Hartford HealthCare Podcast
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Hartford HealthCare Podcast
Transitioning access to gender health
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In this episode, Steve Coates welcomes psychologists Dr. Laura Saunders and Dr. Derek Fenwick, both from the Hartford HealthCare’s Center for Gender Health.
They discuss the needs of those seeking medical gender transition, and the value of providing access to coordinated care in a welcoming environment for this population.
If you, or someone you know, would like to learn more about Hartford HealthCare’s Center for Gender Health, be sure to check the links in this episode’s notes.
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The Center for Gender Health
132 Jefferson St., Hartford
(inside the Community Health Center)
Click for Referrals
It is hard right now in the current climate for LGBT individuals around access to care. There's a lot of barriers in different states to access that. So just thankful that we're in Connecticut where we are able to actually provide these resources for individuals.
SPEAKER_04Welcome to More Life. In this episode, Hartford Healthcare's Steve Coates welcomes psychologists Dr. Laura Saunders and Dr. Derek Fenwick, both from the Hartford Healthcare Center for Gender Health. They discuss the needs of those seeking medical gender transition and the value of providing access to coordinated care in a welcoming environment for this population. Here's Steve Coates.
SPEAKER_01We're so happy to have these services at Hartford Healthcare being able to offer them to the community. Dr. Saunders, first, tell us a little bit about what the Center for Gender Health is.
SPEAKER_00So the Center for Gender Health at Hartford Healthcare is a multidisciplinary center to focus on the needs of transgender or gender diverse or anyone on the LGBTQ spectrum. It's also to facilitate individuals who wish to undergo a medical transition or gender dysphoria, which is the clinical term. And so as a multidisciplinary team, we are currently working under the clinic model, meaning that all disciplines meet in a clinic together. And those disciplines are endocrine, primary care, infectious disease, psychiatry, and psychology, with access to referrals for surgery and voice coaching and through rehab services. So as a clinic model, we are meeting twice a month right now, with the goal to probably increase to once a week because we believe the volumes will support that. And that even in the slow rollout we've had, it does seem like the volumes will support a once a week clinic. So that's the plan at this point, and that's sort of the goal of the Center for Gender Health. It's to meet the needs of this community who we know are underserved.
SPEAKER_05And I think I was gonna say it, I think like, you know, just meeting the needs of the population as well is our goal and focus is having a space where it is welcoming and supportive for everyone. Um, so even though you know we're really focusing on patient care, I think we've done a lot of trying to educate staff, make sure that the whole place where these individuals come into is a welcoming environment because we know that there are determents and people do not access healthcare in this population. So we're really looking to make sure that they feel comfortable whenever they walk into this space as well.
SPEAKER_01So are the majority of your patients those who have gone through the medical transition or those considering the medical transition?
SPEAKER_00So interestingly, in the referrals, even in the short time that we, you know, the website's been live and we've been taking in referrals, and even in the many discussions that that Dr. Fenwick and I have had about this, um, we actually expect to see quite um a range of individuals. So for some, it may be individuals who are really just uh maybe acknowledging their gender dysphoria or identifying as transgender or gender diverse in some way and ready to begin the process, maybe have been in some therapy and ready to begin the process. Um I've actually gotten a number of referrals of individuals who've been on what we call hormone replacement therapy for a couple of years and are looking to transfer their care a more in a more coordinated way into the Hartford healthcare system. Um so you know, I'm I've had young adults all the way up to people in their um 40s so far. So we are really expecting that kind of range and diversity in the referrals that we're getting. Um so people that are more newer in this sort of uh self-discovery and transition process, and then other people who have had care elsewhere, and it's not that they have poor care, it's that it's just easier to have something more localized and more coordinated.
SPEAKER_05And I think as Dr. Saunders is saying, like we don't, it's not kind of like a one size fits all, though. Um, we talk about this all the time that every person's journey is different and unique. So that was also our kind of model in the sense of like people are gonna come in a different pathways, and we want them to access the care wherever they are at in their journey. And so that's gonna be different for everyone. And so we just really meet them where they're at.
SPEAKER_01Take us through the process then for a patient that is a new patient that comes uh to the center, looking, talking uh to you about making that very important uh decision uh for the medical transition. Take us through the process of working with the center.
SPEAKER_05Sure. So I mean, it it depends on, as you mentioned, what they're looking for in services. So if they're seeking surgical um, you know, consult, first, you know, we would have a preliminary intake with them where we have kind of set number of questions that we'll ask them, and then we'll do an internal referral to the surgical team for them to set up a consultation with these individuals. But I think the you know, one of the bigger parts as well is that, you know, WPATH, which stands for the World Professional Association for Transgender Health, at this moment talks about having um therapy letters or letters of support for having surgery for these individuals. And so that's where either primary care or a psychiatrist or psychologist can really come in because they'll need those letters in order to show that there is support for the surgical um team to do the surgery. Um, and so that's partially most of the pathway there, and then from there the surgical team would call and reach out and set up that appointment for the individual.
SPEAKER_00Yeah, as Dr. Penwick noted, um, we follow the W Path guidelines, which has stand for the World Professional Association for Transgender Health. And those guidelines have actually gone through a lot of changes in the past 15 years, right? They used to be called the Harry Benjamin standards, and they were very strict and very rigid in terms of how someone would go through a transition. Now they are considered guidelines, um, you know, with a basic sort of timeline, right? You start a social transition first, which is where you outwardly and present to the world in the gender to which you identify, um, and then you step into some part of a medical transition. Very often it's um hormone replacement therapy where you you take, you know, you take on the hormone, which is a cross-gender hormone. And then once you've been on hormones for a period of time, six to twelve months, you can look at various surgical options. It's important to note that um, you know, we take these guidelines seriously, um, not meant to be as a barrier, but meant to be a way that individuals uh have a sense of what kind of what comes next. So it is our goal to follow the WPATH guidelines um in order to support people in their medical transition.
SPEAKER_01What about patients under the age of 18?
SPEAKER_00So we are at this point um only able to work with individuals basically 17 and up. Um but you're right, there is a tremendous need in that um 16 or 17 age range. Um honestly some of the most important interventions in that age range has to do with uh family support and support and validation within a school setting, because those all those kids go to school. Many of those individuals are eligible for some type of um medical transition or at least puberty blockers, um, but there's an extremely limited access to um pediatric endocrinologists, um, like as in probably a ther at least a 13-month wait for for people in that age range. So um so it is very limiting. I do think that information and education really is key to anything, and providing those the young people and the families, because they they can't do much without family support, um, providing them with information and education is absolutely critical.
SPEAKER_01We obviously have a long way to go in this area and promoting this area, but the center is such a great addition. And Derek and I were talking before we came on the air. While Connecticut is a is a very progressive state, there's some barriers for people not living in this area in the Northeast to having access to these services.
SPEAKER_05I think, you know, nationally there is political turmoil going on that that fuels into some of this and it has created barriers for individuals in different states and accessing that. Um, and I don't we don't know what the outcome of those will be, but we do know that you know we're fortunate to be here in Connecticut where we have you know safe affirming access to you know this care. Um and I'm really happy that we're able to provide that because that's really what we do all the time. Um so I think you know, we're open to having you know individuals that need this, um, welcoming those from other states if that's something that's necessary. But you know, it's it is hard right now in the current climate for LGBT individuals around access to care. Um, and really there's a lot of barriers in different states to access that. So just thankful that we're in Connecticut where we are able to actually provide these resources for individuals.
SPEAKER_00I agree. We're fortunate here, not just in Connecticut, but really in the Northeast for the most part, to be pretty progressive in allowing our medical and behavioral health professionals to make the best decisions for their patients, no matter what their needs are.
SPEAKER_05And I mean, looking at the the research and the science behind it, I mean, all the major kind of you know, psychological, medical journals and organizations, you know, really say this is the standard, gender-affirming care. Um, it does save lives. And so, um, but that's important to look at as well.
SPEAKER_01When you say saving lives, and we're talking about people taking their own lives because of the struggle, is there's data that that shows that, right?
SPEAKER_05Yeah, so you know, LGBT individuals overall, um, there are higher likelihoods of mental health concerns, depression, anxiety, um, and then higher rates of suicidality as well. So we know that the suicide rates are there due to discrimination, rejection, family rejection. Um, and there's, you know, the Trevor Project, the national organization really supports LGBT individuals a lot. They show that the way that we can reduce, just a simple thing to reduce suicide for youth and young adults is, you know, using pronouns. If once pronouns are respected, you know, their suicide rate drops by half, over 50%, if just people around them were to respect pronouns. So there's simple things that we can do. Um, but we know that for this population, a lot of individuals are struggling. Um, and you know, they do take their own life, sadly.
SPEAKER_01You know, I hope we we look back on this in 25 years and say, boy, I can't believe I can't remember a time when we didn't have something like this. What was the journey like for people, or is the journey like for some people that who aren't in Connecticut or don't have access to this? What was that journey like medically for people? I guess it's really fragmented and difficult. And I mean, what was it like?
SPEAKER_00I think fragmented is probably a really good a good word. Um, I mean, it what we are trying to do here at Horford Hospital and Harford Healthcare is improve access to care. And in systems where there isn't good access to care, it is it is fragmented. It, you know, you can't get it in your region, so you have to travel a greater distance. When you travel a greater distance, there's financial costs and entered time and energy costs. And you know, then seeking regular care means you have to travel, you know, and so we're fortunate that we're in a relatively small state and the Northeast as a region isn't too too large. Um, and so when you get fragmented care, that's never good care. So the goal with the Center for Gender Health is to provide improved access to care for individuals who we already know are underserved in the medical and mental health population, they don't seek out medical services because of fear of stigma and stereotype. Um, you know, stigma is the expectation of rejection based on an aspect of identity. So if you need a primary care and you identify as transgender and you don't want to have to teach your provider um the aspects of your care, um those individuals just don't seek care.
SPEAKER_01Let's talk a little bit about logistics. The center is a physical building in Hartford.
SPEAKER_00Yeah, so the right now the Center for Gender Health is located at the Community Care Center, which is on Jefferson Street in Hartford, um, 132 Jefferson. Um we're up on the third floor. So in our clinic model, that's twice a month right now, um, which is we have all four specialties on site at that time. Um, we're using kind of a website portal model. So referrals come through the website or portal, and then we we do a uh intake and then we schedule them based on what their needs are and what services they're looking for.
SPEAKER_01And patients can self-refer to the center?
SPEAKER_00Absolutely. You do not need a provider to refer yourself. We actually have the expectation that a good percentage of individuals will self-refer, although we have gotten a good number of outside providers or Hartford Healthcare providers, which is encouraging. So we believe that the more we get the word out, the more providers will actually ask these questions. And I was at a meeting last week with one of the many groups I've met with, actually, it was the Pelvic Health Council, um, and we got the feedback about providing, you know, a piece of paper with five or six kind of talking points for any provider. If a patient asks or brings up a topic around gender or sexual orientation, to have some talking points for that provider to be able to say, you know, ask these are the questions that you want to ask, or this is what, you know, this is some core information. So I thought that was extremely valuable feedback. So that would be something that we would put together to share with all providers and you know, give people a level of comfort and what words to use and how to answer questions. Um, so that I mean, that's part of our overarching goal as well, is to provide information and education to all providers at Harford Healthcare.
SPEAKER_01And as we're about to close, just a reminder that we'll include a phone number and also the web address for anybody looking to connect with the center. And I'll open this up to both of you. Just advice that you have for people who may be considering this very important decision.
SPEAKER_05Sure. Yeah, so I think um I always love to say keep being yourself. I think that's first and foremost. Um, if we have family members out there really being open to listening to what uh, you know, a family member is going through. Um, and for those patients who are seeking services that we're here to support you, um, we're here to help. So please reach out to us. Um and I think, you know, another thing, everybody's journey is different. So our hope is that once you come into our organization at the Center for Gender Health, you'll see that we are kind of welcoming and supportive. And, you know, you may not need um primary care, but when you come, you might see that those are other options that we have. And so really keeping you um within Hartford Healthcare. So that's our primary goal and just really reaching out to us. We're here to help the community of Hartford and the whole kind of state of Connecticut as well.
SPEAKER_00What we know is that when people feel validated in their identity, it just improves how they feel about themselves. And so, whatever steps we need to take, you know, to help someone feel validated in their identity, you know, we're prepared to do that. Um, I I always like to, you know, remind people as with each step you take, it gets better. So it may not be instantly better, but it it gets better with each step. So to ask for help, look for support, and keep taking a step forward.
SPEAKER_01Thank you so much to both of you for your time today.
SPEAKER_04Thank you. Thank you, Steve Coates and Drs. Saunders and Fenwick. If you or someone you know would like to learn more about Hartford Healthcare's Center for Gender Health, be sure to check the links in this episode's notes. Follow More Life to be notified each time a new episode drops. Just search Hartford Healthcare on your favorite podcast platform. Thanks for listening to More Life.
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