Pink toenails

                       “Well, how about the fact that encouraging the choosing of gender identity, rather than suggesting our children become comfortable with the ones that they got at birth, can throw our species into real psychological turmoil—not to mention crowding operating rooms with procedures to grotesquely amputate body parts?”

What is this quote from? Toemageddon made the news last week in ABC, CBS, with most of the controversy stemming from Fox News.  This is not a news story, but I’m not surprised Fox picked it up. It does surprise me, however, that the author of the op ed piece is a psychiatrist, and frankly this is professionally irresponsible.

Medicine isn’t exactly the most liberal profession, but it is our job to remain neutral, non judgemental and do what is best for our patients, even if includes life choices we would not make for ourselves. Controversial examples of this (although it baffles me that these are controversial) include harm reduction with needle exchanges, STI/sex education, methadone centers, and treating transgender patients with hormones.  But this is not a discussion about transgender children.  Pink toenails do not, in any way, make a gay or trans child.

Many things we consider inherently masculine or feminine are solely cultural constructs. Color coding pink to girls is a recent development:  “The Sunday Sentinel in 1914 told American mothers: 'If you like the colour note on the little one's garments, use pink for the boy and blue for the girl, if you are a follower of convention.'” My father was put in dresses as a baby. The Scots wear kilts.

There are, of course, biological differences between the sexes. The prevalence of many diseases differs based on sex, anatomy and reproductive organs are different – but there are overlaps. Skene’s glands are considered to be the female prostate (and are responsible for female ejaculation), clitoromegaly (which can be a symptom of a congenital anomaly or simply be normal variation) can look like a penis.  If you give a female testosterone, as in the treatment of transgendered individuals, facial hair will grow and menstruation will stop. The dichotomy of the sexes isn’t such a binary after all, but a spectrum. 

So this is not a discussion about transgender children, as I said, but there are important points to be made regarding the treatment of transgender people and about their discrimination within medicine.  The idea that letting children of both genders engage in the same activities, like painting toenails will lead to “crowding operating rooms with procedures to grotesquely amputate body parts," especially needs to be addressed:

#1 – transgendered people are, by far, a minority.  (the American Psychological Association estimates 1 in 10,000 male births and 1 in 30,000 female births.) While the cause is likely multifactorial and not well understood as of yet, we are at least 85% sure that it's not due to pink nail polish.

#2 – There is so much discrimination in health care towards transgender individuals, by the time someone presents to the medical community for help in their transition, it is something they have given a whole lot of thought to. Think about the last time you went to your doctor – did you think about what you wanted to say? What you wanted to ask? How much time did you spend on your mental preparation? Multiply that by years of feeling like you exist in the wrong body.  The idea that something like painting one’s toenails can make one transgender in a flash is preposterous. Moreover, that it will cause “crowding [of] operating rooms” is intentional inflammatory hyperbole.

#3 – Calling transgender surgery grotesque amputation of body parts is wholly irresponsible for it adds to the misconceptions and discrimination faced by these individuals.  The more stigma there is against any group of people in society, the more at risk their health is from long-term stressors. Teen suicide related to perceived sexual orientation has been in the news quite a bit recently. Many transgender people and those who treat them see transitioning as medically necessary.   There is a high risk of depression and suicide in transgender youth, especially related to stigma, harassment, and discrimination.  Any healthcare professional who adds to this stigma and discrimination, goes against his or her oath to do no harm. 

Thanks for the reminder

Sometimes, it’s easy to forget what I’m doing here. Four hours of class. Another 3-6 hours going over those lectures, mandatory clinical sessions, hospital visits, and sometimes managing to cook a meal, there’s not much time in the day for reflection.

So it’s really great to have an amazing significant other (SO) to help remind me why I came to medical school in the first place.  SO is a bit younger than I, and thus a little less jaded, although still plenty angry at the state of affairs in the world. My anger at such things has faded into, “well that’s just how it is.”  I still get angry when people are shocked when they hear about homeless kids or drug addicts who are the victims of domestic violence, or a college graduate becoming homeless.  My reaction is, “really? You’re shocked and appalled? Where have you been? These things happen on your doorstep, in your city, on your block, everyday!”  But that anger has faded, and the momentum to do something about these things has slowed. 

Hello? SR? This is why you came to medical school! Social justice! You’re a science nerd who loves the world a little too much, did you forget? Everyone deserves healthcare, because without health, one can’t pursue the life of one’s choosing, and everyone deserves those choices. That’s what I believe, that’s what I want to help provide and fight for in my career.

Thank you, SO, for waking me up.  The boards are looming, scheduling third year, and the prospect of life after med school seems feasible and scary now. Thank you for pulling me back down and reminding me why I came here in the first place. I know you didn’t even mean to. You were simply venting your frustrations about your own efforts to make social change. But I saw myself in your words. I don’t know what the answers are or how we can make meaningful change, but I have to believe our efforts will help someone.  I don’t know how to fix all the systematic problems that lead to poverty, lack of healthcare, discrimination and all the unfair things in life. All we can do is try. I’m so happy you’re someone who tries. Thank you for reminding me that I am too.