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News & Press: Practice Support

One Doctor's Story: Treating the Transgender Patient

Tuesday, August 25, 2015   (0 Comments)
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John Ferguson, MDBy John C. Ferguson, MD, FACS


This article appeared in the 2015 Issue #2 of Surge.


Here in Waikiki, Honolulu, where I live with my family and work, is a well-established LGBT presence. The area’s bars, restaurants, and social organizations cater to its population, providing a safe and vibrant place for the LGBT community to thrive. As those of you who live in dense urban settings very well know, your neighbors become a large part of your social life. Because of this, my family and I are socially active in the community, participating in and sponsoring transgender pageants and other social functions. Aside from the social efforts, I’m proud to serve as a resource for members of a community that can oftentimes be consumed with fear and uncertainty. My roles as both friend and doctor for the LGBT community have taught me valuable lessons over the years, lessons that I’m proud to apply in all facets of my life.

The Treatment Process

Each transgender patient seeks a unique treatment process. From non-invasive procedures to genital reassignment surgery, the spectrum of treatment is wide. For example, the most common procedures sought after by men are body sculpting and the removal of mammary tissue. These patients often also desire facial masculinization, for which I use fillers and fat to enhance the brows, nose, and jawline. By far the most common procedure for women is the breast augmentation, followed closely by body sculpting, which typically involves fat transfer to provide a more feminine waist and hips. Patients often pursue injectable fillers or other skin care treatments that are normally associated with women, but sometimes, less common and more complicated procedures, including craniofacial resectioning, are preferred. Genital reassignment surgery is only a small, and often unnecessary, part of the transgender patient’s transition process. Contrary to popular belief, most aspects of the masculine or feminine self-image of these patients actually has little to do with genitalia.

The path between establishing gender identity mentally and transforming physically varies from person to person. It is almost impossible to identify a beginning, middle, and end to this process. Because of my social involvement in the LGBT community, I am often sought out by individuals who have mentally come to terms with being transgender, but don’t know where to start with making physical changes. There are several good primary care providers that specialize in and support this process, and I am always more than willing to point these patients in their direction. Once the patient is ready to pursue the physical transition, he or she is sent my direction again. These patients can sometimes be timid, hesitant, and nervous to start the physical transition. On the other hand, at least once a month, I encounter patients with great confidence and find myself performing some type of facial rejuvenation surgery on 70-year-old drag queens. 

The wide range of transgender patients has taught me to approach each patient’s case without expectation, to always invoke patience and understanding. Each transgender patient, each treatment process, should be treated with the same care and respect that any other patient would be. Compared to the traditional medical setting, those of us who practice cosmetic surgery and our staff often develop more personal relationships with our patients. Let us take this privilege seriously and provide a safe place for the transgender patient to seek treatment.

The Surgeon’s Role

The transgender community is very loyal. When I moved to Hawaii, there had been one surgeon that most of the transgender community had gone to for 30 years or so. As my relationships within the transgender community grew, several members started coming to me, as they knew the other doctor’s retirement was approaching. Once he officially retired, I became the go-to doctor in the community. With that, came a great sense of responsibility. I discovered that the most important aspects of the surgeon’s role are acceptance and respect. For example, it is imperative to understand that the flamboyant queen does not standout in a crowd because of her sex chromosomes or sex organs; she stands out because of her personality. The breadth of personalities in the transgender community mirrors that of the non-transgender community. The only real uniqueness that I’ve encountered in this community is the tendency for genuine happiness. Transgender people can often struggle for a long time before finally coming to terms with who they are and what changes they want to make. Once self-acceptance becomes a reality, the road towards happiness is much smoother.

John Ferguson and FriendsFor those of you who are looking to welcome more transgender patients to your practice, treat the expansion just like you would any other business expansion. It mostly comes down to effective marketing and networking. Involve your practice in the conversation on social media and attend events that cater to the LGBT community. My ability to network has been somewhat unique because I live in an urban neighborhood with a well-established LGBT presence. Most large cities have organizations and groups for LGBT-friendly professionals and small business owners. Seek out the appropriate groups and make your practice known as an advocate for potential transgender patients.

Cosmetic surgery is commonly justified as a tool in improving one’s self-esteem. We’ve all met with that shy, goofy kid with big ears and witnessed the positive transformation that followed an otoplasty. We’ve gotten to know the depressed mother of four who discovers new self-confidence following her mommy make-over. Transgender patients struggle with the fundamental essence of who they are for most of their lives. Once they come to terms with who they truly are, we, the surgeons and the staff, have the honor of making what may seem like a daunting physical transition, a life-changing reality.



John C. Ferguson, MD, FACS, is quintuple board-certified by the American Board of Otolaryngology – Head and Neck Surgery, American Board of Facial Plastics and Reconstructive Surgery, American Board of Laser Surgery, American Board of Cosmetic Surgery, and the American Board of Facial Cosmetic Surgery. He is also a fellow of AACS, the American Academy of Facial Plastics and Reconstructive Surgery, and the American College of Surgeons. Born and raised in Texas, he currently practices cosmetic surgery at his clinic in Honolulu, Hawaii.