transgender, gender affirming surgery
Dr. Maurice Garcia with his patient, Liz Youngs (Photo courtesy of Cedars-Sinai Medical Center)

Liz Youngs remembers vividly the day her life changed forever. It was her 50th birthday — April 19, 2017. That marked the end of a 32-year quest to complete her transition from life as a man to life as a woman.

Youngs’ gradual transition, which began at age 18, included psychiatric and psychological evaluations, four years of hormone treatments and a lengthy search to find the right surgeon and support care. Following six-hour gender-affirming genital surgery at Cedars-Sinai Medical Center and a three-month recovery at home, Youngs is now, she says, the person she always was meant to be.

“I’m complete,” said the retired Orange County office worker. “I’m finally happy. I’m comfortable with who I am. I have a whole new life ahead of me.”

Youngs attributes her newfound happiness in large part to the comprehensive services Cedars-Sinai offers transgender people — including gender-affirming and plastic surgeries, hormone management and mental health counseling — through a program designed to meet the needs of this underserved population.

The new interdisciplinary, research-based Transgender Surgery and Health Program is directed by Dr. Maurice Garcia, a leading figure in the field who joined Cedars-Sinai from UC San Francisco Medical Center. The program is staffed by specialists invested in helping members of the transgender community at every stage of their journeys.  Garcia began gender reassignment surgeries in March and since then has done more than 100.

“The bedrock of our program is that we’re as committed to follow-up care as we are to patients’ initial care, something for which an academic medical center is ideally suited,” said Garcia, a board-certified urologist.

Cedars-Sinai is one of only two academic medical centers in the western United States that offers gender-affirming genital surgery, Garcia said. (The other is University of California San Francisco Medical Center). The medical center currently offers male-to-female and female-to-male gender-affirming genital surgeries, as well as several other surgical options to best meet patient needs. Patients already have come from the U.S., Canada, Mexico and Asia.

The need for transgender services is evident. Recent federal and state population studies estimate that about 1.4 million adults, including 218,000 in California, identify as transgender people, according to the Williams Institute at UCLA School of Law. Few surgeons nationally are trained to perform gender-affirming surgery, making Cedars-Sinai a key center for this type of specialized care and research.

Garcia has specialized in gender-affirming surgery for five years. He is an expert in genital surgery as well as male-to-female and female-to-male gender-affirming genital surgery for adults and adolescents. In addition, he provides urologic care to all adults and adolescents.

“Dr. Garcia is superbly qualified to lead this program as one of the only fellowship-trained physicians in this specialty on the West Coast,” said Dr. Bruce Gewertz, Cedars-Sinai surgeon-in-chief and chair of the Department of Surgery. “He has remarkable experience in both the technical and social aspects of the care of transgender patients. He also has top-flight leadership skills and has organized a thoughtful approach to this program.”

Garcia’s team recently organized a transgender sensitivity and awareness training session for Cedars-Sinai staff. The three-hour training covered gender terminology and the processes of coming out and transitioning, among other topics. It was recorded for ongoing use. Additional interactive educational lectures for faculty, students and staff are being planned.

The Cedars-Sinai program is available to all patients seeking gender-affirming surgery and healthcare, including those covered by Medi-Cal and Medicare. The following services are provided:

— Patient education
— Comprehensive male-to-female and female-to-male gender-affirming surgeries
— Complex revision surgeries
— Urologic surgery
— Plastic surgery
— Otolaryngology (ear, nose, throat and facial) surgery
— Hysterectomy
— Colorectal reconstructive surgery
— Radiology diagnostic and surgical planning
— Adolescent medicine
— Geriatric transgender medical and surgical care
— Infectious disease care/HIV specialty care
— Vocal cord and speech therapy
— Dermatology and permanent hair removal
— Fertility preservation
— Hormone management
— Comprehensive gender-affirming care for adolescents
— Mental health and psychiatry services
— Internal medicine, primary care and family medicine

As the program expands, it increasingly will contribute to healthcare on regional and national levels, Garcia said.

“We are a community program and a far-reaching one,” he said. “We offer not just expertise but a strong commitment to providing ongoing access to that expertise.”

Youngs couldn’t agree more.

“After my recovery, I actually felt a sense of letdown when I no longer had the regular, close contact with my doctor and the staff,” she said. “One of the happiest times I have are my car trips on my way back to see Dr. Garcia.”

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