If not providing gender-affirming surgical care for transgender and non-binary patients, Geolani Dy, MDShe considers how she can better care for patients beyond her surgical practice.
“There is already a body of evidence showing that gender-affirming care has many benefits, such as: B. improving mental health and reducing suicidality,” says Dy, an assistant professor of urology and plastic and reconstructive surgery at the OHSU School of Medicine, and also a surgeon involved in OHSU’s transgender health program.
“But a critical perspective is lacking in the medical literature,” she adds. “Now is the time to look at the perspectives of transgender patients and really put them at the center of what effective and successful gender-affirming care looks like. Community-informed research is needed to more accurately define and measure treatment outcomes.”
Dy is one of the few surgeons and scientists who split their time between gender-affirming surgeries and research. She joined OHSU in 2019 after completing a fellowship in reconstructive urology and gender-affirming surgery at New York University.
The demand for gender-affirming care has increased significantly over the past decade as society becomes more accepting of gender diversity and more Americans choose to freely express their gender identity. OHSU is among many institutions across the country that employ specialized staff and train future healthcare leaders to care for transgender patients. Organizations such as the World Professional Association for Transgender Health have established standards of care, and both public and private insurers cover many gender-affirming health services.
Much of what gender-affirming care is today has been shaped by the medical community — whose members are largely cis-gender and cannot fully understand the nuances of what transgender patients need. Dy identifies as cis gender and actively seeks the perspectives of her trans and non-binary colleagues and patients to inform her own work; She wants these experiences to help shape the work of other researchers and clinicians as well.
With support from the non-profit Patient-Centered Outcomes Research Institute, she co-founded the Transgender and Non-Binary Allied Research Collective, or TRANS-ARC, in 2019. The collective seeks trans and non-binary patient perspectives to shape research on gender-affirming genital surgeries. Dy and her colleagues encourage researchers to engage with members of the transgender community early and often, ultimately embedding trans and non-binary people in each step of the study. They say that every detail of research should be evaluated through the trans lens, and that everything – from the topics that should be investigated to the survey questions that should be used – should be considered in partnership with members of the trans community.
The collective organized a virtual summit of researchers, healthcare providers and patients in 2021. Key deliverables from this discussion include a practical guide to best practice and a list of research priorities. Topping that list is examining how insurance coverage—or lack thereof—affects surgical outcomes and how surgery affects sexual health, and comparing outcomes for different surgical methods.
Dy is also leading the creation of a database of gender-affirming surgical outcomes known as the TRANS registry. By considering what makes surgery successful for patients, the registry aims to standardize the measurement of surgical outcomes and improve surgical transparency for both clinicians and patients. Other surgical areas have such registers, but this is expected to be the first centralized register for gender-affirming surgery. Dy and her colleagues are initially compiling data from three major gender-affirming institutions — OHSU, New York University, and the University of Utah — but they ultimately aim to expand the registry into a national resource.
Now, Dy and his colleagues are applying for grants in hopes of conducting research that aligns with the priorities and methods they’ve identified over the past few years.
“TRANS-ARC is just the beginning,” says Dy. “We need to investigate these important questions and share our findings with the transgender community, researchers, physicians and payers. My ultimate goal is to empower research teams, particularly trans-led teams, to conduct meaningful, impactful research related to gender-affirming surgery – and make those findings accessible and useful to members of the trans community, who can hopefully use that information, to get well – make informed decisions about your own health care.”