Clayton Alfonso, MD: An Advocate for Gender-Affirming Care

Duke OB-GYN Clayton Alfonso, MD, is happy to treat patients no matter where they are from. But the circumstances surrounding why one patient drove four hours from South Carolina to see him in Durham were upsetting.

“The OB-GYN provider told them something along the lines of ‘I don't believe in that care,’” Alfonso said of the patient who is a transgender man.

Unfortunately, the experience isn’t uncommon for patients who identify as LGBTQ+. Alfonso said many patients like the one in South Carolina have negative experiences while visiting their OB-GYN or are denied care because of their identity.

“That was one specific experience, but I have countless others, where they may have been dead named, misgendered, or experienced overt discrimination from their OB-GYN,” Alfonso said.

According to a report by KFF, LGBTQ+ adults are twice as likely as non-LGBTQ+ adults to have a negative experience while receiving health care, including being treated unfairly or with disrespect.

“We know that this population of people avoid health care situations because they're more likely to be discriminated against or have had prior poor experiences in a health care setting,” Alfonso said. “Statistically, they're less likely to receive routine preventive health care maintenance.”

Alfonso wants that to change. An assistant professor of obstetrics and gynecology, he strives to make sure everyone who enters his exam room feels welcome and respected and receives evidence-based care. He aspires for this type of gender-affirming care to be the norm for every person, whether they are seen at Duke or elsewhere. In his many roles as a provider, mentor, and advocate on the state and national scene, he is working to address the discrimination LGBTQ+ patients face.

“Seeking gynecologic care can feel intimidating for most people. And that's particularly true for people who come from groups that may have been marginalized because of an identity,” said Corey Bolac, MD, assistant professor of obstetrics and gynecology and division chief for Duke Women’s Health Associates. “Dr. Alfonso has done an exceptional job at creating a safe space for people to receive that care.”

Affirming Care for All

All providers within the Duke Department of Obstetrics and Gynecology can provide gender-affirming care, but Alfonso has identified himself as the department’s point person. Many of his colleagues go to him for questions, and patients often seek him out for care. Many learn of the services offered at Duke by visiting the gender-affirming care website.

Alfonso, who first joined Duke for residency in 2013, sees adult patients of all gender identities, at Duke Women's Health Associates.

The wide range of services that his LGBTQ+ patients seek include cervical cancer screening, contraception management, STI screening and treatment, and prenatal care. He also helps adult patients who are transitioning to stop their menstrual cycle if their menstrual cycle is dysphoric for them. Their care may also involve surgical management as well, which includes hysterectomies, sterilizations, and ovary removal.

Alfonso said that providing these services can make a huge difference for individuals in the LGBTQ+ community.

“For this particular population of individuals, when they don't receive gender-affirming care or when they're not affirmed in the workplace or in the home environment, their rates of suicide, depression, anxiety, self-harming behaviors are astronomically higher than their cisgender, non-queer counterparts,” Alfonso said.

Bolac said Alfonso and others in the department are filling a gap in OB-GYN care. “The impact of somebody being able to seek care that affirms or sees them as who they are is very meaningful,” she added.

A Voice for the Community

As a gay man, Alfonso said he didn’t have many people he could identify with while growing up in a rural, conservative area of Louisiana. Even with all the challenges he faced as a gay man, he recognizes he has a certain amount of privilege that others in the LGBTQ+ community don’t have. He wants to use that privilege to give back and help those whose voices aren’t heard.

“As a cisgender white person, I'm basically accepted in every environment I walk in. I couldn't imagine what it's like to walk into an environment where I'm overtly discriminated against every single time and the toll it takes on your mental health long-term.”

This desire to give back and to lend a voice to others in the community drives Alfonso’s advocacy work. He currently is the legislative chair of the North Carolina section of the American College of Obstetricians and Gynecologists (ACOG). He also is part of North Carolina OB-GYN Society's Legislative Committee. In his role with the ACOG, Alfonso talks with elected officials, both on the state and the federal levels, making them aware of issues affecting OB-GYN patients, including maternal mortality, gender equity, and abortion access.

“I am involved in helping the state section of our national organization combat bad policy that the legislature is introducing as well as promoting good legislation,” he said.

He said because some legislators are introducing bills that negatively affect the health care of LBGTQ+ patients, he makes a point to share stories of patients and families whose lives have been changed by gender-affirming care. He tells the legislators of the smiles on his patient’s faces and the relief they feel. His patients will tell him things such as: “I've been trying to access this care for years and have not been able to receive it. Now I feel like my true self.”

Helping Learners

Alfonso is the faculty sponsor and a mentor for the Duke House Staff Association for Sexual and Gender Minorities. The affinity group offers support and networking opportunities for residents at Duke who identify as LGBTQ+.

In his role as the faculty sponsor, Alfonso offers members of the resident-run group advice on navigating their way through training as an LGBTQ+ individual and the challenges they may face. “Anybody in the group can reach out to me with questions about: ‘How do I deal with a certain situation because I'm queer identifying? How do I look for jobs? Should I hide this information? Should I disclose this information? What do you recommend?’”

He hopes the group will next look for opportunities to partner with the medical student affinity group, DukeMed Pride, and provide mentorship for LGBTQ+ medical students.