Transcriber: Made Pramana Reviewer: Rhonda Jacobs
I am a shy person and I actually don’t like to speak up that often.
So when invited to give these kind of talks,
I must admit it is quite exhausting and nerve wracking and so forth.
But I’m doing it because I’m talking about topics
that are really part of my everyday,
and part of the everyday experience of my patients and my colleagues.
And we are extremely stressed out with what’s going on in the world.
As a clinician and as every part of my pathway to become a clinician
has been challenged by being a gay man in medicine,
and they don’t like that,
I’ve had to see this play out multiple times
for my residents, for my medical students, and most importantly, for my patients.
I have given a number of talks around this
and I’m not alone in giving talks about this.
TED has actually given multiple talks around the experience of being lesbian,
gay, bi, trans or queer in the US and abroad.
And it all has also taken the opportunity to share as much evidence as possible
to explain what that experience is like
and to provide evidence to really try and inform
our straight and cisgender allies to stand up for us.
And there are many, many talks. I can show you all of these talks.
I encourage you to look them up and go click on them.
But what’s happening now
is a major backlash against even the evidence that we do have,
that has withstood the standard of peer review
and all of the rigours of the scientific method.
What we have now is a smear campaign against us,
essentially a massive backlash around LGBTQ issues.
When I was making this talk and was like, Oh, let me listen
to a few of these other talks that are about this topic.
As soon as I clicked, this is the ad that I got targeted to on YouTube -
this is the Ben Shapiro Show.
Ben Shapiro is notoriously anti-LGBTQ,
and here he’s actually advertising “What Is a Woman?”,
which is a horrible documentary, not based in science,
that is attacking the notion around gender-affirming care,
which is what I do as a primary care clinician
and as a researcher.
What we have found is everybody’s focusing on these numbers.
This is the latest data from Gallup, looking at how many adults in the US
identify as lesbian, gay, bi, or trans or queer.
We see that number is going up over time,
and people are terrified of this number going up over time.
They think it is a sign of some sort of social contagion,
some sort of disease that we have to get under control.
When you drill a little bit deeper and understand what’s going on,
you see a lot of generational difference.
So, you see the youngest generation having an uptick from 10% up to 20%,
having the language to really identify
as something other than straight or cisgender.
We see this number has actually been going up for other generations:
my own generation, particularly an elderly millennial -
is the term we have now for my generation -
is also going up over time.
But you also see that Gen X is going up slightly over time ever so slowly.
Other generations are not.
They’re staying flat or actually going down.
People are not drilling into the numbers to really understand what’s happening here
across generations,
to understand what their experience was growing up in society
as lesbian, gay, bi, trans or queer.
And also people are not understanding the evidence that really shows
that how society treats you affects your health
and may in fact - we know this actually - leads to earlier death,
which is why we see the older generation actually petering off.
People have always neglected, when looking at these generational differences,
the context of the history of when people were growing up,
and that includes the HIV epidemic.
So we lost a large number of our potential mentors, elders,
loved ones through this.
But that doesn’t stop other people from taking the data and running with it.
So I remember when somebody forwarded me this clip of Bill Maher
talking about the latest Gallup data and really just driving into it like,
“We’re all going to be gay.”
People are not drilling into the data
to really see what’s going on.
It was meant for a chuckle.
Then it goes on to say that we are harming people
by saying that they’re all LGBTQ and that we are not allowing them
to really explore their identity and become straight and cisgender again.
The problem is, that’s not how this works.
Society, when it doesn’t like something, will oppress a certain human behaviour.
What we are suggesting from the data,
and I want you to use these data that I’m showing you
to really talk to people,
is that we are probably on this uptick of this curve.
We are probably heading towards a steady state
of how people will identify and how they are able to understand
their sexual attraction, their gender identity,
and other components of their sexual and gender identity.
This graph is really helpful to think about a number of characteristics.
This is based on data looking at left handedness.
So I think a lot of us are familiar with perhaps our parents, aunts and uncles,
grandparents, who grew up with what is described as a sinister condition -
I mean, that’s the Latin word for left -
describing what had happened with them growing up where -
my mother and my father will relate stories of having been hit with a ruler -
about being left handed, using their left hand.
What we see, though, as people started to accept this human condition,
this human variation,
the number who could have left handedness went up and then it stayed steady.
That's kind of where we're at right now.
The data we have showing this is probably the case
for sexual identity in particular
is based on National Institutes of Health-funded research
out of UCLA’s Williams Institute,
a leader in understanding LGBTQ population health.
What they had done is they surveyed thousands of people across the US
and asked them a number of questions around identity and behaviour,
focused on lesbian, gay and bi individuals.
They have other data coming out around trans folks.
You can see here,
looking at the top left is “When do you know you’re different?
When do you recognize your sexual attraction for somebody of the same sex?”
Across three age groups, three broad age groups, it’s around the same age.
It's around early puberty.
When we look at components of where they interact with others
and they interact with society and family, the ages start to spread out.
And this is a reflection of acceptance and tolerance.
You can see here “Age of sexual debut,” really broad for the younger generation,
around 16, all the way up to about 19.
And when you see “Coming out to family”
or having a label to identify yourself, much wider spread.
And this is what we think is going on right now.
That’s what we see for a lot of our patients
where they have the language at an earlier age than I did,
or than my mentors did.
They also are able to access community at a much younger age.
I did not grow up with the Internet and go into chatrooms
and meet people from other states
so I didn’t feel like I was the only gay in the village.
So this is what we think is happening in that data,
and people need to really drill into this
to better understand how people are talking about it,
because we’re facing a lot of troubles
in how states are regulating around sexual identity and gender identity.
Yes, we are fortunate to be in Massachusetts,
the first state to really allow same sex marriage,
protect gender-affirming care,
and to protect gender-affirming care even in the post-Roe era.
But that is not the case for all of my patients
and all the families that we take care of.
I want to highlight some key policies here.
This one is general health insurance coverage,
where the state can choose what insurance is willing to cover or not.
We see some states that are very proactive,
insurance cannot deny coverage based on sexual identity
or gender identity or gender-affirming care.
Arkansas was one of the first to say absolutely not;
insurance should not cover it.
Here’s a big issue in terms of actually access to care
around transgender youth accessing care.
More states are coming on in this map, unfortunately.
We’re losing the battle in terms of convincing state legislatures
that the data shows that this is actually life-saving.
And then most recently, unfortunately, this map is already outdated
as of this past Friday, looking at Medicaid coverage.
The most vulnerable people - ensuring that there’s coverage
to medically necessary gender-affirming care -
more states are banning it.
Florida, just this past weekend, said no.
Their medical advisory board said we were going to actually ban
all medical coverage for gender-affirming care across all ages.
Not just youth, but adults as well.
So, we are losing this fight, unfortunately,
even though the data shows we should be winning it.
And we’re losing it around political issues in terms of -
this is becoming the latest wedge issue.
This is becoming a population that doesn’t have as much power,
continues to not have power, and people are punching down.
Greg Abbott, I think, is one of the worst of them.
DeSantis is also one of the worst of them.
And I’m really asking at this point is to recognize that this is harming us.
This is new data out of the government
looking at the experiences of hate crimes based on identity.
No surprise here.
Race, ethnicity remains the leading issue here.
Racism is still a problem.
I don't think anybody here thinks it's not.
But we're also seeing a disproportionate amount around sexual orientation
and gender identity as well.
And again, they’re using our data against us.
They’re really trying to say that,
“No, no. If you actually cite this study and say that there’s actual harm,
nobody’s going to look into it.”
That’s happening, because whenever we drill into their citations,
we find the science is either incorrect -
the methods were inappropriate,
or that they're really just saying what they want to say
and citing our studies at the same time.
We’ve had to speak up at a number of institutions.
This is the Society for General Internal Medicine,
a group of general practitioners and researchers like myself,
and when we had our conference in Florida,
had to speak out against what was happening there with Governor DeSantis
and highlighting what the research shows that what needs to happen
to help youth survive and then actually thrive
is the opposite of what they’re trying to say
in terms of being able to talk about
sexual orientation and gender identity in the classroom.
It’s gone so far as where we actually have to sue our employers in Texas.
When Texas started shutting down the gender identity clinics
in anticipation of essentially the hospitals being sued
or found saying that the clinicians are felons,
Dr. Ximena Lopez, who had her clinic shut down by the hospital,
is actually suing her hospital at this point.
That is what clinicians have had to be prepared to do,
is sue their employers for saying
“You are infringing on my right to provide evidence-based medical care
for transgender youth.”
This has been a battle we’ve been having for quite some time,
and it's been happening more often than I think people realize.
And this was us, a group of us across Massachusetts General
and the Harvard system years ago during the last administration,
where we had to be worried about
how we were even going to be able to fund research
because we weren’t allowed to say “transgender, vulnerable minority”
in grants.
On a cheekier note, what I’m asking everybody here
is to use some of the data that I’ve shown you
but also find more.
There is so much more out there than people realize
that really supports this notion that people are able to access community
and when they have acceptance from community,
they are more comfortable coming out.
Unfortunately, they are coming out into an environment
that the politicians are trying to attack them.
I want you to think about ways of talking to your clinicians about this,
talking to family members about this, living up to the notion of being an ally.
Being an ally is not something you tell yourself you are,
it’s something that you actually do,
and people then tell you that you’re being an ally.
So I encourage you to reach out to your politicians,
provide them the evidence that we’re showing here.
Also be prepared to speak up to the current administration.
They are looking at ways of trying to expand care
and they want to hear from you.
There’s always the opportunity for public comment from people,
both experts as well as people who have LGBTQ family,
about how we should be providing this care.
I like to keep talks brief, so that’s why I want to keep it there.
So thank you so much for your time and thank you for listening.
(Applause)