UM University Health Center Introduces New Trans Care Team

After 15 years of serving transgender and non-binary patients, staff at the University Health Center in the University of Michigan understood there was still a big gap in the community's healthcare: hormone initiation.
This new UHS service is just one component of the team's nearly year-and-a-half effort to create a more inclusive, affirming and safe space for trans and non-binary patients seeking health care. The result is the UHS Trans Care team, a group of nine specialists trained specifically around the needs of the community.
While UHS has provided hormone treatment services for years, the opportunity for patients to initiate hormone treatment at the center has been unavailable until now. Diana Parrish, a social worker and member of the UHS Trans Care team, said this missing element was one of the inspirations behind developing the team.
"A little under two years ago, myself and a staff member at the counseling center started talking more intentionally about students coming to us with the inability to access health care specific to gender-affirming care, and a big gap was initiation of hormone therapy," Parrish said.
"A lot of students were struggling to find where they could be initiated," she continued. "At Michigan Medicine they have offered these services for years. They're wonderful providers. But unlike UHS, those aren't included in tuition. They'd need to use insurance, and oftentimes needed transportation."
UHS staff met over the next 18 months in a variety of training programs before rolling out services under the new Trans Care Team. In addition to hormone initiation, patients can visit the center for sexually transmitted infection testing and treatment; pre-exposure prophylaxis, or PrEP, and post-exposure prophylaxis, or PEP; pelvic exams; cervical cancer screening and pregnancy prevention, among other things.
As a part of the training, staff met with trans and non-binary individuals through focus groups and other avenues to further shape policies. The importance of privacy and confidentiality, as well as a lack of trust due to past negative experiences, were two major themes found in the feedback, Parrish said.
Susan Ernst, a physician in the UHS Women's Health Clinic, said some trans and non-binary patients also reported negative experiences before even meeting with their physician. The stories prompted UHS to involve every staff member in the building – not just physicians – in the cultural sensitivity training sessions.
"One of the students said that some of the barriers come up when they walk into the health care facility," Ernst said. "The staff use their birth name, and that's a negative tone for our vision. The students wanted people to be aware of how they approach patients."
But dwelling on mistakes can be harmful, too.
"One of the other points students have made is that if you use the wrong pronoun, just say 'I'm sorry' and move on," Ernst added. "Don't dwell on it, it just makes it more uncomfortable."
As a social worker with the Trans Care Team, Parrish helps patients navigate the healthcare system and issues around health insurance benefits. She has the authority to assist with name and gender markers within UHS, campus and on identity documents, and can also help patients looking to get a letter of support for hormone therapy and/or surgery.
The Trans Care Team isn't done learning, Parrish said, as she believes in the importance of operating from a place of "cultural humility," which "calls us to be patient-centered, non-judgmental and always learning."
"Even before the formal work on Trans Care services at UHS began, I had to slowly come to the realization that I will never know or understand the complexity and diversity of experiences that trans and non-binary folks move through the world with," Parrish said.
Ernst agrees that there's still much to learn. In dealing with trans and non-binary patients, she believes its best to treat them like they're the experts on the their own body.
Ernst recalls grappling with the decision of whether or not to prescribe the hormone progesterone to a male-to-female transgender patient. After consulting with an expert at Michigan Medicine, she learned that it wasn't her place to choose for the patient.
"I had a patient who was male-to-female transgender, and she wanted me to prescribe progesterone," Ernst said. "I had a hard time with that that, because physiologically there was no need."
"I remember Dr. John Randolph from Michigan Medicine saying that if you have the conversation with her and she understands the risk, if she still wants that because in her mind she think it's the right thing, then he's willing to prescribe progesterone."
Ernst said she is already seeing the impact of the new Trans Care Team. In the last month she recalls meeting with a couple of patients for post-op visits following bottom surgery, as well as another transgender patient who may need surgery.
"That's three times as many as I saw in the last year," she said. "I think we'll see an increase."
Rachelle Wilcox, a primary care provider on the Trans Care Team, said the new team has "absolutely" made an impact from her point of view.
"From my own patient population I've had two patients who plan to initiate hormone therapy sometime soon," Wilcox said.
Trans and non-binary individuals looking to learn more about the Trans Care Team are encouraged to visit uhs.umich.edu/transcare. Here, patients can find information on each member of the team as well as information regarding frequently asked questions.