BACKGROUND:
Gender dysphoria is the emotional distress caused by the incongruity between a person’s perception of their birth and gender identity. Stats NZ reports the incidence in Aotearoa identifying as transgender or non-binary was 0.8% in 2020, and 4.2% identified as LGBTQ+.
The “service line” approach reflects a style of centralizing services around a single point of patient contact. This promotes patient-centred navigation across specialties with collaboration maintained through a central hub at all stages of patient care. Several established successful examples in the United States include bariatric, solid organ transplant, and vascular pathways.
METHODS:
Core elements of the service line model - including functional details of the Johns Hopkins Centre for Transgender Health, operating since 2017 – are identified. This model was applied to create a new Centre for Transgender Health at the University of Florida. Guidelines established by the World Professional Association for Transgender Health (WPATH) were followed.
RESULTS:
An academic, supra-regional Centre for Transgender Health based on the service line model was built at the University of Florida between 2021-2023. 73 patients were seen for gender affirmation surgery. (17 completed surgery: 15 top surgeries, 1 hysterectomy, 1 simple orchiectomy). Multiple specialties were involved including Urology, Gynaecology, Radiology, Breast surgery, endocrinology, social work and psychiatry.
High levels of patient satisfaction were reported. Primary challenges included operative barriers related to restricted funding, and inconsistent public support for transgender care. Other challenges include deviation of mental health documentation from recommended WPATH guidelines.
CONCLUSIONS:
Learnings from both established and newly created multidisciplinary referral centres based on the service-line approach to Transgender Health delivery are described. The infrastructure, resourcing and specialist contributors are discussed. Aotearoa represents a unique health care system and there would be value in stimulating discussion with the group about crossover opportunities with the service line experience presented.