Q&A with Augustus Klein: Advancing Transgender Health Research, Reducing Stigma

By Erin Frick

ALBANY, N.Y. (Dec. 18, 2025) — Throughout his career, Augustus “Gus” Klein has focused on improving care and reducing harm among vulnerable populations. Now an assistant professor in the Department of Health Policy, Management and Behavior and the School of Social Welfare at the College of Integrated Health Sciences, Klein’s current work centers on advancing transgender health research and reducing stigma.

Klein’s service in this space began over three decades ago, when as a young social worker, he began working with LGBTQ+ youth undergoing gender-affirming care. Over the years, Klein has worked to develop, implement and assess strategies to improve care for people affected by various forms of abuse, including domestic violence and drug-related harm, as well as overdose and suicide prevention. 

We caught up with Klein to learn about his evolution as a researcher, the importance of involving impacted communities in work designed to support them, what he wishes more people understood about health care in the trans community, and what he is most looking forward to in his new role at UAlbany.

The interview below has been edited for length. To learn more, read the full version. 

What spurred your work at the intersection of social work, public health and ethics?

My path into this work began long before I became a researcher. I transitioned at a time when access to gender-affirming care was extremely limited — insurance didn’t cover hormones or surgery and very few providers were trained or willing to work with transgender people. Navigating that landscape personally and professionally gave me a unique vantage point: I understood how life-changing this care could be, yet also how difficult it was to obtain.

I started my career as a social worker in the late 1990s at Green Chimneys Gramercy Residence, one of the only residential programs in New York State serving gay, bisexual and transgender youth. At the time, gender-affirming care for young people was emerging quietly, not politicized the way it is today, and it was profoundly moving to support trans youth, most of them youth of color, as they expressed and affirmed who they were.

Witnessing their courage at a time when transgender people were almost entirely absent from public visibility was transformative for me. Their strength helped me find the courage to transition, and their experiences taught me early on that gender-affirming care is not experimental or extraordinary — it is necessary, patient-centered care that saves lives.

Those early years also taught me that high-quality care is fundamentally collaborative. I worked alongside providers who respected young people’s autonomy, believed what they said about who they were and understood that helping them access care was an ethical imperative. That model — care rooted in dignity, trust and partnership — became the foundation for everything I would later pursue as a researcher.

What is trauma-informed health research and what does it look like in practice?

A trauma-informed approach recognizes that trauma affects the whole person — cognitively, emotionally, physically, socially and spiritually. It means understanding that when a participant is hesitant, guarded or inconsistent, they are not being “difficult”; they may be activated by previous experiences of harm in healthcare, research or social service settings. And it means creating research spaces that prioritize emotional safety, informed consent as a process (not just a signature) and methods that avoid retraumatization.

Community engagement is equally essential. Trans communities, like many marginalized communities, have long built their own support systems because institutions often have not shown up for them. Research that does not respect that expertise is incomplete at best and extractive at worst.

In practice, trauma-informed, community-engaged work means designing studies with community partners from the outset of the project. It means building relationships long before data collection begins — showing up to events, being accessible, being accountable. It also means embedding participants’ rights, dignity and autonomy into every step of the process and recognizing communities not as “subjects” but as collaborators and thinkers whose insights deepen the science.

This approach produces research both that communities can trust, and that can truly inform policy and practice change.

What changes when health researchers form authentic partnerships with the communities they study? 

Everything changes.

Authentic partnerships transform research from a one-way extraction of information into a reciprocal exchange of knowledge, resources and shared purpose. Community partners bring expertise that many researchers simply do not have. This includes deep understanding of lived realities, knowledge of what interventions will or will not work and insight into how systems impact people on the ground.

My long-standing partnership with Lyon-Martin Community Health Services in San Francisco is the clearest example. Over the past six years, we have built a collaboration rooted in mutual trust and a shared commitment to providing high-quality health care to trans people — not “trans health care,” but health care that understands and affirms transgender people’s lives. They have opened their clinic doors to me in ways few research teams ever experience, not because I’m an academic, but because I show up as a collaborator who respects their expertise and supports their goals. I’ve used my skills in grant writing, evaluation and research design to build capacity within the clinic, just as they’ve shared their clinical wisdom and on-the-ground realities.

This sort of authentic partnership improves care outcomes because it shifts the center of gravity. Instead of researchers deciding what is important and communities responding, we co-create knowledge that is rooted in lived experience, clinical reality and the pursuit of equity.

How does your work bring attention to bias in health care?

My work highlights bias by revealing how stigma becomes embedded in systems, policies and everyday clinical interactions, often in ways that providers do not recognize. 

For example, my research on HIV prevention among transmasculine individuals shows that providers frequently underestimate their HIV risk, leading to limited discussions around the HIV prophylactic medication PrEP, and missed opportunities for prevention. Similarly, in gender-affirming surgery, surgical criteria based on body mass index (BMI) or outdated psychological assessments disproportionately harm people who already face systemic barriers to care.

Because I collaborate closely with health centers and community partners, these insights are translated into concrete strategies that involve redesigning workflows, improving provider training, adapting measures of patient-reported outcomes and creating trauma-informed guidelines for research and care. 

Bias is rarely about individual prejudice alone — it is about structures that reproduce inequity. My goal is to make those structures visible, understandable and changeable.

What do you wish more people understood about gender-affirming care?

The biggest misconception is that gender-affirming care is something unusual, special or unique to transgender people. In reality, all gendered health care is gender-affirming. When a cisgender man with Peyronie’s disease sees a urologist or when cisgender women receive reproductive health care or when anyone uses hormones to feel more like themselves, that is gender-affirming care. We simply don’t call it that.

If I could tell policymakers one thing, it would be this: Despite heightened visibility, trans people still hold very little social, political or economic power. Policies denying us health care, identification documents, employment protections or even access to bathrooms are forms of social control that make us targets for further violence. Trans people are not abstract debates — we are people and we deserve to live in safety and peace.

If I could tell the general public one thing, it would be that we are not new. Gender diversity has existed across cultures and throughout history. Increased visibility is not “making people trans,” it is creating enough safety for people to live authentically. I love being trans. I have no regrets about my decisions. What is difficult is not being trans — it is navigating systems and structures that treat trans people as threats instead of human beings.

What do you enjoy most about your work? 

I am most energized by the intersections — working alongside trans community partners, mentoring emerging scholars and using implementation science to transform systems so they work better for the people they are meant to serve.

There is nothing more meaningful to me than collaborating with trans-led organizations and seeing the impact of research that is built from the ground up, with community wisdom at its core. I love mentoring students — especially LGBTQ+ students, first-generation scholars and those who are themselves navigating marginalization — and helping them develop the tools and confidence to become leaders in this field.

At its heart, my work is about building systems that are compassionate, ethical and responsive. Implementation science gives me the opportunity to translate evidence into sustainable practice and to design trauma-informed, equity-focused approaches that have real impact. It’s a privilege to do work that aligns so closely with my values and with the communities I care deeply about.

What are you looking forward to as you chart your next research steps at UAlbany?

I’m excited to expand my work in three major directions.

First, I am launching a national mixed-methods study on the real-world implementation of ketamine-assisted psychotherapy (KAP). There is tremendous variability in how KAP is delivered across clinical settings in the U.S. and very little evidence to guide best practices. Implementation science offers tools to understand how providers make decisions, how clients experience treatment and what structural, ethical and regulatory challenges shape access. My goal is to help develop guidelines, training standards and policy frameworks that support safe, equitable and sustainable KAP delivery.

Second, I am beginning to build a large-scale follow-up to my ongoing collaboration with Lyon-Martin Community Health Services examining gender-affirming surgical outcomes and disparities. Early insights from this work highlight crucial gaps in postoperative support, provider communication and patient-reported outcomes. I hope to develop a national multisite implementation study that tests trauma-informed and equity-focused approaches to improving surgical navigation, clinical decision-making and long-term outcomes for transgender and non-binary patients.

Third, I am deeply committed to helping public health departments adopt and integrate implementation science into their everyday practice. Public health systems hold enormous potential to reduce inequities, but they are often under-resourced, overstretched and expected to translate evidence into action without adequate tools or infrastructure. I want to help health departments understand barriers to equitable service delivery, improve uptake of evidence-based interventions and strengthen organizational readiness for change. This work is about moving from “what works in theory” to “what works in practice,” especially for communities most impacted by structural inequities.

Together, these three directions reflect my broader commitment to advancing health equity through system-level change. UAlbany provides an extraordinary opportunity to grow this work in collaboration with colleagues, students, public health partners and community organizations who share a vision for more just, responsive and compassionate health systems.