When she's not providing gender-affirming surgical care for transgender and non-binary patients, Geolani Dy, M.D., thinks about how she can better serve patients beyond her surgical practice.
"There's already a body of evidence that shows gender-affirming care has many benefits, such as improving mental health and reducing suicidality," says Dy, an assistant professor of urology and of plastic and reconstructive surgery in the OHSU School of Medicine, and also a surgeon involved in the OHSU Transgender Health Program.
"But a critical perspective is missing from medical literature," she adds. "Now is the time to dig in and truly center transgender patient perspectives about what effective and successful gender-affirming care looks like. Community-informed research is needed to more accurately define and measure care outcomes."
Dy is one of very few surgeon-scientists who split their time between gender-affirming surgery and research. She joined OHSU in 2019 after completing a reconstructive urology and gender-affirming surgery fellowship at New York University.
Demand for gender-affirming care has grown significantly during the past decade as society becomes increasingly accepting of gender diversity and more Americans decide to freely express their gender identity. OHSU is among many institutions nationwide that employ specialized staff and train future health care leaders to provide care for transgender patients. Organizations such as the World Professional Association for Transgender Health have established standards of care, and public and private insurers alike cover many gender-affirming health services.
Much of what gender-affirming care is today has been determined by the medical community — whose members are largely cis-gender and cannot fully understand the nuances of what transgender patients need. Dy identifies as cis-gender and actively pursues the perspectives of her trans and non-binary colleagues and patients to inform her own work; she wants those experiences to help shape other researchers' and clinicians' work, too.
With support from the nonprofit Patient-Centered Outcomes Research Institute, she co-founded the Transgender and Non-Binary Allied Research Collective, or TRANS-ARC, in 2019. The collective seeks out trans and non-binary patient perspectives to shape research related to gender-affirming genital surgeries. Dy and her colleagues encourage researchers to engage with transgender community members early and often, and ultimately embed trans and non-binary people along each study's steps. They say every research detail should be evaluated through the trans lens and that everything — from which topics should be studied to which survey questions should be used — should be considered in partnership with trans community members.
The collective organized a virtual summit of researchers, health care providers and patients in 2021. Among the key outcomes of that discussion is a practical best practices guide and a list of research priorities. At the top of that list is exploring how insurance coverage — or lack thereof — affects surgery outcomes and how surgery affects sexual health, and comparing outcomes for different surgical methods.
Dy is also leading the creation of a database of gender-affirming surgical outcomes, known as the TRANS Registry. While considering what makes a surgery successful for patients, the registry aims to standardize the measurement of surgical outcomes and improve surgical transparency for both clinicians and patients. Other surgical fields have such registries, but this is expected to be the first centralized registry for gender-affirming surgeries. Dy and her colleagues are initially compiling data from three large gender-affirming institutions -- OHSU, New York University and the University of Utah -- but they eventually aim to expand the registry into a national resource.
Now, Dy and colleagues are applying for grants in the hopes of pursuing research that aligns with the priorities and methods they've identified in recent years.
"TRANS-ARC is just the beginning," Dy says. "We need to study these important questions and share our findings with transgender communities, researchers, clinicians and payers. My ultimate goal is to empower researcher teams, especially trans-led teams, to conduct meaningful, impactful research related to gender-affirming surgery — and to make those findings accessible and useful for trans community members, who can hopefully use this information to make well-informed decisions about their own health care."
