Keck Medicine of USC launches Gender-Affirming Care Program

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LOS ANGELES — When Bridget, 57, moved from the East Coast to Los Angeles, she sought health care to maintain and monitor her hormone therapy.

She was quickly disappointed. One provider admitted they knew nothing about transgender health, and another labeled her transgender status as a “medical problem.”

She then discovered the Keck Medicine of USC Gender-Affirming Care Program and met with Laura Taylor, MD, a Keck Medicine family medicine specialist and medical director of the program. Taylor has been Bridget’s primary care doctor ever since.

As Bridget experienced, transgender people often face barriers to equitable health care. According to a 2021 study from the Center for American Progress, one in three transgender adults said they had to teach their doctors about transgender health to receive appropriate care. Nearly one-half reported having negative or discriminatory experiences with a health care provider.

To address the many health care disparities faced by transgender individuals, Keck Medicine has launched the Gender-Affirming Care Program to meet the comprehensive needs of the transgender, nonbinary and gender-diverse community. Services include everything from routine health care, such as preventive cancer screenings, yearly checkups and flu shots, to gender-affirming hormone therapy and surgery.

The program is comprised of physicians from several disciplines including family medicine, plastic surgery, gynecology, urology and otolaryngology. Specialists in voice, occupational and physical therapy are also available to patients.

A nurse navigator coordinates care with the providers to ensure patients receive seamless specialized treatment. The physicians and program staff have collectively received more than 600 hours of gender-affirming sensitivity and inclusivity training.

“Our program brings together a multidisciplinary group of physicians across specialties to address the specialized needs of this underserved population,” said Taylor. “We’re proud to offer a full range of health care services in a safe and supportive environment.”

Another key aspect of the Gender-Affirming Care Program is that it was designed with input from the local transgender community.

“Due to historic marginalization of the transgender population, some within the community view medical providers with distrust,” said Roberto Travieso, MD, surgical director of the program. “It was important to make our local community part of the process as we built the program.”

As part of its outreach, Keck Medicine partnered with The TransLatin@ Coalition, the largest trans-led nonprofit organization in Los Angeles that advocates for the needs of transgender, gender non-conforming and intersex immigrants across the country.

This collaboration helps Keck Medicine establish a strong foundation within the transgender community and provides ongoing feedback on how the program can best serve patients.

The Gender-Affirming Care Program was in development for several years, but came to full fruition with the arrival of Taylor and Travieso to Keck Medicine, respectively in 2020 and 2021. Taylor is trained in LGBTQ+ health care and Travieso is fellowship-trained in gender-affirming surgery.

The program leaders hope to hire and train more gender-affirming practitioners, build more mental health services into care and foster additional community partnerships.
Meanwhile, for patients like Bridget, the Gender-Affirming Care Program is a gift.
“I am doing really well under Dr. Taylor’s care, and feeling happy and healthy,” she said.
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For more information about Keck Medicine of USC, please visit news.KeckMedicine.org.

The post Keck Medicine of USC launches Gender-Affirming Care Program appeared first on USC News.

Greener GasesĀ 

Keck Medicine of USC is phasing out one of the most commonly used — and environmentally toxic — anesthetics for its surgeries, desflurane.

The discontinuation of desflurane is part of a universitywide effort to re-examine both USC’s and Keck Medicine of USC’s impact on climate change and to implement healthier, sustainable solutions whenever possible.

The operating room is one of the biggest — if not the biggest — waste generators in any hospital, says Arash Motamed, medical director for Keck Main Perioperative Operations and Keck Medicine of USC Sustainability.

“They’re very resistant to degradation; they stay in that environment for many years,” says Motamed, an associate professor and vice chair of clinical operations for the department of anesthesiology at the Keck School of Medicine of USC.

In June, the Association of Anesthetists noted the inconvenient truth about anesthetics.

It cited research showing that anesthetics are responsible for 0.1% of the world’s carbon emissions. At the hospital level, inhaled anesthetics make up more than 5% of acute hospital carbon emissions and 50% of perioperative emissions.

Anesthetics in the atmosphere

During a surgery with anesthetics, a patient breathes in an anesthetic gas, which circulates through the body and keeps the person unconscious. After the operation, the anesthetics are turned off, the concentration in the body decreases and the patient regains consciousness.

Keck’s operating rooms have three primary anesthetics, Motamed says. Each achieves similar effects but has different drawbacks.

Desflurane is very quick to come on and very quick to come off — that’s why people love it. But it’s expensive and horrible for the environment.

Aren Nercisian, anesthesiologist at Keck Medicine of USC

“Desflurane is very quick to come on and very quick to come off — that’s why people love it,” says Aren Nercisian, an anesthesiologist at Keck Medicine of USC. “But it’s expensive and horrible for the environment.”

Desflurane is the most commonly used. Yet, studies show desflurane is so harmful to the environment that an eight-hour surgery causes as much damage to the atmosphere as driving a car from Los Angeles to Maine.

“The contribution to emissions is huge,” said Howard Hu, holder of the Flora L. Thornton Chair in Preventive Medicine and chair and professor of population and public health sciences at the Keck School of Medicine of USC. “That insight became a clarion call for us to do something about it.”

In its own call to action on pollution reduction, the California Society of Anesthesiologists noted that desflurane lingers the longest of any anesthetic — 14 years — in the atmosphere’s lowest layer, the troposphere, just above the Earth’s surface. On the other hand, sevoflurane remains in the troposphere for just over a year while isoflurane lingers for 3.2 years.

Helping the environment, cutting costs

Global warming potential (GWP) is a way to quantify the amount that an agent contributes to global warming over a period of time. Nercisian, who leads sustainability efforts for the anesthesiology department at Keck Medicine of USC, explains that GWP measures how much energy the emission of 1 ton of a gas will absorb over a given period, relative to the emissions of 1 ton of carbon dioxide.” The larger the GWP, the more it warms the Earth compared to carbon dioxide. The GWP of carbon dioxide is 1.

Desflurane has a 20 times higher global warming potential than sevoflurane, Nercisian says.

Desflurane has the highest global warming potential — 2,540 — compared with sevoflurane, which has a GWP of 130.

The triple aim of a health system should be improving patient experience, improving the health of the population and reducing the cost of health care … sustainable delivery of care should be the fourth aim.

Arash Motamed

The three also differ in cost. Desflurane tends to be the most expensive. And so far, no studies have indicated whether one is worse for patients more than the other.

“There’s never been a study to prove that you have better outcomes with sevoflurane vs. desflurane vs. isoflurane,” Nercisian says. “Though some agents have specific advantages.”

Keck Medicine of USC has not ordered more desflurane in the past year.

“According to Institute for Healthcare Improvement, the triple aim of a health system should be improving patient experience, improving the health of the population and reducing the cost of health care,” Motamed says. “Howard Hu, chair of Population and Public Health Sciences at USC, says that sustainable delivery of care should be the fourth aim. I couldn’t agree more.”

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