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Why the Growth of Transgender Surgery Centers In the U.S. Matters

According to a first-of-its-kind study, the number of gender-affirming surgeries performed in the United States increased fourfold from 2000 to 2014, and demand for these procedures has continued to surge in the past few years. While some of this growth can be attributed to changing societal attitudes and a greater buy-in from the medical community, it was broader insurance coverage beginning in 2014 that tipped the scales and kick-started the development of transgender surgery programs at medical centers across the country. In addition to the many private practices that offer gender-affirming surgery,  there are now at least 30 academic medical centers in the U.S. that have a transgender surgery program, signalling a growing trend that is improving access to care and filling an important gap in medical education.

The authors of the aforementioned study point to Medicare’s decision in May 2014 to lift a coverage ban on transgender surgeries as the turning point in access to care, noting that the share of patients seeking gender-affirming procedures covered by Medicare or Medicaid increased from 25% in 2012-2013 to 70% in 2014. After Medicare and Medicaid started covering transgender surgeries, and after the implementation of the Affordable Care Act in 2014, private insurance companies followed suit.

Dr. Loren Schechter, center, operates on 74-year-old Denee Mallon at Weiss Memorial Hospital in Chicago. Mallon was the first person to have Medicare cover her Gender Affirmation Surgery. Jim Seida / NBC News

It was one of Dr. Loren Schechter’s patients, Denee Mallon—a 74-year-old transgender woman—who challenged Medicare’s 1981 ban on transgender surgeries.

“This decision [to remove the ban] opened a floodgate,” said Randi Ettner, PhD, a clinical psychologist and expert on gender identity. “Previously, people who never dreamed they could afford surgery that was medically necessary now could.”

Gender Surgeon Dr. Jonathan Keith agrees. “That’s when the pent-up demand became apparent,” said Keith.

When New York Medicaid started covering gender-affirming procedures, Mount Sinai Beth Israel hospital struggled to meet the new demand.

“The day that announcement was made, when they lifted the Medicaid ban, I got a million calls from people like, ‘I’m ready for the surgery’,” said Dr. Barbara Warren, director for LGBT Health Services at Mount Sinai Beth Israel. “I had to break the news to them that we [didn’t] have a surgeon yet.”

Before broader insurance coverage, transgender people in the U.S. had very limited access to surgical care. While private practices offered transgender surgery, insurance coverage was uncommon. Those who could afford to paid out of pocket, to the tune of tens of thousands of dollars.

Dr. Loren Schechter - Gender Confirmation Surgery in Chicago
Dr. Loren Schechter

“In the earlier days, it was difficult to find an institution that would allow us to perform gender-affirming surgeries, and insurance coverage was rare,” said Dr. Schechter, the medical director of The Center for Gender Confirmation Surgery at Weiss Memorial Hospital in Chicago. “We’ve gone from hospitals shutting the door in patients’ faces to hospitals around the country scrambling to start their own program.”

The rise of transgender surgery programs at academic medical centers in the U.S. allows patients to seek care closer to home, which is not only more affordable for patients but also safer in terms of potential complications and follow-up care.

Performing more transgender surgeries at academic medical centers is also important because it fills a critical gap in medical education, said Dr. Schechter.

“One of the things that’s lacking in medical schools is gender education. When academic medical centers are performing the surgeries, you’ve got exposure to medical students ― the next generation of doctors.”

Doctors say that more academic medical centers tracking the procedures will lead to higher quality studies and ultimately improved techniques and outcomes in the future.

Gender-affirming surgery is lifesaving for many transgender people and it’s crucial for there to be surgery teams across the country who have the training and experience to offer it. The growing trend of transgender surgery programs at academic medical centers is improving access to care in the present while also laying the foundation for more evidence-based care in the future.

List Of Academic Medical Centers In the U.S. With Transgender Surgery Programs

Boston Children’s Hospital Center for Gender Surgery – Boston
Harvard Medical School Teaching Hospital
Procedures: Vaginoplasty, Metoidioplasty, Phalloplasty, Chest Reconstruction, Breast Augmentation
Co-Director: Dr. Oren Ganor
Note: Patients must be under 35 years of age.

BMC Center for Transgender Medicine and Surgery – Boston
Academic medical center.
Launching in 2016, Boston Medical Center’s program was the first center in New England to provide such a comprehensive transgender health program.
Procedures: Top Surgery & Breast Augmentation, Facial Feminization Surgery, Orchiectomy & Vaginoplasty, Hysterectomy
Team: Dr. Robert D Oates (URO); Dr. Jaromir Slama, (Plastic Surgery: Top Surgery, Vaginoplasty), Dr. Jeffrey H. Spiegel (FFS).
News: Boston Medical Center Launches First Comprehensive Transgender Medical Center In Northeast

Cedars Sinai Transgender Surgery & Health Program – Los Angeles
Academic medical center.
Procedures: Facial Feminization, Top Surgery, Breast Augmentation, Body Sculpting, Orchiectomy, Vaginoplasty, Vulvoplasty, Hysterectomy, Vaginectomy, Metoidioplasty, Phalloplasty (RFF & ALT.)
Program Director: Dr. Maurice Garcia
Also offers: Transgender Surgery Fellowship Training
Launched in 2017.
News: Transgender Surgery Comes to Major Southern California Hospital

The Center for Gender Confirmation Surgery at Weiss Memorial Hospital
Weiss was formerly associated with the University of Chicago Hospitals system.
Procedures: Breast Augmentation, Facial Feminization, Metoidioplasty, Orchiectomy, Hysterectomy, Phalloplasty, Top Surgery, Tracheal Shave, Vaginectomy, Vaginoplasty, Body Sculpting
Medical Director: Dr. Loren Schechter

Cleveland Clinic – Cleveland
Cleveland Clinic is an academic medical center owned and operated by the Cleveland Clinic Foundation, an Ohio nonprofit corporation established in 1921.
Procedures: Top Surgery, Hysterectomy, Vaginectomy, Orchiectomy, Vaginoplasty
Program Director: Dr. Cecile Ferrando

Denver Health’s LGBT Center of Excellence – Denver
Denver Health is one of the primary teaching hospitals in Denver and is affiliated with the University of Colorado Denver, Children’s Hospital Colorado, and the Veteran’s Affairs Hospital in Aurora, Colorado.
Procedures: Top Surgery & Breast Augmentation, Hysterectomy, Metoidioplasty, Facial Feminization, Orchiectomy, Vaginoplasty
Team: Dr. Marci Bowers (visiting surgeon providing training), Dr. Jennifer Hyer, Dr. Rodrigo Donalisio da Silva, Dr. Meryl Livermore and Dr. Stephanie Malliaris, Dr. David Khechoyan.

Johns Hopkins Center for Transgender Health – Baltimore
Johns Hopkins University is a private research university.
Procedures: Phalloplasty, Vaginoplasty, Top Surgery, Facial Feminization or Masculinization, Hysterectomy, Voice Surgery
Medical Director: Dr. Devin O’Brien-Coons
News: Johns Hopkins to resume gender-affirming surgeries after nearly 40 years; The prestigious school is finally distancing itself from its anti-trans reputation. (2016)

Massachusetts General Hospital Transgender Health Program – Boston
The #1 research hospital in the United States, with the largest hospital based research program.
Procedures: Top Surgery & Breast augmentation, Facial Feminization, Hysterectomy, Phalloplasty, Vaginoplasty
Team includes Dr. Branko Bojovic, Dr. Curtis Cetrulo, Dr. Heather Faulkner, Dr. Jonathan Winograd.

Mayo Clinic – Transgender and Intersex Specialty Care Clinic – Rochester, MN
Non-profit academic medical center.
Procedures: Facial Feminization, Top Surgery & Breast Augmentation, Orchiectomy, Vaginoplasty, Voice Feminization, Metoidioplasty, Phalloplasty
Program Co-Director: Dr. Oscar J. Manrique
Launched in 2017

Dr. Gabriel Del Corral - Gender Affirming Surgery in Washington DC
Dr. Gabriel Del Corral

MedStar Center for Gender Affirmation – Washington D.C. and Baltimore, Maryland
MedStar Georgetown University Hospital is one of the national capital area’s oldest academic teaching hospitals.
Procedures: Top Surgery & Breast Augmentation, Facial Feminization, Orchiectomy, Phalloplasty, Tracheal Shave, Vaginoplasty, Vulvoplasty.
Surgeon: Dr. Gabriel Del Corral

Mount Sinai Center for Transgender Medicine and Surgery – New York City
Mount Sinai Hospital, founded in 1852, is one of the oldest and largest teaching hospitals in the United States.
Procedures: Breast Augmentation, Vaginoplasty (Penile Inversion), FFS, Voice Feminization, Tracheal Shave; Top Surgery, Hysterectomy, Metoidioplasty (Soon: RFF & ALT Phalloplasty)
Team: Dr. Jess Ting, Dr. Zoe Rodriguez, Dr. Aaron Grotas, Dr. Mark Courey
Also offers: Transgender Surgery Fellowship Training

Northwell’s Gender Affirmation Surgery Program at North Shore University Hospital Gender – Manhasset, NY
North Shore University Hospital is a teaching hospital for the Donald & Barbara Zucker School of Medicine at Hofstra/Northwell.
Procedures: Vaginoplasty, Breast Augmentation, Facial Feminization, Metoidioplasty, Phalloplasty, Top Surgery
Surgeon: Dr. David Whitehead
News: North Shore University Hospital is first on Long Island to offer genital gender-confirmation surgery for transgender patients (Sept 2019)

NYU Langone Medical Center – New York City
450-bed academic teaching hospital.
Procedures: Body Sculpting, Breast Augmentation, Clitoroplasty, FFS, Labiaplasty, Phalloplasty, Top Surgery, Tracheal Shave, Vaginoplasty
Team: Dr. Rachel Bluebond-Langner, Dr. Lee Zhao (URO), Dr. Jamie P. Levine (Microsurgery)
Also offers: Transgender Surgery Fellowship Training

Dr. Jens Berli - Transgender Surgery in Portland
Dr. Jens Berli

OHSU Transgender Health Program – Portland, OR
Oregon Health & Science University is a public university in Oregon with a main campus, including two hospitals.
Procedures: Facial Feminization, Top Surgery & Breast Augmentation, Hysterectomy, Orchiectomy, Vaginoplasty, Vulvoplasty, Metoidioplasty, Phalloplasty (RFF, ALT, Abdominal.)
Team: Dr. Daniel Dugi, Dr. Jens Berli, Dr. Myriam Loyo Li, Dr. Lishiana Shaffer, Dr. Joshua Schindler, Dr. Jyoti Chouhan, Dr. Geolani Dy, Dr. Juliana Hansen, Dr. Kamran Sajadi
Also offers: Transgender Surgery Fellowship Training

Thomas Jefferson University Hospital – Philadelphia
TJUH is an academic medical center ranked as one of the best hospitals in the Philadelphia metro area.
Originally launched in 2016 at Hahnemann University Hospital and moved to JUH in 2019.
Procedures: Facial Feminization, Top Surgery, Breast Augmentation, Body Sculpting, Orchiectomy, Vaginoplasty, Hysterectomy, Vaginectomy, Metoidioplasty, Phalloplasty (MLD & Abdominal.)
Medical Director: Dr. Kathy Rumer
Also offers: Transgender Surgery Fellowship Training

UCLA Gender Health Program – Los Angeles
UCLA Health is an academic medical center which comprises a number of hospitals and an extensive primary care network in the Los Angeles region.
Procedures: Facial Feminization, Top Surgery, Breast Augmentation, Body Sculpting, Orchiectomy, Vaginoplasty, Hysterectomy, Vaginectomy, Metoidioplasty, Phalloplasty.
Team: Dr. Justine Lee, Dr. Wayne Ozaki, Dr. Jason Roostaeian, Dr. Andrew Da Lio, Dr. George Rudkin, Dr. Gladys Ng, Dr. Mark Litwin, Dr. Tamara Grisales, Dr. Valentina Rodriguez-Triana

UCSF Transgender Care – San Francisco
Affiliated with the University of California, UCSF is consistently ranked among the top 10 hospitals in the U.S.
Procedures: Top Surgery & Breast Augmentation, Facial Feminization, Hysterectomy, Orchiectomy.
Surgeons: Dr. Esther Kim (Top), Drs. William Hoffman, Jason Pomerantz, P. Daniel Knott and Rahul Seth (FFS); Drs. Alison Jacoby and Tami Rowen (Hysto); Dr. James Smith (Orchie)

Dr. Dmitriy Nikolavsky - Reconstructive Urology New York
Dr. Dmitriy Nikolavsky

Upstate University Hospital Transgender Care – Syracuse
Public medical school.
Procedures: Top Surgery, Reconstructive Urology.
Surgeons: Dr. Dmitriy Nikolavsky & Dr. Dean DeRoberts

University of Colorado Hospital – UCHealth Integrated Transgender Program
Home to the University of Colorado School of Medicine, University of Colorado Hospital, and other clinical, education, and research facilities.
Procedures: Top Surgery & Breast Augmentation, Facial Feminization, Orchiectomy, Vaginoplasty, Vulvoplasty, Facial masculinization, Phalloplasty.
Surgeon: Dr. Christodoulos Kaoutzanis

University of Kansas Transgender Medicine Program – Overland Park
The University of Kansas Health System combines education, research and patient care.
Procedures: Facial Feminization, Top Surgery & Breast Augmentation, Vaginoplasty, metoidioplasty, Phalloplasty, Body Sculpting.
Team: Plastic surgeons Dr. Richard Korentager, Dr. Satish Ponnoru, Dr. Wojciech Przylecki and Dr. Michelle De Souza; Urologist Dr. Joshua Broghammer; and Gynecologists Dr. Meredith Gray, Dr. Rachel DiTeresi, Dr. Courtney Marsh and Dr. Laura Parks.

University of Kentucky’s Transform Health Clinic – Lexington
UK HealthCare is the health care system that is based on the campus of the University of Kentucky.
Procedures: Top Surgery & Breast Augmentation, Hysterectomy, Phalloplasty, Orchiectomy, Facial Feminization.
Surgeons: Dr. Kant Lin, Dr. James Liau, Dr. Alison Rasper, Dr. Frederick Zachman, Dr. Mark Hoffman, Dr. Nikita Gupta

University of Michigan’s Comprehensive Gender Services Program (CGSP) – Ann Arbor
Procedures: Top Surgery & Breast Augmentation, Hysterectomy, Metoidioplasty, Phalloplasty, Vaginoplasty
Team includes surgeons Dr. William Kuzon, Jr., Dr. Miriam Hadj-Moussa and Dr. Paul Cederna.

Dr. Nicholas Kim - Gender Surgeon at University of Minnesota
Dr. Nicholas Kim

University of Minnesota Health Comprehensive Gender Care – Minneapolis
Procedures: Top Surgery & Breast augmentation, Orchiectomy, Vaginoplasty, Hysterectomy, Phalloplasty
Team includes Plastic Surgeons Dr. Nicholas Kim and Dr. Marie-Claire Buckley, and Urologists Dr. Sean Elliott and Dr. Joshua Bodie.

University of North Carolina Transgender Health Program
Procedures: Top Surgery, Breast Augmentation, Hysterectomy, Metoidioplasty, Phalloplasty, Vaginoplasty, Orchiectomy, Reconstructive Urology.
Surgeons: Dr. Brad Figler, Dr. Kristy Borawski, Dr. R. Matthew Coward (all Urologists)

Dr. Daniel J. Freet
Dr. Daniel J. Freet

University of Texas – Houston
Procedures: Top Surgery & Breast Augmentation, Facial Feminization, Facial Masculinization, Metoidioplasty, Phalloplasty, Tracheal Shave, Vaginoplasty
Surgeon: Dr. Daniel Freet

University of Utah Transgender Health Program – Salt Lake City
Procedures: Top Surgery & Breast Augmentation, Facial Feminization, Vaginoplasty, Vulvoplasty, Orchiectomy
Team includes Plastic Surgeon Dr. Isak Goodwin and Reconstructive Urologist Dr. Jeremy Myers.

Dr. Katherine Gast - Male to Female surgery at UW Health Madison Wisconsin
Dr. Katherine Gast

UW Health Gender Services Program – Madison
Procedures: Top Surgery & Breast Augmentation, Facial Feminization, Vaginoplasty, Vulvoplasty, Hysterectomy, Vaginectomy, Phalloplasty
Medical Director: Dr. Katherine Gast

Vanderbilt University’s Clinic for Transgender Health – Nashville
Procedures: Breast Augmentation, Facial Feminization, Top Surgery, Vaginoplasty, Phalloplasty
Surgeon: Dr. Julian Winocour

Transgender Surgery Programs in Development

Indiana University Health Gender Affirmation Surgery Program – Indianapolis
Previously offered Top Surgery, Breast Augmentation, Orchiectomy and Vaginoplasty with Dr. Sidhbh Gallagher, however Dr. Gallagher is moving to Miami and the program is now seeking another surgeon to replace her.

Duke University Hospital – Durham
Currently offering Top Surgery and Breast Augmentation and has plans to expand.

Rutgers Center for Transgender Health – Newark
Status of the program is unknown as co-founder Dr. Jonathan Keith has gone into private practice.

University of Las Vegas School of Medicine – Las Vegas
Dr. John Brosious, assistant professor of plastic surgery at UNLV, currently offers Top Surgery and is trained to perform bottom surgeries but explained that none of the hospitals in the region currently have the necessary equipment and team of specialists for the procedure.

University of Pittsburgh – Pittsburgh
Pitt and UPMC are planning a transgender health care center in the Three Rivers region.

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