Transgender & Non-Binary Care Frequently Asked Questions

Find questions and answers to topics on gender-affirming surgery, hormone therapy, counseling, and more.

To schedule an appointment with the Pride Network, call 216-957-4905.

How do I make an appointment?

If you are 18 or older, and looking for LGBTQ+ primary care or are interested in discussing medical care for gender affirmation, call 216-957-4906.

If you are under 18, and looking for LGBTQ+ primary care, call 216-957-4906.

If you are under 18, and have concerns about your gender affirmation, call 216-778-3745 for evaluation by our KIDz Pride team.

Do I need letters of recommendation from therapists before I transition?

If you are 18 or over, our clinic uses an informed consent process, which means that you will discuss your medical history, and the risks and benefits of hormonal therapy, along with lab work and examinations tailored to you.

You and your provider will make the decision together about the best way to begin medical gender affirmation and plan for mental health support, surgical support, speech therapy or other interventions as designed for you.

If you are under 18, you and your parents or guardians will start with a conversation with our trained mental health providers.

What is gender dysphoria?

Gender dysphoria is the condition of feeling one's emotional and psychological identity as male or female to be opposite to one's biological sex. It involves a conflict between a person's physical or assigned gender and the gender with which they identify.

I'm unsure of my gender identity. What can I do next?

Lots of people have these struggles at all ages. A good way to start is with a psychologist trained in discussing gender. If you are over 18, feel free to make an appointment to talk with any of our PRIDE providers about options for your care and choices you have.

Can I transition without hormones or surgery?

Yes. Living according to your gender identity does not always mean you need to use hormones or surgery.

You can change your clothing, name, speech, or other things about you to be recognized as the gender you identify with.

If you want to talk about all of these options, feel free to come in to talk with our providers.

How can I come out as transgender/non-binary/genderqueer to my friends and family?

Your identity is your own, and you are the expert in who you are. Let your provider know if you want to talk about strategies and support for sharing this news with the people in your life.

There are as many ways to come out as there are stars in the sky. It can be a difficult discussion as people worry that they will be rejected and may lose their friends and family.

For many people, there are serious issues of emotional, financial, and physical safety that come from telling the people in their lives who they are.

Take as much time as you need to plan to share with others who you really are. It sometimes helps to talk this over with a therapist or counselor before coming out.

While many people prepare for the worst, many families are supportive. Even though you’ve had this gender identity for years, for friends and family, it might be very new. They may need time to come to terms with it.

When can I start hormones to begin my transition?

If you are under 18, that will depend on your working with the PRIDE therapists.

If you are 18 or over, you will be started on hormones after you and your provider decide that you are comfortable moving forward and that you are safe to begin therapy (sometimes this depends on labs or other evaluation). Typically, this takes one or two visits.

When can I have surgery to medically transition?

This depends on the type of surgery you are seeking. Learn more about surgery requirements.

Top Surgery (mastectomy)

We look to the WPATH standards of care. The WPATH Criteria for FTM Top Surgery are:

Persistent, well-documented gender dysphoria
Capacity to make a fully informed decision and to consent for treatment
Be of the age of majority in the country of surgery (and follow SOC rules for children and adolescents*)
Significant medical or mental health concerns, if present, must be reasonably well controlled at the time of surgery

Being on hormone therapy is not a requirement. However, many surgeons request that people on hormones be on those hormones for a year, because hormonal therapy changes people’s chest shape, and that can impact what the surgery will look like. Insurance companies may have different requirements to cover the surgery, if they cover the surgery at all.

Many surgeons want a letter from a mental health specialist that they have assessed your readiness for the surgery.

At MetroHealth, our surgeons require a letter from a mental health specialist and require that you do not smoke tobacco — tobacco smoking decreases the body’s ability to repair itself and can lead to poor surgical results.

Bottom Surgery (hysterectomy/oophorectomy)

For these surgeries, you usually need to have two referrals, from qualified mental health professionals who have independently assessed you.

As well as the criteria listed for top surgery, for bottom surgery the WPATH guidelines call for at least 12 continuous months of appropriate hormone therapy, unless there are reasons why the you can't or won't take hormones.

Breast Enlargement

For transwomen who are not happy with their breast size, we usually encourage them to delay surgery until two (2) years after starting hormones.

This is because, although the breasts usually begin to grow around 3-6 months, a patient won’t get the maximum effect until 2-3 years after starting hormones.