Gender-Affirming Care

Student Health & Well-Being (SHWB) believes every student and trainee deserves care that affirms their identity and strives to fulfill trans and gender expansive students’ needs to help them feel healthy, safe, and empowered.  To help determine the care that’s best for you, we encourage you to visit one of our offices and speak with a professional who will guide you to care options based on your individual needs. Please refer to our eligibility page to find out which services you can access.

schedule an appointment with valerie!

Valerie Brewer, CRNP, has been selected to participate in the Novel Faculty Apprenticeship Program for Transgender and Gender Diverse Primary Care. To schedule an appointment with Valerie, please call 410-516-3311. Valerie sees patients at the East Baltimore and Homewood locations.

external links

The external links on this website are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Johns Hopkins University of any of the products, services or opinions of the corporation or organization or individual. Johns Hopkins University bears no responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

Below, explore the following topic areas and resources regarding:

Gender-Affirming Medical Care Within Student Health and Well-Being

There’s no one right way to transition (socially, medically, etc.). A trans person could choose to engage with all or none of the services that are available. Their identity is not contingent upon the procedures, surgeries, or hormone concentrations they have.

The following FAQs are based on “10 trans questions to ask a doctor” created by TransHub.

Per our policy, patients are treated with respect, consideration, and dignity, regardless of race, ethnicity, gender, sexual orientation, religion, country of origin, or ability to pay. We believe, fundamentally, that every person has equal dignity and worth, and our unwavering commitment to diversity, equity, and inclusion is rooted in this predicate principle.

Led by the mission and goals of our Gender-Affirming Care Team (GACT), we aim to advocate and implement programs and services that provide inclusive health care and safe spaces on campus, increasing awareness and promoting gender equity across the University. Using a holistic and trauma-informed lens, we recognize the various intersectional identities of our students and trainees, and strive to meet them where they are in their individual gender journey.

SHWB considers gender-affirming hormone therapy a medical necessity and primary care service. Details about our mental health surgical readiness letter policy is available in in this document.

All SHWB staff complete Safe Zone training as part of their on-boarding process.

Our providers participate in workshops with Helene Frances Hedian, M.D., Director of Clinical Education, Center for Transgender and Gender Expansive Health.

We have several mental health services staff who have specialized training in the Gender ASSET model and who are familiar with the WPATH 8.0 standards of care.

Our mental health practitioners participate in continuing education and workshops on gender-affirming care and support of trans and gender-expansive clients.

Yes, there are multiple choices for genders and pronouns on our intake forms.

Yes. In our electronic medical record, we receive information on gender from the Office of the Registrar (Student Information System) as well as from our own intake forms. A student’s gender marker can be changed in either or both systems.

To change your gender marker in the SHWB electronic medical record, please update your gender when filling out intake forms prior to your visit.

To change your gender marker within your academic record, also known as the Student Information System (SIS), submit a request through the SEAM Case Management system<

Our intake forms allow students to note and change their pronouns, including multiple choices as well as a free text option.

Yes!

We use the informed consent model for prescribing hormone therapy. You can read more about both feminizing therapy and masculinizing therapy in the documents below:

The Johns Hopkins University is committed to equal opportunity for its faculty, staff, and students. To that end, the university does not discriminate based on sex, gender, marital status, pregnancy, race, color, ethnicity, national origin, age, disability, religion, sexual orientation, gender identity or expression, veteran status, military status, immigration status or other legally protected characteristic.

We hope that this website provides comprehensive information and resources for our students. In addition, there is a wide variety of information and resources available on the Office of Gender and Sexuality Resources website and the Center for Transgender and Gender Expansive Health website.

Insurance

  • General information on the student insurance plan (Wellfleet) is available on the Student Health Benefits website.
  • The announcement on the July 2022 expansions of gender-affirming care benefits and supports for Hopkins is available on the Hub website.
  • Detailed information on gender-affirming care covered by Hopkins insurance plans is available in this document.
  • When you call a specialist office outside of Student Health, the scheduler may not recognize your insurance name, and may tell you that you are not in network. If this happens, tell them that your insurance is under the CIGNA PPO network, and that the scheduler should input your plan group and ID number, or encourage the scheduler to call the verification number on the back of your insurance card.
  • If you have the Wellfleet plan, use this website to find an in-network provider.
  • If you have any questions about the student insurance plan, please email [email protected].
  • People who have Medicaid, Medicare, veterans benefits, or other private insurance should refer to the health coverage guide from the National Center for Transgender Equality.
    • Getting your insurance to cover the health care you need can be difficult. The most important thing to remember is that your insurance should cover transition-related care. However, you may need to show your insurance company why the treatment you need is medically necessary for you, with letters from your health care providers.
    • If you are denied coverage, or if your plan has an exclusion, you may also need to explain to your insurance company or employer why it is illegal discrimination to exclude medically necessary transition-related care.

See our Specialist Referrals page for more info

Privacy of Medical Information

SHWB Primary Care uses an electronic medical record (EMR) separate from the Johns Hopkins Health System. The Johns Hopkins Health System utilizes an EMR called Epic.

If you are accessing care through Johns Hopkins Medicine, you can specify your pronouns using MyChart (the patient portal for Epic). Indicating pronouns in MyChart will result in those pronouns appearing in parts of the medical record, including patient labels that are printed and used in various settings to identify patients.

If you do NOT want pronouns shown on medical labels, you can remove them from MyChart. Since patient labels are meant to be viewed only by the patient and medical staff for clinical purposes, having pronouns appear on labels does not constitute a HIPAA violation

Hormone therapy (HRT)

If you are interested in learning more about whether hormone therapy is right for you, please call your applicable primary care clinic and request an initial appointment to discuss gender affirming care. You can also explore the following documents:

HRT is covered by the student insurance plan (WellFleet), no prior authorization is required. There is a $15 copay for generic medication and a $25 copay for brand name medication. Laboratory costs are covered at 90%. If you have another insurance plan, please contact your insurance company directly to learn more about HRT coverage

other Medical Resources

The services listed below have been compiled from multiple sources. We have not independently verified any of these providers. Please check with your insurance to see if these services are covered and if they are considered in-network or out of network.

This list consists of community resources; please check with your insurance to see if these services are covered. Many hair removal locations do not accept insurance. If this is the case, you can get a receipt for your service and submit this information to your insurance plan to be covered as an Out of Network provider.

This list consists of community resources; please check with your insurance to see if these services are covered.

This list consists of community resources; please check with your insurance to see if these services are covered.

Other Primary Care and Medical Transition Resources

  • Center for Transgender and Gender Expansive Health. The Johns Hopkins Center for Transgender and Gender Expansive Health offers comprehensive, evidence-based and affirming care for transgender youth and adults that is in line with the standards of care set by the World Professional Association for Transgender Health (WPATH). Offering services for children and adolescents, dermatology, facial gender surgery, fertility, gynecology and obstetrics, hormone treatment, hysterectomy, mental health, penile construction (phalloplasty/metoidioplasty), primary care, top surgery (mastectomy or augmentation), urology, vaginal construction (vaginoplasty), and voice therapy.
  • Chase Brexton. Chase Brexton and the Center for LGBTQ Health Equity provide supportive and sensitive care to people of all sexual orientations, gender identities, and gender expressions. Multiple locations in Maryland.
  • Planned Parenthood. Planned Parenthood delivers vital reproductive health care, sex education, and information to millions of people worldwide. Locations in Baltimore and Washington DC.
  • Whitman Walker. Whitman Walker strives to provide a safer, respectful, and affirming environment that meets the needs and supports the livelihood of our transgender and gender expansive patients. Multiple locations in Washington DC.

Surgical Resources

preparing for surgery

Make sure not to underestimate waitlists, consult, and surgery timelines. It’s better to overestimate in order to ensure coverage!

Preparing for your gender affirmation surgery can be daunting. To help provide some guidance for those considering gender affirmation procedures, the team from the Johns Hopkins Center for Transgender and Gender Expansive Health answered some questions about what to expect before and after your surgery.

Your SHWB primary care provider can assist with your pre-surgical evaluation by collecting the information on this pre-intake readiness checklist.

Your SHWB mental health provider can assist with a mental health evaluation for surgical readiness.

  • The term “gender dysphoria” was used in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5), a manual published by the American Psychiatric Association in 2013. This term was intended to focus on gender identity-related distress that some transgender people may experience (and for which they may seek psychiatric, medical, and surgical treatments) rather than on transgender individuals or identities themselves. The DSM–5 states that “gender non-conformity is not in itself a mental disorder,” rather the diagnosis was created to help people with gender dysphoria get access to appropriate health care and treatment.1 (https://www.psychiatry.org/psychiatrists/cultural-competency/education/transgender-and-gender-nonconforming-patients/gender-dysphoria-diagnosis)
  • Criteria: Gender Dysphoria in Adolescents and Adults. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least six months’ duration, as manifested by at least two or more of the following:
    • A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics)
    • A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)
    • A strong desire for the primary and/or secondary sex characteristics of the other gender
    • A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
    • A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)
    • A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)
    • The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.2 (American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.)
  • See our Specialist Referrals page for more info
  • TransHealthCare is a worldwide Gender Surgeon directory that’s built on the largest and most comprehensive database of surgeons who perform Gender Affirming Surgery. You can search by Country, U.S. State, Procedure and Insurance. (Disclaimer – Trans Media Network websites accept forms of cash advertising, sponsorship, paid insertions or other forms of compensation)
  • Breast Augmentation
  • Breast Reduction
  • Brow Lift
  • Buttock Implant
  • Calf Implants
  • Cheek/malar implants
  • Chin/nose implants or genioplasty
  • Coloproctostomy
  • Colpocleisis – vaginal walls sewn together
  • Electrolysis of donor site tissue
  • Eyelid lifts
  • Facial bone reconstruction
  • Forehead contouring
  • Gonadectomy or orchiectomy
  • Hair grafts
  • Hysterectomy and salpingo-oophorectomy
  • Jaw implant
  • Jaw reduction (jaw contouring), jaw and/or chin reshaping
  • Lip reduction/shortening
  • Lipofilling of hips, thighs, buttocks
  • Mastectomy with liposuction of the chest
  • Metoidioplasty
  • Mons lift/mons reduction (lifting and tightening and/or reduction of the mons pubis area)
  • Nipple/areola complex reconstruction (both male to female and female to male)
  • Pectoral implants
  • Penectomy
  • Perineoplasty (narrows vaginal opening)
  • Phalloplasty
  • Repair of introitus
  • Rhinoplasty
  • Scalp (hairline) advancement
  • Scrotoplasty
  • Skin grafts
  • Testicular prosthesis (insertion of)
  • Urethroplasty /urethromeatoplasty
  • Vaginectomy/colpectomy
  • Vaginoplasty
  • Voice modification surgery
  • Vulvectomy
  • Wrinkle removal

Learn more about the following types of surgery and Student Insurance Plan coverage:

Student Insurance Plan Specifics

For the following gender-affirming surgeries and procedures precertification is required.

Requirements for Top Surgery (includes mastectomy, breast reduction, and breast augmentation) are:

  • Single letter of referral or recommendation from a qualified health care provider with training and experience in medical care for gender affirmation patients;
  • Persistent, well-documented gender dysphoria;
  • Capacity to make a fully informed decision and to consent for treatment;
  • Age of majority (18 years of age or older); and
  • If significant medical or mental health concerns are present, they must be reasonably well controlled.

Top surgery may require associated procedures, each of which should be listed for Prior Authorization separately. These include but are not limited to:

  • Nipple-areola reconstruction
  • Pectoral implants
  • Skin grafts

Note: Cosmetic issues due to approved and performed top surgery are part of the risks of this surgery and are considered Healthcare Acquired Conditions (HAC’s). As such, modification procedures to correct cosmetic issues due to previously approved and performed top surgery is not a covered benefit

Masculinizing Top Surgery Resources
Feminizing Top Surgery Resources
Student Insurance Plan Specifics

For the following gender-affirming surgeries and procedures precertification is required.

Requirements for Bottom Surgery (includes hysterectomy and salpingo-oophorectomy, gonadectomy or orchiectomy, and genital reconstructive surgery [vaginoplasty, phalloplasty, or metoidioplasty]) are:

  • Single letter of referral or recommendation from a qualified health care provider (with minimum of Master’s degree or equivalent) with training and experience in medical care for gender affirmation patients with written documentation submitted to the physician performing the surgery;
  • Persistent, well-documented gender identity disorder;
  • Documentation of at least 12 months of continuous hormone therapy as appropriate to the member’s gender goals (unless the member has a medical or other contraindication);
  • Documentation of 12 months of living in a gender role that is congruent with their gender identity (real life experience) and for vaginoplasty, phalloplasty or metoidioplasty (This criterion is not applicable for hysterectomy and salpingo-oophorectomy, gonadectomy or orchiectomy.);
  • Capacity to make a fully informed decision and to consent for treatment;
  • Age of majority (18 years of age or older); and
  • If significant medical or mental health concerns are present, they must be reasonably well controlled

Bottom surgery may require associated procedures, each of which should be listed for Prior Authorization separately. These include but are not limited to:

  • Hysterectomy, salpingo-oophorectomy, orchiectomy
  • Vaginectomy/colpectomy, vulvectomy, metoidioplasty, phalloplasty, scrotoplasty, urethroplasty /urethromeatoplasty, insertion of testicular prosthesis
  • Vaginoplasty, electrolysis of donor site tissue to be used to line the vaginal canal or male urethra, penectomy, vulvoplasty, repair of introitus, coloproctostomy
  • Electrolysis for skin grafting
Bottom Surgery resources
Student Insurance Plan Specifics

For the following gender-affirming surgeries and procedures precertification is required.

Requirements for facial feminizing surgery (facial bone reconstruction) are:

  • Persistent, well-documented gender dysphoria or gender incongruence;
  • Capacity to make a fully informed decision and to consent for treatment;
  • Age of majority (18 years of age or older); and
  • If significant medical or mental health concerns are present, they must be reasonably well controlled

Ancillary procedures and services beyond major facial bone reconstruction, services include but not limited to:

  • Hair transplant
  • Wrinkle removal
  • Nose procedures
  • Dermabrasion
  • Chemical peel
  • Eyelid lifts

Requirements for “Ancillary Procedures” are:

  • Persistent, well-documented gender identity disorder;
  • Capacity to make a fully informed decision and to consent for treatment;
  • Age of majority (18 years of age or older); and
  • If significant medical or mental health concerns are present, they must be reasonably well controlled

Voice modification surgery is covered if voice therapy does not succeed.

Tracheal shave surgery does NOT require precertification with the student insurance plans.

Facial surgery resources

Body Contouring Surgery (BCS) is not a covered benefit under the Student Insurance Plan.

Sexual & Reproductive Health

Student Health & Well-Being Primary Care offers a variety of sexual health services, including contraceptive services, pregnancy testing and counseling, testing for sexually transmitted infections, and more.

Sexual and preventative anatomy-specific health appointments are covered by the student insurance plan; no precertification is required.

Q: I’m trans. Do I need birth control? A: Well, it all depends. It depends on what equipment you’ve got, what you’re doing with it, who you’re doing it with (and what they’ve got), and whether pregnancy is a goal or not. Read this article from Bedsider to find out more!

Wanting to have, or not to have, children are big life choices. Whichever you choose, it’s good to plan ahead. The JHM Fertility Preservation Innovation Center has information to help you do so.

Transgender Men

  • Sexual health for transmen (brochure from UCSF) is important. Each transman is unique, but like anyone else, as a transgender man you want to feel great about your body. You want to have sex that is safe, feels good, and is rewarding.
  • Here are some tips to make pelvic exams a more comfortable experience for trans men, adapted from Apicha Community Health Center:
    • Tell your provider what you want to call the body parts that are going to be examined.
    • Tell them whether or not you want the process to be described while it happens.
    • Ask your provider to show you the speculum and photos of what happens prior to the actual exam
    • Discuss with your provider what position would be the most comfortable for you to lie in.
    • Ask them to divide the exam in two parts—discussion and exam—either in the same or different visits.
    • During the discussion, your provider will likely ask about your overall health, your genitals and the kind of sex you are having.Discuss whether taking anti-anxiety medication could make the exam less stressful.
    • Set a “safe word” so that any time you feel you need some space, your provider will know to stop what they are doing.
    • Ask your provider about letting you read a book, listen to music, or have a friend or partner in the room

Transgender Women

Sexual health for transgender women (brochure from UCSF) is important. Each transwoman is unique, but like anyone else, as a transgender woman you want to feel great about your body. You want to have sex that is safe, feels good, and is rewarding.

Gender-Based Violence

Gender-based violence (GBV) is a form of power-based violence that manifests as sexual assault, intimate partner violence, sexual harassment, and stalking and is linked to normative understandings of gender. GBV mimics or stems from a system of gender power imbalances. The “LGBT power and control wheel” created by loveisrespect.org can help to illustrate those dynamics as it relates to non-heterosexual relationships.

The Gender-Based Violence Prevention team at Johns Hopkins has expanded and now includes multiple confidential support staff. You can reach the GBVP team via email at [email protected] or by calling 443-927-3548.

The Sexual Assault Helpline (410-516-7333) is a confidential service of the Johns Hopkins Mental Health Services. Trained professional counselors are available to ALL JHU students, and offer support, provide resources or answer questions 24/7.

The RAINN National Sexual Assault Hotline. Free. Confidential. 24/7. Call 800-656-HOPE.

Mental Health

SHWB Mental Health Services (MHS) offers safe, confidential, and non-judgmental spaces where students and trainees can explore their identities and get support during the process of any element of transition, from coming out or changing names or pronouns, to readiness and support for a variety of medical transition procedures.

MHS currently has one clinician, Odell Morgan (he/him), who is trained in writing letters of support under the WPATH 8.0 standards of care, and who uses the Gender ASSET model to support those who are seeking surgical procedures. Staff are provided opportunities for continuing education and take part in workshops and didactic seminars to ensure that all learners are offered an affirming experience.

All MHS clinics utilize an electronic health record system that is separate from the platform used by the Johns Hopkins Health System. All patients can specify gender identity, pronouns, and chosen names when initiating care and can update this information at any time.

Other crisis resources outside JHU:

  • National Suicide Prevention Lifeline. Call “988” or “1-800-273-TALK (8255)” for free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.
  • Crisis Text Line. Free 24/7 support for those in crisis. Text 741741 from anywhere in the US to text with a trained Crisis Counselor.
  • Trans Lifeline. Call 1-877-565-8860 for a hotline staffed by transgender people for transgender people. Trans Lifeline volunteers are ready to respond to whatever support needs community members might have.
  • The Trevor Project. A national 24-hour, toll free confidential suicide hotline for LGBTQ youth. If you are a young person in crisis, feeling suicidal, or in need of a safe and judgment-free place to talk, call 1-866-488-7386 to connect with a trained counselor.
  • The LGBT National Help Center. Call 1-888-843-4564. Open to callers of all ages. Provides peer counseling, information, and local resources.
  • LGBT National Youth Talkline. Call 1-​800-246-7743 for ​​Free and Confidential peer support for the LGBTQ and questioning community ages 25 and younger.

The Gender Affirming Care Team

The Gender Affirming Care Team (GACT) is an interdisciplinary group of staff members across divisions of Johns Hopkins University. The GACT supports transgender and gender expansive students, learners, and trainees by identifying and removing barriers to services to optimize their personal and professional growth and enhance success in their academic endeavors. We aim to advocate and implement programs and services that provide inclusive health care and safe spaces on campus, increasing awareness and promoting gender equity across the University. Using a holistic and trauma-informed lens, we recognize the various intersectional identities of our students, learners, and trainees and strive to meet them where they are in their individual gender journey. For further information on the GACT members see the links below:

  • Cathie Axe, MEd (She/Her), Executive Director, Student Disability Services
  • Alyse Campbell, LMSW (She/Her), Associate Director of Student Well-Being, Gender Violence Prevention, Health Promotion & Well-Being
  • Jennifer Howes, Ph.D. (She/Her), Chief Mental Health Director, Student Health & Well-Being
  • Odell Morgan, LMFT (He/Him), Clinician and Coordinator of LGBTQ Services, Mental Health Services
  • Roanna Kessler, M.D. (She/Her), Chief Medical Director, Student Health & Well-Being
  • Fan Liang, M.D. (She/Her) Medical Director, Center for Transgender Health, Assistant Professor of Plastic and Reconstructive Surgery
  • Valerie Brewer, (They/She) Nurse Practitioner, Primary Care
  • Paula M. Neira, JD, MSN, RN, CEN, FAAN (She/Her), Program Director of LGBTQ+ Equity and Education, Johns Hopkins Medicine, Office of Diversity, Inclusion and Health Equity
  • Jennifer Parks, M.P.H. (She/Her), Chief Administrative Officer, Center for Transgender Health
  • Romy Sporn Smith, LMSW (They/Them), Social Worker, Center for Transgender Health
  • Demere Woolway, Ph.D. (Any Pronoun), Executive Director of Inclusive Excellence Education and Development

We would like to acknowledge and thank the Johns Hopkins trans and gender diverse identifying students, whose activism and feedback have enhanced our current services.

We Welcome Your Feedback

We strive to provide high-quality health care and well-being resources that recognize the values, experiences, and needs of our diverse student community. We believe that a confidential, mutually respectful partnership between you and our staff and providers is the foundation necessary to develop and maintain optimal health and well-being. Understanding your Patient Rights and Responsibilities and engaging your feedback about services is central to this partnership.

Your feedback is important to us, so if you had a good experience or have helpful suggestions, we encourage you to share that directly with the staff or provider in the office you visited. Our providers are trained to listen, answer your questions, and work with you to resolve concerns. For questions or concerns that arise prior to working with a provider, or if you feel it is best to speak with someone other than your provider, please share using our online feedback form.

The content of this webpage was curated by Ross Sawilowsky, SHWB Student Intern

Ross Sawilowsky (he/him/his) joined Student Health and Well-Being in July 2022 as a student intern. A psychology major and LGBTQ+ studies minor at the University of Maryland, Ross’ ultimate goal is to work as a clinical psychologist in assisting youth from minority-based and underserved communities.

Currently, Ross is a staff member at an organization that assists students who are experiencing homelessness or have been in foster care, and also works at his university’s LGBTQ+ Equity Center. In addition, he facilitates two LGBTQIA+ student groups at his university. Ross views this involvement as a reflection of his investment in equity and well-being, and just the start of his journey in creating a kinder, happier world.

In his free time, you can find Ross at the gym, creating music, or chatting with his cow-colored cat.

Ross’ contributions to the Gender Affirming Care webpage are dedicated to honoring the memory of a non-binary loved one, Lee Joran (they/them/theirs): a kind, witty, and strong person who touched many hearts and lives (July 9th, 2003 – June 23rd, 2022).