 Good morning and welcome. Thank you for coming. This is our 18th annual symposium, and we've been blessed year after year in February and March with amazing weather and today makes no exception to that. It's a beautiful day outside. Okay, wow, that's great. Good morning and welcome. My name is George Jara. I'm the conference director. If there's one thing I could say today is we have a very packed packed agenda. So when the time is to come back from lunch or come back from break, it's best to come back and do it as fast as possible. I'll usually encourage people to come back. And the reason I say that is because it cuts into the time of each presenter, and we have five distinct parts of today's program. Special surprise in the afternoon. So that timeliness of gathering back together is going to be quite important for the flow of the day. Housekeeping details on your tables. There's pens and a couple of pads. We're going as green as possible. The pads, you know, share the paper for notes, but by and large, I think paying attention to the presentations is going to be key today. Also on your tables are question forms. There's 450 question forms out there. There's 450 here today, so thanks for coming again. So throughout the day when you have a question for an individual speaker or for the panel discussion, you can write those questions and put them either in the basket there. There are two baskets in front of the stage, and there's a basket on the bar on the way when you came in. That's how we figure out the questions for the last section of the day, which starts at three o'clock. It's a good opportunity to turn off your personal devices or at least silence them for the day. There's a typo on the program instructions, which is on the back of the first sheet, which says psychologists no longer need to sign out. Indeed, you do need to sign out. So psychologists on the way out will make sure that, you know, you know where to sign out. It's an early lunch. We're starting at 11.30, and it's going to be served in the Bayroom buffet style. The presenter's slides will not be available. That's something we did in the past. They may be available in the future on our website. At the end of the day, you will not come in the way you, we will not go out of the way you came in. So the exit is going to be behind the screen. It's a grand stairway that goes down, and that's where you'll drop off your course evaluations. Are there any questions? The second page of your program is your course evaluation. It's important you put your name on the bottom of the second side, and when you turn it in, because without that, we can't grant continuing education credits. So just to talk a little bit about continuing education credits, I'm going to introduce Alicia and Ahai. So just to reiterate, because there's always a question from somebody about, I didn't get my units. You must sign in. If you didn't do that, who you came in, please make sure you sign in, and at the end of the day, most of you will only need to do the evaluation and print your name, so it's legible, on the evaluation to get units. That includes for Santa Cruz County staff cultural competence units. So at the end of the day, not before, you will turn in your evaluation. I'll be out there with my little box. Do not leave your evaluation form on the table. We are not going to collect them. They need to be turned in. It may sound petty, but inevitably there's been a handful of people that takes a lot of staff time from various persons to get these. So we want to, you know, we want to be able to to give you the units for attending this wonderful conference. The only people that need to sign out are psychologists. The rest of you just need to sign out by putting your name here. So psychologists, you do this and sign out. I will have the sign out form, and I'll direct you to that. So any questions? See me at the breaks. But welcome. I'm so happy to see such a huge crowd, and I'm really proud of this symposium in general and today's topic in particular, and I think it's just awesome that we sold out. Good job. So as I said, we're at capacity. So one of the requests is that if there is an open seat at one of your tables, raise your hand right now. And so those folks walk around, look for a place to sit, look for those hands up there. Again, there are other seats up along the balcony in the top here. Parking validation, those people who did not get their parking ticket validated during lunch perhaps or a break at your parking ticket validated, and you won't have to pay for parking. Right now, I'd like to introduce Joshua Nath and Ernie Calciano. I want it's my honor to welcome you to our 18th annual Johnny Nath and Ernie Calciano Memorial U Symposium. I'd like to recognize the various organizations that are here today. We've been doing this for many years, and I do encourage you to take the time during the lunches and the breaks to network with them and to speak with them. I'd also like to recognize our high school students. For many years, we've been doing a scholarship program for our students, and this allows various high schools to bring in students that they feel would benefit the most. And then I just request that when you do go back, you take this information and you apply it and you talk to your fellow students as well. You know, my brother John would be 44 years old this year, and as I've grown from an adolescence to a husband and now a father, there's not a day that goes by when I don't think what his life would have been like today. And though this symposium bears his name, I feel it has come to represent all families dealing with suicide, violence, and people with drugs. My family is incredibly glad to have seen the symposium in memory of John develop over the years into the widely attended event of today. And as difficult as our loss continues to be, the community coming together is a very healing force for us. We continue to be impressed by the diversity of the attendees, clinicians, counselors, educators, and public safety officials that have attended our symposium over the years. The post symposium comments and the number of attendees that return year after year clearly show that we are making a real difference in our community. Our deepest thanks and appreciation goes out to those that plan the details of each annual symposium, and we are particularly gratified to George Jaro and all members of the advisory committee. It is their hard work that allows all of this to happen. I have never met a more passionate devoted group of people, and I am honored to be associated with them. I'd also like to recognize the tireless volunteers to help do logistics of the event, and also the Dominican Foundation, which is the philanthropic arm of the symposium, and is with their support that we have established the Johnny Natterney Endowment Fund. We could not have continued to have such wonderful events without their support. But most importantly, I want to recognize all of you and your devotion to your work. For nearly two decades, the symposium has expanded on topics ranging from suicide to autism, and it is your continued quest for knowledge that allows us to bring you such wonderful speakers to you year after year. In summary, I want to thank all of you for coming today, and hope you find this information presented to be beneficial in your work, and hope you will continue to join us year after year. It is now my distinct pleasure to introduce Joel Baum. Joel Baum is the Senior Director of Professional Development and Family Services. He is responsible for all programmatic aspects of gender spectrum. He facilitates trainings and conducts workshops, develops curriculum, consults with parents, professionals, and providers, provides resources and services of a more compassionate understanding of gender. He is a founding member and Director of Education and Advocacy with the Child and Adolescent Gender at UCSF. Working throughout the United States and beyond, he is frequently called upon to help institutions think more expansively about the gender diversity of all children and teens and ways to create more exclusive conditions accordingly. For nearly 30 years, Joel's work as an educator has focused on issues of social justice and equity. First as an award-winning middle school science teacher and school administrator, he has also served as a district administrator in Oakland, California, as well as a school reform coach with the National Equity Project. Joel is also a professor at California University East Bay in the Department of Educational Leadership. Gender spectrum provides education, resources, and support to help create a gender-sensitive and inclusive environment for all children and teens. We accomplish this mission through school trainings, parent support groups, and consultations, policy development, and our annual family conference, and work with medical and mental health care providers, social services, and others working with families and kids. So it's my distinct pleasure to introduce Joel Baum. Wow. Good morning, everyone. All right. We can do a little better. Good morning, everyone. Good morning. All right. So again, let me make sure my doohickey's working here. I'm Joel, and as Josh said, I work for this organization called Gender Spectrum. I'll tell you a little bit more about my background and my experience in education after lunch when we're focused on schools. But today, for the kickoff, I've been asked to really focus on the notion of the dimensions of gender, understanding the complexity of gender. Before I do that, I also want to offer my thanks to the Symposium Organizing Committee, the sponsors of the event. And again, as Josh said, to all of you, for the work you do, helping young people and their caregivers, they need all that we can give them. And I know all of us work very hard to provide the support for them. So again, as a parent myself, I thank you for that. So, gender. What I'm going to provide here for the next 30 or so, 30, 40 minutes, is a model of gender. It's not the model or the only model. I wouldn't even argue about whether it's the right model. It's the model we're going to use right now. What we have found is that this is a model that allows for discourse. I don't want to argue about certain words, and are we using them correctly. I want to communicate and get business done in support of young people. And so I want to be really clear. What I'm going to present is just one way to think about gender. But in the various organizations and institutions we've worked with, it's proven to be a pretty powerful one to allow for conversation and discourse about gender and young people. The work around this topic truly begins inside. We all come to our roles as educators, as counselors, therapists, pastoral care providers, and everything else with our own experiences, our own worldviews, if you will, related to gender. We all are impacted by gender. And we know that without reflecting on that, without reflecting on our own experiences of gender, we can tend to look at the young people and their gender as sort of an other, as if their gender needs to be dealt with, not our gender. And so I'm going to ask you to do a little reflecting on your own experiences of gender. And I'm going to foreshadow the framework that Gender Spectrum uses primarily with schools, but really any organization about change. But it always begins at the personal level, the personal entry point, where we really focus on our own understandings of gender and the ways in which they impact the work we do with young people and their families. So I'm going to do a brief thought experiment here with all of you to kind of key in to that, if you will. I'm going to show you a couple of pictures, and I'm going to read several scenarios. And for each one, I simply want you to turn in, turn inward, and focus on your response, your reaction to each of them. Okay? Here's the first picture. What's wrong with a girl who wears a ball cap? A new approach to parenting gender-fluid children by Ruth Pador. Here's the second. What's wrong with a boy who wears a dress? A new approach to parenting gender-fluid children by Ruth Pador. How might you answer that question? How might you talk about those two pictures with a family member, a colleague, an older relative, a younger relative, someone in your social circle? Jennifer's parents are surprised to hear their five-year-old exclaim, I'm a boy. They say fine and let their child pick a new name and begin using he and his for pronouns. Seven-year-old Chantelle goes to the bathroom to pee, but while she's there, other students constantly ask her why her feet face the wrong direction when she's going. Ten-year-old Devon approaches you and complains that everyone keeps asking, are you a boy or a girl? At 14, Jamie has decided that they want to be known as a gender, but need you to help explain what that means to their parents. Tanya is 16 and explains to you that attending school as a girl has become impossible. Instead, Tanya changes clothes every day on the way to and from campus and is now known at school as Tomas. The school has been supportive, but Tomas does not want his parents to be informed. A neighbor approaches you at Safeway and says, I hear they're letting boys use the girls' restrooms now at the middle school. What the heck is going on there anyway? Regardless of what you're thinking or imagining or how you're responding, that's data for you about where you are when it comes to your notions and understandings and beliefs about gender. And as we work throughout the day, I want to encourage you to both stay connected with those, but at the same time be willing to interrogate them. Be willing to interrogate them in the, in light of the incredible shifting terrain of gender, particularly among young people, that we are literally experiencing beneath our feet. This model is based on three essential ideas. The first is that gender is about more than our bodies, that we have to look at biology, expression, and identity to really understand the authentic experience of gender. Secondly, that it's better represented as a spectrum, rather than a simple binary. And lastly, that gender and sexual orientation are different, and when we conflate them and confuse them, it really creates challenges for young people. Those three ideas, pretty simple in concept, we've found to be significant in creating a perspective around gender that is honoring of all people's experiences. It's not about dismissing gender as a concept. It's not about saying gender doesn't matter. It's expanding our notions of gender in order to be responsive to the needs of everyone. Now, interestingly, that definition is completely consistent with our EB code, which includes gender as a protected class, and names and defines gender to mean a person's sex, and includes their gender identity and their gender expression. Those are the three aspects that we need to focus on in protecting the gender diversity of all young people. So, when someone has a baby, what's the first question we almost always ask? Well, yeah, boy or girl, I always love, though, one of the first few times I was doing this training, I was at a middle school, and at about this juncture, I asked that question, and from the back of the room in a sixth grade class I hear, who's the dad? It's like, okay, I am gonna love this job. I know this is gonna be a great job. No, but of course the question that is asked most often is, is it a boy or a girl, right? And of course the answer to that is based in biology. When that baby's born, we take a look at their body and we make a determination and slap this label of girl or boy on them, okay? Now, right there we have the heart and soul of the binary gender system, the gender binary, okay? And that binary essentially has two main concepts it's built upon, one, that there are only two kinds of bodies, and two, that whatever body you have will equal your gender. So what we do is we assign sex, but we presume gender. And in fact, we're often right. That model works pretty darn well for a lot of us. You know, I bet many people in this room go, yeah right, of course. And that's right, it does work for a lot of us, just not all of us, okay? Because what we know is that at multiple levels gender is a spectrum, a continuum. Now I happen to be, as Josh mentioned, a former science teacher and I was a bit of a math nerd and I want to point out that those lines, that line and all the lines you'll see have arrows on each end, okay? Now my daughter's taking geometry and we're learning about lines versus line segments. Lines are infinite. Line segments have endpoints. These are infinite with these stops along the way of girl or boy, okay? And in each of the dimensions we need to think about the dimension as a spectrum. Even biologically, we know that bodies do not just come in two forms. First of all, what we call boy bodies and girl bodies. If you're looking at me, I'm doing air quotes. I'm not gonna keep doing air quotes because I'm already, you know, kind of warm and doing air quotes all afternoon is gonna be boring. But no really, when we talk about bodies, you know, a boy body is really a penis-bearing human. It's not a boy body because people of all kinds of genders have penises. A girl body is really, you know, an ovary-bearing human, a vulva-bearing human. And while I don't expect you to say, good evening, vulva-bearing humans and penis-bearing humans, you know, I do want to encourage you to disconnect this notion of what's in your pants with who you are because it just doesn't always work. But more than that, there are bodies that don't fit either one. Now, the nomenclature a long time ago was hermaphrodites. Currently, we often refer to individuals as being intersex or an intersex condition. The unfortunate medical nomenclature is DSDs, Disorders of Sex Development. That's a whole different lecture about why that's problematic, but suffice it to say many of the more gender-affirming specialists that I work with refer to differences of sex development. But what we're talking about is a whole range of naturally occurring conditions that belie the physical binary of bodies. Ambiguous genitalia, variations in chromosomes, variations in the way hormones are interfaced with the body, various ways, and even a cellular level that we're beginning to see that gender is not at all this one or the other thing. There are many conditions, physical differences connected to these conditions that are invisible. So we never know, you won't know if a person has an intersex condition is intersex unless they tell you and even in some cases those individuals don't even know themselves. It just is something that's part of the natural interplay of humans. And here's a short clip that helps really bring this home. We'll try that again. Here's a short clip that'll bring these things home. If you have testes. Alright, let's try it one more time. Raise your hands if you have testes. I'm Pigeon. I'm Alice. I'm Emily. I'm Cypher. And we are intersexy. Intersex describes a person who doesn't fit the typical definition of male or female. I have XY chromosomes, but typical female genitalia. I'm a girl who has testes and XY chromosomes. I identify as a queer, gender nonconforming intersex person. I identify as a black intersex man. Intersex is not new. It's been around since the beginning of human existence. I mean there's probably even intersex dinosaurs if you think about it. And that's probably not that far from the truth because as I've said these are naturally occurring variations of living things, right? It's the stuff of evolution, that variation. There's a great quote that Milton Diamond said which is something along the lines of nature loves diversity, but society hates it. And I think that's very much what we're talking about here because this notion of the binary, which for many people is assumed to be one and only based on biology, you know, part and parcel, it breaks down even at this level. It just simply doesn't work to capture the greatest number of humans' experiences. And when we're having models to describe humans, particularly if we have something so essential as gender, we should try to be as inclusive as possible. But biology and sex aren't the same as gender anyway. They're not the same thing. They're different. There's a relationship, but it's only one dimension of an individual's notions of gender. The second dimension is expression. Now, expression often here described as gender expression. I'd like to add two letters, E.D., it's gendered expression. It's really human expression that we have assigned all sorts of attributes to that don't always add up. This is often what I refer to, what you'll hear talked about as the social constructs that are attached to gender. And there's evidence of the binary everywhere. And for our young people, they are like fish in water swimming in the binary. They don't even know it's there half the time. These messages come in so many different forms about how you're supposed to perform girl and how you're supposed to perform boy, let alone someone who might not feel like either one. That's not even on the table. One way to do it or another way to do it. And these things inform so many aspects of our culture, our traditions such as Halloween. Now imagine if you are, you know, say wearing that fairy tale costume or you're that person and you want to wear one of the, I don't know, Star Wars costumes. You need to cross this not so invisible line into that space simply to wear a different costume. Last time I checked costumes were costumes. And yet we put up this barrier that kids are forced to cross in order to simply pursue something or wear something that feels right for them. And sometimes these have real, real impacts. Insidious and less insidious. Obvious and less obvious. But here we have three telescopes. Three telescopes. And what you'll notice for those of you probably can't see in the back is one of them has 525 times magnification is big in the picture. It costs 90 bucks. It's clearly well constructed and happens to have someone that most people would read as a boy looking through it. And then almost as an afterthought in the bottom left-hand corner we have this pink telescope that gets 90, that's good, right, 90 for $15. Again, we can look at that and laugh, but there are messages implicit in these visions and notions of how we are gendering toys, objects, clothing, experiences. And make no mistake, this stuff starts early. A diamond ring for a sweet baby girl and a saw for a busy baby boy. Now these notions of course are in fact quite artificial. Gender expression, the expression of gender, that gendered expression is shifting all the time. Think about it for a second. I want you to imagine being 10 years old again. Raise your hand if when you were 10 you knew men or boys with earrings. Take a look around, you'll see some hands up. You might notice a pattern to whose hands are up, just saying. How about now? Raise your hand if you know men or boys with earrings today. How about this one? Raise your hand if when you were 10 you knew girls with tattoos, girls or women with tattoos. Again, some hands. How about today? These are just two examples of how the notions related to gender are shifting all the time. I mean heck, when I was growing up the only people wearing earrings were women and girls. The only people with tattoos were boys and men and pirates got to do both I guess because they have apparently a lot of freedom out there on the ocean, you know, they're transgressing all sorts of other stuff so why not gender as well? But the fact is this stuff changes and we need to help young people understand that this stuff is shifting all the time. Another great example of that is this phenomenon called the bronies. Now I happen to have two girls both of whom spent quite honestly more time with my little pony than I wish they had. I know way more about Fluttershy than anyone should know about Fluttershy who is one of the characters. Bronies are men, young men, young adults, you know, high school, college aged men who like the franchise My Little Pony. They're bros who like the ponies. They're bronies. And I want to be really clear this is in a non-ironic creepy way, okay? Not a creepy way. It's about, you know, they love the artwork. They love the storylines. They love the collectability of the objects, right? They love the notion of a community that is like connected to this really sort of offbeat thing. And it's something, in fact, it's sort of part of a Comic-Con generation, right? If you go to a comic book store, a game store, you will more than likely begin to find My Little Pony sections in a toy that once was really the domain of girls. And in case you don't believe how mainstream bronies are, that picture in the bottom right-hand corner, that's from the J.C. Penney website, right? I don't think you get more mainstream middle America than J.C. Penney. But perhaps my favorite example of all of this are the colors pink and blue, the old standbys, the sort of holy of holies of gender expression norms. The generally accepted rule is pink for the boys and blue for the girls. The reasons that pink, being a more decided and stronger color, is more suitable for the boy, while blue, which is more delicate and dainty, is prettier for the girl. Trade publication, Earnshaw's infant department, 1980s. So I guess your boys' colors depend entirely on when you like them. When, of course, there's no such thing as boy and girl colors, colors are just colors. This is, as the narrator named, was a trade publication designed for marketing in department stores. If you're gonna be working with families, push the pink stuff on the boys and the blue stuff on the girls. Now interestingly, 100 years later, here we have Target last year, announcing that they were no longer going to separate bedding and clothes based on gender. It used to be you could go in Target and you'd go to the toy aisle and you would see building sets and girls' building sets. Really? Now it's building sets. If you're a girl and you want Spider-Man bed sheets, again, why do you have to go into this aisle with the label boys on it? That automatically means that, well, if you want it, you gotta cross this line and make some sort of declaration when in fact you don't. They're just sheets. Throughout time and from one culture to another, these things are shifting all the time and what we have to help young people recognize is that they will shift while there may be patterns to gender expression. They are not rules. When I was a teacher, I had something I called the smell test and the smell test was, can I stand in front of my eighth graders and make the following statement and have them say, yeah, that smells right. Or do they go, pfft pfft pfft pfft. Oh no no, that's funky, that don't smell right. And if I were to stand up here and say to my eighth graders, oh yeah of course boys, girls, they both wear dresses all the time. Wouldn't pass the smell test. It would. Right? Does that mean all boys don't wear dresses? No. Does that mean all girls don't wear them? Does that mean all boys do? And all girls do? No. Do some boys and some girls? Yeah. What's the pattern? Well, the pattern is that girls wear dresses more commonly than boys do. It's a simple pattern. It's not a rule. Patterns versus rules is an important concept as we talk about gender expression if we want to do it in a way that recognizes and honors the experience of everyone. But when we have someone who doesn't fit the pattern, we can't blame the data. We're making the mistake. We've got the wrong pattern. We need to adjust, right? Versus someone breaking a rule is doing something wrong. We have to adjust our ability to look at new data and say, oh, let me reframe my framework. And so expression represents that second dimension. The third dimension we want to talk about is gender identity. And gender identity refers to our internal sense of self, the core notion of who we are deep inside. Again, the binary assumes that there are two ways to feel. I can feel like a boy and I can feel like a girl. And by the way, it's inextricably linked to my genitals. Whereas we know again identity also is a spectrum, an infinite spectrum in which individuals can feel like girls and boys, both, neither, all sorts of combinations. And as we're going to see in a few minutes, an incredible diversity of possibilities in which young people are asserting, hey, this is what gender means to me. This is my gender. Now, I want you to think for a second about your own experience again. When did you know? How did you know? How old were you? What messages did you get about your gender? What did you encounter in the world around you that reflected or did not reflect your gender? And as you think about that, take a look at this next slide. This slide shares data from transgender adults who were asked, when did you realize that your gender varied from the sex you'd been assigned at birth? Okay. Did you realize when you're 18 or 16 or 14? So along the bottom or the x-axis, we have age. And up the top along the y-axis, we have the percentage of respondents. So let's take a look at when these adults realize this about themselves. Here's the first group who realize basically in high school or older. Okay. Here's the next group who realize this about themselves in middle school or in adolescence. Here's our pre-adolescence in the upper reaches of elementary school. And finally, here's our youngest people who realize their gender identity was different than the sex assigned at birth. Now, I want to be very clear. This is not the only narrative for a transgender person. This is a study. But what it does demonstrate is that for certainly the vast majority of people in that study, they knew quite early. And returning to what I asked you, I'm imagining most of you knew quite early as well. And that's because gender identity is a core aspect. It's about congruence. It's about alignment. It's about this notion of I just feel right or I don't based on the messages I'm getting from others, based on my own body, based on the ways that I'm forced to or allowed to express my gender. Now, interestingly, in a different study that showed very similar results, the average age of realization was just under eight years old. The average age of disclosure was not until 15 and a half. Now, I want you to think about being seven, eight years old, having this profound sense that who you are is not what everyone else thinks, but not disclosing that for another seven plus years. I either can't because I don't have the language. I can't because I know the reaction of the people around me. I can't because no one's created the space for me to understand my own experience. And that, my friends, is a huge burden to ask a little kid to walk around with. And we have to work on creating those spaces where everyone's experiences of gender are on the table to be considered and celebrated. These are just a few quotes from another study, retrospective study of adults reflecting on their experiences. And as you read those, you'll see three ideas. One, there's a ton of pain in not being seen. Two, these are young folks. These are kids again, thinking about their experiences. And interestingly, three, the three at the top, you'll notice they all refer to going to bed, falling asleep at night. And I want you to think about your own experiences. When are we more alone? When are we more just with ourselves than when we're sleeping? That is such a time of privacy and personal reflection. And yet for many of those young, many of these folks, that was a time that was really difficult. And interestingly, many of the families we work with, many of the families of the mental health providers that we collaborate with, talk about their gender expansive kids having trouble sleeping, having issues with sleeping. I got to wonder, they're busy all day long, and now it's just me. And now I just got to face the fact that a lot of people don't really see me for who I am. What she ended up getting was a shot that's called Lupron. It tells her brain to stop producing the male hormone and then was taking an estrogen patch. Now that I've been on hormones for six months and more changes are happening, I'm completely comfortable in my identity. So I don't really even consider myself a trans girl anymore. It's more just like I'm a girl who just happens to be transgender. I feel like I'm just myself. Somebody close now. We're all products of our society, right? The third dimension then is gender identity. Now you notice in talking about these three dimensions, I don't believe I've said the word lesbian, gay, bisexual, asexual, pansexual, omnisexual, or any other kind of sexual. And that's because those are all terms related to sexual orientation. And sexual orientation and gender, again, are not the same thing. Is there a relationship? Sure, but they're not one and the same. I mean, think about it for a second. Sexual orientation in many ways is understood in terms of my experience in relationship to others. Gender, on the other hand, is very much my own experience of self, my experience of who I am. And it's problematic to confuse them for a couple reasons. One is we frequently read a young person's expression and assume it tells us lots of stuff about their identity. And in fact, you know, I was a couple weeks ago doing a presentation for some early childhood educators and one of them raised their hand and said, well, what am I supposed to do with the parent, usually a dad, who comes in and says, I do not want my son playing in the dress-up corner. I do not want a little gay boy on my hands. I'm just not gonna have it. Not gonna have it. What am I supposed to say? And I'm like, well, you know, it's your, first of all, it's your preschool, by the way. And you probably have enough on your hands worrying about keeping the kids safe than what they're playing with. But also, you know, that kid's three, I think. Could we just give him a minute to figure out the attraction stuff and just let him play, right? But more importantly, when we confuse sexual orientation and gender, we put a very adult lens of sexuality on top of the process of identity development that just is not on the table. So when we think about supporting transgender young people in our schools, in restrooms, in locker rooms, on overnight field trips and housing accommodations, many people's minds go straight to sex in a sexually loaded situation. When, in fact, it's not about that. It's about identity. And the issue is not who's gonna have sex with who, but who is gonna be honored for who they are. Now, these three dimensions work together. One, anyway, is like this, where they essentially line up, where biology and identity are aligned and expression frequently follows. And there's a term for that. That term is not normal. It's not the term, or correct, or proper, or as nature intended. It's called cisgender. Cisgender, the prefix cis literally means to be on the same side as like a cis and trans molecule and there are many other places it shows up, is gender typical. Now, why is it important to have a name for that? Well, the fact of the matter is, I would argue this is still probably the dominant experience in our society. And we need to name dominant experiences because if we don't, they become the default, right? If you're not this, you must be something not normal, not regular. No, cisgender is just one form of gender. It's a way we can label the dominant experience. But of course, there's others. We have tomboy's who are assigned the sex of a girl and identify as a girl and are perceived to express their gender in somewhat masculine ways. That's a common word we use for that. We also have another pattern where someone's assigned the sex of a boy and he identifies as a boy, but according to the people around him, he skews to the feminine. You know, like maybe he prefers the color pink or blue or I don't know. Unless he's supposed to play with my little pony, that's a girl toy, isn't it? Anyway, we don't have a name for that kiddo. We don't have a way to refer to that young person, certainly not in a way that's similar to tomboy, which many would argue has become a very positive term. Now, I don't want to pretend that tomboy's universally are accepted and that this boy who's perceived to somehow express gender in a feminine way is universally negative, but as a general rule, our society struggles with our boys that skew to the feminine. Dr. Ernst Aftonai and Dr. Hastings are all part of something called the Child and Adolescent Gender Center Clinic. In our clinic, we never get a call from a parent that sounds like, yeah, I have a five-year-old girl and all she wants to do is wear her brother's clothes. She has a very short haircut and all she wants to do is play baseball and rough house and wrestle. We don't get that call. We get this call all the time. I have a five-year-old boy and he's got very long hair. All he wants to do is wear his sister's clothes and he just loves to do tea parties and do I have a problem? We get that call all the time. Now, there's other possibilities. Here's someone who's assigned the sex of a female, but he identifies as a male. And in this model, we use the term transgender to describe this individual and transgender boy because the identity is male. The trans part is biology and identity across from rather than on the same side as each other. And often, this is a young person who will tell us in no uncertain terms, not that I wish, that I hope, maybe one day I will, it's, oh, I am. I am a boy, especially if they have the space to make that declaration. And a transgender girl, then, is assigned the sex of a boy, but she identifies as a girl. Now, again, this is a model and you will hear the term transgender often used in much more umbrella form. What I'm going to tell you today is in our model, we use it in this very precise way and have a different way of talking about the whole plethora of other possibilities. But before we go there, I want to make one last comment about transgender children because we often get asked, well, how can you tell? I mean, how do you know? Well, is it a phase? Is it not a phase? You know, how can you tell the difference between a phase and someone who's authentically asserting their, their selves, their true selves? Well, often these are three things to think about, persistent, consistent and insistent. One of my girls, when she was four or five years old, thought she was a dog. She thought she was a dog. You know, she played around, I'm a dog daddy, you know, look at my ears. You know, my partner and I, we didn't feed her on the floor. You know, we didn't, we didn't, we didn't accommodate her assertion of dog-ness. We didn't make her pee outside, you know. She would have loved that, by the way. She would have thought that was awesome. But, and when grandma came, was like, okay, sweetie, the, the barking's really not what grandma's here. She just, she's old. She can't handle it, okay? But if you think about someone who is asserting a gender identity and saying, yeah, I want to wear the clothes and be called the name and et cetera, when grandma comes over for that kid and you say you need to cool it, you get a very different reaction. You don't get a, oh, well, fine. You have a problem. You have serious distress. You have insistence, okay? And that, that impact is often a really strong tell. And here's another clip sort of talking about that. But accepting of it, since I've known since way back when. But I could, you know, recall times where I was little and I would, you know, they would put me in the same tub as my little cousin and he would have some things that I didn't. And I was, you know, wondering, I'm like, where's mine? You know, like, hey, who, who forgot to give me mine? You know, like, where's my little Peter Weeter as they called it, you know. And it's like, I don't know. It's like, I would always, I've always admired guys like not like, oh, you know, I like you enough. It was kind of like, you know, I wish I could be you. And I think it's like, I can still remember sitting on the playground and just looking at the dudes and just like, you know, just wishing and imagining how it would be if I were them or if I were born. And, you know, born as a guy, because you know, I was little, you know, you don't really know about sex, but we know gender, we know that, you know, you're always supposed to be the ones in skirts and dresses and guys really jeans and fine all the time, you know. But I think I think what should have been assigned to my parents is that I was a quiet child. I wouldn't fuss, scream, grow anything. But whenever my mom would try to dress me up and put lipstick on me and all this pretty pictures, I would have a, I would throw a tantrum, I would scream, I would bawl, I was on the floor just crying like so. And I would, you know, I was little, I never cried or anything. I was a quiet child. So that should have definitely been a big sign to her that I was not trying to fit into the girl world because, you know, I never did girls did. The most feminine thing I did as a child was paint my nails black. So again, when we do this work, we often find ourselves needing to convince people that transgender people are real, that they exist that a kid can know. Well, fortunately, we've got a lot of backup. These are many of the associations and this is quite old. I'm sure there's many more now that have affirming statements of the rights needs and importance of protecting transgender young people. Quite simply transgender students and young people are not making it up. Who they are is who they are. And they have nothing to gain in asserting a sense of self that isn't authentic. There just isn't, there isn't anything in it that's gonna make that worth it. The difficulties are quite, quite significant. But of course, what I've been talking about to point this point is all very binary, right? This body, this expression, this identity, one or the other. And in fact, that just is a tip of the iceberg. There are many, many places that exist in the land of both and neither and more. And even both doesn't count because that just assumes two when there's so much more. And by way of astrophysics, Neil deGrasse Tyson has a great little clip here that I want to play for you that really captures this. Of course, many of you know Pluto got demoted recently. Pluto's no longer considered a planet or at least by some. And he was asked, so what's the deal with Pluto? Is it a planet or is it not a planet? And in his response, he talks about this notion of false dichotomies. But what he really talks about are the limitations of language and the inability of language to capture concepts that we don't have language for and therefore end up controlling the way we think. Take a listen. So it's not, it's a very human thing to say, is it this or is it that? Is it a planet? Is it not a planet? Is it is it less filling or as a great text? Is it is it gum or as a candy? These are sort of false dichotomies. Something can be both. But our language forces us forces us to require that it fit into one word or another. Okay, what we're not recognizing is that it's not a fault of the object or the concept. It's a defect in our language. And if our thoughts follow language, we have trouble thinking of things that fit more than one category. I think that's the source of most human elements, cultural elements. Are you gay or are you not gay? Are you black? Or you're not? Are you this? Are you that? Are you female? Are you and it's like, chill out, just let it, let, you know, just let things be what they are. Allow there to be a spectrum in order that you see. So does that that doesn't necessarily just mean a broad language but a broadening of the way to human mind think? I think that once you learn language, the language shapes how you think more than your thoughts shape what language does. It takes a very creative person to start inventing words for thoughts that they have for which no words apply. And that right there captures so much of the challenge that we have with gender that doesn't come in one of two boxes because we have a limitation of language. And so much of this is about simply developing the language which captures experiences beyond the binary. Fortunately, we've got, you know, there's a head start. We have a head start because boy versus girl is not universal. There are cultures throughout the world that have become quite comfortable over hundreds and thousands of years recognizing the diversity of gender. These are all at least originally non pejorative terms to describe individuals who do not fit the typical binaries. One example that many of you might be familiar with or what are sometimes described as two-spirit people. People that are more than male and female. They're all of humanity. I don't again want to be very careful about saying both because they're even more than that. And in fact, two spirits are somewhat generic or a name for over 150 different tribes that have some kind of role or tradition or label for individuals who exist in these places. Here's one more. In many cultures, a person existing outside the two accepted genders is seen as confronting, even threatening. But gender is defined by culture. And on South Sulawesi, the Bogeys believe that in addition to men, women and Beesu, there are two more. These two additional genders are made up of people who in the West would be considered transvestites. Tambu's gender is Chalilai. Biologically, she's female, but she lives as a man. I feel comfortable as Chalilai. My family is also comfortable. As long as I'm a good person and I work hard, people accept me. Abdul Rahman or Poppy is Chalilai. He has male genitalia, but has lived as a woman since he was six years old. I'm not special. The Bogeys culture accepts all five genders. So that's just two examples of the many, many different parts of the world that have these notions that have the nuanced understandings of gender. But what's really exciting is we no longer need to go to far flung places to get that sense because there's a growing understanding of this among the young people that we are serving. This is a poll last year that was conducted by Fusion of Millennials, ages 18 to 34. And they were asked, which of these statements do you agree with? There are only two genders, male and female, or genders of spectrum and some people fall outside conventional categories. The results were pretty surprising for many of us. 50% of 18 to 34-year-olds agreed with a statement that gender is a spectrum. Not everyone fits in one of two categories. And what we're going to see is only an increase in that number as we come to understand the complexity of gender. And these ideas are already starting to filter into aspects of popular culture. A couple years ago, Facebook decided with their equity and diversity committee that it was not okay to have a profile that allowed you to be male, female, transgender, or something else, or decline to state. They came up with 51 options, some of which are named there. And they were feeling great. They were on it until someone came along and said, but I'm 52. What about me? And they scrambled and said, you're right, we need to add some. But then someone came along and said, but I'm 59. I'm 137. I'm pi. I'm 1256.9134. And they said, you know what? Let's forget it. Let's do it this way. Let's have a pull-down menu that includes custom. And you tell us. You tell us who you are. Let us know who you are versus fit in these 58 boxes. You tell us who you are. So when we think about the profile of non-binary individuals, then we suddenly start to see a whole lot of complexity showing up, just several of which are named here. The upshot is we're talking about gender expansiveness, individuals who are expanding our notions of gender. And the reason I like this particular term is it puts the onus on us, not on the individual who is simply often being themselves. I'm reminded of a young trans teen who was on a panel that we held recently, actually not recently anymore, a while ago. And during the presentation, he said something effective. He was asked, well, when did you transition? When did you, you know, become a guy? And he kind of paused and looked out at the audience and said, you just don't get it, do you? I've never transitioned. I've always been a guy. It's all of you who need to transition. You need to understand my experience. That's gender expansive, right? He was expanding our understandings. He wasn't doing anything except being who he was. The bottom line is each of us has the right to determine for ourselves the label that we choose, what that label means, and the right to ask others to please respect us and use it. I'm imagining there's many of you out there who identify as guys. I happen to identify as a guy. And yet we might use the same label, but what we mean by that label may be similar and may be vastly different. Right? Each of us has the right to gender self-determination, to personalize our gender, to make gender our own. Come back to a really distinct definition of gender. It's quite difficult. You know, for me, I think it is, it's a spectrum. Actually, it's probably not linear. It's probably circular. It's rather than sort of having a start and an end of male-female. It's probably spherical in terms of how many different variations that there are. And it's only when you try and articulate it that you have to say things like male and female. And that comes down to a restriction of language, really. And there could be a whole vocabulary invented around more appropriate ways to express gender identity. So if you think about it, we started here with the who's the dad. No, not that wasn't the question. What'd you have? That was the question. And we've ended here with a model that for sure takes a little more time, takes us a need to pause for a second and say, right, so what do you mean? It's not neat and clean. In fact, it could be messy sometimes. But that's gender. That recognizes the experience of everyone. One time, you know, someone asked one of my colleagues, how many genders are there then? And they said, well, there's basically one. It's human. And they said, no, no, no, scratch that. Actually, there's an infant number because every one of us has one. And that's what gender is all about. All of us having the right to be ourselves, to assert the meaning of the terms we use, and to ask others to simply respect that. And accept me for knowing my experience more than anyone else. So the punchline is a boy or girl. I don't know. It can't talk yet. So I'm going to stop there. Thank you very much. This framework will inform the rest of our day. So as Diane and Jen and our panel talk about these aspects of gender, we hope that you will continue to expand your understandings as well. So I'll take a break. We'll be back here, please, at 1040, 1015, 1015, 1015, 1015. Okay, thanks, everybody, for coming back on a timely basis. Again, we'll be breaking at 1130 for lunch. It'd be a good time to also network and look at the various tables out there. Diane Ironsaf, PhD, is an associate professor of pediatrics at the University of California, San Francisco, and developmental and clinical psychologist in the San Francisco Bay Area, with a private practice in Oakland, California. She is director of mental health and child adolescent gender center and chief psychologist at the child adolescent gender center clinic at UCSF, Benioff Children's Hospital. She specializes in research, clinical work, and consultations related to gender non-conforming children and assisted reproductive technology families, lecturing, publishing, serving as an expert and witness on both topics nationally and internationally. Dr. Ironsaf received her PhD from the University of Michigan, and has served as faculty at UCSF, University of California Berkeley, the Wright Institute, Psychoanalytical Institute of Northern California, and Access Institute, San Francisco. She is author of Gender Born, Gender Made, Mommy's Daddy's Donors, Sergots Building a Home Within, co-titled with Tony Heinemann, Spoiling Childhood, Parenting Together, and a forthcoming book, The Gender-Creative Child. Dr. Ironsaf is a founding member and senior clinician and board member of a home within a nationally organization addressing the emotional needs of children of foster care and serves on the board of directors of Gender Spectrum, a national organization addressing the needs of gender expansive children and their families. Please welcome Dr. Ironsaf. Well, I can't tell you how delighted I am to be here and to see everybody's face here, because it's because of all of you that we can be here doing what we're doing and we'll do more. And I want to thank everybody who is responsible for having me be here today. And I want to preface it by saying that some of the things I'll be talking about may sound completely repetitious of what you just heard from Joel, because we are like Tweedley D and Tweedley Dum, and we go to the beat of the same drum. So bear with any duplications, but I think it will underline how important we think the points are we want to make. So the first thing I want to introduce you to is Stuart Little. Now you may be wondering why Stuart Little? For those of you who know the story, Mr. and Mrs. Little gave birth to a mouse, Stuart. They were a little perplexed how to raise a mouse. And their doctor was very excited and said it's going to be really good. And they went, I'm not so sure. This can be a little difficult, but they did it. And among other things, they were very worried about Stuart's safety. So they removed the nursery rhyme from the book. They tore the page out three blind mice because they never wanted Stuart to worry that his tail was going to get cut off by the farmer's wife. Now I don't think E.B. White had any idea when he wrote this book in the 1940s that he was writing the allegory of the family who gives birth to a gender expansive child. And the only difference between the littles and families today or historically that give that have a gender expansive child in their midst is you often don't know the day they're born. You may find out in their first year, their second year, you may find out when they're 50. But the task is still the same. How do we support our little Stuart little? And that's what we're going to be talking about this morning in a developmental perspective on gender expansive children. Now the first thing I will say as you saw from Joel's talk is that we have an incredible change in what's happened around gender historically in our culture right now. It used to be bedrock for many people that still is. That's why we say what are you having a boy or a girl? Do you know? Now we have gender as moving boulders. We have created a shake up and what we define gender as being and how we're going to relate to all the genders in our culture. And what I will say about that is we have always had as we saw before historical shifts and shake ups in gender. Here's a picture 17th century, the Netherlands, little boy with his billy goat. This was the typical attire for any child assigned male at birth until age seven. And this is true in Western Europe throughout the 19th century, sometimes into the early 20th century. So there we have boy in address. And now we have 2012. This is the pharmacy near my house. I went there shopping one day and I noticed this child and the mother referred to this child as he and this child if you can't tell is pilfering candy from a table that has candy on it. And what was most notable to me is this child is wearing a little REI jacket, work boots, little painter pants and a pink tutu. And I live in Oakland. Nobody better than I. They just said oh hi. They didn't even notice he was pilfering candy. So then we have this was sent by a colleague of mine. This is her child in the toy department. I believe that toys are us. I mean that is a masochistic thing to do for any parent. But there is their child again that identifies his male with his pink butterfly wings picking out his tonka truck with his pink wand. And then we have this is this was in the New York Times recently. So this is again the ambiguity around gender in 2016. And I'll tell you a story about history. We talked about at different times things have changed. So I would ask you those of you who are old enough. How many of you went to a grade school where girls were required to wear dresses. Quite a few of us. So now I want to bring us to 2000 about 2010. I'm explaining to my granddaughter who is then 10 how I grew up in Chicago and girls were required to wear dresses or skirts to school every day even if there was a blizzard. And my 10 year old granddaughter knowing I was a feminist looked at me and said grandma why didn't you protest. So around the social construct of gender in 2016 I'd be protesting. But we didn't think about it in 2010. It just was the way it was. So the first step in a new developmental model for understanding gender is we have to unlearn most everything we learned in school. So it goes like this. I started graduate school in 1968. My emphasis was gender development. And here's what I learned. You're born. You come out. The doctor and it was usually a doctor not a midwife at the time looks between your legs and goes boy or girl. And then in the first two years of life you learn your core gender identity. You learn in those first two years. I am boy. I am girl. That's your developmental task. If you were born what at that time was called hermaphroditic. Get it corrected right away surgically. And make sure that there's a clear assigned gender from then on because if you don't do it by 18 months at the latest 24 months you've already fixed a gender identity that can't be changed. So make sure you do it early because by two that sense I am a is fixed then. But it's kids don't think it's permanent. You can do some backsies on it. But they know I am boy I'm a girl maybe it'll change later but I know who I am ages two to six. Then you learn what it means to be boy what it means to be girl and there's nothing in between. And you learn that from the people around you they socialize you to teach you how to do your gender. And that should be in place by the time you're six years old. If you were trained psychoanalyptically as I was we have a whole other drama here. Okay. That drama first of all you have a mother and a father heterosexual couple. They have a baby that's you. You fall in love with your opposite sex parent. And then you go oops they're taken and I'm going to get in big trouble. If I try and run off with that parent. So I'm going to give that parent up to dangerous. And instead I'm going to identify with the parent who's the same sex as I am and I'm going to learn how to do it. So when I get older I'll have my own spouse I'll find my own because that one's taken. So then by the time you're six years old. You know that you're a boy or a girl. You know how to be a boy or a girl. And you are also heterosexual if you're a normal. That was the developmental model and sex gender and sexuality were combined as one developmental track. If any of those things weren't in place. And if you were confused if you were a boy or a girl if you did believe there were some backsies on that you could change. Or if you were showing particularly for little boys a feminine traits. Get the to a therapist. Because you have a disorder. That's what I learned. That was the theory. That's the theory that a lot of mental health professionals today. Abide by. That is a big problem because if the theory is robust it has to apply to reality. This theory does not. It does not. First of all let's start with. Let me repeat what Joel said. Gender development and sexual identity development are two separate tracks. Secondly. There are many very healthy gay lesbian bisexual people. It is not disordered. It is healthy variation. Next your gender is not fixed at age six. We see people who change their gender over the course of their life both expressions and identity. With no spurs on their character. And with no spurs on their gender. They are dense on their mental health. So what that means is gender isn't fixed at six. It's a lifelong process and it's not based on the sex assigned at birth. It may be. But let me ask you another question. Raise your hand if you are left handed. Look around everyone. There's not a lot of us. But we're very special. But in other generations we were not special. We were to be fixed. We are a small minority. And we are a healthy variation in human development. The same applies to gender. There are cisgender children. There are transgender children. There are gender expansive children. They're all healthy. So I just want to say we've got to throw this theory out. So that's fine. But what do we replace it with? So this is my idea of a model for thinking about gender and it's very consistent with Joel's has some variations. So we know we talked about gender boxes. Down with gender boxes boys in one, girls in the other, binary. Then we have the gender spectrum. Joel described to you the gender spectrum. It's an excellent way to think about gender and all its hues, colors, variations. But I wanted to go back to that notion of gender as a sphere with infinite possibilities. So I made up the idea of a gender web. That we have a three dimensional web. If you think of a web and a tree, it stretches in three dimensions. And everyone has their own unique gender web like a snowflake. And the gender web has three major threads. They've got the threads of nature, the threads of nurture, and the threads of culture. And now I'm going to break it down even more specifically. We have chromosomes, hormones, hormone receptors, gonads, primary sex characteristics, secondary sex characteristics, your brain, your mind, socialization, family, school, community, and I use community in the largest sense. Culture, the values, the ethics, the laws, the theories and the practices of a culture. All of you sitting here today have all of that infused in you if I ask you what's your gender? Now, we also, to get a little twilight Sony, we have a fourth dimension. And the fourth dimension is time. So each individual alters their gender web as they weave together nature, nurture, and culture over time, which means it's fluid throughout development. And I will say going back to the theory, what is true in that theory is by age two, children can know the gender. And for many people, it does remain stable in terms of our gender identities for the rest of our life, but not necessarily. So we always have to consider the time dimension. Now, the gender web, it's like snowflakes and it's also like fingerprints. So the way it's like fingerprints is every one of us has our own unique set of fingerprints. And they will stay with us from the moment we're born to the moment we die. And that's the one difference. Unlike fingerprints, gender webs are not fixed at birth and they're going to change over the course of your lifetime. So now where do parents come into each little child's gender web? The gender web is each child individual's personal creation. If the parents grab the thread from the child, they're going to mess up the child's gender web and they're going to leave that child feeling all tangled up. But if the parents facilitate the child weaving their own personal gender web, then that child's going to feel expansive, supported. Now, I want to tell you a little bit about labels. We talk about gender infinity and people in, but kids really like self labels. They like to create their own boxes. So these are not fixed boxes, but what I wanted to share with you are some of the self labels that the kids I've worked with have come up with. Now, I'm putting them all under the umbrella of gender non-conforming children. And I'm using that term for the following reason. The word conform in terms of language, we're talking about children who either do not conform to what people told them. They were supposed to be based on what's listed on their birth certificate for their sex, or they're not conforming to the cultural expectations of how to do gender. So underneath that umbrella, we have first our transgender children. Joel has already defined them. They're the children who say, I am not the gender you think I am. I am not another gender, but not that one. We have gender fluid children. And gender fluid children are either gender fluid across time. They may wave and weave their gender as they go, or in one moment they do a mosaic of gender that pulls in all the cultural tropes about boy, girl and other. So there's a gender fluidity. Then we have a whole group of kids who are the gender hybrids. And let me tell you how I came to that. I went to my waiting room to meet with a seven-year-old child whose parents asked me to see the child because they felt the child was confused about their gender. So I went, I got the child, and I saw a little boy in basketball shorts, basketball, tank top, basketball shoes, basketball socks to hear. So I welcomed the child into my office, and as soon as we closed the door, the child whipped around again and said, you see, I'm a Prius. She said, yes, I am a gender Prius. I am a boy in the front and a girl in the back. So we have the idea of a gender Prius, and that gave me the notion of hybrids, and then I started noticing different hybrids. The next is the gender tourist or gender minotaur, whichever you're interested in. And I am one thing on the top and the other on the bottom, and that's often for children to take care of their genitalia that say one thing about them, but their mind and everything else says something else. So they're often, and they'll come in and say, you see I'm a girl on the top but a boy in the bottom, and they love mermaids to play with. So if you're a therapist and you have toys in your office, make sure you have a mermaid, lots of them. Then we have gender by season. I feel comfortable and safe at home wearing my dresses. This is a child identifies as male, wears dresses all the time at home, but I'll never do it at school. It would be terrible to do it at school. So we have gender by season, free in the summer, constricted during the school year, and we can have the opposite. We can have an unaccepted family and an accepting school where the expression of wearing the dress will happen at school and be taken off to go home. And so in the summer, I go back to my boy self at school, I put on my dress. Then we have very similar gender by location. And gender by location is, honey, I don't think grandma's ready. So when we go to grandma's, I think we won't wear the dress. So that would be my location. And I wanted to tell you one that's in there towards the bottom. At our clinic, we had been using a scale that was one equals boy, ten equals girl, or the opposite. One boy, we put boy and girl in either way, but it was a one to ten scale. So we would ask a child, where do you rate yourself? If boy is here, girl is here, where would you put it? And the child said, we don't like the scale. Too linear. Let's not use it anymore. So we agreed as a clinic we weren't going to use it anymore. So I walked into see a child I had been seeing since this child was little. This child was now 11. And the child looked at me with great accusation and said, Dr. Rosenthal, forgot to give me the scale this time. So rather than explaining we're not using the scale anymore, I said I wanted to tell him I moved from a four to a six. Okay, well I'll make sure he knows. And then I decided it was time to tell him about the notion of a gender Prius. I said, well maybe, you know, let me tell you about this idea of a gender Prius. Maybe you're saying you're gender Prius. And this child stopped for a while thoughtfully and said, I think I'm moving towards a Tesla. So we have the all electric child. Which speaks to children are in motion. And that's the kind of transitions we're talking about. Not from male to female, but in development. How they're transitioning in their own development and how we're helping them do that. Now, we have gender ambidextrous children. And this came, this was with parents that I came up with this. These are two moms, they're both scientists. They had at that time a five-year-old who did not want to declare a gender. He said, don't ask me. And told some kids in the neighborhood call me boy, told his sister, you call me girl. Parents said, look, we're scientists, we need an answer. We just need to know. So I did a long assessment and spent time with this child and came back and I said, okay, I'll tell you what I know. You have a gender ambidextrous child. Your child uses both hands. A male hand, a female hand. And they loved it. They said, great, that is scientific. We can tell it to other people. So we now have the new term gender ambidextrous that seems to have caught on for many families. Then we have gender smoothies. This was a teenager who was as gender creative as you will ever meet in a kid and said to me, let me tell you how it works. You take everything about gender. You stick it in the blender. You press the button. You have me. I am a gender smoothie. So we have gender smoothies. We have gender queer youth who would be saying, why are you bothering with this conference? We are so beyond gender. We're about being human. It's about time to stop talking about it. And that's not just individual kids, youth, and adults. It's a whole social movement. Then we have agender youth who also usually identify as gender queer. And agender means one of two things. I'm not any gender or I'm agender. So we have our agender youth. We have proto gay children. Now I'm bringing sexuality back in. There are many children who explore their gender on their way to discovering their sexuality. And these are often the boys who are dragged into clinics for being effeminate. And it turns out they are going to be our healthy gay men if we just let them be. And it can come in any variety of gender. That's the most common way we see it. Then we have the opposite, which is proto transgender youth. And these are children youth who usually place themselves in a community of, well I'm sexual of either gay or lesbian community and discover, often through the romantic experiences, it doesn't fit. So for example, when I'm a girl with a girl being romantic, I'm a boy being with that girl. So they discover their transgender identity through their burgeoning sexual identity, which doesn't feel like a good fit. And then we have the last group, and this is the group that concerns us most as a mental health educational legal community and as families. And those are our gender tootsie roll pops. And the gender tootsie roll pops are one gender on the outside and another in the inside. And that usually means that they're keeping under wraps the real one and creating a candy coating on the outside to protect the inside one from harm. And these are the kids who are often at risk for anxiety, depression, self harm, school related problems, sexual acting out, and unfortunately a high rate of suicidality. So this is why I say we really have to pay attention to these kids who feel they need to protect their gender. Now there's another way in this developmental model to think about gender and it goes to the gender tootsie roll pop. And that way is that we have each of us has a true gender self. It's the core of us, it's how we know ourselves to be, and the kernel of it is there at birth. It doesn't stay there, but there's something there at birth. Then we have the false gender self. And that's the presentation we give to the world because that's what the world wants from us or we're afraid if we show the real one we'll get hurt. Then we have the most important thing, gender creativity. And that is the weaving together of a unique authentic gender self based on core feelings and chosen gender expressions. Every one of us has a true gender self, a false gender self, and some gender creativity we hope if it doesn't get squelched. Because occasionally we are adapting. So I'm going to give you a personal example so you can think of your own. I identify as cisgender. I was always a tomboy and a ballerina at the same time, but I was also very good in math. I went to a big public high school. If you ever saw the movie 16 Candles, that high school is my physical high school. That's where I went to school. And I was now in calculus, AP calculus. I was the only girl in the class. This was 1963. My mother always said, don't tell people your grades, you'll never get a date. I was heterosexual as well. I really wanted a date. So I was really self-conscious about going into my calculus class because everybody would know I was a geek. So I got this idea because there were really crowded halls passing between classes. So I stood in the doorway of my classroom and backed into my class because I felt everybody rushing by would just get a snapshot. They would just see me in the doorway and think I was leaving the algebra class rather than going into the calculus class. Now, how stupid is that to see someone walking backwards into a class? And of course years later, I feel, I can't believe I did that. But I did. And that was my false tender self because I didn't want to be a girl who was good at math in certain contexts. I was fine when I was in the calculus room but not outside it. So we just think about the ways we protect how we do our gender all the time. Now let's bring back in the gender web. So the gender creativity is each child's personal artistry composing a unique, authentic gender web based on core feelings of gender identity and chosen gender expressions. Now, where do parents fit into gender creativity? Really important for anyone who is a parent or works with parents. Parents have very little control over their child's true gender identity. They can suppress it, but they can't make it happen. And they're often accused of making it happen. Why did you let your boy wear a dress? It's all your fault. It would be an accusation. They have very little control over core gender identity but where they do have extensive influence is over their child's gender health and the ability of their child to express themselves authentically about their gender. So we don't believe in pressuring the children when the time is right, they'll choose the appropriate gender. So it's the notion that it's up to the child, not up to them. Now I want to tell you this one story which in terms of parent facilitating, this is the story of Nils Pickard. So Nils Pickard is German. He and his family moved from Berlin to a small town and he had a five-year-old child identify his male who liked to wear dresses. It was okay in their progressive school in Berlin, but in the small town they were moving to, he thought this is going to be a little more complicated. And so his decision on the first day of school in their small town is he would put on a skirt and take his child to school in a dress. And so this is Nils with his child. This story went viral and Nils got voted and elected Father of the Year by Gawker. And I wanted to just read you the email that Nils had sent to me. Hi Diane, since I have up until now practically found no time to read all the stuff written about me wearing a skirt. I'm trying to catch up. I read about your lecture in Canada and you are using me as an example of supporting kids for what they are instead of what we want them to be. Well, what can I say? I'm touched. I'm just trying my best to provide my kids with all the space and understanding they need. If you're all for an equitable society and human rights, which I am, you have to teach your kids about different identities and ways of life. If I would support my boy in being the next big soccer star, no one would have even cared. But I supported him in wearing skirts and dresses. Wow, big thing. But what's the difference? Anyhow, I appreciate your work all the best. So these are the words of a father just supporting his child. Now I want to move to our model of care. This is a typical call we might get either at the clinic or in my private practice. Hi doctor, I came across your information while I was researching for my son. He recently just turned four and he wants to be a girl and is only drawn to girl toys closed for the past two years. We have not spoken with a professional doctor but wanted to reach out early and find ways we as parents can support him. Please let me know if you could help. Thank you. So just hold on to the request. And I want to now tell you that we have a controversy right now in the clinical field as to what would be the best model to approach this mother and help her. So I want to just break down the three major models that exist right now for care of gender non-conforming children. The first is called the live to live in your own skin and it's that approach and that's the model that had been used by Dr. Ken Zucker at the Center for Addiction and Mental Health in Toronto. For those of you who don't know, in December 2015 this clinic was closed for practicing below the standards of care and also in violation of the new statutes in Ontario which legislated against any forms of therapy that attempt to change either a child's gender identity or expressions. So this is the traditional model. It is used, you will find it in the Bay Area and it's basically that children do have a problem, young children and they're confused about their gender if they want to be the other gender or express themselves in accordance with what we call gender-appropriate behavior. And so we try to fix it and we try to fix it by taking away the inappropriate toys, replacing them with appropriate toys by finding same-sex friendships instead of those quote-unquote opposite-sex friendships by getting the parent of the same gender to be more closely involved and having the parent of the opposite gender that the child is identifying with step back and also individual psychotherapy for both the child and the parents and for the parents to figure out their conflicts and their inability to help shape their child's appropriate gender. That's the model. Okay, we don't like that model. The second model is the Dutch model and we owe so much to the Dutch in terms of a progressive form of treatment for gender non-conforming children and they introduced us to the use of puberty blockers to staunch the flow of puberty while children have more time to think about it or where children already know I don't want that puberty. And what they have in their model, however, is that for children who are pre-puberty, let's just do watchful waiting because we don't know yet till they reach puberty and they probably don't know either exactly what their gender is, so let's just support them and their gender expressions and wait till puberty and then if they still are insistent, consistent and persistent we would consider both the social transition and medical interventions. So it's a careful model and it's called watchful waiting. So that's model number two and there are many people who use this model. Now we come to the third model and this is the model we use at the UCSF gender clinic and I call it listen and act and this is also known as the gender affirmative model and I'm going to focus on this model and tell you more about it. So in this gender affirmative model here's our major premises. Gender variations, not disorders. Gender presentations, diverse, varied across cultures. We must have cultural sensitivity then to gender in all its cultural manifestations. Gender interweaving of biology, development and socialization, culture and context. Gender may be fluid, not necessarily binary. Pathology, if there is pathology for a child it's often related to interpersonal and cultural reactions to the child if it's present at all. Therefore, and this is what I want to start, pathology more likely lies in the culture rather than in the child. So it is the culture that needs to be fixed and the last thing we are discovering is that actually they used to think gender was the disease but we're discovering gender is the cure rather than the disease. Now, gender health. A use opportunity to live in the gender that feels most real and comfortable. A use ability to express gender with freedom for restriction, aspersion or rejection. Treatment goals, we want to facilitate an authentic gender self, alleviate gender stress, distress. We want to build gender resilience. That's incredibly important. How to meet up with the world with your authentic gender and we want to make sure we secure social supports. Essential therapeutic tenant. Not for us to tell but for the children to say. I'm not for us to say but for the children to tell. Usually I have the cartoon, it can't talk yet but we all love this cartoon so I'm not going to repeat the cartoon but it's right here. I just wanted to go back to the mother of the four-year-old to give you a sense of how this model works and this is a small print but I'll just go through it for you. These are the kind of questions we might be thinking about with this mother and whoever else are the parenting participants. How long has your child been expressing cross-gender identifications or behaviors? Has it been consistent over a period of time? If able to express a sense of their own gender how does your child articulate it with what feeling? Does your child say, and this is a really important one I want to be a boy girl other or do they say I am a boy girl other that want to be versus am. Important difference in verb. How insistent is your child in declarations and demonstrations of gender? How persistent? Does your child show distress or stress about the body they have? Is your child making serious statements rather than playful gestures when gravitating towards the toys, activities, dress codes, et cetera, typically designated for the other gender within your culture? Does your child express distress when someone quote unquote misgenders them? Does your child show delight when someone perceives them as the opposite gender of what most people know them to be? How do you as parents or other people in your child's life respond to your child's gender messages? So this is what we would just be opening up a conversation to learn more about. Now, we have a challenge here. We say if you listen the children will tell you who they are but how are we ever supposed to know what they're saying? They don't necessarily give you a narrative and tell you in words what they're thinking and feeling. So I just wanted to run through very quickly. This is what we as clinicians do. We listen. We just listen. We mirror. And that's really important. We try to reflect back to the child what we think the child is showing us to see if it is a correct mirror image or not because most of these children are being mis-meared. Nobody is mirroring back to them who they authentically are. We play with them. We get more out of play than words particularly with young children. We have to suspend ourselves in a state of not knowing. Parents do too. Educators do too. There's a period of time when none of us may know what this child's gender is. That going back to bedrock makes us nervous. So we have to work on that anxiety and just live with the excitement of not knowing. Now, this fancy term we monitor our counter-transference experiences that may distort our gender vision. In other words, all those personal experiences we have about gender like, ooh, I don't feel so comfortable about a boy in a dress. That's not going to help that boy in a dress. So we have to really monitor those feelings as they come up in us. We must have cultural sensitivity because gender is culture bound and we also have our universals about gender at the same time and we have to hold both. We must collaborate with parents, family, professionals, community and most importantly with the child. Now, these are some myths about the model I just told you about and they're, let me say it's hot and heavy right now. There are bullets flying in terms of lines in the sand about how to help gender non-conforming children. So, what is criticized? We are told that if we say we listen the child tells, then we just rubber-stamp whatever a child tells us about their gender. We just put a rubber-stamp, send them off, okay, that's who you are. Second myth, we push children to become transgender for our own political reasons with no science to support us. And I'll read you a quote that came from what I thought was a very disturbing op-ed piece in the Wall Street Journal by Deborah So. The silencing of those who oppose letting children make their own choices about gender sends the message to parents that early transitioning is the only valid and ethical approach to a gender dysphoric child. This message pushing children to transition at increasingly early ages so that they will fit neatly into one or two gender categories is false and unscientific. So, the reality, number one, we are not gender pushers. We listen with an ear to finding out what a youth's gender is, provide them with all the nutrients they need to live authentically in that gender. Two, we give it as long as it takes to find out with collaboration among the child, the family, and the professionals. Reality, we really believe in science. We like science. And here's something that I and a colleague of mine just wrote. So what does the emerging science say? It offers several important findings that the gender identity of transgender children is as deeply felt as that of cisgender, non-transgender children, that transgender youth are much less likely to attempt suicide with the strong support of their parents and that the well-being of youth who physically transition in puberty is on par with their cisgender counterparts of the same age 10 years later. It is out of direct recognition of the scientific findings that dozens of new clinic affirming transgender children and their families have been established. The only change added I made on that is that the gender identity of the young children is much less likely to attempt suicide with the strong support of their parents and their families. Now, we have this other clinical controversy. How can a young child know their gender? Now, I'm going to start by saying remember the theory I told you? By age six, you're supposed to know your gender? So why is that true only for cisgender children and not for transgender children? You cannot have it both ways. You receive a gender diagnosis early in life and persist with that diagnosis into adolescence. De-sisters, the young children will receive a gender diagnosis early in life and no longer have that diagnosis by puberty. The majority of children in clinical studies have proven to be de-sisters. The most recent finding, 63%, it's usually quoted as an 85%. So here's the question. How could we possibly sort out the persisters and de-sisters early in life? And if we can't, how could we allow young children to transition from one gender to another which is an option for pre-puberty of children? Why would we care? Because children have better mental health outcomes if we recognize them for the gender they are rather than the gender we think they should be. Now, I'm going to introduce you to apples, oranges and fruit salad. And when I read the persister-de-sister research, I thought, oh my God, we're talking about apples and oranges. Don't they see that? And so I've come up with some categories which I'm now going to share with you. That we have some youth who will be exploring or affirming their gender identity. Those are apples. We have some youth who will be exploring or affirming their gender expressions. Those are oranges. And we have some youth who will be exploring or affirming both. And those are fruit salads. So let's go to, first, what are the general studies concentrate on measures of gender dysphoria in the past gender identity dysphoria? They fail to highlight the two more critical variables. What's a child's gender identity? Just mutually. How do they identify? And what is the child's gender expressions? And let's both, let's look at them and separate them. So to separate apples, oranges and fruit salad, we have to separate gender identity from expressions. So to separate gender identity who I know myself to be at my core, gender expressions, how I do my gender, how I put my gender presentation together. So first step, how to tell if a toy is for boys or girls, do you operate the toy with your genitalia? Yes, it's not for children. No, it is for either boys or girls. And I will simply add to that or children of any gender. But since I didn't make this up, I'm using it as is. And there we have it in terms of toys are human toys or they're x-rated toys. Now let's go to our apples. These are the children who often show up in the gender, child gender research as the persisters. And their cross-gender and their identifications early in life continue on the same track into puberty, into and beyond puberty. So these are the consistent, persistent kids about their identities. Okay? Typically they'll say I am a rather than I wish I wasn't. And these are just guidelines. It's not universally true because sometimes by age 3 kids know we don't speak of such things so I'll soften it. I won't say I am a, but I'll do a false gender self and say well maybe kind of I thought maybe I would like to someday. They may express a lot of body dysphoria. They do this as little kids. Puberty. Puberty around the trauma of a changing body. Little kids. Mommy, can we cut my penis off and make me a vagina? Mommy, when's my penis going to grow? I hate what I have. Why did God get it wrong? Can we go back in and can I come out the right way? Now, for these kids, the gender explorations typically don't present as child's play but serious work. And I will say that many of these children, let's just take a signed male at birth child. That child probably will not be wearing princess dresses but his sisters borrow his sisters clothes. In other words they just want regular girl clothes not costumes. So you're looking for that as something that's not play but expression of daily life and how I want to look. Not always true but it's something to look for. The nature thread of their gender web is often quite strong. So many parents say to me this child just came to me that way. So the question is how did they come? And we're seeing indeed strong biological, genetic and intrauterine influences on gender identity. These are our youngest cohort of transgender people. And here we have an apple. Now I particularly chose this apple because she's from the Netherlands. And what's happening in the Netherlands is although it's a watchful waiting model that dominates the scene families aren't abiding by it and they're simply allowing their children to transition prior to coming to the clinic for services. So this is one of our apples from the Netherlands. Then we have the oranges. These are the children who often show up as the de-sisters and they usually don't repudiate their assigned natal sex but they may say I wish I was a. Large number of these children will become gay or queer exploring gender on the way to discovering sexual identities. They don't tend to repudiate their bodies but they sure can engage in fantasy play or ruminations about life in another body. I had I worked with one girl whose mother was a physician and she got a hold of her mother's surgical gloves and basically made penises out of them and brought them and she packed and then she brought them to school and passed them out to all her friends. So all the girls in school were walking around with packed penises made from surgical gloves in fourth grade and everybody was having a great time but she loved having her penis but she also liked vagina. So this was play. The explorations are more likely in the realm of gender expressions rather than core gender identities and for these kids what we see is nature, nurture and culture are all very strong threads. So we have a little kind of promotion of my books. This is the cover of Gender Born Gender Made that's an orange and this is the cover of my new book Another Orange. So this is a child who's playing with gender expressions so we have two oranges here. Now we go to our fruit salads and I started out with apples and oranges and realized I have to add fruit salads. Somebody said you shouldn't use that fruit is really a derogatory term and usually refers to effeminate men and gay men and I said okay I'm appropriating the term just like we appropriated queer I'm appropriating fruit then so we have our fruit salads and these are children and adults who are a tapestry of self neither male nor female creative understanding of gender both in identities and expressions. These children typically resist gender boxes often live in gender middle grounds no either or but instead all in any they often will identify as a gender, pan gender, gender fluid gender queer children and youth and recently I would say that the culture thread of the gender web is showing up to be very strong and opening up the doors for fruit salads and that children are very influenced by the new notion of gender infinity as we saw in the statistics that 50% of youth don't think there's just two genders and particularly in adolescence if we think adolescence and our culture is about identity exploration we've now thrown gender into the hopper for kids to explore their gender and wonder what that is along with their political affiliations, their religion, etc. Here we have a fruit salad and this is somebody who identifies as a gender now apples what should we do for our apples and if we rule out other possibilities that gender might be a symptom of something other than gender and if we find out the essential issue is gender identity, not gender expressions when the child or youth expresses a need or a desire to transition when the parents or the caregiving environment can offer positive support for the child transitioning then we consider a social transition either everywhere or in safe situations what about our oranges if the issues gender expression not core gender identity then we carve out space and support for the youth to express gender in the way that suits the youth not the way that suits society no social gender transition of identity is called for what about the fruit salads they're a melange some may request or benefit from a gender transition but not necessarily a binary one others are fine with the sex assigned on the birth certificate but redefine what that means and then we stretch our thinking to consider a pan gender a gender third fourth and so forth gender identity what if they change their minds that's the thing that comes up all the time what if they change their minds well then we help them spin together their gender web as they know it now there are no data to indicate that children who change their gender more than once over time including switching back from trans gender to their original gender are at risk for any psychological disturbances as long as we support them in that journey now guidelines for all these children listen to the child, help the child discover the gender position that feels most authentic fortify that child's gender resilience remember gender does not lie between your legs but between your ears in your mind and your brain always keep in mind that penis does not necessarily equal male and vagina does not necessarily equal female I'll add all other sexually defined organs make no attempt to ward off a transgender or gender non-conforming outcome including transitions in pre-puberty children first step in affirming a child's gender is that before looking inside the child take a look inside yourself I'm just reiterating what Joel said at the very beginning of his talk but I want you to think about this we all have gender angels we all do and those are the feelings we learn that help us recognize gender and all the variations we allow us to promote gender health facilitates gender acceptance so call on your gender angels however we all have gender ghosts and these are the things you were taught that come together in beliefs, attitudes, feelings, reactions and they may be unconscious or subconscious they tell you things like gender non-conforming people are really sick or we have to police gender if it doesn't come in two boxes transgender boys and men are not real males transgender girls and women are not real females you can't just live in the middle or say you're neither male or female it doesn't work that way fill in the blank now there's a war of the world between our gender angels and gender ghosts we have both typically they're in conflict with each other our tasks let the gender angels drown out the voices of the gender ghosts how self-examination, self-reflection feedback from those around you why should you bother because anything else is going to cause harm not just to the children but to the families and to the institutions those children reside in not to mention the entire society now to do that beware gender microaggressions they're little pings they're the little things that happen every day to minority populations and gender non-conforming transgender youth and young adults count as such a group if you add up microaggressions they can even cause a tremendous trauma so examples refusal to use correct pronouns constantly slipping forgetting to keep using the correct gender pronoun refusal to use a used preferred name this is particularly important in schools and families both asking someone what's between their legs running out of the bathroom if you see a transgender youth walk in standing by passively when someone is making fun of a youth's gender making jokes about transgender people are not intervening when someone else does another slight one not here is just a little bit of a flick of your eyes even when you see a boy walk in your office wearing a dress it sometimes happens now to be a gender ally you're going to try to eliminate your gender ghosts build a firewall around them so they don't get out and hurt our gender creative youth and you're going to fashion yourself as a full length mirror no one wants to look in a mirror and discover they're invisible so the best gift you can give a gender non-conforming youth is reflect back the authentic positive image of who they are through your words, your actions, feelings when it comes to gender gender is as real as yours and mine and as real as it gets so no gender specialist is an island so therefore you need an interdisciplinary model of care at our clinic we have it, we have a pediatric endocrinologist, a nurse practitioner social worker, psychologist educator, advocate and an attorney so without this whole team we can't meet our treatment goals that we can so I would say it takes a village to support one gender non-conforming child and certainly to support all of our gender non-conforming people who live among us so it's the youth, the family friends, religious leaders educators, mental health professionals medical professionals attorneys, judges, lawmakers legislators and I want to finish with letting the youth speak to one of our patients at the UCF gender clinic when this patient was nine and at age eight this child transitioned from male to female and here was the question what would you do if someone told you that now it was time to go back to living as a boy the emphatic response I'd take him to court and then there was a pause or I can take me to court so I want you to think about that as gender non-conforming children enter your life now I think I finished in time so that we can have I wanted to leave some time for any questions that people might have because we have a little less than 50 minutes so are there any questions or comments that people would like to make yes I definitely will repeat the question and could people stand when they ask the questions I don't think we have a roving mic we do yes we have a roving mic our mic is about to rove where are you stand up and can you stand up what are some words that you use to explain gender to a three, four and five year old so my daughter asks a lot of questions about gender expression and identity without knowing what she's asking but I don't quite have the language to talk to her about it not necessarily for herself but for people who she sees so she's asking about is that a boy is that a girl what does it mean to be a girl is it because they have a penis is it because they have a vagina and I don't quite know how to use gender and I want to so we have transgendered family etc but if you have any words of wisdom for that well I have a few words of wisdom first of all in terms of the question is that a boy or is that a girl I would say you know we don't know we'll have to ask them so that would be the start that only they know for sure so but we can like to be asked some people don't but I would say I would explain the different some people think because by 2 or 3 you're learning, some people think if you have a penis then you're a boy and if you have a vagina you're a girl but actually it's not like that it's not like that at all if you're a boy your mind is telling you I'm a boy, if you're a girl it's because your mind is telling you you're a girl and some girls like to wear dresses and some girls like to dress as Darth Vader so that's not those are people things but there are some people where we live who think one thing is a boy thing and one thing is a girl thing so there is a teaching moment there because I'm studying our culture kids by 3 know their culture and gender socialization starts at 2 so we have to sometimes unsocialize those messages with new messages and then then the next thing is some people think there's only 2 genders but there's lots and lots of genders it's just like a rainbow has all different colors and then I'd stop there because it's almost way too many words already for a 3 year old but I would stop and see what dialogue comes from that so I don't know if that's a helpful start and you still, I mean a 3 year old say yeah I know but is that a boy or a girl so and then you say that's really complicated rather than it's simple because I think it's good to send the message that it's a really good question and we have to put a whole lot of things together to get the answer hello, oh there we go I know that this is a whole other symposium question but could you speak a little bit to gender identity and expression and neurodiversity and to get, because we need to talk about that thanks I could talk about that for hours but I only have a minute or so so the question is about neurodiversity and gender identity, gender expressions so many of you will know neurodiversity as being on the spectrum and not the gender spectrum but the ASD spectrum that to have received a diagnosis of Asperger's of autism at some level here's what we know scientifically we know there is a significant correlation between neurodiversity and gender nonconformity either in expressions or identity so for example in the Dutch clinic there is a much higher incidence of kids who did have an ASD diagnosis who entered the gender clinic then in the general Dutch population it is absolutely true in my office so it is a reality and the big problem around when it's gender and something else is so many people doctors, parents teachers will say well it's just a symptom of the neurodiversity you know there's obsessions and there's just like an obsession now with gender and it is a phase it's a passing obsession so we need not take it seriously we need to take it very seriously it is most likely a core part of the person and one that may not present in the way it would present in somebody who does not have the experience of being neurodiverse but neurotypical and here's an example one of the qualities of being neurodiverse is A, you may not read social cues or you may be impervious to social policing so you go to the beat of your own drum so I've had several young people who have said I'm transgender and I said well how will that make you different? Not in any way whatsoever so the notion of how you do your gender may be very idiosyncratic but that does not negate the core gender identity for example of being trans so I may not want to take any medications I may not want to even change my wardrobe I may want to change my name and my pronoun but this is where the meaning of gender is so critical to explore and I will give you an example of what you have to sort out Yes, gender for any child can be a solution to another set of problems so there have been a number of youth I've worked with who have been diagnosed as neurodiverse who have come up with solutions so for example one 10th grader came to me urgently wanting to transition from male to female had no signs before of any gender nonconformity but was desperate to make friends and at the school this youth attended girls made friends better than boys ergo if I become a girl I'll have friends so make me a girl so I can have friends so we worked on friendships and that seemed to really help and the gender urgency went down so we do have to sort it can be complicated but it's complicated for any child we're doing the same thing for any child but I do want to say I get many calls saying I have a child that's coming in saying they're transgender but they're on the spectrum autism spectrum so I'm going to discount it doing that is very very authentic in the majority of the cases we have some theories about it it may have to do with intrauterine environment it may have to do with the same part of the brain that's affecting both in terms of brain messages and I do want to say about that some people think there's a boy brain and a girl brain there isn't all of our brains are mosaics however we're talking about messages from the brain about our gender when we say gender is between our ears not between our legs we're not talking about boy brains and girl brains we're talking about messages about what gender we are and it's very important to separate that out as well so a very strong message that you've been that people have been talking about this morning is listening to the child and letting them tell us so I'm just wondering if there are recommendations for pre-verbal children so between the ages of one and two what are the recommendations of how to approach the topics that we're talking about today okay so the question is what about the kids between one and two who are just developing language or may not even have it yet they're very action oriented so and in that at that time this is where mirroring is really important and listening to actions so let me give you an example I have a colleague who's transgender and there is a video of him as a toddler so he was assigned female at birth there is a video of him as a toddler tearing barrettes out of then her hair and throwing them on the ground and sobbing that's a gender message and when it happens not just once or twice or three times that's a gender message sometimes kids between the age of one and two with beginning language will say I boy when you say girl those two words I boy that's not a pre-verbal but an early verbal message it's and sometimes there is an urge the tendency to say well honey no you're a girl because little girls have vaginas and you have a vagina so you're a girl and then when they get a little older you hear them say did you not listen to me I said I am a boy with a vagina but they can't say that between one and two but they can show you about what they want to play with and if they feel uncomfortable about how you are responding to them and their gender if you're misgendering them so you look for those kinds of actions like tearing a skirt off there was one I think this was in the Barbara Walters special where this child wore the little onesies with snap ups in between the legs and at age one would unsnap them to make a dress and have the dress flow this was a child who was a sign male that's a communication a pre-verbal communication about gender and the message back should not be to negate any of those expressions but to go with them and see where they go so that's my sense about the one to two year old and children will know as early as the beginning of the second year of life they probably know before but they're really pre-verbal but you can always be a Monday morning quarterback and go back and see things that gave you some indication I hope that's helpful in terms of the one to two year olds and we have I think time for one more question yes I have a question over here where are you right here keep looking over my question is about the pervasive influence of social media on the whole gender expression and gender issues that social media that our youth are dealing with almost every moment of every day okay so the question is about social media and I would like to quote Charles Dickens this is the best of world times this is the worst of times social media has been a godsend for transgender gender non-conforming youth particularly in isolated areas where they can connect with other people and don't feel like they're all alone in this and collect information and learn and get language about who they are one on the other hand social media can be condemning vitriolic against transgender people and that is incredibly harmful including unfortunately we do have some incidents followed by suicides particularly in terms of what I will call social media battering of transgender youth when it goes viral so what we want to do is preserve the good get rid of the bad and really celebrate social media as a tremendous boom while at the same time doing everything we can to keep the harmful parts out and recognize that and to legislate against any bullying harassment that happens to social media and I'll add one last thing there's one problem with social media I do think it's really opened up a lot when I said the cultural component of fruit salads social media is part of that I have many kids who come to me and they come because they want the letter they want hormones often and they will say exactly what they they'll tell me here's who I am and here's what I want and I'll listen I'll I've heard this before I know I've heard this before I've read it before they pulled it off the internet they memorized the script and they're giving the script so it's not they're not telling me their story they're telling me a story so my job is to find out whether it's also but so I would say you may hear that kind of scripting don't dismiss it but don't stop with it either but go below it to find out what it means for that particular youth so on that note I think I will stop and say oh I'm I'm supposed to remind you all if you have questions either from Joel's presentation or mine the basket is here so just drop them in the basket so we'll make sure that we have them later thank you okay welcome back everybody thank you very much if you can hear my voice right now clap once okay Joel taught me this trick if you can hear my voice now clap twice thank you and if you can hear my voice now clap three times okay so just a reminder questions in the question basket panel discussion at the end of the day will include our presenters as well as other local family folks and now I'd just like to go ahead and reboot Joel Baum thank you thank you so much so again welcome back what an amazing day Diane Ehrensaft everyone right I mean amazing Diane happens to be on our organization's board so I'm a little not all objective but I don't think that has anything to do with how great it is so Diane thank you for that so what I want to do next is talk a little bit about this idea of gender inclusive schools and as you heard Diane talk about there are so many different factors that go into the affirmation of a young person's gender at the Child and Adolescent Gender Center we often talk about our families and young people being like on a table right imagine them just sitting on a table and most tables have four legs and if one of those legs doesn't work of course the table tips over and the kids fall off our legs happen to be medical legal mental health and education and we know that education is one of the places that so much plays out when it comes to gender and so we're going to take the next hour or so just to talk about what schools can do to create spaces that honor the gender diversity of young people just to remind you about Gender Spectrum's mission and now I'm going to talk a little bit more about it because not only does our mission inform the work we do at schools but the way we try to achieve that mission is very much part and parcel with how schools often need to approach this work so this notion of creating gender inclusive environments for all young people is at the heart of our work we do that in a number of ways we provide a lot of direct support to families and caregivers we're part of what we like to call the gender discourse we're trying to participate and be thought leaders in the ways that we're thinking about gender for all children and youth and their caregivers we also hold a conference every summer and I want to encourage many of you to consider attending it's an incredible weekend one of the most exhilarating weekends that you'll attend it's just amazing there's a full day professionals there's this symposium that has some 30 or 40 different workshops across all different fields then on Saturday and Sunday the 9th and 10th there's a family gathering that many professionals also come to in many ways Friday's all about the head and Saturday and Sunday's all about the heart and you meet these families there's programming for kids literally from the age of zero to through high school there's a programming for parents there's another documents clinic it's a pretty amazing gathering so please consider attending and or volunteering because like this event it doesn't happen without an amazing team of volunteers but the core of our work is really education and training work focused on supporting institutions around gender and young people that's institutions really of every kind that does work with those groups but schools is sort of our sweet spot if you will over the last 10 years or so we've been able to work in schools of every shape and size all over the country and even beyond and over that time we've learned some really amazing lessons from schools doing incredible work we've refined our own approaches and are now working in a way that is entirely focused on building capacity in schools to own this work is super contextual and as we do our work there's really three important ideas that we ask people to know about us one, we believe in the importance of meeting people where they are as we've talked about now quite a bit we're all over the map when it comes to our own experiences with gender and it would be very easy and I've unfortunately seen organizations similar to ours come in with a somewhat judgmental stance for individuals who don't get it that aren't down with the work and I just don't have a lot of patience for that quite frankly because I believe that most people are where they're at and certainly when it comes to schools care deeply about children and youth want kids to be happy and successful but sometimes don't have all the information to do it and so we really try this idea a friend of mine once said you know it's okay not to know but once you know you can't not know and then you gotta decide what you're gonna do about it and as an educator myself we're in the not knowing business right that's great not knowing is awesome um learning is great someone approached me at the break and said you know I'm a doctor and we birth babies and we gotta call them something are we doing something wrong if we call them a boy or girls like Neil deGrasse Tyson just chill out just let things be what they are of course you're gonna call that baby something but be prepared to be wrong that's all being wrong is awesome because you learn things um I'm an NPR nerd and Neil deGrasse Tyson happened to be on wait wait don't tell me and they did this whole series of questions about something completely silly and he got two of them wrong and the host was like oh I'm really embarrassed but you're wrong and I don't want to tell you wrong he goes don't worry no it's great I learned two things today right being wrong is okay just be prepared to be wrong when you make those judgments the second thing is that we really acknowledge intersectionality so as we think about gender as a concept we're talking very specifically um however when we think about real kids or real communities real schools we have to zoom all the way out and think about the entire constellation of identities that are at play there religion race socioeconomics region uh linguistic patterns you know ethic uh background and a million and other a million and one other contextual aspects that both are informed by and influenced by the gender of the people in them and also significantly inform the gender uh of the young people themselves um the other thing I wanted to share before I share this last last principle my background is as you heard from from Josh earlier is as an educator I was a middle school science teacher for a number of years uh some friends of mine said that I was demoted to some administrative positions um you know the dark side I was a site leader for for many more years um moved into some district leadership did some school reform work and I share that background for a couple reasons when I am proud of my career as an educator um I think being an educator is awesome um and I also like to share that because when I worked at sites quite frankly I hated it when people like me showed up um uh I felt like they had never done my job you know but were more than happy to tell me my business um we all went to school after all so we're all experts right well we've all been to the doctor too um but I would not want me prescribing medicine to any of you right um and so that notion of having worked in schools for us is really important because we hope we're credible we hope when we're talking about the work in schools it's not coming from this sort of ivory tower of this is what you should do even though I've never actually done your job right I've never had to decide if that kid really needs to go to the bathroom or are they just bored right and I have to decide right I never had to call a parent and talk to them about their child's behavior the other thing though about my background is a very quick story my very first day as an educator like many was as a student teacher and I'd been assigned to Chipman Middle School in Alameda California and my master teacher was a woman named Jane Vartanian now Jane had been teaching for years um she actually described herself as being older than dirt that's how she liked to talk about herself and um she actually retired the year that I was her student teacher I don't think they were connected I really don't I think she had planned to retire long and I actually was lucky enough to get her job so I was you know it was great but but I remember I come in it's August when professional development's going on and I've just finished my degree in zoology I have eighth grade science oh Jane it's great to meet you these eighth graders this year they're gonna the wonders of the universe photosynthesis and the periodic table and the difference between cosmology and cosmetology and why it matters and and so I'm going on and on and Jane she all she had these little photos and she always wore this white lab coat right so she's standing across from the the chemical table this is when we weren't being so good about where chemicals were stored and um so she's got her hands in her lab coat and she's looking to be like oh look at you aren't you just cute aren't you so cute with all your enthusiasm um and when I finally took a breath she said something to the effect of well you know Joe that's all well and good but here's the deal our first job is to send these kids home in one piece every single day and if we can do that we will teach them some science along the way I'm very confident in that but we're responsible for these kids right and I remember like wait what it's not about my lesson plan and me and my you know and and they have you mean there's things besides eighth grade science there's English and math and oh yeah and there's our whole lives later on in some dumb graduate course we learn the phrase protective agent educator as protective agent the notion of as educators and I consider any adult on a school campus to be an educator we have a responsibility to take care of the health and well-being of the young people we're privileged to serve and I take that very seriously it also informs the work of gender spectrum um and I take that very seriously for a couple reasons one I have kids myself and I want them healthy and well well-being um but I also I went to Berkeley but I am not a kumbaya kind of guy um you know I mean yeah I want people to feel good but kids learn better when they're safe when they're seen and protective agents make sure kids are safe and are seen and that's the notion that we're trying to work here when it comes to our work in schools the last thing I want to share with you is that this work focuses on all kids we spent a lot of time today talking about transgender youth gender expansive youth, Priuses, Tauruses you know an incredible constellation of individuals who fit that sort of gender expansive uh uh label or frame but the work we're about is actually about every child right it's not uncommon for us to get a call like this hello gender spectrum yeah I'm the principal at such and such and I think we got one you know one of those transgender kids can you help us and our response is always the same which is for sure we would love to collaborate with you to you know support this young person but it can't just be about that young person because if it is all you're doing is putting out a fire you're solving a problem and you're not actually creating conditions that are going to support that child and every other child now to myself I'm also saying and I wish you had a time machine because it would have been great if you had already talked about gender before this young person crossed your threshold because gender as I've been saying impacts every student and what we do when we create gender inclusive schools is help every child's gender be recognized, affirmed so that when any kid comes in and their gender is somehow not consistent with what people are expecting there's suddenly a schema that they can employ to understand that child's gender and support it so I'm going to start here with actually students and the voices of students talking about their own experiences with gender and I'm hoping our sound person is going to make the volume go up when oh good hi thanks I didn't see over there thanks and these are just young people talking about gender and then after we're done with that we'll talk about schools take a look I think let's try that again I still think it could happen like maybe in our lifetime that they wouldn't be called girl things or boy things they would just be called normal things I think gender is kind of like a spectrum and different people are on different levels of the spectrum so there's male on one end and female on the other end and not everyone is you know a male or female everyone's just kind of in between and that's what kind of makes it beautiful the fact that we're all just different people and we're all different areas on the spectrum but it's all just one big rainbow none of the people I care about none of my friends and certainly not him never said or did anything to make me feel like my style dress was wrong there was this thing that had been ingrained in me through years of getting teased and years of getting looked at strangely that said that you are not a girl unless you dress like a girl unless your clothes all come from the department that says girl unless your jeans are tight unless it was it was insane and it really hurt and I'm really happy I managed to get through it and be more okay with when I feel like dressing more masculine and when I feel like dressing more feminine but it was very scary and I even started to feel am I even supposed to be a girl maybe I'm supposed to be a guy because everyone's saying that if you dress like this you're a guy you're gay I don't know it was very frightening I'm glad to see people who are willing to come here and tell people that that's not who I am none of us have to be identified by the way we dress it doesn't mean anything that's the way we dress gender means to me now something completely different since I've had my daughter before growing up it was always male or female to me now it's not just black or white there is that little gray area which to me is more of a rainbow and she has taught me so much that I really just don't believe that gender should be labeled anymore it's almost just an expression a personal expression what do you think? gender is a happy thing gender is a happy thing I agree with that there is a broad spectrum I think society likes to tell us that it's one that you're a boy or a girl and I think it's a broad spectrum and I think everybody has to agree the both or neither or everything and you can be a boy and you can come in things I think there are so many aspects to it that it's a lot more complicated than a lot of people say it well if another kid was teasing someone else for being like if they're a boy and the boy says he's a girl and somebody teased him for that if I what I would do is just leave it alone but now if we talk about it I would go up and like I would talk to the other person that's talking about the person that's being bullied or something and I'll tell them like there's nothing wrong with doing that because people are who they are and they're who they think they are and there's nothing wrong with that gender is something that is really important so like everybody should follow so it's like you were born this way you have to play with this stuff and you were born this way and you have to act like this and play with this and I don't feel like it's relevant anymore in this world we've got so many people or 7 million people why should people fit into two different categories that's boring indeed so sometimes get told kids are too young to be talking about this they're talking about it we might as well contribute to the conversation because they're already talking about it and as we've heard very clearly this morning kids know what the deal is with gender and how they're supposed to be performing it I would argue schools not only need to or should be they must help facilitate that dialogue because they have a lot to say about how kids are going to feel about their gender the other thing though is those clips demonstrate what happens when schools create opportunities for kids to talk about gender when they create the conditions in which young people are able to articulate their own experiences we sometimes just need to get out of the way and listen to them and they will do a lot of our work when we talk about gender inclusive schools I love one of the things Diane mentioned earlier about kids and being invisible there's a great quote I want to start with about gender inclusive schools and what they do that borrows from that that quote of children and students looking into the mirror of their schools and not seeing themselves is what gender inclusive schools are all about gender inclusive schools are schools in which students see their experiences reflected in the day to day operations of the school does that mean they're talking about gender all the time? no does that mean they're talking about it some of the time? yeah probably but what it means is it says we recognize there are lots more experiences out there than maybe any other place recognizes on this campus in our hands we got you and you're going to be okay and we're going to make sure you're okay it's really really important for these schools to be thinking about how they're doing that raise your hand if you're a classroom teacher in here raise your hand if you work on a school site in some way yeah, right on absolutely I want to when I do trainings at schools one of the questions I love to ask is who's looking for more to teach right? yeah not a lot of hands going up on that one we know that it can't be something where it's like this kind of one off that gender has to be integrated and this model that I mentioned earlier is based on some underlying assumptions of what schools are communicating they communicate that all kids are being impacted by gender and gender expansive kids are particularly impacted as well they recognize that focusing on gender is actually climate work that it's creating conditions for learning for every child and they recognize that gender can be a wonderful on-ramp to work related to other forms of difference just last week I was at a wonderful conference in Dallas called time to thrive and there were several people who approached us and were talking about how their work in gender had allowed them to start having some incredible conversations about race and about learning styles and that it was the ability for kids to sort of dip their toe in the water around gender issues that now has them feeling more comfortable raising well here's my experience with race and here's what I need you to know about my experience and these schools do certain things they recognize that gender does impact all kids and they begin to work and interrupt binary notions these schools also do a great job of normalizing gender diversity while honoring the gender of everyone they question limited portrayals of gender they support processes of reflection about gender and a whole lot more and finally they teach empathy and respect as part of their work really what we know of the schools we've worked with how they do it really looks different but if they do it is never in question gender inclusive schools ask how not if now I wanted to share with you just a couple of resources before I really get into this but one is we've got on our website something called our gender inclusive schools toolkit and much of the the work related to that and the gender 101 and many of the tools that we're going to talk about are in there and I just want to let you know that is a resource available and I also wanted to share a document called schools in transition that was released last fall that we were able to co-author with some amazing organizations that really is a very good hands-on guide that focuses specifically on supporting transgender students in K-12 settings and those are just some really wonderful resources I encourage you to take a look at but as I mentioned we have this model of the entry points and when schools want to do gender inclusive work it's like okay go do it like how am I supposed to do that again what we've found is this structure of thinking about these different ways in which to begin the work is helpful because of course every setting is really different now we've already talked about what the personal entry point is that whole notion of understanding what gender is and regardless of what other work we're going to do we always start at the personal you know here all the time oh yeah we're pretty good you know we've got a lot of gay staff members so you know I don't think we need to do the basics in gender I'm like no you just revealed actually you kind of do actually and you know oh we're down we got it we're down I'm like you're so down it might be nice to look up every once in a while just to say but we believe like just humor us let's just assume not everyone is as wise as you are and that we need to establish a common language and so that's where we begin and we've seen what that looks like you know similar to the work we did this morning is building that understanding about the dimensions of gender and then we also encourage schools to do something called my gender journey which allows educators to really reflect on their own experiences with gender how have they experienced gender and what are the ways in which it is showing up in their work as educators are in their role at school so that's kind of the personal entry point the second entry point is structural structural entry points as it says are loud and clear without a sound sound these are the things schools do which communicate to the community we get it we see it all and when your kid comes to this school regardless of their gender they will be seen here it takes a lot of different forms this is a document called a gender inclusiveness assessment which actually looks at all sorts of different aspects of a school and on this page right here I don't know if those little things don't work oh yeah there it is these are the structural elements and it's a way for a school to self assess how are we doing in some of these areas do I even know are these things in place and if so do we all understand that they're in place so it's a great starting point but some of the structural things are things like policies policies are important policies matter having expectations about gender really really matter when they come from the upper level they are necessary but they are not sufficient policies often suffer from an implementation gap we have great ideas about what should happen and then we leave educators high and dry with no idea or support for how to do it right so policies matter but there's other structural things as well things like visual signs signs like this that say to the world we see it oh all genders well you mean both don't you Mr. Baum oh no actually gender is super complicated and there's lots of ways to do it and they're all welcome here in my classroom right signs that say to people we see or images that say to people we see diversity in all its forms and look at these different aspects of gender and you know visuals that point out in a classroom these all speak for themselves they say something about a school's commitment things like this which is from San Francisco Unified which is a space in which students can actually list their preferred name in gender marker so that when a substitute teacher comes and reads the name of the kid they don't read the legal name they read the right name the correct name right how many of you are familiar with the sport of curling you know curling is that sport in the Olympics where they throw the curling stone down the ice and then there the sweepers are sweeping right and trying to keep the ice clean often schools are playing curling with the lives of trans kids because they're trying to identify every place that they might get outed well this is one way that you just take that off the table because kids get outed by student information systems all the time this is a structural approach towards making that doesn't happen registration forms that are all the school based ones that offer again more opportunities for a student and a family to name that student's gender and gender experience and I really very quickly I want to share kind of three stories I've heard recently that relate to this basically these are experienced one of three ways first person comes in it's like okay child's preferred name it's Johnny legal name is Jonathan decline to state whatever child's gender decline to state again what's that male preferred pronoun he and hey listen as I turn my form and what's this all about I've never seen this oh well you see it Joe bound middle school we are really trying to honor the gender diversity of all of our students thank you for asking and we'll take your form next person Tommy Thomas decline to state male yeah preferred pronoun what they he what the heck is going on like why are you asking me these questions I don't oh well you see here Joe bound middle school we're really committed to honoring the gender diversity of all of our students sounds like you know which boxes to check we'll go ahead and just take your form and thank you very much for the third family though who this actually is like oh I've got some different answers you cannot know the impact that has on those families to tell them that you mean I don't have to explain it this time I can maybe even relax and I don't have to educate the educators are supposed to educate my kid that's a huge burden that's lifted and for every one of those instances your institution communicates we see it we got it we know there's a lot more to this gender thing that meets the eye many of these are very simple things low-hanging fruit that schools can do to convey that the third entry pointers the interpersonal entry point these are the ways in which we interact with one another way we use language the question earlier about what do I say to my three-year-old you know to help that child understand about the diversity of gender and you're having language at the ready so that you're able to again convey this notion of gender diversity these interactions do all sorts of things to demonstrate the schools commitment in our interactions and communications and some of them are there I wanted to tell a very quick story and really emphasize the importance of kind of demonstrate walking the talk and doing the work a quick story I was in Madison doing a training with two colleagues and they're both Wynman, Kim and Joanna and it was pouring rain and so I got in the backseat of the car and Kim's driving Joanna's in the front seat and the windshield wiper start don't work like so they're not working properly and so Kim jumps out and starts futzing around with it and she's clearly not going to be able to make it work and overdrags this good mid-western soul to help out and so here I am in the backseat oh jeez this guy like what does he think about me like I'm the guy I'm supposed to be out there doing the windshield wiper and then kind of stepping outside my body I don't know anything about windshield wipers I am not going to be able to contribute anything and yet here I am in Madison, Wisconsin to talk about gender diversity saying I should be out there because I'm the guy right and being able to convey those kinds of stories like this is where I'm at work in progress is a powerful way to convey that again we have a few tools such as using gender inclusive language with kids I just wanted to share some of these helping schools and educators to be ready to respond to the different questions we've been lucky enough to work with all these schools and have heard teachers say well this is what I say this is how I respond to that question or comment and well we've collected them being able to talk about easy steps on the way to gender inclusiveness again simple things you can do one of the most classic examples of gendering in schools is lining kids up by boy and girl I want boys here, I want girls here now problematic for so many reasons God forbid you actually have a child who feels like both where they're supposed to go let alone your transgender kid who really does want to go into the other line but isn't going to be allowed to now they're feeling miserable and again you emphasize the whole idea of it's one or the other there are so many different ways to get kids into groups you don't need to use gender I love this cartoon where are you supposed to line up if you self-identify as awesome but again there are so many different ways odd and even birthdays do you prefer the mountains or the desert you know ice cream or cake there's just a million and one ways to create groups that don't say penis or vulva which is really what we're trying to say when we do the boy girl thing again one of the things we need to be prepared to do is respond to questions that come up from our communities about gender and why we're teaching about it and again my background as an educator I don't ever want to put a leader or a teacher in place of saying because we're supposed to and you better just get over it like that doesn't help respond to someone who's raising a concern wherever they are in this we need to be very much aware of honoring that idea of where people are this is new territory for a lot of people they do have questions and because they don't know they are often going to operate based on what they've heard out there and so as educators we need to be able to respond clearly but respectfully yeah this is new territory and I understand this might be something you're not necessarily comfortable with I know certainly for many of my colleagues we're learning on that too but let me give you some information and so these again from schools all over the country are ways that they've answered some of these common questions and concerns including you know you're talking about sex well actually no we're not so let me help you understand what we are doing and lastly instruction teaching about gender is also really really powerful but it can't all happen only as these one off lessons now I'm going to share that there are certain lessons that you can do but before you start teaching anything look at your institution and talk about what are the concepts we want kids to learn as they move through our institution and then what are the opportunities to do that so that by the time they leave fifth grade or middle school or high school they have a degree of gender literacy that has been thought through that has been created and so these have been some of the general concepts that we've seen schools using to kind of map their work and again these are all available in the back the gender inclusive schools toolkit I don't expect you to write these all down because you can get them there but what they demonstrate is a commitment to be integrated and coherent rather than just random now there are specific lessons that do make sense you know in a history class talking about gender and culture using some of the footage even that I shared this morning or other aspects of gender and culture in advisory and social emotional curriculums giving students opportunities to think about their own gender and map it in a way playing with scenarios and different opportunities for kids to talk about how would you respond in these different situations are all instructional opportunities there's wonderful visuals out there films and books that share stories about gender that can be great direct ways to do instruction as I mentioned there's a lot of great visual opportunities the growing body of films and other resources that bring the topic to your classroom but again not everyone has time to do separate lessons on gender they're powerful and we encourage you to look for those opportunities but you can also integrate gender into instruction this happens to be some pictures of a unit that a school did in I think first grade kindergarten or first grade on the structure of a story it's one of those English standards you have to understand there's plot and there's setting and there's characters and so on and they were working on this activity related to that and they chose to use the book 10,000 dresses which has a character named Bailey and they were meeting the standard but integrating the content of gender 57 students are in the gym 26 of them are boys 29 of them are girls and 2 of them are identified as non-binary what is the percentage of boys girls non-binary if there are 250 students with the same ratio of genders how many of each of them would be there being non-binary what do you mean non-binary oh yeah a lot of people feel like boys and girls some don't some people don't feel like either one they're called non-binary but please get started on the problem because you're going to run out of time right and there's a lot of different ways that you can bring the concept in and it's just not a one off and it's not a throw away but it's like yeah oh yeah right you guys knew that there's non-binary people oh you didn't well let me give you a quick little nugget this happens to be an activity that we developed for art classes profiles and gender doing biographies of all these different artists a lot of art classes have you doing biographies of artists why not include some of those and this happens to be from Peralta elementary school which is a school that you're going to see in a minute and you've already met a couple of their kids that did some work with us over a period of time starting with some professional development did a little bit of consultation coaching with them and over the course of just a few weeks we developed this curriculum map for work that was happening at Peralta in each of the different grades it's hard to read that but another example of this integration is what I like to call the silkworm unit the silkworm unit is a unit that many teachers do where you grow silkworms and then they build they create the cocoons and you unspool them and it's created isn't that cool and okay we grew silkworms it's biology, it's social studies it's concepts of culture it's textiles so what do you silk for you make textiles let's talk about textiles and clothing and all the different ways clothing is worn by different people and different cultures by men and women and different cultures right now you're talking about gender to creating gender inclusive schools and what I'm going to share with you next is a short documentary that is brand new it's only been seen one other public place called creating gender inclusive schools and everything I've just said is going to be sort of demonstrated in the work they did and then we'll have a good 15 or so minutes to just ask questions and check in so I think George is going to help us get the film started with that one more I messed you up, one more there you go I have a friend who's in kindergarten and he wears dresses he's a very nice little boy and I was at first shocked to see that he wore dresses because there wasn't many boys like that I was a little like I didn't wear dresses because I thought they were stupid and ugly I was on a soccer team and some boys said only boys can play soccer because boys are better at sports than girls I still like dresses a little bit in elementary school and kindergarten so sometimes they got made fun of so that's why I stopped wearing dresses some people think oh boys should only do this and girls should only do that or girls should think this and boys should think that it's not true some people have opinions of the room the diversity of our student population has expanded so the issues of safety that we work so hard to maintain here now include students with gender fluid or transgender identities I thought oh my gosh all of a sudden we are having all these transgender kids here is this a fad when I saw the curriculum about gender at first I thought it was a little rough I was like ooh I can't do this gender unfortunately is an area where there's sometimes not as much kindness and respect and parents presented us cases of real suffering that the child and family had gone through and the staff and I immediately decided that we need more information on how to better support this child the family and all of our children it's really important for us to include everybody in this community work because everybody influences the lives of our children you can't just work with one population because if everyone's not learning the language and working together they undercut each other what you have to do is think about your own issues think about what it brings up for you think about what you want for your children in the classroom think about what kind of world you want it to be we started by talking about the biology of gender and this idea about typically female bodies typically male bodies the binary system is based on but in fact that there's a whole range of naturally occurring variations sometimes called intersex conditions that represent the physical part gender is about also gender expression and the ways in which people perform gender if you will our dress, our clothing, our mannerisms accessories also many of the expectations that other people have of us based on our gender or that we might have of other people you know I mean in my 60's I was used to thinking of gender as a biological thing and I wasn't really aware of the different elements she's a girl and she identifies as a boy but she looks just like a boy and she doesn't get upset I had problems with identifying and she loves boy things but she's happy as can be and she told her parents and they're the ones having the problem but she's just fine with it this binary model we talk about is something we all come by quite honestly in this culture and when you add other kinds of lenses the families we grew up in and the communities we grew up in our own religious affiliations and spiritual past I don't want you to be too hard on yourself you're willing this to be like yeah I want to think more about that but I do find the universal experience of meeting the kids is like okay now I get it finally the last aspect of gender is this notion of gender identity gender identity refers to the internal sense who someone knows themselves to be and while a lot of people think of themselves as a boy or a girl there's also individuals who will say you know what I kind of move between the two or maybe even I don't even think about myself as gendered I think of myself as just a person I don't really look at gender staff development for all teachers is important around this issue I think this is not something you can just give a piece of paper to a teacher and say okay read this and you'll be all read this book and you'll be all together you're connected with the tie too which one's to your connector or some of these colors so if I give you a marker get that color of marker and think to yourself is this a boy color or is this a girl color or could this be bull and what I mean by that is could both boys and girls like this color what do you think do you think only girls like only boys people it was interesting because the kids like some of them seem to be really thinking about it like when a girl got a light pink color and so and there were like friends around her who were like both both and then there were other friends around her who were like girl girl and so I think at that moment I asked raise your hand if you like and based on that evidence of who liked pink she chose and so there were lots of girls and lots of boys raising their hand and so she put it in bold all the colors are in the middle in bold does that mean there are colors just for boys no does that mean there are colors just for girls no colors are just colors colors are just colors sister cut her hair short and she dyed it and she wears a lot of bow ties and when I was out my friends who would kind of mean sometimes said ooh you're wearing a bow tie and you got your hair dyed and it's short and I think her hair was did you say anything to your friend I said that is wrong don't judge my sister like that that's called stereotype one stereotype is boys don't play hairdresser Ari told me that only girls like dolls this is a stereotype is this necessarily true because you have real short hair it doesn't mean you're a boy my grandma she has short hair about to hear girls can wear all colors so can boys I'm wearing my sister's stuff this is my sister's she wears this everyday I like doing things that boys like doing like climbing trees and making paper airplanes flying, toy helicopters and things like that my other girly girlfriends aren't very girly anymore but they're not yet boy girls they're like in the middle now sometimes we see people we look at them and think we know about them because of the way they look their gender the group they're in are the language they speak alright today I'm going to read you a story about someone who was stereotyped are you ready to listen? click on your listening ears whenever I read the books the children were very quiet usually they're very loud or they interrupt they want to ask questions but I think this was new for them too Oliver Button got a nice black shiny pair of tap shoes any practice any practice but the boys especially the older ones you are teased Oliver Button one of those shiny shoes sissy why couldn't he do dancing? because he was a boy boys you can't dance? I can dance raise your hand if you're a boy and you can dance you don't necessarily have to tap dance boys can you dance to a little dance a couple of you stand up girls can you dance with them stand up everybody can dance do a little quick dance two three four five six seven eight I think it had never occurred to him that you could look at the world this way that you could take off these labels and try and look at it from a neutral perspective you know at the end of the day there's three things we hope people will leave from these trainings gender is not just about bodies gender is not binary and gender is not about sexual orientation the parent training really helped me feel like I wasn't alone because there are so many of us who didn't quite fit into the rigid box I noticed that you never said feminine or masculine and I'm guessing that you intentionally avoided those words I'm wondering why what we start to call feminine and masculine becomes very very constricting we make feminine become a set of rules that become really really constraining for folks who might see things differently my son 75 ish percent of the people that we come into contact with that don't know him or meeting him for the first time don't recognize his biology and so he's asked me on many occasions or it's a regular thing daddy please correct being able to again have the space of this helped me to reflect on my experience and come back to what we were talking about earlier around how do we support our children so where does the bullying come from if we're all born as an inclusive species what is that point that's a great question kids are in this binary system like fish or in water they don't even know it's there so unless we intentionally interrupt it and say wait wait whoa whoa whoa we can't make these assumptions about kids then they're gonna operate that way and that's where a lot of bullying comes from is the power stuff is the wrong way but as soon as you give them a little bit of information they're like oh okay I got it and it's really important that we understand all of us have parts of behavior that might be identified as boy or parts of behavior that might be identified as girl and it doesn't have to be that rigid we've been discussing a lot of the gender issues in class I told the kids that they'd be breaking into their groups and actually just talking amongst themselves and to be honest I didn't know what to expect from that well it turns out that they couldn't stop and they were all talking about sort of personal experiences having their family in terms of gender issues and so I found myself not being in the position of really having to lead anything if anything I got from them this is the powerful thing for me as a teacher that how much they teach us they how much they teach me personally they really taught me that they are further ahead on the consciousness arc if you will than I was at that age certainly and it just keeps me up to date with things and really the overarching thing for me in the class and the reason I love this is because I think it's important that to get away from all that bullying stuff I'd say nine-tenths of it would disappear if we could deal with each other's differences in a different way one of the things we talked about yesterday was about the boxes that confine us I've always been pretty passionate about talking about things like stereotypes and empowering all people but this framework really helped me to take the conversation to another level we've labeled Kamiya with all these labels just because of her gender it says here that she is too weak to stand up for herself are you too weak to stand up for yourself? no definitely not but see we put that label on her and we don't get to see who she really is right? if you teach somebody about what they wear or what they look like you won't have as many friends you won't be that much happier on life if you teach somebody about that kind of stuff Rassan would have a hard time playing soccer or doing other things that he likes to do with that box on his head and the labels that we put on people make it hard for them to be who they are it makes it so that we can't see how fabulous they really are and it also makes it hard for them to live their lives the way they want to live them my closet was literally pink and now I look in my closet and it's almost all blues blacks and browns I thought that it was different like you should dress like a girl if you're a girl but I don't think that anymore like a lot of even parents think that way because that's what their parents thought then if there was no such thing as boy thing and girl thing probably half of my friends would be wearing dresses over the years well my favorite color has been purple and I told my dad I was like I want some purple skinny jeans he was like are you crazy I put the jeans on I was kind of afraid of what people were going to say about them but I just went with it and then it kind of actually like once I started wearing them it kind of felt normal I'm wearing what I want to wear it doesn't matter what gender you are it matters what kind of person you are like you're a boy and you act like a girl it doesn't matter you're a good person and that's what matters maybe the present can make a law you can't make fun of boys that like to wear dresses or girls that like to color color green and girls who like love monster trucks gender is not binary right what does binary mean it means that there aren't just two types of genders like there's like there are variants of boy and girl it's like there's a spectrum yeah it's very good lots of places in between where you can fall right so today we're going to be looking at gender in 3D meaning gender isn't just about our bodies but it is about it's three dimensional we've got the biology of gender when we're born we've got our gender identity and our gender expression you know you could fall anywhere on the spectrum you could be a boy biologically you could express like a boy but feel like a girl it didn't surprise me but I just never thought of it in those terms of those three different elements doing this work is critical because it not only creates safe space for those students who may be particularly gender diverse or any child who is simply trying to figure out what it means to be a boy or a girl or maybe something different as they go to school where they fall on the gender spectrum I was born as a girl really at school I'm more like over here but other places I'm in the middle and then on the inside I feel in the middle it is so important to build a culture of inclusivity for all children but most importantly for gender non-conforming children because they're facing in all parts of their world and we know very clearly that children can't learn if they don't feel safe and seen we're teaching kids that there are people of differences in the world and we should respect them and love them and treat them kindly and that's it because if they don't put labels everyone can be free they don't have to worry about what their gender is and how they can't do this and how they can't do that there's no complete boundary to stop you by your gender it's okay to be what you want to be instead of just listening to other people as a result of this work I think my students feel happier and that they have permission to be who they are it makes me really sad to think that they're in most places in our country that I mean people commit suicide because they don't feel comfortable being who they are I would say to other parents don't be afraid of this go ahead and take the plunge and start learning about this you'd be surprised at how open-minded parents are and even more so how welcoming children are to learning about this and I think that it's going to create a safer environment for everybody that's ultimately what we're looking for for our children and our families you see kids of all different races all different backgrounds all different classes all the diversity that we can see embracing each other, loving each other having a great time and that's the kind of community that we want to foster and model not only for here in Peralta but for the world so that is, thank you that's something we're super proud of in Peralta's an amazing school that really does a great job of is showing what it can look like to do this work now, Peralta also is a very sort of in the middle of Oakland it's just kind of a basic typical public school it is incredibly high performing they didn't stop teaching math or spelling, they did all that and actually taught students what it demonstrates is that with a little bit of intentionality we can create schools like Peralta schools that are willing to say it's about kindness and respect we're not trying to change people's values and beliefs and make you, you know, tell your the way you were raised was wrong but what we are here to say is that in our schools, every child should feel seen and should be treated respectfully and that's what Peralta's been working on so that's the framework that's the work that we've been doing a little different than the film is we really for the most part are not coming in and doing parent education anymore and even to some extent staff training but instead are working to build the capacity internally so that we're doing more of a trainer-of-trainer model where schools will then have their own people in place so they don't need some joker like me showing up they are their own leaders of this work so with that we have about 10, well almost 15 minutes and we'd like to open it up to any questions or comments that you might have so as educators how do we support students whose parents are ignoring their child's right to gender identity or expression this question comes up a lot how do we deal with the situation where we have a young person asserting their authentic selves and their parents aren't on board and there's a very important word I always like to add to that question which is yet so often schools will have a child and because it's a certain conditions at the school that child might feel safest at school saying actually here's what's going on for me or you might observe it or in some other way come to understand that and they may very well say and please don't say anything to my parents they will never be okay and what we talk about is a couple of things one is particularly depending on the age of the school but almost always affirming the child's gender is the appropriate thing to do at school it is the law in California that we actually have to provide programs, facilities and activities based on gender identity but the fact of the matter is those parents are often not there yet because of fear a friend of mine once said that sometimes rejection is a failed attempt at protection rejection is a failed attempt at protection and what he was saying was these parents are very scared about what might happen to their children based on their own upbringing based on the data that we have and what we try to work with schools to work with families is to make informed decisions again you know Diane's presentation there were some critiques about the mission of the gender center to create trans kids excuse me but well that's not true what our mission is is to make informed decisions or to help families and caregivers and institutions make informed decisions and so when there's a child at a school and the parents aren't there first of all you're not going to be telling the parents something that they don't know what you can do is say listen I want to talk to you about some things we're seeing here at school and I just want to check in and see kind of where you're at not like what's your problem why aren't you supporting your kid you're a bad parent right that's probably not going to win friends and influence anyone but to say you know I'm noticing some things at school and you know your child has shared some information with us and we want to talk to you about how we can work together to support them because I care about and I know you care about your child's health and well-being so what are your thoughts about your child's gender oh it's terrible and you know we're not going to say okay well you know I don't know if you have any information about gender if you've learned anything but I have some great resources and along the way I'm going to depending again on the age of the kid and the interaction I'm going to share you know it sounds like you're really afraid for your child you want to keep them safe and I hope you also understand that the rejection of your child's gender also impacts their health and well-being and what we often find kids and families thinking about is I'm worried what will happen if we support that kid without acknowledging the known which is that kids miserable now right so we know the kids miserable supporting them it might not work out it actually probably will but it might not work out but we know where we're at and so let's talk about what it might look like the thing is you know here at school we have a commitment to gender diversity and equity and so I understand what you do at home is what you're going to do at home but here at school these are the values that we operate by that we believe we're beholden to both ethically and legally and therefore I hope you can understand that we're going to work with and honor your child's request to support them as they know themselves here at our school and again that means are you a teacher yourself okay so I mean that means if you are a teacher you better not be hung out to dry okay by administrator goes she said what oh no no no don't worry we'll make sure you know that's where the system has to be in place saying oh no we affirm the gender of our young people because it makes them safer and it helps them learn better and it's a commitment we have Jill just a quick add on do you have any tricky lines for private schools that are beholden to the laws yeah so your private schools present an interesting conundrum because on the one hand they are not held to ed code standards so they can say you know whatever we're not going to do that and in some cases you know they're not by the same token private schools have a lot more flexibility in a lot of ways and so what we again will try to appeal to a school is like gee I was looking at your website and it says that you know such and such day school or whatever honors the diversity and individuality of all of our students and support each one's have become their full selves and amazingness and like oh okay well I heard you saying that so how does that relate to gender how does that relate to a kid who comes here and asserts their true selves here now what they'll often say is and what the fear is and and I've been on a private schools board and I know the fear is like if we support these kids and do this work there's going to be some kids some families who leave they're not going to be okay with that I'm like yeah you're probably right you are probably right I would ask if they're a good fit in your community anyway but you know but well they bring money okay I get it let me tell you a quick story you know the Girl Scouts in Colorado had a big controversy where they were supporting a transgender girl and there was a you know blowback where there's this huge campaign by an organization to try to boycott Girl Scout cookies because this they were supporting this transgender girl and they were scared to death cookies are the number one thing that supports Girl Scouts financially they really are and they were scared to death that year they had their biggest sale ever more people bought cookies than ever before specifically because of that kid there were people buying hundreds of boxes and saying I can't eat them I don't eat them I have diabetes I'm not supposed to eat them but please give them away give them away so my point is yeah you might have some people who leave you you're also going to have a whole bunch you say thank you I'm proud of you and if you're not ready for that then again then it sounds like this isn't the work you should but at least own it Hi, following up on the last teacher's comment about the inclusivity kids from different races social groups do you have any thoughts or observations about relationship in any direction between systems that are wanting to address this issue and systems that are also wanting to explore issues of race ability class so I think I understand the question I'm going to answer it like I understand it no so there's two ways I thought what you were going to ask first was like what about schools where like the school really wants to do the work and they're concerned like hey we have a very diverse community who not everyone is necessarily in agreement about all this gender diversity stuff and we want to be respectful of values and beliefs and religion and all that stuff so let me answer that first because I know if you're not asking someone else is wondering and our response to that is and I started to allude to it is this isn't about changing your values and beliefs there is one well actually two values we wish to impose with this work kindness and respect you teach whatever you want at home but here at school every child will be treated with kindness and respect if you don't have something nice to say don't say anything at all you may you don't have to march in the transgender parade you don't need to donate to gender spectrum please do but you don't have to but what you can't do is be mean your child cannot be mean to other kids based on their gender now the rejoinder we often get is yeah but what about my child you're making my child not feel safe by talking about all this crazy gender stuff and I'm like so first of all I'm extremely concerned if your child feels unsafe because your child feeling safe oh yeah because you're doing all this gender stuff the kid hasn't said anything by the way but the band oh yeah my kid's unsafe really well tell me how what is someone doing because of course being unsafe happens when someone does something and you know what is making them unsafe well you're just letting you know talk about all this gender stuff it's like and that's making them feel unsafe how exactly like what are they scared of well they're not I mean it's just uncomfortable oh so you're uncomfortable uncomfortable and not safe very different things we live in a democracy we're uncomfortable all the time quite honestly as an educator I love discomfort it's called cognitive dissonance and I want my students to be a little less comfortable we're all a little less comfortable I take that seriously but simply the because this other kid exists that's not making your child unsafe however your child's behavior does make that child unsafe or attitudes such as makes that child unsafe so we'll work with your child's comfort level and we can come up with all sorts of alternatives but it's not going to be on the back of that kid now in terms of the second version of your question that that's what you're probably really asking was you know how do you integrate this with other kinds of systemic efforts of school reform and I would again argue because gender is such a universal experience I don't know anyone over the age of three years old who cannot tell you pretty clearly a time that they were either limited by notions of gender that were imposed on them or held up to some expectation because of notions of gender it is a universal experience in some ways it's very different than race or religion or language or socioeconomics that allows us to start that conversation about critical thinking non-binary thinking things can be both complexity and it's those conversations which often can lead to those more tricky conversations in some of those areas so I mean again I think it's also a great place when we're talking about elementary schools because people are like well I don't want you talking about sex with my child oh well good because I don't want to talk about sex either I'm sure no thanks but we want to talk about gender that's different right we're not doing sex ed we're talking about inclusion and diversity and again that's the entry point I don't know if that gets it what you're we're asking but in terms of other systems those are some of the entry points the other thing is quite frankly depending on the context if there is a really discriminatory situation in place and depending on the state you know at a certain point we'll say so listen superintendent so-and-so principle such and such I assume you like your house right I mean you probably want to keep your house because the law actually can hold you liable for this now that is never an effective approach to start from you must do this so you don't get sued but that doesn't mean you don't pull that out if you need to it's like so let me just make it you know let me make another argument here you can't afford not to do this work because here the law suits here the court findings and we're moving inexorably in that direction South Dakota not withstanding we're going to get to a place where the respect for gender and gender diversity will be we'll be looking at it I mean what side of history do you want to be standing on and a few years we're going to be looking a lot of this stuff about genica what the heck were we doing maybe one last one yes hi so I'm a student at UC Santa Cruz here and I was curious about implementing these on college campuses particularly because you know like right now I'm in a genetics class and we learn male-female like drosophila and fruit flies and I was funny because I've studied with a transgender student here and I've studied with a very cisgendered like non non gender expansive thinking person and like I remember I was like oh yeah we can all study together and then this other girl she's just like is that a boy or a girl and I'm like that's Kaz like that's not relevant you know and I just can't and that you know as we're all about to go have our own children and I see some of my peers who are going to be that parent who are going to have so I just I'm trying to imagine this getting implemented on college campuses and how to work with a more complex student professor and student administration relationship yeah great question and I will say yeah absolutely um yeah good old drosophila melaine a gasper I think it's called yeah so a couple thoughts come to mind so in this was a question I do this is not about getting rid of gender I you know will sometimes say is like a teacher will come up and say listen I'm really sorry but the other day I said boys and girls am I a terrible teacher am I a gender bigot it's like well thank you for empowering me to judge you it's like okay you're fine but this isn't about saying never say boys and girls you can't talk about xx and xy chromosomes and the traits that those lead to it's just don't only talk about that it's don't always talk about that you know again that Neil deGrasse Tyson just chill out like we can be where we are we just have to be careful that we're not always saying boys and girls only male female only one or the other and instead saying sometimes but not always frequently but not always right you may think that but they don't right just giving them this permission for there to be this lack of to get out of the all or nothing thinking that so often informs these conversations in many ways it brings me right to where I was at the beginning of the day it's not about who's right and who's wrong it's about how do we need to be with each other right now in order to have an exchange as human beings and learn or you know be friends or be neighbors or be colleagues or roommates or whatever and that we just need to get out of that absolutist thinking because quite honestly I feel like as someone who you know does this work and works with a lot of colleagues they're often it's difficult to work with in some ways as people I'm really fighting to really get this right it's like come on create some space for other people to be where they are and at the same time don't don't compromise you don't you don't give up your values but you can do it in ways that are not absolute on that side either I don't know if that helps but I think and then the other thing is work with your student governments on the college campuses work with your LGBT centers because they are doing fabulous things they're my friend just applied for college for their or their kid applied really my friend applied but anyway and they are talking about like all these forums they had to fill out for dorms and stuff and so many of them are now talking about do you want to live in a gender neutral dorm and what's your preferred pronoun and there's options that are showing up in ways that really do you know begin to rely the binary notions and demonstrate this growing understanding so for more information please be in touch we do work with schools all over the country and are excited to work with yours and consult and provide any kind of resources we're very much about co-constructing our work with you we do not have a one and done one size fits all drive by professional development model it's very much about what are you trying to accomplish let's imagine together what it could look like so thank you very much for the chance to be here today we're going to take a break and we're going to be starting a little bit before to so please don't make gel George yell at you to get y'all back couple minutes before to please be in your seats ready to go thanks okay we have our own local hero here and I want to say right from the get go that today's conference would not have occurred without the help support and coordination of Dr. Jennifer Hastings we are blessed here in Santa Cruz to have such a powerful woman Jennifer Hastings MD major in women studies at Princeton University and was an art teacher and painter before medical school at UCSF and is grateful for varied life experiences before medicine as assistant clinical professor at UCSF Department of Family and Community Medicine Jen is a family practice physician who started and is director of the transgender health program okay I lost my place Jen is a family practice physician who started and is director of the transgender health care program at Planned Parenthood Mar Monte Santa Cruz and has been actively involved in supporting transgender health care services for youth and adults around the country Jen works closely with the Santa Cruz transgender therapist team and is involved in the integration of behavioral health and primary care for safety net clinics and with mindfulness and medicine Jen is a member of the medical advisory board of the UCSF Center for Excellence for Transgender Health and intimately involved with medical conference programming for gender spectrum Jen works to increase medical access understanding about gender journey Jen Hastings okay so I have instructions on the microphone how is this we're good okay so thanks so much it is truly wonderful to have everybody here in one room it's extraordinary thank you all for taking the time out of your very busy lives to learn about something that I think is extraordinarily important and I just want to thank the people that I've worked with for years here in this community and the incredible patients that I've had the honor to work with really every single person I've worked with probably not just in transgender healthcare but I think the stories that I've been privileged to hear and really to be on this journey with people exploring gender and exploring so many things but I think what I'm hoping today is that your hearts have been opened because I think our hearts are the most important piece of this work and we can't do our work well if our hearts are closed so I'm hoping well you can't help with with Joel and Diane but I hope we'll continue that process together with opening our hearts and just a shout out to Katia Tetzla wonderful graphic artists they are in Chicago and they've helped me a lot over the years with PowerPoints so we have a lot to cover I want to look at best practices in creating transgender healthy excuse me transgender friendly gender affirmative health settings we want to look and what you already have today I think gotten a glimpse at the importance of the interdisciplinary aspect of this work we have to work together you cannot be in your own little box in your practice just like maybe you don't want to be in the box of your gender anymore either medical treatments we'll be exploring those both puberty blockers and cross sex hormones and then we'll just touch briefly on some of the surgical options that are available because things have really a long way to go still in surgery but there's a lot there and not everybody wants surgery I can't see that at all what are you saying okay so very quickly we're going to review the concepts that you already learned today so we're looking we've already had a deep dive into what sex is and really that's you know what's between the legs and we've learned that gender is much more than that because there's our gender identity deep inside ourselves no one can tell you do not know what my gender identity is at all because I haven't told you I haven't shared that with you so that's my internal deeply sense deeply felt sense of what I am in terms of gender and then there's my gender expression or your gender expression and how you do your gender in the world you already saw this slide and really what I want to do by putting up these last two slides is pull you into all the things you've already learned today because that's an incredibly important foundation so if someone is looking at this on YouTube and you just clicked on the section on the medical section you have to go back and listen to everything else because I'm really it's really important to me that these concepts of gender identity, gender expression sex and sexuality that was explored are already there and the concept of gender as a spectrum and that many people do not fit into the box that you already got that because we're going to move forward from there because in order to do gender affirmative care you need to hold that very deeply to be respectful of someone's gender identity the concept of gender spectrum has to be really in the forefront and exploring your own gender is critical so I usually spend a lot of time in my own if I'm presenting all by myself but I don't have to do that today just reminder that in order to do this work exploring your own gender is crucial and that the concept of cultural humility that you don't know the person in front of you until you deeply engage and so we have to be culturally humble the concept of cultural competency is kind of dangerous I think it's not just in this work it's in all the work we do to someone and that's based on stereotypes you're not going to really engage on a deep level so who is the person in front of you so there are structural things that Joel I think already touched on some important things in the school but if you're in an office setting or you have a clinic or you wherever you're working you want to make sure that you create a safe and welcoming space and there are lots of different ways to do that and we could spend a whole three hours on that but we won't assuming that folks don't trust you is I think a good place to start because people have had terrible experiences both in healthcare settings with therapists certainly in the schools and so creating audio visuals that involve trans people are incredibly important and I'll talk more about bathrooms but I can't say enough and today we had this experience where we only had a male bathroom and a female bathroom and so we had to create gender neutral bathrooms so that everyone here felt safe inclusive forms I think Joel talked about that in terms of the schools having names this work moves very fast preferred name and preferred pronoun used to be sort of politically correct no longer what pronoun do you use today is today the most important thing and I want to say if someone is watching this a year from now or even six months have moved this is a very fast moving field the language changes and so you can't just sort of rest on your laurels having come here today you have to keep engaging and learning and train your entire staff you can't just have the medical providers your front office person is probably the most important person and there's something nice from transgender law center 10 tips for serving transgender patients that's good now this I think was already shown but I just highlights like what do you do if you don't fit into one of the bathrooms stalls it's not well but here now I have a place that I can go where I feel comfortable the bathroom is so important we all need to pee and sometimes poop so that's a basic fact working together is crucial as I've already said it Diane said it I think Joel has referred to it as well and now the clickers there we go and depending on the age different things might be important in terms of support social transition is controversial for some people but it's really pretty easy you don't need any medicine for this a haircut a name, clothing, pronouns and then when as a child gets older and begins experiencing puberty then that's when you build on what is available and may consider blockers, hormones or surgery so the concept that needs very at different ages is just very important so I'm saying the same thing that I just did in the previous slide but saying it again because I think it's so important provider education of the school, the family support acceptance incredibly important and it turns out that doesn't go away we need that at every age when puberty comes we have something else to consider and that's puberty blockers and when you get into later adolescence then we can consider cross hormones and surgery so let's look at what the different medical transition options are so I'm repeating myself a bit but the concept of reversible partially reversible and irreversible or permanent are very important so what do you think clothing, social transition hair, is that irreversible no that is completely reversible you just grow your hair and change clothes puberty blockers it turns out which are medications that we'll learn about in a few moments that basically put puberty at pause and we'll learn about them so don't worry about the Giana RH agates yet partially reversible there could be some parts of cross sex hormones which include estrogen, progesterone and testosterone and then irreversible will be some of the effects of hormones and most surgeries are considered irreversible or permanent although you can have a surgery and then basically have another surgery to undo it but that it's for all practical purposes permanent so this is another slide really highlighting highlighting the importance of the collaboration so in order for me to do medical treatments or medical interventions I work very closely with my mental health colleagues and they work closely with me and it's really important that everyone who's providing mental health for transgender youth and adults understand about the medical interventions and it's important that patients and families understand what these interventions do and we call that informed consent so people can sign a paper about a puberty blocker or a cross hormone or a surgery but in my mind that's not informed consent if you haven't really talked about it and so it takes time and I think we also learn more as we go along so informed consent when I first started this work 20 years ago we didn't really think about fertility options for youth now if you're thinking about a puberty blocker you want to talk about fertility but so informed consent really moves as we learn more okay puberty can be difficult especially if a youth is engaging or starting a puberty that they were not aware of what would happen and this is not an unfrequent story that kids will say I didn't think I'd get breasts I didn't think I'd get a period in their mind they knew their gender identity so clearly that they really didn't think that the puberty of their biology would happen so these physical changes are often traumatizing there's a lot of self-harm and there's a very high suicide risk for kids who are not supported during this time and so that's really the power of the hormone blockers can be very helpful for not just the teen but the family as well and often times kids know they're really clear they don't need time to think about whether or not they need cross hormones it's the family that does because as we learned from I think it was Joel's slide about the age between awareness and then the age of telling the family there's often a big time there there's often eight years of a kid knowing their gender but they don't tell their family until puberty is there or it's already happened so these are the things that we know about with many transgender youth and this is really the power of puberty blockers and I want to share these are two teens they're from Boston at the Gems Clinic the young person on the left who was assigned male at birth like her twin brother she got puberty blockers and they were identical twins and it's a very powerful image I think about what puberty blockers can do so she did not get the development of an Adam's apple she did not get the development of facial hair and we're seeing real safety in puberty blockers they were used for years for what's called precocious puberty they started in the 80s the awareness of this kind of puberty blocker and we're not seeing anything untoward in those youth who used the puberty blockers when they had puberty at a very very early age like 3, 4, 5 so that's incredible that we had this medical intervention to stop puberty at the time when it's not appropriate and then when they reach the age when puberty is a when their peers are having puberty stop the puberty blocker and puberty then just starts where it left off so it's really very safe so we have now studies from Holland showing positive effects for these youth actually their general psychological functioning and one of these three studies was higher than their peers and you think about it well puberty is pretty hard so they basically were not having to go through puberty and they were psychologically functioning better all the youth in these three studies went on to have cross sex hormone treatment but that's not a given so this really is truly a time for choice and we are now the big Diane didn't mention it but the Gender Center in San Francisco along with Boston, Chicago and LA are engaging in a four center study of trans youth and it's very exciting for us to get real data so we we've seen the benefits of early support for youth the bottom one there the bottom point allows for selective disclosure this is a whole other talk really about when does a youth share with other peers or other people that they are transgender some for some youth their identity is not trans they are the gender they are and so they may not want to share with others okay so what are puberty blockers I've already shared that there are pause button on puberty and I really want to do a shout out to Stephanie Brill this is really her language the pause button it usually involves an injection every several months or a yearly implant and as I said already they're safe because we know it's we've used a different kind of puberty blockers medroxy progesterone starting in the 70s and then the kind we're using since the 80s so if we stop the puberty blocker puberty resumes in three to six months and we typically start them if we have a youth that we're encountering or working with before they've actually started puberty the time for starting a puberty blocker is something called tanner2 and you think well what's tanner2 well tanner was just a guy a doc named tanner and he described he was from England and he was very interested in puberty and looked at boys and girls going through puberty or I'll say bodies with ovaries and bodies with testicles and described tanner1 which is not puberty not starting yet at all and then tanner2 through 5 is the gradual progression of puberty if you have a body with testicles the testicles begin to get slightly larger and then the penis grows and the testicles grow in hair and then if you're a body with ovaries you begin to get breast buds at tanner2 and the next slide basically shows the tanner staging as a person with testicles it would be tanner2 here which is highlighted now what if someone has already passed tanner2 what if they already are at tanner4 with fairly enlarged testicles a large penis, more pubic hair and at that point you would also have facial hair probably so when we first started doing this work we would say well it's too late you can't start a puberty blocker but things have really changed and we now give puberty blockers even if someone has already gone through and is in a later stage of puberty and I'll talk a little bit more about that sort of decision process if you're a person with ovaries and you're beginning to get pubic hair and just have the beginning of breast buds that is tanner2 for a body with ovaries and that is when you would want to start a puberty blocker if you're aware that this is a child that would need benefit from this intervention now what about body odor and underarm hair well what about that that is not puberty, that's something called adrenarchy and that's the release of from the adrenal cortex and so sometimes parents who are watching carefully get really concerned when they begin to see classic signs of what we've typically associated with puberty underarm hair and body odor so that's not puberty and you would not start your puberty blocker at this point so I now want to talk a little bit more about the physiology of puberty because that really helps us understand how these gonadotropin releasing hormones work so that was a mouthful right gonadotropin releasing hormone so deep in the brain we have something called the hypothalamus and puberty it turns out starts when we have the pulsatile and that's why I have those dotted lines there release of something called gonadotropin releasing hormone now the word gonad refers to and it's a gender neutral term because it includes both ovaries and testicles so gonadotropin releasing hormone refers to exactly what we're seeing that you're going to with a hormone released from the hypothalamus tell the body for the gonads to get going and start working but it takes a couple stages because that gonadotropin releasing hormone which is going beak, beak, beak it's going off and on it's not steady goes to the pituitary and the pituitary goes oh my gosh I can feel pulsatile releases of gonadotropin releasing hormone it's time for me to release luteinizing hormone and follicle stimulating hormone so LH and FSH which are luteinizing hormone and follicle stimulating hormone those are both in bodies with testicles and bodies with ovaries it's not just bodies with ovaries they say okay I'm going down to the gonads and the gonads are the testicles and the ovaries and they are going to make if you have ovaries estrogen and progesterone and actually you actually have testosterone in there as well and if you've got testicles you make predominantly testosterone but testosterone and estrogen basically go back and forth between each other so we all have a little bit of all but so how do the blockers work then okay so we got the hypothalamus and it's puberty starting and I have that pulsatile release of gonadotropin releasing hormone well if I give a gonadotropin releasing hormone analog which means structurally similar or agonist which means makes more of it that's can you see that that's what that said red doesn't show up well but that says GNRH agonist then the pituitary goes oh my god there's so much of that stuff I gotta turn off I can't we can't this is too much I have to regulate things so I'm gonna turn off so I'm not gonna make luteinizing hormone and follicle stimulating hormone and I'm therefore not going to tell the gonads to make hormones so it's very elegant this is extraordinary I mean it's beautiful right extraordinary so that's how the gonadotropin releasing hormone agonist work okay oh there was that last step okay so they come either as an injection either in the muscle or in the skin under the skin or as a pellet there like a rod they're very expensive unfortunately so the one on the left there is Lupron or Elegard those are the brand names what's interesting is that Lupron is marketed for women with a variety of conditions where they need to turn off the the ovaries and guess what that is like 20 times more expensive than Elegard that's marketed for men with prostate cancer there you see it it's exactly the same medicine this is my like really how deep does gender stuff go okay on the right there is Hystralin which is either Supperlin which is a brand name for the medicine that's given for precocious puberty anyone want to guess how much that costs for one implant $23,000 and the one on the left Vantus is marketed for men with prostate cancer and I can buy it as a provider for $2,300 so that tells you the differences between marketing for men and women bodies with ovaries, bodies with testicles really but the implant is made to be used for one year although we found that it lasts really usually for two years so funding this is incredibly difficult because historically when gender care was not covered by insurance there were actually exclusions for gender care this was extremely difficult and the gender spectrum conferences over the years you know we'd have parents in tears because they couldn't afford to buy the implant or to buy the blocker well now with the Affordable Care Act we finally have access for this care and it's spectacular and we're very lucky in the state of California many states still don't have protection we do with our discrimination clause but I'm still having trouble I spend hours and hours and hours getting things covered and we can help each other the Transgender Law Center and the National Center for Lesbian Rights are very helpful in this regard so what about the pros and cons of puberty blockers this is not an easy decision in some cases it's obvious in some cases as well and really the important thing is to individualize the decision it's the person in front of you it's not a protocol and so I think this slide will really change for me over you know shortly but basically the pros are that you buy time to explore gender identity and I already reference the fact that many kids really know they don't need time but the family does so we prevent undesired irreversible changes of puberty and so if you have can prevent the development of breasts or Adam's apple or facial hair markers of secondary sex characteristics or markers that are secondary sex characteristics this is very powerful can prevent then costly surgery and procedures we really see improved function in kids and then typically we use lower doses of the cross hormones although I think that's probably not a hugely compelling reason although for some providers it is so the cons are really that we don't fully understand the effects on brain development although in the studies that have been done that's looking to be a non-issue when we first started using puberty blockers in this older age group we were concerned that there would be an issue and it's really not panning out there's sort of complex issues around height, final height that I think we're still understanding the effects on bone density are a consideration and really when you add the cross hormone then those those issues appear to go away although I think we still have to look really encourage young people to be engaged in physical activity so their bones are getting strong and calcium and other ways to support bone density and bone strength it's incredibly expensive and that's you know in the best of worlds that would not be a reason to not give this medication but then fertility is an issue that we're now looking at and I'll spend a little time at the end because if you blocked the development of the gonads then at this point in time having your own biological children is less is really not feasible right now but there's a lot of well I'll wait for the slides it's you know from the field of pediatric oncology we're getting fertility futures as a possibility so what about a kid who's been on a blocker and they're now getting older what happens next so this is another area of controversy because the studies from Holland started cross hormones at the age of 16 and there was nothing medical about that 16 is the age of consent in Holland kids are adults at the age of 16 and so it was the protocols started by having the kids start the cross hormone which means estrogen or testosterone when they turn 16 well in this country do you think waiting until your 16 is going to work to have your puberty it's kind of late so okay sorry I have to change thoughts here but you have an option of stopping the puberty blocker and going through your own biological puberty or the puberty of your gonads so that's an option the point is that everyone but the point of the slide is everyone has to go through puberty at some point we need hormones the sex hormones for our bone density you can stop agonists and start cross hormone therapy so that's an option and then the one on the right which is continue the puberty blockers and start cross hormone therapy at a lower dose that's another option and that's the one that I think the UCS UCSF gender center is doing primarily but then it's actually incredibly expensive to continue that puberty blocker all the way until you know so when do you stop and what we're finding is that kids do very well stopping the blocker and starting the cross hormone therapy or continuing the blocker for a while and then sort of tapering it off so but what about those older teens who never had the puberty blocker well we do have an option for them as well and that would be depending on where they are with their family starting with their hormones or hormones and blockers so what about cross sex hormones what are they so these are the estrogen testosterone primarily also progesterone where we basically get the secondary sex characteristics of the gender that you are moving towards and there are good studies showing that using cross hormones has tremendous positive effect psychologically in terms of decreasing gender dysphoria, decreasing anxiety depression we've known that for years in adults and we're seeing that in children as well I want to really do a shout out to the non-binary transition so in all of my conversation right now we're sort of you know looking at going one direction or another and there are a lot of youth and adults that don't want to go into towards the other box they want to be in a non-binary space and I just want to shout out to this website by my M-I-C-H-A-H as a great resource for learning more about non-binary transition so let's look at the hormones so in the trans-female spectrum you need something to feminize but you also need something to decrease the level of testosterone testosterone is a stronger hormone and if you put the two hormones kind of head to head testosterone will win so we need something to lower the testosterone so estrogen we use and there are many forms and anti-androgen which is really what will lower that testosterone and sometimes progesterone for the trans-male spectrum it's simpler we just use a prescription or a medication to masculinize and that would be testosterone and likewise we have many different forms and we look to get the physiologic level of the I'll say the word so the cis man or cis woman what is physiologic for those individuals although I would want to just point out that we there's not a lot of data and research helping us with sort of what's the ideal level and how do you measure and it's a more complex issue so how do I know or how does a medical provider say okay time to start a cross hormone so we have guidelines and I just want to point out they are guidelines they're not rules they're not in cement or stone and this is the World Professional Association of Transgender Health or WPATH and basically the guidelines are that someone have persistent gender dysphoria meaning that they're not comfortable in the gender that they were assigned at birth they're able to provide informed consent and that means that they basically understand how the medication works and if they're not 18 because the age of consent in the US is 18 then they need parental or guardian consent and so that's makes sense you want to involve the family if they have concurrent medical or mental health problems it's state that those should be addressed now that's complicated sometimes because as I think Diane pointed out gender is sometimes the cure so in order for someone's severe anxiety and depression to go away you can't wait for that to go away you actually need to use the cross hormone to decrease the anxiety and depression and that's been very problematic I think for people who read the guidelines literally or for who aren't deeply involved in this work they're like oh no no you can't start that hormone because they're not stable enough and so this is exquisite work so maybe start the hormone very very very low level just begin and so oftentimes that's hugely calming for an individual to at least be on the journey at least be starting the process so the version 7 written in 2011 or published in 2011 is so much better than the previous version which had things like real life experience which was you had to live in the gender before you could get the hormones which was often unsafe and it used to be that there was a requirement for 3 or 6 months of mental health but now that's individualized so there are things that are so much better in this version so we don't say you need a certain amount of time really it's the relationship between the mental health provider and the individual to determine what's the right amount of time to work together before starting a cross hormone and the intent to pursue surgical intervention is completely irrelevant whereas before there was sort of the assumption that someone was on this path and there was a certain order of things you know first you had your therapy then you did your real life and then you got your hormones and then you had your surgery boom no it's not that way for many people so let's do a little bit of a deeper dive into the hormones it's slow so both moving and I just want to point out that I used the word feminize and I there was Joel's not there right now but you know we need better language but that's the language we have right now to move in the direction of getting breasts and hips but what are the patient's goals that's probably the most important thing as you're working with someone and the goal may not always be achievable because genetics is you know genetics and so it may not your mother may have had large breasts but you may not because you have your own genetics and this is frustrating and difficult for folks so I just want to go a little bit deeper into what is involved so there are many different forms of estrogen but the safer forms in terms of safety in terms of less likely to cause a blood clot would be things that are not oral that avoids the first pass of the liver and decreases the risk of a blood clot so using the oral form of estrogen the safer form under the tongue a patch or cream or into the muscle and then in terms of our anti-androgens that lower the testosterone we most commonly use spironolactone which is a diuretic which was used for many many years I think in the 1800s it started and what they discovered with men who use spironolactone to lower blood pressure is that they have large breasts and so we just discovered this by observing what happened to cis men or bodies with testicles on spironolactone finasteride and detasteride you probably know for decreasing male pattern baldness they decrease the more potent form of testosterone they're very useful for trans women or for feminization but they can cause sometimes can cause other issues so we watch that and then progesterone which is a sort of its own little area controversial but I think we're more and more using adding progesterone so as I said before this takes time but the skin softens we see less hair growth on the face and on the body muscle mass diminishes fat redistributes to the hips and then breast development which is probably the most significant and typically as we are a breast focused culture often times the most important thing for a trans a person on the trans female spectrum sexuality and this is again very individual but typically libido decreases and decrease ejaculate and less spontaneous erections and maybe harder to get an erection and for many people this is very desired and very welcomed not universally and it doesn't happen universally but something to point out the other thing I want to say about sexuality is that many times people's interest in terms of who they're attracted to and want to be sexual with will change with the use of cross hormone. The testicles get smaller and many people note emotional changes crying more easily, more sensitive being able to multitask I mean I think this is an incredibly fascinating perspective on gender and as a feminist a hard one actually. So the informed consent process which I refer to earlier this is the probably the most important thing that when people start their hormones that they really understand what is permanent and what will stop or go back reverse if they stop their hormone and for a gender neutral or non-binary person on the spectrum you know you can use a low dose sometimes people take hormones for a specific amount of time, 6 months, 2 years and then stop and then it's a kind of movement to try to find where I will be most comfortable with my external presentation with the use of hormones. So you want to talk about sexuality and fertility for sure and the ability to cause a pregnancy so even though the faculate goes down there still are sperm so if you are a trans woman and you still have a penis and you engage with intercourse with a body with a vagina and a uterus and ovaries there's an ability to cause a pregnancy and that's really important that people know that. So the risks are really not completely known we're finally doing more evidence based work we have more studies happening and I just want to say that I don't have the analogous slide for masculinizing hormones but it's a very similar picture which is the picture is that when we look at the long term studies from Holland everything is looking very safe in the sense that we're not seeing cancers, we're not seeing premature death due to cardiovascular disease we're really seeing more so there's a difference between morbidity and mortality so morbidity are things that can kind of go wrong and mortality is actual death so we don't see increased death and the things that we see going wrong are more related to lifestyle so smoking, not exercising engaging in high risk sexual behaviors things that are actually sort of within our control although as we all know changing how we do things in our life is like the most difficult thing so saying to someone well just stop smoking that's easy for you to say it's hard so the other point that I want to make is this is all off-label we don't have FDA approval for any of this and we do a lot of things in medicine that way this is not unique to gender care so that shouldn't frighten anyone so when we look at the masculinizing hormones same thing what are your goals and testosterone is the only thing we need we usually start with an injection under the skin, subcutaneous, or in the muscle and it was Norm Spax from Boston who really discovered the use of subcutaneous testosterone it's always been used intramuscularly for cis men but Norm Spax discovered that if you put it under the skin it is metabolized more quickly and so you have to use a weekly dosing whereas if it's in the muscle you have a little more leeway about length between your dosing you can use a gel, cream, or patch and more and more people are going that way rather than doing self-injection we always used to think like there was something magical about starting with an injection but in fact many people transition beautifully just using a topical so this is what happens with testosterone voice deepens and that sometimes is the first thing that a person will notice and even on I'm using lower and lower levels of testosterone now and men on even just the tiniest amount will say the first or second week they notice the voice lowering having no period is often a very very important thing for someone on the transmasculine spectrum although again there's some people for whom that is not the priority so it's so important to figure out what is important for this person and that will help you direct your therapy sometimes male pattern sorry, facial hair body hair often occurs although again for some people really want you know a full beard and other people like no no no I don't want facial hair and unfortunately we don't have the power to sort of turn it off or on it is what it is and it's really your genetics increased muscle mass it happens change of fat it happens enlargement of the clitoris can happen to a degree that actually that enlarged clitoris becomes well is a phallus and can be used even before surgery for penetrative intercourse and then the emotional changes that we saw with estrogen also we see changes with testosterone and again I think this is really individual men will share with me that they have more difficulty accessing their feelings but if they really pay attention to it it's almost like a muscle that they have to keep but they have to work harder at it again very hard for me to see this when I started doing this work it was painful increased libido is is pretty much you know we see that very often but again not universally so informed consent really important to go over with the person you're working with about these are the things that will not go away even if you stop testosterone so the for the if you're starting testosterone the thickened vocal cords are what cause the deepening voice and that even if you if your voice deepens and you stop testosterone that will never go away if you develop an Adam's apple will never go away and for some people this is brilliant because they don't want to be on testosterone the rest of their lives but they want a deep voice so they just transition to the or use testosterone to the point where they're comfortable and then stop but reversible changes are include you know the stopping of your period the increased libido and the fat and muscle changes and so that can be hard for someone who doesn't want to be on testosterone anymore but really doesn't want their period so this is a you know a navigation and likewise in terms of sexuality many times people's sexual interest changes and ovulation can occur on testosterone so it's so important to review if a trans man is having sex with a body with a penis that has sperm they can get pregnant and there have been many unintended pregnancies because people weren't aware of that so I can't highlight that enough about it's an important conversation and then trans men are sometimes wanting pregnancy so I have a number of patients that have stopped their testosterone they return to regular ovulation and get pregnant and have a completely healthy pregnancy and then resume testosterone after they've delivered their baby and the paps matter for trans men is just a shout out we don't have time today to go into health care for trans people but if you have an organ or a part of your body that needs to be checked regularly it still needs to be checked whether or not you're on testosterone or not or estrogen so let me just look at my time okay so I can't say this strongly enough trans people gender expansive people may or may not want surgery that is a very individual decision it's not a given that someone will want surgery and in our California Department of Motor Vehicles we have a box we have a form for gender change and there's when it'll say male, female and it'll say complete or transitional and now the complete what does that mean aren't we all transitioning always for a whole life whether we're doing gender care or not or gender work or not so there's actually an amazing movement where's Vic Campbell Vic has been working for three years to get the Department of Motor Vehicles to change that so it doesn't say complete or transitional and there is something you can sign outside you can sign to get involved with this and we're going to be doing a whole campaign to get rid of those very disrespectful boxes okay so the most common surgery for someone who is masculinizing is breast reconstruction and that involves taking away the chest tissue or the breast and creating a male appearing chest this is now covered in the state of California if you have Medi-Cal you can get your top surgery this was such a huge change I cannot tell you how my life changed as a provider when the Affordable Care Act included gender care it's just extraordinary it's so the most common surgery if you have a larger breast are two incisions kind of smiles to achieve this surgery those scars really vary many trans people are so proud of those scars and they're beautiful and others develop chest hair and you can't see them at all people used to think that you eventually had to have a hysterectomy because the testosterone was somehow dangerous for the uterus and dangerous for the ovaries we really don't have evidence suggesting that and so we have a lot of websites saying you have to get your uterus out if someone is dysphoric meaning they don't feel good having their uterus that's a good reason to have it removed but at this point and this may change if we get different evidence but current evidence does not suggest that a hysterectomy is needed ufrectomy is the removal of the ovaries likewise the ovaries do not have to be removed and many trans men who want to have future fertility will keep an ovary in order to keep their own eggs metoidioplasty is the creation of a full male phallus with testicles using the enlarged clitoris whereas phalloplasty is creating phallus using tissue from other places often the forearm or the thigh to create the phallus I just want to point out that from metoidioplasty many men enjoy having vaginal intercourse but want metoidioplasty so you can keep the vagina and the ovaries and the uterus typically with phalloplasty the uterus is removed but this is we're finding not required we used to think it was so we'll move to feminizing surgeries and the same thing not required vaginal plasticity is the creation of the vagina using typically of the penis to invert so we invert the penis and that becomes the vagina you can also create a vagina with colon these are beautiful surgeries typical there they're not without problems in the sense and I should have said this as well for phalloplasty and metoidioplasty we're still really at the beginning I think of these surgeries in terms of avoiding difficult outcomes or complications we still have a pretty high complication rate orcheectomy is the removal of the testicles sometimes that's the only surgical intervention a trans woman or a woman on the trans spectrum will want panectomy is the removal of the penis breast augmentation is enlarging of the breast tissue tracheal shave is removing the Adam's apple and facial reconstruction is surgery to create changes in the forehead or the chin to achieve the facial structure that a woman might want so this is really important to me and I've said this already in different ways that you know the transition path and I want to I think Ben you gave me this slide Ben Galhofer thank you so this is letting a person sort of and decide what is their path what comes first how do I want to transition do I want to start some people many trans men will start with their top surgery before starting hormones others not I want to also do a shout out to Rai Testa's book the gender quest workbook which allows people to explore in a workbook fashion what might be the transition related things that they might like to do so now I do have to move more quickly but I want to shout out for a website for people who are working with trans youth the physicians for reproductive health getting a deeper dive into the blockers and cross hormones so unfortunately I have to move a little faster here but I made reference to the fact that we didn't have to we didn't use to talk about fertility issues for trans youth and now we really have to because if you go on a puberty blocker pretty much that means that you won't have your own biological children although as I said this is coming from an area where there is money people aren't giving lots of money to help our trans youth have their own children but people are interested in giving money to kids with cancer who are starting a medication that will remove their possibility for having future fertility because of the chemotoxic drugs so we're going to get a we will piggyback on this work and be able to use this work to help our trans youth and there are many ways to make a family so biological children is really not the end right we have adoption we share we do lots of things that's a whole other talk so I want to really thank Diane Aronsoft and Joel for their work because keeping the focus on the kid is really what I think allows us to do the right thing and to support them so gender is not a choice I think we use that from other fields gender is a spectrum acceptance is really key to the health of our kids and there are medical interventions that can support gender identity I want to point out the importance of resources I'm always learning I'm always reading I'm diving deep into lots of different things and I just for medical providers the line Martin is hugely helpful project health dot org trans line is a wonderful you can call you basically get a call back within a day or two the UCSF center of excellence for transgender health we've been working on revising the protocols now for almost a year it will the new ones will come out soon I promise these are references that when you can spend more time let me know if you want a copy of the slides and I'm happy to give them to you the National Center for Transgender Equality to return a landmark study that really pointed out a lot of the things that we now sort of take for granted in terms of decreased access for example for health for trans individuals that really gave us the data that we needed and we have with title 10 we created brochures on transfertility and self-care this is where I think it's important for you all to go home and start learning reading looking at blogs blogs have really become the place for us to learn and they're more TV shows so I am jazz great place for you to spend a little time and from 3 to infinity is a wonderful film about out of the binary conferences we already learned about gender spectrum but they're all over the country and I really encourage you to go take advantage of the wealth of material that's there and then our local resources so there are a few things I neglected to put on this resource thing so Santa Cruz trans online that will lead you to all the other websites the trans team project there were cards out there their wonderful set of resources the transparent group Heidi Karnkowski who will be on our panel incredible so please take advantage of her P flag there's our programs at Planned Parenthood California Rural Legal Assistance fantastic and then the gender specialist clinical team of the Central Coast that is the trans therapist team that was referred to in the introduction that you couldn't hear and it was Shane Hill who started that group and today and actually he wrote this thing 10 things we can do to support our children who are questioning their gender please get this it's at the table for the gender specialist clinical team and today we have the great honor of honoring Shane Hill who has done so much in our community it's because of him that we are kind of a jewel in really in the United States and in the world in terms of collaboration between mental health providers and come on you guys that's your cue okay guys my name is Heidi and I am the mom yeah I'm a little short you're just right I'm the mom of Jordan who's a 17 year old trans guy I am here to honor Shane Hill for all the work he has done in the transgender community Shane started the trans family support group about six years ago when he saw the need for the parents of transgender kids to have support amongst other parents so in return they could support their transgender or questioning kids Shane continues to support speak and give advice to our group since Shane started the group it has served over 120 families and has had two groups grow from it that serve in the Bay Area as for me personally I am forever grateful for all the work Shane has done with my family and me for all Shane and I have been through and all we will continue to go through I will always call him my friend hi my name is Jordan Korenkowski I'm the 17 year old trans guy son of Heidi Korenkowski um I've been with Shane since I was 11 um and he has opened my eyes to so many different things in life and he is just my whole confidence and self esteem skyrocketed ever since he has been helping me with everything um he has helped me understand my gender and who I am and who I am as a person he has helped me become way more confident for who I am and the trans family support group he has just been such a big part in our family and having our family be more open and me and my mom are closer to each other and we talk about just our problems and we can you know discuss things and um I wouldn't be the trans guy I am today if it wasn't for Shane he is a big part of our family and I hope to have him in my life a bit more so hi I'm Daniel Blumrozen I'm a local emergent family therapist and a trans guy and a gender therapist it's my pleasure to honor my friend and colleague Shane Hill we've known each other for many many years and um when we thought about all the different areas he's impacted the trans community we realized we needed a herd of people to do that because he's really done so many things for so many people so um I'm here to thank him on behalf of the gender specialist clinical team of the Central Coast the Santa Cruz trans family support group Planned Parenthood Marmonte Westside Health Center and the Johnny Natterney-Calciano Memorial Youth Symposium Advisory Committee we wish to thank him for and commemorate his extraordinary service with a redwood tree planted in his honor on the Central Coast may his efforts continue to grow in positive ways for years to come please join me in giving Shane Hill thank you and another round of applause well good afternoon my name is John Leopold of County Supervisor and when I walked in here and I saw that uh Jen Hastings was giving a presentation I thought oh my goodness I have to follow Jen Hastings at an event like this and then just hearing this powerful testimony uh before me I realized that I have a much harder job than what they originally asked me 20 years ago I had the good fortune of being the executive director of the Santa Cruz project and Dr. Shane Hill was hired as part of the AIDS project and was a core member of of that staff that per as a single purpose aid service provider in Santa Cruz County provided incredible resources to the community so it is a great pleasure today that as a county supervisor that I can recognize Shane's work and I'm not sure if everybody knows all the history of Shane and I'll only say the parts that I'm allowed to there's probably things that I'm not allowed to talk about but Shane has done many things over the year he found he was a founder of the queer camp in 2002 which worked to ensure community safety for transgender and queer individuals uh in 2006 he assisted in the founding of what is now known as the gender specialist clinical team as you just heard of Central Coast and he's been a facilitator there for the past decade um he was one of the primary authors of the nationally recognized UCSF Children Child and Adolescent Gender Center Youth Assessment Protocol and created that pamphlet that Jen just talked about about the 10 things we can do for people supporting gender questioning children and youth so it's a great pleasure for me to have a proclamation honoring the outstanding contributions of Dr. Shane Hill through his work on behalf of the transgender and queer communities for the past 20 years and I won't read the whole thing here but I just want to capture a few of these um whereas Dr. Shane Hill has created a vibrant inclusive diverse community of support for transgender and queer individuals and their families and whereas Dr. Hill has immeasurably increased our community's awareness and appreciation for transgender and queer individuals and their families through the founding of the Trans Family Support Group of Santa Cruz County and whereas Dr. Hill has unstintedly provided countless hours of consultation education and training to professionals and lay people in diverse settings to ensure informed quality care for transgender and queer individuals and their families and whereas Dr. Hill has done this all with joy, generosity, expertise and steadfast commitment now therefore I, John Leopold first district supervisor of Santa Cruz County on behalf of the entire Board of Supervisors hereby thank, honor and commend Dr. Shane Hill for his two decades of exceptional work on behalf of communities of Santa Cruz County thank you for your work Shane oh my goodness oh my goodness it's a lot it's a lot of acknowledgement you guys um so right now I'm incredibly grateful I can't believe you guys did this so I did have a little bird told me this was happening about a week ago so I do have a speech plan that's going to be about about 35 minutes long but I'll pare it down to about three minutes so um I am just so grateful because this work means so much to me in my clinical practice you know we all have those of you who are therapists have numerous specialty areas but this specialty area has been the most heart-opening that I've of all of them I have transformed more as a person in all of my work and um I really can't tell you in words how important this means to me that you are all here today and I'm so proud of us in Santa Cruz that we have 450 people here learning about trans issues this is incredible yeah and this work um even though it's true that I do truly enjoy it and have a lot of joy it's not always easy this is a still a controversial edgy area to be involved in the gender affirmative model which Diane has brought to us in such large ways we've always done that with our team here and it has not always been very easy so I'm hoping that um you here in this room will have a level of commitment after hearing all this information and will help all of us continue this to do what I always say whenever I do a training which is I'm really hoping that you all will join us in our commitment to make sure that our community is safe for trans people to live their lives without fear so that is the number one thing I'm hoping that you remember from this and that you you come along on this journey and before I leave I have to acknowledge a few people so um first and foremost I have to acknowledge Dr. Jennifer Hastings who in fact you can come over here Jen because truly what's happened is that Jen has held the medical piece and I for we're both together for over a decade now have the medical piece and the mental health piece and we've been this kind of sort of dynamic duo in Santa Cruz for trans issues doing our best to really expand the a number of medical providers and mental health providers that work with trans people in an appropriate sensitive aware way in order to educate as many people as possible so we're continuing to do this and one of the things that my part of this was to do is to create a team of people and so we started off with eight people ten years ago ten years ago by the way this very month and now we have 32 members on our team so it's very exciting and so I want to acknowledge them and first of all I want to acknowledge the four people that have now recently joined to be a leadership team for us and so I'm going to ask all of you guys to stand up and I want you to stay standing so that everyone in the room gets to see all of you together so I'd like to ask these people to stand as our leadership team so Finn Gratton wherever you are Finn please stand up Marin Martin please stand up Marin Martin Finn Galhuffa please stand Ben and of course Daniel Blumrozen who's right here so let's just have a applause for all of them so please continue to stand and I just want to just say everyone's name that's on the team and they may or may not be here but if you are here obviously stand up so Connie Batten Melissa Bernstein Sally Blumenthal McGannon Victoria Campbell Eileen Cavalier Jin Cheney Kathy Citron Misha Uvaldi Kathy Famey Jennifer Hastings Chris Hoagland I know Chris is here Beth Hyde I know you're here Beth Cleo Calojiva Lane Lease there's a lot of us Carmen Martin Suzanne Nicholas Kristen Oliphson Anna Paganelli Andrew Perchin Marty Riggs Jan Solenbrotherton John Seltzer Sean Smith Claire Tooth Lidavala Judy Van Mazdom and our newest member Colin Dietz so these are all the gender specials in our community please let's give a hand to these people thank you all so very much it means so much to me so the next part of our program is a panel and I'll just move my last slide so there's my email if you want it we're really lucky to have Freddie Weinstein from the Dominican Hospital Dignity be our moderator with all those questions you passed in so he's been studying them and gathering and Bunny if you can come up and join us with Joel and Diana and Freddie will take it away and I see more questions here welcome to the home stretch so I'd like to once again invite back our scheduled speakers Diane and Jennifer and Joel and then we have Heidi and Jordan who have you met already and then I also like to invite us to the stage of Bunny Hogan so as questions come up during the panel presentation please just drop them here at the basket and we'll look to get to them as we go through our panel here is everybody's mics working do these work? we're good to go so since we've already heard quite a bit from Diane and Joel and Jennifer this morning already I'd like to maybe begin the panel by allowing some of our newer members to as much as they're comfortable share their story and sort of thoughts and maybe about today and about their own personal experiences and perhaps maybe begin with Heidi thank you I said earlier my name is Heidi and I'm the facilitator for the trans family support group my son Jordan is our third child I was my second marriage with my husband Ron and so I have a child he has a child and then we decided we needed another child to bond the family and we got Jordan when Jordan was by the way when I named Jordan when I was told I was having a girl I named Jordan Jordan so when Jordan was about 2 it became very clear to me that Jordan liked toy things you know, trucks video games, violence things like that and between 2 and 4 I noticed that he would rip off the pretty little dress as I put on him would go screaming through the house and not leave the house unless he had on his brother's big holy t-shirts and I just thought he was a tomboy my husband thought he was a tomboy we thought it's a phase and it was driving me nuts but it was a phase at the time during this time I worked for a very large church here in Santa Cruz County and yes my husband and I and my entire family were Christians and so with that being said we were told by everyone around us it's just phase just phase, make that kid wear a dress okay if you have a transgender child avoid you cannot make them wear a dress let me just tell you so at about the age of 7 we were having a lot of problems with Jordan we took him to a psychiatrist at the time it was called gender identity disorder it's now not, it's changed but they diagnosed him with that and along with about 6 other diagnoses ADD, bipolar, mood disorder depression, anxiety it was a whole slather of stuff so what the psychiatrist told us to do at that time was to focus on everything else because those are the things that's kind of like what Jen was talking about we needed to focus on those we needed to get the anxiety down we needed to get the depression down and in actuality it was the trans part that was causing a majority of this stuff so from about the age of 7 to 11 throughout his elementary school years they were hell for him he would tell me God made me a boy why did he make a mistake where's my penis and we always said no you're a girl God made you a girl so how confusing for this child that you know we're his parents and telling him that God did not make a mistake and that he's a girl so I was you know getting posters of real strong women like you know the singer Pink like oh this is a real kick ass girl you could be like her when he had a crush on her so it was things like that you know so Jordan obviously had been very depressed about the age of 11 every night times were very difficult it is true that night times are very difficult for our trans kids because they do get quiet and they do get with themselves and I would always have to lay down with Jordan to try to get him to sleep it would take about a 2 to 3 hour process and it would be where he would cry God made a mistake I hate myself I don't want to live now for a parent to hear this every single night is devastating what am I doing what can I do more I constantly worried about this child I was afraid that when I came home the worst I was going to find the worst so at about 11 I laid down with him one night and he said to me um instead of the usual I hate myself I want to die it was he was saying goodbye to me sorry that's still hard he was telling me that he couldn't do this anymore once I got him to sleep I went to my husband and I said we have to make a choice we can hospitalize him we can bury him in 6 months or we can allow this kid to transition that was a no brainer we allowed him to transition now because I'm a very organized type of personality I wanted this transition to go buy the books okay when we sat down and showed Jordan our Walter special he said oh my god oh my god that's me we said okay we're going to let you transition now I thought I had a good few days to get my organization and attack no the next day I was getting phone calls from all his friends parents saying what's going on Jordan says he's taking medicine and become a boy and I'm like holy shit okay I can do this so we had to get on board really fast with it and you know what I'm so grateful he led the way this kid the strongest individual that I know of I have learned so much from him I cannot tell you since we transitioned we've done the hormones we've done the top surgery Jordan has just grown into this amazing amazing human being do we still have issues? yes he's a 17 year old boy who drives me nuts okay and wants his way and thinks my way is old and you know old fashion but he's just an amazing kid will he always have issues with trans and that's his journey but I am here to support him 100% I just want to end real quick we did leave the church because I realized that first and foremost was the support of my child unconditionally and I just want to say this is on a personal note here I am still a Christian this I still believe in my God my God loves my child with all his heart well thank you very very much for that Jordan can we hear maybe a little bit about your story and if you also had some thoughts about this morning speakers and presentations that you wanted to share as well I think when I was younger I used to tell my mom that I want to be a boy or I wish I was a boy because again she would always tell me no you're a girl you're a girl so it's like okay I can't really get through that and telling I am I'm just gonna have to get used to just saying I wish right like want to be and then I do kind of remember I don't remember doing I remember my mom telling me it was Easter we were supposed to go to church and have a nice like service and so my mom put me in a dress walked in the other room and while she left the room she could hear me screaming literally tearing it off so then I just went to church and like dirty blue jeans and a really big t-shirt that was kind of a big signal but when I first transitioned I was really self-conscious of who I was I was really scared of the comments I'd get the type of you know behavior people would have around me how I'd be treated like at schools and stuff like that and you know the six year process of me going on Lupron having testosterone having the top surgery I look back on my 11 year old self and I say who is that how have I become such a much more confident and independent young man and it's just incredible to look at all the support and all the people around me find that I'm actually happy for once in my life as who I am and having you know waking up in the morning not thinking of like man I wish I had a penis or whatever I'm waking up and saying you know what I'm gonna have a good day today I look good I'm gonna shower I'm gonna do my hair I'm gonna put some cologne on I'm gonna go have fun somewhere I can finally have that confidence in myself and not keep thinking of the negatives and yeah thank you very much so Bunny would you mind sharing a little bit of your story I'm 16 my name is Bunny and I'm a gender I use they them pronouns and I'm a junior in high school okay that's me so my story isn't that interesting I mean I was always like trans I was never a cis boy that never happened sorry mom I was always I'm assigned male at birth I was always very like feminine I was like feminine stuff I wish that that went to my fashion sense because all I wore for like 15 years of my life was gym shorts and gym clothes rip rip in peace anyway and so yeah I was just like a feminine boy at the time but then and I would have been non-binary a lot faster let me tell you if I knew that existed like all I was told was this stigmatized version of a trans girl is like my only other option and that it would mean so many bad things to be like a trans woman and they made it sound disgusting and stigmatized and it's like something you don't want to be like taboo and of course no that's not true at all but like that's all I thought existed but then when I was like in eighth grade freshman year something along those lines I figured out what non-binary was and I knew automatically that I fell under that term way more than cis like I'm agender I know that like that's 100% I've always been agender I just didn't know that it existed and so like that's me other than that like my opinions on the panel discussions and everything that happened today just things that I want to like clarify as a trans teenager who goes through being trans every day and the things I deal with cis people and how they react to me and what they say to me just things to tell you guys not to do etc. One a really big thing I wanted to cover is that I am mentally ill I have depression and anxiety and there's this really big stigma against trans people with mental illnesses and it's like really disgusting honestly because I'm not a demon or a monster because trans people are mentally ill because of the things that cis people put them through and it's just cis people then think that it's like the trans person's fault and it's like no no sweetie and just like neurodivergence and being trans most of the trans people I know are neurodivergent and they're some of the nicest people I've ever met like there's someone I know named Odie and they have got to be hands down the nicest person I've ever met like I love them to death and like all of these people the things that you you associate with them just because they're not neurotypical and they're not cis it's like it's just weirdly specific and other than that I don't think it's been completely established today I mean it's been alluded to but I just want to say flat out you don't need dysphoria to be trans you don't need to send gender dysphoria because overall I just want to say that trans people deserve a safe place to live thank you so part of my job is to go through these questions and it seems everybody wants to know about bathrooms it was the number one topic what do we do about bathrooms how do we share the bathrooms I think that was touched upon earlier but there was a variation on that that I thought maybe an interesting scenario that perhaps Bunny, Jordan and Joel can talk about is what about overnight trips overnight school sponsored events where there's cabins involved and they're assigned by gender do either Jordan or Bunny have a personal experience with that Joel how do you see how schools have handled that Jordan looks like you want to go first yeah I went to a Christian camp called Camp Hammer when I was in 4th grade around the time that I was definitely figuring out that that was around the time I was like 11 and I went to the camp identifying as female and dressing as in female clothes and put into a girl's cabin only because I told him he was a girl yeah and I mean you know I didn't want to be in the girl's cabin at all but it it is what it is at that point but I felt very singled out I felt really weird and awkward talking with the girls they talk about this boy that they saw at the swimming pool over here today and talking about his eyes and his eyelashes and I'm just there like can we talk about maybe like video games or sports game that was on last weekend I don't really want to talk about that stuff and it was also kind of hard to find guy friends there because they see a girl go up to talk to them and they just automatically think they were flirting with them no it's not like that no it's weird and they I stopped really going to I left early because I didn't like it at all but I went to a camp for trans kids called Camp Araneutic and that definitely was an eye-opener because I didn't really think that there were other trans kids out there I thought there was the only one in the world who was trans and who had this stuff going on but when I went there there were so many kids there that looked and were just normal people and when I got there I was greeted by this one kid and he said well let's just go walk around and go talk and we met up with a bunch of other kids and we automatically had best friends at camp and yeah that's my experience thank you Bunny did you have any thoughts or experiences yourself? okay so for me bathrooms I have never liked public bathrooms I never will they're gross and so like like even when I was a cis boy I just like which I never was I don't know when people thought I was a cis boy I just like didn't even use public bathrooms there goes who wants to go in there I don't have the time or the patience so I just don't really have any experience with them but like when I do need to use the bathroom I just use the girls bathroom because I'm less likely to be beat up people see like pink and skirts and even though it's not my fault that the only cute clothes they make are like girl coded like that's not my fault I'm sorry anyway so I'm less likely to be like attacked if I go in a girls bathroom so that's basically all I have there thank you and Joel how schools handled that? this is certainly a loaded issue one of the things that we try to work with schools around is this notion of access to restrooms locker rooms and changing areas and while there's variations with each of those there's some basic principles that apply and the first is that there needs to be options for all and restrictions for none what that means is that we need to make non-stigmatized options available for anyone that needs it so let me back up a little what frequently gets said for kids like Jordan or Bunny or someone who identifies as transgender in some ways why can't they just use fill it in the nurses restroom the staff restroom some restroom out there for them well if you think about the history of our country we've had bathrooms for other people for a lot of times and they didn't work and they never have and at the heart of many civil rights battles have been restrooms for a lot of transgender people options are not options at all especially if they're actually not option it's the only choice you can't call it an option but there are a lot of reasons why an optional restroom is needed right beyond gender there could be cultural reasons modesty reasons individuals that have assistance with toileting individuals that are simply shy individuals that are dealing with gender stuff and want more privacy we need to create these non-stigmatized options for anyone that needs it because then let's go to the other side which is when we have our amazing youth who happen to be trans using restrooms when I do these presentations I'll often have people say okay I get all that but what about bathrooms because I mean really trans people in bathrooms because you know and I'm like no I don't what do you mean you know I mean just I'm like no no like remember the movie Philadelphia Denzel Washington said I want you to explain it to me like I'm five years old tell me what the scenarios are that you envision because you go to apparently way more interesting bathrooms than I've ever been and they'll play out every one of these scenarios and you can imagine and I won't get into all the details but what they end up talking about are things like you know what if the transgender child is gonna you know flash their body or make other people uncomfortable with their bodies well we have rules for that from anybody what if they you know are feeling you know other people are gonna make them unsafe well again we have rules you need to feel safe in the restroom and everyone actually has some questions about restroom every single scenario that comes up is about one of three things it's about what I call CBS it's about climate behaviors and supervision what it's not about is genitalia and what ends up actually happening in most scenarios related to restrooms is that some people are just not comfortable with the idea of a transgender person being in there you know if you're a bigot or whatever your issue is well then you need an option see options for all and restrictions for none because the fact is it's not about what's in someone's past as we talked about earlier you know someone going to the restroom Jordan didn't want to be in the boys cabin because he wanted to be with all these penis bearing people and look I mean it was because he was a dude and he should be with the other dudes it wasn't about sex it wasn't about any of the scenarios that often get played out so again I think this is such a difficult topic because it lends itself to soundbites come on we can't let girls or boys in the girls restroom and then we have all these predatory scenarios when in fact we need to be able to say hold on no help me understand have a rational conversation with me about the concerns and we can go point by point by point and we have a lot of problems in restrooms but the genitalia of the people in them isn't it the only folks that are potentially not safe in those restrooms are our trans and gender expansive youth no one else and that's what we have to help people understand and again if you don't like it go use the nurses restroom so Diane there are a couple of questions came up around the interface between gender identification and sexual identification and how one might sort of play off the other whereas gender identification predates sexual identification and thoughts are sort of the interface between the two so one of the things I will say is typically all of us were in touch with our gender before we were in touch with our sexual identities however sexual identities start much much earlier than the general theories tell us because for example when you have a three year old who is imagining they're going to be the prince marrying the princess sexual identity is beginning it's already beginning way early on but usually we know our gender first we can learn as I talked about with the proto-trans gender kids sometimes you learn about your gender through sexual encounter and sometimes you learn about your sexual identity through your gender encounter so I will tell a personal story that made help in terms of answering this I am the mother of an orange when my child was between one and two I would not be able to differentiate yet my child from one of the apples because I had a child who liked all his sister's stuff but particularly her costume stole her tories and I will just say one story I was a feminist mother my daughter first we wanted to raise our children gender neutral around activities so when I had worked in the area of daycare I knew you don't have a doll corner and a truck corner you mix it all up you just have tories shelves made that for my daughter very carefully the trucks gathered dust for almost four years the week her little brother was born I see her madly rushing from her bedroom and she's got things under her shirt and I said Rebecca where are you going what are you doing out fell all these trucks and boy toys she said well I don't play with them maybe he will so they all ended up in his room the only thing he ever used any of them for was he turned the dump truck into a cradle for one of his dolls that was it so he I followed his gender development in the 1970s he was a boy in a tutu and of course people would always say to us don't you think you should stop that or were really worried about him or I think he's going to be gay and we would say look we don't know who he's going to be but we're trying to help him be who he is now so the end of the story is he grew up to be a gay man he is one of the proto gay kids he was an orange and if you saw him now you would not recognize him at all as the little boy with the tutu and I will say that I've worked with many kids who explored their gender on the way to discovering their sexual identity who later when they're in high school and they come back to me they repress their earlier lives they don't even remember it and one of the theories about this is because of the culture that we live in there are so few examples of books for little kids where the prince can fall in love with the prince therefore cognitively when you're little and you are a cis boy and you like the prince you get the idea the only way to do that is to become the princess so I will be a princess then you get a little older and your cognition changes and you go oh my god I don't have to be the princess who has the prince and so they evolve into understanding their sexual identities so that's one trope and as I mentioned many kids through exploring their sexual connections with other people actually get their gender in focus through those experiences so crisscross is all along the way but what we must remember there's two separate tracks three different combination of all different sexualities and all different genders so therefore it's as complex as any of the scribbles just around gender because people assume that a boy in a 2-2 is gay he's not, he's a boy in a 2-2 we'll find out later who he is so end of story is my son is now 39 years old so I decided to finally ask him the question so if you were born if you were 5 years old in 2015 instead of in the early 1980s do you think your path would have been different and do you think you might have followed a transgender path because as you were saying you didn't even know about something until you learned that it existed so if you had known that it existed then do you think it would have been different outcome not missing a beat he said absolutely not it would have been exactly the same so I think our apples know their apples our oranges know their oranges and that we have to accept it's a messy world out there around gender and sexual development thank you anyone else want to comment on the interface between the gender and sexual identification good number of questions around puberty blockers couple sort of categories one had to do with the issue of consent and capacity and if there was a scenario where the minor wanted them and then the adult would not give consent and then also on that same topic Jennifer if you want to cover it also issues with insurance coverage and parity is there any movement out there towards that so for the first one absolutely this is a really challenging area where the parents do not come around don't get it about how the puberty blocker could potentially help their child and we do need the parents consent I don't know if you've had cases at the center where that's come up but it's certainly I've had a few cases eventually kind of over time I feel like we've done a good job in helping the parents understand and eventually gotten to the point of consent I used to feel more we still feel this sort of pressure that puberty is happening and the tests are developing the testicles are enlarging so there is that sort of tension with the importance of getting the puberty blocker sooner that said even without the puberty blocker kids will do well just with a cross hormone if they're puberty blocker they couldn't get the puberty blocker so I think it's especially for parent access financially I would always talk to parents about your child will be okay even if they don't that was when parents couldn't afford it wasn't the fact that the parent wouldn't consent but I think it's tricky because parental education is crucial and yeah, I'm not sure what the person meant by parity maybe someone else we're just really struggling to get insurance companies to get it because of the law at least in the state of California sometimes we run into insurance companies that are based in other states and they do not have that law so that's the reason we struggle so much as well and I would just add a couple of things to that one of the difficulties around consent is post divorce families where one parent is on board and the other parent isn't but they have mutual decision making around medical care and some of those cases have ended up in court and the other issue that's a showstopper now for many parents around giving consent to puberty blockers is the fertility issue that if the child goes straight from puberty blockers directly to cross sex hormones they at this point in history are pretty much forfeiting their fertility and so they will not have a genetically related child and there's a lot of parents who have dreams of becoming grandparents and it's very hard for them to not imagine those genetically related grandchildren and so we have to work with parents about these aren't your dreams we have to focus on your child's dreams and what they want and what I will say about many of the youth who want puberty blockers I have never met such an altruistic group of kids about adoption ever I will adopt because I think there's so many children who need good homes and I think that's both heartfelt but also it's they're trying to tell us the most important thing to me right now is being able to have every opportunity to have my gender affirmation be as complete as possible and anything else is secondary the question is kind of 11 year old, 12 year old at that level of development be really thinking and know what they want at age 30 around their fertility so the answer to that is we don't stop twice about instituting treatments for cancers for children that will compromise their fertility same treatments in some way whatever it is we don't say we're not going to give them the treatment for cancer because it's going to compromise their fertility that for some for other youth having the gender affirmation interventions are as life saving as the oncology services for children who are cancer and I'll just add one other piece which is you know when we're working with families one of the key things is what is the leverage point for that family and that begins with tell me why you don't want your child to do this because in hearing the answer to that or help you understand that a little bit more fully the answer might change and I just why I appreciate Heidi the work you're doing and any of those out there that are working with families so that not only are you supporting those families but they're then willing to tell their stories to another family who maybe isn't quite there so let me not try to convince you would you be willing to talk to another dad who has a child your age who has a similar background would you be willing to at least talk to him to hear his perspective on the very same questions you're asking yourself because the fact of the matter is at the end of the day it is the parent's call our hope is that they will truly make an informed decision and I feel like one of our roles is to say just make sure you have all the information as you make that decision which includes you can either have grandchildren or not have a kid anymore either because they've ended the relationship with you in some cases because they've chosen a more dangerous path for themselves and again we can't kill families into it but they need to have the information and then you've got to look yourself in the mirror and make the decision you're going to make about these issues thank you a couple of the educators in our audience had questions related to incorporating the diverse transgender issue into reproductive health curriculum sex education within the classroom be interesting to hear maybe from Jordan and Bunny as students and so Joel as kind of the educator sort of thoughts, experiences how did you see it done in your schools basically sex ed and incorporating or do they incorporate any transgender transgender issues at all within the sex ed program yes the school on currently enrolling in Delta sex ed program it covers all of what California requires the class is also about different kind of sexualities how people can different kinds of the whole list of genders and it didn't really talk about how trans people have sex but it went over orientation healthy relationships and in every lesson and talk and discussion project we did all kind of incorporated LGBTQ community within it and so everyone had an idea of what was going on and so Bunny you're in the middle of it right now so my experience with sex ed is like in fifth grade of course all we learned about was sex ed relationships and then there was none in middle school but then freshman year and that's all so far really they like a trans senior came in to our health classroom and talked about their experiences but it wasn't really sex ed at all actually but that's like the only and then like recently like life science and stuff as you go on in high school for my school all we learn about is sperm and eggs like nothing we don't learn about like any trans ways of having sex and also sorry that this is unrelated but I forgot to say it in my next section there's a really big stigma against trans people that they want to be cis and some like do but not all trans people live their lives to pass on cis trans people can embrace their transness thank you I'm really excited Jordan to hear your experience because unfortunately that's not totally common although a couple things folks should be aware of just this year a bill was passed now requiring puberty education to bring LGBT and particularly gender identity issues into the mix talk to your directors of instruction and people personnel about some of those issues because no longer in California is it a choice I also want to do a shout out to an organization called advocates for you which put together an incredible very LGBT particularly gender inclusive sex ed curriculum and sexual health curriculum what we found are sort of four key ideas that should inform any sex ed or puberty ed the first is the idea that rather than talking about little boys grow up to be like their daddies and little girls grow up to be like their mommies is to talk about our pathways to adult bodies get it out of the boy girl thing and instead talk about unique pathways to adult bodies that everyone in the room is on because of course we all break change at different rates some of us have help from doctors some of us don't some of us have changes starting happening when we don't want them to wait and they haven't happened one is the principle of it's not about boys becoming men and girls becoming women it's about young people becoming adults and finding their adult bodies the second is to talk about pathways to family because again it's not just sperm and egg and that's how babies get made half the kids in the class are like really that's not my story because I've adopted I was an egg donor I was this it's about pathways to family is another really important frame that universalizes the experience of everyone in the room because you know I used to teach sex ed and my cisgendered kids need to know what they need to know it's not as if that experience is invalid it just isn't the only so again pathways to family is another part a third part is simply getting away and we joked about it from the gendered language boy bodies and girl bodies no bodies with volvas bodies that produce eggs sometimes bodies that produce sperm sometimes these bodies do these things bodies with these parts change in these ways are designed to do these things and then the last is we can't forget to talk about that hormones are in the mix and you will have an adult hormonal experience of some kind most of you will have bodies that produce hormones but not everyone some of you will need additional hormones to help your health some of you will need additional hormones to help your gender some of you will need to have children but you will have an adult hormonal experience so those four principles I don't care what the curriculum is quite honestly those principles need to inform the instruction and create space for everyone I just want to tell a very quick anecdote about a trans kid who I know who didn't go to a school that had that kind of puberty education but her comment was because her parents were really worried aren't you going to feel this because she was very affirmed and knew what her path was going to be she said no it's great because what I do is I just sit back I know none of what they're talking about is going to happen to me and I just laugh at everybody so other kind of topic had sort of come up about challenging home environments specifically for cultural ethnic and religious issues thoughts, resources for those type of situations and that could be to anybody or high dance sounds like you might have had some personal experience with that maybe you can kind of kick it off sure I I have like I said I was raised Southern Baptist and my grandfather was a minister and you know he was not happy because I have probably 10 gay cousins and I mean our family is pretty vast and so for me although I was very open to the LGBT community I still had a lot of pressure about what the organized religion was telling me what the Bible said about my family and especially my son and so I will just say that it took me from me, Jerome was diagnosed at 7 to age 11 unfortunately to get away from that it took me those years to clue in that no I need to not listen to this organized religion I need to listen to my heart and what I say to parents when they do come to see me that are religious and that is their concern it's your relationship with your God is between you and your God and there's no other middle person that needs to be a part of it and I say I know that I'm going to heaven that's my belief and so is my son and so is everybody else in this room and so our group is not religious at all but when people want to talk to me about the religion I just say the best that I can do is give you an example and I will say this it's men that have the hard time okay it's the dads that really struggle and what I find so interesting and kind of comical is that I'll say to a dad if I'm talking to him on the phone or in person hey have you met my husband Ron he likes to drink beer and watch hockey and before you know it they are bonding and pretty soon after that the acceptance of their child goes pretty quick and we've seen that a handful of times in the group so I think that for the cultural for the men is they just need to see other dads that it's okay these dads accept their kids and then for religious part of it I think it's your own journey and you just have to kind of like I say just use this as an example and you really have to come to your own you know your own belief system but I do want to say this real quick once we transition Jordan when I say transition Jordan he was transition when he was two but once we allowed it we did get the phone calls of you're a sinner you're going to hell we will not allow your child to play with our children anymore that was very difficult but I came out of that is this that if I truly am listening to the teachings of what I believe in which are love how is that love and so that's what I just try to say whatever religion you're in basically those teachings are love and acceptance no matter what religion really you're a part of and so if your child are you loving and accepting your child according to those teachings and that's what I think it's all about thank you Diane and I wanted to just piggyback on what Heidi said and Joe made reference to cognitive dissonance is a really good thing for us to shake us up and in my work with families I always use the cognitive dissonance model when the beliefs are not in concordance with what a child is telling me about their gender so and it goes like this somebody and you start where people are at and you have these balancing scale on the one hand my belief system says that it's a sinful thing to be anything but cisgender and straight that's what I've learned in my belief system on the other hand I have a child who showed up who I started loving the day they were born who is now telling me either that they're transgender or they're gay whatever it might be I have a conflict here my beliefs are in conflict with my love for my child so I will hope that love will conquer all and that it is a love for your child that will pull you along around taking a look at those belief systems and challenging them because your child is teaching you something else and I will say very optimistically that given time and listening and dialogue it works and so I encourage everybody to think of that balancing model and there is one thing I will add how I tip the scales I will say look I have to also step in as an expert here it's my job to let you know just some of the risk factors if you stay with this dance the risk factors I'm not saying it will happen to your child but the risk factors are for anxiety, depression self harm, trauma suicidality and to that for their child and when they put that on the scales it also affects the balancing act and I just want to finish with one thing I am a parent but I'm also a provider and I'm constantly being accused of being a sinner I get emails all the time and that I don't follow Christian values by the work I do and the only thing I can say about that is I'm Jewish I'll just add a couple other thoughts here because I think there's a real tragedy when families feel like it's a matter of choosing their faith or their child and that there's sometimes again this false dichotomy look at that there we are again of it's one or the other I think sometimes pointing out it's not a conflict in faith but it might be a conflict with your faith institution and there might be a different institution consistent with your faith that will give you a slightly different message I also want to share there's a great resource and I'm probably getting the name wrong but I think it's called transitioning to inclusion a guide to trans inclusive religious institutions or something like that it's from the pacific school of religion and it's a great resource to provide with your faith based leaders to talk about different ways that churches and other religious institutions can become more inclusive in particular of trans experiences but also generally more gender inclusive and broad and I do think the last thing is our kids as they navigate their worlds they are seeking congruence they're seeking to try to get their internal sense of self aligned with their external as well as the world around them and there are times when they may be in context in which in congruence between your family's religious beliefs and your gender may be a stretch that they may not be able to make it may not happen what are then other ways that we can build your resilience and you need to maybe meet your parents where they are to the extent you can or also just simply you know avoid that area of conflict but to echo what Diane said there's really clear research about the negative impact of religious based condemnation on a young person's health and well-being and again parent make an informed decision so those are some ideas Jennifer? I want to add that in Santa Cruz we have Out In Our Faith which has 25 congregations, Buddhist, Jewish Catholic I pull the list up here Out In Our Faith is a local resource I also want to just slightly different tangent I really want to do a shout out to big brothers big sisters of Santa Cruz County we're just I'm going to say we because we get to be part of them are doing a new trans and gender diverse mentoring program so that's another resource for the first in the country to do something like this Excellent Well in the last few minutes left I just want to sort of extend a special thanks to Heidi and Jordan and Bunny for coming here and sharing their story and to our best of our panel members for their job and making a year 18 a success I think 450 is our biggest other than methamphetamine I think methamphetamine caught up with you guys so meth kills so please the cards you have suggestions for next year comments on this year are very very important the committee uses that to really come up with ideas for future topics and changing the schedule and such those that need to sign out don't forget to do a special thanks to the members of our committee who work all year long to doing this another special shout out to George there he goes you've heard his name oh please bunny I'm sorry I just want to say rest in power to Leela Alcorn Maya Young Veronica Cobb and every other trans person who died because the world wasn't ready for them alright well we'll see you next year thank you very very much for attending