This year, Brigham and Women’s Hospital launched an academic center focused on the healthcare needs of transgender and gender-diverse (TGD) people. The Brigham Center for Transgender Health features a multidisciplinary team committed to supporting TGD patients at every step of their journey.
The center is led by plastic surgeon Devin O’Brien-Coon, MD, MS, clinical director and surgical co-director, and endocrinologist Shalender Bhasin, MD, medical co-director. Before joining the Brigham last year, Dr. Coon served as the founding chief medical director of the Johns Hopkins Center for Transgender Health, where he developed a multidisciplinary service line that became one of the largest academic programs in the country.
“We have a very deep pool of faculty at the Brigham who are interested in transgender health,” Dr. Coon says. “This is an emerging area with a great need for innovation and advancing the knowledge. Our goal is to be a leader nationally in delivering cutting-edge clinical care while also moving forward the field as far as what we know scientifically.”
Consolidating and Coordinating Gender-affirming Care
The formation of the center is an attempt to consolidate and coordinate the provision of gender-affirming care at the Brigham under one roof. Plastic surgery, endocrinology, urology, gynecology, otolaryngology, dermatology, primary care, voice therapy, physical therapy, and mental health are among the many disciplines represented, allowing the center to offer a full range of medical and surgical care.
“The field of gender-affirming care has advanced a lot from where it was even five years ago,” Dr. Coon says. “Continuing to raise the bar will require multiple specialties bringing all they know to the table. Having so many people at the Brigham who are interested and involved in this center is one of the key factors that will make us a leader going forward.”
Brigham urologist William R. Boysen, MD, is already seeing the benefits of this multidisciplinary approach in his practice. He noted that urologists traditionally have not received training on many of the gender-affirming surgeries now available at the Brigham.
“While some elements of all these procedures are quite familiar to urologists, others are less so and require guidance from specialists in other disciplines,” he says. “I feel lucky to be working in this particular center and to be able to take advantage of Dr. Coon’s tremendous experience in this area. Without this kind of collaboration, it would be really, really difficult for a urologist to break into the field and be able to care for these patients.”
Along with centralizing the delivery of gender-affirming care, the Brigham has built an extensive infrastructure to support both providers and patients. Dedicated staff is in place to handle the complexities of insurance coverage, mental health assessments, scheduling physicians, making appointments, and more. As a result, providers can focus on delivering care and patients enjoy a smoother overall experience.
Filling a Gap in High-quality Research
In addition to caring for patients locally, the Center for Transgender Health’s mission includes disseminating gender-affirming clinical care practices nationally and training the next generation of leaders in the field. Conducting cutting-edge research is another key component. Currently, there is a dearth of high-quality clinical, basic and translational research relating to TGD healthcare. The center seeks to fill this gap by bringing together scientists and physicians from across disciplines for research that informs and enhances clinical care.
The center is well positioned to make a significant impact through its research. Dr. Bhasin, for example, is a world-renowned authority on testosterone biology. Sari Reisner, ScD, the center’s director of transgender research, is an NIH-funded researcher who heads a global portfolio of community-engaged TGD health research. Andrea Louise Pusic, MD, chief of the Division of Plastic and Reconstructive Surgery, is an expert in patient-reported outcomes metrics for surgery and leads the international development of GENDER-Q, the first universal, validated measure for patient-reported outcomes in gender care.
Patient-reported outcomes will be a major point of emphasis for the center, according to Dr. Boysen.
“It’s not just asking the surgeon, ‘Did things go well, are you happy with the outcome?’ but really talking to patients and learning from their perspective whether we’re meeting their goals and expectations,” he says. “Because until we have that knowledge, it’s impossible to advance the quality of care we’re providing. If we’re not meeting certain needs, then we have to take the necessary steps to fix that.”
Dr. Coon has been pleased with the support the center has received, which he thinks bodes well for its future.
“We’re fortunate to have had so many strong supporters of the center at the Brigham from the start, including the chairs, like Andrea Pusic, Adam Kibel, MD, from Urology, and Gerry Doherty, MD, from Surgery,” he says. “It even goes up to [President] Bob Higgins, MD, MSHA, [Executive Vice President and Chief Operating Officer] Shelly Anderson, MPM, and [Senior Vice President of Clinical Services] Kevin Giordano, MBA, FACHE, all of whom have been highly supportive of launching this program because it aligns with the Brigham’s mission.”