BALTIMORE — Ashlee Freeman, a transgender woman from Durham, N.C., got a list from her insurer of doctors who could perform her gender-affirming surgery.
The first was nearby but inexperienced in what was once called gender reassignment. The next was at MedStar Franklin Square Hospital just east of Baltimore, which launched a program about three years ago.
"I live really close to the first hospital, but drove five hours to the second," said Freeman, 33, who had a vaginoplasty at Franklin Square in June and recently returned to handle paperwork. "Like everyone who has a major procedure, I wanted the doctor with experience."
Access to such procedures is something of a last frontier for LGBT health care. There are growing lists around the country of primary, specialty and behavioral health providers for transgender people, but big geographic gaps remain between established surgical programs.
With specialized programs at Franklin Square and Johns Hopkins hospitals, providers and observers say Baltimore is becoming an important center for transgender medicine, particularly the surgeries that can be the final step in a transition.
The reputation is largely based on anecdotal evidence. Unlike other specialties, there is little official data on procedures, and there is no certifying medical board for transgender surgeons or even a U.S. News & World Report-style ranking. Hopkins and Franklin Square both launched programs in 2017.
To find surgeons with the most experience and least complications, potential patients rely on message boards and personal recommendations that amount to informal rankings. Freeman says she's shared her experience, and even photos of her new vagina, to others considering the procedure.
Wait times are emerging as an indicator of quality. Freeman waited 6 months for surgery after first meeting her doctor, delayed only somewhat by coronavirus-related limits on some surgeries. For the most complex procedures, such as penis construction and some facial sculpting, top doctors, such as those in Baltimore, New York and San Francisco, have waiting lists that can stretch into years.
Hopkins is among hospitals that have launched fellowship programs to train more surgeons in the field.
For now, many patients will continue to travel to Baltimore. About 90% of Hopkins patients for its most complex surgeries come from around the country. Franklin Square says it's drawing patients from Virginia, Pennsylvania and North Carolina, among other places.