Dr. Angela Sturm is helping trans people affirm their gender identities through facial plastic surgery
(HOUSTON) — For many people, when they hear about a person transitioning, they immediately recall as much information about gender-affirming surgery to the genitals as they know. For almost as many, that’s not much information. However, what most cisgender people fail to understand is that there’s more to gender-affirming surgery than what is often referred to as “bottom” (genital) surgery. As a matter of fact, NBC News reported than in 2016, less than 0.5% of gender-affirming surgeries actually were performed on the genitals. This news isn’t quite revelatory, as the National Transgender Discrimination Survey reports that 33% of trans people have not medically transitioned, with 14% of trans women and 72% of trans men saying that they most likely will not ever transition fully. But with plastic surgery procedures to the face and chest, trans people are able to become more comfortable in their own skin.
That’s where Dr. Angela Sturm comes in. Dr. Sturm (MD, FACS) is a double board certified female facial plastic surgeon. According to her website, she specializes in rhinoplasty, eyelid surgery, facial feminization surgery, and facelifts. Dr. Sturm attended medical school and her residency at Baylor College of Medicine, and has since gone on to join Facial Plastic Surgery Associates here in Houston. She’s been in practice for about six years, and has been doing facial feminization for five of those.
While Dr. Sturm’s patients aren’t all trans, many are. She sat down with About Magazine to discuss her role in the gender-affirming process and her advocacy as an ally to the LGBTQIA community.
About Magazine: Tell us a little bit about what your specialties are.
Dr. Angela Sturm: So, I do facial plastic surgery. I end up doing a lot more feminization than I do masculinization.
An interesting point I hear a lot is that there’s more of an emphasis on feminine trans issues than there is on masculine trans issues. Can you tell me a bit more about what you see when trans men come to see you?
A lot of times the face shape changes a little bit because the facial fat changes. And then the muscles are a little bit bigger. So, where you may have had an oval-shaped face, it may be a little more square now. So, maybe [the shape] is there, but it’s not quite where they want it. Sometimes we’ll put implants on the jawlines to make them a little stronger. I’ve had people who had jawlines that are good, but have the genetic pooch of fat under the chin. You know? So, it’s kind of, “Well, [the jawline] is there, but I’d like to be able to see it better.” And then, of course, there’s the Adam’s apple. Not all men have Adam’s apple. So, we can do a little bit of liposuction right there and contour the area so that we can see a hint of it. We can also do an implant there, but for the most part, you don’t really need to.
In your patient demographic, are you handling cases for patients that are in their younger years? Or are they more middle-age to later in life? Or is it a mix?
It’s kind of a mix. Not as many younger people. A lot of times they’re just into their transition. And hopefully, if they’re transitioning young enough, they may not need me at all. And it would be amazing if we could get to that place where people were able to get on blockers and hormones at an appropriate time to where they make the transition all on their own. It’s more mid-to-late-twenties all the way up to a patient I had in her seventies. She had lived her life. She was in the military. She raised her kids and grandkids. And then when everyone was raised, she was like, “You know what? It’s my turn.” I thought that was awesome.
And do you have any experience doing reconstructive surgery on the genitals?
I do not, because my specialities are head and neck. But I can do referrals. But in Houston, it’s kind of difficult, because there aren’t a lot of physicians doing that. Which is odd, because we have the largest medical center in the world. There are people in Texas doing it who are doing a really good job. But that’s one of my issues with the entire thing. I feel like it’s really unfair that people have to travel outside of the fourth largest city with the largest medical center. It’s ridiculous. San Francisco has more surgeons, as does California in general because they’re more progressive. Plus, everything is covered under their insurance. They can get facial surgery; they can get genital surgery. There are more people doing it there, because there are more people able to afford it. If you want to do it and have the money, you’re more empowered to go out and do it. Surgeons that are doing it are just kind of spread out everywhere, as well as the people who are seeking out the training. And that’s an issue we’re working on, too: getting more surgeons trained in the programs so that more surgeons come out that are able to do it.
On the topic of the cost, a lot of the issue is that it costs so much money to have these surgeries performed. Which can be a hindrance – especially to younger people coming out of college and getting on their feet. Do you think a reform in health insurance could help people be able to afford to be who they are?
I mean, I think we were definitely going in that direction. But I think there’s a lot of uncertainty right now about the direction healthcare is going in.
(Laughs) To say the least.
(Laughs) Yeah, to say the least. But I think healthcare was going in a really good direction, and hopefully it will continue to go in that direction. I know in Texas it’s always slower. But there are more and more states that are getting things covered. And I think as we’re able to show more science and say, “We’re doing these studies. And this is what we’re seeing …” because there’s a ton of research being done now that wasn’t done before that says certain things are medically necessary, and they can’t be denied if they’re medically necessary. We’re getting there. It’s just a matter of collecting all the data and, like you said, fighting the insurance.
Science is constantly evolving, but we’re sitting in an administration that doesn’t seem to value science.
That’s the truth.
It’s clear that you’re an advocate for the trans community. So, what brought you to want to do this with your career?
It all started with talking to people when I was coming out of training about what’s going on in our city and in our country. And it was just being here. I trained here, too, in the largest medical center in the world. And I realized that there was just this huge need, and that it’s such an underserved community right next door that we’re not taking care of. It’s ridiculous to me that trans people are having to travel and go over all these hurdles. So, it was looking at what I do and what the needs are. So, I went and got some extra training in doing the facial feminization and being able to do it to a high level and provide that care, because that’s what everyone deserves. The whole thing was crazy to me that this was a need here in our backyard, if you will. It also kind of spoke to the feminist part of me that was like, “Yeah! Don’t tell me what to do because of my gender! Be yourself. I’m fighting this fight for you, too.”
“Don’t feel like you have to get stuck in one box and be comfortable with it, because there aren’t any boxes!”
There’s the term passing privilege in the trans community, which is something someone has when they’re able to pass as cisgender on the streets when they’re, in fact, trans. And I think that’s what makes the line of work you do so important, because it affords people the opportunity to feel more comfortable in their skin, even if they can’t put forth the cost of a full transition.
To that point, you know it’s letting them feel comfortable, but it’s also their safety. Because the number of trans people that have been assaulted for simply walking down the street is outrageous. It’s that ability to walk out of your house and not worry as much – I don’t know that you’re ever not going to worry. It’s a horrible place to be when you don’t know what’s going to happen when you leave your house.
Exactly. And you know, in the queer community, we’ve gotten to a point where gay and bisexual, cisgender men and women have the luxury of not facing that fear quite as much, but the trans community hasn’t gotten to that point yet. And ignorance really perpetuates itself to the point where people end up losing their lives. Does it give you a little peace of mind to know that you’re making a difference this way?
That’s part of what makes it rewarding. I love what I do and helping them gain confidence and feel good in their skin. But knowing that it’s affecting their life that intimately, it’s an honor for me to be a part of that process.
I know that this isn’t your speciality, but there are a lot of misconceptions about what gender-affirming genital surgeries look like. Do you know enough about it to give a brief description to maybe clear up some of those fallacies?
Probably very generally. (Laughs). Typically it’s much easier to go from male-to-female than it is female-to-male. So, male-to-female involves taking out a large portion of the penis, but you keep a part of the … well, the head, basically, and make that into the clitoris. And then you’re using the testicle skin to make the labia. It depends on the surgeon and how they perform it and what skin they’ll use to make the lining of the vagina. Some people use a skin graft. Some may have enough skin in that area to be able to invert it. It depends on the person’s anatomy, and also the surgeon and what their preferences are. Then they reroute the urethra, so you’re able to have sensation and you’re able to go to the bathroom. There’s a little bit of maintenance, because you have to keep the vagina open. So what a lot of people don’t realize is that you have to dilate it with time. And as time passes, you don’t have to do it as much. But there’s quite a bit of homework on the patient’s end. Things can happen, where you have to go back to surgery. And sometimes it’s more than a one-stage process in order to get things to look and function the way you want.
With the opposite, is the penis able to become as functional as the vagina?
Kind of. It all sort of depends on the doctor, how they’re doing it, and what the patient’s desires are because there is a wide variety of what you can do with it. There’s a surgery called a metoidioplasty, which basically just allows you to be able to stand and go to the bathroom. So, basically, you’re just lengthening the urethra and keeping what you had, but releasing things so you’re able to do that. Then you have the actual phalloplasty, which is where you are creating the penis. So, what they’ll do is actually take tissue from somewhere else – either the leg or the arm – and kind of create it. It’s a very complex surgery. And then you have to hook up all the “plumbing” and all that stuff. So, the people who do that usually have very extensive training in urology and plastic surgery, or they have a team that has that training. A lot goes into it. So, as far as function, there are ways you can make it sort of semi-erect so that you can use it and so that it’s not erect all the time. Or you can have a pump put in it, and some people do it that way. Because it’s so complicated, you make a big decision. Some people will do the metoidioplasty, but it’s not nearly as involved as the entire phalloplasty.
Tell me a bit about your practice.
I am a part of a private practice with another physician, Dr. Russell Kridel. I have clinical appointments at UT Houston and UTMB, so I get to teach and have a foot in academics. But I have the private practice, so I really get to have control over who my staff are and how educated they are on all these things.
When you teach, what are you teaching?
I touch on all of facial plastics, but I do end up spending a fair amount of my time talking about trans and gender-affirming surgeries, because they’re not getting it from other places usually.
With the private practice, is it important for you to have a staff that understands the importance of what you’re doing with the trans community?
Absolutely. It’s always important that your staff understands your patients and the patient experience. But here’s it’s really important.
Do you think it’s important to build a strong doctor-patient relationship?
I mean, I think so. The feedback I get from my patients is positive.
Based on your Vitals.com reviews, people really seem to like you.
I love people and getting to know them. I love to see them at different points in their lives. I have the luxury within medicine to have a practice where I can spend the time to get to know somebody and where they’re coming from. And I love it especially because I’ll get messages from my patients who live in other places who are like, “I’m getting my bottom surgery today!” They let me know where they’re at and how they’re doing. It’s a very cool thing to be a part of all of that. I’d really miss out if I didn’t get to know them so well. You get to get excited with people, and that’s one of the things I love about plastic surgery. I get to be a part of that!
Last question: if you could say something to trans people about medical treatment and surgery, what advice would you give them to help them decide what’s best for them?
These are things that we think about very deeply. And there are a lot of great people, especially in the city, therapists and social workers and such, that are available to talk about all the facets of it. It’s this great self-discovery process, and being able to have someone to talk to is very important. And many of those people who can help are trans themselves. So they’re able to see it differently than you or I can. Gender is three different spectrums. It’s gender identity, gender expression, and biological sex. So, figuring out where you are on those is a big deal. Don’t feel like you have to get stuck in one box and be comfortable with it, because there aren’t any boxes! Being able to figure that out and be comfortable with it is most important. It’s frustrating and amazing trying to find yourself, but you want to be able to have those thoughts and think it through and talk with someone before you have surgery, because it’s a big deal. And with talking to someone, you can sit down and say, “Okay, here’s the plan …”
You can learn more about the amazing Dr. Angela Sturm on her website.