Gender confirmation surgery is becoming more mainstream among surgeons, as doctors learn more about the role surgery plays in caring for transgender individuals.
It was a little over a year ago when, for the first time in its 89-year history, a conference hosted by the American Society of Plastic Surgeons held a session on the topic.
Arkansans searching for trans-related healthcare, including surgery, currently have limited options to do so in-state. There is uncertainty over where to find qualified providers.
In 2009, Dr. Janet Cathey, an OBGYN who specializes in the field, opened the state’s first gender clinic at the University of Arkansas for Medical Sciences (UAMS) because she says she saw a need for healthcare within the community.
"The first trans patient I had, I had an endocrinologist in Little Rock call and say ‘I’ve got a patient that’s male, he’s on hormones, he’s a genetic female and he wants a hysterectomy and I can’t find anyone that will do it. Will you take care of them?’ and it’s like, why would I not?" Cathey said.
Though services for transgender patients are on the rise, some treatments are not yet available in Arkansas, especially gender reassignment surgery.
"We’ve got some options close for doing trans female, male-to-female reassignment surgery. It’s kind of new to the area, but we’ve got someone who’s willing to do it," Cathey said.
"Right now as far as what we say the ‘bottom’ surgery for both, it’s an out-of-state sort of thing. Most of them go out-of-state."
Her clinic provides hormone therapy for men and women who want to transition. Also hysterectomies and breast reduction surgery for men.
But, she says, the demand for gender reassignment surgery remains greater than the options available.
"There is a big need for qualified people that do gender reassignment surgery," Cathey said.
Kendra Johnson is the Arkansas director for the Human Rights Campaign, an advocacy group for the transgender community. She says she thinks with the community becoming more visible in recent years, options for healthcare are growing.
"There were no providers who were out saying ‘these are the services that I offer.’ For example, UAMS and Arkansas Children’s Hospital and some other private doctors have started to state that they may have some services," Johnson said.
Dr. Cathey with the gender clinic says the endpoint for some of those transitioning is hormone therapy, which she can provide, and not necessarily a surgical procedure. It's a spectrum, she explains.
"When they get that sense of wellbeing, sometimes they’re fine with that, that’s all they want. Some people want surgery, some trans males only want top surgery," Cathey said.
Krystopher Stephens, 30, with the Arkansas Transgender Equality Coalition is currently on hormone therapy under the supervision of his primary care doctor. He says he's been on a waiting list to see Dr. Cathey for over six months.
"She’s amazing, and the doctors around here that are affirming, for the most part, the quality of their care has been great," Stephens said.
"As far as the nation as a whole or even the state as a whole outside of Little Rock, quantity and quality aren’t necessarily the same just because there’s a lot doesn’t mean they’re all great."
Stephens says the Transgender Coalition received a grant about two years ago to work with UAMS to educate doctors about the trans experience.
"Education is definitely the biggest problem, just staff being culturally competent and being informed on trans issues, and it could be as simple as using the right pronoun," Stephens said.
"Some things are complicated but some things are simple, but if you don’t know what to do, it just builds up. Especially on the patient, that’s put on them, your misunderstanding or your misinformed opinion, you’ve projected that onto the patient when you refuse to take care of them or you refuse to acknowledge they are trans."
Cathey says the grant is allowing UAMS to work with its centers around the state to provide this type of education outside of central Arkansas as well. The University is also incorporating LGBTQ care into its course curriculum for med students. Some don’t have experience with patients from the community.
Kendra Johnson with the Human Rights Campaign says while trans healthcare is limited for now, the growth she’s seen makes her hopeful for the future.
"I think we could get to a point where there’s a safety net in the medical community for people who are transitioning and to me that’s really exciting because I never thought, given all the prejudice and all the work that we still have to do in this state, that we would have this response from the medical community as seeing it absolutely necessary," Johnson said.
Disclaimer: Kendra Johnson of the Human Rights Campaign is also on the fundraising board for KUAR and KLRE.