Tag Archives: Gender

Gender is a spectrum of identity and expression. Posts in this category typically challenge the Western belief of separate binary options.

Gay doctor? Why I’m out, loud and proud


To this day I do not know a single LGBTQ* person from my youth. I was not privileged to have understanding parents nor to have role models with whom I could connect. Many youth today find themselves in a similar position.

Growing up as an LGBTQ* person is rarely easy. Rejection, isolation, discrimination, harassment and physical violence are all too common. Understandably this results in low self-esteem, risky self-destructive behaviors, homelessness and suicide. Hope for a better future is often an essential lifeline to those of us who are hurting. We need to know that suffering will end and that we can be happy.

I choose to be visible for this reason. As many others have said, I want you to know that life does get better. So much better!

If you are struggling please know that you are not alone. You are precious and you are loved. There are many resources available to you. All you need to do is reach out.

  • The Trevor Project (http://www.thetrevorproject.orgis a 24 hour help line that is available to anyone who needs a listening ear.
    • 866-4-U-TREVOR (866-488-7386)
  • Parents, Families and Friends of Lesbians and Gays (http://www.pflag.org) provides support and resources for families and friends of LGBT people.

Women’s Work?

I was recently interviewed for an article published in the March 2012 edition of Minnesota Medicine, the journal of the Minnesota Medical Association.

In Women’s Work? Obstetrics/gynecology struggles with the gender question, author CArMen PeOtA addresses the gender shift of OB/GYN physicians from once a predominantly male to a now predominantly female presence.

My input lies toward the end of the article, under the “The Value of Gender Balance” section heading. She writes:

Those concerns didn’t put off third-year University of Minnesota ob/gyn resident James Pate, M.D. “There’s such a strong need for providers in every specialty that there will always be jobs available.” His plan is to specialize in caring for patients
with atypical gender experience. Like most men and women who go into ob/gyn, Pate says the appeal of the specialty is that it offers physicians the chance to do both primary care and surgery. Pate actually thinks it’s a good thing that nine out of 10 of his colleagues in ob/gyn residencies are female. “In the past, all of medicine was heavily dominated by men,” he says. “Having the majority of providers [be female] makes sense. They are women, and they care about women and want to provide excellent health care to women.” But he believes both males and females bring a perspective to practice that’s valuable. “Both our female colleagues and our patients appreciate the male presence,” he says.

Dr Cary Gabriel Costello: Intersex Fertility

Dr Cary Gabriel Costello

Dr Costello writes in his blog entry, Intersex Fertility, that “My daughter was not of woman born. That is a concept that has fascinated people through the ages. My daughter’s gestation was perfectly ‘natural,’ I should point out–but I carried her, and I was never of the female sex; I am a so-called ‘true hermaphrodite.’ I was assigned female at birth, and was living as such when I gave birth to her, but I never identified as a woman, and am now legally male.”

He continues, “I’m glad that I was able to become a parent, but believing that this should have ‘cured’ me of my distress with my assignment is magical thinking along the lines of believing that procreating will ‘cure’ a lesbian or gay man and make them heterosexual. Gender identity, sexual orientation, and procreative status are independent characteristics. Lesbians and trans men and intersex individuals aren’t mystically “converted” by pregnancies. Gay men and trans women and intersex individuals who inseminate someone aren’t thereby made straight or cis or dyadically-male-sexed.”

He concludes: “Most of us who do reap the rewards of fertility do this in private, with no medical journal articles trumpeting a star in the east. In fact, some medical ‘corrections’ of our physical differences render us infertile, and I don’t see why that’s treated as unimportant when doctors are so very willing to write articles about their ‘cases’ who do prove fertile. And the magical thinking behind the idea that doctors can validate a sex assignment through the intersex person contributing the ‘correct’ component, egg or sperm, to a conception just boggles my mind. It’s time for some more sophisticated thinking about intersex fertility.”

I couldn’t agree more. Ready more about Dr Costello, his experiences and his scholarly opinions regarding intersex and trans issues on his blogs:

The Genocide of Intersex People


American Grotesque posted The Genocide of Intersex People on 11/28/11. I recently came across it while catching up on twitter and facebook during my holiday break (a true luxury for a resident!). In this post the author discusses the damage perpetuated by the myth of binary gender, its social construction and legal ramification. The author places hir-self in the place of “patients” whose bodies defy the myth and without consent are reconstructed to appear to confirm it. Yet in spite of appearances they remain outside of the binary and their shame and scars and are shrouded in secrecy and silence. Is this moral? Is this fair? Is this just?

“Our lives begin to end the day we become silent about things that matter. [And] In the end, we will remember not the words of our enemies, but the silence of our friends.” ―Martin Luther King Jr

Am I intersexed?

Dear Dr Pate,

I was born with a DSD. Is penoscrotal hypospadias with severe chordee an intersex condition? Am I intersexed?

Dear J,

Your questions are more difficult to answer than one would think. The term “intersex” has changed in meaning over time, more so among doctors than perhaps many who consider themselves to be intersex. From a medical point of view, your condition would not necessarily have been considered an intersex disorder in the past. However, an international consensus reclassified disorders with either abnormal sex chromosomes (ie XO, XXY) or atypical genitalia under the umbrella term “disorders of sex development” (DSD) in 2006. Given that hypospadias is a condition where development of male external genitalia is halted prematurely, this is indeed a DSD. The term “intersex” however is no longer considered to be a contemporary medical word and has been replaced by DSD.

Adults who consider themselves to be intersex generally have a history of ambiguous genitalia, may or may not have been subjected to “normalizing” genital surgeries in infancy and/or childhood, but do not feel that they fit neatly into the binary boxes of male or female. They usually feel that if surgery occurred that it was undesired and destructive. Their gender identity may be the same as their sex of rearing, opposite, a combination, or something else. Adults who identify as intersex are generally offended by the new medical nomenclature “DSD”; they do not feel that their sex is disordered but rather a natural occurrence within the human spectrum. They are also quick to point out that they are not transgender or transsexual and do not feel that they are a part of those communities. Unlike the trans communities, they feel that their gender identities match(ed) their bodies, though they may not match their surgically altered bodies nor the sex of rearing that was chosen for them. The intersex community is still rather small given the shame, embarrassment and mistreatment individuals were subjected to while growing up as well as the continued ignorance of society regarding their existence.

People that continue to be born with chromosome abnormalities and/or varying degrees of genital ambiguity may feel that they are either truly male or truly female with a DSD medical condition, not intersexed. On the other hand, if their gender identity is the opposite of their sex of rearing then they may consider themselves to be trans. Others feel more comfortable with an intersex identity. Thus the matter of what is considered an intersex condition and who considers themselves to be intersex remains quite murky.

There are intersex groups that exist online and occasionally meet in person. If you are interested in chatting with others like you I would recommend checking out Organisation Intersex International (OII). They are “devoted to systemic change to end the fear, shame, secrecy and stigma experienced by children and adults through the practice of non-consensual normalisation treatments for people born with atypical anatomy, and the arbitrary assignment of a particular gender without an informed consultation with the individual concerned.”

Hope this helps and good luck to you. Happy holidays!


James Pate, MD

Ob-Gyns: Prepare to Treat Transgender Patients

Ob-Gyns: Prepare to Treat Transgender Patients
November 21, 2011
From: The American College of Obstetricians and Gynecologists

Washington, DC — To address the significant health care disparities of transgender individuals and to improve their access to care, ob-gyns should prepare to provide routine treatment and screening or refer them to other physicians, according to The American College of Obstetricians and Gynecologists (The College). In a Committee Opinion published today, The College also states its opposition to gender identity discrimination and supports both public and private health insurance coverage for gender identity disorder treatment.

Although the total number of transgender people in the US is unknown, studies suggest they make up a small, though substantial, population. Transgender is a broad umbrella term that includes people whose gender identity and/or gender expression differs from their assigned sex at birth. Female-to-male, male-to-female, crossdressers, bi-gendered, and intersex are the major groups that fall under the term transgender.

“Transgender patients have many of the same health care needs as the rest of our patients,” said Eliza Buyers, MD, former member of The College’s Committee on Health Care for Underserved Women who helped develop the new recommendations. Health outcomes for the transgender community are very poor due to their lack of access to health care, noted Dr. Buyers. “It would be wonderful if all transgender patients had the resources to be seen in a specialized clinic, but the reality is that many forgo care because they don’t. By increasing the number of ob-gyns providing care to transgender patients we can help improve the overall health of the transgender community.”

Transgender individuals who were assigned female sex at birth but are now living as a male will continue needing breast and reproductive organ screening, unless they’ve had mastectomy or had their ovaries, uterus, and/or cervix removed. Male-to-female individuals who have had genital reconstruction may need cancer screening of the neovagina and breast cancer screening if taking estrogen hormones.

“Services that ob-gyns should be able to offer transgender patients include preventive care, Pap tests, sexually transmitted infection (STI) screenings, and hysterectomy for standard indications like heavy bleeding or pain,” said Dr. Buyers. The College recommends ob-gyns first consult with transgender experts before performing hysterectomies as part of gender affirmation surgery. “Hormone replacement can be managed in consultation with experts in transgender care, as many patients will seek hormones on the black market if unable to obtain them from their providers.”

Many, if not most, transgender people face social harassment, discrimination, and rejection from family and society in general. Many of them are homeless, particularly youth who identify as transgender. Transgender individuals are at an increased risk for sexually transmitted infections (STIs), including HIV, and physical abuse.

“We need to make our offices settings that treat all patients with respect,” said Dr. Buyers. The College offers ob-gyns suggestions on how to create an office environment that is welcoming to transgender patients. For instance, asking patients their preferred name and pronoun, posting non-discrimination policies, ensuring confidentiality, and offering sensitivity training for staff are all steps that signal acceptance and let patients know that they will be treated with dignity. “We want the transgender community to know that we, as ob-gyns, care about their health.”

Committee Opinion #512 “Health Care for Transgendered Individuals” is published in the December 2011 issue of Obstetrics & Gynecology.

More evidence against DEX for prenatal treatment of CAH

Related post – Prenatal steroids to prevent boyish baby girls (5/19/11)

On 10/19/11 Science Translational Medicine published the research of Dr Emily Tam, MD, assistant clinical professor of child neurology at UCSF, et al demonstrating Preterm Cerebellar Growth Impairment After Postnatal Exposure to Glucocorticoids. Per study abstract:

“As survival rates of preterm newborns improve as a result of better medical management, these children increasingly show impaired cognition. These adverse cognitive outcomes are associated with decreases in the volume of the cerebellum. Because animals exhibit reduced preterm cerebellar growth after perinatal exposure to glucocorticoids, we sought to determine whether glucocorticoid exposure and other modifiable factors increased the risk for these adverse outcomes in human neonates.”

MRI studies were performed on 172 premature infants exposed to steroids before birth in order to evaluate resultant structural abnormalities of the brain. Betamethasone (the drug of choice to minimize the risk of neonatal respiratory distress syndrome in premature infants) was not associated with measurable differences from controls. However, both dexamethasone (DEX) and hydrocortisone were associated with an 8-10% decrease in the size of the cerebellum, the part of the brain responsible for motor control, balance and cognitive function. The association between cerebellar hypoplasia and impaired motor and cognitive function is well established.

So what does this have to do with congenital adrenal hyperplasia (CAH)? As discussed in my earlier post, Prenatal steroids to prevent boyish baby girls, DEX is a controversial treatment offered to women at risk of having a female fetus with CAH with the only aim being to avert masculinization of her genitalia (enlargement of the clitoris, fusion of the labia and elongation of the urethra). This treatment unnecessarily exposes 7 out of 8 fetuses to high levels of DEX (60 times higher than a normal physiologic level) and many of those female fetuses with CAH aren’t even at risk.

This article provides further evidence that DEX is dangerous, shrinks brains in addition to clitorises and may result in lifelong deficits in motor and cognitive capabilities. Other known risks for babies are:

  • Decreased birth weight
  • More shyness, social anxiety and emotionality
  • Less sociability
  • Poorer working memory (ie reading comprehension) and self-perceived scholastic competence
  • Less masculine males with more neutral gendered behaviors

DEX treatment is NOT the standard of care, it is experimental and controversial and mounting evidence continues to demonstrate that its risks outweigh its benefits.

“Physicians should not sell themselves short in imagining that they cannot — with their words as much as with their knives and drugs — influence parents to accept their children’s bodies and the possibility that their children could lead rewarding lives with those bodies.”
Dr Elizabeth Reis, PhD

Brianna Amat is “The Kicking Queen”

Move over Miss Congeniality…

  • Homecoming queen? [check]
  • Kicked winning homecoming field goal? [check]

Micheline Maynard, New York Times, reports “On Friday [9/30/11], with Pinckney leading powerful Michigan rival Grand Blanc, 6-0, at the half, Amat, the first girl to play football for the school’s varsity, was asked to return to the field. When she arrived, she was told that her fellow students had voted her queen. When the tiara was placed on her head, she was wearing not a dress, like the other girls in the homecoming court, but her No. 12 uniform, pads and all. A short while later, with five minutes to play in the third quarter, Amat was called to the same field to attempt a 31-yard field goal. She split the uprights. The kick proved decisive as Pinckney held on for a 9-7 victory against a Grand Blanc team that had come into the game ranked seventh in the state in its division. It also earned Amat the nickname the Kicking Queen.”