Dr. Shabina Roohi Ahmed’s first transgender patient was a 16-year-old boy who described the depression and desperation he felt while longing for people to see him the way he saw himself.
The boy told Ahmed he’d faced bullying at school, had been worried that his loved ones wouldn’t accept him, and found that even moments of joy could become sources of anxiety because of his internal turmoil.
The lead-up to his mother’s wedding was full of dread, as he envisioned having to wear a dress to the ceremony. He wasn’t sure his mom would understand how deeply that would hurt him.
But when the mother and son finally talked, she didn’t insist on a gown. Instead, she suggested they go shopping for a tuxedo.
“It was just a simple switch,” Ahmed remembers. “And it was so impactful: the gesture from his mother understanding him.”
Since then, the Bethesda endocrinologist says she’s watched patient after patient express a similar rush of relief as she’s guided them through gender-affirming hormone therapy and they begin to feel their bodies aligning with their identities.
It’s an experience that never gets old, says Ahmed, who was drawn into medicine because of its transformative power.
Doctors played an instrumental role in the life of her late mother, whose neck was broken in a severe car accident when Ahmed was 8 years old. Her mother went from being an active woman in her early 30s to bedridden, unable even to lift her toddler son.
Ahmed’s mother spent years in debilitating pain until an operation performed by the late neurosurgeon Dr. Ayub Ommaya—who practiced in Bethesda—restored her ability to work as a child care provider and lead a largely normal life.
“So even though he’s a neurosurgeon and I’m an endocrinologist in a completely different field, I would say that he was one of those people that really inspired me,” Ahmed, 41, says. “That this is what I really want to do: I want to transform people’s lives.”
The type of treatment she provides is under attack in many places around the country, with a wave of states recently looking to restrict access to transgender health care for minors or even to classify it as child abuse. LGBTQ advocates say such laws are discriminatory and withhold vital medical care from an already vulnerable population.
Ahmed, who practices at Johns Hopkins Community Physicians-Downtown Bethesda, says it isn’t unusual for transgender patients to come into her clinic nervous, often because of bad experiences they’ve had in other health care settings. They wonder if providers and staff will treat them with dignity and use the right names and pronouns for them.
So Ahmed’s first task when a patient arrives is to earn their trust and learn about their goals for gender-affirming care.
From there, she says, the transformation begins.
A complete physical change can take between two and five years, she says, but patients usually start seeing differences in the first three to six months. Transgender men on testosterone might notice a bit of facial hair or their voice cracking, she says, while transgender women on estrogen might experience the early stages of breast growth.
In their first visit with Ahmed after starting treatment, she says, patients usually walk back into her office with a big smile, finally feeling more at home in their bodies.
In her own words
Listening to someone’s story
“By the time someone has come to me for gender-affirming care, they’ve really done a lot of soul-searching already. So I just like to sit and use the first meeting as a time to hear about their story. So I give them the stage and say, ‘Tell me about yourself. When did you realize that you were being labeled the wrong gender? What have your experiences been so far?’ ”
Brain changes
“I’ll have patients who are transgender females who come back after starting estrogen therapy and say, ‘I get emotional, I started getting teary when I’m watching a movie that I normally wouldn’t get teary with. And I like it.’ …Transgender males, after they start on testosterone therapy, they’ll come back and say, ‘You know what? My dad says I’m so much more like him now.’ …It’s funny, because some of the things that are being said, it’s almost gender stereotypes. But … we know there’s different effects on the brain from these hormones.”
Time to look inward
“During the pandemic, the numbers of patients that I have been seeing for gender-affirming hormone therapy have really risen. And I’m not sure if that’s a factor of more word-of-mouth news traveling. And/or, I think…many people have had more time and they’ve been more introspective and really kind of come to know themselves and figured out what they wanted and what was making them unhappy and kind of deciding, ‘You know, I’m not going to do this anymore. Like, I’m not happy in the situation. And I need to make a change for myself.’ ”
Community support
“We live in a pretty open-minded area, and I’ve mostly heard only good things about how employers and how work colleagues have handled the transition of my patients. And so, it’s been generally pretty positive. …Even in fields that you wouldn’t imagine, like in law enforcement, for example, where you’d think maybe there would be a different culture.”
Anti-trans laws
“I think this is just the uprising that happens whenever there is any change that people aren’t comfortable with. And more and more, I think that those voices will be quieted. Especially with the next generation, it will be quieted. If you talk to kids my kids’ age—they’re teenagers, I have 14-year-old twins—if you talk to them about the LGBTQ community, there is such a high level of acceptance. …I think this is sort of a last push before things will get better.”
This story appears in the July/August 2022 issue of Bethesda Magazine.