Trans CARE (Clinic for Affirmation and Reproductive Equity)

When you come to our clinic, we do not make you complete extensive pre-visit forms that fail to grasp your identity and needs. During your first visit, we aim to create a safe and open space, and identify your short-term and long-term needs. These may include mental health letters, counseling, initiation or continuation of hormone therapy, surgical affirmation or just basic health care needs. Then, we will personalize your care plan and coordinate your care with other providers.

We Ask Because We Care is a way for our patients to tell us about themselves. If you are a returning patient with a MyChart account, we welcome you to share your preferred name, pronouns, medical history and sexual orientation information confidentially and discreetly through MyChart. You can also schedule your appointments through email or MyChart, without having to speak to a stranger if you choose.

We believe in consistency, so when you have questions or concerns after your visits, you’ll get answers from the same care providers who know and understand you.

It depends. If there is still a cervix, you should have a Pap test at least every three to five years. If there is still a uterus, a gynecologist can help you control or halt the period. A gynecologist also can help you get a referral to an endocrinologist for hormones and access to a hysterectomy if that is part of your journey.

A gynecologist can perform chest exams and provide referrals to an endocrinologist to start hormones.

We understand that having a pelvic exam may be uncomfortable or feel invasive for you, especially if you have not had good experiences with gynecologists in the past. Depending on your comfort level, we may not even recommend a pelvic exam for the first few visits. Our goal is to work in partnership with you and wait until you are ready.

While we believe pelvic exams are important, they are not the most important part of what we do. What’s more important is establishing a long-term, trusting relationship with you.

Any sexual activity, even non-insertional sexual activity, puts you potentially at risk for sexually transmitted infections (STIs) such as HIV, syphilis, hepatitis B and C, gonorrhea, chlamydia, trichomonas and human papillomavirus (HPV). Many factors can increase or decrease this risk, such as your known infection status, your partner’s status, medications, your and your partner’s individual anatomies and the type of intercourse you have (such as receptive anal, insertive anal, oral only, etc.). In some cases, certain hygiene practices, such as frontal or anal douching, may actually increase these risks as well.

The following are some strategies to protect yourself against STIs:

• Use barrier protection (such as condoms or dental dams).
• Get screened regularly after having intercourse with new or multiple partners.
• Seek treatment for any known exposures to STIs, including pre- or post-exposure prophylaxis (PrEP or PEP) for HIV.
• Obtain the HPV vaccine.

We can provide education, guidance, testing and treatment that best optimizes your sexual health.

The term “birth control” can refer to any number of hormone-based (estrogen and/or progesterone) or non-hormone based (condoms, spermicide, etc.) medications or devices that help protect against pregnancy. Any time insertional intercourse (inserting a penis into a frontal opening, or vagina) occurs between a partner carrying sperm and a partner carrying a uterus and ovaries, there is a risk of pregnancy.

Hormonal methods, such as birth control pills, Depo-Provera injections or intrauterine devices (IUDs), not only help to prevent pregnancy, but they can also be effective tools for decreasing or stopping menstruation and/or ovulation in patients who desire this effect.

Some methods, such as IUDs, work by preventing the build-up of the menstrual lining of the uterus. Other methods, such as combined-hormone birth control pills, can prevent ovulation and the pain or discomfort that comes with it. And some, such as Depo-Provera, may do both.

Transgender male and non-binary patients may want to start one of these medications to better control their own menstrual symptoms. Most report an improvement in their mood and mental health as a result. However, the best approach is different for each person. Each carries its own risks and side effects, so it is best to see a knowledgeable healthcare provider to find the option that is right for you.

If there are still ovaries and a uterus and you use testosterone, it is possible that you can still get pregnant. However, there are two important points to remember.

First, with regular use, testosterone can reduce the likelihood of ovulating (the ability to release an egg from an ovary). If you are trying to get pregnant, being on testosterone can make it more difficult. But, if you are trying to avoid pregnancy, testosterone is not contraception. Depending on the type of sex you may be having, it may be possible to have an unplanned pregnancy.

Second, once you are pregnant, it is important to stop using testosterone. It is possible that it can interfere with how the baby develops. For this reason, it is often a good idea to stop testosterone before you plan to get pregnant.

Absolutely. Your options depend on where you are in the transitioning process. We can help you understand what options are available so you can make an informed choice.

Freezing eggs is a process that typically takes two to three weeks. Your eggs are protected in structures that are called follicles. At any given time, you may have a handful of more mature follicles that are almost ready to release an egg (ovulation). By taking certain injectable medications, you can mature some of your follicles over the course of 10 to 12 days.

When your follicles are ready, you can have a procedure under anesthesia to remove the mature eggs from their follicles. These eggs can be frozen or fertilized with the sperm of your choice to create embryos that can be used for pregnancy or frozen for future use. This process is associated with increased estrogen levels. Additionally, pelvic or bottom exams are required to monitor your progress. Sometimes, this can make the process of egg freezing uncomfortable. There are certain medications and techniques that can be used to try to address these issues if you are concerned. Please talk to one of our physicians if you have questions.

In many cases, yes, although it will depend on your insurance. Our full-time financial advisor can help you understand your insurance coverage and explain the cost of treatment.

The first step is meeting with a mental health professional and receiving a diagnosis of gender dysphoria, which is the distress that a person feels when their gender identity does not match the sex they were assigned at birth. Then you will meet with another mental health professional to confirm the diagnosis. Both professionals will then provide letters of support, which are important for insurance purposes.

Before having surgery, it is also important for patients to live in their identified gender role for 12 months. This may occur before or during sessions with a mental health professional to confirm the diagnosis.

Removal of the uterus (hysterectomy), ovaries (oophorectomy) or both is typically reserved for patients 18 and older. When you come to UChicago Medicine, you will meet with a gynecologist to discuss the goals of your treatment.

Often, these procedures can be completed using minimally invasive techniques. During a laparoscopic hysterectomy, we make very small incisions in the belly and remove the uterus and/or ovaries through the frontal opening (vagina). It takes about six weeks to recover and return to your usual activities.

If you have pelvic pain or bleeding, you may be a candidate for the surgery without having to receive letters for support.

If you choose to remove the ovaries, you will not be able to bear or have genetic children. So, if you are considering this surgery, we recommend that you see a reproductive endocrinologist who can discuss your options.

After having a hysterectomy, we typically recommend waiting about three months before having genital surgery, such as a phalloplasty, metoidioplasty or scrotoplasty. This allows enough time to heal and can help ensure there are no complications (although very rare) that could affect the success of your future surgery.

Whether you choose to work with one of our surgeons or a surgeon at another hospital, we will coordinate your care and make sure your procedures are timed appropriately.