 Thank you so much for joining us today. This is our second webinar in the transgender health series, and today our focus is on gender identity and inclusivity. The series kicked off last week, March 31, and it just happened to be on International Day of Transgender Visibility. We heard from Dr. Cheryl Holder and Daria Lester and they spoke about the intersectionality in health disparities, specifically for black transgender women. So today is April 5, 2021, and we are joined by Dr. Lee Pham and Dr. Allison Tao, and they're going to share their experiences with gender identity, inclusivity, and how they make up and how they are affected by the social determinants of health. So this session is being recorded. We will email that to the email addresses that you provided when you registered. We are using Zoom's transcription feature, and for those that are interested, you will receive one hour of CE credit from the Medical Library Association today. So Rebecca is, oh, she just posted in the chat. So she's going to post the link at the end of the session. You can fill out the evaluation and receive that code. I'm going to share my screen. So I'm Nora, Nora Franco. I'm the Consumer Health Librarian. She, her AI, and I am here at the NNLM Pacific Southwest Region at the UCLA Biomedical Library. Hi, my name is April Wright, and I am the, within an LM also, and I'm at the University of Maryland Baltimore. And I'm she, her. Thank you. And you can see my screen right with the slides. Yep. All right. Okay. So before we begin, I wanted to start us out with our land acknowledgement. We are all working from home again, but the NNLM PSR at the UCLA Biomedical Library acknowledges our presence on the traditional ancestral and unseated territory of the Gabrielino Tongva communities. So, well, I'm going to have April, you're going to monitor the chat for me. So just let me know if there's anything. So, we do love our acronyms. I wanted to break these down for those that may not be as familiar with the NNLM. At the top we have the National Institutes of Health, which is the US leading medical research agency. It's made up of 27 different institutes and centers. And the National Library of Medicine, which is the world's largest biomedical library is one of those 27 different institutes and centers. So the NNLM or the network of the National Library of Medicine is where I work and where April works as well. And we are the outreach extension of the NLM. So we're made up of eight different regions and here in the Pacific Southwest. We serve these different states and territories. April in Baltimore, they serve that end of the East Coast part of the East Coast. Here's our mission. I'll go ahead and read that. The mission of the network of the National Library of Medicine is to advance the progress of medicine and improve the public health by providing all US health professionals with equal access to biomedical information and improving the public's access to information to enable them to make informed decisions about their health. The program is coordinated by the National Library of Medicine and carried out through a nationwide network of academic health sciences libraries, hospital pharmaceutical and other special biomedical libraries, public libraries, information centers and community based organizations. You can sign up as individual members as well. You navigate to the page in NLM dot gov slash user slash join and hit the create an account button, and you'll be signed up for our email list you'll we won't spam you we're only going to send you emails about different courses different webinars such as the one that you're on today. All right, I'm going to introduce our first speaker Dr. Lee them. Dr. Lee fam MD is non binary and their pronouns are they them theirs. Dr. Fam received an undergraduate degree in healthcare administration at Washington University in St. Louis, and a master's degree in medical sciences at Boston University before attending medical school at the University of Texas in San Antonio. They were a chief resident of the internal medicine, medicine residency at Louisiana State University in Shreveport before moving to LA. Their main interests include global health and reducing health disparities, especially in the LGBTQ plus community. Along with general internal medicine, Dr. Fam specific areas of focus are in LGBTQ plus health care, gender affirming care which includes hormone therapy and HIV care and prevention. They are a credentialed HIV specialist from the American Academy of HIV medicine. And Dr. Ali the Allison town. She her serves as the regional lead for nuclear medicine in Kaiser Permanente South California and as a faculty member for the KP Bernard J Tyson School of Medicine. She graduated from University of Michigan Medical School and completed her nuclear medicine residency at Stanford University School of Medicine. In addition to her clinical and administrative duties. Dr. Tao devotes her time to training education and advocacy for equitable transgender health care, both within and outside of KP. She helped found the multidisciplinary pediatric gender care clinic at KP San Bernardino County. Dr. Tao also helps facilitate a trans team support group and is active in her local P flag chapter. She lives with her wife of now 23 years and three sons in Newport Beach and enjoys playing double bass and feasting on exquisite sushi. So I'm going to go back and, and have Dr. Fam introduce yourself and if you can share your experiences working and coming out as transgender and gender non binary. I can explain. So I know that before you move to LA you were you were working with COVID patients, and you were living in an area that was actually not protected with anti discrimination laws, and which, which creates a huge potential economic stability with having a social supportive community. So I think that's, that's a really important piece of your story for our audience to hear just that that dichotomy right of one on one hand you're literally risking your life caring for COVID patients. And in another sense you're putting your livelihood at risk because you're not included in those same protections, the same protections that your colleagues had. Yeah. Thank you Nora for the introduction yeah I wanted to I guess we can start from there. I was a resident. When COVID first came out so I was practicing in like the south. And one of the things that people aren't really familiar with is that most of the southern states don't have protections or non discrimination ordinance for LGBT plus population. You know I could have gotten essentially fired or kicked out of my living places because you know only certain areas of Louisiana had protections and I was teaching and working in a very, in the COVID, basically a COVID floor. That's what they used to call it because it was just full of COVID patients, patients who were, this was in the beginning of the pandemic when we really didn't have any, any information about what COVID was besides that it's a virus that had very high possible mortality rates. So I came out. When I was a residence. And, you know, I, and I've been thinking about it for a long time because you know I was never really, I didn't really fit into the boxes right I wasn't just like a woman or man I was like, I didn't want to transition to become male, and I didn't really fit into what I thought was female so whenever I learned more about non binary or gender non conforming that really resonated with me and I felt like that was who I was who I am. And it was a moment where I had clarity in felt more comfortable within myself, you know that that's like the main thing about being is authentic within myself and then because I'm authentic with my myself I feel more comfortable being out. And so one of the things that I did kind of, you know, there's a, and using they them pronouns. So one of the things that I ran into was, you know, it's a learning curve for everyone, and especially for patients but during this time, you know, in the south. There, there's an ingrained belief that you should say, yes sir, yes, ma'am, as a sign of respect. And so, when patients come in, they are I get misgendered all the time serves ma'ams. And part of me understands that it's a sign of respect. But the other part, you know, I use they them pronouns, and it's not really a time to educate when patients are being admitted to the hospital they're in crisis they need help. I'm there to help them, you know, it's not a time where I'm like to say, actually, I use they them pronouns and here's the reasons why you know. It's time to kind of make sure that they are being taken care of in the hospital because you know they're acutely ill, especially even more so during during a pandemic. And you know that felt like I had to ignore part of myself in order to take care, take care of patients and after a while, these things tend to add up or like be very detrimental to I just read like yay for utesca. Yes, utesca add up and you know at during that time everyone's stress already you know the hospitals have stressful place to work at and then you add being a pandemic, and then you add and being gender not conforming. And it's, it's a place where I know it's, it's very hard, you know. And when you add in living in an area that didn't have if if you were living in an area didn't have protections then you have this fear of like oh if I'm out you know what if I don't have a job or what if I can't have a safe living environment, then that all of that combines into a place where how are you how am I supposed to take care of patients to the fullest degree to the best when I'm also dealing with all that other things so and you know using people will say I guess you know it's a small change like using the pronouns but whenever people use my the right pronouns it gives me a sense of it shows them that you know it's affirming you know they see me for who I am and so it's an inclusive environment it's it's a way to show that you are aware of a broader I guess rainbow of people and that are human and that you know it's the same as knowing people's names are asking you know what's your name you know what's your pronoun and then just using it you know I think it's really good to know that you know as long as you don't have to the pressure is like oh what if I mess up and you're like it's okay you just correct and move on and I think that's the the biggest thing yeah yeah definitely and being open right and being open and realizing that that there is that there is more than one gender that people identify differently so I see we do have a question in the chat about the pronouns and we're going to go ahead and let both of our presenters speak and then we'll get to the questions but you know we probably won't have time for everything we only have an hour but you are going to speak on the pronouns more in a little bit Dr. Pham so we'll get to that piece and then you know I I want to also you know pass this to Dr. Ali Tao and you know let her share share her story as well yeah thank you thank you so much for sharing yours Dr. Tao everyone alright thank you thank you thank you Dr. Pham thank you Nora hi everyone I'm Ali Tao thanks for the wonderful introduction Nora and here to share my story with you and I'll just let and also know that the transgender community is not a monolith we all have a story and every story is different just like everybody else just like a fingerprint everybody's is different and you know I always think about like what's the best I can describe gender dysphoria for people especially for those like you know the 99% of the population who doesn't experience it I'd say is like this you know gender dysphoria is like chronic pain and chronic pain is one of those things that doesn't get better on its own it actually just gets worse until you do something about it but something else about chronic pain is also that at some point you don't you lose hope you feel like you can never be free of it so that discouragement that honestly you just give up and that's kind of what it's what it's like to live with gender dysphoria and that's not my story too and one more thing about say gender dysphoria is this is like I know all of you woke up this morning and probably taking you've all taken like thousands of breaths and I'm not going to ask you is how many of you really aware of any single one of them probably not you're not aware of it unless there was a problem and like and for me and but I've been asking you about gender how do you know your how do you know your gender how do you know how you identify but it's not like you woke up you just know it's one of them you woke it's not like you it's not like you woke up one day look down the inventory of body parts and I guess I'm I'm this or that you know I'm it just is kind of like you don't think about it but like for me and like gender it's been like that I've always been aware of it it's like I've always been aware of my breathing it's like ring where breathing there was because there was something wrong and even from my earliest memories from like I was three years old I remember gender was always part of it and always wondering why you know I guess I was a relatively happy kid for just for know when I was young from like three you know just because boys and girls just play together and of course my preference is always just hanging out with other girls and so that was alright and what happened was I remember my family we moved a few years ago and just my parents yes I'm the product of two tiger parents so of course like the good tiger parents they saved everything saved every report card every certificate everything but I remember looking at it and I was looks like I was a kindergarten first grade I remember I was actually they said I was like I was a happy kid we kind of a little silly a little daydreaming but something happened in second grade where all of a sudden I was very became very withdrawn where yeah I didn't smile much anymore and I was thinking back what happened that year because that was the year when and when all of a sudden they started enforcing sort of gender lines kind of gender stereotypes that gave the boys lined up here girls lined up here and and this is what boys do this is what girls do and this is what and this is not what you know and and but of course they say that and anything else is deviant and now I was wondering why how come I couldn't be over there with the rest of the girls those are like oh they're my best friends and them I couldn't really understand why that was the you know that's the way the world was without really good understanding about why I felt the way I felt and why things were harder things felt hard and things also discouraging and of course is growing up in the 70s I know a lot of you all information sciences it's amazing kind of being in a kind of managing a world back in the 70s pre Internet where there was no access there was no way to know there's no way to know anyone felt the way I felt gender dysphoria was still like almost 20 years away from becoming a term and you didn't see anybody there was no again power visibility manners because I I didn't ever saw anyone I didn't I didn't know anybody else felt the way I felt all I knew was that's the way I felt and somehow I wasn't allowed to be doing everything with the girls anymore at the kind of just kind of just hang out on on the other line and and also too was but also new to that couldn't talk about it because you know we know what to say but my parents they're both immigrants from Taiwan they came for their they both came for their PhDs and engineering you know in this good country and so for them they're both engineers and so the world is very they're engineers the world's very discreet and so the world is binary much like a like a like computer like an operating system at the core it's all binary and and also you know the constant the Chinese culture is conservative but also made it harder to I was the first born male and for a lot of cultures you know understand what that all means that means that you have to carry on the name you basically all the entire burden falls on you to kind of to carry the name forward and out of younger brother and so for me so I was the air and he was the spare and so I got all the pressure he didn't I think he also presented the fact that nobody cared what he did you know even you know grades when they got a or C parents didn't it didn't matter as long as I brought as long as I was doing okay then everything was going to be okay and so so I even knew at an early age though that my life didn't belong to me and as much as I wanted to go to sleep and wake up as a girl as my much as I dreamed that I knew that wasn't going to happen and I knew those things as magic so that couldn't happen so what choice did I have and so by even by like age 10 and I'm having the thought that I would never ever be happy because I couldn't really understand why but I knew I couldn't be me I didn't I knew this wasn't what I wanted and and so I learned to not just you know I didn't have to know self esteem I had negative self esteem I learned to hate myself and even by height by you know because what choice that have and the only thing I could do to you know keep my keep me from thinking about this you know myself situation and everything was just to be distracted like you know you heard about some sharks that because they don't have their gills don't move they had to stay in motion to get oxygen through it. I call obligate Ram ventilators, I'm a big nerd, you can tell and and so like a shark had to stay in motion so of course the one way that the two ways I could stay in motion and so is throw myself into academics and music, which of course made my tiger parents very very happy so they thought everything was perfect, I was doing great, even though inside I was dying and by the high by high school, I was suicidal, and I know there's not a week that went by. I didn't think about killing myself, but the only relief I ever had was this in those few moments I could steal away. And I a lot of time find myself for my mom's closet when no one was around. I know I tried something on me a piece of clothing it's really just for a moment where I could just be myself. I remember from those moments where I could just exhale. I just take a deep breath. And I felt like I know I can actually kind of felt like it was really getting oxygen into my body, just like, and everything was okay for there's a brief of some moments but I also knew that I couldn't stay there for long. And so what do you like all you can do is kind of just kind of put yourself together and get back out there, and keep it keep being the person everybody wants you to be. And so, so it was so in those, those few brief know those moments that like, you know, where I could be myself just those, you know, just like, it was like a pressure relief out but that literally was a place where I can get it like to breathe from my tank of oxygen I felt like it was underwater the rest of the time so all the from like before five years old from elementary school junior high high school, even undergrad even into medical school. And that's the, that's the only place I could be be okay. And even the whole time. I was just exceedingly lonely and I was just keep moving forward and I was just hurting. And of course, you know, like I could talk to him about it, I knew that, and I knew about shame that's something no. And they know no, no kid should have to bear that burden of but I knew that it's not something that I could ever tell anyone so it's just suffered in silence, I suffered alone. And so, but everybody thought I was doing okay because some paper, I kind of was bringing home the grades of the awards the accolades so we thought was fine and so all ended into got it, you know, it gets distractions, kept swimming, eventually made it to medical school. And there's actually where I met the kind of hero the story, my future wife, Joyce, and we know, we were med school med school classmates. And for her, it's like, she just, she, her best friend had just graduated and so, and I don't know, some, you know, we became fast friends, we came, you know, became her best friend very quickly and a lot of I think what made that friendship special was this. She never expected something from me like everybody else expected me by a certain way. She just let me be. And we were just when we hang out. I never gender wasn't a thing and just kind of hung out with gal pals we've just. And that was, that was really the one of the only other spaces besides those private moments where I felt like I didn't think about. I could just be, I could breathe. And, you know, it's one of those things about best friends, you know, a lot of times you do, you fall in love. And before you know it, you're engaged and, and you're about to get married until. I think 34th year that's where when we get married, but about two months before that. And something we also learned in medical schools about informed consent. And I felt like, boy, I need to know to which she's getting herself into and so I felt like hey, so I remember like two months before we got married I get my telling when I was at our apartment said hey, Joyce, I need to tell you something. And it felt like I just felt like I don't know how long it was probably about 10 seconds but it was just hard because I never had shared a Sunday before, but the only language I had back then was in 1997 was, you know, gender dysphoria still wasn't even a term yet I just said, the best right explain it as a pay, you know, since I was little. I was stressed on occasion. I come all the way from elementary school, even all the way through into medical school. And I remember she just paused. And she kind of remember her just kind of looking you know, I'm saying that, you know, okay. That wasn't that's different, but it's not a deal breaker. We go we know, we can do we can work through that we can work with that. Okay. And so we got married. And so we got married two months later. And guess what, back to the distractions than the busyness of starting a starting a marriage business of finishing fourth year medical school, then the busyness of getting through internship business of residency, then the busyness of starting a career business of starting a family. And, of course, kept moving kept moving couldn't stop, you know, because I of course I felt like if I ever did stop. I would, I'd have to deal with myself. And I knew I would just spiral down, and I didn't think I'd ever recover so I kept moving kept moving. And so I'm also so fast forward to 2009 and that was the year our third third of three boys were born and I think oh and you know I'm it was finally it was at a time where everything was going well. I had the career I was wanting not the family I always wanted, you know, friendships I've always wanted. And unfortunately, you know, guess what, there wasn't no more distractions. There was nothing left to chase. And of course that by that time it didn't have a name, and I gendered like just for like chronic pain only gets worse over time doesn't get better. Even though I was running away from it. It was there and, and there it was in the smoke cleared. And so I did. I did the one thing I did what this is what I decided to do. I remember that, like, I remember into that summer 2019 2009. I remember going to taking a surf lesson, and you know, let me down here in Orange County, and I remember, like, like, I really enjoyed it, but I kept but the thought came to me is this. Maybe if I became an accomplished surfer. Maybe then I have an identity that could live with, and then I could push this all out of the way. And I think it's like, and also for surfing, it would be by far it was the most macho thing I've ever attempted. And so I started started surfing. I started surfing like, for someone one one morning a week, two more than two and three assert like my life dependent on it. I surfed, like, I get up at like 430 in the morning, I'd be, I'd be leaving the house by five. A lot of times I get end up at the beach and I'd be paddling out at 530 even before the lights, even before the sun came up. I'd surfed a moonlight, and I surfed and surfed like my life depended on it, because I thought it literally did. But also surfing was one of those things most demanding activity I've ever done so surf and so it was after three months. I had lost 30 pounds. And by six months, I hadn't, I lost more. I actually, I didn't lose, I didn't just have a six pack I had an eight pack. Of course, it's kind of hard to imagine now because this is a middle aged Asian mom mod. Thank you hormones. And, and, gosh, it's like, and, and also just, you know, um, you know, I remember, like, I mean, my dad, big delts, big lads, you know, big triceps. And for the first time in my life, I had like, I'm like, like a male body, masculine body. And for me, my, my whole life's been, it's been relatively androgynous because I was, I was at war with it. I hated it. He'd looking in the mirror, he'd looking at myself. And so, and I remember one day, I was taking off my shirt and my wife Joy said, Hey, oh, I like what I see, stop every second. And she was showing me how to make a muscle kind of muscles to use to me how to flex and pose. I never had anything to flex or pose before. So, so did that. And I kept thinking, maybe I should be, I thought, you know, hey, I got, I'm here now, but I thought I should be better. But I wasn't actually I was worse than ever. And the dysphoria had flared so badly that I had started cross resting again going out like staying after work actually telling her that telling family telling Joyce I was staying late to do research or something. And I would literally just go someplace, you know, go change, you know, and put on makeup and just just do something really mundane. I go to the mall, just have a meal, just like kind of like being back in my mom's closet again as a kid. And I did that, of course. In the meantime, what I did, I surfed even harder thinking I could get rid of it. But then, of course, making the transfer, the making the, the spore even worse. Yeah, dumb move. Yeah. And then looking back, of course, you know, of course, I was never going to work. But at the time, I was just desperate. And so, you know, you did after you can only keep that up for especially the secrets I was keeping away from Joyce. So by Christmas 2012 Christmas Day 2012, you know, I think something else about the holidays, I think there's a lot of times where this is an emotional time, but I think a lot of things come to a head. And I think I then I haven't been doing great. I think I'd really kind of withdrawn from the family. And I think, you know, Joyce even knew something was wrong. So but I remember telling her Christmas days and hey, Joyce, said those same words again, we need to talk. Of course, there's no words, no spouse ever wants to hear. So remember, we're, you know, when we're downstairs, I had the lights off, I couldn't even look her in the, I couldn't even look her in her face. And with this one literally felt like an eternity, probably at least at least 1015 minutes before I could actually get the words out and said, you know, Joyce, I've been told her I've been cross dressing again, and I've been doing it for the past, you know, past couple years. And you know, I've been telling him and tell her that I've been, you know, doing it kind of in secret. And I think for her. Of course, it was a mixture of sort of like a, it was, it was confusing because I think for part of it, she was of course, when you know when because she knows with withdrawn, I wasn't, you know, and she of course the first thought was that I was having an affair. And so the first although there's relief that I wasn't that, but also though that the thought was that maybe I was transgender, and she, you know, she's an internist, and, and she's taking care of a lot of trans patients, but she also knows that how devastating can be especially because for me enjoys our marriage is the most important thing we have. And so, and that's the most things most precious to us and she knows that that may most marriages don't survive transition. But at that time, she made a, she remember telling me later on but she had in our mind she had to make a decision. She could either decide that she could either be a speed bump, or she said, or she could be sure she could be helpful. And despite how she felt her misgiving she said, I'm going to choose to be helpful so at that point we decided we're going to go through this together. And, and none of us pulling or pushing. And I told her this as like hey, if you say slow down we slow down we say stop we stop, but we do something we do together. And I think the fact was I wanted her to know that I'm not, she's not being dragged along with the ride that that she's, you know, she's got a foot on the brake pedal. She's not, she's not a victim. She's in control here. And so what's it we did. And so it wasn't much longer before. The physician for the first visit you know we have found a Kaiser we started having that goes the year, the early 2004 and 2013 where we had a registry of physicians who were, you know we're competent and transgender care. So I made a call the member of services guide connected to a family medicine physician who's become actually now one of my close friends but she, I remember talking to her is only a second person ever talked to for 30 minutes yet she didn't say a word but I'll just tell you my story by saying that she was, I was in tears but I think we both knew what that all meant. And I remember she just kind of looked at me with a kind of the with all and with all kindness and empathy and said, Well, are you ready to start hormones, and they know the scares it was. I think Joyce and we've talked about it. We said yes, and it's literally things a point of like a point of no return but we realized that there's only a way, there's only a way forward so we did. So actually we move forward, but then what happened was, like our, we had date nights and our date and I think my grandma would come over to the boys, we'd go out there and like, and we'd sneak it and we go out there we sneak a bag of clothes and stuff and supplies, you know like with makeup and stuff. And so my wife always jokes like if any of you ever need make over by the dim interior light of a Toyota Sienna minivan she's your girl. So we do we go we go someplace she'd help me get ready, you know do hair around clothes and we just go out there we just go to like a someplace we just go to a restaurant and go to mall, and she could just see there while I was just just being able to be she could just see my shoulders relax that all sudden. I can actually I can manage a smile. But of course, even before we got home she could see me tensing up again, and just knowing that this was this only but like like feel like Cinderella like the clock strikes midnight to go back and and do it all over again just kind of be what everybody wants it to be expected to be. And so we just, you know we kept, you know, we did that. And as the year went on one date night became two date nights a week. And the difference between how well I was doing when I was presenting as myself, and then, and versus when I was presenting male drug going to work and if everyone else, the difference became worse and bigger and bigger until Christmas day 2013. And we're up a mammoth for a ski trip and she Joyce woke up that morning. And she noticed I was in there she I wasn't in there in bed. She found me lying on the floor in the middle of our hotel room when I was curled up on the floor in a fetal position. I don't even know how long I've been there for I don't know how I got there. I remember that morning was, I couldn't move on. I was like, I couldn't. I was hurting so badly I just want the pain to stop. I was thinking I can kill myself because I couldn't do that to Joyce or boys, and then our boys, but also couldn't transition fully transition because I couldn't do that to Joyce and the boys. I was just hoping I could just something would happen I could just die and the pain would stop right there on the spot and I just couldn't go on anymore, but she came down. She sat me and she got on the floor sat me up kind of help me by my arms and said, you're going to be okay. We're going to help you transition, you're going to be okay actually you're going to be better than okay, you're going to be the best you've ever been and we as a family, we're going to be the best we've ever been. I don't know why I believe her but I couldn't move but this is Christmas Day within 48 hours. She wrote, you know, she wrote every email made every phone call the devil the research. She had found everything. Like even found a surgical day for me. My biggest source source of dysphoria is looking in the mirror looking at them face that just wasn't mine, which it was just. And, and so for me it was facial feminization surgery that's my gender affirmation surgery that's what I needed needed to move forward. So she found one wasn't a covered benefit that at the time so we actually had the tickets with the flight to Chicago. And so she said Ali hang in there just hang until March 1. All you got to do it the only two things I need you to do is on things I can't do for you as go to a medical appointments and then also go to the courthouse for name and gender change I couldn't do those for you. But there was hope. And she's the one who literally carried me, got us to Chicago had surgery two months, you know, about two months recover, and by the time I, you know, got back even at work. You know, I think there were people there who knew my stores going on, and they went out of the way to make it a safe space for me like a soft like a safe landing spot. They're like even our medical director kind of went in there and said hey, we're going to make it okay. I'll show you a quick story remember which I'll share with them before because he could tell you me before I went off had surgery just you know I was talking to him he said, you know, he said Ali hurts to see hurts me to see you hurting so badly, and said, and he, and he said that the way I look at it, you know, there's only one option because of the alternatives untenable because even that past year, it was, we actually had lost to pay two of our physicians to suicide. And it was a horrible year and he said, he said, we're not losing a third. So we got this so he said he was telling a story about how this one teenager came out, like in the news reading newspaper and the air is very conservative said, when he came out there but nobody mess with them because the full football team had his back he said, he said, and he said Ali. He don't really just have the whole football team, you have the principle behind you, it's going to be alright we're going to make it okay, you just take care of yourself we're going to take care of the rest. So that's what they did, you know, they made, they made, they went department to department. They know your physician leadership, he had multiple multiple, like a little like little sessions, like listening sessions just kind of talking about like hey, what does it mean to take care of someone who's trans. And so the, and how do you love, and then what do you do, but more importantly, what don't you do, and why do, and then they of course share this, then they read out a letter that I wrote a transition letter, and they said, then the kind of like, then by that point everybody was, it was, they were invested, then it became personal said no, and everybody was like, No, we're going to do this we're going to make it okay, we're going to make it for me, they're making it for me. And that's what it was when I got back to work. And, and I've never experienced so much kindness, they showed me more love than I could ever hoped or ever felt like I deserved. So my work family, even be on my my own, my own family, my work family. And so, and that's, and guess what, seven years later, here we are now, and you know, Joyce was right. I am the best I've ever been, our family is the best, if we've ever been. And honestly, I couldn't be more grateful for what I have just because I've spent my whole, you're grateful because, especially grateful because you, especially when you spend your whole life dangling over the precipice, and it feels, it just, you know, it's amazing to be on solid ground. And so, and I keep thinking, because I had those resources and the privilege that I have as a trans person, I had Joyce I had my family, I had my work family who went out of the market, okay. And also the fact was, you know, to physician income, I could afford gender affirming surgery, it was $40,000 out of pocket. That's a, that's a significant, significant barrier. That is one of those social determinants or sES. And that's, I realized that I was never more reckoned, I never wear my privilege. And so, I know that because of my privilege, I had the chance to live my best life. But I know, but I will say no, that's, everybody has a right to live their best life. And so that's what the fight was for, to make sure that take away those barriers so they can be so though all those things that I need, all the resources that I had available to me. So you wouldn't need any of that to be able to move forward to, to, to, to thrive. And so, so back then, so my, so now, all the everything that I needed to do all that $40,000. I was back in 2014. Now it's a part of the fight was actually having its first, as a first person in Southern California Kaiser transition, the first openly transgender physician. And, and so of course being the first means that you have to, you know, they experienced even for the medical group they never had. So I kept telling people exactly, you know, of course, there was like, you know, they, it was transgender care by cis people. And so for them, they, they, for them, it was genitals equals gender so that all they offered were bottom surgery and I kept telling them, no, you don't understand, trans people are so every every transition is different. Everybody needs something different. So that was it, you need trans people to inform transgender care. And so happy to say now it's 2021. And, and all that, all that $40,000 that's been out of pocket, anybody who's a, who's a member can have all that, all those services for $200 co pay. And I'm, I'm, I'm damn proud of that. I'm damn proud of organization for transitioning and that's the hope. And that's the fervent hope and that's why it's important to have trans people in spaces so they can advocate to navigate for themselves or community. And also, and so that's what we can do. And that's what inclusion is all about. That's at the core. And so is, it's like, do you want to do right by trans people, get trans people in the space. What do we do, you know, for even our trans is, you know, guess what, amplify the voices, you know, you know, you know, again, plug in the plug in the amp and pass the mic, but you know, and because there's a lot of, you know, the trans people have a trans community has a lot, you know, there's a lot of things that we can do to make it more, you know, we wanted to move the move toward equity. And so do that, bring people and have those conversations. I know one more thing that I know I'm sharing with nor, you know, we were talking earlier before this, we're talking about even one of those experiences I had back in 2014, it was only like six months after our transition. And, and I don't know, somehow, I found myself because of a little casting call just to the trans community. This is the last year of Glee. This is 2014. And they were for the last season, they wanted to do something for the trans community. And so they had one of the storylines was Coach Beast was transitioning. You know, and, you know, and as part of that, though, as one of them, for those episodes, I think it was season six, episode seven. I think that the name of the title transitions what they wanted was a 200 person all transgender choir. And so they send a call to the community at that time actually, you know, I just kind of like my wife Joyce saying do it. I said, okay, why on the lark so I send an email out do that out there and before I knew it I got a call from my casting director. Before I knew it I was on set. And I just said, Oh my God, I thought I traveled for I live in Orange County driving to there. I wasn't quickly found out that people came from New York, people came from New Orleans, people came from Ohio, people came from all over around the country. And while I was there before that I had only known. And so that was my experience. But while I was there is person after person and kept coming until I met 199 other trans people. And what I saw was realizing that the trans community is just as diverse as the entire world as any other human at the human race, like you know we are all different shapes of colors different ages, and you know, all different sc s different levels of privilege and I was always there very aware became very aware of privilege I have because there are people there who are at the do sex work. And people there who are homeless. There's something special about just being with everyone there and realizing though that remember thinking to myself said, Wow, this is remarkable. It's breathtaking the kaleidoscope, but also the fact that everybody here belongs, everybody here as a place in this world. And, and I realize that one is the different as we all are we're all moving the same direction where each of us are here to help each other move forward. And then and also I think ever they up to that point I was still a little, I was still on the way to be like, you know, sort of like, like even being self affirming being okay with myself being self inclusive getting over, you know, all those being finally embracing who I am and I remember, you know, I after the whole thing I remember talking to Joyce about and she said you know, Ali, I think the reason why I feel different now is because you realize all these people have a, you know, have a place in this world. And what it means is you, Ali, like me, I have a place in this world as well. And so, that's what it is. This is what I'm passionate about. This is what I'm so glad I haven't as a physician that that privilege that platform that amplified voice. And so, I could, I could amplify these stories to make sure that everybody here has a chance and that their stories are amplified and they have a seat at the table. And one thing to do about privilege to is this, realizing that it doesn't have a seat at the main table but you don't realize how much privilege you have until it's gone, like even a medicine being an Asian cisgender male, heterosexual male. There's a lot of privilege that comes with that. You don't realize how much you have until it's gone. And so, but once you don't even one thing though about once once you're the main when you're at the main table, you don't see everybody else who doesn't have a seat. All you're aware, you're not aware of it but when you're actually not there, then you can see it look around the room and see everybody who doesn't have a seat. You realize that then you know who you're fighting for you find everybody who doesn't have a seat. And also to is one thing I always want to share is this, what I learned is this that I may not I will never fully understand their journeys their stories, what it means to be because they're what it means to be black, what it means to be Latinx, what it means to even all these other marginalized groups on they understand, but that doesn't that's not, you know, doesn't stop me from loving. That won't stop me from loving them, advocating for them, and just having compassion, because one thing I didn't I just want to leave you know I want to be able to leave with you all today is that, you know, understanding is not a prerequisite to compassion, or love. So, thank you all. I appreciate you even the giving this time and space, making a safe space to so freeing for me and Dr family bill share stories, and I know you all have questions as well. I want to hand this back to Nora. Thank you all again. Wow. Thank you. Thank you so so much. We've got. I don't know if you can see yeah lots lots of thank yous in the chat for sharing and and being so vulnerable with us. Yeah, we really appreciate it and, and we're really glad that we have both of you. And we have both of you as healthcare providers as MDs at a time when it's so critical, not only during COVID, but just it's incredible. It's critical to have transgender non binary physicians. We have we have seven minutes I'm going to go ahead and share my screen. Again, these were questions that that we selected from the registrations we had that field for people to send in questions so I'm going to let April read these off and have our panelists answer. Thank you, Nora. Thank you so much, Dr towel and Dr fan. I just wanted to just say one thing that the I'm trying to find it is in the chat. Arkansas governor vetoed the anti trans bill. So, you know, that, you know, that's good news. So for question. First one what services organizations programs mentors, etc. Do you wish you had. Do you wish had been available to you in med school and read as residency. Oh, I can answer part of that. You know, Dr towel Ali mentioned like the privilege that we have as physicians and getting to this point you know one of the things that I am really thankful for is that in med school at utesca, you know, this is when you're a student you're learning you, you everyone is your role model. And so I was able to have like a classmates who supported me in my queerness. I was an outstanding physician who supported the pride group and there was a pride group there and I think a lot of med students and med schools don't have a have a safe space and so one of the things that the program did was advocate for having safe spaces advocate for teaching these young soon to be physicians, how to create a safe space and how to support each other. You know, like medicine is hard. And so having the services, a safe space. Mental health, mental health, having organizations like a student run pride faculty group that, you know, mentors and programs to help help facilitate growth and acceptance and compassion. And then that's, that's in med school and residency I was the only out resident gender not conforming in my program so that was one of the things I wanted to do to for future future residents future staff future attendings to be in that program I wanted there to be a place where they can go to to feel acceptance and not start from the beginning again, you know, I want. So that's kind of one of the things that I wish that I that there was available throughout my training. Dr. Todd, did you want to add anything. Okay, well, outing myself in terms of my age, but I started medical school back in 1994. And back then, there was nothing zero. And so, all of that. All of that. But I wish I got even a fraction, I wish I had some, I wish I had what Dr fan had, but also to as, you know, honestly, I couldn't really use some visibility, I would I could use the men, I could be, I could use visibility and a mentor. There was nobody I could even identify with not even though it was possible to that you could, you know, you could talk about this, that you could come out. And so a lot of it is you just sort of. All you do is kind of just, you know, suffer in silence, that's good it was. So maybe that's exactly that's a hope is to build safe spaces now. And that's why Dr. Famer, I are here for the sake of my visibility, but also to help gather allies like yourselves to to, you know, to create these safe spaces. And so, yeah, I wish, wish I had all of that, maybe that would have been 41 years before I transitioned if there was actually knew what was possible. So how can, how can one be inclusive and be an ally. The first step is to be open to learning, because that's like everyone is learning about pronouns that's like a really concrete example of, you know, introducing yourself and then introducing your pronouns as a, as a normal, like, normal, normal way to introduce yourself to not assume, you know, this, I think a lot of cisgendered people, you know, you have, you go like Ali said, you know, when they're not a see the table, you know, people assume you're male or female and you have, you go through your life without having to correct someone, because like your people's assumptions of you match how you feel yourself and so going through and, you know, not kind of looking at your own bias and kind of learning to be gender inclusive using gender neutral terms and that's like one, one step that can be, you know, and being compassionate like these are other human beings right to like how to treat other fellow humans. Bring in trans people, you want to be inclusive and be an ally bring in trans people into all these spaces, bring especially bring non binary folks, because that's, there's so many misunderstandings there's so much for it's not it's so much for the rest of you know, to be self or does not identify the gender and conforming that for us to learn that the pronouns right to be respectful to be affirming to you know, to be able to celebrate. And so, so you know, it's an even the next question is like what it was the most effective forms of advocacy is actually just bringing trans people into all the spaces where decisions are made. Okay, great. Just one more. What is being done to instruct member services staff and reception about proper pronouns. Um, I mean, even within. So before I started at Kaiser you know one of the things that's, I guess my chief did was you know, tell everyone like hey this is going to be a new physician coming in. What are their pronouns are they them. And then, you know, inform everyone that I work with one of the things that we're currently working with is to, and this is part of advocacy and within the health system is having a having our electronic medical record be used you know, gender not conforming and transgender people can't, you know, it flags on their, their medical record when the chart pulls up so that you know, it's very tiring, you know, to always have to correct or be on the lookout for like oh did you miss me. So it's, it takes it away off takes away from the one risk or the responsibility of the person. And so it makes it everyone so that you know that it's not the person's responsibility it's everyone's there. Um, another one is we're working on a module to teach to have people. So just educate on what is pronouns you know something as simple as that. Thank you both very much, Nora, I will turn it over to you. All right, yes, yes we are at time, but again, thank you so so much. We are all really grateful. I'm really happy that that we were able to connect and that you that you agreed to to come on and share your experiences with us. So Rebecca has posted in the chat the link to our evaluation and the instructions for those of you that are interested to receive CE credit from the Medical Library Association. Lots of thank yous lots of thank yous. Thank you all for just for your hearts to want your desire to be here. And thank you for making this a safe space. We deeply appreciate it. Thank you. And I think, you know, people are asking about what they can do what they can do to make things better so I think something as simple as sharing this recording and, and, you know, in whatever space you're working in whether it's healthcare in a library, a CBO sharing people's stories and experiences is one step toward creating change at at an institutional level. All right, well I am going to end our recording now, but thank you all for coming and be sure to tune in next week. Next Monday, April 12 2021 we have our, our last webinar, and this one is going to focus on mental health and resiliency. So I will send out the link for that to register as well. Thank you, Dr. Tell, Dr. Fail.