“It felt like something I have the obligation and excitement to do something about, and for me, IR is the perfect field to enact change.” —BRITTANY BROOKNER, MD


practitioners will know to send their patients directly to an IR.


“With that connection, the local IR will already have established themselves as a culturally and clinically competent physician who knows how to treat transgender and nonbinary patients,” Dr. Brookner said.


colleagues who provide direct gender- affirming care.


Post-surgical care “A lot of gender-affirming care is surgical,” Dr. Brookner said. “We already work closely with our surgical colleagues; therefore it makes sense to build bridges with those who are providing gender-affirming care to help reduce the complications of these surgeries or make recovery easier.”


For example, top surgery—a masculinizing surgery that removes, reduces or reshapes breast tissue—has multiple known complications.


“One complication is post-top surgery pain syndrome,” Dr. Brookner said. “It causes debilitating pain after masculinizing top surgery, and it’s not something that is frequently treated, or even widely talked about.”


However, the effects of post-top surgery pain syndrome are identical to postmastectomy pain syndrome, a common postoperative complication that can affect 20–68% of women who undergo mastectomies.2


“This is a known condition, one that IRs can treat through nerve blocks or radiofrequency neurolysis,” Dr. Brookner said. “The only difference between these two pain syndromes is that one is for cisgender females having mastectomies due to breast cancer, and one is for transgender/nonbinary patients undergoing gender-affirming care.”


It’s an interesting example of how nomenclature and identity can cause a patient to become almost invisible, Dr. Brookner said. However, IRs can help— even a brief procedure can help reduce


22 IRQ | SUMMER 2024


pain and increase patient satisfaction after surgery, Dr. Brookner said.


Navigating clot risks Many patients receiving gender- affirming care also turn to nonsurgical hormone replacement therapy (HRT). Though data linking testosterone use to thrombosis is limited, estrogen hormone therapy has well-documented risks of venous thrombosis as well as pulmonary embolism, cerebral venous thrombosis, retinal vein occlusion and even myocardial infarction and stroke.3


There is evidence that the use of testosterone causes erythrocytosis. One paper discusses the interaction between testosterone, erythrocytosis and arterial thrombosis as well as venous thromboembolism (VTE).4 According to Dr. Brookner, it hasn’t been proven in an RCT; however, the FDA does warn users on the risk of VTE with testosterone usage.


“Many IRs dedicate either their full practice or a sizeable amount of their practice to venous work,” Dr. Brookner said. “Their skill and knowledge in this area means they have the opportunity to educate transgender patients undergoing HRT by reaching out and letting them know the risks. It can be helpful for patients to hear that IRs are a group of physicians who can treat any potential complications in a way that will be more minimally invasive and hopefully reduce hospital stay.”


It’s also a referral opportunity, Dr. Brookner said, suggesting that IRs should connect with primary care providers and those administering HRT, so that if patients come in with leg pain or other warning signs, the


Culturally competent physicians Regardless of whether an IR is seeing a patient for post-gender-affirming treatment risks, or overseeing care for unrelated disease states, all IRs can positively impact not only LGBTQ patient care but also patient experience.


“There are a lot of considerations that anyone who works in healthcare should be aware of, even just on how to use inclusive language,” Dr. Brookner said.


For example, if a patient is referred for prostate artery embolization, one might assume that the patient is male—but Dr. Brookner points out that is not always the case.


“These scenarios provide the opportunity to ask for someone’s gender or pronouns and not just assume based on the condition we’re treating or the internal or external genitalia that someone has,” Dr. Brookner said.


A 2019 article from the Journal of Vascular and Interventional Radiology provides a sample script for such interactions, using the example of a transgender patient undergoing uterine fibroid embolization:


“Alex, we were requested to perform a uterine fibroid embolization, a procedure to treat the fibroids that may be causing you discomfort. A person with a uterus may experience symptoms of lower abdominal pain and unwelcome bleeding. How would you prefer we refer to these parts?”


This will help the patient understand the necessity of questions, ensure the patient is prepared to answer the questions, and give the patient an opportunity to provide feedback.”5


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