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 Hospital, KS), Anesthesia (University of Colorado, CO), Pediatric Anesthesia and Chronic Pain with a focus on Pediatric Chronic Pain (Seattle Children’s Hospital). He was previously the Director of Pediatric Chronic Pain at American Family Children’s Hospital associated with the University of Wisconsin). He is currently practicing in adult general, OB, and cardiac anesthesia.