RWJUH Somerset Offers Hormone Therapy for Transgender Adults in New Jersey

Dr. Lalitha Hansch, MD, FAAFP, DABMA, Program Director, RWJ Somerset Family Practice

According to U.S. News and World Report, over 3.5% of the world identifies as LGBTQIA, but only a handful of healthcare clinics currently exist to care for the population’s unique and diverse needs. A recent article in The Journal for Nurse Practitioners referenced a national survey of transgender people in which it was determined that “over half felt they had to teach their primary care provider how to take care of them, over 20% experienced harassment in health settings and nearly a quarter avoided seeking care due to fear of discrimination, violence, or stigma.”

With negative stigmas and lack of understanding often turning patients away from their local physicians, many New Jersey LGBTQIA community members are forced to commute to New York City or Philadelphia just to receive adequate care by medical professionals that have experience working with transgender individuals. To address the growing needs of New Jersey’s LGBTQIA community, Robert Wood Johnson University Hospital Somerset (RWJUH) will open the PROUD Family Health office on Monday, January 30, providing safe and convenient health care to community members of any identification or affiliation. Now, individuals in New Jersey who identify as LGBTQIA can obtain access to specialized primary care services in their state and no longer have to travel far for treatments.

The PROUD Family Health office will offer primary medical care for LGBTQIA children and adults while providing direct access to the hospital’s comprehensive healthcare services including emergency, laboratory, radiology, oncology and rehabilitation services. Highly-credited physicians from RWJUH Somerset will provide specialized treatments including hormone therapy (HT), HIV care, counseling and support groups to address the unique needs of patients and their families.

The purpose of HT is to allow a transgendered individual to look and be recognized as the gender that they feel inside. This helps ease some of the cognitive dissonance that they grapple with daily. RWJUH Somerset will be offering HT for transgender adults which will include a continuation of HT or beginning HT. HT involves the administering of sex hormones (such as estrogens and antiandrogens for male-to-female HT and androgens like testosterone for female-to-male HT) to achieve an outcome desired by the patient, either masculinization or feminization.

To begin HT, a physician at PROUD Family Health will meet with the patient who is interested in undergoing treatments to have a complete discussion about their health, their journey to this point and explore the outcomes they are looking to achieve. They will also have a detailed discussion about the risks and benefits of HT.

There are some risks associated with HT. For both male-to-female and female-to-male treatments, individuals can have increased cholesterol levels, increased risk of heart disease or stroke, high blood pressure, liver inflammation, acne, depression, anxiety, psychosis, worsening of pre-existing psychiatric illnesses and increased or decreased sex drive and sexual function. Female-to-male HT can cause an increase in the number of red blood cells which can result in headaches, dizziness, visual disturbances, heart attacks and stroke. Male-to-female HT can result in blood clots, breast tumors/cancer, elevated potassium levels and pituitary tumors.

Once the risks and benefits of HT have been discussed, physicians will conduct a full physical and review of medical records. At a patient’s initial consultation with a physician, a prescription will be given to the patient for blood work. Based on the results of the blood test, the patient and physician will decide together whether to start HT.

If a patient decides to pursue HT, they are required to have their blood work monitored to verify the levels of hormones are sufficient, to make sure the body is not reacting negatively to the hormones and to manage any conditions that may elevate due to the hormones (such as cholesterol). Patients are monitored monthly after starting the hormones until they reach the full dose of hormones. If there are no issues presented during this period, patients are then required to be monitored every three months and then every six months after that.

Only adults over the age of 18 are treated with HT at PROUD Family Health. Children are much more complex to treat with hormones not only in regards to their health, but also on an emotional and social level. Many of the changes caused by HT are permanent and the health risks can be serious. At PROUD Family Health, physicians that work with patients under the age of 18 would care for their primary health needs, help them with managing some of the aspects of transitioning and help facilitate the child seeing a pediatric endocrinologist for HT. Once the patient reaches 18, PROUD Family Health would consider prescribing HT.

Some of the changes that result from HT will begin within one to three months, such as the development of acne, fat redistribution and decreased erections. In three to six months, breast growth, decrease in muscle mass, softening of the skin and decreased testicular mass will occur. Other changes may take up to six months to a year to occur including growth of facial hair, androgenic hair loss, deepening of the voice and increased muscle mass. It can take up to six years to notice full physical change with HT. This timeframe is similar for both female-to-male and male-to-female HT. For the female-to-male transition, HT is most effective if administered with weekly or bi-weekly injections. There are topical options but they are less effective. For the male-to-female transition, HT is administered through pills or a combination of pills and a patch.

HT is a lifelong treatment and many of the changes are not reversible. If a person stops taking the hormones for health or financial reasons, some of the changes will be reversed, but not all. If HT is stopped for health reasons, monitoring would continue until the problem has resolved. In some cases, the monitoring may need to be lifelong.

At a dedicated LGBTQIA health center, such as PROUD Family Health, patients can seek both primary and specialized healthcare in a safe, understanding location while having access to specialized hormone or HIV treatments close to home.

RWJUH Somerset’s health care team recognizes the unique medical needs of the LGBTQIA community and is dedicated to providing high-quality care that meets each individual’s healthcare needs. The team of medical professionals at the PROUD Family Health office are all family practitioners who can provide care for individuals in all stages of life. The entire staff at the RWJ Somerset Family Practice and all of the hospital’s employees have undergone LGBTQIA sensitivity training in preparation for the opening of the PROUD Family Health office.

Appointments at the PROUD Family Health office will be offered Monday nights from 6 p.m. - 9 p.m. beginning January 30. The PROUD Family Health office at RWJUH Somerset Family Practice Center is located at 110 Rehill Ave., Somerville, NJ 08876. Free parking is available in the surface lot adjacent to the office. Most major insurance plans will be accepted as well as Medicare and Medicaid. To schedule an appointment or for more information, please call 1-855- PROUD-FH (1-855-776-8334).