Dr. Jeremy Sinkin is a reconstructive surgeon at Rutgers Robert Wood Johnson Medical School who is committed to providing excellent care for his patients. Dr. Sinkin discusses growing up in a big family in upstate New York and his experiences in New York City. He explains the surge in publications and advancements in gender affirming healthcare during the early 2010s. 

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TRANSCRIPT

Interview conduct by John Keller

New Brunswick, New Jersey

March 28, 2023

Transcription by Chrissy Briskin

00:00

Great, so I’m recording now, uh, my name is John Keller, I’m with coLAB Arts, it is Tuesday, March 28, 2023, we’re located in the, um, medical education building at Robert Wood, Rutgers, what’s the formal title?

Yeah I guess it’s Ro– Rutgers Robert Wood Johnson Medical School.

Great, and today we’re interviewing–

Jeremy Sinkin.

Great. Um, and, um, just for, uh, point of reference, where are you, where do you currently reside, what town do you currently reside in?

I personally live in New York City.

Okay, um, and, um, what is your date of birth?

August 4, 1983.

Okay so we’ll just kind of start there.

Okay.

Where were you born?

I was actually born in Berkeley, California. My parents were completing their, uh, pediatric residency training out there. Um, and about a year after I was born, they finished their training and moved to Rochester, New York, so Rochester, New York is where I grew up. It’s what I consider my home town.

Um, in addition to your parents, were there any other kind of adults in your life at that time?

I had an older brother, uh, he’s only a couple years older than me. Um, but we have a large family so, um, growing up there was my parents, my older brother, I have a twin brother as well, and then I have a younger sister and a younger brother, so there’s five of us kids. Two parents, two dogs, pretty large household.

Wow, um, so, uh, sorry again, you were how old when you moved to Rochester?

About a year old.

Okay. What are some of your earliest memories?

Uh, you know I remember, um, I remember my family growing up, um, I remember, um, you know, early childhood memories of summertime in Rochester, New York. I don’t know if you’re familiar with upstate New York, but about, uh, ten months out of the year it’s cold and dreary and the sun doesn’t shine, but, uh, some of my earlier memories are in the summer in Rochester, and being with my family and being outside, it was enjoyable.

Um, what was it like having a lot of siblings around?

It was– I think really good as sort of built-in best friends, especially having a twin brother. Um, my twin brother and also my older brother and I all shared a room growing up ‘til probably we were maybe 10 or 11 years old. Um, and so, you know, there was good and bad in that. We were obviously very close both physically and emotionally and, um, again, had felt very close, um, with my brothers as far as friendships go. Uh, but then, you know, we also developed our own personalities, our own interests and, you know, certainly fought at times, but as enjoyable.

What was your relationship like with your parents or other extended family members?

Close. I think we’re still all very close, um, we all– we’re spread out throughout the country at this point, nobody lives in– my immediate family, nobody lives in Rochester, New York anymore. My folks live in Virginia and, um, my older brother in Maine, my twin brother lives in California, my sister lives in Washington, DC, and my youngest brother lives outside of Seattle, so we’re literally bicoastal. Um, and, uh, but we still, uh, we talk weekly and try to get together, uh, on a yearly basis. We’re all very close.

Um, what was your, kind of like, earliest concept or understanding of the medical profession?

Yeah,that’s a good question. You know, I always knew growing up that my parents were doctors, um, my parents are both pediatricians, but, um, had different subspecialties. My dad is a neonatologist, so he cares for premature babies and runs the intensive care unit, the Neonatal Intensive Care Unit. My mom, um, was a developmental pediatrician, um, and is fellowship-trained in child psychiatry as well. But, my ability to sort of describe that to you, you know, now is totally different than what I understood as a child. So, uh, I knew they were doctors, I knew they went to hospital or, you know, went to the office, they had patients, you know, growing up, uh, but honestly, I don’t think I really understood what that meant ‘til I went to medical school, you know, and became a doctor myself. In fact, my dad, um, as part of his career, uh, ran a lab and they had bunnies in their lab and they did various experiments on bunnies in their lab, but as a child when we would go to visit my dad at work, we would see the bunnies and we always thought that was, you know, great. But, again, later did I put two and two together and realized they were experimental bunnies.

5:08

What was your– as you were a kid and you were starting to get into school, did you start having particular interests that you were kind of gravitating towards?

You know I think I sort of, um, maybe subconsciously was drawn to medicine, uh, neither one of my parents were explicit in their sort of, uh, influence, I think, in as far as medicine goes. Um, but I always liked science, I always liked experiments and sort of, uh, biology, um, and so I always– sort of literal person, I feel like that, you know, I sort of feel like I was fitting into that STEM world. And so I think as I went through school, I gravitated towards the sciences and physics. Uh, and then had an idea when I finally went to college that maybe I would consider medicine and I took the premed classes, but, um, didn't pull the trigger in college. Most, most people these days I think will apply directly to medical school from college, so that when they graduate, they start medical school but I– although I was able to get all my prerequisites, I sort of didn’t pull the trigger, and I graduated college and didn’t really have a job, didn’t know what to do, and I sort of scrapped together a job and then reapplied to medical school after that, after realizing that that’s where my interests were.

Do you have any kind of memories or recollections around your earliest concept of gender, when gender started becoming something that you would understand?

Yeah that’s a great question and, um, I don’t think I had any real sort of insight growing up. Uh, and certainly didn’t, didn’t really appreciate gender or the discussions around gender from an academic standpoint, if you will, until, you know, my career. Um, rewinding a little bit, I suppose I had more of an idea of, um, different types of sexuality growing up, so I knew, uh, people who identified as homosexual growing up, but I don’t think I– in memory, um, uh, certainly to my knowledge, uh, knew anybody who maybe was on the, you know, the gender diverse spectrum.

In terms of awareness, what was your, kind of like, your cultural position in terms of thinking about those ideas? Was it something that was talked about in your family, was it something talked about in your group of friends?

I don’t think so, not explicitly, neither sort of, uh, you know, there was no conversations either in the positive or the negative. Um, not that we, you know, would be opposed to talking about it, I just, I don’t think it ever was part of the conversation. Um, certainly, again, being in a big family, uh, our, you know, conversations at the dinner table were pretty lively and, you know, everybody had something to say, and again, sort of going back to sort of memories, you know, I have fond memories of discussing various things at the dinner table, but, um, you know, specific gender conversations, I don’t think we ever really had it, but I think we would have been open to it, I like to think so, you know.

Was there always an expectation, you know, you’ve obviously have advanced training, was there always an expectation that you would go on to college, that you would go on to some sort of profession?

Yeah I think so. And  again, there was really no sort of explicit statements by my parents, but it was part of the expectation, I mean, myself and all my siblings, I think we all were achievers, we all did well academically growing up. And extracurricular activities, and I think it was always part of the expectation that we would go on and become professionals. Um, you know, in hindsight, now that we’re adults, we have these conversations with my parents about– and I don’t have any kids, but I have nieces and nephews, and so I sort of participants in their conversations about raising kids, and it’s interesting to hear my parents deliver their perspective now in compared to what we felt as children. You know, again, my parents, I think, are pretty accepting people, their sort of standard response is, “We love you no matter what. If you became a doctor, or you didn’t, or whatever it might be.” But, you know, I think they were pretty, um, you know, if not explicit, they were pretty, uh, insistent in their own ways that we became professionals.

 10:04

What was that, kind of like, transition process for you, or decision making process, as you were becoming a teenager and you were starting to make your own decisions. Were there any kind of big aha moments?

I think a lot of my interests kind of aligned with, you know, what my parents wanted for me, which I guess I’m lucky in that regard. Um, you know, I think, again, as we all had extra curricular activities, we all played instruments growing up, I think really my only butting heads moments with my parents and their expectations of me was they wanted me to play the violin, and I did it for many years, but I hated it. Every minute of it. I think that was sort of our big conflict.

How did you, um, uh, when you were starting to get ready to college, what was that trajectory, where did you end up going–

I went to Columbia College in New York City. Um, and actually, you know, admitting, I omitted sort of another big interest [thing] growing up. I was a competitive fencer, so that was a huge part of my childhood, and as I went off to college, um, I sought to continue fencing in college. So I was looking at programs that had very strong intercollegiate, you know, um, NCAA programs, and so went to Columbia, was able to fence for their team, compete for their team, and so that was a huge attraction for me.

Mhm, and in terms of like, you know, the– what kind of course work you started to do and also, what kind of like, what was your personal life like, how did you– what was kind of the navigation that kind of like transition into adulthood?

Yeah so, both my brother and I ended up in New York City for undergrad. I was at Columbia, my brother at NYU. He was also a fencer, so we ended up, uh, despite being on opposite ends of the island, we saw each other quite frequently, both for competitive matches and we would also practice together. Um, but we were both, um, I guess, uh, pretty lucky to be in New York during that time, you know, leaving home and then going to college is sort of a growing up experience for anybody, but doing that in New York City, I think was really special. So, um, especially at Columbia, where it’s not really, it’s a small little campus, but it kind of, it’s– New York is your campus, so we were able to go out, explore, you know, see all sort of diversity on every corner, so, uh, that was eye opening and enjoyable and, um, you know, I still live in New York so it’s something that’s really stuck with me.

How did you get into fencing?

Uh, you know, I think it was one of those things where we were young maybe, early elementary school, and we did it in gym class or there was a demonstration that we were able to sort of participate in, um, we loved it. It was me, my twin brother, my older brother, um, and then eventually my younger sister and younger brother tried it too. But the three of us, the older siblings, we started all at the same time, around ten or eleven years old. And, uh, yeah it was– there was sort of a private club in Rochester, and we’d go several times a week and train and we competed nationally and internationally, yeah it was a lot of fun.

Um, what– when you started– when you were at Columbia in terms of class work and academic interests, how did you gravitate? Did you know right from when you arrived or–

So, no I was sort of lost. I knew that, um, you know, in high school I did all the sort of math and science AP courses and knew I was interested in science, um, but I didn’t really know what to study. And I do remember feeling kind of overwhelmed and lost and got sort of this booklet of classes that are available, and we had certain classes that we needed to take as part of our core curriculum, but beyond that didn’t really know how to structure my major, if you will. Um, and again I think I sort of knew I might be interested in medicine, but didn’t really know what that meant, you know, as far as what I needed to study, and I kind of, sort of, picked and chose random classes in the first couple years and eventually solidified my decision, and I took all the premed classes and, um, I think what I also ended up doing was rather than, uh, taking, like, biology or neuroscience, which people typically do, I think, when they go to medical school, I ended up being a sociology major, so I took a lot of sociology classes, again being at a liberal arts school I just felt like I had to take advantage of that opportunity. And so, yeah, I sort of premed and also sociology major and doing a lot of liberal arts reading and learning.

15:20

Um, what was social life like for you?

Uh, good, I was, you know, involved in the fencing team, so that was sort of my main source of socializing if you will. Um, I actually met my now wife on the Columbia fencing team so, you know, we met over twenty years ago, just about twenty years and, uh, yeah, we’ve– it’s been good.

Was that a romantic relationship at that time or–

Yeah so we, you know, met through the team, became friends first and then it blossomed into a romantic relationship. She was two years behind me academically, so, um, it was really my senior year when I was graduating and she was in her– entering her junior year that we started dating. Um, and you know, it was a little off and on at first but then it continued after graduation, and she actually ended up going to medical school back in Rochester, New York. So she finished her undergrad and then joined me in Rochester, New York and got a Masters, and then she again followed me to Washington, DC where I did my residency training, and we got married down there and we’ve been together.

Nice.

Yeah.

So you said there was a gap between undergrad and med school, what was, kind of like, the transition?

It was just a year, a little bit more than a year, um, I ended up staying in New York City, so again my girlfriend at the time was finishing her undergrad, so I stayed in New York City and I ended up working, um, sort of as a office assistant, research assistant, at Memorial Sloan Kettering, ‘cause at that point, even though I didn’t apply, I knew I was going to be applying to medical schools, so I wanted to be sort of immersed in the medical community, and I was sort of getting that exposure and experience while I was applying to medical school. Then sort of the next, uh, spring where I moved to Rochester, New York and started medical school.

Around that time that you were, so you would have been in Columbia from what years?

2001–5

And being in New York City, spending a lot of time in the city, and the city being your campus, what was your– did you have any experiences that, kind of like, you know, drew you out, kind of like, experientially, like, you know, there was a lot of politics at that time, were you kind of aware of the cultural, kind of, conversations that were happening?

I think in hindsight I sort of, um, you know, I’m a little bit more aware in hindsight I suppose. In the moment, I don’t remember being involved or influenced, if you will, by the sort of politics of New York. The big thing was, it was right after 9/11 and Iraqi invasion and Afghanistan invasion, so that was sort of the big thing on campus was discussions about the geopolitical climate, but, um, uh, you know, things happening around New York, I feel like I was just– I remember being affected by the things that affected me. There was the no smoking ban that went into effect in the bars at that time, that was great for me because I wasn’t a smoker and I was able to come home after a night out and not reek like smoke. So, um, things like that I think, the cleaning up of Times Square and you know less, uh, you know, prostitution on the streets, I think, I just remember all of a sudden being like,”Oh yeah, there’s less of these bars available.” So yeah.

Um, did you have a sense when you, um, when you were starting to think about med school, or you were making your way into med school of what particular fields or interests you were starting to gravitate towards?

Yeah, so I, um, I kind of knew early on in medical school, um, based on my early experiences that I wanted to be a surgeon. Um, again my parents being pediatricians, I kind of thought, “Okay, I’m going to medical school, maybe I’ll be a pediatrician.” Once I got there, I decided quickly that I really liked anatomy, I liked, sort of, the immediacy of surgery. I liked the environment in which healthcare happens, you know,  as far as surgery goes, in the operating room as opposed to the offices. Um, sort of longitudinally, it’s more immediate in surgery, so I think pretty early I gravitated toward surgery. And then it really wasn’t ‘til the end of my medical school career that I was exposed to plastic surgery. Um, and so I was able to sort of rapidly get my application together and apply and succeed in getting a spot in residency training. Um, and you know, it was one of those things where I knew what plastic surgery was, or I thought I knew what plastic surgery was as a medical student, but again, being a plastic surgery resident and being exposed to the full breadth of what plastic surgeons do and can do, I think really, um, you know, sort of was a pleasant surprise a little bit? Being it sort of fits my personality and my interests.

20:40

Is there, kind of like, an average person on the street version, understanding of plastic surgery that changed for you? Like, what would be the average person’s perception of plastic surgery–

Yeah I think when most people hear plastic surgery they automatically think aesthetic surgery, or they think breast augmentations and face lifts and those jobs, sort of the, um, you know, taking features that are “normal” and just maybe improving them type of thing. But really plastic surgery– yeah it is that, it encompasses that, but it encompasses so much more. It’s the, you know, it’s reconstructive surgery, it’s taking damaged tissues or damaged organs and fixing them, um, it’s, uh, you know, so I think the thing that plastic surgeons often describe the field is it’s repair and it’s reconstruction, and it’s sort of the rejuvenation of tissues, but in doing all of that, it’s also, um, you know, we are improving patients’ quality of life. We’re maybe not extending life but we’re improving quality of life, and I think that’s important, you know, an important concept.

Do you ever find yourself at, you know, at a cocktail party and someone asks you what you do and you feel that you have to explain– you feel that you either have to defend or explain?

One hundred percent. I kind of dread that question a little bit [laughter]. I’ve experimented over the years of how I answer that question. I still don’t feel comfortable answering it just 'cause I don’t think I have a good way to– I mean I love what I do and I love to talk about it, but it’s one of those things where you talk to any sort of expert, or somebody with a great interest in the field, and they can go off on it and, you know, there’s a twinkle in their eye, but then the person that’s listening to them is just like, “Okay, when’s this guy going to stop talking?” You know? Um, so I think, you know, over the years when people ask, like, “What do you do?” I’ve answered, I– trying to avoid the topic sometimes, I say, “Oh I’m a physician.”

And then inevitably, “Oh what kind of physician?”

“Oh, I’m a surgeon.”

“Oh what kind of surgeon?”

 “Oh I’m a reconstructive surgeon” Or, “I’m a plastic surgeon.”

“Oh, what kind of plastic surgeon?”

“I’m a reconstruc–” it’s kind of like, you know, it’s like this dance that we do. Um, and so now I think I probably will just own into it and say I’m a plastic surgeon or even a reconstructive surgeon, and then if the questions continue I’ll sort of get into a little more detail about what I do.

Thinking about your medical school experience and how you were trained, you’re working– we’ll get there– but you’re working in a field that is not, uh, that is not commonplace in every hospital in the country, right?

That’s true.

So when you were being trained in medical school, and even when you were doing your surgical, you know, training and residencies, what was the training you were being given when you were receiving around– around transgender identity, around what does it mean to serve that population?

Yeah so I think, um, I can probably– I can say pretty definitively I did not receive any sort of formal training in medical school on the concept of gender identity and transgender healthcare, but everything changed when I went to residency. So I was a resident from 2010 to 2016, and I want to say it was around 2013, 2014 when, you know, the laws changed and, uh, you know, federal laws changed and sort of mandated that the federal insurances and the commercial insurances started paying for gender affirming care, and I was in Washington, DC, which I feel was the hub of these changes. So I was kind of lucky in that sense, being in the right place at the right time, being exposed to the opportunity to, sort of, care for transgender individuals, and by that I mean there was all of a sudden there was this hurdle that was removed financially, um, uh, for patients to seek gender affirming care. So now we’re seeing a bunch of patients who are seeking gender affirming surgeries and, uh, in my sort of “formal” training was happening in that moment. Uh, where we’ve got this field, we’ve got plastic surgeons all over the country who are now seeing more and more consults for gender affirming surgery, and prior to this there was maybe a handful of people in the world who were doing these surgeries routinely. And they published on their experiences, but now all of a sudden everybody’s seeing patients, and collectively we’re like, “Oh, we gotta do this right.” You know so there was, you know, a huge surge in sort of publications, literature, the medical literature, sort of supporting techniques, protocols, and, uh, so we were sort of doing and learning at the same time.

25:48

Do you have any recollection or remember the first time you either heard or you used the phrase gender affirming care?

Mmm, I don’t know, um, I don’t know the first time I suppose, but I feel like even that phrase has evolved as recently as a few years ago. You know, I feel like it was always like, um, uh, we would talk about, you know, it’s completely– on the medical side, it’s completely different, but there’s intersex, we would do like, uh, you know, gender reassignment surgery if you will on intersex patients, there’s, um, you know, I feel like that– that was sort of a holdover, that term was a hold over from that, so I feel like we used gender reassignment for a long time, for many years, until, you know, more recently the language was more developed or at least more accepted by the medical community, as of a few years ago I suppose started using gender affirming, gender affirming care more routinely.

Um, is there a– what was the–  was there a tension in the medical community as you are kind of progressing in your own training and your own trajectory, what is the– in terms of collegial tension?

 There was definitely tension, um, so again, I trained in Washington, DC at Georgetown, which is a Jesuit institution, and so this was a place that, um, you know, as an institution they didn’t provide abortion care, they didn’t provide certain things, so as we started doing more and more gender affirming surgery we sort of were just doing it until people told us not to? And towards the end of my time at Georgetown, there was sort of like, um, sort of institutional, uh, pause if you will. Uh, that being said–

Around what time?

I want to say it was around 2015–2016. That being said, that was just at that one hospital, Georgetown hospital, and my program, my residency program spanned multiple hospitals that were sort of outside the Georgetown, their influence if you will. That was a little bit of tension that I sort of experienced towards the end there of my training. But, um, you know, subsequently coming to Rutgers, um, fully embraced, I feel like we’ve been very lucky in building the program here at Robert Wood Johnson because of the institutional support that we’ve received and enthusiasm. Truthfully, there’s just so much support and, uh, resources that have been devoted to sort of growing the program, growing the safety, growing the volume, and sort of advertising in the community.

What do you think accounts for, I guess the comparison would be– you mentioned the pause at Georgetown versus the enthusiasm at Rutgers, what do you think accounts for those two dynamics?

Well, I do think that, you know, at Georgetown, there was certainly the religious influence and sort of stopping gender affirming care. Um, so I think, you know, the absence of that here at Rutgers, I think, has just removed that barrier. But I think we are seeing nationally just a huge sort of, uh, you know, obviously it’s a national conversation about gender affirming care, and I think we’re seeing a lot of large academic medical centers building transgender programs and I think that speaks to, sort of, where the medical community is as far as their– where they fall on that support system, how they feel about supporting it, so the fact that the large medical centers are throwing their weight behind building this program, I think, speaks volumes.

Um, just to, just to go back to make sure the timeline is right. So, you’re at Columbia from 2001 to 2005?

Correct.

30:08

And then you started med school in 2007?

2006.

2006.

Yeah, yeah.

And that was in Rochester?

That was in Rochester, University of Rochester.

Then you left there–

So I graduated medical school in 2010, uh, I graduated in May and started my residency in June 2010 at Georgetown, so I was in Washington, DC for six years, and I finished there in 2016. Um, I did an additional year of fellowship training at Memorial Sloan Kettering back in New York City, so I was there from 2016 to 2017, and then I started here at Robert Wood Johnson in 2017.

What was that process like, so were you looking for jobs–

Exciting. Yeah,  yeah, so again my background is, you know, my training, uh, all aspects of plastic surgery, right? Residency exposes you to sort of the whole gamut of plastic surgery. Um, and then I, um, solidified my training with a year at Sloan Kettering, which was sort of sub-specialized in complex reconstruction and oncologic reconstruction, cancer reconstruction, and so I knew that, um, you know, I wanted my first job, I wanted my career to be focused on reconstruction. I wanted to be in a, um, institution, an academic institution, where I could sort of grow my practice. Uh, I would have, uh, the ability to treat complex patients, complex reconstructive patients, and have the academic support, uh, work with medical students and residents, and so I would sort of add credence to the academic, uh, you know, my academic sort of prowess if you will. Um, and so you know when I showed up here, I kind of wanted to build on that sort of just the complex reconstruction. And, um, there was a need for providing transgender, gender affirming care and so quickly, um, when I joined here it was just the two of us, my boss Dr. Agag and myself, I was first hired here, um, the two of us were able to sort of jump in and start providing care for transgender individuals. Uh, and the volume just grew exponentially quickly. And it became a pretty large part of my practice. Subsequently now, we have two additional partners, Dr. Van Kouwenberg and Dr. Kanth and all four of us provide gender affirming surgery.

And is that like your entire–

It’s not my entire practice, no, it’s a large percentage of my practice. Um, but I still treat, um, sort of a large spectrum of reconstructive patients. Um, cancer patients, trauma patients, head to toe.

You mentioned that, kind of, the relationship between practice, but then also being part of a teaching hospital, and one of the things that, you know, that when we are ourselves students and then become teachers, sometimes we reflect back on what was missing from our education that we want to make sure that we’re changing or altering. Do you have any of those kinds of–

Yeah, I think, um, you know, I don’t have like a great sort of explicit answer other than I’ve experienced just that, where in my training, um, sort of learning and providing transgender care and gender affirming care, um, its was like learning on the job, figuring out what works and what doesn’t work, building a team, learning the language, if you will, around– around that specialty. Um, and so I feel like now that I’m on the other end of it, I feel like it’s a little bit easier, you know, to teach it than when I was learning it, because I think I can speak the language a little bit more and I can, you know, there’s a number of colleagues that we can call on to, you know, to help, you know, providing sort of comprehensive, multidisciplinary care. Um, I think there’s lots of things we can improve, you know, as far as being able to provide the care, but I think it’s also a great opportunity to teach in this moment, um, because we have, you know, residents and medical students who are absorbing, you know, all of this information whereas, you know, seven, ten years ago, we were sort of making it up as we went along kind of thing. 

What do you think accounts for like that generational shift?

I just think it’s this wave of, uh, inertia, you know, there’s, um, there’s–  just nationwide, there’s a field, plastic surgery, and the medical community at large, everybody’s sort of interested in, um, making transgender care as sort of safe and accepted as possible, I think.

35:22

Um, great, thank you. Uh, speaking, kind of like, making it, making it safe, like, what is a typical process for you when you’re engaging with a patient for the first time?

Yeah, yeah. I’ll say, um, in general I think that gender affirming surgery and transgender healthcare, obviously, is broad. My focus has been mostly on, um, gender affirming chest surgery and body contouring. I don’t offer genital surgery at the moment, and the reason I think is because we haven’t quite, at this institution yet, gotten to the point where we can offer safe surgery. And so, what does that mean? Well, um, when it comes to top surgery, whether it’s masculinizing top surgery, we’re removing the feminine breasts or feminizing surgery where we’re augmenting the feminine chest, um, that’s a procedure that kind of– kind of mimics accepted procedures that we all sort of have comfort performing, you know mastectomies and breast augmentation. So it’s sort of– although there is uniqueness to– to the procedure you perform for transgender individuals, it’s a very translatable skill, if you will. And it’s just, it’s sort of, uh, falls in the hands of plastic surgeons, whereas genital surgery, whether it’s vaginoplasty or phalloplasty, um, it’s involving, it’s sort of crossing the sort of borders of plastic surgery into urology or gynecology, and so I think in order to perform those procedures safely, and not just perform the surgery, but take care of the patients holistically, um, it requires input and collaboration between not just the plastic surgeon, but gynecology, urology, uh, because of, you know, potential implications from the surgery as far as complications go. And so what we’re doing here before we can offer those procedures routinely, we want to be able to build the appropriate team with buy in from plastic surgery, with buy in from all the departments, gynecology, urology, but we’re kind of still sort of building out the personnel and protocols if you will.

Is there– and there is a desire to grow–

Absolutely, and again, I think it’s– what we do is great. Being able to provide some aspect of gender affirming care here surgery-wise, um, but we want to be able to be comprehensive. We want to be able to be sort of,  more or less, a one stop shop. You know, medicine has always been a little bit siloed. There’s different sort of silos of professionals and experts and, you know, you need a kidney doctor, you go there, you need a heart doctor you go there, um, and I think one of the great things about, you know, Rutgers or an academic medical center in general is we’ve got experts under one roof, so it’s a one stop shop for patients whether it’s a transgender patient or anybody else. I think this should just be one place that they go, they don’t have to run around town to find somebody to help them.

Following that thread and thinking about holistic care, like, how how does the surgeon collaborate with like endocrinology, therapy–

Yeah, yeah sure, you know again, when it comes to the surgery that I perform, the top surgery, I will, you know, when I evaluate a patient, I’ll try to get a sense of what they’re looking for surgically, you know, what they’re hoping will– what they’re hoping surgery will accomplish for them, not just aesthetically, you know, what will it sort of enable them to do if it, you know, if their breasts, for example, are in their way, um, from living their truth. So I get a sense from the patient and then, you know, if the patient has– if the patient is on hormone therapy, I will oftentimes, you know, inquire who provides it for them and, you know, what their plan is. Are they going to stay on it, is this a trial, what’s their plan, uh, if the patient has a mental health professional, I’ll usually reach out to them as well, um, I require, I do require a letter of referral for patients, uh, for patients who are going to have surgery.

39:59

From the therapist?

From the therapist, yeah. And what I explain to the patient, you know, I don’t– I do that for a number of reasons. One, it– because I do consider myself just a member of their team, I’m their doctor, but I’m not their sole doctor, right? I want to help them from a physical standpoint, uh, providing their affirming surgery, but we also need to make sure that, you know, that is appropriate holistically and the timing of the surgery is appropriate. So, you know, oftentimes patients, when they have severe dysphoria, they have anxiety, depression, uh, they could be psychosocial stressors that I'm not appreciating as a surgeon, and if I put somebody through surgery, that’s a huge stress on their body, physical stress, which could be exacerbated by, you know, mental health disorders or could certainly worsen their psychosocial stress. I do, um, require the letter, I usually make a phone call to the referring therapist or counselor, usually get their input as to when the appropriate timing would be for surgery. Again, I’m seeing a lot more younger patients nowadays, early twenties, even sort of late teens, and that is a time of big change in somebody’s life going off to college, moving out of the home, uh, which are again huge stressors in a patient’s life and then you throw in surgery, you know, it can be a problem. So again, by requiring that letter and requiring, sort of, communication between all providers, I think provides the best holistic care for the patient, so–

When you’re, um, when you’re first engaging with a patient and you’re first having that first consultation, you know and you can feel free to be as technical as you have the time and care to be, like, what do you talk about?

Yeah, um, so again, as sort of, I try to get the patient’s input at first about what they’re hoping to achieve, because it’s hard to articulate anybody, you know, from their standpoint or even my standpoint about what the surgery can accomplish, more than just sort of you know a physical change. Um, so, you know, oftentimes, patients will describe to me– let’s imagine it’s a trans-masculine patient and they’re coming in to have a mastectomy consultation. You know, they’ll describe that they spend twenty-plus hours a day binding and it hurts and it’s restricting and they just don’t want to, they feel like removing the breasts they don’t have to do that anymore, or they have difficulty shopping for clothes that fit or look good on them because of the breasts. Some patients say they can’t–  they can’t play sports and they feel like they can’t, um, you know, do the activities that they truly love because of the physical, um, sort of burden of their chest. And then there’s the, you know, the dysphoria, the mental anguish from looking in the mirror and seeing a body that doesn’t align with how they see themselves internally. Um, so you know when patients sort of express that to me it sort of– it sort of reassures me that we’re on the right track, right? And I tell them that I can help them, I can provide a surgery that will eliminate a lot of sort of the sources of their dysphoria. Uh, and then we’ll go into the details. Oftentimes I’ll discuss the different sort of scar patterns that a patient might have, um, we’ll talk about, um, just the surgery in general, how long it takes. I send patients home the same day, so they’ll come in the day of the surgery, get the surgery, go home the same day, uh, I’ll tell them about the sort of restrictions I place on them. No strenuous activity for four to six weeks, no going to the gym for about six weeks, I use surgical drains as well, that are placed under the skin, and they’ll go home with, and they’ll have to sort of care for them at home. Uh, and so I kind of paint a picture for what to expect as far as the recovery goes for the first four to six weeks after surgery. Um, and you know, I would say that most patients are super excited, super anxious and really want to get the surgery done ASAP and sort of move on with their lives. Um, and I think that’s great and my patients have been– my transgender patients have been probably the most appreciative patients that I’ve had the opportunity to work with. Uh, and it’s, you know, it’s fantastic. I have a number of patients that I can remember, you know, they– they go into the OR, they’re smiling, they’re thankful, they’re excited, they wake up and they’re laughing in the recovery room and that’s just a rare treat.

Um, you mentioned, kind of like, age groups, um, is there any policy or practice in surgery working with minors?

There’s not like a– um, so there’s guidelines, um, I wouldn’t say that there’s like an institutional policy, but–

45:18

And by guidelines, do you mean technically WPATH guidelines, or Rutgers guidelines, or both?

Well there’s WPATH, there’s supposedly WPATH guidelines, we don’t have a sort of written Rutgers guideline if you will. Um, I think you know um, anybody under 18 it’s sort of special case scenario. Uh, and I’ve had patients who’ve consulted with me who have been 15, 16, 17 years old, uh, and you know, most of the time they are accompanied by a supportive parent or two supportive parents, and this is obviously not a decision that they’ve made lightly or just decided on the day before coming to see me, this is something that they’ve been thinking about and working through for years. So, you know I think, um, in my experience, you know, the adolescents that I treat are sort of perfect cases for providing the care, and, uh, you know, not to get political or change the conversation, I feel like people who oppose that, people who are on the other side of that don’t see that. They think that kids are just waking up one day and deciding to have surgery, and it’s just not the case, so yeah.

So, um, to get political–

Okay.

But I, kind of going there, is that, you know, understanding that, you know, during the time frame of this interview we are also in the midst of very specific legislative movements in states like Florida and states like Texas, um, where how much time of your day do you think about how– how and– or how your profession, your medical profession, also fits in the political landscape?

Yeah, you know, I think– I suppose I don’t spend a lot of time thinking about it, at least not until it’s on my doorstep, if you will. I think– again, 'cause, um, providing gender affirming care is not my sole practice, um, I– I feel like I obviously spend more time thinking about it when I am consulting with a transgender individual, particularly I think we have to be careful in the adolescent age group because, um, yeah I don’t think it would be good to do something that would be ammo for the opposition, if you will. Um, so that being said, you know, I think I kind of not really directly answer question, but when it comes to, you know, adolescent transgender individuals, I– you know, I like to sort of go by the book and make sure that we’re on, you know, we’re following WPATH’s guidelines, uh, we’ve got all the support from, you know, parents, we’ve got support from therapists, and everybody on the multidisciplinary team is sort of on board before moving forward with surgery. Um, again, you know, it’s not to create barriers for a patient but just to sort of eliminate the idea that we can make a misstep and that be used against us if you will.

Um, I asked you a question earlier about the dreaded cocktail party question about surgery itself, but then there’s the added layer talking about politics and culture, sociopolitics. What is the– what is your go to, kind of like, you know, speech about the community that you serve?

Uh, at a cocktail party? Um–

We could talk about the cocktail party version of it, and then the professional, collegial version of it.

Yeah, yeah. I suppose I’ve never– and watch I’m going to say this and now tonight I’m going to have a different experience, but I’ve luckily never sort of encountered a, um, antagonistic sort of response to the fact that I perform gender affirming surgery in sort of a social setting, um, I don’t know, I don’t know what I would do in that scenario. I don’t know– I sort of think about, like, would I try to continue the conversation and sort of explain what I do and my perspective, or would I just sort of say, “No,” and walk away. I don’t know, I don’t know. And I think it really depends on who I’m conversing with. If it’s somebody that– if it’s somebody that I respect, I want to engage them in conversation and understand their perspective, and hope they would understand my perspective, but, yeah, I guess I haven’t been in that situation socially which I guess is good for me.

50:13

And on the flip side, professionally?

Um, professionally, um, so, I’ll just say for the most part, uh, most of my colleagues, if not all but a very select few, are very supportive, you know, of the care that we provide. Um, I think the good thing for my– for any colleague who’s maybe opposed to what I do and the care that we provide, they can sort of select out, they can opt out. They don’t have to participate in the care of our patients, you know? Um, and nobody’s sort of, um, in a professional community, nobody’s sort of mounted this anti-trans movement which I think is great, you know? So the ones who are opposed to it they stay– they opt out and it hasn’t really been an issue. Um, you know, we have, again, going back to sort of outside of work, um, you know, we have been recipients of hate mail and that sort of stuff from the community, and people oppose what we do, and I think it’s sort of comes with the territory a little bit, we kind of have to– any sort of direct threats we have to obviously address, but otherwise we, for the most part, try to just brush it under the rug a little bit and move on.

A lot of the stories– we’ve done a lot of interviews with individuals who identify as transgender, like, you know, access to various stages of care. One of the, kind of like, you know, cultural things that we’ve kind of seen shift is, like, even you mentioned like even five years ago it’s a completely different conversation, but individuals who would go to other major metropolitan areas to access care, and not just gender affirming care, like, if they have the flu, they don’t want to go into a hospital emergency room where they’re going to be discriminated against, so they get on a train to Philadelphia or New York, um. What have you seen change or shift, or have you seen anything change or shift in terms of, like, the holistic care in institutions like this?

Yeah I mean certainly we’ve, um, the conversation is shifted from just providing gender affirming care to providing care, right? It’s, yeah you’re a transgender individual but you still get the flu or a cold or cholecystitis, whatever it is and you still, you know, doing a cholecystectomy is not gender affirming surgery in and of itself, but using the right pronouns for that person is affirming, right? So, um, this institution in the various sort of, um, uh, [unintelligible] support, you know, ancillary support systems if you will, have gone a long way in, um, advocating for, you know, the use of appropriate pronouns and creating a supportive affirming space, even if somebody’s coming in to have their heart checked out and not necessarily getting gender affirming surgery, we need to address them appropriately, we need to be supportive we can’t, you know, we can’t have them check in and be, you know, have them called by the wrong name or the wrong pronouns, so you know, there’s a huge effort to, you know, to sort of make this supportive affirming environment across the board, and I think, again, we weren’t having these conversations more than a few years ago, so–

Um, the, uh, um, there are other, kind of like, systems, support systems built into the process, like, how do you engage with other support groups that are, kind of like, organized, what is your engagement with those groups like?

Sure, you know, we were speaking of Nicki before, so I’m a member of the PROUD advisory committee also a member of the, uh, PROUD what’s the acronym, it’s the, um, PROUD Gender Center of New Jersey, um, so through these, sort of, through these channels, um, again, working with the advisory committee, we’re able to hear from people in the community about, you know, their impressions of our institution, the services we provide here, whether it’s good or bad, or things that we need to change, and we take that information to sort of the leadership of the hospital and the medical school, and we sort of talk about what the “community” is saying and what we can do to improve our care here. And I think that’s, you know, important and it goes both ways, so we hear from the community about things that we can do as an institution or as a, you know, academic medical center, and then also, uh, the academic medical center can sort of put together programs, outreach programs, go out to the community and say, “Hey, listen, this is what we’re offering, we’re working to create this environment and we welcome you.”

55:42

I’m trying to ask this without it sounding like a strategic planning conversation, but, um, you know a one, three, five years into the future, what things need to– what adjustments are you hoping the field makes, and it could be either the institution or the field in general.

Yeah, um, you know, I think there’s a lot of things that happen concurrently. Um, there’s like the small things that we’re still trying to improve and work on, again, making sure that we address every patient by the appropriate name and pronouns, I’m calling it a simple thing because there’s no money that we need to spend to do that, we don’t need to hire people to do that, it’s just something we are capable of doing now. But it’s not that simple because we need to educate people, we need to, you know– it’s not just the doctors, it’s not just the nurses, it’s, you know, it’s the environmental staff, it’s the people checking patients in in the waiting room, so you know, it’s a lot of work we have to do to educate, but that’s–  I feel like that’s ongoing, that’s something that if you were to say, you know, maybe the one year plan would be to make sure that nobody is misgendered, you know? Um, you know, longer term plans would be, you know, shoring up all the different procedures and services that we can provide, not just surgically, but all the different, you know, uh, all the surgical affir– affirming surgery procedures that we can provide. We can provide mental health here because that is something I think most patients are seeking outside of our academic medical center, um, you know, social services, like, if we had a dedicated social worker that could help people, you know, navigate this process, I think that’d be great, and that’s probably a few years as far as timeline. And then maybe a larger timeline would be a literal, um, physical footprint, having a gender center that’s again, all these different services under one roof, and although we sort of have various services under the, um, non-physical roof of Rutgers Robert Wood Johnson, it would be great if we could have sort of one parking lot that somebody drives to and gets out and enters the building and they get all the services there.

Um, when you’re not doing all of this, what are you doing?

[Laughter]That’s a good question and I spent probably the last couple years like most people during Covid trying to figure out hobbies [laughter]. Um, so I most recently ran my first and likely last marathon. I did the New York City Marathon last November, so I was training for that for about five, six months before I ran that, and then also concurrently started playing the saxophone, yeah, so I was sort of in a little bit of a funk and decided I needed some hobbies and so took up running and saxophone

Where are you taking lessons?

I take lessons from a guy in New York [laughter], yeah once a week, yeah. Maybe I’ll start running again, but we’ll see.

Um, is there anything that you were expecting me to ask that I didn’t ask or anything you would ask yourself if you were in this situation?

Nothing comes to mind, I mean I think, um, hopefully it came across in our interview, this is something I really enjoy, uh, you know, one, taking care of patients I think is a huge joy of mine, um, and as I mentioned before, my transgender patients have expressed such, um, appreciation and, like, heartfelt, uh, sort of joy at the care that they receive, especially when it’s good care. When they come in and they feel recognized and they feel affirmed and they have a great experience, they– most patients sort of have no holds barred expressing their appreciation, and I feel like that’s really touched me because it’s not something that most patients, I think, or most other patients that I take care of are, um, as willing to do, and so, you know, maybe it’s a selfish thing, but it’s been a huge pleasure and joy taking care of the gender diverse community.

Any other parting thoughts or–

No, I don't think so.

I’m going to go ahead and stop the recorder now.