TMCC Campus Conversations – Transgender

Thank you all for coming. We really appreciate it We’re so glad to see such a big group come here and learn more about transgender issues We have Kristen Aaquist from the Transgender Allies Group here in Reno They have a variety of events. Some of them are at our center and you can find out more information by going to their website at That;s very easy to remember, so she is going to go through a presentation with you and also give you plenty of opportunities to ask questions, to learn more We’ve also provided some surveys and we would be glad if you would fill those out so that we would have an idea about future programming that you would enjoy Thank you for coming. We hope that you enjoy the presentation and most importantly that you learn a lot. Did I leave anything out? Hi, as she said I an Kristen with the Transgender Allies Group. We are based here in Reno This presentation will take about an hour. I do ask that you hold your questions until the end We are going to answer a lot of questions that you probably have as I go through the presentation If you hold your questions until the end it keeps the flow going and makes sure everyone is following a little bit better and then at the end we’ll give you plenty of time to ask questions Do keep in mind while you are listening to the presentation that this is a safe place to ask questions I’m not going to bite your head off. Nobody’s going to attack you for it I’d rather you ask me than a random person you meet on the street later So if you do have a question, please feel free to ask at the end This presentation is going to cover a lot of things There are a lot of issues within the transgender community to talk about. Both good and bad Hopefully at the end of it you will have a really solid understanding of what the transgender experience is about And you will have a idea of what we are up against and how to be a good ally to the community First and foremost, does everybody have a good idea of what transgender means at this point? If you don’t, don’t worry about it. You’ll have a really good idea at the end of this When you talk about gender identity, being transgender, it’s important to remember that a gender identity is a distinct part of an individual. Separate completely from your sexual orientation Transgender people are not a more extreme form of gay, in other words Even though that idea is out there Everyone has a sexual orientation, even if you are not attracted to anybody Everybody has a gender identity, even if that means you do not absolutely identify as male or female Your sexual orientation is who you are attracted to. Versus your gender identity is who you are You can kind of think about it as your sexual orientation is who you prefer to go to bed with your gender identity is who you go to bed as Remember neither of these things are subject to how people perceive you If you are bisexual and are in a relationship with somebody of the same sex that does not mean you are now gay In the same way if I am out in public, I used to present as male everywhere I went, I used to live as a male. That didn’t make me any less female than I am So public perception of these things are irrelevant to who you really are That’s important to keep in mind So what is gender. Gender is a concept created by a society for the roles and parts you play within that society. And that does vary from culture to culture across the world Your gender is how you fit into that So when you think about what it means to be a woman here in America that’s going to be a little bit different from what it means to be a woman in China or in South Africa. These things are going to vary according to that And because of that we do recognize that gender as a subject is a little be subjective versus it being an absolute objective concept Your gender identity if unique to you You are who you are and how you live your life is based on that Whether you identify as 100% male or female or somewhere in between, that is a unique part of you How you express it and how you live is, and should be, very mush up to you I notice a lot of people have a very similar picture on a flier in front of them This is the Genderbread Person, and this particular one on my presentation talks about four separate parts of an individual You gender identity is up here

Your sexual orientation, being what’s in your heart You biological sex being what’s between your legs And then your gender expression is kind of all over you All of these things, you will note, exist on a spectrum There is no either or, one or the other for any of these, including biological sex Which I will talk a little bit more about in a moment If you think about it, especially with gender expression, you can look around this room and you can see men and women who are dressed differently from one another That’s O.K. None of them are more male or female in their expression and anyone else It’s just different ways of showing the world who you are And the rest of these are the same way. You shouldn’t be worried about trying to fit into and imaginary binary that human society has created Normally when you hear LGBT that’s what you think of We put the extra letters up there to make a point We can tack on a lot more letters to what LGBT stands for Representing various different sexual orientations and gender identities The point of it is not that we’re looking for a way to define everybody The point is there are a lot of different way to describe a human being And each of these letters defines very little of what a human being is If I were to identify myself as heterosexual, well what does that mean? Am I attracted to men with a lot of muscles? Blonde men, men with beards You don’t know from that label. All you know is that would mean that I am attracted to people of the opposite sex And the same with the rest of these, it defines a very small part of what a human being is We are all human and we need to remember that If somebody comes up to you and they have identified in a way that you are not familiar with it’s not so important that you run off to a dictionary and look that word up What’s more important is what that word means to that individual And you can ask them that. Oh, you’re this? What does that mean to you? That will help you understand why they picked that label to represent themselves Cisgender is basically a words that means not transgender So for the transgender person, you are a gender other than what you were assigned at birth For the cisgender person, your gender is the same as what you were assigned at birth So when your doctor help you up and said, “You’ve got a boy.” and you identify as a boy and you are a boy, that means you are cisgender I gave the definition of transgender and it’s pretty broad Identifying as something other than what you were assigned at birth covers a lot of different people You’ll see a few of the different groups up there that we’ve put under the umbrella and they fit in one way When I am talking about transgender in reference to this presentation what I am actually referring to is this word right here, transexual We don’t like to use the word transexual It is for a couple of reasons. Transsexual sounds like heterosexual, homosexual, bisexual That would encourage people to think it is a sexual orientation, and it’s not The other thing is it has the word “sex” in it We don’t want people thinking about our body parts any more than they already do So when I say transgender in this presentation, or trans, I;m referring to specifically to the group of transsexuals. That’s people who will transition or who desire to transition from their birth sex to live as themselves What that means it unique to them, but that’s what that word means When I said biological sex exists on a spectrum, it does Not everybody is born XX female vagina or XY male penis These are things that for the most part fit most people However the Intersex Society pints out that intersex people are people who are born outside of that binary group, make up about the same percentage of the population as redheads We don’t know for sure how many people exist because some forms of intersex are chromosomal and may not generate any physical appearance changes That’s people who are X0, Y0, XXY, XYY, XXXY and so on Other forms are physical and can be seen at birth Most people have hear the term hermaphrodite While it is an outdated term it is something that people know That’s a person who is born with both sets of genitalia. Both male and female That’s one form of intersex Another person might be born with something more in between

We don’t hear a lot about it because nobody covers it in basic biology classes which most of us take in high school Ideally when you are born with XY chromosome while you are gestating in the uterus your body will be forming along male patterns Your testicles will descend and the genitalia will close up and form into male parts It doesn’t work that way for everybody Sometimes when the body gets pelted with androgens, it doesn’t respond to them It’s a condition known as Complete Androgen Insensitivity Syndrome The body is immune to androgen. It cannot close that up and form into male parts So you are going to have an XY individual, born physically female, will grow up identified as female by society When she hits puberty she’s going to develop along somewhat female lines, it tends to be less dramatic She won’t start her period because she has no uterus So they go to the doctor, they do test and they find out that you’re actually XY, but your body doesn’t respond to testosterone so you never developed male And the reverse can happen as well There is a man in his 40s in China, married and living his life normally He went to the hospital for abdominal pain and bleeding They diagnosed him as starting his period Because he had a fully functional female reproductive system inside but his body was responding to those androgens so he developed male in the uterus and was born and identified male by the doctor Now there is incomplete insensitivity in there where a person will be born with something somewhere in between male and female Historically doctors have talked to parents and generally done surgery to transform the person to a more physically female appearance, and the parents raised a girl Intersex people are starting to fight back now because most of these surgeries are not medically necessary There is no threat to being born intersex Unless there is very specific situations So what they recommend now is to let the child develop a gender identity and then do a surgery according to who that child really is So, hopefully going forward there will be more respectful than they have in the past because it doesn’t always work They don’t typically do chromosomal testing to even verify that way they just said it’s easier to make a girl, let’s make this a girl There is a case of a gentleman name David Rhymer. He was born male, he and his twin During a routine circumcision they lost a lot of his penis So they said to the parents, we can make him a girl. You can raise him as a girl and everything will be fine So they tried. They raised a girl And it didn’t quite fit right with him He knew something was off, and when he was a teenager he said this is what really happened, you were born a boy, you started living as a boy, ditched all his female clothes, changed his name, pursued transition Unfortunately because the female to male surgery isn’t as successful and since he was starting from and already surgically changed sex, it wasn’t good for him and he ended up committing suicide His situation along with some other intersex kids has shown you cannot force a gender on a child by raising them a certain way I’ll give you a moment to digest this. This is the definition of gender dysphoria Gender Dysphoria is the clinical diagnosis for a transgender person who feels distress and needs to transition It can take a lot of different forms. It can come in a lot of different strengths, if you will Some people experience very mild gender dysphoria Maybe for those people a name change or clothing change will make them feel more comfortable as who they are And that is fine for them, and they can live the rest of their lives with very minimal change with how society perceives them Other people experience more severe gender dysphoria to the point where they might need hormones and surgery so they can fix their body to live in it Because that;s what gender dysphoria is, is stress It creates distress for somebody to be in the wrong body, if you will Gender Dysphoria and Gender Non-Conformity are not the same thing Most of us grew knowing a Tom-Boy or a more feminine boy

and those people are who they are and that’s them showing who they are A Tom-Boy is not a Trans-Boy who is not quite reached that realization yet. That’s a Tom-Boy That’s a girl who just some more stereotypical masculine things And that’s fine. It’s not an indicator of future gender dysphoria and shouldn’t be treated as such It’s part of a gender variation which is very much natural to biology What we have found though is they do have a lot of things in common, and that is rejection from society People don’t like people who live outside of what they expect It happens more to natal males than natal females, but it is still present They get treated differently because society treats different people different Sometimes the gender non-conforming is a sign of future variant homosexuality or bisexuality or any of the other categories. Sometimes it is not Being transgender in and of itself is not a disorder. It’s not a mental illness It’s not any of those kinds of words anymore. They have recognized that and they are moving forward on that basis What can be associated with trans people however is things like depression and anxiety which are separate from this. Being transgender does not mean you experience gender dysphoria anymore If it has been treated and you are past it, or maybe it is so mild you do not have to deal with it Being trans is not in and of itself a disorder How do we measure how many trans people exist? Well you can ask However in a lot of areas in this country people don’t feel safe identifying who they are In a place like here it is probably much more likely that somebody is willing to say, “Yes, I am transgender.” In places where there are no protections and no safety nets, it’s going to be a lot more difficult We do know, based on the most recent information, about .5% or .58% of the population of the United States is transgender A little bit higher in Nevada That could be that people move here because it is safer or people are just more willing to identify themselves We do expect this number to go up over time as it become more acceptable in society to be yourself Some things not to say to the trans population Any words that mock somebody for not being 100%male or female Things like he-she, it, tranny. These are words you don’t say to another human being There are some groups that have popularized the use of the word tranny, like the drag population has tranny bars They are welcome to use that term to describe themselves if that is what they want Most transgender people do not appreciate being described this way Especially because the word tranny tends to be used while someone is being beaten Some unhelpful questions to think about If you were to meet somebody on campus for the first time you might say things like “What’s your name? What’s your major? What do you want to do for a career?” Most of us wouldn’t then go, “Are you circumcised? Are your breasts real? These kinds of questions happen to trans people I was in a bar with one of my friends and some guy came over and grabbed her and she said “If I stomp my foot twice come and get me” Within 30 seconds of him talking to her (stomp, stomp) I go over and grab her and we go to the dance floor and straight up he asked, “Do you still have a dick?” It doesn’t just happen to random, everyday trans people, this happened to Laverne Cox on national television Katie Couric asked her is she had surgery yet. In front of a national population That is a very, very personal question. Most people don’t expect to talk about out genitals with somebody we just met So that kind of question is something that unless you really know the person you really don’t want to talk about it Other things. You might think with the best of intentions, “Wow, I never would have known.” While that may be complimentary in your eyes it may be received as, I should have, but I can’t tell So that is something to think about as well. It’s been said to me before by somebody with the best of intentions

She didn’t think twice about it and I wasn’t offended by her, but it can be really off-putting to somebody “What’s your real name?” A lot of people, when they know the person is trans and they give them their name, “Well, O.K. but what were you born as?” Unless you are a medical professional who needs to use your name for insurance purposes or a police officer who needs you name for legal reason, you don’t need to know that It’s even like my little kid whose name is Billy Technically it is William, but nobody calls him that. Nobody ever has because that is not his name. His name is Billy. That’s what he goes by, that’s what he responds to You’ll probably get a dirty look if you call him William It’s a matter of respect. If somebody gives you their name, that’s what they want you to call them Some of the challenges that trans people face depression is a big one In a society that doesn’t accept us it is really hard coming to terms with trying to live as somebody that everyone is rejecting Prejudice and discrimination happens in some places more that others, but it happens It can make it difficult to find a job, to obtain routine medical care, let alone specific transgender medical care Even housing can be denied. Some people will say “I’m not going to rent to you.” “Why would I do that?” I am divorced because of my transition and my need to do so I lost three step-kids, and I’m one of the lucky ones. I didn’t lose the rest of my family If you are facing all those issues as they pile up more and more you start into depression because of feeling rejected in general and then you can’t find a job, you can’t find a home and then you can’t get a doctor to look at you Well, when reality is that bad some people turn to substances to get away for a while As you come back down from substances then, there is all of your problems again and since you are not dealing with them they are going to start piling up on you Some of us turn to self harm as a means of doing something that you can control in your life Our suicide attempt rate and suicide rate are still abysmal This is a result of a survey here in Northern Nevada in about 2013 These are barriers to receiving medical care, either real or something that patient sees themselves You will notice the LBGT population does have some issues with their concerns about seeing a doctor People living with HIV. A little bit more but not dramatically so Then you look at the trans population in the middle For a lot of it, like when you go to the doctor and the doctor refuses to use you name Refuses to treat you as who you are Their medical staff will deliberately find ways to say things to you they know are going to be hurtful These things happen I know somebody right here in Reno when she came out to her doctor and started showing up as herself he said “I don’t want other patients seeing you in my waiting room.” Another person, not her but it happened in the U.S she broke her arm and went into the hospital The doctor took one look at her, leaned out into the hallway and said, “Everybody come and look what I have in here.” So she packed up here broken arm and went to a different hospital The biggest thing for trans people when they go into the doctor is a lot of doctors never receive training on how to treat a trans person They just don’t know In previous years there would be a paragraph in a medical book during their years in medical school that talked about trans people, and that was it Now it is getting better. It’s getting a lot better in some areas The University of Nevada, Reno is doing medical outreach on the subject so doctors can get the training that they need They do have resources, but if you are a doctor and you don’t have a patient who has come forward to you and said, “I’m trans, I need your help transitioning.” they’re probably not going to seek out the training They just don’t have any need for it About 50% of us have had to sit down with our doctor and teach the doctor how to provide us medical care When we talk about a doctor refusing you help that is not something that is just a neutral act

It is something that is aggressive toward that person that creates unsafeness where there should be an area of safety AMA rules expressly prohibit this kind of discrimination but, that requires a trans person to have the courage to go forward and press this kind of complaint against their ethics board and who knows if they are just trying to get something treated they may go find another doctor More of the downsides of… of the things that happens during transition is that trans men tend to vanish into…..we call it stealth mode They are just living their lives because society doesn’t see them any differently than they see any other guy It is a lot easier for a trans man to disappear than it is for a trans woman So trans women end up being the ones that get studied We lack a lot of information specifically towards that trans men in this country Suicidal thought and attempts, depending on what statistics you look at, they’re bad Some put the minimum at around 42% – 46% If you talk about a person who is homeless, who has no family, has no job, you are probably looking at close to 69% that have attempted suicide Substance abuse is a big thing. An escape from reality HIV prevalence. If you have no job and no place to live A lot of trans women, particularly trans women of color resort to prostitution Sex work allows them to bring in money It is very unsafe. It leads to more substance abuse and exposure to HIV If you look at the number there, 56% of African American trans women have HIV The national statistics are, I believe, less than 5%. Probably way lower than that for the general population The source of depression, now that they are looking into why we are depressed, other than find out that we are they are finding it is the way the majority of society treats us The better we are treated in society, the less depression we have They found it particularly with trans youth If they are supported in school, supported at home and get to live as who they are, they experience the same levels of deprtession and only slightly elevated levels of anxiety over their peers If they are allowed to be themselves and are accepted at that they are just like anybody else, as far as depression and anxiety go If you take those sources of safety away they resort to substance abuse, sex for acceptance, homelessness, they are often kicked out Remember, the trans population of the United States is somewhere around .6%, that we know of, but we know that in large cities like Chicago, trans youth make up 18% of the homeless youth population Several of us get murdered, unfortunately, and it is a majority trans women of color Last year was another record. I think we hit 25, 26 trans women killed, a couple were trans men This year we are on target to beat that number, again Here’s a fun thing. Think about everything that you have in your life that has your name on it Or even your gender on it Anybody in here change their name due to marriage? So you know, you get to go around and change your drivers license you get to change your mortgage bill your insurance stuff. You go on and on with all these things but you tell that person, “I got married.” and the are excited for you It’s a little bit of a stretch when you are saying, “I know it says Robert, I need it to say Jenny.” And they go, “Wait, what?” Going through all these things, after about two years I finally got around to emailing Netflix back and saying, “You need to change my name of your records.” It took me two years to get around to it. I just wasn’t thinking about it Each time you do it there is a little bit more success You have another thing in your name identifying you as who you are and it just feels so much better Especially for adults, there are a lot things that have your name on them and a lot of companies have a lot of different policies on how to do that Hormones, one of the biggest part of transitioning is getting on hormones What that means if different for the men and the women For a trans man to get on hormone therapy, that is the introduction of testosterone

Testosterone tends to override estrogen very easily. It is a very strong hormone That will create masculinizing effects For the trans women, you first have to block testosterone or estrogen won’t really do much Once you get that introduced, then feminizing effects start to appear Not everybody wants hormones. Remember when I was talking about gender dyphoria not everybody feels the levels that transition requires them to undergo hormone therapy For those that do it is very important that they see an actual doctor or endocrinologist Somebody who know what they are doing because there are side effects While hormone therapy is generally safe, there can be individual side effects that can effect whether or not you can continue, and you need those monitored by a doctor A lot of people in bad areas, those areas without insurance coverage, will buy their hormones online, and that is unsafe They don’t know the dosages very well and they go to the internet to find answers They don’t know how their body is responding. Everybody’s body responds differently to hormones Here are some of the effects of HRT for men You tend to grow a beard. Your voice deepens At certain ages you may develop and Adam’s Apple That’s one of the side effects of testosterone during puberty You will probably develop a different body odor You will be able to develop muscle more easily and your body hair will thicken Many trans guys to get acne as well It can stop the menstrual cycle, it most often does, but it isn’t guaranteed All the effects, to see maximum change, is going to be about 5 years For trans women, there are many changes that go on here as well There’s a lot of things that it won’t do Facial hair doesn’t go away In order to get rid of it you have to get electrolysis or laser hair removal, and both are painful, I can personally attest You lose the ability to develop muscles easily. You may lose a lot of energy Lose sex drive. men tend to gain the sex drive that we lose There will be some level of atrophy within the testicles, they will shrink Erectile dysfunction will follow Male pattern baldness may reverse a little bit, depending on why it is caused If it is from the byproduct of testosterone, it can reverse a bit If it is simply genetic, then it probably won’t Children do not medically transition. They do not get hormones and they do not get surgery They can dress according to who they are, they cam choose a name according to who they are That’s pretty much it. They get that social recognition. They get to live as themselves It is completely, totally and utterly reversible For adolescents, as you approach puberty, human have discovered how puberty works and we discovered how to stop it because of children who went through it’s called precocious puberty, and it starts around 5 years-old So they put puberty blockers in and it confuses the body and stops the body from producing the sex hormones So puberty stalls It remains stalled until those puberty blockers are removed For the child under precocious puberty, when they hi the age were their peers start developing then they can be removed and their puberty can resume For the trans child, it can be introduced at the start of puberty to prevent all of those changes that would happen if they were to continue It gives them time to be properly evaluated by a doctor and by a therapist and make sure this is the right thing for them If they decide transition is not the right thing for them the blockers are removed and they undergo normal puberty If it is the right thing for them, right now the recommendation is at the age of 16 they can start cross-sex hormone therapy They can start getting the puberty they believe and hold dear that they should have That allows them much more freedom to live their lives stealth, if you prefer, or without all the side effects that have to be reversed either through surgery or expensive and painful medical treatments There are some kids, like Jazz Jennings if you have heard of her, she started hormones at the age of 13, she had been consistently identifying herself as Jazz since the age of 5 Her doctors felt comfortable introducing her to the hormones

For kids, if you are 15 years old, and all your friends started puberty at 9 or 10, you’re going to feel awkward because you still have a fairly androgynous body, while all your friends are developing Surgery is for adults While some doctors will do top surgery for a long-time for an accepted trans boy, they will not do any other surgery. There is not sex reassignment surgery or gender confirmation surgery. These are all the same thing Nobody gets bottom surgery before adulthood It is, for trans women, a very successful surgery A lot of sensation is maintained It is a usable, natural looking organ when you are done The vagina looks and feels very much like it should Unfortunately for trans men, it is a much more difficult surgery It is easier to make a cave than a tower Building up from tissue than cannot be separated without losing all that sensation doesn’t provide as much tow work with There does not exist currently all the technology to replicate everything that goes into the penis A lot of trans men opt not to get this surgery For a trans woman bottom surgery runs anywhere from $25,000 to $40,000 dollars Depending on where you go in the country and which doctor you see For a trans man to get this surgery it is usually about 2 -3 surgeries and costs upward of $100,000 dollars Which is another reason why they don’t get it Trans men tend to get top surgery. Trans women tend to get bottom surgery Insurance coverage also helps make that determination Many trans people don’t have insurance coverage for this operation and they have to find a way to save up and pay out of pocket A lot of big companies have come around and are offering it on their insurance plans now I believe we have broken the halfway mark on the Fortune 500s Most of them are starting to offer this They are seeing it as a good thing. All of your big tech companies offer this It’s not for everyone. Not everybody requires surgery to feel at home in themselves That’s fine. Not everybody needs to have surgery. You don’t have to sign up for surgery to be transgender What they have found is that patient’s acceptance of the surgery is very high. Over 90% of patients are happy with their surgery Of course there is some level of regret, but it is a small percentage What is most important is proper follow up with your doctor afterwards If necessary, with a therapist What they have found is that as social acceptance increases, any downside of existing as a trans person drop off, and surgery tends to help that It tends to resolve gender dysphoria perfectly When you decide to transition, there is a lot of things to consider You have to consider how your family, your friends, your coworkers are going to respond to it You have to be ready for those people to have questions, to not be familiar with anything that goes on It is new to them and they have an adjustment period. It;s important to remember that What does transition mean. That’s something you need to think about as you approach transition How am I going to do my hair? Am I going to wear makeup? How am I going to dress? When you are 14, as a girl, and you overdo your makeup and you walk out the door, society is pretty forgiving They know it is a thing that a lot of people go through, they just aren’t experienced with it yet. It will get better over time When you are in your 60s and overdo your makeup, society is not so forgiving Finding treatment is very, very important Some people were able to grab some of our Northern Nevada Resource Guides We have a lot of resources in this area that are great at accepting trans people If you weren’t able to grab a guide and need one, you can find one on our website Social support is equally important Finding groups of people that you fit in with is very valuable Don’t forget your family members and your friends, they might need support Support groups can help them. A lot of parents feel a sense of loss when their child comes out because they had plans for their little boy or their little girl to do certain things in life and now they think those plans are completely destroyed and that’s the loss they feel That’s O.K. People feel loss If you have had a family history of every male becoming a doctor for generations

and then junior decides he wants to be a musician parents feel a loss there too Anytime things are going to be different than what they have been thinking about there is that sense of “Now I need to redo everything that I have been thinking about with this child.” Transgender care didn’t come out of nowhere Has everybody heard of the Kinsey report? Kinsey figured out that not everyone was necessarily 100% heterosexual or homosexual There’s a lot of in between Over time they started recognizing that there is variations in gender Harry Benjamin, who did some less than positive things in his life, but for this part he helped recognize the differences and variations in people’s gender From that we came to where we are now with the WPATH standards of care which is on version 7. Right now they are working on version 8 Which establishes a nice, orderly way of helping a patient transition It tells the doctors how to do hormones. Side effects to look out for How to increase dosages. Things like that If you are interacting with a trans person the #1 most important thing you can do in provide respect Just like my little boy who wants to be called Billy, it’s respectful to call him Billy If a trans person says, “You’ve known me forever as Mark. I’d like you to call me Rebecca now.” it’s respectful to call her Rebecca and to use those pronouns Keep in mind that transition is a long-term process Helping keep that trans person patient as they go through everything is very important Some people tend to expect, “Well, I just did my first shot of hormones, where’s my boobs? Where’s my big muscles?” These things don’t happen right away. Like they didn’t happen for anyone going through puberty It’s hard to keep that in mind when you are excited about getting to move forward as yourself and all these wonderful things are going to happen You have to rein it in a little bit and make sure that if you see bad things start to happen, depressed moods or they are getting mistreated, it’s important to check in with them and make sure they are getting the proper help they need So respect, we can all work to bridge these barriers to care Helping society realize that trans people are just people We have slightly different needs, but hey, everybody has slightly different needs We need to make sure, and we are working on it, that everybody gets individual treatment A trans person is not shelf you bought at IKEA Not every person is going to get the sides here and the shelves here and the back on and then it’s done, everybody needs to have their process evaluated on an individual bases We do need more research. it has become a more interesting and important for people to look at within the scientific community It’s new and there are still a lot of things we don’t know on the scientific level If you are or if you know a medical professional who needs access to the proper information on how to approach treatment these are available The WPATH Standards of Care are available to download for free on the Internet I have my own copy in my phone, in case I need a reference The latest textbook on pediatrics cover trans children If you would like more information, including this presentation it is available on our website at You can also email us if you have a question or are uncomfortable asking in public You can write to us at or use our contact page and we will get back to you most likely 24 hours. Unless you come up with something new and unique, which would be very difficult, but you are welcome to In which case it might take a little bit longer At this point do we have any questions? Keeping in mind this is a safe place to ask your questions You said at the beginning that if you have sex with someone of the same gender or sex you are not necessarily gay. Does it mean, coming from the medical field when we study some (inaudible) You call homosexual if you have sex with someone of the same sex? Right. Is this any different? You’ve got to separate the act from the person It might be a homosexual act They have started referring, in the medical community to

men who have sex with men as men who have sex with men, rather than homosexual men Because a bisexual man could be with a man today, then break up and start going out with a woman the next day It wasn’t that he was gay before and now he is straight, it’s that he is who he is and he was in a gay relationship and how he is in a straight relationship It’s important to make that distinction because we put somebody with that label when we see them with another person and there is a lot of, “Oh, so you are gay now? Oh, so you are straight now?” That doesn’t really encompass who they are They are looking at the relationship and defining the person when they need to separate that relationship and act from the individual A bisexual person remains bisexual regardless of whether they are with a man or a women and just like a person can be having sex with somebody that they are not generally attracted to that group, maybe that guy that they had sex with is the only guy they ever felt sexual attraction to And for the rest of it they are sexually attracted to women So keeping in mind sexual orientation is a very diverse and complex subject that is not easily boiled down in neat boxes Is there a point in time where it is detrimental to stay on hormones, or can you do it indefinitely? That would be an individual concern. Something their doctor should check out Once you have reached a certain point in medical transition if you have had certain surgeries the hormones become necessary Some level or hormones are required in the body So an individual who is post-op from bottom surgery has to have some level of hormones in their system That is who post-menopausal women tend to be put on some level of hormones help prevent things like osteoporosis and other diseases that can pop up just because the body expected these things to be there So with trans people, if they have gotten to that point they need to be on some level of hormones, but that level can be adjusted based on their individual needs So if they have reached a point where some tans men develop policystic ovarian syndrome after being on testosterone, that can be something that causes the doctor to reduce or eliminate testosterone from their transition That is something that is going to have to be evaluated individually I’m a writer, and if I am interviewing someone, and I am not sure of the pronoun, is it respectful to ask them which pronoun they prefer? The nest way to ask them is what pronoun they use The idea that they just prefer it is offensive to some people So if you want to ask what pronoun you use or what are your pronouns, would be the best way to approach I know that there is a whole bunch going on as I referred to when I introduced you My partner attends some of the meeting that the Transgender Allies Group has Would you mind mentioning a couple things that are happening? I know there is a group of you who go out and do things Right now the main focus for a couple of our board members is the legislature If you haven’t heard there are a few LGBT bills in the legislature this year They are positive at this point There is an adjustment to foster parenting they are looking at right now One of the bills is about foster parents getting properly educated on how to work with LGBT children Making sure that if a child come out that it is placed with a foster family that they know how to handle any issues that are coming up and how to deal with them respectfully That’s one of the big bills in the legislature right now The other one is SB110, I think I don’t remember the name of it. It passed the senate and is moving into the house and this is why I don’t go to the legislature I don’t know the players and I can’t keep track of the bills It is trans specific. I know that much We have some people down there. Working with the bills. Working with the legislature, trying to get these certain things through Right now because of the makeup of the legislature there is not much opposition

It has been open and welcoming, which is a wonderful thing We also have a few of us do these presentations at various different whether it is government agencies or businesses that want to be more accepting, we have been to places like Crisis Call Center, we have been to the foster parenting like the social services group, we’ve been to schools to talk to the teachers Anywhere that invites us in we are happy to go talk so we can make sure that if trans people need their services then they know how to handle them properly We also work with medical organizations and insurance companies trying to increase coverage for trans people SB110, I remember hearing that too, exempts from the publication requirement a court ordered change of name if the reason for the change is to confirm the person’s name to his or her gender identity Yes, and that is important, even for children, when you do go to change your name and you get to face that diagram of different companies, your information gets published in the newspaper, and it not just that Greg is changing his name to Barbara, it’s that Greg is changing his name to Barbara and low and behold there is his address And phone number, in case you are looking for them So it is outing. It creates a sense of danger and vulnerability When I changed mine it was right there in the Sparks Tribune, a picture of my form My notice of name change that had my address and phone number I moved from there since then, and nothing happened to me personally but, I do know one person whose neighbor found out and came over and threatened her We are trying to remove that publication process which currently exists If you have been in a domestic violence situation. If you fear for your safety If that person finds our who you are, what you are doing and where you live We are trying to extend that exemption to other people I work in Financial Aid and, as you know, the federal laws have not caught up with current times So if we have a person who, a trans male, who goes through the Selective Service match they won’t match. They won’t pass the match because they weren’t born female and females are not required to register. So we then, it’s horribly invasive for some males to have to go through this because we have to ask for their birth certificate and have to prove they were born a female. That’s currently the federal government’s only way for us to lift that hold on their financial aid So we explain it just like I told you, that’s how we explain it And usually it is fine. It’s just so hard. Do you have any other advice for how we can handle it? That is a tough one. That is one of those steps that is going to be either very unaffirming of who the are or completely detrimental to their experience because, I had to register for Selective Service and it really wasn’t a whole big deal to me at the time but I could see how it would be a really big deal to a trans man who they are a guy who doesn’t have to register for Selective Service because they are not recognized as a guy That lack of recognition is part of the problem It sounds like you are handling it pretty well by being up front wit the reason you have to ask, I guess be ready to be sympathetic if that person has a breakdown over it, because they very well could depending on how important it is to them Depending on where they are coming from that could really be interesting because some states don’t require as many steps to change a birth certificate like here in Nevada so the federal government might be thrown for a loop a little bit Anybody else? A bunch of Fortune 500 companies are becoming supportive of allowing insurance to pay for things but how does that work? What if insurance doesn’t come through?

In some places insurance probably doesn’t know it is elective surgery rather than, So, do you know how they determine whether it is somebody deciding, “Hey I want to be this?” or “Is this something I psychologically and physically need?” When you are talking about the big surgeries, whether it is for a trans man top surgery or for either one of them bottom surgery, WPATH Standards of Care require letters from your therapist before the doctors will perform these surgeries For top surgery it is one letter. You have to have the therapist that you have been seeing who can certify that yes this is what is right for you. It is something they have evaluated over time and it is a source of dysphoria for the patient The doctor can look at that and there is a very long list of details they expect out of it That letter can be used for insurance as well To say this is proof that our patient has a medical need for this operation For the bottom surgery is it two letters usually the primary has to make sure all those steps are covered and the secondary has to sign off to say , yes, everything they said is correct from my experience with this patient and I also recommend that this is the proper surgery for them Those letters can go to the insurance company as part of the approval process Those doctors aren’t going to do surgery without them There’s not going to be a, “Oh, I feel like getting it cut off today.” and running off and having insurance pay for it There is a very specific set of guidelines So, with this being at a college, can you think of a couple best practices or suggestions that you have on how we can all make TMCC an inclusive, trans inclusive environment? I believe your bathrooms are open to trans people, if I am not mistaken So trans people can use the bathrooms here While that covers binary trans people, one of the things to consider is non-binary people They may not feel comfortable in a gender bathroom Even if they pass on one or the other on a regular basis It might be something, if there is a gender neutral facility available, that makes them more comfortable It might make a trans person who is feeling, really awkward that day more comfortable It might even make a cys person feel better knowing that there is a private bathroom they can go to People’s comfort levels over bathrooms is very much a variation from person to person That gender neutral facility can be one of those things allow everybody to feel more at home and at peace One of the other things that I have seen pressed that you might want to rethink is a lot of people have the idea that you can introduce yourself and give your pronouns and that everybody would feel more comfortable because then everybody knows what pronouns to use for everybody While every individual is not ready to use those proper pronouns yet and they may not feel comfortable giving the wrong ones, even though they are presenting that way Or they may not feel comfortable admitting that they use the, they, them pronouns So I would be careful as to approaching things like that I know it has been a big movement in campuses across the country to introduce, give pronouns and ask the same of somebody else particularly in a group setting it can be very unsettling Things like that to keep in mind Student I.D.s tend to be pretty acceptable to use somebody’s name even if it is not their legal name And that is helpful Other than that it is making sure professors are aware and can make use of that name rather than was is on their student records If you are really interested in finding something out, you can ask If they are hesitant, make sure they know they don’t have to give them Something like going around in a room and saying, “Introduce yourself and give your pronouns.” That might make people very uncomfortable It puts them in the position of, well I’m not ready to give my real ones but I don’t want to give my fake ones They prefer to let people assume and then correct later It;s touchy, but when you are dealing with individuals, everything is going to be different on a case by case basis Like I said, feel free to use our contact form or that email address if you have a question

later or you have a friend who has a question. That way you can reach out We will get back to people as fast as we can Is it hard for trans people to get a job? Here we do have employment protections, for what that is worth So you cannot be not hire, or fired, just for being trans gender They can’t state that Women routinely are not hired for jobs because they are pregnant because employers don’t want to deal with it they just don’t say it As far as I know there are a lot of companies locally that are accepting like I said all the big, tech companies are accepting. Starbacks The fast food industry, for what it is, its a job and it can help build your resume and you can make sure that the next job you get is on your merits Walmart and Target, Walmart less publicly, but the are as accepting as Target is So there are a lot of places here that are open to hiring people We do have employment protection under the law, as well as housing and a variety of others Thank you for all coming and listening to me today I hope you learned some information that can help if you see somebody getting harassed for being different if you feel comfortable doing so please speak up It means a lot. If someone is there it tends to diffuse situations Silence tends to be received as affirmation for what the person is doing If you feel comfortable. If you don’t feel comfortable then maybe go get somebody who might be Please just let people get harassed. Whether it is for gender identity, sexuality, race, religion reasons, make sure that people feel safe where they are