The surge in demand for transgender surgeries in the United States has triggered a New York City hospital to launch a program to train doctors to perform gender reassignment procedures.
Mount Sinais Center for Transgender Medicine and Surgery opened early last year in Manhattan and has since operated on roughly 350 patients.
Dr Jess Ting, the centers director of surgery, said the team operates on nearly four patients a week.
But even still, transgender patients experience disproportionate health inequities: only about five hours of medical school training are spent covering issues related to their health.
In an effort to address those inequities, the center has created two year-long fellowships to train a new transgender surgeons and psychiatrists to be able to work with these individuals.
The new program comes as the Trump administration prepares to roll back protections for transgender Americans.
During 2016 more than 3,200 surgeries were performed to help transgender patients feel more like themselves.
That number showed a a 19 percent increase in vaginoplasties, phalloplasties, top surgery and contouring operations, but the waiting list for the surgeries is still incredibly long.
Surgeons in the field claim that figure is a conservative estimate and would likely three times higher if all hospitals had a uniform way of documenting such surgeries.
At Mount Sinai there are roughly 500 patients awaiting gender confirmation surgery.
Dr Ting explained that this is because he is the only surgeon with the expertise to perform these surgeries.
Theres only so many patients I can see at a time, Dr Ting told Daily Mail Online.
So in Julythe team launched the countrys first transgender surgery fellowship which lasts for one year.
During the fellowship the participants will assist and perform surgery, teach residents and medical students and conduct transgender-related research.
Dr Bella Avanessian is the first surgical fellow, and came to Mount Sinai after completing a residency in plastic surgery.
Male to female genital surgery is called vaginoplasty; female to male genital surgery is called phalloplasty. There are various techniques and ways to perform each procedure.
I decided to switch to gender confirmation surgery because I felt it would be more impactful in a city with 500 plastic surgeons and no transgender surgeons, Dr Ting explained.
And the surgeries are beautiful and intricate and complicated. Its so satisfying technically and aesthetically to be able to be able to change someones life so much. Its a privilege.
The fellowship will train one new surgeon who can perform the gender confirmation surgeries each year.
By the time Dr Avanessian finishes her year, Dr Ting said she will be very sought after since there are no other specially-trained surgeons in the field.
Forty percent of transgender adults have attempted or seriously thought about suicide, a rate which is nine times higher than the general population.
So to go along with the surgical fellowship, Mount Sinai also launched a psychiatry fellowship directed by Dr Hansel Arroyo.
Plastic surgeons often partner with other experts to provide comprehensive care, such as doctors who specialize in hormone therapy or urology and with mental health professionals who help patients through the emotional aspects of their transition.
Transgender patients face a great deal of discrimination, Dr Ting explained.
Many doctors wont take care of transgender patients or if they are willing, dont know how. These fellowships will train the next generation of surgeons and psychiatrists to improve healthcare disparities in the transgender community.
Dr Matthew Dominguez is the first fellow and came into the program following completion of his residency in General Adult Psychiatry.
Across the country more hospitals are beginning to offer gender reassignment operations.
In 2016, Boston Medical Center became the first hospital in Massachusetts to offer the surgery, and at the University of Maryland Medical Center in Baltimore surgeons normally complete two of the operations a week.Other hospitals that offer the surgeries are the University of Michigan Medical Health system and the Hahnemann University Hospital in Philadelphia.
The Mount Sinai Icahn School of Medicine is the first and only to offer a program to train people specifically to perform gender reassignment surgeries.
Though the growth in transgender medicine is giving hope to patients and experts in the field, some wonder whether it will continue under the new administration.
Medicaid insurance coverage of sex reassignment surgeries could be rolled back in the coming months.
How can a parent know if their child is transgender? What separates a young boy who might be transgender from one with a vivid imagination who likes to dress up in his sisters dresses? What do you do if your daughter tells you shes a boy?
The Associated Press spoke to gender experts to answer some of parents most commonly asked questions.
My answer is, we dont know, says Dr Diane Ehrensaft, a developmental and clinical psychologist, director of mental health at the University of California, San Franciscos Child and Adolescent Gender Center and author of The Gender Creative Child.
What we know is, you have a son who likes princess dresses. I would say get him the dresses. Have your child feel free to choose. Maybe theyll stop wearing dresses. Maybe theyll grow up to be gay, Dr Ehrensaft explained.
Transgender children will be insistent, consistent and persistent about their gender dysphoria, she says.
Its not something the child says one time and it goes away.
For critics who question whether preschool-age kids should be allowed to socially transition, Dr Ehrensaft says.
We expect a 2-year-old to know I am boy. I am girl. So why cant that also apply to transgender children?
If Im a kid who occasionally wants to put on my moms high-heeled shoes or wear my moms princess dress, Im not the kid who wants to live as a girl. Im the boy who occasionally wants to wear girls clothes, says Dr Johanna Olson-Kennedy, medical director of The Center for Transyouth Health and Development at Childrens Hospital in Los Angeles.
The important thing to ask is whether your child is in distress.
Are you having daily battles about clothing before school? Dr Olson-Kennedy says.
There are some things that are pretty universal. Is this the kid that everyone is trying to give Mutant Ninja Turtles to, and what they really want is the gifts their sisters are getting?
Using a childs happiness and health as a guide is critical, she says.
It can also help for parents to get away somewhere with their child and allow the child to call the shots in terms of their gender, such as letting them use a different pronoun or wear a dress or other clothing of their choice, Dr Olson-Kennedy says.
Do it somewhere where youre not going to see people you know, if thats an issue for you, she says.
Do a weekend as a different gender, and see what you learn.
People have said this over and over again: Oh, my God. I saw a side of my child I had never seen before.
Though there are no set rules, Dr Ehrensaft says some early signals can provide information about whether a child is transgender. They include:
Certain actions at a very young age, such as toddlers pulling barrettes from their hair, grabbing for their sisters dress and dolls, or throwing away their trucks.
The use of verbs regarding gender. Instead of I wish I was a girl, a transgender child will say, I am a girl.
Frustration over their genitals. By around age 3, children understand penis equals boy, and vagina equals girl, Dr Ehrensaft said.
Often those are the kids who cry out, Why did God get it wrong? Mommy, can you put me back inside so I can come out like my sister?
Taking gender expansion play seriously. Many young boys like to play dress-up in their sisters princess costumes, twirling around and then moving on to other toys, Dr Ehrensaft said.
A transgender child also wants to get into his sisters closet, but hes not going to go for the princess dress hes going to go for her school uniform, she says.
Hes going to put on her everyday clothes because he wants to be a regular girl, not a pretend princess, she explained.
First transgender medical fellowships launched in New York – Gears Of Biz