By John C. Ferguson, MD, FACS    Here in Waikiki, Honolulu, where I live with my family and work, is a well-established LGBT presence. The area’s bars, restaurants, and social organizations cater to its population, providing a safe and vibrant place for the LGBT community to thrive. As those of you who live in dense urban settings very well know, your neighbors become a large part of your social life. Because of this, my family and I are socially active in the community, participating in and sponsoring transgender pageants and other social functions. Aside from the social efforts, I’m proud to serve as a resource for members of a community that can oftentimes be consumed with fear and uncertainty. My roles as both friend and doctor for the LGBT community have taught me valuable lessons over the years, lessons that I’m proud to apply in all facets of my life. The Treatment Process Each transgender patient seeks a unique treatment process. From non-invasive procedures to genital reassignment surgery, the spectrum of treatment is wide. For example, the most common procedures sought after by men are body sculpting and the removal of mammary tissue. These patients often also desire facial masculinization, for which I use fillers and fat to enhance the brows, nose, and jawline. By far the most common procedure for women is the breast augmentation, followed closely by body sculpting, which typically involves fat transfer to provide a more feminine waist and hips. Patients often pursue injectable fillers or other skin care treatments that are normally associated with women, but sometimes, less common and more complicated procedures, including craniofacial resectioning, are preferred. Genital reassignment surgery is only a small, and often unnecessary, part of the transgender patient’s transition process. Contrary to popular belief, most aspects of the masculine or feminine self-image of these patients actually has little to do with genitalia. The path between establishing gender identity mentally and transforming physically varies from person to person. It is almost impossible to identify a beginning, middle, and end to this process. Because of my social involvement in the LGBT community, I am often sought out by individuals who have mentally come to terms with being transgender, but don’t know where to start with making physical changes. There are several good primary care providers that specialize in and support this process, and I am always more than willing to point these patients in their direction. Once the patient is ready to pursue the physical transition, he or she is sent my direction again. These patients can sometimes be timid, hesitant, and nervous to start the physical transition. On the other hand, at least once a month, I encounter patients with great confidence and find myself performing some type of facial rejuvenation surgery on 70-year-old drag queens.  This article appeared in the 2015 Issue #2 of Surge. Click here to read more.