1 00:00:00,360 --> 00:00:05,399 Speaker 1: Okay, doctor Hayden Sae Shaeffer is here transgender care specialist. 2 00:00:05,519 --> 00:00:08,760 Speaker 1: Hi Hayden, Hi, thanks so much for having me. Can 3 00:00:08,800 --> 00:00:13,360 Speaker 1: I call you? Hayden Is that I just went there, 4 00:00:13,400 --> 00:00:14,920 Speaker 1: and then I was like, oh, wait, am I supposed 5 00:00:14,920 --> 00:00:19,280 Speaker 1: to say doctor Schaeffer. We were both so we full 6 00:00:19,320 --> 00:00:21,960 Speaker 1: disclosure ship, and I decided that we wanted to have 7 00:00:22,000 --> 00:00:27,040 Speaker 1: this conversation, and I almost hesitated because I just feel 8 00:00:27,120 --> 00:00:30,240 Speaker 1: so uninformed. And this is actually the first time that 9 00:00:30,280 --> 00:00:34,200 Speaker 1: I was really researching the ins and outs of this process. 10 00:00:34,440 --> 00:00:37,479 Speaker 1: And you were so kind to send me some notes 11 00:00:37,560 --> 00:00:39,519 Speaker 1: about some of the work you do or some of 12 00:00:39,560 --> 00:00:42,360 Speaker 1: the breakdowns of what happens when a patient comes to 13 00:00:42,400 --> 00:00:45,160 Speaker 1: see you. But it made me realize too, if I'm 14 00:00:45,200 --> 00:00:48,080 Speaker 1: feeling that way, so many people, and I would imagine 15 00:00:48,120 --> 00:00:51,919 Speaker 1: so many of our listeners are also resonating with that, 16 00:00:52,000 --> 00:00:54,520 Speaker 1: like we just don't know. And so one of the 17 00:00:54,520 --> 00:00:56,480 Speaker 1: main things that I feel like is happening in our 18 00:00:56,520 --> 00:01:00,240 Speaker 1: culture is reforming these opinions we're getting so right piled 19 00:01:00,360 --> 00:01:04,800 Speaker 1: up and we're taking like there's no empathy or experience 20 00:01:04,840 --> 00:01:07,480 Speaker 1: of humanity behind that because we just don't understand what 21 00:01:07,520 --> 00:01:11,560 Speaker 1: the process is, right, So that was kind of our 22 00:01:11,600 --> 00:01:16,080 Speaker 1: goal today. Our topic this month is metamorphosis, and this 23 00:01:16,160 --> 00:01:21,200 Speaker 1: is obviously a really fitting conversation for that word. So 24 00:01:21,800 --> 00:01:24,840 Speaker 1: we wanted to bring on someone who actually knows what 25 00:01:24,880 --> 00:01:27,679 Speaker 1: they're talking about. And it's not shipping. I just forming 26 00:01:27,720 --> 00:01:31,200 Speaker 1: some opinion based off of little headlines we're reading in 27 00:01:31,240 --> 00:01:33,640 Speaker 1: the news. Is that something you're facing a lot where 28 00:01:33,640 --> 00:01:39,040 Speaker 1: people are just uninformed about this topic. Absolutely, But I 29 00:01:39,080 --> 00:01:44,520 Speaker 1: also would point that back to why are people uninformed 30 00:01:44,560 --> 00:01:49,480 Speaker 1: about this is because gender dysphoria or gender in congruence 31 00:01:49,560 --> 00:01:55,960 Speaker 1: itself is rare. There are not many people statistically that 32 00:01:56,000 --> 00:02:01,880 Speaker 1: have this affect them, and historically, because it has been 33 00:02:01,920 --> 00:02:07,120 Speaker 1: such a maligned view even by the medical community. Right, 34 00:02:07,160 --> 00:02:11,959 Speaker 1: it wasn't until two thousand and twelve that gender dysphoria 35 00:02:12,200 --> 00:02:16,360 Speaker 1: was no longer considered to be a mental illness that 36 00:02:16,600 --> 00:02:18,359 Speaker 1: people weren't going to talk about it. You know, it's 37 00:02:18,560 --> 00:02:23,600 Speaker 1: very similar. Um it has a very similar viewpoint from 38 00:02:23,600 --> 00:02:26,200 Speaker 1: the public in the way that people think about addiction. 39 00:02:26,320 --> 00:02:32,040 Speaker 1: In some ways, it can be um over medicalized, pathologized, 40 00:02:32,160 --> 00:02:37,360 Speaker 1: and seen as something taboo to discuss. And so it's 41 00:02:37,400 --> 00:02:40,520 Speaker 1: not it's not a strange idea to me. That this 42 00:02:40,680 --> 00:02:43,919 Speaker 1: is foreign to most people. And I think I'm a 43 00:02:44,240 --> 00:02:46,760 Speaker 1: native Nashville and myself, I was born and raised here, 44 00:02:46,840 --> 00:02:49,799 Speaker 1: and you know, I can say growing up here, I 45 00:02:49,840 --> 00:02:54,560 Speaker 1: never knew someone who was transgender. And you know, over 46 00:02:54,720 --> 00:02:58,840 Speaker 1: the years you find that actually you did know somebody 47 00:02:58,840 --> 00:03:02,200 Speaker 1: who was transgender. They may not have been outwardly expressive 48 00:03:02,240 --> 00:03:06,320 Speaker 1: of that for many, many reasons. And now we're finding 49 00:03:06,400 --> 00:03:10,880 Speaker 1: that people are embracing their gender identity and their gender 50 00:03:10,960 --> 00:03:15,600 Speaker 1: expression in a way that we're talking about gender dysphoria 51 00:03:15,639 --> 00:03:18,360 Speaker 1: and gender diversity way more than we ever have and 52 00:03:18,400 --> 00:03:24,960 Speaker 1: so of course it invites criticism opinions, and that's normal. Yeah. Well, 53 00:03:25,000 --> 00:03:27,800 Speaker 1: you've mentioned the word gender dysphoria a couple of times, 54 00:03:27,840 --> 00:03:29,800 Speaker 1: and I will say, like, that was another word. I 55 00:03:29,800 --> 00:03:32,000 Speaker 1: was like, I need to google this, what exactly is this? 56 00:03:32,200 --> 00:03:37,320 Speaker 1: So can you tell the listeners definition of gender dysphoria. Yeah, so, 57 00:03:39,080 --> 00:03:45,600 Speaker 1: gender dysphoria as a diagnosis arrives to us from the 58 00:03:45,880 --> 00:03:51,160 Speaker 1: world of psychiatry who originally defined this, and it effectively 59 00:03:51,200 --> 00:03:57,800 Speaker 1: would say someone who is having suffering because the gender 60 00:03:58,040 --> 00:04:01,920 Speaker 1: that they were assigned at birth is not consistent with 61 00:04:01,960 --> 00:04:07,240 Speaker 1: the gender who they see themselves as. Over time, the 62 00:04:07,360 --> 00:04:11,840 Speaker 1: emphasis has been moving from gender dysphoria to gender incongruence 63 00:04:12,160 --> 00:04:17,280 Speaker 1: to try and demedicalize it a little bit. But the 64 00:04:17,600 --> 00:04:21,640 Speaker 1: truth is is that if you are assigned male at 65 00:04:21,640 --> 00:04:28,440 Speaker 1: birth and you identify strongly internally as female, that is 66 00:04:28,480 --> 00:04:33,280 Speaker 1: going to result in many symptoms of suffering, right trying 67 00:04:33,279 --> 00:04:37,440 Speaker 1: to live as someone and people treating you as somebody 68 00:04:37,440 --> 00:04:39,160 Speaker 1: who you are not. And so that's at the core 69 00:04:39,360 --> 00:04:44,279 Speaker 1: of gender dysphoria. So when a patient comes to you, 70 00:04:44,680 --> 00:04:47,080 Speaker 1: this is the part that was fascinating to me, Like 71 00:04:47,560 --> 00:04:50,360 Speaker 1: I think people just start to say someone's waking up 72 00:04:50,400 --> 00:04:52,400 Speaker 1: one day and they're like, Okay, I'm going to go 73 00:04:53,000 --> 00:04:55,880 Speaker 1: do this like this process and I'm just going to start, 74 00:04:56,200 --> 00:05:00,080 Speaker 1: And it's so much more complex than that. And so 75 00:05:00,279 --> 00:05:03,039 Speaker 1: when someone comes to you, what's the first thing you 76 00:05:03,160 --> 00:05:08,120 Speaker 1: discussed to kind of navigate with them if this is 77 00:05:08,160 --> 00:05:11,839 Speaker 1: something that's really like they're really going through it, I 78 00:05:11,880 --> 00:05:17,239 Speaker 1: guess is what I'm trying to ask. I always start 79 00:05:17,279 --> 00:05:23,520 Speaker 1: by talking about how they came to understand their gender identity. 80 00:05:23,920 --> 00:05:27,159 Speaker 1: And the most common answer that I get from people 81 00:05:28,240 --> 00:05:31,080 Speaker 1: when I ask, what was the first age you felt 82 00:05:31,120 --> 00:05:34,480 Speaker 1: like that you are not the sex that you were 83 00:05:34,480 --> 00:05:37,880 Speaker 1: given at birth, born ass and most people say age 84 00:05:37,880 --> 00:05:42,520 Speaker 1: four to five, wow, and they'll have very distinct recollections 85 00:05:42,680 --> 00:05:46,840 Speaker 1: of you know, having to be fitted in address for 86 00:05:46,880 --> 00:05:50,719 Speaker 1: Sunday's school and absolutely refusing to put it on and 87 00:05:50,800 --> 00:05:53,360 Speaker 1: wanting to wear more masculine clothes, and that has been 88 00:05:53,640 --> 00:05:56,440 Speaker 1: a sticking memory in their in their mind for their 89 00:05:56,560 --> 00:06:01,240 Speaker 1: entire life as kind of the origin and develop mentally, 90 00:06:01,360 --> 00:06:06,039 Speaker 1: that is consistent with when kids start to understand self insects, 91 00:06:06,480 --> 00:06:09,000 Speaker 1: So it makes sense that that's most of the time, 92 00:06:09,680 --> 00:06:15,880 Speaker 1: and then things catalyze around puberty. So typically puberty for 93 00:06:15,960 --> 00:06:20,400 Speaker 1: people who are transgendered can be very, very very difficult 94 00:06:22,000 --> 00:06:24,719 Speaker 1: as they start to experience further changes that are not 95 00:06:24,960 --> 00:06:31,039 Speaker 1: consistent with who they see themselves as. And so typically 96 00:06:31,680 --> 00:06:34,719 Speaker 1: most of my patients will have a story quite similar 97 00:06:34,760 --> 00:06:40,479 Speaker 1: to that. And so they've expressed this incongruence of their 98 00:06:40,600 --> 00:06:45,960 Speaker 1: gender from an early childhood age on into adulthood or 99 00:06:46,360 --> 00:06:49,480 Speaker 1: adolescence and have arrived at this time and say I 100 00:06:49,720 --> 00:06:52,400 Speaker 1: would like to move forward with changes so that I 101 00:06:52,440 --> 00:06:55,880 Speaker 1: can express myself as who I am right, so as 102 00:06:55,920 --> 00:06:59,680 Speaker 1: the like the teen early teen years, that's because we 103 00:06:59,760 --> 00:07:05,160 Speaker 1: hit puberty, so everything starts to Yeah, so the physical 104 00:07:05,240 --> 00:07:09,440 Speaker 1: and hormonal changes that are going to occur at puberty 105 00:07:09,560 --> 00:07:13,440 Speaker 1: really bring things to the forefront. Yeah, if you are 106 00:07:13,520 --> 00:07:18,400 Speaker 1: assigned female at birth and you are experiencing menstruation for 107 00:07:18,440 --> 00:07:21,400 Speaker 1: the first time and that is just not something that 108 00:07:21,520 --> 00:07:24,360 Speaker 1: you feel like your body should be doing, obviously going 109 00:07:24,400 --> 00:07:28,480 Speaker 1: to invite a ton of suffering on an already you know, 110 00:07:28,520 --> 00:07:33,160 Speaker 1: shaping young mind. Right, But anyone who is going to 111 00:07:33,200 --> 00:07:38,840 Speaker 1: be treated with say hormone therapy or surgical interventions to 112 00:07:38,920 --> 00:07:45,320 Speaker 1: affirm their gender needs to demonstrate a longstanding history of 113 00:07:45,480 --> 00:07:51,040 Speaker 1: this dysphoria or this difference, right You. You couldn't walk 114 00:07:51,080 --> 00:07:55,280 Speaker 1: into a doctor's office and say, I've been feeling this 115 00:07:55,320 --> 00:07:58,720 Speaker 1: way for one month, I would like to proceed with changes. 116 00:07:59,720 --> 00:08:03,000 Speaker 1: No one would move forward with something like that. It 117 00:08:03,040 --> 00:08:08,360 Speaker 1: needs to really be a longstanding problem for that person. Well, 118 00:08:08,360 --> 00:08:11,680 Speaker 1: that's kind of what I feel some of the misunderstanding 119 00:08:12,040 --> 00:08:14,920 Speaker 1: around this topic is is that it's just, like I said, 120 00:08:14,920 --> 00:08:18,040 Speaker 1: it's just a very flippant decision, and it's from what 121 00:08:18,120 --> 00:08:20,560 Speaker 1: everything I read, the stuff that you sent me, the 122 00:08:20,640 --> 00:08:24,960 Speaker 1: other stuff that I researched, it is so not It's 123 00:08:25,080 --> 00:08:28,200 Speaker 1: just not And like even the example, you just gave 124 00:08:28,280 --> 00:08:33,520 Speaker 1: about ministruation, like I didn't want that necessarily as a woman. 125 00:08:33,559 --> 00:08:36,800 Speaker 1: It's not like ministruation it's fun for us. And I 126 00:08:36,800 --> 00:08:39,320 Speaker 1: could say that, but like, I never felt like my 127 00:08:39,360 --> 00:08:42,280 Speaker 1: body wasn't supposed to be doing that, Like it felt 128 00:08:42,440 --> 00:08:45,160 Speaker 1: very in line with who I was supposed to be. 129 00:08:45,240 --> 00:08:47,679 Speaker 1: So I can't imagine that struggle and how much more 130 00:08:47,760 --> 00:08:52,319 Speaker 1: uncomfortable that would, especially make the teenage years, right, And 131 00:08:52,360 --> 00:08:54,760 Speaker 1: I think I like the way that you phrase that 132 00:08:54,880 --> 00:08:57,640 Speaker 1: is and I use this phrase a lot with my patients, 133 00:08:57,640 --> 00:09:01,480 Speaker 1: which is I cannot imagine, can't you know? And for 134 00:09:01,679 --> 00:09:04,120 Speaker 1: the listeners at home to be clear, I'm I'm I'm 135 00:09:04,160 --> 00:09:07,720 Speaker 1: assist man, and so you know, I often phrase back 136 00:09:07,760 --> 00:09:10,560 Speaker 1: to my patients like I do not know what gender 137 00:09:10,600 --> 00:09:15,240 Speaker 1: dysphoria feels. Like I am gaining the understanding through these 138 00:09:15,280 --> 00:09:19,079 Speaker 1: collective experiences that patient share with me about the suffering. 139 00:09:19,120 --> 00:09:22,720 Speaker 1: And I think that is at the heart of the 140 00:09:22,840 --> 00:09:25,120 Speaker 1: empathy that I think could be missing from a lot 141 00:09:25,120 --> 00:09:28,360 Speaker 1: of this conversation, is reflecting back onto ourselves to say, 142 00:09:29,559 --> 00:09:32,320 Speaker 1: you know, I can't feel this, I'll probably never feel that, 143 00:09:32,720 --> 00:09:35,319 Speaker 1: and I have to be okay with that and still 144 00:09:35,360 --> 00:09:39,040 Speaker 1: empathize with this person. Yeah, I mean I think that's common. 145 00:09:39,040 --> 00:09:41,319 Speaker 1: And you know, you can have any sort of doctor. 146 00:09:41,520 --> 00:09:43,360 Speaker 1: You could be a foot doctor and never have any 147 00:09:43,400 --> 00:09:49,720 Speaker 1: feet pain, right like, so you know, to me, I'm 148 00:09:49,760 --> 00:09:54,200 Speaker 1: just it's so such a curious thing. To me, I 149 00:09:54,240 --> 00:09:56,280 Speaker 1: didn't read all the stuff that Kelly's read, so I'm 150 00:09:56,280 --> 00:10:01,240 Speaker 1: coming from a more ignorant point of view, but at 151 00:10:01,160 --> 00:10:06,040 Speaker 1: an understanding point of view, Like is there are there 152 00:10:06,040 --> 00:10:09,360 Speaker 1: any checks and balances in place when someone goes in 153 00:10:09,400 --> 00:10:13,839 Speaker 1: and says I want a breast enlargement, like just because 154 00:10:13,880 --> 00:10:17,000 Speaker 1: I want it? Like, is there a waiting period for 155 00:10:17,080 --> 00:10:22,040 Speaker 1: something like that? And if not, why are you are 156 00:10:22,080 --> 00:10:24,800 Speaker 1: you saying for someone who is transgender or just cosmetically 157 00:10:24,800 --> 00:10:29,439 Speaker 1: in general, cosmetic surgery in general? Oh, I don't think so. No, 158 00:10:29,600 --> 00:10:33,000 Speaker 1: there wouldn't be any sort of weight time to hold 159 00:10:33,120 --> 00:10:36,120 Speaker 1: for an augmentation for a cosmetic purpose. It's pretty much 160 00:10:36,160 --> 00:10:38,600 Speaker 1: just a review of the risks and benefits of the 161 00:10:38,640 --> 00:10:42,040 Speaker 1: procedure with the surgeon. And if you're good with that, 162 00:10:42,080 --> 00:10:44,920 Speaker 1: you're good with that. And so it's interesting that the 163 00:10:44,960 --> 00:10:49,520 Speaker 1: people that would feel that that's okay. And I wonder why. 164 00:10:49,679 --> 00:10:52,240 Speaker 1: I wonder if some of That is the reason why 165 00:10:52,320 --> 00:10:56,280 Speaker 1: people think that a decision to medically transition is a 166 00:10:56,280 --> 00:10:58,760 Speaker 1: flippant thing too, because they know that you can just 167 00:10:58,800 --> 00:11:00,760 Speaker 1: go in and get breast tomorrow if you want them, 168 00:11:00,800 --> 00:11:04,600 Speaker 1: you know, right, and you know, I think it's really 169 00:11:04,640 --> 00:11:08,720 Speaker 1: important for us to stress that it's not that simple 170 00:11:08,760 --> 00:11:13,800 Speaker 1: a process. How long is you know, medically is long enough? 171 00:11:13,920 --> 00:11:17,880 Speaker 1: Like suffering? Long enough? Like how do you how do 172 00:11:17,920 --> 00:11:24,840 Speaker 1: you arrive at that decision? There is not a strict 173 00:11:25,200 --> 00:11:28,840 Speaker 1: number on time that is defined as to say enough 174 00:11:29,080 --> 00:11:32,200 Speaker 1: is enough suffering because defining a time frame like that 175 00:11:32,240 --> 00:11:35,040 Speaker 1: can be so cruel. I think in that way we 176 00:11:35,240 --> 00:11:38,840 Speaker 1: look at more so, how is how is the suffering 177 00:11:38,880 --> 00:11:43,680 Speaker 1: manifesting in your life? Are you suffering to the point 178 00:11:43,720 --> 00:11:47,160 Speaker 1: presently where you have gone ahead and changed your name 179 00:11:47,160 --> 00:11:50,560 Speaker 1: and your pronouns because you cannot stand to be called 180 00:11:51,400 --> 00:11:53,160 Speaker 1: the name given to you at birth and the pronouns 181 00:11:53,160 --> 00:11:55,679 Speaker 1: given to you a birth right. So that's an example 182 00:11:55,720 --> 00:12:00,200 Speaker 1: of somebody already living and what we would say is 183 00:12:00,240 --> 00:12:04,960 Speaker 1: socially transitioning, right, So without any medical intervention, they're already 184 00:12:05,040 --> 00:12:07,120 Speaker 1: changing the other aspects of their life that they do 185 00:12:07,200 --> 00:12:11,080 Speaker 1: have control over. And when you see a pattern of 186 00:12:11,200 --> 00:12:16,359 Speaker 1: consistent social transition. That is a sign that somebody is preparing, 187 00:12:16,480 --> 00:12:21,960 Speaker 1: typically for a medical transition. Okay, well, this kind of 188 00:12:21,960 --> 00:12:24,480 Speaker 1: brings me to the point of like, like, how important 189 00:12:24,480 --> 00:12:27,200 Speaker 1: would you say gender affirming care is, because when I 190 00:12:27,240 --> 00:12:29,920 Speaker 1: was reading, I was like, this is so important to 191 00:12:30,080 --> 00:12:35,559 Speaker 1: have this specific care offered, and people who actually understand 192 00:12:36,040 --> 00:12:38,400 Speaker 1: and work in this day to day like, how what 193 00:12:38,480 --> 00:12:43,880 Speaker 1: would you say the importance of that would be? My 194 00:12:44,000 --> 00:12:47,199 Speaker 1: patients tell me often it's life saving care. Yeah, and 195 00:12:48,000 --> 00:12:52,560 Speaker 1: the data reflects that. You know, the average age of 196 00:12:52,800 --> 00:12:56,920 Speaker 1: a person's lifespan who's transgender in the United States is 197 00:12:56,920 --> 00:13:01,920 Speaker 1: about thirty five Are you kidding? Most people who are 198 00:13:01,920 --> 00:13:05,000 Speaker 1: a transgender will tell you that's kind of about how 199 00:13:05,000 --> 00:13:10,240 Speaker 1: long they expect to live from suicide? Is that? What 200 00:13:10,440 --> 00:13:15,840 Speaker 1: is that the comedy from suicide related to depression? It 201 00:13:15,880 --> 00:13:20,319 Speaker 1: would be from violence against transgender people, right and resulting 202 00:13:20,360 --> 00:13:25,040 Speaker 1: in murder. It would be either because they're afraid to 203 00:13:25,160 --> 00:13:29,200 Speaker 1: access classic safe medical care, they're getting hormone therapy or 204 00:13:29,200 --> 00:13:32,000 Speaker 1: surgeries on the black market and understand that that's going 205 00:13:32,040 --> 00:13:35,240 Speaker 1: to shorten their lifespan because they're regulating it not with 206 00:13:35,520 --> 00:13:41,360 Speaker 1: a physician, And so those are those are the main instances. 207 00:13:42,440 --> 00:13:50,319 Speaker 1: There's well documented evidence that consistently shows that gender affirming care, 208 00:13:50,880 --> 00:13:54,400 Speaker 1: which includes hormone therapy and sometimes surgery for some people, 209 00:13:55,720 --> 00:14:01,000 Speaker 1: remarkably reduces someone's risk of suicide. Right. I don't consider 210 00:14:01,200 --> 00:14:04,840 Speaker 1: this to be a like a medicine for depression. I 211 00:14:04,840 --> 00:14:09,200 Speaker 1: think you have to manage people's other mental conditions like 212 00:14:09,200 --> 00:14:16,760 Speaker 1: depression anxiety alongside gender affirming care. Okay, but that is 213 00:14:17,679 --> 00:14:21,200 Speaker 1: these things together. Being involved in the medical community and 214 00:14:21,320 --> 00:14:23,240 Speaker 1: having people take care of you or is going to 215 00:14:23,360 --> 00:14:28,800 Speaker 1: end up prolonging people's life. And I think that's well, 216 00:14:28,840 --> 00:14:32,480 Speaker 1: there's you know, so many of my patients make their 217 00:14:33,000 --> 00:14:37,400 Speaker 1: appointments on their eighteenth birthday because they that'll be the 218 00:14:37,600 --> 00:14:40,760 Speaker 1: chance for them to proceed with a transition outside of 219 00:14:41,320 --> 00:14:43,400 Speaker 1: you know, whether their family agrees with it or not. 220 00:14:45,200 --> 00:14:49,280 Speaker 1: And so many times the patients will say, I didn't 221 00:14:49,280 --> 00:14:51,600 Speaker 1: think I would make it to my eighteenth birthday. Wow, 222 00:14:51,760 --> 00:14:54,320 Speaker 1: because they thought that they would they would commit suicide 223 00:14:54,320 --> 00:14:58,600 Speaker 1: before that opportunity. And so it is. It is incredibly 224 00:14:58,600 --> 00:15:03,160 Speaker 1: life saving U And the other part of it is 225 00:15:03,400 --> 00:15:07,400 Speaker 1: it's incredibly joy giving. I mean, there are not so 226 00:15:07,440 --> 00:15:10,080 Speaker 1: many times I think that we go to our doctors 227 00:15:10,440 --> 00:15:13,040 Speaker 1: and are elated to be returning to them and being like, 228 00:15:13,080 --> 00:15:15,840 Speaker 1: oh my gosh, look what's happened. I'm so happy with 229 00:15:15,880 --> 00:15:19,000 Speaker 1: what's occurring. And this is one of those It's very 230 00:15:19,080 --> 00:15:24,359 Speaker 1: exciting to see people turn their entire lives around mentally, physically, 231 00:15:24,520 --> 00:15:30,800 Speaker 1: professionally because they're able to express themselves. You mentioned earlier 232 00:15:30,920 --> 00:15:34,880 Speaker 1: that in twenty twelve it was ruled I can't remember 233 00:15:34,880 --> 00:15:36,880 Speaker 1: exactly how you phrased it, but it used to be 234 00:15:36,920 --> 00:15:40,920 Speaker 1: looked at as a mental issue or as a mental illness, 235 00:15:40,920 --> 00:15:44,320 Speaker 1: a mental illness. So what can you I'm assuming that 236 00:15:44,320 --> 00:15:46,680 Speaker 1: there are a lot of people who still think that, 237 00:15:47,440 --> 00:15:49,760 Speaker 1: and so can you talk a little bit about what 238 00:15:49,960 --> 00:15:54,040 Speaker 1: happened there and how that changed and shifted and why 239 00:15:54,080 --> 00:15:57,720 Speaker 1: they made that decision. So it really came at the 240 00:15:57,840 --> 00:16:02,400 Speaker 1: update of what's called the DSM, which is in psychiatric 241 00:16:02,480 --> 00:16:06,400 Speaker 1: medicine kind of the Bible of psychiatric illnesses that comes 242 00:16:06,400 --> 00:16:10,400 Speaker 1: in volumes. We're on volume five, and all previous had 243 00:16:10,480 --> 00:16:15,600 Speaker 1: labeled gender just for you to be a mental disorder. Okay, 244 00:16:15,640 --> 00:16:17,960 Speaker 1: and you know I would say this is not different 245 00:16:18,000 --> 00:16:21,360 Speaker 1: than you know. It wasn't until I believe it was 246 00:16:21,440 --> 00:16:25,960 Speaker 1: the late seventies, before homosexuality was not considered a mental illness. 247 00:16:26,640 --> 00:16:32,360 Speaker 1: And then you know, even before that, historianism, right, which 248 00:16:32,440 --> 00:16:35,600 Speaker 1: was kind of a label to give to housewives who 249 00:16:35,640 --> 00:16:37,640 Speaker 1: would become depressed and they would kind of throw them 250 00:16:37,640 --> 00:16:40,720 Speaker 1: away in a been right in the fifties and sixties. 251 00:16:41,000 --> 00:16:45,480 Speaker 1: And so, uh, it's it's seen as an evolution of 252 00:16:45,800 --> 00:16:51,520 Speaker 1: psychiatric medicine to adapt to what is, you know, effectively 253 00:16:51,880 --> 00:16:56,600 Speaker 1: a societal change and view on this condition. And if 254 00:16:56,640 --> 00:16:58,960 Speaker 1: you want to, you know, talk about it more than 255 00:16:59,000 --> 00:17:01,040 Speaker 1: just how we think about it in the United States. 256 00:17:02,040 --> 00:17:06,920 Speaker 1: Cultures all over the world before the existence of any 257 00:17:07,000 --> 00:17:14,560 Speaker 1: psychiatric medicine had embraced third genders or other genders beyond 258 00:17:15,200 --> 00:17:18,439 Speaker 1: you know what we would call, you know, transgender women 259 00:17:18,440 --> 00:17:21,719 Speaker 1: and men. Today, right, Native Americans have what you call 260 00:17:21,760 --> 00:17:25,480 Speaker 1: a two spirit person, someone who is both male and female, 261 00:17:25,640 --> 00:17:29,040 Speaker 1: highly regarded individuals in their culture. Right. That doesn't quite 262 00:17:29,040 --> 00:17:32,480 Speaker 1: fit into our ideology of what we I think talk 263 00:17:32,560 --> 00:17:36,199 Speaker 1: about nowadays in the US with with everything going on. 264 00:17:39,400 --> 00:17:43,280 Speaker 1: So twenty twelve actually surprises me, and I'm surprised that 265 00:17:43,320 --> 00:17:47,639 Speaker 1: it was that early, Like do you know what I'm saying? 266 00:17:47,720 --> 00:17:50,360 Speaker 1: Because of all the stuff we're facing now like, I'm 267 00:17:50,400 --> 00:17:55,199 Speaker 1: surprised it's not just coming up now to where they're like, no, 268 00:17:55,440 --> 00:18:01,959 Speaker 1: this is not a mental illness, right and wild it 269 00:18:02,160 --> 00:18:07,280 Speaker 1: moving at the speed of medicine is not always expedient, unfortunately, 270 00:18:07,800 --> 00:18:12,080 Speaker 1: What do you mean, you know, because I think that 271 00:18:12,200 --> 00:18:15,240 Speaker 1: the medical community should have arrived at that occlusion several 272 00:18:15,280 --> 00:18:18,760 Speaker 1: decades before. Yeah, and you know, of course it raises 273 00:18:18,760 --> 00:18:20,159 Speaker 1: your question about what are we going to change our 274 00:18:20,200 --> 00:18:25,760 Speaker 1: minds on? Leader, But it is the importance to constantly 275 00:18:25,840 --> 00:18:33,000 Speaker 1: be reevaluating the lenses with which we see what we 276 00:18:33,080 --> 00:18:35,840 Speaker 1: deem as medical illnesses. Right. I think in the last 277 00:18:36,440 --> 00:18:41,520 Speaker 1: twenty years, most Americans perception of addiction has changed in 278 00:18:41,520 --> 00:18:44,040 Speaker 1: a lot of ways. Right, This is something that needs 279 00:18:44,040 --> 00:18:48,040 Speaker 1: to be treated, not shamed. And so over time, as 280 00:18:48,200 --> 00:18:51,480 Speaker 1: as people react to i'd say, more taboo parts of 281 00:18:52,040 --> 00:18:55,399 Speaker 1: American culture and things move out of the shadows, and 282 00:18:55,480 --> 00:18:59,840 Speaker 1: people gain dignity by expressing themselves, not hiding who they are. 283 00:19:00,359 --> 00:19:08,040 Speaker 1: We tend to de medicalize and de destigmatize these things. Ahead, 284 00:19:08,280 --> 00:19:11,040 Speaker 1: go ahead, I was going to ask if their statistics 285 00:19:11,080 --> 00:19:18,719 Speaker 1: that show um an increase in life expectancy post twenty twelve. Mm, 286 00:19:19,440 --> 00:19:22,800 Speaker 1: that's a great question. So this, uh, we do know 287 00:19:22,880 --> 00:19:26,399 Speaker 1: that transgender people are living longer, UM, can it be 288 00:19:26,480 --> 00:19:30,160 Speaker 1: directly tied to that one change? I think that's hard 289 00:19:30,200 --> 00:19:35,760 Speaker 1: to do. UM. But the professional organization that basically helps 290 00:19:35,840 --> 00:19:41,040 Speaker 1: dictate the care of transgender people UM, which is called WPATH, 291 00:19:42,200 --> 00:19:47,520 Speaker 1: issued their newest edition last year that talks a lot 292 00:19:47,600 --> 00:19:52,520 Speaker 1: about the positive changes that we've seen related to how 293 00:19:52,520 --> 00:19:56,000 Speaker 1: the DSM changed their diagnostic criteria. So when you mentioned 294 00:19:56,040 --> 00:20:01,440 Speaker 1: earlier that you, in correlation with what ever you're doing 295 00:20:01,480 --> 00:20:03,600 Speaker 1: with a patient, you believe that they should still be 296 00:20:03,600 --> 00:20:06,679 Speaker 1: working on their mental and emotional health. What are you 297 00:20:06,720 --> 00:20:09,760 Speaker 1: seeing with that? Like? Why are they treated separately? Let 298 00:20:09,760 --> 00:20:13,040 Speaker 1: me put it this way, because when I'm treating somebody 299 00:20:13,160 --> 00:20:17,680 Speaker 1: with gender dysphoria or I'm going to use that other 300 00:20:17,760 --> 00:20:22,919 Speaker 1: term gender incongruence, kind of interchangeably. Here, I am using 301 00:20:23,280 --> 00:20:28,960 Speaker 1: a hormone therapy to improve the way that somebody visualizes 302 00:20:29,000 --> 00:20:32,280 Speaker 1: themselves and to create physical changes that affirm who they are. 303 00:20:33,119 --> 00:20:37,280 Speaker 1: Those are hormones. They are not antidepressants. They are not 304 00:20:37,560 --> 00:20:44,520 Speaker 1: targeting parts of the brain to alleviate mental illnesses like depression, anxiety, 305 00:20:44,520 --> 00:20:50,040 Speaker 1: bipolar disorder, and so there's no amount of estrogen or 306 00:20:50,040 --> 00:20:53,879 Speaker 1: testosterone I can give somebody that will cure them of depression. 307 00:20:54,359 --> 00:20:58,359 Speaker 1: These are are problems that can run alongside one another. 308 00:20:58,920 --> 00:21:01,720 Speaker 1: And while people will have changes in the way that 309 00:21:01,840 --> 00:21:06,040 Speaker 1: their mood, you know, interprets things, right, I would say, 310 00:21:06,240 --> 00:21:10,320 Speaker 1: you know, when people are on estrogen, they will experience 311 00:21:10,400 --> 00:21:13,160 Speaker 1: more mood swings than they would have otherwise. Right. The 312 00:21:13,320 --> 00:21:15,000 Speaker 1: classic one I get is, oh, my gosh, I can 313 00:21:15,040 --> 00:21:19,080 Speaker 1: cry at movies for the first time. That is a 314 00:21:19,119 --> 00:21:24,000 Speaker 1: new way to understand and process through depression, rather than 315 00:21:24,040 --> 00:21:28,360 Speaker 1: to say it is going to outright improve your depression. Yeah, okay, 316 00:21:28,680 --> 00:21:31,200 Speaker 1: so that actually makes sense to me too, because also 317 00:21:31,440 --> 00:21:33,320 Speaker 1: I would I don't know if this is true, but 318 00:21:34,160 --> 00:21:36,240 Speaker 1: I've done fertility stuff and I did a ton of 319 00:21:36,280 --> 00:21:39,560 Speaker 1: hormones on that I'm assuming it's very different. But those 320 00:21:39,600 --> 00:21:43,480 Speaker 1: hormones made me emotionally kind of all over the place, 321 00:21:44,040 --> 00:21:47,760 Speaker 1: And so I could imagine as you transition, even if 322 00:21:47,800 --> 00:21:52,240 Speaker 1: it's something that feels right and what you want, it's different, 323 00:21:52,440 --> 00:21:54,399 Speaker 1: and so there would seem to be a lot of 324 00:21:54,400 --> 00:21:59,239 Speaker 1: adjusting mentally and emotionally and maybe processing that would need 325 00:21:59,280 --> 00:22:05,080 Speaker 1: to have in Yeah. Absolutely, And it is so important 326 00:22:05,119 --> 00:22:07,439 Speaker 1: that any patient who's going through this if they have 327 00:22:07,520 --> 00:22:11,479 Speaker 1: any history of depression, anxiety, by polar disorder, what have you, 328 00:22:12,000 --> 00:22:16,199 Speaker 1: that they stay in great communication with mental health providers, 329 00:22:16,920 --> 00:22:21,200 Speaker 1: including you know, I would consider myself somebody in that 330 00:22:21,240 --> 00:22:24,720 Speaker 1: space through their entire process to be sure that those 331 00:22:24,720 --> 00:22:30,920 Speaker 1: conditions are stable, if not improving, while they're on treatment. Yeah, okay, 332 00:22:30,960 --> 00:22:33,200 Speaker 1: So when you sent me what you sent me that 333 00:22:33,280 --> 00:22:36,040 Speaker 1: it was just a kind of a breakdown of when 334 00:22:36,080 --> 00:22:41,119 Speaker 1: a patient comes in and the different options of ways 335 00:22:41,160 --> 00:22:44,120 Speaker 1: to start. And it's not like someone comes into you 336 00:22:44,280 --> 00:22:47,399 Speaker 1: and they just go into surgery immediately. So can you 337 00:22:47,480 --> 00:22:51,080 Speaker 1: tell the listeners what that looks like and maybe just 338 00:22:51,240 --> 00:22:53,399 Speaker 1: kind of the breakdown that it has in your writing, 339 00:22:53,480 --> 00:22:56,600 Speaker 1: because to me that was really informative too of just like, yeah, 340 00:22:56,640 --> 00:23:00,200 Speaker 1: this isn't a quick process. Is there's a lot of 341 00:23:00,240 --> 00:23:04,600 Speaker 1: steps that happened. There's a lot of when you start 342 00:23:04,640 --> 00:23:07,800 Speaker 1: a process, like if you put them on a hormone therapy, 343 00:23:08,080 --> 00:23:10,720 Speaker 1: they might be done there, Like that might be enough 344 00:23:10,760 --> 00:23:13,439 Speaker 1: for some patients, And that was really eye opening to me. 345 00:23:13,520 --> 00:23:16,640 Speaker 1: So could you explain a bit of that, right, So, 346 00:23:17,000 --> 00:23:22,119 Speaker 1: let's say, for example, the patient is a transgender woman, which, okay, 347 00:23:22,480 --> 00:23:25,919 Speaker 1: that to break that term down that would be somebody 348 00:23:25,960 --> 00:23:29,280 Speaker 1: who was a signmail at birth who is transitioning to 349 00:23:29,320 --> 00:23:35,119 Speaker 1: be a woman. Okay. That individual will likely see me 350 00:23:35,760 --> 00:23:39,280 Speaker 1: and then start on what I would say feminizing hormone 351 00:23:39,280 --> 00:23:43,520 Speaker 1: therapy or estrogen and then a way to stop testosterone 352 00:23:43,560 --> 00:23:46,480 Speaker 1: from acting. Over that period of time, that person is 353 00:23:46,520 --> 00:23:49,520 Speaker 1: going to develop some changes to the way that their 354 00:23:49,600 --> 00:23:53,240 Speaker 1: body fat is distributed. It's going to change the way 355 00:23:54,200 --> 00:23:57,960 Speaker 1: that their body hair grows, but it doesn't eliminate body hair. 356 00:23:58,600 --> 00:24:02,639 Speaker 1: It's going to change their moods significantly, and it's going 357 00:24:02,680 --> 00:24:07,119 Speaker 1: to lead to some breast development. And so for some people, 358 00:24:07,240 --> 00:24:10,639 Speaker 1: over a period of five years is the maximal time 359 00:24:10,720 --> 00:24:15,399 Speaker 1: in which hormonal changes alone are going to change the body. 360 00:24:15,920 --> 00:24:18,879 Speaker 1: People may say I have all of the changes that 361 00:24:19,280 --> 00:24:23,320 Speaker 1: I want to see in myself and I am done, okay, 362 00:24:23,560 --> 00:24:25,960 Speaker 1: and they may just continue on a some dose of 363 00:24:26,200 --> 00:24:30,320 Speaker 1: estrogen for the rest of their lives. Other people along 364 00:24:30,359 --> 00:24:34,119 Speaker 1: that process will say, I would like to have breast 365 00:24:34,160 --> 00:24:38,080 Speaker 1: augmentation because the much like people who went through a 366 00:24:38,160 --> 00:24:40,400 Speaker 1: female puberty, they're not happy with the size of their 367 00:24:40,400 --> 00:24:42,879 Speaker 1: breasts after the puberty is day, and they would like 368 00:24:42,920 --> 00:24:45,320 Speaker 1: them larger. You know, that is their decision. And we 369 00:24:45,359 --> 00:24:48,320 Speaker 1: can move forward with that after the time of breast 370 00:24:48,320 --> 00:24:51,720 Speaker 1: development occurs in hormone therapy, which is typically in two years. 371 00:24:53,520 --> 00:24:55,639 Speaker 1: There are some people will have that surgery and be done. 372 00:24:56,200 --> 00:24:58,639 Speaker 1: There are some people that will say, I would like 373 00:24:59,080 --> 00:25:02,840 Speaker 1: to instead of having a penis and testicles, I would 374 00:25:02,840 --> 00:25:06,360 Speaker 1: like to have a vagina, and then there is complex 375 00:25:06,400 --> 00:25:11,760 Speaker 1: surgical UM processes that can be started to do that. UM. 376 00:25:11,960 --> 00:25:15,560 Speaker 1: But I think one of the mistomers or things that's 377 00:25:15,560 --> 00:25:21,240 Speaker 1: assumed about UM transitioning is that everybody gets hormones and surgery. 378 00:25:21,720 --> 00:25:25,679 Speaker 1: And I would say that is by no means the truth. Okay. 379 00:25:25,880 --> 00:25:30,879 Speaker 1: I would say, for for transgender women, most people do 380 00:25:30,960 --> 00:25:35,800 Speaker 1: not arrive at surgeries and UM. For transgender men, surgeries 381 00:25:35,800 --> 00:25:40,159 Speaker 1: are more common, but it is not. But genital surgeries 382 00:25:40,240 --> 00:25:43,760 Speaker 1: or what you call bottom surgeries are actually not that 383 00:25:43,840 --> 00:25:48,320 Speaker 1: common for transgender people all things considered. Okay, So it's 384 00:25:48,359 --> 00:25:59,680 Speaker 1: the top surgery that you're saying the transgender men. Wait correct, yes, okay, okay, yeah, 385 00:25:59,680 --> 00:26:03,640 Speaker 1: that is that is common for transgender man. Okay, So 386 00:26:03,760 --> 00:26:06,920 Speaker 1: what's the difference between seeing someone over eighteen and then 387 00:26:06,960 --> 00:26:12,800 Speaker 1: seeing someone under eighteen? So it certainly is dictated based 388 00:26:12,920 --> 00:26:20,320 Speaker 1: on the the state that you're in, because the age 389 00:26:20,440 --> 00:26:24,640 Speaker 1: of consent and maturity differs by state. But let's say, 390 00:26:24,680 --> 00:26:26,640 Speaker 1: for example, because the vast majority of the United States 391 00:26:26,680 --> 00:26:29,720 Speaker 1: is eighteen, so let's say eighteen year old. Eighteen year 392 00:26:29,720 --> 00:26:33,400 Speaker 1: olds can present and make all of their own medical 393 00:26:33,480 --> 00:26:37,920 Speaker 1: decisions and consent to the process. If someone is seeing 394 00:26:38,520 --> 00:26:44,960 Speaker 1: someone for transgender care as an adolescent, that often has 395 00:26:45,520 --> 00:26:51,000 Speaker 1: very strictly defined waiting periods before any sort of treatments 396 00:26:51,000 --> 00:26:53,680 Speaker 1: can be done. And this varies based on hospital system, 397 00:26:54,280 --> 00:26:59,200 Speaker 1: and every hospital system that I know of requires some 398 00:26:59,280 --> 00:27:04,040 Speaker 1: parental con sent to move forward with any treatments UM. 399 00:27:04,560 --> 00:27:08,080 Speaker 1: And you know, for some some groups that's one parent 400 00:27:08,200 --> 00:27:12,159 Speaker 1: for SUM it's too UM. For if there's not two parents, 401 00:27:12,160 --> 00:27:15,080 Speaker 1: it's just gonna be one UM. But this is never 402 00:27:15,680 --> 00:27:21,680 Speaker 1: a decision that an adolescent would make by themselves. Right, Well, obviously, 403 00:27:21,960 --> 00:27:25,440 Speaker 1: go ahead, ask is there is there an age? I mean, 404 00:27:25,480 --> 00:27:28,880 Speaker 1: obviously everyone's journey is different, But is there an ideal 405 00:27:29,119 --> 00:27:35,159 Speaker 1: age if you're UM, if your child is presenting or 406 00:27:35,240 --> 00:27:38,000 Speaker 1: saying you know, they're they're giving you all the size 407 00:27:38,640 --> 00:27:42,560 Speaker 1: UM or threatening or saying they want to die or 408 00:27:42,560 --> 00:27:46,399 Speaker 1: whatever it is, is there an age that, like is 409 00:27:46,520 --> 00:27:50,920 Speaker 1: most ideal to begin, you know, even if it's hormone 410 00:27:50,960 --> 00:27:55,600 Speaker 1: therapy or um, even if it's just like um, speaking 411 00:27:55,640 --> 00:27:59,800 Speaker 1: to a mental health professional, right, um, you know what 412 00:28:00,200 --> 00:28:03,320 Speaker 1: age would be the most ideal for the best out 413 00:28:03,480 --> 00:28:05,080 Speaker 1: I don't. I don't know that I'm framing it right, 414 00:28:05,119 --> 00:28:08,240 Speaker 1: but like for the best to give someone the best 415 00:28:08,320 --> 00:28:13,840 Speaker 1: chance at a good life, a good healthy life. Right. Well, first, 416 00:28:13,880 --> 00:28:15,879 Speaker 1: one thing you said, it's like, if somebody is starting 417 00:28:15,880 --> 00:28:19,440 Speaker 1: to say, like, I'm going to commit suicide if I 418 00:28:19,480 --> 00:28:22,280 Speaker 1: don't get hormone therapy, that is actually a very bad 419 00:28:22,320 --> 00:28:25,160 Speaker 1: time to start hormone therapy for that person because you're 420 00:28:25,200 --> 00:28:28,560 Speaker 1: going to induce hormonal and emotional changes that are going 421 00:28:28,600 --> 00:28:32,000 Speaker 1: to make that impulse very difficult to control. So you 422 00:28:32,040 --> 00:28:34,919 Speaker 1: always have to prioritize the safety of the patient first, 423 00:28:35,520 --> 00:28:38,640 Speaker 1: and so making sure that I always tell patients there's 424 00:28:38,640 --> 00:28:42,120 Speaker 1: never a good or there's never a perfect time to 425 00:28:42,240 --> 00:28:45,560 Speaker 1: start hormone therapy, but there are good and bad times. Yeah, 426 00:28:45,560 --> 00:28:48,960 Speaker 1: and when you are in distress, that is a bad time. Yeah, 427 00:28:49,280 --> 00:28:53,440 Speaker 1: that makes so much sense. So assuming things are stable 428 00:28:53,960 --> 00:28:59,640 Speaker 1: mental health wise, health physical health wise. Ideally, when a 429 00:28:59,720 --> 00:29:02,320 Speaker 1: child first expresses to their parent that they do not 430 00:29:02,560 --> 00:29:05,560 Speaker 1: feel like they are a boy or a girl that 431 00:29:05,600 --> 00:29:08,480 Speaker 1: they were born as. That is an excellent time to 432 00:29:08,520 --> 00:29:14,320 Speaker 1: start them seeing a therapist who specializes in gender identity. Okay, 433 00:29:14,400 --> 00:29:16,680 Speaker 1: they are more than welcome to make an appointment at 434 00:29:16,680 --> 00:29:21,800 Speaker 1: a doctor's office at a specialist in gender health. You 435 00:29:22,680 --> 00:29:26,360 Speaker 1: will need to have been in mental health counseling certainly 436 00:29:26,400 --> 00:29:28,720 Speaker 1: for at least a year, if not longer, before any 437 00:29:28,760 --> 00:29:33,600 Speaker 1: medical intervention would be started. In terms of you know, 438 00:29:34,080 --> 00:29:38,160 Speaker 1: hard research that I can tell you that patients have 439 00:29:38,440 --> 00:29:43,080 Speaker 1: better outcomes if they start transitions earlier in life. It's 440 00:29:43,200 --> 00:29:50,840 Speaker 1: really limited data out of Dutch countries, and it does 441 00:29:51,080 --> 00:29:55,040 Speaker 1: seem that patients who are able to undergo a full 442 00:29:55,160 --> 00:29:59,240 Speaker 1: puberty with the hormas that are consistent with who they are, 443 00:30:00,440 --> 00:30:05,200 Speaker 1: have better outcomes. It's really a complex decision though, and 444 00:30:05,240 --> 00:30:09,560 Speaker 1: it's different for every patient, every kid, every family on 445 00:30:09,600 --> 00:30:14,920 Speaker 1: what's right because you are making permanent decisions about a 446 00:30:15,000 --> 00:30:19,400 Speaker 1: child's fertility future, right, and we can't expect kids to 447 00:30:19,560 --> 00:30:23,600 Speaker 1: necessarily be We certainly can't expect them to make that 448 00:30:23,680 --> 00:30:27,440 Speaker 1: decision on their own. But just as we've said, through 449 00:30:27,440 --> 00:30:31,640 Speaker 1: this whole process, it's not fast. It's a very slow process. 450 00:30:31,760 --> 00:30:39,320 Speaker 1: Of seeing consistent ideas presented over time that will allow 451 00:30:39,400 --> 00:30:42,560 Speaker 1: us to move forward with making permanent treatment options for somebody. 452 00:30:43,080 --> 00:30:48,280 Speaker 1: And so all that said, I would say it is 453 00:30:48,360 --> 00:30:53,160 Speaker 1: most important to get someone access to mental health counseling 454 00:30:53,560 --> 00:30:58,840 Speaker 1: the first time that they are expressing discomfort with their gender. Yeah, okay, 455 00:30:59,400 --> 00:31:02,280 Speaker 1: I I don't know if you'll have an answer to 456 00:31:02,360 --> 00:31:05,200 Speaker 1: this question or if it's just so different case by case. 457 00:31:05,440 --> 00:31:09,200 Speaker 1: But one of the things obviously we see being argued 458 00:31:09,200 --> 00:31:11,920 Speaker 1: about a lot is the parents that are signing off 459 00:31:11,920 --> 00:31:17,120 Speaker 1: on their kids starting this process. And as I see 460 00:31:17,160 --> 00:31:19,760 Speaker 1: that argument all the time, I'm like, there is no 461 00:31:19,960 --> 00:31:24,080 Speaker 1: chance that that parent is doing that flippantly, like that 462 00:31:24,240 --> 00:31:26,760 Speaker 1: this has to be something that they have. This is 463 00:31:26,800 --> 00:31:30,600 Speaker 1: just my instinct that they have experienced their child going 464 00:31:30,600 --> 00:31:34,360 Speaker 1: through probably their child's whole life. It's like something that 465 00:31:34,400 --> 00:31:36,560 Speaker 1: they're in tune with with their child. This is the 466 00:31:36,600 --> 00:31:39,200 Speaker 1: story I make up. At least, can you speak to 467 00:31:39,240 --> 00:31:42,800 Speaker 1: that at all so we can understand like what that 468 00:31:43,320 --> 00:31:46,560 Speaker 1: is like and maybe even offers some empathy for the 469 00:31:46,680 --> 00:31:53,840 Speaker 1: parents in this situation. I would point back to any 470 00:31:54,000 --> 00:31:59,720 Speaker 1: family that has seen their child suffering and as a parent, 471 00:32:00,720 --> 00:32:03,880 Speaker 1: knowing that you would do anything to make sure that 472 00:32:03,920 --> 00:32:09,680 Speaker 1: your child does not suffer. And of course, as a parent, 473 00:32:09,920 --> 00:32:13,760 Speaker 1: if you are having a kid that is saying I 474 00:32:13,880 --> 00:32:16,080 Speaker 1: don't feel like I'm in the body that I'm supposed 475 00:32:16,080 --> 00:32:20,200 Speaker 1: to be, You're going to want to help them. Some 476 00:32:20,280 --> 00:32:23,880 Speaker 1: parents do that by seeking care at gender clinics and 477 00:32:24,000 --> 00:32:27,680 Speaker 1: with specialists. Other parents see the best way for them 478 00:32:27,720 --> 00:32:31,680 Speaker 1: to go about that is to have them treated set 479 00:32:31,840 --> 00:32:35,560 Speaker 1: to try and not feel that way anymore. Right, So, 480 00:32:36,240 --> 00:32:40,000 Speaker 1: all parents, i would say, both sides of the argument 481 00:32:41,280 --> 00:32:43,800 Speaker 1: are trying to do the same thing. They are trying 482 00:32:43,840 --> 00:32:49,640 Speaker 1: to take care of their kid. And it is rare 483 00:32:50,560 --> 00:32:53,240 Speaker 1: that you would have a parent be strongly one side 484 00:32:53,320 --> 00:32:56,760 Speaker 1: or the other. Most parents are vastly in the middle, 485 00:32:56,800 --> 00:32:59,680 Speaker 1: and they're like, I don't know anything about this. I 486 00:32:59,720 --> 00:33:03,360 Speaker 1: don't we're supposed to do. Can you please just help me? 487 00:33:04,040 --> 00:33:08,400 Speaker 1: And that's where that time comes in, where not just 488 00:33:08,600 --> 00:33:13,480 Speaker 1: your kids in therapy to help their gender identity, your 489 00:33:13,560 --> 00:33:18,360 Speaker 1: parents are going through educational processes for themselves and being 490 00:33:18,400 --> 00:33:21,400 Speaker 1: able to speak up where they see, you know, potential 491 00:33:21,440 --> 00:33:25,280 Speaker 1: inconsistencies and what's going on and so forth, and so 492 00:33:25,360 --> 00:33:34,400 Speaker 1: it's very much a family centered treatment here in Nashville. 493 00:33:34,440 --> 00:33:36,520 Speaker 1: We had this big concert on the Monday night called 494 00:33:36,560 --> 00:33:39,600 Speaker 1: Love Rising, and I was there and I was speaking 495 00:33:39,600 --> 00:33:41,360 Speaker 1: with a friend of mine there who was telling me 496 00:33:41,440 --> 00:33:44,160 Speaker 1: the story about one of her best friends who has 497 00:33:44,200 --> 00:33:48,640 Speaker 1: a transgender son. And the kid, I think it's like 498 00:33:48,720 --> 00:33:52,400 Speaker 1: five years old, five or six, and they said they 499 00:33:52,400 --> 00:33:55,360 Speaker 1: started seeing signs when they were two. All that they've done, 500 00:33:55,400 --> 00:34:00,840 Speaker 1: the child's in therapy. They've now identifies as a boy, 501 00:34:00,920 --> 00:34:05,840 Speaker 1: as a as a male name, and um what like 502 00:34:06,000 --> 00:34:08,040 Speaker 1: they started all of this right before he went to 503 00:34:08,040 --> 00:34:11,400 Speaker 1: a new school so that he could just start a 504 00:34:11,440 --> 00:34:14,839 Speaker 1: new life. And her friend told him. I told her 505 00:34:14,920 --> 00:34:21,480 Speaker 1: that he's never seen his kid more alive than just 506 00:34:21,680 --> 00:34:24,879 Speaker 1: changing the name. He was like, I was living with 507 00:34:24,920 --> 00:34:27,560 Speaker 1: this child that was telling me that she wanted to die, 508 00:34:27,840 --> 00:34:30,719 Speaker 1: she didn't want to be here, and all he let 509 00:34:30,760 --> 00:34:32,680 Speaker 1: they let they let her, They let him pick his name, 510 00:34:33,719 --> 00:34:36,520 Speaker 1: and he just came to life. But some of the 511 00:34:36,560 --> 00:34:40,000 Speaker 1: interesting things that he had said to my friend was that, um, 512 00:34:40,840 --> 00:34:42,600 Speaker 1: she's like, you know, how do you know what to do? 513 00:34:42,640 --> 00:34:45,400 Speaker 1: And he's like, I don't, you know. Every day I 514 00:34:45,440 --> 00:34:47,440 Speaker 1: struggle with this. I love my kid, and that's all 515 00:34:47,600 --> 00:34:51,040 Speaker 1: that I know. I know how to do, and I'm 516 00:34:51,040 --> 00:34:55,120 Speaker 1: trusting professionals. But something really interesting he said, was the 517 00:34:55,200 --> 00:34:59,120 Speaker 1: hardest part for me is that concurrently I have to 518 00:34:59,200 --> 00:35:02,799 Speaker 1: support myself son and love him and raise him and 519 00:35:02,880 --> 00:35:06,720 Speaker 1: treat him the best while mourning the loss of my daughter. 520 00:35:07,160 --> 00:35:10,000 Speaker 1: And he's like, and I can't do that, not in 521 00:35:10,040 --> 00:35:13,360 Speaker 1: his presence. And um, it was like it was like 522 00:35:13,400 --> 00:35:15,839 Speaker 1: a gut punch when she said that to me. So 523 00:35:15,920 --> 00:35:18,960 Speaker 1: I'm curious, Like, you know, obviously we've all heard the 524 00:35:19,000 --> 00:35:21,120 Speaker 1: stories of like, no, you're not get out of my house, 525 00:35:21,480 --> 00:35:23,640 Speaker 1: and the parents like that's that's a sign of mourning. 526 00:35:23,680 --> 00:35:26,799 Speaker 1: They don't know what to do. But like, do you 527 00:35:26,840 --> 00:35:29,000 Speaker 1: see that, Like is that a conversation that you have 528 00:35:29,080 --> 00:35:31,759 Speaker 1: to have a lot with these parents, Like these are 529 00:35:31,760 --> 00:35:33,640 Speaker 1: the steps that you're going to need to take because 530 00:35:33,680 --> 00:35:35,880 Speaker 1: you're going to feel these emotions that you didn't expect 531 00:35:35,880 --> 00:35:42,359 Speaker 1: to feel. I mean absolutely, And there's fortunately a multitude 532 00:35:42,360 --> 00:35:46,640 Speaker 1: of learning materials for parents who are who are going 533 00:35:46,680 --> 00:35:49,759 Speaker 1: through this, because there there's not one parent I've ever 534 00:35:49,800 --> 00:35:51,840 Speaker 1: heard of that said that they did not mourn the 535 00:35:51,880 --> 00:35:55,879 Speaker 1: loss of of the sex that their child was born 536 00:35:55,920 --> 00:35:58,520 Speaker 1: as because you know, from the time they first got 537 00:35:58,520 --> 00:36:01,279 Speaker 1: that ultrasound. That's what they new and expected, right, it 538 00:36:01,400 --> 00:36:05,040 Speaker 1: is a change for them and that cannot be forgotten. 539 00:36:05,680 --> 00:36:11,839 Speaker 1: In the same way, when I have adults who have 540 00:36:11,880 --> 00:36:15,320 Speaker 1: already had families and choose to transition later in life, 541 00:36:15,920 --> 00:36:20,879 Speaker 1: their kids are faced with the same intellectual challenge of 542 00:36:21,000 --> 00:36:26,400 Speaker 1: seeing a change in gender of their parent. And they're again, 543 00:36:26,520 --> 00:36:29,120 Speaker 1: fortunately a lot of learning materials and we have a 544 00:36:29,120 --> 00:36:33,360 Speaker 1: lot of education about how brains at different age process 545 00:36:33,440 --> 00:36:37,240 Speaker 1: these kinds of changes to help people accommodate and adapt. 546 00:36:38,600 --> 00:36:41,319 Speaker 1: And again, I just go back to that. I love 547 00:36:41,520 --> 00:36:43,400 Speaker 1: that statement. It's like, of course, I'm going to do 548 00:36:43,440 --> 00:36:45,520 Speaker 1: everything to protect my kid, like I am going to 549 00:36:45,600 --> 00:36:48,440 Speaker 1: do and you know, that's the side that I'm on. 550 00:36:49,040 --> 00:36:51,160 Speaker 1: All decisions have to be made in the best interests 551 00:36:51,160 --> 00:36:54,600 Speaker 1: of the kid. But it doesn't mean that there are 552 00:36:54,680 --> 00:36:58,799 Speaker 1: not side effects, pitfalls, consequences to those decisions that you 553 00:36:58,920 --> 00:37:02,359 Speaker 1: also have to treat. Yeah, yeah, we make we make 554 00:37:02,400 --> 00:37:05,359 Speaker 1: decisions that negatively impact our children every day, you know, 555 00:37:05,480 --> 00:37:08,839 Speaker 1: Like like I have kids, but like you know, it's 556 00:37:08,920 --> 00:37:11,400 Speaker 1: and not intentionally. You know, you can send them to 557 00:37:11,400 --> 00:37:15,680 Speaker 1: the wrong school, you know, um or let them go 558 00:37:15,719 --> 00:37:18,319 Speaker 1: to a party with the wrong person, you know, it's 559 00:37:18,440 --> 00:37:22,160 Speaker 1: there's there's I think if the intention behind what a 560 00:37:22,200 --> 00:37:26,120 Speaker 1: parent is trying to do is centered with love, even 561 00:37:26,120 --> 00:37:29,560 Speaker 1: if it is also mired with confusion and pain and 562 00:37:29,680 --> 00:37:33,279 Speaker 1: all of the things, like, that's what's important. And who 563 00:37:33,280 --> 00:37:37,120 Speaker 1: are we to sit back and tell somebody not to 564 00:37:37,200 --> 00:37:40,600 Speaker 1: do that for their kids, right, you know, it's I 565 00:37:41,000 --> 00:37:43,680 Speaker 1: can't imagine it. The other the other really interesting thing 566 00:37:43,680 --> 00:37:46,520 Speaker 1: that he said to my friend was what the other 567 00:37:46,600 --> 00:37:49,680 Speaker 1: hard part is he doesn't get to sit and be 568 00:37:49,719 --> 00:37:54,960 Speaker 1: an advocate for trans kids because in doing that right now, 569 00:37:55,000 --> 00:37:59,000 Speaker 1: he would be outing his child. So he needs people, 570 00:37:59,280 --> 00:38:01,960 Speaker 1: he needs lies to stand up and fight the fight 571 00:38:02,040 --> 00:38:04,600 Speaker 1: for him right now until his child is ready to, 572 00:38:05,120 --> 00:38:08,160 Speaker 1: you know, share with the world that he's trans. Right, 573 00:38:08,520 --> 00:38:10,280 Speaker 1: So he's like, you know, there's a lot of silent 574 00:38:10,360 --> 00:38:12,759 Speaker 1: suffering that all of us are doing in our house 575 00:38:12,880 --> 00:38:16,960 Speaker 1: because we can't stand up and scream. So, you know, 576 00:38:17,000 --> 00:38:18,759 Speaker 1: I thought that was really interesting, and it's someone that 577 00:38:18,800 --> 00:38:21,400 Speaker 1: like I can't wrap my head around the desire to 578 00:38:21,440 --> 00:38:24,000 Speaker 1: want to transition. I'm a gay man, and I had 579 00:38:24,040 --> 00:38:26,800 Speaker 1: to work through the process of coming out and loving 580 00:38:26,840 --> 00:38:29,840 Speaker 1: myself and understanding that, which, by the way, my parents 581 00:38:29,880 --> 00:38:33,560 Speaker 1: struggled with too, because you know, since the ultrasound, they 582 00:38:33,760 --> 00:38:35,200 Speaker 1: were going to have a son that with a wife 583 00:38:35,239 --> 00:38:39,040 Speaker 1: and babies and all the things, and but they have 584 00:38:39,160 --> 00:38:43,960 Speaker 1: loved me through it, and it's you know, but you know, 585 00:38:44,160 --> 00:38:49,120 Speaker 1: I can understand wanting the best for your child, and 586 00:38:49,760 --> 00:38:53,399 Speaker 1: how dare anybody you know get in the way of that. 587 00:38:53,480 --> 00:38:58,359 Speaker 1: It's literally the most important relationship on earth is the 588 00:38:58,480 --> 00:39:01,640 Speaker 1: love of a parent between parent and children. And to 589 00:39:01,719 --> 00:39:04,960 Speaker 1: have government or your neighbor or anyone tell you what 590 00:39:05,080 --> 00:39:07,280 Speaker 1: to do and how to love your child is insane 591 00:39:07,440 --> 00:39:11,640 Speaker 1: unless you are abusing them. And this just doesn't seem 592 00:39:11,680 --> 00:39:17,080 Speaker 1: like abuse in any way to me. It's it's pretty 593 00:39:17,160 --> 00:39:22,160 Speaker 1: pretty clear. But is there like would you what would 594 00:39:22,200 --> 00:39:25,480 Speaker 1: you say if you had to say one thing culturally 595 00:39:25,560 --> 00:39:28,960 Speaker 1: that we're just getting wrong about the trans community? What 596 00:39:29,040 --> 00:39:34,440 Speaker 1: would you say? It's fabulous question, I would say. I 597 00:39:34,480 --> 00:39:40,000 Speaker 1: think what much of this conversation has centered around, which 598 00:39:40,280 --> 00:39:45,520 Speaker 1: is the idea that people who are transitioning will go 599 00:39:45,640 --> 00:39:50,800 Speaker 1: to some sort of gender chop shop, fill out a form, 600 00:39:51,440 --> 00:39:53,879 Speaker 1: check the menu of what they want done to them, 601 00:39:54,000 --> 00:39:58,200 Speaker 1: and out pops the transition, whether that is for an 602 00:39:58,200 --> 00:40:05,640 Speaker 1: adult or a kid, And the process is so obstensibly 603 00:40:05,760 --> 00:40:12,239 Speaker 1: thorough and having the patient's health in every aspect considered. Yeah, 604 00:40:12,880 --> 00:40:17,200 Speaker 1: it couldn't be further from that truth. Yeah, that's kind 605 00:40:17,200 --> 00:40:19,839 Speaker 1: of what I would think. I mean, honestly, it's just 606 00:40:20,400 --> 00:40:25,239 Speaker 1: that it's interesting because I can see things a certain way. 607 00:40:25,280 --> 00:40:28,799 Speaker 1: But I really did not realize how uninformed I was 608 00:40:28,960 --> 00:40:32,400 Speaker 1: until I started doing a deep dive researching for this podcast. 609 00:40:32,440 --> 00:40:35,279 Speaker 1: So it was very It was helpful to me in 610 00:40:35,320 --> 00:40:38,719 Speaker 1: some ways to be like, yeah, I imagined it was 611 00:40:38,760 --> 00:40:41,799 Speaker 1: a process, but to see it in writing and to 612 00:40:41,960 --> 00:40:45,080 Speaker 1: see all of the steps and all of the conversations 613 00:40:45,120 --> 00:40:47,840 Speaker 1: and even ship like what you're saying, like the parents 614 00:40:47,880 --> 00:40:50,360 Speaker 1: and the kids, and how long this has been going on, 615 00:40:50,600 --> 00:40:54,000 Speaker 1: It's just like there is nothing about it that is 616 00:40:54,000 --> 00:40:56,000 Speaker 1: just like you snap your fingers and here we go. 617 00:40:57,480 --> 00:41:00,959 Speaker 1: I feel like the talking point for the the opposition 618 00:41:01,480 --> 00:41:04,120 Speaker 1: has been like the war that keeps coming to my 619 00:41:04,160 --> 00:41:08,120 Speaker 1: mind is irreparable harm to children. Like that It's just 620 00:41:08,120 --> 00:41:10,040 Speaker 1: a really easy thing to say, and it's catchy and 621 00:41:10,080 --> 00:41:15,600 Speaker 1: it's like, of course, nobody wants to see children irreparably harmed. Yeah, 622 00:41:15,920 --> 00:41:20,920 Speaker 1: what if a child does start hormone therapy? Like, what 623 00:41:21,320 --> 00:41:25,480 Speaker 1: is it is that stuff reversible if they stop, Like, 624 00:41:25,600 --> 00:41:29,719 Speaker 1: at what point is it irreparable? So some parts of 625 00:41:29,719 --> 00:41:34,400 Speaker 1: hormone therapy are reversible and some are not. Say, for example, 626 00:41:34,520 --> 00:41:38,600 Speaker 1: breast development is an irreversible part of estrogen therapy unless 627 00:41:38,600 --> 00:41:40,319 Speaker 1: you were to have surgery later on and have the 628 00:41:40,360 --> 00:41:45,000 Speaker 1: breasts removed. Those would not go back for testosterone therapy. Right. 629 00:41:45,120 --> 00:41:49,120 Speaker 1: One of the irreversible changes is the deepening of the voice. Right. 630 00:41:49,160 --> 00:41:53,520 Speaker 1: This can be altered with vocal feminizing surgeries, but otherwise 631 00:41:53,560 --> 00:41:57,839 Speaker 1: would remain the way it is. It takes anywhere from 632 00:41:57,880 --> 00:42:00,600 Speaker 1: six months to one year to begin to see those 633 00:42:00,680 --> 00:42:05,160 Speaker 1: particular changes, right, So if somebody started hormone therapy for 634 00:42:05,400 --> 00:42:08,080 Speaker 1: two to three months and they decided to stop, they 635 00:42:08,120 --> 00:42:13,640 Speaker 1: really would not have any longstanding side effects. Obviously, surgical 636 00:42:13,800 --> 00:42:18,200 Speaker 1: interventions are going to result in irreversible changes unless you 637 00:42:18,239 --> 00:42:22,360 Speaker 1: have surgery to undo that. But those are big undertakings 638 00:42:22,360 --> 00:42:25,799 Speaker 1: and extraordinarily rare. You know what I'll say is and 639 00:42:25,880 --> 00:42:29,440 Speaker 1: what this point is kind of getting to is, you 640 00:42:29,480 --> 00:42:33,520 Speaker 1: know what, individuals start this process and decide they no 641 00:42:33,640 --> 00:42:36,520 Speaker 1: longer want to move forward with it or change their mind. 642 00:42:38,440 --> 00:42:42,680 Speaker 1: And the best evidence that we have to speak against 643 00:42:42,760 --> 00:42:48,719 Speaker 1: that is that when you have competent clinicians who are 644 00:42:48,760 --> 00:42:53,799 Speaker 1: evaluating these people and ensuring that these diagnostic criteria are 645 00:42:53,880 --> 00:42:58,440 Speaker 1: well met before starting any changes. The rate of de 646 00:42:58,680 --> 00:43:03,200 Speaker 1: transitioning or stopping therapy is less than one percent. I 647 00:43:03,239 --> 00:43:06,640 Speaker 1: mean it, really, it's truly not negligible. It's not to 648 00:43:06,680 --> 00:43:08,480 Speaker 1: say that I have never seen it. I have seen it, 649 00:43:08,480 --> 00:43:11,799 Speaker 1: and I've had patience to it. And the conversation isn't 650 00:43:11,800 --> 00:43:14,920 Speaker 1: always as much as I regret what I did or 651 00:43:15,000 --> 00:43:17,399 Speaker 1: I want to stop, I want to go back. That 652 00:43:17,520 --> 00:43:22,040 Speaker 1: is extraordinarily rare. Actually what's more interesting. And I had 653 00:43:22,040 --> 00:43:24,359 Speaker 1: a patient put it to me this way. They had 654 00:43:24,400 --> 00:43:29,520 Speaker 1: been on hormone therapy for five years, and they said, 655 00:43:29,800 --> 00:43:32,000 Speaker 1: this has been a really wonderful part of my life. 656 00:43:32,040 --> 00:43:34,759 Speaker 1: I feel like I have such a better understanding of 657 00:43:34,800 --> 00:43:37,480 Speaker 1: who I am as a person. I'm just done with 658 00:43:37,520 --> 00:43:40,600 Speaker 1: the hormone part of my understanding of my gender identity. 659 00:43:40,760 --> 00:43:42,799 Speaker 1: And that was it. That was it was just all 660 00:43:42,840 --> 00:43:45,960 Speaker 1: they needed, was right. That was part of this, I 661 00:43:45,960 --> 00:43:52,040 Speaker 1: would say, more spiritual process of yes, I was going 662 00:43:52,239 --> 00:43:55,600 Speaker 1: I was gonna use the word spiritual experience. And also 663 00:43:55,680 --> 00:43:58,839 Speaker 1: just the freedom I would think because they could and 664 00:43:58,920 --> 00:44:02,040 Speaker 1: said like it's not. They're not inhibited in the ways 665 00:44:02,080 --> 00:44:05,480 Speaker 1: that they were before the hormone treatment. So it's like 666 00:44:06,000 --> 00:44:08,759 Speaker 1: it's like letting go of your shackles or whatever you 667 00:44:08,760 --> 00:44:11,560 Speaker 1: would say, like taking the way to vest off, allowing 668 00:44:11,560 --> 00:44:14,080 Speaker 1: yourself to love yourself too, you know, or learning to 669 00:44:14,200 --> 00:44:17,120 Speaker 1: love yourself through that, you know. Let's I mean, I 670 00:44:17,160 --> 00:44:20,080 Speaker 1: think in some ways, it's like you think about when 671 00:44:20,080 --> 00:44:22,799 Speaker 1: you're like young and you're like dressing a certain way, 672 00:44:22,840 --> 00:44:24,480 Speaker 1: and then you get it, you get older, and you're like, 673 00:44:24,680 --> 00:44:27,040 Speaker 1: I don't need to feel sexy anymore. Like I've done that, 674 00:44:27,239 --> 00:44:30,000 Speaker 1: you know, like speak for yourself. Man, Well, I know 675 00:44:30,040 --> 00:44:33,480 Speaker 1: you as we don't have to worry about that. I've 676 00:44:33,520 --> 00:44:35,960 Speaker 1: got I've got a question that's like I'm sure some 677 00:44:36,000 --> 00:44:39,279 Speaker 1: people are just carry about curious about it. What part 678 00:44:39,400 --> 00:44:42,520 Speaker 1: are any parts of this covered by insurance? And if not, 679 00:44:42,600 --> 00:44:45,560 Speaker 1: like what is the cost of transit, like if you 680 00:44:45,640 --> 00:44:48,239 Speaker 1: did a full medical transition, Like what are people looking 681 00:44:48,280 --> 00:44:53,920 Speaker 1: at spending? Oh? Boy? Um, it differs by insurance. Uh. 682 00:44:54,200 --> 00:44:59,799 Speaker 1: And so there's an estimation UH in of of this 683 00:44:59,840 --> 00:45:03,600 Speaker 1: was last assessed in twenty twenty, but of fortune to 684 00:45:03,640 --> 00:45:08,200 Speaker 1: five hundred companies, about thirty percent of them cover gender 685 00:45:08,239 --> 00:45:12,880 Speaker 1: affirming care. So, in terms of insurers that go through companies, 686 00:45:15,080 --> 00:45:17,840 Speaker 1: for example, in the state of Tennessee, ten Care or 687 00:45:17,880 --> 00:45:21,440 Speaker 1: Tennessee's Medicaid program does not cover anything related to gender 688 00:45:21,440 --> 00:45:24,799 Speaker 1: affirming care, and so anybody who would seek that with 689 00:45:24,840 --> 00:45:27,400 Speaker 1: that insure would pay out a pocket. You're at it. 690 00:45:28,680 --> 00:45:33,319 Speaker 1: And so hormone therapy in general is quite affordable for 691 00:45:33,360 --> 00:45:37,640 Speaker 1: people even without insurance because these are physiologic hormones that 692 00:45:37,680 --> 00:45:40,760 Speaker 1: have been well identified and produced since the mid fifties 693 00:45:40,760 --> 00:45:43,520 Speaker 1: and sixties, and so they don't have you know, patents 694 00:45:43,520 --> 00:45:46,120 Speaker 1: and whatever anything left on them. So they're all pretty affordable. 695 00:45:47,640 --> 00:45:50,120 Speaker 1: Where you start to encounter cost issues, of course, is 696 00:45:50,160 --> 00:45:55,319 Speaker 1: surgical procedures, right, and it really just depends on what 697 00:45:55,360 --> 00:45:59,080 Speaker 1: you want done. You know, an estimate I could give 698 00:45:59,120 --> 00:46:01,080 Speaker 1: you for some buddy if they wanted to pay out 699 00:46:01,080 --> 00:46:04,600 Speaker 1: a pocket to have top surgery or breasts removed, it's 700 00:46:04,600 --> 00:46:08,600 Speaker 1: about ten ten grand generally, um. And then you know 701 00:46:08,760 --> 00:46:11,560 Speaker 1: other surgeries are far more complex and far more costly. 702 00:46:11,920 --> 00:46:17,480 Speaker 1: Yeah right, imagine. Yeah, I'm I take testosterone because my 703 00:46:17,480 --> 00:46:20,880 Speaker 1: my testosterone account was low, and I'm always shocked at 704 00:46:20,920 --> 00:46:23,319 Speaker 1: how cheap it is. Yeah, yeah, it's pretty really cheap. 705 00:46:24,239 --> 00:46:25,640 Speaker 1: I thought, I was like, oh, do I want to 706 00:46:25,680 --> 00:46:28,040 Speaker 1: get on this road, I'm spend a fortune? Um, and 707 00:46:28,160 --> 00:46:32,000 Speaker 1: it's it's really affordable, surprisingly and it's changed your life. 708 00:46:32,120 --> 00:46:35,520 Speaker 1: It's changed my life, really, it really did. Um. Okay, 709 00:46:35,560 --> 00:46:38,080 Speaker 1: doctor Schaefer, How can listeners if they want to know 710 00:46:38,120 --> 00:46:41,440 Speaker 1: more about this topic or do you have any resources 711 00:46:41,480 --> 00:46:43,960 Speaker 1: you would recommend to people? Are easy places to go 712 00:46:44,040 --> 00:46:48,720 Speaker 1: find more information about this Yeah? Absolutely, And the first 713 00:46:48,719 --> 00:46:53,120 Speaker 1: one I would recommend is if you know a kid 714 00:46:53,200 --> 00:46:58,480 Speaker 1: or adolescent or a family that is dealing with gender 715 00:46:58,560 --> 00:47:02,319 Speaker 1: identity issues and they are looking for ways to get 716 00:47:02,400 --> 00:47:05,560 Speaker 1: help for themselves. The best I would say, like PA 717 00:47:05,880 --> 00:47:10,520 Speaker 1: forward resources through the Trevor Project, which you can go 718 00:47:10,560 --> 00:47:13,759 Speaker 1: to I believe it's Trevor Project dot org. That they 719 00:47:13,800 --> 00:47:18,560 Speaker 1: are full of resources in terms of medical providers, mental 720 00:47:18,560 --> 00:47:24,839 Speaker 1: health specialists, and educational materials that are available specifically for that. 721 00:47:26,920 --> 00:47:33,000 Speaker 1: In terms of adults who are seeking information for themselves 722 00:47:33,160 --> 00:47:37,520 Speaker 1: in proceeding with a transition, the best way to do 723 00:47:37,560 --> 00:47:42,840 Speaker 1: that is to There's a medical professional group called GLAMA 724 00:47:43,000 --> 00:47:47,120 Speaker 1: or the Game Lesbian Medical Association. They host what's called 725 00:47:47,160 --> 00:47:51,520 Speaker 1: an LGBTQ provider profile and you can just google that 726 00:47:52,040 --> 00:47:55,040 Speaker 1: and it'll basically bring up a list of doctors and 727 00:47:55,239 --> 00:47:59,480 Speaker 1: providers in your area who specialize in this type of 728 00:47:59,520 --> 00:48:03,440 Speaker 1: care you can connect with and can help guide you 729 00:48:03,480 --> 00:48:06,600 Speaker 1: further from there. Okay, and then what about people who 730 00:48:06,600 --> 00:48:10,799 Speaker 1: are just like us and want to understand what all 731 00:48:10,840 --> 00:48:13,759 Speaker 1: goes into this and you know, learn and try to 732 00:48:13,760 --> 00:48:16,880 Speaker 1: have more empathy. Is are there resources for people just 733 00:48:16,920 --> 00:48:22,279 Speaker 1: wanting to understand? Yeah? Um, my joke at this time 734 00:48:22,400 --> 00:48:25,319 Speaker 1: is just type it into chatbot GPT and see what 735 00:48:25,360 --> 00:48:28,560 Speaker 1: it tells you, and I'll probably be pretty close. But 736 00:48:28,920 --> 00:48:34,360 Speaker 1: I think realistically, the American Academy of Family Physicians or 737 00:48:34,400 --> 00:48:39,680 Speaker 1: the AAFP has a lot of patient and community we 738 00:48:39,880 --> 00:48:41,680 Speaker 1: used the term late man, which I don't love, but 739 00:48:41,960 --> 00:48:44,960 Speaker 1: they'll lay person we'd be able to read and educate 740 00:48:45,000 --> 00:48:49,040 Speaker 1: themselves on in regards to this. Okay, and I'll put 741 00:48:49,080 --> 00:48:51,520 Speaker 1: all of these resources in the description of this podcast. 742 00:48:51,800 --> 00:48:54,920 Speaker 1: Thank you so much. This was so helpful and I 743 00:48:54,960 --> 00:48:58,440 Speaker 1: just really needed all these explanations. It was. It was 744 00:48:58,480 --> 00:49:01,440 Speaker 1: just very eye opening for me. Thank you all so 745 00:49:01,520 --> 00:49:03,600 Speaker 1: much for having me. I really appreciate. I think this 746 00:49:03,760 --> 00:49:08,440 Speaker 1: conversation's of course more important now than ever as we 747 00:49:08,520 --> 00:49:11,800 Speaker 1: continue to talk about it, and I just encourage everyone, 748 00:49:11,880 --> 00:49:15,560 Speaker 1: no matter where you kind of fall in thinking about 749 00:49:15,600 --> 00:49:20,560 Speaker 1: and conceptualizing this is to treat everyone with kindness. I 750 00:49:20,600 --> 00:49:21,920 Speaker 1: agree wholeheartedly,