Norman Spack: How I help transgender teens become who they want to be

Summary

The speaker, a pediatric endocrinologist, discusses the complexities of gender identity, sexual orientation, and medical care for transgender individuals. They explain the difference between gender identity and sexual orientation, sharing personal experiences with patients navigating these issues. The talk highlights the importance of providing medical support to transgender adolescents through puberty blockers and hormone treatments, as well as the emotional and societal challenges faced by transgender individuals. The speaker advocates for a more inclusive society, urging better healthcare, anti-discrimination laws, and the removal of transgender identity from psychiatric disease classifications.

Takeaways

• 👶 The third word ever said about a person at birth often describes their sex, based on external anatomy.
• 🔄 Gender identity and sexual orientation are different. Gender identity is who you go to bed as, while sexual orientation is who you go to bed with.
• 💉 Early interventions like puberty blockers give time for adolescents to explore their gender identity before irreversible physical changes occur.
• 📊 Studies show that children who express cross-gender behaviors often do not persist in identifying as the opposite gender at puberty, but those who do are likely transgender.
• 🚸 Affirming gender identity in youth is critical to their mental health, as untreated transgender individuals face high risks of suicide.
• 🇳🇱 The Dutch pioneered a model of care for transgender youth, starting with puberty blockers at age 12, hormone therapy at 16, and surgery eligibility at 18.
• 💡 Endocrinologists like the speaker help facilitate gender transitions by managing hormone treatments that align with the patient's affirmed gender.
• 🏥 A pediatric program for treating transgender youth began in Boston in 2007, based on the Dutch model, allowing for safe, early treatment.
• 👨‍👩‍👧 Family and societal acceptance is a challenge, with many transgender individuals facing rejection from loved ones, which underscores the need for better support.
• 🌍 Discrimination laws are still lacking in many places. Only 17 U.S. states have anti-discrimination laws for housing, employment, and public accommodation for transgender people.

Q & A

What is the significance of the 'third word' mentioned in the script?

The 'third word' refers to the description of a newborn's sex, usually based on their external genitalia, following the statement 'It's a...'. This is a key moment when society begins to categorize individuals based on their anatomical sex.

Why is the mixed audience response of 'boy' or 'girl' significant?

The mixed response highlights the uncertainty or complexity of assigning sex at birth, especially in cases where anatomical differences or intersex conditions are present. The speaker uses this to introduce the idea that sex and gender are not always straightforward.

What is the difference between sexual orientation and gender identity as explained by the speaker?

Sexual orientation refers to 'who you go to bed with', meaning the gender of the people you are attracted to, while gender identity refers to 'who you go to bed as', meaning your internal sense of your own gender, regardless of your anatomical sex.

At what age do feelings of being transgender become more likely to persist, according to the speaker?

Feelings of being in the 'wrong body' become almost certain to persist during puberty, typically around ages 10 to 14, when physical changes solidify one’s sense of gender. These feelings are unlikely to change, regardless of any attempts at reparative therapy.

What challenges did the speaker face when treating transgender adults?

The speaker found it painful that many transgender adults had to give up relationships with parents, siblings, children, and spouses. These adults transitioned later in life because they felt they had to affirm their gender identity to avoid the risk of suicide.

What treatment approach did the speaker learn about in the Netherlands for transgender adolescents?

In the Netherlands, adolescents with gender dysphoria undergo psychometric testing and then receive puberty blockers, delaying the onset of puberty. This prevents unwanted physical changes while allowing time for further evaluation and affirmation of their gender identity.

What are the implications of using puberty blockers in transgender adolescents?

Puberty blockers temporarily halt the physical changes of puberty, providing time for the adolescent to explore their gender identity without their body changing in ways that might feel distressing. The effects are reversible, but the use of opposite-sex hormones later can have permanent effects.

What did the speaker mean by the 12-16-18 program in transgender care?

The 12-16-18 program refers to a timeline where puberty blockers are given around age 12, cross-sex hormones may be administered around age 16 after retesting, and gender-affirming surgeries can be performed around age 18. This gradual approach allows for informed, safe transitions.

How does the speaker describe the outcomes for transgender adolescents who receive treatment?

The speaker reports that transgender adolescents who receive puberty blockers and then hormone treatments have normal heights and body development for their affirmed gender. They blend in with their peers and live fulfilling lives without the distress caused by undergoing the 'wrong' puberty.

What are the broader social and legal issues that the speaker identifies regarding transgender rights?

The speaker emphasizes the need for anti-discrimination laws to protect transgender people in housing, employment, and public accommodations. They also argue for the removal of transgender identity from the Diagnostic and Statistical Manual of Mental Disorders (DSM), as it should not be classified as a psychiatric condition.