Meet Priya Phulwani of Connecticut Children's Gender Program

What inspires you about working in endocrinology?

If you have a low hormone, you replace it, if you have too much of a hormone, you bring it down. What a nice, simple way of helping patients. What a happy field! Over the years, I’ve realized it’s far more complicated than that but I still find endocrinology very rewarding.

Tell us about your work with kids who have gender identity concerns.

Some time after joining Connecticut Children's, I had the opportunity to become the endocrinology expert for our clinic for children who are born with what we call variations in sex development. (This is the “I” in intersex in the LGBTQIA phrase.) I started my work with that clinic seeing patients with variations in their chromosomes, external/internal body parts, reproductive structures, or hormones that otherwise would be typically male or female. These patients often, but not always, need hormone management. But over time, the Clinic for Variations of Sex Development evolved...

We started to get referrals for children who just knew their gender did not fit what was designated to them at birth: this is called gender incongruence. We started to realize these children didn’t have intersex conditions, but instead, had discomfort and unease around their gender: this is called gender dysphoria. I attended a conference by Dr. Norman Spack, who was one of the earliest on the east coast to recognize there should be options for youth, not just adults, who feel this way.  
 

Talk to us about the success of Connecticut Children’s Gender Program.

In 2009, the Endocrine Society guidelines provided the first set of medical organization guidelines with clearly outlined youth hormone options. After that, we started Connecticut Children’s Gender Program. At first, we had a few referrals trickle in. Then, as people realized there was a medical option for youth, combined with increased media attention helping people to understand what they were feeling, we saw a major increase in the number of referrals to the clinic. When we started, we would get one or two referrals a month. Now, we easily get two to five new patient referrals per week, so the program is definitely successful. 

>Related: Transgender Health: An Endocrine Society Position Statement 

As an ally to the LGBTQIA community, what advice do you have for others who wish to become better allies for LGBTQIA colleagues, patients and families?

Respect and kindness are the most important things. While you might not fully understand this, and maybe it’s not for you, take a moment to be kind and understand what it means for somebody else and respect that.

Also, think before you speak. Doing this keeps us from making assumptions and also allows people to fully express themselves. Let’s take the colleague example. You might be talking to a female colleague and you’re both complaining about how hard it is to be a parent these days. You ask, “What does your husband do to help?” If you take a minute to think, you could instead ask whether your colleague has help at home or ask who lives at home with them. That opens the door for the person to feel comfortable about sharing their personal situation with you. It also lets them know that you’re open to all walks of life, so when they share that back with you, you’re not surprised and can be supportive. 

Any support that comes from being an ally is important.

>Related: How Connecticut Children's Supports LGBTQIA Patients and Families 

Can you clear up any misconceptions about gender clinics?

Many people believe that when you walk into a gender clinic, you can just leave with a prescription and that doctors prescribe medicines that might decrease your IQ, dissolve your bones or make you infertile. This could not be further from the truth. 

The process is far more thoughtful and there are many steps before any decision. In our clinic, we fully discuss the risks and benefits of treatment options with patients and their families, including the impact on mental health from not treating youth. We make sure patients and families have time to consider all of that because our clinic is a safe place for these conversations.

We also let patients and families know what other specialists from Connecticut Children's will be involved in their child's care. It's also important to keep in mind is that when searching for information about gender clinics, not everything online is true. 

Dr. Phulwani is Medical Director of Connecticut Children’s Gender Program and is Co-director of Connecticut Children’s Clinic for Variations of Sex Development.