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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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Now's your chance to help someone doing good in your community win $1000 towards the charity of their choice

Upworthy and P&G are back with the #ActsOfGood Awards.

Images provided by P&G

Three winners will be selected to receive $1000 donated to the charity of their choice.

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Doing good is its own reward, but sometimes recognizing these acts of kindness helps bring even more good into the world. That’s why we’re excited to partner with P&G again on the #ActsOfGood Awards.

The #ActsOfGood Awards recognize individuals who actively support their communities. It could be a rockstar volunteer, an amazing community leader, or someone who shows up for others in special ways.

Do you know someone in your community doing #ActsOfGood? Nominate them between April 24th-June 3rdhere.Three winners will receive $1,000 dedicated to the charity of their choice, plus their story will be highlighted on Upworthy’s social channels. And yes, it’s totally fine to nominate yourself!

We want to see the good work you’re doing and most of all, we want to help you make a difference.

While every good deed is meaningful, winners will be selected based on how well they reflect Upworthy and P&G’s commitment to do #ActsOfGood to help communities grow.

That means be on the lookout for individuals who:

Strengthen their community

Make a tangible and unique impact

Go above and beyond day-to-day work

The #ActsOfGood Awards are just one part of P&G’s larger mission to help communities around the world to grow. For generations, P&G has been a force for growth—making everyday products that people love and trust—while also being a force for good by giving back to the communities where we live, work, and serve consumers. This includes serving over 90,000 people affected by emergencies and disasters through the Tide Loads of Hope mobile laundry program and helping some of the millions of girls who miss school due to a lack of access to period products through the Always #EndPeriodPoverty initiative.

Visit upworthy.com/actsofgood and fill out the nomination form for a chance for you or someone you know to win. It takes less than ten minutes to help someone make an even bigger impact.

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Joy

We've been Airbnb hosts for 7 years. We agree—cleaning fees and check-out chores are bunk.

This is why Airbnb guests actually make the best hosts.

Photo by Taylor Heery on Unsplash

People are right to complain about being charged a cleaning fee and being asked to do chores.




In 2016, My husband and I started renting our basement apartment out as a short-term rental on Airbnb. We live in a college town and figured we'd get some guests during football game weekends and graduations. We didn't realize how many people come to our town to visit their college kids or check out the school, so we were pleasantly surprised by how regularly we were booked.

In 2019, we bought the house next door and now rent out both floors of the old house as separate units. We love being Airbnb hosts and have had a very successful run of it, with hundreds of 5-star reviews, Superhost status and lots of repeat guests.

We also don't charge a cleaning fee or make guests do check-out chores. In fact, we find both things rather loathsome.

What makes us good hosts is that we've been Airbnb guests for years. As a family of five that travels a lot, we've found far more value in Airbnbs than in hotels over the years. We love having a kitchen, living room and bedrooms and feeling like we have a "home" while traveling. We even spent a nomadic year staying at short-term rentals for a month at a time.

When you've experienced dozens of Airbnbs as a guest, you learn what guests appreciate and what they don't. You see what's annoying and unnecessary and what's to be expected in comparison to a hotel. We started taking mental notes long before we started our own rental about what we would want to do and not do if we ever had one and have implemented those things now that we do.

As guests, we know the pain of the cleaning fee, so we don't charge one.

via GIPHY

It helps that my husband has a flexible schedule and grew up helping with his parents' janitorial service, so most of the time he cleans the apartments himself. We could charge a cleaning fee for his time and labor, but even if we were paying for outside cleaners, we still wouldn't put a separate fee onto guest bookings. It makes far more sense to us to just wrap the cleaning fee into the per-night price.

From a host's perspective, the one-night stay is where the cleaning fee question hits the hardest. Whether someone stays one night or 10 nights, the cleaning cost is the same. But spreading the cost over 10 nights is a very different beast than adding it to one night, especially from a guest's perspective. On the host side, if we had to pay cleaners without passing that fee onto guests, we've barely make anything on one-night stays. But on the guest side, a $100 a night stay suddenly jumping to $150 because a cleaning fee was added is painful, and often a dealbreaker. You can see the conundrum.

The way we see it, and as other Airbnb hosts have found, wrapping cleaning costs into the base price comes out in the wash over time, as long as you have some longer-term stays mixed in with the one-nighters. And it's a much better experience for the guest not to get hit with sticker shock on the "final cost" screen, which is already eye-popping when service fees and taxes are added on.

(I will say, this may only ring true for smaller units. If you're renting a huge home, cleaning costs are going to be higher just because it takes longer to clean. But I still don't think the full cost should be passed onto guests as a separate fee.)

As for check-out chores—asking guests to do things like start laundry, sweep the floor, take out the trash, etc.—those have never made sense to us. Hosts should have enough switch-out linens that laundry doesn't have to be started prior to checking out, and none of those chores save enough time for the cleaning people to make it worth asking guests to do it. I can see taking out trash if there wasn't going to be another guest for a while, but usually you'd want to clean right away after a stay anyway just in case it does get booked last minute.

The only thing we ask guests to do is to start the dishwasher if they have dirty dishes (as a guest, I've never found that an unreasonable request), lock the door and have a safe trip home. Don't need to pull the sheets. Don't need to take out any garbage or recycling. Those things don't take that long, but that's just as much a reason not to ask guests to do it. Annoying your guests by asking them to do something extra isn't worth the tiny bit of time it might save the cleaning people.

And you know what? This approach works really well. Approximately 95% of guests leave the apartments clean and tidy anyway. In seven years, I can count on one hand how many problems we've had with guests leaving a mess. That's been a pleasant surprise, but I think part of the reason is that guest are simply reciprocating the respect and consideration we show them by not making them pay extra fees or do chores on their way out.

To be fair, it probably also helps that we aren't some big real estate tycoon that bought up a bunch of apartments and turning them into short-term rentals run by impersonal management companies. People's complaints about how short-term rentals impact local housing economies are legitimate. We're more aligned with the original "sharing economy" model, renting out our home to guests who come through town. And in a small college town with a large university, there often aren't enough hotel rooms during busy weekends anyway, so it's been a bit of a win-win.

I think being right next door, having personal communication with our guests (but also leaving them their privacy), and not charging or asking anything extra of them makes them want to be respectful guests. From our perspective, both as guests and hosts, cleaning fees and check-out chores simply aren't worth it.

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Bartender in Patagonia takes sustainability to a whole other level

Wait til you see how Federico Gil uses glaciers—yes, glaciers—to distill his signature gin.

Annie Reneau

Federico Gil puts his passion for sustainability into practice.

When people talk about sustainability in the food and drink industry, there's a lot of talk about plastic straws and reducing waste. But at Bar Pionero, the sustainability standard is set much, much higher. They do things I didn't even know were possible, and they don't do things a lot of people—those who put profit before protection of the environment—would do in the name of conservation.

And most of it comes down to the vision of elite bartender Federico Gil.

Gil and his brother founded Bar Pionero 14 years ago, after moving to Chilean Patagonia from Uruguay. The bar sits adjacent to the main lobby of the Las Torres Hotel, just inside Torres del Paine National Park, and with its wall of windows framing a towering mountain, just being in the bar is an experience. The food is good, and as someone who doesn't drink, I was delighted by the incredible mocktail offerings. But the highlight of the bar is Gil himself.

Watching Gil speak about sustainability was mesmerizing, even with him speaking in Spanish and me only understanding a few words of what he said. For the details, I needed the English-speaking translator, but Gil's passion for sustainability needed no translation; it was genuine and palpable.

bartender standing in front of a table full of drink-making materials.

Federico Gil shares how Bar Pionero creates its sustainable cocktails.

Annie Reneau

On a practical level, here are some of the zero-waste practices the bar has implemented:

- Not only do they not use plastic straws but they use signature copper straws. Chile is the world's largest copper producer, so the metal is plentiful. It's also naturally anti-bacterial (though they have a sanitation process they use to clean them, of course).

- They repurpose bottles and jars into drinking glasses and tools for the bartenders. Sometimes they even combine them with copper. Check out this gorgeous glass made from an upside down glass bottle top and copper.

Cocktail glass sitting on a table

Cocktail glass made from a glass bottle top and copper

Annie Reneau

- They make their own mixes, spirits, bitters, vinegars, etc. from the plants that grow naturally in the surrounding landscape as well as from the organic garden on site.

- They also make vinegar by capturing and repurposing the dribbles of beer that come out of the tap after a draft beer is poured.

- They brew their own beer using pure glacial water and hops grown in the garden. The byproduct of the brewing process then goes back into the garden as fertilizer.

glacier

Glacier in Torres del Paine National Park, part of the Southern Patagonia Ice Field

Annie Reneau

- They distill their own gin in small batches, using glacial water, 13 botanicals from the natural landscape and the clay left behind from the moving glaciers. Gil says his goal with the gin is to convey the "spirit of the ice." Glacial gin. Who knew?

The gin is so unique, Gil could certainly make money distributing it around the world, but he refuses. Same with the beer.

"The world doesn't need one more gin or one more beer," he says. The most sustainable way is not to sell it outside the hotel, where it would have to be shipped and transported. "We're not thinking about how much we can sell, but what impact we have," he adds.

It's literally putting their money where their mouth is, knowing they could have a lucrative product on their hands but not capitalizing on it because of the environmental impact that would have. And it's not just a guess—Gil says the bar actually keeps track and calculates their environmental impact using various measures.

bartender painting a rock held in tongs

Federico Gil painting a lemon extraction onto a frozen rock from Torres del Paine National Park

Annie Reneau

On top of all of that, watching Gil craft a cocktail is like watching an artist at work. He's as passionate about creativity as he is about sustainability, and it shows. I watched him light herbs on fire and set a glass bottle top over the flame to capture their essence, then paint a homemade cold extraction of lemon onto a frozen stone from the park, then shake together various liquids created from park botanicals and put it all together into glass made of layers of jar and glass tops.

I'd never seen anything like it, and I've rarely seen anyone who walks the sustainability talk so clearly in their work. It not only gave me hope for the conservation of Torres del Paine and Patagonia (which is stunning—a place bucket lists are made for, seriously), but also made me realize how much we have to learn from one another as we strive to protect our beautiful planet.

If you'd like to see Federico in action, check out this video from my experience there:

This writer was a guest of Las Torres Patagonia. This article was not reviewed by the hotel or anyone associated with it before publication.

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Pop Culture

Music savant Kodi Lee gives a completely new version of 'Bohemian Rhapsody' on 'AGT'

Lee gave "America's Got Talent" audiences chills with his haunting cover.

America's Got Talent/Youtube

Kodi Lee has become an "AGT" fan favorite with his next level skills


Since 2019, Kodi Lee has wowed “America’s Got Talent” audiences with his next-level musical skills. That goes for whether he’s performing touching original works or putting his own personal touch on well-known songs.

For “America’s Got Talent: Fantasy League,” the music savant was guided by his mentor Howie Mandel to cover “Bohemian Rhapsody” by Queen.

It’s hard to imagine a version of this fan-favorite tune you haven’t already heard before, since the song has been covered quite a few times. But once again Lee delivered something epic and completely unique.

Even though judges Mel B and Heidi Klum still prefer Lee’s original songs, all applauded his haunting and emotional piano rendition of the rock-n-roll anthem.

Simon Cowell even said “You use these words ‘Star Quality’ a lot, but you genuinely, Kodi, over the years we’ve got to know you, you’ve just got better as an artist. You’ve never given up, and the Finals just wouldn’t be the same without you in it this year.”

Other viewers applauded Lee for one-of-a-kind performance, agreeing that he did freddie Mercury proud.

One wrote, “‘You can do whatever you want to do in my music, just don't make it boring’ -Freddie. What a magical performance.”

Another added, “Kodi has an amazingly rare talent to be able to sing across different musical genres. He owns them all!!!”

Last but not least, I think this comment sums up the general consensus pretty well: "This version is unlike anything anyone has ever seen before. It’s truly a masterpiece. Kodi is an amazing gift to our world. He continues to change the world just by being himself."

Watch below. And enjoy.

This article originally appeared on 2.13.24

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Parents keep triplets' birth order a secret until a big reveal on their 18th birthday

Why did they wait so long?

via Allan Foster/Flickr

Representative image. Triplet babies in "Thing" outfits.

Many people believe that someone’s personality can be determined by their birth order within a family. Older siblings are often seen as more responsible and the youngest is frequently characterized as the most laid-back. Although there isn’t much research to back up these claims, there is evidence that birth order can affect someone’s intelligence.

So, does birth order have any effect on multiples? In a unique case like triplets, there can be a small, self-fulfilling prophecy effect. Parents and siblings may project stereotypes onto one another, such as, “You were born first, now you’re first at everything,” or “You were born last, no wonder you’re lazy.”

Triplets on TikTok are going viral because they were never able to have any squabbles about their birth order because they never knew it until they turned 18. Janie Hilbert, 18, shared a video in February featuring her triplet brothers, Luke and Wright, that showed their reaction to learning their birth order for the first time.

The video is touching, but it didn’t reveal the actual order, just their reaction and it was still viewed over 20 million times.

x3 🤷😆

@janie.banie4

x3 🤷😆

After the post, TikTok was shouting for a follow-up video that revealed the results. A few days later, Janie posted a video that revealed their birth order, set to the theme song from “Full House.”

triplet birth order reveal!!!

@janie.banie4

triplet birth order reveal!!!

The post showed that Wright is the oldest, followed by middle child Luke and then Janie. Janie was not excited about being the youngest. “I did not want to be the youngest,” Janie told Today.com. “That’s the one thing I really hoped I hadn’t been waiting 18 years to be the youngest and then here we are.”

The triplets’ parents, Stewart Hilbert and Clay Hilbert, told Today.com why they decided to wait until their 18th birthday to learn the truth about their birth order. The decision was made because Clayton, their oldest child, was born three years before the triplets.

“He was also definitely precocious, a rule follower and very literal,” Stewart said, adding that he would probably tried to enforce an “olest gets the bottle first” mentality when the triplets arrived. “We just didn’t want to play his game, and we were like, alright, let’s just keep it a secret. It’ll be fun. They won’t have to subscribe to any of the stereotypes of oldest, middle, youngest, all that.”

It was tough keeping the birth order a secret for all those years, especially with the children constantly begging to find out the answer. “They definitely wanted to know, and that made it even more fun,” Stewart explained.

“We tried to figure it out for so long. We begged and begged. They wouldn’t crack,” Janie added.

The funny thing was that their father secretly revealed the truth in the family group chat which featured the children’s names in birth order. But the triplets never put it together. "I was so excited to try to tell them that it was in front of them the whole time," Clay said.

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Women were asked if they'd rather be trapped in the woods with a bear or a man

Their answers left some men scratching their heads.

Representative photos by Aaron J. Hill and Greta Hoffman

Women choose being alone with bear instead of man in interview

There are often hypothetical scenarios that people get asked just to see what their answer will be. In most cases, the scenario is something that has a very slim chance of ever happening in real life, but it can be fun to allow your brain to wander. A hypothetical scenario is taking over social media right now and it has women nodding in agreement while many men are left scratching their heads.

Screenshot HQ took to the streets and asked random women if they would rather be stuck in the woods with a man or a bear. Overwhelmingly women chose to take their chances with a bear, some providing the inquirer with a reason as to why they'd chose a bear over a man. Unsurprisingly to most women, the participants saw the bear as the safer option.

Some men had a hard time understanding why women would risk being mauled by a bear, but several men did understand and took to social media to attempt to explain.

Some men seemingly easily knew why women would choose to be in the woods with a bear when their partners asked them the same question but the hypothetical woman was their daughter. In the video, one woman makes her case for choosing a bear.

"Well I've heard about bears, they don't always attack you right unless you f**k with them? So maybe a bear," she laughs.

Luis Torio responded to the video with an explanation for men who seemed confused by the amount of women choosing a bear. In his video he asks, "why would a woman choose a man over a bear when the number one predator of a woman is a man and not the bear?" He goes on to explain that if a woman is put in the woods with the wrong man, she could be in a much worse situation than with a bear.

@yourtango

Women were asked if they would rather be stuck in a forest with a man or a bear - and their answers are sad #manvsbear

YourTango jumped in on the debate and dropped a few facts with the most staggering being, "the 750,000 black bears in North America unalive less than one person per year on average. Men aged 18-24 are 167 times more likely to unalive someone." The woman in the video also cites assault statistics for women.

That's not to say that all men would be dangerous if trapped in the woods with them, commenters and content creators point that out. The concern seems to be more about the predictability of bears verses the predictability of an unknown man.

You can watch the original video that started this weeks long debate below:

@screenshothq

The question of being stuck in a forest with a man or a bear is circulating on TikTok right now and sparking some interesting conversation.... we know what our answer would be 🐻🌳 #manvsbear #tiktok #tiktoktrend #trending #challenge #streetinterview #voxpop

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