Aydin Olson Kennedy is a clinical social worker and executive director of the Los Angeles Gender Center. He specialises in working with the parents and families of trans individuals.
In this episode of the GenderGP podcast he joins Dr Helen and Marianne to discuss what it means to be a trans man in the world today and the importance of listening and allowing people to talk and explore their feelings around their gender, wherever they might lead.
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The GenderGP Podcast
Aydin Olson Kennedy – The GenderGP Podcast S4 E5
Hello, this is Dr Helen Webberley. Welcome to our GenderGP Podcast, where we will be discussing some of the issues affecting the trans and non-binary community in the world today, together with my co-host Marianne Oakes, a trans woman herself, and our head of therapy.
Dr Helen Webberley: I’m really delighted to welcome you, Aydin, to our podcast. And thank you for coming to join us. I’m going to let you introduce yourself in a minute, and tell us all about the work that you do. But I just wanted to tell people how Marianne and I met you. And again, back in January this year, and I have said this before on the podcast, we came over to the United States to listen to your weekend talks. And I have to say, it was so inspiring. It has changed the way that we work. And through the podcast that we’ve been able to do, we’re often referring back to what we learned from you and Darlene and Johanna. So, it was amazing. And it’s been inspiring for us and for all the people that listened. So, thank you so much for that. I wanted to pick your brains on some of those things today. And I sure Marianne wants to as well. But in the meantime, Aydin, introduce yourself, tell everybody who you are. And they will be as excited as I am.
Aydin Olson Kennedy: Yeah. So first, it was such a pleasure meeting you all. And I think that it was sort of really exciting to bridge the gap between some of the care that has been happening in the US, and what’s going on over there. Prior to meeting you all in January, there was such a separation that it feels like that bridge has been gapped slightly, so it’s been a real gift for us as well. My name is Aydin Olson Kennedy. In the US, I am called a licensed clinical social worker. I think that is, for context of understanding what it means here, is that I am a therapist. And I work pretty much exclusively with trans folks, parents, and families. I’ve been doing that for about the last 10 years. I am also trans. Having transitioned 11 years ago, so there tends to be a perspective of these experiences that is a little bit different that folks who are not trans who are providing this care or are talking about this care.
Dr Helen Webberley: Thank you. Marianne, I am going to put you in the driving seat. Is there anything—I’ve got so much that I want to ask and say—but I don’t want to steal the show. Marianne, I’m going to put you on the hot seat, and let you fire away with anything you wanted to ask Aydin.
Marianne Oakes: Well, where do we start? First of all, just wanted to reiterate how inspiring it was being over in LA and just listening to the three of you talk. But one of the things that I took away from there was your experience of transitioning, and how, in the social context, you told a story about walking down the street, and there was a lady in front of you, and she was going faster, and you were going faster. And I just thought that in itself encapsulates just one very small dynamic of transitioning. And being trans yourself in the therapy room is—I see so many people that are fixated on this word, transition. And medication. And actually, not what it actually means and what the implications of that are. I am wondering if that is something that you come across with your client work.
Aydin Olson Kennedy: Yeah, I think that transition in some ways has been reduced down to a singular experience. Not experiences, a singular experience that is talked about only as an initiation of either a social transition or a medical transition, right? And of course, both of those things exist as experiences for a lot of people. Some folks don’t medically transition, some folks don’t socially transition. But what I have felt in my own transitioning going into therapy, but also as a therapist in these other spaces, we don’t really talk enough about what does social transition mean beyond names, pronouns, and sort of beyond that physical presentation, right? That we are social beings, which means that as we move into a different social gender role, people are going to interact with us and see us very differently. And as a result of that, it is going to change us, because all of us are changed in our interactions. And I guess as trans people, we often get accused of, “If you transition, you are going to change and become somebody I don’t recognise.” And then we often get put in this very defensive, like, “I am going to be the same person, I am going to be the same person.” And so, I really look forward to the day when we expand that conversation, and we talk about it more accurately. Yes, like, “I am going to change as a result of how people interact with me differently.” And it doesn’t become an accusation of some egregious thing that’s going to happen when we transition. And so, I talk a lot more about social role transition, I talk about legal transition, and I talk about the multitude of other ways that transition encapsulates and interacts in our day to day lives. The pure process, if you will, of medical transition, regardless of how old you are, and relative to our entire lives is actually a relatively short amount of time. You know you are talking about—the longing, if you will, for maybe five years. But those first two years, there is a lot happening. And while you are in it, or you are desperately trying to get to it, that seems like everything. And I don’t disagree that when I was in that place, it really did feel like everything. But eleven years later, I’m like, wait, when was that time again? And what I have now collected is a lot of experiences that are much more around what does it mean to be a man or male or masculine in today’s society? What does it mean about me? What does it mean about the privileges I carry? But also, how do I want to do that? Cause I have a lot of opportunities to make decisions about what kind of man I want to be. So, transition also allows us a lot of freedom in some places but also restricts us in some other areas.
Marianne Oakes: I think that’s the key that how can we prepare for how the world is going to perceive us as we go through transition? I use the, I don’t want to say metaphor, but the idea of if you have a pill and you could take it and wake up tomorrow, and I would have the full body, and nobody would ever know that I was anything other than female. Would I take that pull? And I think that ninety-nine per cent of trans people would snatch your hand off to get that pill. When they woke up and realised they didn’t know how to be in the world in that body and in that—I think that is really interesting. And how we can help people to prepare for that as therapists is really important.
Aydin Olson Kennedy: Yeah, and I wonder about when we ask that question. Are you asking somebody who is at the very beginning of the stages of their process? And it feels like it is the ends, which is not actually a thing, but it feels like the ends are so far away and it is so unattainable. That pill, I think, has value attached to it that maybe once you are further along, it does not have that same value. But also, one of the things I talk a lot about and I think a lot about is intersectionality, and the role that privilege, or perceived privilege, social capital, has in people’s process. I think that there are as many trans folks who even many, many years into transition would still want that pill, because their transness walks into the room often before they do, which then changes the way people see them and interact with them, right? So, the value of what you would potentially get with that pill is different than somebody whose transness doesn’t enter the room before them. There is a different relationship with what it even means, in the sense of social capital, to be trans. And again, this sort of ties in the idea that when we talk about transition, we are also talking about social capital. And privilege. And what you have access to and what you don’t have access to, right? And I think that as a therapist, as a clinician, I have to talk about these things. But I don’t know if you have found this. I have found that in my experience, also, that when people who you would try to talk to, in a couple of years, it very much reminded me of when I was a kid. And people would be talking about, well, when you’re an adult, and I would think, yes, but I am not an adult. I am here, and this is where I am at right now. Sometimes, it was hard to imagine being really in a situation in which this person was talking about many years out. I couldn’t connect anything to really lie experience with that. And that has been a struggle clinically for me, trying to prepare people for experiences.
Marianne Oakes: I think just going back to what you said before as well, that when you look back, eleven years later, that moment where the medical transition, for want of a better description, took place is such a small percentage of the whole. But as I have reflected too—I think my own experience is the build-up to getting that help, it feels like a lifetime. But then when you start it, and you look back, it moves so fast. So it is a little bit like we do get that pill. The irony is that the phase of time seems so short. Trauma features far higher, as well, with the people we are with. Many of the people that come to me that have been to therapists, who have been under the care of the NHS, they’ve been treated like gender dysphoria is something that is purely about hormones and surgeries. When actually, we are treating it as—if people could see this trauma involved here, I think the language that we use and the way that they approach—it would be so, so much different.
Aydin Olson Kennedy: I agree.
Dr Helen Webberley: Aydin, I was going to ask you. You talk a lot about privilege. One of the things that’s been talked about a lot in the UK is the reason why there’s been such an increase in the number of people, especially young people, coming forward for help. And in particular, we have had a sharp increase in the number of assigned female at birth people coming forward. One of the reasons for that has been postulated is, by some quite senior people in healthcare in the UK, is that it is somehow preferable to live in today’s society in a male identity than a female identity. I mean, when you talk about privilege, I am guessing you don’t mean that kind of privilege. But is this something that is talked about, you know, where you are? Do you think there is any merit in that? Would love your thoughts on that, because it’s something that our parents here are being told. And it’s hard when you are being told things like this from experienced practitioners. Is it true? Is it nor true? Of course, we don’t ever know the exact answer, but I am interested in your thoughts on that.
Aydin Olson Kennedy: Yeah, I think when people are saying that, what they are saying is that there is a privilege in being a cisgender male. There is a privilege associated with maleness and masculinity. Which I agree. Which is true. But I think that the argument they are presenting and postulating is inaccurate and incomplete in the sense that if you are an assigned girl, and you decide to pursue transition, medical transition, or social transition, in an attempt to acquire status or privilege, you are acquiring something that you had no actual experience of. So that acquisition of something implies that you are like, “I experienced this thing,” and you want more of it. And that is actually not what is happening. But also, the acquisition of male privilege and that masculine status sort of peace, it is experienced through being a trans person. It’s experienced through oftentimes when people have a lot of dysphoria and a lot of distress. It’s also a sort of experience in the sense that like when you are in male spaces or you are sort of wearing masculinity in that way, you are always wearing that masculinity on top of, you know, “and I am trans.” So, when you get access to, you get access to some things. But the reality is that you are not actually accessing cis male privilege, which is very different. It’s a very different thing. And so, I think it is certainly possible, there would be no way for me to say that, definitely not, that there are people whose experiences have been, outside of their gender identity, their experiences have been really traumatic. They may be on the receiving end of a lot of really horrific sorts of traumas, and the idea of not being exposed through these things through the lens of a female body or femininity. Do I think that these folks sometimes explore the idea of that would be like so much easier to transition? Of course, I think people have those conversations. I don’t think that this is outside of their normal trauma response. Do I think those people transition? No, I do not. I think there is a clear difference between somebody who is like, “This space is causing me so much discomfort and so much distress that I am going to do everything I need to do to move out of or away from this space to acquire something different.” The byproducts or the accidental byproducts of that is that I am moving into a society that is sexist, and a society that has a preference for maleness. Not as just a byproduct of this thing that have to do over here. So, I think it is an inaccurate and inappropriate false paradigm, if you will, that people will transition to acquire something, like, that’s not actually what they’re acquiring. It’s not what they’re getting.
Marianne Oakes: I think that idea that making a choice to move to something better, I think—my experience is, and it doesn’t matter what age people come into the therapy room at, they’ve been through a process of trying to not do this. They actually have tried this avenue, they’ve tried that avenue. I’ve tried everything not to do this. And actually, the pain’s not gone away. The feelings have not gone away. And all they are left with is transition. I don’t ever think that transition is the first road that they go down. It’s the last road that they go down for hope. And unfortunately, I just think that there is a lot of cis people out there who are trying to work in this field or have an opinion in this field that don’t get that at all. It is not the first choice.
Aydin Olson Kennedy: Sure. And I also—again, this is speculation, I don’t know, but I do wonder what people who are putting for a fact that argument if you will, or that assertion, I do wonder how frequently they’ve sat in a room and really listened without pursuit of a specific story or a specific narrative. Like, really sat and listened to trans youth and adults talk about the process that they went through to get to the eventual location and eventual place of saying, “I really feel that I need to transition.” Because they think that if you spend any time being in a space without your own agenda, and really listening to people’s coming in process, listening to people’s stories and experiences, I think it would be very hard to continue to hold on to this idea that people transition for some sort of ulterior motive. Some sort of, like, “I’m going to try to get this thing that I am telling you I am trying to get.” Right? It’s a very fearful conspiracy sort of an approach. You’re just doing this to get this thing, and the US—and as a social worker, part of my training as a social worker, as a discipline, is looking at things from the lens of autonomy and advocacy. And there certainly is a part of me that says, “Okay. Well, what if somebody wants to transition to a different gender role or physical gender presentation, and that actually makes them more comfortable?” So what? Tell me what is so horrible about that, because I can’t find the horrible with that. Because I am uncomfortable here, and I am more comfortable here. And you, as the outside person who is not transitioning at all, you keep doing you the way that you want to do you in your life. And I am going to be over here, and I am going to do me in the way that works for me in my life. And that advocate part is like, so tell me where the problem is in that? Cause I can’t find it. I’m not sure where the problem is. So, there is this advocacy piece of saying what are you talking about and why is that a problem for you?
Dr Helen Webberley: I mean it sounds like I want you to stand up, right now, on top of the highest building in the UK and shout to everybody that’s got an opinion on this because everybody does. And everybody is saying, these kids, these adolescents, these children, these adults, they shouldn’t be doing it. They shouldn’t be allowed to do it. They’re harming bathrooms and sports pictures. And it’s like, autonomy. Let people be in charge of their own destiny. I mean, sure, as medics, from a doctor’s point of view, we give the best advice to help people to do things in the safest way possible, especially if we’re talking about medicine and surgery. But you’re right. And I just want to shout this loudly. Let people be in charge of their own destiny. They’re the ones that have to live and wake up in that body, live in that body, go to sleep in that body, and then wake up again the next day in that body. It’s just incredible how so many people have an opinion on trans people. And I remember that weekend in January, I think as Johanna said, thank you to all those people that she learned from. Because Johanna is not trans, I am not trans, and the way that I learned all that I know is by listening to trans people telling me what it feels like. I have no idea what it could actually feel like. But I have just listened to what people said to me. And I really—I say to people when they are trying to have an opinion on a trans person’s life, I say, “Have you actually ever listened to a trans person? Have you heard their stories? Have you sat down in a room with a trans youngster and heard what it is like for them to be at school or at home or what have you?” And then I think of the people that I have met, who are privileged enough to work in this field, and they clearly have met trans people, and still, they don’t get it. And what you said earlier, Aydin, about that, is that they should stop going for their agenda and listened properly as we should listen, rather than listen to their bits and forget about our own agenda. That probably just explained to me why some people just don’t get it. They’re just listening for their own agenda, to fit their own story.
Aydin Olson Kennedy: It also undervalues—and we talked about this that weekend—it doesn’t take into consideration—and Marianne, you actually reference this, that there is such a process that people go through, right? And Jo and I talked about it from the lens of coming in. And little littles, you know, people who are prepubertal, their coming in, if you will, looks a little different. The little littles sort of arrive at this place of presentation that is in some ways much more authentic and organic in some ways. Because they’re not being scorched particularly before they enter into an education. Here in the US, public education is a pretty oppressive experience for a lot of people. And so, they’re just doing this for this is is what feels right. There is not a lot of social consequences to it. It’s very authentic and organic. And they sort of come to realise what that all means sort of a bit later. But I think that anyone who is post-pubertal, there is such a thorough, thorough process of exploration of self, and exploration of what is this, what does it mean, what does it not mean, could it be A B C D, all the way to Z? And something we have to go back to A just to double-check and make sure, right? And oftentimes, that entire process is happening without the knowledge of those around us. Whether it’s our partners, our parents, our therapists. And I’ve met tons and tons and tons of fourteen and fifteen and sixteen-year-olds who, given the opportunity to talk about their process, that process for them, the questions they had to explore and answer, they had the ability to speak directly to why this false narrative or some sort of choice around their gender, they have the actual language and the evidence to talk about why that narrative doesn’t apply to them. If we ask the right questions, and remain open and listened, most of the fears that parents and therapists and providers have could actually be addressed if we created enough room for people to talk about their story and experience. We don’t do it. Largely. I mean we do, but there are also a lot of people who don’t.
Marianne Oakes: I was just thinking there, language has a lot to play. We sat with two parents and a young child. And we said, have you got any questions? And the parents said, you know, what are the side effects? And my response was, well, what you might consider side effects, I think, you’ll find that a trans person sees as benefits. And if we start off by thinking, well, this is a male that is going to develop breasts, I think a cis person would think, “Oh my god, that is a side effect.” Whereas as a trans person, it’s, “Oh my god, how fantastic.” I think we start out from a cis perspective there that these are side effects. No, they’re not. These are benefits. And the benefits bring with it better emotional wellbeing. It brings a better chance of staying in education. It brings a better chance—you know, they are the benefits. And I am not quite sure what the side effects are. I’m sure Helen could tell me. Other things. But the starting point is the negative language around—
Aydin Olson Kennedy: It’s so cis normative, right?
Marianne Oakes: Yes.
Aydin Olson Kennedy: It’s so cis-normative, and if you approach transness or non-cis-ness, if you will, from a cis perspective, and that everything is then going to be compared to cis-normativity, then, of course, the narrative around trans people and transness is going to be a deficit lens. You’re looking at yourself like cisness is the marker of success around gender, and anything outside of that is going to be, well, it’s going to have that sort of approach. And people feed off of that approach. If I walk into this conversation and I am nervous, and I am uncertain, even if what I was talking about is factual—we’re not talking about gender, I’m talking about history—well, if I was talking about it and I am like, “Well, I think, maybe,” you all’s energy becomes my energy. And so, it is really important that we need to talk about trans experiences and that we’re talking about it from this place that is positive and celebratory. We can still explore all sorts of things and remain in a positive, and looking at exploration as a benefit, not a deficit.
Marianne Oakes: Yes.
Dr Helen Webberley: I love that talk about side effects, actually. Because it’s interesting. Marianne, you mentioned breasts, which is a more obvious side effect of estrogen. And Aydin, you are living proof that you have a lovely beard and moustache, which is just lovely.
Aydin Olson Kennedy: Thank you, thank you.
Dr Helen Webberley: Which is, you know, your side effect of testosterone. But actually, people who have testosterone, whether you are a trans man or a cis man, you are at risk of the side effect of male pattern baldness. And for example, you’re at risk of—men do not live as long as women do, historically. And so those are all side effects. And it’s interesting, because, you know, risk-taking behaviour is more common in men than women, and that applies too to trans men as well as trans women. It’s interesting, the side effects are all the things that men or women have because of their hormone profile.
Aydin Olson Kennedy: It’s the same thing that cis people have.
Dr Helen Webberley: Exactly, exactly. So, you know, welcome to the world of testosterone and what it does to you whether you are cis or trans. Those aren’t effects, side effects, end of story. Which, from a medical point of view, I find fascinating. We talked about that journey of people coming in, and I find that a fascinating concept, and I wondered if you could explain that to people. I’m remembering that beautiful cartoon diagram of that kid in their bedroom with just so much stuff around them coming in. I just wanted to say that to the listeners so you could explain what you call coming in.
Aydin Olson Kennedy: Yeah, so coming in really is the process that people go through that is movement from these first curiosities or questions. They’re often not experienced in the language of gender. Most trans people don’t start out at day one with the question of “Am I trans?” Most people who start at day one, whatever that means, something feels off, something feels different, I don’t know. It is just, like, for a lot of people it is a nagging thing that they are trying to find the words to explain to sort of contextualize. And so, the general, if I’m going to do the thematically generally this is what I’ve seen, and this is obviously going to trickle down into the individual specific ways of each individual person, but there is then a pursuit of what is this thing that I am thinking. What is this thing that I am feeling? But then it moves on, and it moves forward. I don’t know, I don’t really feel like a girl, whatever that means. And so, like, in today’s world, we start googling those things. And if you are really young, you ask Siri to google it for you. And there is this, “Maybe it’s this thing called transgender.” What does that mean? And there is an ongoing pursuit for information. And as people land at new pieces of information, if it doesn’t resonate for them, they will not continue to pursue it. If somebody is like, this transgender thing, and they’re like, that’s a hundred per cent not it, they’re not going to continue to pursue down the rabbit hole of what trans means. And we don’t also think about that, that people are not going to be thinking that, well, I have already started this pursuit and exploration, so I must continue. Until as that process is happening, though, so is oftentimes the increase in the experience of gender dysphoria. Not the diagnostic criteria, which is very different. The experience of gender dysphoria. And Darlene, who you all had on before, does a great job of talking about it in the context of as people gather information and that gender dysphoria increases, it’s not the information that causes the increase in gender dysphoria, and she gives this great example of when you are really busy, it is a long workday, and you have a lot going on, and you haven’t eaten. You’re so busy, and you don’t even realise that you’re hungry until you smell the food. And then you are like, oh my god, I am so hungry I haven’t eaten in 8 hours. The food didn’t make you hungry. The food connected you and put you back into your body to realise that you were hungry. And that is the same as people who are moving to the coming in process. It’s not the information that makes them dysphoric. It’s the information that allows them to put words to the experience of the increased dysphoria. And so, people move through that, and they answer questions like, maybe I am just gay, or maybe I am just lesbian. Maybe this is because I had a fight with my parents this one day. Maybe it’s because of this, this, and this. And those questions have to be answered before we can come out as trans. We cannot come out and say this is who I am, this is who I feel myself to be if those questions were not already explored and answered. And so, when we come out, and we are met with questions that seem reasonable to the person asking them, you know, “Have you thought about this?” What that question doesn’t understand or consider is that this person has spent months and times, years, coming in and answering those very questions, which is often also where friction first arises between the young person and the parents. Because the parents, once they realise and are given this information, they begin their coming in process. They start googling, they start going to groups, they start shifting their support system to understand better and reflect this information that their kid has provided. And so, there is this parallel process of coming in and coming out, and then the parents come in and start choosing people to come out to. We can create that parallel, and we can also shorten the gap and eventually decrease the friction between a parent and child, which is a great outcome.
Marianne Oakes: I think something resonated with me there. I am a lot older than most in this group. I can remember being about 14 and finding the word transvestite. And it was either transvestite or transsexual. And neither fitted perfectly for how it felt. But it was the first inkling that actually these feelings that I have are something and that others feel them. I think the only difference now is that there is so much more access. If you were to google it, that would lead to something else. This was a book in the school library. I don’t even know how I came across the word. It’s ridiculous. It must have been fate. The book just opened on the page. I don’t know, but whatever happened. And oh my god, now, I think, imagine you google it and all the links. And actually, if you follow the wrong set of links, you might actually not feel hungry or feel that it suits you. Because actually, the one thing that my experience gave me was there are choices. There is no one set of experiences. Different experiences may lead to the same result. But, you know, the different experiences that drive the process.
Aydin Olson Kennedy: I think we also, and I think this is the argument often used against supporting young people pursuing medical transition specifically, because medical transition is framed in the lens of permanent, unchangeable, right? It is sort of looked at like this one-way path only. And I don’t think there is a lot of awareness and maybe this resonates for you, but I don’t think there is much awareness that every time, every week I do my injection, I am actually making a decision, I am making a decision every time to continue in this direction, or to make sure that I don’t move in the other direction, right? And that actually there are a million choices or decisions, if you will, when people pursue transition. And this is the same for adolescents and young adults is that there not a decision. There is not like one decision. There are so many decisions around so many things. And I think that we actually need to give more value to those many decisions that are part of this ongoing process. I talked about this that weekend. And I talk about this a lot, that there are going to be people who, at some point, are going to make a different decision. This just proves that there is this real fear of the outcome. And I question of, like, is that a bad outcome, if somebody makes a lot of decisions, and arrives at someplace, when it’s time to make that next decision, and if they are like, “I’m going to do something different instead, I’m going to reroute my GPS here,” and they go on a different direction that feels right for them? Why are we criticizing that? Why do we have to be so terrified of that? As opposed to saying, that’s really wonderful that this person had an environment that supported them and loved them and nurtured them in a way that allowed them to continue to evolve and make decisions in the pursuit of their best self. And when people make a different decision, that’s what they’re doing, largely. There are people who choose to retransition as a result of an oppressive, non-supportive environment. That is different. That’s an experience of this hostile environment not working for me. Which is different to somebody who is super supported and all that, saying I’m going to reroute and do something different about my transition. I have clients that that’s been the decision for them. We shouldn’t use them as a reason to pathologise their experience and make it as a reason to not allow access to all of the people who likely will not reroute, who will likely not move in a direction that is around transition and a direction that is away from their physical assigned sex of birth place.
Marianne Oakes: I have another—I may have used this metaphor before, so I apologise to listeners who have listened to this before, but I had a mother say to me once, who said that I feel like my child is about to jump off a cliff. And I want to make sure that they’ve got a parachute from the way down. They’ve got a packed lunch, and they get a soft landing. And I said, what would the parachute be? And she said, well, a safe environment. And I said, what’s the packed lunch? To make sure that they are getting their education, they’ve got food, and they feel safe. And I said what do you think the soft landing will be? And she said I had no clue. I said the soft landing is to be there for whatever. If on the way down, they change their mind, don’t put the mattress away and say, “I told you so.” That is not a punishment. And really, if we are going to continue with the transition because we are too scared to tell people that we got it wrong, that’s worse than not doing anything at all. So, I like the idea of that metaphor, the way she framed it.
Aydin Olson Kennedy: But also, as the mom or the parent, empowering and reminding parents, I think parents are sometimes really out of control in this process. And reminding parents that there are so many places that they can remain engaged and that they can contribute to the outcome that they both want, but that they’re also super fearful that it’s not going to happen. The parents actually can participate in creating and facilitating an increased likelihood that their kid is going actually to have all the things that they’re super fearful their kid is not going to have. And I think that if parents realise that it is not like, oh my god, I just have to sit back and watch. No, you don’t, actually. You can remain engaged in a way that is super loving. And you can actually simultaneously have uncertainty and fear of your own and acknowledge that, “This is mine,” and still walk the path with your child and support and love. And I think parents just see it as either-or. Like it’s not either-or. Parenting is not either-or. Parents are constantly holding multiple things simultaneously, right? So, I think it is important that parents can remember that for me, anyway, but parents who are often labelled as unsupportive, I actually label as scared, uninformed, and scared. And if we partner with parents and say, like, it sounds like you are really scared, let’s address those fears, and we can help and inform them and move them into a different place, then they start packing the parachute for their kid. They start packing the lunch for their kid, instead of just, I hope they get that somewhere. And it’s like, you got to give that to your kid. You have to participate in that process.
Marianne Oakes: That’s being a parent, isn’t it? The one thing I say to the parents is you don’t stop being a parent if your child swears and curses at you and disrespects you. You’ve still got to teach your child the values. The only thing that you’ve not got control of your child’s gender, whether you like it or not, is being questioned. And you know, we can resist that and cause trauma, or we can be accepting of that but help prepare them to deal with that and give them good values and good parenting. But don’t try to be something that you can’t.
Dr Helen Webberley: That fear that we are talking about there. I mean, there is just so much there, isn’t there? And there is the fear in the parent supporting their child, or what might happen to that person throughout the rest of their life if they are allowed to carry on with this thing, being transgender. There is this immense fear among the medics. Before I came to see you guys in the USA, I’d never heard a doctor be brave enough to say, yes, I have a patient that started T, then stopped T. And then started T again and then stopped T again. And then started T again. Really bravely said. It was such a relief, like someone is brave enough to say that it happens. When I was working, once I had a mum come to me and say, “Dr Webberley, my kid wants to stop the testosterone. What are we going to do?” And I was like, “Well we’ve got to listen to what this child wants. We could understand what’s going on here.” She’s like, well, I’ve got two worries. What if we’ve made a massive mistake and we should have never done it in the first place? And what if they wanted to go back on T and no one would ever let them again? And it’s a tremendous fear, fear, fear, fear, isn’t it, about this? And it’s all-encompassing. One of the other things, Aydin, I wanted to ask you—we haven’t had much fortune to have many trans men with us, I wanted to ask you some questions that people have asked us about binders and packers if you wouldn’t mind. Being a mother and a doctor, binders scare me, but I also have listened and heard what relief they can give people. So, it’s something that mums I know and us, obviously, are going to feel worried about. And kids just want them tighter. And stronger. I’d just really love your thoughts on the experiences that you’ve had with patients or yourself or what have you.
Aydin Olson Kennedy: Yeah, you think that binders are an interesting thing in that sometimes it becomes this point of great contention. It becomes an unnecessary fight between a young person and their parents. And if we sort of pull this lens out of saying what are you fighting about? If you are fighting about gender, your kid’s gender is not wrapped up in the binder. And so like, first of all, let’s ask what is the conflict, where is the issue? I think what binders do is a process that resonates for every person regardless of their gender identity. Binders are an exchange of I am willing to be somewhat physically uncomfortable—because binders are uncomfortable—in the hopes that I will reduce the emotional and psychological pain and discomfort. I would just be hard-pressed to find somebody in the world who could not resonate with the idea that there are some things that cause so much emotional and psychological distress that we’d be willing to be physically uncomfortable. I think that that is why a lot of therapists are in business. So, I think if we look at it from this place as an exchange, and I think you can have conversations around how you safely bind, if you’re not arguing about the binder itself, the young person is going to be much more available in your conversations around how do you safely do this? Because when you are fighting about the binder in and of itself, and then you start talking about safety, and you are using safety as a reason not to support a binder, good luck with that conversation. You’ve like lost the battle straight away. And so, you know, for people who have a lot of chest tissue, binding is going to be a different experience for them, and they are going to have different needs and drives than somebody who has less chest tissue. So, if you have a lot of chest tissue and you are wearing a binder, and you still have chest tissue that one could associate your gender incorrectly because of that chest tissue, that need and urgency to bind more and to wear more binders and wear smaller binders is actually a very reasonable response, if we think about it from that perspective. Rather than, if you will sort of like, shaming or pathologizing or doing something around that if we bring that lens out, it actually is a reasonable response to a reasonable experience that that person is having. And we sort of branch from that place. Look, people say, “Don’t bind for more than 8 hours.” I need to know who came up with 8 hours. I think that someone somewhere was like, I don’t know, eight hours seems like a good amount of time, because you’re at work or you’re at school, and that’s a reasonable amount of time. I am not a proponent of somebody binding for extended amounts of time, but I am also not a proponent of people suffering. I am just not on board for suffering. So being strategic with saying, when you are in spaces when you are the most dysphoric and the most uncomfortable not wearing a binder, that sounds like the time that you should wear a binder. But there are spaces when you can probably tolerate not wearing a binder but wearing something else that is maybe less restrictive, still flattens or alleviates the feeling of t-shirt or shirt material on your chest. That feeling can be very dysphoria producing for people. And so, talking about it from a harm reduction model and from a strategic place, I think it’s going to be much more beneficial. Actually, the most thing that is beneficial is surgery. That is where what alleviates the needing to wear a binder turns out. Like it’s not a giant leap. And we are lucky. In this country, there have been people who have waged the necessary wars and taken the necessary risks in core battles for chest surgery to be done in ways that it has not historically been. And I don’t know, and I am open to being wrong, but it sounds like not yet has arrived in the UK. Chest surgery for adolescents. And so, when people are like, don’t bind, don’t bind, and the non-cis argument is maybe they should have chest surgery if you don’t want them to bind. That is the medical solution to that problem.
Dr Helen Webberley: I love that argument. And I can’t wait for one of our younger patients, younger people, who may be listening to this to be able to use that. You know, mum, if you don’t want me to bind, you could get me that top surgery. Well, doctor, you are telling me not to bind, well do my referral to the surgery. That would be fantastic. I mean, sadly in the UK, definitely no surgery for anyone before 18. And no hormones before 16. And that’s such a legal thing. It’s a protocol that states no hormones before 16. And then you have to be on those hormones before you can even get anywhere near surgery. So, our late adolescents have a lot of suffering, unfortunately.
Aydin Olson Kennedy: Just that model, do you know what I mean? Again, I think if we can collectively pull out the lens and objectively say what is it actually like? For whether you are a trans masculine person or a trans feminine person. What is it actually like to have your body in some ways moving in the opposite directions at the same time? So, you are masculinising, but you don’t have the other things that are necessary for your social experience in the world, and your own experience. It is not okay that we are asking young people to feel unsafe in their bodies. That is unacceptable.
Marianne Oakes: Some people would be appalled at the idea of having top surgery before they start HRT. And actually, the model we’ve got in this country pulls you down the road. And we may end up putting children on medication because the goal was top surgery. And maybe they didn’t really want testosterone, but they felt compelled.
Aydin Olson Kennedy: I had a client who had this happen to them. Their insurance plan required they be on hormones for one year. They did not want to be on hormones. And there were a million roadblocks. They ended up going on the lowest dose of testosterone they possibly could to get surgery. As soon as they got surgery, they stopped hormones. And now they have all this work to do because they had a body that was masculinized in ways that they didn’t want. And they were distressed as a result of that. It’s like, that’s your biggest fear, is it not? Your biggest fear is that you will do something that you regret. Your biggest fear is them doing something that they will regret, but you made them do that thing, right? But I think that the people who are making these decisions around protocols are people who are, again, I wonder how much time they are spending with trans people. I wonder how many conversations they are having. Are they experiencing the social world with these young people and adults who are masculinising or feminising, but without the other parts that are actually really important to our sense of safety in our own bodies, but also in the world? We want all this data about the great outcomes, but we don’t want to actually provide everyone with all of the things that are necessary for people to have safe and positive experiences in their social, legal, medical spheres, right? Like we’re going to give you this thing, which is important, but we are also not going to give you some of the other things that are also important. We’re going to give you one thing, but expect to have an outcome of five things. And what about the other four things? I need those four things too.
Dr Helen Webberley: I think you’re right, Aydin. The decision making is very often made by medics, isn’t it? That’s the hierarchy. And actually, the medic sits at the very end of a very long process that that person has been through since they started accessing healthcare. And so very often, the medic at the end has not experienced all of that. They can read the report, they can read those few words that say, yes, this person is trans, what’s the next step? Oh right, the next step is hormones. They have not listened to an experience like what you and Marianne have been talking about today. They haven’t heard that bit for a very, very long time. And yet, they are the people that hold the key to the policies on the decision making, which is really sad.
Aydin Olson Kennedy: Am I wrong in asking you, as a medical professional, being married to Jo, I know the answer from her perspective—but as a therapist, I feel like all of the weight of the conversation is that I am expected to carry all that weight. But like you just said, I have no ability whatsoever to actually give somebody something that would allow them to alleviate that distress. As a therapist, I don’t have that. And so, I wonder, are medical providers understanding that their role is beyond writing prescriptions? Their roles—is there not a responsibility to also engage in conversation that is about, “Tell me about your coming in process.” As a therapist—and it’s not really the model in the US, so much anymore, unlike all of that stuff, but I wonder if medical providers engaged in more of a conversation with people and looked less at a prescription writer, or the person who is holding all the responsibility, would they have a different relationship with these things?
Dr Helen Webberley: I think that my preference, my delight would be is having the privilege to sit and listen to you and Marianne talking about your own experiences and your experiences with young people, with adults with gender dysphoria. What I feel I would like to do is give that person a blocker, and then, Marianne and Aydin, can you come in here please and can you help me with this person? Because I feel that that person can’t do the best work with you guys until they’ve got their blocker. It’s so encompassing. It’s just like, I just need that blocker. I just need to stop this puberty, please. And then they’ve got some really great work that they can do with you two to really explore what it means on the future and everything. But while that blocker is shouting at them, it’s really hard for me to do that work. It’s really the wrong way around, as a medic, to push them through your service first, and then come to me for the blocker. It’s like, doctor, could you give this patient a blocker, please? And then, can you give them to Aydin and Marianne who can do some really good work? That’s how I feel it should be. And you know what, if the blocker wasn’t the right thing to do, for whatever reason, after three months it’s gone out of your system, and you know, we could reevaluate whether we do another one or not. The same with T. And again, Aydin, you told me this, puberty doesn’t happen overnight, you know? You gave someone some testosterone gel that we use here, even a shot of T, it lasts a finite amount of time. One shot of T, your voice doesn’t break. It’s an ever-evaluating process. A bit like you were saying, you take your shot every week, and every week you make a decision to put your hand on that syringe over your leg or whatever, you know?
Marianne Oakes: I think the biggest differences from where me and Helen are working compared to where Aydin is, that it is state-funded care. And what that means is that the public get a say, and those that have the biggest platform have the loudest voice. And if there is outrage about children getting healthcare in relation to their gender, then the media comes in, and then it becomes this great outcry and all these experts sit there very nervously, and then suddenly there is this bale of there is not enough research. And then this layer on layer on layer on layer. And then at the bottom of all of that—sorry I am getting slightly angry—but at the bottom of it all is a poor child that doesn’t want any of that. They just want somebody to say I believe you and we’re going to give you the care that you need.
Aydin Olson Kennedy: How does one get research if there is no one being given the opportunity to experience the thing that you want to research the outcome of? I am not a researcher, so I don’t really know the answer to that other than it seems like it is a bit of a flat model. We need to have research to talk about the outcomes and the benefits of this thing. However, we are too nervous because we do not have the research, so we’re not going to give you the thing. So, it’s like well, really? Because again, I’m not a researcher, but that seems like a problematic model for me.
Marianne Oakes: Well, the medical model in the UK, my understanding is that it goes back to Harry Benjamin, I believe, in 1966, where he had a model of transness. And it was a flawed model, and the NHS adopted it. And what they’ve done is they readjusted it as it goes along. And if the NHS says to me there is not enough research, I would say well you’ve been doing this since 1966, you set off with a flawed model, so any research you did is flawed, and you just carried on and adopted a flawed model, and we’ve got this point now where we are in 2020, and actually, it’s all rubbish. What we do know is when we give timely care, and good care, we haven’t got bodies piling up on the streets. You now the reality is, the reason you can’t see us, and the reason we are facing this is because we are going about our lives and we’re there whether you’ve got the research or not.
Aydin Olson Kennedy: What’s ironic for me, though, is that Harry Benjamin’s first patient was a 12-year-old girl. His very first patient was an assigned male 12-year-old child who nobody else would give estrogen to. He gave her estrogen. All of her symptoms seemed to diminish. She started to respond very well socially, academically. He then supported her pursuits of genital surgery as an adolescent. She went to Germany, had surgery, and did the very thing you just said. They lost contact with her because she carried on in her life as a woman, was not engaged in medical care as a trans person in that way because her needs had been met. But everyone is like, oh, we’ve only been doing this—the very first patient of Harry Benjamin was a 12-year old girl. And it is just that everyone sort of conveniently skips over that incident. And he outlines that in his book, The Transsexual Phenomenon, which I really think people should read. It’s available for free as a PDF. It’s a really important piece of work that he wrote. It shows that where he was at in the sixties was so advanced. His way of thinking was so advanced as it relates to this care. And that we can fast forward to 2020 and we can see how little we have moved. It is such an important exercise of like, wow, in the sixties this man was like, this is a thing, people. Let’s just do this. And in 2020 people are like, well I am not sure this is a thing. But we are going to use Harry Benjamin as the justification to say this was not a thing when the man was saying in the sixties this is a thing. It’s wild.
Dr Helen Webberley: It’s been amazing listening to you. The people who are listening are going to be inspired again. Inspired by just the simple vision that we should believe people and we should support people. And that that person themselves know themselves best. And perhaps people like you and I can help those people on their journey in whatever way. And I actually think that doing work like this, UK with the USA, we can learn from each other, we can support each other. It feels like a small world, the transgender medical world, support world. And I think by opening up these doors, it can really help therapists, medics, and ultimately the trans person accessing our care. So yeah, thank you so much.
Aydin Olson Kennedy: Yeah, and I think having conversations—I think having conversations that are not punitive. Having conversations that it’s around getting people to get together talk about all of these things, and here’s the thing that I am aware of, is that by participating in this podcast with you all, I am now making myself available to people who are very aggressively in opposition to the work that you and many other people in the UK are doing, sort of thinking about people being willing to take risks because it is the right thing to do, and I feel very honoured that you all have invited me to participate in this conversation and lend a voice to the very important work that you all are doing in a lot of opposition.
Dr Helen Webberley: There is opposition, but I wouldn’t change my involvement in this. I would not change ever. There is a lot of work to be done. There is a lot of attitudes to be changed. Things can only get better, and that is an amazing place to be in. I want to give thanks to all the trans people who have been brave enough to come out. After they’ve come in, to come out over the last five, ten years to increase that visibility for everyone else. You know, Marianne found that word when she was 14 in a sex book. The world is a different place. There have been some very brave people come out to show people, to show me, what being transgender is all about. It’s an exciting future from where I see it. So, thank you so much, again. We will meet again, we will talk again, and we will change the shape of healthcare for trans people, I am sure.
Aydin Olson Kennedy: I believe it.
Dr Helen Webberley: And thank you so much.
Aydin Olson Kennedy: Alright, take care.
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