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It’s been three months since Planned Parenthood New York City began offering hormone therapy for trans patients at its Brooklyn site. The program has been doing so well that PP NYC plans on opening a second location before the end of the year. In fact, Planned Parenthood is now one of the largest sources for transgender health care in the country, even as it continues to operate under constant threat from the Trump administration and the Republican Congress.

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I spoke with Kate Steinle, Director of Quality Management and Transgender Health Services for Planned Parenthood NYC, and Carrie Mumah, Director of Digital and Media Relations, about how the program has been doing, common misconceptions about trans therapy, and why they feel it’s important for all insurance companies to provide these services to trans people.

Note: this interview has been edited and condensed.

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Planned Parenthood NYC has been offering hormone therapy for three months now. What’s the reception been like, and how is the program going?

Steinle: We've had a really great reception. The first day all the slots that we had were filled. We're offering the service once a week in our Brooklyn center, so it's just one clinic day per week. We have two clinicians who are offering the service right now, and we have almost forty patients that we're following and that we've initiated hormone therapy with at this point.

What can you tell us about the patients you’ve been seeing? What demographics are you seeing represented and how have they heard about you?

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Steinle: We offer the service for people who are 18 and over, so we are not seeing anyone under 18 at this point.

The majority of them are in their twenties, but I do have a range of patients—I have one patient who's in his fifties and starting hormones at this point.

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I do think that a lot of it is patients who are coming in and telling their friends about the experience that they've had. They'll say, “my friend so-and-so came in and I want to switch over." Or, "I'm just starting, I just moved here and I want to start with you guys."

What are some of the barriers to access that trans patients face?

Steinle: One is possibly being uninsured or underinsured, and therefore not having access to healthcare providers because they might have to pay out of pocket. [Or] having access to health care providers, but those providers don't know anything about trans hormones, or about the transgender community in general. So, uninformed providers, or at worst, providers who are outright discriminatory to their patients. And that's just in the health care field.

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What misconceptions do people tend to have about hormone therapy?

Steinle: I think a common misconception stems from the fact that when [people] don't understand something, they make a lot of uninformed judgments. For instance, somebody who's like, 'Well, why are you needing to do that? What's the purpose of that? Why should we be paying health care costs for your choice? This isn't a necessary piece of healthcare for you.'

I think all of those pieces are misconceptions of what hormone therapy actually does for somebody, and how necessary it is as a medical service for people. This is something that is necessary. It's a very integral part of health care for transgender people, and should be covered, no question, by all insurance companies.

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Mumah: The other side of that, some people feel like to be trans, you have to have been on hormones. Or it makes you more trans or something like that.

Steinle: That's a really good point. There's no one specific path as a transgender person, right? For some people that means changing their name, changing their gender pronoun. For some people that means doing hormonal therapy and [for] some people that means also doing surgery. Some people just do pieces of those and they take a break and they continue going on. As a provider of this, it's just making sure to have that really in-depth conversation with people to see what [their goals are]. What’s your ideal? And let's try to work within that to see what is possible.

To that person who says “this isn’t necessary health care” or “why should we be paying for your choice,” what would your response be to that type of comment or thinking?

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Steinle: I don't like to use a disease category like diabetes or hypertension, but let's take for instance somebody who, without a certain type of medication—this is a cis-gendered person—without a certain medication their body is unable to function the way it was meant to be. And adding that medication in is going to help make them on that path that makes their body work.

For transgender people, this medication, that necessary medication is transgender hormones. It’s either testosterone or estrogen, and without that estrogen or without that testosterone, their body is not going to function the way it is supposed to.