January 7, 2021
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Activism, Outreach and Education
Transgender Health Program at the University of Utah
50 N. Medical Drive
transgenderhealth@hsc.utah.edu
801.213.2195 | uofuhealth.org/transhealth
At the core of each story in SLUG’s My Body and Me issue lies the powerful force of bodily autonomy. Here, Ariel Malan, the Program Coordinator of the Master of Healthcare Administration and the Transgender Health Program at the University of Utah, talks the physical, social and emotional changes surrounding this identity-affirming body transformation.
SLUG: Can you please fill us in on the history of the Transgender Health Program? How has it changed/grown since its inception?
Malan: Thanks to the work of several dedicated healthcare providers, our Program was officially launched in 2017. Prior to this date, many meetings were held between providers and hospital leadership about the need for more coordinated care for transgender and gender-diverse patients. Since then, we have seen volumes dramatically increase across all of our specialties. We believe that this is predominantly due to the fact that there has been a gap in providing this care to patients—not just in Utah, [but] across the nation. We are the only multidisciplinary program in the Mountain West, and although we serve primarily Utah’s communities, we also see 12% of our patients from other states.
In addition to our growth, we have defined our mission and vision to better serve our communities and continue to hold the Program and our University system accountable for health outcomes:
Vision (where we are going): A patient-centric, multi-disciplinary gender health program for all gender journeys across the lifespan.
Mission (what we do): The Transgender Health Program is committed to providing comprehensive, compassionate, evidence-based care for gender-diverse individuals in a supportive, affirming environment.
Intersectionality: We will recognize the unique social and political identities that exist within gender-diverse individuals and advocate to remove inequalities within healthcare.
Coordinated Care: We will provide coordinated care through patient navigation and provider communication on all aspects of care.
Research: We will engage in research to advance knowledge and well-being for the care of gender-diverse individuals.
Education: We seek to educate providers, trainees and the public on the needs and health of gender diverse individuals.
SLUG: What are the range of services offered at the Program?
Malan: Our Program spans across eight different specialties that coordinate care for all gender-affirming services a patient might need on their gender journey. Patients and families can access the [following] range of services at our website, uofuhealth.org/transhealth: primary care and HRT, plastic surgery, fertility and family planning, voice therapy, physical therapy, laser hair removal, adolescent medicine [and] gynecologic care.
SLUG: Can you please elaborate on the range of staff at the Program? What types of professionals are available?
Malan: Currently, we have three dedicated administrative staff to our Program. This includes two Patient Coordinator roles that assist patients in navigating care and scheduling appointments, and a Program Coordinator role that manages marketing and outreach, education, strategy and other programmatic projects.
Our clinical staff is not dedicated to our Program alone in that they serve in multiple capacities. For example, we have plastic surgeons that are specially trained in gender-affirming surgery, but they also deliver other types of plastic surgery to patients that are not our transgender patients. The range of professional clinical positions include physical therapists, plastic surgeons, family-medicine providers, speech-language pathologists, endocrinologists, adolescent medicine physicians, aestheticians, physician assistants, reproductive specialists, OBGYNs and urologists.
We have high hopes that our hospital system will continue to support us in providing us with more dedicated positions both clinical and administrative.
SLUG: I read in your FAQ a bit about opening up your services to be more inclusive toward nonbinary identities and others. Can you please elaborate on the types of changes the Program is undertaking in this regard?
Malan: Transgender is an umbrella term that encompasses many gender-diverse identities, including those who identify as nonbinary. It’s important that our Program is able to serve all of these identities by not assuming what someone’s gender journey looks like based on how they identify. This is why all of our providers consider every patient’s journey as unique and discusses with them what options exist. Not all transgender people pursue medical transition, and some are only interested in a handful of gender-affirming options.
We are working closely with our new Patient and Family Advisory Board to identify ways that our Program can be more inclusive to gender fluid/nonbinary identities.
SLUG: I saw a section on your website regarding events. While those are (likely) on pause right now, what are the types of events that the Program typically holds or appears at?
Malan: Many of the events we offer are educational either for patients or providers. Every month, we offer a patient-education seminar on various transgender health topics. Our providers are present to talk about the services and what to expect, and we offer a panel of patients who have had that particular service. This is free and open to the community to attend and ask questions. Since COVID, we have hosted these virtually via Zoom and will continue to do this until it is safe to resume back in person. [In these cases,] these are offered at the Utah Pride Center. Patients can visit uofuhealth.org/seminartransgenderhealth to see a list of upcoming seminars.
For our providers, we hosted our first annual conference on transgender health this year and plan to offer this and more educational offerings to community providers.
SLUG: In addition to the medical services you offer, it seems like there are a lot of other areas (counseling, voice therapy, etc.) deal with more “intangible” things. Can you please talk about how these areas interact with things such as surgeries, hormones, etc.?
Malan: For many of our patients, counseling or mental-health therapy may be their first point of contact in a healthcare system in talking about their gender journey. For many folks in the beginning of their journey, they may still be in what’s called their “social transition,” … finding what is most authentic to them in their own expression through body language, adjusting their voice, changing hair or clothing styles, or a legal name change.
These are reversible and fluid things that people are figuring out for themselves, so medical and surgical changes may or may not be on their list to pursue.
An unfortunate barrier that still exists to this day in accessing gender-affirming medical and surgical options are the WPATH (World Professional Association for Transgender Health) requirements. Although these guidelines provide evidence-based practices for providers offering these services, there is a list of criteria, including “living in your desired gender role for at least one year,” before many things can happen. These guidelines can be interpreted loosely by providers to make sure patients get the care they need, but health-insurance companies sometimes have stricter standards they go by in order to cover any services that someone may need as part of their journey.
SLUG: A significant offering at the Program are the youth and teen Transgender Health Services. Can you please elaborate on the breadth of these services and their place in the Transgender Health Program?
Malan: More and more youth are identifying under the transgender umbrella, so the services offered at our Adolescent Medicine Clinic, [such as the] Gender Management and Support are critically important for families and youth.
We have physicians who … specialize in adolescent transgender medicine [and] can provide options for puberty blockers, hormone therapy, behavioral health and nutrition wellness, and coordinate care with our adult providers so the transition to those services can be seamless.
SLUG: How does the Transgender Health Program interact with other aspects of the Utah LGBTQ+ community?
Malan: We are heavily reliant [on] and grateful our community partners. We cannot do the work we do without their help and feedback. A couple of our community partnerships include:
Genderbands: Every year we partner with Genderbands to offer a top surgery grant for those who are uninsured in the community.
Utah Pride Center: Pre-COVID, we used their space to offer our patient-education seminars and refer patients to them for their mental health services and support groups. Every year, we also participate in the annual Utah Pride Festival and Genderevolution conference.
We have been present at many other community organization events through outreach booths, presentations and referring patients directly to them for resources. As mentioned previously, we also have created our own Patient and Family Advisory Board made up of community patients and family members … They are helping us shape the strategy and direction of our Program, which will ensure our services are patient-centric.
SLUG: What’s one thing you’d like the readers to know about the work you do and the communities you work with?
Malan: We are a new and growing Program! This means that we have a long way to go in making sure our Program is remedying the historical trauma that our community has experienced directly by healthcare providers. But this also means we have many exciting opportunities to engage with our community and integrate their feedback into how we provide these services. For our allied healthcare providers, we hope to be a resource in providing education for you and your staff to better serve transgender patients. For our patients, we thank you for your continued vulnerability during our growth and aim to be [a] safe space that can meet your healthcare needs.
SLUG: If a reader is interested in obtaining services, how can they get in touch or schedule an appointment?
Malan: Call us directly at 801.213.2195, option 1, and leave us a voicemail. We receive many phone calls a day, so leaving a voicemail will make sure we can get back to you. Also, emailing us at transgenderhealth@hsc.utah.edu.
SLUG: What does the Transgender Health Program have planned for the future?
Malan: So many things! We are looking forward to creating our first five-year business plan, which will include direct patient feedback from our Advisory Board, and both clinical and administrative input on ensuring the sustainability of our services. We also are launching our first educational-needs assessment that will guide us in delivering needs-based education on LGBTQ+ communities to our providers and staff. A few others to mention: a community photoshoot to use representative photos of our community marketing materials; improving the accessibility of our patient education seminars and other patient education materials; identifying our underserved communities so we can better reach them; creating a development plan to bring fundraising dollars into the Program to fund important initiatives like scholarships for patients and research; work toward requiring standardized education for our system on LGBTQ+ people and get all of our inpatient facilities designated under the Healthcare Equality Index.
Find here a list of additional local resources for transgender individuals, compiled with the invaluable assistance of River Jude August:
- TEA of Utah provides the latest local legislative news & policies, while also working hard to create systemic change on a legislative level.
- Queer-affirming therapists: lgbtqtherapists.com/directory.html
- Trans Equality Healthcare helps individuals to navigate their rights around gender affirming care:
- The Transgender Law Center is an org led by trans folx, who work on the National level & some state levels regarding transgender rights & legislation:
- Trans-friendly/affirming & affordable electrolysis: Jennifer Peck
- Name/gender marker changes: Jessica Couser
- Trans-friendly attorney: Michael Young, with Parsons Behle & Latimer
