Published March 2021
Jake's Journey to Comprehensive Transgender Care
This article is modified from the original, which appeared in Northwestern Medicine Magazine. Read the full article here.
For Jake Dicus, a freelance photographer, transitioning has not been a clear or paved path. Unfortunately, he is not the only one finding obstacles along the way.
The transgender community faces various barriers to accessing quality health care — discrimination, issues with insurance coverage and a lack of providers who specialize in transgender care — as well as problems with housing, transportation and food security.
"In the middle of a major heart attack, often transgender patients would rather go to a community health center than a tertiary medical center because they don't want to deal with discrimination," says Sumanas Wanant Jordan, MD, PhD, a Northwestern Medicine plastic surgeon who specializes in gender-affirming surgery and transgender care.
Jake, who is 38, has endured barriers himself, but his path has also taken some fortunate turns. He has received the transition-specific care he needs to continue becoming Jake.
A Common Roadblock: Access to Health Care
Though living publicly in his affirmed gender since 2010, Jake hit a major roadblock in accessing adequate care to support his transition. After undergoing hormone therapy in 2014 and chest reconstruction surgery in 2016, he struggled for years to find a surgeon to perform additional gender-affirming surgery.
While living in southern Illinois, Jake even traveled out of state to connect with providers in Missouri and Kansas. Those interactions were all disappointing. "The doctors I saw not only didn't want to treat me, but they also didn't want to hear my story," says Jake. "All they wanted to do was get me out the door as quickly as possible."
Support and Perseverance
Jake and his wife, Jennifer, remained determined to find a compassionate surgeon. "We had only been dating a year when I came out, but I could not stand hiding who I was anymore," he says. "She is my rock and keeps me going."
A 2018 Google search eventually led them to Dr. Jordan in the Division of Plastic Surgery at Northwestern Medicine. "She listened to me and treated me like a human being and not like some sort of disease you could catch," recalls Jake.
Pathway to Surgery
Like Jake, many transgender individuals struggle to find high-quality and compassionate health care. According to the National Center for Transgender Equality, a large-scale 2015 survey of transgender individuals found that 23% of participants chose not to see a doctor in the past year because of their fear of being mistreated.
The Northwestern Medicine Gender Pathways Program sought to change this reality. "It became evident very quickly that launching this program would fill a void in our community," says Dr. Jordan, who helped establish the program in 2020. "We want Northwestern Medicine to be welcoming for everyone, no matter their gender identity."
About meeting Dr. Jordan, Jake says, "We fell in love with her as soon as we talked to her." It was Dr. Jordan and her surgical team who successfully performed Jake's hysterectomy in June 2020 and phalloplasty in November 2020.
Dr. Jordan says, "We work hard to help patients overcome obstacles to achieve their transition goals, whatever they might be."
With a collaborative team of physicians from a wide range of specialties, the Gender Pathways Program offers integrated multidisciplinary health services specific to the needs of transgender and gender nonbinary individuals.
Jake's gender-affirming surgery exemplifies the expertise required to support medical services for transgender patients. "For many reconstructive surgeries, you need to know how to move tissue from one part of the body to another," Dr. Jordan explains. In Jake's case, Dr. Jordan moved skin, nerves and blood vessels from his forearm to use for his phalloplasty. Transforming male and female genitalia is not only technically challenging but also demanding from a perioperative perspective, requiring a whole-person approach.
A Whole-Person Approach
From the moment he decided to move forward with his gender-affirming surgery at Northwestern Medicine, Jake was assigned a program coordinator who was with him every step of the way. Jazz McGinnis, LCSW, who identifies as a trans masculine person, coordinated Jake's pre-operative tasks, such as gathering necessary insurance documentation, as well as post-operative care that took socioeconomic factors into account.
With a whole-person approach, the Gender Pathways Program can address many aspects of a patient's transition: medical, emotional, legal, cultural and social. "Sure, patients can come in for one procedure and be done, but achieving the best health outcomes relies on lifelong supportive and thoughtful care," says Dr. Jordan.
Jake continues to receive that care from Northwestern Medicine, on his path to living fully as his true self.