In the months leading up to January 2016, Stephanie Detlefsen, MD, and Heather Leffler had been pulling double duty. In addition to doing their Kaiser Permanente day jobs as general practitioner and medical social worker, respectively, they had been putting in extra hours laying the groundwork for a multidisciplinary clinic for nonbinary and transgender patients.
With the opening of Kaiser Permanente’s Gender Pathways Clinic two years ago, their hard work officially paid off.
A safe environment for care
“In general, nonbinary and transgender patients have a long history of being discriminated against in all avenues of life but also in health care,” says Dr. Detlefsen. “We wanted to provide a safe environment for them to seek care on the gender spectrum.”
The clinic provides primary care and transition-related care for a wide range of patients, from pediatrics through seniors. It also provides counseling, social support and assistance with surgical coordination. Although individual plans vary, Kaiser Permanente is one of the few health care providers that cover many of these treatments.
“These hormones and surgeries are very expensive, and to have them covered, patients are beside themselves,” explains Dr. Detlefsen.
The clinic staff has grown to include two obstetrician-gynecologists, two part-time social workers, and a patient navigator who is often the first point of contact for patients eager to learn more.
“We meet people wherever their transition goals are to fully support them and the people they love,” says Leffler. “And just a massive amount of care coordination goes with whatever those goals are.”
Referrals without a doctor
One of the unique aspects of the clinic is that patients can refer themselves without needing to speak to another doctor, removing a barrier to care that many patients feel. Dr. Detlefsen estimates that 30 to 40 percent of all referrals are self-referrals.
“A lot of patients are afraid of how someone will look at them when they check in, so they’re not treating their blood pressure or diabetes,” she says. “Additionally, we want people to get the care they need based on the organs they have. We want trans men to get pap smears or mammograms if they need them.”
A positive response
Response to Gender Pathways has been overwhelmingly positive. Kaiser Permanente regions in Hawaii, Colorado, California, Washington and the mid-Atlantic have reached out for help in prescribing hormones, interpreting lab tests, supporting surgeries and managing patient care in general.
“My medical assistant was on the phone with someone from North Dakota,” says Dr. Detlefsen. “And the mother was just in tears when she found out that we actually had a transgender clinic because it was so hard for her child to be who they were.”
Education, both internally and in the community, is one of the main goals for the clinic. Members of the clinic regularly speak at universities on the importance of using correct pronouns and honoring people with their preferred name. Dr. Detlefsen finds that kids are generally more accepting while parents benefit greatly from counseling. It’s eye-opening for older patients as well.
“Sixty-, 70-, 80-year-olds come in and say, ‘I never knew there was a name for what I felt like,’” she says. “Just to have someone address them by the correct pronoun, it’s such a simple thing to do, yet it means so much.”
Hormone therapy and surgery is more than just an individual choice; it’s also a group effort involving friends, family, and co-workers. Gender Pathways offers guidance and support in many ways. As Leffler says, “There’s a whole team of folks to advocate for them. We give them a community to empower them to live the best lives they can.
Watch a video segment that profiles Dr. Detlefsen and the Gender Pathways clinic to see how two members have benefited from our transgender care.
Learn more about Kaiser Permanente’s Gender Pathways clinic.