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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]."

[Get our best science, health and technology stories.Sign up for The Conversation's science newsletter.]

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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Adorable Golden Retriever absolutely loses it when he runs into his vet at a bar

No one has ever been this excited to see their doctor.

@cosmo_andtheoddparents/TikTok

He wuvs his vet.

Not every dog might jump with joy after seeing their vet out in public. But for Cosmo the Golden Retriever, it was practically Christmas all over again when he spotted his own vet, Dr. Jones, at a brewery.

In an adorable clip posted to TikTok, we see Cosmo in pure, unadulterated bliss as he snuggles with an equally happy Dr. Jones, who, considering he’s still in his scrubs, might have just gotten out of work to grab a quick pint.

Watch:

@cosmo_andtheoddparents When you run into your vet in public #goldenretrieversoftiktok #vetlife #animallovers #petparents #goldenretriever #goldenretrievers #doglife #dogmom #dailyfluff #charlestondogs #doglover #charlestondog #brewerydog ♬ original sound - Cosmo

Ugh, the cuteness is too much to handle! People in the comments could barely contain their secondhand joy.

“He looked over like, “Mom, do you see who this is?” one person wrote, while another said, “What in the Hallmark movie? Adorable!!”

One person even joked, “Did we all check the vet’s hand for a wedding ring? (Said as a married woman. Looking out for you all, or something.)”

According to Hannah Dweikat, Cosmo’s owner, the two actually share quite a history. She tells Upworthy that when Cosmo was but a wee pup, he “gave a scare” after eating a Sago Palm seed, which are highly toxic to dogs, from a plant in their backyard, which of course resulted in him being rushed to the animal hospital and staying there over the weekend.

While that’s every pet owner’s worst nightmare, and certainly a scary situation for the poor fur baby, Dweikat says that “the calm and patient demeanor” of Dr. Jones and his staff put Cosmo at ease. And because of this, “Cosmo has always loved going to see his friends—especially because they give him lots of treats and snuggles.”

Cosmo and Dr. Jones’ buddyship has also blossomed thanks to proximity, as Dweikat only lives down the street from the clinic. “Which means we get to see Dr. Jones and his staff out in public at times and Cosmo takes every chance he can get to say hi,” she explains. This time, however, she was able to capture it all on video. Yay for us!

What makes a good vet?

While not every vet, however gifted, will be able to elicit this type of reaction from their patients, having a calming presence like Dr. Jones is certainly a good sign for pet owners to be on the lookout for when shopping around for their own vet. But that’s not the only quality a good vet needs. According to Saint Matthews University, a vet also needs to have high stamina (both physically and mentally), as well as an ability to tolerate unpleasant situations (you can’t faint at the sight of blood or vomit), a high level of emotional intelligence (maybe all doctors should possess this skill, but especially those who work with animals), adaptability, a sense of enthusiasm, and finally, excellent communication skills.

Dr. Jones seems to have these attributes in spades, and his patients clearly love him for it. None so much as Cosmo, obviously.

By the way, if you’re in need of even more content featuring this precious pup, you can follow Cosmo on both TikTok and Instagram.

This article originally appeared in February

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Women expose the reality of perimenopausal brain fog resulting in humorously relatable anecdotes

"I forgot the word 'toiletries' and ended up saying 'human condiments'."

Photo credit: Canva

Women expose the hilarious reality of perimenopausal brain fog

One thing that people are becoming increasingly familiar with whether they want to or not is perimenopause. This refers to the several years to a decade before someone reaches full blown menopause, which is marked by 12 consecutive months without menstruation. One of the reasons people are much more aware of the biological condition is because of women like Ari who is speaking openly about her experiences with perimenopause.

In a recent video, Ari, who goes by @Ari_Darling on social media, shared the frustrating experience of perimenopause related brain fog and forgetfulness. Upon sharing an amusing video of her seemingly starting to say something and forgetting what she was saying, women flocked to share their own stories of the phenomenon.

forgetfulness, perimenopause, pre menopause, brain fog, women's health What was I doing again?Photo credit: Canva

Brain fog and forgetfulness are common symptoms of perimenopause that can make someone feel as if they're developing a serious illness. It can be scary at times when the moments go from forgetting why you walked into a room to something that feels more serious, like forgetting words you use frequently and floundering while your brain searches for a placeholder.

Dr. Hadine Joffe, executive director of the Connors Center for Women's Health and Gender Biology at Brigham and Women's ­Hospital and a professor of psychiatry at Harvard Medical School, tells Harvard Women's Health Watchthat decreasing estrogen is the culprit to perimenopausal brain fog and is usually one of the first indications that hormone levels have changed. "We don't know why this happens, because many things are happening across the menopause transition along with the drop in estrogen," Joffe tells the publication.

@ari__darling I can’t believe how bad it is. We need to talk about this more. #perimenopause #forget #words ♬ original sound - Ari__Darling 🇨🇦

No matter the reason people experience brain fog, it's pretty safe to assume that everyone going through it finds it to be quite annoying. In the moment it may be irritating and a little frightening but once it has passed and the panic has subdued, the inconvenient brain glitches can be amusing. That's exactly what the women who found Ari's video bonded over–the hilarity that comes with brain fog and all the wild things their brain shoved out of their mouths when they couldn't remember simple words.

One woman was simply mortified when she couldn't remember an everyday phrase: "I couldn't remember 'flight attendant' but knew 'stewardess' was not pc, I could only remember that it was 2 words....I came up with "space waitress.' fml"

flight attendant, stewardess, brain fog, forgetfulness, perimenopauseA space waitress at work. Photo credit: Canva

It's always a good day when potatoes have babies according to this woman's word flub: "The other day I was trying to think of the word “tater tots” and I asked my husband to get the potato children."

You know, maybe we should petition for this particular change: "Couldn’t remember 'A-list' celebrities. Instead said “this movie has a lot of name brand actors”

Well, you probably don't want to say this to an elderly relative: "Yep, i pulled out "coffin parking lot" the other day when I couldn't remember cemetery."

cemetery, coffin, brain fog, forgetfulness, funny wordsWaking Up Funeral GIFGiphy

"I forgot the word 'toiletries' and ended up saying 'human condiments,'" another shared. Who needs different words when lotion is essentially like like ketchup for your legs? Same thing, right?

"Asking for tongs in the kitchen. My brain throws out food tweezers. I used to be a chef," said another woman. You can still be a chef and use food tweezers. This is a judgement free zone.

Listen, words are hard sometimes and having hormonal fluctuations that make you forget what keys are called doesn't make it any easier. Thankfully, women no longer have to suffer in silence thinking they're alone in their struggles. Thanks to social media, women from all over the world have a better understanding of perimenopause because others refuse to adhere to the idea that "the change" is something private. If you're going through brain fog and forgetfulness related to perimenopause, rest assured you have an entire group of people experiencing the same thing and they're more than happy to commiserate with you.

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A nail salon made an ad so funny that people are taking road trips just for a manicure

Nailed it.

Representative photos by Wonderlane|Flickr and Aris Leoven|Canva

This Canadian nail salon has people packing their bags for a manicure

There are a lot of nail salons out there and, without word of mouth recommendations from people you trust, it can be impossible to know which salon to visit. Thanks to social media, though, many businesses have pages where they can advertise their services without having to spend a lot of money on traditional marketing practices like television, billboards, and radio. Doing their marketing using pictures and videos of their amazing work can help keep a steady flow of customers coming—but one Canadian nail salon is going with a slightly different approach.

Henry Pro Nails in Toronto, Canada is leaving the Internet in stitches after creating a viral ad for his nail salon. The video takes the beginnings of several viral video clips but instead of the expected ending, Henry pops in completing the viral moment in hilarious different ways.

It opens with a familiar viral video of a man on a stretcher being pulled by EMS when the stretcher overturns, flopping the man onto the ground. But instead of it ending with the injured man on the ground, Henry seamlessly appears laid out on the floor of his salon and delivers his first line, "Come to my nail salon. Your nails will look beautiful."

nails, nail salon, manicure, henry's pro nails, adsRihanna Nails GIFGiphy

In another clip, a man holds his leg straight up and somehow flips himself into a split. When the camera cuts back to Henry, he's in the splits on the floor of his nail salon promoting loyalty discounts. The ad is insanely creative and people in the comments can't get enough. Some are even planning a trip to Toronto just to get their nails done by the now Internet famous top nail artist in Canada. This isn't Henry's first rodeo making creative ads, but this is one is without a doubt his most popular—and effective.

"I will fly to Canada to get my nails done here just because of this hilarious video. You win this trend for sure," one woman says.

"Get yourself a passport and make a road trip! My bf and I are legit getting ours and its only a 4 hr drive from where we are in Pennsylvania. Their prices are a lot better than other places I've been too," another person says while convincing a fellow American citizen to make the trip.

"Omg, where are you located? I would fly to get my nails done by you," one person writes.

"The pedicure I had at Henry’s was the best I have ever had. Unfortunately made all other places disappointing and I don’t live close enough for Henry’s to be my regular spot," someone else shares.

To keep up with demand, in late October 2024 Henry's announced another location was coming soon in Vaughan, Ontario. Though there's no word on when the new "more spacious and professional facility" is opening just yet, customers can keep an eye out for Henry's next ad on social media.

It just goes to show that creative advertising can get people to go just about anywhere, but great service is what gets them to come back. If you're ever in Toronto (or Vaughan!) and find yourself needing an emergency manicure, Henry's Pro Nails is apparently the place to be.

This article originally appeared last year.

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Ivy League professor shares one word that makes people 30 percent more likely to be persuaded

This word helps turn actions into identities, which is the key to persuading others.

Photo credit: Canva

Jonah Berger explains how appealing to someone's identity makes them more likely to agree to a request.

Everybody wants to see themselves in a positive light. That’s the key to understanding Jonah Berger’s simple tactic that makes people 30% more likely to do what you ask. Berger is a marketing professor at the Wharton School of the University of Pennsylvania and the bestselling author of “Magic Words: What to Say to Get Your Way.”

Berger explained the technique using a Stanford University study involving preschoolers. The researchers messed up a classroom and made two similar requests to groups of 5-year-olds to help clean up.

One group was asked, "Can you help clean?" The other was asked, “Can you be a helper and clean up?" The kids who were asked if they wanted to be a “helper” were 30% more likely to want to clean the classroom. The children weren’t interested in cleaning but wanted to be known as “helpers.”

- YouTubewww.youtube.com

Berger calls the reframing of the question as turning actions into identities.

"It comes down to the difference between actions and identities. We all want to see ourselves as smart and competent and intelligent in a variety of different things,” Berger told Big Think. “But rather than describing someone as hardworking, describing them as a hard worker will make that trait seem more persistent and more likely to last. Rather than asking people to lead more, tell them, 'Can you be a leader?' Rather than asking them to innovate, can you ask them to 'Be an innovator'? By turning actions into identities, you can make people a lot more likely to engage in those desired actions.”

Berger says that learning to reframe requests to appeal to people’s identities will make you more persuasive.

- YouTubewww.youtube.com

“Framing actions as opportunities to claim desired identities will make people more likely to do them,” Berger tells CNBC Make It. “If voting becomes an opportunity to show myself and others that I am a voter, I’m more likely to do it.”

This technique doesn’t just work because people want to see themselves in a positive light. It also works for the opposite. People also want to avoid seeing themselves being portrayed negatively.

“Cheating is bad, but being a cheater is worse. Losing is bad, being a loser is worse,” Berger says.

The same tactic can also be used to persuade ourselves to change our self-concept. Saying you like to cook is one thing, but calling yourself a chef is an identity. “I’m a runner. I’m a straight-A student. We tell little kids, ‘You don’t just read, you’re a reader,’” Berger says. “You do these things because that’s the identity you hold.”

- YouTubewww.youtube.com

Berger’s work shows how important it is to hone our communication skills. By simply changing one word, we can get people to comply with our requests more effectively. But, as Berger says, words are magic and we have to use them skillfully. “We think individual words don’t really matter that much. That’s a mistake,” says Berger. “You could have excellent ideas, but excellent ideas aren’t necessarily going to get people to listen to you.”

This article originally appeared last year. It has since been updated.

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What trends are accepted now but will be embarrassing in the future? Our readers shared 21 ideas.

Today's trend is tomorrow's cringe.

via Atypeek Dgn/Pexels, Kevin Bidwell/Pexels, Teknorat/Flickr

What's accepted now but will be embarrassing in the future?

We can all be sure that as society evolves, many things that seem normal today will be cringeworthy to people in the future, whether it’s our fashion, politics, civility, or our treatment of the environment.

If we look back just 30 years ago, same-sex marriage was illegal, people routinely smoked in bars and restaurants, and it was fashionable and cool to vogue.

So, when we look back on the world of 2024, there are bound to be many things that we’ll be embarrassed about in 30 years, especially when we are forced to live with the repercussions of the decisions we make today. On a lighter note, we’ll all also have clouds full of photos of ourselves wearing hairstyles and clothes that look utterly ridiculous in hindsight.

Last summer we asked the Upworthy community to share their thoughts by asking a big question on Facebook: "What's something that's accepted now that we'll be embarrassed about in the future?" Our readers responded with funny takes on current fashion and concerns about technology use and how we treat our fellow human beings.

Here are 21 things we accept today that we’ll probably be embarrassed about in the future.

More than a few current fashion trends will look silly in the coming years.

yoga pants, embarrassing, trends, 2024, styleYoga pants.Image via Canva.

"Yoga pants. I love them to death, but I can easily see them as the parachute pants of tomorrow." — Deborah

"Barn doors in your house." — Joyce

"Tattoos all over the body." — Vicki

"People wearing socks and sandals." — Jeremy

"Wearing pajamas in public." — Ivy

"Huge, over-sized false eyelashes." — Patricia

falsies, eyelashes, fake eyelashes, makeup trend, popularOur natural lashes are nice just the way they are!i.pinimg.com


Hopefully, people in the future will be more considerate when using technology than we are today.

"Walking around with your eyes locked on your phone. Or eating at a table with 4 people looking at their phone. One day, we will either fall off a cliff or realize life is what is happening off the screen." — Elise.

"Texting in the presence of another person." — Kate


We can also hope that in the near future, we will be able to solve many of today’s pressing public policy issues so that the next generation will live happier and healthier lives.

"Lack of healthcare for everyone." — Sharon

"Making the planet unlivable for human beings." — Karen

"Spending hundreds of millions of dollars of taxpayer's money to build a sports arena for a billionaire. Then charging the taxpayers outrageous amounts to attend events there." — Stacy

"How the US is systematically clawing back women's rights to decide what they do with their bodies. It's beyond shameful." — Jason.

women's rights, healthcare, politics, change, trendsOne step forward, many steps back. Image via Canva.

"Allowing guns everywhere." — Amy

"That we drive fossil fuel-powered vehicles." — Heidi


Some people are concerned about the way students and their parents behave in modern-day America.

"Parents trying to run schools: yelling at teachers for their child’s poor performance, yelling at principals when their child gets in trouble, book banning based on an individual’s religious ideologies, etc." — Beth.

"Entitled children talking back to their parents and teachers." — Connie

@theclassiiics

Every generation has different types of teachers 🤷🏾‍♂️🤷🏽‍♀️🤣🤣🤣 #comedy #comedyvideos #funnyvideos #classiiic @summerrrwilliams #fyp #teacher #teacher #genz #genx #millennial

"Cry rooms at universities where students can go and work out their anxiety and cry and be upset if their professor uses words that are too difficult for them. Universities are institutes of higher learning, not institutes of babysitting. That will be an embarrassment in the future, as it is an embarrassment to me and many others now." — Della


In 30 years, we may be embarrassed to look back on the level of general civility in 2024.

"Panic buying of toilet paper during the pandemic." — Tony

"Ageism. It’s everywhere, all the time, and no one seems to mind. No one is defined by the amount of time they’ve spent on the planet but it’s used as an identity and as a weapon (ask any teenager, 40-year-old woman, or retiree…). I can only hope that one day it will be a source of embarrassment that we were all so dismissive and judgmental." — Rosy.

"Human beings living on the street." — Andrea

"Torturous killing of animals for food." — Mae

homelessness, homeless, unhoused people, America, USAHomelessness is especially rampant on the West Coast.Image via Canva

While this list may seem like a litany of complaints people have about living in the modern world, it should give people hope. If we’ve overcome past embarrassments, today’s can be fixed as well.


This article originally appeared last year. It has been updated.

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