January 11, 2021 • 46 mins
Alex Iantaffi interviews Dr. Angela Kade Goepferd about puberty blockers, in light of the Bell V Tavistock decision in the UK. They discuss why this decision is relevant in the UK and beyond, what puberty blockers are (and what is puberty), as well as the reasons why this is such a safe and effective treatment for some trans, nonbinary, and/or gender expansive children and youth. Angela Kade Goepferd, MD (she/they), is the Chief Education Officer for Children’s Minnesota, Chief of Staff, pediatrician in the Children’s Minneapolis Primary Care clinic and medical director of Children’s Gender Health Program.
Dr. Goepferd has a passion for working with underserved and at-risk kids and families, speaks Spanish and cares for a diverse community of patients in the primary care clinic. In addition to running the academic education and health professional education programs for Children’s, Dr. Goeperd is the Chief of the Professional Staff. They are a leader in the LGBTQ community who is driving equitable care for LGBTQ youth, particularly transgender and gender expansive youth and is a sought after speaker and trainer on these topics. They were a member of the LGBT Standards of Care Advisory board, which developed the first healthcare standards for LGBT people in the state of Minnesota, and have been a recipient of one of the inaugural Business of Pride awards from the Minneapolis/St. Paul Business Journal in 2018, and winner of a special recognition award from the American Academy of Pediatrics in 2019 for advocacy and education about LGBTQ youth. In 2020 they gave their first TEDx talk, titled “The revolutionary truth about kids and gender identity” as part of TEDxMinneapolis.
Instagram: GenderStories
Hosted by Alex Iantaffi
Music by Maxwell von Raven
Gender Stories logo by Lior Effinger-Weintraub
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Intro (00:30):
Everyone has a relationship with gender. What's
your story? Hello, and welcometo Gender Stories with your
host, Dr. Alex Iantaffi.
Alex Iantaffi (00:38):
Hello and welcome to the first episode of season
four. I cannot believe thatgender stories have been going
on for so long. So thank youeverybody, for listening and for
keep the audience keeps growing.
So thank you for recommendingthis podcast, to your friends
and family. And today as ever, Iam super excited because I
always have the best guests.
(01:00):
That's just how it is I'm sorry.
But today I have Dr. Angela KadeGoepferd with me, and they are
the chief education officer forChildren's Minnesota. They're
the Chief of Staff and thepediatrician in the children's
Minneapolis primary care clinicand the medical director of
Children's Gender HealthProgram. Dr. Goepfert has been
with Children's for 15 years,and in that time, they've been
(01:23):
an advocate for advancingequitable health care for all
children that helped to createand cultivate the children's way
values to ensure a positiveexperience for patients,
families and professional staff.
And they've been an engagedmember and leader on several
committees, strategic planningteams and other initiatives
(01:44):
across the organization. Dr.
Goepfert has a passion forworking with underserved and at
risk kids and families. Theyspeak Spanish and care for a
diverse community of patients inthe primary care clinic that
they're in. In addition, theyalso ran the academic education
and health professionaleducation programs for
Children's and they're the chiefof the professional staff.
(02:04):
They're a leader in the LGBTQcommunity and they're driving
equitable care for LGBTQ youth,particularly trans non binary
and gender expansive youth. Andthey're a sought after speaker
and trainer on this topic. SoI'm really, really excited to be
talking with them about pubertyblockers today, the way a member
of the LGBT standards of careadvisory board that developed
(02:27):
they helped develop the firsthealthcare standards for LGBT
people in the state ofMinnesota. And they're a
recipient of one of theinaugural business of pride
awards from the Minneapolis St.
Paul Business Journal's in 2018.
And we're winner of a specialrecognition award from the
American Academy of Pediatricsin 2019 for advocacy and
education about LGBTQ youth. In2020, they gave their first TEDx
(02:52):
talk titled The RevolutionaryTruth About Kids and Gender
Identity as part of TEDxMinneapolis. And don't worry,
I'll put the link to that TEDxtalk in the episode description
there listeners so that you canfind it and listen to more of
the kids amazing work. Sowelcome on Gender Stories. Thank
you so much for making the timeto speak with me today. I know
(03:15):
that you're incredibly busy. SoI'm so grateful that you made
time for this today.
Dr. Angela Goepferd (03:24):
Yeah, absolutely. Thanks for having
me, Alex, I'm really happy to behere.
So I'm really excited to betalking with you. And I've known
you and community for a littlewhile. So I know just how
amazing the work that you'vebeen doing is. But
unfortunately, one of the thingsthat brought us together today
is this decision in the UK thatpeople may or may not have heard
(03:45):
about called the Bell versusTavistock decision, which kind
of encourage some providers tokind of write a response even
though you are US based. Andthis happened in the UK. And
that decision, really, if Iunderstand correctly, as a non
legal person means that it'sgoing to be incredibly
(04:07):
difficult, if not impossible,for youth in the UK, who are
looking or seeking to getpuberty blockers kind of based
on gender identity issues to beable to access this treatment
unless they're 18 years old. Isthat your understanding as well
of basically what the decisionis?
Unfortunately, that's myunderstanding as well. Yeah.
Alex Iantaffi (04:28):
So and this decision seems to be part of
this much bigger kind of transmoral panic that's been going on
in the UK for several years now.
But this movement seems sadly tobe growing. And I know that many
of my friends and colleagues inthe UK are kind of part of trans
community have been reallyimpacted by different waves of
this kind of trans moral panic.
(04:52):
And often of course, when itcomes to gender, there's always
a moment when people are like,what about the children? You
know, our children are oldenough to make those decisions
you know, should anybody makesthose terrible decisions about
their body before their 18th?
And so today that's, that's whatwe're here to talk about a the
fact that, you know, people makedecisions about their bodies all
(05:13):
the time before they're 18 yearsold. But specifically, what are
puberty blockers? So let's startfrom why is this decision
relevant beyond the UK? So youare based here on the
Anishinaabe lands in what iscurrently known as the United
States? Why does this matter toyou as a pediatrician here?
Dr. Angela Goepferd (05:34):
Well, I mean, first and foremost, it
matters to me because I careabout all kids, no matter where
they live. And I think you know,all kids have the right to grow
up to be happy and healthy andsafe and strong. And so if there
are kids who will never bepatients of mine in the UK, that
can't get the necessary medicalcare that they need, I care
about it. So that's probablyfirst and foremost. But I think,
you know, earlier, youreferenced this trans moral
(05:56):
panic. And that's, that's notunique to the UK. We see that
here in the United States, andwe see it specifically around
this issue. So there have beenseveral, you know, proposed
pieces of legislation acrossthis country that are trying to
restrict access to medical carefor trans people, and
specifically for trans children.
So I have no pretense that whathappens in the UK relative to
(06:20):
this topic will stay in the UK,I think it's happening here in
the United States, and it willonly continue to happen. And
those of us who advocate fortrans and gender expansive kids
need to be strong voices to makesure that we protect the health
and really the right to healthcare for these kids.
Alex Iantaffi (06:41):
Absolutely. I believe that there's a bill kind
of not that different from whathas happened in the UK, kind of
in Montana right now, trying tostop treatment of trans and
gender expansive or non binaryyouth. And I agree this was far
closer to home than, than wewould like to think sometimes I
think there are so manymisconceptions about the
(07:03):
treatment that youth can access.
And so maybe we can start fromthere. Because I think sometimes
people are so confused aboutwhat is happening and to whom on
a medical level, right? And ofcourse, I also really want to
name that not all trans or nonbinary, gender expansive youth
are necessarily all going toseek medical care. But when they
(07:24):
do seek medical care, kind ofwhat when is the first time that
as a pediatrician, you would seelike, trans youth or non binary
youth for gender expansive childkind of in your practice,
specifically for gender relatedtreatment?
Dr. Angela Goepferd (07:42):
Yeah, that's a great question. And
you're right, every, every transor gender diverse kid is
different. And so not all kidsare going to need medical
intervention of any kind. Butmany kids do need a doctor. And
for that reason, I actually haveseen kids, both in my primary
care practice and in the genderhealth program, as young as
(08:03):
three, four and five years old,to have conversations and really
up until kids hit the age ofpuberty. There's no medical
interventions that we offer forkids. And what we're doing in
those situations is reallyhelping parents and kids
understand concepts of gender,we're helping parents understand
how to best support their kids,how to best protect their kids
(08:26):
in school settings, and otherplaces where they may need some
supportive resources around howthey have these conversations
with their teachers, with theirgrandparents, with other family
members, with the neighbors downthe street. So up until the age
of puberty, we certainly seekids at the doctor's office. And
what we're doing is providingsupportive and affirming care,
(08:49):
which is primarily conversationsanswering questions, helping
access resources. So the firstpoint that we would do any type
of medical intervention would bethe onset of puberty, which for
most kids is going to be betweenthe ages of nine and twelve.
Somewhere in there.
Alex Iantaffi (09:06):
Yeah. And I think that this idea of puberty
sometimes is really nebulous forpeople so how do you assess if a
child is kind of hit puberty?
Which I know gets more in themedical stuff, but I think
that's important for peopleto... what are the changes
they're looking for?
Dr. Angela Goepferd (09:22):
It's that's, it's I think, when I
talked to families in clinic,that's where I start is what is
puberty? What are we talkingabout when we talk about
puberty? And you know, when Isay to kids is puberty is kid
bodies changing into grown upbodies? That's what puberty is,
right? And so, up until we startpuberty, all kid bodies are
essentially the same, except forour genitals. And if you have a
(09:46):
pair of underwear on, you can'ttell if a child is male or
female or non binary or whoeverthey may identify by looking at
their body because all by allkid bodies are essentially the
same. It's all a matter ofclothes and haircuts. But then
when you get to puberty bodiesstart to change. And the
hormones that are startcirculating around puberty,
(10:07):
start to develop what we call inthe medical field primary and
secondary sexualcharacteristics, which I also
say is kind of feminizing andmasculinizing characteristics.
And so that starts to happen.
And, you know, I also say, forthose of you who are listening
that are old enough to rememberthis movie, it's not like the
movie Big with Tom Hanks, whereyou, you know, go to bed, a kid,
and then you wake up and adult.
(10:30):
So puberty happens over years,and there are stages of it. So
the first stage of pubertytypically starts between nine
and 12, and progresses all theway until the late teenage
years. And depending on if youwere assigned female or assigned
male at birth, there may beslightly different, typical
starting and end points forthat. But I think the main
(10:51):
takeaway point is it is aprocess. There are stages, it
happens slowly. And it happensover time. So I Is that helpful
to kind of think through likewhat we're talking about when we
say puberty?
Alex Iantaffi (11:05):
I think it's really helpful because I think
that people when, you know,think that children are getting
medical treatment of five or sixyears old, and like you said,
you know, the treatment they'regetting is a lot of
conversation. And so when we'retalking about puberty, a child
is at least nine years old. Andthat is absolutely as early as
puberty can start. I've evenseen kids around eight years
(11:29):
old, starting to develop kind ofsome, you know, starting to
experience some pubertalchanges, you know, so treatment
doesn't medical interventiondoesn't start that early. And
then if there is medicalintervention, what kind of
medical intervention mighthappen during that window of
pubertal changes? And what doesit look like for trans and non
(11:52):
binary or gender expansivechildren and youth?
Dr. Angela Goepferd (11:56):
Yeah, so the first treatment window would
be at what we call in themedical terminology, Tanner
stage two, which is that firststages of when those kid bodies
start to change into grownupbodies. And so depending on
again, the assigned sex at birthof the child, or the hormones
that are circulatingendogenously are sort of nataly
(12:18):
in their bodies, that if you areassigned female at birth, the
first signs of that puberty aregoing to be what we call breast
buds are those little sort ofpender pads of tissue that
developed beneath the nipplesfor kids, where they often kind
of feel them before you can evensee them because they're kind of
tender, and sometimes associatedpubic hair. And then in kids who
(12:39):
are assigned male at birth, it'soften an enlargement of the
testicles, which most kids mayor may not notice. And then some
associated pubic hair with alittle bit of a voice change.
That's kind of what starts tohappen earliest on. And so when
kids get to that stage, thesecond stage of puberty, that's
where we have an opportunity touse a medication called a
(13:00):
puberty blocker, or the medicalterm for those medications is a
GnRH analog is what we callthat. And that is a medication
that can pause puberty, we sayblock, and sometimes we say
stop, but I like to say pause,because specifically, it is a
reversible medication. So we areliterally pausing the pubertal
(13:25):
hormones that are circulating,and therefore we can unpause
them at any time. So in the workthat I do with kids and
families, puberty blockers arereally nice option because kids
actually don't have to have itall figured out at that stage.
What they have to have figuredout is that the changes that are
(13:48):
happening in their body, don'tfeel right to them. They don't,
they're causing distress,they're causing dysphoria,
they're causing them to reallyfeel uncomfortable, and it's
specifically related to theirgender identity. You know,
puberty is not comfortable foranybody. So let's just get that
on the table. No, kids lovepuberty. I mean, a handful of
(14:08):
kids are excited about puberty.
Most kids hate it, right. Soit's not just not wanting to go
through puberty, it's that youridentity, your sense of self,
your gender identity isspecifically being contradicted
by the changes that arehappening in your body. And so
that's an opportunity that wehave to step in and pause that
process.
Alex Iantaffi (14:30):
And that's an important distinction to make,
because as a mental healthprovider who also works with
this population. Often that'swhat I hear from parents, well,
nobody likes puberty, puberty isuncomfortable for everybody. And
then I have to kind of break itdown. But for your kid, this
seems to be uncomfortable inthis very specific, gender
related way, which is differentthan just experiencing the
(14:52):
distress of puberty which isabsolutely real and most people
experienced that. There is anadded kind of factor that is
connected to their genderidentity that their bodies kind
of developing in a way that'snot consistent or congruent with
their version of themselves withtheir identity with, with who
they are inside. Absolutely.
Dr. Angela Goepferd (15:15):
And I like the pause, I like to explain it
as a pause, because, you know,the other thing that's
beneficial about pubertyblockers is, you know, it gives
us some time. So it's areversible intervention that if
you have a kid who may be on theyounger side, say, on the 9, 10,
11 year old side, and we, we arenoticing that they're
(15:35):
experiencing some distressaround their gender identity, or
some dysphoria around theirgender identity, it's an
opportunity for us to pause thepermanent changes of puberty
that are happening, which wedon't talk about that enough,
puberty is permanent. So we'revery hesitant to make permanent
changes in children or adultswhen it comes to initiating
(15:55):
gender affirming hormones. Butwe sometimes forget that puberty
is permanent. So we arecommitting a child to permanent
bodily changes when we allowthem to start to go through
puberty. So we can pause thatfor a period of time to allow
the child to work withpractitioners like you and
others, who can help them sortthrough some of these feelings
to really delineate is this bodydiscomfort? Is this gender
(16:18):
discomfort? Is this what what isthis that's going on? While we
pause those permanent changes,and at any moment, we can
unpause them, and allow kids togo through puberty, if we
choose.
Alex Iantaffi (16:30):
Exactly because basically, then if you stop
puberty blockers without anyother hormonal intervention, the
child would reverse to goingthrough puberty in their
basically gender assigned atbirth, correct?
Dr. Angela Goepferd (16:44):
Correct.
They would go through their whatwe call their natal puberty, or
their puberty associated withtheir, their gender assigned at
birth, from there, just as theyotherwise would, so no long term
changes or consequences. Theythey would progress. And, you
know, these medications, thatthat we're talking about these
puberty blockers, these havebeen around for over 30 years.
Alex Iantaffi (17:09):
And they were not developed for trans kids, right?
Dr. Angela Goepferd (17:12):
Absolutely not. Right, right.
That's my...
Alex Iantaffi (17:14):
So who were they developed for. Do you know?
Dr. Angela Goepferd (17:16):
So well, you referenced this earlier on,
you know, some kids do gothrough puberty, quite young,
and probably the youngest age,we will let someone go through
puberty, particularly if they'reassigned female at birth is
about eight. Eight would bepretty young for someone
assigned male at birth. Butthere are some kids who under
though that age do start to gothrough puberty. And that's just
(17:38):
way too young. One of theprimary processes that happens
during puberty is if is if usingof the growth plates, not only
all of the secondary sexualcharacteristics, but really a
mineralization of using ofgrowth plates, and it just would
stunt their development. So wecan't let kids go through
puberty that young. So thesemedications were developed to
mimic the naturally occurringpuberty hormone is GnRH, which
(18:01):
then blocks the processdownstream from that, to keep
those kids going through earlypuberty that we call precocious
puberty until they were of theage to keep up with their peers
and start that puberty. So wemay start these medications on a
kid who's six or seven startingpuberty too early, and keep
their puberty on pause untilthey hit that 12 or 13 age and
(18:23):
then take it off and have themgo through puberty. So for over
30 years, we've had thesemedications, we've used them in
kids who have puberty too early.
And it's really in the last 20years and probably more
specifically in the last 10years or so that we have used
them for transgender and genderdiverse kids, to pause their
permanent changes of the pubertythat's incongruent with their
identity.
Alex Iantaffi (18:46):
And as far as I know, there was no big
controversy, no legal challengeswhen this treatment was used for
cisgender children were goingthrough precocious, precocious
puberty, which can be quitestressful. I mean, I remember
I'm almost 50. And I remembergrowing up kind of peers, you
know, in school kind of hittingpuberty really early and out
(19:07):
stressful. That was for them.
And you know, I don't believe atthe time there was any treatment
or this treatment would havebeen really, really new, you
know, and I was brought upprenatally, and that was
something that wasn't even awareof until, like 25 years ago or
something. So there were nocontroversy. So the controversy
seems to be just applying thistreatment that existed and was
(19:29):
developed for cisgender kids totrans and gender expansive kids.
What Why do you think thatthat's when it becomes
controversial for people?
Because medically doesn't seemto be any reason for it. Right?
It seems to be.
Dr. Angela Goepferd (19:46):
I mean, it's a very it's a very safe
medication. We've used it for along time in kids with early
puberty. There was, you know, tomy knowledge, no significant
controversy around using thesemedications and cisgender kids
who are experiencing precociouspuberty. And really, you know,
there wasn't at least in thebroader public, much controversy
around these medications upuntil recently. So we've been,
(20:08):
you know, the initiation ofpuberty blockers in trans and
gender diverse kids started asearly as I could find about 20
years ago. That's when our sortof studies on this started
showing up. But you know, more Iwould say, more commonly, maybe
in the last decade, and when,you know, scientists and
(20:30):
physicians and other people whowere prescribing these
medications, endocrinologist, sothe pediatric endocrinology
society, experts in genderhealth, the, you know, World
Professional Association forTransgender Health, the W, Pap,
they developed guidelines aroundthe use of these medications for
a very long time, and no onecared. I mean, yeah, I'm sure
(20:52):
there were people who cared, butyou certainly didn't have bills
about it. In the Senate, youcertainly didn't have legal
cases around it. And youcertainly didn't hear about it
in the mainstream as you do now.
What's happening now is that wehave the most visibility for
trans and gender diverse folksthan we have ever had. And
anytime you have visibility fora population of people, whether
(21:16):
it's trans and gender diversepeople or people of a particular
race, or religion, or whateverit is that the majority doesn't
understand. It induces a fearbased panic. And that's what
we're seeing there is fear andmisunderstanding, this is
becoming more widely known, andpeople are panicking, based in
fear, that it's not based in anyof the good science that we've
(21:41):
had over the last severaldecades, it's really a lot of
fear. And so that's what I seehappening now is, you know,
there's a backlash, I think,happening to the trans
visibility. We see that anincreased violence against
transgender bodies that ishappening in this country, and I
think all over the world aswell. So it's kind of the price,
I think we're paying forincreased visibility for
(22:04):
transgender people ontransgender and gender diverse
kids in particular.
Alex Iantaffi (22:10):
Absolutely, you know, it really feels like
children's bodies are havebecome this kind of
battleground, you know, aroundgender, which is kind of
heartbreaking, because actuallytreatments like puberty
blockers, like you said, thispausing creates so much space,
for a really kind of healthysupport for the child and for
their family. It creates space,which was kind of only one to
(22:34):
need during that time. And, andI think there there are so many
misconceptions, like I've talkedto people are like, the five is
too young, for a child totransition. And I said children
who are transitioning, so tospeak up five, they're just
socially transitioning, youknow, their price that like you
said, it's just the haircut orclothing, or changing the name,
(22:56):
they're using a school. Andusually those children who are
socially transitioning, soyoung, are very strongly
identifying a specific gender orthey have a strong sense of
self, which we don't usuallychallenges in cisgender
children. If a child is gender,and they are assigned male at
birth, and say, I'm a boy, whenthey're three years old, nobody
(23:16):
goes, Don't you think you're alittle too young to know if
you're a boy, right? But theminute that somebody says, you
know, they're assigned male atbirth and says, I'm a girl, or
they're assigned, you know,female at birth and says, I'm a
boy and a girl, like, then thereis all this questioning, you
know, it's suddenly we no longerunderstand our gender identity
development works on apsychological level, even though
(23:39):
we have had theories for decadesand decades that actually, yes,
children.
Dr. Angela Goepferd (23:44):
Yeah, and, and Alex, I would even take that
one step further to say, notonly do we not challenge
cisgender kids, we activelyreinforce up their, their binary
identities. So you know, when athree year old cisgender boy is
expressing masculinity, it's allwe can do to say he's such a
(24:04):
boys boy, or she's such a girl'sgirl and we celebrate it. So we
lean into and celebrate andreinforce binary identifications
in cisgender kids, and wetolerate non binary
identifications and, orpresentations or expressions in
some kids to some extent.
Tomboys not so much femininityin boys. But, you know, when we
(24:26):
have a kid who very stronglyjust like those boys, boys and
girls, girl, yeah, it's clearwith everyone in their life. I
am a boy or I am a girl, eventhough that's not what you
thought when I was born. Wequestion them. We really
question them that even thoughif that child had been assigned,
(24:49):
you know, congruently in acisgender way with their
identification, we wouldcelebrate it and reinforce it.
Alex Iantaffi (24:56):
Absolutely. And that's such an impact not just
on trans, and gender expansivekids, but on all kids, I think
because those cisgender childrenwho do not fall into gender
norms, you know, are alsohearing this very kind of rigid
binary like, what a strong boyyou are. And really setting the
precedents for boys can only bestrong, you know, they're
(25:18):
supposed to relate to others ina specific way. They're not
supposed to feel fear or cry,or, you know, and of course,
it's not always that rigid, butthere is a certain rigidity to
the binary that really impactsall kids in a harmful way, in a
lot of ways. But yeah, thank youfor kind of saying... Yes, not
(25:38):
only do we not question them,yeah, we celebrate them and
someone doesn't even serve themas kids.
Dr. Angela Goepferd (25:45):
Right. And I am all for celebrating kids,
gender identities, I just wantto celebrate all the kids gender
identities, and not just thecisgender binary kids, I want to
celebrate all the kids, I justwant all kids to feel like they
get to be who they know theyare. And they get to express
their identities in all the waysthat feel comfortable to them.
Alex Iantaffi (26:04):
Absolutely. And in ways that are congruent with
them, you know, like, right, mykid loves to talk about, you
know, she has always had astrong like, I'm a girl identity
as a sister, which also goes toshow that having a transparent
does not confuse your kids, shewas brought up around all sorts
of Trans and Queer non binarypeople. And she's never been
(26:24):
confused about our gender, orother people's just to dispel
another myth. But also this ideathat you have to get girl in a
specific way, right? She lovesbeing a girly girl who's also
really into science.
Dr. Angela Goepferd (26:36):
Yeah
Alex Iantaffi (26:36):
And of course, you know, that you don't have to
be one thing or the other.
Right, you don't have to be thestereotypes of gender, that I
think we all end up promoting,if you're not careful.
Dr. Angela Goepferd (26:49):
Yeah, and, you know, in my, in my work, I
think that's the gift that transand gender diverse kids give all
of us is that, when they'restrong enough to be who they
are, it allows the rest of us tobe the full versions of
ourselves. Because none of usare, you know, all one or all
the other, you know, we don'tall want to color with the blue
crayon all the time, or all wantto color with the pink crayon
(27:10):
all the time, you know, a lot ofus just want to explore all the
parts of our identity. And so Ifeel like that's really, you
know, in the face of thisweaponizing of these trans kids
bodies, which is so unfortunate,and putting them at the center
of all this, the gift thatthey're giving us as a society
is really allowing all of us tobe the truest versions of
ourselves, which we all deserveto be.
Alex Iantaffi (27:33):
Absolutely, and I love that there is something
that we can give this kids togive them some space if they're
experiencing distress, whenthose pubertal changes happen.
And one of the things that Ioften hear from parents is this
fear, you know, is this? Arethere going to be side effects
(27:55):
that I don't know, you know,about growth? Are there going to
be cognitive effects? Are theregoing to be effects, not like
bone growth, or bone density? Iknow that some of the concerns I
hear about bone density areabout cognitive changes. Can you
speak to that a little bit tokind of, which is
understandable. As a parent, youknow, I'm also parent, I'm
(28:15):
anxious sometimes if I'mconsidering a medical treatment
for a kid, and I want to know,all the side effects but....
Dr. Angela Goepferd (28:21):
Yeah, absolutely and when we in
medicine say that something issafe. We mean, it doesn't cause
harm. But we don't mean it'swithout side effect, there is
nothing that you can put in yourbody that is without a side
effect, including the caffeineI'm ingesting as we're talking
on this call. Right?
Alex Iantaffi (28:39):
Exactly.
Dr. Angela Goepferd (28:39):
I do that because it's safe. But it's not
without side effects, right. Soif I have too much of it, I'm
going to be jittery and anxious.
So this medications, thesemedications, these GnRH analogs
are puberty blockers. They arenot without side effects, though
they are safe. And the mostcommon sort of side effect that
we talk about is relative tobone health. And what we found
(29:02):
so one of the things that weknow is that as kids go through
puberty and puberty hormones arecirculating in their bodies,
specifically testosterone andestradiol or estrogen. One of
the effects that it has on bonesis something that we call bone
mineralization, or a hardeningof the bones. So during puberty
is actually when kids should begetting a lot of calcium and
(29:24):
vitamin D, whether that'sthrough milk or otherwise. And
often they're not unfortunately,but that's the time when their
bones are becoming thestrongest. And when we pause
puberty, we're pausing thecirculation of those hormones,
those testosterone and estrogenhormones, and so we're
interfering with that bonemineralization process. In the
studies that were done on kidswho had puberty suppression for
early puberty, or precociouspuberty. What we found was that
(29:47):
after six or seven years onthese blockers, there was
noticeable difference in thebone density or hardening or
bone mineralization between kidswho were on the blockers and
kids who were not. A few thingsabout that. One, the good news
is that the kids who had thosenoticeable changes once the
blockers were stopped, and theirpuberty was resumed, when we
(30:09):
remeasured them, their bonedensities caught up. So it's not
it wasn't a permanent change, itwas a temporary change, and it
caught up. The other good newsis that the kids who got these
medications for precociouspuberty would sometimes be on
them for six or seven years. Itis very rare for a transgender
or gender diverse child to be onthem that long. So for most
(30:29):
kids, I would say we're startingthese around 10 11 12, sometimes
even later, 13 14 15. Andthey're on them for typically
two to four years. So less thanthat timeframe where we notice
changes. That being said,because we know that it's a side
effect, we check kids vitamin Dlevels, and make sure they're
getting good calcium and vitaminD, while they're on treatment.
(30:50):
We monitor their bones whilethey're on the treatment. So
every two years, we check a scanto see how healthy and dense
their bones are. And, and wefollow that. And that's really
the biggest side effect or riskthat we know about in terms of
the cognitive changes, weabsolutely know that there are
cognitive changes that happenduring puberty, there are a lot
of them. Your frontal cortexdevelops, your nerves, your
(31:12):
nerves in your brain go throughthis process of pruning, or kind
of weeding out all the stuff youdon't know and solidifying the
past that you really need inyour in your brain. The studies
that have been done have notshown any cognitive impact of
puberty blockers. And again, myreassurance around it when I
talk with families is that thiswe're not postponing puberty
(31:34):
indefinitely, we're pausing it.
So these hormones, whether it bethe masculinizing, or feminizing
hormones, will come into thischild's body, at some point, it
may be the ones that were goingto be in their body, from their
own ovaries or testicles, or itmay be hormones that we give
them as we induce the pubertythat's congruent with our
(31:56):
identity, but they will havethese hormones. So I think that
these cognitive processes arestill happening, I don't think
that they're exclusively ruledby testosterone and estrogen.
And my, my confidence from thebone studies anyways, I think
that this will catch up, theonly thing I can really say to
families is we don't have anyevidence that there are
(32:17):
cognitive effects of pubertyblockers, it doesn't mean 100%
that there aren't, but I don'thave any evidence that there
are. And, and that's really it.
I mean, the bones continue togrow. There's another hormone
called IGF one, which is agrowth hormone that determines
how tall you are. So youcontinue to grow taller, while
(32:39):
you're on puberty blockers, youdon't have the growth spurt that
you would have when estrogen andtestosterone come in, but you
still continue to grow taller.
So you know, the growth isn'tstunted by being on these. And,
you know, there's some fertilityimplications at these
medications, which is a littlebit more complex and involves
(33:01):
whether you go on genderaffirming hormones after or not.
But in terms of a bad healthoutcome, initiated by the
medication, there really arenone. So it's, it's a really,
that's why we say it's a safemedication.
Alex Iantaffi (33:21):
And it's a safe medication, which in my
experience can have a lifechanging impact on sorry, the
children I work with, becausethere can be such a level of
distress, that really hasincredibly negative impact on
their mental health, you can bereally prevented to a great
(33:41):
degree by using pubertyblockers. And I know that as a
mental health provider, I haveseen you know, young kids and
young people really go fromexperiencing very high levels of
anxiety or depression toactually being able to thrive
and be almost completelydifferent, sometimes overnight,
(34:06):
just by having this anxietyabout their body changing in a
way that's distressing to themkind of being put on pause, like
you said.
Dr. Angela Goepferd (34:14):
Absolutely.
Alex Iantaffi (34:15):
Right. I don't know if you, I'm sure you've
witnessed that too.
Dr. Angela Goepferd (34:18):
Yeah, I mean, anecdotally, I see that
all the time. Absolutely. Imean, they're, you know, two, I
see two things, I see that theyoung kids who've identified
early, they know puberty iscoming. They're just terrified
about it. They've been, youknow, living in their, you know,
the gender that's congruent withtheir identity for years now.
(34:39):
And puberty is happening, andthere's just panic. So to be
able to relieve that panic forthem, I mean, that it's just
palpable. But then the otherkids who are maybe a little bit
later to their exploration andthey're already have started
puberty or they're early inpuberty. I've had so many kids
tell me just how much betterthey feel on the blockers. It
just provides them a sense ofrelief that you know, biology,
(35:02):
this train of puberty isn't justhurling down the tracks, I have
their control. And we can saythat anecdotally, but the other
thing we can say is that we haveevidence to really show that
puberty blockers do make adifference. There have been
several studies that show thatmental health outcomes are
improved in kids who are offeredpuberty blockers versus those
(35:23):
who are not. And in fact, therewas a study that was done, that
was published in pediatrics inFebruary of 2020 that for the
first time really showed and ina study of 20,000, plus trans
people, that there wasstatistically significant impact
on suicidality. And kids who aretransgender people who are
(35:44):
transgender who were offeredpuberty blockers versus those
who were not. So not only aretheir mental health markers
better in terms of things likedepression and anxiety, and just
overall well being, butspecifically, their risk of
suicidality is lower on thepuberty blockers. And I was
reviewing that article rightbefore we talked. And one of the
things that I I must have missedwhen I read it last year, but it
(36:05):
really just shown off the pagewhen I read it today is that
what was even more striking tome rereading it is that the
transgender adults who wantedpuberty blockers, but were not
given them or offered them, nineout of 10 of them, 90% of them
had suicidal ideation. So it wasalmost as if we were inducing
(36:29):
suicidal ideation by withholdingthis treatment from those trans
folks. And so for me, that's oneof the things that with this
decision in the UK, the Bellversus Tavistock decision, I
just think of how much harm weare actually going to be causing
to trans kids who we're going tobe putting in a situation where
(36:51):
they know that there's atreatment available to them.
It's, it's one thing to not havea treatment option. Absolutely,
it's a whole nother thing toknow, there's something out
there that you could access thatwould help you and you and you
are being denied access to it.
The impact on someone's mentalhealth and the hopelessness that
comes with that that can inducesuicidality is really alarming
to me.
Alex Iantaffi (37:13):
It is, and I think that's the part that
should be alarming. And I getreally sad when I hear people
saying that's just big rhetoricthat trans people are using,
right, around suicidality,because actually, there is data,
this is not rhetoric as data,like you said, 90% of you know,
we now have adults who couldhave had this access to this
(37:34):
treatment, but were denied itfor whatever reasons 90%, you
know, and and that is a vastmajority. That's almost
everyone. When we think aboutthe fact that in the general
trans population, we know thatin our community, the level of
suicidality is 10 times that ofthe general population, right.
(37:55):
And that's not because we'retrans. But because we live in a
world where our identity andexperiences are continuously
kind of denied and raised orchallenged, as we were saying
earlier, 10 times that of thegeneral population is a huge
number you know, and knowingthat this is one of the
treatments that can make anincredible difference in the
(38:16):
life of children and youngpeople, that is a safe
treatment, and they toreversible treatment.
Dr. Angela Goepferd (38:23):
Right.
Alex Iantaffi (38:23):
You know, there's nothing irreversible that
happens with puberty blockers,right?
Dr. Angela Goepferd (38:27):
Right.
Yeah. And I think, you know, theother point that we sometimes
miss talking about when we talkabout this is, you know, it's
not just that we're relievingkids anxiety and treating the
trans kids and gender diversekids themselves, it's their
parents too. It is not theparents of transgender and
gender diverse kids who areadvocating for this type of
legislation. The people who areadvocating for this know nothing
(38:48):
don't aren't involved with don'thave their own trans and gender
diverse kids. The parents oftrans and gender diverse kids
want access to this treatmentfor their kids. I have kids in
my practice, I have parents inmy practice, I have one that I
just interacted with within thelast month, who is in the face
of the Montana legislation,seriously considering relocating
(39:09):
their family to Canada so thattheir trans daughter can have
access to puberty suppressionwhen she's of age, they want,
they know the data, they knowthe science, they want their
kids to have access to thistreatment. And so we're also
really, you know, harmingfamilies and the parents of
these kids who know the benefitsof this treatment for their
(39:32):
trans and gender diverse kidsand want them to have access.
Alex Iantaffi (39:35):
Absolutely. And like you said, puberty is
actually not reversible. That'sone of the things that sometimes
I talk about with parents is,you know, this safe treatment
could mean that your child doesless or fewer invasive kind of
surgical intervention later on.
For example, a child wasassigned female at birth might
(39:55):
be able to have minimalintervention in terms of chest
reconstruction or sometimes evenno intervention, right, you
know, compared to something likedouble mastectomy, which quite
frankly, I went through as atrans and non binary adult,
which is major surgery.
Dr. Angela Goepferd (40:12):
Right.
Alex Iantaffi (40:12):
You know, and so sometimes for parents kind of
also thinking about what wemight be... how this might be
impacting their kid in the longrun, right? Like you said, if
they don't want any othermedical intervention, puberty
blockers, stop, everything goesback to how it was. But if they
do want more medicalinterventions, it might save
(40:35):
also folks who are assigned maleat birth from really invasive
kind of feminization procedure,or tracheal shavings, or all
sorts of much more invasivesurgical intervention, which
again, not every trans person ornon binary, or gender expansive
person wants, but some people doneed, actually not want, to need
(40:56):
those to feel calm, right,within their body.
Dr. Angela Goepferd (41:00):
Yeah, absolutely, you know, the, the
trans masculine kids that I carefor the two biggest things that
they experience, this worryabout is their chest and their
voice.
Alex Iantaffi (41:08):
Yes.
Dr. Angela Goepferd (41:08):
And, you know, with, with puberty
blockers, we are taking away thechest dysphoria, if we started
early enough for kids, they willnever develop breasts, they will
never have the surgery that youmentioned. And in trans feminine
kids, the two biggest thingsthat I hear about from them are
also their voice, and theirfacial hair. And we can
completely take that away withpuberty blockers. And you know,
(41:31):
once that voice lowers for transfeminine kids, that's a
permanent change. And weestrogen doesn't raise it,
there's no medical interventionwe can do to raise that voice.
And it is probably one of themost distressing you use your
voice all the time, every day,it is so distressing for trans
feminine, and particularly, youknow, really female, binary
(41:52):
feminine identified folks tohave to learn how to handle that
that voice. And again, with hairgrowth, you know, it's not, it
doesn't go away with estrogentreatment, you have to have
electrolysis or some painfulprocedure that is recurrent, to
remove that, that hair and beable to give sort of our trans
(42:16):
kids the freedom of not havingto subject their bodies, to
those kinds of painful medicalinterventions down the road, I
think, is really a gift. And ifyou talk with trans adults who
didn't have the option ofpuberty blocking treatment, many
of them are very much in favorof offering this treatment for
(42:38):
kids because of what they couldhave avoided if they had had
access to.
Alex Iantaffi (42:42):
Oh, yeah, I mean, if I lived in a world where a. I
didn't even realize that transwas a thing, you know, so I just
knew that it was really coolthat people thought I was a boy
on the playground in the 70s.
Right? How cool is that? But ifan adult had been like more
like, whoa, you know, how, whoare you? And how would you feel,
and I've been able to expressthat and have access to this
treatment, life would have beenso different. Well, I feel like
(43:04):
I could talk about this, likefor hours and hours, but I want
to be respectful of your time,which I know is more precious
than ever nowadays, as a medicalprovider. Is there anything that
we haven't talked about that youwould really like to communicate
to people about puberty blockersand specifically, or just the
treatment of kind of genderexpansive youth for anything
(43:27):
that we haven't covered that youthink it's important to name?
Dr. Angela Goepferd (43:34):
You know, I think we covered a lot of it,
you know, I really just wantpeople to understand what the
medication is that we're talkingabout when we use it, the fact
that it is reversible. The factthat we know that it's very safe
that we've studied, studied it,and both cisgender and
transgender kids for severalyears. I also you know, just
because I work so closely withtrans and gender diverse kids,
(43:56):
I, I really want to reinforcethat. Kids do know who they are.
And, you know, we all go througha process of identity
development that happens ourwhole lives, I am not the same
person at 43, as I was at 33, or23, or 13 or seven. I have grown
and developed over that time.
And even for me, there's beensome validity to my gender
identity during that time. Butwe all get permission to go on
(44:18):
that journey. And it's not forus to stop our, you know,
children and adolescents fromgoing on that journey.
Particularly when they are veryconvicted about it. And when you
have a medical team and a mentalhealth team, that is you know,
absolutely convinced that thisis the best best path for a
child and parents who aresupportive. I would really hate
(44:39):
to see there be legislation thatprevents good outcomes, both
physical and mental healthoutcomes for kids. And, you
know, I really just hope that wecontinue to listen to kids and
let them continue to change theworld and us right along with
it. Because I think we'll all bebetter for that in the end.
Alex Iantaffi (45:03):
I agree. I mean, the kids I work with know they
are they know what they want.
And if we just listen to them,and like you said, it's not also
no treatment is given on a whim,right? There's like X rays
involved and blood work andseeing a medical doctor and
often seeing a mental healthprovider. This is a very
involved process. It's not likeeverybody goes in for one and
(45:27):
done visit for puberty blockers,right?
Dr. Angela Goepferd (45:32):
Right.
Alex Iantaffi (45:32):
Yeah, this is something that can really make
such a positive impact in thelife of people and that probably
legislators should stay well thehell out of I would say, it's
not their job. Let's just letthe medical providers do their
job. Right?
Dr. Angela Goepferd (45:47):
Right. Yes.
Well, thank you, Alex, forhaving me. I really appreciate
it.
Alex Iantaffi (45:52):
Thank you. Thank you. Thank you so much for
sharing all this wisdom and thisknowledge with the gender
stories listeners. I also hopethe listeners that you go check
out Kade's TEDx talk is reallygood. So you should watch it.
And then as ever, in the episodedescription, there'll be some
links for you to look at aboutsome of the things that we've
been mentioning. And thank youso much again, Dr. Goepferd for
(46:15):
being on the show today.
Dr. Angela Goepferd (46:17):
Absolutely.
Everyone has a relationship with gender. What's
your story? Hello, and welcometo Gender Stories with your
host, Dr. Alex Iantaffi.
Alex Iantaffi (00:38):
Hello and welcome to the first episode of season
four. I cannot believe thatgender stories have been going
on for so long. So thank youeverybody, for listening and for
keep the audience keeps growing.
So thank you for recommendingthis podcast, to your friends
and family. And today as ever, Iam super excited because I
always have the best guests.
(01:00):
That's just how it is I'm sorry.
But today I have Dr. Angela KadeGoepferd with me, and they are
the chief education officer forChildren's Minnesota. They're
the Chief of Staff and thepediatrician in the children's
Minneapolis primary care clinicand the medical director of
Children's Gender HealthProgram. Dr. Goepfert has been
with Children's for 15 years,and in that time, they've been
(01:23):
an advocate for advancingequitable health care for all
children that helped to createand cultivate the children's way
values to ensure a positiveexperience for patients,
families and professional staff.
And they've been an engagedmember and leader on several
committees, strategic planningteams and other initiatives
(01:44):
across the organization. Dr.
Goepfert has a passion forworking with underserved and at
risk kids and families. Theyspeak Spanish and care for a
diverse community of patients inthe primary care clinic that
they're in. In addition, theyalso ran the academic education
and health professionaleducation programs for
Children's and they're the chiefof the professional staff.
(02:04):
They're a leader in the LGBTQcommunity and they're driving
equitable care for LGBTQ youth,particularly trans non binary
and gender expansive youth. Andthey're a sought after speaker
and trainer on this topic. SoI'm really, really excited to be
talking with them about pubertyblockers today, the way a member
of the LGBT standards of careadvisory board that developed
(02:27):
they helped develop the firsthealthcare standards for LGBT
people in the state ofMinnesota. And they're a
recipient of one of theinaugural business of pride
awards from the Minneapolis St.
Paul Business Journal's in 2018.
And we're winner of a specialrecognition award from the
American Academy of Pediatricsin 2019 for advocacy and
education about LGBTQ youth. In2020, they gave their first TEDx
(02:52):
talk titled The RevolutionaryTruth About Kids and Gender
Identity as part of TEDxMinneapolis. And don't worry,
I'll put the link to that TEDxtalk in the episode description
there listeners so that you canfind it and listen to more of
the kids amazing work. Sowelcome on Gender Stories. Thank
you so much for making the timeto speak with me today. I know
(03:15):
that you're incredibly busy. SoI'm so grateful that you made
time for this today.
Dr. Angela Goepferd (03:24):
Yeah, absolutely. Thanks for having
me, Alex, I'm really happy to behere.
So I'm really excited to betalking with you. And I've known
you and community for a littlewhile. So I know just how
amazing the work that you'vebeen doing is. But
unfortunately, one of the thingsthat brought us together today
is this decision in the UK thatpeople may or may not have heard
(03:45):
about called the Bell versusTavistock decision, which kind
of encourage some providers tokind of write a response even
though you are US based. Andthis happened in the UK. And
that decision, really, if Iunderstand correctly, as a non
legal person means that it'sgoing to be incredibly
(04:07):
difficult, if not impossible,for youth in the UK, who are
looking or seeking to getpuberty blockers kind of based
on gender identity issues to beable to access this treatment
unless they're 18 years old. Isthat your understanding as well
of basically what the decisionis?
Unfortunately, that's myunderstanding as well. Yeah.
Alex Iantaffi (04:28):
So and this decision seems to be part of
this much bigger kind of transmoral panic that's been going on
in the UK for several years now.
But this movement seems sadly tobe growing. And I know that many
of my friends and colleagues inthe UK are kind of part of trans
community have been reallyimpacted by different waves of
this kind of trans moral panic.
(04:52):
And often of course, when itcomes to gender, there's always
a moment when people are like,what about the children? You
know, our children are oldenough to make those decisions
you know, should anybody makesthose terrible decisions about
their body before their 18th?
And so today that's, that's whatwe're here to talk about a the
fact that, you know, people makedecisions about their bodies all
(05:13):
the time before they're 18 yearsold. But specifically, what are
puberty blockers? So let's startfrom why is this decision
relevant beyond the UK? So youare based here on the
Anishinaabe lands in what iscurrently known as the United
States? Why does this matter toyou as a pediatrician here?
Dr. Angela Goepferd (05:34):
Well, I mean, first and foremost, it
matters to me because I careabout all kids, no matter where
they live. And I think you know,all kids have the right to grow
up to be happy and healthy andsafe and strong. And so if there
are kids who will never bepatients of mine in the UK, that
can't get the necessary medicalcare that they need, I care
about it. So that's probablyfirst and foremost. But I think,
you know, earlier, youreferenced this trans moral
(05:56):
panic. And that's, that's notunique to the UK. We see that
here in the United States, andwe see it specifically around
this issue. So there have beenseveral, you know, proposed
pieces of legislation acrossthis country that are trying to
restrict access to medical carefor trans people, and
specifically for trans children.
So I have no pretense that whathappens in the UK relative to
(06:20):
this topic will stay in the UK,I think it's happening here in
the United States, and it willonly continue to happen. And
those of us who advocate fortrans and gender expansive kids
need to be strong voices to makesure that we protect the health
and really the right to healthcare for these kids.
Alex Iantaffi (06:41):
Absolutely. I believe that there's a bill kind
of not that different from whathas happened in the UK, kind of
in Montana right now, trying tostop treatment of trans and
gender expansive or non binaryyouth. And I agree this was far
closer to home than, than wewould like to think sometimes I
think there are so manymisconceptions about the
(07:03):
treatment that youth can access.
And so maybe we can start fromthere. Because I think sometimes
people are so confused aboutwhat is happening and to whom on
a medical level, right? And ofcourse, I also really want to
name that not all trans or nonbinary, gender expansive youth
are necessarily all going toseek medical care. But when they
(07:24):
do seek medical care, kind ofwhat when is the first time that
as a pediatrician, you would seelike, trans youth or non binary
youth for gender expansive childkind of in your practice,
specifically for gender relatedtreatment?
Dr. Angela Goepferd (07:42):
Yeah, that's a great question. And
you're right, every, every transor gender diverse kid is
different. And so not all kidsare going to need medical
intervention of any kind. Butmany kids do need a doctor. And
for that reason, I actually haveseen kids, both in my primary
care practice and in the genderhealth program, as young as
(08:03):
three, four and five years old,to have conversations and really
up until kids hit the age ofpuberty. There's no medical
interventions that we offer forkids. And what we're doing in
those situations is reallyhelping parents and kids
understand concepts of gender,we're helping parents understand
how to best support their kids,how to best protect their kids
(08:26):
in school settings, and otherplaces where they may need some
supportive resources around howthey have these conversations
with their teachers, with theirgrandparents, with other family
members, with the neighbors downthe street. So up until the age
of puberty, we certainly seekids at the doctor's office. And
what we're doing is providingsupportive and affirming care,
(08:49):
which is primarily conversationsanswering questions, helping
access resources. So the firstpoint that we would do any type
of medical intervention would bethe onset of puberty, which for
most kids is going to be betweenthe ages of nine and twelve.
Somewhere in there.
Alex Iantaffi (09:06):
Yeah. And I think that this idea of puberty
sometimes is really nebulous forpeople so how do you assess if a
child is kind of hit puberty?
Which I know gets more in themedical stuff, but I think
that's important for peopleto... what are the changes
they're looking for?
Dr. Angela Goepferd (09:22):
It's that's, it's I think, when I
talked to families in clinic,that's where I start is what is
puberty? What are we talkingabout when we talk about
puberty? And you know, when Isay to kids is puberty is kid
bodies changing into grown upbodies? That's what puberty is,
right? And so, up until we startpuberty, all kid bodies are
essentially the same, except forour genitals. And if you have a
(09:46):
pair of underwear on, you can'ttell if a child is male or
female or non binary or whoeverthey may identify by looking at
their body because all by allkid bodies are essentially the
same. It's all a matter ofclothes and haircuts. But then
when you get to puberty bodiesstart to change. And the
hormones that are startcirculating around puberty,
(10:07):
start to develop what we call inthe medical field primary and
secondary sexualcharacteristics, which I also
say is kind of feminizing andmasculinizing characteristics.
And so that starts to happen.
And, you know, I also say, forthose of you who are listening
that are old enough to rememberthis movie, it's not like the
movie Big with Tom Hanks, whereyou, you know, go to bed, a kid,
and then you wake up and adult.
(10:30):
So puberty happens over years,and there are stages of it. So
the first stage of pubertytypically starts between nine
and 12, and progresses all theway until the late teenage
years. And depending on if youwere assigned female or assigned
male at birth, there may beslightly different, typical
starting and end points forthat. But I think the main
(10:51):
takeaway point is it is aprocess. There are stages, it
happens slowly. And it happensover time. So I Is that helpful
to kind of think through likewhat we're talking about when we
say puberty?
Alex Iantaffi (11:05):
I think it's really helpful because I think
that people when, you know,think that children are getting
medical treatment of five or sixyears old, and like you said,
you know, the treatment they'regetting is a lot of
conversation. And so when we'retalking about puberty, a child
is at least nine years old. Andthat is absolutely as early as
puberty can start. I've evenseen kids around eight years
(11:29):
old, starting to develop kind ofsome, you know, starting to
experience some pubertalchanges, you know, so treatment
doesn't medical interventiondoesn't start that early. And
then if there is medicalintervention, what kind of
medical intervention mighthappen during that window of
pubertal changes? And what doesit look like for trans and non
(11:52):
binary or gender expansivechildren and youth?
Dr. Angela Goepferd (11:56):
Yeah, so the first treatment window would
be at what we call in themedical terminology, Tanner
stage two, which is that firststages of when those kid bodies
start to change into grownupbodies. And so depending on
again, the assigned sex at birthof the child, or the hormones
that are circulatingendogenously are sort of nataly
(12:18):
in their bodies, that if you areassigned female at birth, the
first signs of that puberty aregoing to be what we call breast
buds are those little sort ofpender pads of tissue that
developed beneath the nipplesfor kids, where they often kind
of feel them before you can evensee them because they're kind of
tender, and sometimes associatedpubic hair. And then in kids who
(12:39):
are assigned male at birth, it'soften an enlargement of the
testicles, which most kids mayor may not notice. And then some
associated pubic hair with alittle bit of a voice change.
That's kind of what starts tohappen earliest on. And so when
kids get to that stage, thesecond stage of puberty, that's
where we have an opportunity touse a medication called a
(13:00):
puberty blocker, or the medicalterm for those medications is a
GnRH analog is what we callthat. And that is a medication
that can pause puberty, we sayblock, and sometimes we say
stop, but I like to say pause,because specifically, it is a
reversible medication. So we areliterally pausing the pubertal
(13:25):
hormones that are circulating,and therefore we can unpause
them at any time. So in the workthat I do with kids and
families, puberty blockers arereally nice option because kids
actually don't have to have itall figured out at that stage.
What they have to have figuredout is that the changes that are
(13:48):
happening in their body, don'tfeel right to them. They don't,
they're causing distress,they're causing dysphoria,
they're causing them to reallyfeel uncomfortable, and it's
specifically related to theirgender identity. You know,
puberty is not comfortable foranybody. So let's just get that
on the table. No, kids lovepuberty. I mean, a handful of
(14:08):
kids are excited about puberty.
Most kids hate it, right. Soit's not just not wanting to go
through puberty, it's that youridentity, your sense of self,
your gender identity isspecifically being contradicted
by the changes that arehappening in your body. And so
that's an opportunity that wehave to step in and pause that
process.
Alex Iantaffi (14:30):
And that's an important distinction to make,
because as a mental healthprovider who also works with
this population. Often that'swhat I hear from parents, well,
nobody likes puberty, puberty isuncomfortable for everybody. And
then I have to kind of break itdown. But for your kid, this
seems to be uncomfortable inthis very specific, gender
related way, which is differentthan just experiencing the
(14:52):
distress of puberty which isabsolutely real and most people
experienced that. There is anadded kind of factor that is
connected to their genderidentity that their bodies kind
of developing in a way that'snot consistent or congruent with
their version of themselves withtheir identity with, with who
they are inside. Absolutely.
Dr. Angela Goepferd (15:15):
And I like the pause, I like to explain it
as a pause, because, you know,the other thing that's
beneficial about pubertyblockers is, you know, it gives
us some time. So it's areversible intervention that if
you have a kid who may be on theyounger side, say, on the 9, 10,
11 year old side, and we, we arenoticing that they're
(15:35):
experiencing some distressaround their gender identity, or
some dysphoria around theirgender identity, it's an
opportunity for us to pause thepermanent changes of puberty
that are happening, which wedon't talk about that enough,
puberty is permanent. So we'revery hesitant to make permanent
changes in children or adultswhen it comes to initiating
(15:55):
gender affirming hormones. Butwe sometimes forget that puberty
is permanent. So we arecommitting a child to permanent
bodily changes when we allowthem to start to go through
puberty. So we can pause thatfor a period of time to allow
the child to work withpractitioners like you and
others, who can help them sortthrough some of these feelings
to really delineate is this bodydiscomfort? Is this gender
(16:18):
discomfort? Is this what what isthis that's going on? While we
pause those permanent changes,and at any moment, we can
unpause them, and allow kids togo through puberty, if we
choose.
Alex Iantaffi (16:30):
Exactly because basically, then if you stop
puberty blockers without anyother hormonal intervention, the
child would reverse to goingthrough puberty in their
basically gender assigned atbirth, correct?
Dr. Angela Goepferd (16:44):
Correct.
They would go through their whatwe call their natal puberty, or
their puberty associated withtheir, their gender assigned at
birth, from there, just as theyotherwise would, so no long term
changes or consequences. Theythey would progress. And, you
know, these medications, thatthat we're talking about these
puberty blockers, these havebeen around for over 30 years.
Alex Iantaffi (17:09):
And they were not developed for trans kids, right?
Dr. Angela Goepferd (17:12):
Absolutely not. Right, right.
That's my...
Alex Iantaffi (17:14):
So who were they developed for. Do you know?
Dr. Angela Goepferd (17:16):
So well, you referenced this earlier on,
you know, some kids do gothrough puberty, quite young,
and probably the youngest age,we will let someone go through
puberty, particularly if they'reassigned female at birth is
about eight. Eight would bepretty young for someone
assigned male at birth. Butthere are some kids who under
though that age do start to gothrough puberty. And that's just
(17:38):
way too young. One of theprimary processes that happens
during puberty is if is if usingof the growth plates, not only
all of the secondary sexualcharacteristics, but really a
mineralization of using ofgrowth plates, and it just would
stunt their development. So wecan't let kids go through
puberty that young. So thesemedications were developed to
mimic the naturally occurringpuberty hormone is GnRH, which
(18:01):
then blocks the processdownstream from that, to keep
those kids going through earlypuberty that we call precocious
puberty until they were of theage to keep up with their peers
and start that puberty. So wemay start these medications on a
kid who's six or seven startingpuberty too early, and keep
their puberty on pause untilthey hit that 12 or 13 age and
(18:23):
then take it off and have themgo through puberty. So for over
30 years, we've had thesemedications, we've used them in
kids who have puberty too early.
And it's really in the last 20years and probably more
specifically in the last 10years or so that we have used
them for transgender and genderdiverse kids, to pause their
permanent changes of the pubertythat's incongruent with their
identity.
Alex Iantaffi (18:46):
And as far as I know, there was no big
controversy, no legal challengeswhen this treatment was used for
cisgender children were goingthrough precocious, precocious
puberty, which can be quitestressful. I mean, I remember
I'm almost 50. And I remembergrowing up kind of peers, you
know, in school kind of hittingpuberty really early and out
(19:07):
stressful. That was for them.
And you know, I don't believe atthe time there was any treatment
or this treatment would havebeen really, really new, you
know, and I was brought upprenatally, and that was
something that wasn't even awareof until, like 25 years ago or
something. So there were nocontroversy. So the controversy
seems to be just applying thistreatment that existed and was
(19:29):
developed for cisgender kids totrans and gender expansive kids.
What Why do you think thatthat's when it becomes
controversial for people?
Because medically doesn't seemto be any reason for it. Right?
It seems to be.
Dr. Angela Goepferd (19:46):
I mean, it's a very it's a very safe
medication. We've used it for along time in kids with early
puberty. There was, you know, tomy knowledge, no significant
controversy around using thesemedications and cisgender kids
who are experiencing precociouspuberty. And really, you know,
there wasn't at least in thebroader public, much controversy
around these medications upuntil recently. So we've been,
(20:08):
you know, the initiation ofpuberty blockers in trans and
gender diverse kids started asearly as I could find about 20
years ago. That's when our sortof studies on this started
showing up. But you know, more Iwould say, more commonly, maybe
in the last decade, and when,you know, scientists and
(20:30):
physicians and other people whowere prescribing these
medications, endocrinologist, sothe pediatric endocrinology
society, experts in genderhealth, the, you know, World
Professional Association forTransgender Health, the W, Pap,
they developed guidelines aroundthe use of these medications for
a very long time, and no onecared. I mean, yeah, I'm sure
(20:52):
there were people who cared, butyou certainly didn't have bills
about it. In the Senate, youcertainly didn't have legal
cases around it. And youcertainly didn't hear about it
in the mainstream as you do now.
What's happening now is that wehave the most visibility for
trans and gender diverse folksthan we have ever had. And
anytime you have visibility fora population of people, whether
(21:16):
it's trans and gender diversepeople or people of a particular
race, or religion, or whateverit is that the majority doesn't
understand. It induces a fearbased panic. And that's what
we're seeing there is fear andmisunderstanding, this is
becoming more widely known, andpeople are panicking, based in
fear, that it's not based in anyof the good science that we've
(21:41):
had over the last severaldecades, it's really a lot of
fear. And so that's what I seehappening now is, you know,
there's a backlash, I think,happening to the trans
visibility. We see that anincreased violence against
transgender bodies that ishappening in this country, and I
think all over the world aswell. So it's kind of the price,
I think we're paying forincreased visibility for
(22:04):
transgender people ontransgender and gender diverse
kids in particular.
Alex Iantaffi (22:10):
Absolutely, you know, it really feels like
children's bodies are havebecome this kind of
battleground, you know, aroundgender, which is kind of
heartbreaking, because actuallytreatments like puberty
blockers, like you said, thispausing creates so much space,
for a really kind of healthysupport for the child and for
their family. It creates space,which was kind of only one to
(22:34):
need during that time. And, andI think there there are so many
misconceptions, like I've talkedto people are like, the five is
too young, for a child totransition. And I said children
who are transitioning, so tospeak up five, they're just
socially transitioning, youknow, their price that like you
said, it's just the haircut orclothing, or changing the name,
(22:56):
they're using a school. Andusually those children who are
socially transitioning, soyoung, are very strongly
identifying a specific gender orthey have a strong sense of
self, which we don't usuallychallenges in cisgender
children. If a child is gender,and they are assigned male at
birth, and say, I'm a boy, whenthey're three years old, nobody
(23:16):
goes, Don't you think you're alittle too young to know if
you're a boy, right? But theminute that somebody says, you
know, they're assigned male atbirth and says, I'm a girl, or
they're assigned, you know,female at birth and says, I'm a
boy and a girl, like, then thereis all this questioning, you
know, it's suddenly we no longerunderstand our gender identity
development works on apsychological level, even though
(23:39):
we have had theories for decadesand decades that actually, yes,
children.
Dr. Angela Goepferd (23:44):
Yeah, and, and Alex, I would even take that
one step further to say, notonly do we not challenge
cisgender kids, we activelyreinforce up their, their binary
identities. So you know, when athree year old cisgender boy is
expressing masculinity, it's allwe can do to say he's such a
(24:04):
boys boy, or she's such a girl'sgirl and we celebrate it. So we
lean into and celebrate andreinforce binary identifications
in cisgender kids, and wetolerate non binary
identifications and, orpresentations or expressions in
some kids to some extent.
Tomboys not so much femininityin boys. But, you know, when we
(24:26):
have a kid who very stronglyjust like those boys, boys and
girls, girl, yeah, it's clearwith everyone in their life. I
am a boy or I am a girl, eventhough that's not what you
thought when I was born. Wequestion them. We really
question them that even thoughif that child had been assigned,
(24:49):
you know, congruently in acisgender way with their
identification, we wouldcelebrate it and reinforce it.
Alex Iantaffi (24:56):
Absolutely. And that's such an impact not just
on trans, and gender expansivekids, but on all kids, I think
because those cisgender childrenwho do not fall into gender
norms, you know, are alsohearing this very kind of rigid
binary like, what a strong boyyou are. And really setting the
precedents for boys can only bestrong, you know, they're
(25:18):
supposed to relate to others ina specific way. They're not
supposed to feel fear or cry,or, you know, and of course,
it's not always that rigid, butthere is a certain rigidity to
the binary that really impactsall kids in a harmful way, in a
lot of ways. But yeah, thank youfor kind of saying... Yes, not
(25:38):
only do we not question them,yeah, we celebrate them and
someone doesn't even serve themas kids.
Dr. Angela Goepferd (25:45):
Right. And I am all for celebrating kids,
gender identities, I just wantto celebrate all the kids gender
identities, and not just thecisgender binary kids, I want to
celebrate all the kids, I justwant all kids to feel like they
get to be who they know theyare. And they get to express
their identities in all the waysthat feel comfortable to them.
Alex Iantaffi (26:04):
Absolutely. And in ways that are congruent with
them, you know, like, right, mykid loves to talk about, you
know, she has always had astrong like, I'm a girl identity
as a sister, which also goes toshow that having a transparent
does not confuse your kids, shewas brought up around all sorts
of Trans and Queer non binarypeople. And she's never been
(26:24):
confused about our gender, orother people's just to dispel
another myth. But also this ideathat you have to get girl in a
specific way, right? She lovesbeing a girly girl who's also
really into science.
Dr. Angela Goepferd (26:36):
Yeah
Alex Iantaffi (26:36):
And of course, you know, that you don't have to
be one thing or the other.
Right, you don't have to be thestereotypes of gender, that I
think we all end up promoting,if you're not careful.
Dr. Angela Goepferd (26:49):
Yeah, and, you know, in my, in my work, I
think that's the gift that transand gender diverse kids give all
of us is that, when they'restrong enough to be who they
are, it allows the rest of us tobe the full versions of
ourselves. Because none of usare, you know, all one or all
the other, you know, we don'tall want to color with the blue
crayon all the time, or all wantto color with the pink crayon
(27:10):
all the time, you know, a lot ofus just want to explore all the
parts of our identity. And so Ifeel like that's really, you
know, in the face of thisweaponizing of these trans kids
bodies, which is so unfortunate,and putting them at the center
of all this, the gift thatthey're giving us as a society
is really allowing all of us tobe the truest versions of
ourselves, which we all deserveto be.
Alex Iantaffi (27:33):
Absolutely, and I love that there is something
that we can give this kids togive them some space if they're
experiencing distress, whenthose pubertal changes happen.
And one of the things that Ioften hear from parents is this
fear, you know, is this? Arethere going to be side effects
(27:55):
that I don't know, you know,about growth? Are there going to
be cognitive effects? Are theregoing to be effects, not like
bone growth, or bone density? Iknow that some of the concerns I
hear about bone density areabout cognitive changes. Can you
speak to that a little bit tokind of, which is
understandable. As a parent, youknow, I'm also parent, I'm
(28:15):
anxious sometimes if I'mconsidering a medical treatment
for a kid, and I want to know,all the side effects but....
Dr. Angela Goepferd (28:21):
Yeah, absolutely and when we in
medicine say that something issafe. We mean, it doesn't cause
harm. But we don't mean it'swithout side effect, there is
nothing that you can put in yourbody that is without a side
effect, including the caffeineI'm ingesting as we're talking
on this call. Right?
Alex Iantaffi (28:39):
Exactly.
Dr. Angela Goepferd (28:39):
I do that because it's safe. But it's not
without side effects, right. Soif I have too much of it, I'm
going to be jittery and anxious.
So this medications, thesemedications, these GnRH analogs
are puberty blockers. They arenot without side effects, though
they are safe. And the mostcommon sort of side effect that
we talk about is relative tobone health. And what we found
(29:02):
so one of the things that weknow is that as kids go through
puberty and puberty hormones arecirculating in their bodies,
specifically testosterone andestradiol or estrogen. One of
the effects that it has on bonesis something that we call bone
mineralization, or a hardeningof the bones. So during puberty
is actually when kids should begetting a lot of calcium and
(29:24):
vitamin D, whether that'sthrough milk or otherwise. And
often they're not unfortunately,but that's the time when their
bones are becoming thestrongest. And when we pause
puberty, we're pausing thecirculation of those hormones,
those testosterone and estrogenhormones, and so we're
interfering with that bonemineralization process. In the
studies that were done on kidswho had puberty suppression for
early puberty, or precociouspuberty. What we found was that
(29:47):
after six or seven years onthese blockers, there was
noticeable difference in thebone density or hardening or
bone mineralization between kidswho were on the blockers and
kids who were not. A few thingsabout that. One, the good news
is that the kids who had thosenoticeable changes once the
blockers were stopped, and theirpuberty was resumed, when we
(30:09):
remeasured them, their bonedensities caught up. So it's not
it wasn't a permanent change, itwas a temporary change, and it
caught up. The other good newsis that the kids who got these
medications for precociouspuberty would sometimes be on
them for six or seven years. Itis very rare for a transgender
or gender diverse child to be onthem that long. So for most
(30:29):
kids, I would say we're startingthese around 10 11 12, sometimes
even later, 13 14 15. Andthey're on them for typically
two to four years. So less thanthat timeframe where we notice
changes. That being said,because we know that it's a side
effect, we check kids vitamin Dlevels, and make sure they're
getting good calcium and vitaminD, while they're on treatment.
(30:50):
We monitor their bones whilethey're on the treatment. So
every two years, we check a scanto see how healthy and dense
their bones are. And, and wefollow that. And that's really
the biggest side effect or riskthat we know about in terms of
the cognitive changes, weabsolutely know that there are
cognitive changes that happenduring puberty, there are a lot
of them. Your frontal cortexdevelops, your nerves, your
(31:12):
nerves in your brain go throughthis process of pruning, or kind
of weeding out all the stuff youdon't know and solidifying the
past that you really need inyour in your brain. The studies
that have been done have notshown any cognitive impact of
puberty blockers. And again, myreassurance around it when I
talk with families is that thiswe're not postponing puberty
(31:34):
indefinitely, we're pausing it.
So these hormones, whether it bethe masculinizing, or feminizing
hormones, will come into thischild's body, at some point, it
may be the ones that were goingto be in their body, from their
own ovaries or testicles, or itmay be hormones that we give
them as we induce the pubertythat's congruent with our
(31:56):
identity, but they will havethese hormones. So I think that
these cognitive processes arestill happening, I don't think
that they're exclusively ruledby testosterone and estrogen.
And my, my confidence from thebone studies anyways, I think
that this will catch up, theonly thing I can really say to
families is we don't have anyevidence that there are
(32:17):
cognitive effects of pubertyblockers, it doesn't mean 100%
that there aren't, but I don'thave any evidence that there
are. And, and that's really it.
I mean, the bones continue togrow. There's another hormone
called IGF one, which is agrowth hormone that determines
how tall you are. So youcontinue to grow taller, while
(32:39):
you're on puberty blockers, youdon't have the growth spurt that
you would have when estrogen andtestosterone come in, but you
still continue to grow taller.
So you know, the growth isn'tstunted by being on these. And,
you know, there's some fertilityimplications at these
medications, which is a littlebit more complex and involves
(33:01):
whether you go on genderaffirming hormones after or not.
But in terms of a bad healthoutcome, initiated by the
medication, there really arenone. So it's, it's a really,
that's why we say it's a safemedication.
Alex Iantaffi (33:21):
And it's a safe medication, which in my
experience can have a lifechanging impact on sorry, the
children I work with, becausethere can be such a level of
distress, that really hasincredibly negative impact on
their mental health, you can bereally prevented to a great
(33:41):
degree by using pubertyblockers. And I know that as a
mental health provider, I haveseen you know, young kids and
young people really go fromexperiencing very high levels of
anxiety or depression toactually being able to thrive
and be almost completelydifferent, sometimes overnight,
(34:06):
just by having this anxietyabout their body changing in a
way that's distressing to themkind of being put on pause, like
you said.
Dr. Angela Goepferd (34:14):
Absolutely.
Alex Iantaffi (34:15):
Right. I don't know if you, I'm sure you've
witnessed that too.
Dr. Angela Goepferd (34:18):
Yeah, I mean, anecdotally, I see that
all the time. Absolutely. Imean, they're, you know, two, I
see two things, I see that theyoung kids who've identified
early, they know puberty iscoming. They're just terrified
about it. They've been, youknow, living in their, you know,
the gender that's congruent withtheir identity for years now.
(34:39):
And puberty is happening, andthere's just panic. So to be
able to relieve that panic forthem, I mean, that it's just
palpable. But then the otherkids who are maybe a little bit
later to their exploration andthey're already have started
puberty or they're early inpuberty. I've had so many kids
tell me just how much betterthey feel on the blockers. It
just provides them a sense ofrelief that you know, biology,
(35:02):
this train of puberty isn't justhurling down the tracks, I have
their control. And we can saythat anecdotally, but the other
thing we can say is that we haveevidence to really show that
puberty blockers do make adifference. There have been
several studies that show thatmental health outcomes are
improved in kids who are offeredpuberty blockers versus those
(35:23):
who are not. And in fact, therewas a study that was done, that
was published in pediatrics inFebruary of 2020 that for the
first time really showed and ina study of 20,000, plus trans
people, that there wasstatistically significant impact
on suicidality. And kids who aretransgender people who are
(35:44):
transgender who were offeredpuberty blockers versus those
who were not. So not only aretheir mental health markers
better in terms of things likedepression and anxiety, and just
overall well being, butspecifically, their risk of
suicidality is lower on thepuberty blockers. And I was
reviewing that article rightbefore we talked. And one of the
things that I I must have missedwhen I read it last year, but it
(36:05):
really just shown off the pagewhen I read it today is that
what was even more striking tome rereading it is that the
transgender adults who wantedpuberty blockers, but were not
given them or offered them, nineout of 10 of them, 90% of them
had suicidal ideation. So it wasalmost as if we were inducing
(36:29):
suicidal ideation by withholdingthis treatment from those trans
folks. And so for me, that's oneof the things that with this
decision in the UK, the Bellversus Tavistock decision, I
just think of how much harm weare actually going to be causing
to trans kids who we're going tobe putting in a situation where
(36:51):
they know that there's atreatment available to them.
It's, it's one thing to not havea treatment option. Absolutely,
it's a whole nother thing toknow, there's something out
there that you could access thatwould help you and you and you
are being denied access to it.
The impact on someone's mentalhealth and the hopelessness that
comes with that that can inducesuicidality is really alarming
to me.
Alex Iantaffi (37:13):
It is, and I think that's the part that
should be alarming. And I getreally sad when I hear people
saying that's just big rhetoricthat trans people are using,
right, around suicidality,because actually, there is data,
this is not rhetoric as data,like you said, 90% of you know,
we now have adults who couldhave had this access to this
(37:34):
treatment, but were denied itfor whatever reasons 90%, you
know, and and that is a vastmajority. That's almost
everyone. When we think aboutthe fact that in the general
trans population, we know thatin our community, the level of
suicidality is 10 times that ofthe general population, right.
(37:55):
And that's not because we'retrans. But because we live in a
world where our identity andexperiences are continuously
kind of denied and raised orchallenged, as we were saying
earlier, 10 times that of thegeneral population is a huge
number you know, and knowingthat this is one of the
treatments that can make anincredible difference in the
(38:16):
life of children and youngpeople, that is a safe
treatment, and they toreversible treatment.
Dr. Angela Goepferd (38:23):
Right.
Alex Iantaffi (38:23):
You know, there's nothing irreversible that
happens with puberty blockers,right?
Dr. Angela Goepferd (38:27):
Right.
Yeah. And I think, you know, theother point that we sometimes
miss talking about when we talkabout this is, you know, it's
not just that we're relievingkids anxiety and treating the
trans kids and gender diversekids themselves, it's their
parents too. It is not theparents of transgender and
gender diverse kids who areadvocating for this type of
legislation. The people who areadvocating for this know nothing
(38:48):
don't aren't involved with don'thave their own trans and gender
diverse kids. The parents oftrans and gender diverse kids
want access to this treatmentfor their kids. I have kids in
my practice, I have parents inmy practice, I have one that I
just interacted with within thelast month, who is in the face
of the Montana legislation,seriously considering relocating
(39:09):
their family to Canada so thattheir trans daughter can have
access to puberty suppressionwhen she's of age, they want,
they know the data, they knowthe science, they want their
kids to have access to thistreatment. And so we're also
really, you know, harmingfamilies and the parents of
these kids who know the benefitsof this treatment for their
(39:32):
trans and gender diverse kidsand want them to have access.
Alex Iantaffi (39:35):
Absolutely. And like you said, puberty is
actually not reversible. That'sone of the things that sometimes
I talk about with parents is,you know, this safe treatment
could mean that your child doesless or fewer invasive kind of
surgical intervention later on.
For example, a child wasassigned female at birth might
(39:55):
be able to have minimalintervention in terms of chest
reconstruction or sometimes evenno intervention, right, you
know, compared to something likedouble mastectomy, which quite
frankly, I went through as atrans and non binary adult,
which is major surgery.
Dr. Angela Goepferd (40:12):
Right.
Alex Iantaffi (40:12):
You know, and so sometimes for parents kind of
also thinking about what wemight be... how this might be
impacting their kid in the longrun, right? Like you said, if
they don't want any othermedical intervention, puberty
blockers, stop, everything goesback to how it was. But if they
do want more medicalinterventions, it might save
(40:35):
also folks who are assigned maleat birth from really invasive
kind of feminization procedure,or tracheal shavings, or all
sorts of much more invasivesurgical intervention, which
again, not every trans person ornon binary, or gender expansive
person wants, but some people doneed, actually not want, to need
(40:56):
those to feel calm, right,within their body.
Dr. Angela Goepferd (41:00):
Yeah, absolutely, you know, the, the
trans masculine kids that I carefor the two biggest things that
they experience, this worryabout is their chest and their
voice.
Alex Iantaffi (41:08):
Yes.
Dr. Angela Goepferd (41:08):
And, you know, with, with puberty
blockers, we are taking away thechest dysphoria, if we started
early enough for kids, they willnever develop breasts, they will
never have the surgery that youmentioned. And in trans feminine
kids, the two biggest thingsthat I hear about from them are
also their voice, and theirfacial hair. And we can
completely take that away withpuberty blockers. And you know,
(41:31):
once that voice lowers for transfeminine kids, that's a
permanent change. And weestrogen doesn't raise it,
there's no medical interventionwe can do to raise that voice.
And it is probably one of themost distressing you use your
voice all the time, every day,it is so distressing for trans
feminine, and particularly, youknow, really female, binary
(41:52):
feminine identified folks tohave to learn how to handle that
that voice. And again, with hairgrowth, you know, it's not, it
doesn't go away with estrogentreatment, you have to have
electrolysis or some painfulprocedure that is recurrent, to
remove that, that hair and beable to give sort of our trans
(42:16):
kids the freedom of not havingto subject their bodies, to
those kinds of painful medicalinterventions down the road, I
think, is really a gift. And ifyou talk with trans adults who
didn't have the option ofpuberty blocking treatment, many
of them are very much in favorof offering this treatment for
(42:38):
kids because of what they couldhave avoided if they had had
access to.
Alex Iantaffi (42:42):
Oh, yeah, I mean, if I lived in a world where a. I
didn't even realize that transwas a thing, you know, so I just
knew that it was really coolthat people thought I was a boy
on the playground in the 70s.
Right? How cool is that? But ifan adult had been like more
like, whoa, you know, how, whoare you? And how would you feel,
and I've been able to expressthat and have access to this
treatment, life would have beenso different. Well, I feel like
(43:04):
I could talk about this, likefor hours and hours, but I want
to be respectful of your time,which I know is more precious
than ever nowadays, as a medicalprovider. Is there anything that
we haven't talked about that youwould really like to communicate
to people about puberty blockersand specifically, or just the
treatment of kind of genderexpansive youth for anything
(43:27):
that we haven't covered that youthink it's important to name?
Dr. Angela Goepferd (43:34):
You know, I think we covered a lot of it,
you know, I really just wantpeople to understand what the
medication is that we're talkingabout when we use it, the fact
that it is reversible. The factthat we know that it's very safe
that we've studied, studied it,and both cisgender and
transgender kids for severalyears. I also you know, just
because I work so closely withtrans and gender diverse kids,
(43:56):
I, I really want to reinforcethat. Kids do know who they are.
And, you know, we all go througha process of identity
development that happens ourwhole lives, I am not the same
person at 43, as I was at 33, or23, or 13 or seven. I have grown
and developed over that time.
And even for me, there's beensome validity to my gender
identity during that time. Butwe all get permission to go on
(44:18):
that journey. And it's not forus to stop our, you know,
children and adolescents fromgoing on that journey.
Particularly when they are veryconvicted about it. And when you
have a medical team and a mentalhealth team, that is you know,
absolutely convinced that thisis the best best path for a
child and parents who aresupportive. I would really hate
(44:39):
to see there be legislation thatprevents good outcomes, both
physical and mental healthoutcomes for kids. And, you
know, I really just hope that wecontinue to listen to kids and
let them continue to change theworld and us right along with
it. Because I think we'll all bebetter for that in the end.
Alex Iantaffi (45:03):
I agree. I mean, the kids I work with know they
are they know what they want.
And if we just listen to them,and like you said, it's not also
no treatment is given on a whim,right? There's like X rays
involved and blood work andseeing a medical doctor and
often seeing a mental healthprovider. This is a very
involved process. It's not likeeverybody goes in for one and
(45:27):
done visit for puberty blockers,right?
Dr. Angela Goepferd (45:32):
Right.
Alex Iantaffi (45:32):
Yeah, this is something that can really make
such a positive impact in thelife of people and that probably
legislators should stay well thehell out of I would say, it's
not their job. Let's just letthe medical providers do their
job. Right?
Dr. Angela Goepferd (45:47):
Right. Yes.
Well, thank you, Alex, forhaving me. I really appreciate
it.
Alex Iantaffi (45:52):
Thank you. Thank you. Thank you so much for
sharing all this wisdom and thisknowledge with the gender
stories listeners. I also hopethe listeners that you go check
out Kade's TEDx talk is reallygood. So you should watch it.
And then as ever, in the episodedescription, there'll be some
links for you to look at aboutsome of the things that we've
been mentioning. And thank youso much again, Dr. Goepferd for
(46:15):
being on the show today.
Dr. Angela Goepferd (46:17):
Absolutely.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Special Summer Offer: Exclusively on Apple Podcasts, try our Dateline Premium subscription completely free for one month! With Dateline Premium, you get every episode ad-free plus exclusive bonus content.
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!