LGBTQ clinic at the University of Iowa offers 'relief'

Dr. Nicole Nisly didn’t go into medicine with a desire to help transgender people. It wasn’t her childhood dream. And it wasn’t a personal goal crafted during medical school.

But, while acting as the University’s interim chief diversity officer in 2011, Nisly attended a meeting of the undergraduate Trans Alliance club that focused on issues within the health care system. “Sincerely heartbroken” over the struggles she heard from the gathered students, “the stars aligned” that evening, she said, and she knew she had to offer her help to Iowa City’s transgender population.

After wrestling with exactly how to help, Nisly and her colleague Dr. Katie Imborek landed on opening a well-rounded, holistic clinic that could cater to all the needs of the LGBTQ (lesbian, gay, bisexual, transgender and questioning) community. Built from the ground up out of the pair’s collective “dream,” today the University of Iowa LGBTQ clinic serves thousands of patients from all over the Midwest and has been recognized by the Human Rights Campaign as "a leader in LGBT Healthcare Equality."

Booked through April, the clinic offers exams, hormone therapy, counseling, breast augmentations and mastectomies and orchiectomies (removal of the testicles). The clinic also partners with the university's law school to offer legal advice to transgender patients who are experiencing issues getting identification documents updated or have questions about insurance coverage.

And the clinic's doctors are not done; they hope to continuously add services, including gender-confirming genital surgery.

'I feel alive': Transgender Iowans on medical care, surgeries

To efficiently get their clinic off the ground, the pair used what Nisly calls the "farmers market" model. Instead of fundraising and hiring new providers, they used resources that were already available at the university. Once they had buy-in from then-President Sally Mason, the pair went to work asking fellow doctors to help with the clinic.

Despite the program's rapid growth, its goal remains simple: to offer a space where all the problems that the doctors heard about that 2011 evening wouldn’t be barriers to care, including repeated incorrect pronoun usage, invasive tests and doctors uneducated in transgender-specific needs.

The founders wanted to “create a clinic that is so visible … that you don’t have to worry about who you call, where you call, am I welcome there, are people going to know what to do with me. No, (with our clinic) it is going to be obviously clear.”

Or, to put it plainly, Nisly said, the doctors hoped to alleviate the fears that transgender people have when they walk into a hospital.

“We have patients who come here and they think they have to convince us of their symptoms, and they are prepared to jump through all these hoops,” she said, “and the look on their face when you say, ‘We are here to help you,’ and ‘We want to make these steps as easy as possible,’ it’s just such a sense of relief."

Fear of not being accepted in the health care community is a concern for transgender people nationally.

Respondents to the National Center for Transgender Equality’s just-released Transgender Survey reported encountering “high levels of mistreatment when seeking health care.” More than one-third of respondents said they have had at least one negative experience with a health care provider due to being transgender, and a quarter said they didn’t seek health care because of the “fear of being mistreated as a transgender person.”

The LGBTQ clinic bucks those trends. More than two-thirds of its patients are transgender or gender nonconforming. Not only are those patients returning; more gender variant people are calling every day, Nisly said.

While those involved in the clinic are working on their “big picture goal” of adding more providers and surgical options, the doctors are also working on educating employees and health care providers already involved in the university’s health care system. Nisly and Imborek recently started “terminology trainings," which include best practices for discussing care and using preferred pronouns. A preferred pronoun is especially helpful for transgender people whose gender marker on official documents may be different from how they live their lives.

The pair also worked to ensure the university-wide electronic medical records system allowed for a preferred name to be entered, Nisly said.

“While it seems small, having a preferred name is huge for people who have been called the wrong name their whole lives,” Nisly said. “So if Joe prefers to be known as Alice, we write that in there, and the entire system knows that this person is Alice. We offer it to everybody, so if kids want to be known as Batman or pork chop or whatever name, the system is welcoming and we can offer that.”

Arguably the most exciting part of the clinic’s long-term plan is to offer genital surgeries, which would make it the first hospital in Iowa to do so. Currently, transgender people have to travel to Chicago or the coasts to have any genital surgery.

“In my view, we could start tomorrow, but in reality we need to work towards developing a program that includes training lots of staff and raising some funds,” Nisly said. “We are excited, but it’s going to take a little bit of time to create a structure.”

But, really, Nisly offered, her goals are much simpler and much truer to the clinic’s original design: She doesn’t want her patients to “travel miles and miles and pay lots of money” for needed care. She wants to help them find the care they need right here in the Hawkeye State.

“It’s not my goal to be the best center in the world or anything like that,” she said. “We just want to be really good at what we do and proud of what we do and do everything to the best of our ability.”

About the clinic

To learn more about the LGBTQ Clinic at the University of Iowa, call 319-467-2000 or visit uilgbtqclinic.com.