About this episode

Dr. Tim Casias discusses the complexities of anesthesia in gender transition surgeries and the ethical considerations involved.

In this episode, we sit down with Dr. Tim Casias, an anesthesiologist whose training spans pediatrics, anesthesia, pediatric anesthesia, and pediatric chronic pain. Now the Director of Anesthesia at Aiken Regional Medical Center, Dr. Casias shares how his clinical experience led him into one of the most complex ethical debates in modern medicine: the use of anesthesia in gender transition surgeries. We talk through why he ultimately chose not to participate in these procedures—what he learned from years in pediatric and chronic pain medicine, the clinical concerns that informed his decision, and the ethical framework he applies to high-stakes situations. We also explore the striking differences between gender medicine in the U.S. and the rapidly changing standards in Europe, along with broader issues of medical culture, patient safety, and the pressures physicians face when cultural trends collide with clinical judgment. Tim Casias is an anesthesiologist and the current Director of Anesthesia at Aiken Regional Medical Center in Aiken, SC. He completed his medical training at the University of Colorado in 2009. He is trained and board certified in Pediatrics (Mercy Children’s…

People in this episode

Hosts: Dale Pickett, David Buruchara

Guest: Dr. Tim Casias

Topics covered

• gender transition medicine
• anesthesia
• ethical debates in medicine
• pediatric chronic pain
• medical culture
• patient safety

Keywords

• gender transition
• anesthesiology
• ethical framework
• pediatric anesthesia
• medical standards
• patient safety
• clinical judgment

Mentioned in this episode

Organizations: Aiken Regional Medical Center, University of Colorado, Mercy Children’s Hospital, Seattle Children’s Hospital, American Family Children’s Hospital, University of Wisconsin

More episodes of Two Therapists At A Bar

• Does Everyone Have Trauma? with Dr. Michael Scheeringa · March 25, 2026 · 1h 23m
• How To Receive Critical Feedback · February 18, 2026 · 44 min
• REPLAY: When Grief Breaks You (& What Comes After) with Gene Fought · December 17, 2025 · 1h 30m
• REPLAY: The Brutal Truth About Marriage · December 10, 2025 · 60 min
• REPLAY: Modern Masculinity: What It Means to Be a Man in the 21st Century · December 4, 2025 · 1h 16m
• What the Wild Teaches Men with Chachi Avirett · November 26, 2025 · 1h 30m

Explore listener stats, chart rankings, contacts and more on the Two Therapists At A Bar podcast page.