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[SPEAKER] Ellie winter with the Miami University Alumni Association.
I am very excited to welcome you to our webinar this evening, gender revolution, a community conversation on gender.
Tonight's webinar is sponsored by the 1809 LGBTQ alumni group, plus and Oxford area P flag.
And I am joined by Sabrina from Oxford to moderate the panel.
Super Anna, would you like to welcome people?
Hello, welcome everyone.
We're very excited to collaborate with the 1809 group.
We've done this a couple of times.
This is our first virtual event, however.
And I am the treasure of P flag.
I've been a longtime ally of the LGBTQ Plus community, and I am now with family member.
So welcome and thank you.
Let's have.
[SPEAKER] Sorry.
We will engage in conversation about the National Geographic documentary gender evolution, as well as discussion of local resources and experiences related to gender identity.
There will be an opportunity for questions from then viewers.
Please submit your questions in the link just.
Below the screen.
But now I'm honored to welcome our panelists, but you'll have an each introduced themselves.
So kind of going around the screen.
Hope you're muted.
[SPEAKER] Muted.
[SPEAKER] And you go..
Hi, I'm Anne Barrowix at Wix.
Remember if P flag and a grandmother of a transgender teen.
[SPEAKER] Now you're muted [inaudible].
[SPEAKER] Goodness.
[SPEAKER] I'm just.
Or she her hers.
I'm one of the physicians who work in the Transgender Health Clinic at Cincinnati Children's seeing patients from early as age three to the 25th birthday when our patients graduates.
[SPEAKER] Thank you.
Hi i am.
I am one of the current co-chairs of the 1809 LGBTQ alum Miami alumni board.
And I know it's a little bit of a mouthful.
I'm also obviously a former student, Miami, and a transgender woman myself.
[SPEAKER] Thank you.
[SPEAKER] Kate Yes.
Hi, everyone.
Thanks so much for having me, my name Kate Coover Lanka.
I'm a faculty member at Miami.
I'm in the Department of Family and Social Work, and I am also p flag a board member.
Happy to be here.
[SPEAKER] Thank you.
[SPEAKER] Hi, I'm Christina Miller.
I'm a key flag word member.
I go by, she her hers pronouns.
And I'm also here today as a parent of a transgender child.
Happy to be here.
Thanks [SPEAKER].
Thank you, everybody.
I will turn it over to Sabrina now.
So I think one of the things that we wanted to do is discuss, I'm hoping you all had a chance to review the document.
Which I got to watch again yesterday for probably the third time.
How are we creating opportunities in small towns?
I know we're very thankful to have Children's Hospital down.
In Cincinnati, but in Oxford and other small towns around the country, how do we create more awareness and support for the LGBT community and their families?
Christina, would you like to take that?.
I know one of the ways that we're doing it in Oxford.
Through organizations like P flag.
There are also several organizations that are part of Miami University, both for students and the broader community.
And some of my peers on this panel can speak in more detail about the specific offerings of the university.
But on a community level.
Organizations like host community events, where it's very clear that there's an open and welcoming presence for the community.
For my child that required a lot of outreach to with their school.
So that support system of the school, understood what WAS going ON with MY child and our expectations as parents for the way we wanted the school to respond.
And that just that process alone created a whole ripple effect of conversations with multiple families.
Then the school actually becoming an ally.
Intervening on occasion to bring families of children that were sharing the classroom with our child into the conversation.
So that when the children came home with stories about their friend in class who says that they're transgender.
Were equipped with the parents, weren't necessarily equipped to follow up on this conversation, so those are some of the ways that it's been happening for us.
I'm sorry, there's a loud noise and background, so I was hoping you wouldn't hear that when I got on just a piggyback on what Chrisstina was just saying just thinking about the stories that I've heard from families over the years.
One thing I maybe should have mentioned when I was introducing myself is that I've been doing research with parents and caregivers of transgender children.
Diverse children.
Over the past decade, and so what some things that I've heard from them, especially those who are in small towns on.
So when they're not in cities where maybe supports for LGBTQ people and trans people in particular are more visible.
But it is like Christina as saying it's the schools.
It's the religious institutions, it's athletics, sports where people gather on everyday basis, where people can be doing things to make.
Lgbtq people and trans children, adolescents, and adults feel.
More welcome by doing little things and having conversations and educating themselves about the people who are around them.
And those in their, community and how to be more welcoming.
[SPEAKER] Thank you so much cate.
So kind of going off of that, how can we, society helped to expand our understanding to be more inclusive of gender, of what are some tips maybe Rachel, that might be something that you can help us with.
What are sometimes.
To expand our understanding.
[SPEAKER] For definitely your own personal motivation, but also it's asking for a lot of my patients.
It really varies and how I can support them.
Many folks, it could be making sure to school is a safe place.
So we worked with a lot of school systems and luckily, then goodness nowadays is getting so much., years may school systems have diverse students, so they know exactly how things work.
Or it can be simple things like making sure that they're safe bathrooms in the community.
It could be making sure that the school has resources and tools as well to make sure they have affirming pleas for students and you don't have to reinvent the wheel when it comes to how to support my even in a small community.
There are online resources there online groups where you can figure out how best to support students and community members, like glisten, GLSEN, they have wonderful resources and a great online community where you can absolutely hit them up.
[inaudible] like of course to as well.
Or says wonderful resources to be able to use in a school wide network.
But really it comes down to a personal thing so often ask patients, you know, how can I support you?
What would you want to make the environment around you more affirming?
Is it family level, community level, educational level, worldwide, you wanna be able to travel countries.
They have carry letter that supports your gender identity.
So lots of answers to that.
[SPEAKER] Thank you.
One of my questions is that when a family comes to the children's clinic, I'm assuming there's a multi-disciplinary team that works with them.
Can you describe that a little bit for us, Rachel?
Absolutely we're very blessed today to have.
Huge mega teams.
So due to you won't meet as many members of the team in person, right now since we're limited who can be in clinic, every visit you will meet a provider.
We have two positions and we haven't nurse practitioner.
And also we sometimes have learners with us like our fellows who are pediatricians training specialized adolescent care.
You do have in clinic.
Work teams.
So that will be a two member team, usually you'll meet one of the people.
We also have a Clinical Assistant to runs our family Facebook group where we said we have over 2 thousand patients in clinic announced that's a lot of different parents who are going to the process.
So that's kind their support peer system that we linked them into.
We also have a chaplain that works or clinic because a lot of our patients have.
Struggle and spiritual needs that we can help provide positive resources for with her.
Now, branching out from our clinic, there's not just them.
We also work closely with our OB GYN team.
And we work with chronology team now they work in the puberty blockers side.
Usuallly do adolescent medicine, which is my specialty and branch out from there.
We had the ethics team or quit where deeply involved.
With public relations team, the Government team, we also have who am I forgetting?
Our psychiatry team that we work closely with?
Multiple social workers and therapists throughout six different states because we do see patients from six state catchment area, and somebody I'm forgetting them or feel awful about later, but it's a lot of folks that come together.
Its a large interdisciplinary team that makes sure that we're meeting all of our patients needs and anything that may pop up because everybody's different in terms of what they come in meeting.
[SPEAKER] Wow That's a lot.
So when a family first comes in, do they book a couple of days so they've got appointments, several in a row, or do they come back every couple of weeks?
How does that work?.
[SPEAKER] The first is quite limited.
We don't overwhelm somebody, so it's just going to be really the provider is gonna be social work team.
And we kind of go from there, we see who do need to meet with, who's on your to-do list for people you need to meet with, right now because of covid the chaplain and the clinical system mostly meeting people virtually if they meet there.
For puberty blockers, which you mentioned the documentary, that would actually be a referral.
So it may be a few weeks before you see either endocrinology or OB GYN team.
If it is for hormones that's a whole set of checklist, you have to have evaluation by the medical team.
And depending on your age, it could be a matter of, days two, it could be months or.
Depending on what the requirements are and what's needed for patients.
[SPEAKER] And thank you for the work that you do.
So when we're in the collegiate area, you're working with more well, you're working with kids up till they're 25, so.
The university situation, like Miami University.
Do we have support setup for individuals who are LGBTQ but specifically trans.
And I don't know who that question really is to.
Maybe Kate, maybe a joy.
I know there are therapists in the area, so we do refer out around rather Oxford area.
We have a long list of therapists that we've vetted and people that we've worked with before.
So per people to therapists who are close.
The home, but people usually come on college breaks to the clinic.
So it's actually kind of unfortunate that Maria is not here, because Marie is our gender specific therapist at an Oxford, and we were really lucky to have that, that you can kind of, as freshmen.
God got almost a decade ago.
Look at the walk into the counseling services and say, hey, I would like to talk to someone who is knowledgeable about gender identity.
And that even though a lot of the services available in Oxford not through any fault of the town, just because it's a very small town.
Are limited.
That is one thing that is actually very, that is available to the students, at least though I can't speak to the availability of it to the wider community.
[SPEAKER] I'm on the mental health subcommittee of the Coalition for a healthy community and one of the things we do is quarterly update our list of therapists and counseling services available within the Oxford area.
And it's been really interesting with the telehealth.
Coming into play.
How many how far do we go out?
That still hasn't been really answered.
But one of our issues in Oxford is not only are we small, but most of our therapists are aging out, and so we I know maybe four off the top of mind.
List that our work with LGBTQ individuals and their families.
But we're not getting an influx of new therapists, young therapists coming in, which is something we need to work on.
And I'm not sure.
I guess the more we talk about it and promote it, encourage it, and it'll come.
Puberty blockers.
I have a lot of people ask me about this only because I'm involved with P flag.
Did they even asked me about it and I say, I don't know much beyond that's what it does.
They are pausing the puberty process and allowing time for individuals in their families to make some very serious and lasting decisions.
Would anybody like to talk about that?
I can definitely take it.
Unless say.
Since the talk about him as well,.
[SPEAKER] I think it's best that you start that conversation.
The one with the medical background.
The boring explanation of it.
So biologically the reason why puberty blockers work is they're both something called the GNRH agonists.
That's going to be releasing hormone gonadotropin, releasing hormone is released by the brain.
The essentially.
Triggers the development down pathways to get to the sex hormones.
So to stop estrogen, that's kind boiling down with a lot of steps, but just jumping ahead.
So as they mentioned documentary, this is a reversible medication.
You have two options that are available.
You've got the implant which is [inaudible], usually last one to two years, we tried to keep it in two years.
Then it has to be replaced.
If you go beyond two years, you've got your loop, which is here, injections the folks usually you do, but every one to three months.
Usually three months is what we import because less injections the better.
Through getting a shot every month.
No, both of these medications, it's merely a patient's choice in which way they'd like to however, insurance often may not cover the medications themselves.
So really things have to be run by insurance and patient preference when I meet a patient for the first time, I could determine one if they're a candidate for puberty blockers, you have to actually be in the early stages of puberty are five stages of puberty.
You have to be stage two, which is really early beginnings.
If I determine a patient is at least the stage to puberty, then I will decide.
We'll talk about risk and benefits of blockers.
We'll talk about how the reversible, how, you know, you do need to be monitored on them because if you're not getting hormones, it could affect bone health after many years of use.
As I mentioned the documentary, Yes, we do have data.
We've got at least a decade of data we know what the effects are, the hormones into adulthood.
But I still don't know yet how it affects our 70 to 90 year-olds.
So we want to be as safe about bone health as possible.
So people are regularly track and examined on bone health while they're on the medications.
So that's something to.
That to consider.
And also really just give them.
A lot of education about what the medication does, how long are people on it do you transition straight to hormones?
Do you like cooperativity blockers?
What happens?
Often they will transition a hormones if that's the plan.
So it's a lot of considerations we've got to have on each way.
But the thing that is company to parents is that it is reversible.
Child did wish.
Just to go through the puberty that their body was going to go through, have AI in all the patients that I've ever had get puberty blockers, ever made the decision to go back.
No, actually, all of them have gone on to do gender affirming hormones in the future, but we do send I had estimate at least probably one patient at least every other month.
It's more like at least one a month per provider.
So we're seeing a significant amount of patients.
We do have some patients that we see on an every six month basis just for puberty, watch.
So the second that they start puberty, we go to the blockers and we go from there.
The research that we've done on patients who do, do puberty blockers is.
Very positive you will see patients who are into B.
Getting stages of puberty, having a lot of dysphoria effects on mental health, anxiety, depression that you just see.
Breathe a sigh of relief when they get onto blockers.
And also it's very smooth transition as well, and going into gender affirming hormones.
However, how often do we catch patients?
That perfect timing to benefit from blockers?
Some patients, the ship may pass through the end of puberty.
Some patients they maybe have not gone their family to be on the same boat until they're older.
You've got to have a family that's well-versed family that supportive.
You've got to have a family that educated on what's out there, which is hard because it's not so easy to pick.
Endocrinology journal and be like, yes, I know about this.
It's tough, but I'm really law the families that we do catch on time and had that opportunity.
[SPEAKER] Am I correct that most puberty happens?
Kind of 12.
To 15 and so they're under age and would need parental or guardian consent.
In some puberty begins as early as age 8-9, and people who are assigned female at birth.
So it's a young age for some folks, but yeah, you do have to have parental consent and usually we want for if there are two parental decision-makers, we wanted.
To have been both in the same boat as well.
So that's sometimes it's hard one-party maybe like let's do it the other party might be shuffling their feets and if it's devastating for the patient that's when things get complex, when ethics.
May need but luckily that's very rare.
And I think Rachel would attest to this is a lot of times when issues come to trans kids, the first thing that anyone says is the medical aspect of course they always jump to surgery, which obviously just doesn't happen.
And then hormones, which for the most part doesn't happen.
Get as far as puberty blockers, but I put this question to Rachel about how much of your interaction with gender diverse, or gender questioning youth is around puberty blockers and how much is around the social element and just dealing with being trans.
[SPEAKER] Does vary a lot by age.
So for our kids who present in their teenage or earlier, years so let's break it down to our age.
So I mentioned h3 is the earliest age, usually three to 11 or 12 year olds.
It's all social.
Like we're not really talking about much of that point.
Yes, we may discuss a little hint in puberty blockers talked about what they are, how they exist.
Gives some information on them, especially our kids who may be starting to hit puberty.
But really it's working on school, preschool.
This is school supportive, how are family members doing can help them.
Do you need the chaplin?
Then also our kids who are puberty, age, they may or may not be discussing puberty blockers.
The youngest, we can start people on hormones to be age 14.
So that's really a while longer.
Sometimes they will get some 14-year-olds.
That's what they want to talk about, but that that would probably be about 70% talking about social concerns, 30% hormones.
Now, 18-year-olds or a big different scenario, 18-year-olds made than thinking about gender identity for about the last like almost a decade, they come in years of thinking about things.
But maybe family wasn't supportive, maybe they just didn't have the resources nor the information or the the access even I've had patients like we've seen five providers before we got to you finally.
But at that point, the 18-year-old who come and usually they're actually majority hormone talk because you've been waiting for this forever and they like now that I'm 18 I can make my own legal decisions inside my own consent.
That's why I'm here.
But we're still talking a lot about the social aspect too as well.
So a lot of it when it comes to trans youth, so much of the focus is on the medical side and the reality is, such a minor, not a minor part of it, but it's such a smaller part of it, comparison to the social aspect of it.
And just.
[SPEAKER] Okay, so we're talking about social, we're talking about medical, but we also need to talk about the safety of the individuals, in my work as a social work type person in Oxford, who mostly deals with seniors citizens.
I often get called by the family Resource Center who are trying to work with a young individual who has just become 18 and their family has rejected them.
So how do we provide resources?
And that's one of the hard things about Oxford.
We are.
An incredibly generous community, but we do not have a homeless shelter.
We don't have a lot of things.
So we rely heavily on relationships with lighthouse youth services and checking in with glisten and finding.
Funding for a hotel stay for a couple of nights.
Where we're trying to put some resources together.
And these are the ones that they haven't had family support question, clearly.
And so creating finding space that are safe, that they can get the medical and mental counseling they need.
But also, there were a place where they can start to thrive and be.
Supported and I think that that is.
I think from my point of view, colleges are working hard to create more safe spaces like that.
But I think that even in Oxford, Ohio, which has this lovely new high-school, Well, it's probably ten years old at this point, but we're not we're pretty rural in a lot of our thinking.
And that that saddens me in a little bit frightening also.
Do we have Maria coming in?
No words at all.
[SPEAKER] Thank you.
So much.
Marie, would you like to introduce yourself real quick?
I'm Dr.
West died and I am a psychologist at the counseling center.
I'm the coordinator of LGBTQ.
Ia services.
Thanks [SPEAKER] So much for joining us.
We're awesome we're I'll talk a little bit of we've talked a little bit about medical in some social, but then also going into safety.
But we actually have a question from the audience.
They came and I think actually maybe Anna Cristina, you, you might be.
Great ones to answer this question is, how as parents or grandparents, how can you best prepare yourself, to have that discussion with your children, or grandchildren about all the different things that we've been talking about?.
[SPEAKER] First with that.
Actually, when I saw the question.
In the chat, it was also asked about how I handle that for myself in religious environment.
Well, actually I didn't have to talk to my grandson because he told me he's been very open and we've had really good conversations.
I feel like around it and he's been the one educating me.
But the basic thing is the minute we heard, about it, we just were.
We wanted to know we wanted to learn as much as we could and supporting the best we could.
So I think education piece like the place I started really, and I'm very thankful for the many things I've learned through them.
The way to support a teenager is too, I think is to listen to them.
When it comes to a religious situation, I really didn't like to say this fortunate, but I'm going to say it fortunately, our grandson doesn't have a religious affiliation.
I do, however.
And in fact, we're leaders in our faith community.
So the way we have handled this is to, it doesn't bother me with my faith., but I know that the community that we're in, it does to have transgender people among them were in their community.
So we see our role as just gently telling people what it is and that's all.
Thank you for that, Christine, do you want to weigh in?
Well, it might just help to hear a little bit about how our experience went.
So I've been a supportive LGBTQ ally for a long time.
And really observe my child growing up.
And thought, let's leave the doors wide open here because some of the signs that I'm seeing indicate that my kid might not know just aligned with the gender that they were assigned.
At birth.
And sure enough, even.
Even chosen name originally that was non-binary, not because we had the foresight or anything, but because that's our belief system.
So entering this pretty wide open, but I can't say I wasn't I was nervous the first day of school.
Wasn't the first day of the school year was in the middle of the school year.
And in my child was determined like, can I dress like a girl today?
Like the only thing that would qualify as girl in our closet was a pink t-shirt that they had actually picked out in design for themselves.
A while before.
So it was really just a matter of not not questioning really saying that's what you'd like.
Let's do that.
And carrying carrying forward the desire and really making good on it.
So even after that first day of school, we went to the secondhand clothing store.
And they picked out their first outfit, that they felt truly was theirs, and they were comfortable in it, and then we went to the playground to play in that new outfit with this new thing.
And I was the one like, how do I, what do I how do I tell people?
What do I do?
And it was really just a matter of being.
You haven't seen in awhile.
I didn't want to say that any given see my child in awhile.
Well, they're now.
[SPEAKER] Introducing themselves with she, her, hers.
Move ahead.
2.5 years, and now we're in this phase where we're transitioning a bit again.
To much more of a preference for non-binary identity.
And we're going with they, them, theirs pronouns.
And that's been that's grammatically a bit more of adjustment, but we're in the flow now in school was very open.
And I just heard that last week, there was a great conversation at school within the classmates in the classroom to bring everybody up to speed on what that meant.
So, going with the flow and not challenging the question, somebody put it in a way that I thought was interesting recently, it's like, how do you know, how do you know what your child is saying?
I hope this doesn't seem too simplistic.
But for people that are really questioning are challenging it.
How do you know you're right-handed, or you are left-handed?
Or you're ambidextrous, like you just know.
It's not it's not something that is a problematic aspect of once identity.
So I hope that.
Helps a little bit.
That was great.
[SPEAKER] It was great.
Okay sports [SPEAKER] I'm sorry.
I just wanted to build off.
What Christena was saying.
I think is one of the questions was just talking.
Maybe this wasn't what the question was, by talking with kids in general, kind of Christina saying is going with the flow being open.
I think all parents can do that.
I have a 10-year-old son so far as we know, is cisgender.
And from a young age, I was I just tried to be very open to referring to my child as my child and not putting on him and not talking about him as my son just always referring to him as my child.
And so just letting my kid grew up to be who they are.
Same thing with clothing choices and all that, just letting my kids have a choice.
So I think all parents can do that.
There are great books out there now, so I am Jazz is out there, and so my kid knew early on what it meant to be transgender, and then explaining non-binary.
Because of course, the I am jazz book is very binary trans.
But talking about that kids are, they can get it from a young age if you are just willing to have those conversations.
With them just about the expansiveness and the complexities of gender.
It just in their language, they can get it and they're open to hearing about it.
So my kid I have this story from earlier at elementary school for an open house night, or something.
Where all the different clubs were you could walk around and see what the different clubs were.
And they were having Girl Scouts.
And so my child was asking.
So Girl Scouts who can go there, to the Boy Scouts too.
And I'm like, I'm not sure if they do and I was getting ready for a conversation about boys.
Scouts because I have some issues with the political with that organization, but his idea was that they don't have friends, Scouts because what about the kids who don't identify as girls or boys?
I'm like That is a great question.
Actually, Girl Scouts do accept everyone, but I think the Boy Scouts down now do to kind of taking after them.
But anyway, we can do parents and teachers of cis-gender kids, all children.
We can be teaching them about the expansiveness of gender and not just waiting for trans kids to come out as trans.
All right.
So I'm going to go into the sport situation because I recently listened to an interview I think it was with Megan.
Who's on the women soccer team.
I don't know if.
[SPEAKER] That's how its pronounced.
It doesn't matter.
Your sex come and play with us.
So I know there's been a lot of controversy in politically because everything has to be.
Politicize these days.
In who can play.
And one of the programs that we had at Miami, and I think we still do is that you can play initiative that we don't care what your gender, or sex is.
I think gender is still an issue and that's my question, is, are, you know, it's one thing to be playing soccer at the try when you're five but it's a different thing in college.
But I will say that both my children who played soccer and who were cisgendered, they loved their Co-ed teams.
Those were their favorite teams.
And when our daughter ran track, who knew she was gonna do that, it was so fun because she was competing not directly with the males but they were all together doing the similar events.
And it wasn't just all divided.
So I guess I'd love to hear thoughts.
Well, I can go ahead and something.
I want to preface this by saying, I'm not a sporty person.
I was the cool kid in school who did speak to the debate and marching.
Band that being said, I always loved.
To point out in this discussion that it always completely ignores transmit.
As a lot of transgender discussions do, is all of the always talking about how much all secret manner trying to infiltrate women's sports.
So that they can do whatever.
As if high school sports and the most sacred thing in the world.
Also, they never talked about the fact that through the same logic there having individuals who are transgender males.
Compete with women and men then they do have the physical advantage.
But for what that is worth.
However, to kind of go off that it always is blown up as this giant issue.
And I think people are really underestimating the fact that just because you might have a male body or male hormones.
Does it mean that you automatically have this huge advantage that sports, especially in a team sport like soccer, or football, or baseball.
One player does make a difference of one player is only ever gonna be one player.
People don't realize that even in sports where you can definitely.
[SPEAKER] Compete with your gender identity, there are particular guidelines.
So in order for somebody who is transmasculine to compete in the men's sport, you, obviously, yeah I totally agree that it is easier.
Often for somebody to be on the men's teams.
There are particular testosterone levels you have to have some times to make sure within normal range, but especially in somebody who's transmitting going to women's sport, the our particular testosterone levels, they have to have as well.
So to be in the normal feminine range, which I believe the IOC actually does have guidelines for that where they had to be just below.
The two hundreds.
Don't quote me on that, but there are particular numbers they have now, Ohio does have state guidelines.
I do get educate high-school patients, often asking about whether or not they can compete in the sport that aligns their gender identity.
Which I say