LGBTQ + Health
Gender Medicine in the Twin Cities: A Brief History
I
magine your patient has a condition with somewhere between a five and 40% mortality rate (depending on the study), and you have something that will most likely help. There is even a multinational organization that guides appropriate treatment. But most insurance policies won’t cover it because treatment is deemed to be “medically unnecessary.” So some of your patients can afford treatment, but many cannot. Those who cannot afford treatment and even some of those who can, are unable to live the lives they were meant to live, leading to increasing problems with depression, anxiety, substance abuse, PTSD and hopelessness. Because of discrimination in society, many end up turning to sex work and contracting HIV. Others succumb to the mental health dangers of being denied medically necessary care and/or the ongoing discrimination in society. How would you feel? What would you do? This is what it was like to practice what is now called “Gender Medicine” back in the early 1990s when I first started prescribing hormones and doing hysterectomies for transmen. It was hard work, both literally and emotionally. It was (and still is) a labor of love for my LGBTQ+ community. It took a little while to be able to find my fellow Gender Medicine practicing colleagues in the larger community, though I was very lucky to have been led into this work by my senior partner, Mario Petrini, MD. He was a mentor to me in so many ways that it would take a whole separate article to enumerate them. In more than just this one area, he helped me understand the principles of medical By Debra Thorp, MD
12
September/October 2020
practice; and the transgender and gender non-conforming patients I inherited from him as he gradually retired taught me much in those early days. I am forever grateful to them, as well, for opening my eyes to their everyday realities. What I and my fellow Gender Medicine colleagues across the city did in the beginning, and continue to do now, was to find all the resources that we could find to provide the best possible evidence-based care. There were a few books and journal articles then, as well as the Standards of Care from what was then the Harry Benjamin Society and is now the World Professional Association for Transgender Health (WPATH). Fast forward 30 years — now there is a Transgender Center of Excellence in San Francisco and Los Angeles and the Fenway Clinic in Boston to provide resources online and in written form. WPATH has continued to provide updated Standards of Care (Version 8 is due out soon). There are journals like Transgender Health. And many local healthcare organizations, including HealthPartners, are working to provide ALL clinicians and support staff of all types the kind of education they need to provide respectful, competent care. At Park Nicollet, we have founded a Gender Services Clinic through which we can provide much of the care that our patients need. Where we can’t provide that care ourselves, we work with partners to do so. To have the support of one’s partners and administration to provide care to people who need it so much is one reason I have been so grateful to practice where I do. I am also grateful to still be doing Gender Medicine when most insurance, including Medicare and Medicaid, cover transition care. This is
because Article 1557 of the Affordable Care Act has been interpreted to include sexual orientation and gender identity in the provision where discrimination is illegal based on sex. I understand the practice of Gender Medicine did not start in the Twin Cities with Mario Petrini. Dr. Petrini had run a Gender Identity Clinic while practicing in Detroit. When he moved to the Twin Cities to practice at what was then the St. Louis Park Medical Center (now Park Nicollet Clinic, part of HealthPartners), he began prescribing hormones and doing hysterectomies. The Program in Human Sexuality had been established here long before that, practicing Gender Medicine with hormones, gender affirming surgeries, and the provision of cutting edge mental health services. In fact, the staff at the Program in Human Sexuality, led admirably by Dr. Eli Coleman, have been integral to WPATH for decades, and continue to be extremely active in that organization. Dr. Coleman has been a leader in the development of several versions of the WPATH Standards of Care, including the soon to be released 8th version.
MetroDoctors
The Journal of the Twin Cities Medical Society
