“When I look at my body now, it feels like this is how I’ve always been, which is pretty incredible. It just feels natural.”
Gwyndolin Vail was a student at Rutgers University in 2014 when the transitioning process began. “I had a kind of laissez-faire approach to gender,” says Gwyndolin, now a 30-year-old researcher. “I identify as nonbinary, and that’s been consistent from the start.” The decision to transition to a more feminine appearance was carefully weighed. “It turned out to be a great choice that really improved my quality of life,” Gwyndolin says. “It allowed me to explore gender in a very positive way because it gave me access to how I wanted to look in ways I didn’t think I could before.”
Transitioning also exposed Gwyndolin to more complicated interactions with society, including the health care system. “The LGBTQIA population has often been marginalized, persecuted, looked down upon and judged,” says Sameh Abdelaal, MD, Medical Director of the Babs Siperstein PROUD Center at Robert Wood Johnson University Hospital (RWJUH) Somerset, which offers specialized primary care services for the lesbian, gay, bisexual, transgender, questioning, intersex and asexual community. “People often fear going for medical care or to the pharmacy because of personal challenges that can arise from not being accepted or being under threat of scrutiny and disapproval.”
“It’s daunting to put yourself into the care of doctors who are not necessarily trans focused, especially if they have preconceived notions of what it means to be transgender and what people are trying to achieve with their gender presentation,” says Gwyndolin, who prefers to be referred to with they/them pronouns rather than binary he/him or she/her. “That’s even more true for surgeries. Do you have a doctor who really is going to listen to you and what you want or instead focus on what they think you want?”
Safe, Comfortable Care
Gwyndolin’s transition process first entailed hormone therapy at Rutgers University Student Health, working with Melodee Lasky, MD, Assistant Vice Chancellor for Health and Wellness and a collaborative faculty member at Rutgers Robert Wood Johnson Medical School. Therapy included taking androgen blockers and estrogen. “That produced demasculinizing effects from the blockers and specialized effects from the estrogen,” Gwyndolin says. After graduating, Gwyndolin sought ongoing hormone therapy somewhere that would feel accepting and comfortable. “An endocrinologist at Rutgers Student Health connected me with the Babs Siperstein PROUD Center,” Gwyndolin says.
“We offer comprehensive care to anyone who needs help,” Dr. Abdelaal says. “If they have health needs, our attitude is, ‘You’re a human being; please come in and make yourself comfortable.’” He says a less welcoming attitude increases risks that members of the LGBTQIA community might skip medical care or seek it from unqualified sources.
In the case of transgender patients, “you can obtain hormones on the street or online, and there’s a lot of misinformation about their use,” Dr. Abdelaal says. Hormone treatments affect people differently and each patient’s goals are unique, so regimens need to be tailored and customized. Welcoming all patients helps ensure that care is both safe and respectful, he says.
“Simple things like having the names and pronouns that you want right in your chart make you feel respected for who you are,” Gwyndolin says. “One of the biggest benefits of having LGBTQIA-focused health care is that patients feel included and respected and not made to feel they’re different or strange or subjected to invasive curiosity, which I’ve definitely felt at doctors’ offices before.”
Surgical Solutions
Seven years after beginning the transition process, hormones had only gone so far and Gwyndolin continued to feel a sense of what’s known as gender dysphoria. “I was experiencing a disconnect between my identity and how my body looked,” Gwyndolin says. They made an appointment to discuss breast augmentation surgery through the PROUD Gender Center of New Jersey at Robert Wood Johnson University Hospital (RWJUH), which offers a suite of specialized services to the LGBTQIA community, including gender affirmation surgery.
“The goal of gender-affirming surgery is to align a person’s physical body with their identified gender,” says Jeremy Sinkin, MD, a plastic and reconstructive surgeon at RWJUH and Rutgers Robert Wood Johnson Medical School. “During the surgical consultation to achieve a feminine chest, the surgeon needs to understand what the patient’s goals are for size and aesthetics. We need to agree on what implant sizes are medically appropriate for the patient’s body. It’s a shared decision-making process between patient and surgeon.”
Dr. Sinkin and Gwyndolin met multiple times to discuss goals and options. “I just wanted a little increase in breast size,” Gwyndolin says. “I wanted them to look natural and didn’t want a hyperfeminine body that was out of sync with my nonbinary identity or would impede an androgynous aesthetic.”
The process also entails emotional support, especially from patient navigators such as Jackie Baras, MSN, MBA, RN, and Daniel Fernandez. “Gender affirming surgery is a big change, and there’s a lot to process emotionally,” Gwyndolin says. “I have a good support network in my personal life, but for them to offer support, especially postop, was unexpected and really nice.” Patient navigator Danielle King, MPH, similarly offers support and guidance on appropriate resources and care at the Babs Siperstein PROUD Center.
During Gwyndolin’s May 2021 surgery, Dr. Sinkin made a small incision under the fold of each breast and placed small implants under muscle and native breast tissue. “The outcome has been great and I’m very, very happy,” Gwyndolin says. “When I look at my body now, it feels like this is how I’ve always been, which is pretty incredible. It just feels natural.”
To learn more about the Babs Siperstein PROUD Center at RWJUH Somerset, call 855-776-8334.