For the Love of Health

REPLAY: Busting Myths about Gender-Affirming Care with Dr. Anna Filip and Brett Herb, DSW

• ChristianaCare • Season 2 • Episode 10

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Prepare to challenge your understanding of gender-affirming care.

In this replay of one of our most popular episodes, Dr. Anna Filip, a primary care physician with ChristianaCare, and Brett Herb, DSW, program manager for the ChristianaCare Gender Wellness Program, deliver critical insights into the complexities of sex and gender, gender dysphoria and gender-affirming hormone therapy, while discussing ChristianaCare's leading-edge approach to providing care to transgender people.

Then we tackle a number of common myths, misconceptions and misunderstandings– from the realities of de-transitioning to how children understand their gender identities.

Join us for a conversation that not only educates but also encourages empathy. You'll come away with a new appreciation for the importance of fostering inclusivity in health care.

Dr. Anna Filip is a primary care physician and director of ChristianaCare's Family Medicine Residency program. Filip has been with ChristianaCare since 2016. She has led work around global health in the academic settings, developed innovative and comprehensive models of gender-affirming care, and is staunchly committed to improving the diversity, equity and inclusion efforts across the health system.

Brett Herb, DSW, is the Program Manager for the Gender Wellness Program at ChristianaCare. Herb has been in clinical practice for over 25 years as a psychotherapist and a clinical and administrative manager for various behavioral health programs. He joined ChristianaCare in 2006. Herb oversees the Gender Wellness Program, which provides gender-affirming diagnostic services and psychotherapy to the transgender and gender diverse population.

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Speaker 1:

Hello everyone, I'm Megan McGerman.

Speaker 2:

And I'm Jason Tagarski. Welcome to For the Love of Health brought to you by Christiana Care.

Speaker 1:

We're taking a few-week break from releasing new content, so we're bringing back some of our most popular For the Love of Health episodes.

Speaker 2:

As we approach Transgender Day of Remembrance on November 20th, we're revisiting our episode Busting Myths About Gender-Affirming Care with Brett Herb and Dr Anna Phillip myths about gender-affirming care with Brett Herb and Dr Anna Phillip.

Speaker 3:

It's really important that we're treating someone in the way that they see themselves, because that is the way we keep them healthy.

Speaker 2:

You're listening to For the Love of Health, a podcast about delivering care and creating health, brought to you by Christiana Care. And now here are your hosts.

Speaker 4:

Hi everyone.

Speaker 1:

I'm Michael Chesney and I'm Megan McGerman.

Speaker 4:

Welcome to another episode of For the Love of Health, brought to you by Christiana Care you know, in recent years, healthcare providers have expanded and improved the ways that they care for transgender individuals, from primary care and behavioral health to gender affirming, hormone therapy and beyond.

Speaker 1:

Christiana Care is a leader in LGBTQ plus health care and has providers focused on delivering compassionate, state-of-the-art care for transgender and gender diverse individuals.

Speaker 4:

Here today to talk about Christiana Care's gender wellness program and dispel some common myths and misconceptions about gender wellness are primary care physician Dr Anna, phillip and Brett Herb, doctor of social work and program manager for the gender wellness program. Brett and Anna, thank you so much for being with us. Thank you for having us. Thank you.

Speaker 1:

So let's start by defining some of the terms we'll be discussing during this conversation. What is the difference between sex and gender?

Speaker 5:

Sex is what a person is identified at birth, and so they're identified as male, female or intersex, and gender identity is how a person views their own gender, which may be male, female or have no gender at all.

Speaker 1:

And then, what about gender dysphoria?

Speaker 5:

Those folks who don't feel that their gender that was assigned to them at birth, or what we call their sex assigned at birth, doesn't match up with who they are. So it's a person who was told that they were a girl and they were told they were a girl because their genitalia matched a girl's genitalia. They know that that isn't a match for them. They know that being a girl, whatever that means to them and I'm not focused on just genitalia, but their identity of they're supposed to be a girl doesn't fit for them and they have distress over that. They could have anxiety, they could have depression, they could be very uncomfortable with the way that their body looks.

Speaker 4:

Anna, what about gender-affirming care? And also, what's the difference between that and gender-affirming hormone therapy?

Speaker 3:

Gender-affirming care I like to think of as primary care, and primary care should be gender-affirming. And gender-affirming care means creating a safe space for someone to reach out and get high-quality health care, regardless of who they are or how they identify. And in my office that means asking all the right questions in all the right languages and using the terms that they use to identify themselves. And it's important to take care of someone in their entirety and that means asking about their sexual orientation and their gender identity. And it's important to do this across an entire health system so that you're providing gender affirming care to anyone, wherever they are. When they touch the system With me as a primary care family doc, or with a cardiologist or a surgeon.

Speaker 3:

It's really important that we're treating someone in the way that they see themselves, because that is the way we keep them healthy. So gender-affirming hormone therapy is sometimes used in patients who identify as trans or gender diverse. It's a tool that we use for them to help have their gender identity match their presentation. So sometimes we use hormone therapy. Sometimes people who identify as gender diverse or trans do not need hormone therapy to have affirming care.

Speaker 4:

Why is it so important to provide that kind of space? To make sure that you're using the correct pronouns, the correct name for somebody who's coming in for primary care.

Speaker 3:

Yeah, Frederick, it's Frederick right.

Speaker 4:

It's Michael.

Speaker 3:

Okay, yeah, well, I really appreciate. You know, frederick, when we're talking to people and they have a name that they really identify with, like Frederick, it's really important for them to have that sense of identity. And so I'm just going to stop you there. I know you're not Frederick, I know you're Michael, but I want to know and I often will ask patients something similar to that for them to have that experience of having the wrong name. Because tell me how you felt in that moment.

Speaker 4:

I was really uncomfortable.

Speaker 1:

Just watching it was uncomfortable, I could feel it on my face.

Speaker 2:

You can't see it on the podcast, maybe on the YouTube, but it was just like it just felt.

Speaker 3:

Yeah, absolutely. And I think if I was your doctor in that situation, I think everything I would have said after that moment, or reiterated, when I kept using Frederick instead of Michael, you would have completely ignored me and had no trust in my care. So I think for both of us, trust is really important in the care that we provide our patients, and so you need to do everything to ensure that trust and that mutual respect and relationship, because you're going to get further in someone's care if we're doing that.

Speaker 5:

And that's why both of us always ask that's the first question we ask is we ask a person their name and we ask the person their pronouns? A lot of times, people use the language of preferred name in comparison to legal name. I don't like that. I like just the name that they use.

Speaker 3:

If a patient has reached out to us and we need to schedule an appointment, the first question is what pronouns do you use? I'll even ask when I'm in the room with a patient what name they prefer to be used in the chart, because that's important too for the rest of the care team to have access to that information. You know the care team shares that information in a variety of ways. It's important for me, whenever I do a referral, to put that information in the referral as well, and then we do it in a variety of other ways. All over my office we have lots of pronoun pins, and you have them too at your office. I encourage if my residents and my staff want to express their pronouns, then they'll wear the pins as well.

Speaker 1:

Those pronoun pins are available across the health system, but that is a relatively new initiative here at Christiana Care, and these conversations are being had more and more around the world. How has this work changed over the last few years?

Speaker 5:

I've been working with trans folks for the last 18 years and, as more people are feeling safe to come out, there's just more and more people who are seeking services. I do behavioral health care, so I do psychotherapy, and Christiana Care saw the need and was willing to expand and have it not just be, you know, me being the one doing the treatment. So we now have a gender wellness program where we have three therapists and there's one intern, and we've just gotten a lot of support. Delaware actually has the second highest percentage per capita of transgender and gender diverse people in the United States, and that's why it's so important that Christiana Care is providing these programs that we have, because we need to be able to treat this population.

Speaker 3:

Yeah, and I mean I've been doing this work for over a decade now not quite as long, but since my residency and since training and I think that for me it's changed over that time as well. There's been a lot more increase in research around the care that we're providing. There's been a drastic increase in participation in associations of providers who provide this care. We have a US chapter of the Association for Transgender Health that's part of what's called WPATH, or the World Professional Association of Transgender Health, which has grown over that decade as well. So lots of great work in providing support for the providers so that we can do a better job of providing support for the patients.

Speaker 4:

Now that we've set the stage, we promised that we would address some myths, maybe dispel some of these common thoughts that are out there about the work that you do and the population that you work with. So let's start here. Brett. Myth number one most young people that transition regret their decision and want to detransition.

Speaker 5:

First of all, it's a very small population that does detransition and the ones that do if you interview them, have conversations with them it's due to the fact that they don't have the supports that they need to live in their new gender. They are not able to get jobs, they don't have supportive families, there's health disparities and there's issues around like housing that people aren't able to get. If they're trans folks that detransitioned, really, what's happening is they are just stopping their hormones for a time until they feel safe again. One percent of people that have genital surgeries. There's evidently some regret, but the question is did they talk with the number of professionals they needed to? Did they get have enough conversations with them to make sure that they were making the right decision at the time? And I think that, because it is only 1% that tells us that providers are doing behavioral health and also any of their medical providers are doing a good job at working with those people to figure out if that is something they medically need.

Speaker 3:

And I think it's important to note that that's regrettable or a specific part of their affirming therapy, and so it's not necessarily that they are wanting to stop all affirming therapies like hormones or things like that.

Speaker 1:

And the second myth goes to you. It's the myth that kids are too young to know if they're transgender, or only because they saw it on TikTok do they think that they might be transgender.

Speaker 3:

That's absolutely a myth. You know, as a family doc, I get the joy of being with families from all ages and I really get to watch kids develop over time and with childhood development we know that their identity is forming at a very young age. Childhood development we know that their identity is forming at a very young age and in our cis children. And cis means that their sex assigned at birth is the same as their gender identity. And in our cis kids we know that when they're very young, even at the age of three to four, they're really identifying as I'm a girl, I'm a boy and they stick to that. They're insistent, consistent and persistent in that.

Speaker 3:

Our youth who identify as trans or gender diverse have similar insistent, consistent and persistent in the fact that they don't identify as boy or girl and are trying to figure out what they do identify as. And we find that over time that insistency and consistency and persistency in their identity stays. And when it stays, that's when we know that they will grow up to be trans or gender diverse. Oftentimes kids, as they grow, don't have the language to understand or speak to their identity or the feelings that they're having as they develop. And so in the age of social media and the internet. It's a wider community that kids have access to now, and I often have a lot of patients who come in and say I found a person or I found a group online and they used this word and that word spoke to me and all of a sudden I knew what I was feeling, and so it's that increased access to language and the ability to communicate that helps them identify.

Speaker 4:

And the third one to you gender affirming therapy is unsafe and subjects patients to irreversible medical procedures.

Speaker 3:

I think that that's absolutely a myth and we really need to clarify that, because these are medications and treatments and conversations that clinicians are having with their patients, and this is a long process to really diagnose with gender dysphoria. We have multiple conversations over a long period of time and we do a good job of understanding the patient's needs and desires and coming to an understanding of how we can work together to get to that end. Sometimes it involves hormones. Sometimes, when they're younger, it involves medications that are often called hormone blockers, and hormone blockers are a wonderful tool to use, especially in our youth, because what it can do it allows us to block puberty from starting. We have a lot of information about these medications and the safety of these medications because we use them in a lot of other diagnoses things like precocious puberty or puberty happening too soon for patients and we use them to block that puberty until it's age and developmentally appropriate. And we're doing the exact same thing when we're using it with our trans and gender diverse patients. It's like pressing the pause button and we do a lot more counseling and therapy and work with our patients and families and their support group until we're ready to take the next step. Sometimes that's removing the hormone blockers, Sometimes that's adding a hormone so that they can live an affirming, supportive and healthy life. All of this is done under really close clinician supervision along with our behavioral health colleagues to do this in a really safe and supportive way.

Speaker 3:

For example, we may reach an age where it's time to decide if we're going to add hormones to a patient so that they can go through the puberty of their affirming gender, or we may decide that it's time to remove the hormone blockers and then they will proceed through the puberty of what's called their natal or sex assigned at birth puberty, and either one of those are very safe to do, but it's really important to give them that time to think through that and to work through it, Because if we don't do that, we have a lot of data and a lot of information to know that harm is done if we have the patients go through their natal puberty when that's not the one that's needed.

Speaker 3:

There are changes that are permanent with puberty and those are irreversible and sometimes those can be very triggering and cause significant dysphoria for our patients, and I see that caring for older adults and we know that if we can prevent those. The rates of attempting suicide. The rates at succeeding in suicide drastically decrease in our patients. My job as a doctor is to first do no harm and to support patients in the things that keep them healthy. They need to continue to live to be healthy.

Speaker 1:

And that ties back into the second myth, that they are not too young to be having these conversations.

Speaker 3:

Absolutely, Especially when they're voicing those opinions insistently, consistently and persistently.

Speaker 1:

Brett, the fourth and final myth will go to you. The myth is that the transgender community is looking for special treatment.

Speaker 5:

The answer is no to that. I mean, I often have those conversations with my patients about how they go into situations and all they want to be do is being treated the same, you know, as anybody else, and it's actually something they'll think to talk about, to almost celebrate, when they've had an experience that someone treated them properly, and that's very sad. I mean we should be treating these folks properly. You know, for somebody else who's cis, there's not like saying, oh, my doctor smiled at me today and used the right name, all right.

Speaker 4:

So four myths totally debunked totally bestowed. Nice job. You guys are our myth busters. We really appreciate both of you being with us today.

Speaker 1:

Thank you for having us, and we'll have more information on gender identity, gender affirming care and Christiana Care's gender wellness program in today's show notes.

Speaker 4:

Those are available at christianacareorg slash podcasts, where you can also find links to subscribe to For the Love of Health, on your favorite podcast app.

Speaker 1:

And don't forget to leave us a review to help more people find the show and connect with Christiana Care on social media.

Speaker 4:

We're going to be back in two weeks with another great episode.

Speaker 1:

Until then, thanks for joining us for the Love of Health.

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Megan McGuriman

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