Gender and the “perfect” body

by Priya Phulwani, MD

I am a pediatric endocrinologist with an interest in teens in transition, polycystic ovarian syndrome and gender dysphoria. Not surprisingly I was asked, “What do you make of this whole Caitlyn Jenner thing?” This made me reflect on my recent patients.

An eighteen year who has not had a period in 6 months because she has severely restricted her calories to look good for college this fall.

A sixteen year old who is anxious about her facial and body hair which she constantly struggles to remove or conceal.

A seventeen year old who was heartbroken to hear from me that growth hormone was not an option at this age to make her get taller.

And the most striking was my transgender young woman – severely depressed that she is too tall and despite estrogen hormone therapy looks too masculine.

It seems to me that those of us, who live in society as females, sure are under a great deal of pressure to achieve a certain physical appearance.

The recent news about Caitlyn Jenner has made headlines, but most of the comments have focused on her appearance. Yes, I do think she looks great, but wouldn’t it be wonderful if most of us focused on the incredible bravery she has displayed in being true to her authentic self even at this stage in life? In the words of actress Laverne Cox, “Yes, Caitlyn looks amazing and is beautiful but what I think is most beautiful about her is her heart and soul, the ways she has allowed the world into her vulnerabilities. The love and devotion she has for her family and that they have for her. Her courage to move past denial into her truth so publicly. These things are beyond beautiful to me.”


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I currently have about 80 teens that I provide medical care to for Gender Dysphoria and am always amazed by their stories – their journeys with their families. The most important thing anyone can give them is acceptance – it fulfills the basic human need for respect and dignity. A simple touching letter from a school principal asking for acceptance of a transgender child can go a long way to provide a safe environment. (Click here to read). It is also important to diagnose gender dysphoria early for better mental health outcomes, but of course help at any time is appreciated. Puberty can be a time of great depression and anxiety for any teenager with body image issues. Add to that an undesired puberty, where your body seems to be betraying your mind as it advances to an undesired outcome, and you have a recipe for a high rate of clinical depression. Multiple studies show that using to block further progression of an undesired puberty as early as the first stage of puberty, and using “cross” hormones at age 16 onward to obtain the desired puberty, can reduce the rate of suicide attempts in the adolescent gender dysphoria population from 8-20% to less than 2%.

In Caitlyn’s own words for the interview with Vanity Fair, “I’m not doing this to be interesting. I’m doing this to live.”

For more information on Connecticut Children’s Gender Dysphoria program click here.

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