Hysteria and Other Myths About Women's Reproductive Health, with Dr. Karen Tang
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Today we are meeting with friend of the pod, Dr. Karen Tang, and it is our 4th of July episode. So I'm super excited to be having a patriotic moment with you here to talk all things vaginal health. There is nothing more American than caring about your women's health. Being obsessed with women's reproductive health. It's just what we do. Free women's health. Yes.

Free women's health, life, liberty, and the pursuit of vaginal health. That's what we're doing on this July 4th. Dr. Karen Tang is a board-certified gynecologist and minimally invasive gynecologic surgeon. She is an international recognized leader in reproductive health and social media. She's also the author of Not Hysteria, Everything You Need to Know About Reproductive Health, But We're Never Told. Dr. Tang, welcome to the show. Thank you so much. I'm super excited to be here.

Me too. So first I have to say, what is a minimally invasive gynecologist? And why has this never been offered to me before? You know, I didn't know it existed until I was actually an OBGYN resident, like doing my training that I was like, oh, that's a specialty. I didn't know. And I think it goes to say that like a lot of people don't realize that there are specialties in women's health like

that, it's kind of sad. I had no idea. It's a specialty that does things like endometriosis and fibroids, ovarian cysts, hysterectomies, tubules. So anything that's like surgery for gynecologic issues, we do it with small incisions so people can get back to their life. But the specialty also, because it deals with some of these things like endometriosis, also includes management of chronic pain.

So we're kind of like pain specialists as well. So, you know, so much of, you know, reproductive health has to do with, you know, all these like mysteries, like why does this hurt so much? Like, why is it hurt when I have sex? So, you know, we, we deal with a lot of those things too. Again, a lot of people don't realize that that is even a type of doctor that

which is really sad. I think that speaks to how reproductive health is seen in this country. It's like, oh, there's a doctor for that? Yeah. I had no idea. And also, as a person who has owned a vagina for 41 years, 41 glorious years, I feel like I was only getting informed consent-based care in the last five years. I feel like when I first started going to the gynecologist, it was very...

icky feeling like in the nineties and 2000, early two thousands. And now you go and there's so many more women that I have access to that I didn't feel like I had access to before. And they're like, I'm going to do this now. Is that okay? We're going to do this part now. Is that okay? Is that something, where do you think that came from? Like, and am I real to believe that this is recent or that's what happened? Yeah. I mean, the sad thing is, so I was in my training in like the early two thousands, like I'm old, but you know, we were taught that

Like we were saying, like, okay, you know, you explain what you're about to do before you touch the patient. Like say, okay, I'm going to be doing this type of exam. You may feel this. So it's not like it's a new concept.

But just in execution, like so few people were doing it. Like you're absolutely right. Like recently I've been sent so many videos where people are like, did you know the doctor's supposed to tell you before they do anything? And the exam, like, yes, they're supposed to tell you. They're supposed to like, you know, walk you through it so you know what to expect. And it's not just like things are happening to your body. So like I said, in theory, we were supposed to have been doing that all

along. And I've always done that. But it is something that I think, you know, people are much more aware. It's like the concept too of pain with GYN exams like that really took off on TikTok. And I think, you know, gynecology, we definitely own that. It was too blasé about, oh, well, you know, it's going to hurt for a minute. It

But no, like we should explain like what people might feel, how we can make it more comfortable, how to minimize pain. So, you know, that really, I think with just being aware and having these conversations on social media, like obviously you and I both know there's lots of pluses and minuses on social media. But one of the good things is, you know, getting these conversations to happen that people like kind of just sort of struggled with individually for all of human existence. And they're like, I guess I just have to deal with this.

realizing, oh, no, we don't actually have to just deal with this. We should be asking for more, should be asking for more respect and more involvement in our own care. So that's, like I said, definitely a positive of all of this discussion around reproductive health. Well, I wanted to talk to you about using social media as part of healthcare, which has obviously become more popular. And I feel like maybe TikTok had a good hand in this because it was the pandemic. We were home. Telemedicine became very normalized. All of a sudden, all the things that they said they couldn't do-

We could do. Got to do it. As far as telehealth went. You know, we had to. What else were we going to do? But even with like restaurants who never did pickup before, like fancy restaurants that were like, I don't do takeout. They sure did. And it just like freed us up to be normal and treat people with a little more respect and try a little harder. So I love social media healthcare because there are so many things that I didn't even know were possible to access. Right.

And just normalized conversations around things like gender affirming care, what that means. But also women's health care and all these mysteries that we're taught to just be embarrassed of or, well, this must just be happening to me. And so I don't want to be the weirdo that brings it up to my doctor. They're going to think I'm gross or weird or something. And then you're on social media and there's folks like you who are just making it so normal. And they're like, I see this hundreds of times a day. Please tell me if this is happening to you.

Can you talk a little bit about why you chose to get on social media and use that platform for education? Yeah, you know what's funny? So I was kind of joking that I'm old, but it's kind of true. I didn't do any social media before 2018. And I started on it just because a friend who does a lot of media in general was like, oh, you know, this is where people get their health information now.

They're not like, let me go to my doctor with every single question about my health and my body. No, you're going on TikTok, you're going on Facebook or Reddit or some sort of social media. A lot of us don't have health insurance, Doc, so we're going on social media. Yeah.

So exactly. So I had no idea. Like I was so oblivious to this. I was like, oh my gosh, I got to, you know, get out there and explain, especially, you know, doing a specialty that is, there's so much misinformation about like reproductive health and endometriosis and pain. So I went on there like partly to educate people and partly to just to make people realize that I was, you know, I was there. Like if you want to see a doctor, I'm outside of Philadelphia. Here I am. But

But then the pandemic happened. And that is exactly what happened is that everything shut down. And so, you know, my specialty is not like life or death kind of care. So all of my, you know, my practice got completely shut down. I'm like, what the hell do I do with myself now? So, you know, a couple of other friends who had gone over to TikTok, Dr. Jennifer Lincoln, Austin Chang, like they were doing amazing, right? They are like all stars. So they were like, look, there's such a need out there. You know, Jen just talks about like, initially she was just like, how do you put in a tampon?

Like, how do you like, what's a pap smear? And there was just such a need for this basic information in an easily accessible and understandable way, like not high pressure, not like you have to go sit for your doctor and feel embarrassed, but you could just like scroll and find information out there. So.

I started making videos and they took off. I did initially some of those videos on the difference between gender and sex, that sex is not binary, gender is not binary. So some of those things in addition to the birth control, the periods, the endometriosis, there's just so much to inform about. And then once I started on there, I saw how much crazy bullshit there was.

Like, so now half of my videos are about like dispelling, like, oh my God, you might've seen this crazy guy saying this crazy thing. It's not true. Because there's so much out there that people are having a hard time now, you know, realizing what's normal, what's, you know, what's, what's accurate, what's not.

So, um, just like you said, one of the good things was that really got people kind of talking about these things. You know, now you have doctors getting on there explaining stuff. And I will say that, you know, with the whole idea of like people feeling alone, um, some of the videos that I post, like they're about the kind of just most random things like, um,

you know, butt pain with periods or something called a decidual sack, which is literally just where the entire lining of your uterus comes out in one piece instead of coming out like little bits and blood. It comes out all at once. And it's so scary. And it's so scary. And I didn't know that it was as common as it is because they're like foul.

of comments in these videos being like, oh my God, I had that too and I had no idea what it was but I didn't tell anyone because I was so scared and I was embarrassed. Do you know how many times I thought I had a miscarriage as a lesbian because that happens to me and I'm like, how is this, like, what, like, how could this possibly happen?

Right. And then you're like, well, I guess it is what it is. Right. So I actually, I said that in the video. I'm like, people think that they're having a miscarriage because this big kind of sack thing comes out. Yeah. And so, you know, and the butt pain with periods, people are like, oh my God, I have that. What the hell is that? And I'm like, that's a sign of possible endometriosis or it's pelvic floor spasm. No way. Yeah. Oh my God. I'm learning so much about myself right now. Well, that's what people said. They're like, I've had this for like 15 years and I had no idea what it meant. Yeah.

So there's so much like that, that even us doctors don't realize are as common as they are because people feel embarrassed or they feel ashamed or they feel like, well, I don't want to say this to like, who am I going to tell about my butt pain? Right. But I'm going to come in and be like, so I have a pinchy hiney when I get my period. It stabs me in the ass. I have my

I have my period. But, you know, so so many of those things, it was really quite powerful to see, you know, people realize having this like collective realization, like I kind of like the emperor's new clothing phenomenon where you're like, I thought I was the only one.

And then once you start talking about it, you realize like, no, actually there's like millions, thousands of people who are going through the same thing. And then just everyone had felt so embarrassed to talk about it that they, you know, just didn't feel comfortable sharing that with friends, family, partners, doctors, anybody. And that leads to some of the problems that we have in women's health where, you know, like

People were told, oh, that's just normal. Or we don't know information because we don't treat it like an actual medical condition. It's just like this mysterious lady stuff. You know, so unlike things like diabetes, heart attacks, strokes, cancer, we're like, that's real medicine. Like we should put some research funding towards that. We should do some big studies on.

You know, people's like pain with their periods is like, oh, that's just like a lady problem. You know, who cares about that? So, you know, yeah. So like talking about these things and raising awareness, I think is so key to like making some of these necessary changes. Now with social media, as much as there's been so much help for folks out there, there's been some questions about how patient privacy factors into this and the ethics of talking about cases online. How have you built safety for your patients around this?

Sometimes maybe telling their story as an example without using their name, of course. Yeah. I never share any sort of patient information, a story. Obviously, I've done some videos where I show actual surgical footage. Never, never, never, unless the patient asks me to.

Like, so I've gotten to the point now where enough people know me from social media that are like, actually, could you use this in a video? Or sometimes if I'm like, oh, this is a really powerful point. I think a lot of people feel the same way. Would you mind if I shared this? Obviously not sharing your name or face or any identifying information. No, you know, like I know I don't show any like obviously like

genitals or anything like that, you know, in a way to kind of protect their privacy, but make it educational. So it's always that the patient has the full autonomy to like say yes or no. And again, I try and even make it so that I very rarely ask, you know, I try and see if it's somebody who's very excited to share their story. They're like, actually, could you make this into a video? So pretty much all of the videos I've shown with the surgical footage is from somebody saying, oh my God, can you make a video of me?

because they're really excited. A lot of times they had seen videos that helped. Yeah, they're like, I saw this video you made about hysterectomies. I thought it was amazing. I didn't know what actually happens during a hysterectomy. Can you make a video of blah, blah, blah, my tubal ligation, my endometriosis surgery? I think sometimes if we put too much pressure on a patient to share and they don't feel comfortable, they do feel kind of like,

I don't want to disappoint them. So I, you know, maybe say yes, even though I don't really feel comfortable. So I do try and limit to the ones who are, people are super enthusiastic about it. I do sometimes. This is me. Every time that the doctor comes in and they're like, we have some medical students, would you mind? And I'm like, sure. Well, because you want to, you,

you want to help and you understand it's important for them. And like, if you have something, you know, routine or even something special going on, you're like, yeah, sure. And then there's always like four or five kids that come around the corner and I can look in their eyes and I'm like, one of you watches under the desk. I know this. We're about to get very close. I'm sure half of them are like fans. No, I was at the dermatologist literally the other day and she was like, look, I'm not trying to make this weird, but I know you saw my face when I came around the corner. And yes, I do watch your show, but like, I appreciate you. We're at work right now.

Like, it's cool. It's cool. How's that mole doing? Any discount on the service? Right. Oh, my God. And I do see sometimes, and it's usually people who are younger, like medical students or like trainees or like younger nurses who you're like, oh, that is a clear HIPAA violation where they're just like going super into detail with like, you could identify a patient or if you were the patient, you could identify yourself.

based on this story. And they don't say like, oh, obtain with patient permission. Like, you know, we always have to put all those disclaimers and like, you know, like this was, you know, shared with patient permission, you know, see your doctor. Like if you have something similar, like, you know, this is not medical advice.

But you see a lot of people kind of crossing those boundaries. I think because especially if you're younger, you're so used to sharing all of your life on social media, you forget that there's this like power imbalance and this privacy issue when you're like a healthcare provider and your patient is being vulnerable. Like it's not your story to just like share. I see that a lot. And I always want to be like, come on guys, that's yuck. So it gives me anxiety because before I went in for my top surgery, I was watching a lot of like top surgery TikTok.

And, you know, then you eventually roll up on these nurses who talk shit about their patients. And I was so anxious and I wanted to be this perfect patient so that I wouldn't end up on somebody's crappy TikTok. You know what I mean?

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Bye.

I want to switch gears from social media now to talk about your book, which is so important and so helpful. So tell folks about the book. It claims to go through the myths of women's health and help you find healing.

What are a few of the biggest lies or myths that we've been told that you cover in the book? Yeah. I mean, so, no, just the title itself. It's not hysteria. I think so often for all of human history, you know, women, people assigned female at birth have been kind of told that stuff is in their heads. So, you know, like from like Freud and like the women are actually,

and up and they must just be, you know, all those repressed anxieties are manifesting as this craziness that they're complaining about. You know, we haven't come that far in a lot of ways. So, you know, there is a chapter at the beginning on history and it goes over all like, you know, like the Freud stuff, you know, ancient Greeks, the, you know, like racial disparities, like the history of racism and gynecology. Like there's so many of those things that still kind of linger today.

And just, you know, the talk also about like the lack of research. Like, why is that? Why is women's health not considered as important as other aspects of medicine? And the biggest kind of myth is like, oh, that's just normal. You just have to deal with it.

And that happens so often for so many things like period pain, heavy bleeding, you know, hormone issues like people with PCOS, premenstrual dysphoric disorder, perimenopause, menopause. Like people are really suffering sometimes and they're just told, oh, that's just normal menopause stuff. That's just normal period stuff. You just kind of have to tolerate it like women have done. Oh, these many thousands of years.

So, you know, a lot of times there are actual like treatments that we can offer. You don't have to just keep on suffering. And it's not just in your head. Yeah.

I make the case that, you know, a lot of times if people are having like mystery symptoms, you know, they have lots and lots of different issues affecting their health. A lot of times the reflex from healthcare providers is, well, your labs are normal. Your testing is normal. Your ultrasounds are normal. It must mean that everything's fine and it's psychological. Whereas a lot of women's health issues are actually not detectable with traditional testing. So like endometriosis, I keep bringing it up because there's not an easy test for it.

You have to do a surgery to find it. Like, you have to do a laparoscopic surgery. So someone can have, like, diarrhea, pain, pain with sex, bleeding problems, bloating, vomiting, you know, like, infertility, migraines, like, all these things that don't seem related, but they're actually caused by the same thing. So, you know, because their imaging's normal, your exam looks normal, your blood work looks normal, they're told, oh, it's just normal. But it's really not. There's something, like, you know, serious medically going on. You said something, was it, what was it, dysphoria? Yeah.

Oh, premenstrual dysphoric disorder, PMDD. Yes. What is that? Yeah, this is something that also I'm glad is getting more kind of talk on social media because it is premenstrual dysphoric disorder, PMDD. It's a very extreme kind of version of PMS where it's not just like mild discomfort or like a little bit of mood fluctuations. You have such severe mood symptoms, depression, anxiety, that it affects your ability to function.

So people truly like sometimes they feel like thoughts of self-harm, like they can't go to work. They can't, you know, they have serious relationship issues. And it's always, you know, right before their period starts. It's like, you know, one to two weeks before your period starts, you are just feeling absolutely horrible. And then after your period, you know, begins, then it resolves. It's in the kind of same range as depressive disorders, anxiety disorders, but it's specifically because of the hormone changes that happen right after ovulation and before your period.

And people are like debilitating symptoms. But again, sometimes people are like, oh, well, everybody has some mood symptoms with periods. But this is not just a little bit of moodiness. It's like really, really severe. Yeah, I've seen it in friends and different folks that I'm not going to name, but

There's a treatment for that? Yeah. There's much more common than people think. And yes, there is treatments. It can be hard to treat because it's not just about taking antidepressants, though that is one of the treatments, but also therapy. And from the gynecology perspective, we actually put people on continuous hormones, like continuous birth control with no placebos, because the problem is the ups and downs. So we actually have continuous hormone just to prevent the spike with ovulation and the up and down with ovulation.

And people feel it's like they train, it transforms their life. Like I just did an interview for Huffington Post about, you know, the medical benefits of birth control, because people are trying to take away access to birth control. Oh, my God. And I'm like, it is a medical treatment. And PMDD, like I said, people like, you know, in the comments were like, it changed my life. Like I can function now.

because I'm not feeling so miserable. And it's not just like one thing, like just take this birth control, but it's about like managing all of it. So it's actually quite a complex treatment. There's even some people it's so bad that they actually have to have their ovaries removed. That's very rare. But they just fail every single thing and they just can't function. So, you know, like they try one thing after another and eventually, you know, you take out their ovaries and you give them hormone replacement, you know, but that's extreme. And they're good. Yeah. But then they're fine. Then they're like, I'm myself. Yeah. Yeah.

It's one of those things though that you just think will never get better and there's no option for it. It looks like there is a path here for folks who might not. I mean, I didn't know there was a path here for this too. And I'm going to hang up from you and call a bunch of my friends and be like, hey, did you know there's this thing I just learned about on the show? You know, I always wonder too,

Why is there a placebo in the birth control? Is that necessary? No, it's not. So the placebo week is only to induce a period for a couple of reasons. One is to make people know that they're not pregnant. Because people, you know, there's plenty of people who are like, I just need to see my period to know that I'm not pregnant.

So there's that. And then there is sometimes if you go too long without a period, then you start to break through and you have like kind of uncontrollable spotting, which can be kind of annoying. So that's where you get those birth control packs like the seasonals that have them every three months. So you only have a placebo week every three months just to get occasionally, you know, flush things out. But you can do that with any birth control.

So we do this all the time with people who have painful, heavy periods, PMDD, you know, some, you know, menstrual migraines, like anything where it's like their symptoms are tied to their period. We just make their periods go away. So there's no medical need to have a period. If you're not on birth control, we do want people to have a period because then otherwise the tissue kind of builds up and that can become abnormal. But if you're on the birth control, there's no need to flush it out because the progesterone, the hormone, one of the hormones in the birth control, it's

keeps the tissue from growing. So it's basically that's why it lightens your period. Yeah, that's why people take it and they're like, Oh, my periods later is because it's keeping the tissue from growing. So you don't actually need to flush anything out because there's very little in there. I know. See, there's people like I had no idea. Right. And so I do this all the time. This is like bread and butter, you know, but people like, Oh, but isn't it unhealthy to not have a period? I'm like, No, well, it isn't.

Healthy if you are not having them on your own, like with PCOS, people skip their periods and that can be a health risk. But if we are, you know, taking over, then we, you know, purposely do it so that it's not unhealthy. And we joke, I'm like, there's no medical reason to have a period if you don't want one. So why deal with it? Yeah, I think...

This is discrimination. This is homophobia. Because as a lesbian, I've never been offered birth control. They're like, do you want it? And I'm like, why would I need it? What would I need that for? I have absolutely no risk of this. And they're like, okay. But now I'm going to call my girl up and be like, hey. Yeah, take these periods away. There's no medicals.

Yeah. There's a little joke among gynecologists, but it's totally true that like all of us have a progesterone IUD because like we don't have periods. Like, you know, it's a little bit different because the IUDs don't take away the hormone fluctuations of like, you know, the PMDD and stuff, but it takes away the bleeding because it's controlling that tissue. So all of us have a progesterone IUD, like almost 100%. Like if you poll gynecologists who are women who have periods, we're like, yeah, we got an IUD.

Because we're like, nobody has time to deal with a period or to remember birth control. So it's great. Not doing hot girl stuff. So also in the book, you talk about trad wife, crunchy health, anti-medicine TikTok and the claims that if you combine things like Jell-O and lemon juice and ibuprofen, you can delay or stop your period, all this kind of nonsense. Talk to me about trad.

trad wives on TikTok and their homeopathic gyno medicine. Oh, gosh. Okay. So I was actually just on Nightline. They did a segment on trad wives. And I was there as the working mom, like working woman kind of counterpoint. And I always kind of say like, look- You Jezebel. I know, right? I've abandoned my children. So I always kind of put the point, I obviously don't judge other people's decisions. Being at home is right for you. But

But is where you get like the whole aesthetic of the trad wives who was just like, you know, we made this like thing and like it's all natural and like you don't need health care or vaccines or like that's where it gets dangerous. Where it's like it's not just like I live a traditional life, but like I eschew all of, you know, vaccines, modern medicine, you know, anything like that. It gets a little bit dicey. And so, you know.

In general, with all the crazy stuff that you see on TikTok where people are like, you don't need X, you just do Y. There's no science about it. There's no safety. Sometimes people try and sell you stuff. They're like, oh, this is all natural. It's made of natural vitamins. But I'm like, nobody...

is proving that it's safe. Like there's no safety regulations on those sort of things. And a lot of times it's just like nonsense where, you know, people just like make some stuff up and they call themselves like, you know, like I'm like, like, you know, like a,

I don't even know how to explain it, but like that, you know, I'm, I'm like this natural woman in the farm and I just plucked this leaf from my plant and I create a true blood, you know? So that, okay. So where you make claims that what you say is the right thing and everything else is wrong. I always say use a healthy amount of skepticism for that because like

Those of us in medicine, we're like, we know that there are some limitations to what we're saying. Like, we know that there's not enough research on this sort of thing. We always have to give, like, here's the caveat. You know, whenever someone just says with their whole chest, like, I know more than everyone and my thing is the best. And all of that is, you know, bad for you because it's unhealthy for your body because you're putting poisons like hormones into your body. You know, like I said, you have to use a healthy amount of skepticism for that. And this is for everything. It's not even just like...

Young women and like period stuff. But it's like menopause stuff. Like people are like, oh, you shouldn't take those hormones. Oh, yeah. They got me on the wild yam cream. Oh, my gosh. I was like –

TikTok is so crazy about wild yam cream. And I see like hundreds of ads a day to the point that I was like, you know what? Maybe I should get it. Is it? Yeah. You know who else is always on? It's all those like anti-herpes, like Dr. So-and-so. Like if you make one video about STIs, you have a thousand like troll bots that are like selling like so-and-so's herbal herpes supplement treatments. Those are fake. There's no like treatment for herpes. Just, you know, don't believe them.

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Another hot button issue is gender affirming care for kids. And of course, you must be seeing this with young adults who, you know, I think started going to gynecologist when I was like 13 or something. So you must be seeing some of this. What's your take on gender affirming care for kids? Yeah. And so I have a whole chapter on gender identity and gender affirming care because it is, you know, people are...

Talking about social media, again, not based on actual facts, but about just like rumors and misinformation. So one of the biggest ones is like, oh, well, we don't believe in doing hysterectomies or doing surgeries on children. I'm like, nobody is doing a hysterectomy on pre-puberal children, not a single person. And in fact, like, you know, almost nobody is doing anything like for children.

teenagers, the rare exception are things like top surgery because there's so much dysphoria tied to, you know, like breast tissue, it's hard to compress, you know, like with binders. And so that is like the one exception for people who are past, you know, like puberty, like in their teens that they may have a surgical treatment for.

But the rhetoric is all like, oh, they're mutilating children. They're doing these surgeries, irreversible surgeries on children. Very rarely is that the case. Most treatment of adolescents and minors for gender affirming care is supportive care.

It's basically just giving like therapy resources, you know, encouraging and supporting the child so that they can, you know, understand their gender identity. And also things like pubertal blockers, which are for the most part reversible. So that what do those do? Yeah. So they basically they're actually used for many different things are actually used for like endometriosis and PMDD. They're basically to kind of just shut down the hormone signaling from your brain to your gonads.

So it basically like, you know, for children that haven't gone through puberty, it basically like ceases it so that they can get freedom from the dysphoria. So you don't get those, we call like secondary sexual characteristics like breast growth, you know, like body hair, facial hair for boys. Right.

So it's basically just to be able to kind of like put a temporary stop to those. Even things like the hormones, like taking supplemental hormones, you know, if you're trans boy, trans man, you know, taking testosterone, even that is a little bit like less common. Most of the time it's supportive care, it's pubertal blockers, things that, you know, because we know like, obviously, like people are still understanding who they are. Like we're not expecting them to make like a lifetime decision when they're like 11 or

You know, but it's about making them feel comfortable, protected, you know, safe so that they can explore that identity and make those decisions when they're adults.

A lot of the chapter in the book was about just kind of dispelling these myths and what is actual gender-affirming care, what are the options. And then for adults, I go into things like the surgeries and that sort of stuff. But a lot of the political discourse about youth is it's purposely inflammatory. They're like, they're mutilating the children. I'm like, nobody's mutilating the children. We're trying to save the children. And gender-affirming care, like you said, is something –

Often as simple as a haircut, the way that they get to style their hair or the clothes that they get to pick or to your point, delaying puberty to a point where they're better able to manage it. As a person who was like a double D in sixth grade, man, puberty blockers would have done wonders for me, not just in the fact that I would be an adult who at 37 got top surgery. I was well, well old by the time I decided it was right for me.

But you know what I mean? Compared to like how they do it now. But like, but I would have loved to have maybe had the option for puberty blockers for the sheer fact that I didn't want old men creeping on me because they thought I was so much older than I was. You know what I mean? Like development of children is so unusual now. Yeah.

I look at even my 14 year old niece and she looks like 22. I'm like, you're, you look so much older. So if there was a way to help kids just stay kids and maintain that innocence and, and that time, then why wouldn't we afford that? Exactly. And I actually talk about so much of it is also social too. It's like about involving like the school and like talking about, you know, like names, pronouns, bathrooms, you know, safety, like all that

Yeah, it's just about like, you know, sadly, I think a lot of kids need this just in general, but especially for kids who are, you know, gender diverse, like just to make them feel like comfortable, you know, in their community and their school, you know, like in their neighborhood, like that's so important.

Now, the last question I have for you is there are so many laws being written by politicians who many of them have never been to the gynecologist, but they sure do want to regulate what gynecologists are allowed to do and doctors and women in general. What are your colleagues saying about these new laws that are governing your industry? Yeah, it's horrific. I mean, obviously, even before Dobbs and before Roe, like we kind of saw the writing on the wall with what was going to happen with IVF, with birth control, like emergency contraception.

And it is really horrifying. I mean, honestly, I'm surprised that you've heard obviously about a lot of the OBGYNs leaving states like Idaho, Texas, like these places where in some towns and like, you know, counties, there's no OBGYNs at all, because how can you practice medicine like that?

I mean, you know, again, people who don't know enough about what this all means, again, it's all these like knee jerk reactions, like, oh, we're saving life. We're preserving life. No, you don't know what you've done. Like, you don't realize the Pandora's box that you've opened. And now you have women speaking out like there's so many women who have like sued the state of Texas because they were septic. They were like nearly dead.

by the time the doctor was allowed to take care of them, because some of these laws, they're not written by doctors, obviously. And there's no like, you know, guidance. Like it's so terrifying because say someone comes in, like the patient broke their water, like 14 weeks, there's like no way this, you know, almost certainly this pregnancy is not going to survive. The woman at some point is going to start to bleed or become septic, but the,

There's not a like black or white about that. It's not like this person's dying right now. They're, you know, maybe feeling like their uterus is a little bit tender. Maybe their temperature crept up a little bit, you know, but there's a very fine line between that and suddenly the person is crashing in the ICU and, and,

Where do you go for guidance on that? People are having to call lawyers and ethics committees in the hospital before they're allowed to make these medical decisions, which are just straightforward medical decisions. If somebody has a pregnancy that can't continue, we should be able to counsel them on termination of pregnancy. Chrissy Teigen was just speaking with the vice president about

Her story was she had like placental abruption, like she was bleeding, getting transfused. She was bleeding so heavily. And, you know, the pregnancy couldn't continue. So they ended the pregnancy. She didn't even think of that as an abortion. And a lot of people don't. They don't think of those scenarios as abortions, but they are. You're ending a pregnancy.

That's just the definition of abortion. People think of it as like, oh, somebody was irresponsible and they just don't want to be a parent. But no, there's so many circumstances that we end pregnancies. It doesn't matter. There are medically necessary abortions. There's cases of rape and incest. There's cases where there's an anomaly where the pregnancy can't turn into a normal child that will survive. But

you know, like I said, in the end, because there's so many of these like, you know, shades of gray, it really doesn't matter what the person's reason is. It should be their decision. And I say this all the time. There is literally no other aspect of medical care beyond abortion and gender affirming care where politicians are allowed to impose their beliefs on a medical decision and supersede standard medical care. Like I say, I mean, imagine a world where people,

cancer treatment, strokes, broken bones, erectile dysfunction were legislated by people who had no medical background and said, you know, I just don't believe in chemotherapy. It's harmful. Like there's a lot of risks of that. There's a lot of, you know, side. Why would you put all those chemicals in your body? Chemicals, like they're so toxic. You know, no one should, you know, be exposed to that. It's dangerous. And take away chemotherapy for everyone and call it a felony.

That's ridiculous. There's ridiculous. And this is where, you know, so many of us who are OBGYNs or just healthcare professionals, like never thought that we were political people. We were like, well, we're going to be very neutral. That's what we do as healthcare providers. But because of everything that's happened since 2016, we're just like, oh, we got to speak up because this is our silence has really led to a lot of this where we haven't reclaimed, you know, our role as experts, you know, be like, hey, hold up. Like we're the experts here.

Like, this is what the research says. Like, this politician has no, you know, this judge has no health background. They're completely misinterpreting what's going on. You know, what, you know, like Mifepristone is and how safe it is and what happens, you know, in gender affirming care. But they're allowed to make laws about it.

Well, that's crazy to me because if they were to go out there and try to practice medicine, you would be arrested for impersonating a doctor. Right, or practicing medicine without a license. But at the same time, you can make these laws that completely remove the deference that's given to experts and doctors. People say all the time on my social media, why aren't they suing the Supreme Court justices for practicing medicine without a license? They are. It's crazy. I think we –

It's going to be something because these people only respond to absurdity. We're going to have to do something as absurd as that, as to Sue Marsha Blackburn or whatever that woman's name is for. I can't even, when I don't like something, I can't remember the name of it. So I'm like Marsha, Martha, whatever that lady in Tennessee's name is.

And we'll sue her for practicing medicine without a license. You know, my last question here is about when we think about women's health and reproductive health, we're oftentimes thinking about how women speak to women. How are you counseling the men in women's lives who are now also victims of these laws? I mean, I can't imagine being the husband or partner of someone who's being denied counseling.

a life saving procedure and then just having to stand by and watch that person that you love suffer and feeling like you have no control. I would say these are not women's issues. Like people are like, Oh, you know, like it's a women problem. Like women need to advocate. I'm like, no, this isn't everybody issue. This is a rights issue.

And it's something that everyone should be scared about because again, yeah, now they're coming after just access to birth control that affects like everyone, you know, and you know, all these things, just if you believe in people's bodily autonomy to make decisions about your own health, like, you know, again, people joke on Tik TOK, but it's true. Like imagine if somebody was like, Oh, you're forced to have a vasectomy.

you know, that's crazy, but you would force someone to stay pregnant, which has so many health risks. And, you know, it's such a violation of your body. Like, so anyway, it is, I think something that everyone should be fighting for and, and should be making themselves informed about. So that's why, you know, with the book, some people are like, Oh, I want women to read this. I'm like, I want everyone to read this because it has a chapter on like how pregnancy happens. Like how can you debate pregnancy?

The ethics of all of these things that you were debating, if you don't actually understand how pregnancy occurs, you get these guys who are saying, oh, you can re-implant an ectopic pregnancy, take it out of the tube and just plant it in your uterus. You have to learn how these things work. It's just basic science.

you know, just the things that human beings should know. So I do say, yeah, like, this is something that this is all hands on deck. Like everyone should be talking about, you know, like reproductive health. That's why I call it reproductive health and not just women's health. Obviously it's, you know, a lot of it is focused on women. But this is something for everyone. It's just an aspect of health. Like, you know, gastrointestinal health is it's, it's just part of organ systems that, you know, are,

being debated and legislated and all this stuff. We have to stop separating boys

Boys and girls health education in the high school level, because so often they'll like separate you by gender. And then the boys don't learn anything other than how to put a condom on a banana. They don't learn anything about what's going on with who will likely be in many cases, their future partner or their friend or whatever the case may be. And then we're in this learning deficit where now they're like uncomfortable about learning because their whole life they were told, you know,

That information is not for you. The girls are going to room B, you're going to room A, and you aren't supposed to know what the other one is doing. Yeah, or it becomes like a joke. Like people are like, oh, like period, ha ha ha, tampons, or like, you know, PMS. Like it becomes like, because people are uncomfortable with these things, like you get the boys who are uncomfortable, they joke about it, they tease people, and then girls

They pretend like they don't know how to get it. They're like, how would I know how to pick out a tampon? Have you been in that aisle? I'm like, listen, boyfriend, I have. And I am also confused. So I'm going to just tell you exactly and only what to get me because this is what we've decided. We pick a tampon brand at 13 or 14 and we stick with it for our whole life. Don't mess it up. If they don't have that brand, go to another store. Right.

But yeah, but like, you know, that just perpetuates this whole like feeling of shame or embarrassment. Like, you know, like nobody knows. They laugh about it and they make it a joke. And then the next, you know, person like, oh, my God, I'm not going to talk about this. It's too embarrassing because somebody's going to tease me. So just right from the beginning, like right from when kids are in school, like they set this standard about how people talk about like women's bodies and reproductive health and periods and sex and all this stuff. I

I remember when the little tiny tampons that could fit in like your pocket came out, like the concealable ones. I was like, man, this is going to be a fucking nightmare. This is where it starts. Now, not only is something that's supposed to be embarrassing, but made something that you have to truly hide, like it's secret, secret spy stuff, but this is going to make it even worse.

It has to fit in your pocket. Shove it in there. It has to fit in your pocket. And the purpose is not functionality. It's ability to hide and disguise and mask this thing. And that's where we went wrong. And gender-based sex ed.

Dr. Chang, it is such a pleasure to have you on the show today. Thank you so much. I feel like I can talk to you forever. Your book is incredible. Please tell folks where they can get the book and anything that we might have missed that you're, you're shouting from the roof. Thank you so much. I mean, just having me on and using your platform to talk about, you know, like gynecologic health, period health, all of this stuff is so important. And I, I truly feel like I'm like, I'm just like shout it from the rooftops. Um,

The reason I wrote the book is to have people have a resource. So if you're not on TikTok, if you just want to learn about these things, it's got something for everyone at some phase, from your teen years or your inter-reproductive years, you want to get pregnant or you don't want to get pregnant, if you're menopausal, anything. Any question you may have had is, is this normal? What should I do about this? It's probably in there. So

It's not hysteria, it's available anywhere you buy books. Obviously, if you have a favorite local indie bookstore, request it from there, request it from your library. This is where the booksellers and librarians may not know that people

you know, need this information, but you know, once readers tell them that they do, then they're more likely to share it with others. You probably need it too. So find me on all the social medias, mostly Instagram and Tik TOK, uh, and YouTube at Karen Tang MD. Awesome. Thank you so much. Thank you. Go get the book. You're the best. Get the book, watch the Tik TOKs, talk to your doctor about your period dysphoria, which I'm going to do as soon as we get off. That's great. Yay.

Until next time, I'm Vitus Spear. Sammy will be with us for the next episode. And this has been American Fever Dream. American Fever Dream is hosted by Vitus Spear and Sammy Sage. The show is produced by Rebecca Sous-McCatt, Jorge Morales-Picot, and Rebecca Steinberg. Editing by Rebecca Sous-McCatt. Social media by Bridget Schwartz. And be sure to follow Betches News on Instagram, Twitter, and TikTok. Betches.