Featured Investigator: Robert Garofalo, MD, MPH

November 2022: Robert Garofalo, MD, MPH
Chief, Division of Adolescent & Young Adult Medicine; Lurie Children's Hospital
Potocsnak Family Professor, Department of Pediatrics, Northwestern Feinberg School of Medicine

Dr. Robert Garofalo is a Potocsnak Family Professor of Pediatrics and Preventive Medicine at Northwestern University’s Feinberg School of Medicine in Chicago, Illinois. He is an attending physician at the Ann & Robert H. Lurie Children’s Hospital, where he serves as the Chief of the Division of Adolescent & Young Adult Medicine. He founded and now co-directs the Lurie Children’s Gender & Sex Development Program, the first comprehensive program providing multidisciplinary care to transgender/gender-nonconforming children and adolescents in the Midwest. His primary clinical and research activities relate to the care of marginalized youth populations including HIV-positive and lesbian, gay, bisexual, and transgender (LGBT) young people. His research focuses on HIV prevention, mostly targeting either young men who have sex with men (MSM) or transgender individuals. He has more than 20 years of research experience in this field and is a national authority and advocate on LGBT health issues, adolescent sexuality, and HIV clinical care and prevention. In 2010, he was appointed to the National Academy of Science/Institute of Medicine Committee on LGBT Health Issues and Research Gaps and Opportunities. Dr. Garofalo is the Editor-in-Chief of the Transgender Health journal. He has received numerous awards from community-based and professional organizations for his community service and research. In 2019 he was awarded the Ellen Perrin Lifetime Achievement Award in LGBTQ Health by the American Academy of Pediatrics. He has over 175 peer-reviewed publications in scholarly journals, including seminal work related to LGBTQ youth and developing evidence-based HIV prevention and sexual health interventions for young gay men and transgender women, as well as medication adherence among youth living with HIV. In 2021 he was appointed by the Office of the Director to the Sexual and Gender Minority Health Research Working Group of the NH Council of Councils. In addition to his academic work, Dr. Garofalo is the founder of Fred Says (named after his dog), a 501©3 non-profit charity that since 2013 has raised and donated back to the community over $1 million to support care and services for HIV+ youth. In 2021 he co-authored the book When Dogs Heal: Powerful Stories of People Living with HIV and the Dogs That Saved Them which is based on his own personal journey living with HIV.

Q: What are your current research interests?
A: I have spent the better part of my career trying to better understand the lives and lived experiences of SGM youth populations, with a specific focus on youth often overlooked in prevention science such as youth living with and impacted by HIV, BiPOC transgender women and most recently gender affirming care with children and transgender adolescents. I have always approached research through the lens of a clinician and as someone living with HIV, primarily focused on intervention development aimed at providing solutions and empowering young people with tools they can use to thrive and remain healthy.

Q: Tell us about your career path – how did you end up where you are now?
A: Ha! Honestly, I am not entirely sure. This was never quite the path I envisioned for my career. Truth is I am a clinician and pediatrician at heart. Always have been. Always will be. I will always have a bit of “imposter syndrome” in research spaces, despite being fortunate to have generous funding by the NIH throughout my career. Increasingly these days, my focus is also on global health and on the mentorship of a future generation of clinicians and scientists In SGM fields. I hope I am the kind of leader, and mentor, who not only consumes oxygen in this space but creates oxygen for others. The work that our team is currently doing with youth in Nigeria has proven to be among the most meaningful and impactful of my career. I truly love this job; what I get to do in it and with it. I hope my enthusiasm is evident and rubs off on others. I have never shied away from being authentically myself even if that means I come across as a little quirky or unorthodox. I’ve gauged “success” less by academic titles, and/or grants award, and more by who I am as a person and the lives I get to touch through this work. I have so much gratitude for the opportunity and ability to work with HIV+ young people, SGM youth and their families. In terms of my career path, I also want to give a shout out to the philanthropic work that I get to do through Fred Says, a 501c3 non-profit charitable organization I started in honor of my dog (www.fredsays.org). Giving back to others in the form of philanthropy has been a gift and a complement to my academic career. Fred Says supports SGM youth in the U.S. and across the globe. In 2022, we will surpass the $1 million mark in giving monies back to organizations caring for SGM youth.  

Q: What organizational challenges have you faced?
A:There have been many. Today, the academic field of SGM health and health disparities research seems so well-established, and organized, and mobilized. But it was not that long ago that this was more aspirational than reality. I was the first openly gay physician in my pediatric residency program. I was the first openly gay pediatric faculty member at my current institution.  I was told “NO” so many times early in my career especially when I sought to do research or build clinical programs related to SGM young people (e.g. <18 years of age). I was told that it was too risky for my institution to do basic survey research with gay and lesbian youth <18 years of age without parental consent, that there wouldn’t be any funding or that it just wasn’t the right time to do research with transgender women, and that SGM research with adolescents wasn’t an institutional priority. Thankfully, I seldom listened and made it a priority. Now, have I at times perhaps been pushy, overly emotional or opinionated, even dramatic over the years? Have I made people uncomfortable?  I sure have. But that also made me effective. And in the end, I am fortunate that through it all, I have always felt supported, affirmed and valued.

Q: What advice do you have for trainees and researchers who want to work in this area or are interested in applying for NIH funding? 
A: Always be tenacious, thoughtful, fearless, inclusive, unapologetic and most always, kind. Kindness is underrated in our profession, and it is important. Pick your academic partners wisely, very wisely. Don’t ever emphasize innovation at the expense of practicality. Keep stepping out of the echo (ego)-chamber that often defines academia and remain humble and focused on what really matters – People! And most of all, never let anyone tell you that something is impossible; that often just means they aren’t as stubborn an/or determined as you are. 

Q: Do you have any specific advice for working with and involving SGM populations in research?
A: One bit of advice, and it is something I admittedly must continually work on, is to be creative and very intentional in efforts to ensure that ALL members of SGM populations are not only appropriately reflected in SGM research but in all aspects of our research teams. My other advice is to embrace risk taking and the unknown. Challenge your comfort zones. By far some of the most rewarding career opportunities seemed at the time risky or pushed my limits; whether that be starting an HIV charity with my dog, deciding a decade ago to being doing gender affirming care with gender diverse children and adolescents, taking on the Editor-in-Chief for the journal Transgender Health, or even working with youth in Nigeria. Taking risks for me throughout my career has often produces amazing rewards. 

Q: Who inspires you?
A: I find inspiration in the next generation of SGM researchers. To continue to see this field grow and deepen and improve is really something special. Outside of the professional sphere, I am also inspired by the young gay men and MSM in Nigeria that we work with. They display courage and strength and perseverance in the face of stigma that we in the U.S. can barely imagine and in the face of the criminalization of their lives and relationships. And given the crazy sociopolitical climate that we find ourselves in these days, with full-on misinformation, hateful rhetoric and an overreach of politics into public health policy and research spaces, I want to honor and say how thoroughly inspired I am by my colleagues, particularly pediatricians, who show up for work in hostile and unsafe environments each and every day caring for transgender youth and their families. We stand with you in solidarity and support. And the young people themselves and their parents who are determined to ensure their children get care and services driven by science and the best available research. They are all heroes in my eye.

Q: Any final words of wisdom?
A: Nope. Thank you for letting me share a little bit about my journey and my path in doing this amazing work with these amazing communities.