November 14, 2024 • 16 mins
Prepare to challenge your understanding of gender-affirming care.
In this replay of one of our most popular episodes, Dr. Anna Filip, a primary care physician with ChristianaCare, and Brett Herb, DSW, program manager for the ChristianaCare Gender Wellness Program, deliver critical insights into the complexities of sex and gender, gender dysphoria and gender-affirming hormone therapy, while discussing ChristianaCare's leading-edge approach to providing care to transgender people.
Then we tackle a number of common myths, misconceptions and misunderstandings– from the realities of de-transitioning to how children understand their gender identities.
Join us for a conversation that not only educates but also encourages empathy. You'll come away with a new appreciation for the importance of fostering inclusivity in health care.
Dr. Anna Filip is a primary care physician and director of ChristianaCare's Family Medicine Residency program. Filip has been with ChristianaCare since 2016. She has led work around global health in the academic settings, developed innovative and comprehensive models of gender-affirming care, and is staunchly committed to improving the diversity, equity and inclusion efforts across the health system.
Brett Herb, DSW, is the Program Manager for the Gender Wellness Program at ChristianaCare. Herb has been in clinical practice for over 25 years as a psychotherapist and a clinical and administrative manager for various behavioral health programs. He joined ChristianaCare in 2006. Herb oversees the Gender Wellness Program, which provides gender-affirming diagnostic services and psychotherapy to the transgender and gender diverse population.
LINKS
- ChristianaCare Gender Wellness Program
- Exploring gender wellness at ChristianaCare (video)
- Myths and Facts: Battling Disinformation About Transgender Rights
- The Experiences, Challenges and Hopes of Transgender and Nonbinary U.S. Adults
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hello everyone, I'm Megan McGerman.
Speaker 2 (00:02):
And I'm Jason Tagarski.
Welcome to For the Love ofHealth brought to you by
Christiana Care.
Speaker 1 (00:06):
We're taking a few-week break from releasing
new content, so we're bringingback some of our most popular
For the Love of Health episodes.
Speaker 2 (00:14):
As we approach Transgender Day of Remembrance
on November 20th, we'rerevisiting our episode Busting
Myths About Gender-AffirmingCare with Brett Herb and Dr Anna
Phillip myths aboutgender-affirming care with Brett
Herb and Dr Anna Phillip.
Speaker 3 (00:27):
It's really important that we're treating someone in
the way that they see themselves, because that is the way we
keep them healthy.
Speaker 2 (00:35):
You're listening to For the Love of Health, a
podcast about delivering careand creating health, brought to
you by Christiana Care.
And now here are your hosts.
Speaker 4 (00:45):
Hi everyone.
Speaker 1 (00:45):
I'm Michael Chesney and I'm Megan McGerman.
Speaker 4 (00:47):
Welcome to another episode of For the Love of
Health, brought to you byChristiana Care you know, in
recent years, healthcareproviders have expanded and
improved the ways that they carefor transgender individuals,
from primary care and behavioralhealth to gender affirming,
hormone therapy and beyond.
Speaker 1 (01:02):
Christiana Care is a leader in LGBTQ plus health care
and has providers focused ondelivering compassionate,
state-of-the-art care fortransgender and gender diverse
individuals.
Speaker 4 (01:12):
Here today to talk about Christiana Care's gender
wellness program and dispel somecommon myths and misconceptions
about gender wellness areprimary care physician Dr Anna,
phillip and Brett Herb, doctorof social work and program
manager for the gender wellnessprogram.
Brett and Anna, thank you somuch for being with us.
Thank you for having us.
Thank you.
Speaker 1 (01:31):
So let's start by defining some of the terms we'll
be discussing during thisconversation.
What is the difference betweensex and gender?
Speaker 5 (01:39):
Sex is what a person is identified at birth, and so
they're identified as male,female or intersex, and gender
identity is how a person viewstheir own gender, which may be
male, female or have no genderat all.
Speaker 1 (01:52):
And then, what about gender dysphoria?
Speaker 5 (01:55):
Those folks who don't feel that their gender that was
assigned to them at birth, orwhat we call their sex assigned
at birth, doesn't match up withwho they are.
So it's a person who was toldthat they were a girl and they
were told they were a girlbecause their genitalia matched
a girl's genitalia.
They know that that isn't amatch for them.
(02:15):
They know that being a girl,whatever that means to them and
I'm not focused on justgenitalia, but their identity of
they're supposed to be a girldoesn't fit for them and they
have distress over that.
They could have anxiety, theycould have depression, they
could be very uncomfortable withthe way that their body looks.
Speaker 4 (02:33):
Anna, what about gender-affirming care?
And also, what's the differencebetween that and
gender-affirming hormone therapy?
Speaker 3 (02:42):
Gender-affirming care I like to think of as primary
care, and primary care should begender-affirming.
And gender-affirming care meanscreating a safe space for
someone to reach out and gethigh-quality health care,
regardless of who they are orhow they identify.
And in my office that meansasking all the right questions
in all the right languages andusing the terms that they use to
(03:06):
identify themselves.
And it's important to take careof someone in their entirety
and that means asking abouttheir sexual orientation and
their gender identity.
And it's important to do thisacross an entire health system
so that you're providing genderaffirming care to anyone,
wherever they are.
When they touch the system Withme as a primary care family doc
(03:27):
, or with a cardiologist or asurgeon.
It's really important that we'retreating someone in the way
that they see themselves,because that is the way we keep
them healthy.
So gender-affirming hormonetherapy is sometimes used in
patients who identify as transor gender diverse.
It's a tool that we use forthem to help have their gender
(03:48):
identity match theirpresentation.
So sometimes we use hormonetherapy.
Sometimes people who identifyas gender diverse or trans do
not need hormone therapy to haveaffirming care.
Speaker 4 (04:00):
Why is it so important to provide that kind
of space?
To make sure that you're usingthe correct pronouns, the
correct name for somebody who'scoming in for primary care.
Speaker 3 (04:11):
Yeah, Frederick, it's Frederick right.
Speaker 4 (04:14):
It's Michael.
Speaker 3 (04:15):
Okay, yeah, well, I really appreciate.
You know, frederick, when we'retalking to people and they have
a name that they reallyidentify with, like Frederick,
it's really important for themto have that sense of identity.
And so I'm just going to stopyou there.
I know you're not Frederick, Iknow you're Michael, but I want
(04:36):
to know and I often will askpatients something similar to
that for them to have thatexperience of having the wrong
name.
Because tell me how you felt inthat moment.
Speaker 4 (04:46):
I was really uncomfortable.
Speaker 1 (04:48):
Just watching it was uncomfortable, I could feel it
on my face.
Speaker 2 (04:51):
You can't see it on the podcast, maybe on the
YouTube, but it was just like itjust felt.
Speaker 3 (04:55):
Yeah, absolutely.
And I think if I was yourdoctor in that situation, I
think everything I would havesaid after that moment, or
reiterated, when I kept usingFrederick instead of Michael,
you would have completelyignored me and had no trust in
my care.
So I think for both of us,trust is really important in the
(05:15):
care that we provide ourpatients, and so you need to do
everything to ensure that trustand that mutual respect and
relationship, because you'regoing to get further in
someone's care if we're doingthat.
Speaker 5 (05:27):
And that's why both of us always ask that's the
first question we ask is we aska person their name and we ask
the person their pronouns?
A lot of times, people use thelanguage of preferred name in
comparison to legal name.
I don't like that.
I like just the name that theyuse.
Speaker 3 (05:40):
If a patient has reached out to us and we need to
schedule an appointment, thefirst question is what pronouns
do you use?
I'll even ask when I'm in theroom with a patient what name
they prefer to be used in thechart, because that's important
too for the rest of the careteam to have access to that
information.
You know the care team sharesthat information in a variety of
(06:01):
ways.
It's important for me, wheneverI do a referral, to put that
information in the referral aswell, and then we do it in a
variety of other ways.
All over my office we have lotsof pronoun pins, and you have
them too at your office.
I encourage if my residents andmy staff want to express their
pronouns, then they'll wear thepins as well.
Speaker 1 (06:21):
Those pronoun pins are available across the health
system, but that is a relativelynew initiative here at
Christiana Care, and theseconversations are being had more
and more around the world.
How has this work changed overthe last few years?
Speaker 5 (06:35):
I've been working with trans folks for the last 18
years and, as more people arefeeling safe to come out,
there's just more and morepeople who are seeking services.
I do behavioral health care, soI do psychotherapy, and
Christiana Care saw the need andwas willing to expand and have
it not just be, you know, mebeing the one doing the
treatment.
So we now have a genderwellness program where we have
(06:57):
three therapists and there's oneintern, and we've just gotten a
lot of support.
Delaware actually has thesecond highest percentage per
capita of transgender and genderdiverse people in the United
States, and that's why it's soimportant that Christiana Care
is providing these programs thatwe have, because we need to be
able to treat this population.
Speaker 3 (07:17):
Yeah, and I mean I've been doing this work for over a
decade now not quite as long,but since my residency and since
training and I think that forme it's changed over that time
as well.
There's been a lot moreincrease in research around the
care that we're providing.
There's been a drastic increasein participation in
(07:38):
associations of providers whoprovide this care.
We have a US chapter of theAssociation for Transgender
Health that's part of what'scalled WPATH, or the World
Professional Association ofTransgender Health, which has
grown over that decade as well.
So lots of great work inproviding support for the
providers so that we can do abetter job of providing support
(08:00):
for the patients.
Speaker 4 (08:02):
Now that we've set the stage, we promised that we
would address some myths, maybedispel some of these common
thoughts that are out thereabout the work that you do and
the population that you workwith.
So let's start here.
Brett.
Myth number one most youngpeople that transition regret
their decision and want todetransition.
Speaker 5 (08:22):
First of all, it's a very small population that does
detransition and the ones thatdo if you interview them, have
conversations with them it's dueto the fact that they don't
have the supports that they needto live in their new gender.
They are not able to get jobs,they don't have supportive
families, there's healthdisparities and there's issues
(08:43):
around like housing that peoplearen't able to get.
If they're trans folks thatdetransitioned, really, what's
happening is they are juststopping their hormones for a
time until they feel safe again.
One percent of people that havegenital surgeries.
There's evidently some regret,but the question is did they
talk with the number ofprofessionals they needed to?
Did they get have enoughconversations with them to make
(09:04):
sure that they were making theright decision at the time?
And I think that, because it isonly 1% that tells us that
providers are doing behavioralhealth and also any of their
medical providers are doing agood job at working with those
people to figure out if that issomething they medically need.
Speaker 3 (09:20):
And I think it's important to note that that's
regrettable or a specific partof their affirming therapy, and
so it's not necessarily thatthey are wanting to stop all
affirming therapies likehormones or things like that.
Speaker 1 (09:37):
And the second myth goes to you.
It's the myth that kids are tooyoung to know if they're
transgender, or only becausethey saw it on TikTok do they
think that they might betransgender.
Speaker 3 (09:48):
That's absolutely a myth.
You know, as a family doc, Iget the joy of being with
families from all ages and Ireally get to watch kids develop
over time and with childhooddevelopment we know that their
identity is forming at a veryyoung age.
Childhood development we knowthat their identity is forming
at a very young age and in ourcis children.
(10:08):
And cis means that their sexassigned at birth is the same as
their gender identity.
And in our cis kids we knowthat when they're very young,
even at the age of three to four, they're really identifying as
I'm a girl, I'm a boy and theystick to that.
They're insistent, consistentand persistent in that.
Our youth who identify as transor gender diverse have similar
(10:33):
insistent, consistent andpersistent in the fact that they
don't identify as boy or girland are trying to figure out
what they do identify as.
And we find that over time thatinsistency and consistency and
persistency in their identitystays.
And when it stays, that's whenwe know that they will grow up
(10:57):
to be trans or gender diverse.
Oftentimes kids, as they grow,don't have the language to
understand or speak to theiridentity or the feelings that
they're having as they develop.
And so in the age of socialmedia and the internet.
It's a wider community thatkids have access to now, and I
(11:18):
often have a lot of patients whocome in and say I found a
person or I found a group onlineand they used this word and
that word spoke to me and all ofa sudden I knew what I was
feeling, and so it's thatincreased access to language and
the ability to communicate thathelps them identify.
Speaker 4 (11:37):
And the third one to you gender affirming therapy is
unsafe and subjects patients toirreversible medical procedures.
Speaker 3 (11:46):
I think that that's absolutely a myth and we really
need to clarify that, becausethese are medications and
treatments and conversationsthat clinicians are having with
their patients, and this is along process to really diagnose
with gender dysphoria.
We have multiple conversationsover a long period of time and
(12:09):
we do a good job ofunderstanding the patient's
needs and desires and coming toan understanding of how we can
work together to get to that end.
Sometimes it involves hormones.
Sometimes, when they're younger, it involves medications that
are often called hormoneblockers, and hormone blockers
(12:29):
are a wonderful tool to use,especially in our youth, because
what it can do it allows us toblock puberty from starting.
We have a lot of informationabout these medications and the
safety of these medicationsbecause we use them in a lot of
other diagnoses things likeprecocious puberty or puberty
(12:50):
happening too soon for patientsand we use them to block that
puberty until it's age anddevelopmentally appropriate.
And we're doing the exact samething when we're using it with
our trans and gender diversepatients.
It's like pressing the pausebutton and we do a lot more
counseling and therapy and workwith our patients and families
and their support group untilwe're ready to take the next
(13:12):
step.
Sometimes that's removing thehormone blockers, Sometimes
that's adding a hormone so thatthey can live an affirming,
supportive and healthy life.
All of this is done underreally close clinician
supervision along with ourbehavioral health colleagues to
do this in a really safe andsupportive way.
(13:33):
For example, we may reach an agewhere it's time to decide if
we're going to add hormones to apatient so that they can go
through the puberty of theiraffirming gender, or we may
decide that it's time to removethe hormone blockers and then
they will proceed through thepuberty of what's called their
natal or sex assigned at birthpuberty, and either one of those
(13:57):
are very safe to do, but it'sreally important to give them
that time to think through thatand to work through it, Because
if we don't do that, we have alot of data and a lot of
information to know that harm isdone if we have the patients go
through their natal pubertywhen that's not the one that's
needed.
There are changes that arepermanent with puberty and those
(14:20):
are irreversible and sometimesthose can be very triggering and
cause significant dysphoria forour patients, and I see that
caring for older adults and weknow that if we can prevent
those.
The rates of attempting suicide.
The rates at succeeding insuicide drastically decrease in
our patients.
My job as a doctor is to firstdo no harm and to support
(14:44):
patients in the things that keepthem healthy.
They need to continue to liveto be healthy.
Speaker 1 (14:50):
And that ties back into the second myth, that they
are not too young to be havingthese conversations.
Speaker 3 (14:56):
Absolutely, Especially when they're voicing
those opinions insistently,consistently and persistently.
Speaker 1 (15:03):
Brett, the fourth and final myth will go to you.
The myth is that thetransgender community is looking
for special treatment.
Speaker 5 (15:10):
The answer is no to that.
I mean, I often have thoseconversations with my patients
about how they go intosituations and all they want to
be do is being treated the same,you know, as anybody else, and
it's actually something they'llthink to talk about, to almost
celebrate, when they've had anexperience that someone treated
them properly, and that's verysad.
I mean we should be treatingthese folks properly.
(15:32):
You know, for somebody elsewho's cis, there's not like
saying, oh, my doctor smiled atme today and used the right name
, all right.
Speaker 4 (15:38):
So four myths totally debunked totally bestowed.
Nice job.
You guys are our myth busters.
We really appreciate both ofyou being with us today.
Speaker 1 (15:49):
Thank you for having us, and we'll have more
information on gender identity,gender affirming care and
Christiana Care's genderwellness program in today's show
notes.
Speaker 4 (15:58):
Those are available at christianacareorg slash
podcasts, where you can alsofind links to subscribe to For
the Love of Health, on yourfavorite podcast app.
Speaker 1 (16:06):
And don't forget to leave us a review to help more
people find the show and connectwith Christiana Care on social
media.
Speaker 4 (16:11):
We're going to be back in two weeks with another
great episode.
Speaker 1 (16:14):
Until then, thanks for joining us for the Love of
Health.
Hello everyone, I'm Megan McGerman.
Speaker 2 (00:02):
And I'm Jason Tagarski.
Welcome to For the Love ofHealth brought to you by
Christiana Care.
Speaker 1 (00:06):
We're taking a few-week break from releasing
new content, so we're bringingback some of our most popular
For the Love of Health episodes.
Speaker 2 (00:14):
As we approach Transgender Day of Remembrance
on November 20th, we'rerevisiting our episode Busting
Myths About Gender-AffirmingCare with Brett Herb and Dr Anna
Phillip myths aboutgender-affirming care with Brett
Herb and Dr Anna Phillip.
Speaker 3 (00:27):
It's really important that we're treating someone in
the way that they see themselves, because that is the way we
keep them healthy.
Speaker 2 (00:35):
You're listening to For the Love of Health, a
podcast about delivering careand creating health, brought to
you by Christiana Care.
And now here are your hosts.
Speaker 4 (00:45):
Hi everyone.
Speaker 1 (00:45):
I'm Michael Chesney and I'm Megan McGerman.
Speaker 4 (00:47):
Welcome to another episode of For the Love of
Health, brought to you byChristiana Care you know, in
recent years, healthcareproviders have expanded and
improved the ways that they carefor transgender individuals,
from primary care and behavioralhealth to gender affirming,
hormone therapy and beyond.
Speaker 1 (01:02):
Christiana Care is a leader in LGBTQ plus health care
and has providers focused ondelivering compassionate,
state-of-the-art care fortransgender and gender diverse
individuals.
Speaker 4 (01:12):
Here today to talk about Christiana Care's gender
wellness program and dispel somecommon myths and misconceptions
about gender wellness areprimary care physician Dr Anna,
phillip and Brett Herb, doctorof social work and program
manager for the gender wellnessprogram.
Brett and Anna, thank you somuch for being with us.
Thank you for having us.
Thank you.
Speaker 1 (01:31):
So let's start by defining some of the terms we'll
be discussing during thisconversation.
What is the difference betweensex and gender?
Speaker 5 (01:39):
Sex is what a person is identified at birth, and so
they're identified as male,female or intersex, and gender
identity is how a person viewstheir own gender, which may be
male, female or have no genderat all.
Speaker 1 (01:52):
And then, what about gender dysphoria?
Speaker 5 (01:55):
Those folks who don't feel that their gender that was
assigned to them at birth, orwhat we call their sex assigned
at birth, doesn't match up withwho they are.
So it's a person who was toldthat they were a girl and they
were told they were a girlbecause their genitalia matched
a girl's genitalia.
They know that that isn't amatch for them.
(02:15):
They know that being a girl,whatever that means to them and
I'm not focused on justgenitalia, but their identity of
they're supposed to be a girldoesn't fit for them and they
have distress over that.
They could have anxiety, theycould have depression, they
could be very uncomfortable withthe way that their body looks.
Speaker 4 (02:33):
Anna, what about gender-affirming care?
And also, what's the differencebetween that and
gender-affirming hormone therapy?
Speaker 3 (02:42):
Gender-affirming care I like to think of as primary
care, and primary care should begender-affirming.
And gender-affirming care meanscreating a safe space for
someone to reach out and gethigh-quality health care,
regardless of who they are orhow they identify.
And in my office that meansasking all the right questions
in all the right languages andusing the terms that they use to
(03:06):
identify themselves.
And it's important to take careof someone in their entirety
and that means asking abouttheir sexual orientation and
their gender identity.
And it's important to do thisacross an entire health system
so that you're providing genderaffirming care to anyone,
wherever they are.
When they touch the system Withme as a primary care family doc
(03:27):
, or with a cardiologist or asurgeon.
It's really important that we'retreating someone in the way
that they see themselves,because that is the way we keep
them healthy.
So gender-affirming hormonetherapy is sometimes used in
patients who identify as transor gender diverse.
It's a tool that we use forthem to help have their gender
(03:48):
identity match theirpresentation.
So sometimes we use hormonetherapy.
Sometimes people who identifyas gender diverse or trans do
not need hormone therapy to haveaffirming care.
Speaker 4 (04:00):
Why is it so important to provide that kind
of space?
To make sure that you're usingthe correct pronouns, the
correct name for somebody who'scoming in for primary care.
Speaker 3 (04:11):
Yeah, Frederick, it's Frederick right.
Speaker 4 (04:14):
It's Michael.
Speaker 3 (04:15):
Okay, yeah, well, I really appreciate.
You know, frederick, when we'retalking to people and they have
a name that they reallyidentify with, like Frederick,
it's really important for themto have that sense of identity.
And so I'm just going to stopyou there.
I know you're not Frederick, Iknow you're Michael, but I want
(04:36):
to know and I often will askpatients something similar to
that for them to have thatexperience of having the wrong
name.
Because tell me how you felt inthat moment.
Speaker 4 (04:46):
I was really uncomfortable.
Speaker 1 (04:48):
Just watching it was uncomfortable, I could feel it
on my face.
Speaker 2 (04:51):
You can't see it on the podcast, maybe on the
YouTube, but it was just like itjust felt.
Speaker 3 (04:55):
Yeah, absolutely.
And I think if I was yourdoctor in that situation, I
think everything I would havesaid after that moment, or
reiterated, when I kept usingFrederick instead of Michael,
you would have completelyignored me and had no trust in
my care.
So I think for both of us,trust is really important in the
(05:15):
care that we provide ourpatients, and so you need to do
everything to ensure that trustand that mutual respect and
relationship, because you'regoing to get further in
someone's care if we're doingthat.
Speaker 5 (05:27):
And that's why both of us always ask that's the
first question we ask is we aska person their name and we ask
the person their pronouns?
A lot of times, people use thelanguage of preferred name in
comparison to legal name.
I don't like that.
I like just the name that theyuse.
Speaker 3 (05:40):
If a patient has reached out to us and we need to
schedule an appointment, thefirst question is what pronouns
do you use?
I'll even ask when I'm in theroom with a patient what name
they prefer to be used in thechart, because that's important
too for the rest of the careteam to have access to that
information.
You know the care team sharesthat information in a variety of
(06:01):
ways.
It's important for me, wheneverI do a referral, to put that
information in the referral aswell, and then we do it in a
variety of other ways.
All over my office we have lotsof pronoun pins, and you have
them too at your office.
I encourage if my residents andmy staff want to express their
pronouns, then they'll wear thepins as well.
Speaker 1 (06:21):
Those pronoun pins are available across the health
system, but that is a relativelynew initiative here at
Christiana Care, and theseconversations are being had more
and more around the world.
How has this work changed overthe last few years?
Speaker 5 (06:35):
I've been working with trans folks for the last 18
years and, as more people arefeeling safe to come out,
there's just more and morepeople who are seeking services.
I do behavioral health care, soI do psychotherapy, and
Christiana Care saw the need andwas willing to expand and have
it not just be, you know, mebeing the one doing the
treatment.
So we now have a genderwellness program where we have
(06:57):
three therapists and there's oneintern, and we've just gotten a
lot of support.
Delaware actually has thesecond highest percentage per
capita of transgender and genderdiverse people in the United
States, and that's why it's soimportant that Christiana Care
is providing these programs thatwe have, because we need to be
able to treat this population.
Speaker 3 (07:17):
Yeah, and I mean I've been doing this work for over a
decade now not quite as long,but since my residency and since
training and I think that forme it's changed over that time
as well.
There's been a lot moreincrease in research around the
care that we're providing.
There's been a drastic increasein participation in
(07:38):
associations of providers whoprovide this care.
We have a US chapter of theAssociation for Transgender
Health that's part of what'scalled WPATH, or the World
Professional Association ofTransgender Health, which has
grown over that decade as well.
So lots of great work inproviding support for the
providers so that we can do abetter job of providing support
(08:00):
for the patients.
Speaker 4 (08:02):
Now that we've set the stage, we promised that we
would address some myths, maybedispel some of these common
thoughts that are out thereabout the work that you do and
the population that you workwith.
So let's start here.
Brett.
Myth number one most youngpeople that transition regret
their decision and want todetransition.
Speaker 5 (08:22):
First of all, it's a very small population that does
detransition and the ones thatdo if you interview them, have
conversations with them it's dueto the fact that they don't
have the supports that they needto live in their new gender.
They are not able to get jobs,they don't have supportive
families, there's healthdisparities and there's issues
(08:43):
around like housing that peoplearen't able to get.
If they're trans folks thatdetransitioned, really, what's
happening is they are juststopping their hormones for a
time until they feel safe again.
One percent of people that havegenital surgeries.
There's evidently some regret,but the question is did they
talk with the number ofprofessionals they needed to?
Did they get have enoughconversations with them to make
(09:04):
sure that they were making theright decision at the time?
And I think that, because it isonly 1% that tells us that
providers are doing behavioralhealth and also any of their
medical providers are doing agood job at working with those
people to figure out if that issomething they medically need.
Speaker 3 (09:20):
And I think it's important to note that that's
regrettable or a specific partof their affirming therapy, and
so it's not necessarily thatthey are wanting to stop all
affirming therapies likehormones or things like that.
Speaker 1 (09:37):
And the second myth goes to you.
It's the myth that kids are tooyoung to know if they're
transgender, or only becausethey saw it on TikTok do they
think that they might betransgender.
Speaker 3 (09:48):
That's absolutely a myth.
You know, as a family doc, Iget the joy of being with
families from all ages and Ireally get to watch kids develop
over time and with childhooddevelopment we know that their
identity is forming at a veryyoung age.
Childhood development we knowthat their identity is forming
at a very young age and in ourcis children.
(10:08):
And cis means that their sexassigned at birth is the same as
their gender identity.
And in our cis kids we knowthat when they're very young,
even at the age of three to four, they're really identifying as
I'm a girl, I'm a boy and theystick to that.
They're insistent, consistentand persistent in that.
Our youth who identify as transor gender diverse have similar
(10:33):
insistent, consistent andpersistent in the fact that they
don't identify as boy or girland are trying to figure out
what they do identify as.
And we find that over time thatinsistency and consistency and
persistency in their identitystays.
And when it stays, that's whenwe know that they will grow up
(10:57):
to be trans or gender diverse.
Oftentimes kids, as they grow,don't have the language to
understand or speak to theiridentity or the feelings that
they're having as they develop.
And so in the age of socialmedia and the internet.
It's a wider community thatkids have access to now, and I
(11:18):
often have a lot of patients whocome in and say I found a
person or I found a group onlineand they used this word and
that word spoke to me and all ofa sudden I knew what I was
feeling, and so it's thatincreased access to language and
the ability to communicate thathelps them identify.
Speaker 4 (11:37):
And the third one to you gender affirming therapy is
unsafe and subjects patients toirreversible medical procedures.
Speaker 3 (11:46):
I think that that's absolutely a myth and we really
need to clarify that, becausethese are medications and
treatments and conversationsthat clinicians are having with
their patients, and this is along process to really diagnose
with gender dysphoria.
We have multiple conversationsover a long period of time and
(12:09):
we do a good job ofunderstanding the patient's
needs and desires and coming toan understanding of how we can
work together to get to that end.
Sometimes it involves hormones.
Sometimes, when they're younger, it involves medications that
are often called hormoneblockers, and hormone blockers
(12:29):
are a wonderful tool to use,especially in our youth, because
what it can do it allows us toblock puberty from starting.
We have a lot of informationabout these medications and the
safety of these medicationsbecause we use them in a lot of
other diagnoses things likeprecocious puberty or puberty
(12:50):
happening too soon for patientsand we use them to block that
puberty until it's age anddevelopmentally appropriate.
And we're doing the exact samething when we're using it with
our trans and gender diversepatients.
It's like pressing the pausebutton and we do a lot more
counseling and therapy and workwith our patients and families
and their support group untilwe're ready to take the next
(13:12):
step.
Sometimes that's removing thehormone blockers, Sometimes
that's adding a hormone so thatthey can live an affirming,
supportive and healthy life.
All of this is done underreally close clinician
supervision along with ourbehavioral health colleagues to
do this in a really safe andsupportive way.
(13:33):
For example, we may reach an agewhere it's time to decide if
we're going to add hormones to apatient so that they can go
through the puberty of theiraffirming gender, or we may
decide that it's time to removethe hormone blockers and then
they will proceed through thepuberty of what's called their
natal or sex assigned at birthpuberty, and either one of those
(13:57):
are very safe to do, but it'sreally important to give them
that time to think through thatand to work through it, Because
if we don't do that, we have alot of data and a lot of
information to know that harm isdone if we have the patients go
through their natal pubertywhen that's not the one that's
needed.
There are changes that arepermanent with puberty and those
(14:20):
are irreversible and sometimesthose can be very triggering and
cause significant dysphoria forour patients, and I see that
caring for older adults and weknow that if we can prevent
those.
The rates of attempting suicide.
The rates at succeeding insuicide drastically decrease in
our patients.
My job as a doctor is to firstdo no harm and to support
(14:44):
patients in the things that keepthem healthy.
They need to continue to liveto be healthy.
Speaker 1 (14:50):
And that ties back into the second myth, that they
are not too young to be havingthese conversations.
Speaker 3 (14:56):
Absolutely, Especially when they're voicing
those opinions insistently,consistently and persistently.
Speaker 1 (15:03):
Brett, the fourth and final myth will go to you.
The myth is that thetransgender community is looking
for special treatment.
Speaker 5 (15:10):
The answer is no to that.
I mean, I often have thoseconversations with my patients
about how they go intosituations and all they want to
be do is being treated the same,you know, as anybody else, and
it's actually something they'llthink to talk about, to almost
celebrate, when they've had anexperience that someone treated
them properly, and that's verysad.
I mean we should be treatingthese folks properly.
(15:32):
You know, for somebody elsewho's cis, there's not like
saying, oh, my doctor smiled atme today and used the right name
, all right.
Speaker 4 (15:38):
So four myths totally debunked totally bestowed.
Nice job.
You guys are our myth busters.
We really appreciate both ofyou being with us today.
Speaker 1 (15:49):
Thank you for having us, and we'll have more
information on gender identity,gender affirming care and
Christiana Care's genderwellness program in today's show
notes.
Speaker 4 (15:58):
Those are available at christianacareorg slash
podcasts, where you can alsofind links to subscribe to For
the Love of Health, on yourfavorite podcast app.
Speaker 1 (16:06):
And don't forget to leave us a review to help more
people find the show and connectwith Christiana Care on social
media.
Speaker 4 (16:11):
We're going to be back in two weeks with another
great episode.
Speaker 1 (16:14):
Until then, thanks for joining us for the Love of
Health.
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