Klauser performing earlier this year. Photo by Eric Lee.
As a lifelong performer who began her professional career singing opera music and now produces music for other artists, teaches aspiring musicians, and has performed with many different musical projects over the years, Mattie Chaya Kimberly “Kimi” Klauser is accustomed to living in the stage lights. This year, Klauser began enjoying performance and her everyday life even more as she creates a future where she feels most herself.
“My experience with Penn Medicine was the thing that’s hopefully not just saved my life, but set me up for a future as a person who’s not in the shadows,” Klauser said. “It's the ability to just be within yourself. I feel like I look as close to myself as I’ve ever looked.”
Klauser, a 37-year-old transgender woman who identifies as queer, has struggled with gender dysphoria and suicidal thoughts, and faced everything from casual ignorance to outright aggression from acquaintances, strangers, and even family, throughout her life. Receiving gender-affirming care at Penn Medicine, including facial feminization surgery with plastic surgeon Jordan Swanson, MD, earlier this year, has helped her finally feel like herself.
Penn Medicine’s commitment to LGBTQ+ health
Swanson is one of nearly 100 providers affiliated with the Penn Medicine Program for LGBTQ+ Health, led by Kevin Kline, MD, who was appointed as the program’s inaugural medical director in 2023. One of Swanson’s surgical specialties is a form of major plastic surgery that can change the way certain facial features look to appear more feminine.
“Facial feminization surgery is becoming more common as part of the comprehensive options to help individuals achieve their personal goals for gender-affirming care,” Swanson said. “I’ve seen the incredible impact it can have on patients’ overall well-being.”
Gender-affirming care encompasses a broad set of services that also includes holistic primary care, hormone therapy, family planning, mental health care, physical therapy, gender-affirming surgeries, and more. Gender-affirming care at Penn Medicine is based on a person’s unique goals and does not need to include hormones or surgery, although many people may want one or both at some point in their lives.
The LGBTQ+ Health Program works to increase access to care, along with quality of care and patient experience, for LGBTQ+ individuals across the University of Pennsylvania Health System. It’s part of a broader institutional focus on diversity, inclusion, and equity that aims to foster a vibrant, inclusive environment and better embrace diversity across Penn Medicine.
Since becoming a patient at Penn Medicine in 2021, Klauser has seen changes, such as the practice of asking for a patient’s preferred pronouns, becoming more common.
“I had a breakdown to my doctor during our third appointment together because every time I got called back from the lobby, the staff would address me as ‘sir.’ I’d walk back to the doctor with high blood pressure, on the verge of panic attack, because I’d get misgendered first thing,” Klauser said. “It really has changed over the years. I never received an outward expression of transphobia, but people started really understanding the etiquette of asking more and assuming less.”
One patient’s journey to gender-affirming care
Klauser’s mental health declined, and her gender dysphoria worsened during the sudden isolation of the COVID-19 pandemic, while at the same time the health care system was under pressure and many kinds of treatment were harder to access. She had identified as non-binary for several years, and decided that her next step was to begin gender affirming hormone therapy (GAHT). She joined waitlists with multiple health care providers across the city, and Penn Internal Medicine was the first clinic with an opening.
Nurse practitioner Roxanne Sebeny Cristancho, CRNP, guided Klauser through GAHT, which includes estrogen and medicine to block testosterone production, and referred her to other providers for voice therapy and physical therapy for help adjusting her voice and posture. She also received speech therapy and occupational therapy through Good Shepherd Penn Partners, with speech therapist Alyssa Tarantino, MA CCC-SLP, CBIS, and occupational therapist Sam Mitchell, MS, OTR/L CBIS.
“I consider myself very lucky that I was able to access the centralized care I got at Penn,” Klauser said. “Roxanne has been an angel. She never told me what I needed; she listened to what I wanted and needed and checked in on the effects.”
While gender affirming hormone therapy has clear physical effects, the biggest effect for Klauser was mental. She began to feel at home in her body and more at peace, as her outward gender presentation better matched the way she felt inside. Yet, when she looked in the mirror, she still felt a need to hide the masculine features of her face that she felt didn’t align with the new body she loved.
“When I woke up in the morning, the first thing I would see was the heaviness of my brow, and that could start a really negative spiral from the get-go of my day,” Klauser explained.
Swanson finds that for many patients, the process of discussing dysphoria during a medical visit can be therapeutic, explaining, “I usually frame the consultation around three overlapping areas: the dysphoria a patient experiences internally, the dysphoria they experience from their interactions with others, and what surgical procedures might appropriately feminize those facial attributes in affirmation of their gender.”
Finding an answer in facial feminization surgery
Klauser (in the pink baseball cap) with her bandmates at the Richmond Street Flea Festival.
During a seven-hour surgery in January, Swanson used advanced plastic surgery techniques that hide scarring to subtly, yet emphatically, transform Klauser’s face based on their extensive conversations to plan for the outcomes she desired.
“Testosterone thickens the bone, which creates facial features that we typically associate with masculinity, such as a more pronounced forehead and jawline,” Swanson said. “With this surgery, we study CT scans of the patient’s face to plan a surgery that aligns with what their natural bone structure would look like without the effect of testosterone.”
What “feminine features” look like, and which surgical procedures are part of a facial feminization surgery, is specific to each patient, depending on their personal preferences. Klauser effused on how the results of her surgery were affirming to her own goals: “I now have the same bone structure as my aunt and my sibling and my family members who were biologically born female,” she explained. “When my best friends saw me, their reaction was, like, ‘You look exactly like yourself. You look like the self you were trying to create by hiding with like wigs and bangs and hats and all that.’”
The surgery and recovery were intense and “gross… a baptism by fire,” as Klauser put it, but also “more life- changing than I could have imagined.” Before the surgery, her biggest insecurity was the appearance of her brow and forehead, and that dysphoria has been eliminated.
The surgery was the first of two planned procedures. Once Klauser’s face completely heals and she’s had a chance to let the changes settle in, she’ll decide, together with Swanson, on what steps to take in the second surgery, including jaw and chin shaping.
“Between hormone therapy and the surgery I’ve had so far, I can say there’s this rebirth… I'm starting to do the things that I forgot that I liked, because I was so busy hating myself,” Klauser said. “My quality of life is already 90 percent better. I’m still [recovering from major surgery], but now I get up in the morning and I feel pretty normal, and I go to bed at night, I feel pretty normal… I can see a life in which being trans can fall into more of the background [as a piece of my everyday life] now.”