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I’m a pediatrician who cares for transgender kids – here’s what you need to know

I’m a pediatrician who cares for transgender kids – here’s what you need to know
Photo by Kyle on Unsplash

When Charlie, a 10-year-old boy, came in for his first visit, he didn't look at me or my colleague. Angry and crying, he insisted to us that he was cisgender – that he was a boy and had been born male.

A few months before Charlie came into our office, he handed a note to his mother with four simple words, "I am a boy." Up until that point Charlie had been living in the world as female – the sex he was assigned at birth – though that was not how he felt inside. Charlie was suffering from severe gender dysphoria – a sense of distress someone feels when their gender identity doesn't match up with their assigned gender.

I am a pediatrician and adolescent medicine specialist who has been caring for transgender youth for over a decade using what is called a gender-affirmative approach. In this type of care, medical and mental health providers work side by side to provide education to the patient and family, guide people to social support, address mental health issues and discuss medical interventions.

Getting on the same page

The first thing our team does is make sure our patients and families understand what gender care is. We always begin initial visits in the same way. "Our goal is to support you and your family on this journey, whatever that may look like for you. My name is Mandy and I am one of the doctors at CATCH – the Child and Adolescent Trans/Gender Center for Health program. I use she/her pronouns." Sharing pronouns helps transgender people feel seen and validated.

We then ask patients and families to share their gender journey so we can better understand where they are coming from and where they hope to go. Charlie's story is one we often hear. A kid may not think much about gender until puberty but begins to experience worsening gender dysphoria when their body starts changing in what feels like the wrong way.

Support and acceptance from family has a huge impact on a transgender person's mental health. AP Photo/Lynne Sladky

Social transitions with family help

Transgender and gender-diverse youth (those whose gender identity doesn't conform to the norms expected of their assigned sex) may face transphobia and discrimination, and experience alarmingly higher rates of depression, anxiety, self-harm and suicide than their cisgender peers. One option can be to socially transition to their identified gender, both at home and in the outside world.

An important first step is to help parents become allies and advocates. Connecting parents with one-to-one as well as group support can help facilitate education and acceptance, while helping families process their own experience. Charlie's parents had been attending a local parent group that helped them better understand gender dysphoria.

In addition to being accepted at home, young people often want to live in the world in their identified gender. This could include changing their name and pronouns and coming out to friends and family. It can also include using public spaces like schools and bathrooms, participating on single-gender sports teams and dressing or doing other things like binding breasts or tucking back male genitalia to present more in line with their gender identity. Though more research needs to be done, studies show that youth who socially transition have rates of depression similar to cisgender peers.

Many young people find that making a social transition can be an important step in affirming identity. For those that still struggle with depression, anxiety and managing societal transphobia, seeing a therapist who has knowledge of and experience with gender-diverse identities and gender dysphoria can also be helpful.

However, most young people also need to make physical changes to their bodies as well to feel truly comfortable.

Medical options for transgender youth can include hormone blockers or hormone therapy as a first step. AP Photo/Lynne Sladky

Gender-affirming medical interventions

When I first met Charlie, he had already socially transitioned but was still experiencing dysphoria. Charlie, like many people, wanted his physical body to match his gender identity, and this can be achieved only through medical interventions – namely, puberty blockers, hormonal medications or surgery.

For patients like Charlie who have started experiencing early female or male puberty, hormone blockers are typically the first option. These medications work like a pause button on the physical changes caused by puberty. They are well studied, safe and completely reversible. If a person stops taking hormone blockers, their body will resume going through puberty as it would have. Blockers give people time to further explore gender and to develop social supports. Studies demonstrate that hormone blockers reduce depression, anxiety and risk of suicide among transgender youth.

Once a person has started or completed puberty, taking prescribed hormones can help people match their bodies with their gender identities. One of my patients, Zoe, is an 18-year-old transgender woman who has already completed male puberty. She is taking estrogen and a medication to block the effects of testosterone. Together, these will help Zoe's body develop breasts, reduce hair growth and have an overall more female shape.

Leo, another one of my patients, is a 16-year-old transgender man who is using testosterone. Testosterone will deepen Leo's voice, help him grow facial hair and lead to a more male body shape. In addition to testosterone, transgender men can use an additional short-term medication to stop menstruation. For nonbinary people like my 15-year-old patient Ty, who is not exclusively masculine or feminine, my colleagues and I personalize their treatments to meet their specific need.

The health risks from taking hormones are incredibly small – not significantly different, in fact, than the risks a cisgender person faces from the hormones in their body. Some prescribed hormone effects are partially reversible, but others are more permanent, like voice deepening and growth of facial hair or breasts. Hormones can also impact fertility, so I always make sure that my patients and their families understand the process thoroughly.

The most permanent medical options available are gender-affirming surgeries. These operations can include changes to genitals, chest or breasts and facial structure. Surgeries are not easily reversible, so my colleagues and I always make sure that patients fully understand this decision. Some people think gender-affirming surgeries go too far and that minors are too young to make such a big decision. But based on available research and my own experience, patients who get these surgeries experience improvements in their quality of life through a reduction in dysphoria. I have been told by patients that gender-affirming surgery "literally saved my life. I was free [from dysphoria]."

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Ongoing gender care

In March 2021, nearly five years after our first visit, Charlie walked into my exam room. When we first met, he was struggling with his gender, anxiety and depression. This time, he immediately started talking about playing hockey, hanging out with friends and making the honor roll. He has been on hormone blockers for five years and testosterone for almost a year. With the help of a supportive family and a gender-competent therapist, Charlie is now thriving.

Being transgender is not something that goes away. It is something my patients live with for their entire lives. Our multidisciplinary care team continues to see patients like Charlie on a regular basis, often following them into young adulthood.

While more research is always needed, a gender-affirmative approach and evidence-based medicine allows young transgender people to live in the world as their authentic selves. This improves quality of life and saves lives, as one of our transgender patients said about his experience receiving gender-affirming care. "I honestly don't think I would be here had I not been allowed to transition at that point. I'm not always 100%. But I have hope. I am happy to see tomorrow and I know I will achieve my dreams."


Mandy Coles is a Clinical Associate Professor of Pediatrics and co-director of the Child and Adolescent Trans/Gender Center for Health at Boston University.

This article first appeared on The Conversation. You can read it here.

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When a Patagonia employee breastfed her baby in a meeting her male VP's response was a masterclass in workplace values

Talk about a "family-friendly workplace."

Holly Morissette/LinkedIn

Years after it happened, Patagonia's approach to the "family-friendly workplace" is a whole new level that still deserves our attention - and praise.

The outdoor clothing and gear company has made a name for itself by putting its money where its mouth is. From creating backpacks out of 100% recycled materials to donating their $10 million tax cut to fight climate change to refusing to sell to clients who harm the environment, Patagonia leads by example.

That dedication to principle is clear in its policies for parents who work for them, as evidenced by a 2019 viral post from Holly Morisette, a recruiter at Patagonia.

Morisette wrote on LinkedIn:

"While nursing my baby during a morning meeting the other day after a recent return from maternity leave, our VP (Dean Carter) turned to me and said...'There is no way to measure the ROI on that. But I know it's huge.'

It got me thinking...with the immense gratitude that I have for on-site childcare at Patagonia comes a responsibility to share a 'call to action'. A PSA to tout the extraordinary benefits that come along with not asking employees to make the gut wrenching decision to either leave their jobs or leave their babies. TO HAVE TO LEAVE THEIR JOBS OR LEAVE THEIR BABIES. That perhaps just one person will brave the subject with their employer (big or small) in the hopes that it gets the wheels turning to think differently about how to truly support working families.

That with a bit of creativity, and a whole lot of guts, companies can create a workplace where mothers aren't hiding in broom closets pumping milk, but rather visiting their babies for large doses of love and serotonin before returning to their work and kicking ass.

It's no wonder that Patagonia has 100% retention of moms. Keeping them close to their babies keeps them engaged. And engaged mothers (and fathers!) get stuff done. Thank you, Patagonia, for leading the way. "


Holly Morissette on LinkedIn: "While nursing my baby during a morning meeting the other day after a recent return from maternity leave, our VP (Dean Carter) turned to me and said..."There is no way to measure the ROI on that. But I know it's huge." It got me thinking...with the immense gratitude that I have for on-site childcare at Patagonia comes a responsibility to share a “call to action". A PSA to tout the extraordinary benefits that come along with not asking employees to make the gut wrenching decision to either leave their jobs or leave their babies. TO HAVE TO LEAVE THEIR JOBS OR LEAVE THEIR BABIES. That perhaps just one person will brave the subject with their employer (big or small) in the hopes that it gets the wheels turning to think differently about how to truly support working families. That with a bit of creativity, and a whole lot of guts, companies can create a workplace where mothers aren't hiding in broom closets pumping milk, but rather visiting their babies for large doses of love and serotonin before returning to their work and kicking ass. It's no wonder that Patagonia has 100% retention of moms. Keeping them close to their babies keeps them engaged. And engaged mothers (and fathers!) get stuff done. Thank you, Patagonia, for leading the way. " www.linkedin.com


Just the first eight words of Morisette's post are extraordinary. "While nursing my baby during a morning meeting..."

As if that's totally normal. As if everyone understands that working moms can be much more engaged and efficient in their jobs if they can feed their baby while they go over sales figures. As if the long-held belief that life and work must be completely separate is a construct that deserves to be challenged.

And then the comment from her male colleague about the ROI (Return on Investment) of breastfeeding—witty, considering the time and place, and yet so supportive.

On-site childcare so that parents don't have to choose between leaving their jobs or leaving their babies. Letting life integrate with work so that working families don't have to constantly feel torn in two different directions. Flexibility in meetings and schedules. Allowing for the natural rhythms and needs of breastfeeders. Making childcare as easy and accessible as possible so that employees can be more effective in their jobs.

All of this seems so profoundly logical, it's a wonder that more companies have not figured this out sooner. Clearly, it works. I mean, who has ever heard of a 100% retention rate for mothers?

Patagonia's got it goin' on. Let's hope more companies take their lead.


This article originally appeared on 8.16.19

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Nine common phone behaviors that are relationship red flags, according to couples therapist

Some of these are surprising.

@couplesthearpywithjohnathan/Instagram, Photo credit: Canva

A couples therapist shares the 9 common phone habits that should be considered red flags.

Odds are we all have some bad phone habits that aren’t necessarily serving our intimate relationships. But those flaws, like scrolling through social media during time together, for instance, are totally manageable. A partner’s overt secrecy with their device, on the other hand, might warrant some real concern.

Still, experts usually suggest that we almost never check our significant other’s phones if we suspect questionable behavior, however tempting it may be. However, there are certain signs that one can be on the lookout for in order to make an informed decision.

Couples therapist Jonathan Van Viegen, MA MFT, recently shared the 9 phone behaviors that he and his wife “never let happen” in their marriage.

1. Not sharing passwords

Most American couples tend to share passwords within a few months of dating. So if there’s reluctance to share passwords in a long term relationship, this could be a red flag.

2. Hiding their phone

Guess the saying of “if you’ve got nothing to hide, you’ve got nothing to fear” applies here.

3. Keeping phone face down

While it’s completely understandable to turn the phone face down to escape from a barrage of notifications, this could be something to take note of if you suspect your partner isn’t being truthful.

4. Turning body or phone away from you when they’re on it

Again, this isn’t inherently malicious. Perhaps this partner is simply trying to not distract themselves or their loved one. But it takes on new meaning if it’s combined with these other behaviors and it could spell problems.

5. Closing apps or locking phone when you approach them

This one is a lot less ambiguous, as the person is clearly trying to cover up their tracks.

6. New password change

As someone who’s watched my husband get locked out of accounts randomly and have to change his password countless times, I would argue that there are plenty of benign reasons for changing passwords. But again, in combination with other behaviors, I could see how this might get labeled as a red flag.

7. Hot and cold about you touching their phone.

If “sometimes it’s okay, other times it’s met with a big reaction,” then you’ve got yourself a red flag.

8. Gets angry or defensive when approached about their behavior

This is kind of a red flag for nearly any subject. Couples should be able to have difficult conversations. In this case, about the need for privacy. If they are aggressively “protective” about it, partners should maybe be wary.

9. Suddenly highly protective of their phone

If your partner goes from being completely open about sharing their phone to suddenly not wanting you near it, that could be a red flag. Unless of course they are currently trying to plan a surprise party for you (also speaking from experience here).

Van Viegen did add the disclaimer that while this set of rules works for his marriage, he’s not saying that everyone should “follow our example - so you do you. But be reassured knowing that at least one other couple in the world isn’t putting up with these disheartening red flags.”

Solving Trust Issues in Relationships

Of course, for some couples, it might be less about looking for red flags and instead looking for ways to build, or rebuild trust. In another video, Van Viegen breaks down three steps to help with that.

1. Focus on Your Desired Future

Instead of getting stuck in past betrayals or breaches of trust, envision a future where trust is restored. Imagine what relationship would look like “when trust is fully restored,” and look for “small signs” that trust is returning, he advises.

2. Identify Exceptions

“Nothing is all bad all the time. Reflect on those times when trust was felt, even if it was small or brief…By examining these exceptions, you’ll store moments in your memory bank where trust was possible—allowing you to build on those moments,” Van Viegen writes.

3. Measure Your Progress

Get a clear picture of where your relationship currently stands when it comes to trust on a scale of 1-10. And keep asking yourself “On a scale of 1 to 10, how much trust do I feel in my partner right now?” and “What would need to happen to move that number up just one point?” throughout the process. As with most things, recording progress is very helpful.

For more tips like this, give Van Viegen a follow on Instagram here.

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Here's why you're probably waking up right at 3 or 4 in the morning and how to make it stop

It happens to just about everyone.

via Polina Kovaleva/Pexels

A woman with her eye mask on in bed.

Do you often wake up at 3 or 4 a.m. with an intense feeling of anxiety? Do you get stressed that you’re awake and begin making a mental laundry list of everything you need to do the next day? Do you start thinking about fights you once had with your spouse or ponder how you have let yourself down in the past?

If so, you’re not alone. It’s common for people to wake up at 3 or 4 a.m. regularly and there’s a reason why we choose this time to catastrophize and worry. The good news is that there are some steps we can take to get through that awkward phase of the night so we can wake up refreshed.

Why do I wake up at 3 or 4 a.m. every night?

Many of us reliably wake up in the middle of the night because after we’ve had a good chunk of sleep, our bodies start to slowly prepare us for the day by reducing melatonin, the hormone that puts us to sleep and increasing levels of cortisol, the stress hormone.

That biological phase of sleep is why we start to feel stressed.

sleep, nightmares, cortisole A woman wakes up in the middle of the nightvia Oscar Calstrom/Pexels

After the big hormone release at 3 or 4 in the morning, if you are dealing with stress in your life, you are more likely to wake up. If your life is calmer and you don’t already have a stress baseline, you will probably wake up, fall asleep quickly and forget that it happened.

Why do I wake up feeling stressed in the middle of the night?

If you’re already experiencing stress in your life, that extra cortisol kick is going to cause you to wake up with a feeling of anxiety. The problem is that when we’re lying in bed in the middle of the night, we are in a vulnerable position. “Around this time in the sleep cycle, we’re at our lowest ebb physically and cognitively. From nature’s viewpoint, this is meant to be a time of physical and emotional recovery, so it’s understandable that our internal resources are low,” Greg Murray, a psychology researcher with expertise in mood, sleep, and the circadian system, writes in The Conversation.

“But we also lack other resources in the middle of the night – social connections, cultural assets, all the coping skills of an adult are unavailable at this time,” Murray continues. “With none of our human skills and capital, we are left alone in the dark with our thoughts. So the mind is partly right when it concludes the problems it’s generated are unsolvable – at 3 a.m., most problems literally would be.”


At this moment, when we’re stressed and feeling vulnerable, stuck in bed with no way out, we can begin to spiral. This is when we ruminate on why we forgot to feed the dog that one day in 1994 or contemplate why things went bad with your first significant other at 21. It’s when we start recalling a disagreement with a friend and plotting out what we’ll say the next time the issue arises.

At this point, if we don’t stop spiraling, we’ll be up until 5 a.m. and will feel like garbage when it’s time to go to work.

The good news is that there are ways to get back to sleep and stop the downward anxiety spiral.

Make a list

Dr. Jade Wu says that if you wake up and feel stressed about things you need to take care of, walk out of your room (so you don’t associate it with stressors) and make a list to read in the morning. This will free you of your worries, because you know you can care for them when you are awake.

Pay attention to your breath

Murray says you should redirect your attention from your thoughts to your breath, which is a form of meditation. “I bring my attention to my senses, specifically the sound of my breath. When I notice thoughts arising, I gently bring my attention back to the sound of breathing,” Murray writes in The Conversation. This works in 2 ways: first, it takes your attention away from your spiraling thoughts and second, the breathing exercise helps you relax.

Have a bite to eat

Sometimes, we wake up in the middle of the night because we’re hungry and our blood sugar is dropping. “The first question I ask [my patients] is, ‘When was the last time you ate?’” Michael Breus, Ph.D. psychologist specializing in sleep disorders, told Sleep.com. “Often, they’ve finished their last meal at 7 p.m.; now it’s 3 in the morning — that’s eight hours later — so guess what? They’re out of fuel.” If you’ve woken up because of a drop in blood sugar, experts recommend eating a small snack that includes protein and fat, like peanut butter.

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'I wanted to jump like a girl.' Pole vaulter Sam Kendricks credits women for his success.

The Olympic silver medalist was asked who he wanted to jump like when he was younger. His answer was everything.

Photo credit: filip bossuyt from Kortrijk, Belgium

Sam Kendricks competing at the 2018 IAAF World Indoor Championships in Athletics

Sam Kendricks is an excellent pole vaulter, as evidenced by his multiple national and World Championship wins and his two Olympic medals in the track & field event, and he credits the women in his sport for his rise to the top.

A reporter asked Kendricks, who took home the silver medal at the 2024 Paris Olympic Games, who he wanted to jump like when he was younger, and his answer was refreshing.

Kendricks turns the tables on doing something 'like a girl'

"I wanted to jump like a girl," he said. "It's funny, I was a great loser. I was not the gifted athlete. And at every level in the beginning I was jumping with the girls. And not because they weren't good, but because I can learn a lot from them and they beat me every time. And I learned how to jump like Stacy Dragila, the first Olympic champion in the women's pole vault…I jump like a girl.

Kendricks said that women saved the sport of pole vault because it was too dangerous in the past. He said 17 or 18 young men have died pole vaulting, but no women have.

"Women prove that people can be smart and still pole vault. So it made coaches and athletes get smarter. And girls know how to pole vault because it's different speed, you can't hide flaws. Some of the greatest girls are the best technicians, right? You can't argue that."

Watch:

Women have only been pole vaulting in the Olympics since 2000

People may be surprised to learn how young women's pole vault is as a competitive sport. There wasn't a World Championships for the event until 1999 and women's pole vault was only added to the Olympics in the Sydney games in 2000. (For comparison, men have been pole vaulting in the Olympics since 1896.)

Kendricks casually but confidently giving kudos to women in pole vault is important on multiple levels. For one, seeing a man name a woman as his role model in a sport is unusual. The pioneers of women's sport only had men to look to for training examples and heroes, so seeing the reverse is a heartening sign of a more level playing field. But Kendrick goes a step further in saying that women have made pole vault better. Gender parity isn't just about balancing inequalities—it can actually be beneficial for everyone in the sport.

- YouTubewww.youtube.com

People in the comments appreciated Kendricks' answer.

"What a great guy, its so refreshing to hear him say all this."

"It's almost as if learning from those that have been disadvantaged and found ways to overcome their hurdles, rather than those that depend on luck's gifts, is the best way to become your best self. Who'd have thunk it."

"Open-minded observation leading to smart tactics. That's what we are talking about."

"AND, look how nothing was taken away from him? He complimented, valued, learned and respected a woman/women, and he is just the same person/man, if not better! Who knew? What a great leader for today's men."

"So wonderful to listen to a man so comfortable in his masculinity and prowess that he can actually compliment and acknowledge women's accomplishments without having to lash out and try to destroy. Thank you for your maturity."

Gender parity in sports is beneficial for everyone

Some people pointed out that women frequently have better technique in various sports than men because they can't rely on sheer muscle strength to power through moves. So men can—and do—learn about more effective technique from women.

"Observing and learning from women often leads to better technique. Guys will try to muscle out a move, for most women that is not an option."

"They had to create the correct technique; they couldn’t just be strong. I think it’s the same with rock climbing too."

"I’m no professional athlete, but I’ve learnt (Japanese) archery in the past. And just like him, I was a struggling loser, when I decided to watch closely both men and women, and decided to try to mimic women. In one year, I went from hopeless to one of the main members of my school for the reasons he listed: girls don’t 'brute force' their way with bad technique, in general. Copying their technique was the best choice I ever made in sports."

"This has been true in the sports I participate in as well: snowboarding, now climbing, and skydiving. Women tend to have some of the best technique and most efficient movement."

via GIPHY

"When I coached junior college soccer I would recruit players without a lot of soccer experience, such as basketball players to fill out the roster. I would always tell them to watch high level women’s soccer, like the USA national team because they were technically superior."

Beautiful. Here's to women's sports taking their rightful place in international competitions and here's to the men who recognize, acknowledge and celebrate the ways women having opportunities to compete helps make sports better for everyone.

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Paul Rudd's reaction to being named Sexiest Man Alive is perfectly Paul Rudd

Nothing exemplifies why Rudd was named Sexiest Man Alive more than his reaction to it.

People/Twitter, The Late Show with Stephen Colbert/YouTube

Paul Rudd has been named People's 2021 Sexiest Man Alive.

In perhaps the most universally agreed-upon choice it's ever made, and one of the most surprising, People magazine named Paul Rudd as 2021's Sexiest Man Alive. Even if it's been a few years, it may take some time for that to sink in. I mean we, still can't get over it and present this as evidence that he should be given the new title of Sexiest Man Alive Emeritus.

Rudd, with his boyish grin and flawless skin, is certainly cute. But when you add in his well-established talent and extreme likability, the miraculously immortal icon is equally beloved by rom com fanatics, hipsters and Marvel obsessed comic book fans. He's got it all—the eyes, the hair, the teeth, the bod, as well as the acting chops, the humor, the humility and the genuine nice-guy-ness that makes a man sexy in the eyes of most, if not all, of us.

Nothing exemplifies why Rudd was named Sexiest Man Alive more than his reaction to it.

Check out what he told People:

"I do have an awareness, enough to know that when people hear that I'd be picked for this, they would say, 'What?' This is not false humility. There are so many people that should get this before me."

Humility = sexy.

"When I think about myself, I think of myself as a husband and a father," he said. "Like I'm that. I just hang out with my family when I'm not working. That's what I kind of like the most." (Rudd has been married to his wife Julie for 18 years and they have two kids, Jack, 17, and Darby, 12.)

Family man = super sexy.

"She was stupefied," Rudd said about wife's reaction to the news. "But you know she was very sweet about it. After some giggling and shock, she said 'Oh, they got it right.' And that was very sweet. She was probably not telling the truth, but what's she going to say?"

Sweet husband = oh so sexy.

After saying his friends were going to give him "so much grief" for the title, he added:

"As they should. I would. I mean I'm going to lean into it hard. I'm going to own this. I'm not going to try to be like 'Oh, I'm so modest.' I'm getting business cards made. But all of my friends will destroy me and I expect them to. And that's why they're my friends."

True friendship = Sexy sexy sexy.

Finally, on how his life will change after the title:

"I'm hoping now that I'll finally be invited to some of those sexy dinners with Clooney and Pitt and B. Jordan. And I figure I'll be on a lot more yachts. I'm excited to expand my yachting life. And I'll probably try to get better at brooding in really soft light. I like to ponder. I think this is going to help me become more inward and mysterious. And I'm looking forward to that."

That signature sassy sarcasm that somehow makes him sound self-deprecating = SO DARN SEXY.

He said he had to read the email twice when he received the news, and his first reaction was "Oooh, get ready for outrage."

But of course, there is no outrage because Paul Rudd is a perfect choice. He is *just* unconventionally sexy enough to keep the title interesting, but also totally, 100%, undeniably sexy. Nailed it, People.

And just to add one more fun bit to the mix, watch Stephen Colbert put Paul Rudd through a rigorous audition process to see if he was worthy of being named Sexiest Man Alive:

Which, of course, he is. In both mind and body, as Colbert so hilariously demonstrates:

Thank you, People, for finally acknowledging the obvious. And thanks for the #crushforlife hashtag that speaks for all of us.

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