Transgender adolescents and young adults may wish to use cross-sex hormones as means to achieve identity goals. However, these hormones may impair future reproductive functioning. This case explores the complexities related to clinical decision-making concerning fertility and the use of cross-sex hormones in adolescent and young adult transgender populations.
The findings may be used to guide NP recruitment and retention strategies, influence practice issues, and facilitate job satisfaction for NPs by employing agencies.
To qualify for insurance coverage, healthcare must be classified as “medically necessary,” which often excludes transition-related interventions. This access problem raises broader questions about the goals of the healthcare system and the narrow kinds of stories required to access care. Through an examination of gatekeeping and informed consent models of care provision, diagnostic categories related to gender identity, and strategic narratives told to move transgender people into patient categories and render their needs legible to insurance companies, this paper reframes “medical necessity” to extend its selective elasticity and incorporate ideas of well-being into determinations of eligibility for transition-related coverage.
Transgender people encounter many barriers to health care, and recommendations about where their treatment would best be offered can promote or thwart good care. This case examines the care setting from the perspective of a patient whose experiences with specialists have been negative. We argue that an ethos of harm reduction and informed consent, with a strong emphasis on continuity of care within a primary care setting, should guide questions about how to refer transgender patients to caregivers and to good care settings.
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