Understanding Gender Diversity with Guest Dr. Jessica Conner

Tina: Hey everyone, I'm Tina

Serena: And I'm Serena, and we are the Mental Health Mamas.

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Tina: Welcome to No Need to Explain. We are so glad you're here. 

Serena: First, as always, a quick disclaimer.

Tina: We come to you not as mental health professionals or experts in the field, but rather as parents with lived experience who are on a mission to normalize the conversation around mental health. 

Serena: If you or someone you love is experiencing a mental health crisis, please seek professional support. You'll find a variety of resources in our show notes and on our website noneedtoexplainpodcast.com. 

Tina: As we move our way through our third season, we are working to focus kind of on a handful of topics, themes, you know, we're going to pair some stuff together with different guests. It's our way to kind of delve a little deeper into a variety of super important topics while also sharing some very different perspectives.

Serena: So last week we dropped an episode with guest Heather Hester about parenting your LGBTQ teen. If you haven't listened, go check it out after you finish this episode. Keep listening to this one. So this week we've invited a licensed psychologist to chat with us about this super important topic. In fact, one of her areas of clinical interest is transgender and gender diverse health.

Tina: Dr. Jessica Conner has experience working with people across the lifespan in primary care and is currently the director of behavioral health and a behavioral health consultant for a pediatric practice. We are all about integrated health care, right, Serena? And we are super excited to share this conversation with all of you listeners. Jessica, welcome to the podcast.

Jessica: Thanks so much for having me. I'm really happy to be here and yeah, I'm all for making a mental health conversations part of the daily life for my own disclaimer while I am a mental health professional. I'm not here to give any individual who's listening specific and advice that everyone's lives and experiences are different. So I'm going to be talking in a lot of generalities rather than being able to pinpoint for a specific person what the next good step would be for them. 

Serena: Sure, that's a great point and thank you for sharing that. So before we jump into this conversation, I wonder if you would be willing to share with our audience how you yourself identify and your preferred pronouns? 

Jessica: Yeah, absolutely. So I identify as both queer and gender queer, and I use she, her, and they, them pronouns. And we'll, you know, we can talk a bit more about what some of those terms are. Yeah, it took me a while to come to them as the label that best had a fit how I identify. 

Tina: Yeah, with all of us zooming over the past few years, a lot of people identify right on their zoom screen. So let's talk more about identity and pronouns. Knowing this is super big topic, can you help us understand some of those distinctions specifically between gender identity, gender expression, and sexual orientation? 

Jessica: Yeah, absolutely. I think that these are different categories of who we are and our identities that in some ways interact in some ways are not related. And the big kind of takeaway is to not make assumptions and that people can identify in all kinds of different ways. I think the the simplest way that I think about it, which I stole from someone else, is gender identity is who you go to bed as, and sexual orientation is who you go to bed with. Okay, which is, which is, you know, a bit of an over simplification, but largely, you know, sexual orientation is looking at who you are attracted to in a sexual way in a romantic way. What kind of people you are interested in partnering with or being attracted to, whereas gender identity is not related to relationships. Gender identity is who do you see yourself to be? How do you understand your gender? 

Gender expression is what you see on the outside. So the external way of person expresses their gender with clothing, how their hair is styled, their mannerisms, activities, social roles. You know, all of these are fairly culture bound and really related to the society and the groups we live in. And the best way to know about someone's gender identity, your sexual orientation is to ask rather than trying to guess based off of what someone looks like. 

Serena: Sure, that's great advice. So I'm recalling a gender unicorn that I've seen. I think there's a gender bear too. Am I using the right terms? Is that what it was?

Jessica: Yes, the gender unicorn is my preference over. There's also the gender bread man. There's some like, you know, some tricky things in terms of people taking credit for other people's things. So the gender unicorn is a great, great friend for kind of breaking apart those things for the trans student educational resources. 

Serena: Yeah, I found it really helpful to me. So we will get a link to that and put that in our notes so that people can take a look at that. I think it really, you know, sort of describing it over the air. I think it's easier to kind of look at the visual. 

Tina: Yeah, I love that visual. That was awesome. 

Serena: Yeah. Yeah. So Jessica, can you talk a little more about pronouns? I think this feels like something that is maybe somewhat challenging for some of us who grew up a while ago right, sort of, you know, embracing different pronouns. And yeah, can you maybe talk a little bit personally if you don't mind about how you came to that decision? 

Jessica: Yeah, so I initially came out as probably bisexual as a teen and then later as a lesbian and then later as queer and then even later on got to thinking more about how exactly I understand my gender identity and felt like not fully identifying as a woman, not identifying as a man, you know, existing somewhere in this non-binary kind of space, which is part of the overarching transgender umbrella. But the way I think about my identity as as genderqueer is just, you know, something other than cisgender, something other than identifying in a way that is aligned with my sex assigned at birth, right? So babies born, you know, based off of the look of the external genitalia or nowadays there are so many like genetics screens done in utero, based off of genetics, those kinds of things. What does the doctor say, you know, is this a baby boy? Is this a baby girl? Is this baby intersex? And anyone who, okay, you're born, they say, oh, your sex assigned at birth is male, you identify as a boy or a man, you're considered cisgender.

Genderqueer is just definitely not cisgender, but where exactly people, people fall, tends to vary. I really appreciated, you know, what Heather was sharing last episode about how, yeah, queer and and the related terms, genderqueer terms that were taken back by the LGBTQ plus population. And, and so that's kind of how I understand myself. And so I am fine with her pronouns, which I have a pretty feminine gender expression. So it's what people typically assume that I would use. And then I also feel comfortable when people use they, them pronouns for me. So, you know, pronouns are, I think, important, especially in terms of intention, you know, that it can be tricky if you called someone by one set of pronouns for, you know, a decade to be then asked to use a different set of pronouns for them. It definitely gets a lot easier with practice. And it's something that I really encourage people to just get in the practice of using different pronouns in ways they wouldn't typically. But I think it's a good sign of respect to, to call people what they ask you to call them. And that includes pronouns, which you don't so much use when you're talking to the person directly. It's more about when you're referring to them or talking to someone else about them, which is, I think, an even more important space to be really trying to be respectful of how someone identifies. 

Serena: Yeah, thank you for that. I, yeah, I have so many, I feel like I have a lot of questions. This could be a long episode and I don?t want to make it too long. But I guess I will ask this because it's, it's on my mind right now. You know, you talked about, you're using the proper pronouns and being respectful. So what if we make a mistake? What, what, what do we do?

Jessica: So making mistakes is inevitable, right? Because we are humans and not robots. And then, you know, most agreed upon kind of protocol is to acknowledge it and move forward. You know, so to say, Oh, I messed up, I meant this. And then move forward rather than A, just ignoring it and going on with with not, you know, calling yourself out also better than like making it a whole long big thing that could just kind of be awkward and also put it on the trans or non binary person to like comfort you, you know, if you're going on. Oh, I made a mistake. It's just so hard. And I used to, you know, I remember when you were a little baby and you always wore pink and, you know, the way grammar works. We really shouldn't even be using they them as a singular pronoun. It just doesn't make sense. And it's just so hard on me. You know, it's, it turns it around then to make the the the trans person have to like comfort you for having a hard time using different words. Um, so just a quick acknowledgement and moving forward.

I think the most important thing really is intent though. And I think that people can tell if you just slipped up, but you're putting effort in, or if you're not putting effort in, I think the intent is the most important part. 

Serena: Okay. Thank you. Um, so I'm going to shift gears just a little bit here and talk about a little bit more about mental health. So in our episode last week, we quoted some statistics around the prevalence of mental health diagnoses, um, and specifically around LGBTQ youth. And I'm going to repeat them here just for reference. So according to NAMI, the National Alliance on Mental Illness, LGBTQ youth are more than twice as likely to report experiencing persistent feelings of sadness or hopelessness than their heterosexual peers. Um, you know, and, and knowing the high incidence of mental health struggles in our country right now, these statistics are are pretty scary. Um, so help us with this. What can we do?

Jessica: Yeah, it's definitely, they're, they're often really dark statistics and compared with the rest of the LGBT folks, the trans numbers are, are even worse. You know, like, you know, especially if you look at the rates of suicidal ideation, the rates of abuse, the rates of suicide attempts, like it's just the numbers are really scary. And I think that's what one of the things that, that freaks parents out the most when their kid or teen comes out to them is they, you know, instantly flash and their mind to, well, you know, this is going to be so hard and so scary, and it's going to be, you know, inherently full of mental, the poor mental health. I even remember, you know, when I first came out to my mom, um, you know, what she told me was that that she loved me no matter what, but that she was worried that my life was going to be harder than it would otherwise. 

And so, you know, I think a couple different things with these rates. Number one is that like being trans, being, you know, anywhere in the LGBTQ community is, is not a mental health, um, like it's not a bad thing, right, that identifying in any of these categories through sexual orientation, gender identity, all of them are completely normal and healthy and do not mean that you are going to have mental health concerns. What it does mean is that if you live in a context, in a society, in a family, that is more likely to abandon, victimize, reject you for any reason, then you're more likely to have mental health concerns, right, that if we, if you have a youth who's kicked out of their family and it's homeless, they're going to have higher rates of mental health substance use concerns. Um, you know, if you look at someone who drops out of school because they're being bullied, they're going to have higher rates of mental health substance use, homelessness concerns, right, these folks are going to be less likely to have education, to be having jobs that allow them to have health insurance. There are all these implications about what happens to anyone who is more likely to be an outcast.

You know, so there's this whole minority stress model that was initially based out of our understanding of why people of color have higher rates of mental health substance use kinds of concerns and was then further expanded upon in the LGBTQ community as well, that it's not the identity that's the problem. It's living in a society that's more likely to reject you. That's what, that's what causes a lot of the distress.

Tina: Yeah, so last week we did talk with Heather about some of these very things, right, we talked about, um, she talked a lot about her teen coming out and the kind of anguish that child went through. And a lot of that, Serena tell me if I'm not remembering this, but it was because he, and I'm pretty sure he identified as a he, he had family people, not his immediate family, that he perceived as really having a problem with it. And then that second factor of the world, right, like the world is not always a welcoming place. Right. And, um, yeah, and then I do want to follow up in a minute, but keep talking and I want to follow up with the kind of, um, our kids, especially in teenage should have lots of struggles figuring out who they are, right? That's a further complication. But anyway. 

Jessica: That it is, that it is. Yeah, you know, I think the, the bright side of this though, is that if we can wrap these, you know, kids and teens and adults in love and support, then they do just fine. You know, like the, the mediating factor to all of this is that if kids have family members, close family members who are willing to say, you know, they don't have to say, I completely understand all of this. And I'm on board. If you have a close family member who says, I have your back. You know, I love you no matter what. And I have your back in this and we're going to learn and explore this stuff together. That makes a kid so much safer. That helps all of this. Even if you're in a community, that's not accepting. Even if you're in a state or a country that's not accepting, if in the house you live in, you have people who have your back, then that makes all the difference in the world. And I think that's a huge, you know, relief to a lot of parents. I think it's a huge actionable step too of saying, you know, you don't need to understand how your kid identifies or how their gender expression works with their sexual orientation or their gender identity or why they are saying they identify as a boy, but boy, they are wearing a lot more dresses now that they've told me that and it's confusing to me. You know, you don't have to understand it. You don't have to express to them over and over that you're on their side. 

Tina: Yeah. Yeah. I think that's very comforting for parents because as a parent, I often wonder if I am enough. And if I'm making the right, sending the right messages. And yeah, that's very comforting to know that again, being that safe, stable, loving person, you know, even if you don't know all the things is really good. So let's talk about what parents might expect as kids grow. In other words, you know, what's kind of, and I hate to use the term, but we're going to use it normal in terms of kind of gender identity or expression for kids is there, you know, are there typical ages? I mean, tell us, tell us what you know, to be true. Tell us the trends. 

Jessica: Yeah, absolutely. So, so if we look at, you know, typical child development when kids are like in the, you know, two to three kind of range two or three years old, they're starting to be able to answer the question, you know, are you a boy or a girl? You know, that's, that's, you know, really related to to what messages they've received from the people around them, but more or less they can kind of answer that question. You know, when they get a little bit older the next couple of years, they start to understand that more or less gender remains stable over time and, and get a bit older and that, those like early elementary school years, starting to understand that gender doesn't necessarily depend on external features, right? You can be long have long hair in our society and identify as a boy. You can have, you know, you can wear pants and identify as a girl. 

There's also a lot of really normal, just gender play, you know, in this toddler preschool elementary age that kids will, you know, dress up as different ways. They will, you know, there's, there's a lot of just like freedom and exploration and, you know, I don't think there should ever be, you know, boys toys versus girls toys, but, but even more than ever in this time period, you're just seeing like a bunch of really healthy, normal gender play that has no necessary bearings on how this young person's going to identify throughout, throughout their life.

What we see is that at different ages, people might come to understand their gender identity in a way that may not be consistent with the sex they were assigned at birth. And, you know, the more old school approach to this was, was well, let's kind of wait and see, let's wait and see what happens when they hit puberty. The American Academy of Pediatrics has come out really strongly, I think, in this really wonderful way, saying that if your child, any child who identifies as transgender knows their gender identity just as well as the kid their age who are identifying as cisgender, you know, so it drives me a little bit bonkers whenever, you know, parents will say, oh, well, they're just too young to know these things. They're just too, too young, they couldn't possibly understand what their identity is, but then they're the same people who, you know, will look at, you know, toddler who's assigned male at birth and say, oh, what a ladies man, you know, and they do all of this like sexualization of these small beings and saying, oh, is that your girlfriend? Do you want to hold hands with her? But at the same time, oh, no, you're 10 years old, you couldn't possibly understand if you think of yourself as a boy kind of person or a girl kind of person. 

You know, I think that my, one of my, you know, rule of thumb approaches is to just be neutral and kind of follow your kid or teens, you know, follow their lead with these things that if your kid asks you to call them a specific name, use certain pronouns for them, use a certain name for them to by in large, go with it, because it's very unlikely to do any harm. And it is very likely to send a message to your kid that, again, maybe they don't have a complete understanding of who you are, but they're willing to go with how you identify and how you express yourself. 

Serena: So what I'm hearing you say is that, really everything's normal, right? 

Jessica: I mean, I think there's, there's some boundaries on some things, but yeah, sure. There's no, there's no wrong way to, to express your, to, you know, identify your sexual orientation or gender identity, you know, that, you know, sometimes it can be a bit silly that, you know, we have kids who will come here to the doctor's office and like ask us to call them like very silly nicknames or, you know, my, I have a, I have a two and a four year old and every so, and we've, we've just raised them in a, like, super gender neutral, like, where what you want, like, play with what you want kind of way. And so every so often I'll ask the four year old, you know, do you think of yourself as like a boy kind of person or a girl kind of person? And, and every single time or the past year, they just come back with mommy, I'm a broccoli, which, you know, is certainly not what I would express as, you know, what I actually think their gender identity is going to be one day. Uh, you know, but, but I don't, but there is very little to be gained by trying to convince someone they identify in a certain way. 

Serena: Yeah. Yeah. Yeah. Maybe, maybe broccoli is the future. 

Jessica: I don't know. I don't know. This kid has a lot of ideas. 

Tina: So we know that you host a support group for parents and caregivers of transgender and gender diverse youth without sharing any sort of confidential information. What are sort of the themes that come up for parents? 

Jessica: Yeah. So, so right, I run on monthly parent support group of parents and caregivers of trans and gender diverse youth. And, and we talk about a variety of different things. You know, I send out kind of group expectations ahead of time, which includes in that, that like my bias in facilitating this group is always going to be believing people when they say their identity is what it is. And so between that and living in an, in an area that that tends to be pretty trans affirming, we, we don't spend, you know, like I think, I think there's some selection bias going on in my group in terms of who what kind of parents we pull for and that we tend to pull for parents who are like in general, like on board with like their kids identity, but they're still trying to work through some other things. 

So, some, some different topics that that are that often come up are, you know, ways to help the kids cope with the like broader political landscape and, you know, all of the problematic different laws and things coming out across the country. We talk about what providers are around who, who are trans affirming, whether that be, you know, who's, who's a good therapist, who's a good hormone prescriber, who is a good touch point in the schools, you know, all those different, you know, who are the, the people to connect with. We talk about gender affirming hormones a lot, but that's where a lot of, a lot of the youth are at that stage of a lot of them are, are concerned, the families are working through whether or not the teen is going to start gender affirming hormones. So, that would be, you know, starting testosterone for a trans masculine person, starting estrogen and testosterone blockers for a trans feminine person and really kind of thinking about, you know, ways to gather information and feel like they're doing the right thing for their kids. I think that's a lot of it is like, you know, you know, as the parents are are saying, you know, I love my kid no matter what. 

And, you know, like, I am tasked with helping them make good decisions for their lives. And I don't have a ton of experience or information about these things that seem scary and intense, although I think that ultimately they're less scary and intense than, than people initially experience them as. And, and I think that's what's been really great about the group is that the parents are often at really different stages of things. And so, people are able to hear from other parents directly about what their lived experiences have been, which I think is just so powerful. You know, I can say things all day as a professional, but hearing it from a parent who had those same concerns for their own kid, I think is really powerful. 

Tina: Yeah, thank you for doing that. That is exactly, that's the magic, right? I love that professionals are in our lives and have information and can help us share and connecting with others who are like us is so affirming and so normalizing. And so I have so many questions also. And again, we don't want to make this episode too long. I'm curious about the age ranges of in general. I mean, just be general about this. Do you find that your group is is heavy in one way or another on like age range of kid when the parents come to you. So, I wonder, I feel like we went through a lot of mental health struggles before I connected with other parents. And it was quite a while before I did that. And I'm wondering how early people connect. 

Jessica: I think it's, you know, it's it's often the middle school crowd. Definitely, I have some, you know, third, fourth, fifth grade kind of age kids. Definitely have parents of high schoolers as well, you know, I market it as for parents of youth. So I have a couple like parents of 18, 19 year olds, but not on as much. It's a lot of the like, you know, 13, 14 year olds, which is like, like what a hard time to be a person is middle school. And then you add on trying to understand your gender identity on top of it and parents trying to understand, well, if my teen is non-binary, like do hormones even make sense and like what, like they, they won't talk to me about these things and, and how do I get them to talk to me just like, how do I get them to talk to me about, about anything, right? That's exactly normal content of like things that are hard about parenting a middle schooler. But then there are like extra layers of like making medical decisions about about the, you know, the few words you're able to scrape together from what your teen will tell you so. 

Tina: Yeah. Yeah. So you're doing an awesome thing in having a support group. And I'm curious if you now, we will definitely share these in notes, but if you have some go to resources that you would say to parents like go to these places. 

Jessica: Yes, absolutely. So genderspectrum.org is typically where I recommend people family start that it's just a great place that has, it has a bunch of like national and maybe even international parent support groups. So if people don't happen to be able to come to my one hour a month, then there are lots of opportunities there. They also have this information for all kinds of different, you know, they have information for youth themselves, for family members, for educators, for, you know, religious leaders, just like they have so much content in there for so many different groups. And it tends to be well, you know,I, I have not read through every article in the whole site, but it's all in everything that I have come across as information that I trust.

Another resource that I think is super important to talk about is the Trevor project. So they have an online chat. They have a text. They have a phone line available at 1-866-4887386. So this is the LGBTQ youth kind of crisis line that I really appreciate and think is really important to make sure people know about. Certainly, you know, 988 is is also a number that anyone can call to get support around mental health crisis kinds of, kinds of topics. 

Serena: Sorry Jessica, it is the, is the Trevor project hotline can parents call that too or is it mainly for youth? 

Jessica: It's mainly geared toward youth, but there's definitely resources, like certainly on their website, there's a lot of resources for, for everyone, including parents. And like if parents are in a crisis moment about their, you know, LGBTQ plus teen, then I think they're totally a reasonable place to reach out.

Serena: Okay. Okay.

Jessica: Locally our local Planned Parenthood has a lot of really good LGBTQ plus resources and programming, not all Planned Parenthood's across the country have them, but a lot do. And so I am a really big fan of of that agency as well. 

Serena: Awesome. Yeah. Thank you for all of those super helpful. So before we kind of bring this episode to a close, um, I'm feeling like we may have to have you back again in the future because I just, yeah, coming up with more questions, but, um, what I, what I will ask you is, is there anything that we haven't asked you that you want to make sure you put out there to the world? 

Jessica: Yeah, I guess that like that, that having a teen who or child or young adult or anyone in your life who identify in a, in a particular way in terms of their sexual orientation or gender identity, I think it's, it's just still the same stuff as anything else. You know, it's just about being a loving and caring person, you know, helping people identify other safe spaces, you know, if, if you're, you know, if your immediate family isn't going to be that safe loving, supportive, you know, affirming place, then is there someone, is there a trusted adult at school? Is there a trusted adult in an extracurricular activity, you know, is there a safe place within your religious organization that that it's so important to just for kids to be, to hear that they're love no matter what, you know, and so they need to get that message from somewhere, and the same exact things thing goes for trans youth as anyone else. I think that that in general parents are more likely to panic about it than they necessarily need to. 

I think the way to let your kid explore and figure out who they are is to be neutral about it. You know, like, if your teen tells you they identify in any way, and you come back with, absolutely, you do not, then then they have to dig their heels in and prove to you, no, absolutely, I am. That's when kids get stuck. I think parents fear, well, if I start using this name, I start using these pronouns, am I feeding into it? You know, am I locking them into this identity that that down the line, maybe they won't always identify as, you know, teenage, the teenage time period is such a time of exploration and coming to understand our identities, but the way to give kids the most opportunity to explore and figure out who they are is to let them explore, right? And so maybe that means using a different name or pronouns. Maybe that means letting them, you know, go thrifting and get some different clothes. And then you pause and you ask them, hey, how did that feel? The more you can be low key and neutral and just, you know, walk into it with a mindset of like, you know, who knows how you're going to identify, but I'm going to be respectful enough to call you what you ask right now. And we're going to be curious by trying new things and seeing how it feels. That's what gives kids permission to really explore and really fine tune how they identify if they're given that space and support to try out different things and then know their parents are in neutral because they're, they are to support them no matter what.

Tina: That unconditional love for sure. And so many, yeah, so many ways that we can show it and acceptance and yeah, thank you. Thank you for all your words of wisdom and especially that last in nuggets. We appreciate you joining us today so much. You are a fountain of knowledge and yeah, we really appreciate all the work you're doing to support families and youth.

Jessica: Well, I appreciate you guys inviting me. I'm happy to come back one ever and talk more.

Serena: All right, thanks Jessica. And so podcast friends, we are so grateful that you've chosen to spend time with us today and listen to our podcast. If you happen to get a chance, go buy Apple podcast, leave us to review, subscribe, and please share our podcast with others. You will find more content on our website. Noneedtoexplainpodcast.com. You can connect with us on the socials, call us and leave a voicemail message. You'll find that number in our show notes. You could share your story. Tell us your thoughts or just call to say hi. 

Tina: And this is your gentle reminder to take good care of yourself while you are also taking care of your people. 

Serena: Thanks for listening. 

Tina: Bye!

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