Medical Transition

This is a landing page. Follow the links below to reach content on medical transition at Yale!

Yale Mental Health & Counseling

Hormone Replacement Therapy - HRT

Bloodwork

Electrolysis

Top Surgery

Bottom Surgery

What are my bottom surgery options?

Transfeminine Options

Transmasculine Options

Facial Feminization Surgery - FFS

Notable Mentions

Transitioning Outside of Yale

Notes About Gatekeeping

Medical Transition through Yale

This section will discuss how to access medical transition resources through Yale Health, with special care given to options through the Yale Hospitalization/Specialty Coverage plan that students and faculty can enroll in. Please skip ahead to the next section to find more resources beyond Yale.

As of September 2022, accessing hormone replacement therapy is an informed consent model. For surgery, the requirements vary. See the new website at https://yalehealth.yale.edu/more/gender-transition-services-yale-health. 

As of the editing of this page in February 2024, there are three gender-affirming care coordinators which are nurses at Yale Student Health: Sarah Monico, Christina Pivirotto, and Griffin Radulski. 

Sarah Monico works with Dr. Anika Anam of the Endocrinology department.

Christina Pivirotto assists with referrals for surgery and coordination with Member Services.

Griffin Radulski is assisting with simplifying electrolysis referrals and assists Dr. Deshmukh, Dr. McCarthy, and Dr. Anam

Here is an in-depth link to Yale Specialty's Coverage guidelines. Keep in mind that this has not been updated since 2019, so there are several changes that have not been outlined in the coverage document.

If you have any issues at Yale Health, please submit a comment card. 

Hormone Replacement Therapy - HRT

• As of January 2024, students are able to access hormone replacement therapy prescription regardless of health insurance coverage through Yale Student Health services. This is amazing news that comes after student advocacy across departments.

• ALL students are eligible to meet with primary care physicians as part of the bundle of services available to students under Yale Basic. Presently, two primary care physicians are being onboarded to provide HRT prescriptions to students:

  • Dr. Prium Deshmukh is supporting students in continuing HRT if they were previously prescribed HRT before transferring care to Yale Health

  • Dr. McCarthy is supporting students in starting HRT for the first time

  • Students who are desiring specialized forms of HRT are being referred to Endocrinology, which is not associated with the Yale Basic coverage. "Low complexity" cases are under the jurisdiction of Dr. Deshmukh and Dr. McCarthy. Complexity is determined by prescriber comfort. Presently, low dose testosterone is considered higher complexity, but Dr. Deshmukh and Dr. McCarthy are being onboarded to handle these kinds of cases as well!

• If you go to Planned Parenthood to start HRT, Yale Health is willing to reimburse you for at least one consultation visit's cost. This is regardless of whether you have the Yale Student Insurance or not.

• Under the copayment structure for Yale Health, one month of medication is $10. Two months is $20, three months $30, and so on. If you receive a partial month's supply, Yale Pharmacy/Yale Health round the cost up.

  • You do not need your prescriptions to be sent to Yale Health Pharmacy. We are currently trying to figure out if Yale Health Pharmacy takes GoodRx. If needed, you can send your prescriptions to another pharmacy that will take GoodRx.

Bloodwork

• Bloodwork is free at Yale Health, whether you have private insurance or the specialty plan

• Make sure your blood test is done at Quest Diagnostics in the Yale Health building at 55 Lock Street

• Schedule an appointment here

Electrolysis

• Electrolysis is a form of hair removal that plucks out the hair from the root and then cauterizes the follicle through chemical or heat energy, permanently ending hair growth at that site. 

• Effective April 1, 2023, electrolysis is covered at $125 per hour.

• Coverage for electrolysis is on a reimbursement model.

• How to get reimbursed via the supplemental claim process:

  • Obtain the Supplemental Claim Form from the Yale Health website

  • Go to the Form and Guidelines area of the website (below).

• Once there, scroll to the Claims section and access the Supplemental Claim Form.

• The member should fill out the form with the applicable information and submit form, along with proof of payment, via email or mail to the Yale Health Claims department per the form instructions.

• Members typically receive a reimbursement check within 7-10 business days from receiving the request.

Top Surgery

• Yale offers coverage for both transmasculine and transfeminine top surgeries, with varying eligibility requirements.

  • Currently, Yale Health has one top surgeon: Dr. Angie Paik. Paik graduated from Rutgers New Jersey Medical School in 2014 and served as a Research Fellow with their Division of Plastic and Reconstructive Surgery as well as a Plastic Surgery Resident at Brown University Alpert Medical School. After her residency, she pursued a hand and microsurgery fellowship at The Buncke Clinic in 2021. She joined Yale School of Medicine's staff as an Assistant Professor of Clinical Surgery in 2021 and began practicing chest masculinization and feminization procedures for Yale Health in 2022. Several students who have sought consultations with her have stated that she has a history of performing labiaplasties or as a urologist for labiaplasties; it is unclear because Paik refused to clarify her clinical history when pursued for comment.

  • Yale Health has also in the past referred both transmasc and transfem patients to Dr. Melissa Johnson of Pioneer Valley Plastic Surgery in Springfield, MA.

Bottom Surgery

• All forms of bottom surgery (vaginoplasty, metoidioplasty, phalloplasty, vaginectomy, scrotoplasty, hysterectomy, orchiectomy, etc) are covered by Yale Hospitalization/Specialty Care coverage, however there are no surgeons at Yale Health who conduct bottom surgery. (last updated April 2023)

  • Yale Health does have a hysterectomy surgeon, although this surgeon does not also conduct vaginectomies.

• Since there are no surgeons who conduct bottom surgery at Yale Health, students will be referred to Mt. Sinai or NYU Langone.

  • Mt. Sinai — Yale Hospitalization/Specialty Coverage is partnered with Mt. Sinai, so the costs of appointments and surgery will be covered directly by Yale. You will schedule an appointment with a social worker who will ask you about your plans for post-operative care. After this appointment, you will have to schedule a medical and psychiatric evaluation with Mt. Sinai; they do not accept an evaluation from Yale Health. After completing those evaluations and being cleared, a consultation will be coordinated to discuss surgical options.

  • NYU Langone — Yale Hospitalization/Specialty Coverage is partnered with NYU Langone, so the costs of appointments and surgery will be covered directly by Yale. The wait times for NYU Langone are incredibly long; two students seeking care with them had reported requesting a consultation in May 2022 and acquiring a consultation for May 2025. The vaginoplasty surgeon at NYU Langone is a specialist in methods for genitals that have been impacted by the effects of puberty blockers in childhood/adolescence, which changes the techniques for vaginoplasty.

  • Other In-Network Providers — It is not certain that all providers other than Mt. Sinai and NYU Langone are inherently out-of-network, as individuals have in the past secured up-front insurance coverage to see other surgeons. While this does seem to be possible based on prior cases, the amount of work required to navigate Yale Health's bureaucracy to secure and confirm this coverage can easily make it prohibitively difficult to do so.

  • Out-of-Network Providers — You are also able to be fully reimbursed for a surgeon who is not partnered with Yale Health. The caveat to this is that 

  • Here is more information on different kinds of bottom surgery if you want to learn more.

FFS

• [IN PROGRESS; NEEDS TO BE ADDED]

Other Notable Mentions

• Yale Health also covers IUDs (intrauterine devices), which while not directly transition-related are relevant to many vulva-bodied individuals.

The process for accessing surgery starts with your primary care physician, but many things still require letters from mental health providers.

Medical Transition outside of Yale

If you are not on Yale Hospitalization/Specialty coverage, you can still go through Yale Health but it may make sense to look into your other options. For HRT (hormone replacement therapy), there are options both through doctors’ offices and through some organizations, like Callen Lorde, Planned Parenthood, or Anchor Health. Some of these other options may not require a therapist’s letter. For surgery you will need a letter and to find a surgeon. Callen Lorde provides this list. Make sure you have open lines of communication with your insurance provider, and that you find out exactly what will be covered ahead of time. 

Medical Transition Through Planned Parenthood

Note: This information is based on a meeting with Matt Raiti at Planned Parenthood

I. Typical Process for Yale Students Initiating HRT at Planned Parenthood

1. Insurance & Payment

a. Students with Yale Health Insurance

For students enrolled in the Yale Health Plan, the most effective starting point is the Yale Student Health Center. If a referral is not sent, Planned Parenthood (PP) will still see the patient, but billing may become difficult or unpredictable.

b. Students with Other Insurance

Students not set up with Yale Health may initiate care by calling Planned Parenthood’s central hotline at 1-800-230-PLAN. If a student has previously been seen at Planned Parenthood, they may request appointments through MyChart or schedule directly through PP’s online system:
https://www.plannedparenthood.org/planned-parenthood-southern-new-england/patient-resources/make-appointment
(Occasionally, the scheduling portal may be down for maintenance.)

Planned Parenthood does not require prior medical records. For patients already on hormones, clinicians generally accept self-reported medical history, though they may request confirmation if needed.

c. Students without insurance or opting out of using insurance

Planned Parenthood can support these students through sliding-scale payment plans without sending debts to collectors, without interest, and without discontinuing care due to outstanding balances.

PP does not charge interest, send debt to collectors, or deny care due to outstanding balances.

2. Age-Related Considerations

• Ages 18 and older: Planned Parenthood can provide care directly

• Under 18: Yale Health will not cover HRT for minors. Planned Parenthood therefore refers minors to Anchor Health. (Note: Anchor Health is currently taking few new patients.)

3. Initial & Ongoing Care 

a. Initial Appointment

The first visit typically involves:

• Consultation with the clinician

• Determination of whether labs are required

• Discussion of initiation or continuation of hormone therapy

• Prescription sent via MyChart

  • Notes about MyChart:

    1. Scripts are issued through MyChart. The system may automatically pull prior records from other providers; patients may request that outside providers disable record-sharing.

    2. Names and gender markers: MyChart displays the patient’s preferred name. Legal name and legal gender marker—required by insurance—are kept beneath that.

b. Follow-Up Frequency

• First year: visits approximately every three months

• After stabilization: visits every six months or annually

• Labs drawn 1–2 weeks prior to follow-ups

Most patients use Quest Diagnostics. Patients paying out of pocket, avoiding insurance, or concerned about insurance and/or privacy should schedule their labs at the Planned Parenthood Health Center at 345 Whitney Avenue. PP will then send them to Quest in a way that shields costs and prevents insurance from being billed, when needed.

4. Telehealth

Hormone therapy appointments can be conducted via telehealth, including prescription management. In-person visits are not required for most steps unless labs or specific evaluations are necessary.

5. Medications and Pharmacy Considerations

Planned Parenthood carries a limited in-house supply of hormones and typically sends prescriptions to external pharmacies.

• Students without insurance/opting out of insurance may reduce costs by checking GoodRx for generic medication prices.

• For privacy, prescriptions can be sent to a new pharmacy

  • Best option for privacy: Use a non-chain local pharmacy (though GoodRx coupons may not always work there)

If any issues arise at the pharmacy, patients should contact Planned Parenthood immediately and directly.

II. Broader Gender-Affirming Care

1. Understanding Insurance Documents & Choosing Surgeons

PP provides letters of support for surgery. Before selecting a surgeon, patients should review insurance coverage and consider the following: 

The first step in this process is picking a surgeon. When picking out a surgeon it can be helpful to consider the following: 

• Is this surgeon in-network with your insurance and what are other associated costs?

• How far is the surgeon's office from your home?

• How long is the wait time for a consultation and then for the surgery date?

• Is the surgeon a good match for you in their offered procedures, bedside manner, portfolio, and general reputation?

Sometimes patients believe a provider is a good fit for them, but feel differently after meeting the provider in person. For this reason, it can be helpful to schedule a consultation with a couple of providers at a time so, in the event the provider is not right for you, you will not have to restart the entire process.

Insurance plans vary greatly, even within the same insurance company, so it is important to familiarize yourself with your benefits. This can be done by searching your Evidence of Coverage (EOC) or Certificate of Coverage(COC)- this is a lengthy document provided by your insurance and should be accessible through your insurance company's website. If you can not access, please call the number on the back of your insurance card and ask them to email you a copy of your EOC or COC.

Once you access you EOC or COC you can do a key word search (cntrl+f) to find related coverage. Most insurance companies list this under "gender" " gender affirming" or "transgender." There should be a list of covered and non-covered services. If your insurance does offer coverage then you will want to ask your insurance for a list of in-network providers who offer this service. Most insurance websites will have a search function for this. 

You will need a Referral Letter in order to schedule a consultation with your chosen surgeon and Letters of Support to be approved for surgery.

2. Letters of Support and Next Steps

Once a surgeon is chosen:

• PP arranges a 20-minute call

• The provider drafts the Referral Letter and Letters of Support with the client

• PP supplies a list of mental health clinicians familiar with required documentation (as a letter from a mental health provider is often also required)

• There is no fee for this service.

Note About Gatekeeping

Gatekeeping is when health systems keep us from accessing HRT/surgery because they do not think we are trans enough, sure enough, ready, etc. The main thing to know is that there are therapists and doctors at Yale Health who will help you get the care you need, regardless of your experience of gender, both presently and while growing up. Nonbinary people have successfully accessed hormone treatment, and there are therapists who are obviously sympathetic to our needs.