Kaiser for trans teen

I don't have any experience with Kaiser, but I have a trans daughter that came out to us a few months ago. She hasn't started hormones yet, but it being seen at Stanford. If you are interested in chatting, please contact me through BPN.

i cannot speak to healthcare on this for you. i’m just weighing to applaud you for your kind, loving and level headed approach. and offer a cautionary tale. my teen niece went thru all this over the last three years. she was in the drivers seat with divorced parents who could not agree (mom against, dad didn’t like it but caves to kid on any/every topic) and a therapist who was not only not neutral but who actively championed this. as it wasn’t our kid we kept our mouths shut and watched from afar. the minute kiddo clicked eighteen it was off to florida for top surgery (he spend every waking minute not in school working to save money surgery for two years). the surgery was performed after only a single psychological evaluation. this kid has (and had a history) of significant mood disregulation, issues with executive functioning issues and possible personality disorder. is whip smart and extremely adept at splitting and manipulation. basically a highly pissed off kid unable to sustain relationships even with supportive friends and family. now kiddo has irreparably changed his body with surgery and hormones. is still miserable and feeling victimized by everything and everyone… including the transition. my heart is broken for him. i worked in an industry i loved with queer and a trans oeople for decades so i’m not some prude or backward thinker. but what has unfolded in my own family is nothing short of a greek tragedy. i have zero doubt there might be pushback on my opinion here, but it needs to be said. some kids insisting on medical solutions for problems that are not medical are a train wreck in the making. again my heart is broken for this kid and i’m angry at a system and all the ‘adults’ who allowed it to unfold. you are asking the right questions. refuse to get bullied into silence. either way this goes, your kid needs to you do your best for her especially the thankless job of asking hard questions and demanding answers. the chips are down. i hope is  for the very best outcome for your family.

I would go to genspect and get information, especially genspect.org/guidance.

Segm.org has info in all the countries which have been doing evidence reviews and finding it's insufficient to justify these serious interventions without being much more careful than the Wpath or us models. And much more.

A lot of places follow the affirmative model which does not include careful evaluation.

Drs. Edwards Leeper and Anderson wrote a great op ed about this in the Washington Post last fall. (Note that studies behind these interventions are low quality so that even people who do evaluations are not basing their evaluations on moderate or high quality studies.)

Dr. Anderson has had a few more in the sf examiner early this year and an interview in the uk daily mail last week.

There is a recent medical article by Stephen Levine and others, https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2046221 - "Reconsidering informed consent for trans identified...".

That might give you the best up to date information.

There's also a Medscape article by Will Malone from 2021 (about puberty blockers in the title).

Lots of parent stories at the Pitt substack.

A trans identification can be temporary and related to many things but many clinicians and schools are misinformed and think they have to affirm. That's not true. There's no reliable test to say when it's not temporary (very tough situation), but temporary versions have occurred when trauma, ASD, OCD,  wing gay, anorexia, separation anxiety, depression, etc. are involved.  Many bay area practitioners don't know this. Some even think that a young person is more at risk of suicide if they are not immediately transitioned.  This is false. You can also Google Sinead Watson or Keira Bell or Tullipr (substack) to hear from some of the many detransitioners out there.  No one knows how many detransition, there are inaccurate tiny numbers being thrown around,the studies are unreliable.  

Some people find their conflict between mind and body resolves with exploratory therapy.  Dont let anyone tell you trans is the new gay, one is self perception and one is sexual orientation (sexual orientation seems much less fluid).

It's very important to listen and understand where she is getting her information, too. Some people online will tell a young person that their distress is due to being trans and sometimes a young person stops exploring at that point.   A lot of people giving diagnoses online. 

Some kids also got exposed to porn and were so traumatized it led to a temporary trans identification.

It's not bigoted to explore and ask questions.be aware that se people will think he ser dysphoria is understood and that you should affitm and will treat you with condescension and pretend you are being a helicopter parent.  And will get your kid all excited about being independent and rebelling.  Buy this is a serious and not well understood condition and anyone who tells you otherwise is likely misinformed. 

Also be aware that social transition is not neutral.

Ask questions, this is medical care for your child and the misinformation out there is terrible!

Good luck!

My kid did not get a careful evaluation at UCSF, don't go there.

Please stay clear of Kaiser's gender clinics. They are about as far from "evidence-based medicine" as you can imagine. Our kid was put on blockers after a 1-hour zoom call with a social worker (we've taken our kid off after learning about the harm and because there was no decent mental health support provided — so much for that "pause button" to "explore" their gender). The clinical director wanted to put my kid on hormones despite NEVER MEETING HIM, which would sterilize him within 4 months. When I asked what criteria they use to determine who will and won't benefit from them, she said they have no criteria but get "kind of a sense of" who will benefit. She's since "retired" and the social worker didn't return from maternity leave. The rest are just as bad or worse. Sloppy and dangerous. If you find someone who does a comprehensive evaluation (Dr. Laura Edwards-Leeper's wait list is long, but thinning because people are backing away from this), ask them how long they follow-up with their patients. If it's under 6 years (some say 10 years is a typical time for regret), then they have no idea whether their evaluation is at all meaningful.

You also might want to listen to this podcast. The whole series is really helpful: https://gender-a-wider-lens.captivate.fm/episode/40-social-transition-a…. Someone mentioned the PITT substack (https://pitt.substack.com/). I would read some of those parent stories to get a better picture of things.

You are right to be concerned. I do not have any personal experience with the Kaiser clinic, but as a pediatrician, I have learned a lot about the gender affirming model which is what Kaiser and most other medical institutions embrace these days and I find it problematic, simplistic, and harmful. 

What this model says, among other things, is that what the child says about their gender should be believed-- i.e. taken at face value, regardless of the child's age, history, context, or any co-existing mental health concerns (which are typically attributed to 'interpersonal and cultural reactions to a child, not internal pathology')-- this despite the fact that many kids with gender dysphoria also have anxiety, depression, eating disorders, and/or autism. Another tenet of this model is that "cisgender is only one of many positive pathways-- no one pathway is privileged over another". As a parent and physician, it seems common sense to me that the pathway which allows the child to keep all their original body parts and avoid irrevocable consequences (like possible sterility) and a lifetime of mandatory medication should definitely be privileged. I believe nonurgent decisions with such irrevocable consequences can only be ethically made by fully matured adult brains, which usually happens around age 25. Especially when another tenet of this model is that "gender is not fixed at a moment in time, but a lifelong process". If that's the case (unlike, for example, sexual orientation-- which typically does NOT change over time), doesn't it make sense to explore ways to help kids make peace with the body they were born into?

If you want a 'comprehensive mental health assessment" of your child prior to medicalizing their distress, a gender clinic is definitely not the place to go-- since the affirming model does not view gender dysphoria as pathological, evaluations of mental health are viewed as unnecessary 'gatekeeping' and tend to be more of a rubber stamp (https://www.nytimes.com/2022/01/13/health/transgender-teens-hormones.ht…).

It sounds like you are looking for more of an open exploration of the bigger picture, which makes sense-- unfortunately this can be hard to find but here are a couple good places to start-- The Gender Exploratory Therapy Association ( https://genderexploratory.com/), https://inspiredteentherapy.com/.

Best wishes to you; this is not an easy journey for child or parent.

Run away from Kaiser for this issue. Not only do they not offer comprehensive assessment with their "affirmation only" model of treatment, we had to struggle with them NOT to send our teen to the MST (after a 10 minute Zoom session with them), eventually having to call on a therapist who had known our kid since elementary school to get them to back off before a more exploratory approach not immediately requiring hormones and surgery could be found. The MST clinic seems like a chute - especially if the child is simply in the beginning stages of exploring their gender. I got a distinct sense that Kaiser actively WANTED them to transition medically - despite the lack of evidence based, peer-reviewed research demonstrating long-term positive outcomes for this age group. These are kids who will often be dependent on hormones for life.  I am not transphobic, and do believe that hormones and surgery can be the right path - and life saving - for some who truly are trans, but believe that especially for an age group who are by definition trying lots of things to figure out who they are (and many of who have other mental health concerns) that thorough exploration is the best course. My trans friends transitioned as adults, after their pre-frontal cortexes had developed. I echo others here in urging you to look at the Gender Exploratory Therapy Association (https://genderexploratory.com/) and other resources. It has been hard to find resources that are not on opposite ends of the spectrum (either transphobic or "affirmation only") as the issue is so politicized, especially with the horrorshow of Texan politics. What has resulted, though, especially in the more progressive areas or our country, seems like a backlash resulting in well-intentioned professionals throwing a lot of kids under the train before thoughtful exploration. The GETA seeks to take the politics out.

I am glad to see that - following the path of other countries who are ahead of the US in this arena (Sweden, Finland, the Netherlands) and who have changed their protocol for treatment for this age group - the US may be heading in this direction as well. (See Levine https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2046221 )  Unfortunately it will be too late for many of these kids for whom the medicalized route is not appropriate. 

I don’t have any experience with Kaiser but you’ve gotten a lot of responses about the scary side of transition and just wanted to let you and anyone else reading know that my trans 19 yo is so much happier since medically transitioning. He did get a lot of therapy before starting the medical parts but he feels good about being himself now. Gender Spectrum has some good support groups for parents. I had many doubts and worries which still resurface sometimes but seeing him more comfortable in himself is so reassuring and incredible. It’s a lot to navigate and the current culture wars don’t make it any easier. Take care. 

Hi - My family and I have had an ultimately positive experience at the Kaiser gender clinic. (Our experience may or may not be relevant since our child began to want to explore questions about gender at a younger age (12).) Others have mentioned that things moved too quickly and casually, and I was worried about this too, but I shared my concerns with the gender therapist and she listened, and engaged with me in nuanced conversations. My child talked to her many times on his own and I wasn't part of those conversations, but it seemed to me that if anything she helped him relax and slow down about it all. (My child was initially sure of wanting to make a change, and in a hurry to do it, so that might be different from your situation too.) The doctors were also especially helpful for him and us in that regard. When I'd try to talk to my child on my own about my concerns about medical intervention, the conversations were painful and I could tell he just heard it as "I don't support you." But he was able to listen to his doctors, so we made appointments to talk to them together and I'd ask my questions and voice my concerns. They talked with him with gravity about what medical changes would mean, and he could hear them and ended up asking lots of good questions on his own. In fact he often emails them himself, even though I'm on the emails too. We did end up using an outside therapist as well, both for my child and for me and my husband, because I wanted to make sure we all got frequent, regular appointments and I wasn't sure that would be possible at Kaiser. One thing that I've really liked at Kaiser is the parent support groups. They're on Zoom, which isn't my favorite, but it's really convenient, and it feels like a big relief to be in the company of other parents who are facing these questions with their kids, and just be able to talk and voice what we're going through. In general I find the online/social media conversation about gender transition too polarizing and not nuanced enough. The live conversation with real people who are navigating their way through similar territory has been a real support to me. 

My family had a good experience with Kaiser's youth gender clinic and I have had good experiences collaborating with them as an external healthcare provider on the adult side of things. I think their providers are providing evidence based care and are taking good care of their patients. I'm sorry to hear other BPN families have not had that experience. As a family, I never felt like they were pushing us or rushing us/our child and I do feel like we got an appropriate evaluation. Our experience is recent, within the last 12 months, and we were evaluated promptly upon reaching out.

Every healthcare system is struggling to retain enough mental health providers so if you have the financial means and you aren't primarily pursuing hormone treatment (even if you are doing so in parallel), it may be worth pursuing a skilled therapist outside of the Kaiser system for some support and clarity. I can strongly recommend the mental health providers working in the UCSF Mind the Gap program. My family and child has had a wonderful experience with the therapist we have been working with through this program and the clinicians are located throughout the Bay Area: https://www.genderyouthproviders.com/

I personally would not recommend The Gender Exploratory Therapy Association that others here have directed you to. Its organization name sounds like it's fully exploring gender and that includes gender affirmation but the providers do not affirm transgender/gender expansive individuals.