What’s been your experience with treating patients who are transgender?

Urology Times® reached out to 3 urologists (selected randomly) and asked them each to discuss their experience with treating patients who are transgender.

“Males and females both have urological issues; if they have kidney stones, or recurrent UTIs, we treat them. We currently have 1 transgender patient in our practice. It’s interesting because my partner’s brother is one of the top transgender surgeons on the West Coast.

There’s no issue in our practice. I’ve seen transgender patients for urological issues. The only concern is if additional reconstructive surgeries are needed. Those are very delicate and must be done by people specifically working in that arena, because once they’re done wrong, you’ve lost tissue and have less to work with going forward.

Although our practice is in the South, we’ve a very diverse perspective. I’m the senior doc, I’m African-American. The next senior is Vietnamese; the next, Jewish; the next guy is the only WASP; and the younger two, male and female, are Jewish immigrants from South Africa. Whether patients are queer or straight, whether they’re transgender, patients are patients.

Laws restricting transgender care or allowing doctors not to treat transgender patients are based on ignorance and prejudice. I hope most doctors reflect back on their Hippocratic Oath and say, ‘I never asked your permission to treat or not treat; I’m doing the right thing.’

For general urologic problems, we should be well positioned to treat these patients. Unless they have urethral stenosis issues as a complication, then there could be a problem.

In my system, if one were to act in an untoward way toward a transgender patient, there would be a significant problem.”

Nathaniel Barnes, MD

Houston, Texas

“Gender or sexual orientation doesn’t matter. It has no impact on the quality of care and compassion they’ll receive from both myself and my staff.

I’m in a rural setting, so we don’t have a large population of transgender patients. But transgender patients shouldn’t feel hesitant to come in for care because certainly any urologist that’s judgmental or unkind, based on that, needs to be taken to task. That’s completely opposite the oath we take. We are not supposed to be passing judgment on people.

States that pass laws restricting care and allowing medical people to restrict care are disgraceful.

This isn’t politics or religion. It’s people’s health and well-being. It’s shameful people should be singled out—and their health care affected—by political or religious views. It’s the opposite of what I thought this country was founded on.

I hope urologists would look past their personal views, any sort of societal pressures to alter the way they treat people, except to maybe improve it, to be more compassionate and provide quality care—not deny care to people who are transgender.

Any doctor who says you can’t make somebody treat someone they don’t want to treat, that’s actually not true. You can’t refuse to treat someone of color; that’s a civil rights violation. It’s not ethical; it’s immoral. Outside your scope of practice is 1 thing, but that’s not what we’re talking about. If somebody transgender comes to you and you don’t approve, you still have to treat them.”

Jonathan Fialkov, MD

Creston, Iowa

“We don’t have a program specifically for transgender care here at Penn. Some medical schools are ready to train students in transitioning procedures. It’s a difficult arena for several reasons. It requires a multidisciplinary approach: Plastic surgery, GYN, and urology can all be involved. It’s one of those areas where programs will be different every place, depending on who’s interested in doing it.

There aren’t a lot of people training fellows and residents in these surgical procedures. It may also be difficult for institutions to get people experienced with these kinds of procedures.

As for treating urologic conditions in transgender patients, we do that. Most places do. I can imagine your average physician wouldn’t be completely familiar with the anatomy and their condition. That could create hesitation in some patients in attempting to access care for other general urological things.

I occasionally see transgender patients. I don’t really see a lot of hesitancy on their part. They typically ask if I know they’re transgender and familiar with their surgery. I can usually answer yes. With normal communication, there shouldn’t be a lot of hesitancy, especially if the physician has some experience in subspecialty care; I think they can get good care.

I don’t think a transgender patient should have to go to somebody who specializes in transgender surgery if they have a kidney tumor or prostate cancer or something like that.”

William I. Jaffe, MD

Philadelphia, Pennsylvania