Massachusetts has been gaining a reputation as a growing hub of hospitals offering gender-affirming surgeries. However, the quality of care and support here for transgender people seeking surgery is lower than those living here or coming here for surgery might know.
From my own experiences, I can say that after undergoing a botched feminizing genital remodeling surgery at Boston Medical Center in January 2025, I have been left with constant pain and urinary and sexual dysfunction for the past nearly two years now and missing parts of my body that I explicitly did not consent to the removal of.
Prior to the surgery, staff at Boston Medical Center, including surgeons Dr. Jaromir Slama and Dr. Ricardo Munarriz and Nurse liaison Pamela Klein, participated in pre-operatively giving me false and contradictory information about the nature of the surgery I would be undergoing, my alternative options, and whether I would have opportunities to confirm what I was being told. I was specifically denied opportunities to gain more information and confirmations of what I had already been told, despite requesting it numerous times. I was deliberately separated from my healthcare proxy prior to surgery and taking into the operating room while staff knew that I had still not yet received confirmation of the exact nature of the surgery I would be undergoing, and then pressured into accepting that lack of specific confirmation in the operating room.
All three of the staff members I have named also explicitly participated in post-operatively lying to me about the way my surgery had been performed, once again often giving me contradictory information and then denying it afterwards. This included denying having any memory or knowledge of the conversations I had with them prior to surgery, and escalated into denying having any memory of how my surgery had even been performed.
Dr. Slama additionally wrote multiple false notes in my medical record to alter the nature of conversations we previously had and obfuscate his negligent lack of direct involvement, and Dr. Munarriz reported the removal of a part of my body that did not exist. And another staff member, Nurse Practitioner Marlene Putnam, failed to properly complete the consent form process with me, effectively nullifying any claim that I provided my full informed consent for the surgery that was performed on me. This led to Nurse Klein trying to get my consent for surgery over the phone, which is a violation of Massachusetts medical regulations and is also considered legally invalid consent.
NP Putnam also performed another major HIPAA violation by showing both my healthcare proxy and I the private medical profile of another BMC patient who was there for a pre-surgical consultation with Dr. Munarriz that day (sorry about that, Katie). When I reported this to other BMC staff members, including Nurse Pamela Klein, it was not documented and was covered up by BMC afterwards, with Nurse Klein telling me herself just weeks later that she had no memory of us ever having a conversation about it.
BMC staff in general proved to have a disturbing tendency to not document the specifics of anything discussed with them and to afterwards deny having any specific knowledge of what had been discussed. And when discrepencies were documented, such as a note documenting my immediate post-operative concern of nonconsensual tissue removal and corroborating my lack of informed consent that was written by the acting head nurse of the PACU, they were removed. That note disappeared from my accessible medical record shortly after I contacted BMC's Patient Advocacy department about these events, and their Patient Audit department afterwards told me that there had been no changes or unauthorized access to my medical record - a literal case of "we investigated ourselves and found nothing wrong." I also encountered significant opposition getting access to certain parts of my medical records even before that, including the consent forms I had signed, and to this day I still have no access to that missing note.
Because medical malpractice cases require years of litigation and access to expert testimony costing tens of thousands of dollars or even upwards of $100,000, the nature of the courts to rule in favor of the doctors and hospitals at least 90% of the time, the degree to which BMC has avoided or removed any documentation of their wrongdoing, and the current political climate making juries unfavorable to transgender people, every legal team I have contacted over the past two years had refused to take the case, even to merely help me gain access to my concealed medical records, citing those reasons I just listed. This includes lawyers who specifically work on LGBT medical rights, such as ones connected to GLBTQ Legal Advocates and Defenders, as well as law firms well-known for handling medical malpractice cases and recommended to me by the Massachusetts Bar Association.
Outside of encountering these barriers to legal aid, I have also encountered significant barriers in accessing medical care for my ongoing post-operative complications. I have met with nearly every single surgeon in Massachusetts who performs gender-affirming feminizing genital surgeries, save the team at Brigham and Women's, who until relatively recently were refusing to take any revision cases and whom I have more recently had some significant difficulty scheduling with (although there has finally been some movement on that front). Of the surgeons I have met with, some outright refused to perform any further surgery on me. One such surgeon told me to just expect to continue being in pain (Dr. Marissa Kent). Others dismissed my complications as merely cosmetic concerns and insisted that I should be happy with the result in spite of the nonconsensual nature of the surgery and my ongoing pain and other issues (Dr. Beth Drzewiecki, Dr. Stephanie Preston). Others lacked the skill and knowledge (Dr. Jonathan Winograd) or technology (Dr. Khushabu Kasabwala) to address my complications in any significant way.
Only two surgeons gave me any real positive feedback on their ability to address some of my complications. Dr. Frances Grimstad, however, still lacked the medical technology and skill to perform the method of vaginoplasty I want, which I have been told would be the best way to address my urinary dysfunction. And the alternative method she offers, that of doing a buccal graft, has been compromised by the complications of a supposedly feminizing jaw surgery I underwent with Dr. Branko Bojovic that has left me in even more constant pain for the last nearly 8 months now, on top of other recurring pain from a feminizing forehead surgery I underwent with him a year ago. At the time, I met with her in 2025, Dr. Grimstad also pointed me towards the only other surgeon who gave me truly positive feedback: Dr. Ashley Alford, who was at that time at UMass Memorial Center at the Memorial Campus in Worcester.
Dr. Ashley Alford is the single most empathetic and understanding surgeon I have ever met. She was very open to listening to the full breadth of my complications and trauma, and was the first surgeon to validate that what I was and am still experiencing are very significant complications and that what happened to me was unusual and wrong, all of which was first denied by Dr. Slama and Dr. Munarriz before I completely cut ties with BMC. Dr. Alford offered and agreed to perform robotic peritoneal flap vaginoplasty for me, along with a urethromeatoplasty and clitoroplasty revision and the removal of hair-bearing skin that was placed in my vestibule, with a possible labiaplasty revision and fat grafting as well. She even put forward that since I lack the genital tissue to do otherwise and have the requisite body type, she could and would attempt to perform a full peritoneal vaginoplasty, with a Kerecis xenograft product as a second resort if needed. And she later personally called to follow up with me about scheduling for surgery with her after our initial two meetings.
I met with Dr. Alford again in January 2026, for a final pre-operative appointment two weeks before my surgery date, which is a standard part of her process with patients. This is very unlike the process at Boston Medical Center, whose surgeons expect you to meet with them individually months apart, then sign consent forms months later in their absence, then undergo surgery at an even later date without meeting with them pre-operatively again before that, and sometimes will not even meet with their patients on the day of their surgery, as happened in my case.
During that final pre-operative appointment, Dr. Alford reviewed all of the details of what she would do and the risks involved. And she was willing to take quite a few risks that other surgeons might balk at in order to address my complications, with my full understanding and consent. She was very sympathetic to my sharing of my honest feelings about the surgery I previously underwent, which is that it feels akin to my experiences of being sexually assaulted and raped, and that revising it feels necessary to move forward from that trauma. She has gained a reputation as a sympathetic and skilled surgeon willing to take on difficult cases and not turn away patients who need complicated procedures, unlike many other surgeons in MA. And her reputation and confidence is not unearned. Unlike many surgeons who perform these surgeries, Dr. Alford specialized as a reconstructive urologist specifically to perform gender-affirming surgeries. She trained and completed a full fellowship for this at NYU Langone under Dr. Lee Zhao and Dr. Rachel Bluebond-Langner, who are considered some of the best surgeons in the country. And she specifically started her practice in Worcester to serve an underserved community of trans patients who encounter difficult accessing care in Boston. I felt very safe in her hands.
However, the coding department at UMass messed up considerably and sent more than 30 different codes to my insurance provider, the majority of which were totally unnecessary for the surgery I was having. Neither I nor Dr. Alford had any knowledge of this at the time, but the result was that my insurance provider refused to cover the surgery. Dr. Alford messaged me personally to let me know that the refusal had happened. And after I called my insurance provider and was told about the problem with the codes and that they would need to speak to UMass staff about the situation, she personally worked over the next week to handle the situation herself. She gave me daily updates throughout the convoluted and slow process of trying to get ahold of whoever she needed to speak to.
Unfortunately, my insurance provider was unhelpful, which slowed down the process significantly, forcing Dr. Alford to reschedule my surgery to a week later, which she called discussed with me in advance. The following week, she finally managed to speak with the doctor my insurance provider was putting forward as the final gatekeeper of getting coverage for my surgery. She informed me in advance that she would be speaking to him, and at the end of the day updated me again to let me know that she had spoken to him and that he would be giving his final decision the next day. And the next morning, just three days before my surgery date, she messaged me to let me know that he had gotten back to her. She confirmed that my insurance had agreed to coverage the correct procedural codes, and told me everything was all set for me to see her for surgery on Friday.
And then that same Tuesday afternoon, I received a call from UMass telling me that my surgery would need to be cancelled as Dr. Alford would not be in the clinic that day. When I asked about rescheduling, I was told that they could not reschedule me yet as they did not know when she would be back in her clinic.
Over next several days, UMass very rapidly cancelled the appointments and surgeries of all patients who were scheduled to see Dr. Alford from January through October. They began to tell these other patients and I that Dr. Alford had taken a personal leave of absence. They would not give us any more information other than that she was safe and well. But they would also not let any of us reschedule our appointments with her. By March, it started being reported that Dr. Alford had accepted a new position at Massachusetts General Hospital but would not be starting there until the summer. It was said that patients that wished to continue care with her could schedule appointments with Dr. William Boysen in the meanwhile, even though Dr. Boysen actually works at the Brigham and Women's Hospital of Mass General Brigham. But very soon after that, we started instead being told that patients of Dr. Alford looking to continue their care could instead schedule to see Dr. Stephanie Preston, a plastic surgeon working at a different UMass hospital, UMass Memorial Medical Center's Hahnemann Campus.
I myself was told that Dr. Preston and urologist Dr. Richard Yu were a practiced UMass team performing gender-affirming vaginoplasties. I was told that Dr. Preston had previously worked with Dr. Alford. I was told that Dr. Yu would be taking over Dr. Alford's clinic. I continued to be told that Dr. Alford's absence from her own clinic was a just temporary leave of absence and that she would be returning.
None of this was true.
I believe that very few people know what actually happened: That the residents learning medicine at the UMass hospital where Dr. Alford ran her clinic wrote and signed a statement that said they were collectively refusing to participate in any gender-affirming surgeries performed for transgender people. And that in response, UMass shut down Dr. Alford's clinic and told her that she was no longer allowed to perform any of the gender-affirming surgeries she had previously been doing. The story that Dr. Alford was on a "personal leave of absence" is a complete lie. In reality, she was forced out of practicing at UMass entirely. All of this was deliberately concealed by UMass in order to avoid public backlash, as they had often extolled Dr. Alford's work up until that time, and both local and state news had reported very favorably about her clinic over the prior two years. They knowingly lied to all of Dr. Alford's patients, pretending that she would be shortly returning to her clinic, when in reality they knew that she was gone for good.
And it was never true that she was never going to work at MGH, nor that patients wanting to continue care with her could schedule with Dr. Boyson at BWH. Dr. Alford only interviewed for a position at MGH, but then was told that they would not allow her to start a clinic there either, so she declined to work there at all. After encountering so many barriers to continuing her practice in Massachusetts, she left the state entirely. She now works at Brown Health Urology at Newport Hospital in Newport, RI. But she lacks the laparoscopic robot and access to xenografts that she had at her clinic in UMass, and continues to be unable to perform her surgeries to this day.
Likewise, the information given about Dr. Preston and Dr. Yu was a lie.
As I said before, all transgender UMass patients seeking feminizing genital surgeries are now being funneled to meet with Dr. Preston, with UMass claiming that she performs the same surgeries as Dr. Alford. But as I also said before, when I met with Dr. Preston in April 2026, she first dismissed my complications as merely cosmetic concerns and told me that many patients would be happy with my result. She continued this dismissive and doubtful attitude throughout our conversation. For instance, when I explained the form of vulvoplasty I had wanted and had expected to eventually undergo, a form of surgery that Dr. Alford herself is familiar with, Dr. Preston claimed that she had never heard of it or its benefits for nerve and sexual function. When I cited a number of prominent surgeons who perform it and have published papers about it, she doubtfully said she had never heard of them, citing her authority as a member of the American Society of Gender Surgeons.
When I pushed the conversation to simply focus on my vaginoplasty, Dr. Preston then switched to citing my chronic pain as a reason to not perform it, even though Dr. Alford had believed it was also the best way to address both my urination issues and at least some of my discomfort. Dr. Preston suggested that I do pelvic floor physical therapy instead. When I told her that I had already tried physical therapy, and that Dr. Alford herself had told me she doubted it would do me any good because my complications were not related to my pelvic floor, Dr. Preston once again expressed doubt about that, saying that Dr. Alford was a big proponent of it. She confirmed to me that she had access to the exact same technology that Dr. Alford had, and even said she had begun working with Dr. Alford, but she still kept insisting that she didn't think could help me, even when I told her that I was already scheduled to undergo a bilateral genitofemoral nerve block to help address the pain. Notably, she also repeated the lie that Dr. Alford was on a personal leave of absence. When I continued to push regarding my urination issues, she finally ended by saying that she would contact Dr. Yu, the urologist, to see if he thought they could help me. I assumed this was part of the normal process for scheduling for surgery at UMass, and that like at BMC, I would next meet with Dr. Yu to discuss these issues with him in person.
Instead, early the next day, Dr. Preston messaged me to say that Dr. Yu had said they could not help me. And that was that. I tried to schedule an appointment to see Dr. Yu separately purely for my urination issues, but I kept being told that transgender patients had to be scheduled to see Dr. Preston instead. When I pushed that this was a urination issue unrelated to undergoing vaginoplasty, I was told that it wasn't possible to schedule with Dr. Yu, even though he was supposedly taking over Dr. Alford's clinic.
All of this was very confusing and frustrating for me until I learned the reality of the situation: that Dr. Preston is an extremely new surgeon, who from Dr. Alford's perspective would have been barely trained at all in performing gender-affirming genital surgeries at the time she entirely took over doing them for UMass patients. She had only started working at UMass in late 2025, just a few months before my scheduled surgery with Dr. Alford. And as for "working with Dr. Alford," the reality is that Dr. Preston only shadowed Dr. Alford during a single surgery. That was the complete extent of their association.
Dr. Yu, as well, has very little if any experience in performing gender-affirming genital surgeries. He is not trained in it as a reconstructive urologist like Dr. Alford. He is not even an adult urology surgeon, but rather a pediatric urologist. And he does not even actually formally work at UMass. He is actually based in Boston out of Boston Children's Hospital and Brigham and Women's Hospital. He only ever traveled to UMass in Worcester to perform surgeries maybe once per week in Dr. Alford's time, and only pediatric surgeries. He is not suited to take over Dr. Alford's clinic as was told by UMass staff, because that clinic serves adult patients, not children.
The reality is that UMass Memorial Medical Center repeatedly lied to their patients. They cowed to transphobia by students at the Memorial Campus, forced out Dr. Alford, intentionally misled patients about what was happening and what their options were, and then quickly cobbled together a team to take Dr. Alford's place. Regardless of what surgeries UMass continues to offer and perform for transgender patients, the reality is that transgender healthcare there is compromised now, both by federal funding pressures against offering gender-affirming care for youth and transphobic attitudes among its students. Transphobic people who are not even doctors are effectively controlling the forms and accessibility of transgender healthcare at UMass.
Personally, all of this has left me without much hope for my future. But I'm continuing to seek revision surgery for both my genitals and at Brigham and Women's Hospital, even though the surgeons there will not offer me the same form of peritoneal vaginoplasty that Dr. Alford did. If that fails to lead to anything positive, I also still one other option in mind, which is the final suggestion Dr. Alford gave me to try Mount Sinai. Despite her own training at its effective competitor NYU Langone, she thought that Mount Sinai might be my best option, since NYU Langone's waitlist for surgery is so long and they are slowing down if not stopping entirely on performing revision surgeries. And she offered to have me use her name for a referral there if needed.
As for Dr. Alford herself, I've been told that she hopes to one day be able to perform her surgeries again, when the political climate has changed. She told me that she still considers me her patient, that I can always reach out to her again if needed and use her name for referrals, and if I cannot find help in the next two years, she would try to help me in the future. And for now, that's the way is.
I barely expect anyone to read all of this. And I don't say any of this to scare anyone away from having surgery in Massachusetts if they really want it. Things are not catastrophic here. There are still good surgeons performing relatively good surgeries in a number of hospitals. But I think it is important for people to know that the quality and accessibility of transgender health care in this state has definitely been impacted by the political climate, and it is pushing good surgeons away and enforcing institutional inertia in some places. And I think we should all be more critical of the information we are given about our health care, the quality of care we receive here, and how all of it is changing, both the good and the bad.
In conclusion: Screw BMC and UMass for institutional malpractice. That's all.
