Welcome to the first Nugget of October 2018 - our month on Gender Identity, the Gender Spectrum, and Gender Transitions. We are really excited about this month so make sure you checked out our three earlier episodes this week - Monday, October 1’s Monday Mumbling on the Gender Spectrum, Tuesdays Podcast with Dr. Raj Purohit of Mount Sinai on Gender Affirmation Surgery and Procedures and Monkeys Blog yesterday on his Gender Identity Experiences.
In Today’s Episode:
We are really excited about Dr. Chubak’s return to the barnyard. If you did not catch her earlier visit - you can go back and listen to her from our month on Professional Services where she spoke to us about good ways to find a doctor that will be your partner in your health journey.
Today, Monkey got to sit down with Dr. Chubak again to talk about Gender. As a reminder, Barbara Chubak is a medical doctor at Mount Sinai and an assistant professor with the Department of Urology. She did many things before becoming a doctor, ranging from secretarial work to being a bioethicist, She is full of so much information and knowledge - we knew she would be a frequent visitor and long-term resident of the barnyard.
In Dr. Chubak’s work - she has an intake form where she asks new patients to her practice to fill out a questionnaire. Her first contact with patients, even before meeting them face to face, is to include the questions of preferred name and preferred pronoun as part of her standard intake. She finds this helpful to really relate to her patients. Of course, she does sometimes get pushback from her patients with these questions. She uses those pushbacks to initiate conversations as to the reasons why people are pushing back and why she feels it is important.
Gender Identities and Terminologies:
As always, we do like to find out the definitions people use for some of the common terms around each month's topics.
Cisgender - having a gender identity that is consonant with one’s biological sex. In other words, they match.
Transgender -This definition is not universally true as trans-culture is growing and evolving and accepting more in the realm of gender fluidity and non-binary genders. Transgender started its foundations under the binary gender construct where there was a female gender and a male gender. The idea behind transgender was that someone would transition their gender so that their outsides matched their internal identification of gender, which is at the opposite end of the spectrum from the assigned sex at birth.
Gender Transitions are the processes by which someone changes their physical appearance to match their gender identity through a series of physical changes. There are many different choices that can be made along that pathway and many extremes or minimums that can be chosen. Changes may be hormone therapy or surgical actions. There are additional socialization trainings and re-educations that can be undergone as well.
Urology Concerns in Transgender Patients
At every step of the way through the transitioning process, there are different needs from a medical standpoint. The one constant are the emotional needs of the people who are transitioning. It is critical to provide a supportive, reasonably non-judgemental environment so these individuals can feel comfortable and safe. The safety is critical because transgender people are going through extraordinary changes.
Transgender Youth:
Friends and family and a supportive network is really important. Moral and emotional support is really essential. This is even more important when it is children that are transgendered who are going through transition processes. The current medical guidelines around youth are pretty strongly in support of delaying puberty changes in order to simplify the transitioning process once the child is grown enough to provide their own legal consent. This is very controversial both inside and outside the medical community.
At a recent WPATH conference, several conversations were held around these topics. Several doctors noted that they have been encouraging parents of transgender youth to allow the kids to receive the medications to slow or prevent puberty as the kids grow up and explore their gender identities and dysphoria. The World Professional Association for Transgender Health (WPATH), formerly known as the (Harry Benjamin International Gender Dysphoria Association (HBIGDA), is a 501(c)(3) non-profit, interdisciplinary professional and educational organization devoted to transgender health.
Further complications involve the fluidity and ever-changing aspect of each of us as we grow and live and experience the world. The benefit of simply delaying puberty is that nothing is being done that is permanent - time and space are being provided so that the transgender kid can really make a final decision as to proceed or return to puberty. There are minimal risks to delaying puberty - of course, any medication does have risks. That is the nature of the game, but delaying puberty is fairly minimal from a medical stance. There are also social and cultural considerations that need to be considered - being the only kid in school not going through puberty can be stressful on a different level.
Advice to People Considering Transitions:
Dr. Chubak suggests that if someone is interested in moving through the transition, that they just throw it out there to your primary care physician, and asking if they are comfortable helping you through the transition. Additionally asking for referrals to other doctors. It takes a team of different medical experts working together to facilitate a safe and healthy transition.
Medical Ethics and Transgender Patients:
Historically, transgender patients were not always treated very well or kindly by the medical field. Over time that has changed.
Currently, in the medical field, the pathologization of transgender is really the most important shift. The medicalization of any conditions and functions is morally controversial. Whereas in the past, being transgendered was very clearly defined as being mentally unwell or ill or suffering from insanity. In recent years, the DSM has been updated to remove these conditions. This means medical thought has had a shift away from suggesting these patients as crazy and sick and instead suggests that these conditions are part of the human condition. Variations in the human experience are accommodated by the medical field - not vilified.
The caveat to all of this is, of course, the way that once accesses medical anything. All medical treatments require a diagnosis. That means there is still a bit of tension between doctor and patient - a diagnosis if gender dysphoria must be made to justify doing the medical procedures and to work within the realm of insurance and such.
Barbara is still a part of barnyard as a proud sheep! Come visit her!
About Our Guest:
Dr. Barbara Chubak, MD, is an Assistant Professor of Urology at the Icahn School of Medicine at Mount Sinai. In addition to providing general urologic care, she specializes in the diagnosis and treatment of sexual dysfunction for all patients, regardless of sex, gender, orientation, or congenital condition. She is particularly committed to addressing the sexual health needs of women and other populations who have been historically marginalized and underserved, while also attending to the voiding dysfunctions and pain syndromes with which they are frequently comorbid.
Dr. Chubak received her medical degree from Johns Hopkins, while also earning a master’s degree in the history of medicine. Her residency training at Montefiore Medical Center-Albert Einstein College of Medicine was bracketed by fellowships in bioethics and sexual medicine at the Cleveland Clinic. Her clinical and research pursuits are informed by all of these disciplines, to ensure care that is culturally competent and respectful of differing perspectives without compromising reliance on scientific evidence.
In addition to this academic training, Dr. Chubak is certified in prosthetic surgery by the Sexual Medicine Society of North America and in vulvoscopy by the International Society for the Study of Women’s Sexual Health. As a member of these and other professional organizations, she is active in medical education and peer-review both in the United States and abroad and has been recognized by the American Urological Association for excellence in research.
Currently, Dr. Chubak’s research is focused on cross-cultural comparisons in care for sexual dysfunction, and on expanding patient-centered outcomes to include intimate partners. She is also concerned by the scarcity of scientific evidence available to support some of the most popular and expensive energy, stem-cell, and cytokine-based therapies currently in use for treatment of female sexual dysfunction. As a clinician, she is dedicated to providing safe, effective, and patient-empowering medical and surgical care.
For more information about Dr. Chubak and to provide her your feedback, please click here: http://www.mountsinai.org/profiles/barbara-m-chubak or by Twitter @drbarbarachubak.
Resources and Links:
https://www.transadvocate.com/transgender-pathologization_n_12247.htm
http://transformingcareconference.com/wp-content/uploads/2017/11/Biological-Sex-and-the-Pathologization-of-Transgender-Identities.pdf
https://www.huffpost.com/entry/gender-dysphoria-dsm-5_n_3385287
https://www.scientificamerican.com/article/where-transgender-is-no-longer-a-diagnosis/
https://www.advocate.com/news/2011/11/17/how-do-i-find-trans-friendly-doctor
http://transcaresite.org/
https://www.nbcnews.com/health/health-news/transgender-healthcare-why-finding-trained-doctor-still-hurdle-n594741
