Dandelion Effect Podcast - Dr. Sidhbh Gallagher: Affirming Gender - Andy Vantrease

Dr. Sidhbh Gallagher: Affirming Gender

Dr. Sidhbh Gallagher is double-board certified in general and plastic surgery, and is a leader in the field of gender affirmation surgery. She serves the transgender community through her private practice in Miami, where she performs up to 60 surgeries per month as treatment for gender dysphoria.

Originally from Ireland, Sidhbh earned her medical degree from University College in Dublin then came to the United States to complete eight more years of intensive surgical training. She served as an assistant professor at Indiana University from 2015 to 2020 where she researched and developed new techniques such as Masculoplasty and was the founding surgical director of the Indiana University Gender Affirmation Surgery Program.

Today, Sidhbh joins us for an inspiring conversation about her path to becoming a surgeon and how she works to support people on their journeys to feeling comfortable and complete in their own bodies. She lets us in on the biggest lessons she’s learned from her patients: Humans are complex and it’s time we stop pretending that we all like the same things. Sidhbh debunks incorrect ideas about the transgender population that circulate in the media and shares stories about her most memorable patients that will blow you away and restore your faith in humanity.


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Episode Transcript

Andy Vantrease (00:17):

Welcome to the Dandelion Effect podcast, a space for organic conversation about the magic of living a connected life. Just like the natural world around us, we are all linked through an intricate web, a never ending ripple that spans across the globe. Here we explore the ideas that our guests carry through the world, remember who and what inspired them along the way, and uncover the seeds that help them blossom into their unique version of this human experience. This podcast is a production of the Feathered Pipe Foundation, whose mission is to help people find their direction through access to programs and experiences that support healing, education, community, and empowerment.


Hi everyone. Welcome back to another episode of the Dandelion Effect podcast. I’m your host, Andy Vantrease, and today I am so excited to be recording this introduction from the Feathered Pipe Ranch in a room called the Mousehole, which overlooks the lake. And I’m here just watching the Aspens dance and the pond shimmer. There’s a huge blue sky right in front of me, so we’re gonna be doing some live recording for the podcast here this summer with different teachers that are coming through. And we will also continue to do interviews and episodes with people from all over the country as we continue to expand on the Dandelion Effect, the stories that we are sharing in an effort to unite us and really get to know each other on a deeper level. So today I’m talking with Dr. Sidhbh Gallagher, and Sidhbh is double board certified in general and Plastic surgery, and she’s a leader in the field of gender affirmation surgery.


Sidhbh serves the transgender community through her private practice in Miami, where she performs up to 60 surgeries per month as treatment for gender dysphoria. Originally from Ireland. Sidhbh earned her medical degree from University College in Dublin. Then she came to the United States to complete eight more years of intensive surgical training. She served as an assistant professor at Indiana U from 2015 to 2020 where she researched and developed new techniques and was the founding surgical director of the Indiana University Gender Affirmation Surgery Program. Today Sidhbh joins us for an inspiring conversation about her path to becoming a surgeon and how she works to support people on their journeys to feeling comfortable and complete in their own bodies. She lets us in on the biggest lessons she’s learned from her patients, that humans are complex and it’s time we stop pretending that we all like the same things.


She debunks ideas about the transgender population that circulate in the media, and she shares stories about her most memorable patients that will absolutely blow you away and restore your faith in humanity. Without further ado, please enjoy this conversation and help me welcome my friend Dr. Sidhbh Gallagher. It’s not every day that I get to talk to somebody from Ireland, and even just hearing your voice makes me just remember my trip over there and just love the culture and the people, and especially with the work that you do today. I’m curious of, you know, what you would begin to share about your early upbringing and cultural influence, religious influence, familial influence, uh, what was your early life like growing up in Ireland?

Dr. Sidhbh Gallagher (03:49):

Yeah. Well, so I grew up in Ireland in the eighties. And, um, back then, you know, my memories, obviously I had a very happy childhood for children, but we weren’t particularly well off, although I didn’t really know any better at the time. So I think maybe some aspects of that inspired a lot of ambition in me to work hard in life, and that’s probably one of the things that attracted me to America. And then probably the other aspect of growing up in Ireland, we were heavily influenced by the church. Traditionally, the church and state in Ireland used to have a very close relationship and you know, for some folks it’d be considered not comfortably close relationship. And there was probably to a certain extent, a lot of problems with homophobia and certainly transphobia, which at the time as a child I wouldn’t have necessarily been aware of.


But from my very early days, remember certainly thinking that some of the teachings were not aligned with how I would feel as a feminist, let’s say. So that’s probably one of the earliest, my earliest memories of going to church and just sort of seeing the little inequalities there, the subtle things. I remember them bugging me from when I was very little. And honestly, I think in hindsight those irritations kind of grew. And as I got older, paralleled with the country, like Ireland as a country and who we kinda had this backlash against the church because of course then in the nineties we had the pedophilia scandals, which were subsequently handled pretty badly. And there was a sort of backlash, whereas a lot of the country turned their backs on the Catholic church and stopped attending mass. And I remember over the course of like my teenage years went from a situation where the churches were like packed on a Sunday morning to now going into 2000 and onwards.


Um, the congregation had definitely dwindled. And you know, there were certain things I certainly wouldn’t subscribe to now either. You know, I I felt like sexual shame was certainly on the menu, you know, and the girls’ skirts had to be, be measured and there had to be below the knee. And so I think a lot of that influenced my thinking in that I became extremely progressive as a backlash almost to that much, much later in life when I found myself now as a fully grown surgeon. I remembered those days in Ireland where, you know, certainly minorities were maybe treated differently or people were discriminated against, uh, cause of their gender or their gender identity or their sexuality. And I think that’s always been a very strong force for me. And honestly, these days as a, as a country, Ireland is course very progressive, yet a lot of people don’t seem to understand that.


You know, Ireland was one of the first countries in the world to allow gay marriage and, um, we tend to be a very liberal and accepting culture. And I would have to say, and this is only anecdotally of course, but you know, speaking to relatives and friends at home about my work subsequently, I was always surprised because there would be very woke and that, you know, understand pronouns. You know, I personally believe that folks who were appalled by the Catholic church or like myself raised, um, you know, an environment where you had a strict nun trying to teach this shame <laugh> mm-hmm. <affirmative> associated with let’s say your sexuality or, you know, subsequently that would be, you know, your gender identity. I think a lot of us have a lack of tolerance for any of that. And I, I think that certainly had influenced me.

Andy Vantrease (07:25):

Yeah, that’s so interesting. All of that. Again, I don’t really have a very open window into the history of Ireland from that perspective at all. And so it’s just really interesting to hear, you know, the timeframe of when that happened, and then also the time of your life when all of that was happening, going through the self exploration as well and going like, okay, what have I learned and what do I actually believe? Did you see the United States as a place that was more progressive and like a place you wanted to go in general or when you were looking here? It was more just for medical school and wanting to get additional training?

Dr. Sidhbh Gallagher (08:09):

It was definitely a twofold piece. We viewed America as the land of opportunity for sure. And, um, I did my medical school in Ireland, but it was a post-graduate training. To me it was a, an no brainer to, to leave and right outta medical school, I did experience that certainly in a field like surgery, it was still a bit of an old boys’ club. And this would’ve been about 15, uh, years ago at this point. And it has certainly evolved since then to my knowledge. But I did feel that most surgeons, the vast majority, um, were white men and there were very few women in those positions. I think in the country we had maybe one or two general surgeons, uh, who were female. So for that reason, I felt that for the best possible training and the best, uh, career opportunities, it was a good idea for me to get out early and go to United States. Cause Ireland is such a small country and certainly within the medical community, it’s, it’s very small. It’s, you know, there’s only 4.5 million people in the country anyway. And when I was leaving there, there was 19 plastic surgeons, you know, in the country. Wow. So really not much opportunity there <laugh>. So, um, probably that’s the main reason I gravitated towards the United States.

Andy Vantrease (09:26):

Let’s just walk through a little bit of what that trajectory looked like. So you did five years general surgery in Philadelphia? Yeah, three years in Indianapolis. Um, and at that point you had switched over to plastic surgery.

Dr. Sidhbh Gallagher (09:41):

Uh, a lot of plastic surgeons train in general surgery first, and then subsequently go on to train in plastic surgery. Um, like general surgery training in Philadelphia. It was definitely, I disappeared down the rabbit hole for about five years. <laugh>, I don’t think it’s like, I think they’ve certainly improved in how, how we train surgeons, but it wasn’t the healthiest thing basically at the time. We worked a minimum of 80 hours a week, oftentimes it was more than that. And, um, it was exciting work. It was, it was interesting work. It was a lot of life and death situations. And of course, you know, in Philadelphia we had a lot of what we call penetrating trauma, you know, so it was a life and gun club to a certain extent, which is how you learn and learn fast. So, um, that’s what I did for five years from about 26 to 31. And honestly, I don’t have very me many memories from those years because I was either sleep deprived or I was in a hospital basement. You know, I was living in a hospital basement on cold constantly or, you know, in the operating room or the er. So, um, after those five years, I went on to, uh, do, um, plastic surgery in, um, Indiana University where I did that for three more years. Um, so this was all after medical schools, um, eight years in total of additional training.

Andy Vantrease (10:59):

I’ve always wondered like how people actually survive those situations. Like I, I’ve listened to podcasts and I’ve listened to people talk about residencies and just talk about the model of almost seemingly like purposely sleep depriving residents mm-hmm. <affirmative> so that you can see how they perform under pressure. And I’m just blown away by that’s how we’re doing things. Like that’s how we’re Yeah. You know, that’s the environment for the people who are on the end that’s supposed to be helping us and supposed to be clear.

Dr. Sidhbh Gallagher (11:32):

That’s a very antiquated system. It’s a very macho system. It’s, it causes causes like un tool damage to relationships. Like one of the more notorious, I should say, uh, training programs in the United States. I won’t mention, you know, they used to brag about their divorce rate, you know, that it’s cause our people work so hard, you know, mean with the broom their personal life, you know, which is very true because you can’t just turn your back on your family and your friends and expect them to be waiting for you, you know, on the other end. So there’s absolutely nothing healthy about it. And I think, I honestly think it’s a lot of it, there’s a lot of inefficiencies in the system. There’s a lot of things that could be better delegated, you know, just even rostering of folks, when I trained, I felt it was a little bit too much.


It was like, you know, surely I can get time off to go to my best friend’s wedding. No <laugh>, no, you can’t, you know, so you do sacrifice a hell of a lot. And I think there is a lot of just immaturity in how we do that. And there’s, I don’t think there’s any good whatsoever in sleep depriving people. I think it’s, frankly, it’s extremely dangerous. And there was, you know, I’m hoping now they’re a little bit more strict with the eighty hour work week. But I mean, still eighty hours is an incredible amount to require people. And we used to work 36 hours in succession and nobody can function mm-hmm. <affirmative>, but certainly that person shouldn’t be operating on you at 36 hours. So, you know, like now as a surgeon, sometimes you are up at night and you do find yourself in, in situation if you’re dealing in emergency, but you know, nothing remotely like what I had to deal with in residency and, and honestly it’s something I’m hoping as a medical profession, but gonna grow up a bit and take a long hard look at it.


But there’s a lot of bravado, um, still remain. And, and apparently a lot of it comes from, you know, residencies, um, from the old days where all the residents were on cocaine, <laugh>, I’ve heard that you were allowed do that. So, you know, 36 hours in succession may be quite possible if you’re over the influence of some massive stimulant. And when, you know, for five years I had my own residence in Indiana and I wouldn’t wanna see them. I was like, if you’ve been up all night, go home. Like, don’t come near my patients. You know, it’s like a, you have no place to be there, you know.

Andy Vantrease (13:48):

How did the environment shift for you from doing general surgery in Philly and then going to Indiana and moving into plastics? Like what was that transition like?

Dr. Sidhbh Gallagher (14:00):

Yeah, so they’re extremely different. So, you know, one of the things about medicine, and even like surgery and different branches of surgery, there tends to be a prevalent personalities, basically. You know, we, each specialty as a has a personality and certainly plastics is a lot more mellow. It’s a lot more just people are a lot nicer <laugh> to each other, um, which has always been my experience. And plastics is very different because we’re usually not dealing with life and death situations, but instead we’re taking creative approaches to very difficult problems. So plastics is, for many people, it’s a, a very confusing field because it spans across so many different specialties and it kind of fills in the gaps between other specialties to a certain extent. And there, there’s actually several fields and that people aren’t even aware of. Like, for example, we take care of burden patients, you know, breast reconstruction, hand surgery, uh, cran-facial surgery.


So, you know, people typically when they think of plastic surgery, they think of cosmetic surgery. But within plastics itself, it’s an extremely broad field, you know, and that’s why it takes on top of general surgery, we do three additional years of training, you know, because it’s extremely nuanced and we operate on all ages, all parts of the body. And really there’s never a dull moment with plastic surgery because unlike in general surgery where you’re taken out a gallbladder, for example, you kinda follow a recipe. It’s like a book, you know, you do the different steps in the surgery and follow that plastic surgery. Oftentimes you’re faced with complicated problems, whether it’s reconstructive or cosmetic in that, well, we know where we are, we know where we want to go, and you have to design the surgery every time. So it’s a wonderful field. And I remember going from one to the other, and residency is still pretty tough in plastic surgery.


We certainly do long hours, but I just remember getting this feeling, I was like, can do life be actually this nice? Can it be, is it OK <laugh>? Is this allowed? Am I, you know, am I allowed to go home at night? Am I allowed to, you know, work out after work? Like, well, what is this? You know? So I remember it was certainly a, going into that and I enjoyed my residency. It was, it was three years, I’d great teachers, but I wasn’t too sure. You know, when I got into residency and I was going through the different fields, I was fascinated by many fields and definitely drawn to the creative aspect of it. And more than anything, the aesthetic aspect, I love making things look good, you know? And I think that, again, maybe was influenced by a kid. I always liked, I liked the art room, you know, I like, that was my favorite thing to do at school, was to draw our pants and kinda get into that flow state.


And that’s probably what, what attracted me into plastic surgery, because I was hoping plastic surgery would be like that. And, and it very much so is so, you know, now I’m going from in Philadelphia where you’re dealing with life and death constantly, you know, and whatever you say about it, it’s extremely meaningful work, obviously to, well now we’re doing aesthetic surgery, like cosmetic surgery. Not that there’s anything wrong with that, but it was, I think part of me was long and for a little bit more meaning maybe in my work. And that’s how I came to gender affirmation surgery. Mm-hmm. <affirmative>. So now we have a situation where we are very much so concerned with aesthetics, you know, especially if a person chooses to pass, you know, we really have to hit a home one and get them the best, um, surgical result possible. But it’s the most meaningful work I’ve ever done. Mm-hmm. <affirmative>, it’s, it’s not just, this isn’t about like vanity. Not that there’s anything wrong with that, but it goes so, so much deeper, you know? And many of my patients will consider their surgery lifesaving.

Andy Vantrease (17:37):

How did this door open up to where you started to understand, oh, there’s an entire community here that’s not being served at all. Right.

Dr. Sidhbh Gallagher (17:47):

Yeah, it, you know, that this sort of surgery, I, not much exposure to it, um, until plastic surgery. And I have to say, I immediately gravitated towards it, you know, because it was something that technically interested me. And, you know, like I mentioned earlier, I wouldn’t have shied away from working with the community, but I have to say, I didn’t really know too many people personally who were transgender or non-binary. And so initially my exposure was I got, I got an opportunity to go to San Francisco and I got observe some surgeries out there, and then it just clicked immediately the first time I saw a genital surgery, a to female, uh, genital surgery. So a vaginal-plasty that really clicked with me. Cause my mind was blown on a few different levels. Firstly, technically I thought it was such an elegant procedure. It was so cleverly designed in that we were using parts of the anatomy that were homologous to create their, like structures.


So, you know, from the point of view as a, as an embryo, we’d start out with very similar structures. And then based on our chromosomes, you know, usually, of course there’s intersex states, but usually we, um, differentiate down one path or another. But there’s structures that are homologous to each other. And we’re basically taking those structures and using them to create the homologous parts, you know, the like parts from male to female in the case of a vaginal posy. So that alone absolutely fascinated me. The results, you know, we got were amazing, very functional, very aesthetic. And so I was probably initially drawn in by the technical aspects. And then subsequently it all began to click because I knew I was coming back to work as a surgeon Indiana, and there were absolutely no resources. But I guess what I didn’t really bargain for was that transgender folks are everywhere.


You know, no matter what part of the country, I mean, just, just because it’s a, it’s a kinda more conservative, traditionally conservative area, it doesn’t mean that there’s not a, a lot of folks there who need care. And indeed now we estimate that the problems of being transgender is closer to 1%. You know, and that’s even a conservative estimate. So that’s a lot of folks, you know, who may want or need surgery. So that was initially how I got into it. And um, you know, from there I was absolutely fascinated. And I, I kinda had a vision. I was like, I think this, this might be it, you know? Cause I didn’t really, in all the other fields of plastic surgery, like I said, I loved aesthetics, but it didn’t a hundred percent click with me. Whereas this absolutely did. Um, and then subsequently was quite difficult to get training in it.


There was no formal training. And at the time, a lot of the surgeries were being done by like solo practitioners doing it kinda in silos, like independently, not really sharing techniques, and a lot of secrecy even around it as well. The institutions didn’t necessarily support, you know, the medical community in the United States, uh, you know, going back probably 15, 20 years ago, thought that if you were transgender, you had a mental illness mm-hmm. <affirmative>. And indeed, it used to be thought that we had to change the patient’s gender identity to fit their body. That we had to somehow, almost like a conversion therapy, kinda convince them that No, no, no, you are born in this body, so you need to identify with that. Now, of course we understand that that’s completely wrong, and no professional body in the United States would subscribe to that. And it’s actually, not only does it not work, but it’s pretty unethical as well.


So back then, those surgeries were controversial. They weren’t fully endorsed by the medical board. So, you know, it would be easy to be kinda pulled over and kind of questioned, why are you doing this? Mm-hmm. <affirmative>, a lot of people couldn’t get privileges in hospitals. And I, I experienced that in, in Indiana as well. I had a very tough time getting privilege to do these surgeries. Initially. There’s a lot of resistance, but I can imagine, you know, when I was doing it, it had already been endorsed by the American Medical Association, like these treatments. But, you know, prior to that it was extremely difficult. So within the United States, I wasn’t able to get any sort of training. Um, so that’s why I traveled and subsequently got trained in, in Serbia, Belgium, and Australia. You know, once I’d finished my training, I took some time off and, and went to do that because I, I kind of felt strongly enough that this is what I wanted to do.


But again, at the time it was still kinda a pipe dream. I was sort of thinking, well, here I go back to Indiana, it’s not San Francisco. I mean, is this really gonna work? But lo and behold, my waiting room was full from day one, you know, cause got out <laugh> Yeah, for quite a while. I was the only provider, certainly the only provider doing genital surgeries like in those states in the Midwest, like Kentucky, Indiana, we had a big catchment area, Illinois as well. For my five years in Indiana, we, we just kinda grew, I grew exponentially in the numbers of patients I trained up there.

Andy Vantrease (22:38):

Do you remember your first surgery that you ever did? First gender affirmation surgery?

Dr. Sidhbh Gallagher (22:43):

Oh, I certainly do. Yeah, because it, like I said, it was very difficult, um, to get permission to do it. You know, there were certainly forces at work that didn’t want me doing it. So there was a lot of scrutiny was involved. So I was able to find support in Dr. Harold Reed, who is now retired, great guy who’s actually in Miami at the time. And so on my own dime, I flew him up, up to Indiana to be my proctor as it was. And so he kinda looked over my shoulder for the first surgery and it went really well. And the girl we did in jail, and she’s very open about the fact that she was the first, you know, male to female patient. Um, wonderful girl, Indiana, country girl. And, um, she actually still comes to me in Miami for Botox and fillers. So as she did wonderfully, like she, she did so well, she sailed through the surgery. But yeah, I definitely will always remember that because there were certainly a lot of folks who didn’t necessarily wish us well, you know, and at this point I was so determined, I was so invested in pushing this through and making it happen. And so after that, I wouldn’t say it was smooth sailing, but it was, it was a lot easier. <laugh>, you know, once, once we had the first one done, and she did so well. Yeah.

Andy Vantrease (23:54):

Didn’t you found transgender wellness program at Indiana? U

Dr. Sidhbh Gallagher (23:59):

I was the surgeon. So, um, at the same time, uh, a couple of other primary care docs, they were setting up a program, which was fantastic. It was just completely coincidental. Cause at the time they were being educated in hormones and all that aspect of care. So between the two of us, we, we offered a pretty good comprehensive setup. It was still a struggle though, because a lot of our patients were low income and didn’t have insurance coverage. You know, so many times it kinda killed me a little bit because they would refer the patients to me for surgery and we’d have to say, well, we’re very sorry. We could do it, and we’d love to do it, and you’re a great candidate, but you don’t have coverage, you know, so that was a struggle. But I found that the surgery program there.

Andy Vantrease (24:41):

Do insurances cover it now?

Dr. Sidhbh Gallagher (24:44):

It depends. It’s kind of bizarre. We had this situation where about seven years ago, they started covering it and, and quite well, and probably coverage. There’s actually been more barriers to, to care now for the transgender community as they kinda tend to depend on the policy. There’s a lot of gate keeping, which isn’t really very evidence based, you know, so they’ll request certain things like, you know, if you’re assigned female at birth and you want top surgery or chest surgery to be done, you need to be on a year of hormones, which is not okay because it’s not a binary thing. There are many patients that I have who identify as non-binary and may never want or need to be on hormones. And so you’re assuming, oh, you’re assigned female birth, now you identify as male, so you’re gonna want all the male secondary sexual characteristics, which is absolutely not the case for, I’d say at least 30% of my patients. Mm-hmm. <affirmative>, it’s only, most Medicaids, you can’t get a covered Medicare. So it’s really only good private insurers. And you know, I’ll say about 70% of folks who have private insurance can get it covered, you know, to some extent. But with a lot, a lot of caveats and restrictions, you know, so it, it’s, it’s still very difficult and there are certainly a lot of hoops to jump through. Mm-hmm. <affirmative>. So

Andy Vantrease (26:02):

How many surgeries are you doing, let’s say like a month these days?

Dr. Sidhbh Gallagher (26:08):

Yeah, so right now it’s extremely busy down here. And we were busy during the pandemic, but I think a lot of folks know that they’re vaccinated are ready for surgery. So I’m typically doing about 60 surgeries a month. That’s like, as much as I can do. Mm-hmm. <affirmative>, my, my patients would be my best teachers in this, in that, you know, as a cis head white woman, there’s a lot of things I don’t understand, that I don’t have insight into. And what, what my patients have really taught me is, you know, I, I oftentimes I need to shut up and put my biases to one side. I really listen because if, if I’m gonna be in service to that patient, I have to, along with the patient, figure out what’s gonna be most affirming to them. And so, for example, if I have difficulty from my frame of reference, understand why a patient may want a surgery, you know, I really have to set aside those biases.


And what patients have taught me more and more is if I really, really listen, I can’t think of a single instance where it’s come to bite me, where I’ve regretted it. And it’s one of these things I think, you know, plastic surgery community in general are, are going through an evolution. Whereas we used to be a little bit more paternalistic and we’d be like, no, no, you want this, you know, this would look pretty on you. You know, this is what you want <laugh>. And whereas the patient’s like, absolutely not. And this is, you know, I want, for example, many of my patients will choose when they have their, their top surgery or their chest surgery, for example, if they’re assigned female gender, they may choose not to have their nipples put back on, you know, and like oftentimes I can cause a lot of confusion.


And I’ve subsequently seen a slew of patients, you know, if you saw other surgeons, the surgeon insisted, no, no, no, you need your nipples back on despite the patients, you know, insisting that no, this is not affirming to them. They do not want that. And so then they’ll subsequently come to me to get these nipples off, you know, which is like, like very interesting to me. But these are extremely profound needs they have, and they’re extremely well thought out, you know, so I can’t think of a, like, there’s this kind of stereotype of somebody switching their gender on up whim. We just don’t see that in reality. And indeed de transitioning or regret is extremely rare as well.

Andy Vantrease (28:23):

And that’s something that I have heard as well, where it’s like, I think some of the people who I have listened to who are questioning the nuances of who is seeking surgery, what that surgery looks like, since there’s so much more openness about it, it seems like there is a trend towards younger folks looking towards these surgeries as a solution as well. And I know that there’s a lot of people who question like, how old do you have to be to know that you want to permanently change your body? Where do you draw that line of like, of a parent stepping in and saying yes or no? And yeah, what’s your insight from your perspective on the youth side of things?

Dr. Sidhbh Gallagher (29:12):

It’s a very nuanced area and, and definitely one thing I feel very passionate about is trans youth. Okay. Because as I remember it, going through puberty is stressful enough without, I can’t even fathom what it must be like when you’re going through puberty and you’re now morphing into something that causes you this profound dysphoria. So, um, it’s definitely a very tough time. And we know that like suicidality is seen a lot. What we do understand from the data is that, and there’s a great study done outta Cincinnati looking at siblings and basically the trans sibling from a mental health perspective, as long as they have supportive parents, however, that looks like they, their mental health is on a power with their non-trans sibling, right? Their cisgender sibling, right? Mm-hmm. <affirmative>. So we know that the key, I mean, it, it seems, you know, when you step back and look for it, it seems, um, pretty intuitive, but, you know, we, like a supportive parent is so important and so critical, right?


So the types of patients I typically see who are minors are the ones with supportive parents. What I don’t see, because they obviously never make it to my office, are the folks who are, you know, kicked out, who are rejected by their family, you know, which I, I can’t even fathom. I must be like such a horrendous time. And, you know, there’s the folks that have to suppress it as well, you know, to kinda tow the line. Now with regards to legality of, it’s very simple. Like, I cannot operate on a minor. I can’t even speak to a minor without their parental consent, you know? Um mm-hmm. <affirmative>, unless of course they’re emancipated, which we never see. So that is, is pretty black and white. So typically the folks, the minors who are coming to me, I haven’t as yet ever done a genital surgery on a minor.


And I don’t think many people do. Usually we wait until after, at least after the 18th birthday for that. But sometimes we’re in a situation where we have a kid, like a typical story would be, we have a kid who is socially transitioned. They’ve been on testosterone for maybe two years, they’re 17, they’re living at home with mom and dad, and next year they’re gonna go off to college. So it makes sense, you know, mastenize the chest now, or to do the top surgery now when they’re at home with mom and dad. And so typically I have the luxury as a surgeon, I’m usually one of the last stops in transition. So this patient has already been on testosterone, they’ve seen multiple, oftentimes psychiatrists, psychologists. So what we do in that situation as surgeons is we, you know, we, we make the decision along with, um, patient, family and mental health professionals that now is the time to do it.


And I think what we’re understanding more and more is that waiting until the 18th birthday isn’t a no harm option. Okay? So forcing a kid, let’s say a kid, you know, one I can think of recently who’s, you know, developed a very large chest, you know, but is other way, and he’s binding, and that he won’t take the binder off. You know, his mom is like, you know, catching him sleeping in a constantly, and this is, this is how profound the dysphoria is for these kids. And so to force that kid, you know, to wait another year or two years or whatever it’s gonna be, that’s not a no harm situation. You know, we know dysphoria is a serious medical condition with, I mean, 40%, um, or above, uh, suicide attempt rates. So making a kid put up with that for the sake of numbers, you know, and of, of course, not all 17 year olds or 16 year olds are the same.


There’s different levels of maturity. So those are typically the stories I see. You know, we, we do hear it more so in the media than anything else we hear about the, the trenders or the, these stories of de-transition, which obviously is something I take extremely seriously because, you know, it’s first do no harm. And, you know, I would be horrified to know that I had, you know, performed a surgery on a patient who had later regretted. And that’s something, you know, I take extremely seriously. But whether I’m not being told about it or think more likely it’s just not happening because I’m not hearing about it, you know, anecdotally amongst my patients, you know, which are like several hundred at this point of like, I’m not seeing it and we’re not seeing it show up in the medical literature. What we are seeing, showing up is all the other evidence, like the benefits of doing these treatments and how it improves dysphoria mm-hmm. <affirmative>, which of course is critical to kinda prove that. And also the downsides of dysphoria. So we do have all that data, but we don’t seem to as yet be seeing this phenomenon that we see in the media of detransition.

Andy Vantrease (33:43):

Mm-hmm. <affirmative>, I haven’t heard so much about Detransition, but I would say what I hear more is like the trendiness of people wanting to be a part of the LGBTQ community and wanting to be non-binary and wanting to, to be parts of these communities that have such strong movements Yeah. And, and presence.

Dr. Sidhbh Gallagher (34:05):

Right. Right. I would kind of turn that around almost like the new generation, Gen Z I have like amazing optimism for the future of what these kids mm-hmm. <affirmative>, because I, I don’t think necessarily they’re, they’re trying to be trendy and it’s pure pressure to fit in with each other. But what I’m seeing is in the new generations, it’s not okay to bully somebody because of their sexuality or gender identity. That’s absolutely not all right. And, you know, a lot of the time these kids, you know, for example, I have a close friend who’s a school principal in the middle school, and she’s constantly, you know, she’ll see the other kids rally around to protect the trans kid, you know, which is like, ugh, it’s so horrible.

Andy Vantrease (34:45):


Dr. Sidhbh Gallagher (34:46):

Incredible. You know, what’s happened? Yeah. What’s happened in the past. And there’s almost a peer pressure of respect. You know, I’m, I’m beginning to see more students like come through, like in healthcare who are, are in Gen Z. And I’ve like huge optimism for the future from these kids because just because they’re so woke, they’re so sensitive, uh, you know, to the needs of the minority in that classroom. And, you know, I just think it’s heartwarming. And I think actually now in that generation, it’s quite okay to be who you are. And it doesn’t matter who that is, you know, which, which I think is fabulous.

Andy Vantrease (35:22):

It is, you know, I think that we can learn so much from these younger generations because they’re doing things in such a different way. I feel like when I talk about it, I sound like super old, but it is, there’s a huge difference even between like, like my generation and the generation that’s coming up now in their preteens and teens and just early twenties. It’s like every single one of them that I know is just, they’re like their own activists in so many different ways. Yeah. I’m glad to hear that because I think that, like you’ve mentioned a lot of these different ideas that I’ve been asking about, it’s like media information. And so it’s just nice to hear from somebody who’s so much more steeped in the everyday world of this community to hear what you see going on, you know, from your inside perspective,

Dr. Sidhbh Gallagher (36:12):

What I’m seeing on a day to day basis, it would absolutely blow your mind in that I don’t know how anybody could hate on these kids, you know? And obviously I say kids, the oldest patient, I’ve done general affirmation surgery, I was 74, you know, so it’s all ages, all walks of life. But when you see these stories, you just wanna champion these people, you know, because it’s something we can all relate to, like the sort of bravery you have to exhibit to go through this, you know, that whole thing of, you know, being okay with who you truly are. And you know, it, it sounds cliche, but being your authentic self, I mean, I, I get to see that every day, you know, and it’s just, you really wanna cheer on these patients.

Andy Vantrease (36:51):

Can you share some stories of perhaps some of your most memorable patients?

Dr. Sidhbh Gallagher (36:57):

Yeah, yeah. Well, for sure. I mean, the one that comes to mind, I just brought her up, is the, the 74 year old who, um, was transitioning a signed male at birth, identifies as female, and had identified for 70 years as a female, but had suppressed it and run away from it. Because honestly, you know, back in the day it was not even safe, you know, to transition. So nevermind accepted or anything else. So that patient, she’d lived very successful life as a man, had gotten married, had kids, and then it was the death of a parent in their, gosh, they were in their late sixties, I think, when their parent passed away. And that really opened their eyes. And as she expressed it to me, she couldn’t fathom dying as a man. So even though her kids initially had some trouble with it, thankfully they all came around and were extremely supportive to her.


But she didn’t want that man’s name on her gravestone. You know, there’s definitely not one true story, you know, and you can’t, like if we were saying earlier, you don’t wanna make assumptions that, oh, you’re trans, so there, you’re gonna do the surgery of the hormones. Right? I mean, that’s really offensive. It’s, it’s like I said, it’s like saying to me, oh, you’re a woman, so you wanna get married to a man of kids. Right. You know, it’s like just offensive, you know, don’t do that. But I do oftentimes hear these stories of folks who have felt this way for so long. And so you can imagine then at the, you know, in her late sixties, she medically transitioned, then surgically transition at 74, this girl had a new lease in life, you know? And so it is just, you know, fabulous to see it.


And another story was a girl from Indiana who was a firefighter, had a great career, was like very well respected amongst her peers when she was living as a man, as a firefighter, and had been awarded many times for bravery, but then subsequently transitioned. And, you know, it was a little bit sad because even though her family were very accepting at the time, you know, when we did her surgery, certainly her former colleagues couldn’t understand it. I couldn’t really accept and kind of felt like duped a little bit. Sometimes that happens, you know, that, that she was somehow tricking them all along, you know, that, uh, you know, yeah. So that’s it. Like, sometimes, you know, not being truthful or something, sometimes that’s how people feel, but of course, you know, it wasn’t safe for her to come out. But one of the things she told me, which I was stuck in my mind was she would say, honey, the bravery I had to have to be my true self to change my name, to go on these hormones is so much greater.


Any day of the week, I’d run into a board building that’s nothing <laugh>. So all the things is very interesting to me. All the things that like society had awarded her for, why she was so well respected, you know, she’s like, honey, that’s absolutely nothing compared to these high heels in here today. You know, most of us don’t have like such a, a thing to overcome, you know, as transition, but I think all of us can relate to it on some element that obviously Yeah. You know, like running into a and building like sure, it’s, that’s very brave when we accept it, but then suddenly you do something that maybe society’s not okay with. I mean, that’s 10 times harder.

Andy Vantrease (40:00):

So it is, it is. And I mean, the challenges and the awkwardness and the finding yourself and the who am I and all of this, when you have models that are, that are for you and like you, it’s hard enough. Yeah. And then when you’re looking around at the world and going like, I’m supposed to be this, but I don’t feel that way, that challenge, to me, it really feels like such a heaviness on the soul for sure. I just, I want to be who I am, and how can I do that in a safe way? Yeah. And how can I do that in a way that will liberate

Dr. Sidhbh Gallagher (40:38):

Working in this world? I’ve been in some really kinda privileged situations, I feel like, and I remember one day, I think I was the only cisgender woman in the room, and a middle-aged transgender lady was given a talk, and it just, I remember it struck me so profoundly, it was everybody in the room was probably, most folks were like 40 plus. And it was a conference in Pennsylvania that just, that was their cohort. It was, uh, pretty well to do transfeminine patients who, who gathered once a year. Some of them were out, some of them weren’t out, but they had this one weekend a year where they, they all kinda got together and they would do hair, makeup. It was quite fabulous. But anyway, I just remember being in that situation and the speaker said, well, how many women here thought they were the only person on the planet who felt like they felt, because of course they were coming from a generation before there was internet, right?


Yeah. And like, every hand shot up in the room, and you can imagine the loneliness, the alienation, you know, those, those women would’ve felt right. You know, because you have no clue. You don’t even have the words for it, you know, which is something many of my older patients will relate to me. And, you know, I see folks transitioning surgically at all ages, you know, but would definitely, we do have a fairly large number of folks who do transition later in life. And some of those are, are like my favorite, you know, because it’s really this lifelong yearning and dream that has now come true for them that they never thought would’ve been possible, you know, so mm-hmm. <affirmative>, it’s, it’s such fun work to do.

Andy Vantrease (42:04):

Wow. After hearing about some of the ways that you grew up and how much of an influence the church had over your country and just culture and upbringing and being cis white female, are there any beliefs or conditionings that you are continuing to have to overcome to do this work?

Dr. Sidhbh Gallagher (42:29):

Oh, for sure. Patients still educate me all the time. And, you know, there’s definitely biases there. The language evolves all the time. I have to be careful about that, you know, and, and stay woke <laugh> and listen. And sometimes patients have to, you know, or members of the community have to break it down for me, because like, honestly, I will never understand because I, I’ll never experience this four years, you know, really, I have to shut up and listen much more so than anything else. So definitely people teach me a lot. You know, one, one area of this that fascinates me is of course, your gender identity is very different from your sexuality, right? They’re two completely separate things. But definitely I do get some slight insights because obviously, especially when we’re doing genital surgeries and sexual function and all that definitely comes into play. So we have to discuss that patients will share intimate details of their lives with me.


And I think maybe one of the things I would take away from over the years, well, maybe two lessons patients have taught me, is that like, humans are incredibly diverse creatures. And I think a lot of us have been pretending that we all like the same things. <laugh>, this is not the case at all. You know, because it was difficult, you know, again, that pressure, like society isn’t okay with certain things. So I think that certainly not one size fits all for both on like an identity level or an attraction level. It’s no surprise to me at all that we’re seeing a lot of folks come out as non-binary, because I, I think that’s just humans and we don’t fit in nicely into binary boxes, and humans are on a spectrum. Mm-hmm. <affirmative> very complex and nuanced. Uh, so that would be probably lesson number one. Lesson number two is I would never underestimate, you know, from, again, the stories I was telling you about folks who’ve had to suppress these feelings and the sadness for so long, it’s like, humans are so good at hiding things. <laugh>


Humans are extremely complicated and diverse. I have to surround myself with like, members of the community and like always make sure I listen and try to amplify trans voice as much as possible. You know, because like a huge part of my job, I feel like when I started out in this field, I was very frustrated by, you know, just from a practical point of view, all the myths that were out there about surgery. And I was like, well, that’s not right. And you had people worrying about things they didn’t have to worry about. And, you know, so for, in order to be an effective gender affirmation surgeon, my patients have to be educated really well because the patient is gonna tell me what surgery they need. So they need to understand all the options of what’s possible, what’s not possible. And so definitely education has been a huge passion of mine over the years.


And using social media as a platform for that, you know, has been awesome. But at the end of the day, certainly when it comes to speaking on social issues and, and that sort of thing, I do have to know my place and that, you know, I’m not trans and I can never understand what that is. What I try to do, and I hope I do on social media, is to try to turn my platform over as much as possible to my patients. You know, so their stories are represented, you know, because that’s the most important thing. I’m just here in service, you know, like doing, doing my best, you know? Mm-hmm.

Andy Vantrease (45:32):

<affirmative>. And you have your private practice down in Miami as of last year.

Dr. Sidhbh Gallagher (45:37):

Yeah. That’s been so awesome. You know, because I realized probably a few years ago, I’m, I’m a very bad employee because, you know, when my, my career is my baby, you know, I am probably a little bit of a controlled freak. And if I get the slightest hint that I think maybe my patient is not being spoken to the way I would want them to be spoken to, you know, like with a level of respect or professionalism, these things would make me so mad, you know? And I get really passionate about it. So the clear solution was me to have my own practice where I have this sort of stuff is under my control.

Andy Vantrease (46:07):

There’s a lot going on in legislature with transgender bills down in Florida, across the country in the world, but specifically in Florida. How does that affect your practice

Dr. Sidhbh Gallagher (46:22):

So far? We haven’t been directly affected. You know, the one we’re all watching as providers is that horrific, one that was instituted in Arkansas where it’s a legal to provide care to a transgender minor, which, you know, we talked about earlier. It’s like you take probably one of the most vulnerable populations right now in the United States and deprive them of healthcare. I mean, it’s an abomination really, because, you know, as I mentioned earlier, this stuff isn’t controversial anymore. Like the American Medical Association came out in, I think it was 2011, and said that this is a serious medical condition that needs care. And to the best of our knowledge, this is the goal standard and how we care for folks. And so how you could justify like the government interfering in that and just deprive in you of care is, you know, something very upsetting and very concerning.


And hopefully, I don’t think it’s gonna be a trend. I think what we’re seeing is we’re seeing some minor setbacks along the way, but I think overall society is beginning to get it because it’s all about education. Like, as opposed to, you know, six years ago when my job would come up, I would get a lot of comments that were maybe transphobic or not very educated. Whereas now I find that the average person will, will say, oh yeah, my, my sister’s son, whatever, like they know mm-hmm. <affirmative>, they know somebody personally. So it’s now it’s personal. So I think, you know, even if it’s somebody in media or whatever it is, people are slowly but surely becoming more educated so that the public is just not gonna tolerate this, these rules that are, I mean, a lot of them, it’s just, it’s plain little discrimination. Can we build bigotry?


You know? So, so I think what we’re seeing at the moment is a little bit of a setback and you know, my goodness, there’s so much bigger issues, you know, like mass shootings everywhere, but gosh, these trans kids play in sport. We have to stop that, you know? Mm-hmm. <affirmative>. So I think it’s a little blip. I think overall the trend is in the right direction and certainly in the medical community, you know, we’re seeing, there’s like formal teaching now in most medical schools and you know, transhealth, you know, so things are gonna get better and better and better, but it is a little disturbing to see those archaic rules creeping in. And I know there’s a lot of good organizations who are fighting those now. And I mean, at the end of the day, whatever your beliefs are, you know, you should probably listen to the doctors, you know? And like I said, there isn’t a single medical professional organization that endorses what’s going on in Arkansas right now.

Andy Vantrease (48:54):

Mm-hmm. <affirmative> throughout this entire conversation. There’s so much of it that I think can be transferred to even other areas of life where lack of education, lack of access to different cultures and different people and different populations and different belief systems and ways of being, I think so much discrimination and intolerance comes from lack of connection to other ways of being and to other people. I always feel like one of the answers to unifying is to talk to people who think differently than you, look different than you speak different languages. And that’s something that we try to do on this podcast as well, is really to just build those bridges between people, via stories and educate. Where are some of the ways that people can start that process for themselves if they’re curious?

Dr. Sidhbh Gallagher (49:53):

Absolutely. Well, you know, you hit the nail on the head. There’s so many resources available. And even just in mainstream media, there’s some very responsibly covered documentaries where like trans voices are ified, there’s some good documentaries available. I think National Geographic have done a couple of good jobs, you know, looking at a transition and even reality tv, I am Jazz, Jazz Jennings, they’ve done a great job. They’re even celebrities like Laverne Cox who speaks extremely eloquently on that sort of thing. So really you go to the source, you know, and between social media and mainstream media, there’s so much available. Listening to folks stories I think is probably one of the most powerful ways. Terminology can be a little bit intimidating if you’re not used to it. And certainly some words are privileged that I shouldn’t use as, as a cisgender woman, a great resource for that is glad, glad of a website that that really kinda breaks it down.


It’s like what you should say and what you shouldn’t say and how not to offend people. Because I think at the end of the most of are good natured enough that if you’re not used to interacting with members of the community, we’re just a little bit intimidated and terrified to say the wrong thing. You know? So, so that can be a good resource as well. From a medical point of view, most of the medical professional bodies like the American College psychiatry have a great website on it, just kind of in lay person’s terms, breaking it down, you know, what does gender dysphoria mean? So there’s a ton of resources, June at the Moment’s pride month, you know, so more than ever that’s available. But I, I think the main thing is just listening to transgender stories, transgender voices, and non-binary folks as well, obviously. Mm-hmm.

Andy Vantrease (51:33):

<affirmative>. Awesome. Yeah. My last question that I always ask people, and <laugh>, I feel like you have just exemplified it through the whole conversation, but I’ll ask it anyway. What is the thing that brings you hope and keeps your fire lit? Where do you draw upon that energy? Yeah,

Dr. Sidhbh Gallagher (51:52):

So there’s a few of them. So being in this field is super exciting in that the best minds and surgery in medicine have not been focused on this field, right? So there’s so much opportunity for innovation, which is really exciting to me. One of the things I’ve pioneered a little bit is a technique in female to male top surgery or chest surgery folks travel from all over and like internationally, you know, for that technique. And that to me is just so wonderful that like not only can I provide it for these patients, I can publish on that. So the surgeons all over the world can use this technique. And for me it’s all about being useful, right? So now I’m not only been useful to my own hundreds of patients, but potentially thousands more patients. So innovation is, it’s one thing that really excites me.


And we have a lot of technical big problems that need to be solved in our techniques for gender affirmation, surgery, for example, for the genital surgery, especially for transmasculine patients. We need better techniques there. And so there’s a lot of new really exciting things on the horizon there. So that definitely gets me going. Another thing I would say, like some of the most heartwarming things I’ve ever seen, like come outta this community, and you know, I’ve mentioned some of them already, and I would say probably the thing that really gives me the chills more than anything is when I see a parent, you know, which I see this actually a lot down here in Miami, is this parent in this difficult situation where maybe their community, maybe their church is telling them that this isn’t right and this kid is not right, and they turn their back on their community and their church and support their kid and become fierce advocates.


When I see a parent question all their fundamental beliefs and come out in support of that child, it’s like phenomenal. You know? It’s just, there’s nothing more heartwarming. You’re like, yep, love trumps all my faith and human nature is restored. Thankfully, we get to see it all the time and we see this kid thrive walking out to the waiting room, you know, I gotta do this today. And to tell that parent who’s been through so much to support this kid, tell them they had their surgery, everything went great. And oftentimes there’s like an outpouring of emotion and like, I mean, I’m of course kinda a nice and ice queen, usually a baseline. But when I, when I see that promotion, like they get me <laugh>, you know, like I get the chills when that happens. There’s very few jobs in which, you know, like maybe if I’m not feeling it tomorrow morning and I’ll be like grumbling my way into work. Whereas that person who’s waiting for me has been waiting probably in some cases, you know, like I said, that one patient 70 many years, it’s quite mortifying. The <inaudible> gratitude, they show us you. There’s gifts coming and like <laugh>, the families will come in and support and you know, it’s just, it’s such a big deal for them and obviously you know best in the world. So.

Andy Vantrease (54:52):

Dr. Sidhbh Gallagher, an energizing and heartfelt conversation that really struck a chord with me and opened my eyes to the ways that we continue to suffer from the boxes we’re put in. I see so many of my own struggles with personal identity and self-acceptance in these stories, and like Sidhbh says, we can all relate on some level to this sole journey, how brave we have to be to show up as our true selves in the world. I know I’m always walking the tight rope of how to be authentic and true to myself, amidst, the messaging media and all the external forces that make me feel like I should be someone that I’m not, and to really give ourselves room to change and grow and evolve. That was another lesson that came out of this episode for me. Sidhbh’s, passion and excitement for her work felt so contagious and I was drawn to the personal stories of what lights her up, seeing parents question their beliefs and choose to support their kids.


Every time I heard that section, I just well with pride and hope and faith in people. Faith in the Power of love. Happy pride month to everyone out there. May we continue to listen, learn and love even more. If you’d like to learn more about Sidhbh’s work, visit gallagherplasticsurgery.com.

A special thank you to Matthew Marsolek and the Drum Brothers, whose music you hear at the beginning and end of this podcast, as well as Dr. Jean Shinoda Bolen, who first turned us on to the phenomenon of the Dandelion Effect and how ideas move through the world.

This podcast is a production of the Feathered Pipe Foundation, a 501c3 dedicated to healing, education, community and empowerment. If you’d like to help support this project, please visit FeatheredPipe.com/gratitude or leave a review on Apple podcasts and share with your friends. Be sure to tune in to our next episode in two weeks. We cannot wait to share another amazing conversation with you. Until then, have a beautiful day.

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