Transgender Medicine Treats the Whole Self, Uniquely

Jun. 30, 2021

Transgender patients need individualized care to meet their goals. UC Health’s subspecialists are passionate about providing it.

There may be no better example of individualized medicine than the multidisciplinary care UC Health provides transgender people.

As an academic health system, UC Health offers subspecialists who are highly trained in treatments and procedures that address the varying needs of LGBTQ+ individuals — in addition to their overall health and wellness.

“We take part in every part of their care journey – and aspect of gender journeys are part of that. It’s not separate from anything else they’re experiencing in their physical and mental health,” said Sarah Pickle, MD, associate professor in the Department of Family & Community Medicine at the University of Cincinnati College of Medicine and a UC Health physician. Dr. Pickle is also an expert in transgender medicine.

“We treat the entire person.”

Transgender (the “T” in the LGBTQ community) can describe the gender identity of an individual whose gender is different from that which was assigned at birth. Transgender people may take steps toward aligning their gender identity, their internal sense of self, with their outward expression.

This process can involve social, professional, mental health, legal, physical and medical/surgical changes — it’s up to each individual to determine what their gender journey looks like.

“We can understand each patient’s goals and identify key subspecialists at UC Health who might be a part of that healthcare journey,” said Dr. Pickle. “We often have the ability to keep that patient’s care in our system because we have these subspecialists right at our fingertips.”

LGBTQ Access to Healthcare, Right Here in Cincinnati

It’s not just access to multidisciplinary, highly specialized services and treatments that make UC Health a destination for LGBTQ medicine.

UC Health’s affiliation with the University of Cincinnati makes it a hub for research and teaching — pioneering new treatments and procedures and training the physicians and clinicians of tomorrow.

“What patients are going to see at UC Health is leading-edge physicians who are using evolving and dynamic information about transgender health to create best practices for care,” Dr. Pickle said.

“Transgender medicine is a burgeoning specialty. We don’t always have decades of really well-developed research studies and outcomes, when compared to research involving cis-persons (people whose gender matches the one they were assigned at birth). Instead, we have a smaller amount of research that has been increasing over time, and a growing national and international team of physicians who are developing best practices — and that’s happening here at UC Health.”

Dr. Pickle and Shanna Stryker, MD, assistant professor in the Department of Internal Medicine at the UC College of Medicine and a UC Health physician, have conducted research with their team related to training mental health professionals and physicians in transgender medicine.

“We are training medical students and residents in transgender medicine,” she said. “As our science is evolving and our ability to create best practices is growing, we are prepared to teach the next generation of physicians to meet the needs of transgender people in our community and beyond.”

That’s just one example of the ongoing research at UC and UC Health to move the needle in the United States and beyond — toward better, more innovative transgender care.

Take the field of infectious diseases. Transgender people have higher rates of HIV than cisgender people, requiring subspecialized care and treatment.

According to a 2019–2020 study by the Centers for Disease Control and Prevention, among transgender women interviewed, 42% had HIV.

The UC Health Division of Infectious Diseases Practices are conducting studies engaging transgender individuals to develop new ways to prevent HIV infection, according to Carl J. Fichtenbaum, MD, professor in the Division of Infectious Diseases in the Department of Internal Medicine at the UC College of Medicine and a UC Health physician. Researchers are comparing injectable medications that can prevent HIV to once-daily medication that is proven to prevent HIV.

In the UC Health Voice and Swallowing Program, researchers are gathering data on gender spectrum voice therapy attendance, treatment progress and outcomes in the transgender patient population.

“Our research project aims to understand barriers and facilitators to patients seeking gender-affirming voice care,” said Victoria McKenna, PhD, CCC-SLP, assistant professor in the Department of Communication Sciences and Disorders at UC, who is partnering with UC Health on this research.

Dedicated healthcare for transgender people is also an important part of UC Health’s purpose to advance healing and reduce suffering, bolstered by our foundational value of inclusion.

“For so many of our transgender patients, they have been marginalized, and they’ve been on the outskirts of medicine, and that’s because they’ve been discriminated against,” Dr. Pickle said. “Part of our mission of putting patients and families first means we work diligently to reduce and then eliminate health disparities — and that starts with creating safe spaces to engage with clinicians.”

Multidisciplinary Care, Treatment and Services at UC Health for LGBTQ and Transgender Patients

Subspecialties within internal medicine that address the needs of transgender patients include:

  • Infectious Diseases: Help patients prevent and treat HIV. To learn more about potential studies involving transgender people and HIV, call 513-584-6383. 
  • Endocrinology, Diabetes and Metabolism: Prescribe and manage or hormone replacement therapy (HRT). Depending on their gender, patient’s hormones for feminization (estradiol) or masculinization (testosterone), and for male-to-female transgender persons, an agent is used to block effects of testosterone (bicalutamide).

Gender-Affirming Chest Surgery (“Top Surgery”)

The UC Health Division of Plastic and Reconstructive Surgery offers gender-affirming chest surgery at UC Medical Center and West Chester Hospital.

Gender-affirming chest surgery, also called “top surgery,” involves masculizing the chest (breast reduction/removal) or feminizing the chest (breast implantations).

“Our goal is to provide world-class reconstructive and aesthetic surgery for the range of conditions encountered at an academic health system,” said W. John Kitzmiller, MD, professor in the Department of Surgery at the UC College of Medicine; chief, Division of Plastic, Reconstructive & Hand Surgery/Burn Surgery and a UC Health physician.

“We have a well-established top surgery program, and we are exploring the process of expanding to provide bottom surgery. It has been very gratifying to help our patients on their journey.”

Surgical Urology

UC Health Urology offers patients orchiectomy, or the surgical removal of the testicles.

“Our dedicated healthcare teams from different subspecialties are committed to serving our patients from the community and the region,” said Ayman Mahdy, MD, PhD, interim chief of Urology, associate professor in the Department of Surgery at the UC College of Medicine, R. Bruce and Barbara Bracken Endowed Chair in Surgical Urology, director of Voiding Dysfunction and Female Urology, medical director of Urology at West Chester Hospital, and a UC Health urology surgeon.

“Providing the necessary medical care to our gender affirmation surgery patients is no exception.”

Obstetrics & Gynecology

UC Health provides preventive care and comprehensive family planning to all — including its transgender patients.

“I provide transgender-specific services because everyone should have equal access to quality healthcare and feel welcome, wherever they may be in their transition. I specialize in comprehensive family planning services and minimally invasive gynecology,” said Priya Gursahaney, MD, assistant professor in the Department of Obstetrics & Gynecology at the UC College of Medicine and a UC Health physician.

The UC Health Obstetrics & Gynecology team also offers surgical options that may be part of a transgender patient’s transition care:

  • Hysterectomy (removal of the uterus).
  • Oophorectomy (removal of the ovaries).
  • Sterilization.

“I have been offering surgical treatments for female-to-male transgender patients for about the last nine years,” said Brian Miller, MD, assistant professor in the Department of Obstetrics & Gynecology at the UC College of Medicine and a UC Health physician. “I specialize in minimally invasive hysterectomies. I am happy to provide these services in a very accepting, nonjudgmental office, and have the support of UC Medical Center.” 

Added David Kappa, MD, also an assistant professor in the Department of Obstetrics & Gynecology and a UC Health physician: “I provide the services primarily because it is an area of need that I believe in and that taking care of this population is rewarding and satisfying.”

Voice Surgery and Voice Therapy

An expert team of laryngologists (physicians/surgeons with specialized training in voice) and voice therapists (speech language pathologists) have unique experience in voice modifications for transgender people.

“My unique skillset is in endoscopic voice surgery and open reduction thyroid chondroplasty (tracheal shave, or an Adam’s apple reduction) for gender dysmorphic disorder,” said Rebecca J. Howell, MD, director of Robin Cotton & Rocco dal Vera Professional Voice, Swallowing, Airway; chief in the Division of Laryngology; and associate professor in the Department of Otolaryngology-Head & Neck Surgery at the UC College of Medicine and a UC Health physician.

“The transgender population is a unique group that is often underserved in our community,” Dr. Howell said.

The team also offers gender spectrum voice therapy. Administered by a board-certified, speech-language pathologist (SLP), this form of therapy trains gender-diverse patients to communicate in a way that better matches their gender identity. In doing so, voice therapy can reduce the risk of depression, anxiety and self-harm related to gender dysphoria.

“I am committed to advocating for comprehensive health access for transgender patients within the Cincinnati community, and gender spectrum voice therapy is a way in which I can directly support this highly marginalized population,” said Renée Gustin, CCC-SLP, speech-language pathologist for the Voice and Swallowing Center in the Department of Otolaryngology-Head & Neck Surgery at the UC College of Medicine and a UC Health provider.

“Voice therapy is an important tool that helps gender diverse patients find their true voices, both physically and emotionally.”

Reproductive Endocrinology and Infertility

UC Health’s Center for Reproductive Health provides fertility preservation options, including egg, sperm and embryo freezing (cryopreservation) for future use. Subspecialists can also help patients or couples attempt to achieve pregnancy with donor eggs, donor sperm, donor embryos and/or with use of a gestational carrier.

“Both medical and surgical gender-affirming treatments may impact one’s fertility and ability to conceive in the future,” said Emily Hurley, MD, assistant professor in the Division of Reproductive Endocrinology and Fertility in the Department of Obstetrics & Gynecology at the UC College of Medicine and a UC Health physician. “We believe it is every patient’s right to have a chance at building a family, and we are here to assist in that process.”

Mental Health

UC Health Psychiatry provides services to transgender people that range from helping individuals explore gender identification and expression, to treating a wide range of psychiatric illnesses with medication.

“Scientific literature informs us that transgender and nonbinary gendered individuals experience depression and anxiety at higher rates than the general population and that suicide risk is one of the major health disparities in this population,” said Stephen Rush, MD, associate professor in the Department of Psychiatry and Behavioral Neuroscience at the UC College of Medicine, medical director of Ambulatory Services for UC Health Psychiatry and a UC Health physician.

“I am passionate about providing specialized services for patient populations that are underserved and take seriously the sensitivity, knowledge base and collaboration with other clinicians that is necessary,” said Dr. Rush.