Transgender care at The Polyclinic

Learn about our history of transgender care.

December 24, 2020


Dr. Kevin Hatfield is a family medicine doctor at The Polyclinic Downtown. He has one of the largest groups of transgender care patients in the Puget Sound area.

Two years ago, Dr. Hatfield began to notice a trend that many of his patients were new to the area and had moved to Washington for their transgender care.

"One of my patients had moved here because he'd read online that Washington is a very trans-friendly state," said Dr. Hatfield. "He wanted to transition here because he couldn't afford to do it where he was living." 

The state insurance commissioner required that all health care insurers in Washington must cover transgender care in 2014. Several other states mandate equal coverage for transgender patients.

Caring for an underserved community 

When Dr. Hatfield began his practice in 2002, he publicly welcomed all LGBTQ patients. Dr. Hatfield always had an interest treating transgender patients. Over the years his reputation has grown. Today, he has one of the largest gender care practices in the region.

While building his primary care practice, Dr. Hatfield recognized the need for specialty care for his gender care patients and reached out to Polyclinic colleagues Dr. Emily Bradley, a urologist, and Dr. Rebecca Kulgren, a gynecologist.

“Dr. Hatfield asked if anyone in our office was open to gender care patients and I said yes, along with my OB/GYN partners, Drs. Emily Norland and Katherine Schwab,” said Dr. Kulgren. “This has been one of the most rewarding areas of care that I have ever provided.”

The importance of an outward welcome is valued by all the doctors. "Patients come in with a lot of fear and worry about being judged. We strive to make our gender care patients feel accepted and comfortable,” said Dr. Kulgren.

Dr. Bradley, who performs orchiectomies to remove testicles for transgender women, says that she has really enjoyed building this part of her practice and providing this service to the transgender community.

"The surgery I do as part of gender care is the most common reason that I see transgender patients. However, I am also known as a provider for transgender patients for other urologic issues and conditions, as well.”

Polyclinic plastic surgeons Dr. Jeffrey Kyllo and Dr. Keith Paige are also part of the clinic team serving gender care patients. They do chest reconstruction surgery for both transwomen and transmen.

The Polyclinic can help with many other aspects of transgender care needs, such as long-term hormone therapy.

Challenges to getting transgender care

Until recently, health care services and coverage for transgender patients in Washington was limited. There were no federal laws to safeguard a transgender patient from discrimination or being unable to get equal health care services.

Insurance plans often don't cover transgender care. The Affordable Care Act of 2010 was the first law to set up protections against sex discrimination in health care settings. Some states, including Washington, also require that insurance plans cover transgender care.

Despite limited transgender care services, Seattle is a hub for care compared to other regions. “I see a lot of patients from out of state,” Dr. Cooper continues. “There is an endocrinologist shortage in Alaska, for instance, and very few are doing gender care.”

The National Center for Transgender Rights (NCTR) has a full list of federal laws and policies protecting transgender patients’ access to health care.

Even with coverage improvements, the lack of available providers to offer care services to this community creates a challenge. 

“There are very few fellowships offering this kind of training,” said Dr. Cooper, who completed her endocrinology fellowship through the University of Washington at Harborview Medical Center and the VA Hospital in Seattle.

“I happened to work with a lot of transgender patients because of doing my fellowship in this region,” Dr. Cooper said. “But a lot of providers are going to refuse care to a transgender patient because of inadequate training.”

Together, a select group of Polyclinic’s primary care and specialist doctors are delivering a wide range of services for transgender patients.

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The information provided is for general informational purposes only and is not intended to be medical advice or a substitute for professional health care. You should consult an appropriate health care professional for your specific needs.