This trans health expert just blew up major myths about what it means to be transgender

The past few months have been marked by increasingly shrill debates over whether trans Americans should be allowed to use the bathrooms of their choosing—and have highlighted the fact that many of our country’s leaders have no idea what it means to be trans.

Officials in favor of so-called “bathroom bills,” which would force trans people to use bathrooms that align with the gender on their birth certificates, suggest that trans women pose a threat to cis women and girls. That’s not true—there’s no evidence to support those fears. In fact, violence against trans people spiked significantly in 2015, making it remarkably important to offer them protections now.

Trans youth are especially at risk. According to a 2015 study published in the Journal of Adolescent Health, trans kids and teens are more likely than their peers to experience mental health struggles, including self-harm and suicidal tendencies.

So Thursday’s Reddit AMA with a trans health expert who specializes in working with trans adolescents couldn’t have come at a better time. Dr. Kate Greenberg, who serves as the director of the Gender Health Services clinic at the University of Rochester Medical Center, offered insightful answers to a number of Reddit user questions curious about her work.

“Growing up in a world where outward appearance and identity are so closely intertwined can be difficult, and health professionals are working to support transgender people as they seek to align their physical selves with their sense of self,” Greenberg said by way of introduction.

Through her answers, Greenberg busted a fair number of myths that even more progressive thinkers might hold on to. One Redditor asked, “is it not unethical to use treatments such as puberty blockers at such young ages [pre-pubescence] for patients? Shouldn’t the patients have to be of age to choose, as is the case with pretty much all other body modifications, such as tattoos, piercings etc.?”

Greenberg’s answer was, basically, no. “A perspective that I try to share with parents of my patients, who are in essence allowing their children to choose this or choosing for their child, is that not offering available medical treatment is not a benign option.” She explained further:

For me, it would be unethical to withhold care from a kid for whom the idea of going through puberty is terrifying and likely to vastly increase their distress. For young people who think of themselves as male, the idea of growing breasts and having a period is VERY distressing, and similarly for identified trans-girls the idea of getting facial hair, and a deeper voice, and taller, is not a benign option. Having a young person go through puberty that isn’t aligned with their gender also sentences them to irreversible effects — there is no standard treatment to allow a post-pubertal trans woman to change her voice to a more feminine pitch, and for a trans man to get rid of his breasts requires surgical intervention.

The doctor told a different user, who asked if she worries that “some children are going through a phase and may regret their decision to surgically transition later in life,” that the first step toward transitioning is reversible.

“The youngest patients we see for medical treatment are those who are approaching or have just started puberty; they are offered pubertal suppression,” she said, adding, “which are fully reversible and very safe. Between suppressing biological puberty being sure that this is not a ‘phase’ and the kid is ready to move forward with their affirmed puberty, through hormone treatment, there’s a lot of work being done with the kid, family, etc. to be sure that this the right choice.”

Greenberg also fielded questions from medical professionals who want to best serve trans patients. She explained that trans individuals require different types of care, depending on how they’ve been transitioning. One medical student asked, “If a transgender individual undergoes a medical transition, suppose a male to female, do they go to the gynecologist for their future care?”

She explained that “trans patients can need trans-specific care, like hormones or surgery, but also need primary care based on their anatomy.” She continued:

When speaking with patients, I often ask for an ‘organ inventory’ which I phrase as ‘I need to know what surgeries, if any, you’ve had so that I know what body parts you have. My job is to make sure those parts are being taken care of as well.’ So a trans man who hasn’t had a hysterectomy/oophorectomy will need cancer screenings for those body parts as recommend by standards of care for cis-women; a trans woman who has had vaginoplasty will not need PAP smears, but will need clinical breast exams and breast cancer screenings like a cis-woman. Trans women will always have prostates, regardless of surgery, and so will need screening there. And trans men who’ve had chest reconstruction still need breast exams, and with a significant family history of breast cancer may also need additional imaging for cancer screening.

Overall, her answers are a breath of fresh air for those sick of seeing uninformed opinions being thrown around as fact, and are worth reading in full.

Danielle Wiener-Bronner is a news reporter.