Q&A: Head of a gender clinic for youth

Name: Dr. Stephen Rosenthal

Age: 65

City: San Francisco

Position: Director, UCSF Child and Adolescent Gender Center

Dr. Stephen Rosenthal

J: For most of your career you’ve been a UCSF pediatric endocrinologist. In 2012 you opened the Child and Adolescent Gender Center, which offers medical and psychological care to gender nonconforming and transgender youth. How did it come to be?

Dr. Stephen Rosenthal: In my role as director of endocrinology clinics, I triage new consultation requests. One parent reported he had a 12-year-old who was assigned female but identified as male. They came in asking for help. When we got that request, none of us had any experience in the care of transgender youth.

How does the field of endocrinology, the study of hormones, connect to transgender issues?

My clinic was aware that Dutch researchers had pioneered an approach to the care of transgender adolescents. If you look at gender nonconforming children before they reach physical puberty, it’s difficult to know whether they are having a variation in gender identity, or in expression. Gender dysphoria is the distress and anxiety a person might feel around their gender. Not every transgender person may feel such a level of distress that they need to seek medical solutions to make alterations to their body. What the Dutch found was that only a minority of those kids, maybe 15 to 25 percent, still met the criteria of transgender by puberty and had some form of gender dysphoria. If you persist with these traits, the data suggest you are likely to be transgender throughout life.


What is the treatment?

The Dutch pioneered the use of what we call pubertal blockers, hormones that selectively, temporarily and reversibly turn off the hormones in the pituitary gland, whose role is to turn on the ovaries and testicles. Once these are secreting testosterone and estrogen, that’s what leads to all the physical changes. There was a clever pediatric endocrinologist in Holland who more than 20 years ago said if we know the criteria of transgender, why not let [young patients] have an opportunity to put puberty on pause and have more time to explore their gender identity.

Are these drugs safe for children?

This class of drugs is very familiar to a pediatric endocrinologist. These medications became the gold-standard approach to a different condition we call precocious puberty. We have more than 30 years of experience with these drugs, and their safety profile is excellent.

In 2009 when this family approached me, they asked for pubertal blockers. We realized not only that this was a possibility, but also [knew] the consequences of not helping these kids, which include a tremendous risk of depression, suicide attempts and suicide in trans people who feel they are not supported.

Does your center takes a holistic approach with family, social and psychological assistance, as well as medical?

We had this dream of creating the best possible multidisciplinary program and being the best place to support kids and their families. We’ve had well over 400 patients in the program. We started out one clinic once a month to now a weekly clinic, and expanded to two satellite locations in San Mateo and Oakland.

Having a transgender child must be difficult for some parents.

We meet the family where they are. You can’t even come into the clinic if you don’t have at least one supportive parent. Who knows how many kids we haven’t seen because they don’t have supportive parents? It is not unusual to have one parent with arms crossed and an angry look, so it’s important to let the family know that we have no agenda. Not everybody who comes into our program transitions [the process of altering one’s birth sex]. We don’t do anything without strict criteria, both medically and in terms of mental health.

This has been a big year for the transgender community, with President Obama issuing guidelines to protect the rights of transgender students. But there also has been a backlash to the so-called “bathroom law.”

I don’t think there’s any question that things are better but, no surprise, when an advance is made there is some sort of backlash. How long was it after the president made those proclamations that 11 states sued the federal government? Every kid wants to feel safe at school, and knowing [transgender] kids are already marginalized how important it is for them at least to feel safe and affirmed in school.

You’ve been in the Bay Area since 1970 but grew up Jewish in Hartford, Connecticut. Can you tell me about your family and background?

When I think about why this work touches me deeply, it’s because I’m gay and was a bit gender nonconforming in my own right as a young kid. Whatever sensitivities I have that give me my ability to feel empathy, that comes from my parents and their parents. My father’s mother was born in Palestine. Her husband was from Romania. My mom’s mother came from Lithuania and my grandfather was from a shtetl in Ukraine. I grew up in a Conservative home, had a bar mitzvah and went through Hebrew school through high school. In my family you either became a doctor or a lawyer. I’m lucky because I ended up finding something in medicine I liked.

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Dan Pine

Dan Pine is a contributing editor at J. He was a longtime staff writer at J. and retired as news editor in 2020.