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Adult Gender Clinic Expands Patient Base, Offers Multidisciplinary Care

Clinicians emphasize gender-affirming services

Patient counseled in clinic

An adult gender medicine clinic in Duke’s Division of Endocrinology, Metabolism, and Nutrition and Department of Family Medicine and Community Health enters its third year of operation in 2020, with a growing patient base and an expanded, multidisciplinary focus on gender-affirming services for transgender adults.

The first of its kind based in a North Carolina academic medical center, the clinic began operations on limited basis in 2018 to assess demand while developing an integrated approach to gender medicine.

Clinic co-directors Carly E. Kelley, MD, MPH (Endocrinology) and Tiffany Covas, MD, MPH (Family Medicine) say staff training creates a welcoming environment that reassures patients who have experienced uncomfortable medical encounters. About one-third of patients report having had previous negative clinical experiences.

“Many of our patients express concerns about empathy and understanding because many providers are not trained in care for transgender patients, or they may not understand the language that these patients embrace,” Kelley says. “We emphasize patient-centered care and decision-making.”

The choice of pronouns in gender care, Kelley says, is an important aspect of welcoming patients. “Being addressed in the right way is a form of respect, and it contributes to a more welcoming environment,” she adds.

As the number of patients has increased, specialty consults for gender-affirming services have expanded throughout the Duke medical community to include dermatology, urology, plastic surgery, mental health, reproductive endocrinology, voice therapy, infectious disease, OB/GYN, physical therapy. “We organize regular conferences and discuss our patients in a collaborative setting to plan for their care,” Kelley says.“

Patients benefit from providers with varied training and perspectives

The varied backgrounds of the providers benefit patients, Covas says. “We each come to the process with a different lens. Each patient is unique; each patient is different. Some benefit from a primary care doctor initially. Others may prefer an endocrinologist. The fact that our clinic offers multiple services within the scope of care reassures patients."

Transgender care has been provided for adults by endocrinology and other Duke specialties, but the adult gender clinic offers more focused and comprehensive services. The team collaborates with the Center for Child and Adolescent Gender Care within Duke Children’s Hospital & Health Center. While the collaborating specialties are not located in the same clinic, appointments are coordinated for patient convenience.

Kelley and Covas work to expand patient services by offering consultations at the Duke Student Wellness Center. They also invite medical residents and fellows to complete rotations in the clinic. Kelley also plans to launch gender research projects in the future. “We want to establish a fully integrated program with well-organized gender care while demonstrating advanced knowledge in the field,” she says.

The clinic will coordinate research and health outreach efforts with the Duke Sexual and Gender Minority Health Program, which was launched in February 2020  to help the university and medical center become a leader in research, patient care, education and policy for sexual and gender minority health in the southern United States.

“We want to make sure that we find the gender-affirming services that our patients need,” Kelley says. “If we can’t provide it within the Duke campus, we will identify experts in those areas and help make initial contacts.”