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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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The most inspiring pet stories of 2024

Leading pet brand Nulo knows every cat and dog has the power to be incredible.

via Keswick Mountain Rescue Team/Instagram, Cat Protection/Youtube

Incredible pets deserve incredible food.

2024 was a year filled with heartwarming stories that reminded us of the incredible bond between humans and their furry companions. From acts of bravery to heartwarming gestures, these pets made a huge impact on the lives of their owners… and the lives of many, many more.

It’s stories like these that continue to inspire leading pet nutrition brand Nulo, which is committed to helping pets live their best lives with functional, delicious and nutritious food. Through their innovative and intentional formulas, Nulo fuels incredible cats and dogs just like the ones below each and every day.

Enjoy some stories below of 2024’s goodest boys and girls — courageous dogs, trauma-informed kitties and much, much more —that really show the unwavering love and loyalty animals bring into our lives. Their inspiring actions fuel incredible.

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When a 71-year-old man went unconscious and collapsed during a steep hike, his golden retriever and a black labrador instinctively broke up into a rescue team — the smart and resourceful labrador going off to look for help, and the loyal goldie staying by its owner's side. Sometimes it’s smart to have two of “man’s best friends.”

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Marley, a seven-year-old, black and white feline known for his "incredible gift of empathy” won Cat Protection's National Cat of the Year 2024 for the way he comforts women who have been enslaved, exploited and trafficked and staying at the Caritas Bakhita Safe House in London. He’s known to often leave a reassuring paw on guests’ legs to “let them know they’re not alone,” a gesture often called “the first kindness they’ve experienced in years.”

- YouTubewww.youtube.com

In early 2024, Kobe, a four-year-old husky with an extraordinary sense of smell, began digging obsessively in the yard. At first the pooch’s owner, Chanell Bell, thought this was just typical behavior, but soon discovered that Kobe had indeed detected a dangerously large cloud of natural gas that would have not only been seriously life-threatening to her, but the entire neighborhood. It’s like they say, “the nose knows.”

Eight-year-old golden retriever Roger, may have failed his drug-sniffing training in Taiwan, but it turns out he has a knack for rescue operations during natural disasters. After a 7.4-magnitude earthquake struck, Roger dug through the rubble of a collapsed building to locate the body of one of the 13 people killed in the quake, offering closure to a grieving family. This earned him the nickname of “the pride of Taiwan” on social media.

Dogs don’t only save humans — sometimes they rescue other animals as well.

When folks scrolling through the X account called “Animals Dying” saw a video of a creature swimming through murky water with a deer fawn in its jaws, they probably assumed it was an alligator enjoying its latest meal. But to everyone’s surprise and delight, it was actually a Labrador Retriever making sure the sweet little fawn didn’t drown.

Once a stray, 12-year-old Cilla found her home at Outwoods Primary School in Warwickshire, England, where she calms anxious students, inspires a community of cat lovers on X, and has even used her social media celebrity to help raise £5,000 to restock the school library — a place she loves to lounge in.

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In July, Bloodhound puppy and K-9 unit member Remi used his powerful nose to help an autistic and non-verbal boy who had gotten lost find his way back home. Deputy B. Belk, Remi’s partner, used a piece of sterile gauze to collect the scent from the boy’s forearms and the back of his neck and had Remi “reverse” track backwards for about half a mile to locate the child’s home in a nearby neighborhood.

- YouTubewww.youtube.com

When a beautiful pooch named Gita saw her 84-year-old owner fall and hurt his leg, she ran down to the main road, and refused to move until someone stopped to help. Eventually she was seen by a man named Deputy Wright, who tried to get Gita into his patrol car, but the dog wouldn’t budge. When Gita did finally bolt off, Wright followed her down to where the man had been stranded, and was able to help him. Without her protection, who knows if the man would have been found in time? “The loyalty and heroism of our furry friends never cease to amaze us,” Wright would end up writing on Facebook.

If there’s an incredible furry friend in your own life, nothing says “thank you” quite like a nourishing meal. Check out Nulo for a variety of recipes sure to be loved by your beloved pet.

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Golden Retriever's unbridled excitement over new dog bed is too sweet not to watch

Who wouldn’t be excited?

@wackowinston/TikTok, used with permission

May we all find something that makes us as happy as this dog bed makes Winston.

Dogs of every breed tend to get excited over the littlest things, but Golden Retrievers are just a bit extra whether its with their favorite toys, snacks, or in this case, their beds.

One proud goldie named Winston is winning hearts online thanks to his adorable reaction to a dog bed upgrade. It's honestly understandable—the bed is more of a mini couch. Who wouldn’t be excited?

Winston’s mom, Ashley Jance, not only manages to capture the wholesome moment, but provides the perfect narration.

"This is my old bed... and THIS is my new bed!" Jance says as, indeed, we see Winston jump on one bed then bound to the other as though he were a kid on Christmas showing off his new toys.

And, just like a kid, Winston doesn’t love the idea of sharing as indicated by his playful growls when Dad tries to sit on his new plush throne.

“He’s like, ‘get up!’” Jance says through giggles.

Down in the comments, viewers seemed to catch Winston’s enthusiasm.

“I love this for you Winston!” one person exclaimed.

Another added, “that is the cutest thing I’ve seen in a long time.”

@wackowinston

im very proud and excited

♬ original sound - Winston The Golden

Of course, not all dogs might take to dog beds as happily as Winston did. A 2012 survey by the American Pet Products Association found that 62% of small dogs, 41% of medium-sized dogs, and 32% of large dogs sleep with their owners.

It's a trend not soon to break. In 2022, Psychology Today reported that 76% of American dog owners allows their dogs to sleep with them.

Still, even for pups who don’t take to their own bed immediately, there are certain steps to take to make their beds seem a bit more appealing. Mostly, it takes establishing routine and safety along with some patience as a pet owner.

Of course, if traditional training doesn't work, pet owners could just show their furry friends this video of Winston because boy is his energy contagious!

If you're interested in getting your own pup a bed like Winston's, they're available on Amazon.


This article originally appeared March.

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Wellness

Star neuroscientist Andrew Huberman breaks down two simple exercises to improve vision

The eyes are muscles like any other and need both stimulation and relaxation.

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Treat the eyes like a muscle. Give them exercise and relaxation.

We spend a lot of time looking at things up close, particularly our screens. For many of us, it’s the first thing we look at in the morning, the last thing we look at before going to sleep, and the thing we look at most during all those hours in between. According to a study commissioned by Vision Direct, the average American will spend 44 years looking at a screen. You read that right. Over. Four. Decades.

Really, it’s no wonder that eyesight has worsened. Experts have declared that myopia, aka nearsightedness, has grown to an epidemic level. In addition, we suffer more headaches and migraines, get poor sleep, and tend to feel more fatigued.

Luckily, there are a few things we can do to help, whether we boast 20/20 vision or are already constantly squinting.

Neuroscientist Andrew Huberman, well known for his podcast “Huberman Lab,” breaks down all kinds of science-based life hacks for health, wellness, and fitness.

In addition to studying the brain, one of Huberman’s main research topics is vision. In a video, Huberman shares two simple exercises that can dramatically help improve eyesight.

First and foremost, we need to allow our vision to relax.

You can’t do this just by looking up from your computer screen. Instead, Huberman suggests going to a window and looking out at a point in the distance. Ideally, you would open the window because windows filter out a lot of the blue light and sunlight that you want during the daytime. Better yet, go to a balcony, relax your eyes, and look out at the horizon. This allows the eyes to relax and go into panoramic vision, relieving stress and fatigue.

According to Huberman, you should be doing some kind of relaxation of the eyes, face, and jaw for every 30 minutes of focused work—which works out to at least every 90 minutes.

Second, stimulate the eyes by focusing on motion.

Smooth pursuit is our natural ability to track individual objects moving through space. You can train or improve your vision simply by stimulating this mechanism. To do this, Huberman suggests taking a few minutes each day or every three days to visually track a ball. Or, get outside and watch objects move around. Think swooping birds, falling leaves, etc. If you couldn’t tell, Huberman is a big proponent of going outside.

Bottom line: Our eyes are muscles. Just like our biceps, they need stimulation and relaxation, and while we might not be able to get this kind of nourishment from our tiny screens, nature provides.

This article originally appeared last year.

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Woman with unfortunate initials warns parents to be more careful naming their kids

"When you’re deciding what to name your kids, look at what their initials are going to be."

via Canva/Photos

Woman holding her nose looking in the refrigerator.

A lot of thought goes into choosing a baby’s name. Will other kids have the same name when they start kindergarten? Is the name too dull? Is the name too original? Will the name lead to bullying? Will the name look good on a job application? Could you run for president with this name?

Popular TikToker Emily Windham, 23, from Birmingham, Alabama, is adding another question that parents should ask themselves: What will their initials be? Windham has gone viral for her video in which she reveals how disheartening it is when she has to write her initials, especially when they appear multiple times on a document.

“When you’re deciding what to name your kids, look at what their initials are going to be,” she says at the beginning of her video. “Every time I have to initial a document, I have to write 'EW.' All these little initial lines just say EW EW EW EW.” The situation is frustrating for Emily because her parents considered naming her Alexia, which would have been AW, which is sweet. “That’s so cute,” she said.

@emwindham

Easy em in tha house 🔥🔥🔥🔥🔥🔥

The post inspired other people with unfortunate initials to comment; some of them are much harder to live with than EW.

“Yea… mine is XL,” Xitlali wrote.

“Mine is ‘BLT’ because it was my dad’s favorite sandwich. Mom didn’t notice until it was too late I don’t even like blts,” Bryony Tally Art wrote.

“Mine is ‘PP’ elementary and middle school was a blast,” Pais wrote.

“I knew a girl in school whose name was Amy, and her initials were also AMY, and I’ll never forget because that’s so baller,” Charlie wrote.

“My son's initials are BRB,” Ashleigh wrote.

“My initials are EGG,” El-Glory wrote.

“My initials spell EMO and I think thats awesome,” Elle wrote.

“Mine is OG… now I’m getting married and it’ll be OJ. Can’t decide if I like an original gangster or Orange Juice more,” Olivia wrote.

“Mine is ME, and when I sign out on duties at work, someone goes, ‘Can someone please stop signing ME and sign your initials?’ I’m like, those are my initials,” a TokToker named Madison wrote.

@thesam_show

sorry if i talk about this problem too much but it is HAPPENING AGAIN!!

Emily’s story is similar to that of Samanta Hart, a woman who went viral on TikTok in 2023 because her name doesn’t exactly work well with modern email conventions. Clearly, her parents hadn't thought that her name would cause any trouble in the late '90s when email was a new thing. So, she made a video warning parents to think of their children’s future email addresses before selecting a name.

“My name is Samantha Hart,” the 27-year-old said. “Most companies use the email designation of first initial, last name, meaning my email would be shart.” A shart is an accidental release when one assumes they only have gas, which is not exactly how one wants to be known in professional circles.

“At every single workplace, I have received an email from HR the week before I start letting me know that my name does not exactly fit the company email structure as they would intend and [asked] would I mind if they gave me a different structure for my email,” Hart said. Sadly, Hart will probably have to deal with this whenever she gets a new job. Hopefully, she enjoys doing long stretches with her employers.

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New evidence shows that playing video games has an unexpected effect on kids' IQ

Parents are going to have to rethink things a bit.

via Canva/Photos

Three children enjoying video games.

Since Pong first became a massive hit in the early ‘70s, parents have warned their kids that playing video games will rot their brains. How it not? Most gaming involves kids sitting alone in their homes, mashing buttons and a single game could go on for hours. There’s a good reason why parents should be concerned about the amount of time their kids spend staring at screens, but does gaming have an upside?

A 2022 report from the Karolinska Institute in Sweden has found that playing video games actually increases a child’s IQ. "Our results support the claim that screen time generally doesn't impair children's cognitive abilities, and that playing video games can actually help boost intelligence," neuroscientist Torkel Klingberg from the Karolinska Institute in Sweden said in 2022.

To reach this conclusion, the researchers looked at nearly 10,000 kids between the ages of 9 and 10 who, on average, spent 2.5 hours a day watching TV or online videos, 1 hour playing video games and 30 minutes socializing online with friends or family. Two years later, they compared data on 5,000 of these kids and found that those who spent more time than the norm playing video games had an IQ increase 2.5 points above the average rise.

The IQ point increase was based on their performance in tasks involving self-control, flexible thinking, memory, reading comprehension and visual-spatial processing.



“We didn’t examine the effects of screen behaviour on physical activity, sleep, well-being, or school performance, so we can’t say anything about that,” says Torkel Klingberg, professor of cognitive neuroscience at the Department of Neuroscience, Karolinska Institutet.

The researchers also note that there was no increase in IQ points for those who watched more TV or spent more time on social media than the norm.

Are video games bad for kids?

Kids who run to share this story with their parents should be careful because IQ is just one factor affected by playing video games. "We didn't examine the effects of screen behavior on physical activity, sleep, well-being, or school performance, so we can't say anything about that," said Klingberg. "We'll now be studying the effects of other environmental factors and how the cognitive effects relate to childhood brain development."



The study is a shot in the arm for those who believe video games are good for kids and those who like to play them. However, we know that video games can cause serious problems if played excessively. Studies show that gaming is associated with obesity because when you sit in front of a screen all day, you don’t have much time for exercise. Excessive gaming has also been associated with depression, anxiety, aggression, sleep deprivation, insomnia and circadian rhythm disorders.

Video game addiction has also become a serious problem and may affect over 60 million people worldwide. Parents should be wary of signs of video game addiction in their children, which include a loss of interest in other hobbies, withdrawal symptoms when they're not gaming, and aggression.

As with anything, the key to getting maximum benefits from gaming is to make the activity part of a balanced lifestyle that includes plenty of physical activity, socializing with friends, lots of sleep, good nutrition and a fair amount of reading time. The Child Mind Institute says kids over 6 should spend at most 1 hour a day playing video games on school days and 2 on the weekends. Kids under 6 shouldn't exceed 30 minutes a day playing video games.

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Husband's calm demeanor while encouraging his kids to give his wife 'space' delights fellow parents

Every Dad should try this.

Photo representation by Fortune Vieyra on Unsplash | Jeffery Erhunse on Unsplash

A calm husband is winning praise for giving wife space when raising their children

Parenting is a 24/7 job. However, Kier Gaines, a licensed therapist, husband and father of two little girls, is encouraging parents to take time and space alone to preserve their mental health. In a new video he shared on TikTok titled "Saving Your Partner's Mental Health", Gaines demonstrates the importance of parents creating space at home for not just themselves, but more importantly their partners.

He shows how it can be done by setting boundaries with their children when it comes to being constantly available to them--supporting his wife to take rest rather than busying herself with house work while affirming to his children that giving mommy space is a positive thing.

@kiergaines

From Daddy, with Love 🖤

"Give mommy some space, okay?" he says in the video as he is starting to cook in the kitchen. One of his daughters responds, "Okay. I just wanted to ask her a question."

In an understanding voice, he replies, "I know. Let's give her a little privacy. Let's give her a moment. You know how sometimes you go up in your room and you don't want to be bothered and we give you your space? I think everybody in the house needs that sometimes, what [do] you think?"

Gaines continues filming himself doing some kitchen organizing, pouring cereal boxes into storage containers before moving to the refrigerator to unload some drinks.

"Sydney, you wanna come help me?" he asks his daughter Sydney, before she replies, "No!" He quips, "True!"

man in long sleeve shirt standing beside girl in pink tank top washing hands Photo by CDC on Unsplash

Sydney then adds, "I am very busy right now!" Rather than get upset, Gaines sighs and says, "The fridge needs to be reorganized, but it ain't happening tonight! I'll tell you that."

His wife is heard off-camera chiming in, "I'll do it." But Gaines is having none of it. "Babe, rest your bones," he tells her. She replies, "Yeah, you're right," before Gaines adds in, "You've got enough going on," just..."motioning with his hands for her to step back and take a load off.

"You know I like to be busy," she responds, but Gaines reassures her that all is well as he continues to prepare a meal. "Yeah, you don't have to be busy when you don't have to. Go upstairs, get away from the kids."

The video ends on a funny note: as Gaines tries to open something with a knife, he drops it and it almost stabs his foot.

"Not today, Satan! Not today," he laughs.

Gaines' kind and gentle communication style sent his TikTok followers straight to the comment section to heap praise on him for being an amazing parent and spouse.

"The fact that you said, 'everybody needs space sometimes' instead of throwing mom under the bus with 'mommy needs time away or mommy needs a break' made my heart explode. What an awesome dad 😊," one TikToker wrote. Another added, "Father is fathering, partner is partnering... that's how family life should be ❤️."

Gaines was also commended for his soft tone. "The calm demeanor, the way you give explanations, ask questions, keep it kind. It made me cry. Dads don’t act like this as often as they should." And another declared, "the communication, the tone, and body language showing no anger, this is what every child deserves from their father and mother! i applaud you!❤️"

With nearly 28 million views on his video, Gaines deserves all the kudos.

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