t linger on the topic. Don’t make it about yourself.  

When in doubt:  

• Use they/their pronouns or their name 

• Be genuine and sincere as you apologize, and let the patient know you want to correct your language in the future. “I’m sorry for using the incorrect pronoun. I know you use  _____” and end with “I’ll work on getting it correct next time.” 

Common healthcare needs and concerns

Mental health  

Main factors linked to poor mental health outcomes such as depression and suicidality are marginalization, isolation, rejection, and phobic behavior (Wilson & Cariola, 2019) 

Global mental health problems are elevated among LGB youth (Russell & Fish, 2016) 

Risk factors for GSM youth:  

• Greater likelihood of experiencing universal factors such as family conflict or child maltreatment (Russell & Fish, 2016) 

• Stigma, discrimination, and compound everyday stressors exacerbate poor outcomes for mental health (Russell & Fish, 2016) 

• Lack of support at many institutions that guide their lives, such as school, which leads to increased vulnerability for GSM youth (Russell & Fish, 2016) 

Substance abuse:  

• 39.1% of sexual minority adults reported using drugs compared to 17.1% of sexual majority adults (Medley et al., 2016) 

• 93% of GSM adults and 94% of GSM adolescents indicated an increased risk of drug use/abuse (Plöderla & Tremblay, 2015) 

• LGBT individuals who reported lifetime substance use problems reported higher rates of suicidal ideation

Depression and anxiety:

• GSM youth are 3x more likely to communicate symptoms of depression and 2x more likely to self-harm than heterosexual youth (Wilson & Cariola, 2019) 

• Rates of depression and anxiety are increased across sexual minority subgroups in all dimensions of sexual orientation (behavior, attraction, identity) (Plöderla & Tremblay, 2015) 

• Transgender identity was associated with higher odds of discrimination and depression symptoms as compared to LGB participants (Su et al., 2016) 

• Discrimination and lack of LGBT identity acceptance were primary contributors to depression and anxiety (Su et al., 2016) 

Suicide 

• The National Transgender Discrimination survey found that 60% of respondents reported that they had attempted suicide, which is nearly 37x the rate of the general population (Fitzgerald, Patterson, Hickey, Biko, & Tobin, 2015) 

• Amongst a systematic review, 98% of included studies reported elevated attempted suicide rates for adult and youth sexual minorities across lifetime (Plöderla & Tremblay, 2015) 

• Sexual minority youth were almost 3x as likely to report suicidality (Russell, & Fish, 2016) 

• Risk factors for suicide include depression and substance abuse, which are prevalent in GSM individuals (Coker, Austin, & Schuster, 2010) 

• Risk factors for suicide specific to GSM individuals include: 

  • Early openness about sexual orientation  

  • Parental disapproval  

  • Parental psychological abuse (Coker, Austin, & Schuster, 2010) 

Providers should be able and willing to provide referrals to therapists and psychiatrists when needed in order to assist with mental health issues and to provide holistic, individual patient centered care.

Chest binding 

Chest binding is a technique used to flatten and compress the chest tissue to present more masculine or neutral (Jarrett, Corbet, Gardner, Weinand, & Peitzmeier, 2018). 

• Health risks can include rib fractures, local skin irritation, fungal infections, back pain, overheating, chest pain, shortness of breath, and potential scarring (Jarrett, Corbet, Gardner, Weinand, & Peitzmeier, 2018; Deutsch, 2016) 

• Methods include wearing commercial binders, elastic bandages, duct tape, plastic wrap, or multiple sports bras (Jarrett, Corbet, Gardner, Weinand, & Peitzmeier, 2018) 

• Patients who chest bind are not likely to bring their complications to the attention of a doctor because a doctor’s advice is typically to stop wearing the binder, and this causes psychological distress (Tsjeng, 2016) 

• 88.9% of individuals who bind their chest experience at least one negative physical symptom, but only 14.8% seek care. This is because many transgender individuals do not feel safe and comfortable with their physician (Jarrett, Corbet, Gardner, Weinand, & Peitzmeier, 2018) 

A trusting relationship with the HCW is of the highest priority to increase patient engagement in care (Jarrett, Corbet, Gardner, Weinand, & Peitzmeier, 2018). Providers rarely mention, ask or educate their transgender patients about chest binding, even if they know their patient is binding. Consider providing education and offering non stigmatizing positive options to patients (Jarrett, Corbet, Gardner, Weinand, & Peitzmeier, 2018). Providers can help relieve physical symptoms such as acne, rib fractures, local skin irritations and fungal infections (Jarrett, Corbet, Gardner, Weinand, & Peitzmeier, 2018). 

Tucking / taping (Dornheim, 2020; Moffa, 2019) 

Tucking can be defined as a method to hide the bulge from the penis and testicles so that they cannot be seen through clothing. For many individuals, tucking is a way to more easily wear clothes that affirm the individual’s identity. Talk to the patient about the options and risks regarding tucking and ways to minimize the risk. When discussing tucking with patients it’s important to ask about their future desires and goals about transitioning via gender affirming surgery if applicable.  Also, if they are not wanting to engage in “bottom” surgery, discussing alternative methods of gender-affirming presentation and embodiment is encouraged.

• Patients should have appropriate supplies such as:  

  • Snug pair of underwear 

  • A gaff (if desired) 

  • Medical tape (tucking can be performed without tape) 

• Patients should be encouraged to go slow and be gentle when tucking the testes into the inguinal canal  

• If using tape, patients should always use medical tape and remove hair from the areas of the skin where the tape will be applied 

• Encourage patients to practice tucking at home or in another safe space where they are more likely to go slow and not tuck too tightly due to stress/urgency

Safety 

• Encourage patients to untuck before going to bed and not to tuck tightly all day long to prevent chafing as well as other complications

• It is unknown if tucking is related to infertility. It is speculated that tucking the testes into the inguinal canal raises the temperature and may therefore damage sperm

• Epididymo-orchitis, prostatitis, cystitis, urinary reflux, prostatism, or infection can occur as a result of prolonged tucking (Zevin, 2016) 

• Prolonged tucking may result in pain and can cause testicular torsion 

• Patients with a history of tucking and genital pain should be evaluated for serious complications of tucking such as orchitis and epididymitis

• Encourage patients that even when tucking to still stay hydrated and go to the bathroom regularly to reduce the risk of UTIs

  • Not using tape to tuck can make going to the bathroom easier  

Contraception and Pregnancy 

Contraception and pregnancy in transgender individuals are important topics that tend to be under-discussed. The current standard of care is to discuss fertility desires with transgender individuals prior to medically or surgically transitioning. Due to rapidly changing practices in both GSM and medical communities, contraception and pregnancy need to be ongoing discussions throughout patients’ reproductive years (Light et al., 2018). Furthermore, Amato (2016) states, all transgender people who have gonads and are sexually active with partners that could result in pregnancy, should be counseled on contraception necessity, as infertility is not definite for all transgender individuals on hormone therapy.  

There are many misconceptions among both medical and GSM communities regarding contraception and pregnancy in GSM individuals (Light et al., 2018 and Cipres et al., 2017). 

For those who do carry their pregnancy, there can be challenges for parents who identify as members of the GSM community. Aside from social perception and judgment, parents who are not heteronormative can struggle with a lack of clear role models of what a positive, well integrated, gender-variant parental role looks like (Obedin-Maliver & Makadon, 2015). Due to these misconceptions and additional barriers, it is important to focus on providing affirming and inclusive care beginning with preconception counseling and continuing through the postpartum period (Obedin-Maliver & Makadon, 2015). 

Hormone therapy  

Hormonal therapy is used by transgender individuals to develop secondary sex characteristics of the sex they identify with and suppress/minimize the secondary sex characteristics of their natal sex (Deutsch, 2016b).  

The hormones that transgender individuals take to help transition can have many health risks.  

• For transgender women taking estrogen hormones, some health risks are blood clots, high blood pressure, type 2 diabetes mellitus, cardiovascular disease, and migraines. Many of these risks also increase with tobacco usage, and HCWs should provide education surrounding smoking cessation (Deutsch, 2016b). Another side effect is low libido, or sexual dysfunction, which should be discussed with transgender women before starting hormone therapy.  

• For transgender men taking testosterone, there is a risk for acne, weight gain, hair loss, migraines, polycystic ovarian syndrome, pelvic pain, persistent menses, severe cramping, and polycythemia. With the suppression of estrogen in transgender men, there is a major risk for bacterial vaginosis and vaginitis, as well as dry, burning vaginal discomfort (Deutsch, 2016c). These potential health issues should be discussed with transgender men before starting hormone therapy.  

With hormonal therapy there is a risk for emotional and mental health issues, including PTSD and depression. Routine screening for these issues, providing appropriate referrals to competent mental health specialists should be considered as an initial step to providing care (Deutsch, 2016b).  

Silicone fillers (Zevin & Deutsch, 2016) 

Silicone injections are used for immediate body changes in order to help individuals align their outward appearance with their gender identity.  

• A major risk with many silicone injections, fillers and implants is that many times the procedure is done by unlicensed individuals. These individuals may not use sterile technique and may use substances that are not medical grade, including aircraft lubricant, petroleum jelly, or tire sealant  

• Some rapid side effects include pain, bleeding, infection, edema and allergic reactions. Long term side effects, however, are more severe and could include granulomas, fistulas, lymphedema and sepsis 

Prevention is critical, and HCWs can advise transgender women against seeking cheaper, back-alley options for these procedures from unlicensed personnel and provide relevant education and plausible options for their needs, including hormone therapy and surgery, as well as providing referrals to licensed specialists and GSM-competent surgeons.  

Gender affirming surgery 

In the GSM community, gender affirming surgery can be an important step for some people. It allows individuals to feel more comfortable in their own body. Individuals who decide to get gender affirming surgery should be counseled before and after the procedure. Experts point out the needs of many GSM members post-operatively saying, “recovery from gender affirming surgeries can be complex and involved processes, and there is an additional need for assessment of overall psychosocial functioning and support, health literacy, capacity for self-care, and social support structure in place” (Dickey, Karasic, & Sharon, 2016). It is also important to recognize that transgender individuals in the sex trade cannot always pursue gender affirming surgeries due to the reliance the individual has on their genitalia to provide for themselves in sex work. They may not also be able to afford to take the time off from sex work while recovering from top or bottom gender affirming surgery. 

• In FTM transgender individuals, masculinizing chest surgery is a common gender affirming top surgery that involves removal of breast tissue in order to sculpt a masculine chest that appears natural with the patient’s body (Wang & Kim, 2016a). This surgery has a 12% complication rate. Common complications seen after this procedure include scarring, infection, hematoma, seroma, graft complications, and contour irregularities (Wang & Kim, 2016a). The healing and remodeling of the tissue occurs over a year and can be a painful process (Wang & Kim, 2016a) 

• In MTF transgender individuals, feminizing augmentation mammaplasty is a common gender affirming top surgery that involves implant-based augmentation mammaplasty (Wang & Kim, 2016b). While complications are rare with this procedure, there is risk of hematoma, seroma, infection, incisional complications, implant rupture, and implant malposition and capsular contracture. Recovery for this procedure occurs over the course of several weeks, though some patients may experience prolonged soreness, swelling, and bruising (Wang & Kim, 2016b)

Barriers to healthcare for GSM individuals

There are many significant barriers and challenges for GSM related to taking care of their own health or actively seeking the help of HCW. The National Transgender Survey of the U.S found that 28% of those surveyed reported delaying seeking treatment or medical care due to a fear of discrimination (Grant, Motter, & Tanis, 2011). In another national survey, one third of transgender individuals seeking healthcare reported harassment, were refused treatment, or had to educate providers on transgender health needs (Learmonth, Viloria, Lambert, Goldhammer, & Keuroghlian, 2018). This is a serious issue because delay or avoidance of healthcare visits, such as a physical checkup, can lead to delays in diagnosis and treating serious health issues.  

Furthermore, after seeking medical treatment, GSM individuals are likely to be denied healthcare coverage (Learmonth et al., 2018). One survey found that over 50% of transgender individuals who requested coverage for gender affirming surgery were denied (Learmonth et al., 2018). Many GSM individuals find themselves working in the sex trade due to lack of job opportunities and struggling with homelessness (Roche & Keith, 2014). Furthering the cycles of homelessness and limited job opportunities is that many gender non-conforming people drop out of schooling early due to bullying and discrimination faced in the educational setting (Roche & Keith, 2014). This cycle has a significant toll on the mental health of GSM individuals.  

One study that analyzed the data from a survey of 770 GSM individuals aptly illustrates the mental health problem saying, “Limited access to competent healthcare services is a critical barrier to suicide prevention among transgender persons, and the economic disadvantage disproportionately experienced by transgender individuals can further restrict timely access to needed care. Furthermore, there is a gap between the healthcare needs of transgender individuals and the supply of care providers who have the sensitivities and expertise to provide culturally relevant care” (Su et al., 2016). 

GSM individuals also face many barriers when it comes to the health of their urinary tract system and bladder due what should be a seemingly simple process of going to the bathroom. Unfortunately, what is normally a perfunctory, simple experience for cis-gendered individuals can be an anxiety-inducing and even dangerous experience for gender and sexual minorities. Many GSM individuals perceive going to the bathroom as a dangerous activity; especially male bathrooms where GSM individuals or friends they know have been assaulted because, “they failed to pass as male” (Hardtacker et al., 2019). Physical health issues are common from trying to avoid using public bathrooms (Herman, 2013). Some of these issues include purposeful dehydration so as not to have to use the bathroom (Herman, 2013). This has led to a disproportionate number of urinary tract infections, kidney issues, and other bladder related issues in gender sexual minorities because they view using a public bathroom riskier than the health issues that could arise from not voiding when they need to (Herman, 2013). 

Fortunately, there are ways to address these barriers and reduce the marginalization that GSM communities can face. HCWs should explore, acknowledge, and have sufficient outlets to process their own biases. In order to prepare themselves to be able to deliver non-judgmental and culturally competent care to this population, HCWs should work towards processing these biases outside of a patient care setting. Implicit bias training is vital when entering the workplace to ensure quality care. HCW education and training specifically with a GSM focus can lead to increased confidence, aid to establish a positive attitude and positive performance, and result in safe and comfortable provider visits for GSM patients (Paradiso & Lally, 2018).  

Resources for learning more

Measure implicit (unconscious) bias: 

• https://implicit.harvard.edu/implicit/takeatest.html

• https://www.lgbthealtheducation.org/wp-content/uploads/2018/10/Implicit-Bias-Guide-2018_Final.pdf

• https://www.thomasjbillard.com/attmw

Meeting the healthcare needs of transgender people: https://www.lgbthealtheducation.org/wp-content/uploads/Sari-slides_final1.pdf

Asking for and using pronouns: https://www.brynmawr.edu/sites/default/files/asking-for-name-and-pronouns.pdf

Providing Inclusive Services and Care for LGBT People: https://www.lgbthealtheducation.org/wp-content/uploads/Providing-Inclusive-Services-and-Care-for-LGBT-People.pdf  

LGBT health learning models: https://www.lgbthealtheducation.org/resources/

Trans toolkit: http://www.cedarriverclinics.org/transtoolkit/ 

Transhealth: https://callen-lorde.org/transhealth/ 

Finding a trans/GSM friendly HCW and health services for your patient: 

Ingersoll Center  (plug in the insurance type, location and specialty desired and a list will come up of available providers) 

Stonewall Youth (a list of providers in Seattle and Olympia) 

Seattle area clinics 

• Polyclinic (Dr. Kevin Hatfield)  

• Virginia Mason Transgender Health 

• Seattle Children’s Hospital Gender Clinic 

• Cedar River Clinics