What happens when a pair of endocrinologists with added training in the care of transgender patients join a practice together in eastern Connecticut? A transgender program, of course.
While the rural eastern part of the state may seem an unlikely location for a service addressing the hormonal needs of transgender patients, Drs. Karina Szczepanczyk and Janya Swami have built a base of 14 patients since May 2021, largely due to an influx of college students.
“Most of the transgender patients in the East were going into Rhode Island for care. We wanted resources for them here,” Dr. Szczepanczyk said of the practice at the Backus Outpatient Care Center (BOCC) in Norwich.
Theirs is an adult referral-based network, part of the Hartford Health Excellence for Gender Health Initiative, and currently draws from patients at the Backus Center for Endocrinology, Diabetes & Metabolism.
“Our goal is to help provide network opportunities for primary care providers, behavioral health services, infectious disease, voice therapy and community support,” according to Darleen Caisse, BOCC director. “Our providers also collaborate with urologists and surgeons to help patients achieve gender affirmation.”
Care coordination of such different specialties is the recommended approach for transgender patient care.
“Patients often approach different specialties/disciplines to pursue feminizing or masculinizing hormone therapy,” Dr. Swami added.
The first step is a behavioral health evaluation, assessment and diagnosis of gender dysphoria/gender incongruence, required by the Endocrine Society for endocrinologists to prescribe gender-affirming hormones. The behavioral healthcare, however, is necessary throughout the process, the doctors agreed.
“It doesn’t take long to appreciate the importance of diagnosing and managing gender health issues. Many patients endure a lifetime of struggles before finally transitioning. Even then, the doctors said they require lots of support and our goal is to help make their transition as seamless as possible,” Dr. Szczepanczyk said.
In addition, before considering gender-affirming surgery, Endocrine Society guidelines require patients undergo a year of consistent and compliant hormone treatment.
“It is our job to educate our patients about the consequences, risks and benefits of hormone therapy in order for them to make an informed decision and ensure that the desire for transition is appropriate,” Dr. Szczepanczyk explained.
It’s rewarding to watch patients undergo gender affirming care, they said.
“A huge part is seeing a patient’s reaction to their treatment,” Dr. Swami said. “We can help them be the person they want to be, and celebrate the little joys with them, like a male patient who went topless on a beach for the first time. They’re happy to be in their own skin.”
The doctors credit key partnerships with other Hartford HealthCare providers as they grow their practice, including the guidance of Dr. Priya Phulwani, a pediatric and adult endocrinologist with extensive experience in transgender health and medical director of the gender program at Connecticut Children’s Medical Center.
“We have been very fortunate in our partnerships so far. Multiple specialties have shown interest and enthusiasm in participating in the multidisciplinary framework that is so essential to provide complete and comprehensive care for this population,” Dr. Swami said, adding, “It’s like the Hartford HealthCare vision – we want to be the most trusted for personalized coordinated care. If we can do that in our region, it will be wonderful.”
For more information on transgender care at the endocrinology practice at the Backus Center for Endocrinology, Diabetes & Metabolism clinic, call 860.892.6906.