A conversation with a patient seeking GAHT.
A conversation with a patient seeking GAHT.
Here is a short conversation between a provider and one of their long-time patients about initiating GAHT. For context, Andy is a young adult that has been seeing this provider for several years. Andy identifies as Nonbinary and uses they/them pronouns. Andy wants to talk with their provider about GAHT.
Hi Andy. It’s good to see you again. What can I do for you today?
Last time we met, I think I mentioned that I came out as Nonbinary about a year ago. I’m here today because I want to talk about starting testosterone.
Of course. Like I said before, I’m really happy you took this big step and want to support you however I can. For starters, could you tell me a bit about your health goals and how you see testosterone therapy fitting into those?
Sure. Even though I just came out publicly last year, I’ve identified as Nonbinary to myself for about five years. I always knew that “girl” never quite fit for me, and after college I had this new language I could use to understand my experience. Now that I am out, I want to focus on my identity. I’ve done research on GAHT and believe that it can help me look and feel more like myself. I’m hoping it will result in a more masc presentation.
It sounds like this new understanding of yourself has been really empowering and you are hoping hormone therapy will add to that even more. I would be happy to talk about starting you on testosterone. Tell me a bit about what you know about it, the potential effects, and the risks.
I’ve done some research and I’m aware of and interested in some of the physical changes that may occur, like voice deepening, facial hair growth, and changes in muscle mass. I know testosterone does come with some risks, like acne, weight gain, and the potential for cardiovascular disease.
Sounds like you have done your homework. That’s absolutely right. The one other risk that we should be sure to discuss upfront is the impact on reproductive health. We haven’t talked much about any family planning goals you might have—if that is important to you there are fertility preservation options we can discuss.
I haven’t given that much thought…goals like that felt far off for a long time. I would be interested in getting more info so that I can consider my options.
Certainly. We can get you some information on that. So, it sounds like you understand what to expect in terms of outcomes. The next steps in the process would be for us to do a few labs to establish your current hormone levels, look for any other health conditions we would want to consider as we manage your hormone therapy. After that, we could talk about the various testosterone options available and choose one that works best for you. How does that sound?
That sounds perfect.
Great. I can order those labs today. One other consideration is the financial aspect of treatment. Do you know if your insurance plan covers gender-affirming hormone therapy?
I think they do. They list a set of requirements for pre-approval.
Good. Hormone therapy results aren’t all permanent, so it’s important to have a long-term plan for making it affordable. Let me know what you need from me to get pre-approval.
I appreciate it.
Things to consider.
The provider was able to get an overview of the patient’s gender history by showing basic interest and asking a few simple questions. There was no need to ask more invasive questions or seek evidence from the patient to justify their gender identity.
The provider operated from a place of support, not of risk management. This facilitated an open discussion in which the patient was forthcoming about their understanding of both benefits and risks. If the provider started by expressing more concern about risks, the conversation would likely have gotten locked in a debate about pros and cons of treatment.
How could you maintain a supportive tone when the patient shows less foundational understanding of GAHT?
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