Gender Revolution: Live Aftershow with Katie Couric | National Geographic

Hi everyone! Thank you so much for being here and thanks to so many of you who just tuned in to watch Gender Revolution on National Geographic. My hope was always that this film could be a conversation starter for people all across the country and around the world, for that matter. What better way to take that seriously than to follow it directly with a discussion that includes all of you? So please send us your questions, your comments, please keep it clean, people, and your reactions to the film, and we're going to get to as many as we can for the next half hour or so. I'm very excited that we have a great group of people who have gathered here tonight and many of them from the film.

Jan—uh, Jean Malpass, should I say John or Johnan? Very good one! Yes, Jean Malpass, who you saw in the film, he is a psychotherapist and the director of the Gender and Family Project at the Acrian Institute right here in New York City. Michaela Mendelson, who was also in the film, is a businesswoman and activist who owns six El Loco restaurants in the LA area. We told her story because she's also partnered with the state of California to develop the Trans Workplace Project, which helps businesses hire more trans people. She's also the first trans person to sit on the board of the Trevor Project.

Nicholas—uh, Arameo, Nico AKA Nico is a senior at Yale studying Women’s Gender and Sexuality Studies. Dr. Joshua Safer is an endocrinologist and professor of medicine and molecular medicine at Boston University School of Medicine. That's a lot of medicines there, Josh! He runs the Center for Transgender Medicine and Surgery at Boston Medical Center. Also joining us via Skype from their home in Washington, D.C., are J.R. and Vanessa Ford, the parents of Ellie and Ronnie. We told their stories in this documentary. Georgian Davis, who’s an associate professor of sociology at the University of Nevada—not Nevada, people—Nevada, and the current president of Interact.

Joshua B.L. is also here; he’s the senior staff attorney at the ACLU who’s been working on Gavin Grimm’s Supreme Court case. So welcome to all of you! Welcome to all of you joining us on Facebook Live. Gosh, we’re getting a lot of questions sort of on a bunch of different areas because this really is a survey—a really a primer, if you will, on gender 101 for people who may not be aware of some of the issues in that this whole topic entails.

But before we get to the Facebook questions, let's just go around quickly. You all obviously have been immersed in this for some time professionally, but immersed in working on this documentary, and I’m curious what the reaction has been from people. Some probably are just seeing it tonight, but for others who have seen it already at various screenings, what are you hearing?

Very good responses! I think that people really appreciate the humble, respectful, curious stance that you took and that you took responsibility to educate yourself and meet a large part of the community and talk about a lot of the issues at different age ranges. I just realized I really sounded like I was fishing for compliments with that question, and I'm not.

You know, Josh, what about the medical community? You know, Josh was also on my podcast today, and we were talking about how the medical community is sort of mixed in terms of people's views on these issues. Do you believe it’s starting to become increasingly educated?

Yes, and I wouldn’t say that the views are mixed so much as the knowledge is mixed. So that when people appear to have alternate views, I really just think that's knowledge. It’s pretty fringe at this juncture among informed medical people to be confused on some of these key points that we that are in that documentary. And if I’m answering your question, I think in the crowds in which I travel—the academic crowds—people are pleased because it’s making something accessible for the general community on this important topic.

Miguel, I’m sure that some of your employees at El Aloo Loco—when I visited—were looking forward to seeing sort of how this whole documentary came together because it’s an interesting process. And I was so pleased that Marie was able to come to the New York screening. The fact that these employees were featured in this documentary, I think one of the things that struck me is that how completely their lives change when they are in a workplace where they’re valued, where customers appreciate their employment, and that they’re really excellent employees, aren’t they?

Yeah, well, as I said in the film, 25% have made the path to management. If you can imagine that, and as I also said, this is the first time working in their authentic gender. But if you could imagine most of them having been sitting at home wondering if their lives were worthwhile because of having so much trouble getting employment or being harassed in the job and wondering where to go next that they’d be treated properly. And in this experience, we get to watch their self-esteem just flower because the customers absolutely love it! We get more compliments on them than anyone because the customers are feeling that genuine joy from them of being affirmed in their true gender, and it’s just been fabulous to see them grow through that.

Nico, at Yale, were people aware that this documentary was in the works? Is sort of the gender non-conforming community—the kids and students I talk to—were they conversing about this, and how much is this issue on the forefront? Or is it just kind of accepted at Yale that everybody does fall into a spectrum, as we just heard that Yale student say?

Yeah, I mean I think that's that's an interesting question for that—it’s at Yale. I think there’s definitely a mixed bag. Like, there are definitely communities that are more actively engaging with these questions, with the idea of gender, with gender as a spectrum, and are definitely more willing to tackle these questions and have these conversations. But, you know, at the same time as those communities exist, there are also communities that don’t necessarily think about these things or aren’t actively questioning them. So I think, more than anything, at Yale in general, I don’t think there’s necessarily a specific vibe about it, but I would say that generally speaking there is more of a willingness to converse about these topics. But I think it’s because these communities are kind of forcing this topic out more into the open.

Just someone on Facebook said, “Is this a Yale thing? Is there something unique about Yale?”

Of course, this is going on on college campuses all across the country.

Yeah, I mean, do you feel that Yale is more progressive than some college campuses?

I’m assuming yes.

Okay, so the thing about that is I think that Yale is not necessarily more progressive. I think that the students there are the ones who are making it a more progressive place. I don’t think there’s anything necessarily about Yale as an institution that makes it more progressive, but it’s the communities that exist there. And a lot of these conversations around gender non-conformity and non-binary identities, I think people have this misguided idea that these are conversations that are only sprouting from this elite ivory tower knowledge, when really a lot of these conversations come from a lot of more niche communities that aren’t paid attention to. Especially like queer communities of color that exist in like more diverse areas within cities and things like that—these conversations are happening; it’s just that they don’t have the platform that, like say, an Ivy League university has, so they don’t get the credit for already having these conversations.

Vanessa and J.R. and Georgian, I’m going to get to you in a moment. But I also want to, because I think you’ll be answering some of these questions, and I want to get to since we want this to be interactive and responsive to what people are asking. I got a question from someone—Laz Loz—and it said, “Watching Gender Revolution on Nat Geo UK, my question is why is there such a growing number of trans kids today? What’s different?” I think that’s one of the most often asked questions for people—certainly of my generation—saying, “Hey, we didn’t know a lot of trans kids when we were growing up. Why suddenly are we seeing more?” And when it comes to the numbers, how would you answer that question, John?

I don't know that I would say that there are more of them, but I would say certainly that they’re more visible and that maybe we have more of a language in families and households and communities. In the medical community, pediatricians have a language to start talking about this. And so I think parents are starting to pay attention to what kids are saying, and they educate themselves, and they know—they kind of watch the signs for identity and authenticity a bit earlier.

You know, we were talking about numbers earlier today. You’re probably so sick of me because you were on the podcast too, Josh. But you know, I think a lot of people have again said to me it is so, so, so rare—we use the statistic for intersex people as one in 1500 to 2000 births, Georgian, which is the commonly used statistic in terms of the number of intersex individuals who are born, correct?

Yes, that's commonly used. I mean, I would just say that you know very few people know about intersex. But yet intersex people are everywhere, and I’m confident that every single person in the world has met someone who’s intersex. Part of the reason why there's not more awareness is because of the shame and secrecy tied to being intersex that is often related to the way in which medical doctors treated us historically. And so if you use that number of one in 1500 to one in 2000—Josh, tell me what comment—what the medical community believes—in terms of, is there a statistic?

So the statistic that’s out there right now is about 1 in 200. There have been various surveys. There was a survey a while ago suggesting 3% of the population, 0.5—there’s a more current one, 6—but they’re all in that order of magnitude. So about one in 200, roughly speaking. Pretty common, I think people would be surprised, Michaela, to hear that. But you were citing a recent study that was a very large study and one that was completed not too long ago.

Well, I think the latest one that Dr. Safer may be referring to is the National Center for Transgender Equality study that it was 6% across the nation, but that was adults 18 and over. Recent studies being worked on by The Williams Institute that worked with the NCT are showing us—and the California Institute of Health are showing us—that the numbers of youth 12 to 17 that identify as gender non-conforming is more in the range of 4.5%. So that’s a huge jump! That’s pretty amazing, isn’t it? You think of that number, and I think people are just starting to realize the number of people who fall into this category.

I think this is an important question for the Fords because it’s one that I had when I first met them, and maybe Jean you can add to this, but this is from Anna Miller. I think this is a commonly held belief, and I know you all are so helpful in assisting people when it comes to understanding this. Anna asks: “I’m not trying to be mean, rude, harsh, or bash anyone; however, I just do not see how a four-year-old truly knows what this entails. How do they comprehend that?” She goes on to say, “Children do not have the mental capacity or emotional intelligence; they haven’t fully developed by that age. Brains are fully developed in the mid-20s, or not fully developed until the mid-20s, along with many other factors to have the understanding of gender dysphoria. I do not think that children need to make this decision, especially that young of a child.”

So, Vanessa and J.R., can you sort of help Anna understand why you believe that Ellie was able to make this decision?

Right, so we hear that all the time, and people—especially with young kids in our community of parents—hear that all the time. I think what that’s getting at is there’s a lot of brain development. There’s so many things that kids don’t know at four or five, but the research consistently is showing that gender identity—who people feel they are on the inside—is stable by four and completely stable by five. And it’s so different from sexuality that I think where people get confused is how could they know—they’re only that age, and they’re thinking about this along the lines of sexuality. And that’s not who our daughter says she is.

So it’s the research side, but then there’s just the side of raising a child, and many parents would probably tell you who have young ones like ours that they had a child who was one way when not allowed to live matching their gender identity, and a completely different way when they were. And parents want a happy child and a healthy child. It’s really when you affirm your kid that’s what you get—a happy child!

Yeah, and I think we also would say we can’t get our child to eat vegetables! So what would someone say to—we wouldn’t be pushing her into that. This is who she is. For a four-year-old to say, “I’m a girl at my heart and my brain,” she doesn’t understand the implications and the societal issues right now. She’s proud of who she is! That drawing that says “I love being who I am”—those are her words at four when she drew that family portrait. And so that’s our job as a community to educate others, like this documentary, so that she can just live as who she is.

Sean, I think you must hear this all the time as well, and I know you use “consistent, insistent, persistent,” as a good gauge in terms of recognizing a trans child, but what other things, and maybe do you look for when families come in to talk to you and say, “We think our child may be transgender”?

Well, as Vanessa said, I think first of all, gender identity develops really young, and the research shows that the age of onset when children start expressing their gender dysphoria or gender variance is really around the age of four to seven. So we also know that it’s actually very common. And we do actually really look for persistence, consistency, and insistence, so we really try to see what the kid has been saying. We do a thorough assessment of how they’ve been identifying, what they’ve been saying about themselves, their gender roles, to some extent is really important. We try to assess whether there is gender dysphoria, body dysphoria in a specific way.

But you know, one thing that is really interesting is that when a cisgender little boy or little girl who’s four says “I’m a boy” or “I’m a girl,” we don’t stop them and say, “Hold on, we don’t know that it’s true. We’re going to have to wait until the age of 15 or 18 to know this.” So we also have to ask ourselves why we’re having such a hard time wrapping our minds around gender diversity.

Somebody actually asks, “I have an eight-year-old son that falls in this spectrum. How do you know when the time is right to allow them to transition?” I think we should point out, and I think it’s something you and I talked about, Josh, is socially transitioning. I think sometimes people automatically assume that means there is medical intervention in terms of drugs, hormones, even surgery. I think because people aren’t necessarily familiar with—and that’s one of the reasons I tried to explain this in a way chronologically—with a young child and then with puberty blockers and then with cross hormones. But the social transition is something that is not—it’s absolutely not medical. There’s nothing medical that is done before the beginning of puberty, before the blockers. So everything is reversible, and it really follows the child's lead. And again, it follows their lead for a certain time, so we don’t jump to conclusions; we really make sure that it is the right thing. And most of the time, children do not change their minds; they do not transition back socially. But sometimes it is helpful to just follow the child’s lead and just go with what they’re saying. Even if they change their mind, they might need to sort of experiment and allow them to live outside of the pink and the blue box.

And I would jump in on this, just making one more point, which is that there is a fear that maybe you’ll lead them along and that you’ll permit them to go to someplace that you wouldn’t have wanted them to go. But if this is biology, then that can’t be true. If we were actually able to manipulate gender identity with such a trivial maneuver as simply allowing a child to express him or herself, then we would—then all the story with the intersex individuals would never have occurred because all our interventions there would have actually succeeded.

Vanessa, you wanted to add something?

Yeah! I saw that tweet and reached out to the mom, and we’re connected now. And this is the power of this documentary and reaching out because she lives in a place where there’s no resources and she sees she needs to understand her child. And I don’t know if her child’s gender non-conforming or transgender, but we’re now connected and we’re getting her connected with resources online, which is a really helpful tool for people who are isolated.

So I thought, like to hear that—that question that you just asked actually got to the mom, and she’s now connected with support. Because there are a lot of support groups—I know that J.R. and Vanessa—I was asked on Twitter or Facebook. I know I can’t find it right this second, but a lot of people asked about what sort of support groups and support in general exists out there. And there’s a lot of it now, particularly in the online community, correct?

Yes! There are private groups that are private for very good reasons, for security, for privacy of the families, and also the trans kids who also have their own support. But yeah, you can search. If you just search, most of the groups, whether they’re closed or secret, have a front door that allows you to see it, get in touch with the administrator, and then they’ll vet you before you get in. But the groups are very robust and fall in all kinds of different categories. So just use that search bar, and you’ll get connected to—there are thousands of us parents raising beautiful trans and gender non-conforming kids. You’ll get connected.

Chris Murphy asks, “Where are specific examples in 2017 of discrimination by gender in either government or the workplace?” Let me go, if I could, to Joshua first to talk about that because I think there’s been a lot of activity in this arena.

I think there’s a lot of fear that some of those things will be rolled back. But can you sort of give us, if you will Joshua, the state of play in terms of discrimination in government or the workplace right now?

Absolutely! So I think as a matter of what the law should protect against, we have a statute that protects against sex discrimination that covers all 50 states and should protect trans people in all 50 states too. But that doesn’t always bear out in reality. You know, we get intakes all the time about people who interview for a job before transitioning, get a job offer, show up to work after transitioning, and the job offer is revoked. We get intakes about people who are, you know, harassed on the job, forced to use restrooms in an entirely separate building. Sort of. I was very much reminded of some of the intakes when I watched Hidden Figures. Right, I know people have said that it’s incredible—it’s incredible! I think people don’t come close to understanding the daily impact it has on someone’s life if they're not living it themselves.

And until this past year, the military prohibited trans people from enlisting. And you know, I had a client who was a trans man deployed in Afghanistan and deployed in Iraq as at post-transition. You know, was in a foxhole with his—the rest of his troop. But on routine physical screening, his testosterone popped up and someone up the chain in command saw it, and they started separation proceedings to kick them out. So this is very much still going on, and we're just at the beginning of being able to enjoy the formal protections that we should have, which is why it’s pretty scary to be in a position where we might see all this begin to roll back.

How concerned are you about that?

Well, I think for the past eight years, we've had an administration that has been vigorously enforcing these laws. We—actually, the ACLU had to sue the Bush Administration in 2006 because they fired an amazing person named Diane Shore from her job at the Library of Congress. We won a great decision in 2008, and then for the entire Obama administration, that decision has been implemented sort of across the board by all the agencies. Now, that was powerful because it was right; it’s what the law required, regardless of what those agencies said. But of course, it’s always helpful to have the agencies say it with you, and now we're just sort of back to where we were eight years ago of saying it ourselves and having the courts hopefully agree with us. But we won’t have the important support we’ve had for the past eight years.

And, you know, Gavin’s case has a date set—March 28th of this year—to go before The Supreme Court. A lot of people, I think, have been very taken with how self-possessed Gavin is and how eloquent, and I marvel at his ability at 15 to stand in front of all those adults at that school board meeting and make his case just brilliantly, as only a 15-year-old can. And someone asked, are there—what can be done to support him? And it says Janice Priestess says, “How can we help Gavin Grimm’s case at the Supreme Court?”

Oh, well, you know Gavin has a Facebook page, and there’s like Twitter hashtags, but the most important thing people can be doing is to raise visibility and to tell their stories. I think we won marriage equality a couple years ago. The first lawsuit was brought in 1972, and it took 40 years for people to see gay people as their families, their friends, their neighbors, their co-workers, and to see that they had all the same dreams and the same humanity as straight people. And we need to go through that same educational process in the next two to five months.

So I think it’s really important to—you know, the visibility of this documentary and of all these parents and families that are, you know, so brave in telling their stories here, that’s just as crucial as any legal case can be because, you know, no matter what the law says, if the judges don’t see trans people as people, if they don’t see trans boys as boys and trans girls as girls, they're not going to get it. And so there’s a—you need people to see the discrimination that’s in front of their eyes sometimes, and it takes a lot of humanizing to do that.

You know, Michaela, I know that you’ve been on the forefront, as we’ve said, dealing with helping trans employees in California. Are other states kind of following California’s lead?

Well, California has had some pretty good laws in place for over 20 years, but the Department of Fair Employment and Housing there that really is where these laws and protections come from is about to institute a whole new set of guidelines that’s really broad. And from beginning to end of protection in the workplace that I feel that we’re hoping to get adopted by as many states as possible. So we’re supporting them and getting the word out to all the industries throughout California through training videos and webinars.

And then we’re looking to other states to take on that battle as well and see how we can support them. Nico, you know I’ve gotten a number of questions about non-binary gender. Christine Hall said, “I was hoping to hear a discussion of non-binary gender.” Can we talk about that here? We did talk about it some in the documentary, but I think, you know, what was very interesting to me is the conversation between Har and Renee Richards, where you saw a real generational divide of people—even somebody who is on the pioneer side like Renee really seeing gender in terms of male-female along strict binary lines, if you will. And I think some people still have a difficult time understanding this whole notion of being gender non-conforming or having a pronoun of “they.” And it leaves them scratching their heads. So can you help illuminate us a little bit more about where this falls in terms of understanding the whole issue?

Yeah, I mean I think that a lot of this move towards— I guess what Har called a more gender-chill future I think is very interesting just because I think, at least for the people that I talk to, I think there’s more of an interest around like lowering the stakes of what gender means. That like, you know, when you have cases with like, you know, parents being extremely worried about like their kids having these thoughts at very young ages, it has a lot to do with the fact that it’s like gender is seen as this like all-defining thing about somebody. That like, you are this, therefore you are all like one million of these other things that are characterized by this particular gender identity, right?

I think it’s a way we—many of us have learned to organize the world.

Yeah, exactly! Exactly! So I think that now, like, this move away from that and this move towards like thinking about gender along a spectrum and what it means to be non-binary, like even now, I think there’s this desire to classify non-binary as like another gender category. But like the term “non-binary” itself means, like, “No, we’re trying to define ourselves outside of that.”

At least like in my experience of it, it’s been a lot of like people asking me like whether like being non-binary for me means that like I’m kind of just using this as like a means to an end—a way station, exactly—and like what I’ve tried to explain to people is that like I don’t see it as a means to an end. I see it as an end in and of itself. Like it can be that, and there’s no need to move beyond that. Because if I’m trying to envision myself being a part of like a future that is, I guess, like more gender-chill, then like what is the need for me to define every or to like attribute every aspect of like my physical appearance or my body or like my mannerisms or anything like that to a specific gender category. When the way that I see it, like, as we continue moving along in time—hopefully, you know—we lose those restrictions around like, you know, whether boys get to do this or girls get to do that. And if we lose those restrictions, then the gender categories kind of become obsolete, you know?

Georgian, I’m curious, you know, since I know you’re an associate professor of sociology, as I mentioned, you’re around a lot of college kids. You know, I do feel this is something that definitely, you know, people my age really grapple with. Can you talk about sort of how you’ve been able to process it through your experiences with some of your students?

Sure! Well, I’m an assistant professor, but I’ll take tenure from you, Katie!

That’s fine! You know what? Consider it done, Georgian! You’re now associate professor!

There we go! I will look forward to the raise on my next paycheck!

But I think the students really are pushing me, as they are so many others, and I really think it’s young people that are pushing society forward in terms of understanding the complexities of gender. I think it’s really important to know that, in the case of intersex, I’m always wondering how it is that intersex people are subjected to these medically unnecessary irreversible surgeries, often when they’re young firstborn or teenager, lied to about the diagnosis. But then, you know, without any recourse really, it just happens, as opposed to say in the trans community or the trans world, doctors are reluctant to perform these procedures, reluctant to engage in any sort of modification of bodies or any sort of medicalization services.

So I think it really comes down to that intersex folks and trans folks and everyone else—all of us, regardless of our genitalia—should be the only ones to make autonomous decisions about our bodies.

Well, well, Georgian, I got a lot of questions about that. You know, people saying, “Can you say more about human rights violations against intersex children? What’s being done to protect those rights? Give us a sense of if it's changing in terms of the protocol…” Because as you and I have discussed, the WHO has spoken out against this. I don’t know if that was included in the documentary, but it was a really important point the United Nations said, and yet this is standard operating procedure, so to speak, among a lot of doctors these days. Do you see a shift in that? Because you all have been talking about this for really decades now; this isn’t a new phenomenon.

Yeah, for decades now intersex activists have been saying stop performing medically unnecessary and irreversible surgeries on our bodies, and doctors continue to do so and they violate their own medical protocols that they issue. And you know, I’m not out here as some medical professor or some intersex activist saying these things—as you said, Katie—and as I mentioned to you, I’m not alone. The World Health Organization is saying the same thing. The United Nations is saying the same thing: do not perform these surgeries.

Listen, if someone wants a surgery or wants any sort of medically unnecessary interventions, I’m cool with it as long as they have a say in what’s done to their body. In my case, and in so many other young kids that I’ve met and other adults like me, they’ve removed parts of our genitalia. They’ve taken out testes. They’ve done all sorts of things that are horrific and eliminate any possibility for me, for example, to have biological children. And these are human rights violations. This is sterilization; this is genital mutilation.

Do you see, Josh, the medical community taking notice?

It was—I think that Dr. Dve, who spoke to me for this documentary, which I really appreciated, said it had prompted him to sort of evaluate the way he and other doctors have been trained in these circumstances.

I think he represents a very mainstream view, actually, and that is that they’re still very much in transition and still very conservative in terms of the mindset because that’s how they were taught. And so there’s a little resistance to change—just a little bit.

How are you coming into the whole documentary needing to learn medical professionals at that level who trained a certain way have that perspective? And the good news is that if you’re being taught now, the training in the educational system has changed. It certainly needs to change; I’m in complete alignment with Georgian. That’s what we’re teaching at Boston University now.

I was going to say, are medical schools sort of changing their approach in general?

Well, I can speak for one medical school where, yes, this is exactly what I teach, and I’m the one who does that particular piece. So that’s absolutely been true for us for a number of years. Other schools are beginning to adapt similar things, but it’s still not widespread, and we’ve got a lot of work to do.

I would put it as it’s like—I think I said before—there’s still a lot of ignorance out there and there’s a lot of inertia out there.

Katie, I’ve had—and maybe Dr. Safer can just say something real quick, if maybe Dr. Safer can just add to this—but it’s my understanding that in medical school, these medical students aren’t getting that much information about intersex or trans or the way in which intersex and trans people live their lives and experience medicalization. And in fact, I would think—correct me if I’m wrong—that folks who’ve watched this documentary actually have more knowledge about intersex and trans, both, than medical students these days, would you say that’s correct?

I totally agree with Georgian. I mean, I won’t say—I don’t want to get too extreme in that statement because they learn some of these things in anatomy and such. So it’s not that they really get nothing, but in terms of that whole concept of “first don’t do anything” because you need to let these kids grow and evolve and explore and see what it is they want to do, if anything, and you don’t need to cut them up and force them to conform to some norm. That very specific message—that's still exceedingly rare.

I agree with you absolutely, but you know, Georgian, you and I have talked about this, about how parents are trying to do the right thing for their kids. And I think it’s this fear of having a child who’s different, who doesn’t fit into these categories. And you get upset—I know—when doctors say, “Oh, the parents want it,” because you feel the parents don’t—parents in general don’t necessarily know that there are other options. On the other hand, you know it must be a very scary and unsettling situation for a parent, as we saw in the documentary.

Can I say something, George?

Often what happens—I was going to say, Goed, let me answer this as the doctor in there, because I’m the one who wants to push back on the doctors. And the answer is that people want to choose things that might seem easier, and we advise them all the time. We advise them how what foods they should eat, and then we’re wrong, and we advise them to eat different foods. So we’re very comfortable as physicians advising people when we’re confident that it’s the right thing. And there was an era when we were confident that fitting in was the right thing. And that’s wrong! And now we need to gain confidence to advise parents not to rush into things—to say that that is the correct decision and help them. And they might instinctively want to still make their kid fit into some cookie-cutter shape, but it’s a little that it becomes on the medical establishment to say, “Well, no, that's not standard.” Well, we have to make it not standard so that we can say that.

Of course! And I hear what you’re saying, and I hear what you’re saying, Doctor, but I just want to quickly say that, you know, I traveled around the country, and I interviewed many doctors who treat, in quotes, intersex people. And what they often do is they frame intersex as a medical emergency. And if you frame something as a medical emergency, you’re establishing the need for a medical response. And like most of us, we don’t know about intersex; we’ve never heard of it before.

And what then ends up happening then is that parents, understandably, are lost and confused and then they sort of move forward with it. So as you’re saying Dr. Safer, and I absolutely agree that providers need to slow down that process. Intersex people, or babies born with intersex traits, they’re okay in the majority of cases; there’s no medical emergency, so it shouldn’t be presented that way.

Yeah, and I also just want to build on that—in terms of parents of trans kids, I think most parents love their kids and want to protect their kids and sometimes feel like the best way to protect them is to sort of keep them in the box. But what the research shows is that actually coming from an accepting and supportive family will reduce the risk of suicide or self-harm by 8 to 10 times.

So often parents come to us feeling really helpless, and they say, “I’m not equipped to raise a transgender child. I don’t know the community; I don’t know what’s best to do.” And what we say is: your love, your acceptance, your telling them that you will love them no matter what will actually make them the strongest!

And I think it’s worth reiterating that the suicide rate for trans individuals—and I don’t know if this extends to gender non-conforming—I don’t know if the statistics are—but so—and someone asked, by the way, what’s the difference between trans and gender non-conforming, which we’ll talk about in a second. But that 41%—my understanding is attempted, or 1.6% in the general population US, it goes up to 41% in the trans community.

I read that it was 4.6% in the general population, and 41% for trans. I had 1.6% and 41%, but in any case, the gap is enormous. And it goes even higher if you look at the trans communities of color. So in the African-American community, it is up to 48%. So we just need to really look at that.

So again, acceptance is protection and education leads to acceptance as well. Do you want to take a shot, Nico, at the—the someone who asked, “What’s the difference between being transgender and being gender non-conforming?”

Yeah, so okay, so this is also why for me it’s like very hard to follow statistics about like, you know, there are X number of trans people in the US because a lot of those statistics—like, I don’t really know what the qualifications are for like people who are answering these statistics, right?

So the way that I try and think about it is like basically like if you claim a trans identity, nobody’s allowed to tell you otherwise or tell you that you need to qualify with some sort of biological or psychological or whatever kind of explanation.

But this term of gender non-conforming, it can mean so many different things because it can very much—like, just at its like by definition of the terms—can just mean somebody who does not conform to the expected gender norms.

So like, for example, I have friends like at school who, you know, are—you know, identify as like women and identify as like lesbians but like may dress in like a more masculine fashion. And like they see that as being gender non-conforming because dressing as—like being a woman and not dressing in a feminine fashion is technically gender non-conforming if the society that you live in like expects a certain kind of performance out of a particular gender, right?

But it can also mean a lot more than just that to somebody who identifies with that label.

So, saw the documentary, right? You know, in Samoa with the Fa’afafine— a lot of it is sort of how the culture—everything’s within context! Everything’s within context! There’s nothing that we can say here in the US that we can automatically just export somewhere else and apply somewhere else.

You know, we can’t take our, like, queer identities or like our definition of trans, like, pretty much anywhere else because it’s very much dependent on how we’ve constructed our own ideas around gender here.

I want to get to some sort of real-world questions from some people who watch the documentary. Someone wrote—our 18—actually just a few minutes ago—our 18-year-old daughter told us a year ago she was a transgender male. We saw no signs of that. She wants to start testosterone as soon as possible. She’s of legal age, so we can't stop her and aren’t sure that we should. What is the protocol before doctors start administering hormones? Is there a screening process?

Maybe that one comes to me, I think. And the answer is for an adult there is—well, there used to be. There used to be a bit of a screening process where somebody would be directed to a mental health provider. However, adults are very well able to articulate their gender identity. In fact, I would say, that’s the norm in my experience.

And so depending upon where—what medical professionals their transgender man has access, their—the protocol may simply be confirming somebody—some medical professional confirming “insistent, persistent, consistent,” just as Jean has said with regard to the kids—that they’re confident that this is their identity and that there isn’t a confounding reason why they would think this that’s unrelated, and that’s about it.

But I was going to say 18. I mean, they can this person can do this.

Yes. So I think that the model is “informed consent.” So over 18, someone who can is able to process this question and this decision can make the decision they want. I think there’s a history—the mental health field has really gotten in the way of the trans community a lot, and we’re trying to repair this.

We had what we call a gatekeeping position which has been really unfair. So now we try to really empower the community and not be gatekeeping. An 18-year-old can go to a medical clinic.

And I also think it’s really important to understand there’s not one way; there’s not one trans narrative, there’s not one way of being cisgender, there’s not one way of being transgender. There are individuals who know since the age of three and who can tell you at four in a very persistent and consistent way, and there are individuals who come to terms with their own gender identity later on, and that doesn’t make them less legitimate than someone who was aware at five or six.

But I feel for this father because yes, 18! You know if my 18-year-old came, I would want to make sure, because you know when you start talking about cross hormones, I mean there isn't a lot of—in my understanding, Josh, a ton of medical literature about the long-term effects—the long-term effects—and that’s one of—is that incorrect? One of the reasons I know Christina Olsen is doing this study as well but please.

Yeah, so first of all, if some—so maybe not so reassuring to the parent—most of the kids that age—college kids who come to me and say they’re trans—they’re trans, and it’s pretty straightforward, and there’s not much to discuss. And a trans guy shows up and says, “I’m ready for testosterone, Doc.” We’re looking to make sure it’s safe, and we’re moving forward. A minority are a little bit fuzzier, and I might say—and they might come to me with questions, and they might say, “Okay, I’ll get back to you, Doc, in six months,” or whatever, and so—and so there might be that circumstance, but I want to be clear, most of them are pretty straightforward, and there’s not much else going on.

And what about the medical effects or the long-term effects of cross hormones?

So testosterone—let’s speak specific to this—is pretty safe as a medication. There are a couple of concerns; there are things that we follow for any guys on testosterone, whether it be trans young transgender boys or young transgender men, excuse me, or men who have low testosterone for whatever reason. So there are some things we have to watch.

But as medications go, this is actually a pretty safe intervention. The concern is that there will be permanent effects—so there will be changes in facial hair that will not be that easy to reverse—but it’s—you know, things like appearance.

But what about any other side effects in terms of physiological that aren’t as cosmetic?

Lot’s of anxiety, but men seem to be at higher risk for heart disease because their blood counts go up, and so that’s true, and that’s something we monitor. But we don’t, you know, force other men to avoid having testosterone for, you know, trying to protect them from heart disease as they age. So you know, it’s that kind of thing; it’s pretty safe, actually.

And can I bring something else in that conversation, Dr. Safer? And that is that, really, the only—this hasn’t been said yet, but I know it’s implied; really the only cure for what might be called gender dysphoria—someone who feels that they’re not in the body that they should be—is transition. And nothing else has been proven to help.

And you know, one of the greatest evils that I’ve seen is what they call conversion or reparative therapy, and that’s kind of the opposite, I think, of accepting someone and helping them through the process thinking that we can change biologically who they are. And at the Trevor Project, I’ve seen so many kids—and most of the suicide attempts do happen as adolescence—because they’re going through a period where their body is changing in a way that they’re so dramatically opposed to and they’re confused about it. But I’ve seen so many kids also that have attempted suicide because of reparative therapy.

I think that’s a huge point that Michaela is making, which is to be careful—the caution maybe to the parent here too is to recognize that the idea that you’re going to change their gender identity back is a complete disaster. Where actually going with the flow is the only thing statistically that has any success. In fact, Chris Lopez to the panel members who identify on the spectrum, what do you wish your parents had known or done along your gender journey?

And this is asked by a parent of a 9-year-old female-to-male son, which I think is a really good question. What would you—I mean, either you—what would you say, Nico? Go ahead.

Okay, so I think for me, I don’t know; it's hard just because I feel like I would want more than anything for like parents to know that to begin, like a process of transition or to want a process of transition, like for the most part, it’s something that like if you reach a point where you’re like, “This is something that I need to do,” that it’s not just a decision that you’re just like—you wake up one day and you’re like, “Man, it sure would be nice if I transitioned today! Like, that sounds like fun!” Because there’s pretty much nothing about the process that is enjoyable.

There is like, you know, issues with medical gatekeeping, which definitely still do exist. Even at like the most progressive of places, they still do exist. I can just say like from my own personal experience, it took me a very long time to get access to what I needed because I had to follow specific guidelines that weren’t actually supposed to be enforced at the medical institution that I was working through, but were enforced anyway.

And that a lot of times, like I think I wish that parents had, I guess, more access to more information on like the—I guess like the specific—like, I guess the technical aspects of like transitioning if you choose to do so medically. I think there’s this idea that like as soon as you start hormones, like you’re going to wake up the next day and everything’s going to change or like, you know, like when I—I—when I started testosterone, it was like this idea that I’m going to wake up tomorrow and my voice is going to be like five octaves deeper, but it’s not like that.

It’s like a very, very gradual process that, you know, it kind of like, as you go along changing, at least in my experience, like my family and like my friends were able to transition along with me because you know, I wasn’t just waking up the next day completely different person.

And yeah, people do need that—go through it need therapy, need therapeutic help to work through, you know, the psychological—I mean, if you could imagine anything that’s more dramatic than changing genders, even if you felt all your life you were in the wrong gender, there’s a big process to go through, and my heroes are people like the Fords that support their children.

And there’s—and as Jean was saying, you know, the suicide rate that we find, you know, is like eight times higher for those kids who aren’t supported by their families, and there are places for families to get help—places like PFLAG, right? Someone mentioned that?

Yeah! And I mask constantly because I go out and speak to schools and such and different at the Museum of Tolerance, and I’m asked often by parents, you know, “What do we do? Our kid thinks they’re in the wrong body?” Well, I said, “Well, you can’t do this on your own. You should go seek professional help, but also to join a group!” There’s nothing better that I’ve seen in terms of the bigger picture is that being in a group of like-minded parents that can help them through that process—who’ve been through it—and, you know, that’s out there!

Any parent that’s questioning right now should be joining groups, and John—I mean, and J.R. and Vanessa, I know you can speak for that.

Yeah, that’s been so critically important, hasn’t it, for you both? And you’ve become really sort of like the mother hens for many of these parents, Vanessa.

Well, it’s in my nature, but the truth is I am the mother hen. But there are so many other mother hens above me. And so the most amazing thing about this journey is that we haven’t done it in our own little pocket. There are families like Debbie Jackson who had Avery on the cover of Nacho and Annemarie who had the letter to my 5-year-old son in Boston.

And those were pieces—when I first typed in “I’m a girl in my heart and my brain,” their work showed up, and all of a sudden, I knew there were moms I could talk to and dads that Jay could talk to who had been through it. And so we’re out here; we are accessible. We’ve used our real names in hopes that other families can find us and that we can help guide them because we are safe with our community.

And the other thing, for scared parents or for people to know about how difficult this is to transition, we just don’t know what’s going to change in the next decade. That’s why Dr. Olsen’s work with the Trans study is so important. Ellie’s five—by the time she’s 15, there’ll be a cohort of hundreds of kids who are now in their early 20s who will have gone through puberty blockers, who will have had cross-sex hormones, and then when Ellie gets there, there’ll be a whole other set before them.

And then finally, we really look to people within the trans community—adults—to help teach us. We don’t know! Nico was saying you’re amazing for real, but you were saying that, you know, you wish your parents kind of knew the technical aspects. I’m so lucky to have friends here and many of the mama bears and papa bears out there as well that we have adult friends who are really willing to say to us, “This is what happened, and this is what they did, and this is what things feel like.”

And those conversations are critical because you want your kid—you want to understand what choices you’re helping your kid make.

You know, there are just a couple of—we just have time for a couple more questions, of course. I could be here all night because I love all of you and it’s so interesting to me, and I really appreciate the questions we’re getting from people who watch the documentary. But this one sort of broke my heart, and I’m not going to use his name—I don’t know why I feel like I should protect him—even though he wrote his name. But this viewer wrote, “I watched your show and was moved. I can relate in so many ways. I always felt like the other gender—not my birth gender. I’ve never had the chance to ever talk with anyone about this. I’m 54 now, and I feel like my real and true life has passed me by. I’m moving to Pensacola, Florida, very soon and don’t know how to find a therapist to be able to talk to about this. Not to mention my age. At any rate, thank you for your interest in information and ideas.”

I don’t know who wants to take that.

Well, I just want to say, please don’t feel like your life has passed you by! I transitioned at 54, so it’s never too late to realize that there’s another life ahead of you!

And there’s, you know, a second life that you can live that could be even more fulfilling than the first.

How would you describe your life before and after this decision?

Well, you know it’s such a long story, but to cut it short, I suppressed it my whole life. And one of the great ways I did was by becoming a super jock—and then raising a family of three wonderful kids and a marriage of over 30 years, and extreme sports, and I put all my energy into those things to try and make it go away. But eventually, it just totally caught up with me. I was falling apart, and I just couldn’t do it anymore. But you know, when I found—

Relationships now, though?

Well, it’s—you know, not enough is said about the family that transitions with the person that’s transitioning. Well, we saw with Linda Dora, right?

Right!

And my three kids, it was tough on them because I was this macho figure and this super businessman that they looked up to. And so I kind of fed off a pedestal, and I had to realize it wasn’t until I realized how much they lost that my relationship with them came back together.

MH, and there’s someone named Kimberly Diana who wrote, “As a mama of two trans kids”—by the way, just parenthetically, how unusual is that to have siblings who are trans? And does that sort of—I know with fraternal twins, the likelihood of one being trans if one is trans is very low. With identical twins, it’s 40%, as we mentioned in the documentary. Is it unusual to have siblings, trans siblings, or what are your experiences with that?

Well, siblings would be the same as fraternal twins, right?

Exactly! So it’s very unusual, yeah, it’s unusual in the sense that if we believe the conservative number of one in 200, you know, you can kind of do the math here a little bit.

I’m not very good at math, Josh, help me out!

I guess that, you know, we’re looking at that SAR 200 S. But—but so, well, it’s not completely in common. I would say we have several families in our program at the Gender and Family Project who have two kids—siblings who are both trans-identified or gender non-conforming.

And again—it’s, you know, we have to think—we’re really learning to change our way of thinking about this. When you have two children who are both cisgender, you don’t say, “This is really suspicious; both of them are cisgender!”

Right!

So when I know that statistically, it’s less likely to happen, I think that’s the—but again, we really need to—our shift here is that gender is self-determined, and that kids will—as we let them—really identify themselves more early and let us know.

Right!

And I just want to caveat—it’s not 200 squared because if it’s genetic, then the chance of it recurring a little bit in the family certainly would make some sense, right?

So, well, this viewer goes on to say, “I’m so glad to see this being produced, Katie. I noticed the manner in how you ask questions and how you accept responses of, ‘I’d rather not talk about it’ bothers me. I’m wondering if you could share with viewers more of ‘Is it polite to ask?’ and how to ask questions in addition to receiving responses that establish personal boundaries, like a trans person not wanting to discuss their genitals, dead names, etc.”

Well, since sort of me screwing this up in the first place is one of the reasons I decided to pursue this, you know, I think—that’s helpful! One of the things I learned in the course of making this documentary—and I started to tell you all, but I didn’t want to say it before we were doing this Facebook Live—is I used to think the trans community or the gender non-conforming community that they needed to help other people understand this issue better.

And what I realized is that I don’t go around explaining myself—who I am, how I identify—to every person I meet. I don’t feel like I have to kind of justify that. And I think, I think even Gavin told me that, you know—a lot of—why should it all be on your shoulders, Michaela or Nico, on your shoulders or Georgian for you or Gavin to kind of explain to the rest of the world who they are, why they are, and how they’ve chosen to identify?

So I learned that. So my expectation of whose responsibility it is to educate all of us—it changed in the course of making this film, and I realized it’s all of our responsibility to educate ourselves and having said that to help each other in the process. I think, you know, sometimes there’s too much anger all the way around and that a little patience is—as one of your—May said it, “Radical patience.”

One of our panelists in Washington said, you know, “Radical impatience,” because you can understand that perspective as well, but for those who really, in good faith, want to understand and want to be educated and help others around them be educated, do you have any advice for Kimberly Diana who asked me that question?

I think every one of us as trans or gender non-conforming people becomes sort of ambassadors for the rest—for the whole community, and every day we come in contact with so many people that we have that chance, one at a time, to open and change hearts and minds.

Having you said that, is it a burden sometimes, Michaela?

Yeah, occasionally it is! Occasionally it is, I think what I would say is that in the same way that like, you know, if you’re in a classroom, right, and you have like a question you want to ask, would you go ask like the professor who like chose to take on that role, chose to be an educator, chose to like, I’m actively going to stand in this position because I want you to approach me, versus like say like your classmates who like maybe if they’re your friends, they’ll help you out because they’re your friends and they’re, I understand your intentions are good, but like your classmates might also just be like, “No, I’m trying to pay attention! Like, you know, let me just do my thing!”

So I think that in that way, there are definitely people within the trans community and like, you know, the intersex community as well who are willing to be those educators. Like, I know that for myself, that’s a position that I like to put myself in because I like being that kind of a resource to people.

But we shouldn’t expect it of every—

Exactly!

—exactly!

And like, the reason why I actively put myself in this position is because I know plenty of people who don’t want to be in this position and who don’t want to have these questions asked. But I know that if people interact with me, that means that they interact with those people less, with those same questions.

So you’re a buffer in a way, exactly.

And I think that, you know, if I am somebody who is willing to do that and I don’t necessarily feel it to be as much of a burden as it might be for somebody else, then I feel more compelled to do that, you know, because I’m doing it for my community as much as I’m doing it for the people who like are trying to learn.

I do it more for this community that, like, you know, wants to be understood enough to like be left in peace and be left to like, you know, to like do the things that it needs to do, but you know also doesn’t want to be completely like shunned or put to the side for lack of like understanding or just ignorance, you know?

Yeah! So—and also those of us in educational roles have to have to actually step up and use those positions to actually educate people so that there’s certain base knowledge, and it’s not just on members of the community needing to educate everybody.

Georgian, you’re so chatty! Normally, I figured I was going to give you the last word!

Oh, great! Well, I would just say that if you’re a parent of an intersex child or a trans child, for that, what have you, just find a support group. Google—contact me directly; email me! I will connect you with folks who can help you because what parents need is to know that they’re not alone. Intersex people need to know that they’re not alone, and doctors need to know that we’re here, and you can’t continue to do these types of procedures and medically unnecessary interventions on our bodies.

So find us, and we’ll connect you with other people.

Well, Georgian, thank you for joining us. I like your earbuds; that’s a very good look. They match—they match your glasses!

Georgian is really funny; we’ve had a lot of fun getting to know each other. So thank you, Georgian! I’m sure I’ll see you again. Joshua, are you still there?

Hi! Thank you so much for—please give Gavin our best and please tell him how much I appreciate his participation in this film. I think it’s important for people to see the real-life human being that is part of a Supreme Court case so they’ll have a better understanding as this unfolds in late March.

So Joshua, thank you for being with us. Vanessa and J.R., thank you, guys! It’s late there; you must be tired. I’m tired! Ron just woke up, so Jay was able to keep him upstairs. We’re going to bed soon.

Did Ronnie wake up?

He did! We heard his little running feet! So Jay just went upstairs.

Okay, all right! Well, we’ll let you go. Thank you very much, and thanks for helping so many families, because I know your participation will—

We’ll do that!

And Michaela, who I said Mela—do you prefer Michaela or Mika?

Either is fine, but the correct pronunciation is Mikela.

And I said it right! Thank you!

In the documentary, Josh Safer, thank you very much, and Jean Malpass, thank you!

My pleasure!

You know, it’s pretty difficult to have a substantive conversation about gender in a two-hour film, and even more difficult in an hour conversation with Facebook and Twitter questions. But thank you to everyone who watched the documentary! Thank you for sending us your questions.

We’re providing a free discussion and discussion guide for educators, and I was really impressed with how many schools are very forward-thinking when it comes to this—schools, camps, and other institutions!

And anything else, if you have other questions you may be wondering about, you can visit NatGeo.com/GenderRevolution. You can also find Gender Revolution on demand on iTunes, Hulu, Amazon, and Google Play beginning tomorrow morning.

And a very special announcement: we’re going to be streaming Gender Revolution for free for one week starting February 14th, Valentine’s Day, on the Nat Geo website, Facebook, YouTube, Apple TV, and the Nat Geo app, which I think is a real public service! Hopefully, people can watch it, learn, and have conversations about it. Maybe it will help some families out there as well.

Anyway, thanks again, everyone! Thank you for watching! Good night!