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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.

- "Puberty blockers are a group of medications or hormones that we use in the transgender population to stop puberty from progressing." - "We call them in endocrinology gonadotropin releasing hormone analogs or agonists." - "Their job is to really interfere with the signaling from the brain to either the ovaries or the testicles that produce the hormones." - "When somebody starts puberty, we can use them to stop the puberty from progressing, thereby allowing somebody to really explore their gender without the pressure of having secondary sex characteristics that are often permanent." - "And the really nice thing about puberty blockers is that they are reversible, so it's a really nice way for an adolescent to be able to explore their gender." - "We like to use them in birth assigned males who have already even gone through a full male puberty because they are able to then use a lower dose of estrogen."

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.

Genital mutilation is a human rights violation, especially for minors. It's concerning that American culture is normalizing hormones for minors to prevent development. Do I believe minors are capable of making life-changing decisions about changing one's sex? Transgender medicine is complex with robust research and standards of care. If confirmed, I'll discuss the particulars. I'm alarmed that you won't say minors shouldn't amputate their breasts or genitalia. Minors don't have full rights and parents need to be involved. Will you make a firm decision? Transgender medicine is complex, I would be pleased to discuss the standards of care with you. The witness refused to answer if minors should be making these momentous decisions. You're willing to let a minor take things that prevent their puberty, and you think they get that back? You have permanently changed them. Rachel Levine has been confirmed as the next US Assistant Health Secretary.

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.

In this video, the speaker shares their top surgery results, which they had three years ago with Dr. Katharine Gast. They show their faded scars and mention that they don't do much scar care because they like how they look. The speaker emphasizes the importance of their decision to have top surgery at 16, which involved removing excess chest tissue and masculinizing the shape.

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.

Transitioning carries risks, including potential sterility, loss of breastfeeding ability, and changes in sexual function. It may also impact bone health and height. Despite these risks, the most crucial aspect is to accept and love your child for who they are, regardless of their gender identity.

In a study of 101 young people seeking cross-sex hormones, all participants were able to access hormones. The study also found that 30% of the participants experienced moderate to severe depression symptoms, while 49% had thoughts of suicide and over 30% had attempted suicide. Many of the young people engaged in drug use and some had resorted to sex work for basic needs. Homelessness and foster care were also prevalent among the participants. The speaker then discusses the topic of gender confirmation surgeries for minors, stating that it is understandable for teenagers to desire such procedures. Chest surgery for transgender boys is seen as critical and relatively easy compared to general reconstruction surgeries. The speaker believes that the barrier of surgical sterilization can be overcome and emphasizes the life-saving nature of chest surgery.

The speaker discusses the standards applied to children and the potential benefits of going on blockers. They mention that blockers can prevent the development of a deep voice, Adam's apple, and facial hair. The speaker shares their personal experience of spending $5,000 on facial hair removal and $25,000 on facial feminization surgery. They believe that blockers can prevent the need for such procedures and alleviate stress.

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.

Binding is essentially when someone who's assigned female wears something on their chest to make it appear flatter. And a lot of my patients who identify as transgender male or non binary or male leaning like to do that. The top three tips I have for safe binding are to first make sure you're measuring correctly. And sometimes it might take the assistance of like a parent or a trusted friend to do it right. Second, making sure that you're buying not only the correct size for your chest measurements, but for your shoulder measurements too. Cause a lot of people make mistakes there. And then the third tip is definitely not wearing it for more than ten hours a day.

Doctor Olsen faced a decision regarding Josie's treatment. She advised starting hormone blockers around age 13, ensuring Josie wouldn't have to wait until 16 to begin. Josie received the blockers as an implant in her arm, showing great bravery as she embraced this new chapter in her life. The doctor reflected on how, just twenty years ago, such treatment wouldn't have been possible, and Josie would have faced male puberty, which was a terrifying thought. The doctor expressed relief that they could provide this support now, emphasizing the importance of the decision for Josie's well-being.

An endocrinologist questions the use of powerful hormones and surgeries in gender affirmative therapy without concrete evidence of gender identity. They highlight the high rates of desistance in children with gender dysphoria and the lack of objective markers to determine if a child will persist in their gender identity. The Endocrine Society acknowledges the low quality of evidence and the difficulty in identifying which children require treatment. The American Academy of Pediatrics suggests asking the children themselves. The spread of the affirmative model of care has outpaced the evidence supporting it, as shown by systematic reviews indicating poor quality and uncertain benefits. A study on mastectomy in youth is criticized for drawing conclusions based on a small sample size and short follow-up period. The quality of research in this field is questioned.

"Puberty blockers work at the level of the pituitary gland and they actually suppress the release of the LH and the FSH so that the sex organs are no longer stimulated." "The main benefit is that they prevent the unwanted permanent effects of puberty, and thus future surgeries can be avoided as an adult." "They are also reversible, and thus if the patient decides to stop using pubertal blockers, their endogenous puberty will resume as previous." "Using pubertal blockers can alleviate the depression or worsening gender dysphoria that is often associated with progressing pubertal changes." "Lastly, the use of puberty suppression is recommended by the Pediatric Endocrine Society in their clinical guidelines for the treatment of transgender and gender diverse youth." "The practice of using puberty suppressors in transgender youth is new." "Since the first clinical guidelines were only published in 02/2009."

Michigan Medicine strives to be a safe, welcoming place for transgender individuals and to provide excellent health care regardless of gender. The goal of this video is to improve the comfort and competency of frontline staff in caring for transgender individuals. We will start by talking about gender identity, challenges the transgender community has faced in the health care system, and Michigan's policies regarding gender non-discrimination. The second half of this training is job specific. To discuss gender identity, it is important to understand the difference between sex and gender. Sex refers to one's reproductive organs, native hormones, and chromosomes, while gender identity refers to one's internal sense of gender, a person's basic sense of being a man or boy, a woman or girl, or another gender. Gender identity can be expressed by how individuals present themselves socially, including clothing, physical characteristics, speech, and mannerisms. All people, whether they are transgender or cisgender, meaning not transgender, have a gender identity and expression. Transgender is a term for individuals whose gender identity differs from the gender identity typically associated with their sex assigned at birth. There are many identities that fall under the umbrella of transgender. Transgender men, trans men, or trans masculine refer to people who are assigned female sex at birth but identify as men or masculine. Transgender women, trans women, or trans feminine refer to people who were assigned male sex at birth but identify as women or feminine. Other individuals may identify as genderqueer, agender, genderfluid, two spirited, bigender, or another identity that does not fit neatly into the categories of men or women. All major American medical societies, including the American Medical Association and American Psychological Association, endorse gender affirming care as the standard of care for transgender individuals. This means caring for people in a way that supports their gender transition and gender identity. Transgender people may undergo any one of a number of gender affirming medical interventions, including hormonal therapies like estrogen, testosterone, or hormone blockers, and surgical treatment to change body contours or genitalia. However, it is important to note that one does not have to undergo any medical or surgical treatment to be transgender. Some people are easily read as the gender they affirm while others are visibly gender non conforming or androgynous appearing.

"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."

In the last 15 years, the number of clinics serving pediatric patients on gender issues in the United States has grown from 0 to over 100. This growth can be attributed to various factors, with the main catalyst being the implementation of Obamacare in 2010. The law mandated insurance companies to cover medically necessary gender affirming care, leading to a 50% increase in sex reassignment surgeries and a 25% increase in insurance coverage for transgender individuals between 2010 and 2016. In 2016, an amendment to the Affordable Care Act further prohibited private insurance companies from denying coverage based on gender identity. Consequently, there was a 150% increase in sex reassignment surgeries in the US from 2016 to 2017. The provision was revoked by the Trump administration but reinstated by the Biden administration.

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.

Breast augmentation for transfeminine patients is augmenting or increasing the volume of the breast tissue. And when we do that, we're trying to reconstruct a more feminine appearance to the chest. We typically do that with silicone implants that can either sit under the muscle or under the breast tissue itself. To the majority of the patients, they have this surgery several years after being on estrogen because estrogen itself can cause a building of breast tissue. It's very typical that we will need to increase the distance between the nipple to the fold underneath the breast and we are able to do that in the same procedure as well.

Karen Selva, pediatric endocrinologist and medical director of Randall Children's Hospital T Clinic, discusses puberty blockers for transgender and gender expansive youth. Puberty blockers work at the level of the pituitary gland and they actually suppress the release of the LH and the FSH so that the sex organs are no longer stimulated; The signs are blocked and don't progress. The main benefit is that they prevent the unwanted permanent effects of puberty, and thus future surgeries can be avoided as an adult. We can prevent chest reconstruction in affirm trans males or facial feminization surgery in transfemales. They are reversible; if stopped, endogenous puberty resumes. They can alleviate depression or worsening gender dysphoria. The Pediatric Endocrine Society recommends puberty suppression in clinical guidelines for transgender and gender diverse youth. The practice is new; first guidelines were published in 02/2009, and long-term data are not yet available.