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Episode one, part one

Season two of our GenderGP podcast opens with a two part episode in which your hosts, Dr Helen Webberley and Marianne Oakes, share some of their learnings from the Trans Youth Care conference held in LA, in January 2019.

The two-day conference featured three of the US’ leading voices on the care of younger gender variant people:

  • Dr Johanna Olson-Kennedy, leading medical expert specialising in the care of transgender youth, non-conforming youth and gender variant children.
  • Aydin Olson-Kennedy, well-known human rights activist who has spoken for the past two decades about the importance of rights for transgender individuals, with emphasis on identifying and acknowledging domains of privilege.
  • Darlene Tando, LCSW and a proponent of the informed consent model where the individual is the “expert” on their own gender identity.

Starting from the position that a person who says they are trans is speaking their truth, the two-day event was entirely focused on how best to support gender variant youth. For Marianne and Dr Helen it was a breath of fresh air to be in a room full of parents and professionals, all wanting to learn more about how they could improve their approach at home and at work.

There was so much to share that we have divided the podcast into two parts. In Trans Youth Care part one, Marianne shares her key learnings from a psychological perspective. In part two, Dr Helen discusses the latest medical thinking coming out of the US, and just how similar it is to the patient-led approach taken by those who provide care via GenderGP.

Inspired by the event Dr Helen was quick to invite her esteemed colleagues to join her for a live stream question and answer panel event which will take place on March 31st, 2019 from 3pm-4.30pm. Full details to follow on our website: www.gendergp.com.

“If your child says they are transgender, they probably are.”
A discussion on the subject of gender affirmative healthcare for trans youth.

The event will provide unprecedented access to a formidable panel of guests poised to answer your questions on the subject of healthcare for trans and gender variant youth, where we currently stand in the UK, and how this compares to the approach taken by the largest transgender youth clinic in the United States.

Photo by Jordan McDonald on Unsplash

Season 2. Episode 1. Trans Youth Care (part 1)

Hello, this is Dr. Helen Webberley. Welcome to our Gender GP 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: We’ve just come back from an amazing weekend in LA, where we went to the trans youth care conference, which was run by Johanna Olson-Kennedy and her husband Aiden, and also with the amazing Darlene Tando, who is what we would call a child psychologist or child therapist. I don’t know about you, Marianne, but I was blown away by the attitude towards trans children and trans adolescents. What struck me immediately was we weren’t – I’m guessing there were about a hundred people in the room, maybe more, and we weren’t starting from the point where we often have to start from in the UK of this is what it means to be trans, it’s real, this is how you try and accept a trans person. It was almost like that kind of attitude had all been done many months and years before. Where we were starting was a position from we have a lot of trans children in our country, so how are we as professionals and parents and doctors and counselors and GPS and therapists, going to collectively work together to help these trans children and adolescents and young people to live their life more easily. And I loved that expression. It was not about fitting in, it was not about melding or medical care, it was about just how to let these young people live their life more easily even though they had that difference of having a gender that didn’t quite match the one that society thought they were going to be. I don’t know about you, Marianne, but I found it absolutely amazing. 

Marianne Oakes: I really loved the passion in the room, to be honest, and the way they speak about this whole subject as people living and breathing it. And it felt so refreshing, if I am honest. To hear about the care of trans youth in such a positive way is what I took away from the whole conference, that there was no apology, that there was no fear about anything they had to say. The response in the room mirrored that as well. It was a hundred or hundred and fifty people there. Everybody was only concerned about the patients that we were talking about. There were no politics involved. It was such a refreshing atmosphere.

Dr. Helen Webberley: I agree, definitely, that the lack of politics was amazing, wasn’t it? It was just about how to give these youngsters good care. It was interesting. They started talking about how you fit into a gender role. Often when I am doing pieces of work on the radio, and then the listeners will come in and say, “Well, I just don’t get it.” If you are born with a penis, then surely you are a man. And vice versa. With all due respect, some people do not understand it. They haven’t come across a trans person in their life, and they don’t understand it. In LA, they kind of expanded on that a little bit. And they said, well how does a person fit into their gender role? You know, are you defined in your gender by your chromosomes? XX or XY? Is it the genitals and how they look like on the outside? Is it your reproductive tract on the inside, whether you have a womb or whether you have the tubes that lead to the outside? Is it nurture, how you were brought up? Is gender actually just a socially constructed definition? I am so acutely aware these days of every single time I fill in a form and I am asked my gender. What for? What does it matter? When I am filling in that form, what difference does it make if I am male or female? So is gender just a socially constructed definition, or is it actually a legal designation? Do we need to be put into a category for legal reasons, in terms of pensions or toilets or what mark you have on your passport? It’s interesting, really. What I missed off that list of gender actually is how somebody feels inside. Maybe we need to just completely abandon the whole chromosome, gender, reproductive organs, social construction, nurture, legal designation, and actually gender is just what you feel inside. What is wrong with that?

Marianne Oakes: I agree completely. I have to say that we do get fixated on the biology of gender but I think when I talk to people, the simplest description to me is just a deeper sense of self. I think that concept blows people’s mind. You know, what do we even mean by a deeper sense of self? If everybody looked into themselves, we all have a deeper sense of self. That part of us that is not expressed by what people see in front of them. We can all walk into a room and know we are in the wrong room and we don’t know why. We just know that us as a person do not fit in this room. And I think gender is like we have been pushed into the wrong room in life, and then we have to spend a great deal of time, a great deal of emotional effort trying to find our way out of that room. At every juncture, depending on where we live, it feels like there is somebody blocking the door and preventing us from getting out and making us justify why we want to leave that room. I feel like I just put that in a very simplistic way, but, I am not sure there are other words to describe what our gender is. 

Dr. Helen Webberley: I think what you are saying about being in that room and trying to get out is what Darlene Tander was saying. She talked a lot about how parents can help their trans children. I learned a lot from that. I am not a parent of a trans child, I have met a lot of parents of trans children, but I am not one. And what she said was that normally, when you have got a mother and a child, it’s the parent’s role or the caregiver’s role to teach their children about everything; to teach them about the world, to teach them about being a good person, about educating, about everything. But then you have this issue of when you have a trans child, that you have parents who don’t know anything about that. and you’ve got the child who is then having to teach their patent about their gender. That is quite a big switch there, isn’t it? She also said that we are often faced with how old is a child when they can truly know their gender? She gave two beautiful examples. She said they can tell you when they are three and you will say they are too young to know. But if they tell you when they are fifteen, you say, “That that can’t possibly be true, because why did you not tell me earlier?” These youngsters are in a really hard place. When is the right time to tell? When is the right time to explore? Who is the right person to tell? Who is the right person to explore it with? It’s so tricky, isn’t it? And coming out of that room, Marianne, that you were describing – Darlene was talking about the fear that parents have when they allow their children to try what it is like to socialize in a gender that they feel comfortable in, wearing clothes that people associate with the male gender, trying out that socialization. We are so scared about what if it’s wrong for that child to experiment in that way? What if it’s wrong for this child to be called he when society thinks that they are she? What she was saying is that we have a whole host of people who are socialized in the wrong gender. All of our transgender adults today in this world who have access to health later or transitioned later or affirmed their gender later, they were all socialized in the wrong gender. So we have a wealth of experience of what it’s like to socialize in the wrong gender. We aren’t actually doing any harm for these children, or actually is it a very gender-affirming positive approach, which is how in LA and the team over there is really viewing it.

Marianne Oakes: I think the first thing with where the parents are concerned, they were describing really, is the parents’ first response generally is to project all their fears, all their misconceptions onto the children. That idea of them being frightened of what the people will think, what the neighbors will think, drives and informs how they are going to deal with this with their child. And I think when we are talking about too young or too old, what we are really trying to do is put a hand over the mouth of the child. Because later on they were talking a lot about empathy, when a trans person comes out, having empathy. I think it’s a natural response to want to protect the child and put a hand over the mouth. I am sure we have all been in a situation where our children are saying something that is embarrassing us, and we don’t physically put our hand over their mouth, but we try to stop it and stifle it. The way that the conference took us was about that this would probably be the first response, and this is where we need to get where we can find empathy and trying to understand what the child is going through. I think it’s getting to that point. If we can do it safely without causing any damage in the early stages. I think that’s what they were trying to say, and what I would say to concur with that. We’ve got to allow people to feel, but we have got to be careful not to project it onto others, if that makes sense. 

Dr. Helen Webberley: Certainly. And that hand over the mouth, whether it is your own hand over your own mouth because you are scared what your child is going to say next or whether it’s to stifle the child, to say “Please don’t say that in public”, it’s a really interesting analogy, isn’t it? Darlene was talking about the three approaches that parents might take when their child discloses something like I don’t feel that my gender matches what you think it should be. She says that some parents will try the reparative approach, and I think we have seen this, haven’t we, Marianne, in our own professional work, where doctors and therapists might go “I don’t think this is probably true. I don’t think this exists.” Or “See what it’s like to live as a boy or live as a girl a little bit longer” or “Perhaps this is going to go away in a while.” Which leads us on to the second approach, which is wait and see, nice and safe and smothering in many ways. “Let’s not do that now” or “Wait a few moths or few years”. On the completely other end of the spectrum, is that acceptance and that affirmative model which was so refreshing in that conference. I think everybody was on board with that, what harm is it if we are allowing people to explore and express their gender throughout their childhood and throughout their adulthood in an amazing way? One of the examples which Darlene gave which fits very well with your hand over mouth analogy, is that parents when they say, “Okay, that’s fine, why don’t you wear those clothes at home, and we’ll call you he or she at home, but how about not at school, or not when we go to grandma’s or not when we go out to town?” She was saying that although this sounds like a very safe and protective way, it’s giving a really mixed message to the child. It’s kind of saying that it’s okay to experiment with being yourself inside the house, but it’s not okay to be outside of the home when other people might look at you. That really resonated with me. 

Marianne Oakes: It’s just reinforcing of shame to put any boundaries on. What we are really saying is we are slightly ashamed her, so what we will do is we will play with it in the house, but we don’t want other people to see it. That is really damaging. I think that is what Darlene was trying to say. We either accept it or we don’t. it just reminded me then when you were saying that they talked a lot about the coming in process. And that’s the private self-acceptance of our gender. For some people, it can take a lifetime. We know at Gender GP people who are north of sixty before they ever come to terms with their gender. In others, it can be as young as three. From what they were saying, and from what we experience is that whatever age somebody verbalizes their feelings about gender, that there was a coming in process that there is a period of time where they have battled it, where they have reasoned it in their minds ad probably experimented and probably researched. So at the point where we are talking, everything we said about sit on it think about it explore it and experiment a bit more, that’s already been done. I think that’s the concept that a lot of people can struggle with. That the point where we speak is the point where we need the help. Not the advice, if that makes sense.

Dr. Helen Webberley: Definitely. And we see that a lot as doctors and nurses and therapists, is when that person first comes to see you, you kind of think that the clock is starting then. And then they see you and say that they would like some help with their gender. The automatic reaction is, “How long have you known this?” or “What do you want me to do about this?” or “Do you need to think about this a bit more?” and “We don’t want to be rushing into things, how about you come back and see me in six weeks’ time and we’ll see how you are feeling then?” or “Let’s get you referred but let’s not take things so quickly”. There is this kind of delay, imagining that time has just started at that first appointment. But actually, this coming in idea that Aiden was talking about ever such a lot, was really interesting. We talk about coming out, so you come out to your GP, you come out to your therapist, you come out to your family or your friends or your school your job, but that coming in has taken a long time before that. We were discussing on the conference where people get their information about gender form, and of course, there are a lot of youngsters and adults who will be getting their information from friends and from the internet – such a powerful resource. And Aiden put up some amazing caricatures and cartoons and images of children pouring over their computer and tablet and phone just learning and learning and understanding what gender means, and how it can be that your gender doesn’t feel the same as your friend in the class next to you. That coming in process can take ever such a long time. That’s hard work that that person has done in realizing themselves. And then when it is time to come out, then that is the time that we first see it. But the work has been going on for a long time before that. we as adults or as people who can offer help to patients and clients, we really need to understand that. the coming in bit states a lot of hard work that that person has done on their own at home. I really thought that was an amazing concept. 

Marianne Oakes: I like the way that they used the coming in analogy, really. Because if we are going to come out, then we have got to come in at first. I think it’s a beautiful way of describing the process that we go through. Again, obviously just listening to Aiden talk, it was something in their that I could really relate to. I think because as children, we are swimming against the tide. That was a phrase that they used. We are swimming against the tide, so all the messages we are getting are sending us in a direction, but all our feelings are somewhere else. That is what the coming in process means to me, that we somehow battle against that tide and we search for them glimmers of what is going on. When we find that, I call it the trans switch. When we find that first glimmer, that switch is flipped. That’s it. Our whole focus is about working out what’s going on, and like you say, we have got the internet now. There is so much out there, and there are role models on the internet. By the time somebody has gone to talk to their patents, they’ve been there and seen it and done it. It is not a sudden realization. I think they touched down on that rapid onset gender dysphoria. I have to laugh every time I say that. It is never rapid. It could be a three-year-old, but that three-year-old has not been on the internet, but they will have struggled against that tide same as a thirty-year-old. That coming in process was described far better than I could, I have to say. 

Dr. Helen Webberley: You do a very good job.

Marianne Oakes: One of the main things I took way as a therapist from the conference, and Aiden said it, why do these children need therapy? I will go back to the point of the hand over the mouth, but the way the parents are dealing with their internalized shame is to say oh this is definitely transgender because they have been in therapy. And I think that I experienced that a lot, I get some child sat in front of me looking at me and thinking, I don’t know what to say. And therapy is not needed at the very start in many cases. In some cases, it is. in many cases, it isn’t. I think what I took away from what Aiden was saying, and I agree entirely with it, is therapy is needed when it is needed. You can’t force it. You can’t make therapy work. There will be time sin the child’s life where therapy is going to be really important. Maybe they can be put off therapy if they are taken too soon.

Dr. Helen Webberley: We’ve seen that a lot, haven’t we, Marianne, with people who contact us? They say that they don’t need any counseling, and they don’t want it, if they have to have it, they will, but they don’t want it and they don’t need it. It’s almost that they have been forced, with that anger there. So much counseling has been forced on them that they have stopped seeing it has something that might actually be useful on their journey to help them through the stumbling blocks of life, whether their stumbling blocs are because they are trans, or just because life is tricky. But they have that kind of barrier up, where they say don’t therapy me anymore. And it’s such a shame because I have always had the kind of idea that all of us, it doesn’t matter who we are, what we are, what label we have, we could all do with a therapist in our pocket, to pull out when times are tricky and to cry on their shoulder when we need a tissue passed, and just say, “I am thinking about doing it this way. What does that sound like to you?” Especially with the trans people that come to use, I see so many of them really rejecting the idea of therapy and counseling. Also, you know, when you have a sweet happy-go-lucky child who has got no issue, and then you put them in front of a therapist who goes like, “Let’s talk about your gender” if they are not experiencing any barriers to exploring their gender or expressing their gender, then there really isn’t much to talk about, is there?

Marianne Oakes: two things there, actually. If a child is getting on with their life, why therapy? Just because the people around them can’t contemplate their gender identity doesn’t mean the child needs therapy. I think what we experience is that the child has been traumatized by bad therapy, and one thing of note from the conference was that when they had the panel of trans youth at the end, they all had experience with multiple therapists. And some of them had continued, and some of them were kind of the therapist just reinforced what the parents were dong. The therapist had projected their ignorance and fears around this whole concept onto the client, and actually, in the therapy room, that is really dangerous. We should never forget the position of power that we can hold over somebody, and certainly a young person in the therapy room. To impose our fears on them just reinforces that shame. I think that is where the “I don’t want any more therapy” comes from. “I’ve talked about this enough, I don’t need to explain it again.” I think finally, on that, making somebody validate their gender identity, on any level, is traumatizing.

Dr. Helen Webberley: It is, absolutely. Darlene was talking about the fact that we need to just make this simpler. If a child is asserting that their authentic gender is different to what society thought it would be, then they are most likely transgender. It’s almost that the diagnosis was made very early on. Why would a child talk about their gender in a different way if they weren’t transgender? This isn’t about if you are a tomboy or a sissy girl as they used to call it, I hate that expression, but this isn’t about whether you like climbing trees or getting dirty or whether you lie dancing. This is about actually what you are feeling inside. And if a child is saying that inside they are feeling like a boy or a girl, then they are most likely going to be transgender. What they were very clearly saying over there, over in the USA, is that if we wait for the distress in that child to come through, then we are doing damage. I have seen it over here in the United Kingdom, that many parents have told me that any treatment or gender affirming care is withheld to them until the child or the adolescent or the teenager starts becoming quite distressed. Because then maybe if the child is becoming distressed, maybe that is reinforcing the diagnosis. Maybe we can then believe them. What Darlene was saying is that distress will leave a mark and an imprint. Why do we want our children to become distressed? People talk about post-traumatic stress disorder. Why are we putting stress onto young people? It is going to do harm, it is going to leave a mark, it is going to do damage. A gender-affirmative model that is becoming much more accepted and mush more I feel kind to children, the child speaks and says I am a boy, and parents listen and say I believe you. No distress needed, end of story. If in six months’ time, the child says “I don’t feel like a boy anymore”, and the parent can listen and say, “Okay, I believe you.” What harm has been done? We are not talking about sex change operations, like you would read in the UK media.

Marianne Oakes: I think that is one of the biggest fears of the health professionals and the parents and wider society. What if this is a mistake? And one of the things that I took away from the conference was, why are we focusing on this being a mistake? It’s just something else we did in life. All the other decisions we are ever going to make, you know, we are going to marry somebody and maybe get divorced. We are going to take a career path and maybe change it. I think Joanna explained about how we give the keys to our car, eventually, they can bump it. The gender affirmative approach is kind of saying that this is no bigger a decision than all the rest of the decisions that we are going to be making about our children. For some reason, we find it more difficult. That is what I see and witness with parents that come on into a session with the child, and the child starts talking, and straight away, the parents say, “What if this is a mistake? How do we know that this is real?” And straight away, that is impacting on the child, and it isn’t until they are so distressed that they actually know that we need to do something. One of the things that was touched on at the conference was trauma, and how it is very easy to forget – I don’t want to suggest that all trans children are traumatized – but in my experience is that there is some level of trauma in the child. What we mean by trauma is there is a lifetime of swimming against the tide, and we are drip-fed negative images of people that are trans. It is not overtly done, but it is just fed through the media. It is just a comedian. The pantomime game. The trans child there, they observe it, and what they do is join in with everybody around them so they will laugh at the jokes, while inside the body is responding in a way to hold it in. The body learns to keep these feelings in. that is what I mean by trauma, it is a physical response to a given situation. When that child comes in to the doctor, or the parent, or their teacher – whoever it is that they are first going to open up to – if that person responds in a way that could just be body language or the wrong glance of their eye or the wrong body response, and suddenly that child is close down again. That is where the distress comes. The body is responding. The cognitive thought processes are what I want to say, cannot then get out. 

Dr. Helen Webberley: Joanna was talking about that, wasn’t she? She was telling the audience about the parents that come in with their child. And she is obviously such an open and welcoming person, anyone can talk to her as a doctor. I immediately admired her tremendously. She was talking about the parents who bring their child in and she says, “Hi, how can I help you?” and the child is like, “Mum, don’t tell the doctor. Don’t tell the doctor.” It’s that fear, isn’t it? What is the doctor going to say or do or think of me if my mum was to tell this doctor that I feel that I am trans, or I feel that I am different in some way? It’s such a shame. I am smiling at the memory of it, but for that child it must be hideous, wondering what reaction life is going to give her or him.

Marianne Oakes: Again, it’s just been reinforced. We talk a lot about micro-aggressions and you know, it’s happening to everybody. It is not exclusive to trans children, but I think with trans children, we are faced with not just micro-aggressions in the media, but there are also institutionalized micro-aggressions. And that actually is a lot worse. We at the Gender GP experience, that the system is geared against gender. So, you know, we walk into a shop and there are clearly a girls’ department and a boys’ department. You wouldn’t think that that was micro-aggression, but to the little boy that wants to go and look at the dresses, it’s such a clearly defined direction that he’s walking in the direction they’re walking, is the fear that there are people who are going to judge us for walking towards that department. Whereas if it was all mixed, it would be much easier. Yes, we all suffer micro-aggressions, but I think for trans children in particular, the system is geared against us. 

Dr. Helen Webberley: That is why it was refreshing to listen to Darlene. She wasn’t talking about how to stop your child being trans or make sure it is right or make sure that no mistakes are going to be made, because like Joanna and Darlene and Aiden said, whose fear Is the mistake? It is all the fear of the cis gender parent, teacher, doctor, therapist. It is the cis gender adults that are scared for making a mistake, not the child. Darlene was talking about parents who give their children warnings: “Yes, it’s fine to wear those clothes or have your hair look like that. But be careful when you… you might get teased if you…” She was saying, what does this say to our child when they are trying to express it and work it out? We have got mum saying that it is fine to do that, but if you do that, this might happen to you. It’s a mixed message. What Darlene was saying is that actually what we should be doing is equipping the child with what to do if they were to get teased. Rather than preparing the child to act in a way to prevent getting teased, and not be their authentic self but be a kind of half of their authentic self portrayed in a way to protect society, Darlene was saying, “Let’s get the child some tools for if they get teased.” So if you want to go over to the dresses in the shop, and someone looks at you or laughs at you or teases you, then how should we as a family or as a person or as a mum react to that? Rather than let’s not go to the dresses in the shop, it’s let’s go and if someone gives us a funny look, what should we do about it? And I love that difference. Allowing that authentic gender to experiment. That is what children should be allowed to do.

Marianne Oakes: Just what you were describing there, that picture of the parents wrapping the children in bubble wrap, you know you can wear this dress but we are going to put you in bubble wrap so that if anyone punches you, it’s not going to hurt. Actually, what Darlene was saying is that we don’t need bubble wrap; what we need is life skills. The same way that you would teach your daughter or your son to not get, or to deal with situations, why would it be different for a trans child? I am sure there is a little girl somewhere that wants to go out in a dress that is not appropriate for climbing trees. The parent is going to say do not wear that dress, it is going to be like if you want to climb trees, this would be more appropriate. But when we come to gender, the parents’ fears about how society is going to respond to their child, and actually their shame around that as well, we don’t want other people seeing it, and how does this look to other people about our parenting skills? What other people are going to look at our child? And that projects onto the child, and that is not the child’s problem. It’s for the parents to deal with.

Dr. Helen Webberley: It’s interesting, isn’t it? Parents don’t want to make a mistake; therapists don’t want to make a mistake. I am a doctor, and I don’t’ want to make a mistake, and I feel a bit guilty, because when I have been teaching or talking about gender, and people are kind of asking me to explain how I know somebody is transgender from a doctor’s point of view, so giving back that diagnosis. And you know I don’t like that word, diagnosis. But that is what doctors do. So when I diagnose somebody as being transgender, what we talk to look for is consistent, insistent, and persistent assistant. There is a consistency about it, so the gender feelings have been consistent throughout their life, they have been insistent about it, and it’s the persistence that those feelings started a long time ago, they are continuing now, and they are likely to be persistent for the rest of their life. And Darlene was saying, and I feel bad because as a doctor I have been looking out for those things and it is hard to convince the world that I can diagnose somebody as transgender safely, without getting told off. But not all children are the same. She gave a beautiful simple analogy. She said that some children will eat broccoli, she said some children won’t. Some children who don’t eat broccoli, if you make them eat it, they will eat it. But some children who don’t eat broccoli, however much you nag and however much you moan and say no, they will definitely not eat broccoli. So she was saying that children are different. So when someone says I am a girl once, and someone says no, I don’t think you are, they might give up. Whereas some other children will say it again and again and again. Children are different. Although all of the children will probably have a consistent gender identity feeling, that insistence will vary. If we put a lot of store on that insistence and that the strength of that child to go, no you are not listening to me. I do feel like this, I do feel this is very real to me,” not all children have that capability. Some children and young people may hide those feelings away if the first or second disclosure didn’t go well, for a long time. And eventually if all that time passes and they try to come out to whoever it is, someone will say, I don’t understand, because my child for the last ten years, hasn’t shown any signs of this.” But those are external signs, and maybe they have hidden all of those features because it didn’t go so well when they first tried it out.

Marianne Oakes: You have just described another aspect of the trauma, Helen, if you don’t mind me saying. The other thing that happens is, in childhood, children are so reliant on their parents’ approval. Certainly in early childhood, if something happens very early on, the body can keep it in. what that does sometimes is that they almost forget that they ever had those feelings. And then at some point in their life, it comes out. That is why we will get a thirty-year-old who will say that, “Do you know, last Autumn, I saw something on the telly, and Bang! All these feelings came back. And when I look back, I can remember as s child feeling it.” I think that is a symptom of trauma, you know, where the body just contained it so deep that it didn’t allow it to come out. I think I would imagine that the child who is forced to eat broccoli, as soon as he becomes independent, will stop eating it. Macaroni and cheese comes in. At school, I was forced to eat macaroni and cheese, and I can’t eat cheese at all now.

Dr. Helen Webberley: It’s kidneys for me. Steak and kidney pie. It’s funny, isn’t it? Darlene again, a beautiful quote that she gave was one that I wrote down. She said, “You can’t influence the identity, you can only influence the journey.” And I think that gender affirming care that we learned on that weekend was just amazing.

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