In her 25 years treating transgender and gender-nonconforming patients, alumna Deb Thorp, M.D., has seen young people who were abusing substances, battling depression, and in some cases, considering suicide, metamorphose into healthy, successful adults.
Playing a role in positive transformations never gets old, says Thorp, who graduated from the Medical School in 1984.
“I saw a 21-year-old just yesterday who went from being a very dysfunctional, frequently cutting, drug-using, dysphoric 15-year-old to a young adult who’s in college, with a job, living with his girlfriend — not smoking, not drinking, not cutting, but being a completely functioning, contributing member of society,” Thorp says.
She describes another patient who was assigned female at birth and decided not only to undergo hormone therapy, but also have sex reassignment surgery in his 30s. “He went from being dramatically under-employed, given his intelligence, to running a crew of several people. He has great confidence and runs his crew with great skill,” Thorp says. “He’s in his early 40s now and doing very well.”
Much has changed since Thorp — an ob-gyn by training — began caring for transgender people. “There are a lot more health care providers who are willing and able to provide culturally competent health care to the transgender population,” she says.
‘I learned everything I could’
Thorp’s first few transgender patients, a quarter century ago, came when a retiring partner started referring patients to her. “He gave me a little primer,” she says, “and I just read and learned everything I could.”
The number of patients continued to grow, along with Thorp’s reputation. Eventually, she began practicing gender medicine out of a separate clinic—the Park Nicollet Gender Services Clinic in Minneapolis — from her St. Louis Park ob-gyn practice, where she still devotes about two-thirds of her time.
“In 2010, we probably had a thousand patient visits [in the Gender Services Clinic]. In 2016–17, we saw 2,000 unique, gender-related patients.
“Our patients come from all over Minnesota and western Wisconsin, and we book out several weeks,” says Thorp, adding that many of the clinic’s patients are young adults. “That can mean that they’re healthier — but it also means they’re a little bit more subject to substance abuse disorders.
“We’re also seeing people at the other end of the age spectrum. They’re saying, ‘I never thought I’d be doing this, but as it’s gotten to be more acceptable in the culture, I want to do it.’ So they’re coming in to start hormones in their 60s and 70s,” Thorp says. “And we’re seeing other [older] patients who’ve been on cross-gender hormones for 40 years now.”
Fighting health disparities
Caring for historically marginalized communities is a consistent theme with Thorp. Her ob-gyn practice has long had an outstanding reputation among Somali immigrant women. In 2012, she helped activist Fartun Weli launch the Somali women’s health nonprofit Isuroon, and in 2016, she received the Pete and Weesie Hollis Community Service Award for her outstanding work with the Somali and LGBTQ communities.
“There are some parallels,” Thorp says of these groups. “Both populations are marginalized. Both experience health disparities and have cultural challenges within their own communities.”
In the Gender Services Clinic, she hopes to hire a care coordinator to help patients with what she calls “wraparound services,” including insurance coverage, housing, and mental health care. More clinicians are joining the practice as well.
“I do training for nurse practitioners, physician assistants, and residents who want to learn how to do gender medicine.” It’s a privilege, she says, to help train newcomers to the field: “I like that. A lot.”
While gender medicine isn’t yet a board-recognized subspecialty, WPATH — the World Professional Association for Transgender Health — developed standards of care in 1979 and has refined them multiple times since; the document is now in its seventh iteration. WPATH also is developing a certification process, Thorp says.
“I’m kind of hoping that the need for a [subspecialty] will eventually go away,” she says. “Hopefully, we’ll realize that all primary care providers should have this knowledge and skill set.”