Tuesday, January 31, 2017
INTERVIEW with Dr. Julie Nicole
Tell us a little about your professional background?
I have worked in a variety of fields including teaching, lab technician and banking. I decided to become a physician as a natural progression from my work as a teacher and my love for research. I moved to Vermont in late 2000 where I completed my premedical requirements at Johnson State College before matriculating at the University of Vermont, College of Medicine where I completed both medical school and my OB/GYN residency. My residency program was very supportive of my interest in transgender medicine and I found faculty members who provided me the mentorship I needed to start providing healthcare to the local trans community.
After my training was completed, I joined Dr Bowers' practice in August 2013 and left for Fresno in October 2014 where I grew my practice mostly by word of mouth. I currently care for well over 150 transgender patients and more are coming in every week.
What services do you provide to the transgender community?
I provide mostly hormone replacement therapy and some basic primary care services such as cancer screenings, sexually transmitted diseases screening and treatment and help with legal transition. I also provide surgical care for transmen (total laparoscopic hysterectomies and oophorectomies: removal of uterus and ovaries) along with post operative care for transwomen (problems with granulation tissue, dilation difficulties, etc...).
Why are there so few options for transgender services in the Central Valley and do you see that changing?
I think that for so many providers, transgender medicine is another thing that we need to learn about and that turns people off. Like everyone else, we love our routines! Medicine is always changing and physicians need to keep up with constant changes in recommendations, new data/illnesses to deal with. Zika is a good example of an illness that we, as OB/GYN need to know about. I think many physicians see transgender medicine as another field to master when in reality it is very easy. We already prescribe hormones so why not apply this knowledge to the trans community. But things are slowly changing. I obtained a Clinical Instructor appointment at UCSF-Fresno where I teach residents. I've worked with Family Medicine residents who were able to see first hand how pleasant this field is. I don't expect every providers to be a specialist in starting a hormone replacement regimen but it is my hope that most, if not all, would happily take on a transgender patient and provide exceptional care to this person, like they would do for anybody else.
For a transgender person who knows nothing about how to start seeking help, how to navigate the waters, what do you suggest?
First, realize that you are not alone and get connected in your community. Gay Central Valley is a great resource along with other groups in the Central Valley. I would also recommend visiting the Transgender Law Center's website for information about legal transition. Resist the temptation to use black market hormones as you owe it to yourself to be healthy. Planned parenthood is a safe place for the transgender community to get healthcare. There's also apps for your phone that can help you locate unisex or family type public bathrooms (Pee in peace). Finally, I would suggest patience. People want to transition fast and put that behind them but unfortunately, the process self-paces itself over 2 years for most individuals.
How do people get appointments with you and how do they access your services?
The easiest way is to call my office at Central Valley OB/GYN at 559-266-8989. I am new to this practice and there's a lot of work to be done, but the staff is fantastic there and will gladly help in securing appointments with me. At your first appointment, bring any letters, medical records, other documents (if you have them). Appointments are at our downtown office but surgeries are done either at CRMC (downtown Fresno) or CCMC (Clovis).
What makes you so passionate about serving the transgender community?
I think it stems from the fact that I was an underdog in medical school. I was a single mother, I did not come from a family of doctors and I had to work AND go to medical school to support myself and my daughters. Yet, somehow, I made it through. I see the same resilience in my patients and it resonates with me in a very personal way. It is a very satisfying field as I am almost universally make my patients feel better. The vast majority of my patients are very fun and interesting individuals. They are great ambassadors of the community.
What medical changes do you see on the horizon for members of the transgender community?
There's always new development in improving surgical outcomes especially for genital surgery for transmen. I have been following with interest the development of uterine transplants in transwomen but I still have reservations regarding the risks/benefits ratio. I think the biggest change will be insurance coverage for transition related care. 20 years ago, people had to work 2-3 jobs and save for years in order to be able to afford surgery. This is no longer true right now. I do believe the community will gain more and more acceptance with time.