SAT396 Transgender Care From The VA Perspective

Abstract

Abstract Disclosure: P.R. Nayak: None. Background: Medically necessary care for transgender and gender non-conforming veterans was officially mandated in 2011 by the Veterans Health Administration. However, access to care can be difficult and tortuous to navigate. Additionally, the healthcare disparities experienced by transgender veterans extend beyond medical therapy; mental health services, appropriate sexual health education, and population specific needs and screenings are often inadequate. In 2019, providers and staff at our VA medical center formed a multi-disciplinary team to provide coordinated and whole health focused gender-affirming care for this unique population. The team consists of an endocrinologist, mental health providers, social workers, clinical pharmacist, speech therapist, primary care provider, and a prosthetic representative.Case: A 32 year old transmale veteran with depression and bipolar disorder met with our social worker after expressing his desire to continue his transition. He had come out to his community and presented as male for over a year. He was referred to the endocrinologist who recommended egg harvesting prior to starting hormone replacement therapy per veteran's desire for biologic children. A social worker coordinated his consultation with a reproductive endocrinologist for the procedure. Simultaneously, a prosthetics representative helped veteran obtain a chest binder and a stand-to-pee device. Upon completion of egg harvesting, he started testosterone therapy, titrated to therapeutic levels.A year after starting hormones, he pursued top surgery and completed this locally. Due to ongoing menstrual bleeding on intramuscular testosterone, he was referred to ob-gyn and subsequently underwent hysterectomy and left oophorectomy. Post hysterectomy, he and his partner began experiencing relationship problems. They were referred to the sex therapist to work on their physical intimacy and sexuality. Three years on hormone therapy, veteran reported difficulty with the voice variations, though his voice had deepened to his liking far earlier in his medical transition. He started working with a speech therapist for voice masculinization with improvement noted at follow up. Conclusion: A multi-disciplinary approach to gender-affirming care is beneficial in providing patients with the care they deserve in a timely, respectful and coordinated manner. Our patient experienced a smoother and supportive transition due to the team of providers who were able to provide gender appropriate care across several disciplines during each phase of his transition. Without a team approach, this population often face several hurdles and delays to their transition. Since 2019, we have served over 50 transgender and gender non-confirming veterans in their transition. While not all have met their transition goals, most have benefited from the support and guidance of our team. Presentation: Saturday, June 17, 2023