The University of Virginia (UVA) Medical School hosted an educational session on April 13, 2022, about starting a “gender-affirming” health program and offered a continuing education credit to healthcare professionals who participated, according to a video recording obtained through a public records request by the Daily Caller News Foundation.
The session, “Starting a Gender Affirming Surgery Program,” was presented by the UVA School of Medicine Center for Health Humanities and Ethics and featured a lecture from “gender-affirming” surgeon, Dr. Rachel Bluebond-Langner. In the lecture, Bluebond-Langner described principles that led to the rapid growth of the transgender surgery program at NYU Langone Health and articulated the need for more gender health programs, saying that “more centers are needed to meet the demand.”
Bluebond-Langner suggested the uptick in demand for sex reassignment services was due to the expansion of insurance coverage and societal awareness.
“With the expansion of healthcare coverage as well as increased societal awareness and understanding, there are more and more individuals seeking gender-affirming care. More and more individuals who need gender-affirming care,” Bluebond-Langner said.
She described the importance of collaborating with other medical specialties when growing a gender clinic and recounted her experiences at NYU Langone Health.
“We started small and we really grew intentionally,” she said. “We identified physicians in other specialties who were also providing gender affirming care and we referred to them, talked to them. We partnered with community health organizations and advocacy groups.” (10:00)
Bluebond-Langner described how she built community trust and a referral base.
“I think it’s important to establish relationship within the community and build trust,” she said. “When I first came to New York I went out and met with community health centers, I gave lectures, and really developed a referral base.”
One of the community health centers Bluebond-Langner said she collaborated with was Callen-Lorde, an LGBTQ health center that states they provide gender hormone therapy and assist individuals seeking sex reassignment surgery.
Additionally, Callen-Lorde offers an adolescent health program called HOTT (Health Outreach To Teens) which they describe on their website as a “welcoming, non-judgmental, confidential program designed specifically to meet the medical and mental health needs of LGBTQ adolescents and young adults ages 13-24, as well as other young people in need.” Listed services provided to HOTT clients include transgender healthcare, hormone therapy, and referrals to medical specialists, according to their website.
“We now have monthly case conferences with Callen-Lorde, one of the larger community health centers, to discuss our mutual patients coming to NYU for surgery,” Bluebond-Langner said.
Callen-Lorde offers a seven-page guide titled “Gender Affirming Surgery Navigation Process” which states they can assist clients find a “gender affirming” surgeon and obtain letters of support needed for insurance coverage. Their TransAtlas website includes a searchable database of transgender surgeons, which includes Bluebond-Langner.
Bluebond-Langner emphasized the need of institutional support to establish a successful gender clinic.
“I think a successful program is really impossible without institutional support,” she said. “At NYU the administration has made transgender healthcare and this program a priority. And this goes beyond just the financial support required.”
She described how NYU Langone took steps to create an affirming environment throughout the institution and stop “harmful misgendering.” This included adding patient pronouns to clinical documents and educating hospital staff to avoid misgendering patients.
All of these efforts seem to have paid off: during the presentation Bluebond-Langer reported that in five years, NYU Langone Health saw an almost 200% increase in surgical cases with a gender dysphoria diagnosis.
“Over the last 5 years we’ve seen steady growth in the number of gender affirming surgeries that are being performed across the institution. Prior to our arriving in 2017 there was a smattering, 20, 75. When we first came our first year, we did 213 and then we’ve done over 600 last year and anticipate that this number will continue to go up.” (20:33)
According to her presentation, in 2021 the NYU Langone center performed 289 mastectomies, 140 vaginoplasty procedures, and 103 facial feminization surgeries.
Bluebond-Langner is a co-author of the current World Professional Association For Transgender Health (WPATH) Standards of Care, which are used by insurance companies to determine criteria for coverage approval for sex reassignment services, such as transgender surgery.
Dr. John Stranix stated that UVA was involved in legislative efforts to expand the provision of sex reassignment services.
“As a young gender health program, we’ve all actually been extremely active on the legislative side, and have worked with the state to revise coding and billing to optimize access to care from both a practice standpoint clinically built also from a legal and insurance aspect as well,” Stranix said. “So we’re working on every aspect of that.”
“We’ve also actually started discussions with the law school to expand protection for this, for these rights as well and so we are from every angle trying to care for our population,” he added.
The University of Virginia, NYU Langone Health, and Callen-Lorde did not respond to requests for comment.
Megan Brock on November 16, 2023