Steminist blog: BECOMING Series
Becoming: Interview with Harshini Sivakumar
Olivia Atuah
Dr. Nadia Merchant is a board-certified pediatric endocrinologist and geneticist dedicated to improving care for children with complex endocrine and genetic conditions. Her clinical focus includes skeletal dysplasia and Duchenne muscular dystrophy, where she works to advance both patient outcomes and long-term quality of life.
A self-described third culture kid, Dr. Merchant was born in Texas and spent much of her childhood in the Middle East—an experience that shaped her global perspective and deep appreciation for diverse communities. Outside of medicine, she enjoys traveling to visit friends around the world and staying physically active. An avid runner, she has completed 12 half marathons and is currently building endurance with the goal of finishing her first full marathon.
How do patients and families typically perceive what you do? Are there common misconceptions about pediatric endocrinology?
Many people don’t know what “endocrine” means, so families are sometimes unsure why they’ve been referred in the first place. My work includes treating type 1 and type 2 diabetes, thyroid disorders, hormone and pituitary conditions, and running a skeletal dysplasia clinic for children with genetic short stature. Because of that range, perception really depends on why the patient is there. Perceptions vary depending on the diagnosis. For example, families dealing with type 1 diabetes often focus on insulin injections and glucose checks. A common misconception is that these conditions are overwhelming to manage, when in reality, many are very treatable with the right medications and support.
What is something people outside your field may not realize about your work?
There is a shortage of pediatric endocrinologists, partly because pediatrics and its subspecialties aren’t heavily emphasized in medical school. Compared to internal medicine, there are fewer pediatric endocrinologists, so students have less exposure to the field, and many students don’t even consider it as a career. One main misconception is the idea that adult medicine can be directly applied to children, which isn’t always true. Also, people often associate endocrinology only with diabetes and thyroid issues, but we treat much more—like pediatric osteoporosis and genetic conditions such as Prader-Willi syndrome and Turner syndrome. In some cases, endocrinologists serve as the primary care hub for these patients.
Has there been a moment in your career that changed your perspective or increased your confidence in your field?
The rapid evolution of diabetes care stands out to me. When I started training, insulin pumps and continuous glucose monitors existed, but they didn’t communicate with each other. Now they can work together and adjust insulin delivery based on glucose trends. It’s a much more dynamic system.
Beyond that, advances in precision medicine have been significant. We now have targeted treatments for conditions like congenital adrenal hyperplasia, achondroplasia, and Prader-Willi syndrome. As patients live longer with these conditions, our focus has expanded to long-term quality of life; things like bone health, which has become a major area of interest for me over time.
How have technical advancements influenced your approach to care?
They’ve made care more comprehensive. It’s no longer just about managing a condition in the short term; we’re thinking about long-term outcomes.
Bone health is a good example. Most bone density is built during puberty, so that window is critical. If we don’t optimize it early, patients may face issues later in life. Factors like hormones, nutrition, physical activity, and medications all play a role. That’s why I think about bone health across nearly every condition I treat, whether it’s a chronic illness, a genetic disorder, or even the effects of treatments like steroids.
How do you approach communication with families dealing with complex or lifelong diagnoses, and has your experience made it easier to support families and make difficult decisions?
It’s a process. These diagnoses aren’t one-time conversations; they unfold over time. Families often go through stages of grief as they come to terms with what’s happening. My role is to guide them through that, provide clear information, and offer options. Care has to be individualized. For example, if a child can’t swallow pills, we need to adjust the treatment plan. It’s all about working together with the family to find what’s realistic and sustainable for them.
On the support side, experience helps, but it’s also about learning from patients and colleagues. Every case adds something new. I often discuss complex situations with peers to get different perspectives. Over time, you build both confidence and flexibility in how you approach care.
It’s also important to recognize that trust matters. If a family doesn’t feel comfortable with a physician, it’s okay for them to find someone who’s a better fit.
How do your hobbies and personal interests influence your work?
Work-life balance is very important. Without it, burnout becomes a real risk. I started running during my training, when my schedule was very busy, and it became something I genuinely enjoyed. Staying physically active is important not only for personal health but also as something I can model and encourage in my patients. It’s also a way to challenge yourself and maintain balance outside of work.
