For people with gender dysphoria, hormone therapy can significantly reduce mental distress and improve quality of life. NYU Langone’s multidisciplinary transgender program takes an intensely personalized approach to these treatments, centered on the individual patient’s goals, life circumstances, comorbidities, and evolving clinical response.
Specialized Training Enhances Clinical Precision
Although many medical centers offer gender-affirming hormone therapy, NYU Langone does so under the direction of an endocrinologist who specializes in transgender care. “For these patients, the clinician’s expertise can be crucial to optimizing outcomes,” explains Michele B. Glodowski, MD, clinical instructor in the Department of Medicine, whose fellowship training included extensive clinical rotations at the University of Colorado’s Integrated Transgender Program.
Gender-affirming hormone therapy typically uses different doses and modalities from hormone replacement therapy for postmenopausal cisgender women or cisgender men with low testosterone. The risk of complications, including certain types of cancer, may be heightened as well. “With testosterone, we often see weight gain, changes in LDL and HDL cholesterol, elevations in hematocrit, and increases in insulin resistance and blood pressure,” Dr. Glodowski notes. “Feminizing regimens, such as estradiol, can also trigger weight gain, raise the risk of cardiovascular disease, and often affect liver enzymes and triglycerides.”
Personalizing Treatment to Fit Patients’ Needs
Besides enhancing her ability to monitor and manage side effects, Dr. Glodowski’s training helps her tailor treatment to patients’ unique needs. “There’s a whole spectrum of gender identity and gender expression,” she says, “so it’s important to provide a whole spectrum of care. It looks different for every individual.” Some patients, for example, may identify as definitively male or female, others as nonbinary or gender-fluid. Some may choose to have hormone therapy in conjunction with gender confirmation surgery; others may choose hormones—or surgery—alone. And a wide range of external factors may influence patients’ therapeutic pathways.
“There’s a whole spectrum of gender identity and gender expression, so it’s important to provide a whole spectrum of care.”—Michele B. Glodowski, MD
“Even in 2020, people still lose their jobs or get kicked out of their homes because they’re trans,” Dr. Glodowski observes. “I want to make sure patients are comfortable with all the social aspects that can come into play with gender transition. If someone says, ‘I’m not ready to come out at work yet,’ we might slow the process down a bit. If they say, ‘my parents have 30,000 questions,’ we might arrange a visit with mom and dad. Patients may wish to have their eggs or sperm frozen before hormone therapy begins, to preserve their fertility. Those who do sex work might benefit from screening for sexually transmitted diseases, or consultation with a social worker who can connect them with supportive services.”
In collaboration with her colleagues in the multidisciplinary transgender program—whose specialties include plastic surgery, gynecology, and urology, in addition to endocrinology—Dr. Glodowski is able to ensure that patients receive precisely the care they require.
The Importance of Patient-Centered Care
NYU Langone Health has been certified for 7 consecutive years—with a score of 100 percent—by the Human Rights Campaign Foundation Healthcare Equality Index Report, which evaluates the work of medical facilities in providing equal healthcare access to LGBTQ+ Americans. One factor in that success is the center’s patient-centered approach to transgender care.
“In some practices, patients can walk into the office and have someone use the wrong pronoun,” Dr. Glodowski says. “The doctor might see them briefly, write a prescription, and that’s basically it. At NYU Langone, everyone from the receptionists to the medical assistants to the physicians have been trained to be sensitive to gender identity. I spend 40 minutes with each new patient, and 20 minutes with any follow-ups. In addition, we have one clinic a week specifically dedicated to gender-affirming hormone therapy.”
Harnessing the Benefits of Telehealth
The coronavirus disease (COVID-19) pandemic has also made telehealth a crucial component of the transgender program’s endocrinology practice. Although the crisis has waned in New York City, many patients prefer to continue with video visits—citing both safety and convenience—after an initial in-person consultation. “At the height of the pandemic, many providers turned to telehealth to limit in-person visits for non-urgent care,” Dr. Glodowski explains. “But there is a high rate of suicidal ideation and suicide in patients who are trans-identified. For this patient group, almost all care can be described as urgent, especially for someone who’s new to hormones and may be experiencing severe dysphoria.”
With those who are beginning a course of hormone therapy, Dr. Glodowski typically schedules a video visit to discuss treatment goals, the expected timeline of physiological changes, and potential side effects. “We want to make sure that every patient is very well informed,” she explains. As treatment progresses, she will order lab work and discuss results with patients via video link, as well as checking on therapeutic progress and the patient’s comfort level with the regimen.
Whether a visit is in-person or remote, she adds, “it’s always essential that we provide patients with a safe, gender-affirming space.”