The Twin Cities is home to a comprehensive gender care team that provides transformative care for transgender and gender non-binary patients during all stages of their transition. Over time, the team has steadily grown to incorporate specialized physicians that can meet patients’ unique needs. Surgeons, dermatologists, psychologists, care coordinators and many other medical professionals with University of Minnesota Physicians and M Health Fairview all work to ensure that the process delivers a positive experience.
The University of Minnesota Medical School established one of the longest-running gender care programs within the Program of Human Sexuality in the 1970s, but members of the transgender community still faced significant barriers to obtaining care. Gaps between primary care and specialty care persisted, laboratory work and surgeries were paid for out-of-pocket and discriminatory legislation limited access to treatments and procedures. In addition, care coordination between specialists was almost nonexistent.
M Physicians has worked to eliminate these barriers by providing patients with access to the full spectrum of medical knowledge. “It was about bringing all of these different specialities that don’t normally function in the same clinic space together and coordinating care for patients that need multiple providers to get the care they need done,” said Matthew Mansh, MD, FAAD, M Physicians dermatologist.
Ejay Jack, MSW, MPA, serves as the care coordinator and community liaison for the team and even helped build the program. As a member of the transgender community, Ejay can connect with patients and navigate them through the process. With multiple specialists and procedures needed for each patient, Ejay gets providers the resources they need while managing the varying timelines.
“Coordination of care is very difficult. Yes, tracking hormone levels and surgeries can be difficult, but one of the barriers in the past was not having all of the key players together. Coordinating between all of these providers has become easier now that we have a centralized system. Are we fully there 100 percent? Probably not. But with wider acceptance from the medical and local community, I think things will continue to get better and better."
Nicholas Kim, MD, M Physicians plastic surgeon
Dr. Kim, as well as several others on the team, were recruited to fill a previous void so that patients could access truly comprehensive care. Dr. Kim went into plastic surgery because of its functional approach—reconstruction often helps people regain function—and when the U of M was looking for a genital plastic surgeon, he decided to augment his skillset by training in Ghent, Belgium, with renowned experts.
Sun Hsieh, MD, M Physicians craniofacial surgeon, has a similar story. He completed a specialized training program in Spain with FACIALTEAM, where he worked with and learned from internationally-renowned surgeons who are leading the way in gender care procedures of the face. With his addition to the team, facial gender confirmation surgery, more colloquially known as facial feminization surgery, is now an option as well.
“When I’m looking at helping people, I like working with populations where you can make a huge impact on their life as a whole. We're really trying to set a new precedent within this community. I stepped into a very fortunate situation at the University of Minnesota. A lot of the personnel coordination was already working really well."
Dr. Sun Hsieh
An example: A patient visits with a mental health professional, who then refers them to another provider, and they’re prescribed hormone replacement therapy. The patient begins to develop acne from testosterone and requires laser hair removal. They are then given a referral to a dermatologist such as Dr. Mansh. Ejay continues to manage the timeline and informs the patient and one of the surgeons when it is appropriate to discuss surgical options. After an initial discussion with the patient, surgeons establish a plan for who will do what, since multiple procedures are usually needed. This is a simplification of an incredibly complex process, but it demonstrates the different possibilities and wide-ranging, specialized knowledge that patients have available to them through University of Minnesota Physicians.
Joseph Pariser, MD, M Physicians urologist, is yet another member of the team who joined to help this specific patient population. Dr. Pariser had experience with the transgender community during residency and now regularly collaborates with Dr. Kim to complete surgical plans. “We meet on a regular basis to discuss challenges, and we try to communicate with each other,” Dr. Kim said.
Generally, less invasive procedures are completed first, but the surgeon works to determine the best path for every individual.
“I enjoyed having a connection with patients and doing the unique, creative surgeries that are really impacting their lives,” Dr. Pariser said. “More and more urologists are working on this, and there’s more collaboration between urologists to share knowledge. Surgeries are being more standardized and the cutting-edge stuff is becoming more common.”
The World Professional Association for Transgender Health has resided at the U of M for years, and the organization now sets many of the standard-of-care guidelines for gender care. University of Minnesota Physicians has been and will continue to be a destination for the transgender community. The current gender care team is efficacious because it covers all aspects of care and provides an experience that can’t be found elsewhere in Minnesota. Now, as access to gender care improves nationwide, and with the United States Supreme Court's recent affirmation of LGBTQ+ rights, an increase in patient volume is expected.
Dr. Mansh said, “I think gender care will become increasingly important for all physicians in the future. I see over 100 patients a week normally, and even from epidemiology, it shows that you’re going to be seeing these patients more often, so being comfortable providing care from the medical and surgical standpoint is important.”