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Transgender Health Care at Michigan Medicine

A couple of months ago I was lucky enough to snag a spot to participate in the transgender health care clinical elective here at the University of Michigan Medical School. Michigan is one of a handful of (maybe three) medical schools who offer similar electives and right now it is only offered six months out of the year.

Dr. Shumer and me in the Mott Endocrinology clinic!

Transgender health care is often interdisciplinary; therefore, the elective draws from a variety of specialties. On average, I spent a day per week each in the pediatric and adult gender clinics, staffed by pediatric endocrinologists, and adolescent medicine specialists as well as reproductive endocrinologists. I worked with patients who were following up after surgery, initiating hormone therapy for the first time, receiving counseling on removing their GnRH analog implants, and anything in between. I also went to the Michigan Medicine Comprehensive Gender Services department to observe gender assessments performed by mental health providers. Finally, I spent time in the plastic surgery department, participating both in clinic and in the OR, with patients undergoing procedures like penile inversion vaginoplasty or top surgery (bilateral mastectomy).

Community outreach is also a huge component, which really appealed to me. I had the opportunity to meet with representatives from our law school’s Know Your Rights Project, UM sex therapy, and UM speech pathology. It was great to have an inside look at how trans folks might interface with these groups.

Last year as an M2, the clinical trunk year was all about learning the basics and understanding the foundation of clinical medicine, however, as a student it was often difficult to find continuity. You may be placed in a single clinic for a couple of weeks, without the opportunity to participate with a patient’s follow-up. The trans elective has been a welcome departure from this paradigm. One patient in particular stands out. I went with one of our social workers for the initial mental health gender assessment with a pediatric patient who wanted to start hormones. As he told his story, I couldn’t help but feel humbled and privileged to be even a small part of an identity journey and a medical intervention that he had wanted for so long. This patient was so brave and thoughtful and a teenager. I was in awe.

He came to the medical clinic the following week. Under supervision, I was invited to run the entire visit and the discussion surrounding initiating testosterone therapy. The patient and his family members were so excited to see and speak with a familiar face. It felt like a reunion of sorts. It was one of the more striking times in medical school that I’ve felt the ownership that comes alongside taking care of patients from the start of their medical journey. Side note, I actually wasn’t even supposed to be in clinic that day, but I invited myself in (shout out to the real MVP, Dr. Shumer!) because I loved this patient and his family so much.

As my M4 friends get closer to graduation and I move toward residency application season, I’ve been thinking a lot lately about the type of doctor I aspire to be. I’m planning to apply into Obstetrics and Gynecology this fall, and the reality is there isn’t a lot of formal training out there on how to provide trans inclusive care. I’m grateful that this elective exists and I’m grateful that I get to train at the University of Michigan. Here, we understand that it is our responsibility as future doctors and human beings to care for this population, in all senses of the word.