Transgender Program Addresses Unique Patient Community’s Needs

by Cecile Unger, MD, MPH

The move to incorporate “transgender health” is at the top of many hospital agendas nationwide. With the increasing visibility of the gender minority community, hospital systems are becoming acutely aware of the pressing need to incorporate healthcare services for transgender and genderqueer individuals.

For decades, providers with varying clinical backgrounds have been offering important basic healthcare, as well as transgender-specific services, to these patients. But their access to such care has often been challenged by multiple barriers, including a lack in the actual number of providers willing and able to care for these patients.

Lack of surgical care

The biggest deficit has been in comprehensive care for transgender patients. Few hospitals offer wide-spectrum services, ranging from routine medical visits to assistance in the physical transition process. Even fewer institutions offer surgical care for patients wishing to undergo what is known as “gender-affirming surgery.” Historically, surgery (especially genital surgery) has remained in the private sector, with few academic or university-based hospitals offering this type of care.

Over the last few years, academic hospital centers have actively expanded services to gender- and sex-minority patients, building lesbian, gay, bisexual and transgender (LGBT) as well as “gender” practices, and even centers of excellence.

Pediatric origins

This movement has largely come from large pediatric hospitals, where providers recognize the need to identify and care for gender-nonconforming or transgender children and adolescents using a multidisciplinary approach. This need has spread to the adult population, so that comprehensive care teams are being created across the country. Many are in their infancy, but with the push to ensure that patients are well cared for, a few academic centers have successfully grown such services.

Cleveland Clinic is among these centers. Having recognized the need to provide comprehensive services to transgender patients, our enterprise has supported the development of a multidisciplinary team of medical providers to care for patients. The team’s mission is fourfold:

• To provide world-class care for transgender patients using a team-based approach, in partnership with every clinical institute across our enterprise
• To ensure a safe environment that maintains the respect and dignity of all patients
• To create and implement educational initiatives on the care of trans patients and to improve providers’ understanding of the gender spectrum across the region
• To spread awareness of transgender services (many team members are invited to lecture on transgender health and medicine across the country)

Multiple specialties involved

The transgender team includes specialists from internal medicine, gynecology, psychiatry, endocrinology, female pelvic and reconstructive surgery, urology and plastic surgery. Pediatric and adolescent medicine specialists are also an important part of our team.

We offer routine medical care, tailored specifically to patients’ needs, as well as transition-specific services. These services include psychiatric assessment and therapy; hormone therapy and surveillance; and gender-affirming procedures, including gender confirmation surgery.

Our transgender team continues to grow in order to accommodate patient volume and needs as this important subspecialty evolves.

Dr. Cecile Unger, of the Section of Female Pelvic Medicine and Reconstructive Surgery, specializes in vulvovaginal reconstruction, pelvic floor surgery and genital confirmation surgery for transgender women. She can be reached at ungerc@ccf.org or 216.444.6601.