In 2012, Dr. Luikenaar returned to The Netherlands to train at The Center for Gender Expertise in Amsterdam, with Mick Van Trotsenburg, an obstetrician-gynecologist and medical director of the center, to learn about all aspects of running a multi-disciplinary transgender health center, including training in affirming hormone therapy for people of all ages including adolescents and puberty blockers.
Dr. Luikenaar opened Utah’s first transgender health clinic in 2011 and has had well over 7000 transgender and gender expansive patients under their care. In 2018, she became WPATH Certified as the first cohort of physicians and other health care professionals to receive certification from the World Professional Association for Transgender Health. In 2018, they also completed a subspecialty board certification in pediatric and adolescent gynecology with the American Board for Obstetrics and Gynecology.
Since 2011, they have lectured at many symposia, conferences, Grand Rounds, Medical Schools, and hospital departments nationally and internationally, for many different groups of people teaching many different topics in transgender medicine. They have tutored many medical students, residents, and other healthcare professionals on all aspects of gender-affirming clinical care.
Besides offering primary and preventative medical care, office gynecology, and mental healthcare, Dr. Luikenaar has managed pregnancies and delivered babies for many transmasculine and non-binary people and has performed hundreds of gender-affirming hysterectomy surgeries between 2011 and 2023. From 2016 until 2019, Dr. Luikenaar trained with Dr. Sherman Leis in Philadelphia, Dr. Maurice Garcia in Los Angeles, and Dr. Angela Rodriguez (then with the Crane Center for Transgender Surgery) in San Francisco to learn vaginoplasty. They also attended several cadaver courses organized by WPATH, led by famous surgeons who perform gender-affirming surgery.
Rebirth Health Center has an affiliation with the Crane Center for Transgender Surgery since 2019. This center has trained many excellent surgeons who perform gender-affirming surgery in the United States.
Dr. Luikenaar offers postoperative care after gender-affirming surgery for patients who travel out of state or out of the country and performs office orchiectomy at a low cost for patients with gender dysphoria. They have performed well over 120 orchiectomies at the office, with an in-house anesthesiologist who has many years of experience.
Rebirth Health Center employs 2 certified electrologists who permanently remove all unwanted hair typically required for vaginoplasty and phalloplasty.
Dr. Luikenaar has received many awards for their work in transgender medicine. They received the “Allies Award” from Equality Utah in 2016 for their work for the transgender community.
In 2023, Dr. Luikenaar published the first textbook focused on Obstetrics and Gynecology for transgender and gender-expansive people: “TransGynecology” by Cambridge University Press, as the only US co-editor, together with co-editors Dr. Mick Van Trotsenburg from Austria and Dr. Maria C. Meriggiola from Italy. Dr. Luikenaar co-authored many chapters published in this textbook, including a chapter on complications after vaginoplasty, vaginal dilators, pelvic floor physical therapy after vaginoplasty, chronic pelvic pain, and others.
In 2023, Dr. Luikenaar also opened a psychedelic medicine clinic (ketamine for now) for conditions prevalent in the LGBTQ+ community, such as treatment-resistant depression, PTSD, and anxiety.
Transgender Healthcare includes all gender affirming healthcare for people who are transgender and or gender expansive. Every patient has the right to receive excellent inclusive and nonjudgmental healthcare. Rebirth Health Center aims to provide evidence-based, cutting-edge clinical care for transgender and gender non-binary communities.
Many transgender and gender non-binary people have questions about their gender transition; this is a personal and individual process. Usually, a person first explores their gender (identity), with internal self-reflection, connecting with others for support, and possibly working with a gender therapist who has expertise in gender affirming therapy. This journey can take anywhere from months to a lifetime.
You explore where you think you belong in the gender universe, what your gender is at this time (it changes for some), and how to develop coping skills, resilience, and find social support to help you through transition and cope with a world that is currently dangerous and biased towards transgender and gender expansive people. When you feel ready to move forward, you can explore different areas of transition.
The World Professional Association for Transgender Health (WPATH) has determined in the Standards of Care guidelines (number 8, published in September 2022), that there is no specific required order for these steps of transition. WPATH was established in 1979 and is a professional organization devoted to the understanding and treatment of gender identity and gender dysphoria and creating standardized treatment for transgender and gender variant people. A group of experts in transgender medicine create guidelines based on current evidence-based studies, that are renewed every couple of years.
- Social transition: presenting in public part-time or full-time as yourself, including changing your hair/clothes, packing (with a penile prosthesis), binding with a binder to flatten breasts, tucking (placing testicles into the inguinal canal held in place with a garment called a gaff, or tight underwear). It also includes coming out to partner(s), family, friends, coworkers, classmates, community members. Social transition is not required to start hormone therapy or have gender affirming surgery. For some people, it is not safe to be socially out; it could harm their position at work or their relationship with others. You can do this when you are ready. Sometimes it helps to talk to a therapist on how to navigate this.
- Legal transition: changing your legal documents to your chosen name, gender identity, and pronouns. In Utah, this process goes through the court system. https://www.utcourts.gov/ (petition for name or gender marker change). It requires a letter from your physician who prescribes hormones or therapist stating you are diagnosed with gender dysphoria. You must be 16 to change your birth certificate (due to a new law that took effect in 2023) in Utah. Please make sure you ask the judge to seal your birth certificate, and that this is mentioned on your court order before you submit it to the birth certificate registry. Please feel free to ask us questions about this process if you are an established patient.
- Medical transition: this includes gender affirming hormone therapy, fertility preservation (sperm/egg storage), hair removal (face, body, genital area), and speech therapy. You do not need a letter from a therapist to start gender affirming hormone therapy at our clinic; we are an “Informed Consent” clinic. Unfortunately, with the passing of law SB16 in January 2023, the legislation in Utah placed a ban on hormone therapy and gender affirming surgery for people under 18 who did not receive an official “Gender Dysphoria” diagnosis by January 25, 2023, and they also made it more difficult for healthcare professionals in Utah to practice transgender medicine in general.
- Surgical Transition: any surgery that helps you feel more yourself. This can include breast augmentation, mastectomy (removal of breasts) or breast reduction, facial feminization or masculinization surgery, vocal cord surgery, tracheal shave to remove the Adam’s apple, genital surgeries such as orchiectomy, zero depth vaginoplasty, vaginoplasty, phalloplasty, metoidioplasty including non-binary options as, for example, aphallus sparing vaginoplasty.
The WPATH Standards of Care 8 as well as insurance companies require a letter from a gender affirming therapist to make sure you are prepared for the self-care necessary during the postop period, as well as have a support system in place to support you with follow up visits, and that you are emotionally prepared for the possibility of complications and also that you have realistic expectations of what this surgery will do for you.
- Emotional and spiritual transition. It is important that during this process your mental health is as stable as possible, that you practice self-care, that you are “in touch with yourself”, that you know yourself (or work on getting to know yourself) and what your values are, that you open yourself up to personal growth and learn about your purpose and meaning in life. This is a lifelong ongoing process and sometimes it helps to talk to a therapist or other mental health professional. Some people benefit from psychedelic medicines to help find connection and meaning. This area of transition (spirituality) is often forgotten and has received (too) little attention in the field of transgender medicine. We aim to change this.
What do we offer as far as primary care?
Primary care includes general preventive care such as cancer screenings, blood pressure checks and management of certain general medical conditions and referrals for specialty care. Our services include HIV pre-exposure prophylaxis (PrEP), screening for sexually transmitted infections, contraception and Suboxone for those with OUD (opioid use disorder).
We also offer medical marijuana cards for conditions indicated, determined by the Utah legislation, which include chronic pain, autism, and PTSD.
We also have free fentanyl tests and Narcan available for our patients as we believe in harm reduction.
Fertility and Sexuality
Your fertility and sexuality are very important to us. When we talk about gender affirming hormone therapy, we discuss the impact of the different hormones on fertility and sexuality as we do with every other medication we prescribe, and we discuss this during follow-up visits as well. Don’t hesitate to ask us questions, as there are no embarrassing questions.
We discuss the option of semen and egg preservation if desired and can give you resources on how this works and where to do this and the typical cost. If during your medical transition, you desire to have a baby or breast-/chestfeed, please let us know; there are many ways to create a family. Transfeminine people with breast tissue are able to lactate; several of our patients have been able to do so with the Newman-Goldfarb protocol.
Dr. Luikenaar is a gynecologist with additional training in sexology and has trained with many urologists. Discussions about sex are common and an everyday topic. We do not judge you, we see many patients who are in polyamorous relationships, as well as people who are on the ACE spectrum or are asexual. Some of our patients have frequent casual sexual encounters, and others are sex workers. Many of our patients are gay, lesbian, bisexual, pansexual, and identify anywhere on the sexuality spectrum.
Gender Affirming Hormone Therapy
Dr. Luikenaar has prescribed every possible and available option of gender affirming hormone therapy and stays updated on the latest studies and publications, especially regarding long-term effects and safety. They have learned about hormones ever since Medical School in the 90’s and have prescribed them (as an obstetrician-gynecologist) for over 25 years; they are well-informed about the risks and benefits, and we keep you informed.
Gender is an infinite spectrum, and your gender is personally and uniquely yours. Your gender is as exclusive as your fingerprint. Gender is a social construct that exists not in objective reality but because of human interaction and is an idea that has been created and accepted by the people in society. Some people describe their gender as a “number” that they pick for themselves, as there are infinite numbers, or “stars” in the sky as there are so many.
Most of our patients are looking for a “binary” transition and want to experience an optimal feminine or masculine “puberty,” with all the physical and emotional changes. It can take 6 to 8 years to achieve optimal feminization or masculinization with hormone therapy. For example, when you are taking testosterone, body hair and facial hair can take many years to develop, as can the development of an hourglass figure when you take estradiol. There are many others who do not want optimal feminization or masculinization and want to pursue their own gender with a hormone regimen tailored for them specifically. There is no single correct way to “do” a medical transition; this is not a “one-size-fits-all,” however, we take the WPATH SOC8 guidelines into consideration when we recommend your hormone regimen.
Part of helping resolve your Gender Dysphoria is that you try to figure out your “embodiment” (your physical being, body, thoughts, and actions) and what you think this should look like; what areas on the outside and on the inside of your body (emotions, feelings, desires) you are happy with “as is,” and what you would like to change if possible.
For many, this is a process that is in development and you may not exactly know yet where the finish line is. Others have been unaware of their true gender identity or gender until they experience life transitions as going through puberty, or giving birth, or experiencing menopause. It is never too late; a person can always start a medical transition no matter how old they are. It is important to be able to leave this world as your genuine, authentic self, instead of never getting to know and be the real you; many of our patients have told us that being able to take gender affirming hormones has saved their life. It is important to see a gender affirming therapist and talk to peers if you are not sure, and express this to us, so we can better help you achieve what you are looking for and prevent regret.
For any questions about gender affirming hormone therapy or if you would like to know your options, please give us a call at (801) 272-3909 and make an appointment.
During your first visit with Dr. Luikenaar, we explore what you are looking for and discuss your options. We make sure it is medically safe to start, discuss your family history, your current medications, and other medical and mental conditions. We talk about all the risks, benefits, and options of hormone therapy and the impact on sexuality and fertility. Dr. Luikenaar also wants to know about your support system (who loves you no matter what), your mental health and emotional health, your therapist and family physician, if you have one.
We discuss common conditions as ADHD, autism, sensory processing issues, (social) anxiety, depression, eating disorders, substance use, and a history of trauma; these conditions are very common in the community and are important for us to know about. We have a list of LGBTQ+ inclusive mental health professionals available (many of them are gender expansive or transgender themselves). We have many other resources available to help you with all areas of transition.
There are very few contraindications to hormone therapy, and hormones are affordable. Our clinic is one of the most affordable clinics in Utah. On our clinic’s intake form, we ask about “access needs,” please let us know if you have them. Most of our patients are neurodivergent, and we are aware of this. We use a patient portal that makes communication via email easy, you can make your own appointments online, and request refills of prescriptions online. We send you automatic appointment reminders as well. Blood tests are an important aspect of monitoring gender affirming hormone therapy. We want to make sure you are healthy and that your hormone regimen is optimal and works well for you. You do not need to fast, you can bring headphones, your mask, your support person, and we have juice, snacks, and stress toys available. We have a few rules in place to make sure our clinic continues to run smoothly as we see a lot of patients, these are mentioned on your “new patient registration” forms, please read them.
Other helpful resources: