When Dr. Maurice Garcia was a young surgical intern in San Francisco in the early 2000s, he regularly encountered transgender patients who had horror stories about their encounters with doctors.

Once, a transgender woman came to him distressed that she couldn’t find a surgeon to remove her testicles. Garcia couldn’t fathom why she was having such a difficult time finding someone to perform a simple and common surgery routinely done for people with testicular cancer. He thought it was especially odd because there were significant medical benefits to the procedure; removing the testicles meant the woman could stop taking certain hormones and lower her dosage of other hormones. 

“[She was] told, ‘I’m not a transgender surgeon, you have to find someone else,’” Garcia recalled. “Or, ‘I don’t believe in that.’” 

These kinds of roadblocks moved some patients to seek gender-affirming surgery in Mexico, Thailand or elsewhere, where procedures were cheaper but surgical standards might be lower. When they returned to San Francisco with serious complications from botched procedures, neither Garcia nor his colleagues at the University of California, San Francisco, knew how to manage the injuries.

A Knowledge Gap In Transgender Care

Currently, medical schools devote only an average of five hours of their curriculum to teaching “LGBT-related content,” according to a 2009-2010 survey of deans representing 150 medical schools in North America. This is woefully inadequate to prepare doctors to see and treat the approximately 1.4 million American adults who identify as transgender, and may explain why members of the medical community appear to have such a strained and fraught relationship with their transgender patients. 

Garcia wanted to make things better for his patients. So he sought permission from his superiors to learn more about transgender care and bring the knowledge back to UCSF. He went to the U.K. for a year and put together a curriculum on transgender surgery, training under the guidance of experienced surgeons. When he returned, he established UCSF’s first gender-affirming surgery program.

Now, three years later, he’s brought his expertise to Cedars-Sinai Medical Center in Los Angeles, where he established the hospital’s Transgender Surgery and Health Program — the second such academic medical center to offer gender-affirming surgery on the West Coast, as The New York Times first reported. 

Garcia wanted to make things better for his patients. So he sought permission from his superiors to learn more about transgender care and bring the knowledge back to UCSF. He went to the U.K. for a year and put together a curriculum on transgender surgery, training under the guidance of experienced surgeons. When he returned, he established UCSF’s first gender-affirming surgery program.

Now, three years later, he’s brought his expertise to Cedars-Sinai Medical Center in Los Angeles, where he established the hospital’s Transgender Surgery and Health Program — the second such academic medical center to offer gender-affirming surgery on the West Coast, as The New York Times first reported. 

Garcia believes that academic programs like these are key to helping not just transgender patients in San Francisco and Los Angeles, but patients all over the world. Unlike doctors at private clinics, where it’s thought that the majority of gender confirmation surgeries are conducted, those at academic centers also gather research to be published in peer-reviewed journals that will help deepen the field of genital surgery — perhaps discovering techniques that could help a wounded veteran or cancer survivor retain some measure of fertility, sexual or urinary function.

And most health care professionals, Garcia thinks, would benefit greatly from basic training about transgender patients. He hopes that the research he conducts at his center, as well as the expertise he builds as he develops a model for transgender care, will also help change the dialogue among medical professionals about how to compassionately and competently treat transgender patients.

Performing more gender confirmation surgeries at academic centers is also important because it fills an important gap in medical education, said Dr. Loren Schechter, director of the Center for Gender Confirmation surgery at Weiss Memorial Hospital in Chicago. 

“One of the things that’s lacking in medical schools is gender education,” he said. “When academic medical centers are performing the surgeries, you’ve got exposure to medical students ― the next generation of doctors.” 

Garcia also plans to take the center’s goals a step further by establishing a fellowship program for urology surgeons who want to gain specialty training in transgender surgery. This fellowship, set to launch next summer, is part of a growing movement. The Icahn School of Medicine at Mount Sinai in New York and Weiss Memorial Hospital in Chicago were the first to offer year-long fellowships in transgender surgery in August, and Hahnemann University Hospital in Philadelphia just announced the launch of its new fellowship program for surgeons in November.

Garcia hopes that the spread of fellowship programs in the U.S. means that doctors interested in the field can train at home, as opposed to traveling abroad like he had to when he couldn’t find other experts to mentor him. 

“Private practice is a very lucrative business,” he said. “There isn’t a natural incentive to train people who will then compete with you.” 

The Growth Of Transgender Surgery Centers In The U.S.

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