Good morning and welcome. Thank you for coming. This is our 18th annual symposium, and we've been blessed year after year in February and March with amazing weather and today makes no exception to that. It's a beautiful day outside. Okay, wow, that's great. Good morning and welcome. My name is George Jara. I'm the conference director. If there's one thing I could say today is we have a very packed packed agenda. So when the time is to come back from lunch or come back from break, it's best to come back and do it as fast as possible. I'll usually encourage people to come back. And the reason I say that is because it cuts into the time of each presenter, and we have five distinct parts of today's program. Special surprise in the afternoon. So that timeliness of gathering back together is going to be quite important for the flow of the day. Housekeeping details on your tables. There's pens and a couple of pads. We're going as green as possible. The pads, you know, share the paper for notes, but by and large, I think paying attention to the presentations is going to be key today. Also on your tables are question forms. There's 450 question forms out there. There's 450 here today, so thanks for coming again. So throughout the day when you have a question for an individual speaker or for the panel discussion, you can write those questions and put them either in the basket there. There are two baskets in front of the stage, and there's a basket on the bar on the way when you came in. That's how we figure out the questions for the last section of the day, which starts at three o'clock. It's a good opportunity to turn off your personal devices or at least silence them for the day. There's a typo on the program instructions, which is on the back of the first sheet, which says psychologists no longer need to sign out. Indeed, you do need to sign out. So psychologists on the way out will make sure that, you know, you know where to sign out. It's an early lunch. We're starting at 11.30, and it's going to be served in the Bayroom buffet style. The presenter's slides will not be available. That's something we did in the past. They may be available in the future on our website.  So the exit is going to be behind the screen.  Are there any questions? The second page of your program is your course evaluation. It's important you put your name on the bottom of the second side, and when you turn it in, because without that, we can't grant continuing education credits. So just to talk a little bit about continuing education credits, I'm going to introduce Alicia and Ahai. So just to reiterate, because there's always a question from somebody about, I didn't get my units. You must sign in. If you didn't do that, who you came in, please make sure you sign in, and at the end of the day, most of you will only need to do the evaluation and print your name, so it's legible, on the evaluation to get units. That includes for Santa Cruz County staff cultural competence units. So at the end of the day, not before, you will turn in your evaluation.  Do not leave your evaluation form on the table. We are not going to collect them. They need to be turned in. It may sound petty, but inevitably there's been a handful of people that takes a lot of staff time from various persons to get these. So we want to, you know, we want to be able to to give you the units for attending this wonderful conference. The only people that need to sign out are psychologists. The rest of you just need to sign out by putting your name here. So psychologists, you do this and sign out. I will have the sign out form, and I'll direct you to that. So any questions? See me at the breaks. But welcome. I'm so happy to see such a huge crowd, and I'm really proud of this symposium in general and today's topic in particular, and I think it's just awesome that we sold out. Good job. So as I said, we're at capacity. So one of the requests is that if there is an open seat at one of your tables, raise your hand right now. And so those folks walk around, look for a place to sit, look for those hands up there. Again, there are other seats up along the balcony in the top here. Parking validation, those people who did not get their parking ticket validated during lunch perhaps or a break at your parking ticket validated, and you won't have to pay for parking. Right now, I'd like to introduce Joshua Nath and Ernie Calciano. I want it's my honor to welcome you to our 18th annual Johnny Nath and Ernie Calciano Memorial U Symposium. I'd like to recognize the various organizations that are here today. We've been doing this for many years, and I do encourage you to take the time during the lunches and the breaks to network with them and to speak with them. I'd also like to recognize our high school students. For many years, we've been doing a scholarship program for our students, and this allows various high schools to bring in students that they feel would benefit the most. And then I just request that when you do go back, you take this information and you apply it and you talk to your fellow students as well. You know, my brother John would be 44 years old this year, and as I've grown from an adolescence to a husband and now a father, there's not a day that goes by when I don't think what his life would have been like today. And though this symposium bears his name, I feel it has come to represent all families dealing with suicide, violence, and people with drugs. My family is incredibly glad to have seen the symposium in memory of John develop over the years into the widely attended event of today. And as difficult as our loss continues to be, the community coming together is a very healing force for us. We continue to be impressed by the diversity of the attendees, clinicians, counselors, educators, and public safety officials that have attended our symposium over the years. The post symposium comments and the number of attendees that return year after year clearly show that we are making a real difference in our community. Our deepest thanks and appreciation goes out to those that plan the details of each annual symposium, and we are particularly gratified to George Jaro and all members of the advisory committee. It is their hard work that allows all of this to happen. I have never met a more passionate devoted group of people, and I am honored to be associated with them. I'd also like to recognize the tireless volunteers to help do logistics of the event, and also the Dominican Foundation, which is the philanthropic arm of the symposium, and is with their support that we have established the Johnny Natterney Endowment Fund. We could not have continued to have such wonderful events without their support. But most importantly, I want to recognize all of you and your devotion to your work. For nearly two decades, the symposium has expanded on topics ranging from suicide to autism, and it is your continued quest for knowledge that allows us to bring you such wonderful speakers to you year after year. In summary, I want to thank all of you for coming today, and hope you find this information presented to be beneficial in your work, and hope you will continue to join us year after year. It is now my distinct pleasure to introduce Joel Baum. Joel Baum is the Senior Director of Professional Development and Family Services. He is responsible for all programmatic aspects of gender spectrum. He facilitates trainings and conducts workshops, develops curriculum, consults with parents, professionals, and providers, provides resources and services of a more compassionate understanding of gender. He is a founding member and Director of Education and Advocacy with the Child and Adolescent Gender at UCSF. Working throughout the United States and beyond, he is frequently called upon to help institutions think more expansively about the gender diversity of all children and teens and ways to create more exclusive conditions accordingly. For nearly 30 years, Joel's work as an educator has focused on issues of social justice and equity. First as an award-winning middle school science teacher and school administrator, he has also served as a district administrator in Oakland, California, as well as a school reform coach with the National Equity Project. Joel is also a professor at California University East Bay in the Department of Educational Leadership. Gender spectrum provides education, resources, and support to help create a gender-sensitive and inclusive environment for all children and teens. We accomplish this mission through school trainings, parent support groups, and consultations, policy development, and our annual family conference, and work with medical and mental health care providers, social services, and others working with families and kids. So it's my distinct pleasure to introduce Joel Baum. Wow. Good morning, everyone. All right. We can do a little better. Good morning, everyone. Good morning. All right. So again, let me make sure my doohickey's working here. I'm Joel, and as Josh said, I work for this organization called Gender Spectrum. I'll tell you a little bit more about my background and my experience in education after lunch when we're focused on schools. But today, for the kickoff, I've been asked to really focus on the notion of the dimensions of gender, understanding the complexity of gender. Before I do that, I also want to offer my thanks to the Symposium Organizing Committee, the sponsors of the event. And again, as Josh said, to all of you, for the work you do, helping young people and their caregivers, they need all that we can give them. And I know all of us work very hard to provide the support for them. So again, as a parent myself, I thank you for that. So, gender. What I'm going to provide here for the next 30 or so, 30, 40 minutes, is a model of gender. It's not the model or the only model. I wouldn't even argue about whether it's the right model. It's the model we're going to use right now. What we have found is that this is a model that allows for discourse. I don't want to argue about certain words, and are we using them correctly. I want to communicate and get business done in support of young people. And so I want to be really clear. What I'm going to present is just one way to think about gender. But in the various organizations and institutions we've worked with, it's proven to be a pretty powerful one to allow for conversation and discourse about gender and young people. The work around this topic truly begins inside. We all come to our roles as educators, as counselors, therapists, pastoral care providers, and everything else with our own experiences, our own worldviews, if you will, related to gender. We all are impacted by gender. And we know that without reflecting on that, without reflecting on our own experiences of gender, we can tend to look at the young people and their gender as sort of an other, as if their gender needs to be dealt with, not our gender. And so I'm going to ask you to do a little reflecting on your own experiences of gender. And I'm going to foreshadow the framework that Gender Spectrum uses primarily with schools, but really any organization about change. But it always begins at the personal level, the personal entry point, where we really focus on our own understandings of gender and the ways in which they impact the work we do with young people and their families. So I'm going to do a brief thought experiment here with all of you to kind of key in to that, if you will. I'm going to show you a couple of pictures, and I'm going to read several scenarios. And for each one, I simply want you to turn in, turn inward, and focus on your response, your reaction to each of them. Okay? Here's the first picture. What's wrong with a girl who wears a ball cap? A new approach to parenting gender-fluid children by Ruth Pador. Here's the second. What's wrong with a boy who wears a dress? A new approach to parenting gender-fluid children by Ruth Pador. How might you answer that question? How might you talk about those two pictures with a family member, a colleague, an older relative, a younger relative, someone in your social circle? Jennifer's parents are surprised to hear their five-year-old exclaim, I'm a boy. They say fine and let their child pick a new name and begin using he and his for pronouns. Seven-year-old Chantelle goes to the bathroom to pee, but while she's there, other students constantly ask her why her feet face the wrong direction when she's going. Ten-year-old Devon approaches you and complains that everyone keeps asking, are you a boy or a girl? At 14, Jamie has decided that they want to be known as a gender, but need you to help explain what that means to their parents. Tanya is 16 and explains to you that attending school as a girl has become impossible. Instead, Tanya changes clothes every day on the way to and from campus and is now known at school as Tomas. The school has been supportive, but Tomas does not want his parents to be informed. A neighbor approaches you at Safeway and says, I hear they're letting boys use the girls' restrooms now at the middle school. What the heck is going on there anyway? Regardless of what you're thinking or imagining or how you're responding, that's data for you about where you are when it comes to your notions and understandings and beliefs about gender. And as we work throughout the day, I want to encourage you to both stay connected with those, but at the same time be willing to interrogate them. Be willing to interrogate them in the, in light of the incredible shifting terrain of gender, particularly among young people, that we are literally experiencing beneath our feet. This model is based on three essential ideas. The first is that gender is about more than our bodies, that we have to look at biology, expression, and identity to really understand the authentic experience of gender. Secondly, that it's better represented as a spectrum, rather than a simple binary. And lastly, that gender and sexual orientation are different, and when we conflate them and confuse them, it really creates challenges for young people. Those three ideas, pretty simple in concept, we've found to be significant in creating a perspective around gender that is honoring of all people's experiences. It's not about dismissing gender as a concept. It's not about saying gender doesn't matter. It's expanding our notions of gender in order to be responsive to the needs of everyone. Now, interestingly, that definition is completely consistent with our EB code, which includes gender as a protected class, and names and defines gender to mean a person's sex, and includes their gender identity and their gender expression. Those are the three aspects that we need to focus on in protecting the gender diversity of all young people. So, when someone has a baby, what's the first question we almost always ask? Well, yeah, boy or girl, I always love, though, one of the first few times I was doing this training, I was at a middle school, and at about this juncture, I asked that question, and from the back of the room in a sixth grade class I hear, who's the dad? It's like, okay, I am gonna love this job. I know this is gonna be a great job. No, but of course the question that is asked most often is, is it a boy or a girl, right? And of course the answer to that is based in biology. When that baby's born, we take a look at their body and we make a determination and slap this label of girl or boy on them, okay? Now, right there we have the heart and soul of the binary gender system, the gender binary, okay? And that binary essentially has two main concepts it's built upon, one, that there are only two kinds of bodies, and two, that whatever body you have will equal your gender. So what we do is we assign sex, but we presume gender. And in fact, we're often right. That model works pretty darn well for a lot of us. You know, I bet many people in this room go, yeah right, of course. And that's right, it does work for a lot of us, just not all of us, okay? Because what we know is that at multiple levels gender is a spectrum, a continuum. Now I happen to be, as Josh mentioned, a former science teacher and I was a bit of a math nerd and I want to point out that those lines, that line and all the lines you'll see have arrows on each end, okay? Now my daughter's taking geometry and we're learning about lines versus line segments. Lines are infinite. Line segments have endpoints. These are infinite with these stops along the way of girl or boy, okay? And in each of the dimensions we need to think about the dimension as a spectrum. Even biologically, we know that bodies do not just come in two forms. First of all, what we call boy bodies and girl bodies. If you're looking at me, I'm doing air quotes.  But no really, when we talk about bodies, you know, a boy body is really a penis-bearing human. It's not a boy body because people of all kinds of genders have penises. A girl body is really, you know, an ovary-bearing human, a vulva-bearing human. And while I don't expect you to say, good evening, vulva-bearing humans and penis-bearing humans, you know, I do want to encourage you to disconnect this notion of what's in your pants with who you are because it just doesn't always work. But more than that, there are bodies that don't fit either one. Now, the nomenclature a long time ago was hermaphrodites. Currently, we often refer to individuals as being intersex or an intersex condition. The unfortunate medical nomenclature is DSDs, Disorders of Sex Development. That's a whole different lecture about why that's problematic, but suffice it to say many of the more gender-affirming specialists that I work with refer to differences of sex development. But what we're talking about is a whole range of naturally occurring conditions that belie the physical binary of bodies. Ambiguous genitalia, variations in chromosomes, variations in the way hormones are interfaced with the body, various ways, and even a cellular level that we're beginning to see that gender is not at all this one or the other thing. There are many conditions, physical differences connected to these conditions that are invisible. So we never know, you won't know if a person has an intersex condition is intersex unless they tell you and even in some cases those individuals don't even know themselves. It just is something that's part of the natural interplay of humans. And here's a short clip that helps really bring this home. We'll try that again.  If you have testes. Alright, let's try it one more time. Raise your hands if you have testes. I'm Pigeon. I'm Alice. I'm Emily. I'm Cypher. And we are intersexy. Intersex describes a person who doesn't fit the typical definition of male or female. I have XY chromosomes, but typical female genitalia. I'm a girl who has testes and XY chromosomes. I identify as a queer, gender nonconforming intersex person. I identify as a black intersex man. Intersex is not new. It's been around since the beginning of human existence. I mean there's probably even intersex dinosaurs if you think about it. And that's probably not that far from the truth because as I've said these are naturally occurring variations of living things, right? It's the stuff of evolution, that variation. There's a great quote that Milton Diamond said which is something along the lines of nature loves diversity, but society hates it. And I think that's very much what we're talking about here because this notion of the binary, which for many people is assumed to be one and only based on biology, you know, part and parcel, it breaks down even at this level. It just simply doesn't work to capture the greatest number of humans' experiences. And when we're having models to describe humans, particularly if we have something so essential as gender, we should try to be as inclusive as possible. But biology and sex aren't the same as gender anyway. They're not the same thing. They're different. There's a relationship, but it's only one dimension of an individual's notions of gender. The second dimension is expression. Now, expression often here described as gender expression. I'd like to add two letters, E.D., it's gendered expression. It's really human expression that we have assigned all sorts of attributes to that don't always add up. This is often what I refer to, what you'll hear talked about as the social constructs that are attached to gender. And there's evidence of the binary everywhere. And for our young people, they are like fish in water swimming in the binary. They don't even know it's there half the time. These messages come in so many different forms about how you're supposed to perform girl and how you're supposed to perform boy, let alone someone who might not feel like either one. That's not even on the table. One way to do it or another way to do it. And these things inform so many aspects of our culture, our traditions such as Halloween. Now imagine if you are, you know, say wearing that fairy tale costume or you're that person and you want to wear one of the, I don't know, Star Wars costumes. You need to cross this not so invisible line into that space simply to wear a different costume. Last time I checked costumes were costumes. And yet we put up this barrier that kids are forced to cross in order to simply pursue something or wear something that feels right for them. And sometimes these have real, real impacts. Insidious and less insidious. Obvious and less obvious. But here we have three telescopes. Three telescopes. And what you'll notice for those of you probably can't see in the back is one of them has 525 times magnification is big in the picture. It costs 90 bucks. It's clearly well constructed and happens to have someone that most people would read as a boy looking through it. And then almost as an afterthought in the bottom left-hand corner we have this pink telescope that gets 90, that's good, right, 90 for $15. Again, we can look at that and laugh, but there are messages implicit in these visions and notions of how we are gendering toys, objects, clothing, experiences. And make no mistake, this stuff starts early. A diamond ring for a sweet baby girl and a saw for a busy baby boy. Now these notions of course are in fact quite artificial. Gender expression, the expression of gender, that gendered expression is shifting all the time. Think about it for a second. I want you to imagine being 10 years old again. Raise your hand if when you were 10 you knew men or boys with earrings. Take a look around, you'll see some hands up. You might notice a pattern to whose hands are up, just saying. How about now? Raise your hand if you know men or boys with earrings today. How about this one? Raise your hand if when you were 10 you knew girls with tattoos, girls or women with tattoos. Again, some hands. How about today? These are just two examples of how the notions related to gender are shifting all the time. I mean heck, when I was growing up the only people wearing earrings were women and girls. The only people with tattoos were boys and men and pirates got to do both I guess because they have apparently a lot of freedom out there on the ocean, you know, they're transgressing all sorts of other stuff so why not gender as well? But the fact is this stuff changes and we need to help young people understand that this stuff is shifting all the time. Another great example of that is this phenomenon called the bronies.  I know way more about Fluttershy than anyone should know about Fluttershy who is one of the characters. Bronies are men, young men, young adults, you know, high school, college aged men who like the franchise My Little Pony. They're bros who like the ponies. They're bronies. And I want to be really clear this is in a non-ironic creepy way, okay? Not a creepy way.  They love the storylines. They love the collectability of the objects, right? They love the notion of a community that is like connected to this really sort of offbeat thing. And it's something, in fact, it's sort of part of a Comic-Con generation, right? If you go to a comic book store, a game store, you will more than likely begin to find My Little Pony sections in a toy that once was really the domain of girls. And in case you don't believe how mainstream bronies are, that picture in the bottom right-hand corner, that's from the J.C. Penney website, right? I don't think you get more mainstream middle America than J.C. Penney. But perhaps my favorite example of all of this are the colors pink and blue, the old standbys, the sort of holy of holies of gender expression norms. The generally accepted rule is pink for the boys and blue for the girls. The reasons that pink, being a more decided and stronger color, is more suitable for the boy, while blue, which is more delicate and dainty, is prettier for the girl. Trade publication, Earnshaw's infant department, 1980s. So I guess your boys' colors depend entirely on when you like them. When, of course, there's no such thing as boy and girl colors, colors are just colors. This is, as the narrator named, was a trade publication designed for marketing in department stores. If you're gonna be working with families, push the pink stuff on the boys and the blue stuff on the girls. Now interestingly, 100 years later, here we have Target last year, announcing that they were no longer going to separate bedding and clothes based on gender. It used to be you could go in Target and you'd go to the toy aisle and you would see building sets and girls' building sets. Really? Now it's building sets. If you're a girl and you want Spider-Man bed sheets, again, why do you have to go into this aisle with the label boys on it? That automatically means that, well, if you want it, you gotta cross this line and make some sort of declaration when in fact you don't. They're just sheets. Throughout time and from one culture to another, these things are shifting all the time and what we have to help young people recognize is that they will shift while there may be patterns to gender expression. They are not rules. When I was a teacher, I had something I called the smell test and the smell test was, can I stand in front of my eighth graders and make the following statement and have them say, yeah, that smells right. Or do they go, pfft pfft pfft pfft. Oh no no, that's funky, that don't smell right. And if I were to stand up here and say to my eighth graders, oh yeah of course boys, girls, they both wear dresses all the time. Wouldn't pass the smell test. It would. Right? Does that mean all boys don't wear dresses? No. Does that mean all girls don't wear them? Does that mean all boys do? And all girls do? No. Do some boys and some girls? Yeah. What's the pattern? Well, the pattern is that girls wear dresses more commonly than boys do. It's a simple pattern. It's not a rule. Patterns versus rules is an important concept as we talk about gender expression if we want to do it in a way that recognizes and honors the experience of everyone. But when we have someone who doesn't fit the pattern, we can't blame the data. We're making the mistake. We've got the wrong pattern. We need to adjust, right? Versus someone breaking a rule is doing something wrong. We have to adjust our ability to look at new data and say, oh, let me reframe my framework. And so expression represents that second dimension. The third dimension we want to talk about is gender identity. And gender identity refers to our internal sense of self, the core notion of who we are deep inside. Again, the binary assumes that there are two ways to feel. I can feel like a boy and I can feel like a girl. And by the way, it's inextricably linked to my genitals. Whereas we know again identity also is a spectrum, an infinite spectrum in which individuals can feel like girls and boys, both, neither, all sorts of combinations. And as we're going to see in a few minutes, an incredible diversity of possibilities in which young people are asserting, hey, this is what gender means to me. This is my gender. Now, I want you to think for a second about your own experience again. When did you know? How did you know? How old were you? What messages did you get about your gender? What did you encounter in the world around you that reflected or did not reflect your gender? And as you think about that, take a look at this next slide. This slide shares data from transgender adults who were asked, when did you realize that your gender varied from the sex you'd been assigned at birth? Okay. Did you realize when you're 18 or 16 or 14? So along the bottom or the x-axis, we have age. And up the top along the y-axis, we have the percentage of respondents. So let's take a look at when these adults realize this about themselves. Here's the first group who realize basically in high school or older. Okay. Here's the next group who realize this about themselves in middle school or in adolescence. Here's our pre-adolescence in the upper reaches of elementary school. And finally, here's our youngest people who realize their gender identity was different than the sex assigned at birth. Now, I want to be very clear. This is not the only narrative for a transgender person. This is a study. But what it does demonstrate is that for certainly the vast majority of people in that study, they knew quite early. And returning to what I asked you, I'm imagining most of you knew quite early as well. And that's because gender identity is a core aspect. It's about congruence. It's about alignment. It's about this notion of I just feel right or I don't based on the messages I'm getting from others, based on my own body, based on the ways that I'm forced to or allowed to express my gender. Now, interestingly, in a different study that showed very similar results, the average age of realization was just under eight years old. The average age of disclosure was not until 15 and a half. Now, I want you to think about being seven, eight years old, having this profound sense that who you are is not what everyone else thinks, but not disclosing that for another seven plus years. I either can't because I don't have the language. I can't because I know the reaction of the people around me. I can't because no one's created the space for me to understand my own experience. And that, my friends, is a huge burden to ask a little kid to walk around with. And we have to work on creating those spaces where everyone's experiences of gender are on the table to be considered and celebrated. These are just a few quotes from another study, retrospective study of adults reflecting on their experiences. And as you read those, you'll see three ideas. One, there's a ton of pain in not being seen. Two, these are young folks. These are kids again, thinking about their experiences. And interestingly, three, the three at the top, you'll notice they all refer to going to bed, falling asleep at night. And I want you to think about your own experiences. When are we more alone? When are we more just with ourselves than when we're sleeping? That is such a time of privacy and personal reflection. And yet for many of those young, many of these folks, that was a time that was really difficult. And interestingly, many of the families we work with, many of the families of the mental health providers that we collaborate with, talk about their gender expansive kids having trouble sleeping, having issues with sleeping. I got to wonder, they're busy all day long, and now it's just me. And now I just got to face the fact that a lot of people don't really see me for who I am. What she ended up getting was a shot that's called Lupron. It tells her brain to stop producing the male hormone and then was taking an estrogen patch. Now that I've been on hormones for six months and more changes are happening, I'm completely comfortable in my identity. So I don't really even consider myself a trans girl anymore. It's more just like I'm a girl who just happens to be transgender. I feel like I'm just myself. Somebody close now. We're all products of our society, right? The third dimension then is gender identity. Now you notice in talking about these three dimensions, I don't believe I've said the word lesbian, gay, bisexual, asexual, pansexual, omnisexual, or any other kind of sexual.   Is there a relationship? Sure, but they're not one and the same. I mean, think about it for a second. Sexual orientation in many ways is understood in terms of my experience in relationship to others. Gender, on the other hand, is very much my own experience of self, my experience of who I am. And it's problematic to confuse them for a couple reasons. One is we frequently read a young person's expression and assume it tells us lots of stuff about their identity. And in fact, you know, I was a couple weeks ago doing a presentation for some early childhood educators and one of them raised their hand and said, well, what am I supposed to do with the parent, usually a dad, who comes in and says, I do not want my son playing in the dress-up corner.  I'm just not gonna have it. Not gonna have it. What am I supposed to say? And I'm like, well, you know, it's your, first of all, it's your preschool, by the way. And you probably have enough on your hands worrying about keeping the kids safe than what they're playing with. But also, you know, that kid's three, I think. Could we just give him a minute to figure out the attraction stuff and just let him play, right? But more importantly, when we confuse sexual orientation and gender, we put a very adult lens of sexuality on top of the process of identity development that just is not on the table. So when we think about supporting transgender young people in our schools, in restrooms, in locker rooms, on overnight field trips and housing accommodations, many people's minds go straight to sex in a sexually loaded situation. When, in fact, it's not about that. It's about identity.  Now, these three dimensions work together. One, anyway, is like this, where they essentially line up, where biology and identity are aligned and expression frequently follows. And there's a term for that. That term is not normal. It's not the term, or correct, or proper, or as nature intended. It's called cisgender. Cisgender, the prefix cis literally means to be on the same side as like a cis and trans molecule and there are many other places it shows up, is gender typical. Now, why is it important to have a name for that? Well, the fact of the matter is, I would argue this is still probably the dominant experience in our society. And we need to name dominant experiences because if we don't, they become the default, right? If you're not this, you must be something not normal, not regular. No, cisgender is just one form of gender. It's a way we can label the dominant experience. But of course, there's others. We have tomboy's who are assigned the sex of a girl and identify as a girl and are perceived to express their gender in somewhat masculine ways. That's a common word we use for that. We also have another pattern where someone's assigned the sex of a boy and he identifies as a boy, but according to the people around him, he skews to the feminine. You know, like maybe he prefers the color pink or blue or I don't know. Unless he's supposed to play with my little pony, that's a girl toy, isn't it? Anyway, we don't have a name for that kiddo. We don't have a way to refer to that young person, certainly not in a way that's similar to tomboy, which many would argue has become a very positive term. Now, I don't want to pretend that tomboy's universally are accepted and that this boy who's perceived to somehow express gender in a feminine way is universally negative, but as a general rule, our society struggles with our boys that skew to the feminine. Dr. Ernst Aftonai and Dr. Hastings are all part of something called the Child and Adolescent Gender Center Clinic. In our clinic, we never get a call from a parent that sounds like, yeah, I have a five-year-old girl and all she wants to do is wear her brother's clothes. She has a very short haircut and all she wants to do is play baseball and rough house and wrestle. We don't get that call. We get this call all the time. I have a five-year-old boy and he's got very long hair. All he wants to do is wear his sister's clothes and he just loves to do tea parties and do I have a problem? We get that call all the time. Now, there's other possibilities. Here's someone who's assigned the sex of a female, but he identifies as a male. And in this model, we use the term transgender to describe this individual and transgender boy because the identity is male. The trans part is biology and identity across from rather than on the same side as each other. And often, this is a young person who will tell us in no uncertain terms, not that I wish, that I hope, maybe one day I will, it's, oh, I am. I am a boy, especially if they have the space to make that declaration. And a transgender girl, then, is assigned the sex of a boy, but she identifies as a girl. Now, again, this is a model and you will hear the term transgender often used in much more umbrella form. What I'm going to tell you today is in our model, we use it in this very precise way and have a different way of talking about the whole plethora of other possibilities. But before we go there, I want to make one last comment about transgender children because we often get asked, well, how can you tell? I mean, how do you know? Well, is it a phase? Is it not a phase? You know, how can you tell the difference between a phase and someone who's authentically asserting their, their selves, their true selves? Well, often these are three things to think about, persistent, consistent and insistent. One of my girls, when she was four or five years old, thought she was a dog. She thought she was a dog.   You know, we didn't, we didn't, we didn't accommodate her assertion of dog-ness. We didn't make her pee outside, you know. She would have loved that, by the way. She would have thought that was awesome. But, and when grandma came, was like, okay, sweetie, the, the barking's really not what grandma's here. She just, she's old. She can't handle it, okay? But if you think about someone who is asserting a gender identity and saying, yeah, I want to wear the clothes and be called the name and et cetera, when grandma comes over for that kid and you say you need to cool it, you get a very different reaction. You don't get a, oh, well, fine. You have a problem. You have serious distress. You have insistence, okay? And that, that impact is often a really strong tell. And here's another clip sort of talking about that. But accepting of it, since I've known since way back when.  And I was, you know, wondering, I'm like, where's mine?   And it's like, I don't know.  It was kind of like, you know, I wish I could be you. And I think it's like, I can still remember sitting on the playground and just looking at the dudes and just like, you know, just wishing and imagining how it would be if I were them or if I were born.  But I think I think what should have been assigned to my parents is that I was a quiet child. I wouldn't fuss, scream, grow anything. But whenever my mom would try to dress me up and put lipstick on me and all this pretty pictures, I would have a, I would throw a tantrum, I would scream, I would bawl, I was on the floor just crying like so. And I would, you know, I was little, I never cried or anything. I was a quiet child. So that should have definitely been a big sign to her that I was not trying to fit into the girl world because, you know, I never did girls did. The most feminine thing I did as a child was paint my nails black. So again, when we do this work, we often find ourselves needing to convince people that transgender people are real, that they exist that a kid can know. Well, fortunately, we've got a lot of backup. These are many of the associations and this is quite old. I'm sure there's many more now that have affirming statements of the rights needs and importance of protecting transgender young people. Quite simply transgender students and young people are not making it up. Who they are is who they are. And they have nothing to gain in asserting a sense of self that isn't authentic. There just isn't, there isn't anything in it that's gonna make that worth it. The difficulties are quite, quite significant. But of course, what I've been talking about to point this point is all very binary, right? This body, this expression, this identity, one or the other. And in fact, that just is a tip of the iceberg. There are many, many places that exist in the land of both and neither and more. And even both doesn't count because that just assumes two when there's so much more.  Of course, many of you know Pluto got demoted recently. Pluto's no longer considered a planet or at least by some. And he was asked, so what's the deal with Pluto? Is it a planet or is it not a planet? And in his response, he talks about this notion of false dichotomies. But what he really talks about are the limitations of language and the inability of language to capture concepts that we don't have language for and therefore end up controlling the way we think. Take a listen. So it's not, it's a very human thing to say, is it this or is it that? Is it a planet? Is it not a planet? Is it is it less filling or as a great text? Is it is it gum or as a candy? These are sort of false dichotomies. Something can be both. But our language forces us forces us to require that it fit into one word or another. Okay, what we're not recognizing is that it's not a fault of the object or the concept. It's a defect in our language. And if our thoughts follow language, we have trouble thinking of things that fit more than one category. I think that's the source of most human elements, cultural elements.  Are you black? Or you're not? Are you this? Are you that? Are you female?  Allow there to be a spectrum in order that you see. So does that that doesn't necessarily just mean a broad language but a broadening of the way to human mind think? I think that once you learn language, the language shapes how you think more than your thoughts shape what language does. It takes a very creative person to start inventing words for thoughts that they have for which no words apply. And that right there captures so much of the challenge that we have with gender that doesn't come in one of two boxes because we have a limitation of language. And so much of this is about simply developing the language which captures experiences beyond the binary.  We have a head start because boy versus girl is not universal. There are cultures throughout the world that have become quite comfortable over hundreds and thousands of years recognizing the diversity of gender.  One example that many of you might be familiar with or what are sometimes described as two-spirit people. People that are more than male and female. They're all of humanity. I don't again want to be very careful about saying both because they're even more than that. And in fact, two spirits are somewhat generic or a name for over 150 different tribes that have some kind of role or tradition or label for individuals who exist in these places. Here's one more. In many cultures, a person existing outside the two accepted genders is seen as confronting, even threatening. But gender is defined by culture. And on South Sulawesi, the Bogeys believe that in addition to men, women and Beesu, there are two more. These two additional genders are made up of people who in the West would be considered transvestites. Tambu's gender is Chalilai. Biologically, she's female, but she lives as a man. I feel comfortable as Chalilai. My family is also comfortable. As long as I'm a good person and I work hard, people accept me. Abdul Rahman or Poppy is Chalilai. He has male genitalia, but has lived as a woman since he was six years old. I'm not special. The Bogeys culture accepts all five genders. So that's just two examples of the many, many different parts of the world that have these notions that have the nuanced understandings of gender. But what's really exciting is we no longer need to go to far flung places to get that sense because there's a growing understanding of this among the young people that we are serving. This is a poll last year that was conducted by Fusion of Millennials, ages 18 to 34. And they were asked, which of these statements do you agree with? There are only two genders, male and female, or genders of spectrum and some people fall outside conventional categories. The results were pretty surprising for many of us. 50% of 18 to 34-year-olds agreed with a statement that gender is a spectrum. Not everyone fits in one of two categories. And what we're going to see is only an increase in that number as we come to understand the complexity of gender. And these ideas are already starting to filter into aspects of popular culture. A couple years ago, Facebook decided with their equity and diversity committee that it was not okay to have a profile that allowed you to be male, female, transgender, or something else, or decline to state. They came up with 51 options, some of which are named there. And they were feeling great. They were on it until someone came along and said, but I'm 52. What about me? And they scrambled and said, you're right, we need to add some. But then someone came along and said, but I'm 59. I'm 137. I'm pi. I'm 1256.9134. And they said, you know what? Let's forget it. Let's do it this way. Let's have a pull-down menu that includes custom. And you tell us. You tell us who you are. Let us know who you are versus fit in these 58 boxes. You tell us who you are. So when we think about the profile of non-binary individuals, then we suddenly start to see a whole lot of complexity showing up, just several of which are named here. The upshot is we're talking about gender expansiveness, individuals who are expanding our notions of gender. And the reason I like this particular term is it puts the onus on us, not on the individual who is simply often being themselves. I'm reminded of a young trans teen who was on a panel that we held recently, actually not recently anymore, a while ago. And during the presentation, he said something effective. He was asked, well, when did you transition?  And he kind of paused and looked out at the audience and said, you just don't get it, do you? I've never transitioned. I've always been a guy. It's all of you who need to transition. You need to understand my experience. That's gender expansive, right? He was expanding our understandings. He wasn't doing anything except being who he was. The bottom line is each of us has the right to determine for ourselves the label that we choose, what that label means, and the right to ask others to please respect us and use it. I'm imagining there's many of you out there who identify as guys. I happen to identify as a guy. And yet we might use the same label, but what we mean by that label may be similar and may be vastly different. Right? Each of us has the right to gender self-determination, to personalize our gender, to make gender our own. Come back to a really distinct definition of gender. It's quite difficult. You know, for me, I think it is, it's a spectrum. Actually, it's probably not linear. It's probably circular. It's rather than sort of having a start and an end of male-female. It's probably spherical in terms of how many different variations that there are. And it's only when you try and articulate it that you have to say things like male and female. And that comes down to a restriction of language, really. And there could be a whole vocabulary invented around more appropriate ways to express gender identity. So if you think about it, we started here with the who's the dad. No, not that wasn't the question. What'd you have? That was the question. And we've ended here with a model that for sure takes a little more time, takes us a need to pause for a second and say, right, so what do you mean? It's not neat and clean. In fact, it could be messy sometimes. But that's gender. That recognizes the experience of everyone. One time, you know, someone asked one of my colleagues, how many genders are there then? And they said, well, there's basically one. It's human. And they said, no, no, no, scratch that. Actually, there's an infant number because every one of us has one. And that's what gender is all about. All of us having the right to be ourselves, to assert the meaning of the terms we use, and to ask others to simply respect that. And accept me for knowing my experience more than anyone else. So the punchline is a boy or girl. I don't know. It can't talk yet. So I'm going to stop there. Thank you very much. This framework will inform the rest of our day. So as Diane and Jen and our panel talk about these aspects of gender, we hope that you will continue to expand your understandings as well. So I'll take a break. We'll be back here, please, at 1040, 1015, 1015, 1015, 1015. Okay, thanks, everybody, for coming back on a timely basis. Again, we'll be breaking at 1130 for lunch. It'd be a good time to also network and look at the various tables out there. Diane Ironsaf, PhD, is an associate professor of pediatrics at the University of California, San Francisco, and developmental and clinical psychologist in the San Francisco Bay Area, with a private practice in Oakland, California. She is director of mental health and child adolescent gender center and chief psychologist at the child adolescent gender center clinic at UCSF, Benioff Children's Hospital. She specializes in research, clinical work, and consultations related to gender non-conforming children and assisted reproductive technology families, lecturing, publishing, serving as an expert and witness on both topics nationally and internationally. Dr. Ironsaf received her PhD from the University of Michigan, and has served as faculty at UCSF, University of California Berkeley, the Wright Institute, Psychoanalytical Institute of Northern California, and Access Institute, San Francisco. She is author of Gender Born, Gender Made, Mommy's Daddy's Donors, Sergots Building a Home Within, co-titled with Tony Heinemann, Spoiling Childhood, Parenting Together, and a forthcoming book, The Gender-Creative Child. Dr. Ironsaf is a founding member and senior clinician and board member of a home within a nationally organization addressing the emotional needs of children of foster care and serves on the board of directors of Gender Spectrum, a national organization addressing the needs of gender expansive children and their families. Please welcome Dr. Ironsaf. Well, I can't tell you how delighted I am to be here and to see everybody's face here, because it's because of all of you that we can be here doing what we're doing and we'll do more. And I want to thank everybody who is responsible for having me be here today. And I want to preface it by saying that some of the things I'll be talking about may sound completely repetitious of what you just heard from Joel, because we are like Tweedley D and Tweedley Dum, and we go to the beat of the same drum. So bear with any duplications, but I think it will underline how important we think the points are we want to make. So the first thing I want to introduce you to is Stuart Little. Now you may be wondering why Stuart Little? For those of you who know the story, Mr. and Mrs. Little gave birth to a mouse, Stuart. They were a little perplexed how to raise a mouse. And their doctor was very excited and said it's going to be really good. And they went, I'm not so sure. This can be a little difficult, but they did it. And among other things, they were very worried about Stuart's safety. So they removed the nursery rhyme from the book. They tore the page out three blind mice because they never wanted Stuart to worry that his tail was going to get cut off by the farmer's wife. Now I don't think E.B. White had any idea when he wrote this book in the 1940s that he was writing the allegory of the family who gives birth to a gender expansive child. And the only difference between the littles and families today or historically that give that have a gender expansive child in their midst is you often don't know the day they're born. You may find out in their first year, their second year, you may find out when they're 50. But the task is still the same. How do we support our little Stuart little? And that's what we're going to be talking about this morning in a developmental perspective on gender expansive children. Now the first thing I will say as you saw from Joel's talk is that we have an incredible change in what's happened around gender historically in our culture right now. It used to be bedrock for many people that still is. That's why we say what are you having a boy or a girl? Do you know? Now we have gender as moving boulders. We have created a shake up and what we define gender as being and how we're going to relate to all the genders in our culture. And what I will say about that is we have always had as we saw before historical shifts and shake ups in gender.  This was the typical attire for any child assigned male at birth until age seven. And this is true in Western Europe throughout the 19th century, sometimes into the early 20th century. So there we have boy in address. And now we have 2012. This is the pharmacy near my house. I went there shopping one day and I noticed this child and the mother referred to this child as he and this child if you can't tell is pilfering candy from a table that has candy on it.  And I live in Oakland. Nobody better than I. They just said oh hi. They didn't even notice he was pilfering candy. So then we have this was sent by a colleague of mine. This is her child in the toy department. I believe that toys are us. I mean that is a masochistic thing to do for any parent.  And then we have this is this was in the New York Times recently. So this is again the ambiguity around gender in 2016. And I'll tell you a story about history. We talked about at different times things have changed. So I would ask you those of you who are old enough. How many of you went to a grade school where girls were required to wear dresses. Quite a few of us. So now I want to bring us to 2000 about 2010. I'm explaining to my granddaughter who is then 10 how I grew up in Chicago and girls were required to wear dresses or skirts to school every day even if there was a blizzard. And my 10 year old granddaughter knowing I was a feminist looked at me and said grandma why didn't you protest. So around the social construct of gender in 2016 I'd be protesting. But we didn't think about it in 2010. It just was the way it was. So the first step in a new developmental model for understanding gender is we have to unlearn most everything we learned in school. So it goes like this. I started graduate school in 1968. My emphasis was gender development. And here's what I learned. You're born. You come out. The doctor and it was usually a doctor not a midwife at the time looks between your legs and goes boy or girl. And then in the first two years of life you learn your core gender identity. You learn in those first two years. I am boy. I am girl. That's your developmental task. If you were born what at that time was called hermaphroditic. Get it corrected right away surgically. And make sure that there's a clear assigned gender from then on because if you don't do it by 18 months at the latest 24 months you've already fixed a gender identity that can't be changed. So make sure you do it early because by two that sense I am a is fixed then. But it's kids don't think it's permanent. You can do some backsies on it. But they know I am boy I'm a girl maybe it'll change later but I know who I am ages two to six. Then you learn what it means to be boy what it means to be girl and there's nothing in between.  And that should be in place by the time you're six years old. If you were trained psychoanalyptically as I was we have a whole other drama here. Okay. That drama first of all you have a mother and a father heterosexual couple. They have a baby that's you.    So I'm going to give that parent up to dangerous. And instead I'm going to identify with the parent who's the same sex as I am and I'm going to learn how to do it. So when I get older I'll have my own spouse I'll find my own because that one's taken.   You know how to be a boy or a girl.  That was the developmental model and sex gender and sexuality were combined as one developmental track. If any of those things weren't in place. And if you were confused if you were a boy or a girl if you did believe there were some backsies on that you could change.  Get the to a therapist. Because you have a disorder. That's what I learned. That was the theory. That's the theory that a lot of mental health professionals today. Abide by. That is a big problem because if the theory is robust it has to apply to reality. This theory does not. It does not. First of all let's start with. Let me repeat what Joel said. Gender development and sexual identity development are two separate tracks. Secondly. There are many very healthy gay lesbian bisexual people. It is not disordered. It is healthy variation. Next your gender is not fixed at age six. We see people who change their gender over the course of their life both expressions and identity. With no spurs on their character. And with no spurs on their gender.  So what that means is gender isn't fixed at six. It's a lifelong process and it's not based on the sex assigned at birth. It may be. But let me ask you another question. Raise your hand if you are left handed. Look around everyone. There's not a lot of us. But we're very special. But in other generations we were not special. We were to be fixed.  And we are a healthy variation in human development. The same applies to gender. There are cisgender children. There are transgender children. There are gender expansive children. They're all healthy. So I just want to say we've got to throw this theory out. So that's fine. But what do we replace it with? So this is my idea of a model for thinking about gender and it's very consistent with Joel's has some variations. So we know we talked about gender boxes. Down with gender boxes boys in one, girls in the other, binary. Then we have the gender spectrum. Joel described to you the gender spectrum. It's an excellent way to think about gender and all its hues, colors, variations. But I wanted to go back to that notion of gender as a sphere with infinite possibilities. So I made up the idea of a gender web. That we have a three dimensional web. If you think of a web and a tree, it stretches in three dimensions. And everyone has their own unique gender web like a snowflake. And the gender web has three major threads. They've got the threads of nature, the threads of nurture, and the threads of culture. And now I'm going to break it down even more specifically.  Culture, the values, the ethics, the laws, the theories and the practices of a culture. All of you sitting here today have all of that infused in you if I ask you what's your gender? Now, we also, to get a little twilight Sony, we have a fourth dimension. And the fourth dimension is time. So each individual alters their gender web as they weave together nature, nurture, and culture over time, which means it's fluid throughout development. And I will say going back to the theory, what is true in that theory is by age two, children can know the gender. And for many people, it does remain stable in terms of our gender identities for the rest of our life, but not necessarily. So we always have to consider the time dimension. Now, the gender web, it's like snowflakes and it's also like fingerprints. So the way it's like fingerprints is every one of us has our own unique set of fingerprints. And they will stay with us from the moment we're born to the moment we die. And that's the one difference. Unlike fingerprints, gender webs are not fixed at birth and they're going to change over the course of your lifetime. So now where do parents come into each little child's gender web? The gender web is each child individual's personal creation. If the parents grab the thread from the child, they're going to mess up the child's gender web and they're going to leave that child feeling all tangled up. But if the parents facilitate the child weaving their own personal gender web, then that child's going to feel expansive, supported. Now, I want to tell you a little bit about labels. We talk about gender infinity and people in, but kids really like self labels. They like to create their own boxes. So these are not fixed boxes, but what I wanted to share with you are some of the self labels that the kids I've worked with have come up with. Now, I'm putting them all under the umbrella of gender non-conforming children. And I'm using that term for the following reason. The word conform in terms of language, we're talking about children who either do not conform to what people told them. They were supposed to be based on what's listed on their birth certificate for their sex, or they're not conforming to the cultural expectations of how to do gender. So underneath that umbrella, we have first our transgender children. Joel has already defined them. They're the children who say, I am not the gender you think I am. I am not another gender, but not that one. We have gender fluid children. And gender fluid children are either gender fluid across time. They may wave and weave their gender as they go, or in one moment they do a mosaic of gender that pulls in all the cultural tropes about boy, girl and other. So there's a gender fluidity. Then we have a whole group of kids who are the gender hybrids. And let me tell you how I came to that. I went to my waiting room to meet with a seven-year-old child whose parents asked me to see the child because they felt the child was confused about their gender. So I went, I got the child, and I saw a little boy in basketball shorts, basketball, tank top, basketball shoes, basketball socks to hear. So I welcomed the child into my office, and as soon as we closed the door, the child whipped around again and said, you see, I'm a Prius. She said, yes, I am a gender Prius. I am a boy in the front and a girl in the back. So we have the idea of a gender Prius, and that gave me the notion of hybrids, and then I started noticing different hybrids. The next is the gender tourist or gender minotaur, whichever you're interested in. And I am one thing on the top and the other on the bottom, and that's often for children to take care of their genitalia that say one thing about them, but their mind and everything else says something else. So they're often, and they'll come in and say, you see I'm a girl on the top but a boy in the bottom, and they love mermaids to play with. So if you're a therapist and you have toys in your office, make sure you have a mermaid, lots of them. Then we have gender by season. I feel comfortable and safe at home wearing my dresses. This is a child identifies as male, wears dresses all the time at home, but I'll never do it at school. It would be terrible to do it at school. So we have gender by season, free in the summer, constricted during the school year, and we can have the opposite. We can have an unaccepted family and an accepting school where the expression of wearing the dress will happen at school and be taken off to go home. And so in the summer, I go back to my boy self at school, I put on my dress. Then we have very similar gender by location. And gender by location is, honey, I don't think grandma's ready. So when we go to grandma's, I think we won't wear the dress. So that would be my location. And I wanted to tell you one that's in there towards the bottom. At our clinic, we had been using a scale that was one equals boy, ten equals girl, or the opposite. One boy, we put boy and girl in either way, but it was a one to ten scale. So we would ask a child, where do you rate yourself? If boy is here, girl is here, where would you put it? And the child said, we don't like the scale. Too linear. Let's not use it anymore. So we agreed as a clinic we weren't going to use it anymore. So I walked into see a child I had been seeing since this child was little. This child was now 11. And the child looked at me with great accusation and said, Dr. Rosenthal, forgot to give me the scale this time. So rather than explaining we're not using the scale anymore, I said I wanted to tell him I moved from a four to a six. Okay, well I'll make sure he knows. And then I decided it was time to tell him about the notion of a gender Prius. I said, well maybe, you know, let me tell you about this idea of a gender Prius. Maybe you're saying you're gender Prius. And this child stopped for a while thoughtfully and said, I think I'm moving towards a Tesla. So we have the all electric child. Which speaks to children are in motion. And that's the kind of transitions we're talking about. Not from male to female, but in development. How they're transitioning in their own development and how we're helping them do that. Now, we have gender ambidextrous children. And this came, this was with parents that I came up with this. These are two moms, they're both scientists. They had at that time a five-year-old who did not want to declare a gender. He said, don't ask me.  Parents said, look, we're scientists, we need an answer. We just need to know. So I did a long assessment and spent time with this child and came back and I said, okay, I'll tell you what I know. You have a gender ambidextrous child. Your child uses both hands. A male hand, a female hand. And they loved it. They said, great, that is scientific. We can tell it to other people. So we now have the new term gender ambidextrous that seems to have caught on for many families. Then we have gender smoothies. This was a teenager who was as gender creative as you will ever meet in a kid and said to me, let me tell you how it works. You take everything about gender. You stick it in the blender. You press the button. You have me. I am a gender smoothie. So we have gender smoothies. We have gender queer youth who would be saying, why are you bothering with this conference? We are so beyond gender. We're about being human. It's about time to stop talking about it. And that's not just individual kids, youth, and adults. It's a whole social movement. Then we have agender youth who also usually identify as gender queer. And agender means one of two things. I'm not any gender or I'm agender. So we have our agender youth.  Now I'm bringing sexuality back in. There are many children who explore their gender on their way to discovering their sexuality. And these are often the boys who are dragged into clinics for being effeminate. And it turns out they are going to be our healthy gay men if we just let them be. And it can come in any variety of gender. That's the most common way we see it. Then we have the opposite, which is proto transgender youth. And these are children youth who usually place themselves in a community of, well I'm sexual of either gay or lesbian community and discover, often through the romantic experiences, it doesn't fit. So for example, when I'm a girl with a girl being romantic, I'm a boy being with that girl. So they discover their transgender identity through their burgeoning sexual identity, which doesn't feel like a good fit. And then we have the last group, and this is the group that concerns us most as a mental health educational legal community and as families. And those are our gender tootsie roll pops. And the gender tootsie roll pops are one gender on the outside and another in the inside. And that usually means that they're keeping under wraps the real one and creating a candy coating on the outside to protect the inside one from harm. And these are the kids who are often at risk for anxiety, depression, self harm, school related problems, sexual acting out, and unfortunately a high rate of suicidality. So this is why I say we really have to pay attention to these kids who feel they need to protect their gender. Now there's another way in this developmental model to think about gender and it goes to the gender tootsie roll pop. And that way is that we have each of us has a true gender self. It's the core of us, it's how we know ourselves to be, and the kernel of it is there at birth. It doesn't stay there, but there's something there at birth. Then we have the false gender self. And that's the presentation we give to the world because that's what the world wants from us or we're afraid if we show the real one we'll get hurt. Then we have the most important thing, gender creativity. And that is the weaving together of a unique authentic gender self based on core feelings and chosen gender expressions. Every one of us has a true gender self, a false gender self, and some gender creativity we hope if it doesn't get squelched. Because occasionally we are adapting. So I'm going to give you a personal example so you can think of your own. I identify as cisgender. I was always a tomboy and a ballerina at the same time, but I was also very good in math. I went to a big public high school. If you ever saw the movie 16 Candles, that high school is my physical high school. That's where I went to school. And I was now in calculus, AP calculus. I was the only girl in the class. This was 1963. My mother always said, don't tell people your grades, you'll never get a date. I was heterosexual as well. I really wanted a date. So I was really self-conscious about going into my calculus class because everybody would know I was a geek. So I got this idea because there were really crowded halls passing between classes. So I stood in the doorway of my classroom and backed into my class because I felt everybody rushing by would just get a snapshot. They would just see me in the doorway and think I was leaving the algebra class rather than going into the calculus class.  And of course years later, I feel, I can't believe I did that. But I did. And that was my false tender self because I didn't want to be a girl who was good at math in certain contexts. I was fine when I was in the calculus room but not outside it. So we just think about the ways we protect how we do our gender all the time. Now let's bring back in the gender web. So the gender creativity is each child's personal artistry composing a unique, authentic gender web based on core feelings of gender identity and chosen gender expressions. Now, where do parents fit into gender creativity? Really important for anyone who is a parent or works with parents. Parents have very little control over their child's true gender identity. They can suppress it, but they can't make it happen. And they're often accused of making it happen. Why did you let your boy wear a dress? It's all your fault. It would be an accusation. They have very little control over core gender identity but where they do have extensive influence is over their child's gender health and the ability of their child to express themselves authentically about their gender. So we don't believe in pressuring the children when the time is right, they'll choose the appropriate gender. So it's the notion that it's up to the child, not up to them. Now I want to tell you this one story which in terms of parent facilitating, this is the story of Nils Pickard. So Nils Pickard is German. He and his family moved from Berlin to a small town and he had a five-year-old child identify his male who liked to wear dresses. It was okay in their progressive school in Berlin, but in the small town they were moving to, he thought this is going to be a little more complicated. And so his decision on the first day of school in their small town is he would put on a skirt and take his child to school in a dress. And so this is Nils with his child. This story went viral and Nils got voted and elected Father of the Year by Gawker. And I wanted to just read you the email that Nils had sent to me. Hi Diane, since I have up until now practically found no time to read all the stuff written about me wearing a skirt. I'm trying to catch up. I read about your lecture in Canada and you are using me as an example of supporting kids for what they are instead of what we want them to be. Well, what can I say? I'm touched. I'm just trying my best to provide my kids with all the space and understanding they need. If you're all for an equitable society and human rights, which I am, you have to teach your kids about different identities and ways of life. If I would support my boy in being the next big soccer star, no one would have even cared. But I supported him in wearing skirts and dresses. Wow, big thing. But what's the difference? Anyhow, I appreciate your work all the best. So these are the words of a father just supporting his child. Now I want to move to our model of care. This is a typical call we might get either at the clinic or in my private practice. Hi doctor, I came across your information while I was researching for my son. He recently just turned four and he wants to be a girl and is only drawn to girl toys closed for the past two years. We have not spoken with a professional doctor but wanted to reach out early and find ways we as parents can support him. Please let me know if you could help. Thank you. So just hold on to the request. And I want to now tell you that we have a controversy right now in the clinical field as to what would be the best model to approach this mother and help her. So I want to just break down the three major models that exist right now for care of gender non-conforming children. The first is called the live to live in your own skin and it's that approach and that's the model that had been used by Dr. Ken Zucker at the Center for Addiction and Mental Health in Toronto. For those of you who don't know, in December 2015 this clinic was closed for practicing below the standards of care and also in violation of the new statutes in Ontario which legislated against any forms of therapy that attempt to change either a child's gender identity or expressions. So this is the traditional model. It is used, you will find it in the Bay Area and it's basically that children do have a problem, young children and they're confused about their gender if they want to be the other gender or express themselves in accordance with what we call gender-appropriate behavior. And so we try to fix it and we try to fix it by taking away the inappropriate toys, replacing them with appropriate toys by finding same-sex friendships instead of those quote-unquote opposite-sex friendships by getting the parent of the same gender to be more closely involved and having the parent of the opposite gender that the child is identifying with step back and also individual psychotherapy for both the child and the parents and for the parents to figure out their conflicts and their inability to help shape their child's appropriate gender. That's the model. Okay, we don't like that model. The second model is the Dutch model and we owe so much to the Dutch in terms of a progressive form of treatment for gender non-conforming children and they introduced us to the use of puberty blockers to staunch the flow of puberty while children have more time to think about it or where children already know I don't want that puberty. And what they have in their model, however, is that for children who are pre-puberty, let's just do watchful waiting because we don't know yet till they reach puberty and they probably don't know either exactly what their gender is, so let's just support them and their gender expressions and wait till puberty and then if they still are insistent, consistent and persistent we would consider both the social transition and medical interventions. So it's a careful model and it's called watchful waiting. So that's model number two and there are many people who use this model. Now we come to the third model and this is the model we use at the UCSF gender clinic and I call it listen and act and this is also known as the gender affirmative model and I'm going to focus on this model and tell you more about it. So in this gender affirmative model here's our major premises. Gender variations, not disorders. Gender presentations, diverse, varied across cultures. We must have cultural sensitivity then to gender in all its cultural manifestations. Gender interweaving of biology, development and socialization, culture and context. Gender may be fluid, not necessarily binary. Pathology, if there is pathology for a child it's often related to interpersonal and cultural reactions to the child if it's present at all. Therefore, and this is what I want to start, pathology more likely lies in the culture rather than in the child. So it is the culture that needs to be fixed and the last thing we are discovering is that actually they used to think gender was the disease but we're discovering gender is the cure rather than the disease. Now, gender health. A use opportunity to live in the gender that feels most real and comfortable. A use ability to express gender with freedom for restriction, aspersion or rejection. Treatment goals, we want to facilitate an authentic gender self, alleviate gender stress, distress. We want to build gender resilience. That's incredibly important. How to meet up with the world with your authentic gender and we want to make sure we secure social supports. Essential therapeutic tenant. Not for us to tell but for the children to say. I'm not for us to say but for the children to tell. Usually I have the cartoon, it can't talk yet but we all love this cartoon so I'm not going to repeat the cartoon but it's right here. I just wanted to go back to the mother of the four-year-old to give you a sense of how this model works and this is a small print but I'll just go through it for you. These are the kind of questions we might be thinking about with this mother and whoever else are the parenting participants.  Has it been consistent over a period of time? If able to express a sense of their own gender how does your child articulate it with what feeling? Does your child say, and this is a really important one I want to be a boy girl other or do they say I am a boy girl other that want to be versus am. Important difference in verb. How insistent is your child in declarations and demonstrations of gender? How persistent? Does your child show distress or stress about the body they have? Is your child making serious statements rather than playful gestures when gravitating towards the toys, activities, dress codes, et cetera, typically designated for the other gender within your culture? Does your child express distress when someone quote unquote misgenders them? Does your child show delight when someone perceives them as the opposite gender of what most people know them to be? How do you as parents or other people in your child's life respond to your child's gender messages? So this is what we would just be opening up a conversation to learn more about. Now, we have a challenge here. We say if you listen the children will tell you who they are but how are we ever supposed to know what they're saying? They don't necessarily give you a narrative and tell you in words what they're thinking and feeling. So I just wanted to run through very quickly. This is what we as clinicians do. We listen. We just listen. We mirror. And that's really important. We try to reflect back to the child what we think the child is showing us to see if it is a correct mirror image or not because most of these children are being mis-meared. Nobody is mirroring back to them who they authentically are. We play with them. We get more out of play than words particularly with young children. We have to suspend ourselves in a state of not knowing. Parents do too. Educators do too. There's a period of time when none of us may know what this child's gender is. That going back to bedrock makes us nervous. So we have to work on that anxiety and just live with the excitement of not knowing. Now, this fancy term we monitor our counter-transference experiences that may distort our gender vision. In other words, all those personal experiences we have about gender like, ooh, I don't feel so comfortable about a boy in a dress. That's not going to help that boy in a dress. So we have to really monitor those feelings as they come up in us. We must have cultural sensitivity because gender is culture bound and we also have our universals about gender at the same time and we have to hold both. We must collaborate with parents, family, professionals, community and most importantly with the child. Now, these are some myths about the model I just told you about and they're, let me say it's hot and heavy right now. There are bullets flying in terms of lines in the sand about how to help gender non-conforming children. So, what is criticized?   Second myth, we push children to become transgender for our own political reasons with no science to support us. And I'll read you a quote that came from what I thought was a very disturbing op-ed piece in the Wall Street Journal by Deborah So. The silencing of those who oppose letting children make their own choices about gender sends the message to parents that early transitioning is the only valid and ethical approach to a gender dysphoric child. This message pushing children to transition at increasingly early ages so that they will fit neatly into one or two gender categories is false and unscientific. So, the reality, number one, we are not gender pushers. We listen with an ear to finding out what a youth's gender is, provide them with all the nutrients they need to live authentically in that gender. Two, we give it as long as it takes to find out with collaboration among the child, the family, and the professionals. Reality, we really believe in science. We like science. And here's something that I and a colleague of mine just wrote. So what does the emerging science say? It offers several important findings that the gender identity of transgender children is as deeply felt as that of cisgender, non-transgender children, that transgender youth are much less likely to attempt suicide with the strong support of their parents and that the well-being of youth who physically transition in puberty is on par with their cisgender counterparts of the same age 10 years later. It is out of direct recognition of the scientific findings that dozens of new clinic affirming transgender children and their families have been established. The only change added I made on that is that the gender identity of the young children is much less likely to attempt suicide with the strong support of their parents and their families. Now, we have this other clinical controversy. How can a young child know their gender? Now, I'm going to start by saying remember the theory I told you? By age six, you're supposed to know your gender? So why is that true only for cisgender children and not for transgender children? You cannot have it both ways. You receive a gender diagnosis early in life and persist with that diagnosis into adolescence. De-sisters, the young children will receive a gender diagnosis early in life and no longer have that diagnosis by puberty. The majority of children in clinical studies have proven to be de-sisters. The most recent finding, 63%, it's usually quoted as an 85%. So here's the question. How could we possibly sort out the persisters and de-sisters early in life? And if we can't, how could we allow young children to transition from one gender to another which is an option for pre-puberty of children? Why would we care? Because children have better mental health outcomes if we recognize them for the gender they are rather than the gender we think they should be. Now, I'm going to introduce you to apples, oranges and fruit salad. And when I read the persister-de-sister research, I thought, oh my God, we're talking about apples and oranges. Don't they see that? And so I've come up with some categories which I'm now going to share with you. That we have some youth who will be exploring or affirming their gender identity. Those are apples. We have some youth who will be exploring or affirming their gender expressions. Those are oranges. And we have some youth who will be exploring or affirming both. And those are fruit salads. So let's go to, first, what are the general studies concentrate on measures of gender dysphoria in the past gender identity dysphoria? They fail to highlight the two more critical variables. What's a child's gender identity? Just mutually. How do they identify? And what is the child's gender expressions? And let's both, let's look at them and separate them. So to separate apples, oranges and fruit salad, we have to separate gender identity from expressions. So to separate gender identity who I know myself to be at my core, gender expressions, how I do my gender, how I put my gender presentation together. So first step, how to tell if a toy is for boys or girls, do you operate the toy with your genitalia? Yes, it's not for children. No, it is for either boys or girls. And I will simply add to that or children of any gender. But since I didn't make this up, I'm using it as is. And there we have it in terms of toys are human toys or they're x-rated toys. Now let's go to our apples. These are the children who often show up in the gender, child gender research as the persisters. And their cross-gender and their identifications early in life continue on the same track into puberty, into and beyond puberty. So these are the consistent, persistent kids about their identities. Okay? Typically they'll say I am a rather than I wish I wasn't. And these are just guidelines. It's not universally true because sometimes by age 3 kids know we don't speak of such things so I'll soften it. I won't say I am a, but I'll do a false gender self and say well maybe kind of I thought maybe I would like to someday. They may express a lot of body dysphoria. They do this as little kids. Puberty. Puberty around the trauma of a changing body. Little kids.   I hate what I have. Why did God get it wrong? Can we go back in and can I come out the right way? Now, for these kids, the gender explorations typically don't present as child's play but serious work. And I will say that many of these children, let's just take a signed male at birth child. That child probably will not be wearing princess dresses but his sisters borrow his sisters clothes. In other words they just want regular girl clothes not costumes. So you're looking for that as something that's not play but expression of daily life and how I want to look. Not always true but it's something to look for. The nature thread of their gender web is often quite strong. So many parents say to me this child just came to me that way. So the question is how did they come? And we're seeing indeed strong biological, genetic and intrauterine influences on gender identity. These are our youngest cohort of transgender people. And here we have an apple. Now I particularly chose this apple because she's from the Netherlands. And what's happening in the Netherlands is although it's a watchful waiting model that dominates the scene families aren't abiding by it and they're simply allowing their children to transition prior to coming to the clinic for services. So this is one of our apples from the Netherlands. Then we have the oranges. These are the children who often show up as the de-sisters and they usually don't repudiate their assigned natal sex but they may say I wish I was a.  They don't tend to repudiate their bodies but they sure can engage in fantasy play or ruminations about life in another body. I had I worked with one girl whose mother was a physician and she got a hold of her mother's surgical gloves and basically made penises out of them and brought them and she packed and then she brought them to school and passed them out to all her friends. So all the girls in school were walking around with packed penises made from surgical gloves in fourth grade and everybody was having a great time but she loved having her penis but she also liked vagina. So this was play. The explorations are more likely in the realm of gender expressions rather than core gender identities and for these kids what we see is nature, nurture and culture are all very strong threads. So we have a little kind of promotion of my books. This is the cover of Gender Born Gender Made that's an orange and this is the cover of my new book Another Orange. So this is a child who's playing with gender expressions so we have two oranges here. Now we go to our fruit salads and I started out with apples and oranges and realized I have to add fruit salads. Somebody said you shouldn't use that fruit is really a derogatory term and usually refers to effeminate men and gay men and I said okay I'm appropriating the term just like we appropriated queer I'm appropriating fruit then so we have our fruit salads and these are children and adults who are a tapestry of self neither male nor female creative understanding of gender both in identities and expressions. These children typically resist gender boxes often live in gender middle grounds no either or but instead all in any they often will identify as a gender, pan gender, gender fluid gender queer children and youth and recently I would say that the culture thread of the gender web is showing up to be very strong and opening up the doors for fruit salads and that children are very influenced by the new notion of gender infinity as we saw in the statistics that 50% of youth don't think there's just two genders and particularly in adolescence if we think adolescence and our culture is about identity exploration we've now thrown gender into the hopper for kids to explore their gender and wonder what that is along with their political affiliations, their religion, etc. Here we have a fruit salad and this is somebody who identifies as a gender now apples what should we do for our apples and if we rule out other possibilities that gender might be a symptom of something other than gender and if we find out the essential issue is gender identity, not gender expressions when the child or youth expresses a need or a desire to transition when the parents or the caregiving environment can offer positive support for the child transitioning then we consider a social transition either everywhere or in safe situations what about our oranges if the issues gender expression not core gender identity then we carve out space and support for the youth to express gender in the way that suits the youth not the way that suits society no social gender transition of identity is called for what about the fruit salads they're a melange some may request or benefit from a gender transition but not necessarily a binary one others are fine with the sex assigned on the birth certificate but redefine what that means and then we stretch our thinking to consider a pan gender a gender third fourth and so forth gender identity what if they change their minds that's the thing that comes up all the time what if they change their minds well then we help them spin together their gender web as they know it now there are no data to indicate that children who change their gender more than once over time including switching back from trans gender to their original gender are at risk for any psychological disturbances as long as we support them in that journey now guidelines for all these children listen to the child, help the child discover the gender position that feels most authentic fortify that child's gender resilience remember gender does not lie between your legs but between your ears in your mind and your brain always keep in mind that penis does not necessarily equal male and vagina does not necessarily equal female I'll add all other sexually defined organs make no attempt to ward off a transgender or gender non-conforming outcome including transitions in pre-puberty children first step in affirming a child's gender is that before looking inside the child take a look inside yourself I'm just reiterating what Joel said at the very beginning of his talk but I want you to think about this we all have gender angels we all do and those are the feelings we learn that help us recognize gender and all the variations we allow us to promote gender health facilitates gender acceptance so call on your gender angels however we all have gender ghosts and these are the things you were taught that come together in beliefs, attitudes, feelings, reactions and they may be unconscious or subconscious they tell you things like gender non-conforming people are really sick or we have to police gender if it doesn't come in two boxes transgender boys and men are not real males transgender girls and women are not real females you can't just live in the middle or say you're neither male or female it doesn't work that way fill in the blank now there's a war of the world between our gender angels and gender ghosts we have both typically they're in conflict with each other our tasks let the gender angels drown out the voices of the gender ghosts how self-examination, self-reflection feedback from those around you why should you bother because anything else is going to cause harm not just to the children but to the families and to the institutions those children reside in not to mention the entire society now to do that beware gender microaggressions they're little pings they're the little things that happen every day to minority populations and gender non-conforming transgender youth and young adults count as such a group if you add up microaggressions they can even cause a tremendous trauma so examples refusal to use correct pronouns constantly slipping forgetting to keep using the correct gender pronoun refusal to use a used preferred name this is particularly important in schools and families both asking someone what's between their legs running out of the bathroom if you see a transgender youth walk in standing by passively when someone is making fun of a youth's gender making jokes about transgender people are not intervening when someone else does another slight one not here is just a little bit of a flick of your eyes even when you see a boy walk in your office wearing a dress it sometimes happens now to be a gender ally you're going to try to eliminate your gender ghosts build a firewall around them so they don't get out and hurt our gender creative youth and you're going to fashion yourself as a full length mirror no one wants to look in a mirror and discover they're invisible so the best gift you can give a gender non-conforming youth is reflect back the authentic positive image of who they are through your words, your actions, feelings when it comes to gender gender is as real as yours and mine and as real as it gets so no gender specialist is an island so therefore you need an interdisciplinary model of care at our clinic we have it, we have a pediatric endocrinologist, a nurse practitioner social worker, psychologist educator, advocate and an attorney so without this whole team we can't meet our treatment goals that we can so I would say it takes a village to support one gender non-conforming child and certainly to support all of our gender non-conforming people who live among us so it's the youth, the family friends, religious leaders educators, mental health professionals medical professionals attorneys, judges, lawmakers legislators and I want to finish with letting the youth speak to one of our patients at the UCF gender clinic when this patient was nine and at age eight this child transitioned from male to female and here was the question what would you do if someone told you that now it was time to go back to living as a boy the emphatic response I'd take him to court and then there was a pause or I can take me to court so I want you to think about that as gender non-conforming children enter your life now I think I finished in time so that we can have I wanted to leave some time for any questions that people might have because we have a little less than 50 minutes so are there any questions or comments that people would like to make yes I definitely will repeat the question and could people stand when they ask the questions I don't think we have a roving mic we do yes we have a roving mic our mic is about to rove where are you stand up and can you stand up what are some words that you use to explain gender to a three, four and five year old so my daughter asks a lot of questions about gender expression and identity without knowing what she's asking but I don't quite have the language to talk to her about it not necessarily for herself but for people who she sees so she's asking about is that a boy is that a girl what does it mean to be a girl is it because they have a penis is it because they have a vagina and I don't quite know how to use gender and I want to so we have transgendered family etc but if you have any words of wisdom for that well I have a few words of wisdom first of all in terms of the question is that a boy or is that a girl I would say you know we don't know we'll have to ask them so that would be the start that only they know for sure so but we can like to be asked some people don't but I would say I would explain the different some people think because by 2 or 3 you're learning, some people think if you have a penis then you're a boy and if you have a vagina you're a girl but actually it's not like that it's not like that at all if you're a boy your mind is telling you I'm a boy, if you're a girl it's because your mind is telling you you're a girl and some girls like to wear dresses and some girls like to dress as Darth Vader so that's not those are people things but there are some people where we live who think one thing is a boy thing and one thing is a girl thing so there is a teaching moment there because I'm studying our culture kids by 3 know their culture and gender socialization starts at 2 so we have to sometimes unsocialize those messages with new messages and then then the next thing is some people think there's only 2 genders but there's lots and lots of genders it's just like a rainbow has all different colors and then I'd stop there because it's almost way too many words already for a 3 year old but I would stop and see what dialogue comes from that so I don't know if that's a helpful start and you still, I mean a 3 year old say yeah I know but is that a boy or a girl so and then you say that's really complicated rather than it's simple because I think it's good to send the message that it's a really good question and we have to put a whole lot of things together to get the answer hello, oh there we go I know that this is a whole other symposium question but could you speak a little bit to gender identity and expression and neurodiversity and to get, because we need to talk about that thanks I could talk about that for hours but I only have a minute or so so the question is about neurodiversity and gender identity, gender expressions so many of you will know neurodiversity as being on the spectrum and not the gender spectrum but the ASD spectrum that to have received a diagnosis of Asperger's of autism at some level here's what we know scientifically we know there is a significant correlation between neurodiversity and gender nonconformity either in expressions or identity so for example in the Dutch clinic there is a much higher incidence of kids who did have an ASD diagnosis who entered the gender clinic then in the general Dutch population it is absolutely true in my office so it is a reality and the big problem around when it's gender and something else is so many people doctors, parents teachers will say well it's just a symptom of the neurodiversity you know there's obsessions and there's just like an obsession now with gender and it is a phase it's a passing obsession so we need not take it seriously we need to take it very seriously it is most likely a core part of the person and one that may not present in the way it would present in somebody who does not have the experience of being neurodiverse but neurotypical and here's an example one of the qualities of being neurodiverse is A, you may not read social cues or you may be impervious to social policing so you go to the beat of your own drum so I've had several young people who have said I'm transgender and I said well how will that make you different? Not in any way whatsoever so the notion of how you do your gender may be very idiosyncratic but that does not negate the core gender identity for example of being trans so I may not want to take any medications I may not want to even change my wardrobe I may want to change my name and my pronoun but this is where the meaning of gender is so critical to explore and I will give you an example of what you have to sort out Yes, gender for any child can be a solution to another set of problems so there have been a number of youth I've worked with who have been diagnosed as neurodiverse who have come up with solutions so for example one 10th grader came to me urgently wanting to transition from male to female had no signs before of any gender nonconformity but was desperate to make friends and at the school this youth attended girls made friends better than boys ergo if I become a girl I'll have friends so make me a girl so I can have friends so we worked on friendships and that seemed to really help and the gender urgency went down so we do have to sort it can be complicated but it's complicated for any child we're doing the same thing for any child but I do want to say I get many calls saying I have a child that's coming in saying they're transgender but they're on the spectrum autism spectrum so I'm going to discount it doing that is very very authentic in the majority of the cases we have some theories about it it may have to do with intrauterine environment it may have to do with the same part of the brain that's affecting both in terms of brain messages and I do want to say about that some people think there's a boy brain and a girl brain there isn't all of our brains are mosaics however we're talking about messages from the brain about our gender when we say gender is between our ears not between our legs we're not talking about boy brains and girl brains we're talking about messages about what gender we are and it's very important to separate that out as well so a very strong message that you've been that people have been talking about this morning is listening to the child and letting them tell us so I'm just wondering if there are recommendations for pre-verbal children so between the ages of one and two what are the recommendations of how to approach the topics that we're talking about today okay so the question is what about the kids between one and two who are just developing language or may not even have it yet they're very action oriented so and in that at that time this is where mirroring is really important and listening to actions so let me give you an example I have a colleague who's transgender and there is a video of him as a toddler so he was assigned female at birth there is a video of him as a toddler tearing barrettes out of then her hair and throwing them on the ground and sobbing that's a gender message and when it happens not just once or twice or three times that's a gender message sometimes kids between the age of one and two with beginning language will say I boy when you say girl those two words I boy that's not a pre-verbal but an early verbal message it's and sometimes there is an urge the tendency to say well honey no you're a girl because little girls have vaginas and you have a vagina so you're a girl and then when they get a little older you hear them say did you not listen to me I said I am a boy with a vagina but they can't say that between one and two but they can show you about what they want to play with and if they feel uncomfortable about how you are responding to them and their gender if you're misgendering them so you look for those kinds of actions like tearing a skirt off there was one I think this was in the Barbara Walters special where this child wore the little onesies with snap ups in between the legs and at age one would unsnap them to make a dress and have the dress flow this was a child who was a sign male that's a communication a pre-verbal communication about gender and the message back should not be to negate any of those expressions but to go with them and see where they go so that's my sense about the one to two year old and children will know as early as the beginning of the second year of life they probably know before but they're really pre-verbal but you can always be a Monday morning quarterback and go back and see things that gave you some indication I hope that's helpful in terms of the one to two year olds and we have I think time for one more question yes I have a question over here where are you right here keep looking over my question is about the pervasive influence of social media on the whole gender expression and gender issues that social media that our youth are dealing with almost every moment of every day okay so the question is about social media and I would like to quote Charles Dickens this is the best of world times this is the worst of times social media has been a godsend for transgender gender non-conforming youth particularly in isolated areas where they can connect with other people and don't feel like they're all alone in this and collect information and learn and get language about who they are one on the other hand social media can be condemning vitriolic against transgender people and that is incredibly harmful including unfortunately we do have some incidents followed by suicides particularly in terms of what I will call social media battering of transgender youth when it goes viral so what we want to do is preserve the good get rid of the bad and really celebrate social media as a tremendous boom while at the same time doing everything we can to keep the harmful parts out and recognize that and to legislate against any bullying harassment that happens to social media and I'll add one last thing there's one problem with social media I do think it's really opened up a lot when I said the cultural component of fruit salads social media is part of that I have many kids who come to me and they come because they want the letter they want hormones often and they will say exactly what they they'll tell me here's who I am and here's what I want and I'll listen I'll I've heard this before I know I've heard this before I've read it before they pulled it off the internet they memorized the script and they're giving the script so it's not they're not telling me their story they're telling me a story so my job is to find out whether it's also but so I would say you may hear that kind of scripting don't dismiss it but don't stop with it either but go below it to find out what it means for that particular youth so on that note I think I will stop and say oh I'm I'm supposed to remind you all if you have questions either from Joel's presentation or mine the basket is here so just drop them in the basket so we'll make sure that we have them later thank you okay welcome back everybody thank you very much if you can hear my voice right now clap once okay Joel taught me this trick if you can hear my voice now clap twice thank you and if you can hear my voice now clap three times okay so just a reminder questions in the question basket panel discussion at the end of the day will include our presenters as well as other local family folks and now I'd just like to go ahead and reboot Joel Baum thank you thank you so much so again welcome back what an amazing day Diane Ehrensaft everyone right I mean amazing Diane happens to be on our organization's board so I'm a little not all objective but I don't think that has anything to do with how great it is so Diane thank you for that so what I want to do next is talk a little bit about this idea of gender inclusive schools and as you heard Diane talk about there are so many different factors that go into the affirmation of a young person's gender at the Child and Adolescent Gender Center we often talk about our families and young people being like on a table right imagine them just sitting on a table and most tables have four legs and if one of those legs doesn't work of course the table tips over and the kids fall off our legs happen to be medical legal mental health and education and we know that education is one of the places that so much plays out when it comes to gender and so we're going to take the next hour or so just to talk about what schools can do to create spaces that honor the gender diversity of young people just to remind you about Gender Spectrum's mission and now I'm going to talk a little bit more about it because not only does our mission inform the work we do at schools but the way we try to achieve that mission is very much part and parcel with how schools often need to approach this work so this notion of creating gender inclusive environments for all young people is at the heart of our work we do that in a number of ways we provide a lot of direct support to families and caregivers we're part of what we like to call the gender discourse we're trying to participate and be thought leaders in the ways that we're thinking about gender for all children and youth and their caregivers we also hold a conference every summer and I want to encourage many of you to consider attending it's an incredible weekend one of the most exhilarating weekends that you'll attend it's just amazing there's a full day professionals there's this symposium that has some 30 or 40 different workshops across all different fields then on Saturday and Sunday the 9th and 10th there's a family gathering that many professionals also come to in many ways Friday's all about the head and Saturday and Sunday's all about the heart and you meet these families there's programming for kids literally from the age of zero to through high school there's a programming for parents there's another documents clinic it's a pretty amazing gathering so please consider attending and or volunteering because like this event it doesn't happen without an amazing team of volunteers but the core of our work is really education and training work focused on supporting institutions around gender and young people that's institutions really of every kind that does work with those groups but schools is sort of our sweet spot if you will over the last 10 years or so we've been able to work in schools of every shape and size all over the country and even beyond and over that time we've learned some really amazing lessons from schools doing incredible work we've refined our own approaches and are now working in a way that is entirely focused on building capacity in schools to own this work is super contextual and as we do our work there's really three important ideas that we ask people to know about us one, we believe in the importance of meeting people where they are as we've talked about now quite a bit we're all over the map when it comes to our own experiences with gender and it would be very easy and I've unfortunately seen organizations similar to ours come in with a somewhat judgmental stance for individuals who don't get it that aren't down with the work and I just don't have a lot of patience for that quite frankly because I believe that most people are where they're at and certainly when it comes to schools care deeply about children and youth want kids to be happy and successful but sometimes don't have all the information to do it and so we really try this idea a friend of mine once said you know it's okay not to know but once you know you can't not know and then you gotta decide what you're gonna do about it and as an educator myself we're in the not knowing business right that's great not knowing is awesome um learning is great someone approached me at the break and said you know I'm a doctor and we birth babies and we gotta call them something are we doing something wrong if we call them a boy or girls like Neil deGrasse Tyson just chill out just let things be what they are of course you're gonna call that baby something but be prepared to be wrong that's all being wrong is awesome because you learn things um I'm an NPR nerd and Neil deGrasse Tyson happened to be on wait wait don't tell me and they did this whole series of questions about something completely silly and he got two of them wrong and the host was like oh I'm really embarrassed but you're wrong and I don't want to tell you wrong he goes don't worry no it's great I learned two things today right being wrong is okay just be prepared to be wrong when you make those judgments the second thing is that we really acknowledge intersectionality so as we think about gender as a concept we're talking very specifically um however when we think about real kids or real communities real schools we have to zoom all the way out and think about the entire constellation of identities that are at play there religion race socioeconomics region uh linguistic patterns you know ethic uh background and a million and other a million and one other contextual aspects that both are informed by and influenced by the gender of the people in them and also significantly inform the gender uh of the young people themselves um the other thing I wanted to share before I share this last last principle my background is as you heard from from Josh earlier is as an educator I was a middle school science teacher for a number of years uh some friends of mine said that I was demoted to some administrative positions um you know the dark side I was a site leader for for many more years um moved into some district leadership did some school reform work and I share that background for a couple reasons when I am proud of my career as an educator um I think being an educator is awesome um and I also like to share that because when I worked at sites quite frankly I hated it when people like me showed up um uh I felt like they had never done my job you know but were more than happy to tell me my business um we all went to school after all so we're all experts right well we've all been to the doctor too um but I would not want me prescribing medicine to any of you right um and so that notion of having worked in schools for us is really important because we hope we're credible we hope when we're talking about the work in schools it's not coming from this sort of ivory tower of this is what you should do even though I've never actually done your job right I've never had to decide if that kid really needs to go to the bathroom or are they just bored right and I have to decide right I never had to call a parent and talk to them about their child's behavior the other thing though about my background is a very quick story my very first day as an educator like many was as a student teacher and I'd been assigned to Chipman Middle School in Alameda California and my master teacher was a woman named Jane Vartanian now Jane had been teaching for years um she actually described herself as being older than dirt that's how she liked to talk about herself and um she actually retired the year that I was her student teacher I don't think they were connected I really don't I think she had planned to retire long and I actually was lucky enough to get her job so I was you know it was great but but I remember I come in it's August when professional development's going on and I've just finished my degree in zoology I have eighth grade science oh Jane it's great to meet you these eighth graders this year they're gonna the wonders of the universe photosynthesis and the periodic table and the difference between cosmology and cosmetology and why it matters and and so I'm going on and on and Jane she all she had these little photos and she always wore this white lab coat right so she's standing across from the the chemical table this is when we weren't being so good about where chemicals were stored and um so she's got her hands in her lab coat and she's looking to be like oh look at you aren't you just cute aren't you so cute with all your enthusiasm um and when I finally took a breath she said something to the effect of well you know Joe that's all well and good but here's the deal our first job is to send these kids home in one piece every single day and if we can do that we will teach them some science along the way I'm very confident in that but we're responsible for these kids right and I remember like wait what it's not about my lesson plan and me and my you know and and they have you mean there's things besides eighth grade science there's English and math and oh yeah and there's our whole lives later on in some dumb graduate course we learn the phrase protective agent educator as protective agent the notion of as educators and I consider any adult on a school campus to be an educator we have a responsibility to take care of the health and well-being of the young people we're privileged to serve and I take that very seriously it also informs the work of gender spectrum um and I take that very seriously for a couple reasons one I have kids myself and I want them healthy and well well-being um but I also I went to Berkeley but I am not a kumbaya kind of guy um you know I mean yeah I want people to feel good but kids learn better when they're safe when they're seen and protective agents make sure kids are safe and are seen and that's the notion that we're trying to work here when it comes to our work in schools the last thing I want to share with you is that this work focuses on all kids we spent a lot of time today talking about transgender youth gender expansive youth, Priuses, Tauruses you know an incredible constellation of individuals who fit that sort of gender expansive uh uh label or frame but the work we're about is actually about every child right it's not uncommon for us to get a call like this hello gender spectrum yeah I'm the principal at such and such and I think we got one you know one of those transgender kids can you help us and our response is always the same which is for sure we would love to collaborate with you to you know support this young person but it can't just be about that young person because if it is all you're doing is putting out a fire you're solving a problem and you're not actually creating conditions that are going to support that child and every other child now to myself I'm also saying and I wish you had a time machine because it would have been great if you had already talked about gender before this young person crossed your threshold because gender as I've been saying impacts every student and what we do when we create gender inclusive schools is help every child's gender be recognized, affirmed so that when any kid comes in and their gender is somehow not consistent with what people are expecting there's suddenly a schema that they can employ to understand that child's gender and support it so I'm going to start here with actually students and the voices of students talking about their own experiences with gender and I'm hoping our sound person is going to make the volume go up when oh good hi thanks I didn't see over there thanks and these are just young people talking about gender and then after we're done with that we'll talk about schools take a look I think let's try that again I still think it could happen like maybe in our lifetime that they wouldn't be called girl things or boy things they would just be called normal things I think gender is kind of like a spectrum and different people are on different levels of the spectrum so there's male on one end and female on the other end and not everyone is you know a male or female everyone's just kind of in between and that's what kind of makes it beautiful the fact that we're all just different people and we're all different areas on the spectrum but it's all just one big rainbow none of the people I care about none of my friends and certainly not him never said or did anything to make me feel like my style dress was wrong there was this thing that had been ingrained in me through years of getting teased and years of getting looked at strangely that said that you are not a girl unless you dress like a girl unless your clothes all come from the department that says girl unless your jeans are tight unless it was it was insane and it really hurt and I'm really happy I managed to get through it and be more okay with when I feel like dressing more masculine and when I feel like dressing more feminine but it was very scary and I even started to feel am I even supposed to be a girl maybe I'm supposed to be a guy because everyone's saying that if you dress like this you're a guy you're gay I don't know it was very frightening I'm glad to see people who are willing to come here and tell people that that's not who I am none of us have to be identified by the way we dress it doesn't mean anything that's the way we dress gender means to me now something completely different since I've had my daughter before growing up it was always male or female to me now it's not just black or white there is that little gray area which to me is more of a rainbow and she has taught me so much that I really just don't believe that gender should be labeled anymore it's almost just an expression a personal expression what do you think? gender is a happy thing gender is a happy thing I agree with that there is a broad spectrum I think society likes to tell us that it's one that you're a boy or a girl and I think it's a broad spectrum and I think everybody has to agree the both or neither or everything and you can be a boy and you can come in things I think there are so many aspects to it that it's a lot more complicated than a lot of people say it well if another kid was teasing someone else for being like if they're a boy and the boy says he's a girl and somebody teased him for that if I what I would do is just leave it alone but now if we talk about it I would go up and like I would talk to the other person that's talking about the person that's being bullied or something and I'll tell them like there's nothing wrong with doing that because people are who they are and they're who they think they are and there's nothing wrong with that gender is something that is really important so like everybody should follow so it's like you were born this way you have to play with this stuff and you were born this way and you have to act like this and play with this and I don't feel like it's relevant anymore in this world we've got so many people or 7 million people why should people fit into two different categories that's boring indeed so sometimes get told kids are too young to be talking about this they're talking about it we might as well contribute to the conversation because they're already talking about it and as we've heard very clearly this morning kids know what the deal is with gender and how they're supposed to be performing it I would argue schools not only need to or should be they must help facilitate that dialogue because they have a lot to say about how kids are going to feel about their gender the other thing though is those clips demonstrate what happens when schools create opportunities for kids to talk about gender when they create the conditions in which young people are able to articulate their own experiences we sometimes just need to get out of the way and listen to them and they will do a lot of our work when we talk about gender inclusive schools I love one of the things Diane mentioned earlier about kids and being invisible there's a great quote I want to start with about gender inclusive schools and what they do that borrows from that that quote of children and students looking into the mirror of their schools and not seeing themselves is what gender inclusive schools are all about gender inclusive schools are schools in which students see their experiences reflected in the day to day operations of the school does that mean they're talking about gender all the time? no does that mean they're talking about it some of the time? yeah probably but what it means is it says we recognize there are lots more experiences out there than maybe any other place recognizes on this campus in our hands we got you and you're going to be okay and we're going to make sure you're okay it's really really important for these schools to be thinking about how they're doing that raise your hand if you're a classroom teacher in here raise your hand if you work on a school site in some way yeah, right on absolutely I want to when I do trainings at schools one of the questions I love to ask is who's looking for more to teach right? yeah not a lot of hands going up on that one we know that it can't be something where it's like this kind of one off that gender has to be integrated and this model that I mentioned earlier is based on some underlying assumptions of what schools are communicating they communicate that all kids are being impacted by gender and gender expansive kids are particularly impacted as well they recognize that focusing on gender is actually climate work that it's creating conditions for learning for every child and they recognize that gender can be a wonderful on-ramp to work related to other forms of difference just last week I was at a wonderful conference in Dallas called time to thrive and there were several people who approached us and were talking about how their work in gender had allowed them to start having some incredible conversations about race and about learning styles and that it was the ability for kids to sort of dip their toe in the water around gender issues that now has them feeling more comfortable raising well here's my experience with race and here's what I need you to know about my experience and these schools do certain things they recognize that gender does impact all kids and they begin to work and interrupt binary notions these schools also do a great job of normalizing gender diversity while honoring the gender of everyone they question limited portrayals of gender they support processes of reflection about gender and a whole lot more and finally they teach empathy and respect as part of their work really what we know of the schools we've worked with how they do it really looks different but if they do it is never in question gender inclusive schools ask how not if now I wanted to share with you just a couple of resources before I really get into this but one is we've got on our website something called our gender inclusive schools toolkit and much of the the work related to that and the gender 101 and many of the tools that we're going to talk about are in there and I just want to let you know that is a resource available and I also wanted to share a document called schools in transition that was released last fall that we were able to co-author with s