2023 Gender-Affirming Care - Updates to the IHS Core Formulary

Updated: August 2023

Greetings Clinical Providers,

We write to inform you of recent updates to the IHS National Core Formulary (NCF) that directly impact gender-expansive patients who require medications – commonly known as gender-affirming hormone therapies – for gender dysphoria and affirmation.

New August 2023 Updates!

In August 2023, the National P&T Committee expanded upon the medications approved for contraception and menses suppression. Norgestrel (Opill). an over-the-counter progesterone-based contraceptive medication, was added to the NCF. A subcutaneous formulation of depot medroxyprogesterone acetate (Depo-Provera) was also added; this version of a progesterone-based medication can be self-administered. Additional NCF updates relevant to contraception and menses suppression occurred in 2016 and 2021.

In February 2022, the IHS National Pharmacy and Therapeutics (P&T) Committee (NPTC) approved addition of any drug formulation of estrogen and testosterone to the NCF for medical indications of gender dysphoria/affirmation. This action helps ensure access to essential gender-affirming therapies for gender-expansive patients at all IHS federal direct care and participating Tribal facility pharmacies.

In November 2022, the NPTC also added any depot formulation of leuprolide to the NCF. While added for the FDA-approved indication of prostate cancer, leuprolide can also be used off-label, when clinically indicated, in gender-affirming care to block puberty and suppress testosterone.

In alignment with our Trans & Gender-Affirming Care Strategic Plan¹, we encourage you to consider these gender-affirming hormone therapy agents implemented by the NPTC.

Beyond these measures, we encourage consideration of the following to expand further access to gender-affirming hormone therapies at IHS, Tribal, and urban sites:

Add estradiol patches and parental formulations for gender dysphoria/affirmation
Add any formulation of testosterone for gender dysphoria/affirmation
Add any formulation of leuprolide for gender dysphoria/affirmation
Add micronized progesterone for gender dysphoria/affirmation
Add oral and topical minoxidil and oral finasteride/dutasteride for gender dysphoria/affirmation
Add topical retinoids for gender dysphoria/affirmation

You can speak with a gender-affirming clinical expert via the Clinician Consult Warmline. The warmline, a service of the Indian Country ECHO², offers confidential consultations for clinicians, healthcare providers, and others involved in wellness care delivery for Indigenous Two Spirit, Indigiqueer, trans, or gender-diverse patients. We encourage you to access advice on anonymized issues or general questions for medical, behavioral health, or cultural provision of Indigenous gender-affirming care at no cost to you or your clinic.

Thank you,

Request Clinical Consult

Trans & Gender Affirming Care ECHO

¹ Written by the Northwest Portland Area Indian Health Board and supported through the IHS National

HIV/HCV/STI Program with resources from the Minority HIV/AIDS Fund.

² Indian Country ECHO is managed by the Northwest Portland Area Indian Health Board and supported by the IHS

National HIV/HCV/STI Program through the Minority HIV/AIDS Fund.

Get Connected

Sign-up for ECHO Texts and Emails

Indian Country ECHO