Terry Streetman (Host): Hello, I'm Terry Streetman, Riverside Marketing Communications Representative, and I'm joined on the Well Within Reach podcast today by Dr. Uddin, a Riverside endocrinologist, here to discuss gender-affirming care, a treatment offered by Riverside Medical Group Endocrinology Specialists. Thanks for being here today, Doctor.

Dr. Ashraf Uddin: Glad to be here.

Host: I know you're a returning guest, so you're already a pro at this.

Dr. Ashraf Uddin: You can say that.

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Host: So Dr. Uddin, can you remind folks from last time about your background and your role here at Riverside?

Dr. Ashraf Uddin: I'm an endocrinologist over at Diabetes Endocrinology here at Riverside, and I have a passion in gender-affirming care, and that's what I'm here to talk about today. We see a multitude of endocrine diseases as well, like osteoporosis, thyroid disorders, diabetes, low testosterone, among several others, as well as obesity management, which is one of our new programs. And I'm just happy to share my expertise with the community.

Host: Awesome. We appreciate it. So, we've kind of started touching on the subject. Can you explain for our audience sort of what gender-affirming care is and some of the reasons someone might pursue it?

Dr. Ashraf Uddin: Yeah. Gender-affirming care is treatment that helps you feel like the internal gender you feel is matching the external gender, so that you don't have this feeling of what we call dysphoria, which makes you feel uncomfortable in your body, can affect you in multiple facets of your life, whether that's mental, physical, people have a lot of different symptoms relating to this. Also, technically, it also does not just only apply to transgender people. It's also true for cisgender people, and we've been doing gender-affirming care for some time. So, things like treating somebody for low testosterone, even for a cisgender person, so meaning somebody who was born male at birth and feels like they are male gender, that's also technically gender-affirming care.

Host: All right. Well, thank you for that. And so we've alked about sort of what it is, what sort of services do you provide here at Riverside for gender-affirming care?

Dr. Ashraf Uddin: So, I'm an endocrinologist, so primarily what I do is we kind of have like a role that's almost like the primary care doctor for transgender patients because it's a kind of an evolving field particularly in the United States. And these patients need somebody who's had some expertise for their unique set of problems and things that they have to be watched for.

In particular, what we specialize in is adjusting hormone therapy so that they can kind of achieve the outcomes that match their internal gender. But in addition to that, we have plenty of different services here at Riverside that we can refer them to to help them with, like, vocal training, as well as making sure that we have assessed desires for fertility in the future before starting on a hormone replacement therapy, either that's also screenings for that may be unique for whatever organ systems that that patient may have and watching for complications from hormone therapy and readiness for surgery as well.

Host: Okay. Well, it's great to hear there's sort of an all-around approach to this kind of care. So, we appreciate you giving some of that information because it seems to me like gender-affirming care is something that is poorly understood and has a lot of misconceptions about it. So, I'm wondering if you could share and debunk some of the misconceptions around it.

Dr. Ashraf Uddin: Yeah. Some of that I kind of already alluded to earlier, and I'm kind of trying to make sure that I frame it in the way that we have built our program at the clinic, that this is another medical issue that is not any different than anything else that we manage, whether it's diabetes, osteoporosis, low testosterone, et cetera, et cetera. But a lot of the misconceptions revolving around gender-affirming care have to do with this being a new phenomenon, just because it's gotten a lot of media attention, a lot of political attention as of recently. But people who are trans have existed for some time long before this, and have been getting treatment in other countries. And it's just a matter of the access to care increasing in more recent times as we become more progressive, more open, more understanding to different sorts of lifestyles, as well as different sorts of gender identities.

And I think that was probably the main misconception. Other things happen to do with the safety of it. It's rather safe, and the, benefits of it definitely outweigh the risks for this population. It's one of the few treatments that we have in patients that we can do to lower the risk of death, ultimately, because suicide rates are very high in patients with gender dysphoria and trans that are not able to overcome the dysphoria. And things like hormone replacement, surgeries, as well as other therapies are able to do this, and how many people do we know that are going through depression and other mental health disorders, and we wish we could do something to fix that. And in this set of patients, we're able to do that.

The last misconception that we find in this group of people is that this is a very large, growing group of people, but it is growing, but it's more so in the sense of recognition that this kind of gender dysphoria can exist, and it's very similar to how back in the day we used to say it was bad to be left-handed, you know, suddenly you would have a ton of people ever since that years afterwards saying that hey I am left-handed. You could look at charts in that regard. Same sort of thing is occurring with gender dysphoria and people realizing the trans. But it really is about somewhere between a half percent and one percent of the population at its maximum.

Host: Okay. Well, I'm glad that we're able to provide this information and provide this care for folks who really need this. So before we get into our next question, we'll take a quick break to talk about primary care at Riverside.

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So, we'll jump back into it. What factors should someone consider if they're deciding whether this treatment is right for them?

Dr. Ashraf Uddin: I think that if that question arises with an individual, they should really talk with a doctor to go through those appropriate questions to feel like if that dysphoria is something that is consistent with gender dysphoria. There are some conditions that have some overlap with gender dysphoria that can mimic it, such as like body dysmorphia, et cetera. But most of the time it's a pretty clear-cut thing that when somebody has a gender dysphoria or is trans, I think that it's something that most patients come to the conclusion on their own, at least historically, because they haven't had access to care or understanding of care. But there is a newer group of young patients that are finding out that they may or may not have this condition.

And in that situation, usually, the guidance of a doctor will help. Like I was describing, I like to think of myself as the primary care in this set of patients to help guide sort of some of these decisions. Not everybody needs hormone replacement therapy or surgery or et cetera, all the therapies. It may be sometimes just finding the right people to see to kind of work through some of the symptoms and problems they're having. Some people, it may be a little bit of HRT. Some people, it may be going through surgery and all those things. And that's a process that we can determine together.

Host: Okay. Well, then, we've kind of touched on this a little bit, sort of from an overview standpoint, can you talk a little bit about what that referral and treatment process might be for somebody who's considering?

Dr. Ashraf Uddin: We take referrals generally for the diagnosis of gender dysphoria, but pretty much any diagnosis that relates to transgender identity can be used to key us into that's what the referral is for. It's just a matter of asking your primary doctor to come into the endocrinology clinic. We are a specialist, so that's our base for our clinic to come in and get seen. But after that, it's pretty simple. Once you get in, we can start your care, and it's pretty prompt, and we'll sort through things. And it can be as soon as a couple months after seeing us that you're on hormone replacement therapy.

Host: All right. So, you've talked a little bit about the dysphoria and some of the mental health impacts that folks experience, sort of as they're going through this process, and then some of the other supports that they need. Can you talk a little bit about how you work with other professionals to support patients in more of a holistic, whole-person way?

Dr. Ashraf Uddin: Yeah. When we see a patient, we try to identify what are the main things that are causing the sense of dysphoria for a patient. And then, we identify what things we can manage and see kind of what gets better with either hormone replacement therapy or seeing mental health providers, finding somebody to help you with like the legal name change processes, speech therapy, et cetera. We try and delegate the appropriate things that we can't manage with other individuals in our system. And if not, the people outside the system as well, including surgeons.

Host: Oh, great. Well, I'm glad that there's resources that folks can be connected to, because obviously this is a pretty significant thing for folks who need and seek this treatment. So, that's great that we're covering all those bases. So, we're getting towards the end here. Is there anything else that we haven't covered that you'd like to add for our listeners?

Dr. Ashraf Uddin: I just wanted to let them know, if there's transgender individuals out there that are seeking care, that we are offering this here, you are not alone in your journey, and I'll be happy to help you guide your way through this. And I'd be honored to help you through this path of self-discovery. We are probably the only place, other than the city in here, you know, probably like 80, 90-mile radius. So, we're happy to bring this service to the community. And that's unique. And I encourage everyone to seek it out.

Host: Awesome. Well, thank you for joining us today. We really appreciate the information and, letting people know that this treatment, these services are available close to home, so they don't have to, you know, travel outside the area. For our listeners, if you're interested in learning more about gender-affirming care or other endocrinology treatments, you can call Riverside Diabetes and Endocrinology at 815-936-8909, or visit myRHC.net/endocrinology. Thank you for tuning into Well Within Reach presented by Riverside HealthCare. Please take a moment to rate and leave a review for Well Within Reach on Apple, Spotify, or wherever you get your podcasts. And to learn more about Riverside, visit RiversideHealthCare.org. Thanks so much for talking to us today, Doctor.

Dr. Ashraf Uddin: No problem.