By Megan Smith

As medical director for the Center for Transyouth Health and Development at the Children’s Hospital Los Angeles, Dr. Johanna Olson has gender on her mind night and day. But she’s not the only one—gender plays a huge role in the lives of each of her patients. Board-certified in pediatrics and adolescent medicine, Dr. Olson has dedicated her life’s work to caring for transgender youth and helping her clients live as their authentic selves. She has lent her expertise on the subject to numerous TV shows, including 20/20, The Dr. Phil Show, Dateline, and I Am Cait. On October 23 and 24, Dr. Olson travels to Houston to present at the Gender Infinity Conference, an annual gathering that brings together providers, advocates, and families of transgender and gender-diverse youth in the South. In mid-September, I had the pleasure of speaking to Dr. Olson about her upcoming appearance at the conference, her thoughts about the increased media attention surrounding transgender issues, and how she taught her own child to love and respect others, regardless of gender identity.

Megan Smith: How did you first become interested in providing care for transgender and gender-variant youth?

Dr. Johanna Olson: One of the reasons I actually chose to do a fellowship at the Children’s Hospital Los Angeles was because of the diversity of programs in general. Because of the nature of the work, it’s hard to have rotating doctors coming through, so I didn’t get to do a lot of trans care [during my fellowship].

But when I came back to the hospital in 2006, it coincided with the release of the Netherlands’ blocker protocol—the idea of using puberty blockers to help trans people not go through a wrong puberty. I was really moved by the idea that, as a pediatrician, I could do this miraculous thing for people and help them live authentically. I’ve always been involved in social-justice movements, and this idea that my training as a physician could play a role in a human-rights movement was very compelling to me.

When I first started working with trans youth, I was so blown away by what people would do—and what they would be willing to give up—to live authentically. I really think if everyone in the world would chase authenticity like trans youth do, we would live in a better world.

So many of your patients have seen multiple doctors or traveled across the nation to receive your specialized care. What are some of those initial consultations like for both you and the patients?

What’s important is to think about these youth in three distinct cohorts—pre-pubertal gender-nonconforming children, young people who are in their early stages of puberty, and then later pubertal teenagers and young adults. That’s really critical because the interventions are different, conversations are different, and the resources are different.

Everyone comes in at a different place on this journey. Some people are already very knowledgeable, and they’re just very interested in establishing care because they’re worried my clinic is going to close. [Laughs] And some people come in because they just want to have a conversation about what might happen if their child [is trans] and how to best support their child. So the assessment part is, “What is your story and what do you need from me?” Sometimes that’s telling them they’re not the only family struggling with this issue, and sometimes that’s [giving] advice on helping their children socially transition to live as their authentic selves. It just varies.

Since culturally competent care can unfortunately be hard to find, what do you feel—from a healthcare standpoint—is the greatest need for trans and gender-variant youth?

You just hit the nail on the head—it’s the issues around being able to get high-quality pediatric care at a facility that is culturally competent around gender.

From a medical perspective, health needs are no different for trans youth. But what does need to happen for young people are conversations with mental-health providers about building resiliency and [developing] specific strategies around different issues that are inevitably going to come up for trans kids.

Another thing we often forget about is mental-health therapy support for parents. Because a lot of times—especially with younger kids—the challenges aren’t coming at the kids, they’re coming at the parents. So we really need to give parents the space to have conversations around how they want to manage those issues, as well as to deal with their feelings about their child being gender-nonconforming, and potentially trans, as they get older. It’s about the entire family unit, [because it’s] the whole family that transitions.

What would you say to parents who feel their children are too young to know their own gender identity?

I think we need to think about that question for cisgender people and kids. I often ask adults to reflect on when they might have known their gender. And most people don’t come up with age 16, 18, or 21. So, I think where it’s different for trans and gender-nonconforming kids is that, for many years, people have been telling them something different than how they feel. So of course that’s confusing.

I also think it’s fair to say that there are a lot of kids that do gender-nonconforming behaviors in childhood and are not trans. But those aren’t usually kids coming to my office. People don’t usually come in and say, “My child has been doing this for three months, and I’m a little freaked out about it.” It’s more like, “I’m bringing you my six-year-old [because] since the age of two, this kid has been talking about their gender.”

You’ve been interviewed on 20/20, Dateline, and for the infamous Caitlyn Jenner interview. What part do you see the media playing—either good or bad—in the acceptance of transgender people?

I think the media stuff is very important, because it has opened up a potential conversation for people. However, since we’ve had this national conversation about gender-nonconforming and trans youth, I think there’s a perception that there’s tens of thousands of kids who are coming forward and saying, “My gender is different than my assigned sex.” And that’s just not the reality.

First, trans experience is rare. Secondly, conversations about gender in childhood are rare. So the idea that there are tens of thousands of kids who are socially transitioned is silly—that’s just not happening. It’s just that there’s a lot of media attention on it right now. Also, kids who don’t have something going on with their gender aren’t going to suddenly start having conversations about their gender [because of trans kids in the media]. It’s not trendy to be trans.

What has your experience been in speaking to parents of trans youth? Have you seen an increase in parental support since the general public has become more conscious of transgender issues?

When I talk to parents, I have to honor that this experience is probably something unexpected. And, in many ways, they’re going to have to readjust their stories around their child.

But I think it’s equally important to talk about the things they want for their child. You want your child to be happy, healthy, educated, and for them to contribute to society. Those are the main things that people want for their children, and not a stitch of that has to do with gender.

Even though there are many things I think we would have done differently if we were the producers of I Am Cait, families can look at Caitlyn Jenner and recognize that if this can happen in the Jenner/Kardashian family, they’re not so alone, and that [the trans experience] isn’t weird.

As a mother yourself, how have you taught your own young child to respect trans and gender-variant youth?

I started having conversations with my daughter at a very early age. When she would ask me, “How do you know if someone is a boy or a girl?” we said, “Well, you ask them.”

She’s been overheard in the yard giving lectures on gender. There was a kid who said, “You turn the animal over, and that’s how you tell if it’s a girl or a boy.” And my kid is saying, “Not necessarily—not all boys are born with penises and not all girls are born with vaginas.” I feel bad for her because I think she gets tired of hearing about gender since it’s a family conversation a lot. [Laughs] But she’s also really good about saying, “Why is that a girl’s toy? Why is that a boy’s toy?” She recognizes the kind of silliness around gender constructs.

You’ll be presenting at the Gender Infinity Conference in Houston in October. The South can sometimes feel like a completely different world. Have you ever advocated for trans youth in the South before, and if so, how do attitudes here compare to the rest of the nation?

Yes, I have, and yes, it is. Tolerance of differences is narrower. The origins of that are probably rooted in religious beliefs and overall conservatism. I think that institutionalized racism and heterosexism have a stronger role in the South. That’s not to say they don’t exist in other places in the country, because they do. I can get someone just as angry and hostile in Riverside as I can in Atlanta.

Other than the conference, do you have any stops planned while you’re in Houston?

I don’t, but I’m always open to suggestions!

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