Yale Psychiatry Grand Rounds: Commencement

June 20, 2023

Information

Jay Brown, Senior Vice President, Programs, Research & Training, Human Rights Campaign

"A State of Emergency for LGBTQ+ People."

ID10073

To CiteDCA Citation Guide

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.