The Clinician's Guide to Transgender Care
Key strategies necessary to provide comprehensive, sensitively delivered care

Transgender Medicine: From Consult to Surgery

An expert Q&A with Laura Stein, LMSW, on helping transgender individuals access and create support systems through their transition.

with Laura Stein LMSW, Social Worker at the Center for Transgender Medicine and Surgery at Mount Sinai

How did you come to your job as a social worker for the Center for Transgender Medicine and Surgery?

I myself identify as a lesbian, and I feel very connected to the LGBTQ community personally. I think there's a lot of opportunity here for a social worker to do important work. I've been here about two years, and it's been a great experience so far.

What are the benefits of having a medical social worker guide trans patients through these processes?

Social workers tend to have a macro view of systems and how they interact with one another. That’s especially useful when you're going through a surgery. People you know may think it is just about your body, but the fact is that we all exist in various systems within society. Social workers have training and ability to help people make connections within their communities, so a lot of the work that we do is making sure that while people are going through this life-changing experience they feel connected to resources and are able to take advantage of all of the benefits that are available to them. Doctors provide the concrete steps needed in order for trans patients to reach surgery, while medical social workers take a zoomed-out view of it and assist long-term in other aspects of their journey.

What are questions trans patients have that a medical social worker can help with?

People will come to us with mental health concerns surrounding their surgery and social workers can serve as providers of mental health care as well as give referrals to other mental health resources.

When it comes to the surgery process specifically, there are so many resources that we can help people connect with. After these major surgeries, as trans patients are recovering, they need to rely on other people in their lives for assistance. Sometimes patients will come to us and say they don't know how to talk to their family about their transition, or how to ask a family member or friend to be there for them after surgery, and those are the kinds of conversations that we can facilitate to make sure they have the support they need throughout the process.

Another thing that we frequently assist with around the surgery process is arranging legal help with name changes, housing discrimination, employment discrimination, changing a gender marker on a birth certificate, and other legal issues that come up while transitioning.

How long do trans patients usually have to wait for surgeries?

It depends on how you ask the question, but you could say that a lot of our patients have been waiting their whole lives. They've been waiting to have enough money to take care of themselves afterwards, or they’ve been waiting for their social support network to be strong enough, or they've been waiting to lose the weight that we asked them to lose before surgery. There are so many things that people have been working on leading up to their surgeries, that for a lot trans patients, by the time we see them, it has already been a lifelong journey just to get to us.

Taking your question more literally, it depends on the type of surgery. For bottom surgeries, there are requirements or expectations for trans patients to have been on gender-affirming hormones or hormone replacement therapy for at least a year. Depending on their insurance company or hospital, there are also often expectations that a trans patient will have been living in their gender identity for a certain amount of time before scheduling the surgery. On average, after a person decides that they want to begin the process toward bottom surgery, it's usually between eight months to a year until they have the surgery.

What resources can you recommend for trans patients who may not live near a dedicated center for transgender medicine and surgery?

What I wish a lot of people knew is that there are often programs closer to home than they might think. Often there will be a local chapter of PFLAG that's near their town on Wednesday nights, or a program offering services for trans youth a 20-minute train ride from where they live. 

What I'd love for people to know is that these programs are becoming more and more prevalent. So, what I would urge people to do would be to not necessarily just think about where the closest major city is, if it seems like a barrier to care to have to wait until they can afford to get there, and to really look at their community and see what's available around them. Because more often than not, there are a lot of resources nearby that are closer than you might think.

Transitioning is a very personal process. There are definitely moments of celebration and pride, but there can also be lots of moments of perceived shame, difficulty, and struggle. So, another thing that I would want everyone to know is that asking someone how you can support them through their transition is something that I think a lot of people in this process really appreciate.

What do you find most rewarding about your job as a medical social worker at the Center for Transgender Medicine and Surgery?

I have a patient I referred for surgery 6 months ago. I brought cupcakes because I was so happy for her. I had been working with her for a long time to get the pieces in her life in place so that she was eligible for the surgery, and when she finally got to the point where she had what she needed and was ready, it was so exciting.

Our work together leading up to that point was finding community centers and places where she could meet supportive people and make one friend who could be there for her and help take care of her after her surgery, because you can’t take care of yourself alone after such a major surgery. We did a lot of research on how she could get to these safe places from where she lived, and dealt with everything from transportation challenges to helping her deal with her social anxiety to feel comfortable enough to join groups at those community spaces. Then it was about helping her make contact with people there to eventually find one friend who could be available for her, so that she wouldn’t be alone during her recovery after her surgery.

About a year and a half after that, she called me. She said, “I made a friend, and they agreed to take care of me after my surgery." With her permission, I called the person just to confirm, as that's part of our process to make sure that trans patients have the support they need during their recovery before we can refer them for surgery. The person on the phone said, “You know, I met her at this community group. We've been friends for a few months now, and I would be honored to help her throughout her surgery and recovery." I was on the verge of tears because seeing this patient grow in this way in her life was so incredible. But I like to think of it as she wasn't just doing this for the surgery. She was flexing those muscles and building those skills throughout our work together that she's now going to have for the rest of her life, about how to meet supportive people and build community. And that’s something that I think she can benefit from forever.

Continue Reading:
Cultivating More Inclusive Medical Care for Transgender Patients
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