Raising awareness of health disparities that affect LGBT communities

Last week was National LGBT Health Awareness Week. It is a time to bring attention to the discrimination and health disparities that affect lesbian, gay, bisexual and transgender (LGBT) people nationally and worldwide.

As the Swedish LGBTQI+ Initiative and LGBTQIA+ Caregiver Resource Group has highlighted over the last few months, transgender and gender diverse communities have faced an unprecedented level of transphobic violence nationally with the highest number of fatalities recorded in 2020.

We know based on our health equity data, our gender-diverse patients face higher rates of depression, anxiety and suicide rates; are lower-income and typically have less than a high school education in comparison to our general patient population. As a result of many of these compounding factors, many of our gender diverse patients delay or forgo preventive and necessary medical care resulting in higher utilization of the emergency department.

To honor and celebrate National LGBT Health Awareness week, Swedish is highlighting two of our physician champions and the work they are doing to serve and support our LGBTQI+ community.

Gender-affirming care is a form of treatment that allows a person's second sexual characteristics to become aligned with their gender identity. This includes a whole range of services (social support, behavioral health and medical care). Individuals in transition may elect to undergo hormone therapy and/or surgery.

For persons assigned female at birth, now identifying as transgender men or nonbinary, a hysterectomy may be desired. Gender-affirming hysterectomy can be performed laparoscopically, as a same-day surgery, with only two 5 mm visible incisions. Ovaries can either be removed or left in place, although current guidelines recommend suppressing ovaries with testosterone and leaving them in place.

The technical aspects of the hysterectomy are the same as when the surgery is performed for other indications (e.g., fibroids, endometriosis, pelvic pain). Patients recover in an all-gender outpatient recovery area, go home the same day, require minimal narcotics postoperatively and are typically back to work within a few weeks.

Providers should take steps to make their office environment as inclusive as possible when providing gender-affirming care.

For example:

- Gender-neutral waiting room. Gynecology only offices may be preferred

- Intake forms and electronic medical record with space for chosen vs. legal name, gender identity, sex assigned at birth and correct pronouns (she/her, he/him, they/them)

- All staff (not just providers) trained in gender-affirming care

- Gender-neutral bathrooms

- Coordinated care with other gender-informed providers (e.g. primary care, fertility specialists, counselors, psychologists, psychiatrists and community support groups)

If you are considering a gender-affirming hysterectomy, please call (206) 386-6060 to schedule a consultation with Dr. Winner or her partner Dr. Marrs. You can also visit the Swedish transgender health website to learn more.

Dr. Rebecca Dunsmoor-Su (She/Her/Hers) is a gynecologist and medical director for menopause at Swedish. In her role as a gynecologist and hormone expert, she provides gender-affirming hormone therapy for women and vaginal care for all persons with a vagina.

Many women feel more comfortable seeing a gynecologist for their hormone therapy in an environment that feels geared towards their care. They may also want to explore what types of hormones are available, which are safest and which can be most economical.

While Dr. Dunsmoor-Su does not do bottom surgery, she can be part of your post op care team when neo-vagina surgery has been performed. She also recognizes that many men who have fully transitioned may maintain their vagina for any number of reasons. When on testosterone therapy there can be discomfort both day-to-day and with intercourse. There are many modalities we can employ to ease this discomfort while maintaining appropriate masculinization and testosterone therapy.

In our office, we take care to educate our staff on the importance of asking for and using a person’s correct pronouns and will always do our best to make Swedish a safe place to seek care for all people. In addition, we work closely with the LGBTQI+ Initiative at Swedish to help patients coordinate comprehensive health care. If you would like to schedule with Dr. Dunsmoor-Su, or one of her partners, she can be reached at Swedish OBGYN Specialists at First Hill at (206) 215-6300.

If you have questions or would like to learn more about the efforts of Swedish physicians striving to make care more accessible to members of the transgender and gender diverse community, visit our transgender health website.