PROVIDING transgender and non-binary CARE AT PLANNED PARENTHOOD A Best Practice Guide and Start-Up Action Kit By Maureen Kelly, MATD With the wisdom of experts and practitioners throughout the field. 2018 Planned Parenthood of the Southern Finger Lakes. We encourage and grant permission to reproduce and distribute this publication in whole or in part, provided it is done with attribution. Further written permission is not required. ABOUT PLANNED PARENTHOOD OF THE SOUTHERN FINGER LAKES After decades of advocacy, education, and providing LGBTQ welcoming and affirming care and programming in rural upstate New York, we conducted research in 2008 that helped us better understand emerging community needs related to access to health care and support services for transgender people. For many of us, understanding terminology, the critical and thoughtful use of pronouns, and the unique medical needs and discrimination faced by transgender people posed a learning curve that required training, practice, and resources. In 2013, PPSFL launched our transgender hormone therapy program – the first Planned Parenthood in New York State to do so! - in one center with one clinician and we proudly cared for 28 amazing patients in that inaugural year. As we come to the end of our fifth year of care, we are offering this service in four centers, with nine trained clinicians, we have added a grant funded Transgender Patient Navigator position, and we have proudly cared for more than 600 patients. This has been a remarkable time of learning, serving the underserved, building capacity, creating and sharing resources with sister affiliates, and internal and community collaborations. In our work, we confront the harsh reality that many transgender and non-binary people face extreme barriers to care, often surmount unreasonable hurdles, and once they arrive at a provider’s office are too frequently subjected to bias, stigma, discrimination and uninformed, unprepared providers that can do far more harm than good. We have more work to do! This packet of information comes from our own, and many others’, process of learning and wanting to serve an important and too often underserved population with care and respect. Your ideas, questions, suggestions, and stories of your successes and challenges are invited. In this together, Maureen Kelly Ithaca, New York [email protected] 607-216-0021, ext. 2306 Acknowledgements To the countless transgender and non-binary people, providers, advocates and organizations that I count as friends, co-conspirators, expert resources, and colleagues in this critical work, my thanks here is but a fraction of the gratitude and appreciation I have for you all. For those that choose to trust Planned Parenthood and invite us into your life and share your stories with us and give us the privilege of caring for you - thank you. This work has improved tenfold because of your trust and feedback. To my PPSFL colleagues. Your openness, compassion, drive for excellence, fierce dedication to our patients and eliminating barriers to care leaves me in awe daily. You are true champions with the hearts and expertise to make something exceptional come to life in our affiliate. To Luca Maurer, without your wisdom, depth of intellect, ability to cite references with ease, and your never-ending encouragement, this work would not be what it has become. As a partner in crime, I can imagine no finer than you. To the Rockefeller Foundation. Being selected as a Fellow and afforded the remarkable opportunity to take a month away from my desk and dedicate time and energy to synthesizing, writing, and creating this guide on a lakeside in Italy with some of the finest scholars and thinkers I could wish for was an experience of a lifetime. To all of you thinking about beginning to provide this care, already doing it, imaging better ways and new ideas to improve the lives and health of transgender and non-binary people, we’ve got much to do and I’m so glad we’re doing it together. And finally, to my mom. Kathy Kelly, RN, who died far too young. But not before showing me why a life dedicated to removing barriers to care, cultivating an awareness of and attentiveness to people unjustly pushed to the margins, being a vocal advocate and doer, and always seeking more people from different places and lived experiences to better understand what we don’t know - truly matters and makes us better, providers, teachers, and people. She was a trainer, a caregiver and a friend to many. We can all carry her forward. Cheers, Maureen Table of Contents Introduction ................................................................................................................ 1 In This Together .......................................................................................................... 4 Navigating Transgender Terminology ......................................................................... 9 Glossary of Transgender Terms ................................................................................. 11 Avoiding Outdated & Offensive Terminology ............................................................. 17 Transgender Names, Pronoun Usage & Descriptions ......................................................................... 19 Non-Binary Patients .................................................................................................. 21 An Intersectional Approach ....................................................................................... 22 Statistics, Data & Health Disparities: An Overview .................................................... 27 Routine and Transition-Related Health Care and Coverage ............................................................... 28 Access to Hormone Therapy ............................................................................................................... 29 The Impact of Stigma: Research Highlights and Guidance for Better Care .................. 31 Opening the Door to Transgender Care .............................................................................................. 31 Electronic Health Records and Transgender Patients—Practical Recommendations for the Collection of Gender Identity Data ...................................................................................................................... 31 Cervical Cancer Screening for Patients on the Female-to-Male* Spectrum: a Narrative Review and Guide for Clinicians ............................................................................................................................. 32 Trans* Individuals’ Experiences of Gendered Language with Health Care Providers: Recommendations for Practitioners ................................................................................................... 33 A note on the use of the asterisk with trans* ..................................................................................... 33 Prevalence of pregnancy involvement among Canadian transgender youth and its relation to mental health, sexual health, and gender identity ......................................................................................... 34 Emotional, behavioral, and cognitive reactions to microaggressions: Transgender perspectives ..... 34 Standards of Care & Key Professional Resources ........................................................ 35 The World Association of Transgender Health (WPATH) .................................................................... 35 The National LGBT Health Education Center ...................................................................................... 36 Center for Excellence for Transgender Health at UCSF....................................................................... 37 Planned Parenthood Transgender Working Group ..................................................... 40 Organizational & Association Statements on Transgender Care ................................. 41 The American Academy of Pediatrics ................................................................................................. 41 American Academy of Physician Assistants ........................................................................................ 41 The American College of Obstetricians and Gynecologists (ACOG) .................................................... 41 The American Medical Association ..................................................................................................... 42 The American Psychological Association ............................................................................................ 42 The American Public Health Association............................................................................................. 42 The Endocrine Society ......................................................................................................................... 43 Non-Discrimination Policies: Rationale and Samples .................................................. 44 Informed Consent ..................................................................................................... 45 World Professional Association of Transgender Health (WPATH) ...................................................... 45 Standards of Care, 7th Version ............................................................................................................ 45 The Informed Consent Model of Transgender Care: An Alternative to the Diagnosis of Gender Dysphoria ...........................................................................................................................................