Affirm, Connect, Resist: How Community Shapes Trans Liberation – Part 1

Transcript:

Chynah (00:00):

Hello and welcome to the social work lens. I’m your host for today, Chynah and today we’re tackling an incredibly important and timely topic, gender affirming care. In Vermont. As conversations around gender identity become more visible, there’s a growing need for policies, support systems, and healthcare practices that are inclusive, respectful, and accessible to everyone. Gender affirming care, ranging from mental health support to medical treatments and everything in between has proven to be life changing for many transgender and non-binary individuals, ensuring their dignity and wellbeing. But for those who need it, getting this care isn’t always easy. In Vermont, a state known for its progressive policies, there is still so much work to be done to ensure that gender affirming care is accessible and equitable to all who seek it. Today will be exploring the challenges, opportunities, and the critical role gender affirming care plays in the lives of individuals. In Vermont, we’ll hear from healthcare professionals, advocates, and business owners who are actively working toward creating a more inclusive and supportive environment. Our guests today are Amanda, the associate director of Outright Vermont, who has been on the front lines of providing gender affirming care and advocating for policies that protect access to community, resources and safety for transgender youth. We’re also joined by Luci, an incoming resident physician at the University of Vermont, who is here to provide her knowledge and expertise on the medical side of gender affirming care. And Eli, founder of Shapeshifters, a locally owned and operated business that manufactures and supplies individuals with gender affirming clothing. We’ll hear more about their individual roles. Shortly together we’ll discuss the current state of gender affirming care in Vermont, the challenges that still exist, and what needs to be done to ensure that everyone, regardless of gender identity, has access to the care they deserve. We’ll discuss the myths that we often hear that might cause some confusion or reticence around supporting youth and share some resources. Thank you for tuning in and let’s jump right into today’s conversation. Amanda, what does your organization do to provide gender affirming care?

Amanda (02:20):

Yeah, thanks so much for having me. Out Vermont is building of Vermont where all LGBTQ youth have hope, equity and power. And so that looks like a program suite that looks to transform the systems that impact young people like schools and child protective services to better meet their needs. It looks like helping to build communities where they are affirmed and celebrated for exactly who they are. And that includes a really strong network of parents and caregivers who we know can be the best champions for their young people. And it also means building spaces where LGBTQ youth have their own peer connections and peer support. And so communities where they’re meeting other young people who share aspects of who they are and can really celebrate and boost one another in those spaces. All of that is gender affirming care because that is such a big umbrella term that covers such a lot. And so loosely speaking, at outright we think of gender affirming care and sort of three, I won’t even call ’em buckets, they’re sort of puddles ’cause they’re so squidgy. But loosely speaking, I would say gender affirming care can fall under categories like social and emotional support. And that might be calling young people by their name or not giving them guff for what they’re wearing. It can mean showing up to a space and not having to explain who you are young, you know, young people are gonna use your pronouns. Adults are gonna use your pronouns without giving you a hard time. All of that can be gender affirming care. The other aspects look like sometimes legal support. So that might be going through a legal name change process. It could be getting a driver’s license set tells who you are and some of that can look like physical or medical support. So from outrights perspective, we’re really involved in sort of the building spaces where young people can just be themselves that looks like the social support. And then we offer a little bit of advocacy to create access when it comes to the legal and medical support. But we’re not doctors and we’re not lawyers. So we really just help people navigate those systems rather than delivering those things for themselves. You can’t go to outright and get a driver’s license that has your name on it, but we can give you some support when it comes to navigating the DMV.

Chynah (04:30):

Awesome. Thank you so much. And Luci, what is your role or your institution’s role in providing gender affirming care?

Luci (04:38):

So I am working in the hospital, the UVM Medical Center. And in a way it’s pretty obvious what the hospital does. It provides medications, it provides care to these youth that really, really need it. But what that means specifically for these youth are that there is like a specific transgender youth program at UVM in the children’s hospital. And there are a couple of physicians that work there and they work not only to get medications, but also talk about what are the things that we can do to support you socially. They work to educate parents, educate schools be an advocate for the patients, and they also work on educating other providers because for a long time people in Vermont could only get care in Burlington, but that has changed over the past few years with youth being able to access care in other parts of the state like Montpelier and Brattleboro. So there is a big focus on education both to parents and schools and also to other providers. Yeah, that’s sort of where I come into, is sort of my goal over the next three years that I’m a resident is to help educate all primary care providers to be competent in gender affirming care.

Chynah (05:54):

Awesome. Thank you Luci. And Eli, can you tell me more about Shapeshifters and what you and your business are doing?

Eli (06:01):

Shapeshifters makes custom sized chest binders and other gender affirming shapewear. In our studio in Brattleboro, Vermont, we have an online store where people enter their measurements and according to those measurements we make to their bodies, we are still the only option for chest finders for folks with a lot of accessibility needs. We are the only option for a lot of sizes that are not made in mass production facilities. And we are, to my knowledge, the only chest binder company who works with individual clients in altering each binder to fit their individual bodies. And for 11 years now, we’ve done a lot of this work with trans people in all stages of transition coming to us and saying, this is how my body is shaped. It’s not like the body shapes that I see in models, photo shoots or photo archives on social media or wherever. How do I transition? And though we can’t always an, we can never answer that question fully, we can often say, well, here’s some things that we can do for you and your body specifically that you cannot find in any sort of clothing store. We’re tailors. And I think tailoring has been a part of gender affirming care for hundreds of years at this point. So it has been a true honor of my life to be able to provide this service to community for so long.

Chynah (07:38):

And if I can say they’re just so, so cute, there are so many places where the binders are like drab or only white or black or various flesh tones, but you all have like, if the place to go, to get like mermaid scale binders is shapeshifters. It’s the best. Yeah,

Amanda (07:56):

They Are very cute.

Eli (07:56):

This is precisely why I started <laugh>, that my options for myself were white, black and ugly beige.

Chynah (08:03):

They were not enough.

Eli (08:05):

And I wanted to be covered in sparkles all the time, and I still do. You’ll not catch me without a bright color somewhere on my body. And I, I was making my own before I, I started the shop and then, you know, I had friends who were saying, Hey, could you make one for me? I have asthma and I need one that’s just the right size and a little loose.

Chynah (08:25):

That’s incredible. That really is incredible. And it, it makes me I know that this wasn’t a question that we had talked about previously, but if you, Eli and anybody else who wants to can speak to, like why is it so important that individuals have access to safe garments?

Eli (08:42):

So a myth about chest binding is also a greater myth about transitioning, which is the myth that it should hurt a little. It’s hard, it’s rough. It should be, you should feel in your body that you are doing something that strains you and this is incorrect. A chest binder should fit you well. Your transition should feel good, otherwise why are you even doing it? There are so many things that have to hurt necessarily in medical care, like, you know pain after a surgery, but feeling your gender match how your your identity is inside is a beautiful and wonderful feeling. And your clothing should fit and it shouldn’t hurt you <laugh>. So it’s extremely important for chest binders to fit and do the right thing partially because it could hurt you literally, it could cause further medical problems down the line. And also because there has been this myth for so long that, oh, if it doesn’t hurt, it’s not working. I, when I started my transition in 20 11, 20 12, it was, I think more prevalent than today. But we still see that sometimes this attitude that you should suffer for this. And it’s really important to fight that.

Amanda (10:00):

And I’ll just add, you know, doubly important for young people whose bodies are growing to have safe weight, safe ways to compress their chest. And so young people are evil geniuses and if they’re not getting their needs met safely with support from the adults around them, they find ways to DIY their own care. And that can contribute to really harmful practices like finding with unsafe materials binding for too long. And so restricting access to both the materials to do it safely and joyfully and in ways that fit your body over time versus doing it in secrecy with bad materials and no information about how to do it safely. Like this is just such a crucial component that I think folks miss when they’re talking about like offering gender affirming care to young people and seeing it as a way to promote health and safety rather than reduce it, which is like the scare tactic we’re seeing right now.

Chynah (10:59):

Right. Yeah. And go ahead.

Luci (11:01):

And I can add to that, I’ve like seen in the emergency department, like quite a few times, people who use unsafe materials to bind and they end up with rib fractures or they’re not able to breathe in as deeply because it hurts so much because they’ve not been using the right materials to bind and that affects them. And like playing sports or just being able to function in their daily lives and having access to the things that feel comfortable and make it safe to bind or tuck is really, really important because these folks are gonna have long lasting effects on their daily lives if they’re not able to do it safely. And we see this just all the time, unfortunately, because some people are not able to access these things safely and they cannot tell their parents. And yeah, I just feel really, really sad when I see these folks come in.

Chynah (11:57):

Yeah. Thank you all. Yeah, it, it makes me think of this kind of abstinence only mindset. If we, if we don’t give them the tools to do it, they won’t do it. And that’s just not true. I like how you said like, they’re evil geniuses. They will figure out a way to get this need met.

Amanda (12:12):

Totally. And that connects back to what Eli you were saying in terms of it being framed as like a justified punishment. Like, this should be painful, this should hurt, which is very much a mentality you see around conversations around sexuality of like, it should hurt or you should expect some level of punishment for an activity that is, you know, that society wants to disincentivize in ways that create punishment rather than pathways.

Eli (12:39):

Can I share my favorite combating metaphor?

Chynah (12:42):

Absolutely.

Eli (12:42):

I like to say that shapewear is like shoes. It needs to fit correctly. Everyone needs shoes. Most people really need shoes. We’re in Vermont. I I know at least a few barefoot teenagers, but most people need shoes in their daily lives. And if it’s too small, it will hurt you. And if you wear something too small for too long, you will end up in a ho in the hospital with a broken foot. And if it’s too big, it won’t do anything. You will walk out of it. And you know, some people want basic black boots all the time and some people want sparkly heels and everybody should get to have access to that, but there’s nothing morally right about wearing shoes that don’t fit.

Chynah (13:22):

Yes.

Eli (13:23):

And if you are denied shoes and you end up wrapping your feet with newspapers that’s not a good situation either. <Laugh>

Chynah (13:31):

No, thank you for sharing that. I I imagine that there will be some folks who hear that, that can really grasp that, that metaphor. Thank you so much. I’m loving this so far. So I wanna, I wanna talk about and, and Amanda touched on this already a little bit but what, what is even considered gender affirming care when we use the term gender affirming care? And we’ve said it many times now and I’m sure there are still some people that are like, would you please define this? Is it solely a medical process and are there any myths around it that you would like to bust?

Amanda (14:07):

Oh my gosh, what a question. Questions on questions. Yeah, where I wanna start with gender affirming care is that it’s just such a broad term that, and, you know, from outright perspective can really cover all kinds of ways that we interact with one another. So the thing that gets the most attention and gets the most headlines is gender affirming care related to medical support. And the thing everybody wants to jump right into is talking about surgeries. So one of the myths that I think comes up a lot around gender affirming care is that there’s lots of surgeries happening on little kids. Fascinating, fascinating myth in my opinion. And partly because there’s absolutely no surgeon in the US who is providing gender affirming surgeries on children. That’s just not happening. What is happening are surgeries that happen to kids who are born identifiably, intersex, and then doctors usually with the support of parents are making irreversible medical decisions that often involve surgery to make intersex kids’ bodies look more binary than they did before. That’s a wild practice in my opinion. And so this idea that surgeries are happening to little kids like that is done in service to maintaining a binary system of gender, not to open up the system of gender to trans kids. So, so there has been a lot of work from the intersex community and advocates there to really shift those practices, but just fascinating the way that sort of myth just runs amuck through society. So I think that that gets a lot of focus when it comes to gender affirming care for us. There’s so much more that happens along that spectrum that is really you know, thrown out when the conversation gets really limited to that focus. So I wanna toss into the frame of gender affirming care, calling kids by their names, using their pronouns without giving them a hard time. You know, letting them wear what they want without giving them guff about it, <laugh> giving them access to community that also does not give them a hard time. And in fact, celebrates who they are, right? Letting them have their expression, letting them have their social connections without really policing or interrupting those things in service to maintaining this system of there’s only two genders and only two ways to be in this world. I have so many other myths that I wanna talk about, but maybe I’ll just, I’ll let those work their way into the conversation. Yeah, I I think that’s, that’s where I can put, you know, my lens of gender affirming care.

Luci (16:40):

And I can jump in next about sort of like what happens in the hospital at these appointments that youth have about their gender affirming care. Majority of the appointment is not talking about the medications. Their very first appointment is actually, at least at the transgender youth program, is with the social worker. And they talk about all of the things that really matter to them. Like what does your transition wanna look like? What are, like who are your supports? Who can you safely come out to? Like what are your goals over the next few years? And then also just talking about like, how sure are you, like is this something that you want to do at this point? Do you want to not do something medical? Do you want to do something social? Really just ascertaining what that particular young person wants to do. And then even subsequent appointments, I think the first appointment’s like really like heavy on the social work. And then the second appointment that’s medical is like heavy on like, okay, these are the medications, these are the side effects. Like I want you to be really educated about that. But then after that it’s mostly about like, okay, here are your levels. Do you want them to be different? Are you getting the, the bodily changes that you want? But then also like, is there any bullying at school? What can we do to support you? Is there something that’s going on at home that is making you feel uncomfortable? What is on your mind right now? And oftentimes like these appointments just end up being like more like getting to know you type appointments. Like these young people just start talking about like all of their amazing friends and all the fun things they do at school, but sometimes there are like some difficult conversations that need to happen and they’re not able to have it in a safe place at school or at home. And the only people that they can talk to about them are their physicians. So it’s really important that those appointments are not just about the medications, it’s also about like the social and emotional wellbeing. There is this, there was this really interesting study saying that like, using somebody’s chosen name reduces any sort of mental health issue by a significant amount. I forget the exact number, but it’s, it’s like very efficacious and like helping youth feel like who they wanna be. And then another thing, going back to the point about surgeries, youth in Vermont are not getting surgeries. It’s difficult enough like as an adult to go get a surgery because there are no bottom surgeons in Vermont. There are a couple top surgeons, but they don’t tend to serve people under 18. And then they also have like varying requirements that prevent some people from being able to get surgery. So for most people, getting surgery, like even as an adult is a many, many years process because you have to have documented HRT, you need to have letters from multiple health professionals. And if the surgeon doesn’t like those letters, you have to kind of go back and get them redone and then insurance has to approve everything. So it is a pretty long process. And oh no, you change jobs, like your insurance changes. What, what happens? So I think it’s fairly unrealistic to say that young people are getting surgeries and I think the conversation should be more about how do we increase access to gender affirming medical care and gender affirming surgeries for the entire trans population? Not how do we limit this because that’s not what is happening.

Amanda (20:09):

I just heard you bust a couple of myths and one of those that I feel really is important to talk about is this idea that you know, you were framing it as like how important it’s to call people by their names. And even that can have a drastic reduction in these disparate rates of emotional distress that we see. And you know, at outright we really look at the youth risk behavior survey data. And in Vermont it tells a horrible story about these disparate rates of suicidal ideation and depression and anxiety among and trans youth. And we know it outright that that’s not because it’s something inherent to who they are. So I heard a parent say one time, I won’t let my kid be trans ’cause there’s a really high rate of suicide in that community. And what you were saying, Luci really interrupts that narrative, which is so prevalent, which is that the way that we treat people with respect and dignity in their self-determination has a drastic impact on their mental health. And what research shows is that when and trans people are treated with respect and dignity, with regard to their identity, their rates of mental health distress, including suicidal ideation and depression, start to match that of their cisgender peers. And so it’s really, really crucial to look at these, you know, disparate rates of harm and understand that it’s not inherent to anyone’s gender or sexual identity. It’s really about the way that they are required to then move through the world and navigate their relationships in their communities without support, without affirmation and really obstacle after obstacle. And that would depress anybody <laugh>. So there’s not this like other thing happening, it’s really about the way that we treat one another.

Luci (21:54):

Yeah. I wanna talk about this story that I have of like, there are few patients that I’ve seen in the community here that have like, really, really touched me. And one of them had like a really bad like eating disorder to the point where like, it cannot be managed here in Vermont because we don’t have dedicated eating disorder facilities. And so this young person was sent to a specific eating disorder hospital in another state, which happened to be a red state for their eating disorder treatment. And partway through that they came out as trans. Now backing up a little bit there are like a lot of people that are saying like, okay, like this is a really big thing to start medical transition for youth. And that’s, that is true, it is a big thing to start any sort of medication, but that doesn’t necessarily mean that you withhold it until they become adults. Because what we see in trans youth is that they tend to find ways to get the body that they want. And sometimes this means not eating to suppress puberty and to look more androgynous or look more like the gender that they want to be that they are. And it’s really, really sad because the eating disorder itself puts them at higher risk for things like lower bone density, puts them at like higher risk for like all sorts of metabolic issues moving forward. But if they were just started on gender affirming medication, then things could have been so much better. What ended up happening to this young person was that their parents are amazing and they ended up bringing medication from Vermont to the young person. And within a couple weeks after starting their medication, they’re like eating disorder, like completely disappeared. And then when I saw them with actually like a few years down the line and now they’re just this like super like successful student at their high school, like doing all these great things, winning all of these awards and like hasn’t like, set foot in like a hospital ever since because they can live as who they wanna be. And I don’t know, seeing how confident they were and how happy they were, that just has really stuck with me. And yeah, I just really wish that all young people were able to have the same love and care that these parents and these medical professionals have given this young person because it’s really, really turned their life around.

Chynah (24:39):

It was a really incredible story. Thank you for sharing that, Eli?

Eli (24:42):

Yeah, Lucy, thank you so much. I, that one hit me really hard because I was also a young person with eating disorders and I did not get any idea that transitioning was an option or that gender was a deal until my mid twenties. I just tried to disappear for a solid decade there before anybody thought to even point me at the idea that, hey, maybe it’s not that. Maybe there’s something about your body that you could change that’s not this. So thank you for that. One of the myths about gender affirming care that I’d like to bring up is that it’s just about youth or just for youth. Some of us were youth in red states who just didn’t get it or didn’t even know that it was an option for a really long time. And a lot of kids to this day do not get it or do not even know that they might want it. Some kids go through their entire talking about myself again, autobiographical. Some kids go through their entire teenager hood and puberty just being like, well, this sucks, but there’s no other option until they move to a place with centers and get some trans friends and go, oh, there’s, there was an option. There’s an option other than being totally miserable for decades. So yeah gender affirming care part of that being community and meeting community and being in touch with community, I am a testament to that being my first and biggest revolution in my personal gender affirming care. Just having people who said, Hey, there, there are options. It doesn’t have to be like this. <Laugh>.

Chynah (26:26):

Thank you for sharing that, Eli.

Eli (26:28):

I would also like to mention about gender affirming care on a, on a slightly lighter note, maybe I started out my intro by saying that Taylors have been part of gender affirming care for centuries, and I want to, I want to get a little pedantic for a moment and ask, well, what is gender? We talk about gender as as a medical thing a lot. We talk about gender as part of your body and how your body is shaped and what parts your body has. And what a chromosome test would reveal about your DNA if you ever had one, maybe hypothetically, but we’ve had gender for a lot longer than we’ve had chromosome tests. We’ve had gender for a lot longer than we’ve had reasonably sterile surgeries. We’ve had gender for a lot longer than we’ve had hormone treatments. One of the reasons I think that gender affirming care gets a lot of pushback is that people have a sense of gender is something fundamental and science and medicine is something new and scary and technological. I should qualify that China has had good gender affirming surgeries for thousands of years, but nonetheless, my point still stands that gender is a really broad and solid thing in a, in, I think all human societies even though, like Amanda said, it’s hard to quantify and full of puddles that sort of bleed into each other.

Chynah (27:53):

Totally. So, yeah. Eli, I just wanna say too, like you brought up, you know, we’re talking about gender affirming care and you wanted to expand that from just talking about young people and I wanna say gender affirming care isn’t even limited to the trans community <laugh>, you know?

Eli (28:08):

Yes.

Chynah (28:08):

Like, I wanna shout out my dad for a second who is big mad about gender affirming care, but he loves to celebrate his wife’s appearance and love my stepmom. She dyes her hair. She’s had lots of gender affirming surgery and like her appearance is very much rooted in the gender affirming care that she’s been able to have. Congratulations to her. That’s an amazing gift that all people should have access to self-Determined how they wanna move through the world and what they look like when they do that. That’s a choice that people make every day when they choose what they wanna wear. And it’s so wild to me that we’re spending so much of the national imagination digging up why that’s weird and scary for one group of people to do when all of us have been up to that for a really long time.

Eli (28:52):

When a post-menopausal woman gets hormones so that she feels like she did before menopause, that’s gender affirming care. When a dude goes into a store and gets a flannel, that makes him feel like his shoulders are just a little bit broader and he could stand up a little bit straighter, that’s gender affirming care. When you go to a dance class and you get to choose whether you lead or follow in a way that makes you feel right with yourself and the people around you and how the people around you see you, that can be gender affirming care. This is about how you fit into this society and the way gender plays with our society. And if you fit well, that’s because you had an access and received gender affirming care.

Chynah (29:40):

Wow. I really, I love the way that you, you opened that up to real world examples that I think that will really resonate with people. I think that it, it, it made me start sitting here thinking about the ways that I practice gender affirming care. I mean, like my manicures, you know, so,

Eli (29:59):

And also can I say as a non-binary person, when I access both on either sides and other sides, that’s gender affirming care for me.

Chynah (30:08):

Yes.

Eli (30:08):

Getting the right tattoos at the right moments hits me in the, in the same spot as getting gendered.

Chynah (30:15):

Right. Thank you so much for sharing that. That was really helpful to hear Eli and I would like to wrap us up for this session by talking about why this conversation has been so important for our transgender youth and and broader community.

Luci (30:33):

I can start unfortunately trans youth today are being told that their identities are not real, not valid and that their identities are gonna be used as some sort of like bargaining tool for people to get what they want. And it’s just a really, really scary time for trans youth right now who have just done so well with gender affirming care for many years and now being told that, oh no, like this is, this isn’t actually reality. Like we should actually take this away from you. That’s really, really difficult. Their whole word worlds are gonna be turned upside down and I think now more than ever, they need our support and our like fight. And it’s our desire to help them and the broader community and give them the hugs that they need.

Eli (31:29):

Listen, I’m just desperate for the trans kids today to have a better childhood than I had <laugh>. I, I just want them to get the, the chance at community and self knowledge that I got in my late twenties, early thirties. That is where I’m at, is if I can make this, 2014 was the infamous transgender tipping point. We got visible and now we are seeing the backlash. And if we can ride the backlash out long enough, we will be in such a better place than we were in 2010. This is, we’re talking about a span of 15, 20 years to make huge amounts of change and now is our chance to make life better for millions, probably millions of kids across the whole planet.

Amanda (32:24):

Whew. Okay. Eli, I immediately wrote down community and self-knowledge. ’cause I think that is like, that’s the place I really wanna center. When I was considering this question, I was like, I know that there are ways to tell this from the perspective of young people. So I want to take a moment to just shout out one of our programs, which is Camp Outright, where young people get a chance to spend a whole week in community building their self knowledge and getting to play ball and go swimming and do archery as exactly who they are without anyone giving them a hard time. In fact, everybody building them up and hyping them up and giving everyone around them so much accolade and heck yes. And, and just for showing up as who they are. So after, after six full days of getting to just rest and be celebrated at the end of the week in the closing circle, we pass around cards and young people fill out from their perspective what they wanna remind themselves of six months from now. And so I wanted to share, if it’s okay, some of what young people have said about receiving gender affirming care in the form of getting to be who they are for a whole week in community building that self-knowledge, here’s what they have to say for themselves about why it’s important. I’m gonna do this without crying, I swear. Okay. One young person said, there are people all over the world working hard to build a future for all of us. Another young person said, I’m not alone. No matter how lonely I feel, there are people who respect my identity out there. I just need to find them. Communities without judgment exist and they are so much better. I have a joyful future. I am valid. I am not alone. And there are other people like me. I’m allowed to take up space and exist. I am K-enough and always will be.

Chynah (34:19):

That is incredible. Thank you, Amanda. Let’s pause here because we have so much to cover still. We will return next week to keep hearing from Amanda, Lucy, and Eli.

Cassie Gillespie (34:35):

The social work lens is produced by the University of Vermont’s Child Welfare Training Partnership and the state of Vermont. Our theme music is composed and performed by local band Brick Drop, and our sound production and engineering has been brought to you by Egan Media Productions. We’d also like to give a special thank you to our in-house administrative production assistant Emma Baird. for the social Work lens. I’m Cassie Gillespie and we’ll see you next time.