Discoveries Magazine

Cedars-Sinai

Transformational: Maurice Garcia, MD

The director of the Cedars-Sinai Transgender Surgery and Health Program discusses building trust with patients, leading a team of specialists, and pushing cultural change in medicine.

 

Scott Witter

Urologist Maurice Garcia, MD, is unflinching in his pursuit of the finest treatment for his patients: His top priority, as he develops Cedars-Sinai’s new Transgender Surgery and Health Program, is availability of services. Cedars- Sinai’s program is one of only two based at an academic medical center in the West. Garcia is appreciative of the California mandate t hat insurance providers cannot deny transgender people transition-related surgery and other care. Gender dysphoria—distress caused by a mismatch between gender identity and sex at birth—must be reimbursed like any other condition.

Here, Garcia talks about the learning curve in transgender medicine, and how he hopes to make it accessible to all those who seek it.

Q: What is a common misconception about transgender medicine?
A: Not all transgender patients seek gender reassignment surgery, and it’s not right for every patient. But, for many people, there is a constant reminder that they’re not in the right body—and we need to help them.

 

Q: Why would someone seek medical solutions for gender dysphoria?
A: Being transgender in many ways limits quality of life, in terms of finding jobs, coping with and avoiding substance abuse, and developing relationships. How can you date when you have a body that freaks you out? My research shows that transitioning—whether by gender-affirming surgery or by hormone therapy or social transition—enhances quality of life.

Q: What are the barriers to getting this kind of care?
A: People have loosened up and are more accepting of gender diversity, which helps the social advancement of transgender people. But gender-affirming surgery is still largely inaccessible for many who seek it. It is mostly done in private practice, and far too expensive for most patients. Even to become trained in transgender surgery presents boundaries— to complete my fellowship in transgender surgery in 2013, I had to travel across continents when I transferred from the University of California, San Francisco, to University College London in the U.K.

Q: Is transgender medicine a relatively new field, or are we just finally talking about it publicly?
A: Gender-affirming surgery wasn’t invented yesterday, but it has lived in the shadows for a long time. For so long, there were no guidelines and no data to prove that interventions worked. There wasn’t even consensus about the condition being an innate part of people—it was thought of as a vice or a choice. That’s why I firmly believe transgender care should fall in the domain of academic centers like Cedars-Sinai, where we publish research, help establish guidelines, and educate other medical professionals. A transparent look at outcomes only gets rigorously discussed in an academic domain.

Q: This discipline can seem very niche—how does it fit into the rest of medicine?
A: One of the aims is to try to change the culture of medicine in general. We want to convince surgeons that you don’t have to be an expert in transgender surgery to perform a related procedure. For instance, we can remove a patient’s testicles in case of cancer or trauma, but asking a urologist to remove testicles as part of transgender transition is difficult. As we demonstrate the medical benefit of transgender care and surgery, we can reduce stigma and discrimination. And what should follow is that more medical experts will make their services available to people who really need them.

Q: How do other medical disciplines benefit from your research?
A: One of the greatest values of this program is that it advances our innovation and expertise, which leads to research that can further all fields of medicine. Our findings can contribute to better alternatives for non-transgender patients. For example, our work into vaginal replacement can benefit non-transgender women who lose their vaginas because of cancer or radiation. We’re working on complete penis transplant, and we can apply our surgical techniques to veterans who lose their genitals during landmine blasts and men with penile cancer. Cedars-Sinai is an ideal place for this kind of knowledge sharing, because a center that already has expertise in so many domains is equipped to maximize the benefit. Experts in other fields can take this and run with it or collaborate.

Q: Do you approach young patients differently than adults?
A:We’ve established a bridge clinic for adolescents and young adults who are transgender. We’re a resource for youth, pre-transition, and that’s very innovative. This bridge clinic helps guarantee continuity of care. For adolescents and young adults, we involve their other physicians, caregivers, and, ideally, parents along the way. For younger people, we involve parents, pediatricians, endocrinologists, and social workers in the decision-making and planning phases of surgery to ensure that all the patient’s needs are being met.

Q: Right, and the Cedars-Sinai program includes all kinds of specialties, from dermatology to vocal cord and speech therapy. Why is this important?
A: Our program offers much more than genital surgery alone. Our greatest asset is that we are comprised of many, equally important, leading specialists representing all areas of medicine, who collaborate in work and research.

Few programs in the country are like ours—going so far beyond social work, surgery, and hormone therapy. Everyone who strives to provide a welcoming environment for our patients is equally vital to the quality of our program. We provide geriatric care because, eventually, this population will need it. In a top-tier academic environment like ours, where we have so much expertise, my job is to coordinate involvement between specialties.

Q: What inspired you to specialize in gender-affirming surgery?
A: I’m drawn to the interpersonal dimension of care. Medicine can be a service or it can be a relationship—and, more often than not, this surgery demands it be a relationship. It’s one based on mutual trust: on their part that I have their best interest in mind, and on my part that they will make the best decisions for themselves.

I love the continuity of care I get with patients; it’s a privilege knowing people for a few years. My patients end up being incredibly grateful, and that is very fulfilling to me. I value the text messages I get every holiday from patients far and wide.


MAURICE GARCIA, MD
Director, Cedars-Sinai Transgender Surgery and Health Program

MENTORING
Garcia trains residents from UCLA, UC San Francisco, and Cedars-Sinai with the idea that all medical professionals should be educated on how to work with transgender patients.

INNOVATION
He has active and pending patents on surgical devices and apps for transgender patients, like one that can shape a photographic image of genitals into the best dimensions for a transitioning patient’s body.

L.A. NATIVE
Garcia grew up in Los Angeles and is residing here for the first time since he left for college. He has two children, ages 6 and 11, and likes showing them around his hometown with trips to his favorite outdoor spots, such as the Hollywood Reservoir and Ventura beaches


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