Gender Affirming Care

Gender affirming care at a glance

• Our providers know that gender affirming care is medically necessary and can be lifesaving.
• We welcome transgender, nonbinary and gender-nonconforming patients to our inclusive and supportive environment where they can obtain compassionate gender affirming care and treatment.
• CU OB-GYN East Denver’s gender affirming care begins with personal discussions that identify goals, while we safely manage medical risks or side effects.
• Our care includes gender affirming hormone therapy for transmasculine and transfeminine patients.
• We perform some gender affirming surgeries and provide referrals for those surgeries we don’t perform.
• Our services also include complete gynecologic care for all individuals with female reproductive organs.

The essence of our gender affirming care

Gender affirming care is a holistic approach to providing healthcare and support that aligns with an individual’s gender identity. It encompasses a range of social, psychological, behavioral and medical interventions designed to support and affirm a person’s gender identity.

Our goal is to make that medical transition as comfortable and effective as possible, and as rewarding as anticipated. While our clinical staff does provide emotional support and understanding throughout transitioning care, we can refer patients to other levels of support, be it psychological, behavioral or social.

Benefits of gender affirming treatment

The benefit is improving the overall well-being and quality of life for our transgender and gender-diverse patients. Individuals can achieve physical characteristics matching their gender identity, enhance social integration and support, increase a sense of body comfort, and decrease suicidal thoughts, substance abuse and self-harm.

Addressing gender dysphoria

Treatments can reduce gender dysphoria, which is the distress associated with the incongruence between one’s gender identity and their birth gender, or sex assigned at birth. Gender affirming care can also help reduce anxiety and depression.

Assessing gender affirming goals

There are many options for gender affirming care. Some patients may come to the office ready to begin hormones or to pursue surgery. Other patients may want more time and guidance. Our providers will discuss these issues with each individual and create a plan of care.

People can seek hormonal treatments to transform their body toward the desired gender. This treatment can involve decisions about the pace of hormone therapy and its long-term effects.

Some patients want gender affirming surgery while others do not.

Whatever our patients’ desires are, our specialists can help provide the medical information necessary to inform patients about their options. These conversations enable a person to set realistic goals for treatments.

Gynecologic care for transgender patients

We offer general gynecologic care for both transfeminine and transmasculine patients. Transfeminine and transmasculine terms apply to those who do not identify with their birth gender. These terms encompass transgender women and transgender men respectively, as well as nonbinary and gender fluid individuals.

Gynecology care for transmasculine patients

• Hormone therapy prescribing and monitoring for gender affirming care.
• Cervical cancer and breast/chest cancer screenings.
• STI testing.
• Birth control management.
• Treatment of pelvic symptoms including pain, UTIs, yeast infections, etc.
• Period management.

Gynecology care for transfeminine patients

• Hormone therapy prescribing and monitoring for gender affirming care.
• STI testing.
• Birth control management.

Transmasculine testosterone therapy and monitoring

Discussion with the patient about their goals is the first step. There are different dosing options for testosterone. Expected effects of testosterone depend on the patient’s overall health, age and genetics.

Masculinizing testosterone hormone therapy is much like having a second puberty, which takes years for the full effect. Taking higher doses of hormones does not always speed up the process and can have negative effects. The four general areas of change are physical, sexual, reproductive and emotional. Our providers address all these areas with the patient before initiating therapy.

Primary aspects of testosterone hormone therapy

• Testosterone (topical or injectable), used daily or weekly. Dose adjustable to personal response and goals.
• Finasteride (or similar medications) for male-pattern baldness.
• Follow-up clinic visit will be 1 month after starting therapy. For the first year we have a clinic visit with labs every 3 months. After that we have a clinic visit 1-2 times yearly for ongoing monitoring/maintenance and prescribing.
• Pregnancy is sometimes possible while using testosterone, so contraceptive care and fertility goals are also discussed. We refer patients wishing to preserve their eggs before therapy to an affiliated fertility clinic. Testosterone therapy typically leads to atrophy of the ovaries so that ovulation does not happen. This is sometimes, but not always, reversible.

For more information, please see Related Expert Resources for testosterone therapy below.

Transfeminine estrogen therapy and monitoring

As with transmasculine testosterone therapy, our care begins with a thorough discussion with the patient about goals, considerations and risks. The information above about transmasculine options also applies to feminizing estrogen hormone therapy.

• Estrogen (injectable or oral) & androgen blockers like spironolactone are typically used together and taken daily or weekly. Medication options and dosage are adjustable to personal response and goals.
• Initial follow-up clinic visit will be 1 month after starting therapy. For the first year we have a clinic visit with labs every 3 months. After that we have a clinic visit 1-2 times yearly for ongoing monitoring/maintenance and prescribing.
• Getting someone pregnant is sometimes possible while using estrogen and androgen blockers, so contraceptive care and fertility goals are discussed, including possible referral for sperm freezing prior to treatments. Estrogen therapy typically leads to poor sperm quality or lack of sperm production. This effect is sometimes, but not always, reversible.

For more information, please see Related Expert Resources for estrogen therapy below.

Gender Affirming Surgeries

Gender affirming surgery helps one’s body conform to their gender identity. About 30% of transgender men and transgender women have undergone gender-affirming surgery or other surgeries to alter their appearance, according to a 2023 report. These surgeries include chest, genital, vocal and facial reconstruction surgery.

Gender-affirming surgery can be helpful for those experiencing gender dysphoria.

Our gender affirming surgeries:

• Hysterectomy and salpingectomy (removal of uterus and fallopian tubes).
• Oophorectomy (removal of the ovaries).
• For all other surgeries we can refer patients to the UCHealth Transgender Integrated Care – Plastic Surgery department, or another provider of the patient’s choice.

Risks & complications of gender affirming care

Gender affirming care carries certain risks that vary depending on the particular treatment and the individual’s health. Our providers thoroughly discuss these risks with each patient before and during treatments. We always carefully monitor patients throughout their care with us, including follow-up visits.

Masculinizing and feminizing hormone therapy risks include issues with cardiovascular, liver and bone health. These treatments also carry risk of impaired fertility, which may or may not be reversible after ceasing treatments.

Risks from gender-affirming surgery include those of any surgery such as infection, bleeding, anesthesia reaction and others. Genital surgeries also carry risks of nerve damage, scarring and others.
Transgender treatments may also carry mental health risks due to psychological effects of transitioning and distress due to unmet expectations and societal stigma.