Seen & Heard

Samantha Allen was feeling apprehensive. It was autumn of 2012, and she had recently come out to herself as transgender. As an Emory graduate student, she was looking for assistance on campus. What resources were there? Was Georgia really the best place for a transgender person?

She approached Michael Shutt, then assistant dean for campus life and director of the Office of LGBT Life, who told her that, in addition to a transgender support group that met weekly, Emory was home to a well-known medical expert in transgender health.

Allen set up an appointment with Vin Tangpricha, a professor in the Division of Endocrinology who maintains transgender clinics at Emory University Hospital, Emory University Hospital Midtown, and the Atlanta Veterans Affairs Medical Center.

Tangpricha treats a variety of endocrine conditions in his general practice, but at these clinics he primarily works on the initiation of hormonal therapy as part of gender affirmation treatment. “I have seen about 300 patients at Emory and about 100 at the VA over the past 
10 years,” he says.

Patients usually come to Tangpricha after being referred by a psychiatrist or mental health counselor who has given a diagnosis of gender dysphoria. Allen, who first saw a counselor at Emory’s Student Health Center, says she was excited just to get in to see Tangpricha, whose schedule is almost always full, and relieved she could finally get started.

“The most distinct impression I had from that meeting is, it’s so refreshing to be in a room with a medical professional who supports you, who makes you feel seen and doesn’t make you feel uncomfortable,” Allen says.

With doctors Allen had seen for other issues during the start of her transition, there were awkward moments. “And so to come into the Emory Clinic and have Dr. Tangpricha just see me for who I am and exactly what I need, to make me feel affirmed, that made a huge difference,” she says.

After that first appointment, Allen began hormone treatment, while continuing to pursue a PhD in Women’s, Gender, and Sexuality Studies at the Laney Graduate School. By the time she received her degree in 2015, she had nearly completed her transition, including gender confirmation surgery, which was partially covered under Emory’s student health plan.

Shortly after graduation, Allen began working full time as a writer for The Daily Beast. She’s now a senior reporter covering LGBT issues. In April 2018 she received a GLAAD Media Award for an article that appeared in Splinter, and her book Real Queer America, about LGBT residents in America’s “red” states, is set to be released in March 2019. It includes her own experiences.

Allen’s story, and the way events unfolded for her, is one that would have been far less likely 10 to 15 years ago at Emory or any other institution, says Tangpricha, who began his path into transgender health and medicine in the early 1990s.

One of Tangpricha’s earliest encounters with a transgender patient came when he was a medical intern working at a clinic in Boston. A trans woman came in for some medical care unrelated to being transgender. When he learned that the woman didn’t have a primary care doctor, he asked her to come back to the clinic for future appointments.

That’s when Tangpricha realized that he needed to hit the books. While he’d had a growing interest in hormones—for example the effect of hormone treatment on bone density—he didn’t know much about hormone therapy as part of gender affirmation treatment, or other aspects of transgender medicine.

“What do I do?” he asked himself. “What are the hormones I give to someone who’s transgender?” The young doctor wound up scouring medical libraries all over Boston—Harvard, Tufts, Boston University—looking for literature on the subject. But it wasn’t readily available. So he dug for it, spending long hours looking. When he found articles and chapters, he’d copy them and place them in a makeshift library. “I put them into different folders—one was ‘Hormonal Treatment,’ one was ‘Mental Health,’ one was ‘Surgery.’ I had all these folders.” He ended up with a plastic file box filled with transgender health and medicine articles.

What had started with a desire to help one patient quickly grew. When medical residents in his program at Boston University School of Medicine were asked to do a senior talk, he was well prepared with a subject. He created a medical literature review for his mentor, endocrinologist Stuart Chipkin, who was also interested in transgender issues. “Transgender” was not a term used in the medical field at that time.

Tangpricha was in his first year as a fellow at Boston University when he was called upon to put his knowledge of transgender medicine into practice. Chipkin had left the school for another position. Tangpricha remembers being at a faculty meeting and the immediate question was, “Well, who’s going to take all of Stuart’s patients?” Tangpricha raised his hand and said, “I’ll do it!” With that, he inherited a practice of about 100 transgender patients. “And so I was sort of the expert,” Tangpricha says.

In 2001, he attended the annual meeting of the World Professional Association of Transgender Health (WPATH) and presented a paper on the relationship of hormone therapy and bone health. At the time, he didn’t know anyone who treated transgender patients except his mentor, so it was exciting to be at a conference devoted to the practice. WPATH had between 200 and 300 members then, a number that has since grown to about 2,000, Tangpricha estimates. He has a good idea of the membership numbers because he’s president-elect of WPATH, which has been instrumental in developing a framework for the appropriate evaluation and care of transgender people worldwide.

The 2011 WPATH Symposium was held at Emory and it was then that the latest version of the Standards of Care document was released. Now in its seventh edition, the standards are perhaps the most cited and recognized guidelines for the management of transgender individuals’ health.

Tangpricha was part of the committee that drafted the Endocrine Society’s first-ever clinical practice guideline on treatment for transgender patients, and he was on the committee that developed the newly revised guidelines. The latest recommendations are more evidence-based, he says, and are written not only for endocrinologists but for other physicians who prescribe hormones as well.

“As gender affirmation treatment becomes more common, there aren’t enough endocrinologists to meet the demand, and other doctors should have a reference,” Tangpricha says.

The new guidelines include a broader base of topics; for example, the document now covers the care of adolescents during and after puberty, as more people are seeking treatment for gender dysphoria at a younger age. “I’m proud of the guidelines,” Tangpricha says. “They have really helped a lot of people and have ‘legitimized’ hormone treatment for trans people.”

Although health insurance now covers care related to gender dysphoria, transgender patients still face barriers in the health care realm. These include everything from electronic records that don’t reflect name changes to awkward or embarrassing encounters with medical staff. Tangpricha has heard many transgender patients say they’re scared of doctors. One of the key things health care providers need to get right is the use of correct names and pronouns, he says, because if that is handled incorrectly early in an encounter, the patient’s comfort and trust is lost. “I hear horror stories from my patients about providers who simply refuse to use their preferred names and pronouns,” Tangpricha says.

The addition of a “preferred name” to medical databases and software systems would be useful, says Tangpricha. Also, he suggests that health care workers begin a medical encounter by saying, “Hi, I’m Dr. So-and-so. What name do you want to be called? And what are your preferred pronouns?”

Tangpricha’s colleague, Michael Goodman, a professor in the Rollins School of Public Health at Emory, says it has helped his own research to work with such a trusted and knowledgeable doctor. “With a long history of discrimination and mistreatment, it’s not surprising that transgender individuals 
are apprehensive about participating in medical research,” 
Goodman says.

Recently he and Tangpricha collaborated on a study on the link between hormone use in trans women and an increase in stroke and venous thromboembolism. Tangpricha’s involvement, Goodman says, is one of the main reasons research projects on trans health are now well off the ground. “It takes a person with his expertise, compassion, and communication skills to win the trust of participants,” he says.

By Wendy Darling

Transgender Terminology

transgender
a diverse group of individuals whose cross-culturally defined gender identity differs from the sex they were assigned at birth.

trans man
a male transgender individual who was assigned female sex at birth

trans woman
female transgender individual who was assigned male sex at birth.

gender dysphoria
distress caused by a discrepancy between a person’s gender identity and that person’s external sex characteristics.

gender affirmation
treatment medical treatment for gender dysphoria that may include psychotherapy or counseling, hormone therapy, and surgery, including gender confirmation surgery

transition
common term for the state of moving through gender affirmation treatment.

Source: “Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People” by the World Professional Association for Transgender Health (WPATH)