I am constantly in awe of the patients I want to treat. I cannot fathom their strength to embrace their identity while overcoming prejudice and discrimination. I do not know what it must be like to fear being your true self everyday.
But I do know what it’s like to be told to keep my career interests quiet. When I was interviewing for residency, my goals of serving transgender patients were unacceptable and “weird.”
When I tell people my career plans the reactions are always polar extremes:
“You have got be kidding me,” or “That’s so cool.”
Quickly followed by the question: “How are you planning on doing gender-confirming surgery?” Or more colloquially, “How do you make a penis or vagina?”
These are difficult questions to answer because there are no focused training programs for gender-confirming surgery within the United States. Now with transgenderism increasing in visibility and acceptance, more surgeons are willing to attempt gender-confirming surgery (Google “transgender surgery” and see for yourself). But the majority likely never received formal training in gender-confirming surgery or even had a lecture on it in medical school or residency.
“What’s the big deal?” you may ask. “Shouldn’t training as a surgeon be enough?” “How does this affect me?”
With surgery becoming exponentially complex, more specialties are forming. A surgeon’s ability to fix a fractured bone or remove a cancer from the belly vastly differs in technique and skill. Similarly, making a face feminine, removing breasts to construct a masculine chest, or taking part of the forearm to make a penis, require expertise. We have seen failures in the regulation of cosmetic surgery leading to disastrous outcomes by providers not trained to perform them. Similar outcomes would be expected for those not trained in gender-confirming surgery. And as we all know, surgical complications can lead to mounting health care expenditure affecting all taxpayers.
On the other hand, gender-confirming surgery may be beneficial to health care economics. When a person is aligned with their true gender, they experience reduced psychosocial sequelae. We rallied behind restoring femininity and reducing mental health suffering in women after mastectomy with the passage of the Women’s Health and Cancer Rights Act. So, too, should transgender patients have the same rights to restore their “-ity,” whatever gender it may be.
Even with the proven benefits to patients and the healthcare system with implementing insurance-covered gender transition, few providers are willing to undertake the more complex aspects of gender-confirming surgery. Transgender patients wanting genital surgery have to wait months to years and travel around the globe to find capable surgeons. Trainees in urology and plastic surgery have expressed desires to improve training in gender-confirming surgery. Yet only in leaving the U.S. are formal apprenticeships available for those desiring to learn these techniques. The dearth of providers and training opportunities make it so patients who want gender-confirming surgery, especially genital surgery, often cannot find a qualified provider in proximity to them. Still, instead of offering options to transgender patients by expanding our provider pool, we focus intently on state of their genitals and the bathroom they can use.
By continuing to ignore the paucity of qualified providers willing to care for transgender patients, focus will shift from delivery of necessary care to further alienating this population with discriminatory laws like the bathroom bills. It’s time we embrace the known benefits of gender-confirming surgery, both medically and economically. It’s time develop training programs to support surgeons who want to undertake care of transgender patients. It’s time I can say: “I’m planning on doing a fellowship in gender-confirming surgery.”
Shane D. Morrison is a plastic surgeon.
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