A UU-founded family practice in rural New York offers transgender patients the services they need.
Dr. Carolyn Wolf-Gould has made transgender care a mission at her clinic and at the UU Society of Oneonta. (© 2016 Flynn Larsen, Courtesy of the Robert Wood Johnson Foundation)
Ten years ago, Dr. Carolyn Wolf-Gould, a family practitioner in the small town of Oneonta, New York, got a phone call that would change her life and the lives of hundreds of transgender people in rural New York and surrounding states. A transgender man who needed a refill for his prescription for testosterone, a hormone aiding in his transition, called to see if she’d help. Though sympathetic to his request, Wolf-Gould had no training or experience in treating transgender patients.
“I knew nothing about it, so I told him I couldn’t take care of him,” said Wolf-Gould, a 22-year member of the Unitarian Universalist Society of Oneonta. But the caller was “very persistent,” she recalled. “Our office had always been supportive of LGBT rights,” including placing welcoming stickers on the office door. “He said, ‘I saw the stickers on your door, and I have nowhere else to go. If you say no, I have to drive to Philadelphia to get testosterone. Are you willing to learn? Because I’d be willing to teach you.’”
Though it was an awkward beginning, “it turned into something good,” she said, launching a practice focus that has become her passion and brought much-needed healthcare to a population that often struggles with discrimination, rejection, and uninformed providers. Twenty-eight percent of transgender people are subject to harassment in medical settings, according to a 2010 study from the National Center for Transgender Equality and the National Gay and Lesbian Task Force, and 50 percent have to teach their providers about transgender care, as in Wolf-Gould’s case.
Today, in addition to many cisgender patients, Wolf-Gould and the colleagues in her practice, Susquehanna Family Practice—including her husband and fellow UU, Dr. Christopher Wolf-Gould—treat 335 transgender and gender nonconforming patients. Some of these patients travel long distances to see them, including one who drives 600 miles, she said.
“Providing care to gender nonconforming patients is important to me because this is a vulnerable population that deserves high-quality healthcare and often is unable to find it,” said Christopher Wolf-Gould.
In 2015, the Wolf-Goulds and their colleagues added to their family practice a dedicated trans-health center, the Gender Wellness Center, which includes a physician’s assistant, a social worker, and Dr. Diane Georgeson, who offers trans-affirming gynecological care in the practice, including oophorectomies and hysterectomies. Her addition also means they can do more of certain procedures that can be very difficult for the trans community to obtain, including trans-affirming Pap tests for trans men and postoperative care for trans women who’ve had vaginoplasties.
In September 2016, the practice was selected for a $500,000 grant from the Robert Wood Johnson Foundation Clinical Scholars Program, a new national leadership program that aims to improve health and reduce disparities in wellness and longevity across the United States. Over the next three years, they will be studying the feasibility of creating a rural center of excellence for transgender health.
“It’s a huge deal,” Carolyn Wolf-Gould said, which will allow them to delve more deeply into providing a wide range of medical services to the trans population, both adults and youth, including mental health services, surgical services, training, and research.
Since Donald Trump’s election, many of their trans patients are very worried that legal protections and liberal Medicaid coverage for trans needs supported by the Obama administration are in jeopardy.
“People are feeling like they need to get their surgeries done fast,” she said. “They’re really panicked.”
“It’s more important than ever to build a center where we take care of medical needs as well as mental health needs and surgical needs, and where we provide training for providers as well as legal advocacy for patients,” she said.
Over the past decade, Carolyn Wolf-Gould has become a leader in transgender healthcare and an advocate for transgender rights and inclusion, including at the UU Society of Oneonta, which has put significant focus on transgender rights and has at least five transgender people in the congregation.
“Carolyn is a very modest person, but I think one reason we have as many openly transgender people in our congregation is because of her work in our community,” said the Rev. Craig Schwalenberg, the society’s minister for the past seven years. Under his leadership, and with the help of Wolf-Gould and a transgender member, the congregation has focused on education about transgender issues, hosting workshops and a film series. It also has created a long-term plan for supporting LGBTQ rights and is taking the lead on establishing an LGBTQ center in town, much as the congregation created a free health clinic some years ago.
For the Wolf-Goulds, their work as family practitioners, including their focus on transgender care, is a reflection of their UU values. Carolyn Wolf-Gould was raised a UU by her mother, a family therapist, and inspired to medicine by her father, a neurologist. “My parents raised me to believe that serving was really important, that service is our prayer,” she said. “To me it feels like a privilege to serve in those ways.”
After a post-college stint in the Peace Corps in Zaire (now known as the Congo), she met her husband at the Yale School of Medicine. After graduating in 1990, they did their family practice residencies together, at the University of Rochester, New York. “I love cradle-to-grave care,” she explained. “Delivering a baby, treating someone in hospice, inpatient and outpatient care. Family doctors are always doing a lot of everything. It’s a challenging field where you’re always faced with things you’ve never seen before.”
The couple chose Oneonta to set up their practice because it was close to both of their families, and they wanted to raise a family—their three children are now grown—in a small town. “I really enjoy knowing people over time,” she said, adding, “It’s a very intense process to grow older with your patients.”
After her first transgender patient came aboad in 2007, four more transgender people followed over the next five years. “I loved those patients. They shared their personal journey with me in very personal ways, and to be a physician for someone transitioning, to bear witness to that process, is a very beautiful thing,” she said. “There was also a huge need and it was not being met. People were suffering, and they were not able to get the care they needed.”
In an effort to learn more and improve her skill set in this area, in 2012 Carolyn Wolf-Gould reached out to Arlene Istar Lev, a psychotherapist in Albany who provides trans-affirming mental health services. Lev trained her in cultural competency for this group of patients, something she did not receive in her medical training. “Many doctors don’t understand that it’s very important to use someone’s preferred name and pronoun,” Wolf-Gould said. “They will use a male name or say ‘he’ when the patient is presenting as female; that’s very offensive.” Through her association with Lev, the number of trans patients quickly grew. Today, her youngest patient is 4, the oldest is 78.
The Wolf-Goulds’ family practice continues to include cisgender patients, most of whom have been supportive of—and even thanked them for helping educate them about—this area of their work. Although one of Carolyn Wolf-Gould’s cisgender patients left because his friends were teasing him about the practice’s trans-health focus, he later returned because he wasn’t satisfied with the care he got elsewhere, she said.
But it’s other doctors, far more than cisgender patients, who’ve been resistant to her work. At a shockingly high rate, specialists often refuse to see her patients. “I’ve had that happen a lot—a lot,” she emphasized.
Her patients share “horrific stories of being harassed, refused care, very horrible stories,” she said. Many in her field are ignorant about transsexuals, she said. Until 2014, what is now called gender dysphoria—which she describes as the discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth—was instead known as gender identity disorder in the Diagnostic and Statistical Manual. “The word ‘disorder’ implies that these people are mentally ill or disordered. We now know that gender variance is a matter of diversity, not pathology,” she said. Her office has compiled a list of trans-friendly healthcare specialists for referrals.
The current media attention on transsexuals gives her hope that education will overcome ignorance. That’s why, though normally somewhat shy, she is willing to talk to the media about her practice. She’s also working with the local hospital to train medical students in care for trans patients.
As a result of Wolf-Gould’s leadership in the area, and the efforts of the UU Society of Oneonta, the issue of transgender rights “is a part of who we are right now, and part of our long-range plan,” said the Rev. Schwalenberg. “We are very proud of Carolyn and what she’s doing.”
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Elaine McArdle is a UU World senior editor and a member of First Unitarian Church in Portland, Oregon. An award-winning journalist with more than 20 years of experience, she has also written for the Boston Globe, Harvard Law Bulletin, and others.