Reproductive & gender health.

Adolescents and adults seeking reproductive, sexual, and gender health care integrated with their primary-care record at this practice. Specifically: contraceptive counseling and provision (combined hormonal, progestin-only pills, the patch, ring, depot medroxyprogesterone, IUC, Nexplanon) per the CDC US Medical Eligibility Criteria for Contraceptive Use, 2024; emergency contraception; preconception counseling; prenatal coordination through 28 weeks with handoff to a delivering obstetric service; postpartum primary-care follow-up; perimenopause and menopause hormone therapy aligned to the Menopause Society 2022 position statement; gender-affirming hormone therapy on the UCSF Transgender Care informed-consent model; STI prevention and treatment per CDC STI Treatment Guidelines; and PrEP per CDC clinician guidance.^[01]

This monograph is co-owned by Tessa Voorhies, DO (procedural and prenatal coordination) and Maren Vanderlyn, MD (menopause and GAHT). Helena Rey, FNP-BC performs IUC and Nexplanon placement and removal as a routine part of CCH-005 and serves as primary prenatal-coordination clinician for adolescents.

The visit shape: 30–45 minutes for contraceptive counseling and same-day device placement; 60 minutes for a preconception visit; 30 minutes for routine prenatal visits, with a written handoff to the delivering service at 28 weeks; 45 minutes for a perimenopause new-visit; 75 minutes for a GAHT new-evaluation visit and 30 minutes for ongoing GAHT follow-ups (every 3 months for the first year of estrogen or testosterone therapy, every 6 months thereafter).

For GAHT we use the informed-consent model. We do not require letters from mental-health professionals to initiate hormone therapy in adults. We use the WPATH Standards of Care v8 and the UCSF Transgender Care guidelines as our clinical references, and we screen for and address co-occurring mental health conditions through CCH-003 when indicated.^[02]

Adolescents age 14 and older for contraceptive and STI care under NY Public Health Law § 17; age 16 and older for GAHT initiation (parental engagement encouraged but not legally required); all adults. Insurance: same in-network list as CCH-001.

For contraception with cost concerns, we participate in the NYS family-planning expansion benefit for income-eligible patients without insurance. Title X clinic referrals: Planned Parenthood of the Mid-Hudson Valley, Kingston.

• Contraceptive counseling (CCH-004-CC) — 30 min, same-day device placement available for established patients with prior consult.
• Preconception (CCH-004-PC) — 60 min, including MotherToBaby-aligned medication review.
• Prenatal coordination (CCH-004-PR) — 30 min, every 4 weeks weeks 0–28, with handoff to delivering service at 28 weeks. We do not perform routine ultrasonography for dating/anatomy; MidHudson Regional performs.
• Postpartum primary care (CCH-004-PP) — 60 min at 4–6 weeks postpartum.
• Menopause new-visit (CCH-004-MN) — 45 min; ongoing follow-up every 6 months.
• GAHT new-evaluation (CCH-004-GAHT-N) — 75 min; follow-up at 3, 6, 9, 12 months and every 6 months thereafter.

• Intrapartum care. We do not deliver babies. We coordinate prenatal care through 28 weeks and refer to MidHudson Regional Obstetrics or to NYU Langone MFM for high-risk care.
• High-risk obstetrics (preeclampsia history, multiple gestation, gestational diabetes requiring insulin). Coordinated with MFM from the first prenatal visit; we are the secondary clinician.
• Surgical contraception (tubal, vasectomy). Not performed here. Hudson Valley Urology performs in-office vasectomy. Tubal surgery via gynecology referral.
• Gender-affirming surgery. Not performed here; surgical referrals coordinated with the patient's preferred surgeon. The WPATH SOC v8 describes the readiness criteria each surgical program will use.

1. High-risk pregnancies that require shared management with MFM from the first prenatal visit — we will be the secondary medical home, not the primary prenatal clinician.
2. Patients seeking pregnancy termination — we counsel and refer; Planned Parenthood in Kingston is the closest provider.
3. GAHT initiation in patients younger than age 16 — referred to a hospital-based gender-affirming program (Boston Children's GeMS; NYU Langone Transgender and Non-binary Health).
4. Active psychiatric instability that would compromise informed consent for hormone therapy — addressed first in CCH-003; GAHT initiation paused, not refused.

For contraceptive consults: bring last menstrual period, any prior contraceptive history (including reasons for stopping each method), and any imaging or sexual-history information you want us to know first. Same-day device placement requires the consultation visit to be completed first; for established patients we can compress this into a single visit.

For GAHT: the new-evaluation visit covers the informed-consent process, baseline labs, the medication options and their typical effect timelines (drawing on the UCSF Transgender Care guidelines), and a written follow-up schedule. We will not initiate hormone therapy in the same visit as the new-evaluation — first labs, second visit for prescription, with rare exceptions.

For prenatal coordination: bring any pre-pregnancy prenatal vitamin information, your delivering hospital preference, and your delivering clinician preference. We finish at 28 weeks; the chart, the records, and a printed handoff summary are sent to your delivering service at that visit.

Insurance: contraceptive devices and counseling are covered without copay under the ACA preventive-services list at most plans. Hormone therapy (estrogen, testosterone, progestins) is covered as a standard prescription benefit. GAHT-related labs are covered as standard preventive labs at most plans; we will run the eligibility check at intake.

Membership: $95/month adult covers all CCH-004 visits. Devices (IUC, Nexplanon) and lab/imaging fees are billed to insurance separately.

Cash pricing for an IUC placement (visit + device + insertion) ranges from approximately $700 to $1,200 depending on the device chosen, less than the published rate at the regional academic centers. Bedsider — Methods lists typical national costs by method.

• Fertility treatment (IVF, IUI, hormonal stimulation cycles). Not offered. Referral to Boston IVF or CNY Fertility; we provide the workup and the referral letter.
• Hysterectomy / surgical gynecology. Surgical gynecology referred. Brigham — Reproductive Surgery.
• Hormone-pellet therapy. Not offered. We follow standard-of-care formulations.

This monograph is co-owned by Tessa Voorhies, DO (procedural and prenatal) and Maren Vanderlyn, MD (menopause and GAHT). Helena Rey, FNP-BC contributes the device-placement procedural sections.

v2026.04.12 — supersedes v2026.01.05. Significant changes: § Indications updated to cite the 2024 CDC US MEC; § Mechanism reworded to clarify that we are explicit about the informed-consent model for GAHT; § Outcomes table refreshed. Diff on the errata page.