In “Born to Be,” a documentary about the Mount Sinai Center for Transgender Medicine and Surgery, its Director of Surgery, Jess Ting, MD, center, headed for an operating room with Adriana Macias, RN, and patient Mahogany Phillips.
The Mount Sinai Center for Transgender Medicine and Surgery (CTMS) in three years has become a world leader in the care and support of transgender people, a journey that is the subject of Born to Be, a documentary that premiered on Saturday, September 28, at the 57th New York Film Festival.
“CTMS has treated 2,500 transgender patients since it was founded in 2016 and performed 1,200 ‘trans-related’ surgeries, such as facial feminization and genital reconstruction,” says Joshua Safer, MD, Executive Director of the Center for Transgender Medicine and Surgery, and Professor of Medicine (Endocrinology, Diabetes and Bone Disease), Icahn School of Medicine at Mount Sinai. The Center also offers services in primary care, physical therapy, endocrinology, behavioral health, and social work that are uniquely comprehensive.
Joshua Safer, MD, Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery.
“The one thing that transgender people have in common is that their gender identity is not aligned with the physical anatomy that we see,” Dr. Safer says. “But there is great variability in what they want to do about that, and we think patients should have customized choices, just like treatment for any other medical circumstance.”
The new documentary, directed by Tania Cypriano and produced by Michelle Hayashi, focuses on five patients seeking to transform their lives with surgery performed by Jess Ting, MD, Director of Surgery, Center for Transgender Medicine and Surgery, and Assistant Professor of Surgery (Plastic and Reconstructive Surgery), Icahn School of Medicine at Mount Sinai. They were a varied group, including a self-described survivor of the 1980s drag ball culture, a young professional, and a former model. One patient seemed to speak for many in describing life before the surgery. “You are fighting every day,” he said. “You are fighting to be respected, you are fighting to be comfortable in your own skin.”
The film depicts CTMS in its early days, when Dr. Ting was just transitioning into his role. Since then, Dr. Ting created the nation’s first transgender surgery fellowship and hired the first two graduates of the program. “One new surgeon is coming out of this program every year,” Dr. Ting says. “Over time, we will be able to multiply our expertise and our ability to address health care disparities for transgender patients.”
CTMS has also added two luminaries in gender-affirming surgery: Marci Bowers, MD, a San Francisco-based pioneer in vaginoplasty, and Miroslav Djordjevic, MD, PhD, a specialist in female-to-male genital surgery who leads the Belgrade Center for Genital Reconstructive Surgery in Serbia. Both teach and practice at Mount Sinai several times a year. “These collaborations build upon an already strong program and make CTMS a world leader in gender-affirming surgery,” Dr. Ting says.
Miroslav Djordjevic, MD, PhD, left, and Marci Bowers, MD, two leaders in gender-affirming surgery, are collaborating with the innovative team at Mount Sinai.
In other innovations, CTMS created the first psychiatric fellowship in transgender medicine, and is now training its second fellow. In addition, all endocrine fellows and plastic surgery residents rotate through the transgender program, making Mount Sinai one of the only centers to incorporate the care of transgender and nonbinary patients into its physician training curriculum.
These fellowships are part of the larger mission of CTMS, to provide guidance in a field that is at a crucial “inflection point,” Dr. Safer says. “Until a few years ago, the universe of trans surgery has been really ad hoc,” he says. “The better-known surgeons in North America operated out of freestanding surgery centers, because conventional medical centers would not let them use their operating rooms.” Medicare specifically banned coverage for transgender procedures, and patients paid out of pocket. But in 2015 the government reversed its policy, leading many states—including New York—to obligate private insurers to provide coverage of transgender procedures. This has made such treatment affordable for many more patients, and transgender medicine is rapidly expanding to meet the demand.
Leveraging its resources as a large academic medical center, Mount Sinai is taking the lead in efforts to elevate and standardize important aspects of patient care, including the training of nurses, physical therapy for patients undergoing genital surgery, and the pre- and postsurgery process. To create a national conversation on best practices, CTMS held the first Live Surgery Conference for Gender Affirmation Procedures in spring 2018, co-sponsored by Mount Sinai and the World Professional Association for Transgender Health (WPATH), the leading professional and educational organization for transgender health care. The second such conference, in spring 2019, held panels on social and ethical issues in transgender care and featured live surgeries by experts, including Dr. Ting, Dr. Bowers, and Dr. Djordjevic.
CTMS plans another conference in spring 2020 focusing on medical issues such as perioperative care and adolescent health. “CTMS has become a national model for providing a full-service and integrated system of affirmative patient-centered care, accessible to all transgender and nonbinary patients,” says Barbara Warren, PsyD, Director, LGBT Programs and Policies, Office for Diversity and Inclusion, Mount Sinai Health System. “It also serves as a much-needed resource for educating the next generation of health care providers in culturally and clinically competent care.”
David L. Reich, MD, President and Chief Operating Officer, The Mount Sinai Hospital, who was a driving force in creating CTMS along with Dr. Warren, says: “In so many areas of medicine, we tend to be competitive. In gender affirmation surgery and transgender medicine, however, we need to think broadly to support a community that has for so long been underserved. Our mission and our vision is to bring the care of the community to the next level by sharing our expertise.”
At a screening of the documentary “Born to Be” at the 57th New York Film Festival, from left: the film’s producer, Michelle Hayashi; patients Garnet Rubio and Jordan Rubenstein; Jess Ting, MD, Director of Surgery, Mount Sinai Center for Transgender Medicine and Surgery; patient Mahogany Phillips; and the film’s director, Tania Cypriano.