Dr. Syd Young on Wellness and Care for Trans Patients

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2025/04/04

Dr. Syd Young, a physical therapist in Austin, Texas, specializes in gender-affirming care and operates Out Wellness, an inclusive space for LGBTQ+ individuals. Young provides pre- and post-op care for gender-affirming surgeries and general physical therapy, addressing healthcare discrimination. They emphasize financial accessibility through sliding scales and mutual aid. Young highlights systemic barriers, legislative threats, and misconceptions about trans healthcare. They advocate for broader acceptance and education in gender-affirming care, aiming to normalize affirming practices across healthcare. Their work extends to fitness, self-defense, and community support, reinforcing the need for safe, affirming spaces in a restrictive political climate.

Scott Douglas Jacobsen: So, today we’re here with Dr. Syd Young. They’re very connected to the general health and wellness scene in Austin, Texas, and they work in private practice within the community. As a physical therapist, Syd specializes in gender-affirming care, working with trans populations in Austin. They also own a gym and wellness center, Out Wellness, which serves as an inclusive space for the local LGBTQ+ community. It’s a unique resource offering access to experts in hormone therapy, sex education, self-defense, and trans-affirming fitness classes.

Thank you for joining me today. I appreciate it.

Dr. Syd Young: Yes, of course. I’m happy to be here.

Jacobsen: So, what does your work as a physical therapist specializing in gender-affirming care involve? Many people may use those words, but they might not fully understand what they mean or might interpret them differently.

Young: It means a lot of things. What most people probably associate it with is pre- and post-op gender-affirming surgery care. My background is in sports and orthopedics—I completed a residency and a fellowship in that field. Typically, if someone tears their ACL, they come to physical therapy, we help them get stronger, they have surgery, and then they continue with PT post-op. This means they often work with a physical therapist for a long time.

Because gender-affirming surgeries are relatively new and are not performed by orthopedic surgeons—but rather by plastic surgeons or, in the case of bottom surgery, sometimes urologists—there hasn’t been the same established relationship with physical therapists as there is in orthopedic or trauma surgery. As a result, these surgeons often don’t refer patients to PT, even though there are orthopedic implications to these surgeries. For example, in top surgery, when people are having breast tissue removed, surgeons are often cutting through muscles. Even though it’s not classified as an orthopedic surgery like ACL reconstruction, it still has orthopedic implications.

So, first and foremost, we do a lot of pre- and post-op care for top and bottom surgeries. But beyond that, we also provide general physical therapy care for this population. Many queer and trans folks have had negative experiences in the healthcare system—whether it’s being misgendered, deadnamed, or facing other forms of discrimination. As a result, people also come to us for general PT needs—things like a sprained ankle, lower back pain, or other common injuries. We support them through that care in an affirming and welcoming space where they can access health and wellness services without fear of discrimination.

Jacobsen: So, as an inclusive space for LGBTQ+ individuals, through OutWellness, what is the model used to address gaps that may exist in traditional healthcare? You alluded to issues like misgendering and deadnaming—are those the only concerns?

Young: There are lots of concerns, and it’s important to talk about financial concerns first and foremost, even before we discuss deadnaming, misgendering, and similar issues. We don’t accept insurance here. The American insurance system is flawed at best—most people don’t fully understand their plans, what’s covered, and what’s not. So, rather than navigating that complexity, we work on a sliding scale. The sliding scale almost always results in people paying less than they would if they were using their insurance, and that’s by design.

We live in a capitalist world, so of course, we need to pay rent and keep things running. But we fully believe that health and wellness shouldn’t be a privilege—everyone should be able to access it. That’s why, in addition to our sliding scale, we also have a mutual aid system. People who pay full price understand that part of their payment helps subsidize care for someone who cannot afford it. Those who can pay do, and in turn, that allows us to offer care to those who can’t. It’s a really cool ecosystem that allows us to sustain our operations while ensuring that healthcare isn’t a financial burden for people. Since healthcare often does feel like a privilege in this country, we are doing everything we can to push back against that reality.

And then, something that might sound small but is actually really significant—we are such a queer-centered space that things like deadnaming and misgendering don’t come up here. We ask people for their names and pronouns, and while we do have to keep a legal name on file for documentation purposes, that name is never used otherwise.

I had a situation once with a new client who introduced themselves to me. A couple of weeks later, they said, “Oh my god, I came out!” And I responded, “That’s great! What did you come out as?” And they said, “I came out as Max.” I was momentarily confused because I had only ever known them as Max. Then they said, “Oh, yeah… you’re the only one who knew.” It was one of those moments where I realized that our space had been a safe place for them to try out their identity before fully coming out.

That kind of thing happens a lot here—people will say, “I’m trying out a new name” or “I’m trying these pronouns—can we use them in this space?” And we do. It’s fun, it’s meaningful, and it makes a difference. These issues that are so common in traditional healthcare settings just don’t arise here because we are a fully queer-centered space. We’re part of the community ourselves, so it never feels like an issue.

Jacobsen: So, it feels like you’re more deeply plugged into the community than into what might be called a clinical or sterile mindset?

Young: Yes, exactly.

I work hard to make sure that it doesn’t feel like a traditional healthcare environment. First of all, this is how I’m dressed for work today—this is my work outfit. When you walk into our space, you enter a gym first, and we have to walk through the gym to get to the PT area. That is intentional—it’s designed to be different from a typical clinical setting because many of us have experienced healthcare trauma.

On social media and in public conversations, people call me Dr. Syd, but in practice, nobody does. It’s important to me that no one calls me “Doctor” here because I want to maintain a familiar and equal relationship with my clients. I don’t want people to feel like they’re talking to someone in a position of authority over them. I don’t want there to be any sense of hierarchy or disparity in our relationship. Instead, I want us to feel like equals, working together to develop a plan that makes sense for them.

Jacobsen: I spoke with a surgeon in California, and the situation there seems a bit different—again, I’m speaking as a non-expert. But how have recent legislative changes in Texas impacted access to gender-affirming care? We’ve touched a little on financial barriers, but I’m wondering more about access.

Young: Yes. So, I’m in Texas, and I know that, federally, things have been scary—and here in Texas, things have been especially scary. Fortunately, at the moment, access for adults has remained largely unaffected. However, access for minors has been completely eliminated.

Minors in Texas cannot access gender-affirming care at all. That means families are now searching for resources elsewhere. Right now, the closest available care is in New Mexico, so we are working on gathering resources for parents of trans kids to help them find ways to access care in other states. We’ve also seen a huge outflow of people leaving Texas. It’s been significant—people are moving in large numbers to safer states like Massachusetts and Colorado. That has been one of the most noticeable changes.

In terms of new legislation, the next session is about to begin, so we haven’t seen any new laws passed yet, but we know what’s coming. Right now, they are tracking 106 anti-trans bills in the Texas legislature, and the session hasn’t even started. So, we know that more attacks on trans rights are on the way.

That said, last time, there were three major anti-trans bills that were passed. These included a ban on drag, a ban on gender-affirming care for minors, and a ban on trans women in sports. However, two of the three were overturned after being approved. So, part of what we are trying to do as queer and trans people in Texas is understand that some of these laws are designed to intimidate us. Some of them cannot be upheld legally, even though they are passed. The fear comes from not knowing which ones will be enforced and which won’t.

For now, trans adults still have access to care. We still have gender-affirming doctors and surgeons in the area who are prescribing hormones and performing surgeries. That is where things stand right now, but it is definitely a scary time to be a queer or trans person in Texas.

Jacobsen: Have you thought about moving your practice, given what might be coming up in the near future?

Young: I haven’t. I am very privileged within the queer community—I am white, and I can pass as a cis woman when I want to.

I have very close ties to my family of origin, which provides me with another layer of support. That’s very important, especially as we navigate this difficult time. Now, more than ever, it’s essential that this place exists. We’ve seen that firsthand. Since the beginning of the year, with everything happening politically and socially, we’ve had a huge influx of trans folks coming into this space. People need this.

And honestly, I need this place, too. The feedback I get a lot from clients who move to the East Coast is that spaces like this don’t really exist in places like New York, New Jersey, or Massachusetts. The reason is that trans folks can generally feel safe in any gym or wellness space there. A place like OutWellness might be nice to have in those areas, but it doesn’t feel like a necessity. In Texas, though, it absolutely is. Our approach is that as the federal government or the Texas legislature becomes more restrictive, we double down on our stance of protecting our trans and queer chosen family. I’m pretty stubborn, and that’s the stance we will continue to take.

Jacobsen: I’ve been working on a series of interviews—one on counter-extremism and counterterrorism, another on white nationalism, and a third that’s slipping my mind at the moment. But when you talk to experts in counter-extremism and counterterrorism, they’ll tell you that in Canada, you don’t see as many violent incidents, but you do see a lot of misogynistic extremism, mostly online. The primary or exclusive plotting of terrorist acts are Islamist.

In the U.S., though, a significant portion of terrorist plots—and in many cases, the actual execution of violent acts—are linked to white nationalism. There’s not a complete overlap, but there’s certainly a Venn diagram between white nationalist ideologies and fundamentalist Christianity. These groups tend to have very rigid ideas about sex and gender, which creates an exclusive mental landscape for people who don’t fit into those strict categories.

Relating that back to your work—do you or your clients ever report violent threats or incidents at clinics, patient support programs, or even personally, from individuals associated with these extremist groups?

Young: It’s interesting because you’re absolutely right—these things happen all the time. But we’ve been really lucky, and I do think Austin serves as a bit of a safe haven in all of this.

For three years, I worked out of my home, and my home address was very public. Now it’s not, but it was for a long time. During that time, we had zero instances of harassment, threats, or violence directed at me or at any of my clients here at Out Wellness. I haven’t personally received any direct reports of those kinds of incidents, although, of course, I know they happen elsewhere.

It might sound a little odd, but Austin truly does feel like a safe haven in a red state. That being said, it doesn’t take long to leave that bubble. If you drive just ten miles outside of Austin in any direction, you’re out of that safe zone. But within the city itself, we do have a protective bubble, and I think that helps mitigate some of these risks.

Jacobsen: What are some misconceptions that healthcare providers have about the needs of transgender individuals?

Young: The most common one I hear is that trans folks will go to a provider for an issue completely unrelated to their transness, and yet their trans identity becomes the focus of the conversation.

For example, I’ve had trans clients who are parents. They go to the doctor for a completely routine reason—let’s say they have a cold, or they’re dealing with a minor injury—and somehow, the conversation shifts to their gender identity. It’s as if the provider can’t separate 

It’s this innocuous thing, but it’s almost always linked back to their hormone therapy. A trans person could go in with any unrelated issue, and the provider will immediately jump to, “I don’t know, but it’s probably because you’re on testosterone,” or “I don’t know, you’re on estrogen, so that must be the cause.”

These assumptions are inherently transphobic because they fail to see the whole person. The provider looks at the medication list, sees hormone therapy, and immediately dismisses everything else. 

Jacobsen: It’s like when a kid has symptoms and RFK or others might say everything points to autism. It’s that same reductive thinking.

Young: Now, to be clear, there are physiological implications to being on hormones, and they are important to consider. But more often than not, providers use that as a way to dismiss any other potential diagnosis. Worse, many providers will suggest that the solution is to stop taking hormones altogether—without understanding that these are life-saving medications for many trans people. The harm they do is twofold: first, by falsely attributing unrelated health concerns to hormone therapy, and second, by recommending discontinuation without understanding the consequences. That kind of advice can be incredibly damaging.

The biggest misconception is that gender-affirming hormones are some kind of optional choice, like something trans people can just stop taking at any time. Providers need to understand that these are essential medications. It’s not as simple as, “Oh, just stop.” These are not over-the-counter drugs—they’re prescribed by trained medical professionals.

And, just to be clear, testosterone is a Class C controlled substance. It’s highly regulated. Trans people aren’t just picking up testosterone at the drugstore—we are getting it from licensed medical professionals. Yet, despite that, there’s this assumption that every health issue a trans person experiences must be because of their hormones. It’s completely ridiculous.

We see a double standard at play here. People with uteruses take birth control every day, and yet, because society wants them to be on birth control, no one talks about the health risks associated with it. And in reality, the side effects of birth control are often far more significant than those of gender-affirming hormones. But we don’t see providers blaming every symptom a cis woman has on her birth control, do we? That same consideration is rarely extended to trans people.

Another issue I see often is providers being completely unfamiliar with gender-affirming surgeries. I had a client who needed an X-ray about three or four weeks after top surgery. The technician told them, “Okay, raise your arms over your head.” And they were like, “I literally cannot do that. I physically cannot lift my arms above my head right now.”

Even as a physical therapist, I haven’t treated an ACL reconstruction in about four or five years at this point, but I still have a general understanding of how to approach it. That kind of basic knowledge should apply across the board for all surgeries, but when it comes to gender-affirming procedures, many providers just don’t have the familiarity—or the willingness—to learn.

If someone came to me and said, “I’m ten weeks post-op ACL reconstruction,” I’d immediately think, “Okay, you probably can’t jump right now.” That’s just general knowledge—I don’t need to specialize in ACL rehab to understand that jumping would likely be too painful and beyond their current recovery stage.

Even if I felt that I wasn’t the best person to treat their ACL because I’ve been removed from that kind of work for a while, I could still approach it with a baseline level of understanding. I’d say, “You came to me for PT today, so we’re not going to have you jumping because I know that’s too much for you right now.” That’s just basic competency.

The same kind of basic knowledge should apply to gender-affirming surgeries. It takes around eight to ten weeks for someone to regain full range of motion in their shoulders after top surgery—period. That’s general information. If a provider knows that, they won’t make an uninformed request like, “Raise your arms above your head.” Instead, they’d immediately recognize, “Oh, that was a silly thing for me to ask. Of course, they can’t do that yet.”

Providers should have at least a baseline level of knowledge about gender-affirming care because these surgeries are not rare. They happen all the time. Trans people are everywhere, meaning every provider—whether they realize it or not—is treating trans patients. It’s not just me. It’s not just gender-affirming care specialists. It’s everyone working in healthcare.

And that’s my biggest point. My hope is that by the time I’m old and retired, what I do won’t be considered anything special. Ideally, by then, every practice will be operating the way we do. Places like OutWellness will be obsolete because they won’t need to exist anymore—because every healthcare provider will be providing affirming, competent care. That’s the dream.

Jacobsen: There’s a strange mental economy that people have around this. And I think it applies to Canada as well, though maybe even more so in the United States. People get hair plugs. People get breast augmentations. People get all sorts of cosmetic procedures. When people age and their ears or noses change, they often get procedures for that, too.

There’s dental work, orthodontics—so many things that people don’t question. And in the U.S., since private care is more common than in Canada’s public system, people go out of pocket for all kinds of medical procedures.

So why is there this disconnect when it comes to gender-affirming care? Why do people accept that hair plugs or breast implants are “fine”, but certain gender-affirming procedures are suddenly considered off-limits?

And, as you pointed out, birth control and the morning-after pill also affect hormones. Yet, no one questions their availability. People aren’t campaigning against those in the same way.

Young: Exactly.

Jacobsen: So why is there this gap? Why are these two things—cosmetic procedures and gender-affirming care—not treated the same way? Why does society struggle to bridge that divide?

Young: I don’t know. I have no idea. But the honest answer to your question is that we live in a patriarchal society. The surgeries and hormones that support or reinforce that structure are readily accepted, while those that don’t are not.

We talk about breast augmentations, we talk about gynecomastia surgery for men, and we talk about the morning-after pill—all of these are widely accepted because they align with the male gaze. Procedures that make people more appealing or more “useful” in terms of reproductive control are normalized.

On the other hand, and this is a broad generalization, trans people don’t reinforce or serve the patriarchy in the same way. They don’t necessarily fit into conventional standards of attractiveness as dictated by the male gaze, nor do they conform to traditional reproductive roles. And that’s where the line gets drawn. It’s not that gender-affirming care is fundamentally different from other medical procedures; it’s that it doesn’t serve a patriarchal purpose.

If gender-affirming care were about making people “hotter” or more appealing to men, or if it somehow made them more “useful” within patriarchal structures, it would be viewed completely differently. But because trans people are doing these things for themselves—for their own euphoria, their own well-being—society struggles to understand it.

I also think there’s a fundamental lack of empathy when it comes to dysphoria. People who don’t experience it often have no reference point for what it feels like to live in a body that doesn’t reflect who they truly are. We already live in a society that struggles to believe marginalized people when they speak about their experiences, and that extends to trans people and their needs. At the end of the day, though, I believe much of this resistance comes back to living in a patriarchal society that doesn’t care to understand this population.

Jacobsen: How do you integrate fitness, self-defense, and hormone therapy education? And particularly, what do you mean by self-defense and fitness? Those are broad terms.

Young: Yes, and we keep them intentionally broad. I strongly believe that movement should be fun and personalized to each person.

When I talk about fitness, I mean movement of any kind. Many people come here and say, “I’ve never engaged in movement before, but I want to try a little bit of everything to see what feels good.” And I say, “Cool! Let’s do that.”

A lot of times, that movement ends up being strength training. That might involve using barbells, interval training, or a combination of different exercises. But it’s about finding what works for each individual.

Our self-defense class is taught by a member of our community who has been practicing martial arts for over twenty years. He’s an instructor in several different martial arts disciplines, though, to be honest with you, I don’t even know all of them. He sent me his résumé, and I just looked at it and said, “That looks good! You’re hired!”

Jacobsen: “So, you’re training with Jackie Chan?”

Young: Basically! I saw his qualifications and said, “You’re qualified. That sounds great to me.”

But beyond that, I keep our language intentionally vague because I don’t want people to feel limited by what they can or can’t do here. I firmly believe that movement is whatever you want it to be—whatever feels right for you and whatever you’re going to stick with for the long term. I don’t care what you do for the next three to six months—I care that you’re moving in a way that works for you.

I care about what you’re doing a decade from now. Are you still engaging in movement that you enjoy, or are we back in the vicious cycle of trying to figure it out again? I want to help people break that cycle—to find what feels good and sustainable for them in the long run.

Jacobsen: Now, shifting topics a bit—this will vary by state, but I want to ask about the most pressing legislative issues. At the state level, Texas has its own developments. You have your little oasis in Austin, but what’s happening federally? What policies are currently being enacted, and what new ones are expected? I assume that people who are personally affected by these issues are tracking them closely, since it’s more impactful for them.

Young: Yes. There are so many.

To start, there was the “two genders” policy that was announced at the inauguration. That was one of the first moves, and it impacts people who are either in the middle of transitioning or who have already transitioned but now exist in this legal limbo. It also disproportionately affects people who are androgynous because these policies are designed to enforce strict gender binaries.

I can’t remember the exact name of these laws, but I keep calling them “Good Samaritan laws”, even though that’s not what they are. Essentially, they empower everyday people to police others—giving them the perceived authority to challenge someone’s gender based on their appearance. For example, I have short hair, so under these laws, someone might feel entitled to say, “You look like a man. You shouldn’t be in this bathroom.” These laws create vigilante-style policing of gender identity, which is incredibly dangerous.

Then there’s the attempt to ban gender-affirming care entirely. While that likely won’t hold up legally, the fact that it’s even being proposed is concerning. They’re also pushing a ban on trans women in sports, as well as restrictions on trans people serving in the military.

Another disturbing push is to extend the statute of limitations for people to sue doctors who provided gender-affirming care. That means someone could transition, live as their true self for years, and then suddenly be encouraged to sue their doctor for providing that care. It’s a clear attempt to scare doctors out of offering gender-affirming treatment.

They’re also trying to make it illegal for doctors to refer patients out of state for gender-affirming care. If I went to my doctor in Texas and said, “I want gender-affirming care—can you refer me to someone in New Mexico?”, they’re trying to criminalize that referral. The goal is to box people in, making it as difficult as possible to access care.

Beyond that, they are working to intimidate doctors—to make them afraid to prescribe hormones, perform surgeries, or even provide basic referrals. They’re trying to create an atmosphere of fear around gender-affirming care so that providers will self-censor and stop offering it altogether.

Those are the main policies I can think of off the top of my head, but there are over a hundred federal bills targeting trans rights that are currently in the pipeline. Some of this might be scare tactics, but the reality is, it’s working.

Jacobsen: It sounds like a shotgun approach—throwing everything out there to see what sticks.

Young: Absolutely. And that’s by design. It is a political tactic that has been used before, but we’ve never felt it at the federal level like this. It happened in the Texas legislature before, but now it’s national, and the stakes are even higher.

Jacobsen: What else? Here’s something that people don’t like to talk about—imperfect allies. You’re not going to agree with everyone on everything, but if you can align on one issue, you can get more political action done by working together, even if you disagree on other things. The enemy of my enemy is my friend in that sense. What are your thoughts on that, especially when it comes to some aspects of gender-affirming care that you work with daily?

Young: That’s fair. Imperfect allies are incredibly important. This whole system is designed to divide us. That’s intentional. When all marginalized communities come together, we are actually the majority. But the system separates us—by race, gender, sexuality, class, everything—so that we don’t unify.

So, to your point, I might disagree with someone on one thing, but if we agree on several other major issues, those commonalities outweigh the disagreements. Finding common ground and showing up for each other is essential. That’s a big deal.

We saw this during the BLM movement—queer folks showed up and stood in solidarity. When Roe v. Wade was overturned, the Women’s March happened, and many queer folks showed up for that as well. Now, in this terrifying time for trans people, we hope that allies will show up for us in return. The most important thing we can do is say, “I don’t personally relate to your experience, but I believe you. How can I support you?” Coming together, even when we come from different backgrounds and experiences, is what makes lasting change possible.

Jacobsen: What type of gender-affirming care is least provided, so that people who are interested in entering this field can train in those underserved areas and help fill the gaps?

Young: That’s a great question.

I’m actually in the process of creating a residency program for physical therapy and gender-affirming care. I’m also working on getting post-op protocols published for physical therapists, because those basically don’t exist right now. There are some PTs who specialize in post-op bottom surgery recovery, but it’s a very niche area, and outside of that, there’s almost nothing. There’s very little research available, which makes it difficult for providers to access reliable information.

So I would say that anything in the recovery realm is critically needed. I also work closely with a gender doula who specializes in the very acute post-op phase—helping people with showering, bandage care, infection checks, and mobility assistance. That is an incredibly important and niche area that more professionals should be trained in.

I also work with a primary care doctor who specializes in hormone therapy and gender-affirming care. She’s a general practitioner, but many trans people seek her out specifically because she is affirming and knowledgeable. That’s another area where more providers are needed. Even an orthopedic surgeon who isn’t specifically trained in gender-affirming care could still make a huge difference just by being an affirming provider.

People often assume gender-affirming care is just hormones and surgeries, but it’s so much more than that. It’s also about affirming spaces—saying, “Yes, we can try your new name. Yes, I will respect your pronouns. No, I’m not going to ask invasive questions unless they are absolutely necessary, and if I do, I’ll approach it with care.” Every area of healthcare could benefit from more of this approach.

Jacobsen: What are your favorite quotes? That’s my final question.

Young: My favorite quotes? Well, this isn’t really relevant, but I’ll tell you anyway.

I’m a huge fan of The Office. It’s my favorite show.

Jacobsen: I’ve seen a few episodes.

Young: It’s hilarious.

Jacobsen: Yes, it’s pretty funny.

Young: So my favorite quote from The Office is from Michael Scott: “I’m not superstitious, but I’m a little stitious.”

Jacobsen: [Laughing] That’s good.

Young: As Americans become less religious, that’s kind of how I see them—we’re becoming more woo-woo by the minute, for sure.

Jacobsen: Yes. They’re a little stitious. But that’s still better than big-time organized, politicized superstition.

Young: Correct. I agree.

Jacobsen: So that’s what all of you grew up in, then?

Young: I don’t know. I probably could find another quote that’s more aligned with what we’ve been discussing, but that’s my favorite quote regardless.

Jacobsen: Well, on that little stitious note—thank you. I appreciate it.

Young: Yes, of course.

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