By Kelly M. Marshall
Only in the last few years or so has access to hormone therapy for the transgender and gender non-conforming population become more readily available in the South. Yet, recipients are often barred from hormone therapy by “medical gatekeeping,” which requires each patient to produce a letter of diagnosis and recommendation from a licensed mental health professional and attend up to six months of psychotherapy. Thanks to WPATH (World Professional Association for Transgender Health) and people like Dr. Colt Keo-Meier, however, the informed consent model of hormone access is becoming more widely accepted, even among places like the University of Texas Medical Branch (UTMB) in Galveston, Texas. Medical schools like UTMB help set new standards of care for graduating physicians and healthcare providers. The adjoining clinic now offers informed consent-based hormone therapy and other gender care during dedicated hours.
I sat down with Dr. Colt Keo-Meier, his supervisor Dr. Jesse Gordon, and social worker Amy Barerra-Kovach to talk about their experiences offering gender care services at UTMB.
Kelly Marshall: So, tell me about your journey to UTMB and offering gender care services at the clinic there.
Dr. Colt Keo-Meier: To my knowledge, I’m one of the first openly transgender healthcare practitioners providing hormone therapy in the state of Texas. I’m a clinical psychologist by training and by the time I started applying to medical school over five years ago, there were very few medical professionals who were regularly providing hormone therapy (to the trans/gender non-conforming population) in a way that was safe and up to date with the most recent standards of research and care at the time in Houston. Because I saw that need, I applied to medical school so that I could become a medical provider in addition to a mental health provider.
What does the informed consent model look like for patients who are seeking gender care services?
Dr. Colt Keo-Meier: We at UTMB practice the informed consent model which is outlined in the 7th edition of the WPATH Standards of Care. Patients who are over the age of 18 who come into the clinic seeking hormone therapy, barring any major health issues that would be of concern for initiating hormone treatment, will generally receive their hormone prescription and administering education within two visits. So, there’s no need for a letter from a psychotherapist for hormone treatment or any other sort of gatekeeping involved. Those patients who are under 18 will need parental consent to start hormone treatment unless there is a circumstance where they are able to provide their own consent.
“To my knowledge, I’m one of the first openly transgender healthcare practitioners providing hormone therapy in the state of Texas.” -Dr. Colt Keo-Meier. Photo by Todd Spoth/Courtesy Dr. Colt Keo-Meier.
Do you feel like the WPATH standards are a sufficient standard for clinics and providers to adopt nationally, at this point?
Dr. Colt Keo-Meier: I’m on the hormone therapy chapter of the upcoming 8th version of the WPATH Standards of Care, and I would say that most of us would probably agree that many changes still need to be made to the 7th version of the Standards of Care for transgender and gender non-conforming populations. But I do think it’ll be a huge improvement and it’ll have a lot more information on informed consent and inclusivity of non-binary and genderqueer folks than the 7th version (which was mostly focused on de-psychopathologizing transgender individuals and removing barriers to care). There is a broader diversity of gender non-conforming individuals (transgender, nonbinary, genderqueer, and intersex) who are working on the 8th version, and I have a lot of confidence that it’ll be much better, much more inclusive.
And you know of what you speak! Your research on transgender men and transmasculine individuals and the positive effect that testosterone therapy has on their mental health was directly cited by the American Psychology Association, which helped to officially set the precedent of addressing gender dysphoria with hormone therapy.
Dr. Jesse Gordon, how did you get started with UTMB?
Dr. Jesse Gordon: I was working at the Metro Community Health Center in Pittsburgh, Pennsylvania, and I worked with the transgender and gender non-conforming population from 2013 to 2016, with over 350 patients in that community. It’s always been something I was interested in. I actually spoke to Amy Barrera-Kovach first! She got me connected with everyone who was working with gender care here at UTMB.
Amy, how about you?
Amy Barrera-Kovach: My focus has always been working with the LGBTQ+ population as a mental health practitioner, and there’s such a huge need for support in accessing these services for the transgender and gender non-conforming community. I’m just so happy to help.
What’s your vision for gender care in the future? How would it change?
Dr. Gordon: Insurance coverage is a good start in terms of access. [My vision is for] every primary care doctor to be at least decently versed in gender care, including general knowledge on hormone therapy protocol—especially with regard to providers competently and consistently prescribing hormones for people of varying gender identities.
Dr. Colt Keo-Meier: There are so many barriers to care in general—education (systemic education for LGBTQI patients, from basic respectful intake to consistent competent care); addressing privilege (cultural humility, provision of care, health disparities); creating greater access to care in general; getting people in the door; and building trusting relationships.
Dr: Gordon: We’re seeing many more patients than we have in the past. They do exist, and being proactive about meeting their specific needs has gone a long way.
Amy Barrera-Kovach: Making sure that folks have providers that are fluent in gender care, and that they have a wide network of trusted referrals. Providing resources and making connections, whatever that looks like for someone. And making sure they have a connection to their own community, because even trans and gender non-conforming people can be isolated from their own community.
Amy Barrera-Kovach is available to assist new gender care patients at the UTMB clinic in the Galveston and Houston area. She can help them navigate their healthcare needs and can even provide support with applying for Medicaid, reduced-cost healthcare, or enrolling in the Healthcare Marketplace. Her contact info can be found at utmb.edu/health-resource-center/lgbtq-resources.
