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

ALBANY, N.Y. (Dec. 19, 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 and what he wishes more people understood about health care in the trans community.

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 working with 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.

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.