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Celebrating Transgender Awareness Week: A Trans Healthcare Q&A

A collage of six of Dr. Gallagher’s patients who recieved top surgery, the most common gender confirmation surgery she performs

A collage of six of Dr. Gallagher’s patients who recieved top surgery, the most common gender confirmation surgery she performs

To honor this important LGBTQ+ week, Dr. Sidhbh Gallagher answered questions about the individualized healthcare needs of the transgender community in Indiana and the United States.

Dr. Gallagher is an Assistant Professor of the Indiana University School of Medicine’s Department of Surgery. She’s also the surgical director of the Eskenazi Health Transgender Health & Wellness Program, the first of its kind in Indiana.

How common is being transgender?

It’s now known to be much more common than what I was taught in med school. Data from The Williams Institute estimates 3 in 1,000 people in America identify as transgender. That’s the same prevalence as Type 1 Diabetes!

From left to right: Nicole Jackson, Transgender Surgical Program Coordinator and Dr. Gallagher, Assistant Professor of the Indiana University School of Medicine’s Department of Surgery.

From left to right: Nicole Jackson, Transgender Surgical Program Coordinator and Dr. Gallagher, Assistant Professor of the Indiana University School of Medicine’s Department of Surgery.

How did you become interested in being a plastic surgeon for the trans community?

Gender confirmation surgery is a challenging field so it always keeps me interested! We operate on all parts of the body and sometimes it demands creativity and a good aesthetic eye. We’re concerned with both function and form, not just how the patient looks. The most gratifying thing is the huge difference we make in patients’ lives. It’s such a privilege to work with this brave community and provide a service that was previously unavailable in Indiana.

Why is teaching trans healthcare at Indiana University School of Medicine important?

Every provider needs to know how to speak to a transgender patient and how to understand their medical needs. So, I teach students and colleagues transgender healthcare and cultural competency in the operating room and clinic. It’s so important that our medical students and residents are equipped with this knowledge so moving forward the trans community will have access to care.

What makes the school stand out in transgender patient education?

Indiana University School of Medicine does a very good job of educating future doctors on transgender issues. Unfortunately not many schools in the country have transgender healthcare as a part of their curriculum.  Our plastic surgery residents are actually learning how to do gender confirmation surgeries.

Sadly, the medical profession doesn’t have a great track record in meeting the needs of trans folks. Some of my patients in rural Indiana have to travel 3 hours just to find a primary care doctor. Worse still, many others just don’t go to the doctor. With improved education and awareness like what’s going on here at IU, this will become a thing of the past.

We now have a whole generation of doctors who will have experience in treating and interacting with transgender patients.

What does cultural competency look like for transgender healthcare?

A lot of transgender people have faced ignorance and discrimination in the past from medical professionals, which can make it difficult for them to seek even basic medical care.

As medical professionals – from the employee in the hospital cafeteria, to the clinic’s front desk – our responsibility is to ensure the patient is in a comfortable, safe place. That starts with the basics of knowing how to address your patient in a respectful way. Providers need to be educated about the importance of using appropriate pronouns and ensuring the patient’s preferred name is used.

What are the healthcare issues the trans community faces?

Lack of access to healthcare is a huge problem for the transgender community. A trans patient in the United States has a lot of difficulty finding a provider who is competent in trans health.

Even if a patient finds a doctor, they may not have coverage for surgery or hormones. About 20% of my patients still pay out of pocket for a medically necessary procedure.

This is rapidly changing with many large companies ensuring their employees are covered, including Indiana University, who has been providing benefits since January 2017.

How about this misconception that being transgender is a disease?

Just because you’re transgender doesn’t mean you have a disease. However, a lot of trans folks suffer from gender dysphoria, a serious medical illness that contributes to high suicide rates in the community, about 40% of trans folks attempt suicide in their lifetime.

In the past there was a misconception that the way to treat a patient with gender dysphoria was to try to change their identity to align with the appearance of their body. We now understand that this simply doesn’t work. The best known treatment for gender dysphoria is to help the patient through medical or surgical treatments to align their bodies with their gender identities.

Do all trans people get surgery?

Not all transgender patients want or need surgery. Transgender care is extremely individualized care. Some patients are perfectly fine with hormone therapy. Some want both hormones and surgical procedures to align themselves to their gender identity. Some patients just want mental health support.

I work with a multidisciplinary team who provide individualized treatment options of primary care, mental health and plastic surgery services to relieve gender dysphoria among our patients.

How many surgeries have you performed since you came to Indianapolis?

Overall, we’ve done about 120 surgeries in 2 years and it’s quickly growing, and a third of those are from out of state.

What are the most common surgical procedures you perform?

The most common gender affirmation surgery I perform is top surgery (mastectomy) for patients who identify as non-binary or female to male (FTM) transgender men.

Unlike a cancer patient getting a mastectomy, it’s a happy time for a transgender patient. Top surgery for my patients aligns their appearance with their gender identity and effectively relieves their gender dysphoria. To them, it’s truly a positive life changing surgery.

The second most common surgery I do is an orchiectomy or testicle removal. This is mainly for male to female (MTF) transgender women who aren’t ready for full bottom surgery or don’t have access to it. It’s also an option to decrease testosterone levels and help with a more female-aligned gender identity.

Third is bottom surgery, known as a vaginoplasty. A full genital reconstruction of male to female bottom surgery. We’re actually the only hospital in the state and surrounding states that offer this. And 30% of these transgender patients come from out of state.

What do you want people to take away from transgender awareness week?

Transgender people deserve to be respected and seen! Indiana alone is estimated to have a trans population of about 20,000 people. As public awareness improves, the future is bright for the transgender community. I’m optimistic it won’t be long before the medical community will be meeting transgender healthcare needs even in rural Indiana.

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.

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