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We're starting the process with Ting, who wants a vagina. The network of moms is supportive. Nicole is a junior in high school, planning surgery between junior and senior year. She's doing great.

Welcome to Just Naked. In this show, adults get naked so we can learn from them. Today, we have transgender guests who will answer questions about their bodies. Being transgender means feeling different from the gender you were assigned at birth. Some transgender people choose to have surgery, while others don't. They may still feel uncomfortable with certain body parts. After surgery, some transgender individuals feel euphoric and finally at peace with their bodies. It's important to remember that gender is not just male or female, there is a wide spectrum in between.

Dr. Money concluded the interview by discussing the concept of gender identity. He acknowledged that it can be difficult for individuals to talk about their gender identity, whether they identify as male or female, boy or girl, or man or woman. Many people have come to his office with similar feelings, unable to discuss this important aspect of their lives. Dr. Money assured the person being interviewed that he would be the one person in the world they could confide in.

Talking is definitely a topic that comes up for transgender and gender diverse folks, particularly people who have a feminine or female gender identity and were perhaps assigned male sex at birth. Gender dysphoria is that negative or that uncomfortable distressed feeling that possibly comes with having a gender identity that's different than your sex assigned at birth. So when I think about talking, wanna make sure that people are talking in safe ways. talk to a gender affirming medical provider that's involved in their, child's care or that's involved in your care. I would really recommend that people take breaks from tucking. Pain might feel like an uncomfortable sensation or a tingly sensation, and that's definitely something you'd wanna take a break from and then talk with your medical provider about.

I offer support to find gender affirming care for youth, even if they need to go out of state. If parents are unsupportive, some kids choose to get emancipated at 16 to make their own medical decisions. Dealing with transphobic parents can be tough, especially if they are very right-leaning. It's important to find a chosen family of friends who accept you. I can send you a binder discreetly if needed.

Speaker 1 had gynecomastia surgery because he was tired of worrying about what clothes to wear. During a follow-up appointment, he tells Dr. Duffer that one nipple seems to get more erect than the other and sticks out a little more. Dr. Duffer says that Speaker 1 looks really good and natural and that one side of his chest is firmer, possibly due to more scar tissue. Speaker 1 says he noticed tissue when he was 13 and it never went away with working out or dieting. He researched plastic surgeons and was nervous at first due to swelling, but the results were priceless. He doesn't have to obsess over what to wear anymore. Later, Speaker 1, who is Officer Sewell, offers the doctor and another person a ride to a gay bar. He then invites a cop to hang out with them later at the gay bar.

I'm a trans guy. I've never been to the gynecologist. Today's the fucking day. I asked that they put a note on it: this is a trans guy; he's gonna present male. I called today to make sure the note's on my chart. She said, "The notes on your chart that you're, a trans man and blah blah blah." Okay. Cool. Have a good day, miss Allen. She works at a women's health clinic, and my name is fucking Sasha. Jesus Christ, guys. Full transparency, I'm tweaking out. My anxiety for my fucking audition for The Voice was, like, here. My gyno visit is here. If anything weird occurs, like, people with good intention can just say things uncomfortable and awkward. I don't have the mental capacity; but all I know is afterwards, I'm getting a sweet treat and I'll tell you how it goes. So fucking pray for me.

A lot of parents have questions about social transition at a young age. There are no exact guidelines. Again, everybody has their own gender journey and everything feels right or wrong depending on the family. However, many kids do decide to pursue a social transition. Usually that will start with changing their name or their pronouns. They might want to just try dressing a different way or using a different name at home to get used to it and for the family to get used to it. Some people might want to do it on a vacation where they don't really know anyone as a way to try it out. And then slowly over time they might move into using that more with loved ones at school or with friends. However, kids do benefit from social transition over time.

Speaker 0, a representative from Fairhope of Goodyear, informs Kelly, a 14-year-old who came out as trans to their parents, that they only provide services to individuals over 18. However, Speaker 0 suggests contacting Comenity Healthcare for assistance. Kelly expresses their worries, and Speaker 0 reassures them and provides the number for Comenity Healthcare. Kelly thanks Speaker 0 and ends the call. Kelly then calls Community Healthcare Network and speaks with Speaker 2. Kelly explains their situation and asks for help. Speaker 2 offers primary care, hormonal therapy, and mental health services. They assure Kelly that their parents won't find out and schedule an appointment for August 31st. Kelly provides their information, including their preferred name, Michael, and expresses their nervousness. Speaker 2 completes the chart and tags it for privacy. Kelly expresses concern about their parents finding out and Speaker 2 reassures them. The call ends with Kelly sharing their worries about their parents' reaction.

Max, who identifies as a boy, is visiting the doctor to discuss hormone blockers to prevent puberty. He has started experiencing some breast growth and feels uncomfortable. His parent expresses concern about medical interventions and their effects on bone health and psychosocial development. The doctor explains that hormone blockers can halt puberty progression and reassures that if Max changes his mind, he can still go through female puberty later. The procedure involves inserting a small implant in Max's arm, which will last about 14 to 18 months. The entire process is quick, taking only about 10 to 15 minutes.

"For someone who is assigned male at birth and if they've already been through puberty, they could produce a semen specimen and have it frozen." "If someone is assigned female at birth and they are also all the way through puberty, you can do egg banking, which entails a little bit more." "Typically, you have to take some additional hormone injections and it's a procedure to go in and retrieve the eggs." "We think someone has to be probably in mid male puberty to produce semen." "There have been some case reports of transgender men who were assigned female at birth who weren't completely through puberty and have been able to do fertility preservation, but we don't know if that applies to everybody." "We definitely counsel all of our patients about fertility preservation." "Usually from their first visit, we're starting to talk about it."

There is not one surgery that every transgender person wants. Many transgender people have no interest in having surgery. For other people, they undergo medical transition involving use of gender affirming hormone treatments. And for others, they may have one or more surgeries. They may have top surgery, which is surgery on the chest or breasts. They may have bottom surgery, surgery on the genitals. They may have facial feminization. Trans women may have a tracheal shave to reduce their Adam's apple. No two trans people have the same needs to resolve their gender dysphoria. So you can never make an assumption that any trans person wants any particular surgery or any surgery at all.

Young people and their families need detailed information on physical interventions to make informed decisions. These discussions may be challenging but are necessary.

Most trans kids know they're trans between ages two and seven, with the speaker's daughter knowing around two and a half. The speaker emphasizes that children know things that adults don't, and these are the things to which adults should listen. The speaker states their child is not mentally ill. To begin gender affirming care, the speaker had to consult with numerous healthcare professionals.

During the first bottom-surgery visit at Boston Children’s Hospital, the nurse introduces the team and sets expectations that you’ll meet many people and should not feel overwhelmed or try to remember everyone. The team’s goal is to provide information and answer questions. A social worker and physician's assistant review your medical and behavioral history and your goals for surgery to determine the best bottom-surgery option for you. Then Doctor Ganor and the nurse will wrap up the consult, cover the details of the surgery, post-operative expectations, needed support, how long you’ll be here, and review your questions. If you don’t have questions, staff provide information proactively. If you forget, you can call or email the team the next day; they’re accessible to help navigate the process because it can be a lot.

A child will often know that they are transgender from the moment that they have any ability to express themselves, and parents will often tell us this. We have parents who tell us that their kids, they knew from the minute they were born practically, and actions like refusing to get a haircut or standing to urinate, trying on siblings' clothing, playing with the quote opposite gender toys, things like that. There is more and more a group of adolescents that we are seeing that really are coming to the realization that they might be trans or gender diverse a little bit later on in their life. So what we're seeing from them is that they always sort of knew something was maybe off and didn't have the understanding to know that they might be trans or have a different gender identity than the one they had been assigned. So that is a growing population that we are seeing and that's being recognized as being trans and able to be treated.

"The eligibility for getting gender affirming surgeries at Boston Children's Hospital is basically the same as it would be for most other hospitals or surgeons in The United States." "And that's the case because we all follow the World Professional Association for Transgender Health or WPATH standards of care." "For top surgery, you are requested, but not required to have been on gender affirming hormones for at least a year." "If you're a trans woman, it's really encouraged that you be on estrogen for at least a year because you want to maximize your natural breast growth." "Many surgical centers require you to be 18." "At Boston Children's Hospital for top surgeries, we'll see people as young as age 15 if they've been affirmed in their gender for a long period of time and don't really have any other life complications that make surgery inappropriate."

Admiral Rachel Levine, a pediatrician and the assistant secretary for the Department of Health and Human Services, addresses concerns about children transitioning before 18. She emphasizes the challenges of adolescence, particularly for those experiencing gender dysphoria. If a child feels female but is undergoing male puberty, it can be distressing. Critics argue that children are too young to make such decisions. Levine clarifies that for prepubertal children, no medical procedures are performed; instead, they are supported through therapy to explore their feelings.

Many patients in the GEMS Clinic know their gender well before adulthood; some children know from birth or seemingly from the womb, and they will usually express identity with phrases like "I'm a girl" or "I'm a boy" and continue to explore through age two and three, and usually up to the ages of nine. At the clinic, a psychologist discusses gender with the child and their family and helps ensure they have space and support to explore their gender and do well throughout their development. Parents’ questions are common, and the main guidance is to be supportive—"just be supportive" and "love your child and support them and just allow them to express themselves"—since parental support protects against depression, suicidality, and anxiety. Resources in the GEMS program include individual gender assessments and GEMZ parent nights to learn about interventions and psychosocial aspects.

"Sometimes it may be just a phase of development where they're exploring their gender identity and they're kind of getting a sense of who they are, but a lot of children do end up identifying as that gender into young adulthood and adulthood." "The only real way we know for sure that they're going to continue in that gender identity is just to allow them to develop over time." "And so that's what we recommend to parents is to give them the space." "Even if parents are concerned that it's a phase, we never want to tell the child that they shouldn't be expressing their gender identity or that they should be, ashamed for the way that they're expressing their identity because that can be quite harmful." "We just want to give the child a chance to develop and explore on their own."

Speaker 0 confirms that the person is currently taking 6 milligrams of estrogen per day. Speaker 1 clarifies that they take it twice a day. Speaker 0 reviews the person's history and asks about the surgery they are seeking. They discuss the irreversible effects of estrogen therapy, such as breast development and shrinkage of the testicles. Speaker 0 mentions that hair growth and redistribution may be affected by estrogen. Speaker 1 mentions that they are not complaining about taking daily pills, but rather wondering if it accelerates the process. The conversation ends.

I often see youth who have already undergone medical interventions due to a backlog in mental health support. Children may not fully understand the impact of these interventions, making it challenging to discuss. It can be especially difficult for young adolescents starting puberty suppression. We aim to make kids happy in the moment, but it's crucial to consider the long-term effects on their development. This is a growing challenge in our field that requires further exploration.

- "Vaginoplasty is a relatively big procedure." - "It takes about between four to six hours in the Operating Room and therefore there is some swelling involved, there's some pain involved." - "But most of the times we actually administer epidural anesthesia as well, which helps a lot with the pain management for the patient." - "A very big component of the vaginoplasty procedure is the post op care." - "Seven to ten days after the procedure, the patient is required to start doing dilations." - "In the dilations, they are using different sizes of dilators gradually, and they need to do that several times a day for minutes a day." - "The reason for that is because otherwise the cavity will not be maintained and the old reconstruction can be lost."

If you're transgender or nonbinary and feel uncomfortable with your puberty experiences, you're not alone. Puberty blockers can temporarily halt the changes caused by hormones like testosterone and estrogen, giving you more time to figure out your gender identity. It's okay to not have all the answers right now, as understanding yourself takes time. Talking to a trusted adult, nurse, or doctor can be helpful. To learn more, visit plannedparenthood.org/teens.

Speaker 0: Before publicizing Brenda's case, there were concerns about potential problems. Speaker 1: Brenda showed extreme negativism and aggression during her visits. Doctor Money attempted to make her accept her new gender by discussing the differences between male and female genitalia. Speaker 2: Doctor Money asked Brenda intimate questions to help her understand the distinction between boys and girls. Speaker 3: The questions were explicit and made me uncomfortable. However, some argue that focusing on genitalia was scientifically correct at the time. Speaker 2: Knowing a child's gender based on their genital appearance is important and commonly used clinically. Note: The concise transcript is within the 150-word limit.