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Joshua Safer Part 1, Endocrinology and Transgender Patients




In part 1 of this Exclusive Interview, Joshua Safer talks with Diabetes in Control Publisher Steve Freed about the need to understand the evidence for and approach to transgender medicine, and strategies for the use of hormones.

Joshua Safer, MD, FACP, is the Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery in New York.

Transcript of this video segment:

Freed: This is Steve Freed and we’re here at AACE 2018 in Boston. We have a special guest with us with a unique topic, who’s presenting here, and it’s Joshua Safer. Is that correct?

Safer: Yes, sir.

Freed: So, maybe you can give us the title of your talk. And then probably go into some of the details, what you would like medical professionals to take away from your presentation, so they can feel more comfortable with the topic.

Safer: Sure. My talk today relates to transgender medicine. I actually don’t remember the exact title of the talk, but the point of the talk is to frame the topic in a way that endocrinologists ought to understand it, so they can be the experts for hormone treatment of transgender people in their communities. The field has changed rapidly. We’ve certainly observed it in terms of public interest and such. But part of what’s happened also in the background that’s enormous is a recognition by the establishment medical community that gender identity is a biological thing and not just a passive thing. And that’s resulted in establishment medical organizations rising up and providing guidelines and thinking about what an evidence-based, science-based, approach to care for transgender people would be. And as we, the medical community, go through that journey and think that through, part of that includes endocrinologists knowing the hormone treatments, their logic pattern, the strategy, et cetera, and that’s what my talk today addresses.

Freed: So, what are some of the high points you’d like the medical professionals who’ll watch it to take away from…?

Safer: The main things that people should get out of my talk today are, first of all, understanding why the landscape changed. It’s not that we all became open-minded necessarily, although I think many of us hope we are, but it is more that even as somewhat skeptical scientific sorts waiting to see the evidence that it’s really happened, at least in the establishment medical communities where we have observed that. So, knowing what that evidence even is, so that as medical and scientific people we can be comfortable with what we do know and what we don’t know. It’s not that we’re bought into everything. It’s that we understand certain things and that we have a certain scientific approach, so that’s one. And two, is given that that’s true, what are some strategies for hormones? What’s the point? It’s not just throwing hormones at people. It’s thinking about why it is that the hormones even make any difference and how we’re going to use those hormones, so I would characterize that as two. And the third is something which should actually come easy to endocrinologists because they’re already using these hormones in similar ways for other conditions, how to monitor things and keep them as safe as they can be.

Freed: I was diagnosed with prostate cancer five years ago. And they put me on a female hormone to lower my testosterone and I wouldn’t want to have to go through that again.

Safer: Yeah. Sorry to hear that.

Freed: So, the side effects could be very drastic for people.

Safer: They can indeed. I can observe that transgender people are looking often to have the profile that matches their gender identity with the logic pattern being to have their appearance fit better with their identity. So people, as they walk down the street, treat them how they feel inside, and so that they feel that themselves. So, for them, it is not quite the negative experience that you just recorded but still, yes, it is profound and we need to educate our patients in terms so that they can anticipate the experience correctly.

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