A Portland-Led Approach to Transgender Health Care
Karin Selva, a pediatric endocrinologist at Legacy Emanuel’s Randall Children’s Hospital, saw her first transgender patient in 2010. A teenager assigned male gender at birth, the patient suffered from Type 1 diabetes and depression. After seeing a counselor, the patient revealed she identified as female.
“She was reclusive, depressed, wouldn’t make eye contact, and dropped out of school,” Selva recalls. But after counseling, hormone therapy, and “bottom” surgery, this now-college-aged woman blossomed: “She’s smiling, cracking jokes, and is back at school,” the doctor says.
Selva, who opened Randall’s new transgender-focused T Clinic last June, has worked with 50 patients and their families over the past four years, and says the clinic gets two or three new referrals each month. She’s also presented a series of lectures on the topic to each department at Legacy Emanuel. Selva’s name has become well known in Portland’s trans community, but she also credits increased media coverage of transgender people, from Laverne Cox (who plays Sophia Burset on Orange Is the New Black) to Brad Pitt and Angelina Jolie’s daughter who now goes by John.
“That does a lot, you know,” she says. “And the more parents who accept it, the more kids get care.”
It’s never easy to wrestle with “gender dysphoria”—a person’s distress over his or her gender assigned at birth. But Portland is, by many accounts, a supportive place to do it. This January, the Oregon Health Plan began covering puberty suppression, hormone therapy, and, for adults, sex-reassignment surgery. Portland is also home to TransActive, a nonprofit that offers counseling groups for transgender youth as well as education for professionals who work with families.
One of OHP’s transgender-focused docs is Megan Bird at Legacy Medical Group, a gynecologist who administers hormone therapy to transgender adults and provides hysterectomies to trans-men.
Like Selva, Bird had to learn on the job—medical school provides very little training on transgender care. Bird says she loves her job because she can see direct results of her care.
“Over six months, you really see a big change: they are less depressed, less anxious, and they take better care of themselves. It’s amazing to see them turn around so quickly.”