Your Budding Daughter: Some Practical Suggestions for Parents

What? Already?
Puberty in Girls, Step By Step
The Stages of Development
'Is This Normal?' When to See Your Physician
Helping Your Daughter to Be Well-Informed
Sex Education
Menstruation, tampons and pads
In Closing

What? Already?

Puberty! It started happening to my 10-year-old daughter this spring. She needed new sandals - women's size 7 sandals! She got those little bumps under her nipples that we doctors call 'breast buds'. Next, I was 'excused' from joining her in the dressing room when we shopped for her clothes, and the bathroom door was locked when she showered. The pants I hemmed up in June were too short by October, despite only being washed once. And she admits to 'maybe' having a few hairs 'down there'.

As a loving mom and adolescent medicine specialist, these are heady times for me. I am proud of my daughter and thrilled to see her embark on this road toward womanhood. I know that she is progressing normally. But still, I think, 'Hold on, she's only in fifth grade!'

My daughter is perfectly normal. Puberty, often first recognized at the onset of breast development, usually begins about the time a girl turns 10. There is a wide range of 'normal' starting times, and the onset time varies in different ethnic groups. For instance, it may occur between the ages of 8 and 14 in white girls, and may begin as early as 7 years of age in African American girls.

Puberty in Girls, Step by Step

Puberty is outwardly manifested by two main sets of changes:

  • Rapid increases in height and weight, referred to as the height and weight spurts

  • Development of breasts, and pubic and axillary (underarm) hair

Tracking the changes during puberty

These changes, and the other physical changes of puberty, occur in a predictable sequence. We use sexual maturity rating (SMR) scales to track a youngster's progression through puberty. Knowing the timing of these changes, related to each other and related to the sexual maturity ratings, is very helpful. After all, most of us like to know what to expect. For example, when my daughter developed breast buds, I was able to tell her that she'd start finding little hairs near her labia majora (outer lips of the vagina) within six months or so. And she knows that she is likely to have her first menstrual period about 2 years after her breasts first started developing. This means she'll be a little over 12 years of age, close to the national average of 12 years and 4 months.

The height spurt

Ultimately, 20-25% of a girl's adult height is acquired in puberty. The height spurt usually begins just before or after breast budding develops. Over a period of about 4 years, girls grow close to a foot taller than they were at the beginning of the height spurt. The bones that grow first are those furthest from the center of the body. This is why my daughter's shoe size shot up before the rest of her body began growing faster. The earlier growth in the arms and legs accounts for the awkwardness and 'gangly' appearance of many teenagers. Their center of gravity is shifting, and they haven't gotten used to those long arms and legs. The growth in the spinal column alone accounts for 20% of the height increase. This is why it is important to check for scoliosis (sideways curvature of the back) before puberty begins. A slight curve can turn into a much larger one during all that growth.

The weight spurt

A girl's height spurt is followed about 6 months later by her weight spurt. This is, of course, when she can never get enough to eat. Fully 50% of ideal adult body weight is gained in puberty. In girls, the proportion of body weight in fat increases from about 16% to nearly 27%. Lean body mass, especially muscle and bones, also increase substantially. It's the growth and maturation of bones, in particular, which makes calcium intake so important.

Getting enough calcium

Most of you know of the importance of good calcium intake for all women, especially growing teenagers, pregnant women, and nursing mothers. Milk and other dairy products are the least expensive, most convenient sources. Nonfat milk has just as much calcium as whole milk. If your daughter doesn't like milk, try doctoring it up with chocolate powder or syrup (this is the only way I can get my daughter to drink it). Calcium is also available as a nutritional supplement in tablet form, but many teenagers find the tablets too large to swallow comfortably. Your daughter may like the fruit or chocolate-flavored calcium-supplement chews available in drugstores now.

The Stages of Development

The table below summarizes the events at each stage of development. The average (mean) age listed here can vary widely; about 2 years either side of these listed ages will usually be considered normal.

Sexual Maturity Rating Average Age (Years) Features What Happens
1 8 2/3 Growth, breasts and pubic hair Height spurt begins. Body fat at 15.7%. Breasts are prepubertal; no glandular tissue. No pubic hair.
2 11 1/4 Breasts The areola (pigmented area around the nipple) enlarges and becomes darker. It raises to become a mound with a small amount of breast tissue underneath. This is called a 'bud'.
2 11 3/4 Pubic hair and growth A few long, downy, slightly darkened hairs appear along the labia majora. At the end of this stage, the body fat has increased to 18.9%.
3 11 2/3 Growth Peak height velocity (maximum growth rate) is reached. Body fat is now 21.6%.
3 12 Breasts Development of breast tissue past the edge of the areola.
3 12 1/3 Pubic hair Moderate amount of more curly, pigmented, and coarser hair on the mons pubis (the raised, fatty area above the labia majora). Hair begins to spread more laterally. Menarche (first menstrual period) occurs in 20% of girls during this pubic hair stage
4 12 3/4 Pubic hair Hair is close to adult pubic hair in curliness and coarseness. Area of pubis covered is smaller than adults, and there are no hairs on the middle surfaces of the thighs. Menarche occurs in 50% of girls.
4 13 Breasts Continued development of breast tissue; in side view, areola and nipple protrude.
4 13 Growth End of growth spurt. Body fat reaches mature proportion: 26.7%. After menstruation begins, girls grow at most 4-5", usually less.
5 14 1/2 Pubic hair and Body fat Adult. It is normal for some long pigmented hairs to grow on the inner thighs. Body fat remains at 26.7%.
5 15 1/4 Breasts Adult breasts.

'Is This Normal?' When to See Your Physician

Parents often have concerns about whether their daughter is starting puberty too early or too late, or whether she is progressing normally. Occasionally they may also notice a physical feature which seems 'different' and want to check it out. Hopefully, the information provided above will be useful in charting your daughter's progress. But whenever you are uncertain, it is best to seek out medical advice. Every girl is different.

Some 'differences' that should lead you to the doctor

There are a few things that should definitely lead you to the pediatrician (or adolescent medicine specialist, if there is one in your area). They are:

  • No breast development by age 13.

  • No menstrual period by between the ages of 13 ½ to 14.

  • In a girl who is at Sexual Maturity Rating 3 or higher, cyclic abdominal pain (pain similar to period cramps) every 3 to 5 weeks, but no menstrual periods. This is rare.

  • Development of pubic hair but no breast development within 6 to 9 months.

Breast development is a very individual thing. There are, however, a number of potential 'dilemmas' to be aware of in this process. They are:

  • Asymmetry (one breast much larger than the other): This may be minimal, or it may be visible even when your daughter is dressed. Some girls with asymmetric breast size are embarrassed to wear a swimsuit, regardless of the extent of asymmetry. In severe cases, plastic surgery is the ultimate answer. This can be performed in teenagers after puberty and after the breasts are fully grown.

  • Very large breasts: Very large breasts can be a source of constant embarrassment and self-consciousness from puberty onwards. They can also cause medical difficulties, namely back problems. Plastic surgery is 'medically indicated' and may well be covered by a health plan, particularly if you and your surgeon are persistent.

  • 'Too small' breasts: Breasts that are 'too small' may also cause embarrassment. Small breasts do not cause medical problems; they do not affect a woman's ability to nurse a baby. With that said, I live in southern California, where breast augmentation seems to be 'de rigeur' for anyone who wants it. Regardless of where you live, I suggest trying some of the ideas in the 'tips' section below before delving into the intense debate about breast augmention surgery. Remember also that teenagers are famously self-conscious about their appearance. Once your daughter is older, she will hopefully have developed more self-confidence. She will then be in a better position to make an educated decision about breast augmentation.

  • Inverted nipple(s): An inverted nipple means just that: the nipple is pointed inwards, rather than outwards. Looking at the breast from the side, you do not see the tip of the nipple protruding. This condition occurs occasionally. It can interfere with breast-feeding. If you notice it, bring it to your doctor's attention. A new non-surgical treatment has recently become available.

  • Tuberous breast disorder: This is a fairly uncommon disorder that often goes unrecognized until a new mother has difficulty breast-feeding. In this condition, growth at the base of the breast (where it attaches to the chest wall) is restricted by a band of tissue. Breast tissue, therefore, grows outwardly while the base remains narrow. This results in a breast shaped like a tuber (for example, a potato). Tuberous breast disorder is surgically correctable.

Helping Your Daughter to Be Well-Informed

Hopefully, your daughter is already well-informed about puberty and the menstrual cycle. It is also important at this time that she be well-informed about sexual intercourse and sexuality.

Sex Education

I recommend that you and your spouse/partner talk with your daughter about when you think it is acceptable to have sexual intercourse. Please be sure that she is well equipped to decline or refuse sexual intercourse - and that she knows that anyone, including a friend or a date, who forces her to have sex, is committing a crime.

She should know that pregnancy and sexually transmitted diseases are the common consequences of teenage sexual activity. And, despite your own recommendations, she needs to know about contraception - including emergency contraception. Emergency contraception refers to the 'morning after pill', and it is much less unpleasant and much easier to obtain nowadays.

Menstruation, tampons, and pads

  • I suggest that girls make themselves familiar with their bodies by using a hand-held mirror to look at their genitals, early in puberty if possible. Having a drawing on hand is helpful in identifying the different parts of their anatomy. I believe that this helps girls to become more comfortable with their developing bodies. And when the discussion comes to tampons, as it almost inevitably does, they have a better sense of what is involved.

  • Within a year of the time your daughter begins breast development, purchase several different packages of sanitary supplies for your daughter and invite her to check them out. I consider this part of 'de-mystifying' menstrual periods. (And, one of her visiting friends might need something).

  • Every girl should maintain a menstrual calendar to keep track of her periods. I suggest she keep a small calendar and pen right with her sanitary supplies. It is most helpful for physicans reviewing the calendar if the first day of flow is marked, say, with a circle and the last day with an 'X'.

  • What about tampons? There are pluses and minuses. Sports involvement may be limited or impossible for girls who are having their period but not using tampons. Other girls are fastidious and do not want to risk a bloodstain on their clothes. Still others are uncomfortable about touching their genitals or fearful that using tampons may be painful. Here is what I recommend to my teenage patients:

    • Talk about tampon use with your mother. Some mothers are concerned that using tampons means that a girl will no longer be a virgin. Actually, the opening in the hymen (membrane that partially covers the opening of the vagina) is usually large enough for a mini-sized tampon by the time of a girl's first period. Other mothers are rightfully concerned about the risk of toxic shock syndrome. This has become a rarity since the materials used to make tampons were changed some years ago. I believe that tampons are safe for all women, provided that they are changed at least every 4 hours during the daytime and do not leave the tampon in place for more than 8 hours at night. Some women prefer to use tampons during the daytime only.

    • If staining, and not sports participation, is the primary concern, then an investment in black panties might be all that is needed.

    • Try different brands and types of pads and/or tampons to see what works best for you. 'Super' pads can feel (and look) like a diaper on a diminutive teenager. On the other hand, a 'mini' tampon may not absorb enough flow to last more than a few hours, and this can be a problem at school. I suggest a combination of a mini-tampon and a pad for maximal protection.

    • If your daughter wants to try tampons, I recommend trying teen-sized tampons (marketed as such). I think that a slim plastic applicator is easier for a girl to use than tampons without an applicator or with a cardboard applicator. Also, a bit of lubricating jelly or Vaseline placed on the tip of the applicator may make the insertion easier at first.



  • When to wear a bra? I think that whenever your daughter requests one, it's time. Developing breasts are quite tender, and even the logo on a sports T-shirt may cause discomfort. Fortunately, those smooth cotton 'sports' bras are available everywhere.

  • If your daughter is concerned about breast asymmetry, consider purchasing a padded bra and removing the padding from one side. In more marked cases, you might wish to order a set of the bra inserts advertised in newspapers and women's magazines. Again, use the insert in one side only. If this is inadequate, I recommend that my patients who are too young for surgery, or who can't arrange payment, seek out assistance at a shop specializing in breast prostheses (artificial breasts). Although generally used by women who have had a mastectomy (removal of a breast), a prosthesis can also be helpful for severe breast asymmetry.

  • Given the emphasis on 'normalcy' and on breasts in our society, I think it is reasonable for her to wear a padded or lined bra if she wishes. Most commonly, only older girls (SMR 4 or 5) have this concern. As mentioned earlier, this is a temporary concern for many adolescents.

  • If your daughter has very large breasts, it is important that she wear a bra designed especially to provide extra support, often by use of a criss-cross design in the back. If possible, it should be purchased at a department store that has specially trained undergarment fitters.

Getting more information

If you need help or more information on any of these topics, there are some great web sites operated by SIECUS (the Sexuality Information and Education Council of the United States) and Planned Parenthood. SIECUS has a special 'For Parents' section. Planned Parenthood has a special section for teens, and there is also a special website for adolescents called 'Go Ask Alice' from Columbia University. For the most up-to-date information about emergency contraception, check the Emergency Contraception website at Princeton University.

If you haven't already done so, purchase or borrow books about puberty, sexuality, and teen issues for your daughter. SIECUS provides an excellent bibliography of resources for parents, children, and adolescents. Here are a few of my personal favorites. You'll find more information about them in the SIECUS bibliography.

It's Perfectly Normal: Changing Bodies, Sex and Sexual Health, by Robie H. Harris

My Body, My Self, by Lynda Madaras and Area Madaras

What's Happening to My Body? For Girls, by Lynda Madaras

What's Happening to Me?, by Peter Mayle

The Period Book: Everything You Don't Want to Ask (But Need to Know), by Karen Gravelle and Jennifer Gravelle (When it comes to periods, this is the most practical book; it's fun, too.)

In Closing

This article has focused mostly on normal and non-gynecological aspects of puberty. While my suggestions and recommendations are far from complete and definitely not inclusive, I hope that the information provided above have given you some information on what physical changes to expect during your daughter's puberty.

APA Reference
Staff, H. (2027, December 27). Your Budding Daughter: Some Practical Suggestions for Parents, HealthyPlace. Retrieved on 2023, September 28 from

Last Updated: March 26, 2022

Being Overweight Affects Your Sex Drive

Being overweight hampers your sex life

Add a bad time in bed to the list of ways excess weight can impede your life satisfaction. In a survey of more than 1,000 obese and normal-weight men and women, more than half of obese people reported problems with sexual enjoyment, sex drive or sexual performance or avoided sex altogether, compared with only 5 percent of their normal-weight counterparts. It's unknown whether the problems are physical or psychological. However, losing weight makes obese women feel more confident, says Martin Binks, Ph.D., co-lead researcher and director of behavioral health at Duke Diet & Fitness Center in Durham, N.C. And that's true for women who are merely overweight too: After dropping 10 or 20 pounds, women told Binks "they feel younger sexually."

APA Reference
Staff, H. (2025, December 21). Being Overweight Affects Your Sex Drive, HealthyPlace. Retrieved on 2023, September 28 from

Last Updated: March 26, 2022

Lots of Food. No Sex. Time for Rehab

I'M AN ADDICT. My drug of choice isn't heroin, crystal meth, or crack cocaine, but it's just as destructive and impossible to kick cold turkey. I'm strung out on food.

I'm 35 years old, stand 5'10" tall, and weigh 300 pounds. I am obese. Over the years, I've tried every diet to hit The New York Times best-seller list, yo-yoing all over the scale, from a rotund 315 pounds down to a burly 245, and rebounding back to a plump 300. Nothing seems to work, and inevitably the jones to graze always gets the best of me.

Every evening, I eat myself into a coma, then crash in front of the TV or down enough Jack Daniels and ginger ale to dull my senses. My edibles-as-drugs problem is compounded by the fact that I live in New York City, home of the world's best food fixes--thick, juicy steaks at Smith & Wollensky's, the world's greatest pizza at John's, dry-rub baby-back ribs at Virgil's BBQ, and the tastiest ethnic restaurants. But, let's face it, even if I lived in a gastronomic backwater, I'd still do the same thing.

This is what it's like being a walking fat body: I have to shop at big-and-tall stores, paying top dollar because nothing in the pages of this or any magazine fits me off the rack. I need a seat-belt extender on airplanes. And I have a hard time stuffing myself into the cheap seats at Knicks games.

Even more disturbing: My weight is harshing my sex life. Performance isn't the issue--it's just getting in the game. Usually hesitant to approach women, I often rely on friends to make the opening move. I shrug it off to shyness, but I know the real reason: I'm afraid to have relationships with women because I don't find myself attractive, so why, I figure, should they?

I'm not looking for your pity. Fuck that. I'm comfortable in my skin. While the looks and sneers sting, they usually come from superficial assholes I wouldn't want to know anyway. But the health implications do terrify me: limited mobility, diabetes, liver damage, gout (from which I already suffer), heart disease, and stroke. All point to an early grave.

Then came the assignment: Spend two weeks at the Duke University Diet & Fitness Center (DFC) in Durham, N.C., and write about it for Men's Fitness. I felt like I had just won the lottery.

Orientation: May 9

Established in 1969, the DFC is one of the country's oldest weight-management centers. From the outside, this one-story brick building looks like my old grammar school. But inside, it's more like a clinic, with its large gym, 25-meter pool, and many doctors' offices. Its program teaches health and wellness through diet, exercise, and behavior modification--voluntary rehab for the weight-challenged.

Looking around orientation, I size up my hefty comrades. They, too, seem to think, "What the hell did I get myself into?" When the time comes for introductions, this might as well be A.A. "Hi, my name is Chuck, and I'm obese."

I was sure the other attendees would wallow in self-pity: "I ate myself into a blob because life dealt me crappy cards." Boo-fucking-hoo. But in reality, I get a positive vibe from my fellow food fiends. Most are fired up for the coming battle and unafraid to share experiences. I admire that.

Day One: May 10

Enrolling in the DFC is like earning a master's degree in healthy living. The most repeated lesson: The keys to fitness are time management and organization. But to me, the idea of planning out meals and exercise is non-spontaneous and unappealing--I've always flown by the seat of my extra-large pants. This will be the hardest adjustment.

Medical, nutritional, physical, and psychological evaluations begin today. I'm poked and prodded by anyone in a lab coat. The goal of this interrogation, explains DFC director Dr. Howard Eisenson, is to produce a clinical profile to ensure I'm healthy enough to go through the program. It's humiliating--I can't go more than seven minutes on the treadmill during my stress test. My lab results show no abnormalities, but I still feel like a big whale.

Day Two: May 11

Today we focus on good nutrition. You need a comprehensive understanding of what healthy comestibles are and how they affect your body. Indeed, as Funkadelic once put it, "Free your mind and your ass will follow."

During my physical assessment, I realize exercise doesn't have to be monotonous and shouldn't be painful. The slogan "No pain, no gain" is bull-shit. "If you're hurt," cautions Gerald Endress, DFC's fitness manager, "you won't get off the couch. Your success in this program and in life depends on getting out and doing some physical activity."

As the day ends, one thing is clear: Losing weight and getting healthy will be a long process. I didn't wake up one morning with this huge gut. It took years of lethargy to eat and drink myself into this shape. I simply let my consumption spiral out of control in college--and never stopped.

Day Three: May 12

This morning, I attend a meditation class to learn how to "communicate" with my body and make peace with my inner-hunger demon. Sounds ludicrous, but I am actually able to converse with my pained parts--specifically, my sore back muscles, pounding head, and grumbling stomach--simply by concentrating and asking each what it wants. By recognizing there is a problem, my body feels better. This type of touchy-feely crap normally doesn't fly with me. This experience, however, is enlightening. (It still freaks me out, though.)

Next up, I meet with nutrition manager Elisabetta Politi, who corroborates my worst fear: I eat too much shit. Who would've thought fast food, Chinese delivery, and pizza aren't good for you? "Proper eating is all common sense" she says. "Stay away from heavy fats, count calories, eat less processed sugar, limit your sodium intake, and you'll be fine."

Uh, easy for her to say. In my world, eating isn't just a means of sustenance--it's a social event. Food should be enjoyed, even celebrated. "You can still eat out in restaurants with friends," she assures me. "Just choose the right things off the menu and manage your portions. You'll learn."

Behavior modification, then, is the gateway to shedding pounds. Of course, when I was young, my parents practically taught me the opposite--that leaving food on my plate was a waste of money. Or they'd say, "Clean your plate: Kids are going hungry all over the world." This was clearly a mistake of good intentions, but it's not their fault I have self-control issues. They were looking out for my best interests. Now I'm an adult. I have to learn to leave more food on my plate.

Day Four: May 13

Let's talk alternative exercise--yoga, for instance. I thought that was a chicks-ercise. But after road-testing these simple stretching movements and correct breathing and relaxation techniques, I'm invigorated, my focus and mental acuity enhanced. Also in my new routine are water aerobics, a daily one-hour walk, and, three times a week, a half-mile swim and weight workout. This healthy-living "crap" might just work.

Later, my group gathers to interpret our lab results. Mine are not good. Suddenly, my newfound enthusiasm takes one to the gut--I have quantitative evidence that I'm on the road to an early grave.

My glucose is high. (I'm, like, one candy bar away from diabetes.) My cholesterol's good/bad ratio is bad/bad. (It's 6.2--it should be under 5.0.) And my triglycerides (fat stored in the bloodstream) are double the norm. Plus, I display four of the five indicators for increased risk of heart disease. (My father, while not overweight, died of a heart attack at age 59.)

Graded on a curve, my results aren't so horrible: A couple of people in the group learn they have serious medical conditions needing immediate attention. Others' cholesterol levels are as high as the population of Hong Kong. Still, this doesn't comfort me. After all, I'm on what is derisively called a "fat farm." And I'm not vying for the DFC's coveted Most Weight Lost prize. I'm fighting my own demons.

Day Five: May 14

What a turnaround--I'm on top of the world this morning! I've lost nearly eight pounds.

Portion control helped get me to this point. They're not starving me, just giving me smaller amounts of healthier foods. Instead of eating lots of starchy fillers--potatoes, rice, etc.--my plate is filled with fresh vegetables, salad, and fruits. Food preparation is also key: limiting oil, mayonnaise, and fatty condiments, and grilling or steaming foods, not frying.

The result: I feel better, I have more stamina, and I'm thinking more clearly--after just five days!

I'm also really digging Pilates. The stretching and strength-enhancing movements have loosened my limbs, improved my flexibility, and tightened my stomach muscles. (It's even better in a coed class: Some of the positions are very sexually suggestive.)

Though I'm enjoying my time in this sheltered environment, I wonder how I'm going to translate my experiences here to the real world. That's where today's Planning Your Restaurant Experience class comes in handy. It teaches us how to order off the menu by asking the waiter about ingredients and preparation. And we're reminded about portion control, a difficult hurdle for me because I've always enjoyed the supersize, more-for-my-money mentality.


Day Eight: May 17

Eating healthier starts with buying healthier foods. This afternoon, nutritionist Monette Williams takes me and another patient, Warren, on a tour of a Kroger's supermarket. Instead of grabbing items off the shelves impulsively (as I would at home), we stroll the aisles and carefully read nutrition labels. The foods Warren and I normally buy are loaded with sodium, processed sugars, and wasted calories. Now we're empowered, knowing which foods to reject and which to embrace.

Last Day: May 22

I'm a convert. Two weeks ago, I would never have predicted such a change in lifestyle and attitude. Now I know that pessimism is what killed my other healthy-living attempts.

Still, going home is a little scary. I'm worried about falling back into gluttony. But I've resolved to join a gym, mapped out my exercise regimen, and worked out some menus. I've lost 12.5 pounds and more than halved my triglycerides to normal. Last Thursday, I was ready to buy burial insurance--now I'm looking into mountain bikes.

One Month Later

The real world isn't as scary as I predicted. I'm still losing weight (I'm down 24 pounds), and I exercise daily. Every morning I stretch, then walk an hour. I lift twice a week, play racquetball, and do yoga and Pilates. And I can't imagine powering down Ben & Jerry's Cookie Dough on the couch.

The DFC taught me we all need to get off our fat asses, exercise, and eat healthier foods. More important, I learned I have an amazing support system. My family and friends are here for me, and I can call them anytime.

I'm still hardly slim--I strive to be 200 pounds by May. At that point, I'll be a changed man. Well, a thinner, more fit one, anyway.



According to Harvard research, Body Mass Index (BMI) measurements may incorrectly classify some men as being over-weight when they are, in fact, in very good shape. Why? Muscle weighs more than fat, so a 250-pound weightlifter and a similar-sized office drone can often have the same BMI. That's why--if you're trying to get fit--it's better to focus on your waist circumference, rather than your actual poundage. You can mark progress with a tape measure, or simply grab a pair of jeans you can't fit into anymore and try them on once a week. Even if your weight and BMI aren't changing with your workout, the jeans should gradually start to fit you better--a sure sign your program is working.


It's not just your imagination that having a wife weighs you down. Most married men are thinner pre-vow than post--as those wedding pictures (and cruel friends) are sure to point out. One theory suggests that not being on the lookout for a partner allows you to get comfortable (i.e., fat). On the flip side, marital problems also lead to stress-eating and the inevitable weight gain that follows. But before you swear yourself to the single life or call that divorce attorney, there is one more twist to the equation. You may be thinner when you're single, but studies show that married guys live significantly longer than bachelors. The choice is yours, cowboy.

APA Reference
Staff, H. (2025, December 16). Lots of Food. No Sex. Time for Rehab, HealthyPlace. Retrieved on 2023, September 28 from

Last Updated: March 26, 2022

How Recent Surgery Is Affecting My Mental Health

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A month ago, I underwent knee replacement surgery on my right knee. While my knee is healing well, the surgery's mental health impact is almost unbearable.

My last post was about having a schizoaffective episode right after the surgery. As if that wasn’t enough, I have had to go through and am going through a lot of other stress and anxiety that are taxing my mental health.

Why My Knee Surgery Is Hard for My Schizoaffective Brain

For one thing, there’s the surgery itself. Knee replacement surgery is major surgery, and what affects the mind affects the body and vice versa. After all, the brain is an organ in the body, and our bodies aren’t made up of separate parts. Everything’s connected.

Then there was my stay at the hospital. I was on a heavy narcotic painkiller at first and sometimes, at night, I couldn’t make it to the bathroom in time. So—and this is so embarrassing—I wet the bed. This was nothing new. My psychiatric medications are very sedating and I’ve had problems with incontinence at home a few times before this. But as humiliating as that is, my husband Tom could help me clean it up— I was with someone who loves me. That wasn’t the case at the hospital. At any rate, now I know to bring adult diapers to the hospital when I get the replacement of my left knee.

There’s the rub. Everything I’m going through now I’m going to have to go through again. I’ve wished so many times that I was on my second knee replacement instead of my first. I can only hope that I’ll be freaking out less the second time around with past experience to support me. My right knee is healing well, so that means my left knee should, too. Right?

Physical Therapy Is Crucial, But It’s Hard

Physical therapy has been tough for me, too. I do it religiously because it will make my knees healthy and strong. But I don’t enjoy it. It feels like just one more thing I have to do. Do you want to know what motivates me to keep doing it? I imagine strolling around the Renaissance Faire with Tom next summer. One of several reasons I decided to get knee replacement surgery was so I could go back to the Renaissance Faire. Hey, any reason is a great reason to keep up with physical therapy. Am I right?

Even though I still don’t reply to text messages and emails asking me how I’m doing, the mental anguish is starting to let up. For one thing, I’m getting used to doing the physical therapy exercises at home twice a day in addition to the ones near the hospital. I’m starting to realize that every ache, pain, and wince isn’t a cause for alarm. And I feel prepared for my next hospital stay. I just hope I learned something through all this that will make the next round a little easier.

Healing From Verbal Abuse Required Me To Change My Ways

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Everyone's healing journey away from verbal abuse is unique. Numerous tools and resources are available to use as viable methods for healing. What works for you may not be a helpful solution for others recovering from verbal abuse. One of these methods is changing your own ways regarding relationships. 

As a victim of constant verbal abuse through the years, I used to think I would never escape this behavior. It seemed to appear in many of my relationships, regardless of circumstances. I lived believing my life would always include someone acting rude or mean to me. This dynamic reinforced my low self-esteem and fueled my depleted mental state. Unfortunately, I wallowed in this environment for years without reprieve. 

Therapy Helped Me Change My Ways To Avoid Verbal Abuse

Once I began regular therapy, I was given positive reinforcement to live my life away from verbal abuse. My therapists provided many tools and resources to help me start the healing process. At first, it felt insincere and made me cautious. But, as I began to heal, I realized that the only person who could help me was myself. 

A critical turning point happened when I recognized how I was attracting negative energy and made myself vulnerable to verbal abuse. Before this, I would not speak up for myself when faced with damaging comments or hurtful words. Instead, I would accept them as facts and allow them to deplete my self-worth further. 

My therapists were patient with me and gave me the support I desperately needed to see that I deserved love and acceptance for who I am. 

It Took Time for Me To Change My Ways and Heal From Verbal Abuse

I want to say that once I began therapy, my life turned around, and I lived happily forever. Unfortunately, that isn't the case. I do live a happy and stable life now, but the journey away from verbal abuse was a long one. I still have days when I must re-evaluate a situation and deliberately choose to keep negativity away. 

Changing how I view others and myself was a big part of my healing journey away from verbal abuse. I no longer gravitate towards individuals who make rude comments or put others down. I surround myself with friends and family who are genuine and trustworthy, helping to reinforce my self-worth and create a positive environment. 

I am thankful that I can see now how damaging verbal abuse is to my mental health, and I have the tools to heal. I still have a lot of work to do on myself, but each day, I feel better about my choices and my current relationships. 

Simple Pleasures Help Reduce Anxiety

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I've learned throughout my life, and in having coped with anxiety for many years, that many of the simplest things that bring me pleasure and joy in life can be the most helpful for my anxiety. Therefore, taking the time to appreciate simple pleasures is an instrumental part of my life and my ability to cope with anxiety.

When I am talking about simple pleasures, I'm referring to anything that brings me happiness for a brief period of time. This might be something like my cup of tea in the morning, listening to music, or taking a walk outside in the sun.

How Simple Pleasures Help My Anxiety

I know that, logically, there are specific reasons that brief moments of joy are helpful for my anxiety. As indicated by research, pleasurable activity actually inhibits anxiety responses in the brain1. Therefore, I'm aware that there is scientific research that supports how this happens.

But certainly, I'm also aware that, in my experience, it has been helpful for me. For example, I've noticed that just taking the time to read for a few minutes can help reduce anxiety symptoms. If I go out in my backyard to play with my dogs for a few minutes when I am under quite a bit of stress, it makes me feel better. Something even as simple as using my favorite pen to write in my notebook is sometimes enough to boost my mood.

But I've also noticed that two things are important factors in this -- mindfulness and gratitude. First of all, I have to be mindful of the happiness I feel in the moment, which requires mindfulness. Mindfulness involves my focus on the present moment, which allows me to identify what I am feeling. Additionally, what I feel is typically not only happiness, however fleeting, but gratitude.

All of this results in experiencing the benefits of some of the simplest moments of happiness in my life. And as I intentionally make it a point to incorporate more of these moments in my life, I've found it easier to cope with the emotional difficulties that anxiety may bring my way.

Below, I've shared a video discussing some of the benefits that I've experienced focusing on and being mindful of the simplest joys in life. If you've found this helpful as well, share your own strategies in the comments below.


  1. Pleasurable behaviors reduce stress via brain pathways, research shows. (2010, November 10). ScienceDaily.,anxiety%20responses%20in%20the%20brain.

Healthy Relationships in Early Recovery from Alcoholism

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Forming healthy relationships in early recovery from alcoholism is tricky. If you go the route of inpatient treatment or via Alcoholics Anonymous (AA), you'll soon learn the phrase people, places, and things. Much of that boils down to avoiding people from your active addiction to help you stay sober. So, how does someone new to recovery approach forming healthy relationships and avoid ones that may lead back to alcoholism and addiction?

Should people new to recovery ditch family and friends?

Forming healthier relationships in recovery has plenty of gray areas. When I first heard about "people, places, and things" in AA, it felt somewhat off the mark. It makes sense to avoid people who might lure you back into active alcoholism. However, this advice came across as slightly unrealistic and at odds with how life actually works -- a theme that I found ran throughout AA

In my experience, most people I used to drink heavily with now fully support my current position. And it's possible to form different relationships with people from your past if they're supportive. 

There's a tendency in recovery to curl up like a hedgehog to block out the world. Protection becomes a bubble that addicts use to shield themselves fearfully from their past and anyone from it. But you'll eventually have to deal with people from your old life. 

My take is to be open and honest regarding your recovery. Learn to deal with a new reality where you don't drink, but others do. Certainly, end relationships that endanger you if the other person refuses to accept your recovery and other boundaries. 

A healthy vs. dangerous relationship checklist

As a blogger for the Debunking Addiction Blog at HealthyPlace, one of my aims has been to provide practical solutions or tips (not necessarily advice). Doing hands-on tasks like checklists reduces unwarranted speculation and grounds me in reality.

Before embarking on any relationship in recovery (old or new), ask yourself these questions:

  • Is [the other person] actively drinking or taking drugs unsociably/addictively
  • Are they aware of your alcoholism and are *unsupportive of your decision to stop drinking and/or taking drugs?
  • Are they using alcohol and/or drugs around or near you?

*A quick sidenote about what constitutes support. Not everyone will be fully on board with or understand your decision to be sober. They might seem okay with it, only to start nudging you towards active alcoholism for "old time's sake" later. 

You need to know that this situation is dangerous, lay down your boundaries, and stick to them. 

On the flip side, it helps to avoid assumption and fear-based decisions. The people in your life require some adjustment time, too. Their experience of you is the old you -- allow them to spend some time with sober you, gradually if needs be.

The number one priority is staying sober. And if you answer yes to several points in the above checklist, chances are you're in an unhealthy relationship that needs to be limited or ended. You must do whatever's necessary to remain sober, even if it means making tough decisions.

Healthier relationships begin with your inner relationship

Ultimately, the only relationship needing immediate attention is your inner one. You'll never achieve more beneficial external companionship or kinship until you form a healthier one with yourself.

Begin to speak about and refer to yourself positively, even when it seems forced. In my previous blogs, I talked about overloading shame and fear-based decisions, and it's worth using those short checklists now, too. 

I want to end this article with one suggestion: learn to forgive yourself. 

And I mean physically say the words or write them down about a moment where you've regressed or acted on a negative character trait. 

Don't suppress the feelings that come with this -- accept them and recommit to continuous self-development and growth

Form a healthier relationship with you -- the rest will become more intuitive. 


What Do Being Transgender and Having Bipolar Disorder Have in Common?

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I live as a transgender person and I also have bipolar disorder. While being transgender is not a mental illness, these two things still have a lot in common. Over the years, I've reflected on what these two things share. Today, I'll discuss the commonalities between them and what it feels like to live both as a transgender person and as a person with bipolar disorder. 

Definitions and Statistics about Being Trans and Having Bipolar Disorder

It might be helpful to start by defining what both of these terms mean and to clarify the differences. In short, being transgender means not identifying with the gender one was assigned at birth. For example, I was assigned female at birth and now identify as either male or non-binary (I am also gender fluid, so my gender shifts over time and isn't constant.) In contrast, bipolar disorder is a type of mood disorder. In the HealthyPlace guide about bipolar disorder (which by the way is a fabulous resource if you're looking to learn more about bipolar disorder I might add), bipolar disorder is defined as "an 'affective' or 'mood' disorder that primarily affects your mood (although there are other effects as well) and it is usually diagnoses and treated by a psychiatrist." While a mental health therapist or a psychiatrist can help to diagnose gender dysphoria, this isn't the same thing as being transgender. Most people who realize they are transgender figure this out on their own in the coming out process and it does not require a medical professional to diagnose unless you're looking to pursue medical transition and need your insurance to cover services (you can learn more on medical transitions in my video below.) 

Now let's look at some statistics about how common both of these things are. It is estimated that 1.6 million Americans (approximately 0.5%) are transgender or non-binary, although it is estimated that these numbers are not entirely accurate and actual numbers are much higher1. Similarly, it is estimated that approximately 5.7 million Americans live with bipolar disorder (about 2.6% of the population2). Interestingly, a new study suggests that as many as 5% of young adults in the U.S. may be transgender3. In both the case of being transgender and having bipolar disorder, actual numbers may be higher, as stigma and underreporting may influence these statistics. 

Daniel Lyons Shares Three Commonalities Between Being Transgender and Having Bipolar Disorder

In the video below, I'll share three things in common between being transgender and having bipolar disorder. 

Most interestingly, research suggests there may be a connection between being transgender and having bipolar disorder. While research on the connection between bipolar disorder and being transgender is somewhat scarce, a study conducted in 2019 found that transgender patients had a statistically significant increase in the prevalence of all psychiatric disorders, including bipolar disorder. In this study, the lifetime prevalence of bipolar disorder was found to be at 11%, compared with the study listed above, which cited 2.6% of the general population as having bipolar disorder4

As to why this may be the case, it seems additional research is needed on the topic. All I can say is anecdotally in my life, I have met a lot of transgender folk who also have bipolar disorder and I hope that one day someone will help answer the question 'why.' (Interestingly, research has also been conducted to suggest a connection between neurodivergence and being transgender, but more on that in a future post5). 


  1. Allen, J. (2022, June 10). New study estimates 1.6 million in U.S. identify as transgender. Reuters.
  2. Bipolar Disorder Statistics - Depression and Bipolar Support Alliance. (2019, July 12). Depression and Bipolar Support Alliance.

  3.  Pew Research Center. (2022, June 7). About 5% of young adults in U.S. are transgender or nonbinary | Pew Research Center.

  4. Wanta, J. W., Niforatos, J. D., Durbak, E., Viguera, A. C., & Altinay, M. (2019). Mental health diagnoses among transgender patients in the clinical setting: an All-Payer Electronic Health Record study. Transgender Health, 4(1), 313–315.

  5. Dattaro, L. (2022, August 16). Largest study to date confirms overlap between autism and gender diversity. Spectrum | Autism Research News.


If You Are Not Your Job or Relationship, Who Are You?

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They say you are not your job. Personally, I say one more thing: you are not your relationship. But if you are not your job or relationship, who are you? 

What Defines Your Identity? 

According to the American Psychological Association, identity is defined as follows:

"an individual's sense of self, defined by (a) a set of physical, psychological, and interpersonal characteristics that is not wholly shared with any other person and (b) a range of affiliations (e.g., ethnicity) and social roles). Identity involves a sense of continuity, or the feeling that one is the same person today that one was yesterday or last year (despite physical or other changes). Such a sense is derived from one's body sensations; one's body's image; and the feeling that one's memories, goals, values, expectations, and beliefs belong to the self."1 

As we live in a world where our jobs and romantic relationships define us, many of us attach our identity to our jobs and romantic relationships. This is problematic because both factors--work and partners--exist independently and outside of us. No matter what we do to keep them, there is no guarantee they will remain a part of our lives. This makes them ungovernable, making them another reason why they should not define our identity or sense of self. Philosophically speaking, identity is something that is internal and within our locus of control

Your Self-Worth Cannot Be Measured by Achievements

Identity or sense of self matters because we tend to associate our self-worth with it. According to Dr. Christina Hibbert, self-worth cannot be measured by achievements, or anything else. 

"Self-esteem is what we think and feel and believe about ourselves. Self-worth is recognizing I am greater than all of those things. It is a deep knowing that I am of value, that I am loveable, necessary to this life, and of incomprehensible worth. It is possible to think I'm good at something, yet still not feel convinced that I am loveable and worthy. Self-esteem doesn't last or work without self-worth."2

In other words, self-worth comes from within and does not depend on anything external. This is why I believe a major part of one's identity should be rooted in self-worth. It is the only way we can be emotionally secure individuals at all times. It is also the best way to protect ourselves from the heartbreak of career setbacks and relationship ups and downs


  1. APA Dictionary of Psychology. (n.d.).
  2. Hibbert, C., & Hibbert, C. (2014). Self-Esteem vs. Self-Worth: Q & A w/ Dr. Christina Hibbert | Dr. Christina Hibbert. Dr. Christina Hibbert | Dr. Christina


If You Take Medication Every Day Are You a Drug Addict?

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When I started taking medication every day, I was worried that it would make me a drug addict. Some might find this fear weird, but it was definitely a real fear for me. My father was an addict, and I was terrified of turning into one, too. My psychiatrist at the time did nothing to disabuse me of that notion either (he probably never thought it would cross my mind). So, let's look at whether taking medication every day makes you a drug addict and how to deal with that fear.

Fear of Being an Addict Because of Taking Medication Every Day

A fear may be real, but it may not be based on reality. Part of the reason I was so scared of psychiatric medication was because I was raised in what I would call an antipsychiatry household. I was told that depression was just weakness and medication was just for people who couldn't handle their own lives. I was told it was never needed if you were just strong enough.

Of course, these things aren't true. We know that mental illness is an illness of the brain, and while there are many things you can take control of when you have a mental illness, you need treatment for a mental illness, just like you would for most illnesses. 

My fear about addiction and taking medication daily was built on false ideas. Well, that and the fear of being my father.

Is Taking Medication Every Day the Same as Addiction?

I've professionally written about mental illness for 13 years now, and I can unequivocally say that taking medication every day is not at all the same thing as addiction.

For more on everyday medication and addiction, watch this:

If You're Scared of Addiction Due to Daily Medication

As I said in my video, there's a big difference between taking prescribed medication every day and being addicted to a drug. Nonetheless, the fear of that is real. 

Please remember this. No one would accuse a diabetic of being a drug addict because they need insulin every day. And there's a reason for that. They are not a drug addict. They are a person who is dependent on a medication for their health. And that's okay. Health conditions need mediation sometimes. That's why we have them.

The biggest concern a person with mental illness should have is actual addiction to a nonprescribed drug or alcohol. Levels of addiction are very high in illnesses like bipolar disorder and a real risk. But your prescribed medication? That's just what your brain needs to function healthily right now. You aren't getting high. You're not abusing a drug. You aren't ruining your life because of your drug. You're just taking it to survive, and that's a positive, not a negative.