 Thanks for joining us. This is our final webinar in the Transgender Health series from NNLM. We started this on March 31st, International Day of Transgender Visibility, and those recordings will be put up on the NNLM webpage for those of you that weren't able to join. So today I'll have Molly put the chat. You do receive one CE credit from the Medical Library Association if you complete the evaluation after the webinar. So if that's something you're interested in, make sure that you follow that link and complete the webinar. I'm going to go ahead and share my screen. You can see that's right. You can see it. Okay, just want to ensure. All right, so I just wanted to give a brief introduction for those that are not familiar with NNLM and what we do. Before that, this is the land acknowledgement. So we're currently working from home, but typically our offices are at UCLA. The NNLM PSR at UCLA Biomedical Library acknowledges our presence on the traditional ancestral and unceded territory of the Gavellina Tongva communities. And because we love using our acronyms, I always like to give an explanation of what these mean. So at the top we have the NIH, the National Institutes of Health, which is made up of 27 different institutes and centers. The National Library of Medicine is one of those 27 different institutes. It's also the world's largest biomedical library. And underneath that, we have the network of the National Library of Medicine, which is where I work. And April Wright, who is my co-conspirator in this series, she's at the University of Maryland Baltimore. And here in the Pacific Southwest region, as of now, until the end of April, it's housed at the UCLA Biomedical Library. So the mission of the NNLM is to advance the progress of medicine and improve the public health by providing all U.S. 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 health science libraries and information centers, along with public libraries and community-based organizations. So basically anyone that's providing health information. We are also successful and thanks to our individual membership and we encourage all of you to do so. You can see what other resources and services are available to you. Sign up at NNLM.gov slash user slash join. You'll be placed on our email list and you'll receive notifications of all of the new classes across all of the different regions. So across all of the U.S., a wide variety of health topics, health needs, and speakers, such as Dr. Massey who is joining us today. And I'll go ahead and read this bio. Dr. Massey, he, his, is a licensed psychologist who has practiced in the Atlanta area for over 30 years. Dr. Massey has served on the board of directors of the World Professional Association for Transgender Health, or WPATH, and on the faculty of the WPATH Global Education Initiative. After serving on the GEI Steering Group, he is now the co-chair slash mental health chair of the WPATH GEI. He is also on the committee to update the adolescents chapter and the people living in institutions chapter of the WPATH standards of care for people who are transgender and gender nonconforming. Dr. Massey has published on several topic areas including gender identity and he presents seminars primarily on gender identity issues. He has provided training in the USA and abroad for mental and medical healthcare professionals and students, community groups and faculty and staffs of numerous schools as well as universities. He's an adjunct assistant professor in the Emory University School of Medicine in the Department of Psychiatry and Behavioral Sciences. So thank you so much for joining us and I will hand it over to you. Thank you, Nora. I appreciate that. Hello everybody. It is my pleasure to be with you today. I want to start by telling you that my older sister retired about a year ago from a long career as a librarian and she's told me a lot about her experiences as a manager of a library and so I have a very special place in my heart for the work that all of y'all do and it's really great to be with you especially because I love to do things that are going to help increase access to information about transgender healthcare including for professionals and the public. So I'm going to start by sharing my screen. So we're going to take a minute to do our technology shift over here. We had an intricate show here that we're involving two sets of slides Nora's and then mine. So at any rate here's some of the things we're going to cover and I talk kind of quickly because I'm going to try to cover a lot of info and try to allow some time at the end for Q&A. So I want to cover some foundational information about transgender and gender diversity issues, terms and etiquette which I always think my old fashioned southern mother would be happy to hear me talking about etiquette, school, work, faith, social, mental health concerns for this population as well as what community and organization leaders can do. So we're going to jump right in by talking about what I call a ladder of assumptions that most of us are raised with here in the United States and that ladder does something like this. There are two sets of people we believe we're trained in school and in biology classes and in culture that we can recognize either at birth or in utero that there are going to be people we're going to call male and we're going to make that decision based on the assumption that they have XY chromosomes based on what we believe we see as the testicles and penis again either at birth or in utero and then this thing is going to be done to these individuals and that thing is a legal thing is going to be assigned to them in terms of a male gender marker and this is something all of us have done to us at birth a gender marker is assigned without our consent and it is then assumed these individuals are going to take on a male gender identity. It was so assumed that the term gender identity wasn't even talked about until recent decades and then it was also assumed these individuals would take on a male gender role and all those expectations and the expressions of typical male gender role behavior including being attracted to females. A similar set of assumptions was made of people who seemed at birth or in utero to have a vagina and they were assumed to have XX chromosomes and assigned a female gender marker assumed to take on a female gender identity and then a female gender role and expectations and expression including being attracted to males. So as I started working in this field it was useful for me to do some research and be reminded that actually there's a lot of biology if we look at that ladder of assumption just starting with the biological factors there's a lot of biology outside the binary so what am I talking about for those of you who may not be sure I'm talking about the common phrase in the community that works with this population is intersex this is for folks who may have reproductive organs of both sexes or of neither sex or they may have ambiguous genitalia these the clinical term for this population is disorder of sex development however in the field where I work we often call differences of sex development I really like that term difference because it connotes that variation is a biological normal occurrence that if we could see all of our faces on the screen here today we would see various skin colors various hair colors various hair textures and shapes our bodies our builds our different heights widths even people of the same heights are going to have different frames and shapes and sizes so variation is biologically normal so what are a couple of examples that can lead to these folks having different kinds of genitalia and reproductive structures well there are hormonal variations such as complete or partial androgen insensitivity which leads to the feminization of individuals who have xy chromosomes or there's congenital adrenal hyperplasia which leads to the massilization of folks with xx chromosomes Chromosomal variations include Kline-Felter syndrome which means the person has multiple x's and a y and another variation is Turner's where there's one x and then a blank on the other x on the other chromosome in the pair of chromosomes typically called the sex chromosomes so that alone was very helpful for me to start realizing oh yeah if biology is outside the binary huh you know maybe that ladder isn't working and in fact I understand that in y'all's talk last presentation last week you were introduced to a transgender woman and Aria Lester I believe and here are some other transgender women and in the top left we have Cecilia Chung a transgender activist in America in the top center is Zijing the first woman officially to transition in China top right is Lana Wachowski of the Wachowski brothers formerly and now the Wachowski sisters and they gave us such fine entertainment as the Matrix Trilogy and Cloud Atlas and then in the bottom right is Isis King a model and actress in the States and the bottom left is Angela Pulse who competed in the Miss Universe contest in 2018 so there are a number of examples you have there of transgender women so that's a reminder that not everybody's gender identity matches the gender marker that was assigned to them at birth so let's go a little further down that ladder you know it's important to understand that gender is a social construct the roles and expectations of gender are often taught and enforced by family by peers by schools by religions by the media and culture and these gendered interactions can start at birth even including things like the color blankets that people get for babies and society monitors these rules and people's adherence to them pretty strictly although it's starting to shift and loosen up with the younger generation so gender expression is how we rock our particular version of our gender rule so you know it's our haircuts it's our hair styles but even here we see gender differences but it's it's clear that we all have ways in which we want to present our gender and our personality get to come through what I like in this next slide is that Billy Porter who is a star on the series pose I believe that's on Netflix is you know really rocking this gown that she wore he wore to the to the Oscars a few years ago and it is gender non-conforming you know he's not going with the gender role expectations but is doing a gender expression that is different and is really striking really striking similarly we have another variation here we have Ellen DeGeneres who as far as I know identifies as female but as most of us know she's out as a lesbian and she often presents in very masculine attire but she's also a cover girl I've seen her in the you know ads in the magazines and so she is doing all sorts of bending that ladder of assumptions so it's useful for all of us then to start recognizing that when we're thinking about working with folks we want to think about what I call hetero normative clarifications we call these in the field we call this hetero normative when folks just adhere to the binary and those expectations that we are were most of us brought up with that we would be male or female and we'd be attracted to males or females and it would be heterosexual so in terms of our attractions and so we have the term hetero normative and if you have teenagers and you're able to use the term hetero normative at dinner this evening you might impress them but when I look at this field I think now we clearly recognize that while that set of hetero normative expectations works for a lot of people for the majority of the population even there's a lot of folks it doesn't work for and so we need to think about genetics that the chromosomes and the hormones we have are separate from the legal label that we have which some people are or are not able to change when they go through a gender transition and the legal label can be different than somebody's inner experience of their gender identity and so sometimes again somebody may not be able to get their legal label to change depending on what state or country they live in their gender role is their social presentation which may or may not align with their gender identity and then sexual orientation fortunately for a number of years now we've had more awareness that sexual orientation can be not at all related to somebody's chromosomal wasn't and legal gender are signed at birth so what are we talking about then in terms of frequency in recent research what we're finding is that on average and I say average about one percent of folks are identifying as transgender old research a lot lower numbers and older participants in studies lower numbers however teens are often saying around 1.5 percent of the population is identifying as transgender and very interestingly about two percent identifying as non-binary or other gender identities I'm going to talk a little more about that in a minute so think about that in your population if you're in a city where there's one million people that means that about 10,000 of them are identifying as transgender and 20,000 as gender questioning or non-binary or other identities this is much higher than if you look in the DSM the diagnostic and statistical manual in a lot of older studies and I will tell you my office I don't know that just two or three calls I may need to update this slide it feels like I get four or five calls a week because I've got a waiting list of two to three months for people to see me and it's really important to let you know that you know this is a phenomenon that occurs across all walks of life my practice I see folks very diverse racially ethnically socioeconomic education religion age and abilities so there is a lot of diversity now one thing that's really interesting in doing this work is it is a very evolving field in the last 10 years alone there's been a tremendous shift in vocabulary and especially because I work with young people they're coming up with new terms all the time and I have to stay humble and willing to learn now more or less in the field we've agreed upon transgender as an umbrella term to identify folks who don't identify with a gender marker assigned to them at birth the best known of course are you know like on that slide some of the trans women or women a lot of times people don't even want to be called trans now they just want to call the woman formally male to female was common into F I always encourage using the terminology that people use in referring to themselves if they come to see you in their in your library or send you an email request and then of course trans men or men female to male formally F to M is the other best known groups cisgender applies to a lot of folks in fact most of the population is cisgender that means that your gender identity matches the gender marker assigned to you at birth so there are some other terms I said I would talk about a little bit and we have some umbrella terminology that continues to evolve for folks who are gender expansive or gender and creative creative so a very common term you might see is gender nonconforming that's actually starting to give way some but it is somewhat applicable like some might say that Ellen is gender nonconforming in her presentation because she tends to wear more masculine attire non-binary or gender non-binary a lot of folks are identifying as this that may mean they identify with no gender label they don't identify as male or female they may identify with neither or with both or it may be fluid another term that is really coming into vogue at this point and I think it's going to really stick around for a while it's gotten a lot of traction is gender diverse so folks who may not be male or female binary identified but maybe they're gender nonconforming maybe they're non-binary maybe they're both so this is some ongoing terminology that we're adapting nowadays and then gender variant is an older term that you may still see in some research but it's not used as much now but obviously it's referring to folks who aren't conforming to typical expectations for gender expression or gender experience so I just want to give you a reminder that again since some of these folks are not necessarily binary identified they may not need to take some of the typical steps of a gender transition but they also may not fit in typical heteronormative expectations and there are some folks who may transition or take some steps medically or surgically or may not they may or may not take legal steps they may or may not take social steps of transition it all depends on what their particular needs are so just as one example of somebody who's gender nonconforming or gender diverse we might think about Eddie Izard who if you've never seen him I encourage you to see him he's hilarious he's a very talented comedian and actor he was in the show The Riches and he was on The Good Wife played a very buttoned up accountant in that series he is a British of British origin and he can make world history hilarious in several different languages and he wears on his stand-up routine usually the outfit that he's something like the outfit on the right which I think is really fetching when I've done this talk some of the audiences I speak to the women are like oh I want their shoes so I want to tell you a little bit before we proceed much further about how I got into this area because I didn't expect to be doing this work when I started my career back in 1989 after finishing my PhD there was not a lot of work on gender issues and transgender work in the 1980s but when I look back in my life you know I was born in 1962 my math for you I'm 58 and growing up in the 60s and 70s there was a lot of stuff going on in this in the US about gender because of the women's liberation movement and I was very interested in that because I always thought that the rules for girls and women were kind of stupid I thought some of the rules for men and boys were kind of stupid I particularly didn't like the rules for women and girls because I was assigned a female gender marker at birth I was raised a girl and I felt really constrained by the expectations and rules that I saw in my future now as a little kid my parents and everybody thought it was cute that I was a tomboy and kind of did more typical boyish things playing with cars and army men and football with the guys hot wheels but you know as I got a little older I started feeling this social pressure to conform to expectations of girls and it was really uncomfortable for me and I'm going to ask y'all to think for a moment about this person going into the girls locker room in middle school and in high school and maybe that sounds like oh that's great if you like little girls you're attracted to girls at that age but no it was really uncomfortable I felt very awkward like I'm not supposed to be here but I couldn't say why I didn't have the vocabulary to explain it and this was back in the dark ages before computers and the internet and this thing we have called Google so I just like well I guess I'm just going to make the best of it and try to adhere to the expectations but I remember telling another kid when I was about eight or nine that I wanted to be a boy I just didn't know how to do that so in high school I also started learning about being attracted to girls and the term lesbian and I didn't hear a lot of people talking about it so I didn't talk about it either but I did come out in my 20s and you know I told you my parents were fine with me being a tomboy but they were very conservative and traditional in their ways of thinking and being and they didn't take well to this news that I was a lesbian which by the way kind of cracks me up to say now with this face but you know my siblings and my parents struggle with this particularly my parents and it was really a challenge but over the next couple of decades you know I found a place a community with the lesbian and gay community I finished graduate school I became known by my colleagues in the Georgia Psychological Association or GPA and I did a lot of work and became respected for my work as a lesbian activist and educator in GPA and in the public in the Atlanta area and you know was fortunate in my 40s to have a stable practice to have a very good partner of about 10 years my stepdaughter was nearly done with college and so my life was in a really stable place and a lot of calm and I believe that allowed me to hear that something was missing something still wasn't right and even though I was pretty successful and happy and blessed in my life something was still missing from me and what I started getting in touch with was that I had more masculinity in me that needed more expression and even though my hair had kept getting shorter and shorter and my attire had gotten more and more masculine over the years I was not fully comfortable so spoiler alert I recognized realized over my own counseling, journaling, prayer, meditation that I needed to go through a gender transition and I did that I started that process medically about 11 years ago and that was after a couple of years of soul searching and struggle to really sort this out and let me tell you it it was terrifying as a veteran of two comings out it was much harder coming out as trans because when you come out as trans if you want to transition in place meaning you don't want to lose your whole community that means you got to tell everybody in your community when you come out as gay or lesbian you don't have to necessarily discuss it with your mechanic or your accountant or whatever but I have relationships for years and years and years that I wanted to come along with me you know I wanted my friends and my colleagues to to be supportive and to be in the know and so I had to tell all of them I had to tell all of my clients I had to tell my landlord or my office building I had to tell my accountant who'd done my books for my business for years decades I had to tell my dentist who it might not seem like I have to tell your dentist but if you're going to look different and sound different over time then they need to know what's going on it'd be weird had to tell my pharmacist had to tell my auto mechanic because it's hard to find a really good trustworthy auto mechanic so there are so many people I had to tell oh and my neighbors so they wouldn't be wondering who's walking the dog now uh so it was exhausting but I want to tell you about two really important people or groups of people I came out to my colleagues you know it was it was such a blessing because they knew my history of being a hard worker and straightforward and so they invited me to continue to do things for GPA the Georgia Psychological Association in fact I was invited to chair the annual conference and that's a big responsibility and I worked really hard because I was not going to be the first transgender person to chair it and to mess it up I didn't want to break it and so it was a sell-out conference and was very well received and then they asked me to run for president I declined when they first asked me to run for president because I know now in hindsight that intuitively I realized I was too early in my transition I hadn't grown into myself enough to know who I was and to hold my ground as a man but they asked me again in 2016 and at that point I said yes I'm willing to accept this nomination and I was elected and I served as the GPA president in 2017-2018 and I am so grateful to my colleagues that they entrusted me with my professional association because it's been my home community for now three decades and I am so close to so many of the people there and it's where I have grew up professionally in many ways and it's been an honor to be able to lead that organization to be able to preside over board meetings to represent GPA at the state legislature to advocate for mental health for the public and to even do that at the U.S. Capitol with our federal legislators it has been an honor to be able to serve my profession in this professional organization because they trusted me and I tell this story because it's important for parents and families and so many people to know that when given a chance and recognize for our strengths and capacities trans people want to and are able to come contribute in many ways that we are thrilled to be able to do and it is also something that I would not have done before my transition because I realize now I felt too inhibited I felt too internally conflicted there was energy bound up in that and I did not want the kind of high profile demands of being the president of an organization but they trusted me and I was able to be my authentic self and that allowed me to show up and bring all of myself to that endeavor finally it's hardest to talk about telling my family I mailed letters to my family because when I'd come out as a lesbian it had been very difficult very painful there have been a lot of conflict and so I thought I'm going to write them letters I thought for sure I was going to lose my family over this if being a lesbian was hard I'm going to totally lose them over this but I have to be me and I wrote them letters and thought that way they can think about it process it they're going to have a meltdown a hard time with it then they can contact me later and we can talk about it in a time and a place where they've had a little time to cool down I'll never forget I had conversations with each of them at different times after they received my letters but I'll never forget the call from it from my mother my parents were in their 70s at this point and my mom said your father had to go to his barbershop quartet rehearsal but he said to say hello son and my parents both passed away a few years ago but in the seven years since then since I came out to them they got to know me as their son and to affirm me and embrace me and my father embraced me that way as did my mother even before I had any surgical or hormonal treatment and so it was very very affirming for me and such a relief to have their affirmation and their support for who I was and who I am so my hand slipped and hit some of the slides that I wanted to tell you about next because I think that as much as it means to me as a 58 year old man I want you to think about how important this is to kids to adolescents even young adults and what we see is that there are higher rates of homelessness sex work and suicide attempts for people whose families reject them when they come out as trains they're much lower rates but still there are high rates of homelessness sex work and suicide attempt even when there's family acceptance but I work with a lot of youth and this is really important information for parents and families to have so working with youth another thing that I get from a lot of parents and I'm going to come back to some of this information and a question I often get from parents is can't they just be gay now this kind of cracks me up because when I started my practice in the 90s they would never have said that but I explain to them sexual orientation and gender identity are different you can be cisgender as most people are and gay lesbians straight by pan poly ACE etc. Guess what you can also be transgender and be all of those things so for example I know some transgender guys who look like me they're attracted to men so they are gay men gay trans there are transgender women who are attracted to women they're lesbians transgender women attracted to men and women they're bisexual or attracted to folks regardless of their gender identity they're pansexual they're attracted to men they're heterosexual I used to be attracted to women so I was a lesbian I am still attracted to women so now I'm a straight white man I never saw that coming in my life I promise you so I want to talk about pronouns y'all may have heard a lot about pronouns and it is really important in this population and in terms of working etiquette they them they was the word of the year for Merriam-Webster dictionary in 2019 and it became approved for single use in many style guides like the American Psychological Association for as in referring to a singular individual and so I say this so you have a better understanding like that this has really happened in our society that they is actually codified so here is a little bit more about that now when people are like why they them you know and this is often a pronoun of choice for folks who identify as non-binary or non-conforming so what's the point is it to drive English teachers crazy well maybe a little bit um is it to demonstrate different parents uh any adolescents gonna love to do that confuse any of us north of 40 mayhaps get a little psychological elbow room uh-huh and create some social change or all of the above you know I grew up in an era where there were newspapers and in the newspapers there was universal use of masculine pronouns and there was racist language where only the people who are not white were had their race identified but those norms have changed and as we see with Merriam-Webster terminology is changing so I invite you to honor when people tell you they go by they them pronouns so I'm going to talk about a little data in fact that slide I had earlier about the risks of family rejection they're from this us trans survey which is available at this website and this survey involved over 27 000 adults in the us 18 and up into their 80s and a really important thing again as I work with young people is to make sure people know that there is a misconception that all trans people know by age three four five that they're trans and that's simply not the case these adults reported this range of ages when they knew that they were transgender or that their gender identity wasn't matching what they were told they were even if maybe they didn't have the word now what's really interesting to me and is really important medically speaking and with parents is we see this huge jump at age 11 to 15 whereas only a quarter of kids figured it out before age 10 28 percent get it in the 11 to 15 age range what's happening then puberty and the increase of sex segregated activities locker rooms school activities and gender role expectations get more sex segregated too and then we get another jump of 29 percent who figured out in the age 16 to 20 because they're recognizing oh I maybe even I tried but my gender is not fitting me what is expected of me and then there's the rest of us who are the late to the party figure it out people over age 20 I talked briefly about education because again so many of these folks are figuring out when they're young now over three fourths of people who are trans or out as trans indicated they were mistreated or assaulted in the age grades k through 12 so what is that what does that look like it means they were called the wrong name the wrong pronoun had to use the wrong restroom or locker room were uh ostracized made fun of had to wear the wrong uniform and that ostracism and ridicule can be by teachers staff as well as students they also have been not only verbally assaulted but perhaps physically and even sexually assaulted I've worked with some of these young people who it felt like going to school was like going to a war zone so it's not surprising that 17 percent of them leave school as a result now this is much better in the college years only an almost a fourth report mistreatment but still it's happening so it's important to recognize that what do you think the impact of leaving school is higher unemployment rates because you have fewer job skills fewer credentials so as a result fewer people own homes people are going maybe into blue collar jobs unskilled jobs where they get more abuse people of color were often faring worse again this is from the U.S. Trans Survey many more people twice the rate of the U.S. average living in poverty and again a number going into underground economies like sex work drug sales and other criminalized behavior so I want to touch on a topic that's really relevant relevant here and that is intersectional a term coined in 1991 by Kimberly Kimberly Crenshaw excuse me and she was highlighting that we need to understand that when people of any minority group are encountering the world as we know it they have less advantage less privilege less power accessing the resources you know part of my being able to have such a successful transition is that I have education and I am Caucasian appearing and now I blend in very easily as a male but when people are not straight white male assumed cisgender they are going to be having fewer and fewer privileges women get paid less on the dollar women of color get paid even less on the dollar to to men so these are examples if you look at who's sitting on the boards of corporations and in our legislative houses we see the access to power decreases and if you put in more minority statuses they aren't just additive it's almost multiplicative and it's hard to to exactly come up with an algorithm but all these things can make it harder and harder to get resources and to be treated fairly in culture our our country so if we look at certain social conditions what we see is again looking at some of that population data the U.S. population in general at the time of the survey 14 percent were living in poverty all respondents in the U.S. trans survey twice as many in poverty more in black respondents and even more Latinx respondents we see higher unemployment rates we see higher rates of hiv infection and even look at black trans women they've got the highest rates of hiv infection this is the result of intersectionality because these women often don't blend as well they have fewer educational advantages and they maybe have been more bullied in school and these are all because they have experienced external stressors these external stressors come from what we call macroaggressions and microaggressions so what is a macroaggression structural aggressions in institutions and systems so for example during the prior administration in Washington DC it was instituted that there was a ban on transgender people serving in the military that is codified discrimination to say that i am not qualified to serve in the military just because i'm transgender other ways we might see this are institutions like HR policies or in insurance policies that don't cover transgender benefits but they cover cover other benefits or the same medications may be covered for treating some conditions but if it's used for a trans condition then it's not paid for that's discrimination microaggressions come with being enacted by individuals or small groups and this is a term used by Chester Pierce who was on the faculty uh Harvard as a psychiatrist and he observed that the white students were often making denigrating comments and behaviors toward their black classmates without even recognizing it and so he called these microaggressions it could be over or covert unintentional or unintentional and they aren't named micro because they're small but because it was an individual doing it and i'll tell you i have been in circumstances where people have not known that i was transgender and have said negative things about trans people so that was a microaggression that i experienced and it affects my stress level going out in the world that's just a small example i could give you stories and stories after this i can also tell you that since i am perceived as a straight white man who is a soon to be cisgender i encounter so many more microaggressions against women against people of color and against lgbt folks because people think that i have a certain history and belief system and i now have this privilege that i didn't ask for but i try to use it for good and to debunk people's assumptions uh when they express such microaggressions other places we see those microaggressions are going to be in public settings for this is again trans folks indicated in the past year on the us trans survey that when they were out or perceived as trans perhaps for example their identification didn't match their presentation they would be um verbally harassed in public denied treatment verbally or sexually or physically assaulted similarly people have those treatments in restrooms and so what did they do they avoid the restrooms i want to tell you 60 percent almost said they avoided the restrooms a third of them did that by reducing their food and drink intake think about that i don't know about you but i don't work so well when i'm hungry or thirsty i think about children trying to learn when they're trying to avoid the restrooms and by not eating and not drinking eight percent reported having medical complications as a result uti's urinary tract infections kidney infections a mother told me about having to take her child to the emergency room because the child became so constipated their bowels were impacted which is a condition that can be life-threatening sadly in a lot of faith communities people encounter discrimination as well or people just leave their faith communities because they expect to get rejected and sadly only about 40 found a more welcoming faith community so what does this do this creates what we call minority stress which takes a toll on our mental health and you know that slide on suicide attempts the the small blue dots here represent the the average american population five percent in the past month indicated having serious psychological distress but in the u.s. trans serving 39 percent again almost 4.5 percent indicated suicide attempt in the u.s. population at large but in the trans population 40 percent which is the halfway point of the 33 percent who are accepted by family versus a 50 percent who are rejected by their families this 40 percent number is consistent across a lot of studies so what can you do for your trans employees or people seeking information your co-workers ask and use the names and pronouns people want to go by and even if it takes a little effort you can develop a new part in your brain i promise you that you're all smart folks you can develop that muscle in your brain to call them the name and pronoun they use however it's also where to ask them who knows like if they're coming out to you like you're their boss or co-worker you ask who do they want you to use this in front of or who do they not want you to use in front of and sometimes you're the first person they've told and so you want to be careful now another thing you can do is make sure not to ask about surgeries or anything beyond your level of intimacy with a person right if you're not going to be their doctor or dating them you don't really need to know about all their medical treatments if you're their boss and they need time off they can tell you when they're going to need time off for a surgical procedure but you don't need to ask about a lot of stuff you can ask how you can help that's always useful and a really supportive comment is thank you for telling me that's a really neutral comment and it shows respect for somebody confiding in you or coming out to you which is an act of courage i'm telling you and trust and then some people will be offended if you say i could never tell you were born blah blah blah you know i don't look like a female i don't take offense at it but i know people who are offended by it i will also tell you there are people now who are treated with hormones so early that they blend in so well you would have no idea that they were transgender and saying this is going to potentially be insulting and it may come to light if you hire them but then they have a gender marker that doesn't match that again is because in some states there is not a provision for changing your gender marker leave so if somebody's gender marker doesn't match please be very cautious about ever using that phrase i can never tell all right so a little bit more your organization can consider doing some things like looking at your language like if you're having activities or addressing the crowd if you say ladies and gentlemen that's very binary very heteronormative old school everybody is very inclusive or down in the south here we say y'all and that's a really handy um all inclusive term look at your bathrooms are there signs are they inclusive are they all gendered you have some family and all gender restrooms perhaps allowing space for or inviting a support group for transgender diverse folks or sofas significant others friends family and allies that's the trans pride flag there by the way all right your organization can also look at your forms like your electronic records and any paperwork you may have if you still have old school paperwork do you use male and female do you only use those because if you do that's going to be uninviting versus if you include trans woman trans man non-binary or additional not other but addition look at activities do you need to divide activities up again if you're a school librarian of any type university librarian or do we not need to divide things or can they be divided up based on day of the year you were born or month of the year you were born odds and evils look at the insurance policies non-discrimination with classes where you are where you're working so as librarians you're going to be looking in all sorts of journals it's amazing how many are you know psychiatry psychology social work to cover all of these different areas because it's such a multifaceted field for mental health medical surgical hormonal primary health care reproductive issues policies etc so you're going to have journals you're going to be dealing with in all of these areas i want to tell you briefly got just a few more slides here then i'll stick around a little late for q and a i'm sorry i'm running a little late just got so much i like to share with y'all but w path is the world professional association for transgender health again and we have guidelines from 2011 standards care version seven ssc seven currently being updated to version eight and there are also some models of informed consent that are used for starting hormones but most medical practices insurance companies courts of law will use the standards of care from w path so one other set of resources i'm going to point you to w path dot org is indodashsociety.org the indocrine society put out its latest guidelines in 2017 but i tell you all these mainstream health care professional associations also have guidelines AMA the APA AAP and ACAP as well as there being conferences for lay folks around the globe and around the states like gender spectrum and these are very useful for them to learn about policies about health care about getting support for their gender questions and their gender journeys so i want to thank you for your attention and sorry i'm running a little ran a little late i know it's right at three i will stick around for some questions and i'm going to stop my screen share so that norah can put back up the slide she had and can say you know y'all can toss me any questions you like at this point okay that sounds good thank you so so much i you know you you were able to see the chat but i don't think there was a dry i in the house we're just we're very very grateful and and honored to have you taking the time to speak with us today um i don't think i saw any direct questions i do see a hand raised um michael michael show them back i sent you a private message um so if you want to put your question in the chat or oh i see okay they lowered their hand um but okay so i do see one question if you forget someone's pronouns is it safest to use they in the moment uh i think that's a night that's a nice question that is a good default safe uh step to take yes that's probably a safe step to take you know and in private you can just say i'm sorry i forgot i but i didn't want to out you can you please tell me by the way if you're ever in a social situation and you drop a pronoun which happens to all of us uh then you just say i'm sorry and correct yourself and say he and then continue with your story or your whatever you're engaged in thank you thanks for that um i please feel free to put your your questions in the chat okay we have another one i have a question they is or they are um so uh i i'll i'll use it like this um i saw a kid earlier today and they told me they want to have their name respected and i refer to them this way they are you know not wanting to be called their old name they're and their old pronoun they are wanting to be called their current gender and their gender identification so i hope that helps thank you yeah fred let us know if you and i think there had been a question about resources also especially for young people a really good book for parents and for um clinicians and allies for young people they're two really good ones one is the transgender child and um then later by brill brill and pepper and another book by i think stefanie brill wrote it and i can't remember her co-author's name um the next one was the transgender team so uh but there are a lot of really good books and and i tell you if you um i don't know about how your medical library systems work but i know on uh major bookselling sites that if you enter a couple of those things they will then offer you a whole bunch of others to look into thank you it was brill and pepper the transgender child yeah i'm i found an amazon link to it i was trying to avoid using an amazon link but i avoided using the word so i appreciate uh there's the amazon link i uh i didn't have time to look up the oc lc your world cat um but yeah um okay no you don't say they is you say they are even when you're talking about a singular person okay yeah and that's i think that's the the follow-up to a fresh question um i i put a link earlier i just got a notice i got a ping that the library of congress today about four hours ago they just passed the brand new collections policy statements for lgbt qia plus uh studies as well as women's and gender studies so you know if if you're working in the library and information setting um and you need you know support you want to start creating a collections policy that's an official resource that you can you can go to so that's history in the making uh you know from the library of congress as well as us uh at the national library of medicine so thank you again we can't thank you enough for for being a part of this historical moment as well you know we have a lot that we are are facing and going up against with different states um you know denying access trying to deny access to people's very personal medical care um with these bills that they're trying to pass so i'm really glad that we have experts like you who are representative of the populations that that we are supporting and so i take this as a sign of hope that you know we will continue to progress forward yes i'm i'm optimistic i think that it may take a while but as more people get to know trans people you know i think part of what changed somebody's people's minds about same-sex marriage and gay and lesbian and bisexual rights is that so many people came out to them and they got to know some examples or get to know them in their personal lives and so i'm hoping that by telling my story and now people can be supportive of people come out to them and can get that you know we just want to be productive members of society and have relationships and lives that are meaningful just like anybody else does and with support and opportunities we're able to do so and i appreciate the opportunity to be here with y'all today