Patients With Gender Dysphoria Find New Option at Duke

A new adult gender medicine clinic within the Duke Division of Endocrinology, Metabolism, and Nutrition is accepting intersex patients or those with gender dysphoria or transsexualism. The clinic is one of the first of its kind based in a North Carolina academic medical center.

The clinic began operations on a small scale early in 2018 to assess demand and create a collaborative network within Duke Health by incorporating mental health services as well as relevant medical and surgical specialties.

Endocrinologist Carly E. Kelley, MD, MPH, and Blaine Paxton Hall, PA, a physician assistant who has worked as a Duke hospitalist for more than two decades, will lead the clinic. Their goal is to develop a center that mirrors the long-term work of the Duke Center for Child and Adolescent Gender Care within Duke Children’s Hospital. While transgender care has been provided for adults by endocrinology as well as other Duke clinics, the new program will offer more focused and comprehensive services than existing practice permits. “We want to unify the effort and establish a state-of-the-art approach across the health system,” Kelley says.

The clinic opens at a time when expanded research and development of evidence-based protocols have yielded dramatic improvements in therapeutic strategies. Kelley and Hall will incorporate new Endocrine Society practice guidelines, released in December 2017, to initiate and monitor the use of cross-sex hormones, anti-androgens, GnRH, and other associated medical treatments to facilitate gender transition and confirmation.

“Our team focuses first on developing trust and building strong doctor-patient relationships to assist in a transition that can be difficult and challenging for patients,” Kelley says.

In addition to offering medical treatment for intersex patients, gender dysphoria, and transsexualism, the clinic will create a physician education initiative. “We hope to provide an exciting learning opportunity for fellows, residents, and students across our institution. Many clinicians are not trained to treat gender dysphoria and so we hope to bridge that gap in both knowledge and comfort level,” says Kelley. She adds that the clinic also plans to eventually contribute to gender medicine research.

Although the adult gender medicine clinic had been discussed for several years, the project was shepherded to completion by Hall, who underwent full medical, surgical, and legal gender reassignment in 1983. Hall is an author of the current version of the WPATH (World Professional Association of Transgender Healthcare) Standards of Care as well as an adjunct assistant professor and advocate for gender medicine.

“The lack of a true gender medicine option for adults in North Carolina has created a very haphazard care environment,” Hall says. “However, the primary care community has done a tremendous job caring for these patients.” The clinic will work closely with primary care physicians, who will continue to play an integral role in patient transitions.

David A. D’Alessio, MD, chief of the Endocrinology, Metabolism and Nutrition division, says the long-term objective is to build a clinic to provide multidisciplinary services and state-of-the-art treatment. “People with gender dysphoria are underserved in our region and most of the rest of the United States,” D’Alessio says. “We believe endocrinologists can play a role in the care of transgender people, and we hope our initiative will spur the development of the type of multidisciplinary program at Duke that is ideal for these individuals.”