For years, transgender men and women looking for genital surgery have primarily relied on doctors in private practice, sometimes paying tens of thousands of dollars out of pocket. Recent studies estimate that roughly 1.4 million adults, including 218,000 in California, identify as transgender. While not all of them want genital surgery, it can be prohibitively expensive for those who do.

As a urologist at the University of California San Francisco Medical Center, Maurice Garcia had several transgender patients. He began looking for a place to receive training for genital surgery for transgender adults and adolescents, but with no academic medical centers in the United States that could offer such training, he traveled to England for a yearlong fellowship at University College London. When he returned to U.C.S.F. in 2014 he created the system’s first transgender genital gender-confirming surgery program.

Earlier this year, he began something similar at Cedars-Sinai in Los Angeles — the Transgender Surgery and Health Program — making the hospital one of just two academic medical centers in the West to offer gender reassignment surgery.