Three years ago, transgender and gender-diverse people in Western Massachusetts were given a new option for inclusive healthcare with the opening of Transhealth, a Northampton organization focusing on providing care to these underserved populations. Reminder Publishing checked in with Transhealth CEO in Western Massachusetts to see how the organization has fared since opening and what work still needs to be done.
A 2022 Pew Research Center survey found that 1.6% of U.S. adults are transgender or nonbinary — their gender differs from the sex they were assigned at birth. In July 2021, the American Heart Association found that there are higher levels of heart disease among transgender and gender diverse people which are linked to the stress of experiencing discrimination and transphobia at personal and societal levels. Poorer health outcomes are also linked to lack of equitable access to care and higher levels of smoking and overweight or obesity.
A separate 2022 Pew survey reflected, “Many focus group participants who have sought medical treatment for their gender transition faced barriers, although some had positive experiences. For those who said there were barriers, the cost and the struggle to find sympathetic doctors were often cited as challenges.” The survey included reports of being turned away for treatment, lacking insurance coverage for certain procedures and having to “jump through hoops.” However, others in the survey said access to care has become easier than it was decades ago.
Transhealth is the only healthcare organization in Massachusetts devoted solely to serving the trans and gender-diverse community, said Joan Erwin. Erwin became CEO in late 2022, after serving as the organization’s chief operating officer. The organization was founded on the pillars of physical and mental health care, research, education and advocacy.
Since opening, Transhealth has served 2,380 individual patients, not including those who use the community room. Transhealth offers primary care, pediatric care, mental healthcare and gender-affirming hormonal care, a pharmacy and community programming, which includes social and educational groups, a drop-in space, events and a community closet. Transhealth’s website describes it as “a hub” for trans and gender-diverse community, providing healthcare, community and resources.
Services
Primary care for transgender patients is the same as for cisgender one, Erwin said, adding, “There are just some extra considerations.” She said, “What people do get from us in primary care is recognition of their gender expression. Or people, depending on their gender journey, may get hormones from us,” Erwin said.
Hormone therapy is one possible component of gender-affirming care. According to the federal Department of Health and Human Services’ Office of Population Affairs, “Gender-affirming care is a supportive form of healthcare. It consists of an array of services that may include medical, surgical, mental health and non-medical services for transgender and nonbinary people.”
A 2022 study published by the Colombia University Department of Psychiatry stated, “Research demonstrates that gender-affirming care greatly improves the mental health and overall well-being of gender diverse, transgender, and nonbinary children and adolescents.”
The study goes on to state, “Gender-affirming care is highly individualized and focuses on the needs of each individual by including psychoeducation about gender and sexuality (appropriate to age and developmental level), parental and family support, social interventions and gender-affirming medical interventions.”
Most of the patients receiving care through Transhealth are between the ages of 14 and 22 or 18 to 45, depending on the type of care. However, Erwin said, “We have pediatrics for primary care and mental health for ages 4 and up.”
While Transhealth specializes in gender diverse care, families of patients will sometimes receive care, as well. “We don’t discriminate. We don’t only see people who are trans or gender diverse,” Erwin said.
In addition to in-person appointments and drop-in services, Erwin said, “We do a lot of telehealth.”
Primary care appointments are generally 30 to 60 minutes in length, far longer than the 20 minutes per patient available with many providers. The longer appointments affect revenue, because fewer patients can be seen each day, but Erwin said, “We don’t want our providers to feel rushed and we certainly don’t want our patients to feel short-changed.”
If a patient requires a level of care that is outside of what the providers at Transhealth can offer, the patient is referred to specialists.
There are also a range of mental healthcare services at Transhealth, from surgical letters to therapy and psychiatric prescribers. There is a wait list of between 50 and 75 patients to be seen for mental health services, and patients must have a primary care doctor at the practice. On average, patients spend four to six weeks on the waitlist time.
When it comes to mental health, Erwin said many patients have experiences with past providers who “were not competent” in treating people with the specific needs of gender-diverse patients. She added that Transhealth practices “trauma-informed health” in both mental and primary healthcare.
Political climate
Erwin said people go to Transhealth because the staff are non-judgmental and affirming. “Many people we see have avoided healthcare for years,” Erwin said. “We’re seeing more and more medical refugees who haven’t been able to get that care or can’t get [insurance] coverage for that care, and so people are looking to move here.”
Despite a sometimes-turbulent political climate, Transhealth has experienced no protests or threats since it opened. Nevertheless, Erwin said the facility has “a robust security system.” Northampton is widely considered to be a welcoming and inclusive city, but Erwin said she believes similar organizations could be created in other areas of Western Massachusetts. She said Transhealth may expand to Springfield in the future because it is home to a large, underserved population.
As part of the advocacy and education pillars of Transhealth, Erwin said, “We’re hoping to continue to educate people on the innate right to essential healthcare.” All providers are given four paid hours to interact with and further educate the public. One example of this is staff members who have been invited to speak at schools that have experienced transphobic and homophobic incidents.
“In this national climate, no one really knows what’s going to happen next,” Erwin said. “We have to be a beacon of hope.”
To learn more about Transhealth, visit transhealth.org.
