About eight years ago, Dr. Rhett Brown was asked a question that would change his life and how he practices medicine.
A local therapist who treated transgender patients said many of them traveled great distances to see a doctor who offered the care they needed. Would he be interested in treating transgender people?
As a gay physician, Brown said he had a few transgender patients, but had not given the issue a lot of thought. “She challenged me, ‘Why am I not doing more?’” said Brown. “I was embarrassed to say, ‘I don’t know, but let me see what I can do.’”
Fast forward to today: nearly 500 of Brown’s 2,000 patients at Novant Health Midtown Family Medicine in Charlotte, North Carolina, are transgender, which makes him one of the top providers for transgender care in the fast-growing region.
Although it’s unclear how many Americans actually identify as transgender-- recent research has shown that about 1 in every 250 adults or almost 1 million Americans consider themselves transgender.
It’s humbling, Brown said, to help patients who have struggled so much in their lives to become comfortable with who they are.
What is transgender healthcare?
Transgender individuals are those whose sense of personal identity does not correspond with the gender assigned at birth.
As Brown explains, transgender care can be defined as: “the care directed at reducing a patient’s anxiety, making them feel less ill at ease with how they personally perceive their gender versus what their body physically looks like.”
That includes increasing the quality of their lives by helping them transition into the gender they identify with.
Many transgender patients have struggled to find health care that accommodates those needs. And advocates say they still face a substantial stigma in many corners of American life. The rights of transgender people set off a firestorm in North Carolina in 2016 over the HB2 “bathroom bill,” which reversed a Charlotte ordinance extending some rights to people who are transgender.
Transitioning into another gender is a complex process that requires the involvement of multidisciplinary teams that focus on hormone therapy, mental health counseling and gender reassignment surgery. Brown prescribes hormones for his patients but does not perform surgery.
When patients see Brown, they undergo an assessment to review their medical history to look for persistent and consistent feelings of discomfort regarding their gender. As treatment advances, the most common ways providers help patients begin the transition process is to start hormone therapy, where either testosterone or estrogen is given to patients to help them physically look more like the gender that they identify with.
“We do encourage them to work with a therapist as they work through their feelings of dysphoria (anxiety) and find other ways to put them at ease,” Brown said, “including services like gender reassignment surgery and voice therapy to change the way their voice sounds.”
Not just ‘a phase’
Erica Lachowitz, 42, knows what it takes to make that journey. The road from Eric to Erica was challenging--but she loves where she has landed. Today, Lachowitz is a wife and mother who works as a business applications manager in the manufacturing industry. She also has her own welding and metal craft company.
From an early age, Lachowitz knew that she didn’t identify as male. Her parents supported her, but she often faced judgmental pushback from doctors who often told her that this was “a phase” that she would grow out of eventually.
It was no phase. Many years and $125,000 later, “I completed my transitioning cycle,” Lachowitz said. “Unfortunately for a lot of us, especially those who live in the middle of nowhere America, you really have to drive thousands of miles to get the care you need.”
She feels grateful to have found Brown five years ago. It was the first time she received provider-based medical care for transgender healthcare services. “There’s this thankfulness I have that I can get medical advice that doesn’t come from the streets,” Lachowitz said.
Many studies have shown that there are dire consequences when transgender patients don’t get access to appropriate care. Because many physicians refuse to treat this population, a lot of transgender people don’t seek medical care. Some transgender people are also afraid to visit their local provider. One study from 2014 revealed that around 60 percent of transgender patients who have not found providers have attempted suicide.
“I want patients to come to my office and feel like they can be their entire selves in my exam room, and not be in a position where they are afraid of leaving their car in fear of being judged,” Brown said. “That’s the standard I hold family medicine to.”
To further that standard, in 2012, Brown helped co-found the Charlotte Transgender Healthcare Group , a group of providers from practice areas who work closely with the transgender community. It grew from a handful of seven providers into a 50-member network across many disciplines, including endocrinology and plastic surgery.
The move also fits in with the Novant Health mission of providing inclusive care. Just last year , Novant Health was recognized as one of only nine healthcare systems across the nation to have 10 or more facilities recognized as “Leaders in LGBTQ Healthcare Equality” by the Human Rights Campaign (HRC) Foundation, the educational arm of the country’s largest lesbian, gay, bisexual, transgender and queer (LGBTQ) civil rights organization.
Finding the right provider who is willing to provide transgender care makes a huge impact on the lives of patients like Lachowitz and Kaleb Lyda , a transgender male from Concord, North Carolina, who went on to become an elite Morehead-Cain scholar at University of North Carolina-Chapel Hill.
Trey Greene, a mental health counselor at Time Out Youth, a nonprofit that provides services to LGBTQ teens, was also one of Dr. Brown’s patients.
“Even one person being respectful can make the difference between life and death for this population,” said Greene, a transgender man and the co-founder and executive director of Transcend Charlotte, a nonprofit that serves transgender adults. “For a person to be a doctor who can literally help you start the life you’ve been waiting for is so validating and life changing.”