Shirah Vollmer MD

The Musings of Dr. Vollmer

Gender Health?

Posted by Dr. Vollmer on January 11, 2018


Image result for ucla gender health program


With deep respect for UCLA as an institution, and with deep respect for my training which has entirely occurred at UCLA, and with deep respect for the many departments within UCLA that I have been affiliated, I am quite curious and, dare I say, skeptical, about a “gender health program”. Reflecting back on my training in the 1980s (yea, I am getting old, I know), UCLA was doing transgender surgery, mostly in the department of urology. Mostly they were turning male genitalia into female genitalia. Other tertiary care medical centers were doing this too, and so this was a “standard of care” a phrase which has now been replaced by “evidenced-based medicine”. In the early 90s they stopped doing this surgery and so patients seeking a change in genitalia sought private practice doctors, both here in LA and around the world. Medical tourism was a popular notion among male-female transgender folks as they could pay out of pocket a fraction of the cost in another country, and that would include their airfare, a fancy hotel, and an American trained physician working in another country (usually their birth country). Somewhere around 2010, the “medicalization” of transgender patients took off, with the example being in LA, that children’s hospital started a clinic… and then pediatricians throughout LA, when faced with a patient who expressed discomfort with their gender, would be sent to Children’s Hospital. The assumption is that CHLA is a good hospital and so, therefore, they must appropriately deal with transgender issues, since most pediatricians have no training in this area. Somehow, UCLA seems to want to join the party, and so the Gender Health Program is born. I say this, with the complete disclosure that I am not aware of the politics, or the motivation behind opening this clinic, but I do enjoy speculating publicly (to my 50 or so readers), as to how transgender issues seem to come and go within the medical profession. Having Gender opposed to Gender Identity Disorder (GID)..see below


GID was reclassified to gender dysphoria by the DSM5. … The American Psychiatric Association, publisher of the DSM5, states that “gender nonconformity is not in itself a mental disorder. The critical element ofgender dysphoria is the presence of clinically significant distress associated with the condition.


…is a mental disorder. I am not sure that I agree that those who have distress over their gender are mentally ill. Sure, they need a prescription for hormones, and possibly surgery, to change their gender, so they do need medical care, but whether they need mental health care has more to do with individual preference. A patient, for example, might have extreme distress over the size of their nose, but they don’t need to see a psychiatrist if they opt for rhinoplasty to attempt to minimize their distress. I know this statement is very controversial when it comes to gender, but I think this argument is worth consideration. If the patient is curious as to why their nose distresses them so much, then mental health intervention makes sense, but if there is no curiosity, then mental health care is harder to execute. In the 70s being gay meant you had a mental illness. That quickly got fixed when psychiatrists realized the absurdity of that notion. Being bisexual, or uncertain of your sexuality, is also not a mental illness. So, I would say that being uncertain about your gender is not a diagnosis, but only a nodal point, which suggests thinking about how to proceed. As with all big decisions, we, as psychiatrists, can help people through them, but it is also true that people make big decisions without our help and do just fine.

Returning to the Gender Health Program, I can see the advantage of pooling patient populations in order to develop an expertise. I can also see the marketing advantage that the program makes people feel like they will have a place of understanding. My issue is that Gender Health is a made-up term. I wish they would call it a Gender Program. I am not sure what Health has to do with it, as the patient may not be sick to begin with.



2 Responses to “Gender Health?”

  1. Shelly said

    I enjoyed this piece as I think it’s really the first time I heard your uncertainty about transsexual issues and Gender Health. I’m not sure I agree with you that UCLA is jumping on the bandwagon here. I think that it does have its place right where it belongs and it is justified. Calling it “Gender Health,” in my opinion, makes sense, because there are very particular needs to those who are transitioning, are thinking about it, want to transition, have transitioned, face discrimination, etc., and you psychiatrists are just the people who can help them. At least, this is my belief.

    • I think “gender health” is a marketing term, and there is so much we don’t know about transitioning, but we are afraid to articulate that, as patients look to us like we should know. I am glad you enjoyed this post. I hope uncertainty in many fields of medicine can be embraced for what it is, but sadly, that is often not the case. Thanks, as always.

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