Transgender patients on rise, but medical care and services lag

Published: December 9, 2011

ALBANY — Doctors don’t learn how to treat transgender patients in medical school and the medical establishment has been slow to address a rising trend, according to a local physician.

When Dr. Matthew Leinung, an endocrinologist and professor of medicine, joined the Albany Medical Center staff in 1991, he took over a practice from Dr. David Goodman, who had been seeing a half-dozen transgender patients beginning in the 1970s.

"He (Goodman) was the only one who would treat them at the time in this area and he asked me if I was OK taking those patients," Leinung recalled. "I said I didn’t have any problem with it, but I didn’t know anything about treating them."

Goodman recommended one of the few clinical volumes available on the topic, a text on endocrine treatment of transgender persons by Dr. Louis Gooren, a Dutch endocrinologist considered a pioneer in the field.

"It was very difficult at first," said Leinung, who received no formal training or lectures on treating transgender patients while completing a medical degree at Wake Forest University, a residency at Greenwich Hospital of Yale University and a fellowship in endocrinology at the Mayo Clinic in Minnesota.

By word of mouth, the number of transgender patients in Leinung’s Albany practice began to rise and it has continued to climb during the past 20 years and he has seen more than 300 patients.

The increase has been so dramatic in the past few years that Leinung, the primary endocrinologist treating transgender patients in the Capital Region, has maxed out and cannot accept new transgender patients in a practice that includes an overwhelming majority of diabetics.

"The need is huge and I do this work because I’ve seen success stories," Leinung said. "It’s not an easy road, but some of my patients have made a positive transition."

Although the American Psychiatric Association classifies it as a gender identity disorder in the Diagnostic and Statistical Manual of Mental Disorders, Leinung has worked to remove the stigma of mental illness.

The clinical definition — "a persistent aversion toward some or all of those physical characteristics or social roles that connote one’s own biological sex" — does not begin to capture Leinung’s experience with transgender patients.

"It’s a very complicated area and there has not been much research into it," Leinung said.

The analogy he likes to use is that each person has a switch in the brain that controls a person’s gender identity and a sense of seeing yourself as either male or female.

"For transgender people, the switch is thrown in the opposite direction and they’ve always felt uncomfortable in the gender role they took on through socialization beginning at birth," Leinung said.

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