Gender Affirming Care
At Lavender Spectrum Health, we offer gender affirming care. We believe in an informed-consent model of care for transgender hormone therapy. That means we are not here to gate-keep access to gender affirming care. We are knowledgeable of present guidelines, such as WPATH, and can provide supportive letters that meet these guidelines.
What is gender affirming care?
Gender affirming care is healthcare that is given to people whose gender differs from the gender they were assumed to be at birth. The term for people whose assumed gender at birth is different than their true gender is transgender. Gender affirming care may include many things, including but not limited to counseling, use of hormones, and surgeries. These treatments allow transgender people to have the appearance, body parts, and other features that support and affirm their gender.
Gender affirming care is known to be medically necessary and helpful to transgender people by many professional medical organizations, including the World Health Organization, the World Professional Association for Transgender Health, the American Psychological Association, and the American Medical Association.
What we can do for gender affirming care:
Initiate transgender hormone therapy for individuals over age 18
Maintain gender affirming care near me with hormone therapy for individuals over age 18
Referrals for gender affirming surgical procedures
Letters of support for gender affirming surgical procedures
Letters of medical necessity for electrolysis for gender affirming surgical procedures
Estrogen Therapy
Lavender Spectrum Health provides gender affirming care with estrogen therapy for transgender, non-binary, intersex, two spirit, and gender non-conforming individuals. Estrogen is typically prescribed in the form of injections, patches, or tablets. Typically, estrogen therapy is prescribed alongside a testosterone blocker, and sometimes is accompanied by progesterone. Common goals of estrogen therapy include body fat re-distribution, skin softening, breast development, body odor changes, libido changes, and emotional changes. We help manage complications from estrogen therapy, including erectile dysfunction. We can also help find sperm-banking services prior to initiating estrogen therapy to preserve fertility. Estrogen therapy requires periodic laboratory monitoring; we partner with Quest Diagnostics for laboratory services.
Testosterone Therapy
Lavender Spectrum Health provides gender affirming testosterone therapy for transgender, non-binary, intersex, two spirit, and gender non-conforming individuals. For transgender hormone therapy, testosterone is typically prescribed in the form of injections, patches, or gel. Common goals of testosterone therapy include voice deepening, increased muscle mass, body fat re-distribution, growth of facial and body hair, and "bottom growth" (clitoromegaly). We help manage complications from testosterone therapy including treating acne and vaginal dryness. Testosterone therapy requires periodic laboratory monitoring. We partner with Quest Diagnostics for laboratory services.
Other Gender- Affirming care
Letters to support gender affirming surgical procedures
Referrals for gender-affirming surgery
Numbing Injections
We provide numbing injections for facial and genital electrolysis
We work with Real You Electrolysis which who provides electrolysis
Click here to learn more!
What We Can't Do:
Provide gender-affirming hormone therapy for individuals younger than age 18. We are hoping to change that soon.
Provide mental health therapy
Resources
Here are some support group resources in Portland and Vancouver for LGBTQ+ issues:
https://www.nwgenderalliance.org/
https://www.childrenshomesociety.org/clarkcowlitz
https://www.pdxqcenter.org/groups
https://pflag.org/chapter/portland-2/
Here are some mental health resources I like in Vancouver and Portland where the clinician have experience with neurodivergence and/or LGBTQ+ identity, but please contact them as many places periodically open and close to different insurance companies:
Portland:
Rebel Heart (counseling)
Full Spectrum PDX (counseling)
Portland Mental Health & Wellness (counseling & medication management)
Willamette Health & Wellness (counseling & medication management)
MedRx Partners (medication, ketamine, TMS)
Portland Therapy Center (medication)
Portland DBT Institute (DBT groups)
Northwest DBT (DBT groups)
Integrative Trauma Treatment (trauma counseling)
Vancouver:
Wild Heart Society (counseling
Maitri Mental Health (counseling
A Better Way Counseling (counseling)
MedRx Partners (medication, ketamine, TMS)
Spectrum Mental Health (medication)
TMS NW (TMS)
Associates for Psychiatric & Mental Health (Intensive Outpatient)
Here are some good options for sperm banking:
Legacy - Sperm Banking via telehealth
We are pleased to offer patients a 20% discount at Legacy Sperm banking by following the link above or using the code "LAVENDER" at checkout
OHSU - Sperm Fertility Cryopreservation
Here are my favorite injection teaching videos for how to do subcutaneous hormone injections
https://www.youtube.com/watch?v=ApWiQH4rzlA
https://www.youtube.com/watch?v=DJd02xCNNc0
Here is our favorite video for intramuscular injections
https://www.youtube.com/watch?v=FgCCO9Gqt1Q
If labs were ordered for you during your visit, please schedule yourself for blood tests for labs at Quest Diagnostics. Plan to bring yourself, your ID, and your insurance card to your lab appointment.
Please get labs done fasting, meaning nothing to eat or drink except water or medications for 8-12 hours. This is easiest done if you avoid eating after midnight and get labs done before breakfast. This will allow me to get accurate cholesterol and blood sugar testing. If you are on hormone injections, please schedule your labs about 3-4 days after an injection if possible.
Please also check your supplements and stop any that contain biotin 3 days before lab work. Biotin interferes with many blood test results. Biotin can be found in multivitamins, b-complex vitamins, and "hair skin and nails" vitamins.
Also if you are having hormone labs draw, it takes 10-14 days for testosterone results to come back, so please ensure you have your blood drawn done with enough time for your results to come back before your follow up appointment.
https://appointment.questdiagnostics.com/schedule-appointment/as-reason-for-visit
Select "all other tests" as your reason for visit
As a reminder, it is your responsibility to understand your insurance coverage of any lab tests ordered during your visit. You can contact your insurance company and provide them with the diagnosis codes and lab codes if you are unsure of your benefits.
Options for PrEP include Truvada (daily or on-demand), daily Descovy, or injectable Apretude every 2 months.
Here are some PrEP resources:
https://www.cdc.gov/hiv/risk/prep/index.html
If you are interested in learning more about DoxyPEP for prevention of bacterial sexually transmitted infections, here is some information about it:
https://howardbrown.org/service/doxypep/
Here are the WA Medicaid guidelines for trans health services as well as in network providers.
Gender Affirming Treatment
Other gender-affirming treatments are covered directly by Apple Health fee for service and not by your managed care plan. Apple Health fee for service is also known as ProviderOne (teal-colored card). Use your ProviderOne services card when accessing these services. Services must be provided by an Apple Health approved and enrolled provider. There are different requirements depending on what service you want to have performed.
General requirements
It is a general requirement to be on gender-affirming hormone therapy for a minimum of 12 months preceding treatment/surgery, unless otherwise noted below, or have a medical contraindication to hormone therapy.
Live in a gender role that matches your gender identity for a minimum of 12 months preceding treatment/surgery, unless otherwise noted, or have been unable to live in your desired gender identity due to personal safety concerns.
Criteria
Breast augmentation
One recent (within the past 18 months) full psychosocial evaluation from a licensed mental health care provider;
Recent (within the past 18 months) letter from the provider managing your hormone therapy; and
Recent (within the past 12 months) history and physical and surgical plan from the surgeon who will perform the surgery.
Providers
The following providers offer top surgery (breast augmentation) to treat gender dysphoria for Apple Health clients. The names given here are not recommendations based on care provided or provider preference.
University of Washington Medical Center, Seattle- (206) 520-5000
Dr. Sarah Goldsberry-Long
Dr. Rachel Lentz
Dr. Shane Morrison
PCP Referral required- fax: (206) 744-8948
Swedish Plastics & Aesthetics- Seattle – (206) 215-6221
Dr. Samuel Lien, Everett – (425) 316-5080
Dr. William Schmitt, Seattle – (206) 223-6831
Dr. Geoffrey Stiller, Spokane – (509) 747-5773
Mastectomy
One recent (within the past 18 months) full psychosocial evaluation from a licensed mental health care provider;
Recent (within the past 18 months) letter of medical necessity supporting the request for mastectomy from the primary care provider; and
Recent (within the past 12 months) history and physical and surgical plan from the surgeon who will perform the surgery.
It is a not a requirement that you have been on hormone therapy and/or lived in a gender role that matches your gender identity for a minimum of 12 months.
Providers
The following providers offer top surgery (mastectomy) to treat gender dysphoria for Apple Health clients. The names given here are not recommendations based on care provided or provider preference.
University of Washington Medical Center, (Plastic Surgery) Seattle- (206) 520-5000
Dr. Sarah Goldsberry-Long
Dr. Russell Ettinger
Dr. Shane Morrison
PCP Referral required- fax: (206) 744-8948
Swedish Plastics & Aesthetics- Seattle – (206) 215-6221
Dr. Wandra Miles
Dr. Suzette Miranda
Dr. Mary Lee Peters
Dr. Alexandra Schmidek, Seattle – (206) 223-6831
Dr. Samuel Lien, Everett- (425) 316-5080
Dr. Geoffrey Stiller, Spokane – (509) 747-5773
Dr. Hemangini Thakar, Portland, OR – (503) 413-4992
Hysterectomy and Orchiectomy
One recent (within the past 18 months) full psychosocial evaluation from a licensed mental health care provider;
Recent (within the past 18 months) letter from the provider managing your hormone therapy. It is a general requirement that the client has been on hormone therapy for a minimum of 12 months, before surgery; and
Recent (within the past 12 months) history and physical and surgical plan from the surgeon who will perform the surgery.
It is not a requirement that you have lived in a gender role that matches your gender identity for a minimum of 12 months, preceding surgery.
Providers
The following providers offer surgery to treat gender dysphoria for Apple Health clients. The names given here are not recommendations based on care provided or provider preference.
hysterectomy
Dr. Hasan Abdessamad, Burien – (206) 965-4200
Dr. Jasmine Albrecht, Mill Creek – (425) 316-9159
Dr. Catherine Cairney, Spokane – (509) 755-5205
Dr. Dina Gordon, Edmonds – (425) 640-4810
Dr. Dennis Goulet, Everett – (425) 339-5430
Dr. Mallory Kremer, Seattle – (206) 520-5000
Dr. Lauren Lucas, Spokane – (509) 489-2101
Dr. Linda Mihalov, Seattle – (206) 223-6191
Dr. Adam O’Brien, Wenatchee – (509) 433-2303
Swedish OB/GYN , First Hill – (206) 215-6307
Women’s Health/Gynecology- University of WA-Roosevelt – (206) 598-5500
Harborview OB/GYN Clinic
Dr. Jennie Mao
Sea Mar Community Health Centers
Dr. Richard Kubiniec, Vancouver- (360) 892-0208
orchiectomy
Dr. Megan Bird, Portland, OR – (503) 612-5260
Dr. Emily Bradley, Seattle – (206) 528-4944
Dr. Daniel Dugi, Portland, OR – (503) 346-1500
University of Washington- Harborview, Seattle – (206) 744-3241
Dr. Thomas Walsh
Dr. Judith Hagedorn
Dr. Marah Hehemann, Seattle
Dr. James Kuan, Seattle – (206) 386-6266
Dr. Una Lee, Seattle – (206) 223-6772
Dr. Alvoro Lucioni, Seattle – (206) 223-6772
Dr. Geoffrey Stiller, Spokane – (509) 747-5773
Full bottom surgery
Two recent (within the past 18 months) full psychosocial evaluation from a licensed mental health care provider;
Recent (within the past 18 months) letter from the provider managing your hormone therapy; and
Recent (within the past 12 months) history and physical and surgical plan from the surgeon who will perform the surgery.
Providers
The following providers offer full bottom surgery to treat gender dysphoria for Apple Health clients. The names given here are not recommendations based on care provided or provider preference.
OHSU Urology Clinic, Portland OR– (503) 346-1500
Dr. Daniel Dugi
Dr. Geolani Dy
OHSU Plastic & Reconstructive Surgery Clinic, Portland OR– (503) 494-6687
Dr. Blair Peters
University of Washington Medical Center, (Plastic Surgery) Seattle- (206) 520-5000
Dr. Shane Morrison
PCP Referral required- fax: (206) 744-8948
The Meltzer Clinic- Portland, OR and Scottsdale, AZ – (480) 657-7006
Dr. Toby Meltzer
Dr. Nick Esmonde
Dr. Geoffrey Stiller, Spokane – (509) 747-5773
Hair Removal
Letter from the provider managing the client’s gender affirming hormone therapy (within the past 18 months)
Letter of medical necessity from dermatologist or primary care provider completed within 18 months prior to the request for hair removal, and
Description of medical condition and attempted treatments that prohibit the client from shaving or utilizing other hair removal techniques (except electrolysis or laser). Examples include documented folliculitis, documented sensitivity to hair removal techniques, or thick male pattern hair growth prohibiting adequate hair removal.
Photos of requested area for hair removal from approximately 2 feet (please include method of hair removal in documentation):
Prior to hair removal (include length of time from last hair removal; an 8 hour period of time from last hair removal is recommended), and;
Immediately after hair removal
Letter of medical necessity from the treating provider performing the hair removal that includes the size and location of the area to be treated, and the number of expected units needed to complete treatment.
Providers
The following providers offer hair removal to treat gender dysphoria for Apple Health clients. The names given here are not recommendations based on care provided or provider preference.
Queen Anne Medical Center, Seattle – (206) 281-7163
Stiller Aesthetics, Spokane – (509) 747-5773
Unruhly Medicine (Rainbow Health Center) with Dr. Chelsea Unruh, Olympia – (360) 746-2013
Real You Electrolysis, Vancouver- (360) 217-4205
Laser & Cosmetic Dermatology @ OHSU, Portland – (503) 494-6483
Facial Feminization
One recent (within the past 18 months) comprehensive psychosocial evaluation from a licensed mental health care provider;
Recent (within the past 18 months) letter from the provider managing your gender affirming hormone therapy; and
Recent (within the past 12 months) history and physical and surgical plan from the surgeon who will perform the surgery.
Providers
The following providers offer facial feminization surgery to treat gender dysphoria for Apple Health clients. The names given here are not recommendations based on care provided or provider preference.
University of Washington Medical Center, (Plastic Surgery) Seattle- (206) 520-5000
Dr. Sarah Goldsberry-Long
Dr. Shane Morrison
Dr. Russell Ettinger
PCP Referral required- fax: (206) 744-8948
Dr. Michael Nuara, Seattle – (206) 223-6600
The Meltzer Clinic- Portland, OR – (480) 657-7006
Dr. Toby Meltzer
Dr. Nick Esmonde
Dr. Geoffrey Stiller, Spokane – (509) 747-5773
Gender Affirming Voice Surgery Criteria
Completion of speech/voice therapy
Otolaryngologist consult/evaluation
Live in a gender role that matches clients gender identity for a minimum of 12 months preceding treatment/surgery, unless otherwise noted, or have been unable to live in their desired gender identity due to personal safety concerns.
It is a general requirement to be on gender-affirming hormone therapy for a minimum of 12 months preceding treatment/surgery, or have a medical contraindication to hormone therapy.
Gender affirming hormone therapy is not required for voice feminization.
Required Documentation
Letter of Support (within the past 12 months) from speech language pathologist (SLP) that client has completed speech therapy/voice therapy which includes the outcome of the therapy.
Recent (within the past 12 months) history and physical and treatment plan from the Otolaryngologist who will perform the procedure.
Recent (within the past 18 months) letter of medical necessity supporting the request for voice modification procedure from the primary care provider; or
For voice masculinization a recent (within the past 18 months) letter from the provider managing the client’s hormone therapy.
Providers
The following providers offer voice modification surgery to treat gender dysphoria for Apple Health clients. The names given here are not recommendations based on care provided or provider preference.
UW Medicine- Otolaryngology [ENT]
Dr. John Paul Giliberto (206) 598-4022
You can see any Apple Health enrolled provider that performs the procedure you are seeking. To get started, call the enrolled provider you are interested in seeing and schedule a consultation. Consultations do not require prior approval. The provider will need to get a prior authorization for the gender affirming treatment.
Transportation services
You may be eligible for help with transportation to your health care appointments at no cost to you. If you need help to find transportation, please call 1-800-562-3022 or visit the transportation services webpage to find a transportation broker for your county. Contact a broker 7-14 days before your appointment. Requests to your broker less than two business days before your appointment may not be scheduled.
You can find more information about the Apple Health Transhealth Program on client webpage for the Transhealth Program.