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It’s been 50 years since the LGBT equality movement started in Philadelphia. So Billy Penn decided to look at the transgender experience in the city today, from data to personal stories to health challenges and anti-discrimination policies. This is Trans Philly.

Plastic surgeon Sherman Leis performed his first reconstruction surgery on a transgender person at Springfield Hospital just outside Philadelphia more than 30 years ago. It would be another two decades before he did another.

But about 10 years ago, Leis was convinced to get back into performing gender-related surgeries by a young transgender woman who knew the surgeon had a good reputation. She thought he could serve as a resource for members of the transgender community looking to transition through surgical means.

Leis started reading up again about the latest in performing surgeries on transgender people and observed another surgeon’s work. Soon after, he started advertising that he was equipped to perform gender reassignment surgery in the Philadelphia area — everything from facial changes, to breast surgeries to genital constructions and reconstructions.

Nowadays, he operates on 400 to 500 transgender patients each year.

“It is so invaluable,” Leis said in his Bala Cynwyd office. “There is no profession or endeavor that has the ability to make such an enormous impact like this. What other process can do this? We’re saving lives.”

Leis has become one of the most popular surgeons for transgender people in the area over the last decade. He works out of what looks like a home off the main street in the suburban Philly town. It’s discreet, hidden behind a row of trees, but welcoming — it feels like any other doctor’s office.

And while the 73-year-old surgeon still offers more traditional plastic surgery, he’s separately branded himself as the Transgender Doctor in Philadelphia. He says since starting the business of serving transgender patients 10 years ago, his practice has grown by more than 20 percent each year. He’s actually had to stop taking on new patients.

Dr. Sherman Leis talks in his Bala Cynwyd office about performing surgery on transgender patients. Jared Whalen/Billy Penn

So what’s this long-time Main Line resident and plastic surgeon doing operating on transgender patients from across the world? It’s the field where he feels he can make the most difference.

Facial feminization techniques, breast reductions and genital reassignments can change the life of a transgender person and how they see themselves — not as the gender they were born, but as the gender they’ve always known themselves to be.

It can be difficult for transgender men and women to reconcile with these feelings. High levels of depression are present in the transgender community, and more than 40 percent of transgender people surveyed by the National Center for Transgender Equality said they had attempted suicide, compared with 1.6 percent of the general population. It’s why Leis says something as simple as a facial change can save a life.

He says he finds gratitude in the low incidence of regret that he’s seen associated with any type of gender-related surgery when he performs it. Leis says he actually sees a much higher incidence of after-surgery regret when he performs more run-of-the-mill cosmetic surgeries: boob jobs, nose jobs, face lifts.

Leis is one of just a handful of gender reassignment surgeons in the nation who has a reputation of doing good work, and he sees patients from around the world on a regular basis. He hopes that as current gender reassignment surgeons train others, more choices will be available for patients.

“A lot of surgeons are uptight about being a ‘sex change surgeon,’” Leis said. “They say, ‘I don’t want to be known as a sex change doctor because people might not come for other surgeries.’ I’ve found that that’s not the case at all.”

Inside Sherman Leis' office in Bala Cynwyd. Jared Whalen/Billy Penn

Leis’ 40-year-old practice is growing every year. More people are coming out as transgender, and at earlier ages. He’s consulted teenagers as young as 16 on surgical procedures. In total, he said he treats equally the same number of male-to-female transitions as he does female-to-male.

The different surgeries between the genders though can be stark, especially because many transgender men and women are using hormones to aid the transition. Those can have different effects on different people.

For example, Leis says, he performs more facial feminization surgeries than he does masculinization — mostly because testosterone can change facial appearances better than estrogen. The opposite is true for breasts: More women want breast reductions because testosterone can’t get rid of already-existing breasts. But estrogen can help them form, and surgery may not be necessary.

What patients elect to have done also greatly depends on money. Surgeries can cost thousands of dollars each depending on what’s needed — that varies from person to person — and only about 5 to 10 percent of patients he sees have insurance that covers the procedures. Medicaid in Pennsylvania doesn’t cover anything when it comes to surgery.

But Leis sees that changing in the future. Advocates are trying to bring insurance companies to the table to figure out ways to make it easier for transgender men and women of all social and economic statuses to get the surgery they need.

For him, he’s learned over the last decade that transgender people are just like other patients: “They just want to be treated nicely.”

“They’re not crazy,” he said. “They’re normal people and this can be very confusing for them. But attitudes are slowly changing, and the community is stronger than ever.”

Anna Orso was a reporter/curator at Billy Penn from 2014 to 2017.