By Abby Alten Schwartz
Kevin Kline, MD
“So, do you have a girlfriend?”
It’s what Kevin Kline, MD, was inevitably asked anytime he saw a doctor as a young man.
“And it immediately shut down any response to the contrary,” recalled Kline, now an assistant professor of Family Medicine and Community Health in the Perelman School of Medicine at the University of Pennsylvania.
“I came out in college and didn’t really know how to interact with medical providers around my own sexual health,” he said.
Ironically, Kline was studying to become a family doctor himself. One of his last clinical rotations in medical school, family medicine offered continuity of care—a chance to get to know patients as people. Kline was hooked.
But it was his experience growing up in a small Illinois town and attending med school in St. Louis, Missouri that forged his commitment to LGBTQ+ affirming patient care.
“Being in my early 20s and feeling uncomfortable and ashamed around physicians while in medical school made me think: ‘I’m part of this community. I have plenty of privilege and know how to navigate things. What’s it like for the people who don’t have these advantages?’” he said.
A champion for inclusive care
A key reason Kline chose Penn Medicine for his family medicine residency program was Penn’s work with the LGBTQ+ community. After completing his three-year residency in 2018, he accepted a faculty position.
It didn’t take long for Kline to become the go-to source for answers when his physician colleagues had questions regarding LGBTQ+ clinical care. When patients requested gender-affirming hormone therapy, which labs did they need to order, and how should they interpret the results? Or which providers in other departments would their patients feel safest going to for specialty care? In July 2022, Kline became the Department of Family Medicine and Community Health’s director of LGBTQ+ Health.
One year later, he was appointed to the newly created position of medical director for LGBTQ+ Health, applying his expertise to the entire University of Pennsylvania Health System. In this role, Kline will lead the program in expanding access to high-quality patient care.
“Initially, the LGBTQ+ Health program was focused on improving the climate for all facets of inpatient and outpatient care, whether you’re coming here as a patient or as an employee,” Kline said of the decade-old program. This ranged from creating a more welcoming environment where patients could feel safe and supported, to partnering with Human Resources to ensure inclusion in the workplace, regardless of gender or sexual orientation.
“As we’ve grown and instituted better policies for our patients and staff, we realized it was time to focus more specifically on the actual health care people were receiving,” he added.
Building trust within the LGBTQ+ community
Rebecca Hirsh, MD, an associate professor of Hematology Oncology and co-director of the Penn Medicine Program for LGBTQ Health with critical care physician Judd Flesch, MD, said, “We know that significant health disparities exist for LGBTQ+ people, and having someone like Dr. Kline who is dedicated to culturally appropriate, compassionate, high-quality care is necessary to help bridge the gaps in care experienced by our patients.”
A report published in 2023 on LGBT+ health disparities revealed that LGBT+ people were more likely to be in fair or poor health than non-LGBT+ people and had higher rates of chronic health conditions.
The widespread mishandling of the HIV/AIDS epidemic in the 80s, when the federal government was slow to address a “gay plague,” is one source of the mistrust felt by many in the LGBTQ+ community. However, Kline pointed out that LGBTQ+ people are still facing bias and discrimination in the health care setting, and it’s happening across the country.
“As with any community that’s had bad experiences or been marginalized by the health care industry at large, much of the work ahead involves rebuilding trust,” he said.
For example: A man who has sex with men asks his doctor to prescribe doxycycline for post-exposure prophylaxis to reduce the risk of gonorrhea, chlamydia, and syphilis. The patient wonders why he’s educating the doctor about this treatment, rather than the reverse.
Or a doctor asks a female, cis-gender patient if she’s using birth control without first asking if she has heterosexual intercourse and is concerned about pregnancy.
“Oftentimes it’s not ill-intended, but gives the patient the sense that the provider doesn’t understand them,” Kline said.
He added that fear of mistreatment or discrimination can lead to people delaying care that they need—most often preventive. This results in medical issues, like diabetes or cancer, that could have been treated early being diagnosed later, when they’re more problematic.
Kline said historically there haven’t been structured guidelines or credentials around what it means to be LGBTQ+ affirming—not just at Penn, but at most institutions around the country.
“The addition of a medical director to help define what LGBTQ+ affirming clinical care is at Penn Medicine is a critical step” toward the goal of giving LGBTQ+ patients access to providers and an environment that are intentionally and consistently inclusive, said Rose Thomas, MPH, director of operations for the Penn Medicine Center for Health Equity Advancement and Penn Medicine Program for LGBTQ Health.
Kline said the team has already identified two categories of affirming care, including clinical specialists who provide services specific to LGBTQ+ patients, such as gender-affirming treatments, and providers who agree to “a set of values, such as using the patient’s preferred name and pronouns, and engaging in a respectful and inclusive way.” Kline said his next responsibility will be helping clinicians expand their affirming care and training other staff with less experience treating the LGBTQ+ population.
Feeling seen, safe, and supported
Jennifer Anderson and Mick Masaba have experienced Penn Medicine’s supportive policies toward LGBTQ+ individuals both as employees and as patients.
It’s not just patients who benefit from Penn Medicine’s commitment to LGBTQ+ care. “I take care of a number of our staff who’ve let me know they feel seen and safer and more respected knowing that the institution they work for is actively seeking to improve the care provided to their community,” Kline said.
For Mick Masaba, BSN, RN, a nurse in the Medical-Surgical unit at Pennsylvania Hospital (PAH), and his wife, Jennifer Anderson, an executive assistant for Penn Medicine Corporate Finance, Penn Medicine’s supportive policies toward LGBTQ+ patients and employees have been life-changing.
Masaba, a transgender man, had been dating Anderson long-distance and was thinking about moving from Toronto, Canada, to join her in Philadelphia—specifically, at Penn Medicine. “I asked, ‘If I make this move, what’s my new work environment going to be like? Is it going to be safe for me?’ And she’d show me their policies, which my old employer didn’t have,” Masaba said.
“Changing hospital systems as a nurse and as a patient was very eye-opening,” Masaba said. At Penn Medicine, it didn’t take him long to get an endocrinologist and a prescription for testosterone.
When the couple decided to pursue parenthood, they knew they’d face challenges. “We were worried about being able to get a doctor who could do what we wanted to do, because for our fertility journey, we ended up using Mick’s eggs,” Anderson said.
They originally planned to use Anderson’s egg and sperm from Masaba’s side of the family, but that option fell through. Instead, Scott Edwards, MD, director of Reproductive Endocrinology at PAH, helped the couple conceive by retrieving eggs from Masaba (who had to pause testosterone treatments), donor sperm, and intrauterine insemination (IUI). Anderson became pregnant in mid-summer of 2023 and the couple joyously welcomed their baby in early April.
Masaba praised Edwards and his team for making the couple feel safe. And that’s precisely what Kline wants everyone in the LGBTQ+ community to feel—whenever and wherever they seek care—regardless of whether their medical needs relate to gender or sexual orientation.
“They deserve exceptional care and should be able to receive that here at Penn,” Kline said.