While the Oregon Health Plan (OHP) covers most gender-affirming surgeries, facial feminization surgery-a procedure often desired by transfeminine people-is not covered under the plan. Getting the cost of a medical transition covered by insurance is another challenge OHSUвЂ™s trans patients face. My door is always open for visitors, and I share whatever it is I can share.вЂќ вЂњSo in another 10 years, there wonвЂ™t be this lack of trained providers as there is right now. вЂњThe residents that graduate, theyвЂ™re going to be trained in this type of surgery,вЂќ he says.

In the past year, physicians from the University of Utah, Johns Hopkins University, and a medical system in Chicago have visited him for consults, so they can use his knowledge to inform their own work.

Next year, Berli will welcome OHSUвЂ™s first fellow in gender-affirming plastic surgery, and the OHSU medical students and residents who shadow Berli also currently receive training. This imbalance results in вЂњpatients having access to insurance, but not access to surgeries.вЂќД«erli predicts this problem is a generational one-and one that OHSU faculty can help solve. вЂњItвЂ™s really an unholy alliance of a huge backlog of patients not having had care, and a backlog of untrained providers,вЂќ Berli says. Berli says there simply arenвЂ™t enough surgeons trained in this area of expertise to serve the growing number of trans people seeking gender-affirming surgeries. To help expedite the process, OHSU will sometimes refer patients to other clinics in the area, but itвЂ™s rare to find a medical system that offers a list of gender-affirming surgeries as comprehensive as OHSUвЂ™s.ДЇor example, OHSU is one of only two hospitals on the West Coast that regularly perform phalloplasty, or penis construction. Jens Berli, a plastic surgeon at OHSU who specializes in gender-affirming surgery (or surgeries associated with a medical transition) says itвЂ™s not uncommon for a patient to wait months just to receive an initial consult. It currently has just two full-time employees-a supervisor and an intake referral specialist-though a third employee, a mental health specialist, is expected to join soon.ДЄnother common complaint Penkin hears from trans patients is that the wait time for surgery can be long. The program helps connect trans patients with OHSU doctors representing a wide range of specialties, and offers informational sessions for patients focused on different aspects of a medical transition. The THPвЂ™s website and direct phone line function as access points for many trans patients, medical providers, and community organizations-the program fielded about 3,800 inquiries in 2018 alone. There is no centralized THP clinic, as it is an interdisciplinary program, although different OHSU departments do operate trans-specific clinics a few times a month. The THP was created by a group of OHSU faculty and community members who recognized a lack of accessibility for new trans patients at OHSU. While other trans health programs exist in Portland and around the country, OHSUвЂ™s THP is one of the only programs to provide a comprehensive slate of trans medical services, educate medical professionals inside and outside of its system on trans issues, and provide the space and infastructure for a grassroots-like network of mostly trans volunteers. Palmer is one of the thousands of patients to take advantage of services offered by OHSUвЂ™s Transgender Health Program (THP) since its inception in 2015. Since IвЂ™ve medically transitioned, IвЂ™ve felt comfortable being out and talking to peopleвЂќ вЂњI used to be seriously reclusive, and tried to see people as little as possible,вЂќ she says.

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