Letting the Evidence Speak

by Lauren Thompson

Sari Reisner, ScD

In the Center for Transgender Health, research encompasses every aspect of gender-affirming medicine, from exploring the underlying cellular biology of gender and developing advanced surgical techniques in wound healing, to assessing the safety of hormone therapy at every age and holding focus groups to hear patients’ deeply personal experiences.

“We have an exciting volume of research happening,” says Sari Reisner, ScD, the center’s director of research. “Especially in the last five years, there’s been more recognition of all the unmet needs of the trans and gender diverse population. There are lots of knowledge gaps still to fill, and we look for ways to improve patients’ access to services and their clinical outcomes. The collaboration and community we are creating across different disciplines and perspectives is amazing and valuable, and what we do so well at the Brigham.”

Reisner came to the Brigham in 2020 eager to make healthcare research more gender inclusive. As a prominent researcher in the field of transgender health, and as a trans man himself, he has the academic standing and the lived experience to do it. While Reisner directs the hospital’s entire portfolio of transgender health research, his own studies focus on reducing adverse psychosocial experiences and outcomes faced by many in the trans and gender diverse community.

“Unfortunately, we see a lot of disparities, especially in mental health outcomes,” he says. “That’s why we are so focused on interventions. In a population where there has been a lot of mistrust and historical mistreatment, including trauma inflicted by the medical system, it’s even more important that we are careful and engage populations meaningfully.”

He explains, “Just as in the clinic, we want to ask research questions in a gender-affirming way. It makes a huge difference when people come into a study and their pronouns are respected.”

A major challenge in gender-affirming care is the lack of tools to help providers measure how patients feel about their treatment outcomes. In the Department of Surgery, the mission of the Patient-Reported Outcomes, Value, and Experience (PROVE) Center is to rigorously test methods for integrating patient-reported outcomes into surgical care, including in gender-affirming procedures.

Of the PROVE Center’s many projects, GENDER-Q is poised to dramatically improve understanding of patients’ experiences. GENDER-Q is an international study of patients in Canada, Denmark, the Netherlands, and the U.S. who participate in qualitative interviews about their treatment experiences. Informed by their responses, researchers are designing and testing a series of scales providers can use to guide treatment discussions and follow-up care. 

“Because hormone treatment and gender-affirming surgery can dramatically change how the body looks and functions, patient-reported outcome measurement is an incredibly important element of improving care and delivering value to patients and healthcare systems,” says Andrea Pusic, MD, MHS, FACS, chief of plastic surgery and the director of the PROVE Center. 

“GENDER-Q is going to rewrite this field,” adds plastic surgeon Devin O’Brien-Coon, MD, co-director of the center. “Anti-trans people say there isn’t proof these interventions are positive. Implementing GENDER-Q will help us push back on the misinformation and add even more scientific rigor to what we know clinically about the benefits of gender-affirming surgery.”