Gender Affirming Care: in conversation with Coltan Schoenike

In this episode of Gender Stories, Alex talks to Coltan Schoenike, (they/them) a queer, nonbinary,  trans and femme marriage and family therapist mentee, sex therapist, sex educator, doctoral student, researcher, and author.  Together they discuss gender affirming care: what it is, what it isn't, and why it is vital.

Find out more about Coltan at:
https://www.coltanschoenike.com/

You can also follow them on Twitter and Instagram @ColtanSchoenike

Transcript

Musical Intro: 0:35

There's a whole lot of things I want to tell you about. Adventures dangerous and queer. Some you can guess and some I've only hinted at, so please lend me your ear..

Narrator: 1:00

Everyone has a relationship with gender. What's your story? Hello, and welcome to Gender Stories with your host, Dr. Alex Iantaffi.

Alex Iantaffi: 1:08

Hello, and welcome to another podcast episode of gender stories. This is the first podcast episode that we're also recording and putting out on video. So let us know if this is a welcome addition. Of course, you can still listen to gender stories on any podcast listening platform, and now also on my YouTube channel. So today I am overjoyed, excited, thrilled, you know that I truly authentically am excited about every guest. But I'm extra excited because I'm here to talk with Colton Schoenike who is one of my amazing mentees. Not only are they a therapist in both Minnesota and Wisconsin, a sex therapist, a researcher and doctoral student. They also have a wonderful recipe book for cupcakes called spread love and butter cream highly recommend it. I have tried some of the cupcake recipes and they're amazing. Coltan, what am I missing? You do so many things. Well, what else can I say about you apart from like, singing your praises.

Coltan Schoenike: 2:19

You're really just going to challenge my Midwest humble here.

Alex Iantaffi: 2:22

I really am. Oh,

Coltan Schoenike: 2:24

yeah. My name is Colton, Schoenike. My pronouns are they them. As Alex said, I am so lucky and privileged to be one of their mentees. And yeah, I am a marriage and family therapist and sex therapist, working on my final full licensure for both Wisconsin and Minnesota hopefully in the coming month. And then I also am a doctoral student in couple and family therapy at Antioch University New England, in couple and family therapy. And then I'm also a teaching fellow, they're in their gender affirming clinical practice certificate, which feels really apt and then yeah, I bake cupcakes sometimes. That's fun. I wrote a book once. That was cool. Yeah. So Well, I

Alex Iantaffi: 3:12

think the book is delightful. And there is more than happy recipes in it. And I really recommend you go get spread love and butter cream. But today, we're not here to talk about cupcakes, we're here to talk about gender affirming care, because both of us are therapists who work with a lot of trans non binary or gender expansive people. And in this current climate, there is a lot of misinformation about gender affirming care. So we wanted to kind of just clear the air a little bit gave you some information from the perspective of two therapists who are gender specialists. I'm gonna W path certified gender specialist that matter as well. And so we just want to give you some information, because there is a lot of misinformation out there. So let's start from what is gender affirming care? How would you define a culture? And if you had to define gender affirming care?

Unknown: 4:06

Yeah, absolutely. And it's a really nebulous, sort of all encompassing sperm, which I think is one reason why I'm so excited to be doing research in that area, especially so we can sort of solidify some of these ideas. And yeah, what a time to be doing. So in this political climate. You mentioned no cupcakes today. But as I think about it, I'm like, that would have been helpful to cope, as we discussed some of the goings on but yeah, so it's, it's really an all of the above and I think, really stems from this lens of self determination, autonomy, social justice, really just the idea that, you know, someone is saying who they are, and letting them speak to that, and then the idea of gender affirmation from there, and then, you know, the care components stemming into a myriad of different ways that one may do that. And so there's medical, social, psychological, obviously the realm that we specifically work in as mental health care, so we're on the therapy and, but of course, too, as with a lot of the hot button articles, there's also things like hormones and surgery, treatments that a lot of people have a lot of feelings about. And And yeah, I, I often say that, you know, there's about as many gender experiences and gender identities if we get rid of the boxes and labels and organization and going for closest, you know, there's about as many gender identities as there are people, I'd say the same, there's a, as many ways to practice gender affirming care as those who need it.

Alex Iantaffi: 5:58

I love that. And, and that I think gets to one of the key points of gender affirming care, right, that all gender identities and expressions are valid. You know, it's not just about trans identities or non binary identities. Really, it's like, all identities are valid if somebody is on a journey of exploration, and then decide that their identity is actually to be like, a sis man or a sis woman, or even some people identify as non binary, or cisgender, expansive, like, all gender identities are kind of valid and beautiful, and all gender expressions are valid and beautiful. And so it's not just about affirming some genders above others. I think that's a misconception that people have as well.

Unknown: 6:42

Yeah, absolutely. There's this idea to have like, Oh, if we're, you know, showing people this idea of gender affirming care, they're gonna get all these sorts of ideas and what it means and I also just think of, you know, when I was a kid, you know, 10 o'clock at night, and there's a TV ad of like, pills for men with low testosterone, like, that's gender affirming care. Even like YouTube, I keep seeing a bunch of ads for like, keeps not sponsored. But it's, you know, medication for preventing hair loss, you know, that's gender affirming care. You know, people who identify as female, you know, wanting reduction or augmentation around their breasts, for whatever their expression is, and what they want it to be. That's gender affirming care, it's whatever is aiding you and letting you tell the world and yourself who you are and who you want to be. And that, once again, applies to trans folks, non binary folks, agender. Folks, you spirit folks, just as much as it also applies to cisgender, folks. And then, of course, all of the other myriad beautiful, diverse experiences outside of those couple of labels.

Alex Iantaffi: 7:59

Absolutely. And I think one of the things that's worth mentioning, though, is that for some trans or non binary or gender expensive people who experience gender dysphoria, Justice versus people who experience body dysmorphia, for example, there is very much a component that it's medically necessary, right, there is a real distress, there is a real felt emotional, psychological distress. Often, it's also a relational distress or a vocational distress. That means that it's impacting your capacity to work, or to engage in the way you want to work. And so I think it's important because some people think, well, it's just cosmetic, right? And so why should health insurance cover gender affirming care, for example, but it is not cosmetic, it's really about a deep sense of who we are. And it can cause a lot of stress for people not to be able to identify and express who they are, whatever gender identity and expression they want to embody in the world.

Unknown: 9:05

Yeah, absolutely. And also, like, Let's call a spade a spade in the current political climate, you know, there's a lot of talk around passing and things like that. And not to say that passing should be a necessary goal for anyone, everyone has their own different relationship with it. But for a lot of people passing is also a safety issue as well. And so it can also be to keep people safe. If they are presenting in a certain way that, frankly, and current climate people have some feelings about, you know, these interventions and these things, not only are medically necessary for someone's own sense of well being, but also for some people may help them feel safer as they're navigating the world.

Alex Iantaffi: 9:47

Absolutely, it might make the difference between getting a job not getting a job to survive under capitalism, most of us have to do right, or being able to, you know, move through the world with some level of confidence and safety, like you said, right, whether it's for work, whether it's for leisure, spending time with family, and so on. And so I think it is important to speak to that medically necessary part because people think, Well, anybody can just walk in and get surgery, even if they're minor. And we'll talk about some of those means and that's just not true. Right. And so let's give some examples. You know, I think you've already started talking about how there can be medical interventions there gender affirming social intervention, psychological interventions. What are some of the social things that people might want to do that could fall under the umbrella of gender affirming care, for example?

Unknown: 10:43

Yeah, absolutely. And I appreciate the keyword might, too, because I think it's also important to recognize that once again, you know, every experience is different. And so, you know, some people might want or need certain things and might not want or need other things. I know, for me, myself as a trans person, like, I haven't changed my name, like I'm out on hormones or had surgery. For me, it was a lot more social, rather than medical. And that's just what I wanted and needed, but there's other people who those needs are different. And that's okay. And that's to be human. But so gender affirming care in the social realm. It really just starts with support and that self determination. And I think that's one of the things that I get most scared about with a lot of this legislation and the, the current political climate, a lot of my client base is trans. And so gender affirming care, even in the social component, like one example of social transition is changing your name and your pronouns, that feels correct for you. And so gender affirming care is just using my client's right name and pronouns. What a concept. And as someone with a huge client base of trans people, if, you know, it were to be banned in the state like, oh, I can't use my clients correct name, because that's banned now. And I could get in trouble. What? And so, yeah, it's, it just starts with even how you treat your client like interpersonally. And then as well as supporting them around those things. And so like, if someone is wanting to change their name, you know, helping them process through the emotions and the logistics of going through something like a legal name change, checking in with them, like, okay, you know, you're socially transitioning at work or school, like, how is that going for you? How is it feeling how people been treating you, really just being there alongside? Through that social transition process?

Alex Iantaffi: 12:55

Absolutely. And sometimes, at least in my experience, it also means being there through the doubts, right? I've had clients who are like, I don't know, if I should transition and I'm like, That is okay to slow down, it's okay to stop. It's okay. To You know, if you want to re transition into your gender assigned at birth, I'm here to support you, no matter what. And I think that's another misconception, right, that I think as gender affirming therapists were there to support our clients, no matter what, if there are doubts, if there are, you know, further explorations that are needed, we're there to support our clients through that. And I think that's a psychological element of gender affirming care, right? You need space to explore. Do you want to try a name and pronoun, but you're not sure we can try it out here? Yeah, we feel sad, man. Maybe you have taken it out in the world that you're right. Actually, this is not me. That's okay. We're still here to support you. I think that's that psychological support of really giving the space, giving a container, asking the questions we need to ask when people want to engage in kind of medical procedures as well, to make sure that the clients have really process as much as possible, whatever choices they want to make in their life in whatever direction they choose to move, right?

Unknown: 14:18

Yep. Absolutely.

Alex Iantaffi: 14:21

And we'll talk a little bit more about medical interventions like puberty, suppressions, or surgical interventions, hormonal interventions a little bit later. You know, why might people seek gender affirming care? You know, sometimes people are like, Well, why can't you just be who you are without needing, like, label, for example, or without needing to change anything? Right? Sometimes people, sis people, I would say, say That's right. i Why do you feel that some of us look for gender affirming care?

Unknown: 14:54

Yeah, absolutely. And it's funny, my initial thought, as I was thinking about that question, and my response was, like, if we look at certain definitions, like I mentioned, you know, the idea of gender affirming care, just being me treating you respectfully as a person, you know, does anyone seek it? Or is it just everyone is getting gender affirming care all the time, because, you know, any client that you have coming through the door, you're seeing them for their gender identity and respecting that, hopefully, and if you're a therapist out there who hasn't been doing that, maybe, you know, do some reflection and some supervision work and talk about why that's coming up. But But more specifically, like why people might seek the more traditional, quote unquote, you know, gender affirming care, is meeting that space in that container, I think you put it beautifully. And so depending on what that person is needing, that might differ, what they're going, they're seeking out. For a lot of different medical transition procedures. People need letters from a therapist, or sometimes the goal coming to me might be, hey, can we do some of the talking and discussion and work to get that letter if it's appropriate? Other times, it might be much more exploratory, like you've mentioned, I've had a handful of clients who I just feel so dearly good about just as much with my trans clients who came in, they were like, you know, I'm not sure. But I want to just have some space to think on it and look at it. And at the end of it, they were like, you know, I don't think I'm trans. I don't think I want to transition. But I'm glad I took the space to think about it and ask myself those questions. I love that for you. I'm so glad. It's beautiful. Right? Absolutely. It's you telling me who you are not the other way around. And so, yeah, sometimes it's about those access pieces, like letters, sometimes it's exploratory sometimes, someone's already far into their transition, but also just wants, you know, support and to be affirmed for who they are, perhaps you're dealing with like work or school discrimination or things like that, and just want a space to be yourself. You know, once again, a myriad of reasons.

Alex Iantaffi: 17:16

Absolutely. And, and I think it is important to talk about that there are so many reasons why. And there are also so many benefits, right? Even those clients, like the sad that have come and taken the space to explore, and maybe are like, you know, actually, I'm not trans or, you know, maybe it's just something that I want for myself to feel this gender expansiveness. And I don't need to change anything in my daily life. Right? I think that the benefits are so wide ranging, right? Just from kind of the psychological benefit of an explorer. It's something that questions about now I feel more peace, all the way to lowering symptoms of depression by wearing symptoms of anxiety, lowering suicidal ideation, we know that suicidality is 10 times higher for trans non binary and or gender expensive books than it is for sis population. So that's obviously a huge benefit. Yeah. When people get gender affirming care if they're, if they're experiencing suicidal ideation, that can really be reduced, and sometimes might even go away. Any other benefits that are missing when I think about gender affirming care that haven't been mentioned?

Unknown: 18:28

Yeah, absolutely. Um, when one other thing that I think I, I've seen a bit of that I think is really profound and beautiful to see is, obviously our area specifically is couple and family therapy. So also, relationships are the context of gender affirming care. I've done a lot of beautiful work and gotten to see a lot of beautiful things where both I can give, you know, the person the space to explore as needed. But then also, those relationships, you know, if I have, you know, a trans kiddo coming in, getting to make that space also for the family to better understand who their kid is saying that they are and help foster improving that closeness in that relationship. And really being able to be a part of that process. And so it also can bring families and and couples and other relational systems together and closer and a facilitated experience to better understand each other and hear each other and see each other. And it's just really lovely.

Alex Iantaffi: 19:38

I love that. I love that you mentioned that because as a family therapist, I think that's so precious to me. You know, I often say that somebody's disclosing their gender identity, whether to a partner, or to a parent, or any family member, or friend or co worker, it's really an invitation into further intimacy, it's really taking a risk and saying, I trust you enough to tell you who I truly am. And that hopefully should bring people closer together. I think initially, it can feel like a rapture. But I think that if we can be there to support and create the containers, family therapist, we can really encourage that connection, that deeper intimacy, through vulnerability rather than kind of Abyan that has more division that sometimes people feel initially why then we really want to shorten that we really will Want to bring people in deeper connection? Generally?

Unknown: 20:38

Yeah, absolutely. And it's also just really nice, especially with kids, I think, just because they're, well, first off, they're kids, and they're dealing with their own stuff. And also to just the the way that they can be impacted by things because of their developmental stage. It also is just a great place to have a separate opportunity for parents to like, work with me and like process their own stuff. It's okay if you have stuff, but just process their own stuff and not be putting it on their kids as they're processing this because it is a big change. And that's okay. But it gives that clear, intentional, strategic space of this is where you can process that and do the work around it. And then, you know, the kid isn't having to deal with the brunt of it and the consequences.

Alex Iantaffi: 21:27

Absolutely. And I'm so glad that we're talking about children, because we also know that for children and young people, family support is a protective factor. And what what we mean, when we say it's a protective factor is those higher levels of depression, anxiety suicidality that we often see, because of systemic oppression with trans non binary and gender expansive folks is reduced when there is family support. In fact, there have been some studies that have really shown that with family support trans youth and CSU, almost kind of no difference when it comes to depression, anxiety, substance use suicidality, all the usual kind of symptoms of systemic oppression that lots of minoritized communities experienced family support makes a huge difference. Yeah. And yet, a lot of people say, well, it's fine for grownups to do whatever they want to vote. So why can't we just wait until the child is 18? And not just do anything until that right? What would you say to people who say why can people wait until they're 18?

Unknown: 22:35

Yeah, absolutely. And I think we might get into some hot takes territory, but that's okay. You probably will. Yeah. And, and I think that there's a couple of reasons. Number one, there's been so much research that has shown that, you know, even kids as young as you know, three, four or five, already have a very solid sense of who they are, who they want to be their sense of identity. And, and so this idea of like, let's have kids wait so that they can figure it out, and no more, it doesn't really hold water, when you look at that research and that data. And so at that point, it, it feels like just having someone just sit around and wait to just sit around and wait, and there's not really any purpose or benefit behind it. The other thing, too, that is really important because of that timeline. And thus to is one of the more hot button topics is puberty. Yeah. And so if someone has this very set idea, this is who I am, and it in whatever way This means differs from, you know, what one would expect based on you know, my body. around puberty, there's going to be a lot of things that are going to start happening traditionally, that will probably send someone even farther away from their sense of self and who they are. And if we can prevent that. Great. You know, it's all the easier, especially to if there are things like medical transition that are desired, such as hormones or surgery. Traditionally speaking, and also by narrowly speaking, as well, you know, there's a lot that you have to sort of undo, before you can replace with adults who are transitioning medically, of course, this is all very overly simplistic, of course. But you don't have to deal with that if, for example, there's the option of hormone blockers. And so we can prevent some of the puberty and some of the secondary sex characteristics being introduced in debuting that, you know, would create all the more problems for this person. The other thing that's really great about that is, you know, if someone really is not sure, this by some time, exactly. And so it's, it's just the pros so monumental lessly like outweigh the cons. It's just baffling to me. I was doing some reading and also, there's been some other podcasts who have talked about it like books, good grief books for kids. For instance, in their episode about the times we're in trans kids, that's really delightful. While not delightful, but important. Like, of course, there's always going to be side effects as with any treatment, and there is some reading and some some data to show that, you know, there might be like bone density concerns, for instance, with hormone blockers. First off, there's not nearly enough longitudinal data to actually confirm any sort of severe causality. And also to if that's the case, okay, you know, exactly what's likely to happen. So then offset it. Okay, hormone blockers, and some calcium problems.

Alex Iantaffi: 26:16

And, and I think there's actually more data that people have saying, because and gender stories, has done an episode with the wonderful Dr. Kate Gaffer, and a couple of years ago, with, you know, oversees the gender identity clinic at Children's Hospital here in Minnesota. And they were so eloquent in explaining really, from a medical perspective, right? That the pros really outweigh the cons, because, you know, our scope of practice is mental health. So we'd, like, you know, 100 wonder too much in the medical field. But like you said, it gives children often that and young people that space to explore if they're not sure, it buys time, and it can avoid kind of more significant medical interventions later in life if the young person kind of continues on a path of medical transition? And I say, if because not everybody does, right. And the other thing that was thinking about why can people wait until they're 18, is you're basically asking a child, or young person to put their life on hold. You're right, there's so much else that's happening beyond gender. You know, we know that peer relationships are super important when people are young, like school, hobbies, activities, interest, you know, if people are into sports, or dance, or music, right, you're asking a child or young person to sacrifice an awful lot. Just because their gender identity does not align with their gender assigned at birth. And that's it. I think that often people think about, oh, don't don't change anything, but not doing anything has an impact. Right. And and I don't know, as somebody who's transitioning much later in life in my early 30s, I often think about what would my life have been like, if I transition sooner? If I'd had like, my whole life to be myself?

Unknown: 28:15

Yeah, absolutely. Yeah. Like, not choosing is still choosing?

Alex Iantaffi: 28:22

Exactly. And I think people don't think about that.

Unknown: 28:25

Yeah, absolutely. And yeah, like, as a kid, like, if you're not doing those things, like as you like, you're being asked to pretend to be someone else until you're 18. And then, which, and then just switch it off, which that's not how growing and developing and, you know, personality development and all that stuff works. And so it just, yeah, it doesn't make sense. And, and yeah, you mentioned, you know, transitioning later in life, and you know, what could have been, you know, transitioning in your 30s, even even myself, I came out when I was 20. And I still I'm just like, what could it have been, like, you know, had I been out in high school? I mean, granted, there's also some concern that maybe it's good that I didn't present cons, right, from Brooklyn cons. Yeah, absolutely. But yeah, just wondering, you know, what could have been and like this, I think is what gets into my hot take territory is, you know, there's this idea that hormone blockers, you know, lets you pause, get some time to, like, figure stuff out. And I'm just like, Who wouldn't want that? You know, and granted, for a lot of people, maybe it's not specifically around, you know, hormone blockers or like being able to delay puberty, like if you knew yourself and your gender identity beforehand, and you're like, I can't wait, I'm raring to go give me all the puberty. Great, happy for you. Maybe it is something else. Maybe it's like, Oh, I wish you know, I would have had more time to figure out what I want to be when I grow up. I think we're still constantly figuring that out every day. But, you know, everyone is gonna have their thing that, you know, a little more time wouldn't have hurt. And for some kids, it's that.

Alex Iantaffi: 30:15

Absolutely. And in fact, puberty blockers were born out of the desire to pause precocious puberty, which means puberty that comes too early. For example, when somebody's like, eight years old, you know, and actually, I've been asked a few times like, Well, would you give puberty blockers to your child, and as a yes, absolutely, we, first of all, if they were trans or gender expansive or non binary, and they were distressed by it, yes. And also if they hit puberty early, and that was stressful to them, why wouldn't I want to release their relieve their distress? You know, it's a lot to ask an eight year old to manage pubertal transitions in third grade, it's a lot to ask I think and, and that's where we get the data, right like that. Those weren't even drugs, they were made for trans people. Those drugs were made for since kids who are hitting puberty early. And we know that that can be very stressful on the body and on the psyche, as well. And like you said, Who wouldn't want to relieve that distress for their kid? Right? So I feel like we're starting to go into that territory of debunking some myths about gender affirming care. And so let's do it. Because there's so much misinformation out there. And we've already talked about how gender affirming care is not about convincing somebody that Krantz right, I think there is this idea, you go to the gender specialist, and they're going to make you trans. Right. That's not how it works. Plenty of people come to see us they're still fifth afterwards. No, I don't know if that's your experience. But that's my experience.

Unknown: 31:54

Yeah, absolutely. Yeah. Like I said, I have, I have quite a history with some clients where, you know, I just wanted to explore but this was, you know, what was right for me, and, and, okay, cool. And, and then I have some clients where, you know, it's a big epiphany moment, and they come to realize this different idea of who they are. And that's cool, too. Like, the the way I frame, a lot of the work I do in therapy, and I think applies just the same here is I may be holding the map with some ideas of destinations, but you're driving the car at the end of the day, you know? And so if you tell me where you want to go, like I can help us kind of get there, but you're going to make those calls at the end of the day?

Alex Iantaffi: 32:42

Absolutely. You're the options and you get to pick whatever options work for your life. It's an ala carte menu, it's not a now you're on this train, and we're going in this direction, there is no getting off.

Unknown: 32:54

Yeah. Yeah, it's it's not at all prescriptive, which is funny, because I think that's one of the other myths, or well, not even others just kind of tagging on to what you were saying this myth that, you know, it is so prescriptive. And in fact, I think that they're instead trying to counter with something that's even more prescriptive than how they perceive gender affirming care is being prescriptive. They being like, a lot of these, you know, legislative attacks. And it's funny, because I think those prescriptive approaches, make all the more problems.

Alex Iantaffi: 33:33

Oh, absolutely. And talk about scope of practice, right, we said how important it is to stay within our scope of practice, as therapists and I'm like, how much politicians will stay within their scope of practice? Yep. But that is a whole different conversation, right?

Unknown: 33:47

Yeah, absolutely. But yeah, I was just reading some stuff. Cuz I'm working on editing a paper currently just around like gender affirming research practices, and, and things like that. And one of the things that's been a really hot button topic right now is D transition and re transition. And so you know, those people who decide for themselves for a myriad of reasons, you know, I'm gonna switch gears here, whether it's a reverse direction, or just a different direction. And in reading some of those papers, one of the things that was really fascinating is, like, the, the dogmatic sort of approach and the prescriptive nature, both in what people perceive gender affirming care to be. And then also, frankly, some ways it's had to be with certain things like different standards, and what have you, actually makes it worse and brings about more regret. You know, if I'm a trans person, well, I mean, I am a trans person, but a different trans person in this theoretical scenario who's seeking hormones or surgery or what have you. You know, okay, so I'm thinking I might want to explore this, but there's all these rules. There's all this gatekeeping there's all this like, XYZ of what needs to happen for me to be able to approve this or to be approved for this. Okay, am I going to have to start to sort of skew some things or be strategic or intentional in how I'm portraying things to be able to fit the criteria and people rush into it. And so that's what this research was finding that I thought was really interesting is people because they feel like they have to fit a certain mold to be able to get the things that are To not have as much of the reflection with and that they wouldn't be able to have if it was just open. Because like I said, there's so many different ways to be trans. And thus there should be so many different ways that might maybe qualify for XYZ gender affirming procedure, instead of this suddenly bullet list of, you know, DSM criteria kind of thing. Which is one great way to assess, but it shouldn't be the only. And so it's like, if we had more freedom and more space to just, you know, explore what's going on for you what is the true, nuanced, messy, but beautiful description of your experience? And if you tell me that part of that is then needing this thing, and I don't have to, like, you know, count all the boxes of checks, you know, there's often going to be a lot less chances of regret.

Alex Iantaffi: 36:38

Absolutely. Because there's more space to explore all the things that we do explore with people when they want surgical interventions, right, we talked to them about hey, have you thought about future reproductive capacity and whether you want to have children? Have you thought about aftercare plan? This is major surgery, who's gonna take care of you? How are you gonna make money when you can? No work, right? Thought about the impact this might have on your relationships with those around you? Do you understand this is an irreversible procedure, right? We also assess whether somebody is capable of consenting right? If they're an adult, or whether the family is supportive, if it's a minor, which is much rarer, of course, for surgical interventions, and we'll talk about that in a moment. But like you said, when there is this space for exploration, then people are much more grounded in whatever choice they make, right? And so there is a lower chance of regret, and the regret is so low, it's like one to 2%

Unknown: 37:41

people regret knee replacements.

Alex Iantaffi: 37:43

Absolutely. Then any kind of gender related surgical intervention, it's one to 2% is very, it's actually very successful. Yes. In some ways, right?

Unknown: 37:55

Yeah. And certain certain numbers I've seen have been even lower to I found one, I saw one study that was like nine point or 99 point naught, or 99.7. numbers. So yep, point 3%. Like,

Alex Iantaffi: 38:11

yeah, it's like 99.5% were happy. And then 0.3% regret it. Yeah.

Unknown: 38:17

Right. And then even to when there are instances of regret, which can mean a myriad of things and look a bunch of different ways. They have different conceptions about it, and like, what is the actual thing that, you know, is regretted? Like, a good amount of that already small? Number is, you know, I didn't regret the procedure. But I maybe regretted picking this provider or Yeah, didn't do enough research. But I'm glad that I did the thing or just wish I had better results. Not, I shouldn't have done this procedure, or had this change to my body.

Alex Iantaffi: 38:53

Absolutely. And even people who re transition, not all of them regret, or even deny their trans identity is more like, I don't feel safe, or I cannot, for whatever reason, and navigate this world as a trans person or as a decently trans or non binary trans person. And that's part of the retransmission. Not everybody's also re transitioning because of regret. Right? It's it?

Unknown: 39:22

Yeah. And even if it is a change in conceptualization and identity, you know, not all of those cases are sort of a backward motion. It's not like going back. Some people it's, you know, this was right for me at the time. And now this different, not necessarily reverse, but just different thing is right for me now.

Alex Iantaffi: 39:42

Absolutely. We're fluid, changing relational beings, I truly believe in so many ways, and why not gender? Right. And so we've been talking about this, you know, that sometimes, surgical interventions can be part of gender affirming care. And I think that those surgical interventions can really amplify the leverage and there is this idea in the general public, sometimes that like six or seven year olds, or young teens are getting surgical interventions. And that's just not true. No, like six year olds are getting no medical interventions, first of all, right, like because even Kareem there's nothing to intervene, like even puberty suppression happens at a certain stage of development. And you can listen to the episode with Dr. Gupta, who explains all about the different stages of development. So usually does And until puberty starts. And then surgical interventions are usually for adults and tiny number of people. I think one of the numbers was like 200 people in the US over the last five years, got surgical interventions before 18. And usually those people are already 1617. So they're pretty close to kind of, they have family support, they're pretty close to being a teen, they want to focus on other things in their life, like getting their first job going to college going to prom, rather than gender.

Unknown: 41:07

Yeah, absolutely. That's the other thing too, which is more. So just a product of the way that our society is structured. And for better or for worse, like, when minors do transition. They cannot do that unless those parents are super duper supportive and willing for them to even be able to partake in that. So literally, any single miner who is going to be having any sort of gender affirming procedures are literally in the best circumstances for possible success. Yes, like, Absolutely, we just don't have these scenarios where it's going to be a hot mess, because the way things are structured as a minor in your rights, kids aren't going to be getting into these things if they're not already set up for the best success possible. Absolutely.

Alex Iantaffi: 41:57

And, you know, usually this very tiny number of young people who are usually well over 16, again, they have strong parental support, and also their people who often have been out as trans since a very young age, you know, if you've lived as a boy or a girl, or as a non binary person, since you were like, five or six years old, which is we know, when people get a sense of the gender identity. Why wouldn't you want to like, you know, if your keep going in that direction, it makes sense that you're like, I don't want to have to do this while I'm navigating my first job, or my first year of college or university, right? I want to just like, do, you are in a marriage, I want to do this major surgery while I'm at home with my parents and being cared for my caregivers, you know, my family support for those young people kind of make sense. And like you said, that have strong family support. And they're very scrutinized, there was a lot of scrutiny, not just by provider, but also by insurance companies. There's a lot of scrutiny that goes on for this tiny, tiny, tiny number of people who undergo surgical interventions before 18.

Unknown: 43:11

It's also very interesting to hear we're getting into hot take territory again. It's really interesting to this sort of double bind. damned if you do damned if you don't, that happens with this political climate. Because both hormone blockers and then also surgeries getting so sensationalized, especially around minors, and so there's already this idea, you know, we shouldn't have kids on hormone blockers, you know, they can't decide for themselves, they should just decide when they're older, et cetera, et cetera. And then we also get this sensationalist. zation, about, like, surgical procedures, for instance. There's a lot of discussion right now of like, top surgery, and like breast removal is like, yeah, these scare quotes all over the place, you know, young girls mutilating their bodies and all this stuff, and it's just so gross. But then there's the double bind that happens, where it's like, okay, so I'm not going to let the kid do the thing that would prevent necessitating this procedure. And then I'm going to penalize them and criticize them for getting said procedure to correct the thing that was avoidable because I wouldn't let them do hormone blockers. Yeah, exactly. And I think that tiny case study is just one shining example of how this whole discussion around gender affirming care is not about people being able to be confident in their bodies or all this, like body positivity, safety of women, internalized misogyny, all this stuff. It's just about controlling bodies.

Alex Iantaffi: 44:47

Well, and we do see that because it seems to be the same political actors who are behind some of the Santa trans legislation also seem to be wanting to have a say on any reproductive capacity, for example, or which medications should be accessible again, talking about going beyond your scope of practice as a politician, and we are totally getting into how tag or takes territory. So let's stay sorry. Let's stay into the heartache territory. And let's talk about something that is controversial and it came from just like one research study and a couple of papers, but it's really taken hold of the collective imaginary, which is this idea of rapid onset gender dysphoria. I wrote you EDA, which has been vastly condemned as not a theory by every reputable professional and psychological like Association at this point. Yeah, let's, let's go there. Let's talk about our GD.

Unknown: 45:49

Oh, god, okay, I need to be careful here because as I talk about RGB, I have the tendency to burst into flames. It's just so aggravating. Maybe we'll

Alex Iantaffi: 45:58

just have some adverse rather than full fledged, like,

Unknown: 46:02

no cupcakes, but maybe we can do some s'mores. It's also funny too, as a as a doctoral student in our researching, because I seen all this stuff, even just as a master's level practitioner, and you could already, you know, see straight through it, how transparently bogus it was. But thankfully now as a doctoral student, I can also explain why is bogus. Absolutely. And so it started off with this one fringe paper, even looking at it still, I don't know how in a million years it got published. Because it it recruited strictly from parents did not talk to kids were recruited from parents of several notorious anti trans hate sites. Yes. Like, that's gonna be a biased sample. I don't think that there's another way that you could possibly explain it.

Alex Iantaffi: 46:55

No. And that is the definition of sample sampling bias, actually, right.

Unknown: 47:00

Yeah, exactly. And so and also to only talk to the parents didn't talk to the kids at all. And now I'm at the logical flops, right? Absolutely. And so basically, this whole idea is portraying dysphoria and in this idea of rapid onset gender dysphoria as some sort of social contagion. Basically, the shortest way I can sum it up is just trying to find a nice medical pathologizing researchy speak way of saying, like, my kids saying they're trans because their friends are trans. And it's just ridiculous. It's, it's really interesting. One of the things when I was reading through that paper, for some of the research I was working on a little bit ago, because I was a masochist and decided I needed to read it. Or whatever reason. One of the things that stood out was, you know, it's interesting, like the parents of kids who have rapid on onset gender dysphoria are statistically more likely to have experiences where their kids call them transphobic. Sure.

Alex Iantaffi: 48:21

I am shocked RFI, that is sarcasm. Yes.

Unknown: 48:24

Right, exactly. But so it's also interesting. It's like, perhaps I could theorize this is solely anecdotal, of course. But I could theorize perhaps, if a kid recognizes that you may have some tendencies they perceive as transphobic they probably might avoid telling you that they are trans or feel that they are trans until the last possible moment. Yeah, so that might be why it feels sudden to you.

Alex Iantaffi: 48:57

And sometimes the moment is when puberty hits because puberty is stressful for a lot of people, but especially for trans non binary kids like and young people. It's very stressful.

Unknown: 49:10

Yeah, absolutely. And there's just so many deep seated issues with this entire idea. And this entire notion, also to a lot of the ways that they look at it are so incredibly gendered, and just really gross. And work into a lot of like tropes and stereotypes. I also think a lot of it gets weaponized in really harmful ways. Especially to because it's not science, but yet looks like science. And that's one of the biggest arguments that people try to use against transness. And gender variance is like, what it's science, biology, you know, et cetera, et cetera.

Alex Iantaffi: 49:51

It's actually not but that's exactly

Unknown: 49:55

that's a whole nother conversation. It's not current people have always existed and will always exist. So biologists not as binary as people think that right and, and everything socially constructed and made up. And so it's just so deep seated, how like you can see all of the like methodological problems like all of the ethical problems, all of the clear bias on all of this whole approach. I mentioned bursting into flames like a couple of weeks ago, I had a very similar just like, bursting into flames from sheer rage. Because there was another paper that came out about rapid onset gender dysphoria. Maria. And once again, same issues with the methodological bias the way that they were sampling. It was another It was like they recruited from parents of our odd kids.com. Like what?

Alex Iantaffi: 50:48

Yeah, very problematic data. I think there are also some ethical issues when

Unknown: 50:53

I was just getting into that. They also just blatantly acknowledged in, in their research that they did research on human subjects without IRB approval, which is like the the No, no list of no nose.

Alex Iantaffi: 51:11

Well, because the data was already out there that being that collected by somebody was not a researcher, my understanding was like this time.

Unknown: 51:19

Like, if you really think that you found something, which trust me are odd wouldn't be it, but I'll entertain it for a second. Like if you found something that you think is like big, and like you were just getting some data and you're like, oh, we should make this academic and scientific. I'm sorry, it sucks. But just like, go back and start over just get new data, like having done it through appropriate measures, like getting an IRB ethics approval. And

Alex Iantaffi: 51:44

exactly. Those institutional review boards are there to protect the public exactly. From this kind of misinformation getting out. So shame on the journal that published it. But that's a whole other story that we're not going to get into today. Yes,

Unknown: 51:59

yes, absolutely. Be. So like I said, I just I, I, from time to time will burst into flames just thinking about this. Well, and I

Alex Iantaffi: 52:09

think they're very like scientifically sound flames, and that we're both trained as research. I mean, I know you're still in training, I don't know, I've lost count now. Over 20 years, 30 years, almost, I'm getting hold of research, and I've taught research methodology, and I can see if wild methodology when I see it, but let's not get too technical, I do want to go back to something that you were saying, which I think it's really important, which is if children and young people don't feel safe to tell a parent about their gender identity, they will wait until the last possible minute. So either when, until the distress is high enough or, or even when they've made that sense of themselves, because they're also influenced right by this atmosphere that maybe if not fully transphobic at the very least cisgender is which means it pas you know, if use sis identity as inherently better or superior, or more normal than trans identities, right. And there is like a lot of social discourse around dude, parents have the right to know if their child is using a different name and pronoun, for example, a school or with their therapist, and this idea that the parent or caregiver as the right again, in air quotes to know if their child that's disclose their gender identity to like a trusted therapist or counselor or social workers or a teacher. Yeah, what what do you think about this idea of the parents right to know?

Unknown: 53:44

Yeah, absolutely. And also to discourse is a really nice shorthand for New York opposite or New York Times. Because they've had a lot of feelings about this for a lot of years. And so it's just, it's funny, once again, to like the idea of, you know, if you as a parent feel so strongly that you should be knowing these things about your kids. Even just entertaining that as a notion, like what are you doing, as a parent to facilitate that space where your kid can come to you. Because also to like, this is just my, my bias and my feelings, but that's probably the better way to know things about your kids. I don't think parenting as a surveillance state often tends to go very well. And so hopefully, most of the ways that you know things about your kids are them telling you instead of you having to find out and so yeah, what environment are you setting up for them to feel like they can tell you safely, no matter how messy unpolished you know, we were just in a training this weekend. And one of the phrases I heard a lot that I just really enjoyed, it's like the thought is still cooking. Like, what what atmosphere are you creating for your kids to be able to tell you like, hey, this thing is still cooking, but like, here's what I'm thinking about, you know, just having some thoughts before the last minute. And of course, like I said to you, that's even entertaining. You know, the idea if there is this inherent like ordained rights to know which also is a whole nother can of worms and I think I think as, as a parent, and of course, you I'm going to acknowledge my own positionality as not a parent and have not having had that personal experience. But for parents, I think it's probably better and more helpful to know what's going on in your kid's life and for them to tell you those things. But I also think, I don't think always, but I do think quickly, these ideas of parental rights around knowing these things about your kid and your entitlement to knowing these things, very quickly can transform into discourse that suggests kids as property of parents.

Alex Iantaffi: 56:17

Absolutely. And, you know, and as I'm a parent, as well, yeah, many therapists I'm gonna put my parents hat on. And, first of all, you know, I hope that everything that I do, as a parent, illustrates that Adam pain as a parent, I own my children that I think that's a very challenging way of thinking about parenting, let's say, but also, if, if either of my children discloses something to another trusted adult, and then I found out later, my first part is, I'm so glad that you had somebody you trusted that you put down this true. And second, then I will ask myself, Have I done anything to make you feel not unsafe, or not confident in disclosing this information to me, not because I'm upset, but because I want to be a better parent. So if there is some feedback that I need to receive as a parent, that somehow I've created an environment where you couldn't tell me something? That that's the conversation that I would like to ask not like, Oh, my God, why did you tell this person and not me? I'm your parent, right? We'd be like, I am a hey, I'm so glad you asked somebody you trusted, be like, is there anything I could have done differently to create a better atmosphere which you felt safe and competent to disclose whatever it is that you want to disclose to us?

Unknown: 57:40

And also to like, is you not knowing something as a parent, even automatically a negative value judgment? Absolutely. There's plenty of reasons like, as a, as a sex therapist, it was quick into my adult life that I heard from my mom, you know, like, Honey, you know, you're making your father uncomfortable at dinner. And so like, there are just things that parents might not need to know. And that's not necessarily an inherent value judgment on them, or their safety to tell like maybe they're on the list and just in a different order. Like one of the things that's, you know, really big in, like these op eds, for example, in the New York Times is kids socially transitioning at school and whether the school is required to tell the parents about that. Yeah. First off, I think it opens a whole can of worms around safety issues with abusive households. Absolutely. But even to like putting that aside for now, and just talking about, like, the right to know, and things like that, like, Has anyone asked why the kid hasn't told the parents like, maybe, and I'm sure that this is not a rare occurrence. Like, maybe the kids just trying it out at school and like, workshopping it. Yeah. Before they decide to tell their parents like maybe they're like, hey, I want to just like play around with this and see first and have a better idea. And be more sure. Because I really care about my parents, and also their feelings toward me are of value to me. And I, I also don't want to scare them with the ambiguity of me not knowing so I just want to have a better idea first. Oh,

Alex Iantaffi: 59:24

yeah. It doesn't have to be a negative. Absolutely. And, you know, as, as a parent, who's also sex therapist, and where no conversation is outside at our dinner table. You know, it's also like, you know, it's okay to let your children and young people have some autonomy, of exploring, like, I'm an often when I work with parents, I talked to them and I say, did you have her have something that you wanted to explore for yourself? Are you wanting to keep to yourself, when you were a teenager that you didn't necessarily want to share with your parents? And 99% of parents are like, Oh, yes. And I'm like, so your kid also might have had some things and sometimes that that one of those things, is gender identity that they wanted to like, cook for themselves, or cook with some other people to stay with that metaphor, until it was ready to be presented to you right? Because I think it's so easy for parents to feel out of control. And I think I wonder if that's one of those things where parents are starting to feel out of control, and so they want to regain some some form of control of their child.

Unknown: 1:00:33

So yeah, and also to like, once again, not a parent. So this may differ if I were to be in that position, but you know, of the various things that my kid could be hiding from me good, bad, indifferent, worse, like them trying out a different name or pronouns at school is the least of my concerns.

Alex Iantaffi: 1:00:54

Oh, absolutely. And a lot of people use a different name than their name that were signed up. If you mean even with my health. That's one point, we had a conversation where she was like, I don't like my name. I was like, you can change it if you want to.

Unknown: 1:01:06

Yeah, yeah, it makes me think of this thing I saw a million years ago at this point where like, memes from your parents are a gift. And so of course to if you don't like it like, parent, probably as well not even probably just is valid to have some feelings about that. But all the same, it is a gift, and thus, the person is not obligated to keep it.

Alex Iantaffi: 1:01:31

And it's a gift that's given to somebody you don't know yet. Like when I was choosing the name for my eldest is Molly biocat. So I didn't have a hand in choosing the name of my child. But when I was choosing the name of the my child, one of my children you know, I didn't know her yet. And so you make your best guess based on your own needs, your own wants your own ideas, and then this little being comes into the world and they're themselves. And then they tell you they are and sometimes that doesn't match, and that's okay. Like, you know, we've, we've given you this gift, and we made our best guess that this hopefully will suit you, my baby doesn't and that's okay.

Unknown: 1:02:15

And, and also to like, on on the reverse as well. Like, if we go with this, like overly simplistic idea that like a lot of trans people want to change their names and things like that, like I for one is someone who has all reason where I should quote unquote, want to change my name. I actually really like it. Exactly. So like, cool. Like, it was, it was one thing you picked, right, mom? Like, there were a couple other things that, you know, the guest was incorrect. Like, I think about my parents, you know, laughing about my dad's side of the family joking. You know, everyone stops once they have like, one of each. And it's just me and my sister. So they joke that, you know, they they got out of the way early, and then I messed it up. Plot twist. Yeah. So like, you know, guessing some other things, you know, didn't land as much. But actually, you nailed the name.

Alex Iantaffi: 1:03:10

Yeah, there you go. Exactly. And sometimes also, when you give young people the option to explore, you know, like, with my kid, I was like, Yeah, change your name, you should want to they were like, I thought about it. I didn't feel that strongly about it. And I'm like, oh, no, exactly.

Unknown: 1:03:24

And that goes back into the the idea that like the number one thing that we can do, if we are really truly concerned about like kids making the wrong decision, or regret rates or things like that, the best thing that we can do is encouraging, especially around the area of social transition, a safe space to just try it out.

Alex Iantaffi: 1:03:46

Absolutely. Just play. Yeah. I mean, it's okay. And you're supported, no matter what your love, no matter why you're supported care for no matter what. I feel like that this conversation for a long time, but I want to be respectful of your time. I do have one kind of last question that I want to close on, which is, what do you see them? How do you see the impact of this current kind of political climate and this increasing, increasing wave of anti trans legislation impacting trans folks around you, whether it's clients or focusing community? I know, I've noticed that it's definitely having an impact. And so I was wondering if you've noticed that too.

Unknown: 1:04:28

Yeah, absolutely. And seen and lived, of course, you know, from our own rooms as trans people too. And, and of course, I have the the unique experience of both being a person of live trans experience as well as a provider of gender affirming care. So this kind of double whammy is, you know, personally and professionally. But it's a lot and it's a lot go much and it's so heavy and and the thing that particularly bothers me is like if we think about privilege and the idea of privilege and the things that people take for granted that they don't have to experience so many people in this case, you know, sis, people don't have to wake every day seeing countless news articles, seeing countless videos, treating their legitimacy and right to exist as a political debate.

Alex Iantaffi: 1:05:28

Yes.

Unknown: 1:05:31

And that is heavy. And like it or like, I'm in my late 20s. Like, that already just sucks. And like, I've been in my, like gender identity for almost a decade, like, it sucks. But then I think about the kids dealing with this and having to watch this every day and see this every day and also see it inform how some people may or may not be treating them because of course, this also just emboldens a lot of bullshit, frankly, in interpersonal relationships and from their peers. And it just is gross.

Alex Iantaffi: 1:06:16

And, yeah,

Unknown: 1:06:17

that just gets back to that controlling bodies deciding that we should tell others who they are instead of us getting to, to name our own selves, literally and metaphorically.

Alex Iantaffi: 1:06:29

Absolutely. Yeah. No, I think about that, too. I mean, it gets me down. And I'm, you know, I mean, my 50s have been out for almost 20 years. Now let's dress as like, is it really the longaniza? Yeah, it's getting there. And wow, you know, out to the world. 15 years, but you know, there's all their stages, right, that we go through? Yeah, if this is heavy for me, and I'm a mental health provider, I have a lot of support at home. Yeah, you know, as a caring family, caring partners, caring kiddos, what is it like for like a 12 year old, a 10 year old, a 13 year old to be under this barrage. transphobia, especially if they are not supported at home, my heart really breaks. And when I think about that,

Unknown: 1:07:19

yeah, and as we mentioned before, like, half the point of like, the blockers and other things is the fact that kids are already dealing with so much. So then you add all this, yes. And it just sickens me to my core that so much of the rhetoric around this is around protecting children, and for children's well being and things like that. And it's like, if you just would read or look at even the littlest bit of science or talk to a professional, or God forbid, talk to a person. Yeah. Like, talk to a trans person. Like, I mean, this podcast is called Gender stories, you know, we we all have these stories. And if you would just hear one, yes. With an open mind and open heart, like just seeing you don't trans people or people. It's, it kind of gets into what I was talking about at the beginning to where it's like, like, it's so special getting to provide something as beautiful as gender affirming care, but also at the same time, like, there's simultaneously this weird thing where there's nothing really special about gender affirming care, because it's just pair

Alex Iantaffi: 1:08:38

shooting all care be affirming of

Unknown: 1:08:42

me treating you as a person and letting you say who you are. And, and yeah, so

Alex Iantaffi: 1:08:48

yeah, that's one of my elders would say, it seems like it's just good manners. Yes.

Unknown: 1:08:54

Absolutely. Yes. Yes, good manners.

Alex Iantaffi: 1:09:00

I always ask, is there anything that we haven't covered that you absolutely wanted to make sure that you talked about in this episode?

Unknown: 1:09:10

I think just recognizing that it is really heavy, it's really gross right now. It's a lot. And I think it's a time not that any time has been any different. But I think just now all the moreso where we have to be scared and brave simultaneously. And so I think to the trans folks listening and other gender diverse folks, you know, just keeping on keeping on and knowing that you have community and people around you who love and support you and then for the CES, people and the allies and advocates and accomplices, as my colleague John Thune likes to say, step the hell up. We need you like a lot right now. Call your people get things happening. I see the story now and again of that, like one congressperson who's been filibustering for like four weeks now or something like iconic behavior, you know? Now is the time to not be quiet and just sit and watch on the sidelines, like, get into it. You know, I saw things you were with like if you're, if you claim to be an ally and aren't getting hit by the rocks thrown at us, you're not standing close enough.

Alex Iantaffi: 1:10:36

That's a beautiful way to put it.

Unknown: 1:10:38

So good

Alex Iantaffi: 1:10:40

time to be accomplices as many indigenous movement organizers leaders say rather than allies, right? Absolutely. Well, thank you so much. Colton has been such a pleasure to have this conversation with you. If listeners want to get ahold of you so you can provide a training on gender or to contact you or to buy your beautiful books. buttercream. Where could they find you? Yeah,

Unknown: 1:11:08

so you can find me? My website is just Colton janicki.com You probably will struggle to spell it. So just look at the description of the podcast episode. Well

Alex Iantaffi: 1:11:18

put in the episode. Don't worry.

Unknown: 1:11:21

Yeah, so Colton chanakya.com. And then all the same to you can follow me at Colton Janicki on Twitter. So. Yeah, and Instagram.

Alex Iantaffi: 1:11:31

Yeah, as far as long as Twitter lasts, who knows? Yeah. So thank you so much again. And for all you listeners, I hope that this episode, gender stories was informative. And if you are a salesperson who's listening and you want to do more, there are so many ways to engage and I'll put a couple of those ways to engage and keep up to date with what's happening in the episode description. So thank you again, culture and what a pleasure to have you and that and thank you listeners and viewers, maybe another year if you're on YouTube, for listening or watching this episode. Until next time, bye