LGBTQ+ Veteran Care

Care we provide at VA San Francisco health care

We promote the health, welfare, and dignity of Veterans who identify as lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) or a related identity. We focus on ensuring a safe, welcoming, and affirmative environment when providing you with sensitive and high-quality health care services like: 

• Primary and specialty care
• Substance, alcohol, and tobacco use treatment
• Intimate partner violence reduction and treatment of after-effects
• Treatment and prevention of sexually transmitted infections, including PEP (post-exposure prophylaxis) and PrEP (pre-exposure prophylaxis) for Veterans at risk for HIV
• Military Sexual Trauma (MST) screening and treatment of after-effects
• Whole Health
• Cancer screening, prevention, and treatment

Gender-affirming care:

• Gender-affirming hormone therapy, with the option of egg or sperm preservation before starting hormones
• Gender-affirming prosthetics, gender-affirming speech therapy, and gender-affirming hair removal (electrolysis and laser services available through VA-authorized community care)

Mental health care

• Mental health care, including pre and post-surgical planning and support for gender-affirming surgeries performed outside of VA. Most mental health care can be accessed virtually, through a computer or mobile device from the comfort of your home or at your nearest VA health facility
• Mental health groups specifically designed to meet the needs of LGBTQ+ Veterans and peer support services with an LGBTQ+ Veteran peer
• Suicide prevention services - If you or someone you know is having thoughts of suicide, contact Veterans Crisis Line to receive, confidential support and crisis intervention available 24 hours a day, 7 days a week, 365 days a year. Dial 988 then press 1, text 838255, or chat online at VeteransCrisisLine.Net/Chat

Multidisciplinary Comprehensive Gender Affirming Care Center (CGACC)

San Francisco VA Health Care System (SFVAHCS) is home to a multidisciplinary Comprehensive Gender-Affirming Care Center (CGACC), staffed by experts in the field. Referrals to the CGACC can be made by any VA provider. The majority of our services can be provided via telehealth, including some services available to Veterans enrolled in other VAs in VISN 21 (Northern and Central California, Nevada, Hawaii, and Guam). If you are a Veteran enrolled in one of these regions, and you are not already seen at SFVAHCS for the majority of your care, you may request that one of your providers place an interfacility consult to find out more about the services we can offer.

Please note that VA currently provides all medically necessary gender-affirming care to transgender Veterans with the exception of gender-affirming surgical interventions, due to an exclusion in the VA medical benefits package. The LGBTQ+ Health Program, nationally, announced in summer 2021 that VA will be initiating the rulemaking process to modify the Code of Federal Regulations (CFR) to expand VA’s care to transgender Veterans to include gender-affirming surgery. This process takes time, and more information can be found at the national program’s website. In the meantime, SFVAHCS continues to offer all other medically necessary gender-affirming care.

If you are seeking gender-affirming surgeries, our team is often able to work with you to identify other means of financial coverage, such as MediCal, Medicare, and other health insurance. Referral letters from clinicians needed to obtain these surgeries outside of VA can be written by your VA providers, including providers in the CGACC.  VA also provides medically necessary post-operative and long-term care following gender-affirming surgery. In some cases, this can mean surgical revisions for a surgery that has already been performed by someone outside of VA. If revisions are required, surgeons at SFVAHCS may be able to perform these revisions. Surgical revisions are typically performed by surgical subspecialties already housed within VA, and several of our surgeons are familiar with revision surgeries following gender-affirming surgical procedures, as they also perform these surgeries at our academic affiliate, UCSF.

Please also note that Veterans cannot be denied access to surgical interventions that are medically indicated for other medical conditions simply because the procedure is also consistent with transition goals.

Connect with the Comprehensive Gender Affirming Care Center (CGACC)

Policies and practices to know

The care coordinator can help you get started with care or with navigating any of these issues.

Visitation: Veterans may choose anyone they like to be present with them, for emotional support, during hospital stays.

Definition of family: "Family" may include individual(s) not legally related to the individual. Family members include spouses, domestic partners, and significant others of any gender.

Advance directives: Veterans may designate any person as a decision-maker for care if they won't be able to make these decisions themselves. This includes partners of any gender. Advance directive agents are chosen by the Veteran and do not need to be biologically related.

Documentation in medical records: VA San Francisco maintains the confidentiality of information about sexual orientation, sexual behavior, and gender identity, just like any other private health information.

Changing name or gender in records: Your name in your medical record will reflect your legal name. If you change your legal name, you can request that your record be changed to reflect your legal name change. Use this link to learn how: How to Change Your Legal Name on File with VA

It is VA policy that Veterans must be addressed and referred to by the Veteran’s chosen name, even when the Veteran is not present. The medical record system has created a preferred name field to help VA staff know this information. The preferred name may also be referred to as the “chosen name” or the “name used.” A preferred name field can be added by contacting Member Services at 415-221-4810 ext. 24066.

VA understands that Veterans with transgender and gender-diverse identities face increased health risks and unique challenges in health care, and is committed to promoting a welcoming environment that is inclusive of all Veterans. Previously, your medical record had only one place for your sex and gender. Now, you can have both your birth sex and your self-identified gender identity in your medical record.

Restrooms: You may use any restroom that aligns with your self-identified gender identity. For example, if you self-identify as a woman, you may use the women’s restroom. If you self-identify as a man, you may use the men’s restroom. If you prefer a single-stall restroom, there are several single-stall restrooms throughout the main facility, and in most VA Clinics. On wayfinding maps, these will be identified as “unisex” or “gender-neutral” restrooms.

Gendered spaces (i.e., waiting areas, inpatient rooms): You may access any space that aligns with your self-identified gender. There are no gender restrictions on any waiting areas throughout VA. If you have an appointment in the clinic the waiting room is attached to, or if you are accompanying someone who does, you are welcome in the space. If you need to stay at the hospital for any reason, if room assignments are based on gender, you will be roomed according to your self-identified gender, unless you request otherwise.