Understanding Gender Dysphoria and Affirming Care: An Interview with Dr. John Dornan

In a recent interview with Vicki Hogarth on CHCO-TV’s Southwest Magazine, Dr. John Dornan, an endocrinologist with nearly 37 years of experience in New Brunswick, shed light on the intricacies of gender dysphoria, its early signs, and the importance of gender-affirming care. Dr. Dornan, who has extensive experience treating hormonal problems such as diabetes and thyroid issues, has also been involved in gender-affirming therapy, making him a pivotal figure in this field.

Defining Endocrinology and Gender Dysphoria

Endocrinology, as Dr. Dornan explains, involves the study and treatment of hormonal problems, with significant areas being diabetes and thyroid issues. However, it also encompasses the treatment of gender dysphoria, a condition where a person’s gender identity does not align with their biological sex. Dr. Dornan elaborated, “Where gender dysphoria or transgenderism comes into play is that very often the hormones that a person has support their biologic gender. As they go through transitions, it’s often necessary or preferred to help provide gender reaffirming therapy in the form of hormones.”

Early Recognition and Treatment of Gender Dysphoria

When asked about the age at which gender dysphoria can manifest, Dr. Dornan emphasized that there is no definitive age, although it often becomes noticeable in early adolescence. “When I started helping people with gender dysphoria around 1990, I hadn’t contemplated that it would be an issue for younger people,” he noted. Many individuals recall recognizing their gender incongruence during their teenage years, and as awareness and understanding of gender dysphoria have grown, younger populations are now more frequently diagnosed.

Role of Puberty Blockers

Puberty blockers are a critical component in managing gender dysphoria, especially in younger individuals. These medications delay the onset of puberty, allowing children more time to explore their gender identity without the added stress of developing secondary sexual characteristics. Dr. Dornan explained, “If children identify as transgender and have the support of parents, teachers, psychologists, and it looks like they are truly transgender, the earlier you intervene, the more likely they do not develop into the gender that they don’t want.”

Puberty blockers are typically considered at stage two of sexual development when early signs of puberty begin to appear. The use of these blockers is not without side effects, but Dr. Dornan stressed the importance of a supportive network, including parents, teachers, and psychologists, to help manage any adverse effects and ensure the well-being of the child.

The Journey Beyond Puberty Blockers

For many individuals with gender dysphoria, puberty blockers are just the beginning of their transition. Hormone therapy is often the next step, with testosterone being administered to transgender men and estrogen to transgender women. Dr. Dornan shared that the effects of these therapies are carefully monitored and tailored to the individual’s needs and goals.

Testosterone Therapy for Transgender Men

For transgender men, testosterone therapy can be administered in various forms, including injections, topical gels, pills, and patches. Each method has its advantages and potential side effects. Injections are the most affordable but can cause fluctuations in hormone levels, while topical gels provide more consistent levels but may be costlier. Pills are an option, though not always effective, and patches are less commonly available in Canada. The goal is to achieve the desired masculinizing effects, such as increased body hair, deepened voice, and muscle development, while minimizing adverse side effects.

Estrogen Therapy for Transgender Women

The process for transgender women is more complex, often involving a combination of estrogen, spironolactone (a testosterone blocker), and sometimes cyproterone acetate, another testosterone blocker. These medications help feminize the body by promoting breast growth, reducing body hair, and reshaping body contours. The earlier these treatments are started, the more pronounced the effects.

Surgical Interventions

Not all transgender individuals opt for surgical interventions, but for those who do, the procedures are often covered by Medicare in New Brunswick, a significant advancement in transgender healthcare. For transgender men, mastectomy, or chest reconstruction, is a common and often desired surgery. Dr. Dornan highlighted the expertise of local surgeons in performing these surgeries, ensuring that patients achieve a male-contoured chest.

Addressing Mental Health and Risks

The mental health of transgender individuals is a critical concern, with a high prevalence of depression and suicidal thoughts. “40% of all transgender people will attempt suicide at some point in their life,” Dr. Dornan revealed, underscoring the urgency of providing timely and effective care. Hormone therapy can significantly improve the mental well-being of transgender individuals, offering them a sense of affirmation and congruence with their gender identity.

Regret and Reversibility

While concerns about regret in transgender individuals undergoing hormone therapy or surgery are often discussed, Dr. Dornan’s experience suggests that such cases are rare. “In my practice, except for two cases, I have not seen people with regrets,” he stated. The thorough assessment and gradual approach to treatment help minimize the risk of regret, allowing individuals to explore their gender identity safely.

Public Discourse and Policy 713

The public conversation around gender-affirming care, particularly with the introduction of changes to Policy 713 in New Brunswick schools, has brought the issue into the spotlight. Dr. Dornan expressed disappointment at the polarizing nature of the debate, emphasizing the importance of focusing on supportive care for transgender individuals. “Children that have gender dysphoria are not a big part of our population... but it’s an important issue for those children and those parents and those caregivers,” he noted. He advocates for a compassionate and informed approach to transgender care, prioritizing the well-being and safety of individuals experiencing gender dysphoria.