UC San Diego Gender Health Program is blazing trails and providing much needed help to the community. We sat down with Gender Health Program Coordinator Rai Khamisa, LCSW (They/Them/Theirs) for a very informative Q & A.
Please tell us about UCSD’s Gender Health Program. How is the organization connected to the medical system and the university in general? Does the organization work with the LGBT Resource Center offered to university students or are they completely separate?
UC San Diego’s Gender Health Program specifically serves the hospital system to ensure that patients who are seeking gender affirming care have a centralized model with which to work. Gender affirming care can be overwhelming to access, between finding the right providers, navigating insurance and determining pre-/post-operative requirements. Our program helps patients navigate these areas with more ease and direction so that patients can focus on what they need, NOT on how they are going to meet those medical needs. Although we are not directly connected with the LGBT Resource Center on campus, we partner closely with them and our counterparts on the university campus to ensure continuity of care for those who may move their care over to the health system side or when they need services that only the health system provides.
What kind of services are provided by UCSD’s Gender Health Program? Are all services provided from a single location or are multiple sites used to cover more of the county?
We are proud to say that we are the only system in San Diego that provides a full range of gender affirming options for our adult patients. Patients often start with an intake in our program, where we discuss patient goals and needs. We can provide referrals to our specialty departments at that time and, in many cases, can provide letters of readiness for our patients. Our comprehensive approach to care includes but is not limited to primary care, hormone replacement therapy, body contouring, top surgery, bottom surgery, hair removal, psychiatry, vocal coaching, fertility, and reproductive health. Our website has a more comprehensive list of services and our providers who are part of the team.
What is the history of the program and when did it begin offering services? What initially led to the decision to create the program?
While UC San Diego has been providing gender affirming care since 2018 and more formally in 2020 with the expansion of primary care services at the Owen Clinic, our centralized model launched late 2022 with the centralized model. This new iteration of gender health services at UCSD was envisioned in 2018, when some of our medical providers, including doctors Jill Blumenthal, Amanda Gosman and several others, began advocating for a better system to improve the Trans community’s navigation of the resources already offered and new services to allow for better service integration. It was a new mission for the Health System and thus took time to demonstrate to leadership that it was a critical and invaluable service needed in San Diego County and other surrounding areas.
Our understanding is that UCSD is a pioneer in providing gender affirming care and has received considerable recognition. Please brag a bit on some of the program’s accolades.
UCSD Health has been recognized by the Human Rights Campaign Foundation since 2018 (and again in 2022) as a leader in LGTBQ+ health care equity, achieving a perfect score on the equitable treatment and inclusion of LGTBQ+ patients, visitors, and our employees. Dr. Anne Wallace was the first breast surgeon to perform affirming top surgeries starting in 2016 and Dr. Amanda Gosman the first plastic surgeon to perform facial feminization surgeries in 2018 at UC San Diego Health. Beginning in 2021, Dr. Jennifer Anger was the first urologist in Southern California to perform gender affirming bottom surgeries including vaginoplasties, vulvoplasties and metaoidioplasties. Drs. Jill Blumenthal and Laramie Smith received Valued Ally Awards from the San Diego LGBT Center in 2021 for their ongoing community outreach and engagement with the Transgender and Non-Binary population. In addition, UCSD has a large portfolio of research studies that not only include Transgender individuals as part of their study populations but are also specifically focused on supporting and improving health outcomes for Transgender individuals. UCSD has hosted an annual Transgender Health Symposium since 2019 to educate staff and providers about comprehensive gender-affirming care, with 150 individuals attending for the last three years. In 2020, we started Gender Health Rounds, a monthly CME-accredited series that engages health care providers involved in gender-affirming care for TGNB individuals. The overarching program goal is to provide needs-based education for physicians and health care providers engaged in Transgender health care to improve knowledge, competence and performance and enable the optimum provision of health care to Transgender and Non-Binary individuals. By presenting data on evidence-based practices and discussing challenging clinical cases, we hope to improve learner skills and critical thinking to enhance gender-affirming care.
Who are your typical patients today? How should interested folks or prospective patients reach out to the program?
Our patients are incredible and consist of anyone 18 years of age and older with a variety of health insurance plans including Medi-Cal and Medi-Care looking for gender affirming services in San Diego. Patients can connect with us through our website at https://health.ucsd.edu/specialties/gender-health/Pages/default.aspx, and can email us at genderhealth@health.ucsd.edu.
Our understanding is that a lot of folks who could be receiving gender care are unfortunately being missed. Please tell me about any outreach programs to help reach those underserved folks.
We currently rely heavily on partnerships with the community to communicate about our resources and assess community priorities so we can grow our program in a way that is reflective of those needs. I, along with our Medical Director Dr. Jill Blumenthal, have made it a priority to stay connected with these agencies and programs in Southern California who are doing this work to not only share what we are doing as a program but to also support their community-based efforts. Reaching those who continue to be missed by traditional health systems is one of long-term goals of the Gender Health Program.
We know a lot of gender affirming care can be quite expensive: how do patients pay for the services? Is care only available to the wealthy or those with gold-plated health insurance?
Our mission is to provide affirming, inclusive, and comprehensive care to Transgender and gender diverse communities. We aim to prioritize accessibility, advocacy and accountability to improve the overall well-being of all our patients. UCSD accepts most insurance plans, including Medi-Cal/Medi-Care. We encourage patients to call their insurance to verify their coverage specifically for gender health services and their ability to be seen at UCSD. Insurance is so complicated, and every plan is different, so asking is the best way to get that information to ensure patients can get the coverage they need! We will also help patients in obtaining that information if they require additional assistance. We have an insurance authorization team we work closely to ensure we are doing everything we can to advocate for our patients with insurance, which is a huge asset to being a part of our program.
Please tell us about your current role within the program and how your career path led you to the program.
I’m Rai Khamisa (they/them), Licensed Clinical Social Worker (LCSW) by training and a Queer and Trans-identified person who is very proud to serve my own community in this role. I have been part of the San Diego community for the last 13 years and have worked closely with UCSD, both as an employee and a community partner for around 8 of those years. Like a lot of other social workers, I started out in community mental health in my early years and found out during that time that I really gravitated towards wanting to support our Queer and Trans communities. After working on the campus side of UCSD for some time, I moved into clinical directorship and other leadership roles for a mental health company that services college students near UCSD and continued to see themes of how Trans and Non-Binary communities, specifically communities of color struggle, with access and navigation of both physical and mental healthcare. It was a no-brainer when I saw this amazing opportunity to help create this new iteration of Gender Health services for the hospital system with amazing providers like Dr. Blumenthal who has been fighting for our community to ensure access to care and education within our system, continues to be a priority. My goal is to not only help create an amazing program, but to work toward ensuring that system wide education is provided so that affirming care is not just siloed to the departments associated with the Gender Health Program, but that all services within UC San Diego Health are seen as affirming services. We have a lot of work to do, and the system is committed to seeing this work through.
UCSD has been in San Diego since 1960 and the Hillcrest Medical Center has been operating since 1966. Is there anything else we should know about the program and how it supports and integrates into San Diego’s greater LGBT community?
Of course, one of the primary homes to LGBTQ+ individuals is the Owen Clinic, founded in 1982 and has grown to become the largest, most comprehensive HIV primary care center in San Diego County. Our mission is to provide compassionate, culturally responsive, and patient-centered care to patients living with and at risk for HIV, many of whom are part of the LGBTQ+ community. The Owen Clinic especially focuses its efforts to support low-income, uninsured, and underserved cisgender men who have sex with men and Transgender women, Hispanic individuals, African American individuals, people with substance use disorders, individuals with mental illness, and homeless individuals based on the disproportionate burden of HIV and worse HIV care continuum outcomes in these populations of people living with HIV in San Diego County. Over the last several years, increasing numbers of LGBTQ+ individuals with and without HIV are seeking care at the Owen Clinic as well as other UCSD clinical settings for primary and specialty care that is affirming and inclusive of all their needs.
