From Rare to Routine

Making gender-affirming care more accessible

by Lauren Thompson

To address the severe shortage of providers with expertise in gender-affirming care, a movement is underway to help trans and gender diverse patients access care more comfortably and conveniently.

“We saw early on in the pandemic that our patients, especially those who live out of state, were more satisfied receiving the same quality of care through virtual visits without traveling to us in Boston,” says endocrinologist Ole-Petter Hamnvik, MB BCh BAO, MMSc. “Hormone therapy generally relies on blood work, which can be done anywhere. So unless it’s a complex case, we can provide the same level of care virtually as we can in person.”

In a 2022 report, Hamnvik and colleagues at the Brigham enumerated the benefits of telehealth for trans and gender diverse patients, especially for cost savings and privacy. He also outlines the remaining challenges, including stricter telehealth regulations that prevent patients from seeing providers outside their state. 

“Another major path we are taking is helping clinicians across disciplines, particularly in primary care, to become trained in providing gender-affirming care in their own communities,” Hamnvik says. 

Looking for ways to serve patients closer to home, first-year resident physician Raquel Selcer, MD, and physician assistant Lise Caldara, PA-C, approached primary care leaders to ask how they could help. Their timing was perfect, says Colleen Monaghan, MD, medical director at Family Care Associates (FCA) and associate medical director of Primary Care. Monaghan had met with Hamnvik to discuss enhancing gender-affirming care across all primary care locations. 

Starting at FCA and Brigham and Women’s Primary Care Associates, Selcer, Caldara, and their team will evaluate the clinics’ policies and procedures, multilingual signage, and employee trainings to ensure they follow best practices for gender inclusivity. With input from staff, patients, and local LGBTQ+ community members, the team will then roll out its improvements to all clinics. 

“Each of our clinics is already inclusive, welcoming, and dedicated to providing high-quality care to all of our patients,” Monaghan says. “This pilot is our way of becoming the best we can be and making sure we aren’t doing unintentional harm in any patient interactions, from the front door to the exam rooms.”

For Selcer, who is nonbinary, the initiative was born from personal experience. As a medical student in California, they worked in a gender-affirming clinic that was a model for integrating its services with primary care. Now at the Brigham, they are excited for the chance to bring that approach to patients and families here in Boston.

“I feel really lucky to be part of a diverse and experienced team here at the Brigham—we’re all excited to get the clinics up to speed and better serve our community,” says Selcer. “It can be a real barrier for trans and gender diverse patients to not have a healthcare home for their routine or preventative needs. I hope this work will be a starting point for dedicating more clinical time to see new patients and folks referred to us from endocrinology and other service lines.”

Monaghan believes gender affirmation is part of the mission of primary care, like any other service that helps patients achieve their goals for health and well-being.

“Specialized clinics cannot always meet the volume of need,” she says. “Services like gender-affirming hormone therapy should be embedded within primary care. Especially here, where we have expert consultation from our Center for Transgender Health available at our fingertips.”