She asked her mother for her new name.
“Mom, when I was a baby, what would you have named me? If we could reverse all this and I was in your stomach again?”
She got her answer: Diana Elizabeth Guevara.
It was the final touch on her new, true self. For everything else, the 28-year-old went to Dr. Christopher Salgado at the University of Miami, the lead surgeon at the hospital’s new LGBTQ clinic.
Guevara used to identify as a male Miami-Dade police officer, until she injured herself and left the force. With time on her hands to think, Guevara realized what she’d known since she was a third-grader: She’s a woman.
“I knew I ticked differently, but I didn’t know how,” she said. “Then I figured it out. ‘Oh! I’m trans.’ ”
Transgender people — the T in LGBTQ — are those born with sex organs that don’t match their gender identities. Some trans people undergo complex (and expensive) surgeries to change their genitalia, facial features, vocal cords. Others choose to live out their true gender identities without altering their bodies.
For Guevara, changing herself physically was “something so powerful and so important.”
Word of mouth took her to Salgado, who had been performing the tricky surgeries for a few years by the time she saw him in 2012.
Even five years ago the surgeries were much less common than they are today, Salgado said during a recent tour of the clinic.
He never saw a single case during his residency in the late 1990s, and when he decided to study the surgery in-depth, his best option was a fellowship in Taiwan.
Much has changed since then.
In 2014, Medicare began covering hormone therapy and sexual reassignment surgery, following the trend set by European insurance companies. With more insurance money available for the costly surgeries, Salgado saw more and more patients. At the same time, media celebrities such as Laverne Cox and Caitlin Jenner raised the profile of trans people in the United States. Equality for and understanding of LGBTQ people became a hot topic.
UM opened its LGBTQ center in January to serve the needs of the growing population. The new clinic brings together specialists in urology, endocrinology and psychiatry, as well as a team of surgeons to accompany the patient into the operating room.
Salgado and other doctors can even perform multiple surgeries on a patient simultaneously, so after a marathon session the patient can emerge with everything done at once.
The university also hired Lauren Foster, a high-profile Miami Beach trans model and activist, as UM’s first director of LGBTQ concierge services.
Trans patients “live their lives in stealth mode,” Foster said, so the clinic focuses on privacy. “A lot of patients don’t want people to know why they’re here.”
She said some wealthier patients, primarily from South America and Europe, have even used the hospital’s rooftop helicopter pad as a discreet entrance and exit.
In its fledgling state, the clinic focuses primarily on trans patients, but that’s rapidly changing.
Foster said other doctors in the hospital are reaching out and offering to integrate their services, like HIV tests, anal pap smears, or PrEP — an HIV prevention treatment.
Dr. Wrood Kassira, who focuses on chest surgery and facial feminization, said the clinic sees about four new trans patients a week.
When she walks her patients through the surgery, she said they don’t ask for drastic changes. They just want to be comfortable in their own skin.
“They tell me, ‘I don’t want to be looked at funny. I don’t want people to see me as the other gender,’ ” Kassira said.
But the power of gender affirmation surgery, as it is sometimes called, goes beyond that of just altering appearances. Research indicates the operation can drastically improve the mental health of trans people, who studies show are much more likely to attempt suicide than the general population.
Salgado likened the surgery to removing a cancerous tumor. “It’s life saving,” he said.
Before the procedures, Guevara said, her life was emotionally draining. Even a quick trip to the mall left her on edge. But the day after her chest reconstruction, she looked in the mirror and cried tears of joy.
“I was changing and being myself,” she said. “It doesn’t seem like it should be such a big step, but it is.”
Want to know more?
To find out more information or to set up an appointment at UM’s LGBTQ clinic, call 305-243-4500 or e-mail MiamiTransgender@med.miami.edu