Yale Psychiatry Grand Rounds: Commencement

Transcript

• 00:00Up at the beginning and they're
• 00:02going to be recording it.
• 00:07And then and then Dr.
• 00:09Olas Esky and I are going to sit down for
• 00:11a little bit of a conversation so you
• 00:13don't have to stare at me for too long.
• 00:15But I am going to share some words
• 00:17up front so you know, I'm Jay.
• 00:18At first shout out to all the folks
• 00:20who are using pronouns on their zoom.
• 00:22I used he, him pronouns.
• 00:24And I'm the senior vice President
• 00:25of Programs, Research and training
• 00:27at the Human Rights Campaign.
• 00:29We're the nation's largest lesbian,
• 00:30gay, bisexual, transgender and
• 00:32queer civil rights organization,
• 00:34and my team manages our foundation.
• 00:36We work across institutions
• 00:38that span every stage of life,
• 00:40adoption and foster care agencies,
• 00:42schools and universities,
• 00:44hospitals and longterm care communities,
• 00:46and at many of the largest
• 00:48companies in the world.
• 00:49Our goal is pretty simple.
• 00:51We're empowering L, GB,
• 00:52TQ people by making sure that the
• 00:54places where we live, where we work,
• 00:55where we learn, are safe and inclusive.
• 00:58We're reducing harm for our people,
• 01:00and we're increasing our visibility.
• 01:02And we're building power.
• 01:04The foundation began this work in
• 01:06the late 19 in the In the 1990s,
• 01:08Washington was deeply divided.
• 01:09A Democrat was in the White House.
• 01:12The far right was in control of Congress.
• 01:14New drugs promised hope to the
• 01:16community as the HIV epidemic raged on,
• 01:19yet deep racial disparities persisted.
• 01:22Gold culture War crusaders,
• 01:23including politicians who controlled the
• 01:26GOP were demonizing L GB TQ plus people,
• 01:29spreading disinformation and
• 01:30fear about who we were.
• 01:32Sound familiar?
• 01:34History is definitely repeating
• 01:36itself right now.
• 01:37Except back then,
• 01:38only about 1/3 of Americans thought they
• 01:40knew somebody who was gay or lesbian.
• 01:42And trans visibility was at an all time low.
• 01:45Was virtually nonexistent.
• 01:46And this was very much the world
• 01:48of that I came came up in.
• 01:50Growing up, I never saw anybody out
• 01:51there in the world who looked like me,
• 01:53or who I who I felt reflected
• 01:56my my realities.
• 01:58I didn't even know trans men existed,
• 02:00but I knew who who I was from
• 02:02as young as I can remember.
• 02:03I just didn't have the words for it.
• 02:05At five years old,
• 02:06I went to bed every night praying
• 02:07to wake up as a boy.
• 02:08Spoiler alert, it's not that easy.
• 02:11I was also.
• 02:12It was something I also couldn't deny.
• 02:14It was fundamentally a part of me.
• 02:15It was me, and I couldn't be anybody else.
• 02:17I wanted to play third base for the Orioles.
• 02:20I wished I could pee in the
• 02:21woods like my cousin.
• 02:22We went to the Hair Cuttery
• 02:24and I settled for a bowl cut,
• 02:26but I got that really wanted a buzz cut.
• 02:28Now I just wish I had hair.
• 02:31Nobody knows exactly what it means,
• 02:33what it makes somebody L, GB, TQ.
• 02:35And I'm not sure it actually
• 02:37even really matters.
• 02:38But I can tell you it's not our DNA and
• 02:41it's not our it's not nurture either.
• 02:43I have an identical twin sister.
• 02:45My parents treated us exactly the same,
• 02:48and we both saw the same image
• 02:49when we looked in the mirror,
• 02:50but from as young, young as what I can,
• 02:52as we can eat both of us.
• 02:53Remember we both had different
• 02:55relationships to the reflections
• 02:56that were staring back at us.
• 02:58My mom and dad were great.
• 02:59Just let us being ourselves.
• 03:02Even still, at an early age,
• 03:03I knew I was difference and that
• 03:05that difference didn't feel good.
• 03:07When we were out and about and folks would
• 03:10talk to my parents about their son AK and me,
• 03:12I would feel mostly shame.
• 03:14At the same time, I also felt right
• 03:17and I felt some some amount of pride.
• 03:19It was very confusing.
• 03:22Fast forward.
• 03:23To the end of high school,
• 03:24when I had my first brush
• 03:26with activism for girls,
• 03:27my principal had a no slacks allowed policy.
• 03:31I couldn't fathom wearing a dress
• 03:33as I walked across that stage.
• 03:35So I pulled very politely,
• 03:36asked and asked if I could wear pants,
• 03:39and he threatened to ban
• 03:40me from the ceremony.
• 03:41It became a big thing on national
• 03:44news and it was quite a scene.
• 03:46But ultimately the policy changed
• 03:48and I got to walk with honors.
• 03:50Around this time,
• 03:51I also came out as a lesbian.
• 03:53It was the closest language I
• 03:55had to describe who I was on
• 03:58shows like Phil Donahue or Oprah.
• 04:00I know I'm dating myself there.
• 04:02There were a couple of examples of lesbians,
• 04:05gay men and very sparingly trans
• 04:08women in the media and entertainment.
• 04:09A handful of folks were becoming
• 04:11more visible,
• 04:12but there was never a trans man.
• 04:14It wasn't until college that I
• 04:16heard the story of Brandon Tina,
• 04:17a young trans man who died in a
• 04:20horrible hate crime in Nebraska.
• 04:22Let me tell you,
• 04:23that's not a great way to find out
• 04:24you exist in the world.
• 04:26It was that case and Matthew Shepard's murder
• 04:30that moved me to become a queer activist,
• 04:33and in 2000, I started working at HRC,
• 04:35where I finally knowingly
• 04:37met an actual trans man.
• 04:40Shortly thereafter, I came out.
• 04:42And I became one of the few trans
• 04:44people that many of my HRC colleagues
• 04:47know knew at the time.
• 04:48And over time, I wasn't the only
• 04:50trans person in my workplace.
• 04:51But others came out, too.
• 04:53I'm sharing all this
• 04:54because visibility matters.
• 04:55It mattered then, and it still matters today.
• 04:58Visibility accelerates acceptance.
• 05:00It's not just among ourselves,
• 05:03but among our friends and our family,
• 05:05Harvey Milk once said.
• 05:07When they realize we are everywhere,
• 05:09every lie will be destroyed.
• 05:12He was right.
• 05:12It's that simple.
• 05:13When we see ourselves and others,
• 05:15we come out.
• 05:15And when we come out,
• 05:17the people in our lives,
• 05:18our friends,
• 05:19our families,
• 05:20are forced to reconsider their
• 05:22assumptions and question the poisonous
• 05:25rhetoric and misinformation that's
• 05:27often pushed by far right extremists.
• 05:29Through my work with the Foundation,
• 05:31I've seen this shift happen across
• 05:33society as people got to know they're out
• 05:36and proud colleagues in the workplace.
• 05:37More people supported our rights.
• 05:40As straight parents met queer families,
• 05:42they realized, hey,
• 05:43we're not that different.
• 05:44And it's no coincidence that 7 and
• 05:4610 people say they know somebody
• 05:48gay or lesbian and that 7 and 10
• 05:51people support marriage equality.
• 05:52Today's world is much more queer
• 05:55friendly and, well, more queer.
• 05:56I want to be clear about why that is.
• 05:59It's not like Ellen came out on TV
• 06:01and all of a sudden perfectly straight
• 06:04women suddenly turned into lesbians.
• 06:07It's simply because queer people saw other
• 06:09queer people and knew we weren't alone.
• 06:12There is no social contagion
• 06:13when it comes to being L GB TQ.
• 06:15Plus, what's contagious is courage,
• 06:19and coming out takes courage year after year,
• 06:22no matter what they throw at us.
• 06:24We come out in larger numbers because we
• 06:25see more people like ourselves in the world.
• 06:27If I were growing up in 2023,
• 06:30I wouldn't have to look at daytime
• 06:32talk shows for representation.
• 06:33At least 20 more at least 20 million
• 06:36adults now identify as L GB TQ.
• 06:38Plus,
• 06:38that's seventeen million more
• 06:40people than live in the entire
• 06:43state of Connecticut and by 2031,
• 06:47and seven of all US adults were
• 06:49identify as L GB TQ among Gen.
• 06:52Z1 and five identifies as L GB TQ.
• 06:56And while the data isn't out there,
• 06:57I put money on the fact the majority of
• 06:59these young people, they've grown up.
• 07:01With somebody who identifies as
• 07:03trans or nonbinary. Of course.
• 07:06With progress also comes backlash.
• 07:09It happened in the late 70s,
• 07:11in the late 90s,
• 07:12in the mid 2000s,
• 07:14all following moments when our movement
• 07:16was ascending and our progress was
• 07:18being made and we were more visible.
• 07:21It's happening now in the wake
• 07:22of our winning a major Supreme
• 07:23Court victory with Alberta fell,
• 07:25and then with boss stock.
• 07:27Right now, we're facing some of the
• 07:29most significant backlash I've ever
• 07:30witnessed in my time in the movement.
• 07:32This is truly a moment of
• 07:34crisis for the community,
• 07:34specifically for trans youth.
• 07:38The statistics are sobering.
• 07:40More than 525 anti L GB TQ bills have been
• 07:44introduced in just the last six months.
• 07:47More than 220 of those bills
• 07:49specifically target trans people,
• 07:51especially trans kids,
• 07:52and more than 75 of these bills are now law.
• 07:58We've seen governor sign laws that ban books
• 08:00and censor curriculum in the classroom,
• 08:02that forbid trans kids from being able
• 08:05to safely use the bathroom at school,
• 08:07that prohibit trans kids from
• 08:09playing sports with their friends,
• 08:11and that ban lifesaving,
• 08:12medically necessary, gender affirming
• 08:14healthcare for trans young people,
• 08:15despite what the evidence recommends,
• 08:17despite their doctors and parents support.
• 08:21Now visibility accelerates progress,
• 08:22but fear and shame can stall it.
• 08:25That's what these laws are designed to do.
• 08:28They isolate and alienate trans kids from
• 08:31their support systems, their teachers,
• 08:33their coaches, their doctors,
• 08:35their parents, and their friends.
• 08:37The effect is chilling.
• 08:38Data from our most most recent survey of L,
• 08:41GB, T plus teens shows that these
• 08:43laws make kids feel unsafe at school,
• 08:45increase their anxiety and depression,
• 08:47and impact their ability to see
• 08:50a future that involves them.
• 08:52Right now, one in five of all hate
• 08:54crimes is motivated by anti L,
• 08:56GB TQ bias,
• 08:58and nearly 40% of trans youth
• 09:00have considered suicide,
• 09:02not because there's anything wrong with them,
• 09:03but because there's something
• 09:05wrong with the world around them.
• 09:06This situation has grown so dire that
• 09:09this month, for the first time ever,
• 09:11HRC declared a national state of
• 09:12emergency for the L, GB TQ Plus community.
• 09:15You all are in.
• 09:17You all are in the practice of medicine
• 09:19and this is a public health crisis.
• 09:22Of course we've seen this,
• 09:23this playbook before.
• 09:24The same horrific things that they
• 09:26were saying about lesbian and
• 09:27gay people 20 and 30 years ago,
• 09:29they're saying about trans people now.
• 09:31New right wing, same old tactics.
• 09:33And just like we did back then,
• 09:34we're tracking bills,
• 09:35mobilizing volunteers and building
• 09:36our people power.
• 09:38And leading A/C through the fight is
• 09:40our new president, Kelly Robinson.
• 09:41She's been ultimately very clear
• 09:43about our mission, a mission.
• 09:45So we're centering trans people and
• 09:47black and brown L GB TQ people as we
• 09:49fight for liberation and justice for all.
• 09:51Without exception,
• 09:51we're creating a world where L GB TQ
• 09:54plus people and all people can be safe,
• 09:56celebrated and joyful in all
• 09:58aspects of our lives.
• 10:00But we're just one organization,
• 10:01and to address this public health crisis,
• 10:03we need the help of our
• 10:05public health professionals.
• 10:06All of you in this room and on the zoom room,
• 10:09As you know,
• 10:10the community and the medical field have
• 10:12long and sometimes fraught histories.
• 10:15Up until 1973, the DSM classified
• 10:19homosexuality as a mental disorder,
• 10:21and up until 2019,
• 10:23who classified being transgender
• 10:24as a mental disorder.
• 10:26Just a couple of examples of of
• 10:28where we've been in the past.
• 10:31These diagnosis perpetuated stigma and
• 10:33were used to justify conversion therapies.
• 10:36But for as long as healthcare
• 10:37has been used as
• 10:38a cudgel, there have also been
• 10:40brave catalysts for change.
• 10:42People like Doctor John Fryer,
• 10:43who came out as gay in the 1972 APA
• 10:46annual conference and whose speech
• 10:48is credited with changing the DSL.
• 10:51Doctor Matilda Krim,
• 10:52who raised early awareness for AIDS,
• 10:55fought for patients rights and founded
• 10:57the American Foundation for AIDS Research.
• 10:59And Doctor Hamina Lopez,
• 11:01a friend and an incredible pediatric
• 11:02endocrinologist who opened the first
• 11:04clinic for young people who need
• 11:06gender affirming care in Dallas, TX.
• 11:08She has provided a safe place for hundreds,
• 11:10if not thousands of young people
• 11:12over the course of her career.
• 11:14Doctor Olazeski as well I I would be
• 11:16remiss not to mention her name among
• 11:18this list of of folks who are bravely
• 11:21standing in the center of storms and and
• 11:23fighting for the change that's needed.
• 11:25There are countless other
• 11:26healthcare professionals who sat
• 11:28at bedsides when families wouldn't.
• 11:29Who shot down spurious claims
• 11:31and scientific facts?
• 11:32Who've helped our community through
• 11:34crises by sharing their expertise,
• 11:35their knowledge,
• 11:36and their compassion for the community,
• 11:39for their patients.
• 11:40Today,
• 11:40I'm asking you to continue that legacy.
• 11:43Far right Politicians can ban
• 11:44every drag show, burn every book,
• 11:47boycott every L, GB,
• 11:48TQ friendly brand and police every bathroom.
• 11:51But trans kids would still exist.
• 11:53They've always existed on proof of that.
• 11:56The true debate isn't whether we're real,
• 11:58it's whether we should be afforded
• 12:00basic human rights like the ability
• 12:02to move freely in the world,
• 12:04to hold down jobs,
• 12:05and to access the healthcare that we need.
• 12:08Every major Medical Association believes
• 12:09that gender affirming care is not
• 12:11just necessary but often lifesaving,
• 12:13and all of you can play a role in making
• 12:15sure that that today's trans people,
• 12:17trans young people,
• 12:18receive it.
• 12:19You can do this by listening,
• 12:20by using the right pronouns and
• 12:22upholding the W Path Standards of care.
• 12:24And you can do this by approaching
• 12:27trans people without stigma and
• 12:28transness as just one of the many
• 12:31elements of human diversity.
• 12:32You can do this by accepting everyone's
• 12:35distinct expiration of gender,
• 12:36whether that involves simply a
• 12:38new haircut or hormone therapy.
• 12:41And you can do this by putting gender
• 12:42reforming care on the same continuum of
• 12:44care as any other type of healthcare,
• 12:45because that's what it is.
• 12:47It's true that this is a moment of crisis,
• 12:49but with crisis also comes opportunity.
• 12:52It also also comes a reckoning.
• 12:55This is a unique opportunity for
• 12:58bold and transformative change.
• 12:59You all can be a part of that
• 13:01change and I hope you'll join me.
• 13:03I've done a lot of talking at you,
• 13:05so I'm going to turn it over to
• 13:08a video to hear from an amazing
• 13:11pediatrician who has worked with
• 13:13trans youth in in Minnesota.
• 13:16And then Dr.
• 13:16Olas Esky and I are going to have
• 13:18a conversation.
• 13:19We'll take some questions on Zoom and
• 13:21she's also got some questions that
• 13:23have been submitted to her in advance.
• 13:25So one second, see if I can do this.
• 13:30Pediatricians are pretty beloved.
• 13:32I mean, we're the people out there with,
• 13:34you know, the soft voices and
• 13:36the bow ties and, you know,
• 13:38smiles and pinwheels and things like that.
• 13:40And you don't go into Pediatrics
• 13:43really expecting to be.
• 13:44Attacked for the care that you provide.
• 13:47In recent weeks, several
• 13:49children's hospitals have become
• 13:51targets of far right attacks.
• 13:52The FBI has arrested a woman for
• 13:55making bomb threats. The Boston
• 13:57Children's Hospital.
• 13:57Growing number of doctors say
• 13:59they are under threat from far
• 14:01right activists because they
• 14:02care for transgender patients.
• 14:04There's sometimes attacks
• 14:06on health systems people.
• 14:08Contacting to complain or share
• 14:10comments that are threatening,
• 14:12like bodily harm should come to
• 14:14me for the care that I provide.
• 14:16It's shocking.
• 14:17That's just never something I
• 14:19thought would be part of my career.
• 14:22I'm a pediatrician because I think
• 14:24that every child deserves to meet
• 14:26their optimal health outcomes.
• 14:28I want every kid to be the
• 14:30healthiest they can possibly be,
• 14:31and for me that also includes
• 14:34transgender and gender diverse kids.
• 14:38Gender firming care is providing A supportive
• 14:41environment for kids and families to
• 14:44ask knowledgeable healthcare providers,
• 14:46whether they're doctors or psychologists
• 14:49or anyone who has experience caring
• 14:52for transgender gender diverse kids,
• 14:54how to understand and interpret
• 14:56what's going on with their child.
• 14:58If the child is young and they're
• 15:01experimenting with gender expression,
• 15:02what what do they do about it?
• 15:04How do they? Support them.
• 15:06Are there certain questions they
• 15:08should or shouldn't be asking?
• 15:10What should they do if a child
• 15:11gets picked on at school?
• 15:12Or should they talk to the teachers?
• 15:16A good majority of what we do is have long,
• 15:19thoughtful,
• 15:20emotional conversations with
• 15:22kids and families about how to
• 15:25provide love and support.
• 15:28We live in a time where there is a lot
• 15:30of rampant misinformation out on the
• 15:32Internet that people can easily access.
• 15:35So I do want people to know that
• 15:36when we say gender affirming care,
• 15:38we are not talking about giving
• 15:40medications to very young children.
• 15:41That's just not something
• 15:42that's a part of what we do.
• 15:44We are not talking about
• 15:46surgeries on children.
• 15:48That's just not really a part
• 15:50of the care approach for kids.
• 15:52Certainly surgeries and other medical
• 15:54procedures can be things that transgender
• 15:56people have as a part of their care,
• 15:58but that's not how we
• 16:00start this care with kids.
• 16:03This fear of what's going to happen and
• 16:05will my child be targeted or will you be
• 16:07targeted or will this clinic be targeted,
• 16:09is really causing, you know,
• 16:10an everyday fear in the
• 16:12lives of kids and families.
• 16:13Kids and families deserve somewhere to
• 16:15go to get their questions answered.
• 16:17And if my child had diabetes
• 16:21or cancer or asthma,
• 16:24I deserve to be able to go to an
• 16:26asthma specialist to find out what
• 16:28things can we do to make it better,
• 16:31what things might make it worse.
• 16:33And if you have a child who is transgender,
• 16:35you deserve that same thing.
• 16:37At just a real, basic,
• 16:38fundamental level,
• 16:40Kids deserve healthcare that
• 16:42is specialized and tailored
• 16:44to the healthcare needs.
• 16:45Transgender kids deserve that too.
• 17:09Now I'm going to try to do a
• 17:11camera switch here so you can
• 17:14see us better. Nope. Hold on.
• 17:19Nobody. Nobody. needs Wayfair.
• 17:22All right. Very good.
• 17:23I think it works. Yeah. All right.
• 17:30All right. So
• 17:31I think you can see us better now, right?
• 17:36Awesome. Hi, everyone.
• 17:40Thank you so much,
• 17:40Dave, for being here.
• 17:42And I just want to say
• 17:43congratulations to everybody who
• 17:45just graduated last night. So. So
• 17:52we're going to have a conversation.
• 17:54And then we're going to have a
• 17:56moderate where we have some, yeah,
• 17:57you're going to check the cook unit.
• 17:58Awesome. So if folks that
• 18:00are online have questions,
• 18:01please feel free For all y'all
• 18:03that are here with us today,
• 18:05please feel free to ask
• 18:08questions towards the end.
• 18:11So first I'd love to, I,
• 18:13I know you talked a little bit about this,
• 18:14but can we start with talking about L,
• 18:16GB, TQ, healthcare,
• 18:18the history of healthcare and
• 18:20what the the experience has been?
• 18:23Historically for your healthcare, yeah,
• 18:25Yeah. I mean, I think many of you
• 18:28probably know that, as I said,
• 18:31it's been fraught over time. I think
• 18:36there's a large number of LGBTQ folks
• 18:38who are not out to their doctors and
• 18:41who fear and that's been historically
• 18:43true and continues to be true today,
• 18:45who fear bias in the doctor's room.
• 18:48Who are worried about being judged?
• 18:50Who, who, who have heard and have
• 18:53experienced stigma and shame when
• 18:55they do talk about sort of, you know,
• 18:58any kind of healthcare realities that
• 19:00they're dealing with related to their
• 19:02sexual orientation or gender identity.
• 19:04And you know,
• 19:06I think it's particularly unique with
• 19:08trans folks that we have, we have.
• 19:12Also had an interesting relationship
• 19:14with the medical field where many
• 19:16of us have have needed medical care
• 19:19and there have been as I said brave
• 19:21catalyst for change in that in that
• 19:24space who have helped us unlock new
• 19:27futures and possibilities for ourselves.
• 19:29So it's a it's an interesting reality,
• 19:33you know healthcare disparities for L,
• 19:36GB, TQ plus folks across the continuum.
• 19:39Are there those disparities
• 19:41increase around racial divides,
• 19:44especially black and brown LGBTQ folks,
• 19:46plebs, folks who lack more healthcare
• 19:49access and and the HIV epidemic?
• 19:53Everything.
• 19:53A lot of folks think that it
• 19:55was solved in the 80s and 90s.
• 19:57In fact,
• 19:57you know it is raging on and it it continues
• 20:01to disproportionately affect affect,
• 20:03brown and black,
• 20:04L, GB,
• 20:04TQ plus gay and bisexual men
• 20:07especially and and trans women.
• 20:09So there is a lot of work that needs
• 20:11to be done to address some of the
• 20:14disparities within the community that exist.
• 20:16But just broadly the experience
• 20:19can be somewhat challenging
• 20:21around medical providers.
• 20:23Relationship with L GB TQ plus folks,
• 20:26your visibility as allies or as L
• 20:29GB TQ plus providers yourselves
• 20:32can go such a long way and opening
• 20:34up a patient's ability to sort
• 20:37of give you a fuller picture of
• 20:40what they're experiencing.
• 20:41We have a product called the
• 20:43Healthcare Quality Index that we
• 20:45run at the Human Rights Campaign
• 20:47and that works with with with with
• 20:49hospitals across the country and.
• 20:51One of the things that we do in
• 20:53that and that work is just talk
• 20:54about the importance of what you
• 20:56you do are doing right now We're
• 20:58your lanyard with the rainbow and
• 20:59the progress flag on it.
• 21:01The small indications of support
• 21:03can make a big difference from for
• 21:06patients and and and ultimately
• 21:07you know get folks to care that
• 21:10they they need and and deserve.
• 21:16We know that education is lacking
• 21:18and that providers are lacking and
• 21:20you had mentioned that there are 500
• 21:23plus bills that have been introduced
• 21:25in 2023 alone across the USI think
• 21:3070 right 75 that have been passed,
• 21:3220 that are prohibiting gender,
• 21:36reforming care.
• 21:36How is this further impacting what
• 21:38we're seeing right now and how is this
• 21:41going to impact not only healthcare
• 21:42but also education and training?
• 21:46It is. It's a really scary
• 21:47state right now when it
• 21:49comes to gender firm and care.
• 21:51I mean you and I were talking earlier.
• 21:53It's not like the field was robust
• 21:55and to begin with we still needed
• 21:58providers in in much larger numbers.
• 22:00We needed, we needed schools doing what
• 22:02young medical does in terms of you know,
• 22:04integrating these discussions,
• 22:06what what you're doing with with
• 22:08the students here into the the
• 22:11educational experience for providers.
• 22:13I have a friend who's a
• 22:15pediatrician in Chicago and he does
• 22:17gender affirming care there.
• 22:18And you know,
• 22:20there are tons of folks coming to him
• 22:23with folks who have congratulations
• 22:26to who have just graduated and are
• 22:29interested in going into the field.
• 22:31And the the clinics that are closing
• 22:34across the country now have have
• 22:37no openings for for for providers.
• 22:39These providers who who go into this
• 22:42care desperately wanting to do good for,
• 22:45for their patients are are
• 22:48are receiving death threats,
• 22:49are being you know are are being you
• 22:53know sort of are really being attacked
• 22:57and then you know in the educational
• 22:58space I think what you're seeing.
• 23:00Just just recently Project Veritas
• 23:03was recording patient and doctor
• 23:08interviews and and then posting those online.
• 23:12So you're seeing things like that happen
• 23:14also in the educational space and I
• 23:16think it it has a chilling effect.
• 23:18They the opposition really
• 23:20doesn't want us talking.
• 23:21They don't want things like this
• 23:23to happen and then they are
• 23:26using anything we say against us
• 23:28splicing it in different ways.
• 23:30That really exaggerate the realities
• 23:33of what's happening and and make it
• 23:36harder to provide the kind of care
• 23:38that is actually really needed.
• 23:40You know that it is so cynical what
• 23:43what's happening here If they the folks,
• 23:46there's a group of folks who who are
• 23:49sort of trying to get people to think
• 23:51that trans kids are convincing other
• 23:54kids that they're trans and that
• 23:57that that that there's not enough.
• 24:01Vigor in providing transforming
• 24:04care among pediatricians and and
• 24:08psychologists and psychiatrists and
• 24:11and if if that truly were the case,
• 24:14what you would do is you would provide
• 24:17more training to the medical field.
• 24:20You'd provide more robust support
• 24:23for expertise in this field.
• 24:26You would not shut down the care.
• 24:28So,
• 24:28so what's what I'm worried about
• 24:30is not only what this means for
• 24:32the field and for what it means
• 24:34for the number of of doctors who
• 24:36are coming into their careers,
• 24:39but also what it means for the community
• 24:43and where folks will have to turn
• 24:45for care without anybody to turn to.
• 24:54Oh, sure. Sorry. Yeah.
• 24:57And and and I think that's really
• 24:58important to think about, right is,
• 25:00is with folks that are trying to access care,
• 25:04not being able to access care.
• 25:05You had mentioned you know before
• 25:07with the bills also not being able
• 25:08to access supports through schools
• 25:10or beyond sports teams etcetera.
• 25:12And also providers not being able to
• 25:15access education because they don't have
• 25:17these residency programs or fellowships
• 25:20or advanced trainings etcetera.
• 25:22And so this is, this is very much.
• 25:25A bleak A bleak picture right now
• 25:28and so how as as future folks going
• 25:33into different programs across
• 25:34the US you know what are what are
• 25:37some ways that we can increase the
• 25:39education or increase the discussion.
• 25:41Yeah,
• 25:41I mean I I think you all have
• 25:45a really good starting point.
• 25:46I mean you have a lot more
• 25:48knowledge probably just in.
• 25:50I'm sure you've done much more than just what
• 25:53I've explained in the last 30 minutes or so.
• 25:56But even the last 30 minutes or so is is
• 25:59probably more facts than many folks have.
• 26:02So just starting with some, you know,
• 26:08combating the misinformation and the
• 26:09disinformation that's out there is,
• 26:11is is really important and I I know so
• 26:14many providers probably like yourself who?
• 26:18You know, went into pediatric
• 26:20endocrinology or went into Pediatrics
• 26:23or went into the psychiatry,
• 26:25never thinking that they would ever get into
• 26:27anything related to gender affirming care.
• 26:28And then they've had
• 26:30their first trans patient,
• 26:31they met their first trans kiddo.
• 26:33And like any provider is supposed to do,
• 26:36they they learned more about
• 26:38it and and then they had,
• 26:40you know, word of mouth,
• 26:42whole community of folks showing up.
• 26:44In in their offices and that can
• 26:48happen anywhere now.
• 26:49Now providers you know depending on
• 26:52where you're going right like you
• 26:54are going to be restricted by law
• 26:56around what you can and can't provide.
• 26:59But how you show up,
• 27:00how you are there for your patients is
• 27:02is going to matter more than anything.
• 27:06And you know I was I was saying
• 27:08earlier one thing that I.
• 27:10Try to When I talk to parents of trans
• 27:12kids and and kids who are who are
• 27:16living in some of these hostile states,
• 27:19you know one thing that I,
• 27:20I try to remind them is just
• 27:22the long arc of history.
• 27:23We didn't have transferring care
• 27:26widely accessible until very recently.
• 27:29We can make it through this in the interim,
• 27:33we need folks who are just going
• 27:35to provide safe spaces.
• 27:37And who are going to educate each
• 27:39other and and continue to to grow the
• 27:41field in whatever ways we possibly can.
• 27:44So you know it,
• 27:46it can be as small as wearing a lanyard.
• 27:49And that's that's representative of
• 27:52of having a a conversation with a,
• 27:55you know a fellow provider and and
• 27:57making sure that those folks who are
• 27:59coming into your office or you're
• 28:01sitting down with in your care are
• 28:03are are clear on where you stand on
• 28:06on on on on accepting the community.
• 28:10One thing that I think that is is
• 28:13interesting too is is you know the
• 28:16field still even in some of them.
• 28:18I I I had an experience where I
• 28:22was in a a pediatric hospital in a
• 28:28psychiatric unit and overheard doctors
• 28:31huddled around the front of the desk.
• 28:34It was in the ER in the front
• 28:37desk making a a transphobic joke.
• 28:40And this is in a hospital that gets.
• 28:43100% on our healthcare quality
• 28:45index because they have all the
• 28:47right policies they have they do
• 28:48all the right things.
• 28:50But there was still that one provider
• 28:52and the providers around him who
• 28:55who either laughed or didn't say a
• 28:57thing when when he made the joke.
• 28:59You're going to be in spaces like that.
• 29:01You're going to be in experiences
• 29:03like that and you know you saying
• 29:07respectfully that's that's.
• 29:09There's no place for that here.
• 29:11And we're here to take care of.
• 29:12Folks can go a long way, you know,
• 29:17to the first person who's, you know,
• 29:19just trying to like get through the
• 29:22moment that they're in and and you know,
• 29:25nobody around there.
• 29:26If I didn't tell you I was trans,
• 29:28you probably wouldn't know.
• 29:29And they had no idea that they had
• 29:32said this around the trans guy
• 29:34who actually also is is in charge
• 29:36of the healthcare quality index.
• 29:39So it it was,
• 29:40it was an experience that just sort
• 29:43of reminded me of the importance
• 29:45of allyship among providers.
• 29:46And I think that's the kind of thing
• 29:49that that you all will have the
• 29:52opportunity unfortunately to interrupt
• 29:53by us in those sort of everyday
• 29:55moments wherever you are and and I
• 29:57and I hope you're able to do that.
• 30:00And related to that,
• 30:02you know you have folks that are going
• 30:04out into different systems that you
• 30:06know this one had a had a score of 100,
• 30:08but they're going to be going
• 30:10into systems that are oppressive
• 30:12and have been oppressive.
• 30:13To different multiple marginalized
• 30:16folks across time And so you know
• 30:18what are some words of advice or
• 30:20things to think about as as folks are
• 30:22going into these systems of care to
• 30:24be aware of and to be thinking about
• 30:25and to to advocate for patients.
• 30:27Yeah. And and we do this a lot in our work
• 30:30across different different institutions.
• 30:32I mean the institute we we
• 30:35are in a country that is.
• 30:37On a long March toward justice.
• 30:39Way too long.
• 30:40And so all of the systems around us,
• 30:44they're racist. They're transphobic.
• 30:46They're sexist and and so how you go
• 30:50about making change within systems and
• 30:53especially the most hostile systems can
• 30:56be frustratingly Mattingly slow at times.
• 31:00You know it can be fast with with
• 31:02litigation but the courts aren't quite
• 31:04on our side at this moment so that's.
• 31:07Taking a longer time than
• 31:08anybody wants as well,
• 31:10I think start to identify your friends.
• 31:13Start to identify folks who you
• 31:16you can build alliances with,
• 31:19who you have shared understanding with, who.
• 31:22Maybe they're not an expert
• 31:24on on gender affirming care,
• 31:25but they seem to be pretty well up
• 31:29to speed on other progressive medical
• 31:32issues and supportive and build.
• 31:35Alliances.
• 31:35Because you can't doing it alone is
• 31:39an exhausting feat and and also you
• 31:42know I I find that my cup is filled
• 31:46when I take on one hard thing and make
• 31:49some see some degree of progress right.
• 31:52So don't feel like you have to boil the
• 31:56ocean try to find the one thing that one
• 31:59moment of progress that you can make and.
• 32:02Pretty soon you know you'll see you,
• 32:05you've you've amassed a lot of achievements.
• 32:09But try not to be discouraged and
• 32:11try to find friends in the fight
• 32:13because there are good people
• 32:15everywhere who want to be better and
• 32:17and sometimes they just don't know.
• 32:19So I think that's you know,
• 32:21it's simple but but it is,
• 32:23you know probably important to
• 32:25always try to stay grounded,
• 32:26especially when you're in in
• 32:28some pretty tough spots.
• 32:30And related to that, how to
• 32:32keep moving and what to do when
• 32:35things get dangerous. Yeah,
• 32:37I mean I I really that pediatricians
• 32:40and folks like you were not having to
• 32:43worry about their own personal safety
• 32:46in the way that they are right now.
• 32:49It is a very dangerous time to be L, GB,
• 32:52TQ plus to be doing transaffirming care
• 32:56to be speaking out about trans rights.
• 33:00And it's a dangerous time to be in this
• 33:03country. And things are so polarized.
• 33:07I, you know, I have talked to a lot of
• 33:11folks who are in the field right now who
• 33:14are having to think about security in
• 33:16ways they never had to and and hospitals.
• 33:19That are really talking to local FBI offices
• 33:24in ways that they never had to in the past,
• 33:28providing security to providers on the way
• 33:30to their cars in ways that's remind me of,
• 33:33you know, abortion care providers
• 33:34and what what those providers have
• 33:36had to go through over the years.
• 33:38Pediatricians don't think they're signing
• 33:40up for that kind of vitriol and reality.
• 33:44So, you know, I again,
• 33:46I think it finding finding friends.
• 33:49This, you know,
• 33:51we have at times because we work with
• 33:54a lot of providers who, you know,
• 33:56you, a lot of our families go to
• 34:00and things like that.
• 34:02You know,
• 34:02we've provided spaces for them to come
• 34:04together and learn from each other and
• 34:06learn what what each other is doing to
• 34:10navigate the realities and their situations.
• 34:13You know,
• 34:14there are also fortunately right now the,
• 34:16the, the.
• 34:18DOJ and some of the federal mechanisms
• 34:22are out there wanting to provide whatever
• 34:25they can in terms of protection.
• 34:28The Boston Children's Hospital as,
• 34:30as was in the video,
• 34:31there were arrests made in those
• 34:34cases and and and did.
• 34:36The Department of Justice is pursuing
• 34:39cases across the country.
• 34:40So I think, you know,
• 34:42knowing what your rights are and knowing
• 34:45where to find support is really important.
• 34:49And also just building community.
• 34:51Everybody needs community,
• 34:53including providers.
• 34:54And I think that's really,
• 34:55really an important piece of it
• 34:57for sure. And behind a lot of this,
• 34:59as you've alluded to,
• 35:01is a lot of disinformation.
• 35:03So can you talk a little bit about
• 35:05the disinformation and what you
• 35:06would hope that providers would know
• 35:08and be able to share with patients,
• 35:10families, etcetera? Yeah,
• 35:12I mean I wish that more folks understood
• 35:17you know you this is, this is yo
• 35:19medical and it's about medical stuff,
• 35:21but often being trans is like met the medical
• 35:25stuff is just one small iota of it, right.
• 35:28And when it comes to transforming
• 35:30care for young folks.
• 35:32A lot of it is about the social
• 35:34aspects of transition,
• 35:36about being affirmed with the names,
• 35:38the pronouns, the style of dress that
• 35:40folks are that kids feel comfortable in.
• 35:42We don't get into the any of the
• 35:45medical sort of even interventions
• 35:47until you know, puberty.
• 35:49And then it's it's all reversible, right.
• 35:52So I think understanding that that we,
• 35:55you know other than like what Fox
• 36:00News would have you believe around.
• 36:02Surgeries on 3 year olds is just
• 36:04not happening.
• 36:05It doesn't happen.
• 36:06And and you know the level of and Frank,
• 36:10frankly among adults,
• 36:12the level of surgical regret around trans
• 36:14affirming care is minuscule compared to
• 36:18the level of surgical regret for knee
• 36:22surgeries or hip replacements or you know
• 36:25any other kind of care that everybody acts.
• 36:28Like is just normal care,
• 36:29right?
• 36:29So you know,
• 36:30I one thing I really wish and I think
• 36:33it's a bridge too far for some folks,
• 36:36but I really wish we could just
• 36:40remove the stigma associated with
• 36:43with transaffirming care period.
• 36:45If there was no stigma in somebody,
• 36:48you know, exploring their gender then.
• 36:51If you know that if they're so
• 36:54worried about somebody who who
• 36:56has transitioned and then decides
• 36:58that's not right for them,
• 37:00that would just be a part of
• 37:02the human experience,
• 37:03it would not be a bad thing either which
• 37:06way they go on that sort of that journey.
• 37:09But getting folks to kind of unpack
• 37:11that in their heads and think through
• 37:13stigma in that way is is hard.
• 37:16It's very hard,
• 37:17especially with something that people think.
• 37:19Is so ingrained in in the human
• 37:22experience so we've got a lot of
• 37:24education we've got to do the
• 37:26disinformation right now is really
• 37:29making it harder and and what we
• 37:31have to I think what we have to
• 37:33do is start by calming folks down
• 37:34trying to trying to remove the
• 37:36fear a little bit from folks have
• 37:38them in like meet trans people know
• 37:41that we have always existed here
• 37:44here are stories get to see us that
• 37:47like I'm a dad I have two kids.
• 37:50You know I have a wife of almost 20 years,
• 37:5320 years in November.
• 37:55Like my family experience,
• 37:57what I'm doing on a daytoday basis
• 38:01probably matches a lot of folks experiences.
• 38:04Right?
• 38:05Tomorrow,
• 38:06flying back tonight,
• 38:06tomorrow I have to go to my kids
• 38:09swim meet and do time trials right?
• 38:10Like I've I've that's the kind of
• 38:12stuff that makes up my my daily
• 38:14routine when I'm not fighting
• 38:16for justice for my people.
• 38:18So that.
• 38:18That's the kind of stuff that
• 38:20I think we just need to kind of
• 38:23reintroduce ourselves to the
• 38:24country they are the opposition is
• 38:26really making it unsafe to do that.
• 38:30So we can't sort of let our foot off of
• 38:33the the gas on this as hard as it might be,
• 38:36as tough as it might seem you know
• 38:39visibility really does matter to to changing
• 38:42changing the narrative and getting folks.
• 38:44To be more fully aware and
• 38:46doing things like this.
• 38:47So I really got to give you know credit
• 38:49to you all in the student body for for
• 38:52wanting to have this conversation as
• 38:54your last conversation at before you
• 38:56go off into the field because because
• 38:59if more folks were doing this think
• 39:01about the numbers that would be in a
• 39:04in a much more supportive place for
• 39:06for our people and so so you know it's
• 39:09it's hard work but it's we're going
• 39:12to kind of be relentless in it and.
• 39:14And we could use all the help we can
• 39:16get and and making sure that folks
• 39:17are fighting the fear with some facts.
• 39:21That's great. And I think, you know,
• 39:22the other piece that I hear from
• 39:23folks is we talk a lot about,
• 39:25you know, suicide rates and
• 39:26negative things that are happening,
• 39:28anxiety, depression, etcetera.
• 39:29A whole bunch of psychiatrists
• 39:32in this room, you know,
• 39:33also thinking about gender joy though,
• 39:35and how do we talk about that and
• 39:37how do we shed a light on gender joy?
• 39:40Yeah, I mean, we've been
• 39:40talking a lot about joy. I mean,
• 39:42I think it's very easy to just get
• 39:47defeated and and feel like everything's
• 39:50going to hell and in a handbasket.
• 39:54But being queer,
• 39:55there's this element of defiant joy in
• 39:58the queer experience that I just love.
• 40:00And and I think I don't know if
• 40:04folks saw this, but there are these
• 40:06amazing young folks who I happen to know.
• 40:10Three of them. Pretty.
• 40:10Two of them pretty well, three of them.
• 40:12I'm getting to know the other one well,
• 40:15who organized a trans prom
• 40:18in DC in in the spring?
• 40:22And Daniel, who is a close,
• 40:25close friend of the family.
• 40:2713 year old trans kid.
• 40:29No, no, he's older than that.
• 40:30I'm sorry, he'd be mad at me.
• 40:3215 year old trans kid,
• 40:34almost 16, who is in Arizona.
• 40:39In the middle of this fight
• 40:41is state legislature has gone
• 40:43back and forth on these bills.
• 40:45Libby,
• 40:45who's 13 and is in Texas and has
• 40:49been back and forth to to testify
• 40:52for her need for healthcare,
• 40:55very Public Advocate.
• 40:56And they just sort of came together and
• 41:00they said listen like this is hard.
• 41:02We need to do something fun.
• 41:03And so they organized a prom
• 41:06for trans kids that was in.
• 41:09DC in front of,
• 41:10they actually was in front of
• 41:11the nation's capital.
• 41:12There were,
• 41:13you know,
• 41:14I think more than I would say
• 41:16they're probably at 200 kids from
• 41:18all across the country who came
• 41:21and danced and and and you know,
• 41:24some of them gave speeches and then
• 41:28they they marched to the SCOTUS steps.
• 41:31But they just had fun.
• 41:33They just spent you know a lot of
• 41:35them spent about a week together
• 41:36in DC and it was just like it
• 41:38was in the midst of all this.
• 41:41They just knew that having fun was
• 41:44an important part of sort of staying
• 41:46in it and and so and you know we're
• 41:49we're sitting here in pride month
• 41:51and I think that that you know,
• 41:53that has.
• 41:54It is just a great example of what
• 41:56our community does to sort of,
• 41:59even in the face of of real horrors,
• 42:03right.
• 42:03Pride started as a protest of of of
• 42:07bar raids in in New York City and
• 42:11and and and we marched and we danced
• 42:15and we celebrated and that that's
• 42:18always been a part of our experience.
• 42:20So don't.
• 42:20Don't get sort of so bogged down in
• 42:23the heart to not find ways to find joy.
• 42:26It is so important.
• 42:27It is so important to us keeping going.
• 42:31And it's important that your
• 42:33patients understand that too.
• 42:34You know,
• 42:35as you as you find young folks in your
• 42:38care who who are feeling these things,
• 42:41to let them know that there's just
• 42:43almost like a superpower that
• 42:45queer folks have to find joy and.
• 42:47I think is is a really important
• 42:49part of their community history
• 42:50that that we need to make sure that
• 42:52they know. But I think that you
• 42:54know you you all do very hard work,
• 42:57like being a psychiatrist
• 42:58is not an easy thing, right?
• 43:00And so for you all to also make sure
• 43:02you're taking care of yourselves,
• 43:04you're finding your joy, I think is really,
• 43:06really important because it's
• 43:07going to make you better providers.
• 43:09So you know maybe join a pride
• 43:12parade or or something like that.
• 43:14It'll it'll lift your spirits
• 43:15if you've never been to 1.
• 43:17No, that's really great.
• 43:18And and I think that you know,
• 43:19I oftentimes hear from kids like we just want
• 43:21to be kids and we want to have fun, right.
• 43:22And we want our care as you
• 43:24were mentioning, you know,
• 43:25we want to have our healthcare too.
• 43:28And so thinking about healthcare,
• 43:30I want to make sure that we have time for,
• 43:32for, for questions from the audience also.
• 43:34But thinking about this,
• 43:35you know, going out as new
• 43:41staff, faculty, etcetera,
• 43:42providers in the community,
• 43:44what are some words of advice?
• 43:46That you have for our graduates
• 43:49in going out there and and
• 43:51working with LGBTQ folks.
• 43:54Yeah, I mean, I mean,
• 43:55so many folks are afraid of
• 43:57getting it wrong that they don't do anything.
• 44:00And I think that's the worst
• 44:02thing to do most folks.
• 44:04I I have been so forgiving of my providers.
• 44:07In fact, I was telling you it was not
• 44:09until I think 5 or 10 years ago that
• 44:11I had my first provider who I was
• 44:12not their first trans patient, right.
• 44:14Like we are so used to to to being
• 44:19a teacher of the folks who provide
• 44:22our care that we are just human
• 44:26beings who want to be respected and
• 44:29seen and and and knowing that you.
• 44:32Might slip up but you're going to get
• 44:35in there is going to be making making
• 44:38it's going to make the world of a of
• 44:41difference for your patients so so
• 44:42don't don't be so scared of getting
• 44:45it wrong that you don't don't start
• 44:48so you might have everybody stumbles.
• 44:51We all do in whatever care we're
• 44:53providing as parents as as.
• 44:56As providers as healthcare providers
• 44:59but but that just makes you better
• 45:01you learn and and you and you become
• 45:04stronger and and better for it so
• 45:06so ultimately I think so many folks
• 45:08right now especially with the trans
• 45:10issue with when it comes to trans
• 45:13people who we are what we need are so
• 45:15scared of getting something wrong that
• 45:17they're just not saying anything and.
• 45:20You you're hearing so much from folks who
• 45:23know exactly what they're getting wrong
• 45:25and and are doing that deliberately.
• 45:28So please,
• 45:28please just speak up and give it a shot
• 45:32because we need more folks in that space.
• 45:35Thank you. That's so important.
• 45:36There is so much disinformation
• 45:38and folks continue to say it.
• 45:40The same thing and and are hurt a lot.
• 45:43So I think you know yeah getting
• 45:44in there and and being supportive
• 45:46of folks and providing good
• 45:48cares is really important.
• 45:49I'm going to pause.
• 45:50Do we have any questions from the.