0:00:00.880,0:00:03.576
About six months[br]into my career as a therapist,

0:00:03.600,0:00:06.896
I was working at a drug[br]and alcohol rehab facility.

0:00:06.920,0:00:10.496
I got a call from one of the nurses[br]down at the detox unit.

0:00:10.520,0:00:13.376
She asked me to come down[br]and assess one of the new patients

0:00:13.400,0:00:15.256
that had arrived earlier in the day.

0:00:15.280,0:00:18.696
So I went down to the unit[br]and had the pleasure of meeting Anne.

0:00:18.720,0:00:22.176
Anne's a transgender female,[br]and as her and I started talking,

0:00:22.200,0:00:25.216
she was sharing with me[br]about what brought her into treatment,

0:00:25.240,0:00:27.976
but I could hear this fear in her voice,

0:00:28.000,0:00:29.896
and I could see this worry in her eyes,

0:00:29.920,0:00:32.896
and she began to tell me[br]that she didn't fear coming into rehab

0:00:32.920,0:00:35.296
and having to give up drugs and alcohol.

0:00:35.320,0:00:38.336
Her fear was that the doctors[br]that were going to be treating her

0:00:38.360,0:00:40.240
would not treat her as her female self.

0:00:41.360,0:00:45.176
She then told me about this ongoing pain[br]that she has experienced her whole life

0:00:45.200,0:00:47.656
of being assigned male[br]but knowing she's female.

0:00:47.680,0:00:50.976
And what she meant by that is,[br]when she was born,

0:00:51.000,0:00:53.136
the doctor held her up to her parents

0:00:53.160,0:00:55.056
and based on her genitalia said,

0:00:55.080,0:00:56.816
"It's a boy."

0:00:56.840,0:00:58.480
She always knew she wasn't a boy.

0:00:59.920,0:01:02.536
Many years passed and the feelings[br]that she was feeling

0:01:02.560,0:01:04.575
and holding all this in grew and grew,

0:01:04.599,0:01:06.896
and she knew she had[br]to come out to her family.

0:01:06.920,0:01:09.576
And when she did,[br]it didn't go over so well.

0:01:09.600,0:01:12.136
Her parents said,[br]"Absolutely not. You're not a girl.

0:01:12.160,0:01:15.416
This is not how we raised you.[br]We don't know what you're thinking.

0:01:15.440,0:01:16.640
Get out."

0:01:17.560,0:01:21.256
So Anne then found herself on the streets[br]and in and out of homeless shelters,

0:01:21.280,0:01:24.456
and it's here where[br]she started using drugs and alcohol

0:01:24.480,0:01:26.480
to numb this pain she felt inside.

0:01:27.720,0:01:31.216
She told me about her journey of being[br]in and out of hospitals and rehabs

0:01:31.240,0:01:32.496
trying to get sober,

0:01:32.520,0:01:35.456
and when she did, the health care[br]providers and doctors

0:01:35.480,0:01:38.536
wouldn't use the correct[br]female name or pronouns.

0:01:38.560,0:01:39.920
This caused her pain.

0:01:41.120,0:01:43.536
You see, when I was studying[br]to become a therapist,

0:01:43.560,0:01:46.120
I wasn't taught how to work[br]with transgender patients.

0:01:47.120,0:01:50.040
I had no idea these would be[br]the patients I'd be working with.

0:01:50.800,0:01:54.096
But the more I worked with Anne[br]and other patients like Anne,

0:01:54.120,0:01:56.416
I began to see my mission evolve,

0:01:56.440,0:01:59.496
and that was to make sure[br]that the transgender community

0:01:59.520,0:02:01.280
got their health care needs met.

0:02:02.320,0:02:06.456
The more I looked into this,[br]I saw how this very real fear

0:02:06.480,0:02:10.256
of violence, discrimination[br]and this lack of acceptance

0:02:10.280,0:02:14.416
caused so many of these patients[br]to turn to alcohol and drugs.

0:02:14.440,0:02:17.016
And I also heard these horror stories

0:02:17.040,0:02:19.976
of when these patients[br]were seeking medical care

0:02:20.000,0:02:21.416
and how they were treated,

0:02:21.440,0:02:23.774
and how a lot of their[br]medical needs were ignored.

0:02:25.480,0:02:27.536
Now let me tell you about Leah.

0:02:27.560,0:02:30.736
I had the pleasure[br]of meeting Leah a few years back.

0:02:30.760,0:02:34.040
She's a female and she has[br]a wife and a child.

0:02:34.920,0:02:37.856
See, Leah was also assigned male at birth

0:02:37.880,0:02:41.696
and she knew since she was a young child[br]that she was not a male,

0:02:41.720,0:02:42.920
that she was a female.

0:02:43.720,0:02:46.856
She hid it from herself[br]and from everyone she knew,

0:02:46.880,0:02:49.496
especially from her wife,[br]until the age of 50.

0:02:49.520,0:02:50.936
She couldn't take it anymore.

0:02:50.960,0:02:53.056
She was like, I can't[br]keep living like this.

0:02:53.080,0:02:54.296
I gotta get honest.

0:02:54.320,0:02:56.976
She was extremely scared to tell her wife.

0:02:57.000,0:02:58.256
What if her wife said,

0:02:58.280,0:03:01.000
"This is unacceptable,[br]I want a divorce, get out"?

0:03:02.080,0:03:05.136
To her surprise, her wife was accepting.

0:03:05.160,0:03:08.176
She said, "I love you[br]regardless of who you are.

0:03:08.200,0:03:10.080
I want to help you in every way I can."

0:03:10.960,0:03:12.296
So she talked with her wife,

0:03:12.320,0:03:16.496
and she made the decision[br]that she wanted to medically transition,

0:03:16.520,0:03:19.976
and she was interested in being[br]assessed for hormone replacement therapy,

0:03:20.000,0:03:21.280
otherwise known as HRT.

0:03:22.320,0:03:24.360
So she made an appointment[br]with her doctor.

0:03:25.560,0:03:28.136
She arrived on the day[br]of her appointment early.

0:03:28.160,0:03:29.776
She filled out all the paperwork,

0:03:29.800,0:03:32.400
put the name correctly down there[br]and waited patiently.

0:03:34.120,0:03:37.560
A little bit of time passed and a nurse[br]called her back to the exam room.

0:03:38.400,0:03:40.976
When she got back there,[br]she took a deep breath,

0:03:41.000,0:03:42.880
and the doctor and the nurse walked in.

0:03:44.160,0:03:47.040
She extended her hand to the doctor[br]and said, "Hi, I'm Leah."

0:03:47.840,0:03:51.136
The doctor looked at her,[br]didn't shake her hand and said,

0:03:51.160,0:03:52.360
"Why are you here?"

0:03:53.600,0:03:55.520
She took another deep breath and said,

0:03:57.040,0:03:58.976
"Well, I'm a transgender female.

0:03:59.000,0:04:01.696
I've known this my whole life,[br]I've hid it from everyone,

0:04:01.720,0:04:03.016
but I can't do it anymore.

0:04:03.040,0:04:05.816
My wife's supportive,[br]I can financially afford it,

0:04:05.840,0:04:07.336
I've got to make these changes.

0:04:07.360,0:04:10.880
Please consider me,[br]and let's evaluate me for HRT."

0:04:11.600,0:04:13.736
The doctor said,[br]"We can't do anything today.

0:04:13.760,0:04:15.320
You need to go get an HIV test."

0:04:17.160,0:04:18.360
She couldn't believe it.

0:04:19.160,0:04:20.375
She was furious.

0:04:20.399,0:04:22.200
She was angry. She was disappointed.

0:04:23.040,0:04:26.896
If her doctor treated her this way,[br]how would the rest of the world treat her?

0:04:26.920,0:04:29.296
First, he wouldn't shake her hand,

0:04:29.320,0:04:32.456
and second, when he heard[br]she was transgender,

0:04:32.480,0:04:35.776
all he cared about was getting[br]an HIV test and ending the appointment.

0:04:35.800,0:04:37.840
He didn't even ask her[br]any other questions.

0:04:38.520,0:04:41.256
See, I can understand[br]where Leah's coming from,

0:04:41.280,0:04:43.856
because the years that I've worked[br]with the community,

0:04:43.880,0:04:47.456
I hear myths every single day[br]that aren't true at all.

0:04:47.480,0:04:49.416
A couple of those are:

0:04:49.440,0:04:54.056
every transgender person wants[br]to transition with medication or surgery;

0:04:54.080,0:04:56.976
transgender people are mentally ill,[br]this is a disorder;

0:04:57.000,0:04:59.480
and: these people[br]aren't real men and women.

0:05:00.480,0:05:02.200
These are all myths and untrue.

0:05:03.240,0:05:06.256
As this community expands and grows older,

0:05:06.280,0:05:09.416
it is imperative that all[br]health care providers be trained

0:05:09.440,0:05:12.136
on how to take care[br]of their health care needs.

0:05:12.160,0:05:14.656
Back in 2015, a survey was done

0:05:14.680,0:05:18.216
and found that 72 percent[br]of health care providers

0:05:18.240,0:05:20.656
did not feel well-informed

0:05:20.680,0:05:23.480
on the health care needs[br]of the LGBT community.

0:05:25.120,0:05:27.640
There's a huge gap[br]in the education and training.

0:05:28.880,0:05:30.336
Today, in this talk,

0:05:30.360,0:05:33.536
I want to offer a new way of thinking[br]for three groups of people:

0:05:33.560,0:05:37.856
doctors, the transgender community[br]and, well, the rest of us.

0:05:37.880,0:05:40.616
But before we do, I want to cover[br]a couple of definitions

0:05:40.640,0:05:44.496
that's going to help you wrap your head[br]around gender identity a little bit more.

0:05:44.520,0:05:48.176
So I hope you've got your paper and pen.[br]Get ready to take some notes.

0:05:48.200,0:05:51.496
So let's start out[br]with this idea of a binary system.

0:05:51.520,0:05:52.776
And what this means is,

0:05:52.800,0:05:55.736
before, we always thought[br]there was only two, male and female.

0:05:55.760,0:05:57.416
Get it? Binary? Right?

0:05:57.440,0:06:00.000
So we've come to find out[br]that this isn't true.

0:06:00.680,0:06:03.456
Gender identity is a spectrum

0:06:03.480,0:06:05.416
with maleness on one side

0:06:05.440,0:06:07.816
and femaleness over here[br]on the other side.

0:06:07.840,0:06:10.296
This spectrum of identities

0:06:10.320,0:06:13.696
include identities such as[br]gender-nonconforming,

0:06:13.720,0:06:15.016
gender-affirming,

0:06:15.040,0:06:16.336
gender-nonbinary,

0:06:16.360,0:06:18.616
two-spirited, three-spirited,

0:06:18.640,0:06:20.360
as well as people that are intersex.

0:06:21.120,0:06:23.976
The term transgender is this umbrella term

0:06:24.000,0:06:27.160
that encompasses all these[br]different types of identities.

0:06:27.880,0:06:30.696
But for today's talk, I want you[br]to think about transgender

0:06:30.720,0:06:34.256
as someone who is assigned[br]a sex at birth that doesn't match

0:06:34.280,0:06:37.136
with who they are as a person[br]and their sense of self.

0:06:37.160,0:06:39.416
Now, this is very different[br]than biological sex.

0:06:39.440,0:06:41.816
So gender identity is sense of self.

0:06:41.840,0:06:45.136
So think of it as[br]what's between your ears:

0:06:45.160,0:06:47.016
sense of self, who you are.

0:06:47.040,0:06:49.776
This is very different[br]than biological sex, right?

0:06:49.800,0:06:51.736
Hormones, genitalia, chromosomes:

0:06:51.760,0:06:53.400
that's what's between our legs.

0:06:55.040,0:06:58.776
Now, you may be thinking, "Dr. Kristie,[br]I have never questioned who I am.

0:06:58.800,0:07:01.496
I know I'm a man, or I know I'm a woman."

0:07:01.520,0:07:03.120
I get it. You know who you are.

0:07:04.200,0:07:06.536
This is how many[br]transgender individuals feel.

0:07:06.560,0:07:08.216
They just know who they are

0:07:08.240,0:07:10.320
with that same conviction.

0:07:12.320,0:07:15.776
It's important to know that there[br]are many different types of identities,

0:07:15.800,0:07:18.816
and I identify as a cisgender female.

0:07:18.840,0:07:22.016
Now, for all y'all out there[br]that like to know how to spell things,

0:07:22.040,0:07:24.736
cis is spelled "c-i-s."

0:07:24.760,0:07:27.696
It's the Latin term[br]for "on the same side of."

0:07:27.720,0:07:29.176
When I was born,

0:07:29.200,0:07:31.296
the doctor held me up[br]to my parents and said,

0:07:31.320,0:07:32.576
"It's a girl."

0:07:32.600,0:07:34.656
All this, based on my genitalia.

0:07:34.680,0:07:37.456
Even though I grew up[br]in a small farm town in Georgia,

0:07:37.480,0:07:40.696
very much a tomboy,

0:07:40.720,0:07:42.736
I never questioned that I was a female.

0:07:42.760,0:07:44.296
I've always known I was a girl,

0:07:44.320,0:07:46.736
regardless of how I was as a kid.

0:07:46.760,0:07:49.576
Now, this is very different[br]than someone who's transgender.

0:07:49.600,0:07:53.736
Now, trans is a Latin term[br]for "on the other side of" --

0:07:53.760,0:07:55.616
think about transcontinental airlines,

0:07:55.640,0:07:57.496
across, on the other side of --

0:07:57.520,0:08:00.536
someone that's assigned a sex at birth

0:08:00.560,0:08:03.000
and they identify[br]on the other side of the spectrum.

0:08:03.680,0:08:07.696
A transgender male is someone[br]who was assigned female at birth,

0:08:07.720,0:08:11.056
but their sense of self,[br]who they are, how they live their life,

0:08:11.080,0:08:12.616
is as a male.

0:08:12.640,0:08:14.696
And the opposite is, as we talked earlier,

0:08:14.720,0:08:17.536
a transgender female,[br]someone that's assigned male at birth

0:08:17.560,0:08:20.616
but lives their live[br]and sense of self as a female.

0:08:20.640,0:08:22.456
It's also important to point out here

0:08:22.480,0:08:25.496
that not everyone[br]that has a nonbinary identity

0:08:25.520,0:08:27.440
identifies with the term "transgender."

0:08:28.680,0:08:32.256
Just so nobody gets confused,[br]I want to point out sexual identity,

0:08:32.280,0:08:33.816
or orientation.

0:08:33.840,0:08:36.576
That is simply who we're attracted to,

0:08:36.600,0:08:39.480
physically, emotionally,[br]sexually, spiritually.

0:08:40.640,0:08:42.736
It's got nothing to do[br]with gender identity.

0:08:42.760,0:08:45.096
So just for a quick recap,[br]before we continue on:

0:08:45.120,0:08:46.816
gender identity between the ears,

0:08:46.840,0:08:50.016
biological sex, just think[br]of it between your legs,

0:08:50.040,0:08:52.856
and then sexual identity,[br]well, sometimes we use our heart,

0:08:52.880,0:08:54.296
but it's here.

0:08:54.320,0:08:57.120
Three very different identity spectrums.

0:08:59.000,0:09:01.296
Now, the average medical student

0:09:01.320,0:09:06.616
spends about five hours learning[br]about the LGBT health-related needs

0:09:06.640,0:09:08.456
while they're in medical school.

0:09:08.480,0:09:12.296
Now, this is despite us knowing[br]that there are unique health risks

0:09:12.320,0:09:13.520
to this community.

0:09:15.320,0:09:19.096
And there's an estimated[br]10 million American adults

0:09:19.120,0:09:20.520
that identify as LGBT.

0:09:22.000,0:09:24.416
Most doctors that work[br]with transgender patients,

0:09:24.440,0:09:26.480
they learn trial by fire.

0:09:27.280,0:09:29.496
That means they figure it out[br]as they go along,

0:09:29.520,0:09:31.816
or the patient ends up spending their time

0:09:31.840,0:09:34.280
trying to teach the doctor[br]how to take care of them.

0:09:35.200,0:09:38.696
Many doctors don't feel comfortable[br]asking about gender identities.

0:09:38.720,0:09:42.016
Some don't feel like it's relevant at all[br]to their medical care

0:09:42.040,0:09:44.600
and others just don't want[br]to say the wrong thing.

0:09:46.400,0:09:48.816
Many doctors who say[br]something inappropriate

0:09:48.840,0:09:50.336
or they say something negative,

0:09:50.360,0:09:53.936
they may not be coming[br]from a malicious or mean place,

0:09:53.960,0:09:57.776
they may have never been trained[br]on how to care for these individuals.

0:09:57.800,0:10:00.560
But this can't be accepted[br]as a norm anymore either.

0:10:02.080,0:10:05.496
So what happens to a transgender male --

0:10:05.520,0:10:08.576
for a quick recap, that's someone[br]who is assigned female at birth

0:10:08.600,0:10:10.216
but lives their life as a male --

0:10:10.240,0:10:14.720
what happens when this transgender male[br]goes for their yearly gynecological visit?

0:10:16.440,0:10:19.216
How that doctor treats that patient

0:10:19.240,0:10:21.496
will set the whole tone for the office.

0:10:21.520,0:10:26.096
If that doctor treats that male[br]with the correct pronouns, correct name,

0:10:26.120,0:10:28.336
gives dignity and respect,

0:10:28.360,0:10:30.960
it's highly likely[br]that the rest of the staff will too.

0:10:32.080,0:10:34.536
So that's a little bit[br]about my thoughts on doctors,

0:10:34.560,0:10:37.256
and now let's move on[br]to the transgender community.

0:10:37.280,0:10:39.536
I'm here talking about fear,

0:10:39.560,0:10:42.696
but y'all know who[br]is really fearful, right?

0:10:42.720,0:10:45.096
It's the transgender community.

0:10:45.120,0:10:46.936
Earlier I shared the story about Anne

0:10:46.960,0:10:49.456
and how she was so worried[br]about going into treatment

0:10:49.480,0:10:51.536
and not being respected[br]as her female self,

0:10:51.560,0:10:54.496
and then Leah who was scared[br]about how her doctor would react,

0:10:54.500,0:10:56.576
and the second[br]that he didn't shake her hand

0:10:56.600,0:10:59.200
and ordered that HIV test,[br]her fears came true.

0:11:00.680,0:11:03.336
The transgender community[br]needs to be empowered

0:11:03.360,0:11:06.056
to speak up for their health care needs.

0:11:06.080,0:11:10.200
The days of remaining silent and taking[br]whatever treatment you can get are over.

0:11:11.000,0:11:13.856
If you don't speak up[br]for your health care needs,

0:11:13.880,0:11:15.440
no one's going to do it for you.

0:11:17.080,0:11:18.480
So what about the rest of us?

0:11:20.040,0:11:22.936
A lot of y'all, maybe in the next week[br]or a couple of months,

0:11:22.960,0:11:25.216
are going to have[br]a doctor's appointment, right?

0:11:25.240,0:11:27.576
So let's say you go[br]to your doctor's appointment

0:11:27.600,0:11:28.936
and when it's over,

0:11:28.960,0:11:31.760
you feel worse than you did[br]when you got there.

0:11:32.800,0:11:35.176
What if you felt dismissed by the doctor,

0:11:35.200,0:11:36.816
that they ignored your needs,

0:11:36.840,0:11:38.920
or you even felt judged?

0:11:40.360,0:11:44.936
That's what happens for many[br]of the 1.4 million transgender adults

0:11:44.960,0:11:46.216
here in the US

0:11:46.240,0:11:48.400
if they're lucky enough[br]to get an appointment.

0:11:49.880,0:11:52.856
Now, you may be thinking,[br]"Why is this important to me?

0:11:52.880,0:11:55.776
I'm not transgender.[br]I don't know anybody that's transgender.

0:11:55.800,0:11:57.040
Why should I even care?"

0:11:58.080,0:11:59.656
Think of it this way.

0:11:59.680,0:12:02.296
A transgender individual is human,

0:12:02.320,0:12:03.520
just like you and me.

0:12:04.480,0:12:07.456
They deserve competent[br]and trained health care providers,

0:12:07.480,0:12:08.720
just like you and me.

0:12:10.120,0:12:12.616
So let me ask, if you don't[br]mind raising your hand:

0:12:12.640,0:12:16.376
Do you know or have you met[br]anyone who is transgender,

0:12:16.400,0:12:20.736
gender-nonconforming, agender, intersex,[br]two-spirited, three-spirited?

0:12:20.760,0:12:23.080
Thank y'all so much. Lovely. Thank y'all.

0:12:23.840,0:12:26.336
Every one of y'all[br]who did not raise your hand,

0:12:26.360,0:12:28.656
in the very near future

0:12:28.680,0:12:30.416
you will get the opportunity to meet

0:12:30.440,0:12:34.136
someone that falls into one[br]of these identities, I guarantee it.

0:12:34.160,0:12:36.640
The number of this[br]community is increasing.

0:12:37.480,0:12:40.280
That's not because it's a fad[br]or the new thing to do.

0:12:41.120,0:12:43.000
It's safer to come out.

0:12:43.680,0:12:46.656
There's more awareness.[br]There's more visibility.

0:12:46.680,0:12:49.896
There's more safety, so people[br]are speaking up about their true self

0:12:49.920,0:12:51.160
like never before.

0:12:52.160,0:12:56.136
That's why it's so important[br]that our health care system get on board

0:12:56.160,0:12:59.976
and make sure that our doctors[br]and health care providers are trained

0:13:00.000,0:13:03.256
to approach these patients[br]with dignity and respect,

0:13:03.280,0:13:05.200
just like we expect.

0:13:06.640,0:13:09.056
I remember being[br]in my 11th grade literature class,

0:13:09.080,0:13:11.256
with one of my favorite[br]teachers, Mr. McClain,

0:13:11.280,0:13:14.896
and he shared this quote by Heraclitus[br]that sticks with me to this day.

0:13:14.920,0:13:16.576
Y'all may have even heard it.

0:13:16.600,0:13:20.600
It's, "The only thing that is constant[br]is that things will change."

0:13:22.600,0:13:23.800
Familiar, right?

0:13:24.640,0:13:27.776
Every single one of us[br]face changes in our lives,

0:13:27.800,0:13:30.136
and often when we're faced[br]with these changes,

0:13:30.160,0:13:32.200
we've got some difficult[br]decisions to make.

0:13:33.320,0:13:36.936
Will we remain in fear, stay stuck

0:13:36.960,0:13:38.616
and not grow?

0:13:38.640,0:13:43.016
Or, will we face fear with bravery,

0:13:43.040,0:13:45.600
evolve, take the opportunity to grow?

0:13:47.000,0:13:49.856
Every one of us face new things.

0:13:49.880,0:13:51.080
What will you do?

0:13:51.920,0:13:54.176
Will you remain in fear,

0:13:54.200,0:13:56.080
or will you grow?

0:13:57.040,0:14:00.696
I invite each of you, doctors,[br]the transgender community

0:14:00.720,0:14:02.056
and you and I,

0:14:02.080,0:14:03.776
to face fear together

0:14:03.800,0:14:06.536
as we walk into this brave new world.

0:14:06.560,0:14:07.776
Thank you.

0:14:07.800,0:14:12.200
(Applause)