Ask The Experts

The Doctor Is In: New York City

The Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery on practicing medicine in Manhattan

With Joshua D. Safer, MD, FACP, FACE

Dr. Joshua Safer

You’re originally from Wisconsin. How did you end up as Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery in New York City?

I first moved to New York for my residency. Then I moved to Boston to do an endocrinology fellowship, taking advantage of the more research-oriented Harvard programs including at Beth Israel Deaconess Medical Center (BIDMC). I spent a number of years looking at the molecular biology of thyroid hormone action, which is what I started to do after I took my first serious faculty position. I was briefly faculty at Harvard, where I began to switch it up a bit and focus on skin tissue, and then I was hired for a more permanent position at Boston University (BU). I continued to be a member of the “thyroid clique” while running the endocrinology fellowship program at BU. The first fellow I worked with in that program had begun to focus on transgender medicine. When he left for a faculty position at Emory, he also left me with his trans patients and my name on their charts. As a result, I needed to become educated in transgender medicine very quickly to provide them the best quality of care. I think I represent the circumstance of a convert becoming a zealot.

This was in 2004, when it was still the case that transgender patients were viewed as having a mental health concern in conventional medicine. The idea of giving people with mental health concerns hormones or using surgeries for them did not follow classic medical models at that time, and so I found myself in an entire field that was outside of establishment medicine. Despite that, it was absolutely clear to me based on my medical training that there was tremendous evidence that gender identity had a substantial biological component, and that it was actually a more logical approach to medically and surgically assist trans patients who request to alter their bodies to match their gender identities as opposed to treating them as if they had a mental illness, as was the standard at that time. Considering the number of trans patients I was seeing with these requests, I knew that transgender medicine would eventually become a part of establishment medicine. So, I started to get more involved in making that happen over time. 

In 2014, a Medicare patient who was transgender contested the fact that Medicare formerly blocked and banned transgender care. A determination was made within Medicare to lift the ban, and the other insurers and payers are so influenced by Medicare, that it resulted in a large fraction of them starting to figure out how they could include transgender health care among their services. What that meant was that transgender medicine stopped being a small, cash-only operation for those who could afford it, and became a medical specialty that conventional medical institutions could add to what they were offering to their patients.

We took advantage of that paradigm shift at Boston Medical Center and the BU Teaching Hospital. I was the founding medical director of that comprehensive transgender health care program in parallel to my current role at Mount Sinai.

What made you want to return to New York City to practice medicine after 20 years in Boston?

I'm a city person. I'm from Milwaukee. I went to college and medical school in Madison. When I finished medical school, the logical thing would have been to move to Chicago, which maybe I should have done or could have done. But I decided if I was going to move, I was going to do it big and move to Manhattan. It was a little bit of a stereotype in a sense that I really did fly on a plane and arrive in New York City with two big suitcases, hail a yellow cab at LaGuardia Airport, and go straight to the resident housing that I was assigned to in Manhattan.

What can I say? I like the restaurant scene and the museums, and I am a big walker. I run for exercise, and so being able to not have a car and just walk all over the place, get wherever you get, and then maybe take a train back really suits me. I'm not really much into cabs, so it’s mostly the subway. I met my wife here those years, and she's the same way.

I love Boston and had my family there. But, when the opportunity arose to come back to New York, it was timed exactly right. 20 years was long enough that my last kid had gone away to college. We were happy to be able to come back to Manhattan.

What do you think is unique about practicing medicine in New York City?

What's special about being located in Manhattan is the access to all the things that New York has: the food, the culture, and the fact you can still run out and get almost anything you want pretty much 24/7, even now. Having lived in Wisconsin and Boston before, I can say that the imitation recipes for New York foods that are now ubiquitous across the country are still inferior to the real things. Bagels in New York are still better, even if you can get bagels everywhere. Israeli and Middle Eastern food in general are much better here. Call me crazy, but I still like the coffee I get for a buck from those little stands that I can always find outside any of the locations of Mount Sinai better than anything at Starbucks. All the street vendors! I was really missing a lobster roll the other day because I lived in Boston for so long, but then the next day, I of course found a lobster truck parked in front of the hospital that's actually really good. There's a taco truck on the street corner where my apartment is uptown, right downstairs in front of the entrance, and a vegetable stand on the corner, so you don't even have to go to the grocery store. I'm hoping the city will keep all of the outdoor dining and the bars with drinks to go where you can just grab a beer from a keg on your walk home from work forever. A keg on the street is quite a treat. Only in New York!

Joshua D. Safer, MD, FACP, FACE is the Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery (CTMS) and Professor of Medicine at the Icahn School of Medicine at Mount Sinai. Dr. Safer was the inaugural president of the United States Professional Association for Transgender Health (USPATH). He also serves on the Global Education Initiative committee for the World Professional Association for Transgender Health (WPATH) and on the Standards of Care revision committee for WPATH. Dr. Safer was a co-author of the Endocrine Society guidelines for the medical care of transgender patients and has been a scientific co-chair for WPATH's international meetings. Dr. Safer’s research focus is on demonstrating the health and quality of life benefits for transgender patients from increased access to care.

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