Transgender, gender expansive, non-binary Veterans’ guide to navigating Minneapolis VA

According to VHA Directive 1341 Providing Health Care for Transgender and Intersex Veterans, “It is VHA policy that staff provide clinically appropriate, comprehensive, Veteran-centered care with respect and dignity to enrolled or otherwise eligible transgender and intersex Veterans, including but not limited to hormonal therapy, mental health care, preoperative evaluation, and medically necessary post-operative and long-term care following gender confirming/affirming surgery. It is VHA policy that Veterans must be addressed based upon their self-identified gender identity; the use of Veteran’s preferred name and pronoun is required.

LGBTQ+ Veteran care

Our LGBTQ+ Veteran care coordinators are fully equipped to support you.

The following services and treatment options available at Minneapolis VA medical center.

Transgender/gender-diverse support group

A support group for transgender/non-binary/gender-diverse Veterans that meets once per month. Currently, the group is meeting via VA Video Connect. If you want more information about the group, please talk with your outpatient mental health provider. If you are interested in attending this group, request that your mental health provider contact staff psychologist, Holly McKinley, PsyD, LP, who facilitates the group.

Individual therapy

Though not a requirement, psychotherapy is recommended for individuals exploring gender identity and/or pursuing transition. Psychotherapy can provide a setting in which individuals can explore options for gender identity and expression and navigate challenges (e.g., coming out, finding safe spaces, building community). Psychotherapy can also address mental health symptoms that may impede progress toward gender-related goals. To request individual therapy support if you are not already connected to the mental health service line, call Mental Health Intake at . If you are already seeing a mental health provider and want to actively incorporate gender identity into your care, you are encouraged to come out to your provider.

Couples therapy

Transition can affect partnerships and families too. Couples therapy is available to help navigate changes related to transition. If you already have a mental health treatment coordinator, ask them to refer you to couples therapy. If you do not have a mental health treatment coordinator you will first need to get connected with mental health services by calling Mental Health Intake at and after an initial intake appointment ask for a referral for couples services.

Gender-affirming hormone therapy

Hormone therapy can be provided/managed through your primary care physician if such treatment is judged to be safe and appropriate for your care.

Before hormone therapy can begin a diagnostic and mental health readiness evaluation must be completed by a licensed mental health provider. Mental health providers may differ in their levels of comfort and expertise with these evaluations. If you are already working with a mental health provider who feels comfortable completing a diagnostic assessment for gender dysphoria as well as a mental health readiness evaluation for gender-affirming hormones, have them provide these services and document the results in your medical record. If your mental health provider does not feel qualified to do these evaluations, request that they put in a consult. They can find the consult request under Mental Health Consults for Outpatients (Mental Health Evaluation for Medical Intervention).

If your medical provider needs support or assistance in initiating or monitoring hormone therapy, you can recommend they submit an e-consult with specific questions and an expert team will provide guidance/recommendations. They can find the consult request on the main consult request page in CPRS (Transgender National E-Consult).

Fertility preservation

If a medical intervention for gender affirmation may negatively impact the Veteran’s reproductive capacity, VA is able to pay for up to five years of cryopreservation should the Veteran wish to preserve fertility. VA will not pay for the IVF or other fertility treatments to use the preserved eggs/sperm.

Hair removal

Veterans in the Minneapolis VA Health Care System are eligible for facial hair removal by laser or electrolysis. This care is provided through a care in the community consult. If you have been diagnosed with gender dysphoria, your primary care or mental health provider can submit a community care dermatology consult for this medically necessary procedure to alleviate symptoms of gender dysphoria.

Letters in support of gender-affirming surgery

Although VA does not currently provide or pay for surgeries with the specific goal of gender affirmation, VA providers can write letters of support to be used towards surgery outside VA. Letters can be written after undergoing a readiness evaluation with a qualified mental health provider. Please consult with your surgeon to ensure the requirements for type of provider (e.g., doctoral-level mental health provider) and documentation are met. If you are already receiving mental health services, you can ask your provider to write you a letter in support of surgery.

Corrective procedures and post-operative care

Veterans can access corrective medical procedures and surgeries if complications arise from gender-affirming surgeries obtained through community providers.

Carry letters

Veterans can request a ‘carry letter’ from their medical provider to facilitate day-to-day interactions where a person might benefit from confirmation of their gender identity and advocacy for equal treatment. In addition, such letters may be required for legal name change and gender marker change, depending on your state of residence.

Speech therapy

Voice and communication training is available through our speech pathology department. The focus of training includes work on verbal and non-verbal aspects of communication. To set up an initial session please request a speech pathology consult from your primary care provider within the VA. Once the consult is placed our medical support staff will contact you to set up an appointment.

Prosthetics

If you have been diagnosed with gender dysphoria, your primary care or mental health provider can submit a request for medically necessary prosthetics to alleviate symptoms of gender dysphoria. Current approved items are breast forms, bras, wigs, chest binders, STPs, packers and packing harnesses/underwear, gaffs, and vaginal dilators. When entering a prosthetic consult, your provider should 1) verify the diagnosis of gender dysphoria, 2) clearly state the medical necessity of the requested prosthetic item, as well as 3) provide details of the item being requested so the correct item can be dispensed.

Changing your name/gender marker in your medical chart

For legal name change, Veterans should fill out form 10-5345a (Individuals’ Request for a Copy of Their Own Health Information) as well as submit the necessary documentation for name and/or gender marker change. Please see the Minneapolis VA LGBTQ+ Veteran care website for forms and full details regarding how to update name and/or gender marker in VA patient record system. Veterans additionally have the option for their chosen name, pronouns, and self-identified gender identity to be reflected in their chart. Veterans can contact the Eligibility and Enrollment department ) to submit this information.

Education resources

The Health and Wellness Learning Center (1S-134) near the outpatient entrance has a variety of books available for Veterans related to LGBT identities. Reading material ranges from personal memoirs, histories of LGBT communities, resource guides, and general education related to LGBT identities. For VA providers, the medical library has a variety of educational resources available related to transgender identities and culturally competent and inclusive care services.

Other VA resources

• If your provider(s) has questions about transgender health care within VA, encourage them to submit an e-consult with specific questions and an expert team will provide guidance/
  recommendations. They can find the consult request under “other consults” as part of the
  outpatient consult menu (Transgender E-Consult).
• If your provider(s) need more specific information regarding general transgender health care and/or accessing services within the Minneapolis VA, encourage them to visit the Minneapolis VA Transgender Health Care SharePoint site (only available internally).
• For more information regarding local and/or national resources, please visit the Minneapolis VA LGBTQ+ Veteran care website.
• If you encounter any issues with your care, or need additional help navigating the system, please contact our LGBT Veteran Care Coordinators: Rebekah Austin, LICSW; Teresa Capecchi, MSN, RN; Eliza McManus, Ph.D., LP; Paul Portenlanger, CRNA; Molly Smith, MSW, LICSW; or Lauren Robinson, BSN, RN, by sending an email to VHAMINLGBTVCC@va.gov
• If you are in crisis
  • Call the Veterans Crisis Line at 988 (press 1), chat on-line, or text 838255.
  • Call the Trans Crisis Line (a non-VA crisis line staffed 24/7 by transgender people) at 1-.

NOTE: VA does not provide or fund gender confirming/affirming surgeries because VA regulation excludes them from the medical benefits package.

VHA Directive 1341 “Providing Health Care for Transgender and Intersex Veterans”, May 23, 2018