Swati Rao was a medical resident in the UC Davis combined family medicine and psychiatry program in 2012 when she became aware of the need for health care services dedicated to transgender people. When the Sacramento Gender Health Center (GHC) established a free clinic to prescribe hormones to trans people undergoing a medical gender transition, she enlisted as a volunteer.
Now a UC Davis assistant clinical professor of psychiatry and behavioral sciences, Rao is contracted by her department to spend most of her clinical time at the Sacramento County Mental Health Treatment Center. But several days each month for the past six years, she and her wife, Sutter Health family practice physician Katherine Gardner, have volunteered as co-medical directors of the GHC’s hormone prescription clinic, working with UC Davis medical student volunteers.
Rao also teaches medical students and psychiatry residents about transgender physical and mental health, in which she has developed expertise.
Q. How did you become so passionate about this area of practice?
A. My wife and I are members of the LGBTQ community, and I identify as queer. Data very clearly reveals that transgender people within the LGBTQ community face disproportionately large amounts of abuse, trauma, discrimination and harassment. I believe there’s a very clear connection between recognizing and validating someone’s gender and their identity as they see it, and improved health outcomes for them.
Q. What services do you perform for patients in the hormone clinic?
A. I prescribe hormones as well as HIV pre-exposure prophylaxis, or HIV prep. We have a patient panel of close to 500 people now. I also help social workers at the Gender Health Center find primary care doctors in the community who are willing to assume responsibility for prescribing hormones for patients.
Q. In what ways do you work with other physicians?
A. A large part of my work at the hormone clinic involves education. I coach primary care doctors to put in referrals for transgender patients for any kind of gender-affirming surgeries that they desire, because surgical referrals have to be placed by a physician who is in the patient’s insurance network. We cannot do that at the free clinic because the Gender Health Facility is not a medical facility, so we serve as a liaison.
Q. What must a physician know about referrals for transgender patients?
A. When a patient wants gender-affirming surgery, surgeons and insurance companies commonly require a letter from the hormone prescriber as well as a mental health doctor, attesting that the person is ready for surgery from a psychiatric as well as a medical standpoint. I coach doctors how on to write those letters, and how to guide patients through the legal paperwork that transgender people must complete in order to legally change their name and gender on their license, their Social Security card, birth certificate, passport and other documentation. Much of what I do for the hormone clinic is an extension of the education mission that attracted me to academic medicine, and I encourage other physicians to volunteer there [http://www.thegenderhealthcenter.org].
Pearls of WISDOM about leveraging privilege
“Transgender people are some of the most vulnerable, marginalized and almost invisible people, even within the queer or LGBTQ community. With that in mind, I see my role as a physician – and its accompanying class privilege, power and respect in society – as a means to be a spokesperson on behalf of transgender people. I try to leverage that privilege to improve quality of life, safety and wellness for trans people. That is what drives me.”
– Swati Rao, assistant clinical professor of psychiatry and behavioral sciences
Want to learn more? Register for the 2018 Improving OUTcomes Conference – Educating health care and allied service providers throughout the Sacramento region to improve health outcomes for lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ+) people and their families.