September 23, 2025 • 60 mins
What happens when a child who once embraced their biological sex suddenly announces they're transgender following a traumatic experience? Is this genuine gender dysphoria or trauma manifesting as identity fracture? These are the questions we're not afraid to ask in this thought-provoking discussion.
The statistics are startling—3.3% of American teenagers now identify as transgender while adult rates remain steady at 0.5%. Something significant is happening with our youth, but what exactly? We dive deep into the potential explanations, from increased social acceptance to the possibility that many cases represent trauma responses rather than lifelong gender incongruence.
Melissa, a clinical therapist, shares her professional perspective on how trauma can manifest as identity confusion and why a rush to medical intervention might miss critical underlying issues. We explore how the concept of gender itself has evolved historically, from its linguistic roots to its modern application, and examine why teenagers might be particularly vulnerable to identity exploration through this lens rather than through other developmental pathways.
The financial realities can't be ignored—gender surgeries can cost upwards of $120,000 with lifelong pharmaceutical regimens, while therapy-first approaches cost a fraction. Are medical systems and insurance companies incentivized to promote certain pathways over others? The UK's Cass Review recently called the evidence for youth medical transition "remarkably weak," raising serious questions about clinical practices.
For parents navigating these waters, Melissa offers this crucial advice: "Pause and don't be afraid that your child is going to hate you for the rest of their life. Get a second opinion from a different provider that views things differently." Trust your instincts, seek comprehensive care, and remember that addressing potential trauma isn't denying your child's experience—it's ensuring they receive complete care before making life-altering decisions.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Evan (00:02):
Imagine a 10 year old girl , the girliest girl you've ever
met.
I'm talking dresses, makeup,hair, all of it.
Then, at 10 years old, shesuffers traumatic sexual abuse
and stews quietly over the nextfew years.
She withdraws, she battlesanxiety and depression.
She stops shaving her legs,starts dressing more like a boy
(00:22):
by 17.
She wants she wants to becalled Sam.
This isn't a hypothetical.
This is the kind of storytherapists are seeing more and
more.
And here's the question Is thisgender dysphoria or is it
trauma manifesting as afractured sense of self?
Right now, youth gender identityis exploding.
The Williams Institute at UCLAsays 3.3% of American teenagers
(00:48):
over 700,000 American kids nowidentify as transgender, while
adults remain flat at about 0.5%.
The New York Times admits itcould be social acceptance, but
also peer influence or politicalclimate.
At the same time, activistplaybooks are out in the open.
One major NGO report literallytold campaigners to target youth
(01:10):
politicians, to demedicalizethe campaign, to get ahead of
the media and to frame it as ahuman rights battle rather than
a medical one.
And it's working.
Schools, politicians, evenclinics are fast-tracking
affirmation.
Schools, politicians, evenclinics are fast-tracking
affirmation.
But here's the problem.
An independent review conductedby Dr Hilary Cass in the UK
called the evidence for youthmedical transition, quote
(01:33):
remarkably weak and slammedclinicians for abandoning normal
holistic assessment.
Meanwhile, in America, a singlephalloplasty can run $120,000.
Vaginoplasties, top surgeries,hormone prescriptions for life
all mostly covered by insurance,which means billions flowing to
hospitals and drug companies.
Compare that with therapy-firstapproaches, which cost a
(01:56):
fraction.
Which pathway do you think ourhealthcare system is
incentivized to favor?
This isn't about denying transpeople exist.
It's about asking are we doingright by children in distress or
are we letting ideology,advocacy, money and profit drive
life altering decisions beforethe root causes are even
understood?
(02:16):
Tonight, melissa and I aregoing to unpack the evidence,
the trauma link and the ethicsof how we care for kids caught
in the storm of gender identity.
Melissa, let me start with thebig picture.
We've got 3.3% of US teens nowidentifying as transgender,
770,000-ish, but the adultnumber has been flat at about a
(02:39):
half a percent for decades.
From your perspective as aclinician, does this look like
organic growth or something elsegoing on?
Melissa (02:49):
Evan, I definitely think that something else is
going on here.
We have a culture and societyof kids that are struggling to
figure out who they are ingeneral, are struggling to
figure out who they are ingeneral and where you and I went
(03:14):
through our middle school yearsand you know, really, from
about 12 up through 17,.
We tried to figure out who wewere.
We explored different sports,we maybe did some art or some
music.
You know, you listened to whatkind of music as a middle school
and high schooler.
Evan (03:27):
Gangsta rap.
Melissa (03:28):
Right and I went through a Christian music phase
for a little while there.
Evan (03:33):
I had my Christian music phase too.
Me and Casting Crowns werefriends for a while.
Melissa (03:37):
That's right, but just trying to figure out who am I
and what do I like and what aremy interests.
And today, because really we'vethis whole concept of gender
didn't exist 100 years ago itwas just male or female.
(03:58):
What were you at birth?
At birth, and when this wholeconcept or shift in vocabulary
came about, it opened up thiswhole other area for people to
explore in a socially acceptableway.
And even as kids I playedfootball with the boys.
(04:22):
I had a stage where I dressedin oh, baggier jeans were in
back then, but I dressed inbaggier clothes and didn't wear
makeup and just kind of figuredout myself and struggled through
that, sure, through that.
(04:48):
Today, a lot of our kids, theydon't have the ability to
struggle through, they'reemotionally sensitive, they're
hurt over anything that's said,that doesn't feel safe and they
collapse under any kind ofpressure or any kind of
challenge.
And ultimately, it's my beliefthat identity, gender, which is
(05:15):
something biological, is one ofthe last things in our society
that can really be.
Evan (05:27):
It's a final absolute right.
It's one of the few things thatis a yes or a no, it's a black
or a white.
It's a binary code, absolutely,you know, you're a one or a
zero right.
So we talked a little bit aboutthis earlier today and we were
talking about the etymology ofgender and sex because, you know
, in our family conversationsthese kinds of topics come up
(05:51):
because we're not afraid to talkabout the unmentionables.
Melissa (05:54):
Which is funny when mom walks into the room into the
middle of the conversation.
Evan (05:59):
What did I walk into?
But so we talked about this andcorrect me if I'm wrong on this
.
I'm sure that you'll get to thedetails of it.
But sex, in terms of biologicalsex, male and female, do you
have a peepee or do you not havea peepee?
That has been a binary questionand answer for the entire human
(06:25):
history.
It's always been male or female.
The concept of gender, I think,didn't even come around until
what did we say?
The late 1700s, maybe late1600s?
Melissa (06:40):
So I looked up the etymology, and its ancient roots
are in the Latin term genus,which is a kind, a type or a
sort.
You know genus and species,right Sure, and by the 14th
century the English used genderto describe grammatical
(07:01):
categories of nouns masculine,feminine and neuter.
Evan (07:04):
Which makes sense.
If you've ever taken, if you'rean American and you've ever
taken a foreign language classlike german, spanish, french,
you might have heard terms givenin two different genders, males
and females.
Melissa (07:19):
Which has thoroughly and completely confused me ever
since I started taking German inthe seventh grade.
So it was never extended.
Gender was never extended to beused in regard to people until
the late 14th and 15th century,and it was in part Shakespeare
(07:45):
who used gender in the sense ofsex.
What sex was someone?
And then up until the mid 20thcentury, gender and sex were
used almost interchangeably inEnglish.
Evan (07:59):
It wasn't until good old Dr John Money in the night of
David Reimer fame, if I'mcorrect, right.
Melissa (08:07):
Yes, and for those of you who don't know who David
Reimer is David Reimer, who welearned about actually in
undergraduate social work in ahuman sexuality class way back
in the early 2000s.
David had a botchedcircumcision so they decided,
courtesy of Dr John Money, thatthis is just a social construct.
(08:29):
So we can just do surgery andturn David into a girl.
And if you raise David as agirl, then this child won't know
the difference, they'llsocially adapt and we won't have
a problem.
Evan (08:49):
So biology means nothing to Dr Money at this point.
It's all social construct.
Melissa (08:53):
It's all a social construct.
Evan (08:54):
Okay, correct, how'd that work out?
Melissa (08:56):
It was a very poor outcome and unfortunately, David
ended up committing suicide,and part of it was that they,
the family was told don't tellDavid, keep David in the dark.
And so David struggled withthese feelings, and this was
nothing new, honestly.
The term intersexed used to bebeing a hermaphrodite, which was
(09:25):
somebody who was born witheither an enlarged clitoris or
super small penis.
And if we look at generalanatomy, right, the clitoris is
no different than the tip of themale penis.
It all comes from the sameplace, and so it was easier to
shrink something than to try tomake it grow.
(09:49):
So when children were born andagain, this is a very small
percentage, but when they'reborn with ambiguous genitalia
the professional term for itparents for a long time were
told that they needed to decide,because the sooner you did the
surgery, the better a childwould be able to navigate life.
(10:14):
And as more and more studiescame out, they realized that
this was such an epic failure onthe part of the medical
community and this is some ofthe people who are now adults
that just felt like they didn'tbelong in their body, which is
now why we frown upon doingthese surgeries super early, but
(10:39):
going back to that shift.
So Dr John Money, who was asexologist and a psychologist,
started using this word genderin the 1950s and 60s to
distinguish biological sex, maleversus female anatomy, from a
social or psychological role andidentity.
(11:00):
And it was there in the 50s and60s that this term gender
identity, gender role, launchedand that was where we started to
see some of these shifts andchanges.
Evan (11:15):
Yeah.
So let me ask you this Are allcases of gender dysphoria or
gender identity disorder,whatever?
I think it's, gender dysphoriais the right term.
Are all cases of genderdysphoria?
You know lifelong, you knowunderstandings that you know
I've always just been a woman,or I've always just been a man
(11:38):
and I wasn't born in the rightbody, or is there such a.
.
.
I think I've seen a term calleda Rapid Pnset gender dysphoria.
Can you talk a little bit aboutthe difference between those
two?
Melissa (11:51):
Sure.
So no, not all cases of genderdysphoria are those lifelong
cases, and especially even nowwe can diagnose Klinefelter
syndrome, and those are thefolks that actually diagnosed
Klinefelter syndrome and thoseare the folks that actually,
from a chromosome perspective,are XXY.
There are absolutely caseswhere someone is truly in the
(12:12):
wrong body by no fault of theirown.
The cases that are soconcerning are particularly
those late onset ones, and bylate onset what we really mean
is around 12 or after 12.
(12:32):
And this is a child who maybewas born a girl and did ballet
and also did soccer and, youknow, like to get dressed up and
wear pretty things and had acute haircut and was walking
(12:55):
through life relatively normallyuntil some kind kind of trauma
happened.
And when a child hits puberty,their hormones are all shifting,
their body is developing, andthe autism spectrum plays a huge
(13:16):
role in this, because whileit's hard for a neurotypical kid
to go through puberty, it'seven harder for kids that are
diagnosed or undiagnosed on theautism spectrum from the social
perspective.
Evan (13:31):
Yeah, so I gave that sort of example earlier, a very
similar one to the one that youjust brought up, and it sounds
like it's fairly common for thiskind of trauma to present this
way.
Is it common for trauma topresent as a new identity?
Melissa (13:49):
Yes, we call it DID.
It's dissociative identitydisorder, and that's where the
trauma and so a key part of thisis those identities don't know
(14:11):
about each other.
They're blind to the fact thatothers exist and they rule in
different ways in differentareas.
But really what you're lookingat is, depending on the level of
trauma and the way we suppressit or if it's not addressed,
(14:36):
people don't know that somethinghappened.
It's stored and, through thisidentity process in those teen
years, this concept of beingtrans was never a thing 50 years
ago and it certainly wasn'tanything that was socially
really talked about until moreso over the past 10 years, and
(15:03):
it's now an option over the past10 years and it's now an option
.
So back in the day people diddifferent things.
We've gone through the furrytrend where that was a big thing
.
We went through a trend wherepeople called themselves
pansexual.
It used to be.
(15:24):
What are some of the otherthings that, as teenagers
growing up, you know we kind ofwent to.
Evan (15:33):
Well, I think most people had some phase or another where
they were emo or or used pot orused some kind of recreational
drugs or something like thatJust pot.
Melissa (15:45):
Or used some kind of recreational drugs or something
like that, and really what it isin all of these different
examples and again, not always,but when there's trauma involved
it's an escape.
It's I need to escape the chaosthat exists within me, and so
(16:06):
I'm going to pretend to be a catfor a while, or I'm going to
pretend that I'm a boy for awhile, or I'm going to use pot
to escape for a while, or becomeemo to mask who I am underneath
and not let people see it.
Evan (16:26):
So this is not about language and social acceptance
and cultural norms changing tomake it safer for these kids who
would have always been transidentifying anyway.
This is as much, or maybe evenmore so, about trying to cope
with severe trauma situations asit is anything that's organic.
Melissa (16:50):
I think it is wonderful that as a society we are so
much more open to people who arechanging that part of who they
are and it has nothing to dowith trauma.
It was a misgendering, it wasambiguous genitalia, it is
(17:13):
Kleinfelter's For people whotruly just feel that they're in
the wrong body.
I think it's beautiful as asociety that we can embrace that
and say you know what?
I love you as a person and Iwill embrace all of who you are.
(17:35):
My concern is the rapid increasein these cases and we know that
there's a rapid increase indisclosed trauma and even among
kids who transitioned, and thenyou hear stories of
(17:57):
detransitioning.
Every stinking time there'strauma, there's unresolved
trauma and people say I wishsomebody had helped me work
through this trauma instead ofjust allowing me to.
Really we're talking aboutexiling a part that was hurt and
(18:20):
saying you no longer existbecause I got hurt because of
you, so I'm going to shift intosomebody else that I can design
and make who I want, and theneverything will be fine.
And it's just not fine becausethe trauma doesn't go away.
Evan (18:41):
Yeah, so in many cases, what sounds like gender
dysphoria could actually just bea trauma response, and if we
don't investigate the rootcauses of that trauma response
or that trauma, we risk treatingthe symptom but not the wound.
Melissa (18:57):
Absolutely.
Evan (18:58):
Like putting a Band-Aid on a bullet wound.
Melissa (19:00):
That's a good T Swifty reference there.
We can't put Band-Aids onbullet holes.
Evan (19:08):
So let's talk about the evidence.
The UK Hillary Cass did anindependent review just in the
last year or so.
She's called the research onyouth transitions quote
remarkably weak and said thatclinicians abandon holistic care
.
Would you agree with thatassessment?
Melissa (19:28):
I sure would.
I think that with the increasein media on this, of social
media influencers and just themedia in general, I'll say I
(19:48):
think there's a lot ofclinicians that are well
unknowledgeable and some who arejust afraid Because deep down
as a clinician right, I knowthat if I tell you something
that you don't want to hear, orI ask you to look at something
from another perspective, justto solidify where you stand on
(20:10):
something, I recognize that ifit doesn't align with your
beliefs, you might walk away asa client.
Evan (20:21):
And could it not be more serious, right?
So one of the things that wehear about a lot in the news and
social media, especially theinfluencers my God, these
influencers.
They will come out and theywill tell you that the
statistics on transgenderedsuicides are exponentially high.
(20:42):
They're through the roof.
If Sure, they're not affirmedin you know, whatever belief
that they have in that moment.
Melissa (20:50):
Yes, and we're a feelings driven world.
Evan (20:54):
Now, We've lost sight Very much so.
Melissa (20:56):
It's no longer about what are the facts.
What are the facts of whathappened?
What are the facts of who I am?
What are the facts of how I wasraised as a clinician is?
Evan (21:08):
there fear that this patient or this client that I'm
treating, if I don't handle themgently, if I don't follow best
practices, this client could gohome and commit suicide.
And not just will I be liablefor that potentially right
(21:29):
Because of the society that welive in, but, like, just as a
clinician, on a personal level,nobody wants somebody to go home
and commit suicide, of course,because they were pressed into,
you know, taking a stance or aposition that they didn't want
to take.
Melissa (21:43):
Well, and if I don't ask the question, there's an
equal chance?
Because the reality is, ifwe're looking at suicide
statistics among transgenderedindividuals, the risk was there
in the first place, the risk wasthere no matter what.
And so, as a clinician, do Iask, do I not ask?
(22:03):
Do I probe, do I not probe?
And you know we were talkingabout this earlier.
We have a group of emotionallyfragile adolescents on our hands
and you can't disagree withthem.
(22:39):
Otherwise, you know, there'semotional upheaval, and so
adolescents thinking that theyjust deserve ultimate respect
when it's not even necessarilygiven.
Evan (22:51):
Yeah, it's absolutely, absolutely wild to me the lack
of real detailed study that'sbeen done on this issue for as
big of an issue as it appears.
Melissa (23:07):
Well, and longitudinally.
How would they?
Because all of this is still sonew.
You're talking about a 0.5%stable number, yeah, among
adults, among adults.
And now suddenly we have 3.3%of adolescents, which screams
(23:32):
something changed.
Something changed here.
It's interesting because we'realso seeing a significant rise
in autism, and what we know fromagain research is that those
who are diagnosed on the autismspectrum struggle with
(23:55):
understanding social cues,socially engaging and
interacting with peers.
They tend to be morecomfortable with same-sex peers.
So what we saw 10, 15 years agois that the rate of people with
autism that identified ashomosexual was higher than those
(24:18):
that were not diagnosed on theautism spectrum.
And it makes sense because herewe get along with somebody of
our gender more easily.
They're easier to understand,they're easier to relate to,
picking up on the social cues,sure, and they find love with
(24:40):
someone in that way.
What I think that's now morphedinto is well, now I can just
change my gender and then I canbe normal like everyone else.
Evan (24:54):
It feels like such a zero to 100 approach that we've taken
.
I know that there aresafeguards in place and you know
in in most cases you don't havepeople that walk into a
therapist's office and 55minutes later get diagnosed with
gender dysphoria and off theygo in a few months.
Melissa (25:14):
It's actually highly undiagnosed in people that
identify as transsexual.
Evan (25:21):
Okay.
Melissa (25:22):
Which clinically blows my mind, because if somebody is
going to identify that way, thenas a clinician we would have to
diagnose them with genderdysphoria.
Sure, we can't say that this isany different.
Evan (25:37):
Right.
Melissa (25:38):
And yet it's chronically underdiagnosed.
Hmm some of that is a fear thatif they're diagnosed with it
then there's a stigma and theywon't be able to transition
because doctors will view itdifferently, just like any other
(25:58):
mental health diagnosis.
As soon as there's comorbidityhere, people view it as a red
flag for the medical side.
Evan (26:08):
And I guess that's where I'm kind of going with this as
well is that, given that we havesuch a limited research base
because, quite frankly, wehaven't been in this business
for that long Right Right, andalso we're talking about things.
Look, when it comes to ADHD andautism, there are a lot of not
(26:31):
gentle medications, but thereare a lot of medications that
are stimulant-based or othersthat are maybe less long-term
effective Mood-based, mood-basedright that are less long-term
effective than, for example,taking hormone blockers right,
that are less long-termeffective than, for example,
taking hormone blockers right.
So why do we, in the case ofsomeone who potentially wants to
(26:52):
, you know, has a genderdysphoria condition and wants to
change their gender, sort of godirectly to let's get you
started on hormone blockers, asopposed to?
Would it really be harmful tospend two, three, four, five
years maybe your childhood yearsat least, walking through how
(27:14):
you feel and why you're there?
Melissa (27:16):
Well, the question popping up in my head right now,
as we're talking about this, iswhy do we care?
Why, as a child, do you carewhat gender you are?
Evan (27:37):
Why does it matter?
How does it impact how you dolife day to day?
Well, I think, especially forteenagers, gender, your
biological sex, does a lot.
It determines where you playsports and which teams you're on
and what friend groups you hangout with.
It can determine a lot ofthings at that stage of your
life.
But I also question whether ornot that's a construct of ours
(28:00):
that we've put into place, wherewe've overcomplicated things to
a certain degree when it comesto gender.
Now, certainly I think you andI are on the same page about
biological sex.
Men should be playing with men,boys should be playing with
boys.
Melissa (28:14):
And that's what you were just talking about.
You were talking aboutbiological sex.
Evan (28:18):
Correct.
You weren't talking about thissocial construct of gender,
because I don't see that Agreedthis social construct of gender,
because I don't see that Agreed.
Melissa (28:26):
So if I don't know if I feel today like more of a boy
or a girl, how does that impactmy daily activities?
Evan (28:41):
The only way it possibly can is if your happiness is tied
to the acceptance andappreciation of others.
Melissa (28:49):
And that's where it is and that's where everyone else
needs to affirm who I am or whoI feel like today in order for
me to feel okay with myself.
And the reality is we know thatthe brain, the prefrontal
cortex that has to do with logicand reasoning and organization
(29:11):
and all those fun higher levelexecutive functioning concepts,
doesn't fully develop until atleast, if not well, after the
age of 25.
The age of 25.
(29:33):
And so, as young adults, asadolescents, it's not harming
anybody to sit in who I am andgo through my day.
I sit back and I say why isthis even an issue today?
Why is this even an issue today?
That I need to figure out who Ifeel like I am today in order
to function in society?
(29:53):
You and I, as kids, didn't sitback and go.
You know, do I feel like ahuman or a cat today?
Evan (30:03):
No, I don't think that was ever a question.
Melissa (30:05):
If I feel like a cat.
Maybe I won't go to schoolbecause cats don't go to school.
Or do I feel like a boy or agirl?
It's not like I can decidewhich bathroom I want to use.
It's not like I can changewhich gym class I'm
participating in or whichathletic program I'm in.
(30:28):
It's set and so whatever it isthat I'm questioning in my brain
has zero bearing on what playsout in my day.
I am stuck in my sympatheticnervous system, which is our
(30:52):
fight or flight, our feelings,all those big energy things.
And I'm stuck there because,from a factual standpoint, I
can't look down and ask myselfdo I have a penis or a vagina?
Because that's going to tell mehow I need to proceed through
my day.
But I'm stuck in how I feel,which could be anything.
(31:14):
I could feel like an attackhelicopter today, but does that
mean that I run around and wavemy hands spinning, like, like,
what are they called on?
The top Blades, blades,propeller blades and start, you
know, pew-pewing at people?
They'd think I was crazy.
Evan (31:35):
They would indeed.
Melissa (31:37):
And so because we clearly can say that is not
reality, right?
Evan (31:42):
No, you are not a Buick.
You're not an attack helicopter, you're a human.
But will you pretend with metodayick You're not an attack
helicopter.
Melissa (31:46):
You're a human, but will you pretend with me today,
cause I feel like an attackhelicopter?
Do you want to pretend with me?
Not right?
Evan (31:52):
now, but maybe later.
Melissa (31:53):
Yeah, okay, that sounds fun, but you know I can't
decide.
Today I want to be a potato, soI'm going to sit here and not
do anything.
Evan (32:08):
Don't we all wish we could do that?
Melissa (32:10):
You know the other.
The other thing that I'm seeingis that youth, youth have this
luxury, this luxury of feelingand using it as an it as an
excuse for everything.
Evan (32:28):
That's pretty recent too, right.
It is when I told my parentshow I felt my dad was like okay,
Right, Get your ass on the bus,kid.
Melissa (32:38):
And the reality as an adult is I can wake up in the
morning and feel down, I canfeel like not getting out of bed
because I'm tired and it'srainy and I just don't really
feel like adulting today.
But I can't just decide.
I'm not an adult.
(32:58):
I have to get up and for a lotof us as adults, things like
depression, we don't get to gobe depressed because there's all
these other people andresponsibilities that we have.
We need to suck it up and moveforward and hopefully have
outlets to deal with that andtry to keep ourselves balanced.
(33:21):
But kids today say I feeldepressed and magically we're
not in school, magically what'sexpected of us has decreased and
if I have trauma, forget aboutit.
Evan (33:37):
I need a mental health day .
Melissa (33:39):
Sorry, you don't get one.
Evan (33:44):
So, but we don't I don't want to't want to over
trivialize this right.
So we understand that there arereal issues.
There are certainly some somethese are very real issues yes,
well, there are some situationswhere, as you've pointed out,
there are, there are realdisorders, there are real things
going on here, not justfeelings, and I think that when
(34:05):
people use it from a feelingsperspective, it really
invalidates and downplays thereal situations where people are
deeply struggling.
Melissa (34:17):
slow down, let's do the hard work first.
Evan (34:28):
Don't exceptionalize these kids just because they're
presenting in a certain way.
Let them grow through it.
Let them get to a stage where,even if the answer doesn't
change, at least they've donethe processing work to get there
.
Melissa (34:45):
And they've grown as a human.
They have sat in the discomfortof life and learned how to
persevere, where our societytoday is about fast answers and
quick solutions and no distresstolerance.
Evan (35:05):
Absolutely From an ethical standpoint.
How do you see the HippocraticOath, for example, applying here
?
Are we doing harm by pushingaffirmation too quickly?
Melissa (35:17):
I absolutely believe we are.
And the flip side of that isgoing to say well, are we doing
harm?
If we don't, because then whatif they go kill themselves?
And I go back to if suicidalityis there it was there before
you.
It didn't magically appear andthis person is so miserable and
(35:42):
literally in their own skin,whether it's by trauma or
avoidance again, not talkingabout the very legitimate cases
here when we push a quicksolution and we don't let them
(36:08):
walk through life and actuallywork through the issues because
we're afraid to.
Evan (36:16):
How do you, as a clinician , if you've ever dealt with
anything like this before, howdo you let a client walk through
it without?
How do you let a client walkthrough it without necessarily
affirming or validating whatthey're saying?
Melissa (36:31):
Sure.
So I feel like you can alwaysvalidate someone without
agreeing.
So somebody can come in and sayI feel like I'm a boy and not a
girl.
Okay, well, help me understandwhat causes you to feel that way
, and they tell me all thereasons that they feel that way,
(36:59):
which often is well, justbecause.
I don't, it's a feeling right,Because it's a feeling, in these
cases, Sure and okay, so I canunderstand that it feels that
way.
It feels that way.
What are the facts?
And we call this DBT.
It's dialectical behavioraltherapy, and many, many
(37:19):
therapies come from here, but itis taking fact and taking
feeling and looking at where thetruth lies in the middle.
A lot of our therapies, evenEMDR work, looks at what are the
facts.
I know what are the feelingsthat I have and can we merge the
(37:42):
two and see what we find in thecenter?
We merge the two and see whatwe find in the center.
So different therapies call itdifferent things but nothing is
looking at.
Evan (37:56):
I just want to go by how I feel today.
Okay, how long does it take foryou to decide whether someone
is ready or not ready?
Melissa (38:14):
So, for example, ready or not ready to what?
Evan (38:17):
to take the next step on their journey.
So, for example, we've talkedabout how there are, or you've
talked about how there are, somepeople who present and they
have true gender dysphoria.
They have a real condition thatneeds to lead them in this
(38:38):
direction, versus someone who,as you pointed out, may be
hiding from trauma.
Is this something that you meetwith a client for one session
and you could determine?
Is it three months of sessions?
Melissa (38:51):
Is it a year?
There's no finite timeline anddifferent clinicians are going
to look at things differently.
There are some who want toaffirm and just believe the
first thing that everybody says,which is not clinical best
(39:12):
practice.
We're talking about needing todig in and ask those hard
questions, ask people to thinkabout things and the reality is,
if you ask the hard questionsand they leave, you know the
answer.
Evan (39:28):
Sure Sure.
So it sounds like there'ssafeguards in clinical best
practices, but they're appliedinconsistently.
Melissa (39:38):
I think that different clinicians use different
theories and models and comefrom different worldviews.
So if someone has a biasagainst the LGBTQ lifestyle or
(39:59):
transitioning in general, thenthey're probably going to take a
lot more time to assess it andlook for other things that could
be coexisting or comorbid,whereas someone who is extremely
supportive of you know what.
If you feel like that, then youjust go do it and everything
(40:23):
will be okay and everything willbe okay is far less likely to
rule out all the other things,like autism, trauma, any other
mental health issues, DID.
Evan (40:40):
It strikes me and I'll come back to this in a minute,
but it always strikes me alittle bit that we and I
understand why because the humancondition is such that we want
others with us.
Right, we want others toembrace us and to affirm us.
But it does strike me that whenwe talk about things like
medical conditions, an awful lotof people would probably go get
(41:02):
a second opinion if they weretold we need to do heart valve
surgery on you, or we need to doheart valve surgery on you,
they sure would.
Or we need to do some kind ofinvasive surgery or take these
pills.
And yet I worry, or I wonderhow many trans-identifying
individuals, and especiallyyouth, seek out other potential
(41:24):
options to rule out before theygo under the knife.
Melissa (41:29):
And I think, as parents , a lot of parents are afraid
because if somebody gives thismedical opinion or a clinical
diagnosis, as a parent you wantto trust those people that are
involved with your child andfundamentally I think there's a
(41:50):
fear that what if my child doesself-harm?
What if my child takes thispath?
You know what's better.
Evan (42:02):
And I feel like there's also a fair number of medical
professionals.
Certainly I don't know so muchabout on the therapy side, but
certainly on the medical sidethere's an awful lot of those
individuals who, once they'vemade up their determination
about what should be the parents, stop mattering.
Melissa (42:19):
Yes, absolutely.
Evan (42:21):
Yeah, and I think as parents, that puts you in a
difficult position, because thenit becomes the child and the
doctor versus the parent.
Right and the doctor's tellingthe kid what they want to hear.
The parent is too restrictive.
And remember, kids alreadythink that we are too
restrictive too restrictive justjust by the fact that we're
(42:43):
parents.
Melissa (42:44):
Despite the fact that we know kids need consistency
and structure and rules andboundaries to thrive.
And seek those out wheneverthey can find them, Absolutely
they do.
Evan (42:54):
And connection so tell me about.
Let's talk about informedconsent and for me, the concept
of informed consent as it soundsright, being informed and being
able to provide your consentfor treatment, right, with an
informed opinion.
So I know what you're about todo, what the risks and harms are
(43:16):
, what the upside is, what thedownside is, and I'm willing to
say let's do this right.
But is that compromised whenwe're talking about a child in
distress in this kind of asituation?
Melissa (43:31):
Well, first of all, let's just note that at 14 in
most states, if not all, 14 isthe age for mental health
consent, and certainly it isthat here in Pennsylvania, where
we are.
So once that child turns 14,they have to consent to the
parent being involved.
Under the age of 14, we lookfor dual consent.
(43:54):
We want consent from this childsaying I want to be here, and
then we have to have consentfrom the parent allowing that
child to be there.
Now, medically speaking, oncethey turn 14, at least here in
our state, they now get toconsent to their own drug and
(44:14):
alcohol counseling or treatment.
They get to consent to many oftheir own choices in regard to
pregnancy, birth control, sexualhealth which does.
Do puberty blockers fall underthat or not?
I'm not sure to be honest withyou and the third one being the
(44:36):
mental health piece.
But otherwise, until they're 18, they need parental consent in
order to do these things.
Evan (44:47):
But we've heard in maybe it's not so much here in
Pennsylvania but in other states, especially California,
washington State, montana, evenyou know schools and medical
professionals working with kidsbehind the backs of parents, and
I guess some of that is statelaw related but just Well, and
(45:19):
the school's overwhelmingdisrespect for the role and
authority of parents.
Melissa (45:21):
Today, you know we're fortunate enough to live in a
district that recognizes andsupports the authority of the
parent, and I think they knowGod help them if they would do
anything like that to overrulethe authority of the parents in
our district, because it wouldbe very interesting when in some
other states maybe it's thesame concept of I'm not
(45:48):
explicitly handing my rightsover to you, but they've slowly
been taken and now you just kindof do what you want and I'm off
here on the sidelinequestioning when I ever yielded
my authority over.
Yeah.
Evan (46:00):
It seems like every time we close our eyes for a second
to catch a breath, they're 10yards ahead of us with our kids
and our rights as parents.
And it's like how did thishappen?
Melissa (46:15):
Right?
Well, and this is no differentthan in the schools, when they
send home the opt-out versus theopt-in consent.
And how do we know?
If the opt-out even came home?
But if it's not returned sayingyou're opting your kid out,
then they just go ahead and doit.
Evan (46:32):
Right.
Melissa (46:33):
And that's where they're playing the role of the
parent as well.
Evan (46:37):
Absolutely so.
That's the key informed consent.
If we can't do a fullexplanation of all the
underlying issues here, thenwe're really violating the first
rule of medicine, which isfirst do no harm, Correct Right.
So I think we need to take alook at that.
Look, I want to getuncomfortable.
Now we're going to starttalking about money.
(46:58):
We mentioned this before Aphalloplasty can run $120,000, a
vaginoplasty between $40,000and $50,000, and the hormones
create lifelong pharmaceuticalcustomers.
Do you think that there'sfinancial incentives?
Melissa (47:17):
that are influencing the system.
How many cha-chings are goingoff in my head right now?
Evan (47:24):
Money, money, money money.
Melissa (47:26):
John money.
Evan (47:27):
We're getting there.
Melissa (47:28):
But, oh my gosh, you're talking about people having to
follow up with medical providers.
How many times, as opposed toyour average healthy individual?
I mean, I go to the doctor whenI'm sick.
Evan (47:45):
Sure.
Melissa (47:47):
Honestly, it's not a repetitive thing, and you're
talking about people who now arenot only having to have routine
follow-ups, but withspecialists that are being paid
God knows how much money.
You're talking aboutpharmaceutical companies making
money hand over fist on thesedrugs that now these people are
(48:10):
dependent on and can't get offof.
Evan (48:15):
Absolutely.
I mean, we're talking about atransition that can cost
$175,000, plus lifetime hormones.
Melissa (48:25):
I have a question.
Can I ask a question quick?
Evan (48:27):
Absolutely.
Melissa (48:28):
So what happens when somebody wants to detransition?
Do they pay for that too?
Evan (48:31):
A lot of that is not paid for by insurance.
Melissa (48:34):
You know what else is not paid for by a lot of
insurances Infertilitytreatments, weight loss
treatments, cosmetic work.
Can I go get a liposuction andhave my insurance company pay
for it?
Evan (48:49):
No, no, but that's an elective surgery.
Melissa (48:51):
Correct, it's elective.
Evan (48:54):
But what's interesting to me is we're talking about a
transition that can cost, say,between 70 and $175,000, plus
lifetime hormone costs and allthe other things that go into
the pharmaceutical side Therapy.
First treatments are in therange of what?
17 to 25,000, depending on howlong it is.
Melissa (49:17):
And you'd have to do the math on that.
I can tell you that for anaverage one hour session, at
least here in Pennsylvania, weget anywhere typically around
$120, paid for by insurance, andthen you add somebody's copay
or deductible or coinsurance ontop of it.
Evan (49:35):
It's a fraction, even if we said that was $17,000, which
is probably an extensive amountof money for a long period of
time to undergo these treatments.
That's a huge disparity and itbegs the question why wouldn't
we want them to go the mentalhealth route first?
Melissa (49:59):
Well, what happens if we fix the issue?
Evan (50:01):
And I think therein lies the problem right, if we fix the
issue, then we don't have thosechunk costs, those $175,000 in
costs, and we haven't createdlifelong customers in our
pharmaceutical industry, and notjust the pharmaceuticals
associated with this particularsituation.
(50:24):
But we also know from havinglooked at the research on this,
and I think you can attest tothis from a medical standpoint
there's a lot of comorbiditiesthat come along as people make
these transitions when they goon these hormone blockers and
they go on these other things.
Other conditions come up.
(50:45):
Early onset menopause, I think,is one that comes up.
There could be issues with theway the muscle and tissue is
built and so that can createthings like arthritis and
osteoporosis, and you know itcan change your the way your
(51:07):
blood pressure reacts, and soyou could have high or low blood
pressure.
And there's all these differentother medical conditions.
Some of these are cancer drugs,Correct?
Melissa (51:17):
Cancer drugs with an, every medication we put in our
body, I mean we.
We just found out today Tylenol.
Tylenol in pregnancy is nowbeing linked to autism.
Every single thing that we putin our body has known and
unknown outcomes.
And to think of putting thesethings for cancer in our
(51:42):
children, I mean even in adults.
Enhancer in our children, Imean even in adults.
So we were at the memorialservice for my dad earlier today
and this just makes me think.
About a couple of years ago hehad tried to pursue getting a
lung transplant, a double lungtransplant, and they went
through this laundry list oftests and rule outs and all this
(52:06):
other stuff just to determineif he was actually a candidate.
You do the lung replacement,you'll have five years at most
(52:29):
because you'll have to be on allthese different anti-rejection,
anti-whatever drugs that willgive you cancer and you will end
up dying of cancer.
Evan (52:42):
So we can give you five for cancer, or you can get
potentially five to 10 if you donothing.
Melissa (52:49):
Correct.
But even these meds right thatwere used to treat the potential
rejection and at the end of theday he decided he wouldn't have
done it even if he had beenapproved.
Evan (53:03):
Sure.
Melissa (53:03):
Because they all have side effects.
Evan (53:08):
They do, and I think they all have incentives.
They sure do.
But I say that and I don't meanto say that all clinicians, or
really most clinicians, aremalicious, but I think the
incentives matter.
Melissa (53:27):
As a clinician, I really have no incentive because
I'm not prescribing meds.
I don't get any kind ofkickback for surgeries.
I don't have anything.
The biggest thing that I'mrisking is, if I don't
delicately navigate this with myclient, is my client going to
go out and say awful thingsabout me as a clinician If I
(53:50):
don't tell them what they wantto hear, is this person going to
go and commit suicide and thenI'll be blamed for it.
Yeah, how, as a clinician, do Isee the level of pain that
might exist under the surfacethere and know I can't force
(54:11):
this person to get help.
I can't force them to take thehelp.
Evan (54:16):
Yeah, exactly.
I mean no one's saying thatdoctors and clinicians are
greedy villains here, but whenbillions of insurance dollars
are flowing towards surgeriesand drugs and not towards root
cause therapy, when theinvestment's not there on the
root cause therapy side, thesystem tilts.
Melissa (54:33):
And it's not invested by the clients usually either.
Evan (54:36):
No, and the kids are paying the price.
Melissa (54:37):
Correct.
Evan (54:40):
Melissa, my final question to you if you had one message
for parents listening who arefacing this with their kids
right now, what would it be?
Melissa (54:50):
Pause and don't be afraid that your child is going
to hate you for the rest oftheir life.
And get a second opinion from adifferent provider that views
things differently, not anotherone that believes the same way,
but get other thoughts and otherperspectives because, at the
(55:13):
end of the day, this is yourchild.
Whether you birthed that childor you didn't birth that child,
this is your child and you get avoice into that.
And the medical community iswell known for they have all the
answers, whereas, coming from asocial work background, we
(55:36):
believe you have all the answers.
I don't think that's told toparents enough is.
You really can trust your gutand your intuition and you will
have support if you look in theright places.
So stand up and parent yourchildren.
Evan (55:57):
And that's what this comes down to.
Gender dysphoria can be real,but trauma is also real and
often hidden, if we let politicsAbsolutely
Imagine a 10 year old girl , the girliest girl you've ever
met.
I'm talking dresses, makeup,hair, all of it.
Then, at 10 years old, shesuffers traumatic sexual abuse
and stews quietly over the nextfew years.
She withdraws, she battlesanxiety and depression.
She stops shaving her legs,starts dressing more like a boy
(00:22):
by 17.
She wants she wants to becalled Sam.
This isn't a hypothetical.
This is the kind of storytherapists are seeing more and
more.
And here's the question Is thisgender dysphoria or is it
trauma manifesting as afractured sense of self?
Right now, youth gender identityis exploding.
The Williams Institute at UCLAsays 3.3% of American teenagers
(00:48):
over 700,000 American kids nowidentify as transgender, while
adults remain flat at about 0.5%.
The New York Times admits itcould be social acceptance, but
also peer influence or politicalclimate.
At the same time, activistplaybooks are out in the open.
One major NGO report literallytold campaigners to target youth
(01:10):
politicians, to demedicalizethe campaign, to get ahead of
the media and to frame it as ahuman rights battle rather than
a medical one.
And it's working.
Schools, politicians, evenclinics are fast-tracking
affirmation.
Schools, politicians, evenclinics are fast-tracking
affirmation.
But here's the problem.
An independent review conductedby Dr Hilary Cass in the UK
called the evidence for youthmedical transition, quote
(01:33):
remarkably weak and slammedclinicians for abandoning normal
holistic assessment.
Meanwhile, in America, a singlephalloplasty can run $120,000.
Vaginoplasties, top surgeries,hormone prescriptions for life
all mostly covered by insurance,which means billions flowing to
hospitals and drug companies.
Compare that with therapy-firstapproaches, which cost a
(01:56):
fraction.
Which pathway do you think ourhealthcare system is
incentivized to favor?
This isn't about denying transpeople exist.
It's about asking are we doingright by children in distress or
are we letting ideology,advocacy, money and profit drive
life altering decisions beforethe root causes are even
understood?
(02:16):
Tonight, melissa and I aregoing to unpack the evidence,
the trauma link and the ethicsof how we care for kids caught
in the storm of gender identity.
Melissa, let me start with thebig picture.
We've got 3.3% of US teens nowidentifying as transgender,
770,000-ish, but the adultnumber has been flat at about a
(02:39):
half a percent for decades.
From your perspective as aclinician, does this look like
organic growth or something elsegoing on?
Melissa (02:49):
Evan, I definitely think that something else is
going on here.
We have a culture and societyof kids that are struggling to
figure out who they are ingeneral, are struggling to
figure out who they are ingeneral and where you and I went
(03:14):
through our middle school yearsand you know, really, from
about 12 up through 17,.
We tried to figure out who wewere.
We explored different sports,we maybe did some art or some
music.
You know, you listened to whatkind of music as a middle school
and high schooler.
Evan (03:27):
Gangsta rap.
Melissa (03:28):
Right and I went through a Christian music phase
for a little while there.
Evan (03:33):
I had my Christian music phase too.
Me and Casting Crowns werefriends for a while.
Melissa (03:37):
That's right, but just trying to figure out who am I
and what do I like and what aremy interests.
And today, because really we'vethis whole concept of gender
didn't exist 100 years ago itwas just male or female.
(03:58):
What were you at birth?
At birth, and when this wholeconcept or shift in vocabulary
came about, it opened up thiswhole other area for people to
explore in a socially acceptableway.
And even as kids I playedfootball with the boys.
(04:22):
I had a stage where I dressedin oh, baggier jeans were in
back then, but I dressed inbaggier clothes and didn't wear
makeup and just kind of figuredout myself and struggled through
that, sure, through that.
(04:48):
Today, a lot of our kids, theydon't have the ability to
struggle through, they'reemotionally sensitive, they're
hurt over anything that's said,that doesn't feel safe and they
collapse under any kind ofpressure or any kind of
challenge.
And ultimately, it's my beliefthat identity, gender, which is
(05:15):
something biological, is one ofthe last things in our society
that can really be.
Evan (05:27):
It's a final absolute right.
It's one of the few things thatis a yes or a no, it's a black
or a white.
It's a binary code, absolutely,you know, you're a one or a
zero right.
So we talked a little bit aboutthis earlier today and we were
talking about the etymology ofgender and sex because, you know
, in our family conversationsthese kinds of topics come up
(05:51):
because we're not afraid to talkabout the unmentionables.
Melissa (05:54):
Which is funny when mom walks into the room into the
middle of the conversation.
Evan (05:59):
What did I walk into?
But so we talked about this andcorrect me if I'm wrong on this
.
I'm sure that you'll get to thedetails of it.
But sex, in terms of biologicalsex, male and female, do you
have a peepee or do you not havea peepee?
That has been a binary questionand answer for the entire human
(06:25):
history.
It's always been male or female.
The concept of gender, I think,didn't even come around until
what did we say?
The late 1700s, maybe late1600s?
Melissa (06:40):
So I looked up the etymology, and its ancient roots
are in the Latin term genus,which is a kind, a type or a
sort.
You know genus and species,right Sure, and by the 14th
century the English used genderto describe grammatical
(07:01):
categories of nouns masculine,feminine and neuter.
Evan (07:04):
Which makes sense.
If you've ever taken, if you'rean American and you've ever
taken a foreign language classlike german, spanish, french,
you might have heard terms givenin two different genders, males
and females.
Melissa (07:19):
Which has thoroughly and completely confused me ever
since I started taking German inthe seventh grade.
So it was never extended.
Gender was never extended to beused in regard to people until
the late 14th and 15th century,and it was in part Shakespeare
(07:45):
who used gender in the sense ofsex.
What sex was someone?
And then up until the mid 20thcentury, gender and sex were
used almost interchangeably inEnglish.
Evan (07:59):
It wasn't until good old Dr John Money in the night of
David Reimer fame, if I'mcorrect, right.
Melissa (08:07):
Yes, and for those of you who don't know who David
Reimer is David Reimer, who welearned about actually in
undergraduate social work in ahuman sexuality class way back
in the early 2000s.
David had a botchedcircumcision so they decided,
courtesy of Dr John Money, thatthis is just a social construct.
(08:29):
So we can just do surgery andturn David into a girl.
And if you raise David as agirl, then this child won't know
the difference, they'llsocially adapt and we won't have
a problem.
Evan (08:49):
So biology means nothing to Dr Money at this point.
It's all social construct.
Melissa (08:53):
It's all a social construct.
Evan (08:54):
Okay, correct, how'd that work out?
Melissa (08:56):
It was a very poor outcome and unfortunately, David
ended up committing suicide,and part of it was that they,
the family was told don't tellDavid, keep David in the dark.
And so David struggled withthese feelings, and this was
nothing new, honestly.
The term intersexed used to bebeing a hermaphrodite, which was
(09:25):
somebody who was born witheither an enlarged clitoris or
super small penis.
And if we look at generalanatomy, right, the clitoris is
no different than the tip of themale penis.
It all comes from the sameplace, and so it was easier to
shrink something than to try tomake it grow.
(09:49):
So when children were born andagain, this is a very small
percentage, but when they'reborn with ambiguous genitalia
the professional term for itparents for a long time were
told that they needed to decide,because the sooner you did the
surgery, the better a childwould be able to navigate life.
(10:14):
And as more and more studiescame out, they realized that
this was such an epic failure onthe part of the medical
community and this is some ofthe people who are now adults
that just felt like they didn'tbelong in their body, which is
now why we frown upon doingthese surgeries super early, but
(10:39):
going back to that shift.
So Dr John Money, who was asexologist and a psychologist,
started using this word genderin the 1950s and 60s to
distinguish biological sex, maleversus female anatomy, from a
social or psychological role andidentity.
(11:00):
And it was there in the 50s and60s that this term gender
identity, gender role, launchedand that was where we started to
see some of these shifts andchanges.
Evan (11:15):
Yeah.
So let me ask you this Are allcases of gender dysphoria or
gender identity disorder,whatever?
I think it's, gender dysphoriais the right term.
Are all cases of genderdysphoria?
You know lifelong, you knowunderstandings that you know
I've always just been a woman,or I've always just been a man
(11:38):
and I wasn't born in the rightbody, or is there such a.
.
.
I think I've seen a term calleda Rapid Pnset gender dysphoria.
Can you talk a little bit aboutthe difference between those
two?
Melissa (11:51):
Sure.
So no, not all cases of genderdysphoria are those lifelong
cases, and especially even nowwe can diagnose Klinefelter
syndrome, and those are thefolks that actually diagnosed
Klinefelter syndrome and thoseare the folks that actually,
from a chromosome perspective,are XXY.
There are absolutely caseswhere someone is truly in the
(12:12):
wrong body by no fault of theirown.
The cases that are soconcerning are particularly
those late onset ones, and bylate onset what we really mean
is around 12 or after 12.
(12:32):
And this is a child who maybewas born a girl and did ballet
and also did soccer and, youknow, like to get dressed up and
wear pretty things and had acute haircut and was walking
(12:55):
through life relatively normallyuntil some kind kind of trauma
happened.
And when a child hits puberty,their hormones are all shifting,
their body is developing, andthe autism spectrum plays a huge
(13:16):
role in this, because whileit's hard for a neurotypical kid
to go through puberty, it'seven harder for kids that are
diagnosed or undiagnosed on theautism spectrum from the social
perspective.
Evan (13:31):
Yeah, so I gave that sort of example earlier, a very
similar one to the one that youjust brought up, and it sounds
like it's fairly common for thiskind of trauma to present this
way.
Is it common for trauma topresent as a new identity?
Melissa (13:49):
Yes, we call it DID.
It's dissociative identitydisorder, and that's where the
trauma and so a key part of thisis those identities don't know
(14:11):
about each other.
They're blind to the fact thatothers exist and they rule in
different ways in differentareas.
But really what you're lookingat is, depending on the level of
trauma and the way we suppressit or if it's not addressed,
(14:36):
people don't know that somethinghappened.
It's stored and, through thisidentity process in those teen
years, this concept of beingtrans was never a thing 50 years
ago and it certainly wasn'tanything that was socially
really talked about until moreso over the past 10 years, and
(15:03):
it's now an option over the past10 years and it's now an option
.
So back in the day people diddifferent things.
We've gone through the furrytrend where that was a big thing
.
We went through a trend wherepeople called themselves
pansexual.
It used to be.
(15:24):
What are some of the otherthings that, as teenagers
growing up, you know we kind ofwent to.
Evan (15:33):
Well, I think most people had some phase or another where
they were emo or or used pot orused some kind of recreational
drugs or something like thatJust pot.
Melissa (15:45):
Or used some kind of recreational drugs or something
like that, and really what it isin all of these different
examples and again, not always,but when there's trauma involved
it's an escape.
It's I need to escape the chaosthat exists within me, and so
(16:06):
I'm going to pretend to be a catfor a while, or I'm going to
pretend that I'm a boy for awhile, or I'm going to use pot
to escape for a while, or becomeemo to mask who I am underneath
and not let people see it.
Evan (16:26):
So this is not about language and social acceptance
and cultural norms changing tomake it safer for these kids who
would have always been transidentifying anyway.
This is as much, or maybe evenmore so, about trying to cope
with severe trauma situations asit is anything that's organic.
Melissa (16:50):
I think it is wonderful that as a society we are so
much more open to people who arechanging that part of who they
are and it has nothing to dowith trauma.
It was a misgendering, it wasambiguous genitalia, it is
(17:13):
Kleinfelter's For people whotruly just feel that they're in
the wrong body.
I think it's beautiful as asociety that we can embrace that
and say you know what?
I love you as a person and Iwill embrace all of who you are.
(17:35):
My concern is the rapid increasein these cases and we know that
there's a rapid increase indisclosed trauma and even among
kids who transitioned, and thenyou hear stories of
(17:57):
detransitioning.
Every stinking time there'strauma, there's unresolved
trauma and people say I wishsomebody had helped me work
through this trauma instead ofjust allowing me to.
Really we're talking aboutexiling a part that was hurt and
(18:20):
saying you no longer existbecause I got hurt because of
you, so I'm going to shift intosomebody else that I can design
and make who I want, and theneverything will be fine.
And it's just not fine becausethe trauma doesn't go away.
Evan (18:41):
Yeah, so in many cases, what sounds like gender
dysphoria could actually just bea trauma response, and if we
don't investigate the rootcauses of that trauma response
or that trauma, we risk treatingthe symptom but not the wound.
Melissa (18:57):
Absolutely.
Evan (18:58):
Like putting a Band-Aid on a bullet wound.
Melissa (19:00):
That's a good T Swifty reference there.
We can't put Band-Aids onbullet holes.
Evan (19:08):
So let's talk about the evidence.
The UK Hillary Cass did anindependent review just in the
last year or so.
She's called the research onyouth transitions quote
remarkably weak and said thatclinicians abandon holistic care
.
Would you agree with thatassessment?
Melissa (19:28):
I sure would.
I think that with the increasein media on this, of social
media influencers and just themedia in general, I'll say I
(19:48):
think there's a lot ofclinicians that are well
unknowledgeable and some who arejust afraid Because deep down
as a clinician right, I knowthat if I tell you something
that you don't want to hear, orI ask you to look at something
from another perspective, justto solidify where you stand on
(20:10):
something, I recognize that ifit doesn't align with your
beliefs, you might walk away asa client.
Evan (20:21):
And could it not be more serious, right?
So one of the things that wehear about a lot in the news and
social media, especially theinfluencers my God, these
influencers.
They will come out and theywill tell you that the
statistics on transgenderedsuicides are exponentially high.
(20:42):
They're through the roof.
If Sure, they're not affirmedin you know, whatever belief
that they have in that moment.
Melissa (20:50):
Yes, and we're a feelings driven world.
Evan (20:54):
Now, We've lost sight Very much so.
Melissa (20:56):
It's no longer about what are the facts.
What are the facts of whathappened?
What are the facts of who I am?
What are the facts of how I wasraised as a clinician is?
Evan (21:08):
there fear that this patient or this client that I'm
treating, if I don't handle themgently, if I don't follow best
practices, this client could gohome and commit suicide.
And not just will I be liablefor that potentially right
(21:29):
Because of the society that welive in, but, like, just as a
clinician, on a personal level,nobody wants somebody to go home
and commit suicide, of course,because they were pressed into,
you know, taking a stance or aposition that they didn't want
to take.
Melissa (21:43):
Well, and if I don't ask the question, there's an
equal chance?
Because the reality is, ifwe're looking at suicide
statistics among transgenderedindividuals, the risk was there
in the first place, the risk wasthere no matter what.
And so, as a clinician, do Iask, do I not ask?
(22:03):
Do I probe, do I not probe?
And you know we were talkingabout this earlier.
We have a group of emotionallyfragile adolescents on our hands
and you can't disagree withthem.
(22:39):
Otherwise, you know, there'semotional upheaval, and so
adolescents thinking that theyjust deserve ultimate respect
when it's not even necessarilygiven.
Evan (22:51):
Yeah, it's absolutely, absolutely wild to me the lack
of real detailed study that'sbeen done on this issue for as
big of an issue as it appears.
Melissa (23:07):
Well, and longitudinally.
How would they?
Because all of this is still sonew.
You're talking about a 0.5%stable number, yeah, among
adults, among adults.
And now suddenly we have 3.3%of adolescents, which screams
(23:32):
something changed.
Something changed here.
It's interesting because we'realso seeing a significant rise
in autism, and what we know fromagain research is that those
who are diagnosed on the autismspectrum struggle with
(23:55):
understanding social cues,socially engaging and
interacting with peers.
They tend to be morecomfortable with same-sex peers.
So what we saw 10, 15 years agois that the rate of people with
autism that identified ashomosexual was higher than those
(24:18):
that were not diagnosed on theautism spectrum.
And it makes sense because herewe get along with somebody of
our gender more easily.
They're easier to understand,they're easier to relate to,
picking up on the social cues,sure, and they find love with
(24:40):
someone in that way.
What I think that's now morphedinto is well, now I can just
change my gender and then I canbe normal like everyone else.
Evan (24:54):
It feels like such a zero to 100 approach that we've taken
.
I know that there aresafeguards in place and you know
in in most cases you don't havepeople that walk into a
therapist's office and 55minutes later get diagnosed with
gender dysphoria and off theygo in a few months.
Melissa (25:14):
It's actually highly undiagnosed in people that
identify as transsexual.
Evan (25:21):
Okay.
Melissa (25:22):
Which clinically blows my mind, because if somebody is
going to identify that way, thenas a clinician we would have to
diagnose them with genderdysphoria.
Sure, we can't say that this isany different.
Evan (25:37):
Right.
Melissa (25:38):
And yet it's chronically underdiagnosed.
Hmm some of that is a fear thatif they're diagnosed with it
then there's a stigma and theywon't be able to transition
because doctors will view itdifferently, just like any other
(25:58):
mental health diagnosis.
As soon as there's comorbidityhere, people view it as a red
flag for the medical side.
Evan (26:08):
And I guess that's where I'm kind of going with this as
well is that, given that we havesuch a limited research base
because, quite frankly, wehaven't been in this business
for that long Right Right, andalso we're talking about things.
Look, when it comes to ADHD andautism, there are a lot of not
(26:31):
gentle medications, but thereare a lot of medications that
are stimulant-based or othersthat are maybe less long-term
effective Mood-based, mood-basedright that are less long-term
effective than, for example,taking hormone blockers right,
that are less long-termeffective than, for example,
taking hormone blockers right.
So why do we, in the case ofsomeone who potentially wants to
(26:52):
, you know, has a genderdysphoria condition and wants to
change their gender, sort of godirectly to let's get you
started on hormone blockers, asopposed to?
Would it really be harmful tospend two, three, four, five
years maybe your childhood yearsat least, walking through how
(27:14):
you feel and why you're there?
Melissa (27:16):
Well, the question popping up in my head right now,
as we're talking about this, iswhy do we care?
Why, as a child, do you carewhat gender you are?
Evan (27:37):
Why does it matter?
How does it impact how you dolife day to day?
Well, I think, especially forteenagers, gender, your
biological sex, does a lot.
It determines where you playsports and which teams you're on
and what friend groups you hangout with.
It can determine a lot ofthings at that stage of your
life.
But I also question whether ornot that's a construct of ours
(28:00):
that we've put into place, wherewe've overcomplicated things to
a certain degree when it comesto gender.
Now, certainly I think you andI are on the same page about
biological sex.
Men should be playing with men,boys should be playing with
boys.
Melissa (28:14):
And that's what you were just talking about.
You were talking aboutbiological sex.
Evan (28:18):
Correct.
You weren't talking about thissocial construct of gender,
because I don't see that Agreedthis social construct of gender,
because I don't see that Agreed.
Melissa (28:26):
So if I don't know if I feel today like more of a boy
or a girl, how does that impactmy daily activities?
Evan (28:41):
The only way it possibly can is if your happiness is tied
to the acceptance andappreciation of others.
Melissa (28:49):
And that's where it is and that's where everyone else
needs to affirm who I am or whoI feel like today in order for
me to feel okay with myself.
And the reality is we know thatthe brain, the prefrontal
cortex that has to do with logicand reasoning and organization
(29:11):
and all those fun higher levelexecutive functioning concepts,
doesn't fully develop until atleast, if not well, after the
age of 25.
The age of 25.
(29:33):
And so, as young adults, asadolescents, it's not harming
anybody to sit in who I am andgo through my day.
I sit back and I say why isthis even an issue today?
Why is this even an issue today?
That I need to figure out who Ifeel like I am today in order
to function in society?
(29:53):
You and I, as kids, didn't sitback and go.
You know, do I feel like ahuman or a cat today?
Evan (30:03):
No, I don't think that was ever a question.
Melissa (30:05):
If I feel like a cat.
Maybe I won't go to schoolbecause cats don't go to school.
Or do I feel like a boy or agirl?
It's not like I can decidewhich bathroom I want to use.
It's not like I can changewhich gym class I'm
participating in or whichathletic program I'm in.
(30:28):
It's set and so whatever it isthat I'm questioning in my brain
has zero bearing on what playsout in my day.
I am stuck in my sympatheticnervous system, which is our
(30:52):
fight or flight, our feelings,all those big energy things.
And I'm stuck there because,from a factual standpoint, I
can't look down and ask myselfdo I have a penis or a vagina?
Because that's going to tell mehow I need to proceed through
my day.
But I'm stuck in how I feel,which could be anything.
(31:14):
I could feel like an attackhelicopter today, but does that
mean that I run around and wavemy hands spinning, like, like,
what are they called on?
The top Blades, blades,propeller blades and start, you
know, pew-pewing at people?
They'd think I was crazy.
Evan (31:35):
They would indeed.
Melissa (31:37):
And so because we clearly can say that is not
reality, right?
Evan (31:42):
No, you are not a Buick.
You're not an attack helicopter, you're a human.
But will you pretend with metodayick You're not an attack
helicopter.
Melissa (31:46):
You're a human, but will you pretend with me today,
cause I feel like an attackhelicopter?
Do you want to pretend with me?
Not right?
Evan (31:52):
now, but maybe later.
Melissa (31:53):
Yeah, okay, that sounds fun, but you know I can't
decide.
Today I want to be a potato, soI'm going to sit here and not
do anything.
Evan (32:08):
Don't we all wish we could do that?
Melissa (32:10):
You know the other.
The other thing that I'm seeingis that youth, youth have this
luxury, this luxury of feelingand using it as an it as an
excuse for everything.
Evan (32:28):
That's pretty recent too, right.
It is when I told my parentshow I felt my dad was like okay,
Right, Get your ass on the bus,kid.
Melissa (32:38):
And the reality as an adult is I can wake up in the
morning and feel down, I canfeel like not getting out of bed
because I'm tired and it'srainy and I just don't really
feel like adulting today.
But I can't just decide.
I'm not an adult.
(32:58):
I have to get up and for a lotof us as adults, things like
depression, we don't get to gobe depressed because there's all
these other people andresponsibilities that we have.
We need to suck it up and moveforward and hopefully have
outlets to deal with that andtry to keep ourselves balanced.
(33:21):
But kids today say I feeldepressed and magically we're
not in school, magically what'sexpected of us has decreased and
if I have trauma, forget aboutit.
Evan (33:37):
I need a mental health day .
Melissa (33:39):
Sorry, you don't get one.
Evan (33:44):
So, but we don't I don't want to't want to over
trivialize this right.
So we understand that there arereal issues.
There are certainly some somethese are very real issues yes,
well, there are some situationswhere, as you've pointed out,
there are, there are realdisorders, there are real things
going on here, not justfeelings, and I think that when
(34:05):
people use it from a feelingsperspective, it really
invalidates and downplays thereal situations where people are
deeply struggling.
Melissa (34:17):
slow down, let's do the hard work first.
Evan (34:28):
Don't exceptionalize these kids just because they're
presenting in a certain way.
Let them grow through it.
Let them get to a stage where,even if the answer doesn't
change, at least they've donethe processing work to get there
.
Melissa (34:45):
And they've grown as a human.
They have sat in the discomfortof life and learned how to
persevere, where our societytoday is about fast answers and
quick solutions and no distresstolerance.
Evan (35:05):
Absolutely From an ethical standpoint.
How do you see the HippocraticOath, for example, applying here
?
Are we doing harm by pushingaffirmation too quickly?
Melissa (35:17):
I absolutely believe we are.
And the flip side of that isgoing to say well, are we doing
harm?
If we don't, because then whatif they go kill themselves?
And I go back to if suicidalityis there it was there before
you.
It didn't magically appear andthis person is so miserable and
(35:42):
literally in their own skin,whether it's by trauma or
avoidance again, not talkingabout the very legitimate cases
here when we push a quicksolution and we don't let them
(36:08):
walk through life and actuallywork through the issues because
we're afraid to.
Evan (36:16):
How do you, as a clinician , if you've ever dealt with
anything like this before, howdo you let a client walk through
it without?
How do you let a client walkthrough it without necessarily
affirming or validating whatthey're saying?
Melissa (36:31):
Sure.
So I feel like you can alwaysvalidate someone without
agreeing.
So somebody can come in and sayI feel like I'm a boy and not a
girl.
Okay, well, help me understandwhat causes you to feel that way
, and they tell me all thereasons that they feel that way,
(36:59):
which often is well, justbecause.
I don't, it's a feeling right,Because it's a feeling, in these
cases, Sure and okay, so I canunderstand that it feels that
way.
It feels that way.
What are the facts?
And we call this DBT.
It's dialectical behavioraltherapy, and many, many
(37:19):
therapies come from here, but itis taking fact and taking
feeling and looking at where thetruth lies in the middle.
A lot of our therapies, evenEMDR work, looks at what are the
facts.
I know what are the feelingsthat I have and can we merge the
(37:42):
two and see what we find in thecenter?
We merge the two and see whatwe find in the center.
So different therapies call itdifferent things but nothing is
looking at.
Evan (37:56):
I just want to go by how I feel today.
Okay, how long does it take foryou to decide whether someone
is ready or not ready?
Melissa (38:14):
So, for example, ready or not ready to what?
Evan (38:17):
to take the next step on their journey.
So, for example, we've talkedabout how there are, or you've
talked about how there are, somepeople who present and they
have true gender dysphoria.
They have a real condition thatneeds to lead them in this
(38:38):
direction, versus someone who,as you pointed out, may be
hiding from trauma.
Is this something that you meetwith a client for one session
and you could determine?
Is it three months of sessions?
Melissa (38:51):
Is it a year?
There's no finite timeline anddifferent clinicians are going
to look at things differently.
There are some who want toaffirm and just believe the
first thing that everybody says,which is not clinical best
(39:12):
practice.
We're talking about needing todig in and ask those hard
questions, ask people to thinkabout things and the reality is,
if you ask the hard questionsand they leave, you know the
answer.
Evan (39:28):
Sure Sure.
So it sounds like there'ssafeguards in clinical best
practices, but they're appliedinconsistently.
Melissa (39:38):
I think that different clinicians use different
theories and models and comefrom different worldviews.
So if someone has a biasagainst the LGBTQ lifestyle or
(39:59):
transitioning in general, thenthey're probably going to take a
lot more time to assess it andlook for other things that could
be coexisting or comorbid,whereas someone who is extremely
supportive of you know what.
If you feel like that, then youjust go do it and everything
(40:23):
will be okay and everything willbe okay is far less likely to
rule out all the other things,like autism, trauma, any other
mental health issues, DID.
Evan (40:40):
It strikes me and I'll come back to this in a minute,
but it always strikes me alittle bit that we and I
understand why because the humancondition is such that we want
others with us.
Right, we want others toembrace us and to affirm us.
But it does strike me that whenwe talk about things like
medical conditions, an awful lotof people would probably go get
(41:02):
a second opinion if they weretold we need to do heart valve
surgery on you, or we need to doheart valve surgery on you,
they sure would.
Or we need to do some kind ofinvasive surgery or take these
pills.
And yet I worry, or I wonderhow many trans-identifying
individuals, and especiallyyouth, seek out other potential
(41:24):
options to rule out before theygo under the knife.
Melissa (41:29):
And I think, as parents , a lot of parents are afraid
because if somebody gives thismedical opinion or a clinical
diagnosis, as a parent you wantto trust those people that are
involved with your child andfundamentally I think there's a
(41:50):
fear that what if my child doesself-harm?
What if my child takes thispath?
You know what's better.
Evan (42:02):
And I feel like there's also a fair number of medical
professionals.
Certainly I don't know so muchabout on the therapy side, but
certainly on the medical sidethere's an awful lot of those
individuals who, once they'vemade up their determination
about what should be the parents, stop mattering.
Melissa (42:19):
Yes, absolutely.
Evan (42:21):
Yeah, and I think as parents, that puts you in a
difficult position, because thenit becomes the child and the
doctor versus the parent.
Right and the doctor's tellingthe kid what they want to hear.
The parent is too restrictive.
And remember, kids alreadythink that we are too
restrictive too restrictive justjust by the fact that we're
(42:43):
parents.
Melissa (42:44):
Despite the fact that we know kids need consistency
and structure and rules andboundaries to thrive.
And seek those out wheneverthey can find them, Absolutely
they do.
Evan (42:54):
And connection so tell me about.
Let's talk about informedconsent and for me, the concept
of informed consent as it soundsright, being informed and being
able to provide your consentfor treatment, right, with an
informed opinion.
So I know what you're about todo, what the risks and harms are
(43:16):
, what the upside is, what thedownside is, and I'm willing to
say let's do this right.
But is that compromised whenwe're talking about a child in
distress in this kind of asituation?
Melissa (43:31):
Well, first of all, let's just note that at 14 in
most states, if not all, 14 isthe age for mental health
consent, and certainly it isthat here in Pennsylvania, where
we are.
So once that child turns 14,they have to consent to the
parent being involved.
Under the age of 14, we lookfor dual consent.
(43:54):
We want consent from this childsaying I want to be here, and
then we have to have consentfrom the parent allowing that
child to be there.
Now, medically speaking, oncethey turn 14, at least here in
our state, they now get toconsent to their own drug and
(44:14):
alcohol counseling or treatment.
They get to consent to many oftheir own choices in regard to
pregnancy, birth control, sexualhealth which does.
Do puberty blockers fall underthat or not?
I'm not sure to be honest withyou and the third one being the
(44:36):
mental health piece.
But otherwise, until they're 18, they need parental consent in
order to do these things.
Evan (44:47):
But we've heard in maybe it's not so much here in
Pennsylvania but in other states, especially California,
washington State, montana, evenyou know schools and medical
professionals working with kidsbehind the backs of parents, and
I guess some of that is statelaw related but just Well, and
(45:19):
the school's overwhelmingdisrespect for the role and
authority of parents.
Melissa (45:21):
Today, you know we're fortunate enough to live in a
district that recognizes andsupports the authority of the
parent, and I think they knowGod help them if they would do
anything like that to overrulethe authority of the parents in
our district, because it wouldbe very interesting when in some
other states maybe it's thesame concept of I'm not
(45:48):
explicitly handing my rightsover to you, but they've slowly
been taken and now you just kindof do what you want and I'm off
here on the sidelinequestioning when I ever yielded
my authority over.
Yeah.
Evan (46:00):
It seems like every time we close our eyes for a second
to catch a breath, they're 10yards ahead of us with our kids
and our rights as parents.
And it's like how did thishappen?
Melissa (46:15):
Right?
Well, and this is no differentthan in the schools, when they
send home the opt-out versus theopt-in consent.
And how do we know?
If the opt-out even came home?
But if it's not returned sayingyou're opting your kid out,
then they just go ahead and doit.
Evan (46:32):
Right.
Melissa (46:33):
And that's where they're playing the role of the
parent as well.
Evan (46:37):
Absolutely so.
That's the key informed consent.
If we can't do a fullexplanation of all the
underlying issues here, thenwe're really violating the first
rule of medicine, which isfirst do no harm, Correct Right.
So I think we need to take alook at that.
Look, I want to getuncomfortable.
Now we're going to starttalking about money.
(46:58):
We mentioned this before Aphalloplasty can run $120,000, a
vaginoplasty between $40,000and $50,000, and the hormones
create lifelong pharmaceuticalcustomers.
Do you think that there'sfinancial incentives?
Melissa (47:17):
that are influencing the system.
How many cha-chings are goingoff in my head right now?
Evan (47:24):
Money, money, money money.
Melissa (47:26):
John money.
Evan (47:27):
We're getting there.
Melissa (47:28):
But, oh my gosh, you're talking about people having to
follow up with medical providers.
How many times, as opposed toyour average healthy individual?
I mean, I go to the doctor whenI'm sick.
Evan (47:45):
Sure.
Melissa (47:47):
Honestly, it's not a repetitive thing, and you're
talking about people who now arenot only having to have routine
follow-ups, but withspecialists that are being paid
God knows how much money.
You're talking aboutpharmaceutical companies making
money hand over fist on thesedrugs that now these people are
(48:10):
dependent on and can't get offof.
Evan (48:15):
Absolutely.
I mean, we're talking about atransition that can cost
$175,000, plus lifetime hormones.
Melissa (48:25):
I have a question.
Can I ask a question quick?
Evan (48:27):
Absolutely.
Melissa (48:28):
So what happens when somebody wants to detransition?
Do they pay for that too?
Evan (48:31):
A lot of that is not paid for by insurance.
Melissa (48:34):
You know what else is not paid for by a lot of
insurances Infertilitytreatments, weight loss
treatments, cosmetic work.
Can I go get a liposuction andhave my insurance company pay
for it?
Evan (48:49):
No, no, but that's an elective surgery.
Melissa (48:51):
Correct, it's elective.
Evan (48:54):
But what's interesting to me is we're talking about a
transition that can cost, say,between 70 and $175,000, plus
lifetime hormone costs and allthe other things that go into
the pharmaceutical side Therapy.
First treatments are in therange of what?
17 to 25,000, depending on howlong it is.
Melissa (49:17):
And you'd have to do the math on that.
I can tell you that for anaverage one hour session, at
least here in Pennsylvania, weget anywhere typically around
$120, paid for by insurance, andthen you add somebody's copay
or deductible or coinsurance ontop of it.
Evan (49:35):
It's a fraction, even if we said that was $17,000, which
is probably an extensive amountof money for a long period of
time to undergo these treatments.
That's a huge disparity and itbegs the question why wouldn't
we want them to go the mentalhealth route first?
Melissa (49:59):
Well, what happens if we fix the issue?
Evan (50:01):
And I think therein lies the problem right, if we fix the
issue, then we don't have thosechunk costs, those $175,000 in
costs, and we haven't createdlifelong customers in our
pharmaceutical industry, and notjust the pharmaceuticals
associated with this particularsituation.
(50:24):
But we also know from havinglooked at the research on this,
and I think you can attest tothis from a medical standpoint
there's a lot of comorbiditiesthat come along as people make
these transitions when they goon these hormone blockers and
they go on these other things.
Other conditions come up.
(50:45):
Early onset menopause, I think,is one that comes up.
There could be issues with theway the muscle and tissue is
built and so that can createthings like arthritis and
osteoporosis, and you know itcan change your the way your
(51:07):
blood pressure reacts, and soyou could have high or low blood
pressure.
And there's all these differentother medical conditions.
Some of these are cancer drugs,Correct?
Melissa (51:17):
Cancer drugs with an, every medication we put in our
body, I mean we.
We just found out today Tylenol.
Tylenol in pregnancy is nowbeing linked to autism.
Every single thing that we putin our body has known and
unknown outcomes.
And to think of putting thesethings for cancer in our
(51:42):
children, I mean even in adults.
Enhancer in our children, Imean even in adults.
So we were at the memorialservice for my dad earlier today
and this just makes me think.
About a couple of years ago hehad tried to pursue getting a
lung transplant, a double lungtransplant, and they went
through this laundry list oftests and rule outs and all this
(52:06):
other stuff just to determineif he was actually a candidate.
You do the lung replacement,you'll have five years at most
(52:29):
because you'll have to be on allthese different anti-rejection,
anti-whatever drugs that willgive you cancer and you will end
up dying of cancer.
Evan (52:42):
So we can give you five for cancer, or you can get
potentially five to 10 if you donothing.
Melissa (52:49):
Correct.
But even these meds right thatwere used to treat the potential
rejection and at the end of theday he decided he wouldn't have
done it even if he had beenapproved.
Evan (53:03):
Sure.
Melissa (53:03):
Because they all have side effects.
Evan (53:08):
They do, and I think they all have incentives.
They sure do.
But I say that and I don't meanto say that all clinicians, or
really most clinicians, aremalicious, but I think the
incentives matter.
Melissa (53:27):
As a clinician, I really have no incentive because
I'm not prescribing meds.
I don't get any kind ofkickback for surgeries.
I don't have anything.
The biggest thing that I'mrisking is, if I don't
delicately navigate this with myclient, is my client going to
go out and say awful thingsabout me as a clinician If I
(53:50):
don't tell them what they wantto hear, is this person going to
go and commit suicide and thenI'll be blamed for it.
Yeah, how, as a clinician, do Isee the level of pain that
might exist under the surfacethere and know I can't force
(54:11):
this person to get help.
I can't force them to take thehelp.
Evan (54:16):
Yeah, exactly.
I mean no one's saying thatdoctors and clinicians are
greedy villains here, but whenbillions of insurance dollars
are flowing towards surgeriesand drugs and not towards root
cause therapy, when theinvestment's not there on the
root cause therapy side, thesystem tilts.
Melissa (54:33):
And it's not invested by the clients usually either.
Evan (54:36):
No, and the kids are paying the price.
Melissa (54:37):
Correct.
Evan (54:40):
Melissa, my final question to you if you had one message
for parents listening who arefacing this with their kids
right now, what would it be?
Melissa (54:50):
Pause and don't be afraid that your child is going
to hate you for the rest oftheir life.
And get a second opinion from adifferent provider that views
things differently, not anotherone that believes the same way,
but get other thoughts and otherperspectives because, at the
(55:13):
end of the day, this is yourchild.
Whether you birthed that childor you didn't birth that child,
this is your child and you get avoice into that.
And the medical community iswell known for they have all the
answers, whereas, coming from asocial work background, we
(55:36):
believe you have all the answers.
I don't think that's told toparents enough is.
You really can trust your gutand your intuition and you will
have support if you look in theright places.
So stand up and parent yourchildren.
Evan (55:57):
And that's what this comes down to.
Gender dysphoria can be real,but trauma is also real and
often hidden, if we let politicsAbsolutely
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