A protester holds an American flag and rainbow flag in front of the Miami-Dade Courthouse to show his support of the LGBTQ couples inside the courthouse were asking the state of Florida to recognize their marriage on July 2, 2014 in Miami, Florida.

A protester holds an American flag and rainbow flag in front of the Miami-Dade Courthouse to show his support of the LGBTQ couples inside the courthouse were asking the state of Florida to recognize their marriage on July 2, 2014 in Miami, Florida.

Throughout history, there have always been people who defied gender norms. In the nineteen-fifties, Americans met Christine Jorgensen, a soldier who was born a man but was determined to live her life as a woman. In the decades that followed, a transformation in understanding and defining transgender people has taken place. Last year, psychiatry’s diagnostic manual replaced gender identity disorder with gender dysphoria. Medicare now covers sex-change surgery. And a new California law requires schools to allow students to use facilities and join sports teams that match their gender identity. Understanding transgender people and their struggle for civil rights and acceptance in American society.


  • Mara Keisling Founding executive director, National Center for Transgender Equality. Mara is a transgender-identified woman and a parent.
  • Katy Steinmetz Reporter, TIME magazine
  • Aidan Key Gender specialist, Gender Diversity group; works with public and private schools K-12 to create gender-inclusive learning environments, identify measures to decrease bullying, and provide assistance with gender-transitioning students or employees
  • Dr. Julie Eastin, Ph.D. Director, Behavioral Health Mt. Vernon at Chase Brexton Health Care, Inc.


  • 11:06:53

    MS. DIANE REHMThanks for joining us. I'm Diane Rehm. More than one and a half million Americans identify themselves as transgender. They describe a painful mismatch between their biological gender at birth and the gender with which they identify. This long misunderstood minority is emerging from the sidelines following a string of victories at the federal and state levels.

  • 11:07:24

    MS. DIANE REHMEighteen states have passed nondiscrimination measures that include gender identity. Joining me to talk about being transgender in America today, Mara Keisling of the National Center For Transgender Equality and Dr. Julie Eastin of Chase Brexton Health Care. Joining us from member station KQED in San Francisco, Katy Steinmetz of TIME magazine.

  • 11:07:57

    MS. DIANE REHMI'm sure many of you will want to chime in today. Give us a call at 800-433-8850. Send us an email to drshow@wamu.org. Follow us on Facebook or send us a tweet. Welcome to all of you.

  • 11:08:18


  • 11:08:20

    MS. MARA KEISLINGIt's so wonderful to be here.

  • 11:08:20

    MS. KATY STEINMETZThank you.

  • 11:08:21

    REHMGood to have you all here. And Dr. Eastin, I'll start with you. Talk about what it means to be transgender.

  • 11:08:33

    EASTINHum. Well, so the perspective I'll be giving on that is that I'm a clinician. I'm a director of behavioral health service at Chase Brexton Health Care where we serve a lot of the LGBT population. And really what it means to be transgender is a real spectrum of things. Basically, I think the only sort of key denominator is that there's a dissonance. There's a lack of a connection between the sex that you were assigned at birth or the gender you were assigned at birth and how you feel about yourself and how you see yourself and the rest of the world.

  • 11:09:08

    EASTINSo what that looks like can really vary for a wide variety of people being transgender. Maybe somebody who really feels like, you know, I need full hormone replacement therapy and I need sex reassignment surgery and I need to present in a very sort of stereotypically masculine or feminine kind of way, depending on how they feel and other folks might feel that that's not the case at all, that they actually may not need those interventions and they also may feel like they can be very fluid in their expression of their gender.

  • 11:09:41

    REHMAnd Katy Steinmetz, you recently wrote a story for TIME magazine which featured the first ever transgender person on the cover. Can you talk about how many transgender people there are in this country now and how the outlook for them seems to be changing?

  • 11:10:12

    STEINMETZSure. Well, there aren't hard statistics because census workers aren't going from door to door asking people about their gender identity, but most surveys that we have out there put the number at around .5 percent of the population, about 1.5 million people. But in the many interviews I did for the story, I spoke with Susan Stryker, who's a leading academic on transgender issues at the University of Arizona, and she pointed out that if you phrase the question do you identity as transgender, you get about .5 percent of the population.

  • 11:10:46

    STEINMETZBut if you ask it more broadly, is there something about being a man or a woman in society that you don't feel really matches up with yourself, you may get something closer to 10 percent.

  • 11:10:59


  • 11:10:59

    STEINMETZAnd the outlook seems to be changing on a lot of levels. There are school policies that are changing. There are nondiscrimination measures that are being passed, but there's still a long, long way to go.

  • 11:11:14

    REHMOf course. And Mara Keisling, Katy Steinmetz's cover story talked about a tipping point here in this country in regard to how people understand, appreciate, accept, perhaps, transgender people. Do you agree?

  • 11:11:40

    KEISLINGYeah. It is very obvious that America is really getting to know us, that more and more of us are out. More and more of us are circulating in the world and educating people at our schools and our mosques and churches and our neighbors. And more and more people are understanding that we're in their families. We work at the Starbucks they go to in the morning.

  • 11:12:05

    KEISLINGWe're their doctor. And as that's happening, things are changing very quickly culturally and policy-wise, the transgender rights part of the LGBT movement is moving faster than any other movement, including the LGBT movement has ever moved.

  • 11:12:22

    REHMWhy do you suppose that is?

  • 11:12:24

    KEISLINGWell, I think it's important to recognize that part of it is we're piggybacking on all of these other civil rights movements who have done so well and created the contexts and the processes and the language that we use. So we really are on the shoulders of champions, as they say. But also, part of it is, we now have the internet, and a lot of these movements started before the internet, but our people are desperate because while we're having all these victories, while we're changing policy and changing hearts and minds, we're still seeing thousands or more tragedies every single day.

  • 11:12:59

    KEISLINGWe had four transgender women murdered around the country in June just for being transgender. And, you know, every day we have a victory. Somebody somewhere is having a judge take away their kids and et cetera. So there's still a lot of tragedy, but we're -- it really feels like we're on a dead spread to the finish.

  • 11:13:22

    REHMCan you talk about your own story? Did you always, as Dr. Eastin suggested, feel a mismatch between who you felt you were and who you were?

  • 11:13:41

    KEISLINGYeah. I sure did. And, you know, in our culture, we are often gendered before we are even named. And one of the first things we're taught when we're very tiny is that there's mommies and daddies and brothers and sisters and grandmas and grandpas, et cetera, and boys and girls. And I was a fairly rational little kid and I knew I was one of the boys, I knew I was one of the brothers, but I also knew that wasn't right.

  • 11:14:05

    KEISLINGI knew I didn't want to be and I didn't have words for it. Apparently, I tried to talk about it when I was three and my parents -- this was 1964 or '63. My parents kind of brushed it aside, explained why that wasn't possible and I knew I had to be quiet about it. So I...

  • 11:14:21

    REHMWhat do you mean, you tried to talk about it?

  • 11:14:24

    KEISLINGWell, apparently, I went into the living room wearing my sister's Brownie uniform.

  • 11:14:27

    REHMI see.

  • 11:14:28

    KEISLINGBut I was three years old. And apparently, my parents were both very nice about it, but it was 1963. There was not a lot they could've learned. There was no Chase Brexton Center. There was no TIME magazine article. There were no experts. There was no internet. So they basically told me what everybody they knew that everybody was a boy or a girl and it had to stay that way.

  • 11:14:49

    REHMAnd how long did it stay that way for you?

  • 11:14:54

    KEISLINGFor me, I probably outran it until I was about 38 years old. And I think of it as outrunning it. You know, people find this odd, but I bet I have thought about my gender every single day of my life since I was three. And it has been in my head. It has been the biggest distraction in my life. And so I've always known and it's always been a part of me.

  • 11:15:21

    KEISLINGI didn't have the words for it. The word transgender hadn't even been invented. But then, with the advent of the internet, a lot of us who had been outrunning it for a while were able to see that it was a real thing. It was people like me. I wasn't alone. And we were able to build virtual communities that helped us build actual real communities.

  • 11:15:46

    REHMSo you lived as a man for 38 years and then to whom did you speak about wanting to become, truly become a woman?

  • 11:16:05

    KEISLINGInitially people on the internet. In the early '90s, it became possible to meet real live people via the internet and then I went to a conference. And at the time, I was teaching on an adjunct basis at George Mason and Marymount University here in D.C. and I met a college professor at a transgender conference in Provincetown, Massachusetts, who was transitioning.

  • 11:16:31

    KEISLINGAnd she was my height. I'm relatively tall, as you probably noticed when I walked in. And she was a college professor who was my height. And I thought, wow, it can be people like me. And that changed my life and I was able to do what I had to do to be me.

  • 11:16:50

    REHMDid you see a psychiatrist during any of those years?

  • 11:16:58

    KEISLINGSure. I was fortunate and privileged enough that I was able to afford to go see a mental health professional. It's recommended for people who are transitioning and personally, I say if you can afford to find a mental health provider or if there's a clinic near you, that really does help 'cause it can really get into your head. You're about to do something that your whole life you've been told doesn't make any sense.

  • 11:17:27

    KEISLINGAnd you're about to face some societal pressures that are completely unfair and surprising.

  • 11:17:35

    REHMWhat about pressures from your family? Were your parents still living?

  • 11:17:40

    KEISLINGYes. My parents are still living and are amazing, kind, wonderful, smart people. You know, I always joke that when I transitioned, I didn't even lose the family members I wanted to lose. That's not aimed at any particular family members. It's more of just a joke in the family. But I've been very, very fortunate to have been 100 percent supported by my family, my friends.

  • 11:18:09

    KEISLINGI lost a couple clients at the time, but, you know, that was their loss.

  • 11:18:14


  • 11:18:15

    KEISLINGYes. I was a consultant doing social marketing.

  • 11:18:17

    REHMI see. Mara Keisling, founding director of the National Center for Transgender Equality. Mara is also a transgender identified woman and a parent. Short break here. We'll be right back.

  • 11:20:01

    REHMAnd welcome back. We're addressing transgender issues in this hour. A recent cover story for Time Magazine, by Katy Steinmetz, put the first transgender individual on the cover of Time Magazine for the very first time. Her story in the June 9th issue is titled, "The Transgender Tipping Point." She's on the line with us from KQED in San Francisco.

  • 11:20:40

    REHMHere in the studio, Dr. Julie Eastin, director of behavioral health at the Mt. Vernon at Chase Brexton Health Care, Inc. And Mara Keisling, founding executive director of the National Center for Transgender Equality. Dr. Eastin, if you could, tell us how an individual might come to you, how that conversation might actually begin.

  • 11:21:19

    EASTINWell, there's really a range of experiences, but very often people come into treatment basically saying -- nowadays I think this point that Mara makes of saying that, you know, the internet is this incredible resource. Many people have done their research by the time they come and see us. And they are looking to transition. And they're wondering what that looks like.

  • 11:21:42

    EASTINSome folks are coming in and they want to basically explore transitioning without having any sort of medical intervention at first. Many folks maybe are deciding that this is too much to really hand my family. I'll wait until a little bit later to do that. Well, how do I live my life in a way that presents my internal feelings about how I am and see the world to the external world, in a way that feels more in line.

  • 11:22:11

    EASTINAnd folks will often -- they'll come feeling a lot of confusion and sadness and difficulty with having to confront the ways in which they're anatomical features, and their sort of assigned gender at birth, don't match the way they see themselves. And so beginning their days with taking care of themselves and presenting themselves to the world and handling all the things that actually don't cooperate when you're -- and the biology doesn't match with that sort of -- that identity piece. It's really hard and it can be really difficult for folks.

  • 11:22:48

    REHMKaty Steinmetz, as you reported this story for Time Magazine, talk about the range of feelings and experiences you encountered.

  • 11:23:03

    STEINMETZSure. Well, I think if there is one rule about all of this, it is that there's no single transgender experience. I don't think I talked to any people who had the exact same story. Some people have already built lives where they're married and have children and then decide to transition. Other people, especially young people now -- as it's been said a few times, we have the internet as a resource -- might decide very young that they identify as transgender, and have an easier time than people from previous generations.

  • 11:23:35

    STEINMETZBut a lot of people experience -- as it's been said -- a lot of dissidence, depression. The attempted suicide rate among people who identify as transgender is 41 percent. So you know that daily life for a lot of people dealing with these feelings that they have and the way that other people treat them is incredibly difficult.

  • 11:23:58

    REHMAnd did the people that you spoke with -- were they happy to speak with you about their experiences or were they reluctant?

  • 11:24:14

    STEINMETZI think both. A lot of advocates for transgender rights feel like the best thing they can do for the movement is to live visibly and to tell their stories. And to let other people who might read them know that they're not alone and there are other people like them. So they want to put that out there. But at the same time, nothing could be more personal.

  • 11:24:37

    STEINMETZAnd a lot of people who've been through painful divorces or have had their kids taken away from them -- and who know that people are going to ask about what's in their pants, even though that's an issue that they would like people not to concentrate on -- are a little bit reluctant. I mean they are really opening up and sharing something that most of us would never imagine sharing with another person.

  • 11:25:01

    REHMNow, you heard Mara Keisling talk about the fact that at age three she put on her sister's Brownie uniform. I wonder at what age you encountered the people you wrote about. Was it an entire range of ages or had most people already settled into what they felt was their final identity?

  • 11:25:36

    STEINMETZNo. It was a huge range. The youngest I spoke to was a sixth grader from Tacoma, Wash., who's a young transgender boy, who's playing on the boys' basketball team. And there was a lot of difficulty in his family. His sisters did not accept the fact that he identified as transgender at all. Said, "I don't believe in being transgender." But the parents were very supportive.

  • 11:26:07

    STEINMETZAnd the basketball team provided this really interesting outlet. It was the first time that this young transgender boy had ever felt solidarity or had had these experiences with other young males and really felt like he was in the type of social group he should be in. And then there were people I talked to who are in their 50s who lived their lives and a year or two ago -- usually often, like Mara was talking about -- someone's who's encountered someone else who's living as transgender -- and Laverne Cox, the actress from "Orange is the New Black," calls these possibility models.

  • 11:26:45

    STEINMETZThese are people who show you that, hey, maybe I can live this life that I've either been telling myself I can't live or shouldn't live or other people have been telling me because here's someone who's doing it. Again, that's not universal, but it's very common.

  • 11:27:02

    REHMAnd, Katy, there is one issue that I think a great many people who are listening to the program might question, and that is authenticity. And the authenticity of the individual who transgenders and whether that person is really who he or she says he or she is.

  • 11:27:38

    STEINMETZA really safe rule -- if you want to come at this from a point of being accepting -- is look at the person in front of you and ask them. You know, ask them, you know, tell me about yourself. How do you identify? There is a lot of tension here between -- do bureaucracies, for instance, who control whether you have male or female on your passport or your driver's license, are they in charge of telling you whether you're male or female? Or is it your own personal experience and do you let that entirely guide it?

  • 11:28:12

    STEINMETZThe new California law, for instance, is entirely based on gender identity, regardless of any sex that's on official records. And very much defers to a person's individual feelings. But it's different for every person and it's safest to just let them tell you where they are.

  • 11:28:33

    REHMMara, how have you dealt with those issues? Passports, for example, driver's license, job applications. What have you done?

  • 11:28:46

    KEISLINGSo in our county currently it's really important to have accurate and consistent identification documents. And until about five or six years ago it was really getting very difficult for transpeople to get it correctly. And, you know, I would say it's all about authenticity. And it's fascinating to a lot of us because the public often thinks of transpeople as being inherently inauthentic or even fraudulent, when in reality it is exactly the opposite.

  • 11:29:16

    KEISLINGYou know, sometimes I just think, well, we're the only people who have actually really analyzed who we are and gone about being our true selves. But we've been working really hard as a movement and as a community to change rules. You know, in Washington, D.C., where I live now and almost half the other states, you just -- you don't need to prove you've had any particular kind of medical treatment in order to change your driver's license. You know, there shouldn't really even be sex markers on driver's licenses.

  • 11:29:47

    KEISLINGThey -- that comes -- that's an old remnant from when there didn't use to be pictures. So, you know, they should take the sex markers off the driver's licenses and passports. And the U.S. Passport Agency under President Obama changed their rule, because they understood passports were for allowing Americans to travel safely. And if I have to travel with an "M" for male on my passport, I can't travel safely.

  • 11:30:12

    KEISLINGSo they made it a lot easier for people to just say, here's who I am. Look at me if you want, but, you know, I need an "F" on my passport. And the Passport Agency now says, "We trust you on that. You have a note saying that you have transitioned. We'll support that." So it's getting better.

  • 11:30:33

    REHMAnd that's what you have, a note saying you have transitioned?

  • 11:30:38

    KEISLINGYeah, it's not the ideal situation yet. Again, I think they should take sex markers off of licenses and passports, but for now you have to get -- in a lot of these states and with the Passport Agency, you have to have a signature from a medical provider saying that you have in fact transitioned. But transition doesn't mean that you've had any particular kind of medical care, just that you are living your life…

  • 11:31:03


  • 11:31:03

    KEISLING…as male or female.

  • 11:31:05

    REHMNow, I want to ask you one more question, Mara, before we welcome another guest into the program to talk about schools and the like. How did you live those first 38 years?

  • 11:31:26

    KEISLINGYou know, it is hard being anybody. Everybody had struggles.

  • 11:31:33

    REHMOf course.

  • 11:31:34

    KEISLINGThat was a big struggle for me. It was a big distraction, as I mentioned earlier. But I'm also a very practical person. And I understand that my life has more fullness to it. And I was just able to concentrate enough to do that. But it's also true that things were different. Until maybe 1990 and when the internet first became really known to me. Transitioning wasn't a real thing. So it's not like I was struggling to not transition. It was that wasn't a thing.

  • 11:32:14

    REHMSo you were living life as a man?

  • 11:32:18


  • 11:32:19

    REHMAnd you were doing all the things that men do and still feeling as though something was very wrong.

  • 11:32:32

    KEISLINGAbsolutely. And I had an inside life that was able to help me vent that.

  • 11:32:40

    REHMAnd you're listening to "The Diane Rehm Show." And joining us now is Aidan Key. He's a gender specialist at the Gender Diversity Group. He works with public and private schools, K through12, to create gender-inclusive learning environments. He is also a transgender-identified man. Aidan Key, welcome to the program.

  • 11:33:15

    MR. AIDAN KEYThank you. It's really great to be here.

  • 11:33:17

    REHMThank you. Talk about your work for schools and parents in Washington State and the kinds of advice you're providing.

  • 11:33:30

    KEYWhen I entered this work I didn't quite know what to expect or what I was going to encounter. In some respects I thought, well, I'll need to be an expert in education. I'll need to be an expert in the medical field or the mental health field to be able do trainings in those types of environments and with those professionals. And what I found is that no matter what level of education, no matter what environment I went to, the questions were all the same.

  • 11:34:01

    KEYIn relation to the children especially, I -- most of the calls that I get, most of the trainings that I do are with younger children, elementary age children. So they have some very recurring questions. And that is what if this is a phase? What if this child changes their mind? Aren't they too young to know? How is this different than being gay? And so I have not only attempted to answer those questions, but just to find the underlying themes that bring those about.

  • 11:34:42

    KEYAs many adult transgender people mentioned -- or experience, and as Mara mentioned, the focus is so often on genitals. And in some respects, most people will view being transgender as an alternative and a strange form of sexual orientation. And that's just not the case. And so the bulk of my work is pulling this issue out of a sexual-orientation context and putting it where it belongs, which is gender identity or a person's innate sense of their own gender.

  • 11:35:23

    KEYAnd also gender expression. For example, I -- many kindergarten teachers have said, "Well, I have a kid like that in every class. And I just assumed that that child was gay. And because we don't talk about issues of sexual orientation with the -- with children that young, I didn't say anything." But what that teacher is witnessing is that child's gender expression. So that might be a greater degree of femininity in a boy, or a degree of masculinity in a girl. That child may grow up to be gay or lesbian, but maybe heterosexual as well. We just don't know that.

  • 11:36:06

    REHMAnd you're dealing, of course, not only with teachers. You're dealing with parents. What about the bathroom question. That comes up so often, especially in these younger-age schools.

  • 11:36:29

    KEYIt comes up every time, every time. What about the bathroom? The bathroom is -- in some respects, it's a very simple question. What about the bathroom? A child uses the bathroom that aligns with their gender identity. That's the solution. But, again, there's an undercurrent that -- and typically it's adults that experience this. The children can readily understand concepts like gender identity and gender expression.

  • 11:37:01

    KEYBut for adults it touches on that -- the fear. It touches on the unknown. And it touches upon the fact that we, as a society, collectively agree and support the idea that gender is fixed, that it is only male or only female.

  • 11:37:21

    REHMAll right. Aidan Key is a gender specialist. He is out in Seattle, Wash. We will continue this conversation and take your calls after a short break. Stay with us.

  • 11:40:01

    REHMAnd welcome back as we talk about being transgender in America, the issues that those who identify themselves as transgender face, and how we as a society react to them. Here's an email from Greg in Ohio and I'll ask you, Kristin (sic) , to -- forgive me, Julie Eastin, to take it. "Please discuss the difference, if any, between sex and gender. We seem to use these words interchangeably.

  • 11:40:47

    EASTINYeah, that's a great question. So sex we often talk about as being sort of related to our biological sex or our chromosomes, right, and how we have anatomical parts that we sort of assign and say, that's our biological sex. And then according to those things we're assigned a certain gender at birth, right.

  • 11:41:09

    EASTINAnd gender is much more about how you might express how you feel about yourself. You might think -- people talk about sort of a gender binary being male and female but that there's actually a continuum of gender. So if masculinity to femininity and that you express your gender based on where you feel most comfortable in that continuum. And that may not be the same thing.

  • 11:41:30

    EASTINSo I used to give my women studies 101 students an assignment to go and be gender nonconforming. And some of them would go and take for the day sit on a bus and put their knees apart and take up a lot of space in their chairs and say, yes, I was trying to be male. And they would say like, the responses that they got or their feeling of feeling like they were somehow being transgressive or being very, you know, in some way difficult and, you know, causing disruption.

  • 11:42:00

    EASTINBecause we are taught that there are certain ways to be gendered. What we often call it as binary is we call them a term that's called cisgender which means that your male biology and your sort of masculine presentation are sort of more traditional in a sense. And that's some way -- some people might really want to feel like that's them and they feel comfortable being that way. Some people not so much.

  • 11:42:28

    REHMAnd Mara, you're trying to get rid of this separation between sex and gender.

  • 11:42:38

    KEISLINGWell, certainly in the policy context absolutely. One of the ways we've been winning victories in protecting transgender people is to convince judges, convince policy makers that illegal sex discrimination covers transgender people. So just as you would fire somebody from converting from Catholicism to Judaism and say, well, that wasn't religious discrimination. You converted, we don't think you can say, well, you were fired for being trans. That's not sex discrimination because you converted. It doesn't make any sense.

  • 11:43:12

    KEISLINGSo we do try to minimize the difference -- the theoretical difference between sex and gender in the policy context as often as we can.

  • 11:43:23

    REHMAnd Katy, give us some examples of the recent changes in laws and policies in both the states and the federal government.

  • 11:43:37

    STEINMETZSure. Well, the State Department was the first one that I covered back in 2011 when, as Mara said, they made it a lot easier. Rather than requiring any kind of surgery you can have a doctor's note, which might be as simple as saying, this person is in conversations with someone about their gender and they can switch it.

  • 11:43:57

    STEINMETZIn California a controversial law passed last year called AB1266 that allows K through 12 students to access facilities including locker rooms and bathrooms as well as sport teams throughout the state based entirely on their gender identity and regardless of the sex on the records. And social conservative groups collected signatures to try to get that law put on the ballot and overturn it and missed it by about 14,000 signatures. They got about 490,000 but 504,000 were required.

  • 11:44:37

    REHMSo do you think they will continue to try to achieve that overturning it?

  • 11:44:46

    STEINMETZThey say that they will. There are groups like the Pacific Justice Institute who say they're still working to fight these laws in the courts if they can't do it on the ballot. And certainly all of these laws -- there is a new employment nondiscrimination law in Maryland. And there are people there collecting signatures too. And like many of these debates, the bathroom has been the incendiary point where people often phrase it as worrying that females will be vulnerable and their privacy will be compromised. There's pretty much no law about this that gets passed that isn't fought on one side or another.

  • 11:45:34

    REHMAll right. I'm going to open the phones now. We'll go first to John in Houston, Texas. Hi, you're on the air.

  • 11:45:46

    JOHNThanks for taking my call, Diane.

  • 11:45:47


  • 11:45:49

    JOHNI have an honest question that I'm afraid might be taken as rude but it is a genuine question. And it's as long as I've been familiar with the issue it's been widely accepted. And I know there are a lot of people that might think that it seems a bit like supported delusion. But I'm wondering how it missed the possibility that these individuals might have a chemical imbalance of some sort or that it might be more of a psychiatric issue. Thank you.

  • 11:46:30

    REHMDr. Eastin.

  • 11:46:32

    EASTINYeah, what we -- you know, I think what we know is that we're not seeing a chemical imbalance or a problem in that way. We do know that there's likely some biological component because very often, as we're talking about, kids know, they know something generally early on for the most part around three, usually solidified by seven. There's a sense of whether their assigned gender actually matches with their biological sex.

  • 11:47:06

    EASTINAnd we don't -- in terms of the research, we don't actually know enough. I think they're doing some research around sort of genetics and other things to better understand it. And I actually am not able to quote that research to you. But what we know is primarily that there is a biological component. We don't think there's sort of a chemistry problem in someone's brain the way you might think of sort of a mental disorder in any way.

  • 11:47:30

    REHMAidan, can you tell us a bit about your own story, how old you were when you began to feel a mismatch with your birth gender?

  • 11:47:47

    KEYSure. I think the question isn't really when did I know that something was up with me or when did I discover that my gender was different. It was when did I notice that society was not receiving me in the way that I was. And I have an identical twin sister so it's an interesting component to my story in that there's often a debate about is gender nature-based or nurture-based. And because I have an identical twin, we have the same nature. We experienced the same nurture.

  • 11:48:27

    KEYAnd we have some differences. And for us as children, those differences were just we were different as people and my gender was just the way I was, her gender was the way she was. But it's when society feeds back, reflects back that who I was in the world was not jiving with the expected norms of female behavior.

  • 11:48:56

    KEYYour caller's question is a good one in that many parents -- almost all of the parents I encounter will ask a similar question like, where does this come from. Is this some sort of environmental influence? Is it chromosomally-based? What -- how does this happen? And ultimately we are waiting for some answers. And there are biological indicators, as was mentioned.

  • 11:49:25

    KEYBut ultimately it really doesn't matter because we have our lives. These families have their children. Schools have these students. And the shift now, it has gone from one of let's change this child so that they best fit into society, which has failed miserably as indicated by the 41 percent attempted suicide rates of adult transgender people, most of whom experience an attempt by family or society to change them to an approach that says, let's take a look at this. Let's support these kids and who they say they are and move forward and see if at least that love and support doesn't provide them greater resiliency and greater strength.

  • 11:50:21

    REHMAnd Aidan, for you, how did transition surgery change your life?

  • 11:50:30

    KEYIt was a component. You know, we have a lot of transitions in life. We transition from high school to adulthood. We get married. We have a death in the family. We change careers or move locations. All of those are transitions. This transition is one that is scarier because myself as an individual, I didn't know what to expect. And I didn't know who was going to come along this journey with me. Would I maintain my relationships in the world?

  • 11:51:10

    KEYSo that's the scarier component, not so much the physical transition, although that's interesting. And I'm sure we could dedicate a lot of time to that. But the -- transgender people being such a small percentage of society and it being such a huge national discussion, really speaks to the gender norms, the gendered expectations and stereotypes of society and the fear that overall society has of actually providing a little bit more room, a little bit more latitude.

  • 11:51:48

    REHMAll right. Let's take a caller in Blacksburg, Va. Hi, Greg. You're on the air.

  • 11:51:56

    GREGHi. Thank you so much for taking my call.

  • 11:51:58


  • 11:51:59

    GREGFirst of all, I want to preface my call with I think that your panel is incredibly brave to be out on the forefront of this issue. Originally I was a little uncomfortable with the idea of transgender, however my understand is evolving. And I think that the public's is too in a good way. However, I think -- I want your panelists to comment on a slippery slope of a culture of unquestioned acceptance of sexual identity and expression. Particularly my concern is that one day we'll think that pedophilia is okay. So if they could comment on that I would really appreciate it.

  • 11:52:39

    REHMAll right. Katy Steinmetz.

  • 11:52:42

    STEINMETZWell, I think most LGBT activists would resent the comparison between gender identity and something like pedophilia. It's like someone talking about same-sex marriage and saying, you know, marry your dog, you know, those types of controversial comments that get made. I think the education point that people are trying to get to here is everyone has a gender identity the same way that gay activists trying to tell everybody has a sexual orientation. It's not just homosexual people, it's heterosexual people.

  • 11:53:15

    STEINMETZWe all have a sexual orientation. We all have a gender identity. And it just so happens that for 98.5 percent of us -- 99.5 percent of us it matches with our anatomy. And gender is something that happens in the background that most of us don't have to question, that is this jumble of clothes that we wear and drinks we're expected to order and the way that people treat us on the bus, who flirts with us.

  • 11:53:43

    STEINMETZAnd for these people like Mara and who explained it's this distraction, it's something in the background they're constantly questioning. So it's not about how they're going to treat other people. It's about how they want to be treated.

  • 11:53:55

    REHMAnd Mara, how do you approach the idea of changing people's minds?

  • 11:54:06

    KEISLINGWell, that's what we do. We as a transgender community and a transgender movement, all we're really doing is educating people. And, you know, the best education is just the incidental education that you have from being in people's lives. But we win people over. And I think if -- and, by the way, I really appreciate the way that Greg and John asked the questions. You know, in my mind they have a little more education to do but they were respectful. And I think that's a really good sign.

  • 11:54:37

    KEISLINGBut I think when you understand the facts, we win. Science is transgender people's best friend. Everything we learn about transgender people is such an important educational tool. Yeah, there are more and more people who are trying to pretend they don't believe in science, but science is what it is. And understanding the facts, we're always going to win.

  • 11:55:03

    REHMAnd to you, Katy Steinmetz, do you believe society is at that tipping point of acceptance?

  • 11:55:17

    STEINMETZThat was a tough cover line to choose because it's hard to know whether we really are a tipping point. But I think if you look at it issue to issue, in some ways we are at a tipping point and in some ways we're just beginning. There may be people out there who have never heard the word transgender before. But certainly that shift where people are encountering transgender people is happening. And a lot of them has to do with public figures. Chaz Bono, Chelsea Manning, Janet Mock, Laverne Cox, these actresses or public personalities that all of a sudden are in a spotlight that wasn't there five or ten years ago.

  • 11:56:00

    STEINMETZAnd when people see them leading healthy lives, Laverne Cox being an Emmy nomination for Orange is a New Black, they start to think, okay, maybe this is something I need to know more about.

  • 11:56:12

    REHMAll right.

  • 11:56:13

    STEINMETZAnd I think that shift is happening.

  • 11:56:15

    REHMAll right. Finally I want to read to all of you an email from Anna here in D.C. who says, "I am the mother of a transgender child. The science tells us this happens in utero. Gender identity is formed in the brain in utero and does not always match genitalia. It is critical that parents in schools and communities understand this, otherwise these children face a suicide attempt rate of 60 percent. Thank you so much for doing this program. Fight for these children, their right to exist. Love them. And thank you for this program."

  • 11:57:14

    REHMThanks to you Aidan Key, Katy Steinmetz, Dr. Julie Eastin and Mara Keisling. Thank you all and thanks for listening. I'm Diane Rehm.

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