An Open Letter: A Call for Informed Consent for HRT Care In and For Our Community
Ignorance and transphobia in the medical establishment is a concern to us across the nation as well as in our Little Apple community. In lieu of Transgender Awareness Week, our board members have written the following letter which will be distributed to the local healthcare professionals.
Many health services across the U.S. use what is known as an informed consent approach for care connected to hormone therapy (HRT). An informed consent approach removes the requirement to meet with a mental health provider as a prerequisite to accessing gender affirming care. From University Health Services to Planned Parenthood to individual Primary Care Physicians, informed consent has become an evidence-based standard for providers committed to best practices for trans, gender non-conforming, and queer care. The Flint Hills Human Rights Project calls on healthcare providers in our community to practice informed consent for HRT prescriptions in order to better care for our community.
The outdated and harmful alternative to informed consent is unfortunately starting to become more the norm than the exception here in the Flint Hills. Too often trans, gender non-conforming, and queer patients are being subjected to costly, stigmatizing, burdensome practices when it comes to accessing hormones and gender affirming care. Requiring clients first be treated by a mental health professional and receive a letter of assessment with formal endorsement in support of medical care is a gate-keeping measure and double standard. Those seeking hormone therapy for menopause, low testosterone, birth control, hirsutism, male-pattern hair loss, and other conditions are not forced to get an endorsement of their mental health. Not only is getting a letter from a mental health professional a double standard when it comes to prescribing hormones, it has material consequences. In a state with almost a quarter of a million people without health insurance (2018 Kansas Health Institute Report) and a trans population subjected to poverty at a rate of 36 percent (U.S. Transgender Survey Report: Kansas), which is triple the rate of the general population, requiring unnecessary and expensive mental healthcare to access gender affirming care is devastating. It is cost prohibitive for many. It will drive some to access hormones through extra-legal methods, which will risk further exposure to the criminal punishment system. But for those who go through the process of getting their letter, it is a stigmatizing experience that further fuels health disparities. It also assumes we don’t know who we are or what our needs are in terms of our gender.
The Flint Hills Human Rights Project calls on local healthcare providers to join us in working to eliminate health bias and health disparities by adopting an informed consent approach to gender affirming HRT care. Access to gender affirming care improves lives. It saves lives. It helps physicians fulfill their oath to do no harm by removing these expensive, often cost-prohibitive, and pathologizing obstacles to care. We are advocates for and proponents of mental health care and increased access to services. Therapy can be life changing but should not be used as a bully stick nor obstacle to services.
Recommendations for further reading:
To learn more about informed consent for hormone therapy see this article by Timothy Cavanaugh, Ruben Hopwood, and Cei Lambert as well as this article by Sarah L. Schulz.
For research on concerns about regret or malpractice claims see this article by Madeline B Deutsch.
For “Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People” from the Center of Excellence for Transgender Health at University of California, San Francisco, see this PDF.