For Christine Bryan-Burnell, gender affirming care has helped her find a sense of peace and a personal freedom that she said is hard to describe.
“I feel like I’m no longer bound to anything that doesn’t represent who I am,” she said.
But for a lot of transgender and gender non-conforming people nationwide, it can be hard to access similar medical services.
It’s something a new doctor in Virginia Beach wants to play a part in improving in Hampton Roads.
"Frustrating game"
Bryan-Burnell is a stay-at-home mom. A former U.S. Army service member, she knew she was transgender from an early age.
“It was just one of those things I just always knew I had to keep to myself,” she said. “That was kind of a tough thing as a kid, knowing that you had to have a secret that you couldn't tell anybody – not even your parents.”
Bryan-Burnell didn’t have a lot of options for support growing up in Portsmouth in the ’80s and ’90s. Public tolerance and visibility of the LGBT community in Virginia was low. She largely kept her identity to herself until 2013, when she told her wife at the time.
“There were resources online – luckily, that led me to the right places – but there still weren’t … the flooding of information and places to reach out to that there are nowadays,” Bryan-Burnell said.
It was online that she came across the LGBT Life Center, then called the LGBT Center of Hampton Roads. The people there directed Christine to resources that helped her as she started down her gender journey.
The center served as a lifeline for Bryan-Burnell at that time, connecting her with mental health professionals as well as other people who understood what she was going through.
But her journey was not a simple one. Christine was discharged from the Army in 2015, which she attributes to her gender identity. Prior to a 2016 rule change, openly transgender soldiers could be discharged. New rules banning trans troops were implemented under former President Donald Trump before being repealed by President Joe Biden in 2021.
She also stopped taking hormone therapy medication, which can lead gender affirming physical changes to begin to reverse, during a low point while struggling with a “lack of stability, lack of income, lack of availability of care.”
“I was uninsured, so I was paying out of pocket not only for doctor visits, but also for the meds themselves,” Bryan-Burnell said.
Things began to turn around for Christine in 2019. She moved to Elizabeth City to start over, also restarting hormone therapy. Then, she met the person who would become her wife in 2021.
“(She) helped me achieve the most stability that I’ve had since I came out,” Bryan-Burnell said. “She’s just been a complete ally to every single aspect of my life … and I just never looked back from there.”
They married in 2022. With a newfound stability, and moving again to Virginia Beach, Bryan-Burnell began looking into gender affirming surgeries.
Gender affirming care refers to a range of health services from counseling and therapy to hormone replacement and gender affirming surgeries.
“I wanted to just finally feel complete,” she said. “I wanted to feel like there was nothing left that I had to associate with my former self.”
Bryan-Burnell and her wife found that gender affirming care can be covered by insurance, but the hard part was finding a provider that would accept it.
“It’s asking the right question to the right people, and it’s a very frustrating game,” Bryan-Burnell said.
After 20 cold calls to medical offices, she learned that Sentara’s plastic surgery division in Norfolk would take her insurance. It was through Sentara in 2023 that Christine got her top surgery, a procedure that alters one’s bust to present more feminine in her case.
It was also through Sentara that she learned Dr. Nima Baradaran was moving to Virginia Beach in early 2024.
"Alleviate some of their burden"
Baradaran is a reconstructive urologist with Urology of Virginia, which works with several hospital systems in the Hampton Roads region.
It’s the only medical provider in the area that provides bottom surgeries, another type of gender affirming surgery that transforms one’s genitals to reflect their gender identity.
Baradaran came to Virginia by way of Ohio, where he was a part of the Ohio State University Wexner Medical Center’s gender affirming surgery program. Like in Virginia, providers of those services were scant – but Baradaran said they formed an oasis in Columbus.
“We developed a program and it became multi-disciplinary and very successful, with high volume and high quality,” he said. “We’re hoping to reproduce that process here in Hampton Roads.”
Word of his move to the area spread quickly because aside from himself, Baradaran said the closest offices he’s aware of that perform bottom surgeries are in Washington D.C. or Chapel Hill, North Carolina.
“I have patients that I’ve seen (for post-op care) who had their surgeries done as far away as Austin, Texas,” Baradaran said. “They travel long and far to get access, and I hope that being able to provide this locally will alleviate some of their burden.”
While there’s multiple factors that create barriers to gender affirming care, Baradaran said in this case it’s a result of a lack of specialized surgeons.
“We have a shortage of urologists at baseline,” he said. “Now we’re talking sub-sub-specialized urologists, so it’s only feasible to think that it’s just we don’t have enough specialized training.”
Surgery is just one approach to addressing gender dysphoria, or the psychological distress felt by someone whose sex assigned at birth differs from their gender identity. Such procedures have been associated with significant reductions in suicidal ideation for those who seek them out.
“The amount of happiness and joy that I’ve seen, the number of times I’ve been hugged, (the) number of times people have cried in the office out of joy and happiness has been many, many,” Baradaran said.
Narissa Rahaman, executive director of Equality Virginia, said gender affirming surgeries are never a snap decision.
“It is a really personal decision that a patient is making, a person’s making,” Rahaman said. “They are really making these decisions along with their doctor, because there are best practices … that the doctors are making sure to follow.”
Those best practices are set by the World Professional Association for Transgender Health, which outlines the conditions a patient must meet to qualify for gender affirming services – including surgeries.
“That usually involves living in their desired gender for a certain period of time (and) having continuous mental health support,” Baradaran said.
A detailed letter from a mental health provider recommending a patient for gender affirming care is also an important requirement for approval, and to ensure a procedure gets covered by insurance.
Baradaran said he also makes sure to meet with patients “as many times as necessary” to ensure they are fully prepared for a procedure.
“If I feel someone needs five sessions for them to be ready, we will meet five sessions and there’s no problem with doing that,” he said. “The goal is for them to be comfortable. This is a major step in their transition life, and in their life in general.”
"Peace"
Bryan-Burnell was more than prepared when Baradaran arrived in Virginia Beach in early 2024.
“Most bottom surgeons require two letters from two separate therapists – I already had that,” Bryan-Burnell said. “He said ‘Oh, wow, you really do have all your ducks in a row.’ I said “Sure do. What are you doing next week?’”
She got in touch with Baradaran’s office in January and had her first consultation with him in April. Bryan-Burnell’s surgery was in May.
“I will never be able to put into words just how much (he) saved my life,” she said. “He is just an amazing person.”
It’s helped Bryan-Burnell heal. She now looks back at her gender journey as a story of redemption.
“It’s given me peace, and it’s given me just a sense of personal freedom that I’ve never experienced before,” she said. “I want everyone else who’s ever been in my shoes to be able to feel what I feel now.”
Bryan-Burnell said the trans community needs more people like Baradaran and more services like those he provides to be able to achieve that.
Baradaran is hopeful that with increased transgender visibility in society, that the number of specialized urologists will also increase in the coming years. In the meantime, he’s trying to build new roots in Hampton Roads and take care of those in need of his care.
Bryan-Burnell hopes others will do the same.
“It’s extremely important,” she said. “It’s extremely needed.”
Produced with assistance from the Public Media Journalists Association Editor Corps funded by the Corporation for Public Broadcasting, a private corporation funded by the American people.
