pathfinder in transgender health care

Zil Goldstein works at the forefront of transgender health care as program director of Mount Sinai Hospital’s pioneering Center for Transgender Medicine and Surgery.

The center provides comprehensive health care for the transgender community, offering a full range of crucial services that, until recently, patients couldn’t access from a single provider. Goldstein, a board-certified family nurse practitioner, has a hand in all aspects of the center’s mission, from clinical practice to education and research.

It its recently completed first year, the center served more than 800 people — the response has been so strong, Goldstein said, that the center is already in need of additional capacity to accommodate patient demand. “The community response has been pretty amazing,” Goldstein said. “We’ve gotten a lot of thank-you letters from a lot of very appreciative folks who have been wanting to get these services for years.”

Goldstein’s path to medicine was paved by her work as an activist, advocating for access to healthcare and nondiscrimination for transgender people. “I saw people getting inadequate care, not getting what they needed, and being shamed about needing the care to transition,” Goldstein said. “I wanted to go into healthcare so I could be someone who could provide these life-saving medical and surgical services without any of those barriers.” As an author and a regular panelist on the conference circuit, Goldstein has distinguished herself as a leader in the field, both in terms of practice and advocacy.

Goldstein’s responsibilities extend throughout the Mount Sinai system in her role as an educator, working with members of other departments and the community at large to promote more sophisticated care and more sophisticated sensitivity for transgender patients.

The center’s multidisciplinary approach is designed to provide patients with the full suite of medical services in a one location, including primary care, hormonal therapy, surgical procedures, and mental health care. When Goldstein started in the field, finding a center with such comprehensive care “was just not possible.”

Being a part of the team that launched the Center for Transgender Medicine and Surgery last year was a “fantastic” experience, Goldstein said. “I’ve been doing this work for over ten years now, and I put a lot of thought into how to run and build something exactly like this,” she said.

Goldstein hopes that Mount Sinai’s groundbreaking holistic approach can become a model for transgender health care elsewhere. “One of the things we’ve been able to do is have this open to a broader spectrum of people who didn’t have any access to care before because they didn’t have one place that could handle all of the different aspects,” she said. Crucially, the center accepts insurance for services that, for decades, in many cases, were strictly available on a cash-only basis.

Providing full services to people who have been turned away elsewhere is among the most important aspects of the center’s work, Goldstein explained. The surgical procedures offered by Mount Sinai now include male and female chest reconstruction, vaginoplasty, metoidioplasty, and phalloplasty.

“A few months ago we were able to complete a vaginoplasty on a 77-year-old woman who had been waiting her entire life to have a vagina,” Goldstein said. “She was just so happy that she was finally able to achieve that.”