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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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Too young to be a Boomer, too old to be Gen X: Meet the microgeneration 'Generation Jones'

Generation Jones is made up of people born from 1954 to 1965.

generation jones, gen jones, gen jonesers, girls in 1970s, 1970s, teens 1970s
Image via Wikimedia Commons

Generation Jones is the microgeneration of people born from 1954 to 1965.

Generational labels have become cultural identifiers. These include Baby Boomers, Gen X, Millennials, Gen Z and Gen Alpha. And each of these generations is defined by its unique characteristics, personalities and experiences that set them apart from other generations.

But in-between these generational categories are "microgenerations", who straddle the generation before and after them. For example, "Xennial" is the microgeneration name for those who fall on the cusp of Gen X and Millennials.

And there is also a microgeneration between Baby Boomers and Gen X called Generation Jones, which is made up of people born from 1954 to 1965. But what exactly differentiates Gen Jones from the Boomers and Gen Xers that flank it?

- YouTube www.youtube.com

What is Generation Jones?

"Generation Jones" was coined by writer, television producer and social commentator Jonathan Pontell to describe the decade of Americans who grew up in the '60s and '70s. As Pontell wrote of Gen Jonesers in Politico:

"We fill the space between Woodstock and Lollapalooza, between the Paris student riots and the anti-globalisation protests, and between Dylan going electric and Nirvana going unplugged. Jonesers have a unique identity separate from Boomers and GenXers. An avalanche of attitudinal and behavioural data corroborates this distinction."

Pontell describes Jonesers as "practical idealists" who were "forged in the fires of social upheaval while too young to play a part." They are the younger siblings of the boomer civil rights and anti-war activists who grew up witnessing and being moved by the passion of those movements but were met with a fatigued culture by the time they themselves came of age. Sometimes, they're described as the cool older siblings of Gen X. Unlike their older boomer counterparts, most Jonesers were not raised by WWII veteran fathers and were too young to be drafted into Vietnam, leaving them in between on military experience.

How did Generation Jones get its name?

generation jones, gen jones, gen jones teen, generation jones teenager, what is generation jones A Generation Jones teenager poses in her room.Image via Wikmedia Commons

Gen Jones gets its name from the competitive "keeping up with the Joneses" spirit that spawned during their populous birth years, but also from the term "jonesin'," meaning an intense craving, that they coined—a drug reference but also a reflection of the yearning to make a difference that their "unrequited idealism" left them with. According to Pontell, their competitiveness and identity as a "generation aching to act" may make Jonesers particularly effective leaders:

"What makes us Jonesers also makes us uniquely positioned to bring about a new era in international affairs. Our practical idealism was created by witnessing the often unrealistic idealism of the 1960s. And we weren’t engaged in that era’s ideological battles; we were children playing with toys while boomers argued over issues. Our non-ideological pragmatism allows us to resolve intra-boomer skirmishes and to bridge that volatile Boomer-GenXer divide. We can lead."

@grownupdish

Are you Generation Jones? Definitive Guide to Generation Jones https://grownupdish.com/the-definitive-guide-to-generation-jones/ #greenscreen #generationjones #babyboomer #generationx #GenX #over50 #over60 #1970s #midlife #middleage #midlifewomen #grownupdish #over50tiktok #over60women #over60tiktok #over60club

However, generations aren't just calculated by birth year but by a person's cultural reality. Some on the cusp may find themselves identifying more with one generation than the other, such as being culturally more Gen X than boomer. And, of course, not everyone fits into whatever generality they happened to be born into, so stereotyping someone based on their birth year isn't a wise practice. Knowing about these microgenerational differences, however, can help us understand certain sociological realities better as well as help people feel like they have a "home" in the generational discourse.

As many Gen Jonesers have commented, it's nice to "find your people" when you haven't felt like you've fit into the generation you fall into by age. Perhaps in our fast-paced, ever-shifting, interconnected world where culture shifts so swiftly, we need to break generations into 10 year increments instead of 20 to 30 to give everyone a generation that better suits their sensibilities.

This article originally appeared two years ago. It has been updated.

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Employee's 'power-tripping' boss kept scheduling lunch meetings. The payback was brilliant.

"Well, we all have to make sacrifices sometimes."

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via Canva/Photos and Heather/Flickr

A boss is fed up with his employee's antics.

One of the most frequently debated topics in professional etiquette is which foods are appropriate to eat in the office. People often take offense when others cook smelly foods, such as fish or broccoli, in a shared microwave. It can also be rude to bring a bag of snacks into a meeting as a lot of folks don't want to hear chewing while they're trying to think.

When it comes to remote workers, people are even less sure about proper eating etiquette. Is it okay to eat a large meal during an all-hands meeting? One remote worker recently claimed they pushed those boundaries to the limit when their boss allegedly did something most employees would find rude: He scheduled meetings during lunchtime and showed zero interest in apologizing for it.

office, office kitchen, office fridge, workers, employees An office kitchen.via Canva/Photos

"I used to take my lunch break at the same time every day - 12 to 1. I don't eat breakfast (just coffee and lots of water), so my lunch is essential, and I can't just skip it," a Redditor wrote. "My calendar was blocked, but my boss (newly promoted, power-tripping) started scheduling meetings right in the middle of it."

At first, it wasn't a problem, but it became a habit. "The first couple of times, I let it slide," the employee continued. "Figured maybe it was urgent. But then it became a pattern. I pushed back and reminded him that it was during my break, and he said, 'Well, we all have to make sacrifices sometimes.'"

spaghetti, mean spaghetti, pasta, italian food, lunch An angry man eating spaghetti.via Canva/Photos

Sometimes? That would make sense if the boss only occasionally scheduled lunchtime meetings, but this was becoming a regular thing. So, the employee decided they wouldn't skip lunch and would make the meeting as uncomfortable as possible.

"Next meeting, I showed up with a full plate of spaghetti and meatballs. Had my camera on and mic unmuted, slurping and chewing, occasionally gave thumbs up while mid-bite," they wrote. "A few days later, it repeated, so I brought sticky wings. Last week on Thursday, it happened again, glad I still had my pizza."

"We all have to make sacrifices sometimes"

After the boss started noticing a trend, he spoke up: "Do you have to eat during the meeting?" The employee had the perfect response: "I smiled and said, 'We all have to make sacrifices sometimes.'" During the following week, the boss didn't schedule any lunch meetings.

The post went viral. After receiving countless awards from readers, the poster joked about new and inventive ways they could get back at their boss, including dressing up as a Benihana chef and performing an onion volcano, heating cheese mid-meeting with a fondue pot, and carving a massive tomahawk steak on camera.

The Redditor also claimed they purposely behaved obnoxiously during the meeting to further drive home their point. But where do people draw the line when it comes to eating during a remote meeting?

Kate Noel, head of People Ops at Morning Brew, said it's important to read the room:

"All Zoom meetings are not created equal," Noel wrote. "If it's with your closest teammates, it's probably nbd. But if you feel nervous about eating your sushi on camera, then you might want to wait until after the awkward goodbye waves at the end of your meeting. Not for nothing, you could probably get away with keeping your video off during a larger group meeting to eat food. But at your own risk, so choose your own adventure."

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People rally behind an older woman who refused to train her 25-year-old replacement

"They expected me to teach her the job they said I wasn't good enough for."

ageism, workplace ageism, workplace violations, hr, negotiating severance package, exit strategy, hiring, jobs
Photo credit: Canva

An older employee refused two train her replacement who was "fresh out of grad school."

When an older employee was asked to train a 25-year-old to do the same job she'd been doing for as long as the young recruit had been alive, she had some choice words. And it became a vital lesson in not getting exploited.

The TikTok creator, who goes by The Unobsolete (@theunobsolete) centers her content around helping people “fight age bias” in the workplace. She explained how she had been “passed over” for a promotion that she had rightfully earned over the past two-and-a-half decades and was instead expected to train someone “fresh out of grad school” who presumably would then do the job for a fraction of the price.

“They expected me to teach her the job they said I wasn’t good enough for.”

The Unobsolete didn’t entertain pleasantries as she flat-out said “no.”

@theunobsolete watched 25-year-old get my promotion then ask me to train her. I said no. Not sorry. Not maybe. Just no. She shocked. Manager furious. HR email about team player. Don’t care. They passed me over for promotion I earned. Gave it to someone with zero experience. Expected me to teach her job they said I wasn’t good enough for. Train my replacement? Pay me. Want 25 years knowledge? Triple salary consulting rates. Want me to smile while you humiliate me? Wrong person. Not your free training program. Not making cheap hire look competent. Not handing over everything so you can pay her half. They said unprofessional. I said appropriately compensated or not sharing. They said not supporting team. I said team didn’t support me. Silence. Second you stop being useful they stop caring. Stop pretending you owe them anything.#promotions #over50 #notateamplayer #genx #isaidno ♬ original sound - The Unobsolete

"I'm not your free training program," she explained. "Want me to smile while you humiliate me? Wrong person." Furthermore, she noted that if she were going to move forward with the training, she would be expecting “triple salary consulting rates” as payment.

While she got reprimanded by HR for not “being a team player,” she maintained her stance that she deserved to be “fairly compensated for her expertise” or she wasn’t sharing it.

"They said [I was] not supporting [the] team. I said [the] team didn’t support me."

She then concluded the video with a word of caution to other folks who might find themselves in similar situations:

"The second you stop being useful, they stop pretending to care. So stop pretending you owe them anything."

With over four million views, the video certainly resonated. People flooded the comments agreeing how real ageism is in the workplace, and commended The Unobsolete for standing her ground.

"Can't be a team player for a team that played you," one person said.

Quite a few shared their own horror stories. One person recalled, "They hired 6 people to replace me and the work I was doing & wanted me to train them. Nope."

Another said, “I was laid off from a job and they said they’d be fine, because I wrote a literal manual on how to do everything for when I was on vacation. First thing I threw in the trash cleaning out my office. They emailed a few days later, asking where it was. I told them.”

In subsequent videos, The Unobsolete shared that while she didn’t get fired outright (for obvious legal reasons), the company had less direct ways of phasing her out. First, a meeting was held to discuss her "attitude.” Then, she was excluded from company functions and given less work. Eventually, she was called into another meeting and told the company's culture might not be a "good fit" for her.

@theunobsolete UPDATE: Refused to train replacement. What happened next I expected. Two days later meeting with manager and HR. My attitude. Not that they passed me over or wanted free labor. My attitude refusing exploitation. They said not collaborative poor leadership need team players. I said you passed me over want free training punish boundaries that’s control not collaboration. Silence. Not willing develop staff maybe not culture fit. I said right. Culture exploiting experience isn’t my fit. Ready for compensation talk? No? Back to my job. Didn’t fire me. Can’t. Lawsuit risk. Instead stopped including meetings gave projects away documented everything performance issues. Managed out playbook. I documented everything back. Every email meeting project. Knew exactly what they were doing. #promotions #isaidno #refused# #over45 #corporatetiktok ♬ original sound - The Unobsolete


"I agree," The Unobsolete apparently said in the meeting. "A culture that exploits experience isn't a fit for me."

Still, she didn’t back down and asked what the severance package she would receive for leaving. Unsurprisingly, that offer started off low with two weeks' worth of pay. The Unobsolete told them she expected six months of pay with full benefits through the end of the year, plus a neutral reference letter, and a release stating that they wouldn’t contest her unemployment.

When the manager said her demands were “unreasonable,” The Unobsolete replied, “So is asking me to train my replacement for free.”

@theunobsolete UPDATE PART 3: Refused train replacement. How it ended. Three weeks managed out documented retaliation. Manager and HR called me in. Don’t think right fit anymore. Best we part ways.#refusedtotrain #notateamplayer #isaidno #over50 #corporatetiktok ♬ original sound - The Unobsolete

“I’ve never been prouder of someone I don’t know,” one viewer wrote.

Thankfully, this story has a happy ending. The Unobsolete got her demands met, and with that six months of pay, she was able to build what she “actually wanted.” Furthermore, she learned that not long after she left, the 25-year-old quit the job and the company was left scrambling to fill the position. Talk about karmic justice.

“Turns out, I wasn’t obsolete after all. I was just undervalued. There’s a difference.”

Now, she’s taking what she’s learned to help other experienced professionals protect themselves against being taken advantage of.

“They’re counting on you being afraid…stop being what they’re counting on.”

That’s useful advice for anyone, no matter what age they are.

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An Irish woman went to the doctor for a routine eye exam. She left with bright neon green eyes.

It's not easy seeing green.

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Photo credit: @margoinireland on Instagram

Did she get superpowers?

Going to the eye doctor can be a hassle and a pain. It's not just the routine issues and inconveniences that come along when making a doctor appointment, but sometimes the various devices being used to check your eyes' health feel invasive and uncomfortable. But at least at the end of the appointment, most of us don't look like we're turning into The Incredible Hulk. That wasn't the case for one Irish woman.

Photographer Margerita B. Wargola was just going in for a routine eye exam at the hospital but ended up leaving with her eyes a shocking, bright neon green.

At the doctor's office, the nurse practitioner was prepping Wargola for a test with a machine that Wargola had experienced before. Before the test started, Wargola presumed the nurse had dropped some saline into her eyes, as they were feeling dry. After she blinked, everything went yellow.

Wargola and the nurse initially panicked. Neither knew what was going on as Wargola suddenly had yellow vision and radioactive-looking green eyes. After the initial shock, both realized the issue: the nurse forgot to ask Wargola to remove her contact lenses before putting contrast drops in her eyes for the exam. Wargola and the nurse quickly removed the lenses from her eyes and washed them thoroughly with saline. Fortunately, Wargola's eyes were unharmed. Unfortunately, her contacts were permanently stained and she didn't bring a spare pair.

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Since she has poor vision, Wargola was forced to drive herself home after the eye exam wearing the neon-green contact lenses that make her look like a member of the Green Lantern Corps. She couldn't help but laugh at her predicament and recorded a video explaining it all on social media. Since then, her video has sparked a couple Reddit threads and collected a bunch of comments on Instagram:

“But the REAL question is: do you now have X-Ray vision?”

“You can just say you're a superhero.”

“I would make a few stops on the way home just to freak some people out!”

“I would have lived it up! Grab a coffee, do grocery shopping, walk around a shopping center.”

“This one would pair well with that girl who ate something with turmeric with her invisalign on and walked around Paris smiling at people with seemingly BRIGHT YELLOW TEETH.”

“I would save those for fancy special occasions! WOW!”

“Every time I'd stop I'd turn slowly and stare at the person in the car next to me.”

“Keep them. Tell people what to do. They’ll do your bidding.”

In a follow-up Instagram video, Wargola showed her followers that she was safe at home with normal eyes, showing that the damaged contact lenses were so stained that they turned the saline solution in her contacts case into a bright Gatorade yellow. She wasn't mad at the nurse and, in fact, plans on keeping the lenses to wear on St. Patrick's Day or some other special occasion.

While no harm was done and a good laugh was had, it's still best for doctors, nurses, and patients alike to double-check and ask or tell if contact lenses are being worn before each eye test. If not, there might be more than ultra-green eyes to worry about.

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Teacher shares her surprisingly wholesome story of learning what ‘Netflix and chill’ means

She chalked this up to being an “oblivious Millennial.”

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Image via Canva

An image of an embarrassed woman interlaid with a picture of two people cuddling while watching Netflix.

For many, if not most of us, when someone uses the term “Netflix and chill,” we know it to be a euphemism for, well, not much TV watching.

And yet, not everyone knows that this phrase has sexual connotations, apparently. At least one 34-year-old female college professor recently admitted to not knowing. Too bad she had been using the phrase as one of her go-to “icebreakers” in class.

A teacher learns she’s been using “Netflix and chill” wrong

As she shared on Reddit, she would often list “Netflix and chill” as one of her favorite hobbies. Not only that, but whenever students mentioned how stressed they were, she would reiterate: “While it's important to study, it's also important to take time to relax and recharge, so I hope they are able to do something for themselves soon, like ‘Netflix and chill.’”

It wasn’t until she visited her husband for lunch at his work and struck up a conversation with two of his co-workers that she discovered her hefty misunderstanding.

“I'm currently on maternity leave and mentioned to his co-workers that I can't wait for my infant to be older so I can ‘Netflix and chill’ again instead of having to feed and change diapers,” she wrote.

When one of the coworkers had a “shocked look on his face,” the OP was “confused.” She couldn’t believe it when this person explained that it’s a “euphemism for hooking up.” And yet, when the other coworker, a 50-year-old female, said, "Oh he's right, even I know what that means!" there was really no denying it.

Photo credit: Canva


Well, understandably, this woman was “mortified” at having learned the truth and was “now terrified I'm going to be reported for sexual harassment because I guess I've been inadvertently telling my students I love to hook up and have been encouraging them to hook up, too??”

In her defense, it's true that “Netflix and chill” used to mean relaxing while streaming, but that was about 17 years ago. The context we are all familiar with has been around since 2015.


She also noted that she and her husband married young and therefore never spent much time on dating apps, which could help explain why she remained unaware. Plus, she lived at home and worked two jobs during her college years, which meant "Netflix and chill” was literally “Netflixing and chilling,” she quipped.

All in all, she chalked this up to being an “oblivious Millennial.” And by that, she meant a “Millennial who is clearly oblivious” to something “invented by Millennials and has been around for at least 10-15 years.”

Reddit's reactions

Down in the comments, people tried to ease her worries about the whole accidental harassment thing.

"They either thought you were adorably clueless, or just a very cool teacher. Don't sweat it."

“Either people figured she didn’t know and thought it was funny or just assumed they’re very open and sex positive. NBD either way.”

“Rate my professor: 10/10. She told me I can come over and netflix and chill anytime 🥵”

Others didn’t let her off so easily, especially when she surmised that her older coworkers also likely didn’t know what it meant.

“I was shocked when I opened the post and saw OP was 34. I expected her to be 64.”

“I am 38 and have known what it means since it’s been around. This definitely isn’t an age thing, this is a living under a rock thing lol”

“I’m an out of touch millennial but that’s been a saying for like a decade now. lol. You might be under a rock.”

Photo credit: Canva


Regardless, the OP has had a good sense of humor despite being mortified. She concluded her post by saying, “Anyone who has lived the past decade+ under a rock like me is welcome to come over to my place and literally chill and watch Netflix with me anytime! I'll supply the popcorn 🤣”

Listen, it’s bonkers when things like this happen, but they do happen. Is it embarrassing? Sure. But does it remind us that life is about laughing at ourselves? Also yes.

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