Council award
tioner to reach beyond the medical model to
which they are accustomed. Adolescence is
second only to infancy in terms of the degree
of change undergone through this period of
their lives. Our medical input is just one of
the many competing domains that preoccupy
them. Hence, they may not necessarily be
ready to accept our advice, leaving providers
potentially frustrated and even angry. My experience is quite the opposite. When working
with youth, I feel that I am auditioning as I
attempt to establish a safe space within which
they can divulge their most worrisome concerns and within which we can work collaboratively to help them achieve their dreams.
Q: You also work with transgender
teens. What are some of the unique
health issues that confront these patients?
A: Their primary health risk derives from
the intense dysphoria they experience – the
intense dismay at seeing their bodies develop
and function in a way that they know is
intrinsically a mistake. This may provoke an
internalized sense of shame and self-criticism
which is associated with depression, anxiety,
self-injury, or suicidal behaviour. Happily,
through the commitment to working with
families and advocacy within the community,
particularly in schools, many of these threats
can be substantially mitigated.
Q: What are some of the research gaps
around transgender adolescent health
that you’re hoping your research will fill?
A: Research intended to better understand
and to serve trans youth is still in its early
stages. Research done in the past has not
always benefitted or at times respected the
studied population. How many young people
are struggling with this issue? How do we best
support children and families in fostering a
positive sense of self, however they wish their
gender to be expressed? We need data to help
18
Dialogue Issue 1, 2016
us better guide young people and their families regarding optimizing outcomes through
timely interventions.
Q: What are some of the commonalities
between eating disorders in adolescents
and transgender health issues? Do you
see a lot of crossover in these two areas
of your work?
A: There is a significant over-representation
of eating disorder diagnosis and behaviour
among the gender dysphoric population.
Youth with gender dysphoria are highly
dissatisfied with their outward appearance because it does not match what they feel inside.
Youth with eating disorders have significant
body dissatisfaction because their distorted
perception makes them feel that their bodies are too large and hence that they, too, fail
to live up to societal expectation. The treatment strategies, while different, both seek to
empower the family and to help the young
person feel comfortable in their own skin.
Q: Good communication is paramount
to the clinical work you do with adolescents. What advice would you give to
physicians for whom good communication skills don’t come easily?
A: Effective communication with our patients
makes our work so much more satisfying. As
providers we need to move from a hierarchical
to a collaborative relationship. We must be
prepared to not know all the answers and to
learn from our patients. In listening to their
narrative, we can put ourselves in their shoes.
The youth bring to the table their strengths,
their optimism and their dreams. We bring
our experience, our judgment and our more
developed cognitive skills. This potential
synergy ensures that the youth will no longer
have to feel isolated and alone.
This interview has been edited and condensed. As told
to Mark Sampson.