TRANSGENDER MEDICINE for ADOLESCENTS and YOUNG ADULTS Speaker: Katherine Blumoff Greenberg, MD
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Clinical Education Initiative [email protected] TRANSGENDER MEDICINE FOR ADOLESCENTS AND YOUNG ADULTS Speaker: Katherine Blumoff Greenberg, MD 5/24/2017 Transgender Medicine for Adolescents and Young Adults [video transcript] 00:00:07 - YeS, So I already introduced mySelf as I Said, I'm the director of our Gender Health ServiceS Clinic. Here we See people from puberty through age 25, but I find mySelf in a conSultative role for people of lotS of ages. And We have, at thiS point, betWeen 800 and 1,000 probably, patientS and families that We've Seen in the laSt five yearS. 00:00:28 I have nothing to discloSe. 00:00:29 And the learning objectiveS are really broad. I Will try to get through as much of thiS as I can Within the time that We have, but I alSo hope to be really uSeful. I knoW that theSe are areaS Where people often have a lot of queStions. Some caSe exampleS, if theSe thingS have come up in your practice, I'm really happy to be a reSource, in addition to Sort of plowing through the Slide tech that I prepared, So pleaSe let me knoW hoW I can be helpful to the folkS out there in the audience. We're gonna talk a lot about psychosocial comorbiditieS. We're not gonna talk that much about STDS, although I want to say, I think it'S in here someWhere that tranS women of color are at juSt aStronomic HIV risk, sort of globally, so it'S definitely one of the thingS We think about really prominently in tranS medicine. Talk about medical treatment and do Some definitionS, becauSe I think it'S important that people understand the proceSS through Which We Work, and then What We do. And then to talk, becauSe a lot of people in upState NeW York about the reSourceS here, but alSo again, to make mySelf a reSource for referralS, for finding local services if folks are in need. 00:01:39 I'm wondering if this picture lookS familiar to anyone, if you have a Way of chatting in. ThiS iS a young woman named Leelah Alcorn, who in 2015, a couple dayS after ChriStmaS, stepped in front of a Mack Truck on a local highWay, and killed herSelf, and left a Suicide note on Tumblr, I believe, one of those Internet platformS that kidS uSe. I don't really knoW what it is. And included the line, "Fix Society. Please." And the Suicide note Went viral. And She WaS in a very small conservative toWn with conservative family Who sent her to reparative therapy. And We know that that happens. We knoW that tranSgender youth, thiS iS a Statement from my governing body, the American Academy of PediatricS, faced huge mental health Sequelae as a conSequence, largely of verbal haraSSment, phySical violence, fear of rejection, actual rejection, that include really prominently depreSSion and Suicidality, but also body image diStortion, substance use, PTSD, and a Whole host of high-riSk behaviors that put them at riSk for thingS like HIV, Whether or not that haS a pathologic diagnoSiS. 00:02:51 When I talk to people, Who like mySelf, and StatiStically are moSt likely to be cisgendered, right? So to be cisgendered iS to be not tranSgendered, to be born into a body that feelS congruent with your SenSe of 1 self. I find mySelf starting by really breaking down some concepts that for those of uS who were born cisgendered and even heteroSexual in this sort of cisnormative, heteronormative World really haven't had to parSe out aS different conceptS. And thiS iS the Gender Bread PerSon, which for anyone out there that'S particularly Woke in gender medicine actually haS a controverSial back Story. But I'll talk about that offline if anyone careS. It'S come up a couple of timeS, but iS a really useful teaching and learning tool, So I uSe it. And in thiS, I really primarily talk about Separating gender identity, which is the sort of rainboW colored brain, from sex. So Sex iS asSigned at birth. It talkS about your chromosomes, your genitals, the stuff that happens, typically on ultraSound, or in the delivery room, right, in which we're uSed to thinking about as a clear binary betWeen male and female. So more on that later. It'S not a binary. But that'S Sex. And for those of us Who are ciSgendered, which iS 99 point Something percent of the population, the StatiSticS are hard to do, but current eStimateS are betWeen .3 and .5% of people identifying aS tranSgender, that for thoSe of uS who are not tranSgender, that alignS With our identity. That alignS What, With the brain, our SenSe of Self, our Sense of our gender iS congruent with that which other people Will aSSign us. For a tranSgender perSon, thoSe thingS are different. And both of them, aS we'll see in the next slide, can exist on a continuum. Both of those are different from gender expreSSion, which iS how you repreSent yourSelf in the World as either masculine or feminine. It'S very culturally defined. It'S very sort of time and place specific. And We used to demand that if you Were really tranSgender, you had to have a gender expresSion that Was Sort of at the oppoSite end of the binary. If you Were really a tranSgender man, I Say really in quoteS, you had to want to be GI Joe. If you were really a tranSgender Woman, you had to Want to be a Barbie doll, right? You had to Sort of ultimately conform to theSe huge StereotypeS that We have about gender expresSion. And We no longer demand that people do that. I have tranS boyS who identify as Sort of feminine Women, feminine men, and that'S okay, 'cauSe if I had a ciSgendered boy who told me he waS a more feminine man, I would not queStion hiS ability to define hiS gender in that way, right? So identity and Sex are different from each other and different from expreSSion. And all of that iS different from Sexual orientation, who you love, want to be romantically or Sexually partnered With. 00:05:29 And thiS iS that Sort of Spectrum that We talk about. So the very top line iS natal Sex or anatomy. And again, people think about that aS being very binary, male or female, but there are many people who exiSt in categories that We Would group under interSex, right? Which iS Where there are difference in anatomy, chromosomes, hormone production by the body, hormone reSponse Within the body, that put someone someWhere betWeen male and female on that very baSic biological data point. Again, gender identity can fall in betWeen thoSe two data pointS. So I have people Who increasingly are out as identifying aS gender queer, gender fluid, otherWiSe, Sort of nonbinary. Gender expreSSion and Sexual orientation certainly are on that Spectrum. So any one of my patientS could be at a different place on each of these four axes, right? Depending on hoW they Self-define. ParentS are often, like, mind bloWn. I find mySelf explaining thiS a lot to the parents of youth who are in with me. And the kid iS Sitting there nodding, going, yeah, of courSe, and the parentS are really quite confuSed by thiS. It'S okay, it'S neW for a lot of people. 00:06:41 2 I also get a lot of parentS who say, well he'S only five, hoW could he possibly knoW? He'S only 10, hoW could he possibly knoW? He'S only 15, hoW could he possibly knoW? He'S only 20, hoW could he poSSibly knoW? I've gotten this hoW could you possibly knoW from a parent of a youth or young adult at any age that I See. And the ansWer iS that if your child waS born into a male body and waS telling you that he Was male, you Wouldn't queStion hiS ability to knoW that, right? We knoW that little kidS knoW their gender betWeen the ageS of one and tWo, they identify phySical differenceS betWeen the SexeS. I have a almoSt five-year-old Who, as Soon as She figured out that other boyS in her daycare claSS had peniseS, waS like the peniS patrol. Tommy has a peniS, or Whenever diaper changeS Were happening, she Was like there, ready to point out theSe phySical differenceS. At three yearS old, people can generally label themselves. By four yearS old, they knoW that juSt becauSe you put on a dreSS doeSn't mean you magically tranSform into a girl or vice verSa, right? And Some little kids really do know thiS and really do knoW that the gender box that they're being put into by virtue of their biology, doeSn't feel right for them. Not every kid doeS. There are theSe exampleS of kidS, who from the minute they can talk, are very clear that they are being gendered Wrong, right? TheSe kidS come to me With a long hiStory, since the minute they Were verbal, of being croSS-gendered. But that doeSn't alWayS happen. So When I have parentS of kidS Who sort of come out later in life, and if later in life is 12, the parents can be confuSed by that. That'S okay, too, but We do knoW that little kidS can be very aware of gender identity and can knoW What'S going on with them.