“There are as many ways to interact with gender identity as there are people.”  ~River Green, Outside In Medical Assistant 

Gender-affirming care is built into all of our health services at Outside In. But what is gender-affirming care, and what does it look like at Outside In? 

At Outside In, gender-affirming care means having a medical provider and clinic staff that is supportive, understanding, educated, and respectful when it comes to gender divergent experiences and the different ways an individual can feel, see, and experience their gender. This can look like making sure we correctly represent a patient’s affirmed name, pronouns, and identity in their chart, so that all staff see the patient as the patient sees themselves. We do not require that patients use their legal name, if they do not want to. We make sure that our staff are familiar with gender variants and are sensitive to how a person may or may not want to talk about their body, their gender, or their experience.  

“There are as many ways to interact with gender identity as there are people.” 
~River Green, Medical Assistant 

Our providers have taken the time to learn how to provide treatment for gender dysphoria, which is the feeling of discomfort that can occur in people whose gender identity is different from the sex they were assigned at birth, and can support patients who are interested in medical interventions. We also offer gender affirming hormone therapy (GAH). While Outside In staff participate in an orientation and training related to gender affirming care, much of our staff’s knowledge comes from their experience and from a genuine openness to learning from patients. 

In Oregon, we have what is called “informed consent” for patients who are interested in gender affirming hormones. This means that if a patient is interested in gender affirming hormones, then our providers talk to them about what to expect, what the risks are, what the timeline is for changes, whether changes are reversible, what their future plans are for transition (both social and medical transitions), and confirms that the patient understands and agrees with the treatment.  

Why is gender affirming care important? 

In the mid 1990s, Outside In responded to a growing community need by creating a transgender clinic. It started as an evening clinic that often included pizza parties while offering medical supports, social service connections, and community to transgender patients. Over the years, this clinic evolved based on feedback from patients and our strong commitment to meet the needs of our community. Today, gender affirming care is fully integrated into our primary care services, and we offer a wide range of support to hundreds of transgender and gender nonconforming patients each year. 

It is important that gender affirming care is offered to everyone and is part of everyone’s care – even people who are not here specifically for transgender care. Health care and other services are commonly a closed door for people. And when doors are closed, it can mean a lack of pursuing care. It is not uncommon for transgender and gender nonconforming people to have a marginalized health care experience – and that can make it difficult to come to a clinic. It can be so demoralizing and devastating for someone to have an institution deny their identity – deny who they are.  

We never know who may be interested in transgender care. Having gender affirming care integrated into our primary care opens that door for everyone. By offering a place that is affirming of people’s experiences and identities – it makes health care more accessible. It means that our patients are able to care for themselves in a way that they otherwise wouldn’t be able to. 

It is so important for patients to trust that their provider will treat them with compassion, will treat them as their gender – and will treat them at all. Transgender and gender nonconforming people often postpone or choose to not engage in health care because of discrimination. There are still many places where transgender people can be denied care. And it is common for transgender people to encounter providers who discount their symptoms because they are transgender, and this makes people not want to go to the doctor at all.  

At Outside In, we want to make sure that the people we are serving are getting the care and attention they need and that they feel welcome and comfortable. We want our patients to know that they can come to us with their needs, problems, barriers – anything that is making them feel unwell or unhealthy or harder for them to live their lives. 

What does gender affirming care look like at Outside In? 

When a patient comes into the clinic, they are acknowledged by our front desk staff. They are asked what pronouns they use and how they like to be addressed. And then they are addressed in that way – by the front desk staff, by their medical assistants and nurses, and by their providers.  

We want our patients to feel comfortable talking about their needs, their goals, and how their gender identity affects their health and their needs as a patient. Our staff are respectful of patients and want to work with and empower patients to reach their goals. 

It is so important that we offer a place that is affirming of people’s experiences and identities. We open a door for people and make health care accessible. I love that we are a place that does that for our community. 
~Violeta Wallace, Transgender Services Coordinator 

The Role of Outside In’s Transgender Services Coordinator 

Outside In’s Transgender Services Coordinator, Violeta Wallace, supports patients that could use help or assistance related to gender affirming care. This could include providing specific resources, supporting with legal name changes, or helping to navigate the health care system to access gender affirming surgeries. Violeta is able to answer questions, provide guidance, and support with accessing financial assistance. 

Violeta is also available to Outside In staff who want to know about resources for current or future clients or who want to be more comfortable addressing patients and clients who might have questions or needs related to gender affirming care. 

Outside In’s Identity Project supports people with legal name and gender changes – an important step to getting a social security card, driver’s license, birth certificate, or passport with a person’s legal name. Violeta helps to guide people through the process of getting a court order for the legal name change, and we also have funding set aside to help patients with the cost of this process. 

Finally, Violeta also handles phone calls and emails from other organizations, people in other parts of the state, and parents who have questions about resources and name changes. Just being able to answer questions or connect someone with a therapist or point to another organization where they can access resources is incredibly important.  

Gender Affirming Care Resources 

Our staff recommended the University of California, San Francisco Transgender Care site as a good resource for both providers and patients. Locally, OHSU has a Transgender Health Program and Kaiser has a Gender Pathways Clinic that are both good resources for patients.  

UCSF Transgender Care  

OHSU Transgender Health Program 

Kaiser Gender Pathways Clinic 

Outside In Transgender Services 

Thank you!

It is because of you – our community –
that Outside In is able to save the lives of thousands of people each year.

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Your support of Outside In creates health and hope for the more than 11,000 people we serve every year. We can’t say it enough: THANK YOU!