Providing transgender hormone therapy in a community health setting: A policy analysis

The need to provide transgender inclusive health care services has emerged in recent years as the transgender community becomes more visible in the media, academic literature and public health practice. The Harry Benjiman International Gender Dysphoria Association's Standards of Care, a generally accepted professional consensus in transgender hormone provision, stipulate psychotherapy and/or gender presentation requirements before the initiation of treatment. These standards have become increasingly questioned as providers and public health professionals recognize their potential to limit access to care and to produce negative health outcomes for this high-risk population.

Access to trans-inclusive services is a public health priority, and there are currently initiatives among community health organizations to expand that priority into trans-specific health services such as hormone treatment modalities. Given the distinctive health concerns of transgender people including high incidences of violence against transpeople, the illegal acquisition of hormones, high incidences of HIV/AIDS and unique mental health needs, it is cogent to assess transgender hormone therapy through a harm reduction model. A case study from a community health organization in western Massachusetts will be used to analyze the programmatic, political, and economic ramifications of this service provision at the community level. By combining focus group data with a review of other LGBT health center protocols, I address the viability of provision using a harm reduction model of care. Policy alternatives are explored with a recommendation of expanded service provision to the local transgender population.