Trans Medicine: Ahead of the Curve

Photo caption: Pam Klein (back, second from left) and Sara Reid (back, second from right) lobbying for trans medicine in Washington, DC.

Transgender health care is considered an emerging field, but at BHCHP it has been part of our practice since 2008, when nurse Pam Klein launched a pilot program based on her experience working in transgender health in San Francisco. Among other services, we offer primary and urgent care, behavioral health, a support group, and hormone replacement therapy at our South End location, and we connect patients to Boston Medical Center (BMC) for medical/surgical services as needed. We also offer services at several of our other locations such as Pine Street Inn, Bridge over Troubled Waters, and the New England Center and Home for Veterans.

As the Project Manager of Transgender Services, Pam Klein manages BHCHP’s services across all sites within the program. Sara Reid is a consumer and advocate, serving on BHCHP’s Consumer Advisory Board and Board of Directors. Together Sara and Pam have worked tirelessly to advocate for the trans community, both within BHCHP and beyond, speaking at local and national conferences about transgender medicine.

LGBTQ people are overrepresented in the homeless population, and trans women face a disturbing level of violence, with 20 violent deaths of trans women in the US in 2017. As Pam explains, trans patients face the same obstacles as the rest of our patients, but with an additional layer of stigma. Sara put it another way: for trans people, no matter how many years you’ve been off the streets, no matter how stable your life feels, it can all be gone in the matter of an afternoon and then you’re back on the street.

But why is that? Sara explains what she and so many other trans people have felt: the need to prove who they are and their inherent value, over and over again. Many transgender patients who are homeless or marginally housed are disconnected from primary medical care. Their isolation and feelings of mistrust may be magnified by prior negative experiences within the mainstream health care system.

A major component of the trans team’s success is how their work has always been informed by trans patients. Pam and her cross-discipline team are continuously surveying their patients to assess their needs in order to update or improve services.

Trans patients have specific health care needs that must be taken into account. The focus tends to be on hormone therapy and gender alignment surgery, or other practices associated with transitioning, but there are other concerns as well. Before hormones were covered by insurance, side effects from unregulated hormones or black market silicone were a serious concern. Risk reduction for sexually transmitted infections, particularly HIV, is a priority, as trans women of color have the highest rate of HIV in the US.

Prior to 2014, all care related to being trans could be denied by their insurance provider, like therapy if the diagnosis was gender dysmorphic disorder, or a pap smear for a trans man. That was a dangerous and discriminatory practice, and one that advocates fear could return. These days, thankfully, medicine is more equitable and accessible for trans patients, although there’s still a long way to go. At BHCHP, we strive to provide respectful, high quality care to all of our patients, regardless of how they identify. 

The future of trans medicine at BHCHP is hopeful: Pam and Sara both work with our partner, Boston Medical Center, on their Center for Transgender Medicine and Surgery, to consolidate the variety of services, train clinicians, and make it easier for patients to access care. Beyond that, BHCHP is working toward certification as a leader in LGBTQ health care equality. Because if we want our medicine to truly matter, it must be truly inclusive.

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