Birmingham clinic faces scrutiny over delays in care for transgender patients

Magic City Wellness Center, a medical clinic focused on providing comprehensive health care to Birmingham’s LGBTQ+ community, has recently come under scrutiny over barriers transgender patients face when trying to access hormone replacement therapy, or HRT.

In early August, a petition titled “Petition for Fair Access to Care for Transgender Patients at Magic City Wellness Center” was created on Change.org. The petition calls on the clinic to “expand access to gender-affirming hormone replacement therapy (HRT) by ensuring that all primary care providers are trained and supported to provide this essential aspect of healthcare.”

Since the petition’s publication, APR has spoken with several individuals familiar with the provision of HRT care at MCWC, many of whom expressed frustration with the difficulties patients face when attempting to access gender-affirming care through the clinic.

The individuals, all of whom spoke with APR on the condition of anonymity, detailed many of the same concerns outlined in the petition, specifically noting that just one provider—medical director Dr. Scott Weisberg—is currently responsible for treating all transgender patients seeking HRT care from the clinic. Several sources said that arrangement has created a massive waitlist that can leave patients waiting months, if not years, before their first appointment with Weisberg.

One individual who spoke with APR said they waited more than a year to be seen at MCWC because of the bottleneck and knew of other patients who had to wait several years. The individual, who was referred to MCWC after moving to Alabama from out of state, said the waitlist at MCWC was far longer than at any other clinic they had previously relied on.

Another patient told APR they knew of individuals who had given up on starting their transition and receiving gender-affirming care altogether because of MCWC’s lengthy waitlist.

Even after transgender patients make it off the clinic’s waitlist, barriers to care remain.

Multiple patients told APR that Weisberg is regularly late to scheduled phone and telehealth appointments because of his excessive patient load. One patient said that if their appointment was scheduled for 5 p.m., they might not hear from Weisberg until 8 or 9 p.m. One source told APR they feel the need to clear their schedule on days when they have an appointment because missing a call from Weisberg can mean waiting months to be seen again and further delaying care.

The individuals who spoke with APR stressed that the issues are not a reflection of the quality of care provided by Weisberg and MCWC and that they still view the clinic as an invaluable resource for Alabama’s LGBTQ+ community. Multiple sources said they simply want to highlight areas where the clinic could improve and increase access to care for transgender patients.

In addition to training all primary care providers to provide and monitor HRT, the Change.org petition calls on MCWC to improve scheduling flexibility; train providers to “understand and navigate Informed Consent practices” to further reduce wait times; and create a diverse patient advisory board to “ensure patients, providers, and administration can coordinate and provide valuable input to policy surrounding patient care.”

Although the patient backlog at MCWC can result in significant delays in care, Dr. Jasper Kennedy, medical director at WAWC Healthcare in Birmingham and Tuscaloosa, told APR there are few viable alternatives for transgender Alabamians seeking HRT care in the state.

“There are only a few people providing hormone therapy for trans patients in Alabama as a whole,” Kennedy told APR in a recent phone interview. “There is sort of a smattering of individual providers, often primary care providers who have some expertise in gender affirming care or a handful of endocrinologists or OB-GYN physicians in the Huntsville area. There are maybe a couple of those types of folks in the Birmingham area who are individual primary care providers or sort of semi-specialized folks. But the bulk of gender-affirming care in our area is provided by my clinic, the Birmingham WAWC location, Magic City Wellness Center, and the UAB Gender Clinic.”

Although some out-of-state providers offer licensed telemedicine services for transgender patients in Alabama, Kennedy said those services can often be prohibitively expensive.

“Another important factor in this too is the telemedicine providers,” Kennedy said. “These are usually folks who are out-of-state providers who are licensed in the state of Alabama and with some restrictions around arranging for their patients to be able to have at least a yearly in-person appointment with either an advanced practice provider or a nurse who is local in the state of Alabama. They can see patients almost exclusively by telemed.”

“A lot of it is very dependent on whether the provider is able to gain licensure in the state,” he added. “So those tend to be subscription-based models…It's best designed for someone who can afford a monthly subscription, which the population that we are serving is very often not able to do…Trans people are very often working class, cash poor, probably not able to afford something like that long-term. So I do have patients who come in fairly regularly saying that they had been using a telemed provider for their hormone therapy and just weren't able to continue paying for it.”

Kennedy told APR he often sees patients at his own clinic who have been on the MCWC waitlist for many months, if not years.

“It saddens me too, because trans people often wait a long time already to start hormone therapy, particularly in our state where it is not legal to provide care to minor patients, so people under the age of 19,” Kennedy said. “It's very common for me, since I have a little bit more availability, to see patients who schedule their appointment on their 19th birthday or very close to it, and they will tell me they've been waiting for years for this. I have patients who I see who are in their 50s or 60s, and they will tell me they've been waiting a long time to start therapy and some of those patients even longer still because they've been on a waitlist for a clinic that has not been able to get people in in time.”

However, Kennedy also said he understands how a clinic like MCWC, which provides HRT services in addition to traditional primary care, could struggle to keep up with demand.

“But I mean, as a provider too, I know that if you are a popular clinic, often you will fill up, and it is hard to get people in,” Kennedy said. “I think a clinic that is doing both primary care and HRT, I would understand how you have more patients, you have more needs that you're meeting for those people.”

Still, Kennedy stressed that providers can do more to expand access to care, echoing the petition’s call for increased HRT training among primary care providers.

“I think we have a really unique opportunity as people who either work at a primary care clinic or it's within our scope to do primary care, to give our trans patients the gift of treating their hormone therapy like any other aspect of their medical care, which I think really reduces the stigma around it and makes it more accessible because it is frankly not that complicated to do,” Kennedy said. “If you're a provider who has HRT within your scope and you're able to manage someone's hypertension or their cholesterol medication and you're able to read the guidelines on that as they come out and are updated, you can teach yourself how to do HRT because there are guidelines available.”

“As providers, there is an expectation for continuing education. So as the need arises in your community, if there's a need you can meet that is within your scope and you have the resources to meet it, it is reasonable to try to do that for people,” Kennedy added. “And I would love to try to empower people who are doing primary care in this state to treat HRT for their trans patients like they would any other aspect of primary care.”

APR made multiple attempts to reach MCWC to ask why the clinic continues to direct all transgender patients seeking HRT to one provider, whether MCWC plans to expand the number of providers who can treat transgender patients seeking HRT and whether it is considering establishing a patient advisory board as outlined in the petition. MCWC did not respond to APR’s requests for comment.