LGBTQ Transgender Medicine
We need your help to build a Transgender Medicine program that meets your needs.
MHW is excited by the opportunity to increase the number of transgender medicine services. And to continue the development of our Transgender Medicine Health Program through our specialist Kelly Washburn, NP. We can’t build the program without the help of the transgender community. We welcome feedback to ensure that MHW’s services are meeting your needs.
Contact Kelly Washburn at kelly@merritthw.com to learn more.
Support of Our Transgender Patients
In light of recent statements made by national leadership towards members of the transgender community we have this response. MHW’s Transgender Health Program would like to take a moment to state our commitment to your health and wellness.
First of all, we recognize fully that the uncertainty in our political environment. And gestures of intolerance can result in a wide range of emotions for patients and the community at large. We encourage you to reach out if you are experiencing distress, and would like to point out some resources. Below, we included good sources of support for individuals in crisis.
Our Mission
Know that we will remain unwavering in our mission to serve you. Most of all, to the best of our capacity, with full recognition of the impact of gender. Finally, on the well being of transgender and gender diverse individuals. We will continue to be advocates at the system, community and state level. Also, for the needs of the gender diverse community, we will not let political decisions deter us from our care.
Thank you,
The Merritt Health and Wellness Team
Frequently Asked Questions
What is the Transgender Health Program with Kelly Washburn, NP
The MHW Transgender Health Program is an umbrella program for the transgender health services at MHW. It supports coordination and alignment of all clinical services. Furthermore, a resource to help anyone navigate transgender related care.
Who can access the Transgender Health Program?
We are available as a medical home and primary care clinic for transgender and gender-diverse people of all ages. Also, their family members, partners, friends, and other supports. We are also a resource for health care providers, health plans, and community and advocacy groups.
Where is the Transgender Health Program located?
Our office is located in Portland, but our information and consultation services are available to anyone by phone or email. In person consultation takes place on the OHSU Marquam Hill or South Waterfront campus. Arrangements for consultation at any of OHSU’s satellite programs can be arranged as needed.
What is the WPATH Standards of Care and how does MHW follow these guidelines?
WPATH is the World Professional Association for Transgender Health. It is a nonprofit, interdisciplinary, professional and educational organization. First of all, devoted to transgender health whose mission is to promote evidence-based health care. In addition, education, research, advocacy, public policy and respect in transgender health. WPATH publishes the Standards of Care and Ethical Guidelines. Which, articulate a professional consensus about the treatment and management of gender issues. MHW providers and most insurance plans follow the guidelines set forth in the Standards of Care. The Standards of Care are available at www.wpath.org.
Portland LGBTQ
It’s never easy to wrestle with “gender dysphoria”—a person’s distress over his or her gender assigned at birth. But Portland is, by many accounts, a supportive place to do it. The Oregon Health Plan began covering puberty suppression, hormone therapy, and, for adults, sex-reassignment surgery. Portland is also home to TransActive, a nonprofit that offers counseling groups for transgender youth. Also, education for professionals who work with families.
Over six months, you really see a big change. Patients are less depressed, less anxious, and they take better care of themselves. It’s amazing to see patients turn around so quickly.
Transgender Health Medicine Primary Care
Services include Hormone therapy for transgender patients. Hormones and anti -androgen medications are prescribed. Bio-identical hormones in various forms are available as well as conventional hormone prescriptions.
Natural and specialized Transgender medicine can address health risks and medication side effects. Most of all, it can occur with hormone therapy. For example, testosterone can adversely affect cholesterol and lipid levels. There are effective natural treatments in addition to diet and exercise counseling for treatment. Therefore, it can be used to reduce the cardiovascular risks associated with unhealthy lipid levels.
Each transgender person’s goals and expectations for transitioning are as individual as they are. The transition can be with or without hormone therapy and/or surgery. Hormone therapy is generally continued life long, although doses may be reduced over time or post surgery.
Kink, poly and all sexualities and genders welcome.
Click on one of these selections for more information:
FEMINIZING HORMONE REGIMENS
Changes occur slowly and may be less than desired.
Body/bone size and structure, facial hair growth patterns will not change. Beard hair will be less thick but will remain.
Electrolysis and laser hair removal are helpful, but can be costly and require multiple treatment sessions.
Voice pitch will not change, but more typically feminine vocal patterns can be taught.
Most changes are reversible, except breast enlargement.
Feminizing Hormone Therapy
- Estrogens can be taken as pills, patches or injections.
- Dose may be reduced after orchiectomy surgery or after maximum feminization is reached.
- Doses are 4 to 8 times the HRT dose for menopausal women. Patch reduces risk for blood clots.
- Must be stopped for 2 weeks prior to surgery due to risk of blood clots.
- Anti-androgen: usually spironolactone (a diuretic with testosterone reducing and receptor blocking effects). Finasteride may also be used to block DHT (a form of testosterone)
- Progesterone may be added later.
Expected Desirable Effects:
- breast development- a size B cup is usually maximum, and will take at least 2 years to reach.
- redistribution of body fat, increasing in hips, thighs and buttocks and less in abdomen.
- softening of skin
- suppression of testosterone production, decreased size of testes and possible penis, with less frequent and weaker erections
- less muscle mass in upper body (and strength)
- torso and extremity hair will lessen over several years, but areola, armpit and pubic hair change less.
- slowed or reversed loss of scalp hair
Possible or Theoretical Desirable Effects:
- decreased heart disease risks, improved lipid profile
- improved mood and impulse control
- decreased benign prostatic hypertrophy
Adverse Effects:
- blood clots (venous thrombosis) in legs, lungs, other areas. Pulmonary embolism, heart attack and stroke may be fatal.
- thrombophlebitis
- Also, hypertension, prolactinoma, diabetes, nausea vomiting, migraine headache, decreased libido, impotence, gallbladder disease, abnormal liver or kidney function tests. In addition, mood disorder/depression, melasma (skin darkening in spots), low sodium, elevated triglycerides, elevated potassium.
Possible or Theoretical Adverse Effects:
- increased risk of breast cancer, hepatitis, heart attack, stroke, other cancers, infertility (possibly permanent)
- Consider sperm banking, if appropriate
Based on the risk of adverse effects, there are some corresponding precautions and contraindications for hormone therapy.
MASCULINIZING HORMONE REGIMENS
Changes occur quickly, within a few months, and most are permanent.
Masculinizing hormone therapy
- Testosterone: by self-injection every one to two weeks, patch or topical cream or gel.
- Dose may be reduced after oophorectomy, must must be maintained for osteoporosis prevention and masculinization effects.
Expected desirable effects
- cessation of menses
- lowered voice range (permanent)
- increased hair growth on face, chest, extremities (permanent)
- upper body muscle mass and strength
- increased weight
- clitoral enlargement (permanent)
- redistribution of body fat from hips to abdomen
- mild breast atrophy
Possible or theoretical desirable effects
- decreased risk of osteoporosis
- increased libido, interest and arousability
- increased physical energy
Adverse effects
- abdominal (apple shaped) obesity
- peripheral edema
- acne
- erythrocytosis, abnormal liver tests
- worsening of cholesterol profile, increased risk of cardiovascular disease
- headache
- coarsening of skin
- emotional lability, increased anger and aggression
- male pattern baldness (permanent)
- infertility (may be permanent)
Possible or theoretical risks
- increased risk of breast cancer
- hypertension
- polycystic ovaries, ovarian cancer
Based on these risks, there are corresponding precautions and contraindications for hormone therapy.
Reproductive counseling regarding loss of fertility should be included in informed consent.
ADDITIONAL RESOURCES
Identification change resources
How to change your gender marker or name in Oregon
Basic Rights Oregon’s step-by-step guide: Identification and Gender Marker Documents
Updating federal documents
The Transgender Law Center: How to Update your Federal Documents
(Recording and PDF slide presentation)
A concise list of healthcare services available at MHW to meet the culturally specific needs of our LGBTQ community.