Gender-Affirming Care

- [Commentator] "Flatland in Focus" is brought to you in part through the generous support of AARP, the Health Forward Foundation, and RSM.

- Hi, I'm D. Rashaan Gilmore and welcome to "Flatland in Focus."

For this episode, we'll be talking about gender-affirming care and how limiting access to that care affects our community.

(light music) As of this taping, there have been 540 anti-trans bills introduced across the country.

Recently, Kansas passed sweeping legislation that among other things, will prevent those who are trans from accessing spaces that match their gender identity, spaces such as bathrooms, shelters, and prisons.

On the Missouri side, Attorney General Andrew Bailey has proposed a rule that would create significant barriers to gender-affirming care for youth and adults.

For now, this ruling has been stalled by the courts, but let's hear how some attempts to prevent access to this care is already affecting those in our community.

(upbeat music) - [Olive] The viscus rose is like really floral and the passion fruit is really like tangy and like fruity.

- Passion fruit.

- Passion fruit?

Awesome.

- Yeah.

Thank you very much.

- Thank you.

So I'm one of the founders of Cauldron Collective, a worker-owned, vegan pop-up.

I've spent the last six years building a community around me, like becoming a part of like the queer community, and the punk community, and the art community here.

I want to like put down roots.

I wanna open a brick and mortar, you know, Cauldron Collective Restaurant.

Starting Cauldron Collective with Kim and Six, it was just so special that we were all able to like find each other at the right time and it's hard to imagine doing this without them.

- My Name is Kim Conyers.

Let's see, what's nice spiel?

Bartender, bassist, DJ, fire juggler, vegan chef.

- [Reporter] And local celebrity.

- Yeah.

With all of this though, I am going to be moving to Portland, Oregon, which is really tough because I have fallen in love with Kansas City and I have a lot of things that I really love about Kansas City.

I'm not feeling welcomed by the state of Missouri.

- [Reporter] Legislation that restricts gender-affirming care and trans athletes is now headed to Governor Mike Parson's desk.

- [Reporter] Kansas will soon have what may be the most sweeping transgender law in the U.S. - [Reporter] A new court filing lays out the Missouri Attorney General's arguments against all transgender care from minors and adults.

- On one side of the state line, I'm not allowed to get estrogen on the other side of the state line, I'm not allowed to go to the bathroom, which do I pick?

(people laughing) - They wanna make sure we do not have access to public accommodations, to restrooms, and to healthcare facilities.

- It's a disturbing trend.

Policy-wise it's setting a horrible precedence in terms of politicizing a subcategory of a community, but also socially it's really painting a horrible message of it is okay to be transphobic.

It's okay to question that person's humanity.

- Trans rights are human rights.

- [Crowd] Trans rights are human rights.

- It's more of a state of panic.

You know, I have people told me they're leaving the state, they're getting emergency funds set up.

A lot of this is by design to silence people from not only being themselves, but having political power.

It's to get us to move.

And at that point they will consolidate power even more.

- Your friends are literally fleeing the state for their safety.

We're at that point and what we need people to understand is like, you know, they're not gonna stop with the AG order.

They're not gonna stop with like banning transitional care for kids.

They're gonna try to take away the very life-saving medical care that me and so many of my friends need for nothing because I wanna wear a dress.

- I think it's important also, depending on where you're coming in this conversation, understanding what it means to be a transgender person, right?

That your external body in some way is not congruent with how you feel as a person.

There are a number of tools in the toolbox for addressing that.

Sometimes people choose to have gender-affirming care and again, that's a broad definition.

That doesn't mean that much.

Some of it involves helping their body to adapt to how they feel and that can be through hormones.

People who are not trans also do that all the time.

Bodies naturally go through a withdrawal of those hormones as we age, menopause being the most common one that almost everyone is familiar with.

To pretend that there's not ongoing research all the time into something so pressing and affects so many lives, isn't true.

Of course there is.

- I think it doesn't put as much value on the fact that there's a lot of medical components to it.

Gender therapy and treatment of gender dysphoria is not strictly a one-man approach.

It is a team approach.

Fear has hit all of the professionals involved in this.

- Some of the things that are included in some of these bans, like three years of a diagnosis and 15 months of consecutive therapy, or resolution of a mental health condition.

Those are things that just don't oftentimes really exist or are written in such a way as to be a hurdle that can never be overcome.

- There are not nearly enough mental health services in Kansas or Missouri, but if we take a whole group of people just arbitrarily and say they are required to access these services that to be honest just don't exist, it's gonna limit even further an overtaxed system to where folks who are not trans are not gonna be able to access these services even more so than now.

- If it was depression, would we be like "Are we really sure Billy's sad?

Are we really sure?"

They're not going anywhere.

So to say I can't do the work that I need to do with them, I'm not really sure how that benefits them.

I would go so far as to say you're endangering the kids.

- If I were to ask you what you want for your children, you want them to have life satisfaction, feel good about themselves, to feel good about where their life is headed, that they can accomplish the things they need to do.

You don't want them to have severe anxiety, depression, suicide, you don't want them to end up incarcerated, right?

All those end points get better with gender-affirming care.

I think individuals who go and actually meet those folks and ask them what gender-affirming care has done for them, that'll speak volumes more than any statistics ever could.

- If there was an antidepressant in this world that had a 97% success rate and decreased rates of suicide like that, it would be a miracle.

Yet, when it's something like gender-affirming care which does have a very significant decrease in suicidality, a significant increase in quality of life, then why is this something we're taking away from people?

And it is supported by the American Medical Association and the American Association of Pediatrics.

Providing me gender-affirming care is medically founded.

To anyone like that is struggling with understanding who I am, you don't have to understand.

I am happier than I've ever been now that I've been on hormones and you can't take that joy away.

You might take away my access to gender-affirming care.

You might completely disrespect my name, but you can't take away the joy I first felt when I started hormones, even if I have to stop right now, as soon as I leave this interview and never take another shot of hormones again.

The two months I've gotten to have gender-affirming care were the best of my life.

- I really don't see any other future outside of me being me right now.

That's what it is.

You know, it was either this or I was not gonna be here.

I'm pretty sure I wouldn't be alive today.

- I lost a friend, I lost a trans friend.

I lost her Tuesday and she took her own life.

All this anti-trans (beep), it didn't help.

I'm asking you reach out to your friends and if you're hurting, reach out to someone.

- We focus a lot on the trauma aspect, which are very real and very critical and tough conversations that need to have in order to help change hearts and minds.

But we also wanna lean into that joy, right?

That way to our people that you know have agency and deserve to live a life that is vibrant.

- What I organized was called the Trans Joy Picnic.

Over 100 trans people coming together, literally just laying their blankets out, laying their food out, and putting some music on to have a moment where we can just enjoy ourselves and remind ourselves that we are people and that we deserve to have enjoyment in our lives as well.

You suddenly feel so full of like, I'm not alone.

We have this whole entire community around us and it fills you with an ability to be resilient.

- For anyone that's here, there's always resources, there's always amazing community and there's mutual aid networks and there's always a battle that's worth fighting and it's really important that someone is here to do that.

- I care about saving our future trans and gender non-conforming children from the trauma that I've survived and that people can accept them for who they are and eliminate the need to constantly barter or negotiate who they are to other people.

It can lead to anxiety, depression, we know this, suicide ideation and in the worst severe cases, suicidality.

That is what I truly care about and what I wanna prevent, right, for our future babies.

And that means your kids too.

- I am a nurse, I am a caregiver, I am a homeowner.

I am a part of the fabric of this city.

I'm taking care of your sick, I'm taking care of your kids, I'm taking care of your grandparents.

I'm paying my taxes that pay, you know, the people's salaries who are debating whether or not I should be able to live here.

- [Freddie] We're dedicated to be who we are, period.

I went through the darkest parts of myself to get here.

What makes you think that I'm willing to go back especially not without a fight?

- Alright, we're back in the studio for the panel discussion of today's program and I'd like to welcome to the table, Dr. AJ Strickland, a physician practicing family medicine in Kansas, along with Joan Rose, co-owner of Goofball Sk8boards, and Suzanne Wheeler, executive director of the MidAmerica lesbian, gay, bisexual and Trans Chamber of Congress here in Kansas City.

It's a strange time for many of us who are of the LGBTQ community and we are facing down a lot of really tough challenges and they affect a lot of us across a very broad spectrum.

I wanna point out that we had a guest that was gonna join us today, but is unable to make it and so we'll try to include them in our "Flatland" followup.

A young person who is black and is a trans man and is navigating his way through the community.

For now, I just wanna kinda start with you, Joan.

So much of this has kicked off around sports.

- Yes.

- And so obviously you started a new business this year in that area.

And so I'm just curious if you can tell us what do you feel is the the motivating reason behind why you started this sports league anyway?

- Yeah, my wife and I got into skateboarding at the beginning of the pandemic and I was very new, new, new to it.

So I was going to parks and realizing that I didn't feel very welcome there.

We're seeking to make skateboarding for everyone.

You don't have to be good at skateboarding to come skate with us.

We just wanna have fun and really open the opportunity for everyone to join in if they want to.

- Imagine that, sports for all.

Well, I'm gonna come at some point, but I'm gonna be the guy that's bandaged up like a mummy to make sure I don't hurt myself and have to go see Dr. Strickland here.

But Suzanne, let me ask you this question.

Nationally, 540 pieces of anti-trans legislation targeting what is essentially 1.6% of our whole population in this country.

What have you been hearing from other business leaders that are either part of the chamber as allies or maybe trans business owners?

What are they saying?

- Oh my goodness.

It's an enormous disruptor at this point in time.

You know, business leaders don't know how everything that's going on at this point in time is going to impact their human resources policies, impact their ability to recruit folks.

That has a major impact.

I was at a conference in Albuquerque with several other LGBT chamber leaders from across the country at the same time that Wisconsin passed their Sanctuary Bill for LGBT individuals, basically saying nobody's ever going to cut you off from your healthcare in Wisconsin.

And we were all talking about how that is such a brilliant move because so many of the folks in the generation of the future workforce want to go to someplace that's affirming, that affirms their value.

- Sure.

So what is your take on what the city of Kansas City thanks to its LGBT Commission is proposing in terms of making Kansas City a safe space effectively for members of the trans and LGBTQ community more broadly?

- Oh absolutely.

Kansas City is, you know, 20 years ago they had a non-discrimination ordinance in place.

They were one of the first cities in the nation to do that.

And now with this movement of looking to be a sanctuary city, the challenge is they say all politics are local?

- Yeah.

- Until the state houses get involved.

- We saw that with the abortion issue where the Supreme Court said, "Well, it's gonna be a state's issue.

We'll let the states deal with it."

And we see how that's blowing up all over the country in various states, but I'm interested to know from your perspective as a provider what is it like to have legislators telling you basically how to do your job and it really frankly being inconsistent with the broad view of virtually every national major medical organization?

- Well, you know, there's been a strong current of this kind of disassociation of our healthcare from the doctor-patient relationship in general.

You know, we've seen that with just county health departments, a lot of them losing the ability to have that final say of whether or not that health professional whose job is to protect that community can be able to issue any kind of guidance.

- Yeah.

- You know, that power is being taken away and it's largely happened all the way across our healthcare.

We're seeing something that's just so counter evidence-based medicine.

I mean, you can look at a lot of those like you mentioned the attorney general emergency rule and you look down through all of those individual quotations, right.

The references of what they're referencing.

You can go back to those articles and see exactly what they say and they're very much gender-affirming care is healthcare.

It is evidence-based.

It's affirming, it's evolving like everything in healthcare.

- Would you please talk about what affirming care actually is?

And also if you can, what it is not.

- It's a journey that a family typically takes with their child or with a consenting adult with they explore their gender identity and sometimes that involves getting healthcare involved.

It doesn't always, that doesn't define somebody's gender, but it helps them reflect that in the world around them.

But they're incredibly safe.

We're talking about gender-affirming hormones, sometimes surgery, but these kind of radicalized images like you're mentioning, never.

I never see that.

That's just not what's happening.

First of all, nobody has access to care at those ages, they ever have.

We do have the opportunity when given access to gender-affirming care at an appropriate age to explore with that child or explore with that adult what ways they're wanting to express themselves in a healthy way.

- Joan, what was your journey like and then were there supports, whether from family or medically or otherwise that helped you not only in making the decision, but in living into it?

- Yeah, I think, you know, the most supportive person was my wife who really saw me struggling.

And you know, she said, you know, "Look at yourself.

You look at yourself with such hatred in the mirror.

You deserve affirming care and we can get that for you."

And once I really internalized that, I thought, "You know what, I do deserve care."

And after that, looked into hormone replacement therapy, into top surgery.

And I don't think without those things I'd be able to be a community member in the way that I am.

And I don't think I'd be able to show up for the youth in my community without having gone through that journey and without being given that opportunity.

I wanna see the kids that come through our doors grow into successful adults and I'd hate for them to see that their state doesn't want them around or doesn't even see them as they are and God forbid to take their own lives.

That's a nightmare scenario for me.

I want these kids to live.

I want to live and I wanna be a part of my community and I want my community to say, "Hey, we want you."

- As a trans woman operating in this space in this state, how does that make you feel?

- Nervous and scared because I get my healthcare on the Missouri side of the state line.

- So it could really materially change how you access care.

- Absolutely, absolutely.

And as a middle-aged trans woman who is 10 years removed now almost from my transition, to have that all upset because the attorney general or the state legislature has certain criteria that doesn't meet what the medical community wants met for me to be able to transition, to have that, that's terrifying in itself.

So obviously I'm looking at providers on the Kansas side of the line now.

Kansas has said there are only two genders and that's defined by your sex at birth and your ability to either produce or fertilize ova.

So now I'm in the situation of can I even still go to the bathroom in my own home state without getting arrested?

And they just passed a bill around incarceration saying that you have to be incarcerated by your sex at birth.

All it serves to do is to increase the rhetoric around the trans community, the fear around the trans community.

- But let's talk about that.

Let's dive into that a little bit more.

What is the real intent, Joan, in your view of this legislation?

I'd like each of you to answer that question.

- To me the intent is to stop people from transitioning.

Just full stop.

- Is it to disappear?

To the end of disappearing trans people?

Is that what they hope will happen?

- On this route, yes.

That's what it looks like to me.

People are already fleeing, making our communities smaller which is putting us in more danger and more open to being eradicated.

When talking about it with my wife, we wanna plan for the future, and we wanna take these things into consideration.

But it's a hard line to walk between coming up with a safety plan and catastrophizing something that's not going to happen.

Living in that fear, it makes living a little more unsafe for us.

- They want us to either go back into the closet or move out of their locales.

That is the entire intent behind it.

We hear what they're saying at the table, but the rhetoric is very damaging to transgender, non-binary individuals.

It's very dangerous.

When you go online and you look at how many transgender people have attacked somebody in a restroom in Kansas or Missouri.

That has not happened.

However, there are hundreds of attacks on a yearly basis against trans individuals.

- Absolutely.

- And our politicians are just serving to increase those numbers.

- 47 trans people in the U.S. lost their lives due the violence in the prior year.

And 70% of those were black trans women.

Suzanne, for the person who is in business, or maybe they're not in business, but maybe they are someone who knows trans folks and they want to figure out how to be an ally.

How do they step up?

How do they support?

What should they be doing and saying and to whom?

- Support through letting that person know that they're individually supported.

Then the next big piece is the water cooler discussion.

When you hear the myths and lies being spread you have to call those out.

You have to say, "No, trans people are people too and we're not going to change what we're doing.

Change our acceptance.

Change our morals because somebody's trying to scare us with the trans boogeyman.

That's not gonna happen."

We live in a community that is very, very supportive of trans individuals for the most part.

There are attacks.

Those are fringe, but for the most part, everyday folks don't believe that trans people should be discriminated against.

There have been several recent polls that have come out around that.

Despite what folks' belief is around gender identity and all of those things, they're not supportive of discrimination.

So, you know, letting folks know you're going against the grain if they do wanna discriminate - If there are other providers who are struggling with the decision about if they can help, should they help?

Maybe this is a part of their practice and they're thinking about letting it go.

What message do you have for other providers?

- There are so many great family medicine doctors out there who wanna take care of their patients.

And some of them, just like you said, 1.6% of the population, some just haven't had exposure.

I start out by meeting one lovely woman who came to me as a patient and I love taking care of her.

She was not getting great care before.

And I said, "I don't know a lot about this, but it's my job to find out and take care of you."

And so that's what I did.

And that's how it became a big part of what I do as a family medicine doctor.

But it's a big part of what all of us do as family medicine doctors.

It's just, if you've never had a patient with malignant hypertension and you see it, you look it up, you learn how to take care of it.

And that's what that is.

And to the politicians that are making these decisions, take a step back and just start with love and acceptance and go from there.

I mean, you get to meet people.

You know, I grew up in a small, rural town in Kansas.

I never met nobody from the LGBT community for many years in my life.

- That you know of.

- Right.

That I know of.

You can really start to appreciate, understand, and fall in love with taking care of those people.

And that's what I do.

And I think that if they got a chance to hear those stories more from the place where their family, their friends, I think that they might have a change of heart.

- We've always been here.

We will always be here.

There's nothing anyone can do to stop that, regardless of the laws they pass.

And there will always be people fighting back, regardless of the loudest voices in the room saying that that's not possible.

- You've been listening to Dr. AJ Strickland, a family medicine physician in Kansas.

Joan Rose, the co-owner and co-founder of Goofball Sk8boards.

I'm gonna come out and join you guys soon.

And Suzanne Wheeler, the executive director of the MidAmerica LGBT Chamber of Commerce.

You can find additional reporting on gender-affirming care on flatlandshow.org, our website.

And please join us on Instagram at FlatlandKC for our "Flatland" followup right after this show.

It's an open discussion where we invite anyone to come join the conversation and talk more about this important issue.

This has been "Flatland in Focus."

I'm D. Rashaan Gilmore.

And as always, thank you for the pleasure of your time.

- [Commentator] "Flatland in Focus" is brought to you in part through the generous support of AARP, the Health Forward Foundation, and RSM.

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