How to find a trans-friendly gynecologist in Washington

Isla Oliver, DNP, CNM, ARNP

It is often daunting and overwhelming trying to choose someone to trust with vulnerable topics like your pelvic and chest/breast health. This is especially true for transgender and gender non-conforming people who are at increased risk of very real harm in the healthcare space. The good news is that there are resources to help you find the right provider for you.

When you choose a provider, remember that you are entering a working relationship designed to serve you, and you have the right to end the relationship if it’s not a good fit. You can fire your doctor (even in the middle of a visit if you need to). You are not stuck with the first person you are assigned to, and you do not have to deal with environments where you don’t feel safe.

Where do I find safe providers who know how to treat trans patients?

There are many online databases that providers have to actively opt into, and can be a good signal that they are LGBTQ+ friendly and informed. These include:

OutCare Health - OutCare Health - LGBTQ+ Healthcare Resources & Providers

                Not only does OutCare have a database of providers, but also help with care navigation, peer support, and more.

GLMA - Home - GLMA: Health Professionals Advancing LGBTQ Equality

                Great resources on advocacy, policies, and an LGBTQ+ Healthcare Directory.

Hysterectomy & Sterilization Provider List - r/childfree Wiki: Sterilization Doctors by State

                While this is not a LGBTQ+ specific list, this list includes names of providers with patient testimonials for low-barrier sterilization and hysterectomy procedures. I recommend reading the reviews for surgeons in your area.

Planned Parenthood - About PPGNHAIK | Planned Parenthood Great Northwest, Hawaiʻi, Alaska, Indiana, Kentucky

                Planned parenthood is a great resource for gender affirming care of all types. From competent sexual health screenings & services, to gender affirming hormone therapy & help navigating surgical processes. Every employee from the front desk to the providers are trained specifically to welcome and support transgender and gender non-conforming patients.

What should I expect from a gender-affirming hormone therapy (GAHT) visit?

When you meet with a provider to discuss gender affirming hormone therapy, the provider has a few tasks that must be done:

1. Establish what your goals are, and how long you have had these goals, so that we can determine if treatment is effective in the future.

2. Counsel you on the risks, side effects, permanent & non-permanent effects, & expected timeline of GAHT.

3. Establish if hormone therapy is safe for you by checking labs & asking about your medical history.

4. Counsel you on the many types of hormone therapy that exist & dose the medications based on your goals.

   
   

Many patients come to GAHT visits with a strong understanding of hormones and available options. As providers, we will still need to review & document adequate counseling so that we aren’t assuming what you do, and do not know already. Providers should also never be trying to sway you in favor of or against hormone therapy, as long as it is a safe option.

This visit is an excellent time to bring up any questions you have, concerns, or worries, and to establish a relationship with a provider you can expect to see multiple times in the first year of treatment.

Do I need to see an in-person gynecologist for a pelvic or chest/breast exam?

Every person who has a cervix, regardless of gender and sexual activity, should start having pap smears to screen for cervical cancer beginning between age 21-25. There are some laboratories that are starting to offer patient-collected HPV swabs. These can be an option for patients who wish to avoid pelvic exams. Pap smears can feel very invasive for a lot of people, so I recommend seeking out providers and clinics that openly advertise a welcoming environment for transgender and gender diverse people. 1

For breast/chest exams – for the average risk person who has breast tissue that developed in puberty, it is recommended that you start mammogram screening at age 40. Sometimes these are recommended earlier based on family & genetic history. You should talk to your providers about what screening you need by age 25. 2

Research has shown that there is no clear evidence that clinical breast exams performed by a provider have a health benefit. Rather than focusing on breast exams, we recommend patients are generally familiar with their tissue and report any changes to their provider right away. 3

If you developed breast tissue as a result of GAHT, have an average risk of breast cancer, and have been on GAHT for at least 5 years, it is recommended that you start having mammograms between ages 40 and 50. This is an area that is still being researched and recommendations are likely to continue to change. In general, transgender women & nonbinary people on estrogen therapy are at lower risk of breast cancer than cisgender women due to their shorter duration of exposure to estrogens and progesterone. 4, 5

The take home message.

No matter what you are being seen for, you should always feel heard, safe, and included in decision making when it comes to your health and your hormones. Know that there are lots of resources at your disposal if you are looking for specific care or specific providers, and it’s okay if it takes you more than one try to find where you are comfortable receiving care. It’s worth looking around so that you get the best care for you.