“Many people who are gender diverse don’t seek medical care because they’re afraid how they’ll be treated or had a bad experience before. As a further tragic consequence, they don’t receive preventive care and may wait to treat significant health conditions,” says Corinne Heinen, MD, a family medicine physician who sees patients at UW Medicine Primary Care at Belltown.

In fact, a report developed by the University of Washington in 2020 found that among LGBTQ+ adult participants, 76% delayed needed health care, including 63% who postponed health care even when sick. The most cited barriers were distrust of doctors, financial barriers and lack of LGBTQ+ friendly healthcare.

Enter UW Medicine’s Transgender and Gender Non-Binary Health Program, for which Heinen is the clinical director. The program’s goal is to create a safe, supportive space in which transgender and non-binary people can receive affirming, respectful care that is coordinated with all their providers across the UW Medicine system.

From education to collaboration

Heinen is no stranger to gender-affirming care: She’s been providing it to patients since the early 1990s at the UW Medicine Primary Care at Belltown and at Harborview Medical Center’s Madison Clinic.

Her journey to create the Transgender and Gender Non-Binary Health Program began in 2016, when she appealed to leadership for funding. The program then became official as part of the Care Transformation initiative, which also saw the creation of UW Medicine’s Healthcare Equity Program, now the Office of Healthcare Equity (OHCE).

Heinen’s first goal was to educate primary care providers and patient-facing staff on how to work with gender diverse patients, such as using someone’s correct name and pronouns as well as having an appreciation for their life experiences.

Another goal was to make referrals a smooth process for patients. “Many specialists had been providing care to transgender patients already but it was word of mouth, which made it hard for primary care providers to know to whom to refer,” says Heinen.

Heinen works regularly with specialists from surgery — including plastic surgery, gynecology and urology — and mental health care or, as Heinen prefers to call it, brain health.

“A lot of gender diverse patients have gone through traumatic events and intense discrimination. Rates of post-traumatic stress disorder, for example, are extremely high. Some of that arises from seeking medical care and being maltreated, rejected or neglected. We’re trying to reform the system so anyone who comes in and is gender diverse can feel comfortable,” she says.

A core team of surgeons and specialists collaborate to make these services possible, which is essential not just for ensuring patients can access care easily, but to make sure patients’ experiences are consistent and all providers have the same, accurate information.

Corinne Heinen

Corinne Heinen, MD, family medicine physician

Sean Johnson

Sean Johnson, program director, Transgender and Gender Non-Binary Health Program

Growing the program

Sean Johnson joined the Transgender and Gender Non-Binary Health Program in 2019 and is now the program director. With relationships among specialties established, Johnson and Heinen have also developed a monthly Trans Health Ally meeting to go over cases.

Despite the small team and need for more resources, they have ushered in many new service offerings. Currently, the program offers many gender-affirming services, from hormone management and fertility care to orchiectomy and hysterectomy to chest masculinization and breast augmentation, as well as affirming facial surgery. Genital reconstruction surgery, which includes vulvovaginoplasty, phalloplasty and metoidioplasty, will be offered starting later in 2022.

“We will be the only provider in Washington state for phalloplasty and metoidioplasty, and just the second provider in the state for vulvovaginoplasty, which will be a welcomed offering,” says Johnson.

In fact, UW Medicine will be the only provider of these services across the entire WWAMI region, which includes Washington, Wyoming, Alaska, Montana and Idaho.

Aside from direct care for patients, the team also does behind-the-scenes work to make UW Medicine’s patient and work environments — and the broader community — more inclusive, from working toward ensuring faculty and staff badges list pronouns to creating gender-neutral bathrooms to providing consultations and trainings for outside organizations.

Looking ahead

Johnson sees many opportunities for the program’s expansion and donor support is critical to seizing these opportunities. Currently, he and Heinen are solely responsible for the program’s organization. With donor support, the program could add staff and expand services even further.

While Johnson sees many opportunities for growth in the future of gender-affirming care delivery, he is motivated by the buy-in he has witnessed from people across UW Medicine.

“People are better informed and more vocal and more attentive to trans patients. It’s been amazing. Our admin staff and providers working with patients are the ones hounding the system to hurry up and build this program. I’ve felt supported by them. From my lived experiences as a trans person, I wasn’t expecting that. The overwhelming majority of people have been supportive,” Johnson says.

Written by McKenna Princing with contributions by Erin M. Schadt

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