Trans Psychiatrist Answers – What the Public Needs to Know About Queer and Genderqueer People.

Queer and genderqueer people have a long history of stigmatization and discrimination.

A little over 50 years ago, psychiatrist John E. Fryer had to where a disguise and use an alias at an APA conference to discuss being gay. He had to do this out of fear of being fired or worse, having his professional license attacked.

It would take almost another decade for homosexuality to be depathologized in the DSM of mental disorders. Up until then, homosexuality was considered a sexual disorder. Even after homosexuality was depathologized, pathological theories and treatments around homosexuality remained.  Queer children were forced to undergo inhumane forms of conversion therapy in the name of science. Now we know that being gay, queer, or homosexual is about WHO YOU LOVE. Queer identities are not sexual or socially appropriated, and they never were.

But social contagion is often the erroneous argument behind every don’t say gay bill and book ban. This concept is utterly preposterous and without any evidence, yet it still remains, and such unscientific and bigoted ideas continue to be legislated upon, negatively impacting the lives of queer people, and queer kids today.

Transgender and Gender Diverse People are equally misunderstood. While being queer is about who you love, being genderqueer is about WHO YOU ARE.

Gender diversity like homosexuality has also long been sexualized by the researchers and the greater medical community. This has led to largely debunked and poorly supported sexualized models of gender diversity such as autogynophilia.

It’s only been in the last decade that the DSM has depathologized gender identity and recognized gender diversity as inherent facet of human diversity. Despite this, genderqueer people are often called “groomers” and legislated against just for being themselves. It’s utterly appalling and sad, and as a society everyone needs to know that being trans, non-binary, or genderqueer is not sexual. It never has been.

The impact of being sexualized in media and in the medical literature has a significant impact on the psyches of trans people. Because they are forced to hide their exceptional gender qualities, they sometimes express their authentic gender through sexual fantasy or acts. Freud believed that dreams and sexual fantasies represented attempts by the unconscious to resolve a wish or conflict. The wish was repressed by the ego due to shame/guilt or because it represented something unaccepted by society (Freud, 1899; Schept, 2007). This is commonly seen in early transition but diminishes as individuals proceed in their transition and become their authentic selves.

As a psychiatrist, a transgender person, and a human being I implore all of you to open your hearts to queer and genderqueer people. All we want is to be ourselves free of discrimination. We can’t do this without you.

Be an ally. Be an upstander. And stand up against discrimination in all its forms.

Buddhist Principles for the Modern Age: Mindfulness, Vigilance, & Carefulness

A core practice of Buddhism is to take up good actions and to reject negative ones. On a spiritual level, this purifies karma and improves the chance of a prosperous rebirth. On a more practical level, taking up good actions and rejecting negative ones improves our relationships, our mood, and health.

But how does one apply this practice in real time? The answer is mindfulness, vigilance, and carefulness.

This practice or skillful means is introduced in Patrul Rinpoche’s Words of My Perfect Teacher text. They are defined as follows:

Mindfulness is awareness of one’s thoughts, feelings, and emotions. As an action it is not forgetting what to do and what not to do. Without mindfulness, our minds will be prone to irrational, emotional reactions. Here, our ability to name our mental states and emotions in real time becomes important. By naming our emotions, we gain power over them and can change them. In neuroscience, this represents top-down control over our more primitive emotional brains.

Vigilance is to make oneself examine one’s actions, words, and thoughts. It is the invisible action that follows from mindful awareness. Vigilance allows us to examine the past and present, and change our future actions. Vigilance helps us be more mindful, and reinforces what to do and what not to do. In a practical sense, it is restraint and action with purpose.

Carefulness is to exercise the utmost prudence in doing what is right and avoiding what is wrong. Carefulness and mindfulness walk together. As an inward action, it is to avoid negative emotions and self-defeating thoughts. As an outward action it is speaking and acting kindly.

Practical Example:

Jamie is the team leader for a team of presentation planners who work for a local health and welfare office. Each team member has been assigned an important piece of a shared presentation that is due today for review. When Jamie arrives at work on the morning of the deadline, they find that one team member’s portion has not been completed. Jamie experiences anger because she reminded this employee several times of the deadline and to reach out if for any reason they would not be able to finish. Jamie begins to write an email when they recognize their anger and negative thoughts (mindfulness). They pause, suddenly aware of how these feelings are being reflected in the email. Jamie remembers how writing an email while angry in the past led to negative effects (vigilance), and decides that an email might not be the best way to address this problem. Jamie deletes the draft email and decides to have a face to face meeting with the team member. While they meet, they are careful to speak kindly while addressing their concerns. They are also careful how they respond during the discussion, mindful and vigilant of the shifting landscape of their thoughts, emotions, and feelings.

Photo by Bagus Pangestu on Pexels.com

Psychiatrist Answers – Coping with Discrimination: Generating Impartiality

Let’s speak plainly, there is a lot of discrimination out there. For those of us who identify with a minority class, the weight of bigotry and prejudice feels heavier than normal. We have shifted from a society who embraces individuality and self-expression to one that seems bent on squashing diversity. It is hard not to feel angry and dismayed by some of the things happening in today’s world. It is important we find ways to cope and not allow those who would seek to erase our expression steal our joy and strength.

One way of coping with discrimination and minority stress is to modify our reactions to it through the process of generating impartiality. Impartiality is similar to the philosophical teachings of Stoicism, which teach that contentment is a product of focusing on what one can control (such as our thoughts, emotions, and actions), and accepting the things one cannot control, such as the actions of others. Impartiality is not a form of nihilism in that is does not reject the existence of discrimination or the need to overcome it. Instead, impartiality is a method of managing difficult experiences in a manner that does not impede or delay our constructive responses to them.

To use an analogy, generating impartiality is similar to being a stone in a river. As much as the river flows, the stone remains motionless.

In the meditative traditions, impartiality means giving up our hatred for enemies and cultivating an even-tempered attitude to all people and situations. One way to do this is to imagine our enemies as neither good or bad, but rather neutral. If this is difficult, try to reflect on their ignorance and imagine they are someone you care about who is doing harm to themselves. Compassion is often a great antidote to our own negative emotions, and can help us generate impartiality toward those who hate us.

To generate an impartial mind, we need to recognize how our responses to our environment impact our mental states. When someone says something unkind to us, or reacts to us with anger, our initial impulse is to react in kind. Using the previous analogy, we get swept away by the river. By reacting in this way, we give away what power we have to the other person, and this makes us less effective in our response.

Impartiality then requires mindfulness. It starts with an awareness of our initial emotional responses and an active choice not to react in the same way. At first, it may be helpful to imagine one’s power as a brilliant jewel. When we react to anger with anger, or hatred with hatred, we give away our power (you have handed your jewel to the other person). If this happens, visualize the brilliant jewel in the other person’s hand and gently reach out and take it back. Taking back our power gives us the ability to react in a more constructive way.

As one trains their mind in impartiality, the propensity to give away power will diminish. Instead, when confronted with discrimination, the wound of it will not go so deep, and we will be able to respond to it constructively with love and compassion.

Let’s make the world a better place together. 🙂

The “Queer” Agenda

“Equal rights for others does not mean fewer rights for you. It’s not pie.” -Jesse Williams

In the last year, the queer and genderqueer communities have been increasingly on the defensive. Across the U.S., and in much of the world, a series of laws and policies have sought to erase LGBTQIA+ people from public life. These policies amount to a quiet genocide.

Don’t say gay bills sexualize and demonize queer identities, forcing teachers back into the closet, and depriving young people of the ability to explore their gender and sexuality in safe, supportive spaces.

So called, bathroom bills, draw upon false narratives of safety, categorizing trans people as predators to be feared, when in fact they are often the victims of violence.

Anti-drag bills attack displays of queer expression, marginalizing queer people, and removing them from public spaces.

Bans on gender affirming care for minors and adults deprive individuals access to life saving treatment, increasing their risk of depression and suicide. In some places, these laws have also labeled this care as child abuse.

These laws and polices are inhumane, unethical, and truly hateful. The sum of them is the forced disappearance of queer people from the world–a genocide. And, right now, their actions are having an impact.

The politicians and promotors of these laws would have you believe they are under assault, that queer kids and adults are confused, that queer people are dangerous, and that somehow gender expression and identities are contagious, like a disease. In this way, they fashion queer and genderqueer people as unnatural and undeserving of equal rights. If this all sounds familiar, it should. The face of the civil rights movement may change, but the struggle never ends.

Queer and genderqueer people only want equal rights and protections under the law. They want to grow up in a world where their gender identity and expression is not pathologized, where they are respected for who they are, and not discriminated against in public spaces. They want access to evidence based healthcare that helps them achieve authentic gender embodiment and the ability to legally transition when appropriate. More than anything, queer and genderqueer people just want to be themselves and not be harassed by ignorant people who hate with impunity. This is the “queer” agenda, and it is one everyone who is kind and ethical should support.

Photo by Francesco Ungaro on Pexels.com

The Fight for Civil Rights and Social Justice Never Ends

Have you ever met someone who claims to support equality and civil rights but considers the current social justice struggles to be ‘Woke’ or somehow less meaningful than those of the past? For example, they may say they are for women’s rights, but not for the rights of transgender women.

This is absurd.

It is convenient to say one is for the hard won rights of past activists. Those battles have already been fought; the blood of them spilled. It is harder to acknowledge and face the bigotry and prejudice that exists today.

The truth is simple. If you’re not for social justice today, you would not have been for social justice in 1860 or 1920 or even 1960. The lens of bigotry and prejudice are near sighted. They always have been and they always will be.

So let’s stop pretending there is any difference between social justice then and now. The target of hatred and bigotry may change, but the struggle for civil rights and social justice never ends.

Hate and ignorance don’t smell any different with time and true heroes never put up their capes. Let us stand among the heroes of social justice so that every generation may see more freedom and opportunity than the last.

Happy Pride Month!

Trans Kids Should Not Have To Be Activists

Right now, it is a challenging time to be a transgender person in America. States across the Union are passing laws that negatively impact the trans community.

These laws target almost every facet of a transgender person’s identity and expression, from access to medically necessary transition related care, legal recognition of gender identity, access to gendered spaces, and/or the ability to play in sports. A sub-group of the community that has been disproportionately impacted by anti-trans legislation are trans youth.

Proponents of these laws say that medical care for trans youth is “experimental” or causes harm. Nothing could be further from the truth. In a majority of cases, supporting a youth in their gender identity has profoundly beneficial effects. As Connolly, et al., notes, “Gender-affirming medical therapy and supported social transition in childhood have been shown to correlate with improved psychological functioning for gender-variant children and adolescents.” Conversely, trans youth who lack social support and access to gender affirming medical interventions are at high rate of depression, eating disorders, suicide, and other psychosocial problems.

Given the positive impacts of supporting trans-youth in their transitions, legislation targeting trans youth is unscientific and immoral.

These laws force trans-kids to be more than just kids–it forces them to be activists for their own survival. Today, it is not uncommon to see trans-youth offer public testimony against regressive and hateful legislation. This exposes trans youth and their families to the most ugly and hateful elements of our society. As much their bravery and passion should be praised, no trans youth should have to be anything but a happy, healthy kid.

As a society and medical community, we must do better to support trans youth in their social, medical, and legal transitions. We must speak up and reject hate and unscientific laws and rhetoric. For those youth who choose to stand up for their rights, we should stand beside them in support and fight together for a day that no trans kid should have to be an activist for their own survival.

References:

Connolly, Maureen D., et al. “The mental health of transgender youth: Advances in understanding.” Journal of Adolescent Health 59.5 (2016): 489-495.

Creatine Supplementation: Is it safe?

Creatine Monophosphate is a very common supplement used by body builders and athletes. There are many rumors out there about creatine’s safety and efficacy. In this blog post, I’ll discuss what creatine is, whether it’s safe, and what are some of the potential benefits for it’s use based on the scientific literature.

What is it?

Creatine (methylguanidine-acetic acid) is an amino acid. It is not a steroid. In the diet creatine comes primarily from meat or supplementation. The body stores creatine as phosphocreatine in the muscle where it is used to make adenosine triphosphate (ATP), the energy molecule of the cell. Supplementation has been shown to increase muscle performance and growth over a training period.

Is it safe?

Greater than 20 years of research shows that in healthy individuals, there is no evidence of adverse effects at the recommended daily doses 2-5 grams per day. Case studies that have shown possible negative effects of creatine on the kidneys are confounded by pre-existing kidney disease, medications, and higher than normal doses of creatine. According to the International Society of Sports Nutrition (ISSN), “There is no scientific evidence that the short- or longterm use of creatine monohydrate has any detrimental effects on otherwise healthy individuals.”

Can it prevent muscle loss and improve bone mineral density?

Sarcopenia is the loss of muscle mass, strength, and functionality. It is associated with increased morbidity and mortality. Sarcopenia is increased on those on androgen blockade or those who are post-menopausal.

Resistance weight training is considered the cornerstone treatment for sarcopenia Growing evidence shows that adding creatine to weight training can have a substantial added benefit. Creatine without weight training do not appear to increase lean mass.

Studies show that creatine supplementation when combined with weight training can increase bone mineral density and attenuate the rate of bone mineral loss. A two-year study of post-menopausal women who took creatine without resistance training resulted in no improvements in bone mass.

What are some other potential benefits of creatine use?

There is evidence that creatine supplementation may reduce muscle damage, injury, and enhance recovery time following intense exercise. Supplementing with creatine may reduce inflammation and muscle soreness after exercise. Creatine supplementation may improve hydration and thereby increase heat tolerance during training. Additionally, There is also evidence creatine may be neuroprotective and can reduce spinal cord injury, cerebral ischemia, and concussion/traumatic brain injury.

Conclusions:

At a recommended range of 2-5 grams per day, creatine supplementation when combined with weight training is safe and can provide myriad benefits!

References:

Antonio, J., Candow, D.G., Forbes, S.C., Gualano, B., Jagim, A.R., Kreider, R.B., Rawson, E.S., Smith-Ryan, A.E., VanDusseldorp, T.A., Willoughby, D.S. and Ziegenfuss, T.N., 2021. Common questions and misconceptions about creatine supplementation: what does the scientific evidence really show?. Journal of the International Society of Sports Nutrition, 18(1), p.13. Article Link

Buford, T.W., Kreider, R.B., Stout, J.R., Greenwood, M., Campbell, B., Spano, M., Ziegenfuss, T., Lopez, H., Landis, J. and Antonio, J., 2007. International Society of Sports Nutrition position stand: creatine supplementation and exercise. Journal of the International Society of Sports Nutrition, 4(1), pp.1-8. Article Link

About me: I am a medical doctor living in Northern California. I received a Master’s Degree in Nutrition from Columbia University in 2010. I’ve been a practicing vegetarian since 2007.

Keep the Government OUT of the Medical Office

As a physician, yesterday’s news about the overturning of Roe v Wade came as a shock. Even though the decision had been leaked, a part of me could not believe it then or now. For a half a century, Roe v Wade protected a woman’s right to make a medically informed decision about her body. Now that right is gone.

The decision highlights the twisted hypocrisy among the far right and anti-abortion religious leaders, who claim to stand for limited government and individual liberty, while supporting decisions that take away individual liberty and place the government directly in the medical office.

The medical office is supposed to be a sacred place of choice. It is where some of the most difficult life decisions are made. Through the process of informed consent, a physician explains the benefits and risks of a treatment based on medical science and research, and then supports that patient’s choice. Sometimes, the scar of these decisions can last a lifetime, but they are made with the solidarity and belief in the personal freedom of each individual to make an informed decision about their medical care that supports their values and goals.

Today, in America, women have lost that right.

Overturning Roe v Wade is an ominous sign of what could come. Justice Clarence Thomas has already said that rulings protecting contraception, marriage equality, and privacy in the bedroom should be overturned. At risk are Americans’ fundamental privacy. It is not hard to imagine the same questionable arguments used in overturning Roe v Wade applied to these cases.

If SCOTUS and others truly wish to protect individual liberties and freedoms they should keep the government out of the medical office. The right to privacy is a fundamental right. Instead of impeding this right, the government and its branches should seek to safeguard the right to privacy at every turn. It is arrogant and misguided to think a woman, or any other person, lacks the capacity to make an informed medical decision with their physician. Sadly, that’s the America we wake up to today.

Photo by EKATERINA BOLOVTSOVA on Pexels.com

Military Transgender Policy is Still Trapped in the Gender Binary

Gay. Non-Binary. Psychiatrist. Military Officer. Wait, military officer?

In 2015, I commissioned as an officer in the U.S. Army Reserve. Last year, I was promoted to the rank of Major. This is a part of my life I rarely share on this blog; however, I think there are a few things I need to say about my service as someone who is gay and non-binary.

In 2010, I declined a military scholarship for medical school because of the ‘Don’t Ask Don’t Tell’ policy. A year later, this policy would be lifted, opening up the path for my future commission. For me, serving with honor and upholding the military code of ethics meant being able to express my sexuality.

In 2016, when President Obama lifted the transgender ban in the military, I was overjoyed. Even though the policy focused on individuals moving from one end of the gender binary to the next, the change opened the door for other forms of gender expression.

When the ban was reinstated in 2019, it felt like a step backwards for many non-binary service members. As I note in a previous post, the term transgender defines any person who identifies a gender not listed on their birth certificate. Thus, non-binary persons are transgender, but in terms of military policy, non-binary people don’t exist.

In 2021, the ban was lifted again, but the policy remained trapped in the gender binary, focusing on individuals wishing to transition completely from one sex to another. It did not address individuals with more neutral or androgenous forms of gender expression like myself.

There is some evidence this may be changing. According to Military.com, the “Institute of Defense Analyses, at the Pentagon’s request, is researching how nonbinary troops could be allowed to serve more openly.” Some branches like the Air Force are already ahead of the curve allowing service members to list their preferred pronouns on email chains.

In my opinion, clear policies recognizing non-binary persons are necessary to support and retain fighting strength. Non-binary persons fill critical needs specialities within the military that are essential for mission success. As definitions of gender move away from the binary, the military, as an all voluntary force, must also adapt and change.

I am proud to serve in the U.S. Army Reserve as an openly gay, non-binary soldier.

Happy Pride Month!

References:

https://www.military.com/daily-news/2022/01/18/pentagon-quietly-looking-how-nonbinary-troops-could-serve-openly.html

https://www.military.com/daily-news/2022/02/11/im-pretty-much-leading-double-life-nonbinary-troops-and-pentagons-next-frontier.html

Click to access ARN32878-ARMY_DIR_2021-22-000-WEB-1.pdf

Headwinds of Intolerance

For many LGBTQ+ persons engaging in a gender transition, the headwinds of intolerance are a real obstacle. It can mean rejection from friends, family, and even community. All transgender persons struggle with this truth. For this reason, it takes courage to align one’s gender expression to their gender identity.

In my previous article, The LGBTQ Psychiatrist Educator (Article Available on Request), I discuss under what circumstances it may be appropriate to share one’s sexuality in the clinical learning environment. In a thoughtful follow-up Letter (also Available on Request), a “bisexual” medical student, and now doctor, noted that transgender persons who are expressing their gender identity don’t always have the luxury of selective disclosures. For this reason, transgender persons often face the greatest headwinds of intolerance.

She’s right!

Intolerance comes in many forms, both passive and active. The natural reaction to intolerance is to shirk away from it or to change one’s behavior to avoid it. For transgender persons, this could mean changing where they shop, moving to a different community, making a career shift, or even finding new friends. The most difficult choice faced by some transgender persons is whether to hide their gender expression, which could lead to significant dysphoria but protect them from threats of physical violence.

Transgender persons remain one of the most stigmatized, misunderstood, mislabeled, feared, and marginalized minority populations. As Dr. Benfield stated at the end of her letter, we “…should strive towards creating a safe, inclusive workplace for trans people, and commit to role modelling trans allyship in our professional and personal lives.”

Happy Pride Month!

References:

1. Agapoff JR. The LGBTQ psychiatrist educator. The clinical teacher. 2021;18(5):472-473. doi:10.1111/tct.13335

2. Benfield E. LGBTQ educators: an LGBTQ student’s response. The clinical teacher. 2021;18(3):314-314. doi:10.1111/tct.13349

Photo by Francesco Ungaro on Pexels.com