Our Mission

Our Mission

Cleveland Clinic named as a top performer for the Human Rights Campaign's Healthcare Equality Index
Cleveland Clinic is recognized as a ‘Top Performer’ in caring for LGBTQ patients by the Health Care Equality Index.

We provide comprehensive and compassionate care for all patients regardless of sexual orientation or gender identity. Lesbian, gay, bisexual, and transgender (LGBTQ+) patients have historically been an underserved community with unique health needs. We aim to eradicate long-standing health disparities while furthering the care, research, educational, and service goals of the Cleveland Clinic enterprise.

Center for LGBTQ+ Care

Cleveland Clinic’s Center for Lesbian, Gay, Bisexual and Transgender (LGBTQ+) Care offers healthcare services at the Lakewood Family Health Center, 216.237.5500. Embedded in a primary care practice, the center provides care for all patients in a safe and welcoming environment. It includes providers who understand the health needs of LGBT patients, and access to specialists with expertise in LGBTQ+ care.

Healthcare Equality Index

Since 2016, The Human Rights Campaign has recognized Cleveland Clinic hospitals for inclusive, culturally competent care.

The Human Rights Campaign's Healthcare Equality Index is a national benchmarking tool that evaluates healthcare facilities for their dedication to the equitable treatment and inclusion of their LGBTQ (Lesbian, Gay, Bisexual, Transgender, Queer or Questioning) patients, visitors and employees.

In 2019, more Cleveland Clinic hospitals participated in the HEI survey than ever before. Honorees include:

Adult Patients

Adult Patients

Gay and Bisexual Men Health

Gay men and men who have sex with men (MSM) have many similar health challenges when compared with their heterosexual counterparts, but they also face additional obstacles to health which are often not well understood by health care providers. Fear of rejection or embarrassment often contributes to a delay in accessing needed preventive or disease management services by these men. Limited information about culturally competent providers does not allow for patients in a community to be matched with practitioners possessing necessary training and experience to best address their unique health care needs. Furthermore, gay men and MSM may feel as though their confidentiality will not be protected among health care staff or with insurance providers, or that they may face a hostile response from front desk, nursing or ancillary staff when addressing deeply personal matters. These fears and resulting actions, when examined at a population level, lead to health care disparities.

For more information contact the Center for LGBT Care at Lakewood Family Health Center at 216.237.5500.

Health care disparities for gay men and MSM include:

  • An increased risk for mental health concerns including depression, anxiety disorders, and suicidal thoughts and actions. Stigmatization by society has been identified as an important factor in the development of these conditions. A lack of effective wellness models for the gay and MSM community is also a contributor.
  • A higher frequency of sexually transmitted and other infectious diseases is seen in gay men, including the human immunodeficiency virus (HIV). This is especially true in younger men and in men who are also members of a racial or ethnic minority community.
  • Gay men and MSM are more likely to smoke and to abuse or become dependent on alcohol and drugs.
  • Young gay men and MSM are more likely to be the victims of violence, to be homeless, and to engage in risky behaviors in general.
  • Gay men and MSM are at an increased risk for certain types of cancers (both HIV and non-HIV related).
  • Elderly gay men and MSM have additional struggles maintaining health due to isolation and the absence of appropriate social support and health care providers sensitive to their needs.

Services

To help address these disparities, Cleveland Clinic offers the following services to gay men and MSM:

  • Primary Care. General preventive health, screening for disease including cancer and infectious disease, immunizations, and counseling related to healthy behaviors. While all health care providers have a basic knowledge to care for many types of patients, the Cleveland Clinic has identified a group of providers who have a specialty interest in the care of lesbian, gay, bisexual and transgender (LGBT) patients.
  • Behavioral Health. Behavioral health services offer providers with special interest in LGBT psychological health needs.
  • Specialty Care. Cleveland Clinic has worked to identify providers within the majority of sub-specialty disciplines who have an interest in the care of LGBT patients.

Lesbian and Bisexual Women Health

Lesbian women and women who have sex with women (WSW) require routine health care maintenance like all patients, but they are also at increased risk for certain medical and mental health conditions. Unfortunately, access to good health care can sometimes be a challenge for this community. Improved access starts with a better understanding by both providers and patients about the type of care that is needed.

We recommend that in addition to routine medical care, WSW and lesbian patients also undergo screening for the conditions listed below.

  • WSW have specific risk factors that may put them at increased risk of developing cancer of the reproductive organs and yearly pelvic examination should be performed for all women.
  • WSW have specific risk factors that may put them at risk for breast cancer, and these women should undergo routine screening with mammography, and should also be taught how to perform breast self-examination.
  • WSW are at no less risk for cervical cancer than heterosexual women, and all lesbians and WSW should undergo cervical cancer screening.
  • All women should undergo routine screening for colon cancer, and guidelines should be followed according to the woman's age, and personal or family history of colon cancer.
  • Population studies have shown that the rate of substance abuse is higher in the lesbian community than in the general population, and patients should routinely be screened for alcohol and illicit substance abuse. As such, patients should also be offered counseling and education regarding substance abuse and risk-taking behaviors.
  • Population studies also show that WSW have higher rates of tobacco use than the general population, and patients should be screened for this and provided with counseling and education about smoking cessation.
  • WSW have a slightly higher rate of obesity than the general population. Compounded with their higher rate of tobacco use, routine screening for heart disease is necessary. In addition, patients should be offered weight loss counseling and provided with information about healthy lifestyle behaviors and choices.
  • Depression, anxiety, and post-traumatic stress disorder (PTSD) occur at higher rates among WSW, often as a result of poor social supports, and these conditions should be screened for regularly, and addressed by medical providers.
  • Individuals who engage in risk-taking behaviors such as substance abuse and unprotected sex are at risk for sexually transmitted infections, including HIV. Patients who present with these risk factors should be screened for these infections.
  • Studies show that many WSW also engage in sexual activity with men, and therefore, family planning services such as pregnancy-related care and contraceptive counseling are important aspects of routine health care for this community.

Services

Below are the services we currently provide for our lesbian and women who have sex with women (WSW) patients. We offer comprehensive care through a multi-disciplinary team of providers that are housed amongst our many institutes at Cleveland Clinic.

  • Primary Care. Routine health care maintenance, surveillance of chronic medical conditions, access to providers for acute medical visits, smoking cessation, management of and referral for psychiatric conditions such as mood disorders and substance abuse problems.
  • Gynecologic Care. Routine gynecologic care including cancer screening, pelvic examinations, management of chronic or acute gynecologic conditions, contraceptive counseling and management, fertility consultation and treatment, evaluation and treatment of sexual pain.
  • Endocrinology and Metabolism Care. Specialty help for metabolic disease and obesity through consultation with nutritionists, endocrinologists, and bariatric surgery.
  • Specialty Care. Cleveland Clinic has worked to identify providers within the majority of subspecialty disciplines who have an interest in the care of LGBT patients.
  • Behavioral Health. Cleveland Clinic's behavioral health services offer providers with special interest in LGBT psychological health needs.

Transgender Health

Transgender individuals require routine health care maintenance like all patients, but they are also at increased risk for certain medical and mental health conditions. Unfortunately, access to good health care can sometimes be a challenge for this community. Improved access starts with a better understanding by both providers and patients about the type of care that is needed.

We recommend that in addition to routine medical care, transgender patients also undergo screening for the conditions listed below:

  • Metabolic conditions such as hypertension (high blood pressure), glucose intolerance (diabetes), liver dysfunction, and dyslipidemia (high cholesterol) can develop as a result of long-term hormonal (both estrogen and testosterone) therapy.
  • Transgender men and women have a slightly higher rate of obesity. Compounded with their long-term hormone use and higher rate of tobacco use, routine screening for heart disease is necessary.
  • Transgender women (male-to-female) should have cancer screening for cancers of the breast, prostate, and anus.
  • Screening for cancer of the reproductive organs should be done for all symptomatic transgender men. Transgender men (female-to-male) should also need cancer screening for cancers of the breast, cervix, and anus, depending upon anatomy and stage of transition.
  • Population studies have shown that the rate of substance abuse is higher in the transgender community than in the general population, and patients should routinely be screened for alcohol and illicit substance abuse. As such, patients should also be offered counseling and education regarding substance abuse and risk-taking behaviors.
  • Population studies also show that transgender men and women have higher rates of tobacco use than the general population, and patients should be screened for this and provided with counseling and education about smoking cessation.
  • Depression, anxiety, and post-traumatic stress disorder (PTSD) occur at higher rates among transgender individuals, often as a result of poor social supports, and these conditions should be screened for regularly, and addressed by medical providers.
  • Individuals who engage in risk-taking behaviors such as substance abuse and unprotected sex are at risk for sexually transmitted infections, including HIV. Patients who present with these risk factors should be screened for these infections.

Services

Below are the services we currently provide for our transgender patients. We offer comprehensive care through a multi-disciplinary team of providers that are housed amongst our many institutes at Cleveland Clinic.

  • Primary Care. Routine health care maintenance, surveillance of chronic medical conditions, access to providers for acute medical visits, smoking cessation.
  • Gynecologic Care. Routine gynecologic care including cancer screening, pelvic examinations, management of chronic or acute gynecologic conditions, contraceptive counseling and management, fertility consultation and treatment, evaluation and treatment of sexual pain.
  • Hormone Therapy & Surveillance.Initiation, maintenance, and surveillance of cross-sex hormones.
  • Behavioral Health. Diagnosis of gender dysphoria, treatment and management of other comorbid conditions (depression, anxiety, PTSD), management of substance abuse problems.
  • Obesity Services.Multidisciplinary approaches to weight loss and maintenance, referral to bariatric surgery.
  • Surgical Services.Referral within Cleveland Clinic to providers who perform gender confirmation procedures.
Transgender Surgery and Medicine Program

Transgender Surgery and Medicine Program

The Transgender Surgery and Medicine Program provides surgical services to transgender patients seeking transition. Our goal is to help transgender patients successfully affirm themselves in the gender in which they identify. Our team works in accordance with the guidelines provided by the World Professional Association for Transgender Health (WPATH) in order to ensure that all of our patients are cared for appropriately and consistently.

Services

  • Primary Care, STI Testing, PReP/PEP, Anal PAP Testing
  • Pediatric Care
  • Hormone Surveillance (Adults and Peds)
  • Psychiatry (Adults and Peds)
  • Allergy and Immunology
  • Plastic Surgery (Chest Reconstruction, Facial Surgery, TrachSurgery)
  • Voice Surgery
  • Voice Therapy
  • Urogynecology(Vaginoplasty, Orchiectomy, Hysterectomy/Oophorectomy)
  • Gynecology (PAP Testing, Complete Gynecologic Services)
  • Digestive Diseases (Including Anal Dysplasia Treatment)
  • Ortho Surgery
  • Endocrinology (Including Weight Loss)
  • Nutrition Services
  • Urology
  • Fertility and Gamete Preservation
  • Laboratory Services

Integrated into multi-specialty, the Center for LGBTQI+ Care offers a safe, welcoming environment in which we provide respectful, expert healthcare for all of our patients.

General Surgical Criteria

  • No nicotine or related products for a minimum of 3 months
  • Healthy Kidney, Liver, Heart and Lung Function
  • Well Controlled Blood Pressure
  • Well Controlled Blood Glucose (Diabetic Patients)
  • BMI<32 (Healthy weight/height ratio)
  • Referral from Primary Care Doctor or Endocrinologist
  • Primary letter of recommendation from Psychiatrist or Psychologist
  • Secondary letter of recommendation from additional mental health provider

*Consider gamete/oocyte cryopreservation when possible and appropriate

WPATH Guidelines

  • Age of majority (<18)
  • Hormone therapy for 12 consecutive months unless medically contraindicated
  • Living in gender role full time for minimum of 12 consecutive months
  • Demonstrated the capacity to make a fully informed decision and consent for treatment and the ability to comply with medical instruction
  • Demonstrated understanding of surgery and the implications of this irreversible step
  • Stable mental health, sufficiently self-aware, and successfully managing identified issues with depression

WPATH Logo | Cleveland Clinic


A Message from Our Director

Cecile Unger, MD, MPH
Cecile Ferrando, MD, MPH

"I perform vaginoplasty and vaginoplasty revision surgery for transgender women seeking gender affirmation surgery. I performed my first surgery in 2015 and since 2016, our team has been performing these surgeries consistently on a monthly basis. The goal of the surgery is to create female external genitalia that is both functional and cosmetically appealing. I also perform hysterectomy for transgender men seeking gender affirmation surgery. These surgeries are performed in a minimally invasive fashion using advanced laparoscopic techniques. All gender affirming surgeries are performed at the Cleveland Clinic Main Campus."

For more information about the program or to make an appointment, please contact Christina Reed at 216.445.6308.

Youth Patients

Youth Patients

LGBT or "Questioning" Youth Health

Sexuality and sexual orientation are often challenging topics for youth and their parents. They are subjects that can be difficult to openly talk about and sometimes are actively avoided. Yet we know that children and teens who are (or are questioning whether they may be) gay, lesbian, bisexual or transgender are at much greater risk of:

  • Engaging in unhealthy behaviors and/or of being bullied or victimized
  • Experiencing anxiety, depression, and other emotional symptoms at a much higher rate than their peers
  • Engaging in self-harm (including suicide) at a higher incidence

For these and many other reasons, physical and psychological health care are essential for these individuals and their families. Like their adult counterparts, however, LGBT youth may be hesitant to seek care due to fear of stigmatization or lack of understanding by healthcare providers.

Similarly, issues related to gender and gender identity are frequently sensitive subjects and parents as well as youth may be fearful of the response if such topics are raised to healthcare providers. Gender identity develops differently in every child and gender differences can present at almost any age, sometimes in early childhood, sometimes much later. “Gender non-conforming” and “transgender” (the “T” in LGBT) are terms used to describe individuals whose gender expression or gender identity do not conform to that typically associated with the gender they were assigned at birth. Being gender non-conforming is not a disorder, but many youth who demonstrate a consistent and persistent pattern over time that they wish to be (or “are”) the opposite gender experience very significant distress living with the body that they have.

Services

Cleveland Clinic Children’s provides a full array of healthcare services for LGBT youth and their families. All care is individualized, designed to meet the needs of each unique situation while at the same time complying with the standards and best practices for this population.

Services available include:

  • Pediatric providers with understanding of and sensitivity to the issues of LGBT youth
  • Psychological services offered by LGBT affirmative behavioral health providers (including specialized assessment related to referral for hormone consultation/treatment or other transgender services)
  • Affirmative support and education for youth and families regarding LGBT issues and challenges

Specialized healthcare services can be an essential part of improving the overall health and well-being for transgender youth. These include affirmative and understanding support and education for youth and families as well as assistance in the process of transitioning to the preferred gender. Cleveland Clinic Children’s GUIDE program (Gender Understanding, Identity, and Expression) includes a multidisciplinary team of healthcare providers with expertise in helping transgender youth and their families as they consider the range of options available to them. GUIDE provides education, support, psychological services, pediatric endocrinology services (for possible hormone suppression and/or hormone treatments), psychiatric consultation, and gynecology and urology services.

  • For more information on Cleveland Clinic Children’s GUIDE program please call 216.444.1917.
Gender Affirming Services

Gender Affirming Services

Affirming, Caring Primary Healthcare

Our team primary care staff offer a safe space to review your personal healthcare needs, offer the correct health screenings and resources in a supportive, judgment free environment.

Cross Sex Hormone Therapy

Individualized cross sex hormone therapy is initiated and monitored by a team of medical professionals with expertise in their field! In addition to hormone surveillance we offer referrals to our team of fertility preservation experts to support future reproductive goals.

Masculinizing/Defeminizing Chest Reconstructive Surgery (Mastectomy)

Male chest reconstructive surgery is a covered service with most insurance plans when criteria has been met, you are required to have one letter of referral from a qualified mental health provider with expertise in WPATH guidelines. Your BMI must be less than 40 (and as close to 32 as possible) and you must be a non-smoker (confirmed with laboratory testing). You must have a family member, friend or caregiver drive you home from surgery as medical transportation cannot be used upon hospital discharge.

Male Hysterectomy/Vaginectomy

Surgical removal of the cervix, uterus, ovaries and tubes is performed in an outpatient setting and is typically a covered service under most insurance plans when criteria has been met: We will need two (WPATH format) letters; the first letter must be from a doctoral degreed mental health provider (in most states this would be someone with MD, DO, PhD, PsyD); the second letter should be obtained from a masters degreed licensed mental health professional (counselor, social worker, etc.) but MUST meet WPATH criteria.

The letters must be dated within the past 12 months; you are required to be a non-smoker (confirmed with laboratory testing) and have a family member, friend or caregiver drive you home from surgery as medical transportation cannot be used upon hospital discharge.

Facial Feminization Procedures

These services are very specialized and often not a covered service under insurance plans, contact office with questions. We will need two (WPATH format) letters; the first letter must be from a doctoral degreed mental health provider (in most states this would be someone with MD, DO, PhD, PsyD); the second letter should be obtained from a master’s degreed licensed mental health professional (counselor, social worker, etc) but MUST meet WPATH criteria

The letters must be dated within the past 12 months; you are required to be a non-smoker (confirmed with laboratory testing) and have a family member, friend or caregiver drive you home from surgery as medical transportation cannot be used upon hospital discharge.

Orchiectomy (Surgical Removal of the Testes)

Orchiectomy describes surgical removal of the testes, in an affirmed woman this is done to eliminate the need for androgen (testosterone) suppression and optimizes estrogen. This is performed in an outpatient setting and is a covered service with most insurance plans when criteria has been met.

We will need two (WPATH format) letters; the first letter must be from a doctoral degreed mental health provider (in most states this would be someone with MD, DO, PhD, PsyD); the second letter should be obtained from a master’s degreed licensed mental health professional (counselor, social worker, etc) but MUST meet WPATH criteria

The letters must be dated within the past 12 months. You are required to be a non-smoker (confirmed with laboratory testing) and have a family member, friend or caregiver drive you home from surgery as medical transportation cannot be used upon hospital discharge. Undergoing this procedure will not interfere with the possibility of having future vaginoplasty .

Vaginoplasty (Female Genital Reconstructive Surgery)

Before your consultation
You are required to be free of nicotine and any non-prescribed substances (confirmed by blood testing). For complete pelvic reconstruction you will need to complete permanent hair removal (laser and/or electrolysis) in the surgical area (this is required by the surgeon AND NON NEGOTIABLE). The areas of treatment are the scrotum, perineum, shaft of penis and 1" radius around base. This process typically takes 9-12 months to complete so you will want to start right away; your primary care doctor can provide a prescription for numbing cream (Emla) to apply to the treatment areas if you wish; there is an over the counter 5% lidocaine cream available without a prescription. Either cream should be applied approximately 40 minutes prior to each treatment, covering the area with plastic wrap will optimize absorption and efficacy. Dr. Ferrando requests this process be 60-70% completed before meeting with her.

We will need two (WPATH format) letters; the first letter must be from a doctoral degreed mental health provider (in most states this would be someone with MD, DO, PhD, PsyD). The second letter should be obtained from a master’s degreed licensed mental health professional (counselor, social worker, etc) but MUST meet WPATH criteria. The letters must be dated within the past 12 months (insurance requirement), so be sure to maintain your relationship with your current mental healthcare team! [When your hair removal is half way completed, your mental health letters can be faxed to Tina Reed at fax number 216.636.1963.]

We will need copies of your most recent primary care medical records; your BMI must be equal to or less than 32kg/m(2) to proceed with a surgical consultation and less than 30kg/m(2) to proceed with surgery; you must be tobacco and substance free and in excellent health.

After your consult
We will submit a predetermination to your insurance; the insurance has 30 days to respond with your decision.

Once approved
Insurance companies cover a 3 day inpatient hospital stay but due to the invasive nature of the surgery will require you on campus for a longer duration. To reduce your out of pocket expense of inpatient postoperative stay we have collaborated with the hotel attached to the hospital for a discounted hotel rate which allows you to stay on campus and available for Dr. Ferrando's team to make room calls to make sure your recovery is going well.

The cost of your postoperative stay is as follows:

$169.00@16.5%=$169.88/night X 7 nights = $1378.19; there is an additional $75/day ($525.00) hold for incidental occurrences and funds will be required at the time of reservation. ($1903.19) You are required to have someone stay at the hotel with you during recovery. Our office will arrange your hotel stay when a surgical date is selected. (This is for your safety and not negotiable.) Your complete postoperative recovery will be about 6-8 weeks but this varies with each individual. We’re happy to complete FMLA and STD paperwork if applicable.

Special Considerations

Out of State Residents: You may want to include your pre-operative day as well as the 3 days you will be in the hospital in your hotel reservation if you are traveling from afar; this will allow a safe and comfortable place for you to perform your peri-operative preparations as well as provide your guest with a place to stay nearby while you are in the hospital.

Please plan for postoperative appointments at 3, 4 and 9 weeks postop; you will need to have a driver for the 3 week postop visit. You will be required to meet with our team psychiatrist pre and postoperatively as well as our pelvic floor physical therapist.

Patient Checklist

  • Nicotine/nicotine-related product free (minimum 3 months).
  • Free of any non-prescribed substances including marijuana (minimum 6 months).
  • Hair removal completed, free of regrowth.
  • Two letters of support from qualified mental health providers dated within the past 12 months.
  • Funds (approximately $2,000) available for postoperative stay.
  • Companion to accompany you for postoperative stay.

I'm happy to share a list of qualified hair removal providers as well as qualified mental health providers upon request. Once all criteria has been met we will be happy to schedule a consultation.

Spiritual Care

At Cleveland Clinic, we take great pride in caring for the entire person, including their spiritual health. Our team of supportive, affirming spiritual care staff is here to provide 24/7 support services.

After you have thoroughly reviewed this information I'm happy to answer any additional questions, please contact my office at 216.445.6308 or via email: reedc@ccf.org.

Appointments

Appointments

While all Cleveland Clinic providers are committed to creating a safe environment that maintains the respect and dignity of all patients, some providers have specific interests in working with the LGBT community.

Adult LGB Care – Lakewood Family Health Center, 216.237.5500

Transgender Care – Cleveland Clinic Main Campus, 216.445.6308

LGBT Youth Care – Lakewood Family Health Center, 216.444.1917

Functional Pride

What is Functional Pride?

The Center for LGBT+ Care has partnered with the Center for Functional Medicine to offer a series of eight consecutive shared medical appointments that introduce LGBT+ patients to the Functional Medicine approach and provide the necessary health information, dietary guidance and wellness coaching to promote self-management of physical and mental wellness

The Functional Pride program will:

  • Ensure quality care to LGBT+ patients with chronic conditions
  • Create a safe, non-judgmental and comfortable space for LGBT+ patients to express their health concerns
  • Teach self-care management skills
  • Address stress and coping mechanisms related to social transitions and discrimination

Program Details

  • Eight weekly sessions. Each session is one to two hour(s) long
  • Designed for patients with chronic conditions interested in physical and mental wellness

Upcoming Dates:

To register for the Functional Pride program, visit Clevelandclinic.org/PrideSMA or call 216.444.8716.

Nutrition appointments are covered by many insurance companies, please verify coverage with your health insurance provider.