How nonprofit healthcare center Transhealth is expanding access to care for trans and gender-nonconforming patients

Healthcare access for transgender and gender-nonconforming patients has severely diminished in recent years, with laws in 19 states either banning or restricting access to gender-affirming services.

That’s why Dallas Ducar, who has experience working as a nurse practitioner, researcher, and health policy expert, founded the nonprofit healthcare center Transhealth, which provides primary care and mental health services to roughly 2,000 patients across New England.

Transhealth, which opened in May 2021 in western Massachusetts, accepts all major insurers and provides gender-affirming services, including hormone therapy and community support groups. It also provides what Ducar calls “affirming care”—which she says is the “future of healthcare.”

“I see [affirming care] as healthcare that is person-centered and based not only on what your problems are, but how you’re doing and where you want to go,” Ducar told Healthcare Brew. “There’s a lot of appetite for patients to be able to receive affirming healthcare—to be able to be affirmed in their identity and who they are—regardless of being trans or LGBTQ or straight or cis.”

How Transhealth works

Transhealth has 53 staff members, including primary care physicians, nurses, psychiatrists, researchers, and health policy experts, according to Ducar, who serves as the healthcare center’s CEO.

The center treats patients with health concerns that are similar to issues addressed at the typical primary care center, Ducar said. The clinicians also provide care for a range of mental health conditions, including anxiety, depression, and post-traumatic stress disorder.

But many patients who go to Transhealth haven’t received healthcare in a long time, so their needs “become much more complex,” Ducar said.

“We know the rates of deferring healthcare in the trans community are very high because of the experience of discrimination,” she said. “Many of these patients have gone without care for so long and have remained resilient over time.”

Roughly 75% of Transhealth’s patients are seen virtually for at least part of their care, according to Ducar.

“When you have access to telehealth, you can have patients in rural settings, urban settings—wherever they may be—get access to really competent providers,” Ducar said. “You’re not forced to go to the provider that’s next door that may be so confused about your gender identity that they may not actually treat you.”

Telehealth can also be a safer option for people who may be at risk of facing violence when leaving home, she added.

Gender-affirming care as ‘the core issue’

The top healthcare needs for trans and gender-nonconforming patients are access to gender-affirming care and mental health care, according to Ducar.

“We’re seeing the additive effects of very, very coordinated media strategies to really harm trans people and get individuals in general to distrust trans people, and it’s causing a lot of additional, compounded mental health issues for the trans community,” she said.

In addition, trans and gender-nonconforming patients face a high risk of suicide and HIV.

But at the root of all these issues is access to gender-affirming care, according to Ducar, because “the core issue is not being able to be affirmed as oneself.”

How clinicians can provide ‘affirming care’

Being a better provider for trans and gender-nonconforming patients “really isn’t rocket science,” according to Ducar.

“I think there’s a lot of folks who might see this and be like, ‘Whoa, gender-affirming care—I’m gonna need a lot of education on this before I do anything,’” she said. “It really starts with listening to the patient, affirming and mirroring the patient, and responding with compassion. It’s very basic stuff at the beginning.”

Ducar advises providers to start with what she calls “universal precautions”—start every patient interaction by introducing your name and pronouns, and asking the patient their name and pronouns “just like you’d wash your hands before you go into any room.” This goes for every patient, not just those suspected to be trans or gender-nonconforming, she said.

“It really can be a gateway into a conversation for many who might be otherwise scared to be out in any way,” Ducar said.

It’s important to not make any assumptions about a patient’s gender identity, sexuality, pronouns, or needs, she added.

It’s also critical for providers to get a core understanding of gender and sexual diversity as well as what the difference between those concepts is—and not rely on patients to teach them, according to Ducar.

“This is all stuff that I’m saying that’s not just particular to trans people,” Ducar said. “This is really why I believe this is a model for all healthcare.”