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  • Thursday, February 2, 2017

    February 02, 2017 2:30 PM - February 02, 2017 3:30 PM

    • Todd Nippoldt, MD ;
    • Kim Klauer, MA MBA ;
    • Caroline Davidge-Pitts, MD ;
    • Lauren Radziejewski, RN CNP ;
    • Jordan Rullo, PhD LP ;
    • Cesar Gonzalez, PhD LP ;
    • Jorys Martinez-Jorge, MD ;
    • Valerie Lemaine, MD ;
    • Aida Lteif, MD ;
    • Alexis Laungani, MD ;
    • J. Bostwick, MD

    The practice model to care for transgender and intersex people can take many forms depending on the goals, resources, and philosophy of the health care institution.Here we share our experience, from conceptualization to implementation and ongoing evaluation, of an integrated transgender and intersex health clinic at the Mayo Clinic, the largest private nonprofit medical practice in the United States.

    Materials and Methods:

    Mayo Clinic institutional leadership advised the development of a coordinated program to meet the needs of transgender and intersex patients after a task force identified inequities in care for this population.A small planning committee was charged to develop a proposal that followed the institutional model of patient care, education, and research.Members analyzed the services required and desired for this patient population, and identified the current strengths and weaknesses of the practice. The leaders of medicine, surgery, mental health and social services departments were contacted to engage support and to identify individuals with expertise and/or enthusiasm for providing transgender care.In those areas where expertise needed to be developed or capacity expanded, a plan was made to achieve this.Successful transgender practices across the country were visited to assess best practices and learn how common barriers were overcome.


    A proposal to implement the Transgender Intersex Specialty Care Clinic (TISCC) on a pilot basis was developed and approved.Key components of the proposal included:

    • A mission statement

    • Provision of social, mental health, medical and surgical services by Mayo Clinic providers in Rochester, MN

    • Located in a consistent physical space to ensure a safe, comfortable and welcoming environment

    • Providers come to the TISCC to see the patients rather than the patients going to each individual provider’s home office

    • Cultural competency training for all providers, paramedical, office and administrative staff

    • The practice conforms to WPATH SOC v7

    • Utilize a transgender care coordinator for pre-appointment assessment, organization of appropriate appointments, patient intake, and patient and family education and support

    • Patient care conferences to discuss individual cases prior to significant interventions

    • Partner with primary care areas to assure ongoing and appropriate general health care

    • Engagement with community transgender support and advocacy groups including one to one interviews

    • Formal presentations on transgender health care to Mayo departments and the community

    • Development of standardized practice protocols, templates and an electronic data base to facilitate practice, education and research goals

    • Encourage continuing education and scholarly activity for providers

    • Structure the TISCC to allow for future expansion to other Mayo sites

    • Analysis of the pilot practice including demographic, financial, patient survey, and practice data to identify patient demand, desired services, personnel and space requirements, and unanticipated issues

    Conclusion: From this analysis we identified obstacles and opportunities that we will address and incorporate in our ongoing practice. Major items included the need for significantly greater mental health care capacity, unanticipated high demand for adolescent patients, the need for cultural competency training across the institution, high interest for education and participation at the medical school, residency and fellowship levels, and the need for modifications of the electronic health record.
    Category: Standards of Care