Matching Mind & Body

Individualized care is key in transgender medicine. There are multiple surgeries and multiple hormone treatments. In this podcast, Joshua Safer, MD, Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery, discusses the role of medical care.


[00:00:00] Stephen Calabria: For the Mount Sinai Health System in New York City, this is Road to Resilience, a podcast about facing adversity. I'm your host, Stephen Calabria, Mount Sinai's Director of Podcasting. On today's episode, and in honor of Pride Month, we welcome Joshua Safer, MD.

[00:00:17] Dr. Safer is the Executive Director of Mount Sinai's Center for Transgender Medicine and Surgery. In this role, and many others throughout his career, Dr. Safer's work has focused on providing safe and accessible treatment for transgender patients.

[00:00:31] As Dr. Safer makes clear, the medical and social challenges involved in transgender medicine illustrate the overwhelming resilience each of his patients must exhibit. We're honored to have Dr. Joshua Safer on the show.

[00:00:44] Dr. Joshua Safer, welcome to Road to Resilience.

[00:00:48] Josh Safer: Well, thank you for having me.

[00:00:50] Stephen Calabria: Could you give us some overview of your background and how long you've been involved in transgender medicine?

[00:00:55] Josh Safer: I'm an endocrinologist myself by training, and I started seeing transgender people in approximately 2004. And then I was involved in developing a program at Boston University when the insurance landscape changed, and allowed us to provide care for transgender people as part of a standard medical operation.

[00:01:20] That was 2015 2016 when Mount Sinai set up its program here. And I joined. The program here in 2018.

[00:01:29] Stephen Calabria: What does resilience mean to you in your practice?

[00:01:32] Josh Safer: Resilience means putting up with adversity and succeeding in any case.

[00:01:41] Stephen Calabria: Well, how is that reflected in what it is that you do?

[00:01:44] Josh Safer: Well, it's no surprise, I think, to just about anyone who knows anything about transgender people, that there are barriers to care that have been there for years, and there has been a surprising targeting of transgender people by various groups with, I think, various other motives.

[00:02:07] Making for a very uncomfortable reality the past few years. And yet, it's striking to me to observe in my clinic that, it's really quite a festive place. That is to say that my patients, despite all of this, are in surprisingly good places in terms of their mental health when they come to see us.

[00:02:30] Stephen Calabria: It'd be helpful if you could start us off with a clinical definition of what constitutes transgender care.

[00:02:37] Josh Safer: Transgender people are anyone whose gender identity, that is, the biology of your brain that tells you what sex you are anyone who has their gender identity not completely aligned with the rest of their biology.

[00:02:53] Specifically, their genitals and such. And transgender care, or gender affirming care, there are several terms, are medical interventions we can do to help people align the rest of their biology with their gender identity. That is, with their brain biology.

[00:03:12] Stephen Calabria: Now what makes an endocrinologist the, or one of the, best people to undertake this.

[00:03:20] Josh Safer: Well among the things that we can do for transgender people our hormone treatments and surgeries and most transgender people who have medical interventions have hormone treatments of various sorts very much the domain of us endocrinologists.

[00:03:39] Stephen Calabria: If you would, walk us through a typical life cycle of care for a given patient. Is there a specific age range at which patients first start coming to you and why do they start coming to you?

[00:03:51] Josh Safer: We see people across the entire lifespan and people are very heterogeneous in terms of their needs. The people look for hormones, people look for surgery, some people look for no interventions at all, actually.

[00:04:05] And we individualize treatment to do what makes most sense for people influenced by where they sit in society. There are other partners and relationships and such. So we see people coming to us, typically younger, meaning not older people.

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