LGBTQ+ Health Services
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Improving LGBTQ+ Health Care
At Boston Direct Health, we advocate for three fundamental tenets to improve care for LGBTQ+ patients:
- Patients can safely seek and receive healthcare services, be treated with dignity and respect, and be confident that their care is tailored to who they are as a person. Inclusive of their unique needs as an LGBTQ+ person.
- Several intersecting factors shape diversity in LGBTQ+ communities, including gender identity and expression, sexual orientation, race and ethnicity, ability, place of geographical residence, socioeconomic status, country of origin, housing situation, and age. All of these factors are key considerations in our patient care.
- The reported history of adversity faced by LGBTQ+ patients when accessing and receiving services is acknowledged and addressed using trauma-informed approaches to ensure that all patients feel respected, cared for, and safe when coming to our practice.
Our LGBTQ+ Health Care Services
Sexual Health
Mental Health and Substance Use
Gender Affirming Care
What are your goals?
- Are you wanting to pursue the maximum degree of medically appropriate feminizing/masculinizing effects?
- Are you non-binary and only want partial effects of the hormones?
- Do you know your reproductive plans for the future?
- Are you unsure about what you want and looking to explore with your doctor?
Feminizing Gender-Affirming Treatment
- Pores become smaller, less oil production, sweat less
- Nipple tenderness and appearance of small “buds” under the nipples. The rate of breast growth, size, and shape vary from person to person. Breasts can take a couple of years on hormones before fully developed.
- Fat redistributes on the face for a more feminine appearance and body fat depositing more in the hips and thighs as opposed to the abdomen.
- Hair thickness will decrease on the face and body, but will not fully go away unless pursuing laser hair and/or electrolysis treatments. Any balding spots on the scalp will likely remain.
- No change to vocal cords.
- As testosterone levels drop, desire for sex may decrease, and obtaining an erection for penetrative sex can be more challenging. Depending on an individual’s desired sexual function there is a role for maintaining a higher testosterone level or initiating medications such as Sildenafil or Tadalafil (Viagra and Cialis).
- Testicles will decrease in size.
- The impact of feminizing hormones on long-term fertility is unclear. There is a decrease in sperm production, but it doesn’t always stop completely. If sexually active with someone who can become pregnant then using a form of birth control is important. Some individuals, when trying to reproduce, will stop feminizing hormones for about 3-6 months with good success. Lastly, sperm banking prior to initiating hormones can be helpful to ensure fewer difficulties with fertility in the future. A great referral place we send patients is at the Boston IVF: https://www.bostonivf.com/
- Risks: blood clots - including heart attack and stroke risk is higher in tobacco smokers, increase risk of breast cancer, possible increase in migraine headaches, gallbladder disease
Masculinizing Gender-Affirming Treatment
- Skin becomes thicker, with larger pores, more oily skin, a change in body odor and an increase risk of acne
- Body fat will redistribute with less fat around the hips and thighs, gain body fat around the abdomen. Generally, there is no change to the chest wall due to the hormones and would need surgery to make any changes.
- Muscle mass will increase, more so if exercising, which is recommended.
- Thickening of the vocal cords will result in lowering of the voice. This is a permanent change.
- Increase thickness and amount of body hair and facial hair. Potential for hair thinning on the scalp. Hair growth and hair loss are largely genetic.
- Increase in libido, the desire for sex.
- Enlargement of the clitoris, this effect is permanent.
- Individuals notice that their periods become light, arrive later, and are shorter in duration. After a few cycles, they stop altogether.
- Testosterone decreases the chances of becoming pregnant but does not eliminate the odds. It is important to use a form of birth control if sexually active with an individual who may result in a pregnancy.
- Testosterone may make it difficult for eggs to be released from the ovaries and depending on the length of hormone therapy, may make reproduction very challenging. Some individuals choose to bank eggs prior to initiating hormone therapy, we generally refer to Boston IVF https://www.bostonivf.com/
- Risks: increase in blood pressure and higher cholesterol, increase in hemoglobin and hematocrit that may increase the risk of heart attack and stroke,
- Breast, Ovarian, Uterine, and Cervical cancer is not eliminated by going on testosterone therapy. As long as an individual has the organ, it is important to continue appropriate age-related cancer screening.
In addition to gender-affirming hormone management, we help our patients with referrals to surgical specialists for gender-affirming procedures and help guide patients through the complex process of changing the name and/or gender on birth certificates, driver’s license, social security card, and other forms of identification.
Get Started Today
Boston Direct Health provide a safe, judgement-free environment, delivering specialized LGBTQ+ health care service. Boston primary care physician Dr. Steven Zivich and his staff proudy serve LGBTQ+ patients in vital prevention, assessment, and treatment services. When you’re ready for LGBTQ+ health services, call our office 617-304-1965 in Back Bay today to schedule an appointment.
Why Coming Out to Your Doctor is So Important
Only 16% of LGBTQ+ patients choose to inform their doctor of their sexual orientation. Coming out is never easy. Those of us in the LGBTQ+ community find ourselves having to come out over and over and over again. Sometimes it’s easier. Sometimes it’s not. Whether it’s easy for you to come out to your doctor … Why Coming Out to Your Doctor is So Important Read More »

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