HBHC’s Revised THInC Protocol

What You Need to Know

We have changed and improved our Transgender Hormone Informed Consent (THInC) process for patients at Howard Brown Health. By studying best practices across the nation and analyzing internal data and patient feedback, we designed a new care model to better serve our transgender and gender non-conforming patients 18 and older.  The new treatment protocol is designed to reduce barriers to care, improve the informed consent process and provide even better services to our community by shortening the process to receive hormone replacement therapy in an affirming and affordable way.

Instead of a 3-step process, the new treatment protocol will involve 1-2 steps.  To do so, we are no longer requiring everyone to complete a Hormone Advocate Appointment. Instead, patients can request a FREE Hormone Information Appointment when they are in the clinic or attending an After Hours Drop-In to discuss any specific questions they have about hormone therapy.

Additionally, Howard Brown believes that our patients and clients do not need therapy to make a decision about whether hormone therapy is right for them. Instead, people should be given complete, accurate information, and supported in making their own decisions about whether to get hormone therapy or not.

We hope that this revision in how we offer hormone prescriptions will help reduce unnecessary travel and extra appointments that could be a hardship or a barrier to care for people seeking care from Howard Brown.

 

Hormone Therapy (HT) FAQ’s

What is HT?

HT is an abbreviation for Hormone Therapy.  Someone gets HT when a medical provider gives them hormones that their body doesn’t make and/or when they get medicine that blocks the hormones that their body does make.  Taking hormones changes your body (sometimes permanently) and can affect your emotions, thinking and behavior.  Some people will want to take estrogen and/or spironolactone (which blocks testosterone). Some people may take testosterone.

 

What is THInC?

THInC is an abbreviation for Transgender Hormone Informed Consent.  This is Howard Brown’s name for the process that helps us provide you with important information about HT and helps us make sure that you understand the information we have given you.

 

Why does Howard Brown use an “informed consent” approach to HT and what does that mean?

Howard Brown believes that people have a right to make decisions about their gender, gender identity and whether they would like to use HT.  In many places in the past, patients had to get a letter from a therapist saying that they could get HT before they could get hormones.  Howard Brown does not believe that people need therapy before they can make a decision about whether HT is right for them. Howard Brown believes that people should be given complete, accurate information, and supported in making their own decisions about whether to get HT or not.

When someone has “informed consent” that means that:
1) the person has correct information about HT
2) the person can understand the information about HT
3) the person can use the information to make a decision.

Do other providers or places use a different approach to HT?

Yes, some other local clinicians or medical providers use a different approach that may require people to demonstrate “lived experience” or get a letter from a therapist before considering HT.  While other providers have chosen to use that model, Howard Brown uses an informed consent model and believes that it is the best match for people who get medical care at Howard Brown.

 

Am I guaranteed to get hormones if I follow these steps?

No.  We can’t promise that you will get hormones if you follow the steps outlined here in the How do I get started? section. Before we can give you hormones, we have to make sure that you have the ability to make this important decision and that you understand the information we give you about HT.  If you can’t understand the information about HT right away, Howard Brown will work with you to help you understand. Also, your medical provider will need to make sure that a prescription for hormones is safe for you and your medical conditions.

 

Will my identity and what I want hormones to do to my body be respected?

Yes.  Howard Brown will work hard to understand your identity and the body changes you would like from HT. Howard Brown wants to help everyone who wants HT, no matter how they identify.  While Howard Brown can’t change what hormones will do to your body, we can work with you to choose the right amount of hormones to help you get as close as you can to the body changes you want.

 

Can I stop taking HT at any time?

Yes. It is up to you when you take HT and how long you want to take it.  You can choose to stop and start HT when you want. If you stop HT, we might ask you to come in for a medical appointment for us to check your health and your blood before you get your new prescription.  A medical appointment like that will help us understand the health of your body and to see whether your prescription should be adjusted.

 

Will I receive a diagnosis when I get HT?  What information will be shared with my insurance company?

If you are prescribed hormones, you will receive a diagnosis of Endocrine Disorder (ICD code 259.9).  Unless you specifically request it, you will not receive a diagnosis of Gender Identity Disorder, Gender Dysphoria or Transsexualism.  In many places in the past, patients would receive one of these diagnoses automatically.  Howard Brown does not believe that being transgender, gender non-conforming or gender queer is a sign of mental illness or a gender identity disorder.  Instead, Howard Brown believes that patients who ask for HT are asking for care that will help their bodies match their gender identity.  If you currently have a diagnosis of Gender Identity Disorder, Gender Dysphoria or Transsexualism it will be replaced with Endocrine Disorder.

If you get HT and use your insurance, your insurance company will see a diagnosis of Endocrine Disorder and will know which hormones or hormone blockers you got.  If you choose not to use your insurance for HT, you will have to pay the full cost for any HT care any time you have an appointment or get your blood tested.

 

What if I have already taken hormones?

It depends on where you got the hormones and how recently you’ve taken them.

If you have gotten HT from a medical provider who is not at Howard Brown, you can bring in your most recent prescription and/or medical records showing your HT treatment. Your medical provider will talk with you about the next steps.

If you have taken hormones without a prescription, used “street” hormones or bought hormones on-line, you can still get a prescription from Howard Brown.  If you have used hormones like that, bring in the bottle or package and tell your medical provider how much you are taking.  This will help your medical provider give you the best care.
You don’t need to worry if you’ve used street hormones, got hormones from other people or bought them on-line; that won’t stop you from getting HT from Howard Brown now.  Howard Brown just wants to help you get hormones in the safest way possible.

 

I have taken some other kinds of supplements to help my transition. Should I tell my medical provider?

Yes.  Tell your medical provider anything you have taken to help your transition when you got it from a friend, on the street or on-line or if you bought it at a store. If you have used anything like that, bring in the bottle or package and tell your medical provider how much you are taking.  This will help your medical provider give you the best care.
You don’t need to worry if you’ve used supplements; that won’t stop you from getting HT from Howard Brown now.

 

Do I have to go to therapy to get hormones?

No.  Howard Brown does not believe that being transgender, gender non-conforming or gender queer is a sign of mental illness. Instead, we believe that people should get correct information about HT and get support to make their own decisions about whether or not to get HT.  To make sure that you get all of the information you want and need about HT, we offer our medical patients a free 20-minute Hormone Information Appointment (HIA) if you are thinking about taking HT or if there are some things you’d like to discuss about HT.  A HIA can be scheduled when you come in to see your medical provider or at a later time.  The HIA is not a therapy appointment, it is a meeting you can use to get information about hormones and ask questions.

If you would like to be in therapy or would like some counseling to develop your transition plan before beginning HT, you are welcome to request counseling services at Howard Brown or begin counseling with a therapist somewhere else.

 

Can I get a letter for hormones from Howard Brown Health that I can take to another medical provider?

No. Howard Brown does not produce letters of permission for HT for any medical providers.  If you need to get a letter for your current medical provider, we can offer you referral to therapists that may be willing to see you for a fee to provide you a letter like that.

 

How do I get started?

Start by making an appointment with your medical provider at Howard Brown to talk about HT. You can do this by calling us at 773.388.1600.  At your appointment, your medical provider will ask for some blood tests to check the health of your body.  Your medical provider may give you a prescription at your appointment or may wait to look at your blood tests before giving you a prescription. Your medical provider can get your blood tests back in a few days, review them and decide whether or not it is safe to prescribe hormones for your body. If it is safe, your provider will call in your prescription and you will be able to pick it up. If your provider is worried that it might not be safe to prescribe HT or if your provider needs more tests to know for sure, you’ll be called and another appointment will be scheduled with your medical provider.

After you start a prescription for HT, you’ll have another appointment with your medical provider in 4-8 weeks for new blood tests. The new blood tests will help your provider see how your body is using the HT and what (if any) changes you need for your HT to work better.

 

How much will this cost?

The cost of HT depends on many things. Costs are different if you have insurance.  If you have insurance, your insurance may or may not pay for HT. The cost of any blood tests, labs or medical tests and the cost for hormones are different for each person depending on your medical conditions and the kinds of hormones that are prescribed.  Howard Brown has a discount program for certain pharmacies for patients who don’t have insurance or whose insurance doesn’t’ cover HT.  The Hormone Information Appointment is free.

 

I want surgery. Can Howard Brown Health tell me what surgeons to use?

No, but your medical provider can offer you some information about surgeons that other Howard Brown patients have said that they have liked.  Howard Brown doesn’t recommend specific doctors to do surgery.

 

I’m under 18. Can I get hormones?

Yes, however, we use a different process when someone under 18 asks for HT. To learn about the process to ask for HT if you are under 18 years old, you can make a medical appointment or contact TGNC Youth Hormone Navigator at 773.388.1600 ext. 1984 or YouthHormoneProgram@howardbrown.org. They can tell you about our hormone prescription process for people under 18 and can also help you introduce the idea to your parent(s) or guardian(s).  Howard Brown doesn’t have a specific age cut-off for considering a hormone prescription; instead we will talk with you and will look to see if  your body is ready for HT.  Usually, Howard Brown has to get signed permission from all of your parents/guardians to give you HT.  However, parental or guardian permission is not required for you to call and ask Kimberly about the possibility of HT.