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VA Eastern Colorado Health Care System
Eastern Colorado Geriatric Research, Education and Clinical Center (GRECC)
Eastern Colorado GRECC Investigators
20 December 2019
Sean Iwamoto, MD
- Title: Instructor of Medicine, Endocrinology
- Contact: firstname.lastname@example.org
- Personal Statement
Transgender (trans) people have a gender identity that does not align with their sex assigned at birth. Many trans people experience distress associated with this gender incongruence, known as gender dysphoria. Health care disparities among trans people are prevalent and related to gender dysphoria, fears of discrimination and many other barriers. There is increasing research around the world to better understand the basis for and evaluate solutions to reduce differential health outcomes based on gender identity.
- As an early career endocrinologist, my trajectory in academics is to explore the impacts of aging, obesity and gender-affirming hormone therapy (GAHT, or using sex hormones of the affirmed gender) on cardiometabolic risk in trans people. My current research on vascular endothelial function and aging in trans women will provide preliminary data for further investigations on the effects of sex steroids in trans as well as cisgender (cis) people, individuals whose gender identity aligns with their sex assigned at birth. My interest in trans health outcomes research, though in its infancy, has a foundation in years of volunteer work within the trans and other sexual/gender minority communities. Over the years, I have heard from trans patients about continued stigma within medicine regarding access to culturally sensitive and comprehensive care. These patients deserve evidence-based best practices for health care delivery, particularly in the setting of GAHT, which has been associated with an increased risk of cardiovascular disease (CVD) and venous thromboembolism in trans women.
- In September 2017, I co-founded the UCHealth Integrated Transgender Program (ITP) with my mentor, Dr. Micol Rothman, and other specialists in psychiatry, internal medicine, gynecology and plastics and reconstructive surgery, to provide safe and comprehensive care to our trans patients during a single clinic visit within the Endocrinology Clinic. ITP has also been involved in educating providers, staff and learners across the hospital system and within the community. We received a 2018 University of Colorado President’s Diversity & Inclusive Excellence Grant to hold a Provider Education Day in November 2018 about managing trans patients. We have also begun collecting qualitative (e.g., patient and provider needs assessments, focus groups and surveys) and quantitative (e.g., Pap test and other cancer screening compliance, smoking cessation rates, hormone monitoring, body mass index [BMI] and body composition changes, laboratory trends, pre-/post-Provider Education Day knowledge differences) data. As our clinic demand has increased, we hope to establish a Community Advisory Board to engage community stakeholders in developing ideas for future research collaborations and participant recruitment. We are also establishing a registry of trans patients at the University of Colorado and will collect prospective data on health outcomes (i.e., metabolic parameters, bone mineral density and mental health).
- To learn more about trans health research, I worked with Dr. Guy T’Sjoen (Ghent University Hospital, Belgium) and Dr. Martin den Heijer (Amsterdam University Medical Center, the Netherlands) as part of a 2017 American Association of Clinical Endocrinologists/American College of Endocrinology Dr. Lewis E. Braverman Educational Fund Travel Grant. Both are clinician researchers, endocrinologists and primary investigators of the European Network for the Investigation of Gender Incongruence (ENIGI), the first collaboration to create a multicenter, multinational, standardized treatment and follow up protocol to prospectively investigate the effects of GAHT in trans people. Since then, we have collaborated on a workshop about GAHT outcomes at the European Professional Association for Transgender Health in April 2019 and submitted a narrative review manuscript on feminizing GAHT. I have also submitted a proposal to conduct subgroup analyses on existing ENIGI data to see if/how BMI and age influence various health outcomes in that cohort of patients.
- In summary, I hope to establish myself as an advocate and part of a new wave of academic physicians who are dedicated to improving health care and outcomes for trans patients through clinical translational research, particularly with a focus on obesity and aging, and fostering more international collaborations.
Eastern Colorado GRECC
Rocky Mountain Regional VAMC (RMR VAMC)
1700 N Wheeling St
Aurora, CO 80045