Podcast: Play in new window | Download
Finding and navigating gender affirming care in our world of health care is not an easy task. Fortunately, we have people like Dr. Ken McGee paving the way in the world of physical therapy to provide trauma-informed care for people in this community.
In this conversation, we discuss topic of navigating gender affirming care in physical therapy to improve transgender care, pelvic pain, top and bottom surgeries, and the voice to pelvic floor connection. You’ll learn about connections between identifying as transgendered and pelvic floor dysfunction, plus what you can actually do to help these challenges through pelvic floor physical therapy.
Dr. McGee has their own experience of navigating a change in sexual identity and shares their personal insights, providing us an opportunity to improve our interactions with people who are both like or not like us. This is true in healthcare and in the places we simply live our lives.
Ken McGee, PT, DPT, (they/he) is a queer transmasculine pelvic health physical therapist based in Seattle. Their mission is to bring greater awareness to the pelvic health needs of the LGBTQIA2S+ community. They enjoy mentoring other rehabilitation professionals to better care for people of all genders.
Ken received their Doctor of Physical Therapy from the University of Washington in 2014 and their board certification as a Women’s Health Clinic Specialist (WCS) in 2018. Ken has lectured nationally and internationally on birth tears. Their practice, B3 Physical Therapy, centers on transgender and perinatal rehabilitation. Ken also provides peer lactation education and doula care.
0:00 Dr. Ginger Garner: Hi everyone and welcome back. I am really excited to be bringing a brand new topic that I have wanted to talk about for a while to the podcast. So, Living Well, folks, here we go. Today, I’m welcoming Dr. Ken McGee to the show.
1:51 Dr. Ken McGee: Thank you so much for having me here.
1:53 Dr. Ginger Garner: I’m so glad that you’re here. I’m so glad that you’re here. So you guys, we have quite a lot to talk about today. And before I introduce you to the topic, because y’all don’t even know what it’s about that much. Right. Other than the title, I need to do a little bit of bragging as usual. So here goes. Dr. Ken McGee is a doctor of physical therapy. He is a queer transmasculine pelvic health PT living in Seattle, where the weather is apparently quite mild and nice today.
Their mission is to bring greater awareness to the pelvic health needs of the LGBTQIA to S+ community and they really enjoy mentoring other rehab pros. And this is a topic that is so greatly needed because, um, I’m going to break from the brag moment for a moment, but it is kind of bragging some more it because not enough people know what pelvic PT or OT is.
But then when you talk about transgender care and people are like, I don’t even know. And the therapists can be saying the same thing. I’m not even sure. I don’t know as a pelvic PT or OT how to provide care that’s really appropriate and trauma-informed and all the stuff that we want to be. So first of all, just applause that you’re doing that and you’re providing the container for people to be able to enter into that journey collectively with other people because it’s so needed.
All right, back to more bragging. Ken received their DPT, what we know as Doctor of Physical Therapy from the University of Washington in 2014. Coming up on the 10 year anniversary. [So excited.] Yeah. And also a board certification as a women’s health clinical specialist in 2018. Also a great accomplishment there. Ken has lectured nationally, internationally on birth tears and their practice, B3PT, I like saying that fast, B3PT, centers on transgender and perinatal rehab. And because that’s not enough, you also provide peer lactation education and doula care, which is, I’m a huge fan of doulas too. So welcome.
4:18 Dr. Ken McGee: Thank you again.
4:19 Dr. Ginger Garner: Yeah. Okay, so the first thing that I want to talk to you about because I, I have more than 20 questions. I have tons of questions and I’m very curious and I’ve been a PT for almost 30 years and I feel like. That old cliche, the more you know, the more you realize you don’t know. Yeah, every single day, every day. So I’m wondering what, when did you get passionate about the need for transgender care and trauma informed care?
4:53 Dr. Ken McGee: Yeah, there were lots of things that kind of came to a head at once. I had my first kiddo in 2016. And then there’s a phrase where people sometimes say, like, having gender feels like. Having a baby was this turning point. I don’t know if it was like a hormonal shift or what. But I stopped feeling aligned with the idea of being a woman and more with the idea of being non-binary. And then within the first year of having my kiddo, I got to go to a gender conference. and be in the presence of hundreds of trans people. And I realized like, oh, this is what I was missing in my life.
One thing about being trans is it’s hard to know that you’re trans unless you have a reference point to compare other people. And the common narrative is that like, oh, you’ll feel like you’re born in the wrong body or something. But if you don’t drastically hate your body or know that you hate your body because you just ignored it, it can be really tough to find that.
Kind of going into, you know, 2017 being more out as a non-binary person, definitely started working with more trans people in the physical therapy clinic and kind of grew from there. Another turning point is that my spouse is a trans woman and she began her medical transition right after we had our second kiddo. It’s kind of like, okay, we’ve like made all the babies we need to make. So I’ve gotten to see her go through the process of hormones, vaginoplasty. And then when I was done lactating, I myself in 2022 got to start testosterone and then have a gender affirming mastectomy and have learned a lot along the ways from both of our journeys.
6:29 Dr. Ginger Garner: Wow. My mind is like, okay, my mind is blown on multiple levels because you said your first, you had your first baby in 2016? Yeah. 2016. And you graduated in 2014.
6:43 Dr. Ken McGee: yeah i was definitely like on the escalator like grad school house car baby.
6:49 Dr. Ginger Garner: Really really busy and then you had all this all these feelings going on and you know and realizations like total evolution in the background. Wow. That’s like, that’s cause for pause, right? That’s a lot of stuff that you were going through and then have your partner going through that as well. I’m, it’s going to take the whole, like bit of our time for me to like wrap my head around how much you guys went through and, um, hopefully we’ll get to talk a little bit more about that, but then I’m guessing because of that experience, is that what led you into pelvic PT as well?
7:29 Dr. Ken McGee: I think so. And there are connections and threads you can’t see until you’re like, you know, into the future. And so my own journey into pelvic health was that I was having urge urinary incontinence in undergrad. So I was like, 21, I would walk into a bathroom and lose everything. And I was in the group health medical system, now Kaiser, it’s managed care, it’s closed, I couldn’t like go to a specialist unless I got like, a referral from my doctor. That took a while to get even when pelvic floor PT was considered a good idea, it’s like, well, we don’t have anybody to see you. And so I kind of had to like learn the rehab on my own about like, you know, it’s so funny, you know, some people, they can’t even do, you know, pelvic floor muscle squeeze. I was the person that had to figure out weights. And I’m like, oh, a weight will get me to squeeze. Like, this is why the handouts on the pelvic floor exercises didn’t work for me. And so, Looking back though, how does that feed into being trans? Well, people who are neurodivergent are more likely to have pelvic floor dysfunction.
So I was a toe walker until PT school and I figured out like how to not do that. And there are things about how neurodivergence can manifest differently and how we perceive it. Somebody’s assigned female at birth or assigned male at birth. And so I do wonder if some of that urinary dysfunction was maybe a possible hint at being trans later.
We see trans people being several times more likely to be neurodivergent and autistic. So we don’t have a connection from like, you know, trans people with pelvic floor dysfunctions like back, but we do see these like stepping stones from one condition to the other. Again, comorbidities are often related and we do see hypermobility disorders and pelvic floor dysfunction being highly correlated with being transgender and non-binary.
9:21 Dr. Ginger Garner: I can, you know, as a fellow colleague, I can totally feel that. You know, I can feel the plantar fascia and toe walking and my pelvic floor went just now. Oh, that might be an issue, you know, because of the myofascial connection, the neural connection. Feeling stress about not knowing where you fit in and whether or not you fit in your own body.
If you think about just clenching your jaw, your pelvic floor will do the same thing. There’s such an intimate connection there. So let’s talk a little bit about your background. Obviously, you have a very rich background and so much knowledge in this field of transgender care and your own experience and, and your professional training. So talk to me for a minute about what is the role of and what does it look like. What of gender affirming care in physical therapy because people don’t think of that pretty much at all.
I mean, we do yes for pelvic PTs. It’s just the vernacular and and it’s, you know, we know it exists. But for everyone listening out there that is curious and going through the process themselves are wondering, where can I get care? What do you do? What’s the role of gender affirming PT care?
10:47 Dr. Ken McGee: Yes, so gender affirming physical therapy looks a lot like your regular like sprained an ankle physical therapy. You go in, you talk to somebody, you might chat for 15 to 30 minutes to get a sense of the problem. You might do an examination that could be off the body, that could be examining within the body if somebody consents to that. And then coming up with activities, exercises, movement to help somebody move forward. Visit length is a lot like what orthopedic physical therapy is like.
What’s different usually is what gets treated. So one of the most common things that falls under the gender-affirming physical therapy umbrella is helping people after they have a vaginoplasty. So again vaginoplasty refers to the creation of a new vagina. Somebody may have that they’re a trans woman, somebody may have that if they are non-binary, or even if they’re a cisgender woman that was born without a vagina due to developmental differences.
And so when new vaginas are made, they don’t just magically stay open. People often have to place sticks in them, we might call these vaginal trainers or dilators, and that can be really tough for people. And as you can imagine, like, it’s not like when we think about people who are like cisgender, born with vaginas, um doing dilation and vaginal training is like so tough to begin with and then you add like a surgical site on top of it like it’s just a big challenge. So that’s one of the really big domains I focus on.
And then and there are two other big domains i focus on the next is pelvic pain when people start testosterone the vast majority of them develop pelvic pain studies kind of say anywhere from like 69 to like 72%. And then when people are on testosterone, go to have a hysterectomy, and they’ve had a history of pelvic pain, we see a third of those people having endometriosis compared to 10% of the cisgender female population having endometriosis.
So there’s more underlying pain drivers, we think. And so both the testosterone and the endometriosis gives a lot for me to help people with as far as treatment. And then my absolute favorite thing to treat in transgender health care is top surgery scars, whether that’s from people adding more tissue augmentation or taking away tissue, that could be a reduction, that could be double incision mastectomy.
13:07 Dr. Ginger Garner: You know, the statistics you just cited are worth pausing over too. Let’s go back to the second one you mentioned, having hysterectomies and then discovering endometriosis. And what was the stat that you mentioned on that again?
13:23 Dr. Ken McGee: Yes. So say someone has pelvic pain and then they go to have a gender affirming hysterectomy. In one study, they found that a third of those people had endometriosis in their pelvis. And again, we expect 10% of the other population to have endometriosis.
13:40 Dr. Ginger Garner: Yeah, we expect 1 out of 10. And even in that population, it’s estimated to be low, but we don’t know because it’s hard to identify because it requires surgery. But it being 1 in 3 in this population is definitely, because endometriosis is so complex and so layered to treat that, um, that’s definitely worth noting because I mentioned that because this season really is all about medical gaslighting.
And if you’re one of those people who are struggling to feel listened to in your appointments, this adds another layer, another element, because endo can be far away. The pain can be far away from the pelvis. It can be breathing pain, right? It can be GI, digestion, pain, bloating. Pain all the way up into the orofacial area and the jaw. So if you’re listening and you’re having these, you know, the pain and areas that seem or that someone has told you is unrelated, that’s a good thing to talk to your pelvic PT about so they can help you find the right care. Yeah, that’s not missed.
14:50 Dr. Ken McGee: And the medical gaslighting is definitely on my mind. I have a particular client right now where they are under age 18 dealing with this pain, and then the common medical advice is get a hysterectomy to deal with the endo, but this person wants to have kids. And so it’s like, oh no, this person’s in it for the long haul with dealing with their endo. And I think that’s something that’s underappreciated is how many queer people want to go on to build families and have families.
And so that’s where a lot of my doulal and lactation work loops in, because we see queer people actually overrepresented as parents. And so it’s like, all right, how, you know, going forward into the future, we expect, you know, Gen Z has about one in 20 people as trans or non-binary that may grow as we move into future generations. But yeah, pelvic rehab providers, we can’t ignore how many trans and non-binary people will be coming up through the generations and finding themselves as parents and in pelvic health.
15:45 Dr. Ginger Garner: Yeah, absolutely. So if you’re one of those people who want to start a family and you are having pelvic pain, or maybe you’ve been diagnosed or suspect that you might have endometriosis based on your symptoms, you know, I encourage everyone listening not to accept a hysterectomy as an answer because it’s actually not the answer for endometriosis.
It’s the only thing that can treat adenomyosis, which is very different and happens in the uterus but endo can happen, obviously outside the uterus and so if you’ve gotten the recommendation of just go on birth control or just have a hysterectomy. It’s an incomplete answer and maybe at worst a flat out wrong answer that is entirely avoidable.
There are lots of amazing endosurgeons around the country that focus on fertility sparing techniques for excision. And so just a note out there, if you’re suffering from multiple things and endo might be one of them, we are always poised to help. So reach out to us and we’ll be glad to answer your questions and point you in the right direction.
16:53 Dr. Ken McGee: I just want to add one more thing. Going back to birth control isn’t always the answer. I think one thing that frustrates me is a lot of surgeons will say, or endospecialists, not amazing endospecialists, there are amazing endospecialists out there. But they’ll say, oh, you’re on testosterone, you don’t have to worry about endometriosis. It’s like, no, no, no, that’s not how endometriosis works. It’s not all perfectly hormonally driven. There are non-hormonal parts to endometriosis too.
17:18 Dr. Ginger Garner: Mm-hmm. Yeah. Yeah. That’s a very big misconception is that endo is only hormonally mediated. It’s one of the working theories and truths about it. It’s also inflammatory mediated, right? Yeah. But it’s also environmentally and immune mediated too. So it is multifaceted. It’s why having a therapist who’s versed in all those things is so darn important. Thanks for mentioning that. Yeah.
So some of the other stats and things you mentioned on treatments are also incredible. You mentioned comorbidities in trans folks. Can you explain to the listener? Well, it’s a comorbidity. And what are some of those things that we see together?
18:02 Dr. Ken McGee: Yeah, so comorbidity, so co means happening together, and morbidity is not quite mortality. It’s often you’ll hear morbidity and mortality used very close together. But morbidity would be disease burden, so kind of two disease burdens happening together.
So you can imagine somebody with irritable bowel syndrome where it hurts maybe right before they have to have a bowel movement. They might fluctuate between constipation and diarrhea. It would be really common for a comorbid condition to be visceral hypersensitivity syndrome. So we see a lot of people with IBS also then have pain if their abdomen is touched or if there’s pressure against their intestines.
And so taking that to the trans world is where you see people have, again, saying endometriosis is often comorbid with being transmasculine. And then what’s interesting is even before hormones get looped in, even before surgeries, we see pelvic floor dysfunctions occurring at higher rates in the transgender population. We have the most research on people who are trans femme.
So they’re born, assigned birth as male, and then they want to manifest more of a non-binary or feminine appearance and lifestyle and like way of being in the world. And so those people are getting higher rates of urinary incontinence, higher rates of pelvic pain, And definitely there’s room for the rehab population to serve this group better.
19:29 Dr. Ginger Garner: Yeah. So, so y’all listening, you know, things don’t happen in isolation, right? We don’t just have an isolated pelvic pain issue and, you know, and then, or you’re isolated, you know, going through gender affirming care. This stuff gets all, it’s a soup, you know, it all comes together.
And, and so I just want to encourage you when you’re seeking out the care that you deserve, and that you need, don’t allow people to put you into a silo, oh, you have back pain, or oh, it’s GI pain, but they’re not related. It is all related. Yes, it is all related. Or if you’re having depressive feelings with that back pain, right, or the pelvic pain that may be associated with care. It is all intertwined.
And there are really beautiful ways to take care of that. And of course, that’s why Ken is here to talk to us about that, because there’s lifestyle medicine, there are mindfulness techniques, there are all kinds of things that should be integrated into your care, and that you should be offered. And that if you aren’t, maybe you’re not getting the best care yet.
20:39 Dr. Ken McGee: Yeah. And I think one thing that’s really frustrating is medical providers often make assumptions about what their client can handle or what’s meaningful to them. And so they won’t offer referral to the nutritionist. They won’t offer, like, maybe you should also see a personal trainer to, like, get day-to-day support.
Or, yes, I will take care of, say, like, your diabetes medications, but you should also go see a lifestyle medicine specialist so they can really, like, hone in on some of, say, like, the glucose numbers or the cortisol that might be influencing that diabetes.
21:09 Dr. Ginger Garner: Yeah. Yeah. Yeah. So I hope you guys are getting, you know, really taking notes here and getting tips about some of the practitioners that you can see, um, that can help you manage it. And sometimes you’ll, you’ll visit a pelvic specialist and they happen to do three or four of those things, you know, and they get kind of wrapped up in offering multiple services, you know, like Ken you’re offering doula care and lactation support and which is amazing alongside all of the things that you already do. [Thank you.]
Yeah. So next question, because I think that we can all make assumptions about when somebody identifies as, you know, as gay or whatever they feel comfortable with. Externally, society has this maybe idea that’s false, that now they know what to do with their new body and their and their thinking, like, that they’re super confident in how they should interact with, you know, a partner emotionally or physically to create safe space, that kind of thing.
So my question is really centered around my personal experience, my professional practice, that some people struggle to know how to use their body, right? However they identify, sexually, physically, emotionally, that includes their voice. Using their voice if they’re, you know, new into their gender-affirming journey and process.
So what are some, as people are making this transition, what are some encouraging things that you can give to them from your personal experience, from your professional experience? And this may start with something as simple as neutral word choices for anatomy, right? It can be very small how we start to talk about and normalize being comfortable having these conversations. whether it’s with a friend or a family member, or it’s their intimate partner, right?
23:20 Dr. Ken McGee: Yeah. Oh, gosh. You know, there’s a million things to say, and obviously people spend hours talking about this. I think before anything else, people just want to be seen as human. So if the first question you ask a patient or a friend, like, hey, have you had the surgery? Like, whoa, you’re not seeing that person as a human. You’re seeing them as like, oh, trans or, somehow different in their gender. And so I think, you know, what helps me feel the best is when people maybe don’t even talk to me about gender. I love talking about gender in medical settings, but if it’s like people I interact with at volunteer work or something, I’m like, we don’t have to bring it up. It’s okay.
And you know, the other way I’ll frame this is like when teenagers are going through puberty, like they don’t want to be talked to about puberty. And it’s, you know, we often think about gender transition as the second puberty where you, or people can’t, and I’m not speaking for everybody, but a lot of people feel awkward or unsure of themselves, or it’s like, oh, am I wearing too baggy of clothing? Like, are people gonna notice, like, something about me that’s weird today? But yeah, so just kind of like thinking about how you’d interact with that person if they weren’t even trans.
Okay, but then, all right, acknowledging that, like, we can’t just, like, we can’t be colorblind. We can’t be blind to people as gender either. And so you bring up the point of gender-neutral language. So there’s all sorts of ways to weave gender-neutral language into the way we move through the world.
So I heard one, again, you can be as creative with this as you want. But I heard somebody say bits or external genitals, internal genitals, if you do need to ask that, especially if you’re a medical provider. Do you have any pain in your internal genitals or your external genitals?
And then I’m going to take a step back for a moment for the medical providers is like always asked to. Sometimes people don’t have the bandwidth to like talk about genital pain, even if they’re coming to pelvic health, you’d think they’d have the bandwidth like, oh, they’re here because like, we’re treating pelvic pain.
But you may have those days with clients where, you know, they’re like, no, this is actually just like a work on meditation and hip stretching kind of day. And having that flexibility to meet people with it where they’re at is so important.
25:32 Dr. Ginger Garner: Yeah, that’s, that’s, you know, such an important point, I think that we can get hung up so much on labels, that people don’t know how to approach someone else, no matter what they identify as to just talk to them as a human being. And then, if you talk about from the internal experience of someone who identifies in the LGBTQIA+ community.
I think what I want to understand is clinically, but personally, how some of the internal struggles. How can we understand a little bit more about the internal struggles of how they want to feel comfortable with interacting? Let’s just say with an emotionally and physically safe environment, you know, with a partner.
Because I think everyone assumes, Oh, well, they, that person’s come out as, you know, as a lesbian or whatever, what kind of confidence she must have as a person, but I don’t think that the two necessarily go together. You know what I’m saying? Just because someone has had enough courage, which takes a lot of courage to say, this is who I am, doesn’t mean they don’t still struggle with like self-worth and confidence and feeling good about themselves and, you know, that kind of thing.
26:59 Dr. Ken McGee: Oh my gosh. So there’s a million ways to answer that question. So keep redirecting me if I’m not getting it the way you want. But yeah, so you kind of mentioned like, oh, somebody might seem confident for coming out. And then I think one thing that’s, you know, surprising to me is the duality of being trans. Like, I didn’t realize I never looked at myself in the mirror until I started testosterone. Like I just was so dissociated from my appearance. Like I would just put my hair in a bun, wear the same maternity shirts every day and just like, do whatever I could to not think about it without being aware of it.
And so I can be really excited to be like oh my gosh I finally love who I see in the mirror, but I can also feel like horrible and like I’ll never like I don’t look like the way I want to look on my head maybe. And so people who are Trans may often have this experience of both loving their body and really struggling, and that’s where we kind of hear these terms of gender euphoria and gender dysphoria. Some people only experience dysphoria, some people only experience euphoria. Most people are experiencing a combination of both, and somebody can be experiencing both at the same time as well.
28:04 Dr. Ginger Garner: Yes. Yes, that’s exactly, that’s exactly it. Like in, and to get a little bit nerdy for a second, like with DBT or dialectical behavioral therapy, where some, you can hold two truths at the same time. Like you can love where you are and who you are, and then also freaking hate it and struggle with it at the same time. So you can hold these two polarities, you know, at the same time.
And so that’s, that was my real question because. I think that we skim the surface of talking about gender identity as if it’s party talk or of some interest. Like it’s the latest news in town or whatever, when there’s such a bigger and deeper struggle happening.
And because there has been an external stigma applied by society, which we’re working very hard to remove. It leaves, I think it leaves people in this community, who I love very much, more vulnerable to having those polarizing feelings of, I love where I’m going and I’m confident and I came out, but at the same time, oh my God, look at what I had to go through to get here. Look at the struggle, I’m still getting used to things, et cetera.
It’s not so much of a question as just an acknowledgement for everyone listening that we hope that your provider that you find and your friends and your family and everybody that love you acknowledge that. That it’s not so simple. It’s not just one courageous step forward, you know. That it’s very nuanced and that what I want to do as a provider and as a person is to be able to hold space for that when someone comes in and sits down.
So I think out of that, I do have a question, which is, if we want to hold space for that experience, knowing that it’s not just so simple, yes, you might have your hamstring stretch and your whatever day, but then there might be a day where you’re really struggling with that identity and full acceptance, which is something that really everyone struggles with, right? It’s just that, You had to go through, you had to go further to get to the same place, the same like esteem struggles, right? Yeah, that we all struggle with. How do we hold space for that? How do you hold space for that for yourself, for your clients, which requires like a discussion about how important trauma informed care is?
30:42 Dr. Ken McGee: Yeah, I think a lot of it is like, ask, I think sometimes people are afraid if they ask questions that maybe they won’t seem competent, or some people think they don’t know what they’re doing. And always ere towards asking more questions. Stay away from assuming as much as possible.
So it’s like saying, like, hey, is this a day where you want to work on internal pelvic floor work? Or do you want to keep clothes on today? What would feel supportive to your body today? And I had these things in mind. Do you like those ideas? Or do you like none of those ideas and I should come up with something else? Staying away from being like pushy and like, oh, I think this is what you really need.
Or I get really nervous when I hear clinicians, especially people who do pelvic rehab say like, oh, we’ve really got to do your pelvic floor. We really need to stretch out those muscles. And that person may have like used up all of their energy. If anybody’s a spoonie, like all of their spoons to just come to that appointment and like going to the pelvis is just like, there’s no bandwidth left for it.
31:43 Dr. Ginger Garner: Yeah, that’s so important. I’ve heard that in kind of all communities. So that’s your, that’s your red flag, everybody. If you go to your pelvic practitioner, whomever it is. Could be a PT, could be OT, could be a surgeon. It could, it could be multiple, you know, types of people. What else? Asexuality counselor, like. therapy, there’s so many different, you know, body workers, et cetera, that might be approaching this conversation with you.
They’re not the sage on the stage. They should be the guide on the side. And they need to provide you, just as a recap of what, you know, you just said, Ken. Trauma-informed care requires that you that practitioner needs to let you know where they feel like the session may need to go, but then also give you three, four options at the same time and put you in charge. Yeah.
32:49 Dr. Ken McGee: And a big, yeah, a big challenge to the clinicians. And this is a, something like challenging myself on too, is we have this idea of consent in American society where it’s like, you say yes or no to something. But how do you get your clients or people in your lives to feel comfortable saying no to you?
So I know one really great trans care doctor who tells their adolescent patients, like, you got to tell me no to one thing today, pick which one thing you’re going to say no to, and like doing that. And I can imagine with some of these people that you work with your gender, again, like the chronic pain world where it’s like, they don’t get it, practice.
So the doctor’s like, well, we’ll do this test or now we’re going to try this intervention, or this is the next thing we got to do. And there’s never really a great window or a great opportunity to say no without either like me damaging that relationship with that medical provider or losing access to medications. And especially when it comes to narcotic pain medication.
33:49 Dr. Ginger Garner: Yeah, I think that’s so important. So green flag. is to make sure that your practitioner gives you that option. And I love that story about the surgeon. Was a surgeon or a doc?
34:05 Dr. Ken McGee: More of a doctor. They’re more of a hormones prescriber.
34:08 Dr. Ginger Garner: Oh, hormone. OK, hormone balance and prescription. I love that story, actually. That’s a really good way, especially with younger people who are going to default to just say yes. And people who have experienced trauma are going to have a harder time saying no and just default to being a people pleaser or just to shrink or get small or to just dissociate altogether.
And, you know, those are the things that we look for as trauma-informed providers. So if you do get quiet, you know, in a session and you’re the patient, you’re the client, That should be a yellow flag for your practitioner to say, oh, wait, let’s pause for a second. I saw that you paused or that you took a deep breath or you looked down or your eyes just looked a little further away. Do you mind if we talk about that feeling, you know, just to invite them to the therapeutic table. To be able to access new stress management strategies, new coping strategies, because as you know, we can’t use the dissociation, get small, withdraw, and say yes, right?
I mean, that’s not a sustainable stress response, but it’s a coping mechanism we all know. We’ve probably all used it at least half a dozen times in our lives. But we want to get people to the empowered place where they can ask for what they need and realize that they deserve care. And they deserve this. Everyone deserves care. But I think that there’s such vitriol out there and hate for people who choose whatever lifestyle they choose because certain people have never loved or been friends with someone that’s different than them, you know? Who is it that said it’s hard to hate close up? I don’t remember who said that. Do you remember?
36:25 Dr. Ken McGee: I don’t, but that’s a great quote.
36:27 Dr. Ginger Garner: Yeah, you can’t hate close up. And I think that’s a big problem. I see. I live in North Carolina. I live in the South. I hear and see all kinds of things. And so that’s the phrase I always go to when I see something that I’m so disappointed with or I know that’s really not aligned with my core values. And as a mom of three boys that I would never want them to, you know, emulate.
So Yeah. So that means teaching people to use their voice, teaching people to speak up. And on that note, what do you see in the care that you provide that connects? Because the voice is important. Like if you’re transitioning from one gender to another, your voice changes, right? Your vocal folds change. Vocal folds can get strained. If you’re not using the right vocal techniques.
In my work, in imaging and pelvic PT, I see it being very damaging to the pelvic floor. That the respiratory diaphragm gets involved, and then the vagus nerve gets involved, and then everyone’s upset. It’s like from a like a stress, you know, neuroscience perspective. So what have you seen? What have you seen in relationship to, you know, the voice and the pelvic floor, the jaw and the pelvic floor, that kind of thing, in terms of connection?
38:03 Dr. Ken McGee: Yeah. So an experiment that people listening or watching can do is if you draw the corners of your cheek wide and go, eee, that will often engage the pelvic floor and close it. And so when somebody wants a brighter and higher voice, they’re often encouraged, like, hey, speak up here like this. But that, yes, may make it a little bit tougher for their pelvic floor. So I am a big fan of people balancing the lift with also breathing into the pelvic floor, taking some time to get some expansion.
A lot of people, you know, if they are learning voice techniques online and don’t have somebody guiding them, can get more into this, like, gripped throat, like, hey, my name is so-and-so. And that can be really tough as well. When we go the opposite direction, so instead of brighter higher to like deeper, darker, lower. Sometimes people will try and talk lower but not bring their larynx down, or their voice box.
And so that can kind of create a lot of neck strain. Thank goodness it doesn’t tend to affect the pelvic floor as much but people definitely run out of voice or it gets a little squeaky or almost kind of like I want to say like a vibration to it.
39:23 Dr. Ginger Garner: Yeah. I see people, um, in an attempt to be bolder and louder or lower with a voice, they will actually push more air forcefully through. And as from a nerdy perspective for the, for y’all listening, when we exhale and create sound, the pelvic floor naturally comes up. And so when I’m using, as a clinician, when I’m in my office, that’s my universal sign for when I’m in my office. For those of you that aren’t on YouTube, I’m actually doing like the, oh, go on, you know, kind of sign.
So when I’m in my clinic, I see people really engaging the obliques and pushing the air out. They might even push the belly out, you know, on an exhale. Yes. Yeah. And Ken’s doing one finger up, one finger down, because as they’re really pushing to get the voice they want, especially the low voice, they shove the pelvic floor down.
40:23 Dr. Ken McGee: Yeah, I see people leaking urine. I especially see transmasculine people like leaking urine with shouting or something.
40:33 Dr. Ginger Garner: Yeah, yes, yeah. So that’s something to be aware of that your clinician should be looking at your voice when they are evaluating all your pelvic floor and lumbopelvic needs. Same thing can happen with going high. I see a lot of, like you were mentioning, that ee, that orofacial tension. Superhyoid, subhyoid, and for those of you listening, that is if you grab your chin right where the crease of the chin is, like go below your chin.
Sorry, I grabbed the throat, not the chin. Right where the crease is, that’s where your hyoid bone is, and there are muscles above and muscles below. And I see those getting really exquisitely tight. And then the abs almost become rigid, which goes along with what you were mentioning about the abdominal wall, the visceral situation. Can you explain that just a little bit more?
41:23 Dr. Ken McGee: Oh, when I was referring to like visceral hypersensitivity?
41:26 Dr. Ginger Garner: Yeah, yeah.
41:28 Dr. Ken McGee: Yeah. So chronic pain is an interesting thing. Pain exists in our brain and how we make sense of it, but we also think some of it exists in the spinal cord, like how our body decides to route information. And then chronic pain can also manifest as changes along the length of nerves. And so if somebody has a lot of, again, I could talk for hours about this, a lot of inflammation in their gut, or they’re not sleeping well, not getting the support and nutrition they need, then that can lead to some nerve changes and over time that builds up to a pain sensation.
And so this pain that happens in the gut can be really tough to get rid of. You know, say it’s just like the tip of your pinky finger that hurts. It’s like, okay, we can like touch it and desensitize it and do mirror therapy. But to the best of my knowledge, we don’t have like great mirror therapy for like rewiring how we sense our gut. And so the gut, when it starts hurting, can be a really tough thing to undo.
42:26 Dr. Ginger Garner: Yeah, yeah, I see that a lot in the clinic as well. And I found visceral mobilization and gentle in the beginning. Yeah. It’s also called visceral manipulation, which sounds quite aggressive. But, you know, starting with myofascial release can can help a lot with the visceral mobilization and that kind of thing.
42:50 Dr. Ken McGee: Oh, one thing I want to add, going back to the voice, last piece, if somebody is planning, so there’s lots of reasons somebody could have a mastectomy, again, somebody could be a cisgender person and have breast cancer, like male or female, anybody can have breast cancer. But a lot of times with these techniques, there’s an incision on the lower chest, and people think, oh, they just cut out the chest tissue. But no, they pull down the whole skin and reattach it.
And so I’ll be working with people, like I saw somebody yesterday, where from the skin being pulled down, there’s just tension all through the throat. And even if they lay on their back, it’s tight through the throat from the mastectomy. Yeah. And so getting back to this, like, what helps transgender people often helps everybody else. So if you’re somebody that’s going through a surgery, a family or friend, that’s gone through some sort of treatment for breast cancer, and you know, it’s you can validate if they’re having tightness around the chest. If maybe they want to work with somebody who’s a rehab provider, like Ginger, or speech therapist, that kind of thing.
43:49 Dr. Ginger Garner: Yeah, I’ve had that experience personally. So it gets incredibly tight, incredibly tight. And I told this story to a colleague the other day. I had surgery for endo six weeks ago. And when I woke up in recovery, it was unconscious. But as I came to in recovery, my hand was already doing orofacial myofascial release because even though it was a pelvic surgery, really, I felt it first as pain in the orofacial area. Which I found pretty interesting.
Yeah. Funny story. All right. Let’s talk about where people can find you and what you’re doing and all the awesome things. But I have a question that people may not know. Now, they can find you at b3ptco.com. What does the B3 stand for?
44:42 Dr. Ken McGee: It’s really silly. It’s bellies, backs, and bottoms. I feel like I treat a lot of the core, and a purist would maybe say I should add on the vocal cords because they’re working so closely with the bottom. But that, I think, encapsulates most of what I treat. I will occasionally treat an ankle, a wrist problem, but I really like focusing on the center of the human body.
45:04 Dr. Ginger Garner: Well, I pulled a little bit of info about that so I could let everybody know. All right. So in the backs area, we’ve got pain and stiffness. In the bellies area, you’ve got top surgery, which we’ve talked about, and diastasis recti recovery. That’s a big one. I’ve had that one too. And then bottoms. Bottom surgery rehab, leakage, pelvic pain, and that’s leakage from anywhere, pelvic pain, and sexual dysfunction.
Does that cover everything, I think? Yeah. Yeah. All right. Awesome. Ken, it’s been a total pleasure speaking to you. I know we could continue to talk about this, and then maybe we will and have you back on the show. But you guys, if you want to find them, and I default saying guys all the time as a gender neutral human being, so you humans out there, I’ve been doing that for 20 years, I should probably shift that. If you want to learn more, go to b3ptco.com. Is there a quick way you say the website?
46:10 Dr. Ken McGee: Oh, I say, yeah, B3PTO, but I think when I tell somebody it’s like, oh, my company is B3 physical therapy company.
46:20 Dr. Ginger Garner: Okay. Yeah. All right. B3ptco.com you guys. Are you also on social media? Can we find you there as well?
46:29 Dr. Ken McGee: Yes. I’m most active on Instagram. I try TikTok, but it’s like not committed enough. Um, yeah, but I’m pretty accessible on Instagram. I’ll check my direct messages and whatnot on there.
46:40 Dr. Ginger Garner: Okay, awesome. All right, we’re going to put these links in the show notes. And Dr. McGee, did you have any other links or resources that you wanted to share? You can just shout those out and we’ll put them in the show notes.
46:55 Dr. Ken McGee: Yes, my very favorite website for free amazing education is getplume.co not “com”, “.co”. And that website if you go to events has a bunch of recorded zooms on a number of topics. So it’s like what if I want to start testosterone? What if I’m considering this surgery this and that. And it can be really helpful like even if you’re a cisgender guy who like was thinking about like testosterone for low Like you could get some idea like what’s the science there. So again, these resources can be helpful to just about anybody. My other favorite website is folkshealth.com. That’s F-O-L-Xhealth.com. And they also have great articles and diagrams for understanding this stuff better.
47:40 Dr. Ginger Garner: Awesome. Thank you so much. Thanks for taking the time to talk with us today and give us all this incredible information. You guys will definitely be putting all these links into the show notes. And now you know where to get in touch with Dr. McGee out in Seattle. And yeah, I look forward to seeing you and talking in the near future. Thank you.
48:02 Dr. Ken McGee: You’re so welcome.
https://youtu.be/g7F7Pq2_aiY Follow us for Free: About the Episode: What does it really mean when your doctor says your labs are “normal” — but you still don’t feel well? In this episode, I sit down...
https://youtu.be/J3EW-uatTqs Follow us for Free: About the Episode: In Part 2 of this conversation, Dr. Ginger continues her discussion with Heather Edwards, writer, sexuality counselor, and pelvic...
https://youtu.be/8lm9bh_z67k?si=DV6KYoHKGiMNcLl6 Follow us for Free: About the Episode: Talking about sex doesn’t have to feel awkward or unsafe. In this episode of The Vocal Pelvic Floor, Dr....