PEABODY — Gender-affirming health care for transgender people is a hot button issue that carries immense political weight, but at Lahey Hospital & Medical Center, providing health care is all about the patients.
After years of providing gender-affirming care as a part of the institution’s comprehensive care, they identified a need to create a specific care program for transgender health care. “Over the past few years we have identified an opportunity and a need in general to formalize the program in order to really show our commitment as an institution to this community,” said Dr. Dinamarie Garcia-Banigan, co-director of the program. The Transgender Health Program at Lahey opened at the end of June.
The program is co-directed by Garcia-Banigan, an endocrinologist, and Dr. Khushabu D. Kasabwala, a reconstructive urologist. Both manage both cisgender and transgender patients within their specialties.
As an endocrinologist, Garcia-Banigan treats patients seeking hormone-related care. This includes women seeking menopausal treatment and aging men as well as transgender individuals seeking hormone replacement therapy. She is one of the first providers a transgender person would see after being referred to the Transgender Health Program.
Kasabwala is a reconstructive urologist, which means she is a surgeon who focuses on genital surgery for cis and transgender people. She said that “a small percentage of transgender and gender diverse individuals seek out surgery.” Those who do are typically seeking “feminizing” or “masculinizing” surgeries, often called bottom surgery.
With the official program came the role of a Transgender Health Program coordinator, who helps individuals seeking gender-affirming care figure out where to start. “Several patients in the past because there haven’t been established programs felt like they have had to [navigate] this all alone,” said Garcia-Banigan. This is important, Kasabwala said, because of how different each patient is.
“There’s no linear model or mold of gender-affirming care that fits all. There may be people who have a preconceived notion that individuals start off one way and then they do this part and then they do this part and then they come for surgery,” Kasabwala continued, “Everyone has individual goals, everyone has individual aspirations for what their gender identity means for them.”
In addition to surgery and hormone management, LHMC offers a wide array of supporting care like behavioral therapy, voice and speech therapy, and dermatology. “When a patient comes into our program … it basically is a comprehensive history and physical so that we can get to know the person physically, emotionally, and mentally,” said Garcia-Banigan.
Prior to LHMC offering transgender medical and surgical services, many patients had to seek care in Boston. Garcia-Banigan said “In Boston, [it has] always been known as this academic center, academic city where you had to go downtown to get your care, and this is a clear example of that’s not the case.”
She continued, “It’s important that we are bringing health care into communities as we just continue to emphasize the importance of health and weaving it into other aspects of your life, not [as] something you have to go out of your way for.”
Gender-affirming health care services for transgender people, like those offered by Garcia-Banigan and Kasabwala, have been embroiled in nationwide controversy, with numerous proposed bills classifying youth gender-affirming care as abuse. But for transgender individuals, getting this care is a part of being their healthiest self.
Garcia-Banigan noted that transgender people who do not receive gender-affirming care are more likely to have worse health outcomes and have an increased rate of suicide.
The attempted suicide rate for the transgender community is estimated to be around 40 percent, with a suicidal ideation rate at 82 percent. A study published in January 2022 found that transgender people who want and receive gender-affirming hormones in adolescence (ages 14-17) and adulthood have a significantly lower rate of suicide than those who want but cannot access gender-affirming hormones.
Receiving gender-affirming care can provide quality of life benefits for transgender people beyond the procedure or medical services themselves. Garcia-Banigan said, “[Transgender patients] look me in the eye and say, ‘this is the first time that I really feel like somebody is seeing me, that somebody is hearing me, that somebody is recognizing me.’ Just the simple fact that somebody is there and present and just really feels accepted and wants to continue– that first step is very meaningful.”
“It’s an institutional commitment because, in general, it is the most important thing to preserve someone’s health and [get the] best outcomes … This is an institutional initiative and commitment and it’s important because, if anything it’s long overdue, trying to get everyone on the same page, not to push one group ahead of the other,” said Garcia-Banigan.
“Our goal at Lahey is to create a space and providers that are knowledgeable in treating transgender and other gender-diverse individuals in a safe and affirming environment,” said Kasabwala. “Gender-affirming health care is health care.”
Emma Fringuelli can be reached at [email protected].
