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- We are all hindered by this,

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and I want us to understand

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that children who are not gender atypical,

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children that are totally
hetero-normative in terms

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of their gender, that
they're gender-normative

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in their behaviors, are also
harmed and also hindered

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by the social world that we live in

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that limits their gender identity,

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their gender expression,
their gender play.

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So we need to be open to various

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resolutions, changes and movements

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throughout childhood and adolescence.

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And this perhaps is one
of the hardest struggles

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because children are relatively
rigid in their perceptions,

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so they're not really interested in having

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a more fluid or open
view, and often parents,

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and I'll talk more about this soon,

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who are these parents who are dealing with

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gender nonconforming children are under

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tremendous pressure and tremendous stress

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and like all parents, they sort of

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want to resolve the issues
as quickly as they can.

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So the child is saying,
"Mom, I think I'm a boy."

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Go to a therapist, talk about it.

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Child cuts their hair,
child wants male pronouns,

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child changes name, and the parent

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kind of wants this to be done.

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"Can we sort of move on?"

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This was a lot of
challenging and difficult

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work for us to do as a family.

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And they're often times
not open to that changing,

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so I'll tell one other story here.

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And I want to again be really clear.

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These stories I'm telling are not common.

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They're unusual.

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But that doesn't mean
we can't pay attention,

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that we shouldn't pay attention to them.

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So I worked with a family who had a

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a male-born child who had transitioned

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as a third or fourth
grader to living as a girl.

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I actually was not part
of that clinical process.

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The family came to me later
in the child's development.

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Had been living successfully as

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a little girl for many, many years.

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There actually was a very funny story

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that I was at an event
and that kid was playing

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in childcare, and I guess
people in the community

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had heard that this child was transgender,

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and somebody came up to me and said,

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"Hey, look at that girl over there.

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"Do you know that she's transgender?"

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I guess they didn't know that
the child was born a boy,

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and said to me, "It's really
hard, I know the parents say

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"that she's transgendered, but I don't see

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"anything masculine about her at all."

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Meaning that they thought
that the child was

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transgender moving from female to male,

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but the child was so socialized female

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that it had never crossed
their mind the child

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was actually born male
and living as a female.

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And of course, being a therapist,
I couldn't say anything

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except, "Mhm," and moved on.

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But what happened was, is this child went

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into puberty, and about
11 or 12 years old,

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came to their parents and
said, "I need to talk to you."

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And said, "Would you
guys be really mad at me

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"if I went back to living as a boy?"

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And like I said, these
parents go through a lot

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to assist children in
these transitions, and

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sort of like, "Sure, sweetie, great, why?"

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And this was the child's answer.

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The child said, "As
I'm going into puberty,

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"I realize that I'm attracted to girls,

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"but I don't feel like
I'm attracted to girls

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"the way a girl would
be attracted to girls.

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"I feel like I'm attracted
to a girl the way

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"a boy would be attracted to girls."

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Now I want to be clear with you.

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I have no idea what that means.

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I mean, I don't know
what the difference is

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between the way a boy likes a
girl and a girl likes a girl.

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What I accept is that this
child understood something about

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his sexual orientation
and his gender identity

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that shifted during the course of his life

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and his childhood, and he
had parents that were willing

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to say, when he said,
"I want to be a girl,"

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they said, "That's fine, we support you."

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And when he said, "I want to be a boy,"

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they said, "That's fine
and we support you."

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So again, we're looking at gender health.

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I want to repeat again, that's
not a common experience,

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but the ability for a parent
to live with a little bit

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of ambiguity, and maybe
all of us as parents

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need to learn to live with
more ambiguity around gender

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and gender expression and gender identity,

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and we'd all be healthier for that,

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but especially for this population.

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Sometimes they actually
start to shut down around the

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ambiguity because they sort
of want to resolve this,

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and they don't want to come
back to talking about it.

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So I think we, as people
working with families,

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need to be sensitive to that.

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Okay, what I want to talk about is

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the changing models of working with

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gender nonconforming children
and transgender youth.

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So we talked earlier
about these older models

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that sort of pathologized the parents,

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pathologized the children,
are trying to prevent

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homosexuality, trying to
prevent transgenderism,

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and in some kind of crazy way,

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trying to prevent peer ostracism.

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The medical model that we have worked with

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for the last 50 years in
this country to work with

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adults who are transsexual,
and it's important to realize

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that the model really is a
model working with adults,

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was not really designed with
children and youth in mind.

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It sort of assumes, its very
basis, assumes that people

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will transition in adulthood,
that people will come in

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to therapy seeking treatments
for gender dysphoria

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in their adulthood, and that
we sort of proceed from there

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in terms of thinking about
hormones and surgery.

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So the treatment strategy with children

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has really been to fix
the children, to make

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the children, in some
way, non-transsexual.

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They actually have language that they use,

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what they call "pre-homosexual children."

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So we want to work with
these children before,

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it is believed, that their
faulty sexual orientation

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or gender identity is established,

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and we're going to, again, fix them to be

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normative, heterosexual,
and cisgender adults.

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So it assumes pathology,
that if gender does not

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in some way match one's
natal sex, there's a problem

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and that problem needs
a clinical intervention.

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We wait until adulthood
to assist them, and

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one of, there's many problems associated

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with that, which we'll talk about, but one

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of the most significant problems is that

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for people who are transsexual,

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to not receive medical treatments,

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and we will talk in a few minutes about

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what some of these medical treatments are,

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to not receive any kind
of medical treatments,

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social treatments or medical treatments,

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means that they will
have gone through puberty

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in the, quote unquote, "wrong direction."

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So in other words, if
somebody is born male

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who identifies as female,
that their gender identity

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is female, and they experience puberty

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that would be a normative
puberty for a male,

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which means that they will...

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Anybody here that's ever witnessed

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puberty in young people, you
know that it's really quite

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dramatic, that they go from being

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pre-pubescent children,
and all of a sudden

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there's facial hair, all of
a sudden there's skin texture

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changes, in a very short period
of time they grow in height,

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their hands, size of their hands change,

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the size of their feet change.

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I'm just laughing trying to remember,

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remembering my older son sort
of tripping over his feet

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at about 13 or 14 a lot, because his feet

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had grown to a size 12 shoe.

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The changes are dramatic
in the facial structure,

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certainly in the dropping
of the voice and in,

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in growing facial hair, what some people

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call "testosterone poisoning."

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If you're a girl, and you
have those kinds of changes

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happening, you can see how that would be

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really frightening and
really dramatic, and they're

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also irreversible, and that's
really an important thing

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to sort of be aware of, is
that these kinds of changes

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that happen to the human
body cannot be changed.

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They cannot be fixed later.

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So a lot of our treatments
that we are looking at now

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for working with children
and youth, are ways of

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putting puberty in a kind
of stasis until the child

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and the adults around them feel confident

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that the cross-gender gender identity

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is solid and accurate, and
we're able to move forward.

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The idea of waiting until
adulthood really has

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potentially negative
effects for these children.

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So what I want to look at
are some of the contemporary

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affirmative approaches
that we're now using,

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and this slide I'm borrowing
from my colleague Jean Malpas

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who works at the Gender
and Family Project,

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which is part of the Ackerman Institute

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for the Family in New York City.

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What Jean says is these
are the most important

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aspects of affirmative approaches.

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So first of all we're
looking at the physical

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and emotional safety for the child.

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We're following the child's lead in terms

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of gender roles and identification.

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So a child who says, "I
feel more comfortable

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"with short hair," then we
honor that in the child.

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That when a child is saying,
"I don't want to go to school

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"as a boy, I want to go
to school as a girl,"

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that we are listening and
following the child's lead.

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That our goal is to help support and build

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self-confidence with the
child, and helping them

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to socially integrate
into their communities,

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their social environments,
and their schools.

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Jean, like myself, is a family
therapist, and of course

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we believe that the real
work here is with families.

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I often say that there's
actually very little work

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I have to do with some of these children,

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that the children are really doing fine.

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The parents are the ones
that are struggling,

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and I really think when
you can help parents to

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feel good about their
children, and feel good about

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how they are parenting,
and help them to resolve

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some of the struggles or
ambiguities that they have,

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that they're actually
able to be better parents.

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They know how to parent their children.

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They're the ones who are needing support.

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That we want to create safe spaces

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to explore gender and emergent identity.

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I'll give you an example of
what that might look like.

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I was working with a young child,

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born female, who identified as a boy.

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Was very, very nervous,
though, to come out about this

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at school in fourth grade, fifth grade.

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Although he was definitely identified,

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he was living as a girl at the time,

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that he was definitely
identified as different

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from the other girls, and a
lot of kids would sort of say,

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"Are you a boy or are you a girl?"

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because of the way that she,
at the time, was dressing.

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And he really wanted to
explore his gender identity,

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but it wasn't safe to do
that in the home community.

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So the family went on sort
of the classic American

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car trip across the US, and during

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this trip, he got to be a boy.

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He was very sweet, he got a button,

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and he made himself a
button that said on it,

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"He" in big letters, so every
time his parents accidentally,

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interestingly enough,
his sister never slipped,

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but the parents often
slipped, and he would take

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the button and say, "He."

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But he got to explore
what it felt like to just

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do sort of normal life,
to go into a restaurant,

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to be camping, to be
hiking, and to have people

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on the trail, people he was
meeting, people in restaurants,

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identify him as a boy, and how that felt.

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So we create safe spaces
for our children to explore

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their gender identity, and
also often with these children,

248
00:12:30,906 --> 00:12:33,464
there's a tremendous
amount of school advocacy.

249
00:12:33,464 --> 00:12:35,048
And I'm talking here not just about

250
00:12:35,048 --> 00:12:36,902
children that have socially transitioned.

251
00:12:36,902 --> 00:12:39,191
That, of course, there's
a lot of advocacy.

252
00:12:39,191 --> 00:12:41,407
But even children before transition,

253
00:12:41,407 --> 00:12:44,239
or children who never transition.

254
00:12:46,568 --> 00:12:48,910
That the challenge of being
a gender nonconforming

255
00:12:48,910 --> 00:12:51,758
or gender variant child
within a school system

256
00:12:51,758 --> 00:12:54,278
is often very difficult,
and schools often spend

257
00:12:54,278 --> 00:12:57,111
enormous amounts of
time gendering children

258
00:12:57,111 --> 00:12:59,447
in ways that they don't think about,

259
00:12:59,447 --> 00:13:01,230
and that are probably unnecessary.

260
00:13:01,230 --> 00:13:03,686
Boys here and girls here,
the girls are going to go

261
00:13:03,686 --> 00:13:05,153
to the gym, the boys are going to go

262
00:13:05,153 --> 00:13:06,942
to the gym, everybody line up here,

263
00:13:06,942 --> 00:13:09,067
boys on one side, girls on the other.

264
00:13:11,031 --> 00:13:13,528
In the younger grades,
there's the sort of boy toys

265
00:13:13,528 --> 00:13:14,948
on one side of the room and the girl toys

266
00:13:14,948 --> 00:13:16,353
on the other side of the room.

267
00:13:16,353 --> 00:13:18,625
There are ways that
teachers reinforce this

268
00:13:18,625 --> 00:13:22,269
and there are ways that
teachers can not reinforce it.

269
00:13:25,867 --> 00:13:28,939
So in terms of diagnostics,

270
00:13:29,884 --> 00:13:31,239
there's a couple of things that

271
00:13:31,239 --> 00:13:32,679
we really have to be clear about.

272
00:13:32,679 --> 00:13:36,495
The first one is that we
need to make a distinction

273
00:13:36,495 --> 00:13:41,155
between gender nonconformity
and gender dysphoria.

274
00:13:41,454 --> 00:13:45,542
So there are lots of children
that are gender nonconforming,

275
00:13:45,542 --> 00:13:49,710
meaning that they don't
fit in to the simple

276
00:13:49,710 --> 00:13:53,913
criteria, the simple boxes,
that are typical behaviors

277
00:13:53,913 --> 00:13:56,576
for boys and girls, like the
child I mentioned earlier,

278
00:13:56,576 --> 00:13:59,552
a little boy who liked to
play with Barbie dolls.

279
00:13:59,552 --> 00:14:02,114
There are lots of little girls
that are rough and tumble,

280
00:14:02,114 --> 00:14:06,217
and they're not really
expressing any distress about it,

281
00:14:06,217 --> 00:14:08,937
nor are they saying the words,

282
00:14:08,937 --> 00:14:11,157
"I'm not a girl," or "I'm not a boy."

283
00:14:11,157 --> 00:14:15,625
They're just needing more space
to be exactly who they are.

284
00:14:15,733 --> 00:14:17,357
It is really very different-looking

285
00:14:17,357 --> 00:14:19,349
than children who are dysphoric.

286
00:14:19,349 --> 00:14:22,673
Children who are dysphoric
are often depressed.

287
00:14:22,806 --> 00:14:24,822
They're often anxious when
they have to do things

288
00:14:24,822 --> 00:14:28,102
that they perceive to be
normative for that gender.

289
00:14:28,102 --> 00:14:29,973
If they're going to a
family wedding and that

290
00:14:29,973 --> 00:14:32,181
little boy has to put on a suit and tie,

291
00:14:32,181 --> 00:14:34,262
they're often very
resistant to doing that.

292
00:14:34,262 --> 00:14:36,413
They hate getting their hair cut.

293
00:14:36,413 --> 00:14:37,845
These are just examples.

294
00:14:37,845 --> 00:14:39,933
They're very uncomfortable
on the sports teams,

295
00:14:39,933 --> 00:14:41,926
and again, I'm not trying to reinforce

296
00:14:41,926 --> 00:14:46,004
these arbitrary gender
things that boys like sports

297
00:14:46,004 --> 00:14:47,930
and girls don't like
sports, I'm just trying to

298
00:14:47,930 --> 00:14:49,930
make the point that in the world that we

299
00:14:49,930 --> 00:14:52,175
live in, the world is very gendered.

300
00:14:52,175 --> 00:14:55,002
I often tell a story that I went into

301
00:14:55,002 --> 00:14:59,370
my son's elementary school when he was in

302
00:14:59,370 --> 00:15:02,938
the fifth grade, and I
was walking down the hall

303
00:15:02,938 --> 00:15:05,901
and coming down the hall was
a group of second graders.

304
00:15:05,901 --> 00:15:07,419
And again, they were in line.

305
00:15:07,419 --> 00:15:10,823
The boys were on one side, the
girls were on the other side.

306
00:15:11,652 --> 00:15:15,393
The boys, the entire line
of boys, were wearing

307
00:15:15,393 --> 00:15:18,592
dark blue, dark brown, they were wearing

308
00:15:18,592 --> 00:15:21,405
jeans, they were wearing sneakers.

309
00:15:23,240 --> 00:15:25,045
What color did I miss there?

310
00:15:25,045 --> 00:15:29,309
Black, blue, brown, and
one little boy had on

311
00:15:29,309 --> 00:15:32,235
a sort of dark green shirt
that was the brightest

312
00:15:32,235 --> 00:15:35,671
of any of the colors that
the little boys were wearing.

313
00:15:35,795 --> 00:15:38,267
The little girls looked like we had

314
00:15:38,267 --> 00:15:41,419
entered some Neverland fantasy world.

315
00:15:41,419 --> 00:15:44,989
They were in pinks and purples and blues.

316
00:15:44,989 --> 00:15:47,263
They had things in their
hair and things around

317
00:15:47,263 --> 00:15:49,286
their neck and things in their hand.

318
00:15:49,286 --> 00:15:51,790
The pencils that they
were holding in their hand

319
00:15:51,790 --> 00:15:54,487
were multi-colored with long strings

320
00:15:54,487 --> 00:15:57,486
on the end of the eraser part of it.

321
00:15:57,486 --> 00:15:59,278
Their backpacks were colorful.

322
00:15:59,278 --> 00:16:03,287
Everything about them was
sort of a ballet performance

323
00:16:03,287 --> 00:16:06,558
and they were indeed kind
of skipping down the hall

324
00:16:06,558 --> 00:16:09,682
where the boys were kind
of trudging down the hall.

325
00:16:10,233 --> 00:16:12,782
These roles are really...

326
00:16:14,022 --> 00:16:16,893
They're taught, they're reinforced,

327
00:16:16,893 --> 00:16:20,366
and stepping out of them are punished.

328
00:16:20,366 --> 00:16:23,070
So sometimes children who
are gender nonconforming

329
00:16:23,070 --> 00:16:25,081
are going to feel very oppressed.

330
00:16:25,081 --> 00:16:26,590
I mean, they may not have that word,

331
00:16:26,590 --> 00:16:28,370
but they're going to be
feeling very oppressed.

332
00:16:28,370 --> 00:16:31,738
But it's different feeling
oppressed because the social

333
00:16:31,738 --> 00:16:36,444
world is limiting you
than it is the dysphoria

334
00:16:36,444 --> 00:16:38,551
that some of these
children are experiencing,

335
00:16:38,551 --> 00:16:41,103
which is often in their
bodies, and they'll say that.

336
00:16:41,103 --> 00:16:44,142
They'll say, "I don't know
why God gave me a penis.

337
00:16:44,142 --> 00:16:47,110
"I know that I'm a
girl, I don't understand

338
00:16:47,110 --> 00:16:49,623
"why my body looks the way it does."

339
00:16:51,787 --> 00:16:55,562
The dysphoria is exactly what
we're talking about here.

340
00:16:55,562 --> 00:16:59,162
It is dysphoric, it is
uncomfortable, it is distressful.

341
00:16:59,583 --> 00:17:01,950
Again, gender nonconforming
children are often

342
00:17:01,950 --> 00:17:05,134
in various levels of
distress too, but it is not

343
00:17:05,134 --> 00:17:09,547
often as focused on their
anatomy, this anatomical

344
00:17:09,547 --> 00:17:13,590
dysmorphia, the sense that
their body is somehow wrong.

345
00:17:13,590 --> 00:17:16,630
And that is really one of those places

346
00:17:16,630 --> 00:17:19,126
where there is a branching of the road.

347
00:17:19,126 --> 00:17:22,600
That children who are
experiencing this dysphoria

348
00:17:22,600 --> 00:17:25,834
in their bodies, in addition
to gender nonconforming

349
00:17:25,834 --> 00:17:29,331
behaviors and mannerisms,
you are looking more

350
00:17:29,331 --> 00:17:32,987
at a child whose trajectory is more likely

351
00:17:32,987 --> 00:17:36,187
to be a transgender
trajectory than children

352
00:17:36,187 --> 00:17:39,608
whose behavior is atypical,
but are not expressing

353
00:17:39,608 --> 00:17:42,444
that much distress, and
are really not expressing

354
00:17:42,444 --> 00:17:44,614
any distress about their bodies.

355
00:17:44,614 --> 00:17:46,199
Again, I'm not saying that...

356
00:17:46,796 --> 00:17:48,279
I've made the point over and over again

357
00:17:48,279 --> 00:17:50,615
that this is fluid, so the
child who is not having

358
00:17:50,615 --> 00:17:53,208
anatomical dysphoria
at age seven might have

359
00:17:53,208 --> 00:17:56,051
a lot of anatomical dysphoria at age 14.

360
00:17:56,051 --> 00:17:59,255
But that is one of the
ways that we're looking at,

361
00:17:59,255 --> 00:18:01,927
how do we make the
decisions of moving from

362
00:18:01,927 --> 00:18:04,215
one stage to another with these children?

363
00:18:04,215 --> 00:18:06,783
The third one is persistence over time,

364
00:18:06,783 --> 00:18:11,783
is the idea that gender
dysphoria is not fleeting.

365
00:18:12,373 --> 00:18:15,258
That anatomical dysmorphia
is not fleeting.

366
00:18:15,258 --> 00:18:18,005
It's not something that kids
feel for a week or two weeks

367
00:18:18,005 --> 00:18:20,902
or three weeks, and then
it sort of goes away.

368
00:18:20,902 --> 00:18:23,866
So this idea that this is a phase...

369
00:18:24,230 --> 00:18:29,102
Phases are phases, and what
makes a phase a phase is that

370
00:18:29,102 --> 00:18:33,804
it ends, and that for these
children, it doesn't end.

371
00:18:33,804 --> 00:18:36,451
It not only doesn't end, it persists,

372
00:18:36,451 --> 00:18:39,966
and it persists more strongly over time.

373
00:18:40,746 --> 00:18:42,811
My son went through a
phase where he thought

374
00:18:42,811 --> 00:18:45,507
he was a Power Ranger, and it
lasted for quite a long time.

375
00:18:45,507 --> 00:18:47,718
I'd say it lasted about six months.

376
00:18:48,270 --> 00:18:51,760
But at 14, he no longer
thinks he's a Power Ranger.

377
00:18:51,760 --> 00:18:53,402
I think, I hope.

378
00:18:53,402 --> 00:18:56,151
So my point is, is that we're looking

379
00:18:56,151 --> 00:18:58,652
at a number of issues
here, we're looking at

380
00:18:58,652 --> 00:19:03,401
the physicality, their
comfort in their body.

381
00:19:03,401 --> 00:19:05,993
We're looking at their
behavior and their mannerisms

382
00:19:05,993 --> 00:19:08,931
in terms of what is expected behavior

383
00:19:08,931 --> 00:19:11,702
and how much they deviate
from that, and we're also

384
00:19:11,702 --> 00:19:16,338
looking at this having
taken place across time.

385
00:19:16,598 --> 00:19:18,390
So the other distinction I want to make

386
00:19:18,390 --> 00:19:21,326
is between social transitions
and medical transitions,

387
00:19:21,326 --> 00:19:23,317
and this is something that the media

388
00:19:23,317 --> 00:19:25,687
gets really confused about often.

389
00:19:25,687 --> 00:19:28,891
And I just actually was
having dinner with a very

390
00:19:28,891 --> 00:19:31,190
dear friend of mine who's not a therapist

391
00:19:31,190 --> 00:19:33,415
and does not work in this
field, but knows of course

392
00:19:33,415 --> 00:19:35,454
that I do, and said to me over dinner,

393
00:19:35,454 --> 00:19:37,606
"Oh, I wanted to tell you.

394
00:19:37,606 --> 00:19:40,326
"I was talking to a friend
of mine and her cousin

395
00:19:40,726 --> 00:19:44,561
"has a kid who is," this was the quote,

396
00:19:44,561 --> 00:19:48,317
"the youngest child to
ever have gender surgery."

397
00:19:48,770 --> 00:19:50,777
And I said, "Really,
how old was the child?"

398
00:19:50,777 --> 00:19:52,387
And I forgot what she said but it was like

399
00:19:52,387 --> 00:19:56,050
nine or something, and
I said, "I assure you."

400
00:19:56,050 --> 00:19:57,988
And we're separating
this out from children

401
00:19:57,988 --> 00:20:00,266
with intersex conditions,
which as we discussed before,

402
00:20:00,266 --> 00:20:03,385
is very complicated, and
we're just looking at children

403
00:20:03,385 --> 00:20:08,385
who are not intersexed,
but who are transgender.

404
00:20:11,775 --> 00:20:15,633
I recognize that I'm on
film here and you say things

405
00:20:15,633 --> 00:20:17,645
and then you want to eat your words later,

406
00:20:17,645 --> 00:20:20,339
but to my knowledge, there
is not a single child

407
00:20:20,339 --> 00:20:23,360
in the world that has had
gender confirming surgery

408
00:20:23,360 --> 00:20:26,700
at nine years old, that
that is just not something

409
00:20:26,700 --> 00:20:29,013
that anybody would
consider, that what we're

410
00:20:29,013 --> 00:20:30,717
talking about when we're talking about

411
00:20:30,717 --> 00:20:33,829
pre-pubescent children
are social transitions.

412
00:20:33,829 --> 00:20:36,893
We're talking about a
child changing their name.

413
00:20:36,893 --> 00:20:41,017
We're talking about
people using pronouns that

414
00:20:41,017 --> 00:20:43,504
connect with their gender, meaning that

415
00:20:43,504 --> 00:20:47,368
even if the child is
female-born, if he is living

416
00:20:47,368 --> 00:20:50,229
as a boy, then we use boy pronouns.

417
00:20:50,229 --> 00:20:52,882
That kind of seems logical, doesn't it?

418
00:20:53,958 --> 00:20:57,613
The cut-off process that we're
talking about here is age.

419
00:20:59,604 --> 00:21:01,501
The issue here is puberty.

420
00:21:01,501 --> 00:21:04,580
So if we're talking about
under the age of puberty,

421
00:21:04,580 --> 00:21:09,580
a child who has persistent
gender dysphoria over time,

422
00:21:10,798 --> 00:21:15,556
anatomical dysphoria, is
uncomfortable in their body,

423
00:21:15,556 --> 00:21:19,398
is exhibiting cross-gender
behaviors, and is saying,

424
00:21:19,398 --> 00:21:22,930
"I want to be, live, be addressed,

425
00:21:22,930 --> 00:21:26,490
"with the pronouns of the other sex.

426
00:21:26,490 --> 00:21:29,291
"Please mommy and daddy,
please let me do that."

427
00:21:29,291 --> 00:21:32,034
We're looking at the possibility of

428
00:21:32,034 --> 00:21:34,346
a social transition for that child.

429
00:21:34,346 --> 00:21:37,010
We're not talking about
medical transitions

430
00:21:37,010 --> 00:21:38,930
until we go into puberty, and I will

431
00:21:38,930 --> 00:21:40,861
talk about that in just a second.

432
00:21:40,861 --> 00:21:43,604
So age is the cutoff in that place.

433
00:21:43,604 --> 00:21:48,203
So the Tanners Stages,
for those of you not

434
00:21:48,203 --> 00:21:50,995
medically oriented, and I
would be one of those people,

435
00:21:50,995 --> 00:21:55,717
is a developmental process
of looking at a child's body

436
00:21:55,717 --> 00:21:59,118
and the physical development
of what puberty does.

437
00:21:59,118 --> 00:22:03,038
So if you will, adults
are Tanner Stage Five,

438
00:22:03,038 --> 00:22:05,544
meaning that our bodies
have fully matured,

439
00:22:05,544 --> 00:22:10,441
and Tanner Stage One are
pre-pubescent children.

440
00:22:10,788 --> 00:22:14,278
So what happens is right
at Tanner Stage Two,

441
00:22:14,278 --> 00:22:17,847
when children start
developing, so female children

442
00:22:17,847 --> 00:22:22,604
develop breast buds, their
bodies start to change,

443
00:22:23,573 --> 00:22:26,819
the shape of their bodies
start to change to look more

444
00:22:26,819 --> 00:22:29,184
what we think of as female bodies looking.

445
00:22:29,184 --> 00:22:31,271
We talked earlier about what the process

446
00:22:31,271 --> 00:22:34,128
of testosterone does for male bodies.

447
00:22:34,128 --> 00:22:37,227
When I say male here, XY bodies.

448
00:22:37,227 --> 00:22:40,303
So this process of puberty starts.

449
00:22:40,607 --> 00:22:43,280
Now with this population, puberty

450
00:22:43,280 --> 00:22:46,775
often brings great distress.

451
00:22:47,163 --> 00:22:49,237
And you can imagine that if you're a boy,

452
00:22:49,237 --> 00:22:51,562
if you feel yourself as a
boy, if you know yourself

453
00:22:51,562 --> 00:22:54,311
to be a boy, and you suddenly
start growing breasts,

454
00:22:54,311 --> 00:22:57,097
generally speaking, you're not
going to be happy with that.

455
00:22:57,541 --> 00:23:01,460
That if you see yourself
as a girl, and you're

456
00:23:03,167 --> 00:23:05,590
starting to develop
facial hair and your voice

457
00:23:05,590 --> 00:23:08,439
is starting to drop, this
is really frightening

458
00:23:08,439 --> 00:23:11,177
about what is happening to your body.

459
00:23:11,543 --> 00:23:13,682
One of the things that we can do,

460
00:23:13,682 --> 00:23:16,743
and when I say "we" here I
don't mean family therapists

461
00:23:16,743 --> 00:23:18,743
and social workers and psychologists,

462
00:23:18,743 --> 00:23:22,747
but I mean medical doctors, is offer

463
00:23:23,111 --> 00:23:27,070
hormone blockers starting
at Tanner Stage Two.

464
00:23:27,070 --> 00:23:29,297
And what these blockers do is they put

465
00:23:29,297 --> 00:23:32,472
the pubescent body in a kind of stasis,

466
00:23:32,472 --> 00:23:34,633
which I want to say has its own problems.

467
00:23:34,633 --> 00:23:37,992
When you are 12 years old
and your friends are starting

468
00:23:37,992 --> 00:23:42,992
to develop, and now you're
13 years old or 14 years old

469
00:23:43,232 --> 00:23:44,932
and your friends are now really starting

470
00:23:44,932 --> 00:23:47,823
to move through puberty but you're not,

471
00:23:48,634 --> 00:23:52,050
it's kind of a little
awkward, but it is generally

472
00:23:52,050 --> 00:23:55,163
considered a much better
alternative for these young people

473
00:23:55,163 --> 00:23:59,402
then to move into what
is for them the wrong,

474
00:24:02,408 --> 00:24:07,408
the wrong puberty, the puberty
that their body would go into

475
00:24:09,063 --> 00:24:11,802
but one that does not fit how they see

476
00:24:11,802 --> 00:24:14,986
their social and psychological selves.

477
00:24:15,389 --> 00:24:18,917
So this business of distinguishing between

478
00:24:18,917 --> 00:24:23,238
gender nonconforming
children and kids who will

479
00:24:23,238 --> 00:24:26,434
become transgendered adolescents is really

480
00:24:26,434 --> 00:24:29,185
one of the key issues, and this is why.

481
00:24:29,185 --> 00:24:34,185
Because for children who are transgender,

482
00:24:35,369 --> 00:24:39,737
who are going to become transgender teens

483
00:24:39,737 --> 00:24:43,020
and who are going to eventually transition

484
00:24:43,020 --> 00:24:48,020
and identify themselves as
adults as transgender people,

485
00:24:48,156 --> 00:24:51,636
as transsexuals or, as we
said earlier, as men and women

486
00:24:51,636 --> 00:24:55,124
who may have been born
in a different body.

487
00:24:55,508 --> 00:24:58,086
Rosalyne Blumenstein refers to,

488
00:24:58,086 --> 00:25:01,225
"I'm a woman of transsexual experience."

489
00:25:01,620 --> 00:25:03,565
A phrase that I just really love.

490
00:25:04,454 --> 00:25:07,229
So for people who are going to move on

491
00:25:07,229 --> 00:25:11,021
in their transition process, the earlier

492
00:25:11,021 --> 00:25:14,866
we can identify them,
the more we can give them

493
00:25:14,866 --> 00:25:18,142
the specific support that they need,

494
00:25:18,546 --> 00:25:21,817
which would include social transition,

495
00:25:21,817 --> 00:25:25,694
would include puberty
suppression, as well as advocacy,

496
00:25:25,694 --> 00:25:28,930
again, in the schools and
in their social world.

497
00:25:29,487 --> 00:25:32,087
For children that are, and
I don't really want to use

498
00:25:32,087 --> 00:25:34,758
the word here, "just," but I will,

499
00:25:34,758 --> 00:25:37,526
who are just gender nonconforming,

500
00:25:37,526 --> 00:25:40,454
for children that have
fluid gender identities,

501
00:25:40,454 --> 00:25:43,366
for children who are gender atypical

502
00:25:43,366 --> 00:25:46,389
but not necessarily experiencing distress,

503
00:25:47,840 --> 00:25:52,282
social transition would
be contraindicated.

504
00:25:52,282 --> 00:25:56,746
That treatment for suppressing puberty

505
00:25:56,746 --> 00:25:59,082
would be contraindicated.

506
00:25:59,082 --> 00:26:01,778
So understanding which of these two groups

507
00:26:01,778 --> 00:26:04,387
we're working with helps us determine

508
00:26:04,387 --> 00:26:06,627
the kind of treatment
plans that we develop.

509
00:26:06,627 --> 00:26:08,458
And I also want to be really clear here.

510
00:26:08,458 --> 00:26:10,416
There is no litmus test.

511
00:26:10,416 --> 00:26:13,706
There is no strict assessment.

512
00:26:13,706 --> 00:26:18,688
This is a dialogue that a
therapist is having with a client,

513
00:26:18,688 --> 00:26:21,474
with a young person, that
the therapist is having with

514
00:26:21,474 --> 00:26:24,480
the parents, that the parents
are having with the doctor,

515
00:26:24,480 --> 00:26:27,455
that the team is sitting
down together and working on

516
00:26:27,455 --> 00:26:30,454
and it changes over time, of how,

517
00:26:30,454 --> 00:26:33,311
how the child sees it and
how the parents see it.

518
00:26:33,311 --> 00:26:35,086
Sometimes parents are very resistant

519
00:26:35,086 --> 00:26:37,231
to the puberty suppression
in the beginning,

520
00:26:37,231 --> 00:26:39,208
and then they become
very supportive of it.

521
00:26:39,208 --> 00:26:44,208
Sometimes the child really doesn't care,

522
00:26:44,801 --> 00:26:46,482
Sometimes the parents are saying,

523
00:26:46,482 --> 00:26:48,964
"Do you want us to do something
to suppress your puberty?"

524
00:26:48,964 --> 00:26:50,180
And the kid's going, "I don't know,

525
00:26:50,180 --> 00:26:51,797
"leave me alone, I don't really care."

526
00:26:51,797 --> 00:26:53,638
And then all of a sudden
the body starts developing

527
00:26:53,638 --> 00:26:55,997
in a particular way and
they're like, "Whoa, mom,

528
00:26:55,997 --> 00:26:58,105
"you've got to do something
about this right away."

529
00:26:58,664 --> 00:27:01,716
This is an ongoing
discussion that takes place.

530
00:27:01,716 --> 00:27:04,840
I do want to say something about hormones,

531
00:27:05,317 --> 00:27:07,401
about puberty-blocking hormones.

532
00:27:07,812 --> 00:27:10,133
Of course one of the first
questions that parents

533
00:27:10,133 --> 00:27:13,606
raise here is, "Are these dangerous?"

534
00:27:14,677 --> 00:27:17,903
I will say that any time we
are putting any substance

535
00:27:17,903 --> 00:27:22,325
in our body, including coffee,
it has potential effects

536
00:27:22,325 --> 00:27:24,289
on our body that can be negative.

537
00:27:24,289 --> 00:27:25,691
It's a medication.

538
00:27:25,691 --> 00:27:29,986
However, these medications have been used

539
00:27:30,854 --> 00:27:33,703
for children who have precocious puberty,

540
00:27:33,703 --> 00:27:36,558
meaning girls who are going into puberty

541
00:27:36,558 --> 00:27:39,237
at age six or age seven,
and of course we don't

542
00:27:39,237 --> 00:27:41,498
want to do that, so we
want to hold off puberty.

543
00:27:42,733 --> 00:27:44,765
We give them these
medications and then we stop

544
00:27:44,765 --> 00:27:47,427
giving it to them when they reach an age

545
00:27:47,427 --> 00:27:49,745
where puberty would be more appropriate,

546
00:27:49,745 --> 00:27:54,345
not only physiologically but
psychologically and socially.

547
00:27:55,045 --> 00:27:57,517
We have used these for years.

548
00:27:57,716 --> 00:28:00,900
There is a little bit of
evidence that it can effect

549
00:28:00,900 --> 00:28:04,839
bone growth, but almost
everybody in the field

550
00:28:04,839 --> 00:28:07,347
believes that these children
are on these medications

551
00:28:07,347 --> 00:28:09,587
for a short enough period of time

552
00:28:09,587 --> 00:28:11,568
that the effects are negligible.

553
00:28:11,568 --> 00:28:13,675
Because again, we're looking
at putting a kid on this

554
00:28:13,675 --> 00:28:16,459
at 11 or 12 years old, and really,

555
00:28:16,459 --> 00:28:18,907
by the time a child is 15 years old,

556
00:28:18,907 --> 00:28:21,407
we're moving into another
stage of development.

557
00:28:21,407 --> 00:28:23,243
We would probably be taking the child

558
00:28:23,243 --> 00:28:25,449
off of puberty suppression hormones.

559
00:28:25,449 --> 00:28:27,267
It's also important to be aware

560
00:28:27,267 --> 00:28:29,376
that the way the hormones work, is that

561
00:28:29,376 --> 00:28:31,772
if you stop the hormones at any point...

562
00:28:31,772 --> 00:28:33,445
I want to be clear, I'm talking about

563
00:28:33,445 --> 00:28:35,724
the puberty suppression hormones.

564
00:28:35,724 --> 00:28:37,884
So you put the child on it.

565
00:28:37,884 --> 00:28:39,969
Puberty goes into stasis.

566
00:28:39,969 --> 00:28:41,385
Nothing is happening, not boy,

567
00:28:41,385 --> 00:28:43,818
not girl, nothing is happening.

568
00:28:43,818 --> 00:28:46,161
And then let's say two
years down the road,

569
00:28:46,161 --> 00:28:48,473
you stop those hormones.

570
00:28:48,473 --> 00:28:53,127
That child will, at that
point, start to develop

571
00:28:53,127 --> 00:28:58,127
in the gender, their
puberty development will be

572
00:28:59,520 --> 00:29:03,698
in the gender to which
they were natally born.

573
00:29:03,698 --> 00:29:07,044
So if you are an XX child, you
will go into female puberty,

574
00:29:07,044 --> 00:29:09,993
if you are an XY child,
you'll go into male puberty,

575
00:29:11,317 --> 00:29:15,156
as if we had not stopped the puberty.

576
00:29:15,377 --> 00:29:17,998
So even though you're starting
that process two years later,

577
00:29:17,998 --> 00:29:20,081
the development would be completely

578
00:29:20,081 --> 00:29:22,129
a normal process from that point on.

579
00:29:22,129 --> 00:29:25,060
Let's say the child, at
that point, decided to not

580
00:29:25,060 --> 00:29:29,714
transition, to not continue
on a transgender trajectory.

581
00:29:29,974 --> 00:29:32,507
So I hope that that makes sense.

582
00:29:32,678 --> 00:29:34,426
More commonly, what we do at that point

583
00:29:34,426 --> 00:29:36,630
is then begin to talk
about putting the child

584
00:29:36,630 --> 00:29:38,965
on cross-gender hormones, which again,

585
00:29:38,965 --> 00:29:42,062
for them is not really cross-gender

586
00:29:42,062 --> 00:29:45,371
because it is the gender
to which they identify.

587
00:29:46,126 --> 00:29:48,825
So again, I want to mention
the Standards of Care here.

588
00:29:48,825 --> 00:29:51,333
The Standards of Care
make a very strong point

589
00:29:51,333 --> 00:29:54,056
that mental health
professionals and schools

590
00:29:54,056 --> 00:29:57,183
should not impose a binary view of gender.

591
00:29:57,183 --> 00:29:59,795
They should give ample room
for children to explore

592
00:29:59,795 --> 00:30:02,382
different gender options, and accomodate

593
00:30:02,382 --> 00:30:04,167
the child's gender expression.

594
00:30:04,167 --> 00:30:06,231
That is for gender nonconforming children

595
00:30:06,231 --> 00:30:08,526
as well as transgender children.

596
00:30:08,526 --> 00:30:10,310
Somewhere in here, Toby, I want

597
00:30:10,310 --> 00:30:13,318
to show some of the videos of Jazz.

598
00:30:13,318 --> 00:30:15,021
You have the links on the last page.

599
00:30:15,021 --> 00:30:17,286
I will probably send you
slightly different links.

600
00:30:17,286 --> 00:30:20,343
So this clip, these words
I'm going to say now,

601
00:30:20,343 --> 00:30:23,143
associate with that piece,
and I'm not 100 percent

602
00:30:23,143 --> 00:30:25,138
sure where we're going to put it.

603
00:30:27,263 --> 00:30:30,358
I want to show you what

604
00:30:30,358 --> 00:30:32,550
the process looks like for young children,

605
00:30:32,550 --> 00:30:36,236
because it may be, there's
a lot of words here.

606
00:30:37,924 --> 00:30:41,178
It's easy for us as grown-ups,

607
00:30:41,178 --> 00:30:43,464
and perhaps many of us who are not

608
00:30:43,464 --> 00:30:45,790
immersed in transgender community

609
00:30:45,790 --> 00:30:48,350
and transgender politics,
who may not have a lot

610
00:30:48,350 --> 00:30:52,112
of close transgender friends,
to not really understand.

611
00:30:52,112 --> 00:30:54,644
Actually I was having
dinner last night here

612
00:30:54,644 --> 00:30:58,644
at Smith College and was talking
to a colleague's husband.

613
00:30:58,644 --> 00:31:02,804
He's not a social worker,
and asked me what I did.

614
00:31:02,804 --> 00:31:06,197
I said something, and he said,
"Yeah, I don't get that."

615
00:31:06,197 --> 00:31:09,170
He said, "I get the gay
thing, but I don't really get,

616
00:31:09,170 --> 00:31:10,382
"what would make someone feel that

617
00:31:10,382 --> 00:31:12,541
"uncomfortable in their body?"

618
00:31:12,541 --> 00:31:14,860
I'm not saying that judgmentally.

619
00:31:14,860 --> 00:31:16,598
It's a hard thing to get.

620
00:31:16,598 --> 00:31:19,597
So what I want to do is I want to show you

621
00:31:19,597 --> 00:31:23,146
what it looks like, even
as young as 18 months old,

622
00:31:23,146 --> 00:31:25,607
even as young as five or six years old,

623
00:31:25,607 --> 00:31:29,670
what these children are expressing
that would make a parent

624
00:31:29,670 --> 00:31:33,388
want to say, "There's
something real going on here.

625
00:31:33,388 --> 00:31:35,744
"That when I tell my little boy,

626
00:31:35,744 --> 00:31:38,528
"'You have to wear boy's clothes,'

627
00:31:38,528 --> 00:31:40,600
"I have a very depressed child.

628
00:31:40,600 --> 00:31:45,347
"When I let my child do
what 'he' wants to do,

629
00:31:45,347 --> 00:31:48,245
"what he wants to do is
dress in girl's clothing

630
00:31:48,245 --> 00:31:51,220
"and play girl's games
and play with other girls

631
00:31:51,220 --> 00:31:54,149
"and do things that, if
he had a female body,

632
00:31:54,149 --> 00:31:56,333
"we would consider 100 percent normal

633
00:31:56,333 --> 00:31:58,905
"girl behavior in this culture."

634
00:31:59,373 --> 00:32:01,727
So witnessing your child
moving from sort of

635
00:32:01,727 --> 00:32:05,374
a state of depression to a
state of happiness, is very

636
00:32:05,374 --> 00:32:09,484
compelling for most of us as
parents and as therapists.

637
00:32:09,484 --> 00:32:12,781
So I want to show you Jazz, whose family

638
00:32:12,781 --> 00:32:15,727
has documented her transition.

639
00:32:15,727 --> 00:32:17,789
She's now a teenager,
so I'm going to show you

640
00:32:17,789 --> 00:32:21,320
some clips of her now, and I'm
also going to show you some,

641
00:32:21,496 --> 00:32:24,557
I'm going to show you some
clips of her as a young child,

642
00:32:24,557 --> 00:32:28,497
as a preteen, and as she's
moving into the teenage years.

643
00:32:30,437 --> 00:32:32,492
So I'm going to show
you some clips of Jazz

644
00:32:32,492 --> 00:32:35,732
as she is now, as she's
maturing and getting older.

645
00:32:43,209 --> 00:32:44,609
Okay.

646
00:32:44,609 --> 00:32:48,169
So Jean Malpas, who I mentioned earlier,

647
00:32:48,169 --> 00:32:51,459
this is also a slide of his.

648
00:32:51,536 --> 00:32:53,892
Looking at these three...

649
00:32:56,608 --> 00:32:58,631
I'm going to say kinds of children,

650
00:32:58,631 --> 00:33:00,944
and of course, each of these...

651
00:33:00,944 --> 00:33:05,944
This is a spectrum, but even
within each of the labels,

652
00:33:06,424 --> 00:33:09,781
there is a diversity of presentations.

653
00:33:09,781 --> 00:33:12,102
So there are children
that are nonconforming,

654
00:33:12,102 --> 00:33:15,126
children that are atypical,
children that don't fit

655
00:33:15,126 --> 00:33:19,033
the standard views of what boys
and girls should look like.

656
00:33:19,341 --> 00:33:22,597
There are children that
are gender dysphoric where,

657
00:33:23,538 --> 00:33:27,046
in addition to usually
being gender nonconforming,

658
00:33:27,046 --> 00:33:30,774
they are really uncomfortable
in their bodies,

659
00:33:31,968 --> 00:33:35,360
with their anatomy, and I
want to say that sometimes

660
00:33:35,360 --> 00:33:38,857
kids can be gender dysphoric
and not gender nonconforming,

661
00:33:38,857 --> 00:33:41,139
because that has a lot
to do with the freedom

662
00:33:41,139 --> 00:33:43,645
that they've had to explore,
and in some families

663
00:33:43,645 --> 00:33:45,945
there is no freedom to
explore, so the children

664
00:33:45,945 --> 00:33:48,907
are uncomfortable, but
are really not allowed

665
00:33:48,907 --> 00:33:51,251
to ever, ever, ever have the experience

666
00:33:51,251 --> 00:33:54,662
of wearing clothes of the other gender.

667
00:33:55,457 --> 00:33:59,730
And children that are
cross-gender identified, okay,

668
00:33:59,730 --> 00:34:02,421
that are actually living, they
are socially transitioned,

669
00:34:02,421 --> 00:34:04,245
if they're teens, they're beginning

670
00:34:04,245 --> 00:34:08,717
a medical transition of their gender.

671
00:34:08,717 --> 00:34:10,377
Those are sort of the three groups

672
00:34:10,377 --> 00:34:13,097
of children that we're talking about.

673
00:34:13,097 --> 00:34:16,545
And the three groups of families
that we are talking about

674
00:34:16,545 --> 00:34:18,881
are families that are, I'm
actually going to start

675
00:34:18,881 --> 00:34:22,946
on the other side, families
that are struggling,

676
00:34:23,173 --> 00:34:26,356
that are conflicted, that
have children that are gender

677
00:34:26,356 --> 00:34:29,389
nonconforming, it is causing
them tremendous pain.

678
00:34:29,389 --> 00:34:33,694
Sometimes the pain is in a heterosexual

679
00:34:33,694 --> 00:34:36,304
family where there are two parents.

680
00:34:36,304 --> 00:34:38,400
Sometimes it's very gender-split,

681
00:34:38,400 --> 00:34:41,593
meaning mom is very
supportive, and dad isn't,

682
00:34:41,593 --> 00:34:43,473
and I assume there are families out there

683
00:34:43,473 --> 00:34:46,753
where that is reversed, but I
see that much less frequently.

684
00:34:46,753 --> 00:34:49,120
Most of the time it is the mothers who,

685
00:34:49,120 --> 00:34:51,488
and who are often, in our
culture, spending more time

686
00:34:51,488 --> 00:34:54,286
with their children, and
are witnessing the pain

687
00:34:54,286 --> 00:34:57,520
of what happens when you try to take away

688
00:34:57,520 --> 00:35:01,729
the girl toys from the child
who is anatomically a boy.

689
00:35:02,043 --> 00:35:04,462
So these parents are
struggling, they're conflicted.

690
00:35:04,462 --> 00:35:06,217
Sometimes there's a cultural fit.

691
00:35:06,217 --> 00:35:09,749
We're dealing with religiosity,
we're dealing with immigrant

692
00:35:09,749 --> 00:35:12,061
families who may come from
cultures where there's

693
00:35:12,061 --> 00:35:16,721
much stricter gender roles, so
we have to really look at...

694
00:35:17,512 --> 00:35:21,275
It's easy, I think, maybe too easy,

695
00:35:21,275 --> 00:35:25,352
for us as social workers
to become advocates

696
00:35:25,352 --> 00:35:29,898
for these children, and
not really compassionate

697
00:35:29,898 --> 00:35:32,616
for the struggles that the
parents are going through

698
00:35:32,616 --> 00:35:34,803
in families where this really does feel

699
00:35:34,803 --> 00:35:37,516
like this is against God,
where it feels like they're

700
00:35:37,516 --> 00:35:40,860
going to get into, they're
going to get ex-communicated

701
00:35:40,860 --> 00:35:43,066
from their religious families,
that they're going to be

702
00:35:43,066 --> 00:35:45,887
ostracized from their cultural
and ethnic communities.

703
00:35:45,887 --> 00:35:48,188
So we have to be really
sensitive to the struggles

704
00:35:48,188 --> 00:35:50,755
that the parents are
going through as well.

705
00:35:50,755 --> 00:35:53,198
There are parents, and this
is actually the population

706
00:35:53,198 --> 00:35:55,731
of parents that I see the most common,

707
00:35:55,731 --> 00:35:59,418
parents who are accepting,
they're concerned,

708
00:35:59,418 --> 00:36:02,499
they're educated, but I
would say that they're still

709
00:36:02,499 --> 00:36:06,058
confused or they're unsure
of how to move forward.

710
00:36:06,168 --> 00:36:08,660
That they want very much
to respect their children,

711
00:36:08,660 --> 00:36:12,828
they love their children, they can see

712
00:36:12,828 --> 00:36:15,792
that their children are not typical.

713
00:36:15,792 --> 00:36:17,560
In many cases they have other children

714
00:36:17,560 --> 00:36:20,282
in the family that were very typical.

715
00:36:20,282 --> 00:36:22,280
They want to support their children.

716
00:36:22,280 --> 00:36:24,328
They have done a lot of reading.

717
00:36:24,328 --> 00:36:25,904
They have gone on the Internet.

718
00:36:25,904 --> 00:36:28,032
Sometimes they've gone to conferences

719
00:36:28,032 --> 00:36:30,137
and they're trying to figure out

720
00:36:30,137 --> 00:36:32,622
what's the best move for their family.

721
00:36:32,622 --> 00:36:37,622
And I want to say sometimes
this population of parents,

722
00:36:39,415 --> 00:36:42,356
there's one of the complications for them.

723
00:36:42,356 --> 00:36:44,722
I talked earlier about the fact that

724
00:36:44,722 --> 00:36:48,027
in their exuberance of
supporting their children,

725
00:36:48,027 --> 00:36:51,325
they're sometimes moving
faster than their children are.

726
00:36:51,866 --> 00:36:53,473
"Do you want to start hormones, honey?"

727
00:36:53,473 --> 00:36:56,250
"No, mom, I just want
to play video games."

728
00:36:56,250 --> 00:37:00,146
They're kind of, they're
anxious, because having a child

729
00:37:00,146 --> 00:37:03,538
whose gender is ambiguous in our culture

730
00:37:04,322 --> 00:37:07,828
often makes us want to

731
00:37:08,566 --> 00:37:10,646
make a decision and move forward

732
00:37:10,646 --> 00:37:12,678
and sort of to shut down the options.

733
00:37:12,678 --> 00:37:15,413
So a lot of times, you know, I remember

734
00:37:15,890 --> 00:37:17,623
I got a phone call once from a mom.

735
00:37:17,623 --> 00:37:18,894
I had worked with the family since

736
00:37:18,894 --> 00:37:21,146
the kid was five or six years old,

737
00:37:21,146 --> 00:37:24,038
and during the long years of therapy,

738
00:37:24,038 --> 00:37:26,846
the kid had moved from
kind of a gender atypical

739
00:37:26,846 --> 00:37:31,232
presentation to a fairly
male presentation.

740
00:37:31,460 --> 00:37:34,205
He was thinking he very
much wanted to mature

741
00:37:34,205 --> 00:37:37,277
and live as a boy in his teenage years.

742
00:37:37,277 --> 00:37:41,840
But he was pretty happy
as a 9, 10 year old

743
00:37:41,840 --> 00:37:44,827
and not really asking
the parents for anything

744
00:37:44,827 --> 00:37:47,576
regarding pronoun change or school change.

745
00:37:47,576 --> 00:37:50,400
Just kind of doing his
thing, but at the time,

746
00:37:50,400 --> 00:37:53,795
living as a girl, and
they had come to a place

747
00:37:53,795 --> 00:37:56,667
where he was really clear
he wanted to live as a boy.

748
00:37:57,440 --> 00:37:59,802
The parents called me up
one day, and very anxious

749
00:37:59,802 --> 00:38:02,434
on the phone, the mom is
like, "I know you said

750
00:38:02,434 --> 00:38:04,706
"that we have to get him on
puberty suppressing hormones

751
00:38:04,706 --> 00:38:07,514
"right away, and that it's,
that the window, we have to get,

752
00:38:07,514 --> 00:38:10,810
"we have to do this
before the window closes."

753
00:38:11,793 --> 00:38:16,793
The window of Tanner Stage
Two, the window of what,

754
00:38:18,130 --> 00:38:20,954
of what puberty looks like.

755
00:38:20,954 --> 00:38:22,945
Again, anybody here
that's raised children,

756
00:38:22,945 --> 00:38:24,825
anybody here that works
in a school system,

757
00:38:24,825 --> 00:38:29,825
it is not exactly like you
go to bed on Monday night

758
00:38:30,800 --> 00:38:34,887
as a pre-pubescent child,
and you wake up looking

759
00:38:34,887 --> 00:38:39,887
like a 16 year old child in puberty.

760
00:38:42,493 --> 00:38:43,943
And I said to her, I said, "This is

761
00:38:43,943 --> 00:38:46,355
"a very large bay window here.

762
00:38:46,355 --> 00:38:49,116
"We can make an appointment
to see the doctor.

763
00:38:49,116 --> 00:38:51,156
"If it's a week or two before we get in,

764
00:38:51,156 --> 00:38:53,867
"if it's even a month or two, nothing much

765
00:38:53,867 --> 00:38:56,161
"is going to change with
your child in a two-month

766
00:38:56,161 --> 00:38:59,154
"period that is life threatening here.

767
00:38:59,154 --> 00:39:01,163
"I'm not telling you to wait two years.

768
00:39:01,163 --> 00:39:03,729
"I'm not even telling
you to wait nine months."

769
00:39:03,729 --> 00:39:07,512
But there's a sense sometimes
with this population

770
00:39:07,595 --> 00:39:10,566
where they're just very anxious and they

771
00:39:10,566 --> 00:39:13,856
are often times ahead of their children

772
00:39:13,856 --> 00:39:16,417
and they're often times really...

773
00:39:16,417 --> 00:39:19,227
Their concern for their children is so big

774
00:39:19,227 --> 00:39:23,067
that it almost makes it hard
for them to think clearly

775
00:39:23,067 --> 00:39:25,939
about the fact that we're
talking about young people here

776
00:39:25,939 --> 00:39:29,300
who move through a lot of emotional states

777
00:39:29,300 --> 00:39:33,333
and that because their
children are gender-variant,

778
00:39:33,333 --> 00:39:37,714
they're taking concerns,
very real concerns,

779
00:39:37,714 --> 00:39:40,574
that the child is having,
and sort of amplifying them

780
00:39:40,574 --> 00:39:42,971
in a way that they might
not do with all of the

781
00:39:42,971 --> 00:39:46,261
10,000 other concerns that
young people might have.

782
00:39:46,261 --> 00:39:49,003
So anyway, this third
group here are families

783
00:39:49,003 --> 00:39:51,399
where the children have
socially transitioned,

784
00:39:51,399 --> 00:39:53,863
and often they serve as community mentors

785
00:39:53,863 --> 00:39:58,199
for families in the other stages
that we were talking about.

786
00:39:58,531 --> 00:40:00,244
And I said earlier in the very beginning

787
00:40:00,244 --> 00:40:02,604
that this is a population
that needs a tremendous amount

788
00:40:02,604 --> 00:40:06,132
of support because they're
often, they're viewed

789
00:40:06,824 --> 00:40:09,534
in very negative ways
sometimes by communities

790
00:40:09,534 --> 00:40:13,919
and families, that they
created this, that they are

791
00:40:14,068 --> 00:40:17,619
pushing their children
into these identities

792
00:40:17,619 --> 00:40:21,865
that aren't accurate, so they
really need a lot of backing

793
00:40:21,865 --> 00:40:24,729
and a lot of support, and they also

794
00:40:24,729 --> 00:40:27,431
sometimes need a little bit of help.

795
00:40:27,431 --> 00:40:29,297
There's one mom that I work with

796
00:40:29,297 --> 00:40:31,401
who comes to a support group that I run,

797
00:40:31,401 --> 00:40:35,230
and she's so, she's marvelous,
and she's 100 percent

798
00:40:35,230 --> 00:40:38,276
supportive of her kid, and
her kid is doing phenomenal,

799
00:40:38,276 --> 00:40:42,822
but it's sometimes in her
enthusiasm and her support

800
00:40:42,822 --> 00:40:45,895
and her sense of wanting
to convey to the parents

801
00:40:45,895 --> 00:40:48,732
that the kids are going to be
fine, just have their back,

802
00:40:48,732 --> 00:40:51,480
the kids are going to be
fine, she sometimes is moving

803
00:40:51,480 --> 00:40:55,007
faster than the folks that are struggling

804
00:40:55,007 --> 00:40:57,546
and conflicted are able to move.

805
00:40:57,546 --> 00:41:01,468
So I kind of have to slow her down because

806
00:41:02,760 --> 00:41:05,507
it sometimes feels intimidating to people

807
00:41:05,507 --> 00:41:07,349
who really are saying,
"We're not there yet.

808
00:41:07,349 --> 00:41:09,481
"We're not ready yet."

809
00:41:09,628 --> 00:41:12,205
There's a spectrum of behaviors,

810
00:41:12,205 --> 00:41:16,229
of experiences and behaviors
for children and for families.

811
00:41:16,234 --> 00:41:18,728
This is Diane Ehrensaft.

812
00:41:19,246 --> 00:41:21,468
Actually, what are the
words that these kids

813
00:41:21,468 --> 00:41:23,309
use to talk about themselves?

814
00:41:23,309 --> 00:41:25,622
I'm using the term "gender nonconforming,"

815
00:41:25,622 --> 00:41:28,069
but children don't very
often come into therapy

816
00:41:28,069 --> 00:41:30,079
and say, "Hi, I'm gender nonconforming."

817
00:41:31,267 --> 00:41:32,965
I'll actually tell you what one

818
00:41:32,965 --> 00:41:35,510
young person came into my office and said.

819
00:41:35,866 --> 00:41:37,970
It was actually very sweet.

820
00:41:37,970 --> 00:41:42,119
I had met with the parents
first for a couple of sessions,

821
00:41:42,119 --> 00:41:44,532
and then they brought their child,

822
00:41:44,532 --> 00:41:47,788
who was then a girl, into the office.

823
00:41:47,788 --> 00:41:50,132
Little child, six years
old, so of course the first

824
00:41:50,132 --> 00:41:51,841
thing that I say to the child is,

825
00:41:51,841 --> 00:41:53,399
"Do you want to come
in with your parents?"

826
00:41:53,399 --> 00:41:55,260
Thinking a lot of six
year olds do not want

827
00:41:55,260 --> 00:41:57,477
to walk into a therapy
office without their parents,

828
00:41:57,477 --> 00:42:00,028
and she looked at me and she said,

829
00:42:00,028 --> 00:42:03,085
"No, I want to go in myself."

830
00:42:03,085 --> 00:42:05,221
I said, "Okay," and she
sat down on my couch,

831
00:42:05,221 --> 00:42:07,353
and she looked at me straight in the eyes,

832
00:42:07,353 --> 00:42:09,898
and she says, "The reason that I'm here

833
00:42:09,898 --> 00:42:11,693
"is because my parents are having

834
00:42:11,693 --> 00:42:14,947
"a very hard time accepting my gender."

835
00:42:17,239 --> 00:42:19,321
Six years old.

836
00:42:19,575 --> 00:42:23,322
And then said, she asked me
if I knew what a tomboy meant.

837
00:42:23,322 --> 00:42:25,833
And I told her that I thought
I did, but I asked her

838
00:42:25,833 --> 00:42:29,253
to tell me what that
meant to her and she did,

839
00:42:29,253 --> 00:42:32,929
and then she said, "I
just want you to know

840
00:42:32,929 --> 00:42:36,350
"that if your intention," and
that was the word she used,

841
00:42:36,350 --> 00:42:39,845
"if your intention is to make me

842
00:42:39,845 --> 00:42:43,911
"wear dresses, this is not going to work."

843
00:42:44,219 --> 00:42:47,651
So these kids are very clear often,

844
00:42:47,651 --> 00:42:50,162
not always, about who they are.

845
00:42:50,162 --> 00:42:52,691
But again, they don't walk in and say,

846
00:42:52,691 --> 00:42:54,931
"I'm gender nonconforming," or often,

847
00:42:54,931 --> 00:42:57,440
young kids, "I'm transgender."

848
00:42:57,440 --> 00:42:59,059
But this is some of what they say.

849
00:42:59,059 --> 00:43:01,151
They say, "I'm gender fluid."

850
00:43:01,331 --> 00:43:03,362
They say, "I'm a gender hybrid."

851
00:43:03,362 --> 00:43:05,821
They say, "I'm a gender smoothie."

852
00:43:05,821 --> 00:43:07,675
They say, "I'm a gender oreo."

853
00:43:07,675 --> 00:43:11,335
They say, "I'm a gender Prius,
half girl and half boy."

854
00:43:12,211 --> 00:43:16,866
Gender Tauruses, who are a girl
on top and a boy on bottom.

855
00:43:19,012 --> 00:43:23,159
So they have ways of talking
about their gender that are not

856
00:43:23,159 --> 00:43:26,753
necessarily the clinical
languages that we would use.

857
00:43:26,753 --> 00:43:30,536
So what are the criteria that
we use for social transition?

858
00:43:31,493 --> 00:43:34,116
Social transition before
puberty is complex.

859
00:43:34,116 --> 00:43:36,248
It needs to be thought through.

860
00:43:37,044 --> 00:43:38,670
Some of the questions we want to ask,

861
00:43:38,670 --> 00:43:42,241
is, "Is it necessary, is
it crucial to the child?

862
00:43:42,241 --> 00:43:43,812
"Has it been crucial?

863
00:43:43,812 --> 00:43:46,293
"Is this child saying,
'I can't go on this way,

864
00:43:46,293 --> 00:43:49,845
"'I can't live this way, I
hate what is happening to me,

865
00:43:49,845 --> 00:43:52,141
"'we have to do something'?"

866
00:43:52,141 --> 00:43:55,893
And there are children that
are absolutely saying that.

867
00:43:56,269 --> 00:43:58,148
Is it safe?

868
00:43:58,148 --> 00:44:01,672
Is the environment they are
living in safe for a transition?

869
00:44:01,672 --> 00:44:03,646
Is their home safe?

870
00:44:03,646 --> 00:44:05,499
I'm talking about their
father, I'm talking about

871
00:44:05,499 --> 00:44:08,348
their brothers, I'm talking
about their grandparents,

872
00:44:08,348 --> 00:44:11,216
I'm talking about the other
siblings in the house.

873
00:44:12,934 --> 00:44:14,961
Is their school safe, and what can

874
00:44:14,961 --> 00:44:16,783
we do to make the school safe?

875
00:44:16,783 --> 00:44:18,316
What is their teacher like?

876
00:44:18,316 --> 00:44:20,762
What is the administration
of the school like?

877
00:44:20,762 --> 00:44:23,791
What does the school board
say about children like this?

878
00:44:23,791 --> 00:44:28,628
Will they have a place to
pee in the school itself?

879
00:44:28,628 --> 00:44:30,318
What is their neighborhood like?

880
00:44:30,318 --> 00:44:31,990
Are they safe leaving the house?

881
00:44:31,990 --> 00:44:34,644
Are they going to get beaten
up in the neighborhood?

882
00:44:34,872 --> 00:44:36,624
Is it safe enough, and what do

883
00:44:36,624 --> 00:44:38,693
we have to do to make it safer?

884
00:44:38,693 --> 00:44:40,766
And this is the place
where we are advocates,

885
00:44:40,766 --> 00:44:42,534
this is the place that we are trainers.

886
00:44:42,534 --> 00:44:44,606
This is not enough to send the parents out

887
00:44:44,606 --> 00:44:46,382
to go talk to the school systems.

888
00:44:46,382 --> 00:44:50,899
We need to bear, we need to use the weight

889
00:44:50,899 --> 00:44:54,372
of our professional
knowledge and expertise

890
00:44:54,372 --> 00:44:56,797
because they will listen
to us in a way that they

891
00:44:56,797 --> 00:44:59,841
sometimes will not listen to the families.

892
00:45:00,138 --> 00:45:01,750
So are they ready?

893
00:45:01,750 --> 00:45:04,494
And there's a difference between
eligibility and readiness.

894
00:45:04,494 --> 00:45:07,738
This is a language of the
World Professional Association

895
00:45:07,738 --> 00:45:11,057
of Transgender Health, and
of the Standards of Care.

896
00:45:11,057 --> 00:45:14,109
People can be eligible for certain things,

897
00:45:14,109 --> 00:45:15,965
but they may not be ready.

898
00:45:15,965 --> 00:45:18,437
That's why we have a
gap year for some kids

899
00:45:18,437 --> 00:45:21,404
who are graduating high
school that are eligible

900
00:45:21,404 --> 00:45:25,066
for college, but they're really
not quite ready for college.

901
00:45:25,066 --> 00:45:27,264
So is the family and community ready?

902
00:45:27,264 --> 00:45:30,563
Is there enough support for
the child and the parents?

903
00:45:31,095 --> 00:45:34,380
And flexibility, are the
parents willing to see this

904
00:45:34,380 --> 00:45:36,723
as an experiment, and be committed

905
00:45:36,723 --> 00:45:38,983
to it while remaining flexible?

906
00:45:38,983 --> 00:45:40,298
Just think about that.

907
00:45:40,298 --> 00:45:42,330
That you're committed
to it, you're on board,

908
00:45:42,330 --> 00:45:44,305
you're behind your kid,
you're talking to the school,

909
00:45:44,305 --> 00:45:45,913
you're supporting your
kid, you're making sure

910
00:45:45,913 --> 00:45:48,929
your kid is safe, you're doing
all the work you need to do,

911
00:45:48,929 --> 00:45:51,499
and at the same time, you're okay with

912
00:45:51,499 --> 00:45:54,091
your kid shifting and changing.

913
00:45:54,091 --> 00:45:58,209
And anybody who's parenting
children knows that

914
00:45:58,209 --> 00:46:01,112
this is sort of part of the way it is.

915
00:46:01,112 --> 00:46:02,979
That kids are, you know...

916
00:46:02,979 --> 00:46:05,028
really, really, really,
really, want to go overseas

917
00:46:05,028 --> 00:46:07,315
and study, and then a week
before it's time to go,

918
00:46:07,315 --> 00:46:10,945
they say, "Dad, I can't
go, I'm too scared to go."

919
00:46:10,945 --> 00:46:13,987
That we're sort of moving in
and out of a lot of shifts

920
00:46:13,987 --> 00:46:18,874
and a lot of changes with this
population of young people.

921
00:46:19,880 --> 00:46:21,927
So I want to repeat
something I said earlier.

922
00:46:21,927 --> 00:46:23,082
Probably going to repeat it at least

923
00:46:23,082 --> 00:46:24,811
one more before we're done.

924
00:46:24,811 --> 00:46:28,026
Regardless of whether a
gender nonconforming child

925
00:46:28,026 --> 00:46:33,026
transitions socially, it
is in the best interest

926
00:46:33,618 --> 00:46:37,850
of all children who express
gender nonconformity

927
00:46:37,850 --> 00:46:41,711
to have their authentic
expressions of gender

928
00:46:41,711 --> 00:46:45,417
supported by peers, parents, teachers,

929
00:46:45,417 --> 00:46:48,092
and other adults in their lives.

930
00:46:48,468 --> 00:46:51,089
So whether the child is gender atypical,

931
00:46:51,089 --> 00:46:53,566
whether the child is gender dysphoric,

932
00:46:53,566 --> 00:46:58,566
whether the child is
incredibly gender typical,

933
00:46:58,708 --> 00:47:03,708
our job as parents is to support
children's gender identity.

934
00:47:04,727 --> 00:47:06,534
So this what the Standards of Care

935
00:47:06,534 --> 00:47:09,440
have to say about medical treatments.

936
00:47:11,020 --> 00:47:14,152
They talk about three
levels of treatments.

937
00:47:14,152 --> 00:47:16,677
Treatments that are fully reversible,

938
00:47:16,677 --> 00:47:18,884
and the puberty suppression
hormones that we've talked about

939
00:47:18,884 --> 00:47:23,057
are considered fully reversible.

940
00:47:23,057 --> 00:47:26,587
Like I said earlier, you
stop taking the suppressant,

941
00:47:26,587 --> 00:47:30,946
and you go right into
the normative puberty

942
00:47:30,946 --> 00:47:34,963
for children of that, who
are born of that natal sex.

943
00:47:35,639 --> 00:47:39,038
Partially reversible are
considered hormonal therapy.

944
00:47:39,038 --> 00:47:41,482
So generally speaking, we would not

945
00:47:42,082 --> 00:47:44,365
start a child on hormone therapy until

946
00:47:44,365 --> 00:47:47,302
they are at least 15 or 16 years old.

947
00:47:48,130 --> 00:47:51,460
How early we do that really
depends on the history.

948
00:47:51,460 --> 00:47:54,078
For example, if a...

949
00:47:55,433 --> 00:47:58,952
12 or 13 year old child
comes to my office,

950
00:47:58,952 --> 00:48:01,192
is expressing gender nonconformity,

951
00:48:01,192 --> 00:48:03,634
wants to start on
hormones, we put that kid

952
00:48:03,634 --> 00:48:07,032
on a hormone suppressant, we
do the work with the family,

953
00:48:07,032 --> 00:48:09,335
do the work with the kid, blah blah blah.

954
00:48:09,335 --> 00:48:12,044
You go through the whole
process of doing that,

955
00:48:12,751 --> 00:48:16,459
and the kid is wanting to take hormones,

956
00:48:16,459 --> 00:48:19,270
but you've only really
been in therapy, let's say,

957
00:48:19,270 --> 00:48:21,119
for a year or a year and a half,

958
00:48:21,119 --> 00:48:23,603
or maybe there's other
issues going on with the kid,

959
00:48:23,603 --> 00:48:26,926
that might be a kid who
doesn't start on cross-gender

960
00:48:26,926 --> 00:48:30,815
hormones until they're further
along in their puberty.

961
00:48:31,060 --> 00:48:35,563
A child like Jazz, okay,
who has been exhibiting

962
00:48:35,563 --> 00:48:39,179
this experience since
they were a small child,

963
00:48:39,179 --> 00:48:42,355
who starts living in a
cross-gender identity

964
00:48:42,355 --> 00:48:45,208
at five or six or seven
or eight years old,

965
00:48:45,208 --> 00:48:48,454
is in school in a cross-gender identity,

966
00:48:48,454 --> 00:48:51,331
has been placed on
puberty-blocking hormones

967
00:48:52,300 --> 00:48:57,300
at Tanner Stage 2 and is now 15 years old,

968
00:48:58,004 --> 00:49:01,607
and essentially, has been
living a cross-gender identity

969
00:49:01,607 --> 00:49:04,858
for over a decade, and
nobody in this child's life,

970
00:49:04,858 --> 00:49:08,382
the child included, is
seeing any evidence that this

971
00:49:08,382 --> 00:49:11,779
is changing or abating, it just
seems like there's no reason

972
00:49:11,779 --> 00:49:16,779
to not provide cross-gender
hormones to support,

973
00:49:18,494 --> 00:49:21,025
to affirm the gender
identity that the child

974
00:49:21,025 --> 00:49:23,246
is going to be living
in, and the child is now

975
00:49:23,246 --> 00:49:26,486
going to go through their puberty

976
00:49:26,486 --> 00:49:29,538
at the correct time in their lives.

977
00:49:30,029 --> 00:49:33,453
Medical treatments that
are considered irreversible

978
00:49:33,453 --> 00:49:37,034
are surgeries, and again, nobody is doing

979
00:49:37,034 --> 00:49:39,591
genital surgery on teenagers.

980
00:49:39,591 --> 00:49:41,256
Certainly nobody is doing them on

981
00:49:41,256 --> 00:49:43,195
anyone younger than teenagers.

982
00:49:43,195 --> 00:49:48,195
Occasionally, a handful
of doctors are doing

983
00:49:49,984 --> 00:49:54,984
breast removal and chest
reconstruction for older teens.

984
00:49:56,881 --> 00:49:59,190
But in terms of genital surgeries, nobody

985
00:49:59,190 --> 00:50:01,822
is doing those before the age of 18,

986
00:50:01,822 --> 00:50:05,310
and they are considered
irreversible surgeries.

987
00:50:05,310 --> 00:50:07,587
That doesn't mean that
gender is irreversible.

988
00:50:07,587 --> 00:50:10,958
People can still change
their gender if that is

989
00:50:10,958 --> 00:50:13,735
how they come to experience themselves

990
00:50:13,735 --> 00:50:16,400
later down the road, but it does of course

991
00:50:16,400 --> 00:50:20,338
make for major complications
in terms of surgery.

992
00:50:20,732 --> 00:50:24,196
So here's the criteria for
puberty delaying hormones.

993
00:50:24,196 --> 00:50:28,509
Long-lasting and intense
pattern of gender dysphoria.

994
00:50:28,624 --> 00:50:31,265
Again, it can be suppressed or
expressed, meaning there are

995
00:50:31,265 --> 00:50:33,330
kids that are sort of
underground about their gender,

996
00:50:33,330 --> 00:50:35,696
and kids that are way out
there about their gender.

997
00:50:35,696 --> 00:50:39,557
So long-lasting and intense
pattern of gender dysphoria.

998
00:50:40,172 --> 00:50:44,461
That the gender dysphoria
emerges or worsens with puberty.

999
00:50:44,461 --> 00:50:46,756
And again, this is this big area.

1000
00:50:46,756 --> 00:50:50,325
For some kids, they're gender
atypical, but they really

1001
00:50:50,325 --> 00:50:53,711
don't have a lot of dysphoria,
until boom, they hit puberty,

1002
00:50:53,711 --> 00:50:56,362
and they're like, "Whoa, what
is happening with my body?"

1003
00:50:56,362 --> 00:50:59,041
For other kids, they've had
the dysphoria all along,

1004
00:50:59,041 --> 00:51:03,416
but it gets very, very, very
big when they hit puberty.

1005
00:51:03,902 --> 00:51:08,664
That any co-existing
psychological, medical, or social

1006
00:51:08,664 --> 00:51:10,734
problems that could interfere with

1007
00:51:10,734 --> 00:51:13,319
treatment have been addressed.

1008
00:51:13,319 --> 00:51:14,809
Now this is complicated.

1009
00:51:14,809 --> 00:51:17,806
Again, we're dealing with
youth, with a particular group

1010
00:51:17,806 --> 00:51:22,078
of youth that are often
experiencing all kinds of social

1011
00:51:22,078 --> 00:51:26,455
ostracism, they're often
experiencing social oppression,

1012
00:51:26,455 --> 00:51:29,839
their bias, they're struggling
with their own identity,

1013
00:51:29,839 --> 00:51:33,557
they're struggling with how
to fit in psycho-socially

1014
00:51:33,557 --> 00:51:36,381
with their peers on a lot of levels.

1015
00:51:37,659 --> 00:51:39,887
It's complicated, puberty is complicated,

1016
00:51:39,887 --> 00:51:42,894
youth is complicated,
adolescence is complicated

1017
00:51:42,894 --> 00:51:46,451
without having gender issues,
that it is just complicated.

1018
00:51:46,743 --> 00:51:49,839
But as much as able, we want to help

1019
00:51:49,839 --> 00:51:53,078
deal with any comorbid issues.

1020
00:51:53,078 --> 00:51:55,439
Any depression, any
anxiety, certainly any kinds

1021
00:51:55,439 --> 00:51:57,918
of substance abuse,
certainly any kinds of major

1022
00:51:57,918 --> 00:52:01,423
mental health issues, that we
want to do everything we can

1023
00:52:01,423 --> 00:52:05,373
to assist the child in
being in the healthiest

1024
00:52:05,373 --> 00:52:08,287
and most stable place
that we can at the time

1025
00:52:08,287 --> 00:52:12,071
that we start administering
puberty-delaying hormones.

1026
00:52:12,416 --> 00:52:14,105
We want to make sure that the adolescent

1027
00:52:14,105 --> 00:52:16,144
has been given informed consent.

1028
00:52:16,144 --> 00:52:20,487
Is the adolescent able to,
do they have the skills,

1029
00:52:20,487 --> 00:52:23,540
to understand what it
is that they're doing?

1030
00:52:23,598 --> 00:52:26,059
And that parents and
caregivers have consented

1031
00:52:26,059 --> 00:52:28,592
to the treatment throughout
the treatment process.

1032
00:52:28,592 --> 00:52:33,387
So one of the things that we
examine when we're looking at,

1033
00:52:33,583 --> 00:52:36,387
not just puberty-delaying
hormones, but also

1034
00:52:36,387 --> 00:52:38,939
most specifically cross-gender hormones,

1035
00:52:38,939 --> 00:52:42,239
is the effects that this will
likely have on fertility.

1036
00:52:42,669 --> 00:52:43,986
Now I'm not a medical doctor and I'm not

1037
00:52:43,986 --> 00:52:46,502
going to go into a lot of
the details about that.

1038
00:52:46,502 --> 00:52:49,279
But what I want to say
is that part of my job

1039
00:52:49,279 --> 00:52:53,130
is to talk to 14 year
olds and 15 year olds

1040
00:52:53,130 --> 00:52:56,542
and 16 year olds about
their future fertility.

1041
00:52:56,722 --> 00:53:00,174
Now I think that it is so
important that we do this.

1042
00:53:00,174 --> 00:53:03,768
I was so supportive of the
WPATH Standards of Care

1043
00:53:05,798 --> 00:53:10,087
when they put directly into the...

1044
00:53:10,951 --> 00:53:14,281
the Standards of Care
that fertility needs to be

1045
00:53:14,281 --> 00:53:16,650
one of the things that we assess for.

1046
00:53:16,650 --> 00:53:21,650
However, it is really hard
to talk to a 15 year old

1047
00:53:21,842 --> 00:53:24,072
about whether or not they may want

1048
00:53:24,072 --> 00:53:27,442
to get pregnant in 10 years or 20 years.

1049
00:53:27,442 --> 00:53:31,356
It's really difficult to talk
about sperm preservation.

1050
00:53:31,356 --> 00:53:34,262
It's really difficult to talk
about the quality of your eggs

1051
00:53:34,262 --> 00:53:38,021
or how that may effect your
ability to carry a child.

1052
00:53:38,319 --> 00:53:41,422
The average 15 year old
couldn't care less about

1053
00:53:41,422 --> 00:53:43,124
those things, and there are exceptions.

1054
00:53:43,124 --> 00:53:46,410
I actually once did a consult

1055
00:53:46,410 --> 00:53:51,410
with a young, young
here being 16 years old,

1056
00:53:52,885 --> 00:53:56,243
female who was considered transitioning,

1057
00:53:56,243 --> 00:53:59,895
and did three sessions where on her own,

1058
00:53:59,895 --> 00:54:02,697
she came in to treatment
saying that she really,

1059
00:54:02,697 --> 00:54:04,541
that was what she wanted to look at,

1060
00:54:04,541 --> 00:54:07,198
was whether or not she
could preserve her fertility

1061
00:54:07,198 --> 00:54:09,257
because that was really important to her,

1062
00:54:09,257 --> 00:54:11,497
and it was so important that
she was willing to delay

1063
00:54:11,497 --> 00:54:14,513
starting testosterone, if need be,

1064
00:54:14,513 --> 00:54:17,329
until she got pregnant and had children.

1065
00:54:17,329 --> 00:54:19,357
So there are exceptions to this,

1066
00:54:19,357 --> 00:54:23,282
but most of the time,
young people, it's just...

1067
00:54:23,970 --> 00:54:27,458
It's like talking to them
about their retirement fund.

1068
00:54:27,458 --> 00:54:29,751
Like they just have no idea
what you're talking about.

1069
00:54:29,751 --> 00:54:33,462
And I'm not trying to put down
young people when I say this.

1070
00:54:33,462 --> 00:54:37,099
It is just developmentally, a 15 year old

1071
00:54:37,099 --> 00:54:42,091
is really not capable of
the kind of informed consent

1072
00:54:42,091 --> 00:54:45,813
that we would like them to be
able to be responsible for.

1073
00:54:45,813 --> 00:54:47,143
They're just not.

1074
00:54:47,143 --> 00:54:49,664
They're 15 years old, and, you know,

1075
00:54:50,467 --> 00:54:53,521
getting hormones is
really important to them.

1076
00:54:53,521 --> 00:54:55,290
That's what's really
important, not whether

1077
00:54:55,290 --> 00:54:56,613
or not they're going to be able...

1078
00:54:56,613 --> 00:54:57,911
So the most common answer we get

1079
00:54:57,911 --> 00:55:00,699
from children is, "I'm
really fine adopting."

1080
00:55:00,699 --> 00:55:02,753
Which is great, I'm an adoptive parent,

1081
00:55:02,753 --> 00:55:05,388
I think adoption is a marvelous thing

1082
00:55:05,388 --> 00:55:07,827
and I support these kids,
but I do want to say,

1083
00:55:07,827 --> 00:55:09,931
when we talk about some
of the ethical concerns,

1084
00:55:09,931 --> 00:55:12,811
is I do suspect that some
of these young people

1085
00:55:12,811 --> 00:55:16,754
might later on have
some regrets about that.

1086
00:55:16,754 --> 00:55:21,323
The example I want to give to
you in thinking about this is,

1087
00:55:22,319 --> 00:55:25,113
I understand these are
really weighty decisions

1088
00:55:25,113 --> 00:55:28,507
that we're making, but if you
had a child, a female child,

1089
00:55:28,507 --> 00:55:31,495
who came into your
office who was pregnant,

1090
00:55:31,495 --> 00:55:35,287
and she said, "I'm 16 years old,

1091
00:55:35,287 --> 00:55:38,600
"I'm three months pregnant,
I don't believe in abortion,

1092
00:55:38,600 --> 00:55:41,787
"and I want to have this child."

1093
00:55:42,343 --> 00:55:44,615
I suspect that nobody listening to this

1094
00:55:44,615 --> 00:55:47,001
would say that we should
force her to have an abortion.

1095
00:55:48,124 --> 00:55:50,152
I suspect that anybody
who's listening to this

1096
00:55:50,152 --> 00:55:54,046
that's over 25 or 30 yourself
recognizes how difficult

1097
00:55:54,046 --> 00:55:57,065
it is to be a parent,
period, let alone to be

1098
00:55:57,065 --> 00:56:00,297
a 16 year old parent, and
we're going to have concerns

1099
00:56:00,297 --> 00:56:04,133
about this child moving
forward, who I don't think

1100
00:56:04,133 --> 00:56:07,156
is capable of understanding,
at 16 years old,

1101
00:56:07,156 --> 00:56:10,017
what it really means to
be responsible for a baby,

1102
00:56:10,017 --> 00:56:13,845
let alone that baby for the next 18 years.

1103
00:56:14,393 --> 00:56:16,289
And as the mother of an 18-year-old,

1104
00:56:16,289 --> 00:56:18,347
it doesn't stop at 18, right?

1105
00:56:18,347 --> 00:56:20,681
The responsibility that
we have to our children

1106
00:56:20,681 --> 00:56:24,221
and our care and our love
goes on way past that.

1107
00:56:24,514 --> 00:56:27,003
I don't think a 16 year
old is capable of that,

1108
00:56:27,003 --> 00:56:28,393
but that doesn't mean it's not

1109
00:56:28,393 --> 00:56:31,134
her right to make that choice.

1110
00:56:31,503 --> 00:56:33,555
We understand that the choice she makes,

1111
00:56:33,555 --> 00:56:35,871
if she makes a choice to have an abortion,

1112
00:56:35,871 --> 00:56:39,625
I've certainly had numbers of grown women

1113
00:56:39,625 --> 00:56:42,347
in my office who are grieving abortions

1114
00:56:42,347 --> 00:56:44,746
that they had when they were younger.

1115
00:56:45,040 --> 00:56:47,822
That we make choices to
the best of our ability.

1116
00:56:47,822 --> 00:56:50,782
My somewhat tongue-in-cheek example

1117
00:56:50,782 --> 00:56:54,786
is people are allowed to get
married even when we think

1118
00:56:54,786 --> 00:56:58,032
they're marrying a really
stupid, shitty person.

1119
00:56:58,032 --> 00:57:00,288
They're allowed to do that.

1120
00:57:00,288 --> 00:57:03,372
We don't interfere with people's rights.

1121
00:57:03,372 --> 00:57:06,393
What we do is we try to give
them all the information

1122
00:57:06,393 --> 00:57:08,700
we can about the choices
that they can make.

1123
00:57:08,700 --> 00:57:12,015
Do birth mothers feel sad sometimes

1124
00:57:12,015 --> 00:57:14,836
that they placed children for adoption?

1125
00:57:15,152 --> 00:57:18,829
Do birth mothers, I would
say, mostly feel sad about it?

1126
00:57:18,829 --> 00:57:21,232
Do they sometimes regret it later in life?

1127
00:57:21,232 --> 00:57:23,196
That's true.

1128
00:57:23,704 --> 00:57:25,730
That doesn't mean birth
mothers should not have

1129
00:57:25,730 --> 00:57:28,984
the right to place children for adoption.

1130
00:57:28,984 --> 00:57:32,934
That these decisions are
complicated on multiple levels.

1131
00:57:32,934 --> 00:57:36,291
We're going to move to the
best kind of informed consent

1132
00:57:36,291 --> 00:57:38,912
that we can possibly
provide, the best kind

1133
00:57:38,912 --> 00:57:41,585
of psycho-education
for everybody involved,

1134
00:57:41,585 --> 00:57:44,885
but then there's a piece
here that we have to accept

1135
00:57:44,885 --> 00:57:47,772
that there are limitations of knowledge

1136
00:57:47,772 --> 00:57:51,190
and limitations of ability to understand.

1137
00:57:51,190 --> 00:57:53,716
I think anybody here that has a child

1138
00:57:53,716 --> 00:57:56,137
that's listening to this knows that,

1139
00:57:56,137 --> 00:57:57,956
prepared as you might have been,

1140
00:57:57,956 --> 00:58:01,372
that there's no way to
prepare for being a parent.

1141
00:58:01,652 --> 00:58:04,410
It's absolutely a different experience.

1142
00:58:06,116 --> 00:58:09,206
The map is not the territory,
as they say, right?

1143
00:58:09,206 --> 00:58:12,322
So we can listen to these young people

1144
00:58:12,322 --> 00:58:15,532
talk about their gender
and how they experience it.

1145
00:58:15,532 --> 00:58:18,100
We can help them make the best choices,

1146
00:58:18,100 --> 00:58:20,989
but how they settle with those choices

1147
00:58:20,989 --> 00:58:23,892
is going to continuously evolve

1148
00:58:23,892 --> 00:58:26,713
over the years and decades to come,

1149
00:58:26,713 --> 00:58:30,034
and our job is to support
them in those changes

1150
00:58:30,034 --> 00:58:33,320
that may happen as they go through this.

1151
00:58:33,621 --> 00:58:37,446
Okay, so feminizing and
masculinizing hormone therapy.

1152
00:58:37,446 --> 00:58:39,714
Adolescents, this is from
the Standards of Care,

1153
00:58:39,714 --> 00:58:42,743
may be eligible to begin hormone therapy,

1154
00:58:42,743 --> 00:58:44,838
preferably with parental consent,

1155
00:58:44,838 --> 00:58:47,624
as young as 16, and often 18.

1156
00:58:47,624 --> 00:58:49,933
What we say is that it's the laws

1157
00:58:49,933 --> 00:58:51,798
of the country that you live in.

1158
00:58:51,798 --> 00:58:54,238
In the US, you're an adult at 18.

1159
00:58:54,238 --> 00:58:56,968
In other countries you're
an adult at younger ages.

1160
00:58:57,550 --> 00:59:01,307
We often, again, with
young people that have

1161
00:59:01,307 --> 00:59:05,572
a persistent history,
we often start to make

1162
00:59:05,572 --> 00:59:08,626
these decisions at 16 and 17 years old.

1163
00:59:09,422 --> 00:59:12,984
Ideally, the treatment is
made with the adolescent,

1164
00:59:12,984 --> 00:59:15,506
the family, and a treatment team.

1165
00:59:15,558 --> 00:59:17,485
I know that some of you
are working in clinics

1166
00:59:17,485 --> 00:59:20,406
and situations where
these children are living,

1167
00:59:20,406 --> 00:59:22,162
these young people are
living on the streets,

1168
00:59:22,162 --> 00:59:24,291
that they don't have
connection with their families.

1169
00:59:24,291 --> 00:59:25,795
Their families are not supportive,

1170
00:59:25,795 --> 00:59:27,395
their families are
abandoning, their families

1171
00:59:27,395 --> 00:59:29,894
are abusive to them in all kinds of ways,

1172
00:59:29,894 --> 00:59:33,083
and these decisions are not
made with family involved,

1173
00:59:33,083 --> 00:59:35,034
and that when we're making those decisions

1174
00:59:35,034 --> 00:59:38,131
without family involved,
it behooves us as adults

1175
00:59:38,131 --> 00:59:41,155
in these young people's
lives, to in some way

1176
00:59:41,155 --> 00:59:45,343
replace the kind of love and
caring that they should be

1177
00:59:45,343 --> 00:59:48,243
having at home with their
family, with a treatment team

1178
00:59:48,243 --> 00:59:50,873
of adults that are able
to help them think through

1179
00:59:50,873 --> 00:59:52,665
these decisions, and make the best

1180
00:59:52,665 --> 00:59:55,207
possible choices that they can make.

1181
00:59:55,775 --> 00:59:59,309
So what are some of the
ethics of medical referral?

1182
01:00:00,251 --> 01:00:03,120
Some of the pros, that
gender dysphoria impacts

1183
01:00:03,120 --> 01:00:06,978
self-esteem and interferes
with normative development.

1184
01:00:06,978 --> 01:00:09,822
So these teens are already struggling

1185
01:00:10,451 --> 01:00:13,131
with how they feel about themselves,

1186
01:00:13,131 --> 01:00:16,736
and they're struggling with
just being able to move through

1187
01:00:16,736 --> 01:00:19,897
a normal developmental adolescence

1188
01:00:19,897 --> 01:00:22,036
because of their gender dysphoria.

1189
01:00:22,036 --> 01:00:25,117
So the puberty blocking
treatments, as well as

1190
01:00:25,117 --> 01:00:27,698
the later hormonal
treatments, help them to move

1191
01:00:27,698 --> 01:00:30,245
through a more normative development.

1192
01:00:31,114 --> 01:00:33,501
You know, that young people, especially

1193
01:00:33,501 --> 01:00:36,859
these days, see transgender adults.

1194
01:00:36,859 --> 01:00:39,427
They're getting on YouTube
and they're seeing other kids

1195
01:00:39,427 --> 01:00:42,321
that are following through
on these kind of treatments.

1196
01:00:42,321 --> 01:00:46,116
So it's not like they
don't know the options.

1197
01:00:46,116 --> 01:00:47,725
A lot of times when I work with adults,

1198
01:00:47,725 --> 01:00:49,159
they'll say, "I didn't know."

1199
01:00:49,159 --> 01:00:50,382
Like "I didn't know that I could have

1200
01:00:50,382 --> 01:00:51,696
"done this when I was younger."

1201
01:00:51,696 --> 01:00:53,295
And the truth is, when
you're 40 years old,

1202
01:00:53,295 --> 01:00:54,868
they couldn't have done
it when they were younger,

1203
01:00:54,868 --> 01:00:56,976
because these options did not exist then.

1204
01:00:56,976 --> 01:00:58,589
So they know what can be done.

1205
01:00:58,589 --> 01:01:00,748
And I want to remind you
of what I said earlier,

1206
01:01:00,748 --> 01:01:04,792
which is most transsexuals,
most adult transsexuals,

1207
01:01:04,792 --> 01:01:07,938
knew from the time they were very young.

1208
01:01:08,125 --> 01:01:10,627
So when we're looking
at this cohort of kids

1209
01:01:10,627 --> 01:01:15,627
who have persistent gender
dysphoria over time,

1210
01:01:15,978 --> 01:01:19,237
that they exhibited these
cross-gender behaviors

1211
01:01:19,237 --> 01:01:23,538
from a young age, that have
this anatomical dysphoria,

1212
01:01:23,538 --> 01:01:28,227
that are in this cohort
who are most likely going

1213
01:01:28,227 --> 01:01:33,227
to grow up and be transsexual,
that we are helping,

1214
01:01:33,845 --> 01:01:36,196
we are helping them to be on

1215
01:01:36,196 --> 01:01:38,748
the correct developmental path.

1216
01:01:38,748 --> 01:01:42,261
Some of the concerns is, hello,

1217
01:01:42,261 --> 01:01:44,156
young people do not always make

1218
01:01:44,156 --> 01:01:45,924
healthy and sound
decisions for themselves.

1219
01:01:45,924 --> 01:01:49,633
I am the mother of two
delightful young teenage men,

1220
01:01:49,633 --> 01:01:53,584
and I can tell you that it
is a whirlwind watching...

1221
01:01:53,920 --> 01:01:56,417
And I'm not talking about
cross-gender hormones here.

1222
01:01:56,417 --> 01:01:59,266
I'm talking about, "What did you eat?"

1223
01:01:59,266 --> 01:02:01,523
"Well, the last five meals I had pizza."

1224
01:02:01,523 --> 01:02:03,437
"Well, that might be why
you have a bellyache.

1225
01:02:03,437 --> 01:02:05,181
"I'm not a hundred percent sure, honey,

1226
01:02:05,181 --> 01:02:07,013
"but that might be why
you have a bellyache."

1227
01:02:07,013 --> 01:02:08,605
You know, that they make...

1228
01:02:08,605 --> 01:02:10,188
Actually my favorite
line, I'll share with you.

1229
01:02:10,188 --> 01:02:12,719
Years ago a friend of
mine's son said to her,

1230
01:02:12,719 --> 01:02:14,990
"I figured out, mom, that you don't

1231
01:02:14,990 --> 01:02:17,344
"actually have to wash your jeans.

1232
01:02:17,344 --> 01:02:19,856
"That if you just put them in the dryer

1233
01:02:19,856 --> 01:02:21,823
"they just smell clean."

1234
01:02:22,131 --> 01:02:24,407
So young people do not always make

1235
01:02:24,407 --> 01:02:27,004
healthy and sound
decisions for themselves.

1236
01:02:27,004 --> 01:02:30,086
And especially these days,
where access to YouTube,

1237
01:02:30,086 --> 01:02:34,359
access to communities
of transgender youth,

1238
01:02:34,359 --> 01:02:37,591
that kids that are disenfranchised,
kids that are struggling

1239
01:02:37,591 --> 01:02:40,931
with all kinds of other
things about their identity,

1240
01:02:41,996 --> 01:02:45,243
where being "queer" and
being "gender-bending"

1241
01:02:45,243 --> 01:02:50,204
is sometimes cool, and where we know that

1242
01:02:50,204 --> 01:02:54,161
some of these kids are
going to identify as adults

1243
01:02:54,161 --> 01:02:57,681
not as transgender, but as gay.

1244
01:02:58,593 --> 01:03:03,094
That there's a lot of different
decisions that are coming in

1245
01:03:03,094 --> 01:03:05,807
when they're coming into
our office for assessment.

1246
01:03:05,807 --> 01:03:08,344
So we need to be also looking.

1247
01:03:08,344 --> 01:03:09,916
It's a balance here.

1248
01:03:09,916 --> 01:03:11,842
We want to be advocates,
we want to be supporting

1249
01:03:11,842 --> 01:03:13,992
these kids, because most people aren't.

1250
01:03:13,992 --> 01:03:16,316
Most therapists they're going in to see

1251
01:03:16,316 --> 01:03:18,581
are psychoanalyzing them, or thinking,

1252
01:03:18,581 --> 01:03:20,388
"Do you think you're transgender

1253
01:03:20,388 --> 01:03:22,449
"because your parents are divorced?

1254
01:03:22,449 --> 01:03:25,712
"I think that you're transgender
because your dads are gay."

1255
01:03:25,712 --> 01:03:28,533
All this stuff, all this psycho-babble.

1256
01:03:28,533 --> 01:03:31,780
So it is so important
for us to listen to their

1257
01:03:31,780 --> 01:03:34,825
authentic stories about their gender,

1258
01:03:34,825 --> 01:03:37,146
and to be advocates and support them.

1259
01:03:37,146 --> 01:03:40,315
But on the other hand, it
would be irresponsible for us

1260
01:03:40,315 --> 01:03:43,339
to not recognize that we are adults,

1261
01:03:43,339 --> 01:03:46,602
and that they are children,
they are young people,

1262
01:03:46,602 --> 01:03:49,818
who are dealing within
a very complicated world

1263
01:03:49,818 --> 01:03:52,115
trying to understand their identity.

1264
01:03:52,115 --> 01:03:54,146
We know from Erik Erikson's work that

1265
01:03:54,146 --> 01:03:59,006
this is a stage, this is
a process, so how they...

1266
01:03:59,006 --> 01:04:01,605
Any of you that are
listening, if you think back

1267
01:04:01,605 --> 01:04:06,145
on your 15 year old self, I suggest

1268
01:04:06,145 --> 01:04:09,994
that you've probably changed
a little bit since that self.

1269
01:04:09,994 --> 01:04:11,792
And some of the things that you knew,

1270
01:04:11,792 --> 01:04:14,074
that you knew were about yourself,

1271
01:04:14,074 --> 01:04:16,319
you knew would never
change about yourself,

1272
01:04:16,319 --> 01:04:19,765
well guess what, it has
changed about who you are.

1273
01:04:19,765 --> 01:04:23,268
So again, it's a balance
that we're trying to do,

1274
01:04:23,268 --> 01:04:25,813
and there's a handful of
kids, there's not many,

1275
01:04:25,813 --> 01:04:28,463
but there's a handful of kids who

1276
01:04:29,002 --> 01:04:34,002
are sort of caught up in more of a

1277
01:04:35,090 --> 01:04:39,494
gender celebratory, youthful party,

1278
01:04:39,494 --> 01:04:43,169
then they are really experiencing
any kind of dysphoria,

1279
01:04:43,169 --> 01:04:45,475
and the assessment process of whether

1280
01:04:45,475 --> 01:04:48,610
it is appropriate for them to have

1281
01:04:49,669 --> 01:04:52,157
puberty suppressing hormones
or cross-gender hormones

1282
01:04:52,157 --> 01:04:54,184
is a little bit more
complicated than the kids

1283
01:04:54,184 --> 01:04:57,145
that are clearly experiencing
gender dysphoria.

1284
01:04:57,604 --> 01:05:01,217
Okay, so let's look at some of
the implications of research.

1285
01:05:01,477 --> 01:05:04,408
So the good news, and I
do think it is good news,

1286
01:05:04,408 --> 01:05:09,046
that research has shown that
people who medically transition

1287
01:05:09,046 --> 01:05:14,046
in adolescence show improved post-surgical

1288
01:05:14,134 --> 01:05:16,925
psychological adjustment, as compared

1289
01:05:16,925 --> 01:05:19,652
to transsexuals who
transition later in life.

1290
01:05:19,652 --> 01:05:23,463
So what I'm saying is
that kids that have been

1291
01:05:23,463 --> 01:05:28,020
assessed and assisted, in
either puberty blocking hormones

1292
01:05:28,020 --> 01:05:31,544
and later cross-sex
hormones, that when we follow

1293
01:05:31,544 --> 01:05:36,544
these children over time,
that their post-surgical,

1294
01:05:36,842 --> 01:05:41,842
post-transition adjustment,
how they are doing at age 25,

1295
01:05:44,794 --> 01:05:49,185
is better than transsexuals
who begin the process

1296
01:05:49,185 --> 01:05:53,483
of transition, let's say when
they are in their 20s or 30s

1297
01:05:53,483 --> 01:05:58,483
or, commonly for male-to-females,
in their 40s and 50s.

1298
01:06:00,718 --> 01:06:02,886
That their adjustment is more difficult,

1299
01:06:02,886 --> 01:06:04,574
and doesn't that make sense?

1300
01:06:04,574 --> 01:06:07,174
You're 35 years old, you're married,

1301
01:06:07,174 --> 01:06:09,535
you have teenage children yourself,

1302
01:06:09,842 --> 01:06:12,824
you're fired from your job when
you try to talk about this,

1303
01:06:12,824 --> 01:06:16,468
that you have an established
life that, generally speaking,

1304
01:06:16,468 --> 01:06:20,552
transition is not considered
what anybody expected

1305
01:06:20,552 --> 01:06:22,850
to be in your trajectory,
by your wife, by your kids,

1306
01:06:22,850 --> 01:06:24,371
by your job, by your neighborhood,

1307
01:06:24,371 --> 01:06:26,436
by your church, etcetera, etcetera.

1308
01:06:26,436 --> 01:06:30,260
That when people transition younger,

1309
01:06:30,670 --> 01:06:34,531
they have the ability for
having successful adult lives,

1310
01:06:34,531 --> 01:06:37,377
that their relationship,
their education, their career

1311
01:06:37,377 --> 01:06:42,179
is all done in their
correct, affirmed gender.

1312
01:06:42,585 --> 01:06:44,810
So you transition,
let's say you transition

1313
01:06:44,810 --> 01:06:49,349
socially at age 10, and you start taking

1314
01:06:49,349 --> 01:06:54,349
puberty suppressing
hormones at age 11 or 12.

1315
01:06:55,458 --> 01:06:58,038
You're living now, I'm
going to say female-to-male

1316
01:06:58,038 --> 01:07:00,879
for no particular reason,
but female-to-male,

1317
01:07:00,879 --> 01:07:03,186
and you're living now as a boy,

1318
01:07:03,186 --> 01:07:06,263
and now you're entering high
school and you're a boy,

1319
01:07:06,263 --> 01:07:11,263
and you're able to be
socially identified as a boy.

1320
01:07:11,670 --> 01:07:14,105
You're able to date however you

1321
01:07:14,105 --> 01:07:17,162
would, gay or straight, as a boy.

1322
01:07:17,519 --> 01:07:19,666
Now you're taking cross-gender hormones,

1323
01:07:19,666 --> 01:07:21,525
so you're maturing as a boy.

1324
01:07:21,525 --> 01:07:24,589
You're able to make
decisions for your life,

1325
01:07:24,589 --> 01:07:27,685
the decisions about what
college you want to go to,

1326
01:07:27,685 --> 01:07:29,567
you're able to make
decisions about where...

1327
01:07:29,567 --> 01:07:32,335
As a boy, you're able to make your

1328
01:07:32,335 --> 01:07:35,339
career decisions as a boy, that the name

1329
01:07:35,339 --> 01:07:38,564
on your high school
diploma is a boy's name.

1330
01:07:38,564 --> 01:07:41,236
So the adjustment is easier.

1331
01:07:41,692 --> 01:07:43,782
I also want to ask you to think about

1332
01:07:43,782 --> 01:07:46,893
what are the ethical implications

1333
01:07:46,893 --> 01:07:49,157
of not assisting these young people?

1334
01:07:49,157 --> 01:07:52,204
What happens if we choose
to not assist them?

1335
01:07:53,255 --> 01:07:57,056
So this quote here by...

1336
01:07:57,556 --> 01:08:02,346
These folks, Gooren and de
Waal, are some of the early...

1337
01:08:02,828 --> 01:08:05,220
They've been doing research
in cross-gender hormones

1338
01:08:05,220 --> 01:08:07,598
for decades now, so they
are really the folks

1339
01:08:07,598 --> 01:08:11,934
who all of the, you know,
we are the inheritors

1340
01:08:11,934 --> 01:08:14,818
of their medical expertise and knowledge.

1341
01:08:15,209 --> 01:08:18,005
"It is to be remembered that giving,

1342
01:08:18,837 --> 01:08:23,837
"but also withholding, endocrine treatment

1343
01:08:23,846 --> 01:08:26,523
"is a momentous and responsible decision."

1344
01:08:26,523 --> 01:08:31,424
So it's not just giving,
but actually withholding,

1345
01:08:31,424 --> 01:08:35,232
is a momentous and responsible decision.

1346
01:08:35,720 --> 01:08:40,114
And one cannot sidestep
the ethical dilemmas

1347
01:08:40,114 --> 01:08:45,114
by merely avoiding them, especially given

1348
01:08:45,163 --> 01:08:49,674
the devastating impact puberty
can have on this population.

1349
01:08:49,674 --> 01:08:53,619
And they mean that endocrinologically,

1350
01:08:53,973 --> 01:08:57,921
physiologically, as
well as psychologically.

1351
01:08:58,508 --> 01:09:00,567
So some other benefits.

1352
01:09:01,079 --> 01:09:05,628
Another benefit of early
gender reassignment,

1353
01:09:05,628 --> 01:09:07,916
gender confirmation, is that these youth

1354
01:09:07,916 --> 01:09:11,290
would not need to develop a false sense

1355
01:09:11,290 --> 01:09:13,307
in a gender identity and expression that

1356
01:09:13,307 --> 01:09:15,249
does not feel authentic to them.

1357
01:09:15,252 --> 01:09:17,354
So again, think about that.

1358
01:09:17,590 --> 01:09:21,418
You're born a girl, you identify as a boy,

1359
01:09:21,418 --> 01:09:23,519
but you can't live as a
boy because your family

1360
01:09:23,519 --> 01:09:25,622
or school or neighborhood
won't allow you to.

1361
01:09:25,622 --> 01:09:27,030
You can't even really talk about it,

1362
01:09:27,030 --> 01:09:29,654
you can't even really tell
anybody, so you're a girl.

1363
01:09:29,654 --> 01:09:31,926
And how successful at being a girl

1364
01:09:31,926 --> 01:09:33,719
are you going to be socially?

1365
01:09:33,719 --> 01:09:35,550
How successful are you going to be dating?

1366
01:09:35,550 --> 01:09:39,268
How are, what is your sweet
16 going to look like?

1367
01:09:39,268 --> 01:09:43,326
How are you going be able to
move through this process?

1368
01:09:43,560 --> 01:09:47,095
And you're going to have to
create a false sense to do that.

1369
01:09:47,095 --> 01:09:49,961
And I think that everybody
listening understands

1370
01:09:49,961 --> 01:09:52,235
the incredible psychological damage

1371
01:09:52,235 --> 01:09:55,517
of what it means to not
have an authentic self.

1372
01:09:56,649 --> 01:10:01,055
So their socialization as
women or men gets to happen

1373
01:10:01,055 --> 01:10:06,055
naturally in their pre-pubescent
and pubescent years.

1374
01:10:06,124 --> 01:10:09,581
They don't have to unlearn their original

1375
01:10:09,581 --> 01:10:12,931
gender socialization and
then re-learn a new one.

1376
01:10:12,931 --> 01:10:14,295
And you know, for those of us that work

1377
01:10:14,295 --> 01:10:17,563
with adult transsexuals, you know, again,

1378
01:10:18,835 --> 01:10:22,762
I completely recognize
all of the stupidity

1379
01:10:22,762 --> 01:10:26,498
of gender roles and all of the
ways that it is just stupid

1380
01:10:26,498 --> 01:10:28,772
that girls can do this
and boys can do this

1381
01:10:28,772 --> 01:10:30,981
and girls act like this
and boys act like this,

1382
01:10:30,981 --> 01:10:33,386
and I recognize all the limitations of it.

1383
01:10:33,386 --> 01:10:35,929
But when you have been raised as a man

1384
01:10:35,929 --> 01:10:39,247
and socialized as a man, and you're trying

1385
01:10:39,247 --> 01:10:44,247
to live your life as a
woman, the ability to pass,

1386
01:10:44,675 --> 01:10:48,405
to move through the
world in ways that will

1387
01:10:48,405 --> 01:10:51,988
appear to others to be
the way they expect women

1388
01:10:51,988 --> 01:10:55,642
to look and behave,
becomes really important,

1389
01:10:55,642 --> 01:11:00,056
and re-learning a new gender socialization

1390
01:11:00,056 --> 01:11:03,904
is a tremendous amount of effort and time.

1391
01:11:05,719 --> 01:11:08,699
And lastly, the developmental process

1392
01:11:08,699 --> 01:11:11,649
would take place during
the proper life cycle.

1393
01:11:11,649 --> 01:11:15,704
In other words, your teenage years is when

1394
01:11:15,704 --> 01:11:18,006
you're supposed to be
exploring sex and gender.

1395
01:11:18,006 --> 01:11:19,285
That doesn't mean you're not allowed

1396
01:11:19,285 --> 01:11:21,663
to explore it for the rest of your life.

1397
01:11:22,174 --> 01:11:25,093
But that this is the
part of the life cycle

1398
01:11:25,093 --> 01:11:28,889
where people are absolutely
beginning to figure out

1399
01:11:28,889 --> 01:11:30,969
"Am I gay or am I straight?

1400
01:11:30,969 --> 01:11:32,742
"Do I like boys or do I like girls?

1401
01:11:32,742 --> 01:11:34,522
"Do I want to date or
don't I want to date?

1402
01:11:34,522 --> 01:11:36,288
"How do I want to present myself?"

1403
01:11:36,288 --> 01:11:39,073
Children go through this period of

1404
01:11:39,073 --> 01:11:41,394
sort of changing how they look.

1405
01:11:41,394 --> 01:11:46,394
They go from sort of
Abercrombie to grunge,

1406
01:11:47,441 --> 01:11:52,135
from sophomore to junior
year of high school.

1407
01:11:52,135 --> 01:11:54,109
They're trying on identities to say,

1408
01:11:54,109 --> 01:11:57,248
"Where do I fit in to the world?"

1409
01:11:57,248 --> 01:12:02,248
And they're doing this in
their proper gender identity

1410
01:12:02,337 --> 01:12:06,549
when we support them in young transitions.

1411
01:12:07,107 --> 01:12:10,637
So some of the challenges
working with parents.

1412
01:12:11,802 --> 01:12:15,369
Parents main concerns, of course,
are fear for their child's

1413
01:12:15,369 --> 01:12:20,369
safety, and their hopes for
the child's social integration.

1414
01:12:21,161 --> 01:12:25,561
Their main experience, and
again I'm quoting Jean Malpas,

1415
01:12:25,561 --> 01:12:29,333
anxiety on the edge of the unknown.

1416
01:12:29,939 --> 01:12:32,265
Now, again, I think
that's the main experience

1417
01:12:32,265 --> 01:12:35,181
of being a parent, to be
really honest with you.

1418
01:12:35,181 --> 01:12:39,721
It's a constant, "What does this mean

1419
01:12:39,721 --> 01:12:43,647
"and what should I do, and how do I be

1420
01:12:43,647 --> 01:12:47,323
"a good parent to my child
with what's going on?"

1421
01:12:47,323 --> 01:12:49,989
But certainly when a child
is dealing with gender

1422
01:12:49,989 --> 01:12:53,167
transitions or gender atypical behavior,

1423
01:12:53,167 --> 01:12:55,559
the anxiety of the parent of not knowing

1424
01:12:55,559 --> 01:12:58,779
what is going to happen
is very overwhelming.

1425
01:12:59,353 --> 01:13:01,968
That there's a sense of responsibility

1426
01:13:01,968 --> 01:13:03,727
and a fear of influence.

1427
01:13:03,727 --> 01:13:05,765
They're afraid of their
children's peers and how

1428
01:13:05,765 --> 01:13:07,800
they're influencing them,
they're skeptical of the

1429
01:13:07,800 --> 01:13:10,926
therapists and whatever
your agenda is about.

1430
01:13:11,344 --> 01:13:13,892
They are afraid, they
go online and, again,

1431
01:13:13,892 --> 01:13:15,923
there are lots of parents
who have been advocates

1432
01:13:15,923 --> 01:13:18,045
for children that have
successfully transitioned.

1433
01:13:18,045 --> 01:13:20,306
They're just very leery of
everybody, they don't know

1434
01:13:20,306 --> 01:13:22,833
who to trust and who to believe.

1435
01:13:23,860 --> 01:13:27,115
If they're too accepting of their child,

1436
01:13:27,115 --> 01:13:30,184
they're afraid they're going
to expose them to violence.

1437
01:13:30,400 --> 01:13:32,822
If they're not accepting
enough, they're afraid

1438
01:13:32,822 --> 01:13:35,324
that they're going to
inflict more suffering,

1439
01:13:35,324 --> 01:13:38,929
and particularly fears around suicidality.

1440
01:13:38,929 --> 01:13:42,847
There's a lot of literature
out there saying that

1441
01:13:44,205 --> 01:13:49,186
children who have atypical
gender identities,

1442
01:13:49,186 --> 01:13:54,186
children that are identifying
as gay or bisexual,

1443
01:13:56,739 --> 01:14:00,035
have much higher risk of so many issues,

1444
01:14:00,035 --> 01:14:03,565
but one of them is a
higher risk of suicidality.

1445
01:14:03,565 --> 01:14:07,653
There are some argument
in the research about

1446
01:14:07,653 --> 01:14:12,653
whether or not this population
is really more suicidal

1447
01:14:12,868 --> 01:14:15,824
than other teens are, and
there's some critiques

1448
01:14:15,824 --> 01:14:17,616
about the research that's been done.

1449
01:14:17,616 --> 01:14:22,275
If you ask a kid, "Have you
ever thought about suicide?"

1450
01:14:23,447 --> 01:14:26,429
I don't know that that
is hard science there,

1451
01:14:26,429 --> 01:14:29,013
of the kind of answer that
a 14 year old would give

1452
01:14:29,013 --> 01:14:31,834
and what they mean by, "Yeah,
I've thought of suicide,"

1453
01:14:31,834 --> 01:14:34,883
might not be what we as
clinicians or researchers

1454
01:14:34,883 --> 01:14:36,923
think as an answer to that question.

1455
01:14:36,923 --> 01:14:40,292
So it's a complicated area,
but there is just no question

1456
01:14:40,292 --> 01:14:42,495
that this is a vulnerable
population and that they are

1457
01:14:42,495 --> 01:14:45,305
vulnerable to both hurting
themselves and being hurt

1458
01:14:45,305 --> 01:14:48,935
by others, and parents are
incredibly aware of that

1459
01:14:48,935 --> 01:14:51,054
and incredibly protective
and frightened about it.

1460
01:14:51,054 --> 01:14:53,624
Except of course the parents that are

1461
01:14:53,624 --> 01:14:56,155
inflicting that violence themselves.

1462
01:14:56,328 --> 01:14:58,865
So parents, working with parents,

1463
01:14:58,865 --> 01:15:01,527
you need to work with
their loss of expectations

1464
01:15:01,527 --> 01:15:04,979
and narratives, their
dreams, their fantasies.

1465
01:15:06,743 --> 01:15:09,732
I had one family that I
worked with where the mom

1466
01:15:09,732 --> 01:15:11,755
and her sister were very
close, and then she had

1467
01:15:11,755 --> 01:15:15,727
two daughters, and she really saw that...

1468
01:15:16,163 --> 01:15:18,539
Her hope was that her
daughters were going to be

1469
01:15:18,539 --> 01:15:21,022
as close to each other
as she was to her sister.

1470
01:15:21,022 --> 01:15:23,295
And indeed the siblings
still remain close,

1471
01:15:23,295 --> 01:15:25,524
but they're no longer a
daughter and a daughter.

1472
01:15:25,524 --> 01:15:27,436
They're a daughter and a son now.

1473
01:15:27,436 --> 01:15:31,304
So how do these narratives
that we have about...

1474
01:15:32,516 --> 01:15:35,164
You know, the father's fantasy
of his daughter's wedding

1475
01:15:35,164 --> 01:15:39,359
and what that looks like when
his daughter is now his son.

1476
01:15:40,074 --> 01:15:41,836
So what are our narratives, what are

1477
01:15:41,836 --> 01:15:44,639
the expectations we have,
what are the dreams?

1478
01:15:45,365 --> 01:15:48,189
The sense I talked about
earlier of feeling scrutinized

1479
01:15:48,189 --> 01:15:51,467
and blamed, of living with this ambiguity.

1480
01:15:52,045 --> 01:15:54,171
But I also want to say this last one,

1481
01:15:54,171 --> 01:15:57,389
which is maintaining
normative parental control.

1482
01:15:57,893 --> 01:16:01,185
That when your child, quote unquote,

1483
01:16:01,185 --> 01:16:05,109
changes their sex, changes their gender,

1484
01:16:05,521 --> 01:16:08,534
that is an enormous amount of power

1485
01:16:08,534 --> 01:16:10,937
for a young person, for an eight year old

1486
01:16:10,937 --> 01:16:13,686
or 12 year old or 14 year old.

1487
01:16:13,686 --> 01:16:17,204
And sometimes what
parents need to remember

1488
01:16:17,204 --> 01:16:19,695
more than anything is sort of like,

1489
01:16:19,695 --> 01:16:24,661
"Okay, you used to be a
girl, and now you're a boy.

1490
01:16:24,661 --> 01:16:26,732
"You need to go do your homework.

1491
01:16:26,732 --> 01:16:28,543
"Okay, now you're a boy.

1492
01:16:28,543 --> 01:16:30,864
"Can you please start to do your chores?"

1493
01:16:30,864 --> 01:16:34,311
That we need to sort of
get back into the dailiness

1494
01:16:34,311 --> 01:16:38,028
of life, and not sort of live
in a world where everything...

1495
01:16:38,328 --> 01:16:40,671
"I can't do the chores, mom,
because everyone at school

1496
01:16:40,671 --> 01:16:43,519
"is making fun of me
because I'm gender variant."

1497
01:16:43,519 --> 01:16:45,490
"So sorry everyone's making fun of you

1498
01:16:45,490 --> 01:16:47,249
"because you're gender variant.

1499
01:16:47,249 --> 01:16:48,301
"I love you very much.

1500
01:16:48,301 --> 01:16:50,092
"Can you please go unload the dishwasher?"

1501
01:16:50,092 --> 01:16:52,058
That there has to be
a way that we maintain

1502
01:16:52,058 --> 01:16:55,630
some kind of normative
family life and don't allow

1503
01:16:55,630 --> 01:16:58,956
these children to kind of
get a little too puffed up

1504
01:16:58,956 --> 01:17:01,425
about how much power they have.

1505
01:17:01,425 --> 01:17:04,364
It is good that they have
power over their gender,

1506
01:17:04,364 --> 01:17:07,212
and it's good that they have
parents that have their backs,

1507
01:17:07,212 --> 01:17:09,417
but it's also good that they learn how

1508
01:17:09,417 --> 01:17:11,456
to do their chores and their homework.

1509
01:17:12,186 --> 01:17:14,617
I want to talk a little
bit about Caitlin Ryan

1510
01:17:14,617 --> 01:17:17,021
and the Family Acceptance Project.

1511
01:17:17,021 --> 01:17:20,337
Caitlin Ryan is a social worker,
and the Family Acceptance

1512
01:17:20,337 --> 01:17:24,139
Project comes out of San Francisco.

1513
01:17:24,480 --> 01:17:26,435
One of the first things I want
to say about Caitlin Ryan's

1514
01:17:26,435 --> 01:17:31,435
work is that it has a
quality to me of "duh."

1515
01:17:33,953 --> 01:17:37,125
What I mean by that is, I
could have told you this.

1516
01:17:37,125 --> 01:17:42,082
What she's saying is so
incredibly simple, that when

1517
01:17:42,082 --> 01:17:46,159
parents support their
children, children do better.

1518
01:17:46,461 --> 01:17:49,610
They have more positive
outcomes on every issue,

1519
01:17:49,610 --> 01:17:51,066
we're going to be going
through these issues in just

1520
01:17:51,066 --> 01:17:53,605
a second, than parents who
don't accept their children.

1521
01:17:53,605 --> 01:17:54,916
That if you accept your children
and you love your children,

1522
01:17:54,916 --> 01:17:56,752
your children do better than
if you don't accept them.

1523
01:17:56,752 --> 01:17:58,368
Like, duh.

1524
01:17:58,368 --> 01:18:01,644
But we also know that my
saying that doesn't really

1525
01:18:01,644 --> 01:18:05,572
have any power assailants
in the world at all.

1526
01:18:05,572 --> 01:18:10,572
But having research that shows
that helps direct policy.

1527
01:18:11,200 --> 01:18:13,192
It helps direct funding.

1528
01:18:13,192 --> 01:18:16,720
So Caitlin Ryan's work,
although it does have

1529
01:18:16,720 --> 01:18:20,025
a "duh" factor to it, has
been one of the most important

1530
01:18:20,025 --> 01:18:24,110
pieces of research that has come out

1531
01:18:24,110 --> 01:18:28,906
in LGBT studies in decades, in my opinion.

1532
01:18:30,349 --> 01:18:34,413
So Caitlin Ryan did a study
in the San Francisco Bay area

1533
01:18:34,413 --> 01:18:37,667
looking at children from
diverse ethnic backgrounds.

1534
01:18:37,667 --> 01:18:41,483
White kids, African-American
kids, Latina, Latino kids,

1535
01:18:41,483 --> 01:18:44,764
and Asian-Pacific Island kids.

1536
01:18:46,754 --> 01:18:51,387
What her research showed is
that across ethnic identities,

1537
01:18:52,725 --> 01:18:56,256
that if we look at every
area, in every area that we

1538
01:18:56,256 --> 01:19:01,256
look at, from drug and
alcohol use, suicidality,

1539
01:19:03,574 --> 01:19:08,574
HIV infection, homelessness,
school leaving,

1540
01:19:11,402 --> 01:19:16,309
that the more a parent
accepts their child,

1541
01:19:16,309 --> 01:19:19,217
the better the child is going to do.

1542
01:19:20,053 --> 01:19:23,484
And it also says that if
we can move a child...

1543
01:19:26,340 --> 01:19:31,340
If we can move a parent from
a rejecting, hostile stance,

1544
01:19:33,965 --> 01:19:38,965
to a slightly less hostile
stance, if we can move them from

1545
01:19:40,291 --> 01:19:45,291
a coldness to warmth,
if we can move them from

1546
01:19:45,980 --> 01:19:48,383
"I'm throwing you out of the house,"

1547
01:19:48,383 --> 01:19:50,705
to "You can live in the house,

1548
01:19:50,705 --> 01:19:53,261
"but I really don't like your behavior."

1549
01:19:53,261 --> 01:19:56,086
If we can move them from, "I don't accept

1550
01:19:56,086 --> 01:19:59,328
"what you're saying,"
to "I don't understand

1551
01:19:59,328 --> 01:20:01,863
"what you're saying, but I love you."

1552
01:20:01,863 --> 01:20:06,180
That the more we can move
the parent, step-by-step,

1553
01:20:06,180 --> 01:20:10,236
to a state of acceptance,
the better the children do.

1554
01:20:10,236 --> 01:20:13,004
And the bar graph just shows us

1555
01:20:13,004 --> 01:20:18,004
that the incidents of drug
and alcohol use and misuse,

1556
01:20:19,445 --> 01:20:24,445
the experience of suicidal
ideation and suicidal attempts,

1557
01:20:26,034 --> 01:20:29,482
that the dropout rate,
that the homelessness rate,

1558
01:20:29,482 --> 01:20:33,726
that HIV infection, that every
area that we can think of

1559
01:20:33,726 --> 01:20:38,726
that is a potential mental and
physical danger for children,

1560
01:20:39,465 --> 01:20:42,745
that the more accepting
the parents' behavior is,

1561
01:20:42,745 --> 01:20:45,637
the better the child is doing.

1562
01:20:45,885 --> 01:20:50,124
And this also gives us some
insight into working with kids

1563
01:20:50,124 --> 01:20:52,912
that are runaways, kids
that have already left home,

1564
01:20:52,912 --> 01:20:55,272
that we are working with in the context

1565
01:20:55,272 --> 01:21:00,151
of agencies and social
service organizations

1566
01:21:00,151 --> 01:21:05,151
where the family is already
a shadow, is already in

1567
01:21:05,465 --> 01:21:08,202
the past, and the kids
are kind of on their own.

1568
01:21:08,202 --> 01:21:09,793
Oh, I didn't mention prostitution

1569
01:21:09,793 --> 01:21:12,214
before, that's another big issue.

1570
01:21:12,353 --> 01:21:14,108
So we're sort of picking up these kids

1571
01:21:14,108 --> 01:21:15,449
who have already left home.

1572
01:21:15,449 --> 01:21:16,109
In some cases the parents don't

1573
01:21:16,109 --> 01:21:18,179
even know where the kids are.

1574
01:21:19,105 --> 01:21:22,394
So when we are building programs that

1575
01:21:22,394 --> 01:21:24,660
we're helping these kids find shelter,

1576
01:21:24,660 --> 01:21:26,698
and we're helping these kids get food,

1577
01:21:26,698 --> 01:21:29,202
and we're helping these
kids have access to safe sex

1578
01:21:29,202 --> 01:21:31,753
and birth control, and we're
helping these kids find

1579
01:21:31,753 --> 01:21:34,316
other ways of supporting themselves

1580
01:21:34,316 --> 01:21:38,119
than survival sex and
prostitution, that we're helping

1581
01:21:38,119 --> 01:21:40,997
these kids get their
GED, that we're helping

1582
01:21:40,997 --> 01:21:42,734
these kids get back into school.

1583
01:21:42,734 --> 01:21:44,778
All of these things that we're doing,

1584
01:21:44,778 --> 01:21:49,225
I want to encourage all of
you to not forget the family.

1585
01:21:49,225 --> 01:21:52,579
That sometimes what
the kids are saying is,

1586
01:21:52,579 --> 01:21:55,747
"My family hates me,
my family threw me out,

1587
01:21:55,747 --> 01:21:58,152
"my family is abusive,"
and there's no doubt

1588
01:21:58,152 --> 01:22:00,949
about it, that families can be abusive.

1589
01:22:00,949 --> 01:22:02,387
There's no doubt about it that parents do

1590
01:22:02,387 --> 01:22:05,327
sometimes throw their kids away.

1591
01:22:05,790 --> 01:22:08,712
But I also know, and again I
know this having teenagers,

1592
01:22:08,712 --> 01:22:11,155
that sometimes the way they perceive

1593
01:22:11,155 --> 01:22:14,426
parents' statements, parents' behavior,

1594
01:22:14,426 --> 01:22:18,254
is not necessarily the way...

1595
01:22:20,271 --> 01:22:22,342
It's not necessarily what happened.

1596
01:22:23,828 --> 01:22:26,841
And of course, you know,
there are lots of times that

1597
01:22:26,841 --> 01:22:31,841
the child, who now has
this cross-gender identity,

1598
01:22:32,940 --> 01:22:36,021
has all these friends online,
is feeling really good

1599
01:22:36,021 --> 01:22:38,660
about being genderqueer, but
hasn't talked to the parent

1600
01:22:38,660 --> 01:22:40,634
about this at all,
because what's happening

1601
01:22:40,634 --> 01:22:43,739
in the child's room on the computer is not

1602
01:22:43,739 --> 01:22:46,013
something the parent has access to.

1603
01:22:46,013 --> 01:22:48,835
We could have a whole
other workshop all about

1604
01:22:48,835 --> 01:22:51,577
computers and technology
and monitoring that

1605
01:22:51,577 --> 01:22:53,674
and what parents are doing
and what we're not doing

1606
01:22:53,674 --> 01:22:55,929
and what we're trying to
do, but they're smarter

1607
01:22:55,929 --> 01:22:58,233
than we are, and all
of that kind of stuff.

1608
01:22:58,233 --> 01:23:00,777
But the point is, that by
the time the child says

1609
01:23:00,777 --> 01:23:03,790
to the parent, "Boom, I'm genderqueer.

1610
01:23:03,790 --> 01:23:05,420
"Boom, I'm transgender.

1611
01:23:05,420 --> 01:23:07,464
"Boom, I got hormones on the Internet

1612
01:23:07,464 --> 01:23:09,587
"and I'm using them
and you can't stop me."

1613
01:23:09,587 --> 01:23:11,335
That sometimes parents react to that

1614
01:23:11,335 --> 01:23:16,074
in really unprepared ways, they say

1615
01:23:16,074 --> 01:23:18,550
stupid things, they say judgmental things.

1616
01:23:18,550 --> 01:23:20,350
I'm not defending the
parents for doing that,

1617
01:23:20,350 --> 01:23:23,713
I'm just saying that they're
human, too, they make mistakes.

1618
01:23:23,713 --> 01:23:27,265
But children, young people,
with their frontal lobe

1619
01:23:27,265 --> 01:23:30,192
the way it is, may not recognize that.

1620
01:23:30,192 --> 01:23:32,416
So the parent who says,
"I can't deal with this,

1621
01:23:32,416 --> 01:23:34,673
"get the fuck out of the house,"

1622
01:23:35,506 --> 01:23:37,777
may not feel that way in
two hours or four hours

1623
01:23:37,777 --> 01:23:40,623
but the kid's already taken
a bus to New York City

1624
01:23:40,623 --> 01:23:43,437
and now the parent is
desperately searching for the kid

1625
01:23:43,437 --> 01:23:46,462
who has now managed to really disappear.

1626
01:23:47,697 --> 01:23:50,779
I just want to remind us
here that a part of our work

1627
01:23:50,779 --> 01:23:54,963
with these gender
nonconforming, transgender youth

1628
01:23:54,963 --> 01:23:56,851
who are homeless and living
on the street that come

1629
01:23:56,851 --> 01:24:01,379
into our care is, you
may find if you reach out

1630
01:24:01,379 --> 01:24:04,461
to the parents, obviously
with the kid's support here

1631
01:24:04,461 --> 01:24:07,688
or the kid's permission,
that they're really glad

1632
01:24:07,688 --> 01:24:09,874
to hear from you, that
they're terribly worried

1633
01:24:09,874 --> 01:24:14,669
about their children, that they might want

1634
01:24:14,669 --> 01:24:16,942
to apologize to the
child for what they said,

1635
01:24:16,942 --> 01:24:18,773
that they might want to support the child,

1636
01:24:18,773 --> 01:24:21,067
and that actually the child
who appears to be homeless

1637
01:24:21,067 --> 01:24:23,454
might not really be homeless at all.

1638
01:24:23,454 --> 01:24:25,732
But there might be some
need for some serious

1639
01:24:25,732 --> 01:24:29,507
family work to have
happen to integrate this

1640
01:24:31,189 --> 01:24:34,930
child in their confirmed
gender with parents who

1641
01:24:34,930 --> 01:24:37,966
completely were blindsided
by this information.

1642
01:24:38,141 --> 01:24:41,163
I don't want to lose the families here,

1643
01:24:41,163 --> 01:24:43,558
and I want us to be thinking about

1644
01:24:43,558 --> 01:24:46,378
the kinds of policy
decisions that we're making,

1645
01:24:46,378 --> 01:24:51,378
and the kinds of ways that we are, again,

1646
01:24:51,802 --> 01:24:54,644
we're balancing advocacy for these kids,

1647
01:24:54,644 --> 01:24:57,457
support for these kids, at
the same time that we're

1648
01:24:57,457 --> 01:25:02,252
recognizing that they are
young people who may not have

1649
01:25:02,252 --> 01:25:04,860
the complete, that what
they're hearing and what

1650
01:25:04,860 --> 01:25:08,459
they're seeing may not be the same thing.

1651
01:25:08,807 --> 01:25:12,389
I was just talking to
a student the other day

1652
01:25:12,389 --> 01:25:15,663
who is the mother of a teenager,

1653
01:25:15,663 --> 01:25:18,056
and I was talking about this very issue.

1654
01:25:18,056 --> 01:25:20,437
This has nothing to do
with gender, she just

1655
01:25:20,437 --> 01:25:25,437
shared to me that she told her teenage son

1656
01:25:25,581 --> 01:25:30,581
that she was taking away his phone because

1657
01:25:31,946 --> 01:25:33,980
he was like playing games on his phone

1658
01:25:33,980 --> 01:25:35,548
when he should be doing his homework.

1659
01:25:35,548 --> 01:25:37,158
And the kid, and the
parents were divorced,

1660
01:25:37,158 --> 01:25:38,742
and the kid called up the dad and said,

1661
01:25:38,742 --> 01:25:40,834
"Mom threw me out of the house."

1662
01:25:41,302 --> 01:25:42,596
And the kid really believed that.

1663
01:25:42,596 --> 01:25:44,672
That's what the kid absolutely
heard the parent say,

1664
01:25:44,672 --> 01:25:46,309
when the parent said,
"Give me your phone."

1665
01:25:46,309 --> 01:25:47,829
And I could (laughs)

1666
01:25:47,829 --> 01:25:48,967
Our phones are really important

1667
01:25:48,967 --> 01:25:51,273
to us, I understand all of that.

1668
01:25:51,714 --> 01:25:54,188
We just have to remember
we're dealing with

1669
01:25:54,188 --> 01:25:58,403
a not fully developed pre-frontal cortex

1670
01:25:58,403 --> 01:26:00,529
of young people that are
dealing with a lot of gender

1671
01:26:00,529 --> 01:26:05,529
issues, and the nature of
parental and child interactions

1672
01:26:05,891 --> 01:26:09,937
in these teenage years,
by its nature, is children

1673
01:26:09,937 --> 01:26:13,698
are pushing away, they're pushing away,

1674
01:26:13,698 --> 01:26:15,733
they desperately want to be independent,

1675
01:26:15,733 --> 01:26:19,617
their parents embarrass them,
their parents are stupid.

1676
01:26:20,830 --> 01:26:24,051
My favorite line my partner
said when we entered adolescence

1677
01:26:24,065 --> 01:26:26,920
is overnight we became the village idiots.

1678
01:26:27,172 --> 01:26:29,207
Which is really hard,
you know, when you were

1679
01:26:29,207 --> 01:26:32,072
your child's most beloved,
that they just thought

1680
01:26:32,072 --> 01:26:34,009
you were the best people
in the world, and suddenly

1681
01:26:34,009 --> 01:26:37,931
overnight you're just a
complete and total fool.

1682
01:26:37,931 --> 01:26:40,320
And this is developmentally normal,

1683
01:26:40,320 --> 01:26:42,158
at least in Western
cultures, it's not so much

1684
01:26:42,158 --> 01:26:44,643
in other cultures, but in
Western cultures this is part

1685
01:26:44,643 --> 01:26:47,994
of their developmental
bid for independence,

1686
01:26:47,994 --> 01:26:51,812
and it is natural for parents
to go through all kinds

1687
01:26:51,812 --> 01:26:54,444
of places, of being
overprotective, of being

1688
01:26:54,444 --> 01:26:59,444
under-protective, of
feeling rejected, of being,

1689
01:27:02,586 --> 01:27:06,047
trying to not let them
leave the nest and then

1690
01:27:06,047 --> 01:27:09,390
ultimately probably pushing
them out of the nest.

1691
01:27:09,640 --> 01:27:12,524
This is all normal, and
when you confound that

1692
01:27:12,524 --> 01:27:15,256
with all of these issues of
gender, that by and large

1693
01:27:15,256 --> 01:27:17,866
most parents don't
understand, and by and large

1694
01:27:17,866 --> 01:27:22,866
most parents are really confused about,

1695
01:27:23,330 --> 01:27:26,463
and bottom line, they're really
concerned about their kids

1696
01:27:26,463 --> 01:27:27,978
and they don't know how to make sense

1697
01:27:27,978 --> 01:27:29,594
of what, to them, really sounds crazy.

1698
01:27:29,594 --> 01:27:31,443
Like, "I gave birth to
you, I know you're a girl,

1699
01:27:31,443 --> 01:27:34,483
"I don't know what you're
talking about, you're not a boy."

1700
01:27:35,040 --> 01:27:37,419
There's a process for both of
them to have to go through.

1701
01:27:37,419 --> 01:27:39,875
Okay, so what are our goals?

1702
01:27:39,875 --> 01:27:42,701
We want to reduce the
anxiety and the reactivity.

1703
01:27:42,701 --> 01:27:44,761
We want to be a resource to the child

1704
01:27:44,761 --> 01:27:46,655
and we want to be a
resource to the parents

1705
01:27:46,655 --> 01:27:50,420
so they can be a resource to
their child, that's our goal.

1706
01:27:50,679 --> 01:27:54,523
We want to identify how
reactions to the personal

1707
01:27:54,523 --> 01:27:57,846
meaning of gender and
gender variance might

1708
01:27:57,846 --> 01:28:00,718
complicate relationships with the child.

1709
01:28:00,718 --> 01:28:03,400
What I mean by that is,

1710
01:28:04,173 --> 01:28:07,480
a mother who was a tomboy, who now

1711
01:28:07,480 --> 01:28:10,148
feels comfortable living as a woman,

1712
01:28:10,148 --> 01:28:15,116
might not understand that her
female child is not a tomboy.

1713
01:28:15,318 --> 01:28:18,895
That her female child actually
has a male gender identity.

1714
01:28:18,895 --> 01:28:21,484
That a father who, and
I would say this is true

1715
01:28:21,484 --> 01:28:23,680
for almost all men in our
culture whether they are

1716
01:28:23,680 --> 01:28:26,835
men's men or whether they
are, quote unquote, sissy men,

1717
01:28:26,835 --> 01:28:31,162
that the way boys and men
are treated in this culture

1718
01:28:31,162 --> 01:28:34,011
when they step out of
traditional male roles

1719
01:28:34,011 --> 01:28:37,064
is just horrendous and awful.

1720
01:28:37,064 --> 01:28:42,064
So the protection that fathers
have to their trans-female,

1721
01:28:44,004 --> 01:28:47,825
trans-female, born-male
children, is often highly

1722
01:28:47,825 --> 01:28:52,036
protective, and it's not
just about their child,

1723
01:28:52,036 --> 01:28:53,708
but it's about their own memories.

1724
01:28:53,708 --> 01:28:56,191
So when you do the therapy
work of saying to the dad,

1725
01:28:56,191 --> 01:28:57,837
"Well, what happened to you?

1726
01:28:57,837 --> 01:29:00,276
"Do you have an experience
in your childhood

1727
01:29:00,276 --> 01:29:02,603
"where you were treated as being a sissy,

1728
01:29:02,603 --> 01:29:05,528
"or you were treated for being too girly?"

1729
01:29:05,528 --> 01:29:07,813
And it's a rare man in our
culture that doesn't have

1730
01:29:07,813 --> 01:29:10,935
painful stories associated
with this, in relationship

1731
01:29:10,935 --> 01:29:13,485
to their own father, and when
they get in touch with that,

1732
01:29:13,485 --> 01:29:15,345
when they realize, "I don't
want to treat my child

1733
01:29:15,345 --> 01:29:18,373
"like this," it's very powerful work.

1734
01:29:18,652 --> 01:29:20,486
That we want to facilitate co-parenting

1735
01:29:20,486 --> 01:29:22,776
relationships and conflict resolution.

1736
01:29:22,776 --> 01:29:26,852
Again, in heterosexual
mother-father families,

1737
01:29:26,852 --> 01:29:30,104
there is often a conflict
between the mother

1738
01:29:30,104 --> 01:29:32,358
and the father about
that should be treated.

1739
01:29:32,358 --> 01:29:34,687
In families where there's
divorce, and sometimes there's

1740
01:29:35,240 --> 01:29:38,285
new step-parents involved
too, there's conflict

1741
01:29:38,285 --> 01:29:41,135
between the two families about
how this should be treated,

1742
01:29:41,135 --> 01:29:45,003
and almost always one side is more

1743
01:29:45,003 --> 01:29:47,006
supportive than the other side.

1744
01:29:47,006 --> 01:29:49,353
So facilitating these conversations

1745
01:29:49,353 --> 01:29:51,686
becomes one of our goals.

1746
01:29:52,391 --> 01:29:54,528
And assessing the needs and conditions.

1747
01:29:54,528 --> 01:29:58,999
Does this child need to
socially transition, and if so,

1748
01:29:58,999 --> 01:30:02,204
what is the advocacy work
we need to do at the school?

1749
01:30:02,204 --> 01:30:05,087
How do we facilitate the
conversation with the pediatrician,

1750
01:30:05,087 --> 01:30:07,495
who may be on board and may be resistant?

1751
01:30:07,495 --> 01:30:10,840
How do we find the best
pediatric endocrinologist

1752
01:30:10,840 --> 01:30:13,728
or family physician for
this family to work with?

1753
01:30:13,728 --> 01:30:17,190
That is going to, not
just prescribe hormones,

1754
01:30:17,190 --> 01:30:19,500
but actually help them psychologically

1755
01:30:19,500 --> 01:30:22,106
and support them in
understanding what is happening.

1756
01:30:22,106 --> 01:30:24,406
So those are some of our goals.

1757
01:30:25,373 --> 01:30:27,088
Support, you know...

1758
01:30:27,443 --> 01:30:28,660
I think having support groups

1759
01:30:28,660 --> 01:30:30,573
for parents is really important.

1760
01:30:30,573 --> 01:30:32,899
I think offering family therapy, both with

1761
01:30:32,899 --> 01:30:36,072
the parents alone as well
as with the children...

1762
01:30:37,248 --> 01:30:40,593
I just was working with
a kid the other day who

1763
01:30:41,020 --> 01:30:44,030
was talking about how he, female-to-male,

1764
01:30:44,030 --> 01:30:46,826
how he had come out to some friends,

1765
01:30:46,826 --> 01:30:48,620
and then he came out to
the school social worker,

1766
01:30:48,620 --> 01:30:50,160
and then he came out at school,

1767
01:30:50,160 --> 01:30:51,751
but he hadn't yet told his parents.

1768
01:30:51,751 --> 01:30:55,390
And I said, "Do you think your
parents will be rejecting?"

1769
01:30:55,390 --> 01:30:56,847
And he said, "No, no, not at all.

1770
01:30:56,847 --> 01:30:58,903
"My parents are really great,
they're really quite liberal

1771
01:30:58,903 --> 01:31:00,714
"and I think they'll be very supportive."

1772
01:31:00,714 --> 01:31:02,666
"Well, why haven't you told your parents?"

1773
01:31:02,945 --> 01:31:04,961
"I'm really scared to tell my parents."

1774
01:31:05,374 --> 01:31:06,052
"I thought you just said that they're

1775
01:31:06,052 --> 01:31:06,919
"really liberal and supportive."

1776
01:31:06,919 --> 01:31:08,414
"Oh no, they really are."

1777
01:31:08,414 --> 01:31:13,414
The terror of having a parent
reject you is so intense,

1778
01:31:13,590 --> 01:31:15,836
that even though you know
your parent won't reject you,

1779
01:31:15,836 --> 01:31:18,052
it doesn't stop you from being terrified.

1780
01:31:18,052 --> 01:31:21,733
So sometimes having the kid and the family

1781
01:31:21,733 --> 01:31:24,235
in the room together, and
facilitating some of these

1782
01:31:24,235 --> 01:31:26,306
conversations can be really helpful.

1783
01:31:26,306 --> 01:31:28,072
I talked about school advocacy.

1784
01:31:28,072 --> 01:31:29,640
Sometimes it's with physicians.

1785
01:31:29,640 --> 01:31:31,325
You know, physicians that
are really opposed to it,

1786
01:31:31,325 --> 01:31:32,833
physicians that won't provide treatment.

1787
01:31:32,833 --> 01:31:35,231
This is really a big
deal if you're living in

1788
01:31:35,231 --> 01:31:37,448
more rural parts of the United States

1789
01:31:37,448 --> 01:31:39,669
where you don't have access to pediatric

1790
01:31:39,669 --> 01:31:41,842
endocrinologists that are trained in this.

1791
01:31:41,842 --> 01:31:45,603
We need to rely on the
pediatrician to be able to help,

1792
01:31:45,603 --> 01:31:48,412
so there has to be advocacy here.

1793
01:31:48,730 --> 01:31:52,971
And again, we want to encourage
exploration and expression.

1794
01:31:52,971 --> 01:31:56,519
We want to give these
children spaces to explore.

1795
01:31:56,811 --> 01:31:59,157
So what I want to do is I want to give you

1796
01:31:59,620 --> 01:32:03,668
just a couple of really brief
cases to kind of look at this.

1797
01:32:03,962 --> 01:32:07,010
So this is a child I'm
going to call Jayce.

1798
01:32:07,010 --> 01:32:09,902
Mom called, and mom
almost always does call.

1799
01:32:10,306 --> 01:32:14,161
The exception to that is
sometimes dads make the phone call

1800
01:32:14,161 --> 01:32:19,161
when their trans sons, again
female-to-male, are in college.

1801
01:32:20,187 --> 01:32:23,061
For some reason I get more calls from dads

1802
01:32:23,061 --> 01:32:27,699
of kids of that age, and always
female-to-male of that age.

1803
01:32:27,699 --> 01:32:30,674
Other than that it's almost
always mothers that call.

1804
01:32:30,674 --> 01:32:32,514
The family has four children.

1805
01:32:32,514 --> 01:32:34,452
The marriage is strained.

1806
01:32:34,452 --> 01:32:36,397
The youngest is a five year old

1807
01:32:36,397 --> 01:32:38,197
who has always been feminine.

1808
01:32:38,197 --> 01:32:40,432
Natal male, always been feminine,

1809
01:32:40,432 --> 01:32:43,609
likes to wear women's
clothing, girl's clothing,

1810
01:32:43,609 --> 01:32:48,609
wears hair long, wants to be
called Jayce instead of Jay.

1811
01:32:49,311 --> 01:32:52,647
The parents are tolerant
but very uncomfortable,

1812
01:32:52,647 --> 01:32:54,984
and the child is going to
start school in the fall

1813
01:32:54,984 --> 01:32:58,672
and is extremely anxious
about going as a boy.

1814
01:32:58,976 --> 01:33:01,772
And again, this is at
the place where I receive

1815
01:33:01,772 --> 01:33:03,946
more phone calls from parents of children

1816
01:33:03,946 --> 01:33:06,293
between five and seven
years old than any other

1817
01:33:06,293 --> 01:33:09,165
age group because that
is where school comes in.

1818
01:33:09,165 --> 01:33:12,937
And school becomes the
dividing line between,

1819
01:33:12,937 --> 01:33:15,739
at home the child can
dress in various ways,

1820
01:33:15,739 --> 01:33:19,021
but at school there's limitations.

1821
01:33:19,021 --> 01:33:22,043
At school, taking a little Dora backpack

1822
01:33:22,043 --> 01:33:24,641
can affect your social relationships.

1823
01:33:24,641 --> 01:33:26,805
So some of the ethical questions.

1824
01:33:26,805 --> 01:33:28,981
How does a young person know that

1825
01:33:28,981 --> 01:33:32,531
their gender is not what it appears to be?

1826
01:33:32,531 --> 01:33:34,324
I mean, how does a child know that?

1827
01:33:34,324 --> 01:33:37,501
And I think, as grown-ups,
we struggle with that.

1828
01:33:37,501 --> 01:33:41,044
But I think when you think
back and you think of yourself

1829
01:33:41,044 --> 01:33:43,154
at five years old, when you
think of yourself as six

1830
01:33:43,154 --> 01:33:47,300
years old, you knew whether or
not you were a boy or a girl.

1831
01:33:47,300 --> 01:33:50,019
I think this ability to trust children,

1832
01:33:50,019 --> 01:33:53,312
again, not 100 percent,

1833
01:33:53,883 --> 01:33:58,883
but that this experience
that they're having is not

1834
01:33:59,088 --> 01:34:02,840
something that they are
pulling out of the ether.

1835
01:34:02,840 --> 01:34:05,505
This is something very real and internal.

1836
01:34:05,721 --> 01:34:09,407
That we need to start this
ethical process of understanding

1837
01:34:09,407 --> 01:34:13,841
the difference between
gender nonconforming

1838
01:34:13,841 --> 01:34:17,985
children and gender dysphoria, what I am

1839
01:34:17,985 --> 01:34:20,533
calling here in quotes "sissy boys."

1840
01:34:22,640 --> 01:34:24,704
There's a famous research study

1841
01:34:24,704 --> 01:34:26,784
called "The Sissy Boy Study."

1842
01:34:26,784 --> 01:34:29,615
Sissy boys and trans
girls, in other words,

1843
01:34:29,615 --> 01:34:33,712
where is the place where
this is a boy who is feminine

1844
01:34:33,712 --> 01:34:38,509
versus a child who is
a girl in a boy's body.

1845
01:34:38,859 --> 01:34:43,587
Where's the place where this
is a girl who is a tomboy

1846
01:34:43,587 --> 01:34:47,737
versus this is a child
who is a boy but who

1847
01:34:47,737 --> 01:34:50,433
is born into a natal female body.

1848
01:34:50,433 --> 01:34:53,337
How do we determine which
children are really trans

1849
01:34:53,337 --> 01:34:55,910
and which are, again, pre-homosexual?

1850
01:34:55,910 --> 01:34:59,237
Who are just tomboys or very girly boys.

1851
01:34:59,237 --> 01:35:01,067
How do we determine the difference between

1852
01:35:01,067 --> 01:35:04,368
gender role and gender identity?

1853
01:35:04,368 --> 01:35:06,236
Between the core sense of gender

1854
01:35:06,236 --> 01:35:08,794
and how people dress
or present themselves.

1855
01:35:08,794 --> 01:35:12,090
Again, within the context of a world

1856
01:35:12,090 --> 01:35:16,277
where the children are
not allowed to cross those

1857
01:35:16,277 --> 01:35:21,277
boundaries without
experiencing strong resistance

1858
01:35:21,461 --> 01:35:23,594
and reaction from the world around them.

1859
01:35:23,594 --> 01:35:24,912
How do we help children and their

1860
01:35:24,912 --> 01:35:27,467
families to figure this out?

1861
01:35:27,467 --> 01:35:31,061
Is there more plasticity of
gender for young children?

1862
01:35:31,061 --> 01:35:34,403
In other words, for
those people who believe

1863
01:35:34,403 --> 01:35:37,060
in reparative therapy, who
are not working in affirmative

1864
01:35:37,060 --> 01:35:40,237
models, what they would say is gender

1865
01:35:40,237 --> 01:35:42,801
at this young age is pretty plastic.

1866
01:35:42,801 --> 01:35:46,158
That you can sort of help
children mold a sense,

1867
01:35:46,158 --> 01:35:48,741
that the sissy boy can develop a sense

1868
01:35:48,741 --> 01:35:53,741
of being a boy, and being
comfortable being a boy,

1869
01:35:54,036 --> 01:35:57,114
even if the child is, quote
unquote, "really trans,"

1870
01:35:57,114 --> 01:36:00,225
whatever that means,
that you can help people,

1871
01:36:00,225 --> 01:36:05,225
because if you can help people
to fit into their natal body

1872
01:36:05,443 --> 01:36:09,143
without having to take
hormones and surgery,

1873
01:36:09,143 --> 01:36:10,960
is that not a better choice?

1874
01:36:10,960 --> 01:36:13,537
Now of course I would
say that this kind of

1875
01:36:13,537 --> 01:36:16,115
reparative therapy does not
work, but these are the kind

1876
01:36:16,115 --> 01:36:18,689
of ethical questions that people raise.

1877
01:36:18,689 --> 01:36:21,775
Can they express gender
discomfort as reactive

1878
01:36:21,775 --> 01:36:23,656
to any number of issues in the family?

1879
01:36:23,656 --> 01:36:25,963
In other words, are we really
looking at gender here,

1880
01:36:25,963 --> 01:36:28,939
or are we looking at a
whole bunch of other issues

1881
01:36:28,939 --> 01:36:32,373
of real pathological stuff
going on in the family

1882
01:36:32,373 --> 01:36:34,656
or mental health issues that the child

1883
01:36:34,656 --> 01:36:36,978
is exhibiting in some way around gender?

1884
01:36:36,978 --> 01:36:40,596
And again, I think this
is important to explore.

1885
01:36:42,313 --> 01:36:44,160
I don't see it a lot.

1886
01:36:44,160 --> 01:36:46,923
What I see a lot is children who

1887
01:36:46,923 --> 01:36:49,498
really have authentic gender issues.

1888
01:36:49,498 --> 01:36:52,284
But I do think it is incumbent upon us

1889
01:36:52,284 --> 01:36:54,597
to ask these questions and look at it.

1890
01:36:54,597 --> 01:36:59,597
What does it mean to be gender
atypical in a sexist world?

1891
01:36:59,986 --> 01:37:02,890
What does it mean to be
stepping out of gender roles?

1892
01:37:02,890 --> 01:37:07,565
So if you are a female
child who is more masculine

1893
01:37:07,565 --> 01:37:10,189
in your presentation,
how do you find yourself

1894
01:37:10,189 --> 01:37:13,648
mirrored in the world in
a way that you can develop

1895
01:37:13,648 --> 01:37:18,219
a strong self-identity as
a more masculine female?

1896
01:37:18,797 --> 01:37:21,625
And is the desire to say, "I'm a boy,"

1897
01:37:21,625 --> 01:37:24,335
because there's not a lot of
other models for these kids?

1898
01:37:24,335 --> 01:37:26,535
I think we need to be looking at

1899
01:37:26,535 --> 01:37:29,689
all of those ethical questions also.

1900
01:37:35,450 --> 01:37:37,958
It's also important to be aware that

1901
01:37:39,634 --> 01:37:43,026
most gender specialists have worked

1902
01:37:43,026 --> 01:37:44,738
with adults, not children.

1903
01:37:44,738 --> 01:37:46,626
So what happens is you're
a gender specialist,

1904
01:37:46,626 --> 01:37:48,362
you work with adult transgender people,

1905
01:37:48,362 --> 01:37:52,714
you start to get calls from
families of young children.

1906
01:37:53,221 --> 01:37:55,374
And even though that's not your expertise,

1907
01:37:55,374 --> 01:37:58,076
many of us started to do this work.

1908
01:37:58,076 --> 01:38:01,219
So we're gender specialists
without specific training

1909
01:38:01,219 --> 01:38:04,206
in child and adolescent
psychology, and on the other hand,

1910
01:38:04,206 --> 01:38:06,809
those people who are child
and adolescent specialists

1911
01:38:06,809 --> 01:38:09,730
are rarely also trained in gender.

1912
01:38:09,730 --> 01:38:13,717
So we have these two populations that are

1913
01:38:13,717 --> 01:38:15,934
rarely working together, so
I think one of the things

1914
01:38:15,934 --> 01:38:19,333
that we need to be looking
at is working together

1915
01:38:19,333 --> 01:38:22,000
in interdisciplinary teams that include

1916
01:38:22,000 --> 01:38:24,654
pediatric endocrinologists
as well as child and

1917
01:38:24,654 --> 01:38:27,467
adolescent specialists as
well as gender specialists.

1918
01:38:29,739 --> 01:38:32,928
And the question of how
are the parents' behaviors

1919
01:38:33,926 --> 01:38:36,307
encouraging, reinforcing, or

1920
01:38:36,307 --> 01:38:38,497
limiting the child's expression?

1921
01:38:38,497 --> 01:38:39,935
All three of those.

1922
01:38:39,935 --> 01:38:43,921
How do parents deal
with the gender-variant

1923
01:38:43,921 --> 01:38:46,522
behavior of their children?

1924
01:38:46,522 --> 01:38:48,910
How do they respond to that behavior?

1925
01:38:49,300 --> 01:38:52,215
In some families, it's
just not a really big deal.

1926
01:38:52,215 --> 01:38:54,996
Your son comes down for dinner wearing

1927
01:38:54,996 --> 01:38:56,889
pink nail polish and everybody just says,

1928
01:38:56,889 --> 01:38:58,588
"Pass the mashed potatoes."

1929
01:38:58,588 --> 01:39:01,372
In other families you get
beat up or punished for that.

1930
01:39:01,372 --> 01:39:03,580
In other families you
get humiliated for that.

1931
01:39:03,580 --> 01:39:05,692
How are the parents responding to that,

1932
01:39:05,692 --> 01:39:07,527
because I think that that effects how

1933
01:39:07,527 --> 01:39:10,639
the child's identity is developing.

1934
01:39:11,191 --> 01:39:14,255
The second case I want
to talk about is Max.

1935
01:39:14,594 --> 01:39:17,234
So Max, you know,
received a call from mom.

1936
01:39:17,234 --> 01:39:21,416
Max is the middle child, natal female,

1937
01:39:21,416 --> 01:39:24,912
is 13 years old, identities
as a "trannyboi,"

1938
01:39:25,372 --> 01:39:28,193
and is attracted to females,
dresses and wears hair

1939
01:39:28,193 --> 01:39:32,219
in a male style, seeking
to stop female puberty.

1940
01:39:32,522 --> 01:39:35,770
Mother is accepting but ambivalent.

1941
01:39:35,770 --> 01:39:40,533
Max views hirself outside
of the gender binary.

1942
01:39:40,533 --> 01:39:44,801
So Max is rejecting male
and female pronouns,

1943
01:39:44,801 --> 01:39:49,231
is wanting to use neither
male nor female pronouns,

1944
01:39:50,338 --> 01:39:53,955
often times using plural
pronouns like "they,"

1945
01:39:53,955 --> 01:39:58,176
sometimes using "hir" or "ze."

1946
01:39:59,096 --> 01:40:02,905
So how do we assess gender
identities outside of the binary?

1947
01:40:02,905 --> 01:40:04,109
I mean, who has...

1948
01:40:04,109 --> 01:40:07,514
Anybody out there have an
assessment tool for me for that?

1949
01:40:07,514 --> 01:40:09,554
How will these decisions affect Max's

1950
01:40:09,554 --> 01:40:12,649
gender identity, including
fertility issues?

1951
01:40:13,378 --> 01:40:16,399
We talked about the fad
of gender flexibility,

1952
01:40:16,399 --> 01:40:18,557
particularly in urban settings.

1953
01:40:18,557 --> 01:40:21,325
The reality is Max can get
hormones on the Internet.

1954
01:40:21,325 --> 01:40:23,173
Max does not need a therapist,

1955
01:40:23,173 --> 01:40:24,797
Max does not need a doctor.

1956
01:40:24,797 --> 01:40:26,861
That's just a reality for the world.

1957
01:40:26,861 --> 01:40:28,972
So how do we know with this population

1958
01:40:28,972 --> 01:40:32,033
when it's right to
pursue early transitions?

1959
01:40:32,033 --> 01:40:36,135
I remember one client I
worked with many years ago,

1960
01:40:36,135 --> 01:40:38,510
about 17 years old, female child,

1961
01:40:38,510 --> 01:40:42,279
very actually feminine
in her presentation.

1962
01:40:42,279 --> 01:40:45,587
I would say she was beautiful in a sort of

1963
01:40:45,587 --> 01:40:49,294
stereotypical female,
culturally approved kind of way.

1964
01:40:49,294 --> 01:40:54,294
And "ze" wanted to remove their breasts.

1965
01:40:58,456 --> 01:41:01,882
My favorite line during the
therapy was when ze said,

1966
01:41:03,274 --> 01:41:06,325
"It's not that my breasts
are not beautiful.

1967
01:41:06,325 --> 01:41:09,154
"They just don't belong on my body."

1968
01:41:09,154 --> 01:41:11,661
This raised a lot of ethical questions

1969
01:41:11,661 --> 01:41:14,704
and a lot of work with
the parents about this.

1970
01:41:15,290 --> 01:41:19,004
In the end, wrote a letter to approve,

1971
01:41:20,044 --> 01:41:22,360
approve the surgery, and to my knowledge,

1972
01:41:22,360 --> 01:41:26,410
I spoke to them about
ten years following that,

1973
01:41:26,410 --> 01:41:29,664
and they were doing great
and happy not to have,

1974
01:41:30,060 --> 01:41:31,955
any longer have those breasts that did not

1975
01:41:31,955 --> 01:41:34,374
belong on their body, which is great.

1976
01:41:34,374 --> 01:41:37,704
Although other than that, the person was

1977
01:41:37,704 --> 01:41:39,985
presented fairly female in the world,

1978
01:41:39,985 --> 01:41:44,985
but identified as sort of
non-gendered or outside of gender.

1979
01:41:45,297 --> 01:41:50,238
Is the child feeling pressured to fit in?

1980
01:41:51,701 --> 01:41:54,993
Is the child going through,
quote unquote, a phase?

1981
01:41:55,517 --> 01:41:58,659
Is the child experiencing
severe gender dysphoria?

1982
01:41:59,127 --> 01:42:02,203
We need to sort of look at,
what are the complications

1983
01:42:02,203 --> 01:42:06,701
with this, as well as the
right to self-determination,

1984
01:42:06,701 --> 01:42:10,610
for people to identify
themselves as they are

1985
01:42:10,610 --> 01:42:12,660
and as they see
themselves, and the reality

1986
01:42:12,660 --> 01:42:15,635
for us older folks to really
get it, that there really are

1987
01:42:15,635 --> 01:42:17,696
a lot more options out there available.

1988
01:42:17,696 --> 01:42:20,074
Now how will this translate
into, quote unquote,

1989
01:42:20,074 --> 01:42:23,056
the real world in 10 or 15 years?

1990
01:42:23,810 --> 01:42:27,541
I have a very distinct memory
from my own younger days.

1991
01:42:27,541 --> 01:42:29,320
I was in my early 20s, I was living in the

1992
01:42:29,320 --> 01:42:31,686
San Francisco Bay area,
I was hanging out with

1993
01:42:31,686 --> 01:42:34,871
a bunch of radical
dykes who looked nothing

1994
01:42:34,871 --> 01:42:37,705
like my mother thought that
women should look like.

1995
01:42:37,705 --> 01:42:39,977
And we were all going out to dinner at

1996
01:42:41,130 --> 01:42:46,073
an organic restaurant at a
time when the word "organic"

1997
01:42:46,073 --> 01:42:49,593
didn't exist outside of the
San Francisco Bay area really.

1998
01:42:50,593 --> 01:42:53,862
I remember my mom saying to
my friends in this restaurant,

1999
01:42:54,464 --> 01:42:57,215
with her great Brooklyn accent,

2000
01:42:57,215 --> 01:43:00,301
"You know, you girls can't live this way."

2001
01:43:01,324 --> 01:43:04,249
"Live this way" meant you
had to get married to men,

2002
01:43:04,249 --> 01:43:06,826
you had to stop looking like boys,

2003
01:43:06,826 --> 01:43:09,950
you had to start looking
like girls in our culture,

2004
01:43:09,950 --> 01:43:11,655
like women are supposed to look.

2005
01:43:11,655 --> 01:43:13,157
You had to wear high
heels shoes, you had to

2006
01:43:13,157 --> 01:43:16,476
go get some kind of decent, real job.

2007
01:43:18,067 --> 01:43:21,493
The reality is that all of
those women that I was sitting

2008
01:43:21,493 --> 01:43:25,403
at that table with, they
all have real jobs today.

2009
01:43:25,403 --> 01:43:30,403
They're rabbis and physician's
assistants and educators

2010
01:43:30,643 --> 01:43:35,643
and they're all living lives,
but all of them still are

2011
01:43:38,563 --> 01:43:41,951
sexual orientation and gender radicals

2012
01:43:41,951 --> 01:43:44,945
compared to the world that
my mother thought existed,

2013
01:43:44,945 --> 01:43:47,792
and my mother's world, what she
thought was possible for us,

2014
01:43:47,792 --> 01:43:50,422
that we created a different
world for ourselves,

2015
01:43:50,422 --> 01:43:53,905
and I really trust that
this generation of youth

2016
01:43:53,905 --> 01:43:56,639
are creating a different
world, and that the world

2017
01:43:56,639 --> 01:43:59,511
that they are creating, by
the time they are 30 and 40

2018
01:43:59,511 --> 01:44:03,345
years old, that being
genderqueer will just be

2019
01:44:03,345 --> 01:44:05,982
one of the options that
are available to people

2020
01:44:05,982 --> 01:44:08,624
living in the world in the
same way that being a lesbian

2021
01:44:08,624 --> 01:44:12,236
and a lesbian mom and
partnered with a butch partner

2022
01:44:12,236 --> 01:44:15,143
is one of the possibilities
that's available to me

2023
01:44:15,143 --> 01:44:18,126
in this world, and I
still get to have a job

2024
01:44:18,126 --> 01:44:20,574
and get hired at Smith
College and I still get to be

2025
01:44:20,574 --> 01:44:22,829
a professional, and I get
to do all those things

2026
01:44:22,829 --> 01:44:24,638
at the same time that I get to be

2027
01:44:24,638 --> 01:44:26,765
the kind of queer self that I have.

2028
01:44:26,765 --> 01:44:28,494
They're going to be able to create

2029
01:44:28,494 --> 01:44:30,601
a world where that will be true too.

2030
01:44:30,601 --> 01:44:33,035
Okay, my last case I
want to do is Felisha,

2031
01:44:33,035 --> 01:44:35,911
who is a 16 year old male who ran away

2032
01:44:35,911 --> 01:44:38,111
from home to live as a girl, so again,

2033
01:44:38,111 --> 01:44:40,867
home was not safe, home did not feel safe.

2034
01:44:40,867 --> 01:44:44,602
She's been taking estrogen
that she got legally,

2035
01:44:44,602 --> 01:44:47,069
illegally, I'm sorry, on the Internet.

2036
01:44:47,069 --> 01:44:49,167
Has been pumping silicone
through a friend,

2037
01:44:49,167 --> 01:44:51,811
a very dangerous practice,
something to be very aware of

2038
01:44:51,811 --> 01:44:55,156
with young people and
also not so young people.

2039
01:44:57,380 --> 01:45:00,142
The pumping basically means
that they're taking silicone

2040
01:45:00,142 --> 01:45:04,381
and it is often not the grade
of silicone that a doctor

2041
01:45:04,381 --> 01:45:09,381
would use to do breast implants,
it's an industrial level

2042
01:45:09,424 --> 01:45:13,071
of silicone that is pumped
literally into the body,

2043
01:45:13,071 --> 01:45:15,755
injected into the body, to
make the breasts look fuller,

2044
01:45:15,755 --> 01:45:18,340
to make the hips look
fuller, etcetera, etcetera.

2045
01:45:18,340 --> 01:45:21,953
It's extremely dangerous,
it migrates around the body.

2046
01:45:23,424 --> 01:45:27,340
The health ramifications of this

2047
01:45:28,146 --> 01:45:30,650
are horrible, they're extraordinary.

2048
01:45:30,650 --> 01:45:33,947
So Felisha's parents do not
want to support this decision,

2049
01:45:33,947 --> 01:45:37,907
but they want "him" to
come home and get therapy.

2050
01:45:40,897 --> 01:45:45,327
How do we know when it's right
to pursue early transitions?

2051
01:45:45,792 --> 01:45:48,163
How do we know how to
help parents like this

2052
01:45:48,163 --> 01:45:50,282
to support their child,
to help them accept

2053
01:45:50,282 --> 01:45:52,384
that whether or not they like it or not,

2054
01:45:52,384 --> 01:45:54,475
their kid is living as a girl.

2055
01:45:54,475 --> 01:45:56,066
That's not going to change.

2056
01:45:56,649 --> 01:45:58,361
I shouldn't say that's
not going to change.

2057
01:45:58,361 --> 01:46:00,156
I don't know what's going
to happen in the future,

2058
01:46:00,156 --> 01:46:02,532
but what I know is right now
this kid is living as a girl

2059
01:46:02,532 --> 01:46:05,639
and they either need to
get on board or their kid

2060
01:46:05,639 --> 01:46:08,978
is going to be doing really,
really dangerous stuff.

2061
01:46:09,178 --> 01:46:12,797
If the kid is going to be pumping silicone

2062
01:46:12,797 --> 01:46:15,283
and getting hormones on the
Internet, at this point,

2063
01:46:15,775 --> 01:46:19,448
the conversation is over
about whether this is healthy

2064
01:46:19,448 --> 01:46:21,645
or not healthy or good or bad.

2065
01:46:21,645 --> 01:46:23,973
I want to get my kid in to see a doctor

2066
01:46:23,973 --> 01:46:27,501
who is going to prescribe
hormones in the right dosage

2067
01:46:27,501 --> 01:46:30,962
and level for that child,
in a way that is healthy.

2068
01:46:31,661 --> 01:46:34,982
Can a young person understand the enormity

2069
01:46:34,982 --> 01:46:37,086
of these decisions that they're making?

2070
01:46:37,675 --> 01:46:41,868
Running away from home, pumping silicone.

2071
01:46:44,113 --> 01:46:46,109
Are they able to make
an informed decision?

2072
01:46:46,109 --> 01:46:48,498
And as I said earlier,
I think it is limited,

2073
01:46:48,498 --> 01:46:52,571
the kind of informed consent
that they are capable of,

2074
01:46:52,571 --> 01:46:55,003
but they are capable of and allowed to

2075
01:46:55,003 --> 01:46:58,353
make decisions for their lives,
and there's a piece of it,

2076
01:46:58,353 --> 01:47:01,196
again, if your kid decides
to drop out of high school,

2077
01:47:01,196 --> 01:47:04,806
you may think that's a bad
decision, but at 16 years old,

2078
01:47:04,806 --> 01:47:06,841
your kid is allowed to
drop out of high school.

2079
01:47:06,841 --> 01:47:08,741
So how do you therefore, from that

2080
01:47:08,741 --> 01:47:11,239
point on, support your child?

2081
01:47:11,239 --> 01:47:14,101
How do we help manage the family's anxiety

2082
01:47:14,101 --> 01:47:17,482
and, if you will, the
normative family dysfunction.

2083
01:47:17,482 --> 01:47:19,761
All of our families are a little crazy.

2084
01:47:19,761 --> 01:47:21,593
All of us are doing the best we can.

2085
01:47:21,593 --> 01:47:24,391
Most of us are, by the
time we get to be parents,

2086
01:47:24,391 --> 01:47:26,218
are carrying a lot of baggage with us.

2087
01:47:26,218 --> 01:47:28,525
We're doing the best we
can to do the right thing.

2088
01:47:28,525 --> 01:47:30,667
We're going to make a lot
of mistakes along the way.

2089
01:47:30,667 --> 01:47:33,370
How do we help families
sort out what is really

2090
01:47:33,370 --> 01:47:36,454
gender issues in the family,
which actually might be

2091
01:47:36,454 --> 01:47:39,138
relatively easily treated,
and what are all the rest

2092
01:47:39,138 --> 01:47:41,237
of the issues that are
happening in the family

2093
01:47:41,237 --> 01:47:43,798
that actually might be more complicated?

2094
01:47:45,279 --> 01:47:48,636
Looking at, is the
environment free of coercion?

2095
01:47:48,636 --> 01:47:52,421
Is this child really free
to be making decisions?

2096
01:47:52,421 --> 01:47:54,766
I just had a case I was working on,

2097
01:47:55,335 --> 01:47:59,345
an older young person, 20 years old,

2098
01:47:59,345 --> 01:48:04,122
who showed up in my office just so angry

2099
01:48:04,122 --> 01:48:07,882
and resistant and hostile,
and was just like...

2100
01:48:08,298 --> 01:48:10,337
When I was like, "Hello," and it was like,

2101
01:48:10,337 --> 01:48:12,943
"I don't want to be here
and I don't want to do this,

2102
01:48:12,943 --> 01:48:15,772
"and this is just stupid
and my mother made me come."

2103
01:48:15,772 --> 01:48:17,580
"Okay, well what's the problem?"

2104
01:48:17,580 --> 01:48:21,398
"What the problem is, is I
just want female hormones

2105
01:48:21,398 --> 01:48:24,347
"and I'm just so sick of talking
to all you stupid people."

2106
01:48:24,347 --> 01:48:26,066
"Well, who are us stupid people?"

2107
01:48:26,066 --> 01:48:29,194
"Well, the doctor and the
therapist and this other

2108
01:48:29,194 --> 01:48:31,656
"person and nobody knows anything,

2109
01:48:32,332 --> 01:48:35,047
"and all I want to do is live as a girl."

2110
01:48:35,362 --> 01:48:37,702
And I said, "So I just want to clarify.

2111
01:48:37,702 --> 01:48:39,301
"I want to make sure I
understand what you're saying

2112
01:48:39,301 --> 01:48:41,885
"is that you perceive
yourself to be a girl

2113
01:48:41,885 --> 01:48:43,415
"and you want to take female hormones

2114
01:48:43,415 --> 01:48:45,489
"and you feel like everybody's
really blocking you,

2115
01:48:45,489 --> 01:48:47,250
"that they're gatekeeping you."

2116
01:48:47,250 --> 01:48:48,399
"Yeah."

2117
01:48:48,399 --> 01:48:49,946
"Okay, so let's get it off the table.

2118
01:48:49,946 --> 01:48:52,613
"I have the power to
get you female hormones,

2119
01:48:52,613 --> 01:48:54,250
"and I'm going to say right now

2120
01:48:54,250 --> 01:48:55,932
"that I will help you do that.

2121
01:48:55,932 --> 01:48:57,448
"So let's take that off the plate,

2122
01:48:57,448 --> 01:48:59,261
"that I will help you do that.

2123
01:48:59,261 --> 01:49:01,324
"What next?"

2124
01:49:01,824 --> 01:49:05,325
Kid looks at me and says,
"I just want hormones."

2125
01:49:05,325 --> 01:49:07,229
And I said, "I heard
you, I just told you that

2126
01:49:07,229 --> 01:49:09,299
"I would be happy to
help you get hormones.

2127
01:49:09,299 --> 01:49:11,447
"So is there anything else
you want to talk about?"

2128
01:49:12,576 --> 01:49:14,968
"Just like that you're going
to let me take hormones?"

2129
01:49:14,968 --> 01:49:17,847
"You know, you're 20 years
old, you're an adult.

2130
01:49:17,847 --> 01:49:19,497
"You're telling me you
want to take hormones,

2131
01:49:19,497 --> 01:49:21,352
"you're telling me everyone's
giving you a hard time.

2132
01:49:21,352 --> 01:49:22,986
"I don't want to give you a hard time.

2133
01:49:22,986 --> 01:49:24,071
"I mean there's a couple of things I,

2134
01:49:24,071 --> 01:49:25,023
"there's some questions I want to ask you,

2135
01:49:25,023 --> 01:49:26,374
"there's some things I
want to talk to you about,

2136
01:49:26,374 --> 01:49:28,184
"but I'm telling you right now that unless

2137
01:49:28,184 --> 01:49:32,064
"I come to the conclusion
that you are really crazy,

2138
01:49:32,064 --> 01:49:33,737
"you're really sort of mentally ill,

2139
01:49:33,737 --> 01:49:35,248
"you don't know what you're talking about,

2140
01:49:35,248 --> 01:49:36,699
"I will help you do that."

2141
01:49:36,699 --> 01:49:38,559
And the second I took that off the plate,

2142
01:49:38,559 --> 01:49:41,651
the second this hostile, angry kid,

2143
01:49:41,651 --> 01:49:45,441
just weeping in my office,
just weeping in my office,

2144
01:49:46,636 --> 01:49:51,179
and part of the weeping was, "I don't know

2145
01:49:51,179 --> 01:49:54,089
"if I should do this, I don't
know if I should go forward.

2146
01:49:54,089 --> 01:49:55,723
"I'm scared to go forward.

2147
01:49:55,723 --> 01:49:57,654
"What would it look
like if I went forward?

2148
01:49:57,654 --> 01:49:59,215
"How do I present as a girl?

2149
01:49:59,215 --> 01:50:01,096
"I don't know how to
do any of this stuff."

2150
01:50:01,096 --> 01:50:03,792
So when I'm talking about coercion here...

2151
01:50:04,587 --> 01:50:06,303
The coercion can go the other way,

2152
01:50:06,303 --> 01:50:08,340
that we're blocking people in.

2153
01:50:08,340 --> 01:50:09,897
Take that off the table.

2154
01:50:09,897 --> 01:50:13,288
Take it off the table, so that
the person has the ability

2155
01:50:13,288 --> 01:50:16,392
to really explore what
this means for them,

2156
01:50:16,392 --> 01:50:18,323
and if they feel like what they have to do

2157
01:50:18,323 --> 01:50:20,312
is prove something to us, then they're not

2158
01:50:20,312 --> 01:50:22,341
going to feel free to do that.

2159
01:50:22,341 --> 01:50:24,256
Do they have the necessary information?

2160
01:50:24,256 --> 01:50:26,238
Do they understand the risks and benefits?

2161
01:50:26,238 --> 01:50:29,326
Do they understand what
hormones will and will not do?

2162
01:50:29,326 --> 01:50:31,486
And in my experience,
there's lots and lots

2163
01:50:31,486 --> 01:50:34,543
of misinformation on
the Internet, and among

2164
01:50:34,543 --> 01:50:36,719
people that are fairly
well-educated about it,

2165
01:50:36,719 --> 01:50:38,617
of what they think will happen.

2166
01:50:38,617 --> 01:50:41,428
Is there any other alternative
course of treatment?

2167
01:50:41,659 --> 01:50:43,529
Sometimes just saying to people,

2168
01:50:44,164 --> 01:50:45,717
"Well, I just want to
wear women's clothes,

2169
01:50:45,717 --> 01:50:47,979
"but I don't really
want to take hormones."

2170
01:50:47,979 --> 01:50:49,549
"Okay."

2171
01:50:49,549 --> 01:50:50,394
"That's okay?"

2172
01:50:50,394 --> 01:50:51,720
"That's okay."

2173
01:50:51,720 --> 01:50:52,684
"You mean that's really okay?"

2174
01:50:52,684 --> 01:50:53,805
"No, it's really okay."

2175
01:50:53,805 --> 01:50:54,878
"So what would that look like?"

2176
01:50:54,878 --> 01:50:56,670
"I don't know, let's talk
about, what would it look like?"

2177
01:50:56,670 --> 01:50:59,405
So the idea of really
opening up options for them.

2178
01:51:00,055 --> 01:51:03,653
So some of the youth specific issues.

2179
01:51:04,578 --> 01:51:07,672
Kids come in a lot and
say, "I hate my body."

2180
01:51:08,938 --> 01:51:11,085
Most teenagers hate their body.

2181
01:51:11,085 --> 01:51:12,773
Most girls that are getting their period

2182
01:51:12,773 --> 01:51:14,795
hate their bodies for doing that.

2183
01:51:14,795 --> 01:51:16,923
So again, we have to
do a careful assessment

2184
01:51:16,923 --> 01:51:21,923
of what is typical teenage body anxiety

2185
01:51:22,586 --> 01:51:25,617
and what is really gender dysphoria.

2186
01:51:26,084 --> 01:51:29,069
We need to do a complete assessment around

2187
01:51:29,069 --> 01:51:32,476
sexual orientation versus gender identity.

2188
01:51:32,476 --> 01:51:35,026
So it's a fairly common...

2189
01:51:36,614 --> 01:51:41,614
experience that as the
female child is experiencing

2190
01:51:42,595 --> 01:51:45,015
the early stages of
their sexual orientation,

2191
01:51:45,015 --> 01:51:47,493
their gender identity,
they're liking a girl,

2192
01:51:47,493 --> 01:51:50,634
and they're thinking,
"Well if I like girls,

2193
01:51:50,634 --> 01:51:52,990
"it must be that I am a boy."

2194
01:51:52,990 --> 01:51:55,068
And they may not be able to have an image

2195
01:51:55,068 --> 01:52:00,068
of what it means to be a
female who likes other females,

2196
01:52:00,932 --> 01:52:05,530
especially if their
gender role, not gender

2197
01:52:05,530 --> 01:52:08,809
identity here, gender role, is different.

2198
01:52:08,809 --> 01:52:11,082
So in other words, if
they're attracted to very

2199
01:52:11,082 --> 01:52:14,147
feminine girls, but they see themselves as

2200
01:52:14,147 --> 01:52:17,157
a more masculine girl,
there may not be many

2201
01:52:17,157 --> 01:52:19,249
public images out of there of, what does

2202
01:52:19,249 --> 01:52:22,140
it mean to be a masculine female?

2203
01:52:22,560 --> 01:52:24,345
There may actually be more images in this

2204
01:52:24,345 --> 01:52:26,897
day and age to be a transgender male.

2205
01:52:26,897 --> 01:52:28,717
So sorting out, what is sexual

2206
01:52:28,717 --> 01:52:31,268
orientation and gender identity?

2207
01:52:31,268 --> 01:52:34,615
Recognizing the freedom
that young people have

2208
01:52:34,615 --> 01:52:36,717
regarding the Internet,
the amount of information

2209
01:52:36,717 --> 01:52:39,555
they have at their fingertips,
their inability to actually

2210
01:52:39,555 --> 01:52:42,603
use and discern what is
good and bad information.

2211
01:52:42,603 --> 01:52:45,515
That's one of the things
that I see having teenagers

2212
01:52:45,515 --> 01:52:48,906
and also teaching young people in colleges

2213
01:52:48,906 --> 01:52:52,125
is that the first thing that
pops up on a search engine

2214
01:52:52,125 --> 01:52:55,152
is sort of viewed as the gospel truth,

2215
01:52:55,152 --> 01:52:59,133
and they have very little
good critical thinking skills

2216
01:52:59,133 --> 01:53:01,399
of how to sort through
what is a good website

2217
01:53:01,399 --> 01:53:03,087
and what is a bad
website, what is accurate

2218
01:53:03,087 --> 01:53:05,677
information and what is not.

2219
01:53:06,136 --> 01:53:08,145
We want to look at the distinction between

2220
01:53:08,145 --> 01:53:12,110
experimentation versus authenticity.

2221
01:53:13,039 --> 01:53:17,292
We want to support our
kids in experimenting and

2222
01:53:17,292 --> 01:53:21,322
expressing all of these
different ways of being

2223
01:53:21,322 --> 01:53:25,404
in their youth and their
teenage years, and also

2224
01:53:25,404 --> 01:53:29,488
helping them to understand
what of that is an experience

2225
01:53:29,488 --> 01:53:31,499
and what of that is sort
of a permanent sense

2226
01:53:31,499 --> 01:53:33,509
of authenticity with their identity.

2227
01:53:33,509 --> 01:53:35,265
And again, this is really
hard because most of us

2228
01:53:35,265 --> 01:53:39,499
don't really land in who we
are until at least our mid-20s,

2229
01:53:39,499 --> 01:53:42,479
so it's hard work to do, and
I want to say one more time

2230
01:53:42,479 --> 01:53:46,042
to just be really
sensitive to the challenges

2231
01:53:46,042 --> 01:53:49,248
of frontal lobe development
and emotional reactivity

2232
01:53:49,248 --> 01:53:53,824
that is just part of what
this population is all about.

2233
01:53:54,114 --> 01:53:58,484
So I hope that in the last couple of hours

2234
01:53:58,484 --> 01:54:01,046
this has been helpful
for people to understand

2235
01:54:01,046 --> 01:54:03,429
some of the clinical
information, some of the clinical

2236
01:54:03,429 --> 01:54:07,164
implications, of working
with this population,

2237
01:54:07,164 --> 01:54:10,266
of understanding the differences between

2238
01:54:10,679 --> 01:54:14,466
gender nonconforming behavior
and gender dysphoria.

2239
01:54:14,466 --> 01:54:18,557
Understanding some of
the medical treatments

2240
01:54:18,557 --> 01:54:21,500
that are available, the difference
between hormone blockers

2241
01:54:21,500 --> 01:54:24,321
and cross-gender hormones,
the difference between

2242
01:54:24,321 --> 01:54:28,810
the treatment of pre-pubescent
kids versus teenagers,

2243
01:54:28,810 --> 01:54:31,718
the really important need
for parental support,

2244
01:54:31,718 --> 01:54:34,440
the really important need
for education and advocacy

2245
01:54:34,440 --> 01:54:36,810
out in the school systems,
the need for family

2246
01:54:36,810 --> 01:54:40,035
systems work, where
we're assisting parents

2247
01:54:40,035 --> 01:54:42,354
in accepting their
children, because we know

2248
01:54:42,354 --> 01:54:44,454
the outcomes are going to be better.

2249
01:54:44,454 --> 01:54:49,082
And I just want to end
by saying, I work...

2250
01:54:53,057 --> 01:54:56,294
I'm tempted to say that awful
sentence, so you can all

2251
01:54:56,294 --> 01:54:59,740
throw a pillow, nothing
harder than a pillow,

2252
01:54:59,740 --> 01:55:02,810
at your computer screen
right now, but you know,

2253
01:55:02,810 --> 01:55:05,061
some of my best friends are.

2254
01:55:06,150 --> 01:55:09,291
Some of my best friends
are very successful

2255
01:55:09,291 --> 01:55:12,704
transgender adults, therapists.

2256
01:55:13,901 --> 01:55:17,222
That being transgender...

2257
01:55:22,249 --> 01:55:25,910
That people who are transgender can live

2258
01:55:25,910 --> 01:55:29,361
successful, happy, and satisfying lives.

2259
01:55:29,361 --> 01:55:32,953
And that assisting young
people who are transgender,

2260
01:55:32,953 --> 01:55:34,770
because we can't make people transgender

2261
01:55:34,770 --> 01:55:37,363
or not transgender, we
can't, in my opinion,

2262
01:55:37,363 --> 01:55:40,246
fix people to be anything
other than who we are.

2263
01:55:40,246 --> 01:55:44,067
The only thing that we can
do, to use Diane Ehrensaft's

2264
01:55:44,067 --> 01:55:46,997
words, is assist them and their families

2265
01:55:46,997 --> 01:55:50,144
in transgender health,
to assist them in this

2266
01:55:50,144 --> 01:55:53,476
normative developmental lifestyle process,

2267
01:55:53,476 --> 01:55:55,161
but one that's not talked about

2268
01:55:55,161 --> 01:55:59,029
in most of our human behavior
textbooks at this point.

2269
01:55:59,029 --> 01:56:01,835
That to assist people in a process

2270
01:56:01,835 --> 01:56:04,726
of how to love and nurture.