SwatTalk: "The Politics of Transgender Health"
with Kellan Baker '04
Recorded on Tuesday, Oct. 24, 2023
Twan Claiborne ’07 Good morning, good evening, good afternoon, and thank you for tuning in to tonight's SwatTalk, which is entitled "The States Versus Science, the Politics of Transgender Youth." We are here with Dr. Kellan Baker, who has dedicated his time to this work and is battling through a health, but he is bright and ready to talk and dig into this work. Before we start, I want to introduce myself. My name is Twan Claiborne, class of 2007, and I will be the facilitator, moderator, bringer of questions and all things to the discussion. Before we get started, I also want to thank a few people who have made this SwatTalk possible. On the back end from the Office of Advancement, Amy Gertz, and our technician extraordinaire, Meghan Bloom. I'd also like to thank Jason Zengerle, class of '96, who is the SwatTalk liaison for the Alumni Council. Also would like to thank our alumni council president, Ayana Johnson, class of 2009, and the executive committee and the SwatTalk larger committee for putting this together. I'd also like to extend a thank you to our co-sponsor, as it is LGBTQ+ Month centering on all things LGBTQ+. This is sponsored by the Affinity Group entitled LGBTQ+ Steering Committee. The LGBTQ+ Steering Committee is a group of individuals spanning various classes from the '70s to the 2020s, and our work is centered on creating and fostering connections between the Swarthmore alumni base who identify as part of the community and connecting them with resources and folks on campus. We have participated in mentorship programs. We have also hosted various events, mainly virtual because, you know, world events. However, we are moving to do a more in-person connection as well. If you are in the New York area, in fact, we have an in-person gathering on November 9th at 6:00 p.m. at the legendary Stonewall Inn. So if you want to come and meet some folks, including me, I'm on that panel and a couple of other members of the steering committee, come to that event. If you are interested in participating or learning more about that, I'm going to put the email address that you can link yourself to and ask questions and if you wanna participate somehow, reach out in that email. The format of this evening's conversation is Kellan and I will do our banter. I'll ask questions, he will give us things to think about, little nuggets and morsels to chew on. There is a tab for Q&A questions, so if you have questions as things come up, you can type those in and should time allow, I will look into them and ask those questions and we'll just fire away. But we'll keep it cute, but also keep it deep. So thank you all for tuning in. Are you ready?
Kellan Baker ’04 Let's do it.
Twan Claiborne ’07 Thank you again for dedicating your time tonight. Oh, I forgot something. Look at me, oh goodness, it's been a day. Let me introduce our panelist, because we can't just have you up here talking and people not know the caliber of person that we bring to the table. Dr. Kellan Baker is the executive director of the Whitman-Walker Institute. The Whitman-Walker Institute is a Washington, D.C.-based nonprofit organization devoted to advancing the health and well-being of LGBTQ+ folks in that area and also on a national level being at the forefront of research and policy advocacy for HIV treatment and prevention. In addition to that, while he was at Swarthmore, he studied astrophysics and Russian, getting an honors double major and then moved to Moscow right after graduation to work as a translator for the Russian Academy of Sciences for about three years. This included also working for the, oh my gosh, "Kommersant," excuse my pronunciations. Please correct me 'cause my Russian is non-existent, a liberal newspaper and the Special Olympics in Russia. Also, he spent a year in Vienna studying German economics before moving back to the States in 2008, and completing a master's in public health and a master's in international development at George Washington University in Washington, D.C. Post-graduation, he became involved in developing domestic health policy by being an LGBTQ+ political organizer in his spare time, a passion he developed while he was in grad school, which led him to being part of the first class of White House interns in the Obama Administration in 2009. He was the first openly transgender intern. Oh, yes, you were, yeah. I'm reading this from my piece of paper. Yes, first.
Kellan Baker ’04 This is mortifying. You didn't tell me you were gonna read it straight off the paper. This is very thorough and thoroughly embarrassing, Twan.
Twan Claiborne ’07 I put this in paragraph form, so I made sure to make everything also align, but you know, this is what I do. I wanna make sure people know, you know, your work and also because as we'll get into this talk, lots of folks who are unfortunately on the opposite side of the table, tend to have the most flimsy of resumes, so I want to make sure that we get it right for you. But yes, in addition to that work, this will be last tidbit. He was a senior fellow for the Center of American Progress, and also worked with drafting and passing and implementation of the Affordable Care Act and developing a website for LGBTQ+ folks to register for ACA as well. Thank you for being here. That was a long introduction, but I needed to make sure I got all of that right 'cause that's what we deserve during this month.
Kellan Baker ’04 Well, thank you for having me.
Twan Claiborne ’07 Of course. So I think we'll start off first because there's so much to talk about and discuss, and I feel like with these topics and in this climate of anti-intellectualism and anti-science, many people don't really know what we're talking about when we're talking about transgender health and gender-affirming care outside of buzzwords in major newspapers that sometimes really don't do the thorough research and give it the credit it deserves. So I think we should start. Basic. What is gender-affirming care?
Kellan Baker ’04 Gender-affirming care is individualized and age appropriate care, whether that is social support or mental health counseling, hormone therapy, or for adults' reconstructive surgeries that just help trans people be who they truly are, walk through the world safely, authentically as who they are. And so there's really a lot of misconceptions around gender-affirming care. A lot of that is intentional, and there's a pretty common idea that gender-affirming care is new. In fact, gender-affirming care, the standards of care for that field of medicine are substantially older than I am, which, you know, don't do that math with '04, but suffice it to say it's been decades that we have been providing gender-affirming care that is safe, medically necessary and beneficial for the health and well-being of transgender people like me.
Twan Claiborne ’07 Hmm. Now, I feel like it's really important. You mentioned the actual medicine part, and you also mentioned the other parts of it, like psychiatry and mental health. Is there a reason why that aspect of gender-affirming care is not part of how the populace understands gender-affirming care to be?
Kellan Baker ’04 I think because there are a lot of folks out there who are intentionally misrepresenting what gender-affirming care is, and they're exploiting ignorance that, as you noted, it's a pretty common thread, not just around transgender health, but around so many things, COVID, climate change, right? There's any number of topics where there's a pretty substantial proportion of people in power who have a real vested interest in not telling the truth about what's going on in people's lives. And so talking about gender-affirming care as a full spectrum of medically necessary services that are provided by licensed clinicians to people who need that care and who benefit from that care, it really is part and parcel of this whole concerted push, I would say, to disenfranchise a lot of members, a lot of groups in our society, and really to cover up the fact that there aren't a lot of really good policy ideas for some of these pressing problems that are coming from some of these people in power.
Twan Claiborne ’07 Hmm. Seems like a vested and niche rooted in maintaining power and also money flowing, which, we will talk about because a lot of these movements seem to be interlinked with big business and other things as well. Something you mentioned earlier about misrepresentation, and a lot of articles, including in esteemed newspapers such as "New York Times" and "Washington Journal" and, well, sorry, "Wall Street Journal," and "Washington Post" has, you know, thrown around, not really statistics, but sort of given alarm bells to a particular type of gender-affirming care, particularly as it's horribly framed, and excuse my language, gender mutilation. Like they're saying things inflammatory like youth, however that is defined, are going in and you know, doing things to their body that they shouldn't be doing. What is the actual statistical data, if any, of student, of youth, first of all, we have to define what is youth? Because is it students who are five, which some of these pundits say, is it students who are 17? What is youth in terms of talking about gender-affirming care, the actual definition, and then what are the statistics of students of youth? I say students 'cause I'm a teacher, receiving this specific type of care, one that is in the media, and two, on the real side?
Kellan Baker ’04 There's a misconception that there is a huge surge in the number of people identifying as transgender. What's really happening is that people are able to be more open about who they are. It is easier now to come out as transgender than it was 20, 30, 40 years ago. It's still not easy, and often parents are among the last to know, because a lot of young people are concerned, they're scared that people are gonna react badly and this political environment isn't helping. But when you look at the actual size of the transgender population, about 0.6% of the US population identifies as transgender. Less than 1% of young people have been diagnosed with gender dysphoria, which is the internationally recognized diagnosis that describes the clinically significant distress and impairment that can accompany a difference between someone's gender and the sex that they were assigned at birth. Every single major American Medical Association recognizes gender dysphoria as a serious medical condition and recognizes the 40 plus year old standards of care that outline the treatment or the services that may be medically necessary for a given transgender person to be authentically and truly who they are. So the numbers are very, very small, but it is a common phenomenon that we're, you know, again, exploiting a lack of awareness of just how few transgender people there actually are and what trans people's lives actually look like to make it seem as if there is this enormous groundswell of transgender people. There simply isn't. There aren't that many of us. Sorry, special unicorns, We can't get around everywhere, like all in one night. There aren't that many trans people. And the effect of being sort of constantly featured in the media as some sort of cautionary tale, as some sort of controversy as being described as, for example, "The New York Times" has described transgender young people as patient zero, that has really damaging detrimental effects on people's health and well-being over their entire life. So it's pretty concerning to watch the mischaracterization of exactly who trans people are and what gender-affirming care is. Because to your point about age, if you're talking about kids, if you're talking about children before puberty, there's no medical intervention whatsoever. The only thing that you would do for a kid at that age is just to listen to them when they tell you who they are, how they wanna wear their hair, what they want to dress like, maybe there's a name or a pronoun that feels like it fits them better. When you get to puberty, that's when things start becoming really intense and really distressing for a lot of transgender young people, because suddenly, your body is changing in ways that are irreversible and that are out of alignment with who you are. So that's why the standard of care is puberty delay medications. These medications, they're GnRH analogs, so they have been used for years for both cisgender and transgender kids to pause puberty that essentially hits a pause button and says, we're gonna not have those irreversible changes of puberty right now, so that you can make sure that you are making the right next step, you know, you're making the right decisions, you're taking the right next step for you. So puberty delay meds are really what we're talking about when we're talking about people at the age of puberty, they're reversible and they've been used for years. For older adolescents, there may be hormone therapy, which is the right next step for transgender young people who are continuing on the path of exploring and coming into their own in their gender. And then when we're talking about surgeries, we're really talking about adults. It's exceptionally rare that there are any surgeries performed for adolescents, and of course, there are no surgeries at all for children.
Twan Claiborne ’07 Right. Which we know, but we know intellectually. But you know, we have these organizations and we'll get into some of them, like Alliance Defending Freedom and other folks who are waving flags of saying that children are, you know, doing things to their body and using such extreme language to try to, you know, get things passed and really cause harm to the community, which is unfortunate. Thank you for outlining that because I think, again, even some folks who would identify as left-leaning and progressive, this has been such a issue that they've been concerned with because of course, it's framed what about the children? And the way they so eloquently laid out is one, they're not doing what it said is doing and the resources that they actually need is what these pundits are trying to stop.
Kellan Baker ’04 Well, and it's also framed as something new. You know, I remember 20 years ago, when my first classmate at Swarthmore came out as trans and it was gobsmacking, it was totally new, and none of us knew what to do and none of us knew, you know, sort of what was the right approach to supporting this friend and classmate who was transgender. For any given person, you don't have to know everything. There are lots of things that are gonna be new. Transgender people, transgender issues have been around for a long time, but it really hasn't been something that folks have been very safe in talking about. And it's been really, you know, something that for a long time was kept under the radar. I didn't know the words to describe what was going on for me when I was a kid in the '80s. I just knew that there was something off and it took me a long time to figure out what that was because I didn't have words for it because trans issues are new for a lot of people. Again, you know, whether that's 40 years ago, 20, 30 years ago, or whether that's now, where folks maybe have met a person who identifies as gay or identifies as queer, you know, is sort of part of the LGBT community. But knowing a transgender person, you know, again, there aren't that many of us, so we do try to get around to all of you and make sure that you've all met one of us. But you know, it takes a minute. So I think there is this perception that because transgender issues may be new for a lot of people, that somehow the science is new, and that's not correct. The science is not new. The science has been around for a long time and the clinical practice has been around for a long time, as have the standards of care. So transgender people and care for transgender people is not new. What is new is this sort of ginning up of the entire apparatus, of state governments and increasingly trying to use the federal government to stand between doctors and their patients, stand between parents and their kids and ban best practice medical care.
Twan Claiborne ’07 Hmm.
Kellan Baker ’04 It's not the first time something like that has happened. Abortion, for example, is a safe, medically necessary procedure that is widely subjected to politicized bans. And I think it's important that we look at all of these things as part and parcel of the same issue. This is about bodily autonomy. It's about who gets to make decisions about our bodies, what we do with them, what kind of medical care we can get, and it really is linked not just to abortion or reproductive healthcare. It's really, you know, not just trans people and gender-affirming care. It's also things like immigration. It's the US carceral state. It's the historical and ongoing sin of slavery and racism in this country. The ways that there has so often been this desire for political purposes, for power purposes, to control other people's lives and say, "I'm going to make it impossible for you to make personal decisions about who you are, what you need, where you live, you know, what your status is as a human being in society." That is something that the United States has long struggled with, and so transgender people are really just the most recent tip of that iceberg.
Twan Claiborne ’07 Mm, and we are woo! Since the beginning of the founding of this country, you know, the folks, the lovely term colonizers, have not known what to do with people who they deem others, so what do they try to do? Control their bodies in other ways. And as you mentioned, it is, all of those things are so interconnected in so many ways. I wanna go back and think about the history when this, because you mentioned, trans folks have been around for a very long time. You know, I think about in my own knowledge, hearing names like, oh my gosh, excuse my last name, I forget her last name, but you know, Christine Jorgensen or someone you know, like Dora Richter who were among in the 1920s and '30s, the first folks to have gender-affirming care to become their authentic selves. Keeping that in mind that this has been in conversation for a while in terms of the access to this care for folks. When did it become a politicized movement where a considerable population, particularly evangelical Christians, white evangelical Christians said that, you know, enough is enough and we need to do something about it. When did it become part of the conversation in the general political sphere?
Kellan Baker ’04 I mean, you really see its roots again, intertwined with conversations around reproductive health, abortion, bodily autonomy generally. In terms of when it really started to hit the state and national political landscapes though, was really around the time of the Supreme Court's decision in Obergefell, which legalized marriage equality for same-sex couples nationwide. There are a number of recordings and even things published by folks themselves in the aftermath of that decision, decrying it and saying essentially what we lost on the gay stuff. So who can we go after now? And saying, noting that historically the LGBT umbrella, if you will, has not always hung together. You know, transgender people have been part of the movement for quote unquote gay rights or LGBTQ liberation since the beginning, but there have always been efforts to try to carve off different pieces of the community to try to divide and conquer, to try to weaken that political power. You saw it with the, you know, some of the infighting and feminist movement or women's movement in the 1970s. You saw it with transgender people being left behind. You saw it with the racism that is so often present in LGBTQ movements. And we see it now with this effort to identify transgender people as really the weak link, the weak part of the herd that can be kind of carved off and specifically gone after. Now that the gays, if you will, sort of speaking, you know, as a political movement, now that the gay rights movement has gotten marriage and has achieved a certain level of social protections and social acceptance, there is, I think, a perception that transgender people are the ones who are left vulnerable, which is, you know, really unfortunately, not surprising, if you look historically at how transgender people have been treated. The myths and misinformation about who transgender people are, the painting of transgender people as freaks or misfits or violent weirdos. If you look at, you know, how Hollywood has historically portrayed transgender people. And transgender people really strike, I think, at the heart of so much of the anxiety that we have in our country about how do we understand who we are in the terms of understanding our own identities, how we move through the world. There's so many fraught conversations around gender and sexuality. And so a lot of that anxiety, I think comes home to roost on transgender people. And trans people are effectively used as a scapegoat for a lot of the anxiety around changing norms around gender and sexuality in the US today.
Twan Claiborne ’07 Thank you, Puritans. You know, the not relinquishing those shackles of the 1600s that unfortunately, still are with us today. And, you know, thinking about the representation piece and you talking about in the two thousands, you know, not knowing the language and remembering some of the awful reality television shows where they were, you know, mapping out being a trans person as deceitful and lying I definitely remember that language and, you know, being high-key horrified that that was being framed in such a way and folks, unfortunately, cis gay men in particular really buying into that and there's cis women, lesbians also buying into that. But really in that time, I remember it being, you know, cis gay men being the loudest vocals, and then also too with the marriage movement, I hate to bring them down, but you know, Humans Right Commission at the time when trans folks were rightfully saying, "Hey, giving you a warning, they're coming for us too." And folks being like, "Hush. Let's just focus on this marriage thing," which, you know, if we're going to be fully honest, doesn't really impact everyone equitably because there's resources with that, but that's a whole conversation for another day. But yeah, everything that you're saying in terms of how it has become politicized makes sense in turn. And really we're at a point in the culture where there is a divide and conquer aspect and trans folks tend to be that target. Do you think that part of that target is, you know, there's been conversation particularly in the world of athletics and having trans people, really trans women 'cause I don't really hear about it as much with trans men, but correct me if I'm wrong, around trans women participating in athletics and other things with quote, unquote traditional women. How do you see those conversations being interwoven? Is that conversation informing the battle to stop gender-affirming care? Or are they just two separate entities that just happen to have trans people at the focal point?
Kellan Baker ’04 They're definitely related, and I think ironically, so in the sense that a lot of what folks are talking about when they're concerned about fairness on the playing field is presumed advantages that come from gender specifically that come from going through puberty based on testosterone. And that's a misconception in the sense that testosterone does not confer an ambiguous athletic advantage. There are plenty of reasons. There are plenty of things that differentiate our bodies from each other and some of those things map onto some of the bimodal distributions that we tend to see around, for example, how much testosterone you have in your body. But it is far from the only attribute that affects people's prowess, if you will, in different sports. But if you do want to be concerned about the presence of testosterone, then you would make it possible for young people to have access to puberty delay medications so that they're going through the right puberty and then you don't have to have the conversation at all about whether or not any given young person should be able to play on any given team. When it comes to adults, there are plenty of guidances out there, there's been quite a bit of research by the international sporting associations that have identified, in some cases, sports-specific criteria that they use to make it safe and equitable for everyone to participate. But really what we're talking about when we're talking about sports, you know, people always wanna make it about young people. And when we're talking about young people playing sports, we're talking about learning fairness, we're talking about learning sportsmanship, we're talking about being able to play with your peers. And again, we're not really talking about that many trans people at all. There was this big push to ban sports participation for trans kids in Kentucky. You know, how many trans high school athletes there were in Kentucky at the time?
Twan Claiborne ’07 One.
Kellan Baker ’04 One. One. About whom there had been no complaints, no one had a problem until a politician decided to use that trans young person as a political pawn.
Twan Claiborne ’07 Hmm.
Kellan Baker ’04 So I think it's a really, it's misplaced concerns. If we're talking about safety and fairness, we should wanna make sure that everyone can play. We should make sure that everyone can access the healthcare that they need. We should make sure that people aren't being bullied either by their peers at school or by legislators or other powerful folks in the media or on the floor of a legislature.
Twan Claiborne ’07 Just trying to seize power. But, you know, for some people, all it takes is one. The mere existence, like you said, less than 1% of youth identify as transgender versus, you know, 0.6% of the general population. So like, what is the reason, to quote the great Cardi B, what is the reason? I also wanna, you mentioned earlier about the divide and conquer, and even in terms of these conversations and my research, including the articles you've provided for me, just my own research into this topic, I've noticed a focus to be on trans women and in terms of who they're focusing on in these conversations, especially in conversations with quote unquote fairness in sports. Is that part of the... I mean, I can assume that it's linked to bodily autonomy, especially with non-male identified folks, but is that a specific reason that folks have said, particularly these politicians and these think tanks have focused primarily on trans women when they're talking about trans folk and not, you know, others in terms of trans men in this conversation?
Kellan Baker ’04 I think it's deeply rooted in sexism and misogyny. And that's why I find it so sad to see that there are so many folks who believe ardently in the importance of fighting sexism, the importance of raising up women and girls, the importance of pointing out how deeply sexism and misogyny are rooted in this country. And then those same folks trying to demonize and exclude transgender people because transgender people understand the dynamics of sexism and misogyny and we are doing our part to fight it as well. It is something that we can actually work together on. There's no need to exclude transgender people, transgender men or transgender women, in order to make a compelling case that women are targeted, whether cisgender or transgender, are targeted for violence in our society. They are marginalized, they are excluded, they're asked to accept less constantly. And we don't have to demonize transgender women or transgender people broadly in order to be pro-women in order to fight sexism and in order to fight misogyny. So I really think that is really what's going on when we're talking about how often transgender women are targeted because they're women and women in this society continue to be targeted for all kinds of reasons. Gay or straight, cis or trans, Black, white, Indigenous, you name it. The experience of women in this country is often not an easy one or a happy one, and there are structural barriers that are put in place to prevent women from succeeding and transgender people, trans men, trans women, non-binary people can be and are allies in that fight against those barriers.
Twan Claiborne ’07 Boom. I feel like, oh, mic needs to be dropped because one, the divide and conquering is working, right? Because people can see things within their realm and then you throw a wrench in the plan and then all of a sudden, it's complicated, but then it's not, and it takes some time to really sit down and do the research and listen to see the connections because it is all interconnections. Yet here we are with folks who sound reasonable and can point out, yes, there is sexism and even within the feminism movement, there's different racialized, but you throw in the word trans or you know, something about gender, then it's like, whoops. Unfortunately, folks weaponize masculinity and femininity to the detriment of not just the trans folks, but to everyone around them because they're reinforcing those systems. I wanna paint a picture of the folks as we haven't really deep dived in, and actually this is connected to one of the questions that was posed in the chat. There's organizations like Alliance Defending Freedom, and there is a connection between the evangelical Christian movement dating back to the '80s, and folks who are opponents of bodily autonomy. What is the, if any, ideological basis connected to preventing gender-affirming care? Or really, if we're going to be frank, stopping the existence and the authenticity and the livelihood of trans folks?
Kellan Baker ’04 Power. A desire for a society where people aren't able to be who they are. Again, whether that's gay or straight, cis or trans, men, women, non-binary people. I think it's a concerted effort to impose a certain view of humanity on the rest of us. I am a Christian, I was raised in the Episcopal church, and when I read the Bible and other theological literature, I see words about liberation. I see words about love and mercy and justice and kindness. What I don't see is calling for bans, calling for exclusions, calling for cutting people off from the resources, support services they need to thrive. And, you know, that is not the way that I read the gospels. It's not the way that I understand religious traditions. So I think it's pretty unfortunate, honestly, in the LGBTQ movement, how a lot of us are very uncomfortable sort of dealing with or engaging with religion. And I think it's entirely understandable because religion has been used so often against so many of us, has been used as a cudgel instead of as a comfort. And so it's totally understandable why so many of us are reluctant to embrace religion and to allow for it to, you know, have the potential of contributing something to the conversation about liberation and justice. But I really see religious traditions as potentially a really potent force, or understanding the inherent worth and dignity of every human being and pushing back against people or systems of power and oppression that are trying to take that away from us.
Twan Claiborne ’07 Yes. As a great history teacher of mine said, "Ideas are great on paper, it's just when they get in the hands of humans, we make things worse." And honestly, the root of it is power, as you said, and it's power looking in so many different ways. We wanna say it's Christianity and stuff, but it's not necessarily Christianity. It's people who desire power, weaponizing Christianity for nefarious purposes. But I feel like sometimes it's easy for folks to use religion or something else as a crutch to really get down deep because I think maybe they're uncomfortable with that answer and hearing power. Because when you think about the constant of power, it feels like nothing tangible you can do with that. Right? If you know that it's Christians, then you can, you know, maybe do something like stop going to church or not read the Bible. If you know that it's politicians, you can call your representatives or go out and vote and do something. But like power, that involves so much, right? So much work to really get that done. And in thinking about what we can do, what are some ways that we can tackle the folks who are trying to ban the care head on, you know, their strategies like calling your politician? What else can we do to make our voices heard and hold the people to task who are trying to pass these laws that deny the dignity of fellow humans?
Kellan Baker ’04 Believe trans people, believe medicine and science. I see a question, Linda, in the chat about what data do we have so far? We have a lot of data. Not all of us are lucky enough to be connected to a school library that will get us all of those papers from behind the paywalls, which is unfortunate and contributes to a lack of scientific literacy for many folks in our society, but there is a very robust body of literature out there that talks about the experiences of trans people from a qualitative perspective. It also talks about trans people's experiences from a quantitative perspective. How do, for example, depression score changes. Depression scores change when people are able to access gender-affirming care. You can read a nice synopsis of the literature in the World Professional Association for Transgender Health The Standards of Care Version 8. Those standards of care have been around since 1979, so for more than 40 years. They're regularly updated. And this most recent version involved hundreds of experts in transgender health from around the world in a Delphi process, which is a consensus-based process for arriving at recommendations. And it was all based on a large body of systematic reviews that I and other colleagues participated in at the Evidence-based Practice Center at Johns Hopkins, which is where my PhD is from. There is science on this, there is medicine, and reading it and being aware of it and being literate in it, I think is a very important component of starting to identify where mistruths or myths are masquerading as facts. I would also say to recognize those points of continuity, again, between the experiences of trans people and the experiences of others who are facing barriers to accessing, for example, the medically necessary healthcare that they need. This isn't about trans kids. This isn't about protecting trans kids. It isn't even about trans people. It's about a political strategy for political power that comes from excluding specific groups of people or making it almost impossible, trying to make it impossible for entire groups of people to be who they are, to participate in social life, civic life, political life. And again, it didn't start with trans people and it's not gonna stop with trans people. And then the last thing I would say is just, especially for folks who are parents, put yourselves in the position of my parents. They had to learn, they had to figure out with me what was going on. We spent a lot of time on it. No one knows this stuff immediately. And let me tell you, the pundits who are out there, they don't know what they're talking about. The people who do are transgender people and the people who love them, who are in their families, who have had to go through the same journeys of trying to understand, trying to figure out what to do. And if you're a parent, I sincerely doubt that you want a politician telling you that you are banned from getting your kid access to the care that your kid needs. That isn't something that parents would stand for in pretty much any circumstance and there's no reason why we should allow the parents of transgender children, transgender young people to be treated that way. This is a very personal decision. It is a very personal path that young people, parents, other members, you know, of the sort of core support group, doctors, mental health professionals, these are very personal, complicated, nuanced, long, long, long decision processes. And so reserving the right for parents to love and support their kids, rather than allowing a politician to literally investigate those parents with child protective services for supporting a transgender young person and working with a doctor according to best practice standards of care to get their kid the healthcare that they need. That isn't something that any of us, I think would want, so putting yourself in the shoes of these families who are really being affected by these bans.
Twan Claiborne ’07 I think it's so important that you mention that because I don't think a lot of people fathom the danger to livelihood that this movement is causing. Right? It's not just about denying children, adults, the care that they need. It's criminalizing it, where, you know, in some states, if I were to even talk to a student about their identity and their process, I could be arrested as someone who is an advocate or put on, you know, a list. It's very hard and it's very urgent. And I also think part of that too is on a larger scale, a lot of us, not myself, but I think in general, a lot of people are looking for an easy way, and a convenient way that doesn't necessarily involve the work that you mentioned, right? Believing trans people sounds so fundamentally easy, yet it's so hard because I think that folks have to really confront some uncomfortable truths that they've learned and that they've internalized and that they have to unlearn to really be as effective in supporting trans folks in the ways they need to be supported, so I thank you for mentioning that. And also that's a question in here that I found very interesting. I'm trying to figure out the best way to word it, right? Another concern that has been brought by these politicians in terms of long-term care is this idea of regret, right? Framing it as if a person's going to go through this care. And if we're gonna be frank, they're not talking about the long-term gender-affirming care you mentioned at the very beginning. They're talking about the body changes that they're going through and somehow they'll regret it. Are there stories where I don't even, the question is like, are there stories that are framed that way? And as such, is there a responsibility of folks who are involved in gender-affirming care to be responsible for those regrets?
Kellan Baker ’04 Regret is exceptionally rare. That's why it becomes such a media circus whenever someone is identified as talking about regretting gender-affirming care. And in particular, you know, there's a very, very small handful of folks who have made something of a cottage industry of going around to different states talking about banning this care as the only answer to the possibility that someone would regret getting gender-affirming care. These bans do exactly the opposite of protecting those people because they make it impossible for doctors, parents, patients to sit down together and have real conversations about what care they actually need and then to follow the standards of care, follow an individualized path with the thoughtfulness that that requires. Because if you are coming in with a ban, you're shutting down the conversation right from the very beginning and you're making it impossible for young people, transgender young people to get the care that they need. There is literature out there looking at the prevalence of regret. And again, extremely rare, recent meta-analysis, for example, of almost 8,000 patients found a regret rate of around 1%. By contrast, if you look for example, at some of these common... Not to make any assumptions in this group of alums here, you know, but arthritis, you know, are the joints they start to break down. You got your knee replacements, you got your hip replacements, I've had a hip replacement at the grand old age of 41. And the regret rates for procedures like that are anywhere from 15 to 30%.
Twan Claiborne ’07 Mm.
Kellan Baker ’04 Medical care is not perfect. There is always the possibility that there will be something that doesn't work right. I still can't run after my hip replacement surgery. We're talking about widely accepted surgeries, widely accepted standards of care that understand and anticipate that there are regret rates 15, 20, 25, 30% for knee replacements, for hip replacements. Don't even get me started about lower back surgery.
Twan Claiborne ’07 Oof. Yeah. Oh geez.
Kellan Baker ’04 By comparison, never let anyone cut into your back, kids. It's not gonna end well.
Twan Claiborne ’07 Nope.
Kellan Baker ’04 By contrast, gender-affirming care has exceptionally low regret rates. And I wish, I'm gonna have to go look, I appreciate the comment about Masha Gessen talking on Ezra Klein's podcast. I'm gonna have to go look that up. I haven't actually seen it, but Masha Gessen is of course, a very thoughtful commentator as is Ezra Klein. And Masha Gessen knows a little something about a government coming in and telling you how you can and can't live your life, and that is why they are now essentially in exile in the United States because it is no longer safe to live in Russia.
Twan Claiborne ’07 Right.
Kellan Baker ’04 Ironically, I transitioned in Russia and the fact that when we're talking about, for example, European countries that are supposedly banning care, no European country has banned gender-affirming care, with the exception maybe depending on whether you wanna consider it a European country, with the exception of Russia, which, you know, I don't really think we tend to pattern a lot of what we want to see out of our medical system on Russia. It wasn't super easy to transition there. It wasn't super pleasant.
Twan Claiborne ’07 Yeah.
Kellan Baker ’04 But my experience was a lot easier than my Russian friends and colleagues because of my American citizenship, which allowed me access to different types of care and an easier process to change my documentation. And that is not to say that, you know, your average Russian is transphobic any more than your average American is transphobic. But there is a real parallel in the conversations in both Russia and the United States, this desire for power, centralized power and willing to steamroller whichever groups are perceived as standing in the way. And in particular, LGBTQ people, not just trans people, but LGBTQ people are often used as the scapegoat and as a means of working to secure additional power.
Twan Claiborne ’07 Hmm. Gosh, it's almost as if the Cold War hasn't really ended. You got two people on the opposite ends of the spectrum utilizing the exact same modes of oppression to maintain power. Gosh, I wonder what that's about. This would probably be our final question 'cause I think about this a lot, right? Especially given the recent human rights movements in the United States, thinking about the Black Lives Movement in particular, right? There are folks who are involved and really folks outside of the movement who, when we have given suggestions about how to move through spaces and how to support and believe us, don't feel like how we present our arguments are going to help our cause or aren't the right way of speaking about it. And a question was asked, right? Something you said earlier about believing trans folks and letting them be who they are in their spaces may not be helpful in terms of talking about securing policy and law to ensure that folks get the care that they need. Is there a right quote unquote way or better way to speak about it in terms of how we counter that? And I think also a deeper question is who is that right way for?
Kellan Baker ’04 Yeah, I think it depends on your audience. If you're talking to trans young people, for example, telling them that who they are is okay. That's important. That wasn't a message that I got. I had to carve that out, blood, sweat and tears for myself through a tormented adolescence. I double majored in Russian and astrophysics because it's amazing what gender dysphoria will make you do to try to hide from yourself and hide what you're going through. So when you're talking to trans people, talking to trans young people, I think that message of who you are is okay is a really foundational and important one. When you're talking to folks who are in a position to make decisions about access to gender-affirming care, politicians, folks in the media, etcetera. I am a scientist, I would say follow the science. Believe that who they are is a vampire. So gender-affirming care is a recognized treatment for a recognized diagnosis, which is gender dysphoria. There is a substantial body of literature that shows that gender-affirming care is an effective treatment for gender dysphoria and it is outlined as such in expert standards of care by the World Professional Association for Transgender Health, the Endocrine Society. There's a whole list of organizations, medical bodies, etcetera. The American Medical Association, for example, that has described the phenomenon of gender dysphoria, what it means for transgender people when they're not able to access treatment and described why that treatment is so important and what that treatment looks like. So I would say follow the science rather than this, you know, assuming that anyone who's talking about transgender people or transgender health is, you know, operating out of some fantasy of, well, it's hip now to be trans. Trust me, it's not hip to be trans. No kid is running around thinking that it's hip to be trans. Well, I actually do think. You know, I am glad that I'm trans. I think it gives me a different perspective on a lot of the challenges that, you know, folks are experiencing from a wide variety of perspectives. But it is no walk in the park. And so I think following the science and acknowledging that trans people are real, that the experience of needing medical care or social affirmation in order to be who you are, yes, be who you are, in order to effectively treat gender dysphoria, that is something that as scientists, as logical thinking people as Swatties, I would hope can get behind, that there are data and we can follow them.
Twan Claiborne ’07 And that is how you end our SwatTalk. Thank you so much, Kellan, for taking the time out to give us the full lowdown, the honest and authentic truth. And I hope folks will go out and do the work, not just look at the statistics and think about ways to support, but also do the internal work. Because as I mentioned earlier and as Kellan implied, it's not just simply reading statistics and writing them off to people and talking about those numbers and concepts like regret and even gender-affirming care itself. It's about centering voices and people and confronting larger ideas that we've internalized and doing that work. It starts with us how. As hokey as that really sounds, it starts with us and it's not just connected to this movement, it's connected to all movements. We have to sit in that discomfort before we can actually go out and call a politician or say the statistics, because if you don't believe the statistics and you don't believe the voices of the people you're championing, then your work is useless. Thank you again for doing that. I hope you all enjoyed this talk. It is recorded so you can go back and revisit, re-ponder and share with your friends. And on that note, we say good morning, good evening, and good night. Get some rest, Kellan. Take care. Drink some tea, get some hugging and get some sleep and take-
Kellan Baker ’04 I managed not to cough. I'm really proud of myself
Twan Claiborne ’07 I know, look, here we go. What is that called? Growth. Thank you and take care, everybody.
Kellan Baker ’04 Thank you, Twan. Thanks, everyone.
Twan Claiborne ’07 Of course.