A Pioneering Program at Cedars-Sinai Is Helping Trans People Get the Care They Need

From gender surgery to hormone treatment and mental health counseling

The first time Liz Youngs asked her doctor about having sex reassignment surgery, she was 33. It was the year 2000, and the doctor declined to help. For one thing, the procedure wouldn’t be covered by her insurance. For another, he said, identifying as transgender wasn’t a valid reason to get the common testicle removal surgery she wanted. So Youngs gave up. “At that time it was just way too difficult,” she says. “The programs weren’t available. There was maybe one SRS surgeon in the country.”

Nearly two decades later, in April of last year, Youngs was able to make the transition because of Cedars-Sinai Medical Center’s new Transgender Surgery and Health Program. Founded by Maurice Garcia in 2017, it’s only the second academic medical center in the west to offer gender reassignment surgery and the host of other services that can go along with it, including hormone treatment, plastic surgery, and mental health counseling.

That matters for several reasons. Historically, genital surgery, which can cost tens of thousands of dollars, has been limited to private clinics. While various states have recently moved to require insurers to cover gender-affirming surgeries, private clinics often don’t accept Medi-Cal or Medicaid—a huge obstacle for a segment of the population that has comparatively high rates of poverty and unemployment. Cedars accepts the public insurance, but Garcia, who founded a similar program in San Francisco in 2014, wants to do more than just expand service options for the nearly 0.5 percent of Californians who identify as transgender. He wants to create a paradigm shift in trans health care.

One major goal is to establish real standards for genital surgery. “It’s not especially well studied or described,” says Garcia. “For the few people in the country who were offering it, it was just sort of proprietary. They did their own thing.” By offering educational and research opportunities to medical residents and fellows, Garcia wants to change that while deepening the pool of doctors available to patients.

Cedars also provides services to adolescents who are more likely to identify as transgender than any other demographic  Garcia says that despite high-quality trans youth programs at places like Children’s Hospital Los Angeles, young patients often “fall o the grid” once they age out of pediatric care. His program offers them access to surgery and hormone treatment and makes it easier to find doctors who understand transgender care.

In a 2017 NPR poll, nearly a quarter of transgender individuals reported that they’d avoided health care due to fear of discrimination; 31 percent said they have no doctor or regular form of health care. With approximately 1.4 million adults in the U.S. identifying as transgender, the need for doctors who are better trained—in all senses—is a no-brainer. “The same things that consumers of medical care have historically expected and demanded should be [offered] in this field: choice, high-quality care that follows guidelines and standards of care, and a reliable environment where people are well trained and don’t say inappropriate things,” says Garcia. “We shouldn’t expect transgender people to settle.”

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