30.1 Gender Dysphoria and Medical Education with Nikki Johnson, MD

[00:00:00] Managing transgender youth's health care is another really kind of hot-button political issue. And I think, again, just like so many issues in our society, there is this dichotomization or this polarization of for or against when there's so much more nuance that is needed there.

[00:00:22] I mean, you could think as that kind of pendulum swings on one end, you have, well, do I believe that everybody should have a right to express themselves the way that they want to express themselves? Sure. Should somebody be able to dress and act in a way that they want to dress and act? Yeah, absolutely. Somebody get this guy some help.

[00:00:55] Disclaimer. This podcast is for informational purposes only. The information provided in this podcast and related materials are meant only to educate. This information is not intended as a substitute for professional medical advice. While I am a medical doctor and many of my guests have extensive medical training and experience, nothing stated in this podcast nor materials related to this podcast, including recommended websites, texts, graphics, images, or any other materials, should be treated as a substitute for professional, medical, or psychological advice, diagnosis, or treatment. All listeners should consult with a medical professional, licensed mental health provider, or other health care provider if seeking medical advice, diagnosis, or treatment. Or, put more simply...

[00:01:24] If you need help like this guy, call your own doctor. So, I want to take a minute to make sure and summarize and clarify some of my beliefs prior to airing this interview with Dr. Nikki Johnson, where we discuss issues including the profit-driven monopolization of continued medical education by the American Board of Medical Specialties, and other efforts of manipulation used to control what and how doctors think.

[00:01:51] But, more importantly to this introduction, we're talking about gender-affirming care. Look, I care deeply about my patients, regardless of their gender, race, sexual identity, or orientation, or any other specific factor or aspect of themselves that they identify with. The reality is that LGBTQ plus patients are at a higher risk of mental health disorders,

[00:02:20] and most importantly to what I do, suicide. So, finding effective solutions to their care is absolutely important. However, I don't think people are disordered because of their identity or orientation. I think the disordered part is how we, as a society, respond to anybody who presents themselves as different. Whether you're going back to the asinine Jim Crow laws,

[00:02:47] pervasive across the South as recently as a few decades ago, with social views and implications of those laws still in effect today, or the early treatment of Native peoples in America, when primarily white settlers landed here and proceeded to remove people from their native land. From my standpoint, my patients are not fundamentally different than I am.

[00:03:14] We're human beings trying to exist in this crazy world, trying to identify and chase after things that matter in our lives, and allow us to find meaning and purpose in our human existence. But, this issue raises a lot of emotion on both sides, and I recognize that my views, which in my opinion are appropriately nuanced,

[00:03:41] may be divisive to those on either side of this so-called debate. I actually think we agree on more than we realize, and part of this purported debate is another government and or media effort to divide us, and have us respond to each other with fear and anxiety, as opposed to compassion, humaneness, and inclusiveness. Nevertheless, I want to clarify my views here,

[00:04:11] and summarize my beliefs on this issue, which are moldable over time. I don't think there's anything inherently wrong with identifying as LGBTQ. I think there is inherently something wrong with our societal inability to accept people who are different from the norm, whoever the fuck the norm is supposed to represent.

[00:04:35] I can imagine how diminished I might feel if I transitioned, only to find out that the society I live in still didn't accept me. From my social perspective, this is the problem. And organizations and people with financial interests are guiding us to believe our identities are what is problematic,

[00:05:00] as opposed to outside persons' desires to control other individuals' identities. Like so many other hot-button political topics in medicine over the last several decades, this one has been hijacked by extremists. I just want to help the individuals who are so much more complex than any one given aspect of their identity that are sitting in front of me, in my office.

[00:05:30] The stark reality is there are truths and falsities on both extremes of this argument. Just like using SSRIs for long-term depression, or expanding the recommendations of statin drugs for lowering cholesterol in people who are not likely to have any significant long-term benefit in their outcomes, or, very, very personal to me, telling Appalachia and later America

[00:05:58] that Oxycontin was this non-addictive opioid and that treating chronic pain was a God-given right, there are often financially motivated entities and individuals driving these conversations. In my medical opinion, there's just not enough good evidence to recommend a universal approach of giving hormones to adolescents, and certainly not for doing irreversible surgical interventions

[00:06:27] on children questioning their identity. There is also no good evidence that the unsupportive, demonizing, and coerced reparative or conversion therapy is at all helpful. Now, I am by no means an expert in this area, but I try to apply common sense and look at good data and evidence,

[00:06:52] also understanding the medical history relevant to this topic. What we need are long-term studies on these issues. The ones that I've seen don't reveal a long-term reduction in depression or suicide, and some reveal an increase in depression and suicide in the long term. Again, in my mind, lending credence to the idea that

[00:07:20] what is most harmful in this population is that society is not accepting them for who they are. There is evidence and data of short-term reductions in some of these studies on gender-affirming care, but I wonder if it's related not to the procedure or the hormonal therapy itself, but rather the support that the person feels when engaging with treatment providers

[00:07:48] or the support that they maybe get from a previously unsupportive parent that recognize how much distress that they're in. This may explain why some of the shorter-term studies show a benefit that may be temporary and fade over time. Now, it may be hard to hear a psychiatric provider going against some of America's major medical organizations in my professional opinion,

[00:08:16] but keep in mind that I'm going with several other countries' major medical organizations' medical opinion on this topic. What I will go against in regards to the American right-wing media, influencers, and extremists is that there is absolutely more than one gender. There is an entire subset of medically non-binary individuals which get lost in this debate.

[00:08:45] Those with XXY genetic codes, or X0, or XYY. Those with vaginal and uterine tracts that don't develop normally. Those who have XY genetic codes with internal male sex organs and have female external genitalia. Or the reverse. There is so much more nuance to this conversation than what is portrayed by the media

[00:09:14] and the extremists on both sides. I'm trying to appreciate that nuance and apply it to this conversation. In my experience with patients and individuals I personally know that identify along the LGBTQ plus spectrum and those persons who don't identify LGBTQ plus, we have diverse opinions on how to address medical interventions in this population.

[00:09:43] I think there's a near universal agreement of unbigoted parties that, like any marginalized group, if we could do a better job of socially accepting people's individual differences, outcomes would more naturally improve. And in the profession of psychiatry, one with a history steeped in labeling people as a way to promote an ulterior motive

[00:10:10] of sterilization and at its worst, extermination. Prime example, our early treatment of individuals diagnosed with schizophrenia or feeble-mindedness and the sterilization campaigns that followed with several prominent eugenicists running the major organizations responsible for guidelines dictating psychological and psychiatric care. I worry about unforeseen impacts

[00:10:39] and motivations behind promoting these treatments or the alternative extreme, promoting conversion therapy treatments. I certainly hope that for anybody that I have seen, that I may see in the future or treat, regardless of how they identify, that I am just trying to understand this issue as deeply as scientifically possible and make the best recommendations

[00:11:09] for my patient's treatment. Because I care about my patients and I don't want to see terrible things happen in my patients' lives that make it impossible for them to chase after what they care about in their short time on this planet, in this existence that we call human life. Thank you. I hope you enjoy. Feel free to fire some, hopefully constructive, feedback my way

[00:11:39] if you disagree with my beliefs. But I come to this discussion from a place of compassion and care for my patients. And I want everybody to at least hear me say that, even if you don't agree with my views. Thanks again for listening. Let's keep appreciating the nuance of all of these all or nothing black or white conversations that exist politically and allow scientists and researchers

[00:12:08] to shed their political beliefs, their emotional attachment to issues and sit down together and debate these topics based on the information and data we have available to us. Thank you so much for listening. I appreciate your time. Today, I have Dr. Nikki Johnson, born and raised in East Cleveland, Ohio, went to undergraduate and graduated from medical school

[00:12:37] at Case Western Reserve. Dr. Johnson is certified in internal medicine and pediatrics and board certified in general pediatrics as well as pediatric critical care, has more than 20 years of experience working in medicine as a healer, but also as a teacher and as an advocate. And I don't know when this was, but somewhat recently also got a certification as a diplomat for the National Board

[00:13:07] of Physicians and Surgeons and serve on FAIR. Is that correct? There's a couple of things I'll clarify, but yes, I'm serving as the co-director of FAIR and medicine right now. Yes. Okay. What I liked most on your bio was this statement where you put it very succinctly, health and healing belong in the hands of the patients and their doctors and nurses. a tenet of medicine that I think we have gotten so far away from

[00:13:36] and it is so frustrating as a young provider to see that what I'm supposed to be doing is being dictated by people who are not scientists, who are not lifelong academics or lifelong researchers of these things. Policy seems to be dictated by profit-driven entities. So that really spoke to me, but give us a little bit more about your training background and what you're doing now. Okay,

[00:14:06] so let me start back. Let me go back. I was trained in internal medicine and pediatrics, so I did complete a four-year residency in both internal medicine and pediatrics. I did not take my internal medicine boards. Instead, I went the route of pediatric intensive care. So I took my general pediatrics boards, got certified there and then got certified for pediatric critical care medicine as well. I struggled a little bit with that exam, by the way, but I got it. And then later, the American Board

[00:14:35] of Physicians and Surgeons formed because of the fight against required or mandatory maintenance of certification by the American Boards of Medical Specialties. They often state that it's not required that you do maintenance of certification, but for the most part, a lot of us getting jobs, getting insurance to cover us, requires some sort of continued education and maintenance that's beyond what's required

[00:15:05] for the licensing boards. So the ABMS member societies, your American Board of Pediatrics, your American Board of Psychiatry, all of those boards that certify us started requiring a product called MOC and each of the boards do their own version of it, but it's a trademark product and they essentially monopolize the market and then you spend thousands of hours doing this, you have all of these detailed things that you have to follow through with

[00:15:34] in order to meet the requirement to do it and it also costs money. So what physicians on the National Board of Physicians and Services decided to do was look at the data and some other doctors have already been looking at this data as well and determined that the maintenance of certification product itself was not actually improving the knowledge of physicians and was not tied in any way

[00:16:02] to competency or improvements of patient care. It was just taking a lot of time away from doctors' work and costing us more money that wasn't necessary and then they started looking into the books and realized that the board board members of these certification boards including the overarching ABMS were using this money for their

[00:16:31] expense accounts, retirement accounts and not really putting that into any kind of healthcare dollars or any research or anything that benefited healthcare in any way. So it just really became a big scam and so the National Board of Physicians and Services decided to make an alternative way that we could get maintenance of certification and really it's just the same requirements

[00:17:00] as for continuing medical education and so they are offering a different way a cheaper a more affordable way and an effective way to meet the idea of maintenance of certification which we've all been doing historically through continuing medical education so that is the diplomat for National Board of Physicians and Services is what I add on to my initials because I think it's really

[00:17:30] important for us to fight for things that actually matter for physicians and fight against these powerful entities that keep telling us how we're supposed to practice medicine that was also one of the ways that I was introduced to health policy was discovering this issue on social media if you're a physician and you're on social media especially if you're in lots of physician groups you start to see the common

[00:18:00] complaints from physicians right that insurance companies are deciding how I care for my patients they are requiring me to do a pre-authorization for a medication or a procedure and sometimes they don't approve that a lot of the things that we're starting to complain about they're requiring us to do so many other things in academics in order to get promoted we're all complaining about it not enough people are actually doing anything about it organizations that are supposed to

[00:18:29] be advocating for us American Association and all of the state level bodies all of the advocacy organizations the American Academy of Pediatrics all those things those aren't serving to actually meet the needs of not only physicians but also not patients so we're all complaining about this stuff and nobody was really organizing so I joined up with some other people to do some grassroots work around maintenance or certification and then it

[00:18:59] just sort of snowballed from there lots of the issues that people were complaining about were starting to tackle and different grassroots organizations were doing that one of my friends and I would count as a mentor in this whole advocacy realm and grassroots medical organization group is Dr. Marian Moss she works at CHOP but she formed an organization called Free to Care F-R-E-E the number two care

[00:19:29] dot org is where you can find some of our work and we wrote a white paper on lowering the cost of health care and in that paper we talked about physician shortage we talked about lots of things that could also improve the doctor patient relationship because that's a poor goal and then to kind of get rid of all of those dirty middlemen who aren't actually contributing to health and affordability and in fact are making the problem worse we wrote a white paper published that presented it at

[00:19:59] the Library of Congress and then we a couple years later we revised it and wrote another one and that you can actually find on the website right now I am a contributor to that white paper and the organization Free to Care is a mixture of more than 8 million physicians and patients former healthcare executives and everybody who's interested in doing all of this work and multiple multiple different grassroots organizations some of them are patient led some of them are physician led

[00:20:29] some of them are nurse led some of them are health just kind of professionals and health executives administrators former administrators rather those are led so it's a large organization of grassroots so if anybody is saying that nobody is doing anything that's a lie we are trying but our lobby is small it really is even though 8 million seems like a big number our lobby is small and less powerful than the other groups that

[00:20:58] are out there unfortunately but the ideas are there and we've been active lobbying our own legislature legislators at our state level but also at the national level we presented our ideas in the library of congress back in 2018 2019 I think after that first white paper and then we went out and dispersed and talked to all of these legislators about it and we talked to everybody on both sides of the aisle

[00:21:27] and some of our ideas are starting to come full circle we're starting to see the fruits of our efforts there we've seen a lot of PBM reform bills that have come out in the last several months we've also seen several bills that would increase graduate medical education funding so that we'd have more residency spots that kind of thing with a particular focus on rural health care but that's kind of like my beginning kind of the birth of my advocacy and that's

[00:21:57] really 100% of what I do I left my clinical practice back in 2022 I had a light bulb moment that went up multiple years pushing nagging at me to really do something about it because I wasn't seeing the results of my efforts within my own hospital system and I was getting a lot of pushback and making life harder for me not only professionally and academically but also personally

[00:22:27] because of things that I was actually advocating for and it wasn't so obvious I can't sue anybody for it you know that kind of thing that were just kind of nitpicking type of things that were happening because I was asking questions about maintenance of certification trying to get that and our hospital bylines I'm sorry bylaws making the requirement broad really wanting to make sure that our credentialing department

[00:22:56] would accept national boards of physician services certification over the ABS and ABP and all of these other organizations and I just wasn't getting help I was getting up a lot of roadblocks and making enemies throughout the hospital I made a lot of enemies with my thoughts on COVID policy my thoughts on over medicating children these kinds of things and medical education of residents and training I really butt heads there

[00:23:26] and started to have my ethics questioned and my professionalism questioned because I had a different philosophy about educating residents and so it became difficult I left but now I'm 100% full-time advocate it doesn't always pay the bills the same way but it is worth it for my spirit and my overall health so that's where I sit right now thank you for your

[00:23:56] advocacy I just know based on my limited experiences brushing up against the face of corporate healthcare entities that when you come into it with an open critically thinking mind in making some of these complex healthcare decisions that you do get some pushback you do get labeled as unprofessional or as going against the medical science one of the things that I thought has been revealing to me and my experiences is in being

[00:24:26] you know essentially terminated from a couple of different addiction jobs there was no desire for the other side to have a discussion about why I was doing things the way that I was doing them it was just no that's not how we do it it wasn't you know this is what the science says like there's one side of the scientific argument that is absolutely correct and the other side is a bunch of misinformers or pseudoscientists so yeah I mean I

[00:24:55] understand it's not easy to advocate and it certainly can take a huge professional but also personal toll you know it requires us to lift each other up and say thank you for putting yourself out there when in a lot of ways it's easier just to go with the status quo from day to day but like you I want to be able to crawl into my bed at night and feel proud about the things that I'm saying and doing within my profession

[00:25:24] I mean in psychiatry it's absolutely rampant and you mentioned over medicating kids going from 0.2% of you know medicated youths in 1987 to somewhere close to 15 to 20% now are we that much sicker or are we just falling victim to a system predicated on making as much profit as possible regardless of the risk to our health we've got to take

[00:25:53] back the science and that doesn't mean that we stranglehold everybody into believing that our views are correct it means that we are open to having these discussions with other scientists and researchers not some suits who are working at GSK or Pfizer or Biogen no we need to have these conversations we need independent review and these are things that aren't

[00:26:23] happening so you know and I want to say this too I think there are the suits do have a role to play but I think the scientists at Biogen and Pfizer and physicians that are working there also have a role to play I think we've gotten to the point that you made about not that we're always right I think we've gotten to a point that we either are completely distrustful of allopathic medicine and the

[00:26:52] conventional way that we're doing things or quote unquote the science that we've gotten to not trust all of it and everyone is involved in the industry now it's also dangerous too distrusted correct and so then we start to have these silos of people who start to think and believe other things are the absolute truth and that's just completely dangerous I just actually posted on X I've actually been doing this experiment on X I just

[00:27:22] added my hashtag which we can talk about to the whole not a provider thing I've been doing this experiment where I'm challenging the challengers now as you well know Bobby Kennedy Jr. was nominated for HHS secretary I think that he'll be a good secretary but I challenge a lot of the things that he's saying as absolutes so a lot of people are saying our food is killing us right okay so let's prove that our food is killing us I posted

[00:27:52] just this morning something about just because pesticides used in conventional foods are bad doesn't prove that organic food is necessarily better for us I know I'm going to get a bunch of people saying calling me an idiot calling me a bad doctor telling me I'm bought and paid for by pharma and probably a handful of people will actually come through with some thoughtful ideas about

[00:28:21] how we can figure out that organic food is actually going to benefit us organic farming is going to benefit us and that's the conversation that we need to be having we need to be debating these things and discussing them with a nuanced approach that gets to the matter of our disease and how we're going to fix things this isn't black or white what works for one person may not work for another you could have a small organic garden

[00:28:50] and that could completely be beneficial to you and your family feeding the world best way to do it the cleanest or safest we don't know that we haven't seen the data that proves this and so that is my challenge to people every day is to actually really think about the conclusions that you're drawing and how you got there if it makes sense do you have

[00:29:20] proof of it and really get back to having a good conversation about these things and really good healthy debates it sounds like you and I may have something in common I will gauge that based on how hard you laugh or don't laugh at what I'm about to say I

[00:29:56] laugh I get all the time and the funny thing about it is I am very conservative I was raised conservative my

[00:30:26] and any one person in any single political party thinks exactly the same way but yeah I get that all the time it's constant and it's often used to actually argue against my point you know it's basically you're trying to insult me into to now defending my political position when I'm really having a conversation about something else I know I find myself speaking on an issue

[00:30:56] in kind of just these personal social circles and then one issue somebody tries to bring in other what they may take as associated issues and tell me what my viewpoint is on that next issue and I'm like no each of these issues is different and unique and the reality is that the healthcare that we are being sold preying on Americans hope for better technologies and better medications we talk about that a lot but the

[00:31:26] same thing is happening on the flip side of the pendulum where others are also preying on your distrust of the American healthcare system and they are promoting supplements or things kind of off the beaten path that also don't have evidence that are not proven and are preying on your distrust and suspicion of the American medical system oh my gosh yes absolutely I see that and since you brought the politics into it I think it's really

[00:31:56] funny that probably about maybe 10 or 15 years ago the people who were all organic everything completely against vaccinations were on the left they were the granola crunchy people living in California were the people who were Democrats and now these people are on the right it doesn't mean just because you have these ideas that has nothing to do with your political position whatsoever we can have a conversation in the

[00:32:25] room about this stuff never mentioning politics at all you get a lot of people to agree with you and not have any idea where they're voting politically absolutely you alluded to this earlier but I just wanted to make a follow up comment on it I don't think that the general public realizes how much money goes in on the personal side for somebody pursuing medicine and it's not just the absurd cost of medical school now

[00:32:55] and the very very basic wages you get paid as a resident a highly trained and skilled position managing people's health but is not paid as such and there's not a legitimate increase as your responsibility and accountability to your patients increases I would understand for example paying a first year resident somewhere between $45,000 and $65,000 depending on where they live in the area of the

[00:33:25] country and the program specifically but why is it that residents get their pay their salary increased by $1,000 a year over four years when as a third or fourth year resident in whatever specialty or field you're training in you're essentially running the show you are a lot of the times you're working outside of your residency program and you are the directly accountable provider to somebody you've already gotten your license

[00:33:54] but aside from even that kind of opportunity cost lost out on you know you're paying multiple thousands of dollars for each of these standardized tests and the prep materials that may come with those you get out

[00:35:06] so it was actually the American Academy of Pediatrics conference when you're going through all your training you're trying to absorb a bunch of information right and you generally have this trust of the people who are the experts and the people who

[00:36:06] and you're trying to eventually pass an examination that will allow you to get certified that you're competent enough to take care of patients which the initial board certification actually does demonstrate competency is demonstrated to show that you are capable of taking care of patients safely without killing people right okay so that's the point and what you're trying to do through all of the training through all of the long early nights sleepless nights delayed

[00:36:36] gratification all that stuff that's what you're trying to get to so most of us who are members of these organizations are using the organization for the information that they provide the guidance that they provide as a quick way to have reference to this information so that's really how I was with the American Academy of Pediatrics for the majority of my career I was a maintenance

[00:37:05] of certification get some CME credit those kinds of things and so around 2018 when I really started to be openly critical it probably started when President Trump was elected in 2016 when they started putting out statements against the president and never before had I seen Madison do that it just started to become a lot more political kind of over time but 2018 was when they published the consensus statement and for gender

[00:37:35] affirming care was when I started to be vocal against the American Academy of Pediatrics COVID escalated things as well when they were telling us that masking toddlers and infant babies was not going to change how they learned speech and language I I just was dumbfounded it this doesn't make common sense right it doesn't make any common sense that if a baby cannot see the way that your mouth is forming words that would

[00:38:05] not impact their language development yeah and then when they obviously made a political statement they first initially recommended opening schools and the moment that Donald Trump said we should open schools they retracted their statement you know and knowing lots of the national teachers association had some sort of push and involvement with creating that policy and influencing CDC guidelines all of that stuff was when I started to

[00:38:35] realize that these organizations were not doing the job that they were doing I could no longer trust their guidance for sure I information including my own actual mentors were saying things that didn't make sense I questioned every single thing that I learned in medicine and that was the beginning of everything I went through a period of depression around

[00:39:05] that time during COVID especially because because of that I was you know it just was a huge blow it's really hard to take all of these tests to have to get a certain number correct in order to prove your worth and on the test this is one of my big pushes in medical training is we need to give oral exams exams to you to see the way somebody

[00:39:35] critically thinks thinks thinks and works through a problem like they would in the actual clinical situation where they can ask for more information they can run a test you can keep a kind of running gauge on how efficient they're being in terms of cost because you don't want somebody that goes out and runs 150 tests for somebody who's got a hangnail but we get so used to finding the right answer and being right in medical school in residency

[00:40:05] training when you have to let go of that and you have to openly question your own views that you've accumulated over decade or decades of learning and experience that's hard to do it shakes your foundation a little bit yeah it's critically crucially important but it is hard to do and I think there's a reason why a lot of people what they learn in medical school in their training and maybe their first couple of early years out of training

[00:40:35] they stick with that same knowledge base for the next three or four decades and it's also difficult while you're training while you're a medical student while you're resident your career is based on these people who make opinions about you so it is very difficult to speak out there are some who paid the price Kevin Bass who has a sub stack he was on Twitter he's still on Twitter but he was a medical student when he was challenging the COVID dogma and suffered for that

[00:41:05] you suffer in your career for that and that is it's difficult you're paying student loans at this point you've already gotten in you don't want to ruin and jeopardize that when you're not going to be able to do anything outside of that there's a lot of people who go into medicine don't do anything else don't have any other skills or don't know that they have other skills or abilities their life is completely focused on learning and studying

[00:41:34] medicine you can't be great at it unless you're fully focused on it and doing the work itself is extremely time consuming you really do take time away from being with family starting a family doing all the fun things that all of your friends in college who gone and just gotten their career right out of college are doing so for you to question things openly and take that risk it does not come without a cost so

[00:42:04] doing it when you got into the level you know I was an employed physician so I was taking a risk particularly with COVID I was actually going against hospital policy technically because we were supposed to have a disclaimer on I did not speak on behalf of my hospital because someone reported my tweets to human resources so I'm

[00:42:34] sitting in the office with my department chair my chief medical officer and a human resources representative really going who have printed copies of my tweets going down and I'm having to defend my statement so challenging the dog I challenged the American Academy of Pediatrics their statement against myocarditis and its association with the vaccine when it was very early on when we really had no data they made a definitive

[00:43:04] statement that it was not related I challenged that and I was asked by my own chief medical officer why are you going against the American Academy of Pediatrics and I flat out said because they're wrong even if they're not wrong you had a similar response that I did where is all this vitriol with their statement coming from how can you say with such certainty

[00:43:34] that a brand new vaccine technology that has been out for six months and given to millions of people how can you say at that point with 100% confidence that it's either completely safe or completely effective even if that turns out to be right which I would argue that it is not turning out to be right and will not turn out to

[00:44:13] basic and obvious question in my mind to ask in a market that you and I recognize they're like again I've got a recurring direct to consumer advertising series that has kind

[00:44:43] perceived benefit from it this is happening over and over again for the last five decades yes and nobody's asking questions we're just taking their words we're not asking for transparent data we're not asking for raw data we're just taking the word even when the evidence against it is out there which you saw in my Roger McPhillon and I talked about in the webinar that I did for fair with him on SSRIs people are ignoring it or it gets buried so

[00:45:13] that's kind of the foundation of me questioning the American Academy of Pediatrics and I was actually attending because I planned to attend the conference virtually because I could not go to Orlando for the weekend and thankfully I didn't make plans because there was a big storm hurricane around that time and everything but I planned to attend virtually on behalf of myself to get continuing medical education but also I wanted to interact with people through

[00:45:42] the web forums about their views on a lot of this stuff and Rachel Levine was scheduled to speak as a keynote speaker and the American Pediatrics not even a full year prior had made a statement that they would review data on gender affirming care and do their own review and publish their review after the cast report came out and hadn't done

[00:46:12] so and instead they were inviting someone who was openly pro gender affirming care and I wanted to get a gauge of what the academy members thought of this presentation and I wanted to hear the speech from the inside but also to get some other continuing medical education which is required for me to maintain my medical license which I do do because I feel like it gives me

[00:48:26] and their booth was removed I wasn't a part of the organization at all at that point so I think that it might have had something to do with that I can only speculate because this past October there was another group that went and one of the detransitioners who was

[00:48:56] basically stating that fear shouldn't have been allowed at the group because they're transphobic and all this so I honestly don't really care what the American Academy of Pediatrics thinks about me and what my opinion is but to deny me after I was already registered without an explanation is a key sign to me that there's some political attachment here to their decision making and if you truly believe that everything that you're

[00:49:25] recommending and guiding people into doing is worth listening to and worth hearing then you would then welcome people who actually have questions about that right if you think you're doing the right thing and modeling the right form of what this

[00:49:55] I couldn't I am not a hacker I am not a coder I can't take down the whole web app I can't turn off the AV equipment or anything to stop the broadcast I am not really sure why I was denied managing transgender youth's health care is

[00:50:24] another really hot button political issue and I think again just like so many issues in our society there is this dichotomization or this polarization of for or against when there's so much more nuance that is needed there you could think as that pendulum swings on one end you have well do I believe that everybody should have a right to express

[00:50:54] themselves the way that they want to express themselves sure should somebody be able to dress and act in a way that they want to dress and act yeah absolutely but once you start getting to medication and especially surgery as a physician you want to have the data and this is a great kind of parallel with something like an SSRI not just the data of how does this make the person feel you know two or three weeks later

[00:51:24] what is the long term outcome of doing this procedure in the biggest population that are are what are Switzerland or Sweden one of the Scandinavian countries I thought had the

[00:51:54] best data or the most comprehensive data in a relatively large cohort in terms of this topic I think it was Switzerland that said yeah we are no longer recommending this from our national health service what our role and responsibility is first and foremost is to ask why our patients are having this problem right and then what is the real diagnosis before we even get to the medicine part of things

[00:52:24] what is really happening here that is causing a bunch of children who were developing normally all along in healthy bodies decided to question their gender what's happening no one's asking that question they're not some of the people who are figuring out that a lot of this is coming from external sources from the internet from social media from teachers in schools from other adults and from their own parents

[00:52:52] that you're not recognizing that this is not some organic development here that's happening even when they present to you your first response shouldn't be okay if that's what you want to do or it's okay go ahead and dress the way you want it should be why are you thinking this way and how can I help you not feel this way how can I help you understand that

[00:53:22] what you are and who you are is just fine let's start there that's what I think so that's the social transitioning part of this that I think is often neglected even before we get to the medical part of this because if we allow that to be okay then we are pushing more people towards the medical and the surgical part of this because they will then think there is something wrong with me and then the way to fix

[00:53:52] something wrong with me and treatment of depression it's because we're not recognizing that this is a normal part of child development to question your identity particularly your identity as it is in places of the world

[00:54:22] determined by your sex and other immutable characteristics this is normal development so then our response you know is to pathologize it that's where I have a problem and I think we're doing the same thing with depression you're taking someone who's having a natural reaction to something traumatic or emotional that happened in their life and then saying okay if you've had these same feelings for six weeks or more you're supposed to get medicine to treat

[00:57:51] from these biologic interventions, they want us to over-identify with one aspect of ourselves. You know, whether it's somebody struggling with addiction, I don't use the term addict. If it's somebody who is struggling with a mental health condition, you know, I don't say you are bipolar, right? You have symptoms consistent with what we call bipolar. You know, you are questioning

[00:58:20] your sexuality. Like this is one element of who you are. And I see a lot of transgender youth or, you know, young adolescents, and I don't want to ostracize that population. I want what's best for every single one of my patients, regardless of how they identify or what issues they care about, you know, what's important to them in their lives. I want what's best for every patient. And if

[00:58:49] me doing what's best for somebody means standing up to my patient and telling them, this is probably not in your best interest long-term, or there are significant risks and unknowns about this decision. Well, that's inevitably going to be the harder thing to do. There's going to be more discomfort with that. But at the end of the day, it's extremely, extremely important. I want to point out here though, again, in talking about these pendulums and

[00:59:18] these political, not nuanced ideologies, you know, we've got these entities that are pushing, you know, that there are two genders in this kind of hell bent on this aspect of the conversation or extremely focused. And I always have to point out, there are a lot of medical conditions. And I think these are the individuals who really can get lost in this discussion who do deal with biologic

[00:59:47] conditions where there is some ambiguity between male and female. You've got genetic chromosomal issues like Klinefelter's and Turner syndrome. You've got issues where the gonads don't form or don't form properly. You've got congenital adrenal hyperplasia, malaria and agenesis, androgen insensitivity, 5-alpha reductase deficiency. There are a significant, you know, number of conditions

[01:00:13] that do produce some sort of ambiguity. And that, I really, I just think that that piece of nuance gets lost in the discussion. I think the physiological and physical ambiguity doesn't necessarily correlate with a person's belief about who they are and their place in their role in society. Even with the chromosomal abnormalities, they still tend to have features of one sex or the other. So

[01:00:43] I don't even like to use the term gender because I think that's something that's also been really, you know, constructed out of this whole thing. Most people, most human beings will identify with being one sex or the other. But absolutely, I agree with you. There is a complexity to this and how people feel about themselves and how they operate within the world. We should consider that. Absolutely. But if we get to a point where we start saying that there's multiple genders or multiple sexes,

[01:01:13] because, and nobody's even saying there's multiple sexes, which I think is very interesting about this. You're either transgender or you're cisgender generally, right? So, but yes, I do agree with you. I think there's having this full on just sort of black and white approach to how we treat people. It shouldn't be the way we do things either. However, I do think we need to take a hard line on telling people what is truth and how to navigate the world. Like we can't, because all of

[01:01:41] this other stuff is just going to confuse children to me who are the most vulnerable in this state. And if children believe that they can be something other than what their sex is, the majority of the world is either female or male. These other medical, you know, the diagnoses and problems are still rare. There's enough of them, but they're still rare. They're the outliers.

[01:02:07] If we go down the road of telling children this confusing message about gender and sex, then to me, that's just going to be detrimental. That got us to the, down the slippery slope we've already gone down. A great example or a person who everybody is familiar with is the Olympic boxer. And I feel so bad for her because this was not a choice, you know,

[01:02:34] at least in my understanding, it was not her choice and her receiving the personal backlash. That's really tough. Now I understand that the conversation at the level of who and who should be allowed to compete, you know, there are certainly nuances there, but the personal backlash against that individual, you know, acting like it was, you know, her decision about whether to compete or not, or, or that she didn't see herself as female for her entire life. Those are, those are kind

[01:03:03] of the examples that are tough, but like anything in medicine, in psychiatry, industry takes advantage of those to try to push the envelope that the majority of people are, you know, dealing with some biologic issue. Thanks again for watching and or listening. If you're passionate about the subjects that I discuss

[01:03:25] on the channel, do me a favor and like, comment, subscribe, do whatever you can to make your voice heard that these are problems that must be addressed in our society. If you have any questions, comments, or concerns, I want to hear them. Feel free to reach out on social media or email us at

[01:03:49] renegadesyke at gmail.com. And if you'd like to be a guest of the show, or you have a connection to somebody that you think would be a good guest, let us know. Thanks again for listening.