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Gender services
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CrescentCare strives to treat all patients with respect and compassion, regardless of gender identity or expression. Gender Services is an umbrella term for our many programs that serve transgender, non-binary, gender-nonconforming, and gender-diverse communities with culturally humble, affirming healthcare. To schedule a new patient appointment for gender-affirming care, please call us at 504-821-2601.
For existing patients, contacting our call center at 504-821-2601 is the fastest way to receive support with things like rescheduling an appointment, prescription refills, messaging your provider, requesting labs, accessing the patient portal, and much more.
When accessing any of the gender-affirming services described below, we encourage you to also access primary care with us. Establishing primary care is a great way to check up on your holistic health, obtain preventative care, maintain an established relationship with a provider when urgent issues come up, and access referrals to specialists.
How can I provide feedback on my experiences at CrescentCare?
We value your feedback regarding the quality of care you receive at CrescentCare. Let us know how we are doing by calling our Gender Clinic feedback hotline and leaving a voicemail at 504-207-2273, ext. 6887.
You may also provide comments on your care in the Gender Services online feedback form.
Both methods are checked by the Trans Advisory Committee. This means trans staff and our allies have your back in tracking how we can improve our services and in advocating for systems to shift as needed.
What name and gender marker will be used in CrescentCare systems?
The name and gender marker associated with your insurance (or ID documents if you are uninsured) is what will show up in our system. This means you may see your legal name or gender marker show up in writing – like in your patient portal or medical record. However, we should only ever use the name and pronouns you ask us to use while you receive care here. We are currently advocating for change in our electronic health record to better meet the needs of our communities who use different names and pronouns than what is associated with their ID documents and insurance.
My GAHT prescription is not covered by my insurance, and I cannot afford it. What do I do now?
If your hormone prescription is not covered by your insurance, or you are uninsured, talk to your provider about this issue. There is a chance that we can get you a discount on your hormone prescription via our partner pharmacies, and a program called 340B pricing.
Visit our list of partner pharmacies, many of whom can ship your meds to you if needed.
Do I need to access hormones to be affirmed as who I am at CrescentCare?
We reject body essentialism at this agency. Body essentialism, or gender essentialism, is the inaccurate belief in Western cultures that men and women are fundamentally different due to their biology and maintain characteristics and behaviors due to these biological differences. This has long been discredited by psychologists, the medical community more broadly, and trans communities. This belief leads some people to mistakenly project that someone is only legitimate as a person of trans experience if they pursue all available hormone therapy and gender affirming surgery options that would ideally bring their bodies into alignment with stereotypical western, colonial ideals of “men” and “women.” This belief completely and intentionally erases people of nonbinary experience as being legitimate and/or “real,” and reinforces harmful constructed notions of femininity and masculinity for both cis and trans folk.
When you access care here, no matter how you present yourself, no matter your goals and needs in the realm of what the medical community considers gender affirming care, we will see you as you want us to see you. Thank you for trusting us with your care.
We commit to keeping our gender services team members as up to date as possible about the resources available in our communities. We adhere to international standards of care for trans people, utilizing WPATH and UCSF guidelines. We commit to providing continuing education for our staff to provide gender diverse communities with exceptionally great care.
We utilize an informed consent model for gender-affirming hormone therapy (GAHT). This means we do not require patients to obtain a letter of support from a therapist or counselor to begin GAHT (often referred to as hormone replacement therapy or “HRT”). We recognize that everyone’s goals of transition are unique, so your provider will have a conversation with you about your health history, your personal needs and goals, your experience of gender, everything we know about GAHT and associated timelines of changes the hormones will initiate, and any questions you may have. From there you will work together to come up with an individualized care plan using shared decision-making.
While some patients begin hormone therapy right away, our medical providers may request further assessment and labs based on your individual health history. We deliver care using a team approach, where multiple members of our gender care team are there to support you in meeting your individual needs.
In the gender clinic, we believe that everyone deserves access to safe, affirming, trauma-informed care and compassionate mental health practitioners. We acknowledge that many people of trans experience have had complex experiences with the medical system, so we want to ensure gender-affirming behavioral health care is not only accessible—it should be the norm.
While there is an amazing behavioral health team at CrescentCare, they currently have months-long wait times for individual therapy. For this reason, the gender services team keeps a list of external behavioral health providers in the Greater New Orleans area who are specifically recommended to us by gender clinic clients. Ask your medical provider for a copy of this list if you think it may be of use to you.
In 2022, patient navigators and gender services staff at CrescentCare partnered with Lagniappe Law Lab to create a comprehensive online tool to understand the legal name and gender marker change process in the state of Louisiana. This tool will help you understand if you are eligible to change your name and what steps are required to complete the process.
Here are the structural basics to know:
- In short, you will pay a fee and file a Petition for Name Change along with copies of your identification at the clerk of court in either the parish where you live, the parish you were born in, or in Orleans Parish. The petition will be sent to the District Attorney’s office where they will run a background check on you. Once the DA approves your background check, they relay this information to the Clerk of Court, who then gives you an official Certified Name Change document. You will bring this document to most places where you will be changing your name. Since this document is so important for accessing the next steps, we strongly recommend asking for multiple “certified copies” (usually costs a few dollars each) of this Certified Name Change document to have as backups as some government offices require keeping a certified copy.
- If you want to change your gender marker as well, at this point you should ask your medical provider at CrescentCare for a gender marker change letter. You will bring this document to places where you will be changing your gender marker.
- Once you have your Certified Name Change document and your gender marker change letter, if updating your gender marker, you will then gather other ID documents to prove who you are and go to offices like the Birth and Vital Records Office, Social Security Office, OMV, and Passport Office to update your information. From there, most people use their corrected ID documents to update their bank, doctor, employer, school, utility companies, voter registrar, insurance company, military/VA record, attorney, will, library, professional licenses, car title, etc.
Best practices for completing the process:
- Call the agency or office in advance of going there to make sure you have everything you need (appropriate identifying documents, payment in acceptable format, etc.) to complete that step. Remember, cisgender people have been legally changing their names forever for a million reasons. Most places you need to change your name already have information ready on how to navigate that specific system. When in doubt, look it up or call ahead!
- Here in the gender services team, we hear about a myriad of experiences from clients who are changing their names and/or gender marker in our state. Some of these stories include happy surprises and joyful moments, and others include experiences of transphobia and gatekeeping. If you experience unfair treatment while trying to change your name and/or gender marker, here are some things we have seen our clients successfully do to work around an obstructive person or system:
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- Bring an advocate who is willing to speak up if someone is mistreating you.
- Ask to speak to a manager.
- Ask to work with a different person in that office.
- Go back on a different day of the week.
- Document the name of the person who mistreated you and call the office to report your experience to management.
- Overall, whenever you are going to do another step in the name change process, we recommend planning a way to do something nice for yourself afterward. You are undertaking a sometimes long and generally expensive process. You always deserve care, support, and rest, but especially while you navigate these systems.
Name-Change FAQ:
Unfortunately, anyone convicted of a violent felony, people who have outstanding warrants for their arrest or pending felony charges, and people who are currently on parole or probation cannot legally change their names.
Changing your name as a minor in the state of Louisiana is a bit more complicated, but not impossible. This process does require support from both parents if they are alive and you are legally in their custody. Talk to your provider if you are a minor initiating the name change process to get connected to resources and Gender Services staff who can talk with you about how to proceed.
Unfortunately, the state of Louisiana does not currently offer a nonbinary gender marker option on our state-specific identification documents.
Changing gender markers on birth certificates in dependent on rules of the state and parish/county in which you were born. We understand the current legislation in the state of LA to only allow gender marker change after successful completion of vaginoplasty or phalloplasty. We recommend people who were born out of state contact the office of birth and vital records of their home county/parish to find out the rules for their region, as they may be more affirming/accessible.
Unfortunately, most insurance companies still maintain a binary understanding of gender and code certain types of care, often reproductive care, in gendered ways for billing purposes. For example, people who have ovaries and cervixes require routine medical screening and it is not uncommon for an insurance company to deny coverage for pap-smears and cervical care for people who are listed as male in their system. This also happens with historically gendered surgical care, like hysterectomies. This limited systemic understanding of gender leads many people assigned female at birth to opt to change their gender marker on most ID documents but keep an “F” with their insurance company to ensure coverage of organ-specific care.
There is less organ-specific maintenance for people who have a prostate, though if you have a family history of prostate cancer, it is worth considering if you would prefer to keep an “M” gender marker for coverage of prostate screening. Similarly, if you are a person planning to have an orchiectomy and wanting to change your gender marker with insurance to female, you may want to wait to update your gender marker until after your surgery.
We recommend looking at the resources created by Real Name Campaign and the Louisiana Trans Advocates ID Documents Center when initiating this process as they are filled with tips and tricks for navigating this stressful process with as much ease as possible.
While we do not provide any surgical procedures at CrescentCare, our medical providers stay up to date with the gender-affirming surgery (GAS) resources in the region. If a GAS procedure is something you want or are considering, talk to your medical provider about your goals and needs and they will let you know what resources exist in our area based on what you’re looking for.
Here is a breakdown of the GAS requirements and referral process at CrescentCare:
- Once you have established care with a CrescentCare medical provider and you have discussed gender-affirming surgery, request a referral for a surgery consultation.
- Your CrescentCare medical team will schedule a Gender Affirming Surgery Letter appointment with one of our behavioral health providers. This appointment will be either in-person or telehealth.
- If bottom surgery (vaginoplasty, phalloplasty, metoidioplasty, orchiectomy, or hysterectomy): your provider will schedule a Gender Affirming Surgery Letter appointment with two different behavioral health providers.
- If top surgery (breast augmentation, double mastectomy): your provider will schedule a Gender Affirming Surgery Letter appointment with one behavioral health provider.
- We send these letters to the surgeon’s office, who submit them to your insurance company, asserting that your gender affirming surgery is medically necessary and that you have the necessary resources to have a successful outcome.
- Please know that the behavioral health provider you meet with is available to provide brief support if issues arise during recovery from surgery. You may message them requesting a follow up appointment via your patient portal.
- Your medical provider will schedule a follow-up appointment with you to have one final discussion about surgery before we place your referral to the surgeon’s office.
- During the follow-up appointment, your provider will briefly review the next steps of the process, discuss your plan for surgery and recovery, address any questions or concerns you may have, and remind you with which surgeon and facility the referral will be placed. They will also make sure you have the contact information to the gender clinic patient navigators, who will support you in tracking your care and ultimately accessing surgery once the referral is placed.
- Your provider will then complete a Medical Clearance Letter. In short, this letter states that you are physically healthy to undergo surgery and reasserts to the insurance company that your surgery is medically necessary.
- Your provider places the referral to CrescentCare’s referral coordinators, who then send the referral with your basic medical information and all your clearance letters to the surgeon.
- One of the Patient Navigators will follow-up with you to ensure the consult with your surgeon gets scheduled, you understand the insurance approval (or denial and appeal) process, to track your care, and support you in making your recovery plan, if necessary.
- In future appointments, your provider will check in with you to see if the surgery process has moved forward and note any important dates (consult, pre-op appointment, surgery, etc.) in your chart for care coordination.
Gender-Affirming Surgery FAQ
We even have examples of sample letters that we can send to your behavioral health provider, if they are unfamiliar with writing GAS letters. Once your therapist completes your letter, they may either send it directly to the surgeon’s office or to a gender clinic patient navigator at CrescentCare for submission to the surgeon’s office with your other letters.
We need to work quickly to appeal the denial. You should get a letter in the mail outlining how to appeal your denial, usually within a specific number of days.
We keep a list of organizations who support trans people in paying for surgery out of pocket when they are ineligible for insurance, or their surgery is not covered by their healthcare plan. Know many of these funds have tight application windows and sometimes are only available to people from certain backgrounds or geographic areas. Ask your medical provider for a copy of this list if you think it may be of use to you.
Unfortunately, some surgeons utilize BMI, or body-mass-index, a specious value derived from the weight and height of a person, to determine if they will operate on someone. Oftentimes these surgeons will tell their patient they must lose a certain amount of weight to access surgery, usually citing healing complications that some people with higher BMIs experience.
CrescentCare does not condone or support the use of a person’s weight-to-height ratio as a reason for a GAS to be unattainable. If you are denied a surgery due to the size of your body, we are here to support you in figuring out next steps. Some people choose to crowdfund and find a different surgeon to work with (potentially out of your insurance network or geographic area) while others choose to access support at CrescentCare like our nutrition services to get to the weight the surgeon requires they be to perform surgery. We know this is very frustrating. We are with you, and we are working to make sure these systems change for the better and for the liberation of our communities.
Another factor that may affect your ability to access surgery is your age. Currently, there are no surgeons providing bottom surgeries in the state of Louisiana to anyone under the age of 18. There are some surgeons providing top surgery to minors, in very specific cases. Talk to your provider if surgery is one of your goals in the context of medical transition.
Smoking may also affect your ability to access surgery. As smoking tobacco affects our lungs, heart, and blood flow, stopping smoking will help you both get through surgery and anesthesia as well as heal properly. Talk to your surgeon about your smoking history and let us know if we can support you with smoking cessation as they will most likely give you a deadline to quit before surgery.
The last thing we see get in the way of accessing surgery includes issues like housing instability, recovery care team issues, substance use complications, medical problems, and other structural issues. We mention this to say: please tell your care team about what you are experiencing so we can creatively support you in getting through surgery and recovery. Many of these roadblocks can be worked around, we just need to know about them as they come up to support you in meeting your surgical goals.
Your providers are here to support you, as well as the gender clinic patient navigators. The navigators are here to make sure all your referral goes through, your letters of clearance get to the surgeon’s office, your consult and surgery gets scheduled, and that you make it through recovery healed and with your needs met.
The patient navigators for the Gender Clinic work to stay as up to date as possible with the gender-specific resources available for our communities. The medical team you will work with has access to our lists of community resources – feel free to ask your providers about this while accessing care with us.
Visit the Community Resource Guide, a comprehensive list of resources in the city, updated yearly by a dedicated group of volunteers from Antigravity Magazine.
