Dr. Kevin Hatfield, a family medicine physician at The Polyclinic Downtown has one of the largest patient panels of gender care patients (also known as transgender care) in the Puget Sound region. Two years ago he began to see a common thread among this group of his patients—that many of them are new to Seattle, and purposely moving to Washington for their care.
“One of my patients had moved here because he’d read online that Washington is a very trans-friendly state,” says Dr. Hatfield. “He wanted to transition here because he couldn’t afford to do it where he was living.”
The state insurance commissioner mandated that all health care insurers in Washington must cover transgender care in 2014. Several other states mandate equal coverage for transgender patients. “In choosing a place to live, patients want to go where they will not be judged and where their insurance will pay for their care,” says Dr. Hatfield.
Caring for an Underserved Community
When Dr. Hatfield began his practice in 2002, he publically welcomed all LGBTQ patients, with a particular interest in treating transgender patients. Over the years his reputation has grown, and today he has one of the largest panels of gender care patients in the region.
While building his primary care practice, Dr. Hatfield recognized the need for specialty care for his gender care patients and reached out to Polyclinic colleagues Dr. Emily Bradley, a urologist and Dr. Rebecca Kulgren, a gynecologist. “Dr. Hatfield asked if anyone in our office was open to gender care patients and I said yes, along with my OB/GYN partners, Drs. Emily Norland and Katherine Schwab,” says Dr. Kulgren. “This has been one of the most rewarding areas of care that I have ever provided.”
All the physicians speak to the importance of an outward welcome to this community of patients. “Patients come in with a lot of fear and anxiety about being judged. We strive to make our gender care patients feel accepted and comfortable,” says Dr. Kulgren.
Dr. Bradley, who performs orchiectomies to remove testicles for transgender women, says that she has really enjoyed building this part of her practice and providing this service to the transgender community. "The procedure I do as part of gender care is the most common reason that I see transgender patients. However, I am also known as a provider for transgender patients for other urologic issues and conditions as well.”
Polyclinic plastic surgeons Dr. Jeffrey Kyllo and Dr. Keith Paige are also part of the clinic team serving gender care patients. They perform chest reconstruction surgery for both transwomen and transmen. The Polyclinic can manage many other aspects of transgender care needs such as long-term hormone therapy. Polyclinic endocrinologist Dr. Lori Cooper works closely with patients receiving long-term hormone therapy.
Challenges to Access and Coverage
Until recently, health care access and coverage for transgender patients in Washington was limited: no federal protections existed to safeguard a transgender patient from discrimination and insurance plans excluded transition-related coverage. The Affordable Care Act of 2010 was the first law to establish protections against sex discrimination in health care settings. Some states, including Washington, further mandate that insurance plans cover transgender care.
Despite limited access, Seattle is a hub for care compared to other regions. “I see a lot of patients from out of state,” Dr. Cooper continues. “There is an endocrinologist shortage in Alaska, for instance, and none are doing gender care.”
The National Center for Transgender Rights (NCTR) has a full list of federal laws and policies protecting transgender patients’ access to health care.
Even with coverage improvements the lack of available providers experienced in or willing to treat this community creates a challenge. “There are very few fellowships offering this kind of training,” says Dr. Cooper, who completed her endocrinology fellowship through the University of Washington at Harborview Medical Center and the VA Hospital in Seattle. “I happened to work with a lot of transgender patients because of doing my fellowship in this region,” she says. “But a lot of providers are going to refuse care to a transgender patient because of inadequate training.”
Together, a select group of Polyclinic’s primary care and specialist physicians are delivering a wide range of services for transgender patients.