Madison and Middleton are among the few Wisconsin cities with surgeons available for people in the transgender, non-binary and gender-expansive communities who wish to undergo gender-affirming surgery.
Top and bottom surgery — which includes gender mastectomy, vaginoplasty and phalloplasty procedures — is offered limitedly in the state. Dr. Clifford King at Top Surgery Midwest and Dr. Katherine Gast at UW Health are the only practicing providers locally.
Still, UW Health has been ranked highly by prominent LGBTQ+ civil rights organization, the Human Rights Campaign Foundation, as a health care system that provides its LGBTQ+ patients with the best practice and care.
UW Health was named a “Leader in LGBTQ Healthcare Equality" in 2019 by the Human Rights Campaign Foundation, according to the 12th edition of the Healthcare Equality Index. No other health care systems in the Madison area were recipients of the same accolades for their care.
"We are committed to offering compassionate care and remarkable healthcare, so it is an honor to be recognized again," UW Health CEO Dr. Alan Kaplan said in a press release. "Diversity and inclusion are critical to UW Health's mission."
UW Health Gender Services Navigator, Emily Smith, stated she is proud of the work being done in the city to provide care to those seeking gender-affirming surgeries.
“There are so many great resources in the Madison area and within UW Health,” Smith said. “My hopes and goals are to bring all of these resources together to better help patients, as well as educate and empower employees and staff [on] gender-affirming healthcare.”
For those looking to surgically transition, UW Health offers several gender-affirming surgeries within its Surgical Services department of the Gender Services unit. Such surgeries can take place in the region at Transformations, a facility in Middleton, or at University Hospital.
According to Smith, UW Health is considered a high-volume facility for gender-affirming surgeries. 10 Vaginoplasties, 15 top surgeries and one or two phalloplasties are performed each month. Facial feminization, voice surgery, simple orchiectomies and gender-affirming hysterectomies also take place amongst these.
Although UW Health is well-respected for its care of LGBTQ+ patients, this does not mean that its providers are the best fit for every person seeking gender-affirming surgeries. With so few cities in the state offering gender services and related surgeries, this poses a problem for those seeking care.
Sebastian Daniel, a transgender man who uses he/him/his pronouns, underwent a bilateral mastectomy — top surgery — in February 2018.
“At the time of my search, there were only two surgeons available: Dr. Clifford King, in Middleton, and Dr. Katherine Gast in Madison,” Daniel said. “The most relevant information that a lot of trans men like myself look for is pre and post-operative results. Dr. King had a section on his website with said photos, and, ultimately, I went with Dr. King because of that.”
Health care providers and their staff may have a view on the overall accessibility of gender-affirming surgery that differs from those who undergo the surgeries themselves.
“I think we have helpful resources in the Madison area, such as healthcare navigation assistance and legal help. It makes me hopeful with the changes I have witnessed in one year, that we will continue to pick up momentum with better healthcare coverage for LGBTQ+ patients,” Smith said.
However, Daniel had a less optimistic perspective about the process based on his own experiences in Madison.
“It is incredibly difficult to follow the path of finding care, then finding covered services, having the actual surgery and dealing with post-operative healing,” he said. “It was a bit of a hassle to find information that was accurate, relevant and recent.”
Despite the limited number of providers within the state, the wait time for Daniel’s top surgery was not an issue. The main obstacle he faced came from his insurance requiring him to prove he was experiencing gender dysphoria and was, in fact, a trans man through a letter of recommendation.
Surgeons who follow World Professional Association for Transgender Health standards require those seeking top surgery to provide one letter of support from a mental health provider; those seeking bottom surgery must provide two.
Daniel described various other challenges on the path through his transition, including hours of draining phone calls with his health care system and insurance company to cross-check his insurance coverage for the top surgery. Despite his work advocating for the coverage he needed, unexplained costs still appeared at the end of the process.
While months leading up to the surgery and the surgery itself left him physically and mentally exhausted, the results made every hurdle worth the jump, Daniel said. Now, he wants to share his experiences and advice with those enduring the same set of obstacles.
“Be prepared to fight a lot of battles,” he said. “Standing up for yourself against the broken health insurance system we currently have can be taxing and downright exhausting. Seek support from your friends, family and community to help with this. The reward is very worth the battle in the end.”
Despite the challenges of navigating the process of surgically transitioning in Wisconsin, Daniel still expressed hope.
“The queer community in Madison has blossomed and has grown in a way that I can safely say, yes, there are potential resources out there to assist with this journey, myself included,” Daniel said.
[Editor’s Note: 1/21/2019, 5:30 p.m.] An earlier version of this story cited Madison and Middleton as the only cities with gender-affirming surgery facilities, however, Milwaukee also provides these services.