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Introducing Dr. Eric Walser – Trailblazer in Prostate Cancer Treatment

Just down near the Gulf in Galveston, Dr. Eric Walser and his team of talented medical health professionals at the University of Texas Medical Branch’s Wavelengh Medical are tackling prostate cancer in a new way.

(GALVESTON) – There are a number of medical concerns that plague the LGBTIA community. When we think about health crises, a lot of thoughts can tend to center around topics such as HIV/AIDS, safe sex practices, hormone replacement therapy, and suicide coupled with the dangers of untreated mental health. While none of these issues are necessarily specific to just our community, they have historically played a larger role in the lives of LGBTQIA people than they have in other communities. However, it is important for queer-identifying people to remember that these are not the only concerns that could arise in their lives. Queer people, just like all other people, are susceptible to problems in all the other varying realms of healthcare. One of which that does not discriminate against people of any sexual orientation or gender identification is cancer.

utmbteam Introducing Dr. Eric Walser - Trailblazer in Prostate Cancer Treatment
Dr. Walser and his staff at UTMB’s Wavelength Medical

Cancer appears in individuals of all sorts in various forms. For some, it can affect the brain, others the breasts, but can appear anywhere from within the bones to atop the skin and to any other part of the body. For many, this can mean the prostate. For those who aren’t familiar with the prostate, it is the gland that surrounds the bladder in people born anatomically male. It is the organ responsible for the propulsion of seminal fluid and the velocity of urination. And while it is known to be one of the more treatable cancers and has an extremely high survival rate, it is still an issue that—like all other cancers—can consume the patient’s life while undergoing treatment, especially so if left long undetected. Just like with all other cancers, the key to survival is early detection.

This isn’t just a problem for men, however. Often, the relevance of the prostate can even expand to transgender women, regardless of whether or not they’ve undergone reassignment surgery from male to female. As it turns out, during transitional surgeries (which often happen over the course of several procedures and after intensive hormone replacement therapy) the prostate is not typically removed due to potential complications with the surrounding nerves and blood vessels surrounding it. That said, trans women and those who identify as gender nonbinary, like cisgender men, should be cognizant of the need for prostate cancer screenings.

For this to happen, between the ages of 40 and 50-years-old, a person should be meeting regularly with a licensed physician (typically a primary care physician if the person has one) to begin having the prostate checked regularly throughout the remainder of their adult life. When this happens, the physician will be checking the patient’s prostate-specific antigen (or PSA) typically through blood test, looking to see if the patient has normal PSA levels. What is considerably adequate for good prostate health is a level under 4 nanograms per milliliter (ng/mL) in the blood draw. However, if that number is upward of 4 ng/mL, the doctor will monitor these levels to watch for an uptick. Because PSA levels are not diagnostic, they are not necessarily indicative of prostate cancer. This is only the first step in the process of obtaining a conclusive diagnosis. In fact, stimulation of the prostate resulting in an active gland can cause these levels to rise through exercise, manual labor, or sexual activity. The uptake in PSA levels could also very simply be due to a prostate that is inflamed, but not breeding cancerous cells. That being said, to rule out the chance of prostate cancer, the patient’s physician will at this point refer the patient to a specialist. From there, the specialist—a urologist (or a doctor who specializes in diseases of the urinary tract) in this case— will carry out measures to ascertain a diagnosis.

Now, this is where things get a bit more complicated. The most commonly practiced method for diagnosing prostate cancer from this point is for the urologist to perform what is known as a “blind” biopsy. What is meant by the word ‘blind’ is that the urologist has not performed an MRI (magnetic resonance imaging) in order to assess whether or not a cancerous lesion is visible on the prostate. The process of performing a biopsy without an MRI involves sticking approximately 12-15 needles into the gland to take samples.

walser-cropped-bw Introducing Dr. Eric Walser - Trailblazer in Prostate Cancer Treatment
Dr. Eric Walser

Enter Dr. Eric Walser, an interventional radiologist at the University of Texas Medical Branch (UTMB) and physician at Wavelength Medical practice who believes that this may not be the best practice of diagnosing prostate cancer. As a radiologist, Dr. Walser understands the importance and benefits of not performing a biopsy without imaging, and instead has the MRI performed preemptive of the poking and prodding in order to see if a biopsy is even necessary. By performing the scan ahead of the biopsy, Dr. Walser is able to screen for cancerous lesions in the prostate. If a lesion is found, a biopsy can then be ordered with a more specific target zone so that only 2-3 needles need to be inserted into the gland as opposed to the aforementioned 12-15. By minimizing the invasiveness of the procedure, Dr. Walser’s methods can decrease the chance of urinary incontinence and erectile dysfunction that can often be side effects of the biopsy. Additionally, a patient who undergoes a biopsy will still likely be asked to undergo an MRI, as well. Unfortunately due to the amount of blood that will appear on the scan if done too soon after biopsy, the patient can often be asked to wait anywhere from 4 to 6 weeks to have the MRI performed if the biopsy comes back positive. And while this isn’t the standard practice for physicians in this field, evidence supporting it is appearing rapidly. For example, the New England Journal of Medicine published a study just this past May, which concluded that having an MRI performed before a biopsy, or having an MRI-targeted biopsy performed, is the superior method of diagnosis.

wvm-with-utmb@3x Introducing Dr. Eric Walser - Trailblazer in Prostate Cancer Treatment
Wavelength Medical at UTMB in Galveston

But diagnosis isn’t where Dr. Walser’s interest in prostate cancer ends; and understanding his next move may come easier with a little background on his career. Dr. Walser once practiced medicine at the world-renowned Mayo Clinic’s campus in Florida where he was researching focal laser ablation (or surgical removal) of cancer from the lungs and liver. While researching these methods of treatment, Dr. Walser saw the opportunity to make a difference with those suffering from prostate cancer. For a long time, there were only a few options for conquering prostate cancer, which are still the most commonly practiced today. The first of which is radiation therapy (whether it be internal or external) to try to kill the cancer cells, which is sometimes accompanied by hormone therapy. Hormone therapy (though not a cure for cancer) is a method by which a physician will reduce the level of androgens in the body in order to stop or slow the growth of cancer cells, as cancer cells feed off androgens and use them to grow. Radiation, however, does not come without side effects, as radiation is toxic to organic matter, of which the human body is composed. According the American Cancer Society, radiation in its varied forms can lead to troubles with the bowels, urinary incontinence, erectile dysfunction, and impotency. The other option, and often one of the more popular among physicians and their patients, is total removal of the prostate, or prostatectomy. This too can lead to issues of urinary incontinence and erectile dysfunction, but also can leave damaging amounts of scar tissue that may affect a physician’s ability to cut through and reach the area necessary to treat the patient again if the cancer were to recur.

And that’s where Dr. Walser’s love of focal laser ablation is helping those with prostate cancer. With his method, Dr. Walser is using focal laser ablation to excise cancer with a laser rather than removing the entirety of the prostate or poisoning the body with radiation in order to keep the prostate intact and, in turn, minimize the invasiveness of the entire course of treatment—from diagnosis to recovery. According to the Prostate Cancer Foundation, recurrence of prostate cancer can happen in anywhere from 30-90% of people after initial remission. This relapse generally takes places after 5-7 years of treatment and remission. However, through his studies and practices, Dr. Walser is coming to find that the chances of recurrence using his methods is somewhere near 15%—a drastic difference. However, since laser ablation for prostate cancer is new, there is not enough follow up to fully compare it to traditional therapies.

ann-cropped-bw Introducing Dr. Eric Walser - Trailblazer in Prostate Cancer Treatment
Anne Nance, Nurse Practitioner

The process of the procedure is typically quite simple. Candidates for Dr. Walser’s program travel to UTMB on a Thursday night or Friday morning for a busy weekend. The first step in this process includes a mid-morning appointment with Dr. Walser’s in-house nurse practitioner, Anne Nance (APRN, NP-C), who talks with patients about their family histories, symptoms, plans, then rounds out to a procedure on a Saturday or Sunday with Dr. Walser (who kindly works weekends to better accommodate the schedules of his patients, who often travel from far beyond Galveston for treatment). The day of the procedure, patients can expect the ablation to last to last approximately 4 hours. From there, a catheter will be inserted into the patient due to the prostate swelling postoperatively, which closes the urethra and prevents urination. The catheter could be worn anywhere from 3-5 days, but sometimes even as little as 2. After that, the patient should take the time to recover for 1-2 weeks. Most patients can go back to normal activities of daily life soon after ablation, but should be mindful not to overexert themselves.

becky-cropped-bw Introducing Dr. Eric Walser - Trailblazer in Prostate Cancer Treatment
Rebecca White, Registered Nurse

But like all good tales, this story, too, has its down side. Because focal laser ablation of prostate cancer is new to this field of medicine, insurance companies typically do not cover the procedure, which can leave patients having to spend more money to have this performed. But that isn’t a deterrent for Dr. Walser and his team at UTMB, and isn’t always one for his patients. In fact, the team’s biggest concern is making sure that patient’s get treatment and are diagnosed adequately. Speaking with Rebecca White (MBA, BSN, RN) of Dr. Walser’s team at Wavelength Medical, she stated, “Let us help you with the diagnosis. [Patients] may not be able to afford the treatment, but the process of diagnosis is usually covered by insurance.” She went on to say that by having the MRI performed before the biopsy, it could eliminate an additional cost to patients who don’t need the biopsy performed if there are no lesions found by MRI. And the way Dr. Walser and his team are practicing their methods of diagnosis, that could end up being the case for many, as White also states that due to the practice of blind biopsy, there’s a large chance for misdiagnosis or over-diagnosis in this field.

So, even if it comes down to not being able to afford this specific method of treatment, at least the folks at UTMB’s Wavelength Medical can help guide patients through the process of diagnosing in a way that could end up being more cost-effective and to a lesser degree of pain and wait time than many other practitioners in their field. Just because the “disposable gay income” isn’t a myth for everyone in the LGBTQIA community does not mean that money has to be thrown away on tests that could prove to be unnecessary. And Dr. Walser and his staff are only truly concerned about the health and lifespan of those they treat and diagnose. If that means getting a person treated by way of radiation or prostatectomy because focal laser ablation is unaffordable, that’s what these fine people will help you to make happen. It’s also worth noting for the LGBTQIA community that UTMB was recently one of only three Houston-area medical facilities to be named as a “leader” by the Human Rights Campaign (HRC) when it released its 2018 Healthcare Equality Index. This status bestowed upon UTMB is specifically awarded to the best of best, and is held in the highest regard with the HRC. In order for a facility to land this honor, they must score a perfect 100% on the HRC’s index, which takes into account a variety of factors, most notably LGBTQIA patient care and community outreach.

Cancer is scary; and prostate cancer gone undetected could considerably affect the lives of a great number of LGBTQIA people. Like other cancers, it can metastasize to other parts of the body and put a person at risk of larger health issues, some even resulting in death in the worst case. But with the help of people like Dr. Walser, Anne Nance, Rebecca White, and the rest of the incredible team at UTMB’s Wavelength Medical, it doesn’t have to come to that. With innovation like Dr. Walser’s and medical literature supporting these methods being researched and released consistently, their team is here to provide people who may be suffering prostate cancer with the opportunity to live a life not ruled by disease in a brand new way, while also redefining how prostate cancer is treated and the outcomes for patients.

Is The Texas Foster Care System Failing LGBTQ Youth?

Is the Texas Foster Care System Failing LGBTQ Youth?
Kristopher Sharp (left) and his partner Kahlib Barton. Sharp grew up mostly in foster care institutions, in part because he was identified as gay when he entered Foster care.

 

Is The Texas Foster Care System Failing LGBTQ Youth?

The Texas Foster Care System Is Designed To Protect All Youth. But The System Failed One LGBTQ Youth In A Major Way!


 By Cade Michals | Investigative Journalist, About News

Most can’t imagine the thought of not experiencing love from a parental figure. At age 18, Kristopher Sharp aged out of the Texas Foster Care System becoming homeless, with no skills, or job. He became one of Houston’s unspoken problems plaguing the streets of Montrose, which no one wants to talk about.

It wasn’t long after being on the streets that a ‘drug dealer’ took Sharp under his wing; and the two became lovers. Their relationship was built around abuse that often landed Sharp in the hospital. “I can tell you about the first time I felt I was loved,” Sharp says. “This is after I aged out of the foster care system.”

A few days shy of his 10th birthday, Sharp entered foster care after being removed from his home. Sharp describes how his mother was a drug user and would heat up metal hangers to lash him and his siblings.

Sharp now identifies as gay, but he says he didn’t know that as a 9-year-old boy. Sharp said he didn’t even know the meaning of the word. But the caseworker did. “Whenever I first entered Foster care, the case worker told me that it would be hard to find me a family because I was gay.” Sharp stated.

In 2014 there were 31,176 children in foster care in Texas. As of January 2015 there were 4,041 children waiting for adoptive families. There are less than 2,000 foster families. The State of Texas hires subcontractors; and children like Sharp, whom are LGBTQ are most often cared for by these contractors.

Adam McCormick, a professor at St. Edward’s University in Austin has been documenting the experiences of LGBTQ youth over the last year or so. He’s found that of the thousands of children in foster care, the ones who have it the worst are LGBTQ kids.

“The state has failed to do really what it’s intended to do – to protect youth – as well as to establish some sense of permanency,” McCormick says.

“We tend to recruit foster parents from very conservative faith-based backgrounds – churches and faith-based organizations – and so the pool of individuals who are capable of providing affirming and accepting environments, capable of empowering LGBT youth is very limited,” McCormick says.

McCormick believes it’s time for Texas to start strategically recruiting foster parents who can commit to supporting and affirming kids who are LGBTQ. But at the state level several legislative attempts to put it in the books have failed.

Sharp has since left Texas, and lives in Washington, D.C. He’s graduated college and works as a legislative aid in Congress. He’s now advocating on behalf of children in the system – and he’s found love doing it.

“I’m in a relationship with a very sweet man who is a great advocate and works all across this country, who genuinely loves me and cares about me,” Sharp says.

Confrontational Activist And Gay Publisher Has Died.

Tim Campbell
Tim Campbell

Gay activist and publisher Tim Campbell, has died. He passed away on December 26 at a local Houston hospice. He was 76. Campbell had suffered from an aggressive form of esophageal cancer.

Campbell founded the Twin Cities gay newspaper GLC Voice and served as its editor until 1992.

 

Meet the Doctor Changing Trans Lives

Dr. Angela Sturm is helping trans people affirm their gender identities through facial plastic surgery

(HOUSTON) — For many people, when they hear about a person transitioning, they immediately recall as much information about gender-affirming surgery to the genitals as they know. For almost as many, that’s not much information. However, what most cisgender people fail to understand is that there’s more to gender-affirming surgery than what is often referred to as “bottom” (genital) surgery. As a matter of fact, NBC News reported than in 2016, less than 0.5% of gender-affirming surgeries actually were performed on the genitals. This news isn’t quite revelatory, as the National Transgender Discrimination Survey reports that 33% of trans people have not medically transitioned, with 14% of trans women and 72% of trans men saying that they most likely will not ever transition fully. But with plastic surgery procedures to the face and chest, trans people are able to become more comfortable in their own skin.

LADD7089_high_res-218x300 Meet the Doctor Changing Trans LivesThat’s where Dr. Angela Sturm comes in. Dr. Sturm (MD, FACS) is a double board certified female facial plastic surgeon. According to her website, she specializes in rhinoplasty, eyelid surgery, facial feminization surgery, and facelifts. Dr. Sturm attended medical school and her residency at Baylor College of Medicine, and has since gone on to join Facial Plastic Surgery Associates here in Houston. She’s been in practice for about six years, and has been doing facial feminization for five of those.

While Dr. Sturm’s patients aren’t all trans, many are. She sat down with About Magazine to discuss her role in the gender-affirming process and her advocacy as an ally to the LGBTQIA community.

About Magazine: Tell us a little bit about what your specialties are.

Dr. Angela Sturm: So, I do facial plastic surgery. I end up doing a lot more feminization than I do masculinization.

An interesting point I hear a lot is that there’s more of an emphasis on feminine trans issues than there is on masculine trans issues. Can you tell me a bit more about what you see when trans men come to see you?

A lot of times the face shape changes a little bit because the facial fat changes. And then the muscles are a little bit bigger. So, where you may have had an oval-shaped face, it may be a little more square now. So, maybe [the shape] is there, but it’s not quite where they want it. Sometimes we’ll put implants on the jawlines to make them a little stronger. I’ve had people who had jawlines that are good, but have the genetic pooch of fat under the chin. You know? So, it’s kind of, “Well, [the jawline] is there, but I’d like to be able to see it better.” And then, of course, there’s the Adam’s apple. Not all men have Adam’s apple. So, we can do a little bit of liposuction right there and contour the area so that we can see a hint of it. We can also do an implant there, but for the most part, you don’t really need to.

In your patient demographic, are you handling cases for patients that are in their younger years? Or are they more middle-age to later in life? Or is it a mix?

It’s kind of a mix. Not as many younger people. A lot of times they’re just into their transition. And hopefully, if they’re transitioning young enough, they may not need me at all. And it would be amazing if we could get to that place where people were able to get on blockers and hormones at an appropriate time to where they make the transition all on their own. It’s more mid-to-late-twenties all the way up to a patient I had in her seventies. She had lived her life. She was in the military. She raised her kids and grandkids. And then when everyone was raised, she was like, “You know what? It’s my turn.” I thought that was awesome.

DSC_8839-3512605090-O-300x200 Meet the Doctor Changing Trans LivesAnd do you have any experience doing reconstructive surgery on the genitals? 

I do not, because my specialities are head and neck. But I can do referrals. But in Houston, it’s kind of difficult, because there aren’t a lot of physicians doing that. Which is odd, because we have the largest medical center in the world. There are people in Texas doing it who are doing a really good job. But that’s one of my issues with the entire thing. I feel like it’s really unfair that people have to travel outside of the fourth largest city with the largest medical center. It’s ridiculous. San Francisco has more surgeons, as does California in general because they’re more progressive. Plus, everything is covered under their insurance. They can get facial surgery; they can get genital surgery. There are more people doing it there, because there are more people able to afford it. If you want to do it and have the money, you’re more empowered to go out and do it. Surgeons that are doing it are just kind of spread out everywhere, as well as the people who are seeking out the training. And that’s an issue we’re working on, too: getting more surgeons trained in the programs so that more surgeons come out that are able to do it.

On the topic of the cost, a lot of the issue is that it costs so much money to have these surgeries performed. Which can be a hindrance – especially to younger people coming out of college and getting on their feet. Do you think a reform in health insurance could help people be able to afford to be who they are?

I mean, I think we were definitely going in that direction. But I think there’s a lot of uncertainty right now about the direction healthcare is going in.

(Laughs) To say the least.

(Laughs) Yeah, to say the least. But I think healthcare was going in a really good direction, and hopefully it will continue to go in that direction. I know in Texas it’s always slower. But there are more and more states that are getting things covered. And I think as we’re able to show more science and say, “We’re doing these studies. And this is what we’re seeing …” because there’s a ton of research being done now that wasn’t done before that says certain things are medically necessary, and they can’t be denied if they’re medically necessary. We’re getting there. It’s just a matter of collecting all the data and, like you said, fighting the insurance.

Science is constantly evolving, but we’re sitting in an administration that doesn’t seem to value science. 

That’s the truth.

It’s clear that you’re an advocate for the trans community. So, what brought you to want to do this with your career?

It all started with talking to people when I was coming out of training about what’s going on in our city and in our country. And it was just being here. I trained here, too, in the largest medical center in the world. And I realized that there was just this huge need, and that it’s such an underserved community right next door that we’re not taking care of. It’s ridiculous to me that trans people are having to travel and go over all these hurdles. So, it was looking at what I do and what the needs are. So, I went and got some extra training in doing the facial feminization and being able to do it to a high level and provide that care, because that’s what everyone deserves. The whole thing was crazy to me that this was a need here in our backyard, if you will. It also kind of spoke to the feminist part of me that was like, “Yeah! Don’t tell me what to do because of my gender! Be yourself. I’m fighting this fight for you, too.”

“Don’t feel like you have to get stuck in one box and be comfortable with it, because there aren’t any boxes!”

There’s the term passing privilege in the trans community, which is something someone has when they’re able to pass as cisgender on the streets when they’re, in fact, trans. And I think that’s what makes the line of work you do so important, because it affords people the opportunity to feel more comfortable in their skin, even if they can’t put forth the cost of a full transition.

To that point, you know it’s letting them feel comfortable, but it’s also their safety. Because the number of trans people that have been assaulted for simply walking down the street is outrageous. It’s that ability to walk out of your house and not worry as much – I don’t know that you’re ever not going to worry. It’s a horrible place to be when you don’t know what’s going to happen when you leave your house.

Exactly. And you know, in the queer community, we’ve gotten to a point where gay and bisexual, cisgender men and women have the luxury of not facing that fear quite as much, but the trans community hasn’t gotten to that point yet. And ignorance really perpetuates itself to the point where people end up losing their lives. Does it give you a little peace of mind to know that you’re making a difference this way?

That’s part of what makes it rewarding. I love what I do and helping them gain confidence and feel good in their skin. But knowing that it’s affecting their life that intimately, it’s an honor for me to be a part of that process.

I know that this isn’t your speciality, but there are a lot of misconceptions about what gender-affirming genital surgeries look like. Do you know enough about it to give a brief description to maybe clear up some of those fallacies? 

Probably very generally. (Laughs). Typically it’s much easier to go from male-to-female than it is female-to-male. So, male-to-female involves taking out a large portion of the penis, but you keep a part of the … well, the head, basically, and make that into the clitoris. And then you’re using the testicle skin to make the labia. It depends on the surgeon and how they perform it and what skin they’ll use to make the lining of the vagina. Some people use a skin graft. Some may have enough skin in that area to be able to invert it. It depends on the person’s anatomy, and also the surgeon and what their preferences are. Then they reroute the urethra, so you’re able to have sensation and you’re able to go to the bathroom. There’s a little bit of maintenance, because you have to keep the vagina open. So what a lot of people don’t realize is that you have to dilate it with time. And as time passes, you don’t have to do it as much. But there’s quite a bit of homework on the patient’s end. Things can happen, where you have to go back to surgery. And sometimes it’s more than a one-stage process in order to get things to look and function the way you want.

With the opposite, is the penis able to become as functional as the vagina? 

Kind of. It all sort of depends on the doctor, how they’re doing it, and what the patient’s desires are because there is a wide variety of what you can do with it. There’s a surgery called a metoidioplasty, which basically just allows you to be able to stand and go to the bathroom. So, basically, you’re just lengthening the urethra and keeping what you had, but releasing things so you’re able to do that. Then you have the actual phalloplasty, which is where you are creating the penis. So, what they’ll do is actually take tissue from somewhere else – either the leg or the arm – and kind of create it. It’s a very complex surgery. And then you have to hook up all the “plumbing” and all that stuff. So, the people who do that usually have very extensive training in urology and plastic surgery, or they have a team that has that training. A lot goes into it. So, as far as function, there are ways you can make it sort of semi-erect so that you can use it and so that it’s not erect all the time. Or you can have a pump put in it, and some people do it that way. Because it’s so complicated, you make a big decision. Some people will do the metoidioplasty, but it’s not nearly as involved as the entire phalloplasty.

Tell me a bit about your practice.

I am a part of a private practice with another physician, Dr. Russell Kridel. I have clinical appointments at UT Houston and UTMB, so I get to teach and have a foot in academics. But I have the private practice, so I really get to have control over who my staff are and how educated they are on all these things.

When you teach, what are you teaching?

I touch on all of facial plastics, but I do end up spending a fair amount of my time talking about trans and gender-affirming surgeries, because they’re not getting it from other places usually.

With the private practice, is it important for you to have a staff that understands the importance of what you’re doing with the trans community?

Absolutely. It’s always important that your staff understands your patients and the patient experience. But here’s it’s really important.

Do you think it’s important to build a strong doctor-patient relationship? 

I mean, I think so. The feedback I get from my patients is positive.

Based on your Vitals.com reviews, people really seem to like you.

I love people and getting to know them. I love to see them at different points in their lives. I have the luxury within medicine to have a practice where I can spend the time to get to know somebody and where they’re coming from. And I love it especially because I’ll get messages from my patients who live in other places who are like, “I’m getting my bottom surgery today!” They let me know where they’re at and how they’re doing. It’s a very cool thing to be a part of all of that. I’d really miss out if I didn’t get to know them so well. You get to get excited with people, and that’s one of the things I love about plastic surgery. I get to be a part of that!

Last question: if you could say something to trans people about medical treatment and surgery, what advice would you give them to help them decide what’s best for them?

These are things that we think about very deeply. And there are a lot of great people, especially in the city, therapists and social workers and such, that are available to talk about all the facets of it. It’s this great self-discovery process, and being able to have someone to talk to is very important. And many of those people who can help are trans themselves. So they’re able to see it differently than you or I can. Gender is three different spectrums. It’s gender identity, gender expression, and biological sex. So, figuring out where you are on those is a big deal. Don’t feel like you have to get stuck in one box and be comfortable with it, because there aren’t any boxes! Being able to figure that out and be comfortable with it is most important. It’s frustrating and amazing trying to find yourself, but you want to be able to have those thoughts and think it through and talk with someone before you have surgery, because it’s a big deal. And with talking to someone, you can sit down and say, “Okay, here’s the plan …”


You can learn more about the amazing Dr. Angela Sturm on her website.