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Excellence in Gender-Affirming Surgical Care: An Interview With Dr. Heidi Wittenberg

Dignity Health’s Saint Francis Memorial Hospital has been caring and advocating for LGBTQ patients and their families for decades—and has been recognized as an LGBTQ Healthcare Equality Leader by the Human Rights Campaign (HRC) for its commitment to LGBTQ health equity. That commitment shines bright within the Gender Institute at Saint Francis.

Video source: Saint Francis Foundation

At the heart of the Gender Institute is a council of transgender health experts and community members dedicated to continuously assessing and addressing the needs of transgender patients. Guided by this council, the Institute has become home to a group of dedicated, highly experienced clinicians who offer a wide range of transgender medical services, bridging gaps in care within San Francisco and beyond. The Institute has also committed itself to transgender health education, training Saint Francis staff and partnering with the World Professional Association for Transgender Health (WPATH) to hold a groundbreaking conference in 2019.

The Gender Institute is led by Medical Director Dr. Heidi Wittenberg. In this interview, Dr. Wittenberg shares what attracted her to Saint Francis and the Institute, what makes it unique and why she’s inspired by her patients.  

What inspires you about the transgender community and the patients you work with?

There are so many obstacles these patients have to go through, and when I started doing [gender-affirming] surgeries in 2015, we weren’t seeing the younger generation that had supportive parents. We were seeing older patients that were experiencing the pain of coming out and not being supported by families, friends and loved ones.

So, the inspiring stories for me are people staying true to themselves and working through their journeys. And I just loved when I saw someone with their significant other or family member that loved them for them. That partner loved them and supported them through the process. I find that so inspiring when I see it.

Can you describe the Gender Institute?

The Gender Institute has the goal of taking care of transgender and gender-non-conforming patients who don’t have a dedicated place to go. We have created and want to further create a safe space to provide the best care for [these] patients. We have a long history of taking care of this population, which is very vulnerable and often does not seek out help. We’re right there in the forefront of medicine in providing care to these patients.

What’s your background, Dr. Wittenberg?

I started practicing in San Francisco in 1999 as an OB-GYN, and I delivered babies for over a decade. But really my specialty was urogynecology, which is now female pelvic medicine or reconstructive surgery. I was recruited by a local transgender-only surgical practice because of my history. I thought, “Why wouldn’t I help?!”

I trained with that practice for a year, did a fellowship with them, and decided to concentrate on [gender-affirming] surgery. This was so in line with my background, training, and expertise that it just made sense. I’m now 100% focused on transgender, gender diverse and gender-non-conforming surgery. I feel like I have come full circle and I’m delivering new babies into the world.

How did you come to work at the Gender Institute?

I’d been working at Saint Francis since 2005 as a gynecological surgeon, but over time decided to do more of my surgeries there, because of how well my patients were treated. I am honored to be medical director of the Gender Institute.

What makes the Gender Institute unique?

San Francisco has—though there’s not many of us—the most transgender and gender-non-conforming surgeons, who [offer] the whole gamut of [gender-affirming] surgeries. We’re really fortunate. I think other areas of the country are going to grow their practices, but we have the largest number of experienced surgeons, to the point that surgeons come to train with us here and our patients are national and international.

Some of the forefathers of transgender and gender-non-conforming surgery came from San Francisco, so that’s part of our heritage and history. And a lot of our surgeons at Saint Francis were with those early practices or evolved from those practices, and practice at the Gender Institute today. There are 12 highly experienced surgeons that are part of the Gender Institute—in this field, that’s a large number.

How do patients get referred to you?

The biggest referral driver to Saint Francis, because of the level of experience of our surgeons, is the patients themselves—word of mouth. We don’t advertise. Our patients talk, and the more you do for the patient population, the better the reputation gets. Our patients aren’t just from California; they’re from all over the country and even international.

How does Saint Francis approach transgender and gender-non-conforming patients?

Saint Francis has done a lot of intentional work to train staff on transgender and gender-non-conforming patients—for example, using appropriate names and preferred pronouns. It’s been working with everyone from registration to nurses to dietary and beyond. It was and is a concerted effort.

I have worked in multiple different hospitals over the years. I would have to do damage control often at these other places, because someone got mis-gendered or called by the wrong pronoun. At Saint Francis, it’s so rare for things like that to happen. It’s been a joy to feel that my patients are safe here.

Saint Francis gets it, and I don’t have to stomp out fires, do damage control or educate people again and again about things that should really be, in this day and age, common knowledge. Saint Francis has the heart, it has the training, it was in the forefront—it really knows how to take care of our patients.

What would the general public be surprised to know about Saint Francis or the Gender Institute?

Saint Francis and Dignity Health have been portrayed by some as being not LGBTQ-friendly or not women-friendly. Not only did St. Mary’s Medical Center rise to the occasion to take care of AIDS patients during the 1980s, but it was also among the first to reach out and care for this population. And there’s actually a long and rich history of the hospital doing transgender and gender-non-conforming surgeries and supporting the community. The Gender Institute evolved because there was a crew of surgeons already doing these procedures at Saint Francis. It was a natural evolution to elevate the work, do more teaching, and provide more services for our patients.

We’ve been teaching residents, students, and attending physicians. They come over to observe and learn about surgery. They watch us in our clinics. We’ve established a long history of supportive services. We’re developing more. We want to continue helping not just local but other institutions and health professionals—providers, nurses, and students—to continue to grow in this field and make sure we are all providing the best care for our patients.


The Gender Institute at Saint Francis Memorial Hospital

At the Saint Francis Memorial Hospital Gender Institute, our goal is to deliver compassionate, high-quality, and affordable health services to transgender patients and their families.

Learn more about The Gender Institute at Saint Francis Memorial Hospital