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Joshua Safer Part 2, Interacting with New Transgender Patients




In part 2 of this Exclusive Interview, Joshua Safer talks with Diabetes in Control Publisher Steve Freed about working with new transgender patients and the course of a conversation with a new patient.

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: What do you tell someone when they come into your office and they say that this is what they want and you’re the first medical person that they’ve seen?

Safer: We have no tests. We have no blood test. We have no brain scan in order to determine somebody’s gender identity. And so, that does make — that is a weakness. That said, most people who are otherwise sane and articulate can tell me their gender identity and be pretty accurate and pretty reliable with it, especially adults and even older teenagers. So, in my experience as a clinician, I don’t have any patients who are coming back to me and saying, “Oh, I guess, I wasn’t transgender after all.” When they’ve come to me and said they were transgender, it is pretty much it. It’s reasonably reliable. When I see somebody, I usually insist that they also have a mental health provider to help in case going through any of this is stressful which it can certainly be and can be in a surprising way even for the people who weren’t thinking it would be. So, I like to have that. Providers who are less comfortable, who see fewer patients than I do for example, might actually want that mental health provider to aid them with the diagnosis just making sure that it is really true. That there isn’t some other — that there isn’t a mental health concern that might be causing them to think they’re transgender when they’re not. But that’s about it. It’s actually much more straightforward than people recognize.

Freed: What do you see as far as the age of people? You get a transgender child, I would imagine it’s certainly more difficult, where an adult can make a decision for himself. Now, with the child, now you’ve got the parents you have to deal with. How do you handle that situation?

Safer: So, in broad terms, I divide people into three age groups. And so, the youngest age groups are those people pre-puberty and those kids don’t require medical interventions. So, my main message to parents is for the most part you can be relaxed about this because, one, we’re not going to do anything medically, so there’s nothing irreversible. And, two, you can’t brainwash your child to be transgender or not. And that’s actually the news to the medical community the past 10 years or so. We thought we could. We even tried. And our failure is part of the evidence that this is really some biological thing where we can’t change things. And that cuts both ways. And as much as we’re saying, “Oh, you can’t brainwash your kid not to be transgender,” if they are, they are — the flip side is also true. If you think your kid is going through a stage and they are going through a stage, and you say, “Well, okay,” and let them go to school wearing different clothes or different haircut, whatever — you won’t have accidentally let them become transgender. When they’re through with that stage, they’ll stop being transgender because it’s a biological thing and you can’t convince them. So, again, the point being somewhat trying to be reassuring to that kid’s parents of that age, just let them do whatever they want essentially. Next age, up, peripuberty. We have hormone regiments to delay puberty that we use for kids who enter puberty too early and we’ve used them for decades. And we can apply to transgender kids, so that we have time to think things through because we don’t have a test to know if they’re transgender or not, so that we can be thoughtful and conservative in our approach. And then the last age group will be the older teenagers or adults, where we’re quite confident where we stand and where we can start to implement hormones with confidence that this is the right thing to be doing.

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