446 Who am I?

Medical Help that Saves Children’s Lives

Featuring Dr. Rachel Sewall:

“I want to shout from the mountain tops!”

Today we hear from Rachel Sewall, M.D., a Stanford pediatric endocrinologist who provides medically necessary care for transgender and gender diverse young people. She says that her work is highly emotional, with extreme highs and lows. People view this population with great fear and considerable ignorance as well. Valid medical information is powerful and important. Seeing how people view these young people is constantly on my mind.

She says:

When I was a medical student, I didn’t have clear goals for what type of medical practice I would pursue. However, during my work in the emergency room, I realized, as did my colleagues, that I got very excited when working with children, so I decided to focus on pediatrics.

I knew I’d be an advocate for LGBTQ+ young people. A colleague implied that they are rare, but I realized that wasn’t true. In fact, surveys tend to underestimate the percent of trans individuals and LGBTQ+, do to underreporting due to feelings of shame and fear, but the surveys still suggest a trans population around 2% and an LBTQ+ population around 15%. So, together, we are likely looking at roughly 20% of the population fall into one or both of these two categories.

As a first-year medical student, I did research on hormones. These are chemical messengers telling our bodies to do things. Figuring out the actions of hormones is like a complicated puzzle (Rachel explain a little, pleaee.

I also went to a camp for kids with Type I diabetes. It was a perfect marriage for me! (Rachel fill in why please).

My work with children and teens is a combination of medical and emotional support. More than anything else, these kids want to be listed to and respected. And the highs and lows I experience, as I mentioned earlier, can be extreme. Many begin sobbing when I talk to them, because they’re so grateful that someone is listening!

Reviewing basic definitions, your gender is usually assigned at birth, due to your sexual organs. They say, “Hurray! It’s a boy!” Or “Hurray! It’s a  girl!”

But as your identity and sense of our gender evolves, and it may not be the same as the gender assigned to you at birth. Gender identity begins to form around 18 months to 3 years old, but can emerge at any time later as well. Most of us “know” our gender identity by the time we are 5 or 6, but it can also emerge during puberty as well, or even later.

They may suddenly say, “this is not whom I am.” And some, of course, say “I am neither male nor femail.”

That’s where the terms cis and trans come from. Cis means that your assignment at birth and your gender identity—your sense of who you really are—can be the same. If so, you are a cis male or a cis female. But if they are not the same, you are a trans.

For example, a trans male was born with female genitalia but a male identity evolved. And a trans female was born with male genitalia but a female identity evolve. Many trans individuals experience great distress when taking showers, since they may feel repulsed when they see that they have the “wrong” genitals. Gender identity has overwhelming power. Some have told me, “I just want to tear my skin off!”

Sexual preference and gender identity are not the same or linked in any particular way. Sexual preference simply refers to who you love, sexually and emotionally, and want to partner with.

Rachel continued,

Hormonal interventions can be life-saving. If you are a trans male, having periods can be profoundly disturbing, often to the point of triggering suicidal urges. Helping these kinds and their periods via hormonal interventions can bring enormous relief. They often say, “Dr. Rachel, you saved my life!”

I almost always work with the family, and my goal is for the family to learn to function as a team, all working together to provide love and support for their child, so they can say, “this is my child and I love and accept them unconditionally!”

I emphasize that there is no right or wrong on their gender journey. Metabolic and surgical interventions both have their place in treatment.

The time to go public with who you really are is an important social and cultural decision, and this also varies tremendously. But regardless of age, gender-affirming medical care can always make a tremendous difference in your life!

Rhonda and I are deeply grateful to Rachel for giving us this wonderfully patient and clear education in a field that was not even covered, to the best of my knowledge, when I was a medical student at Stanford. We hope your voice today, Rachel, will be heard by many, and will hep to bring greater peace, acceptance, love and understanding to our many podcast fans.

Thanks!

Rachel, Rhonda, and David