{"id":193959,"date":"2024-12-03T19:11:15","date_gmt":"2024-12-04T00:11:15","guid":{"rendered":"https:\/\/www.aclu.org\/?post_type=podcast&p=193959"},"modified":"2024-12-04T17:34:54","modified_gmt":"2024-12-04T22:34:54","slug":"the-truth-about-gender-affirming-care-with-w-kamau-bell","status":"publish","type":"podcast","link":"https:\/\/www.aclu.org\/podcast\/the-truth-about-gender-affirming-care-with-w-kamau-bell","title":{"rendered":"The Truth About Gender-Affirming Care with W. Kamau Bell, Nava Mau, and Dr. Susan Lacy"},"excerpt":{"rendered":"

You may recognize W. Kamau Bell from his three-time Emmy Award-winning docuseries United Shades of America, or from his Substack Who\u2019s With Me, or from his commercials for the ACLU. If you're a long-time ACLU supporter, you'll know Bell has worked with us for more than a decade as our Artist Ambassador for Racial Justice. We're excited to have him as our interim host for our At Liberty podcast, where he will host conversations with leaders, legal experts, artists, and storytellers dedicated to the fight for civil rights and civil liberties.
\nIn this episode, Kamau discusses how gender-affirming health care can save lives with activist and Emmy-nominated actress Nava Mau and Dr. Susan Lacy, a board-certified gynecologist who has provided the care at her Memphis clinic for decades. They get into how the transgender community accesses this health care, why it\u2019s vital to them, the misconceptions around it, and why \u2014 on the heels of a Supreme Court case that could threaten access \u2014 we all need to get involved. The case, U.S. v. Skrmetti, centers on when, where, and how the government can discriminate against transgender people and the health care they receive. Mau and Dr. Lacy, a plaintiff in the case representing herself and her patients, address what\u2019s at stake and what practical next steps we can take to help protect transgender rights from an avalanche of legal and legislative battles.<\/p>\n","protected":false},"featured_media":194073,"template":"","series":[],"class_list":["post-193959","podcast","type-podcast","status-publish","has-post-thumbnail","hentry"],"acf":{"date":"20241203","audio":194028,"transcript":"[00:00:00] W. Kamau Bell:<\/strong> Hey everybody. It's me, W. Kamau Bell, standup comic, TV host, filmmaker, dad, pretty good husband, and interim director of the ACLU's podcast At Liberty. I went to the Oprah school of talking. Today we're speaking with Emmy nominated actress, author, trans advocate, Nava Mau , and board certified gynecologist, Dr. Susan Lacey. What you might ask could bring the three of us together? On December 4th, the U. S. Supreme Court will hear a case about when, where, and how the government can discriminate against transgender people. The case comes down to a 2023 Tennessee law that bans medical treatments like puberty blockers and hormones for trans youth.\r\n\r\n[00:00:46] W. Kamau Bell:<\/strong> In other words, if you're not transgender, you already have access to these medications, but if you are trans, you do not. The ACLU and the Justice Department will argue that the ban is unconstitutional under the Equal Protection Clause of the 14th Amendment, which says the government cannot discriminate on the basis of sex. And the Tennessee ban isn't an isolated attack. It's part of a larger effort to silence, marginalize, and erase transgender lives. The 2024 legislative session was the fifth consecutive record breaking year for total anti trans bills and Tennessee's healthcare ban is one of 24, just like it passed in 2021. Surveys tell us that most people don't even know a transgender person, let alone have familiarity with their health care. Just like with abortion, birth control, or even vaccines, the lies about gender affirming medical care are spreading far and wide.\r\n\r\n[00:01:38] W. Kamau Bell:<\/strong> Dr. Susan Lacy has practiced medicine for almost 30 years. In the upcoming Supreme Court case, she's a plaintiff challenging Tennessee's ban on behalf of her practice and her transgender patients. Today, I'm speaking with her and the actress, Nava Mao, to talk about what this health care means in practice and why it's so important for transgender people.\r\n\r\n[00:01:59] W. Kamau Bell:<\/strong> Thank you for taking your time out of your busy schedules, both of you, to do this.\r\n\r\n[00:02:03] W. Kamau Bell:<\/strong> Thank you for having it, having here, and thank you for showing up for the ACLU in all the ways that you do. Thank you. I'm coming to you both from Oakland, California. We're here in Oakland, California. Nava, you spent time in Oakland, huh? Is that true? Huh.\r\n\r\n[00:02:15] Nava Mau:<\/strong> I did, and I was actually just there a few days ago.\r\n\r\n[00:02:18] Nava Mau:<\/strong> I went for the premiere of this documentary I executive produced called Survivor Maid.\r\n\r\n[00:02:23] W. Kamau Bell:<\/strong> Oh, wow. And you lived here for a while, correct?\r\n\r\n[00:02:26] Nava Mau:<\/strong> Yes. Yeah. I was there for about four years. It was kind of where everything happened. It's where I transitioned actually. It's very fitting. And I have really huge place in my heart for Oakland.\r\n\r\n[00:02:39] W. Kamau Bell:<\/strong> Oh that's good to know. When I was watching baby reindeer, first of all, let me just say, let me tell you, that's just good. I don't know if you've heard that, gotten that feedback Nava , but that the show is entertaining and good. But but yeah, I just, when I was watching that, I remember when you came on screen, but I was as this moment of wait, who is this person who just exploded on the screen that I'm not familiar with their work before?\r\n\r\n[00:02:59] W. Kamau Bell:<\/strong> And so I had to pause and do a deep dive on you in the middle of watching the show, just because I was The show is so quirky and doing its own thing. And you felt like such a force of nature in that show. So I just really want to compliment you and your work that it actually made me pause and figure out who is this person I can't pay attention to.\r\n\r\n[00:03:14] W. Kamau Bell:<\/strong> I know who this person is. So thank you for your work.\r\n\r\n[00:03:18] Nava Mau:<\/strong> Thank you. That is so sweet. That really means the world. I've been a fan of yours for so long, so this is. Like I'm getting a little bit of goosebumps right now.\r\n\r\n[00:03:29] W. Kamau Bell:<\/strong> No that makes me feel good. Thank you. And now I'm getting reverse goosebumps.\r\n\r\n[00:03:33] W. Kamau Bell:<\/strong> Thank you for your work. And I know as a person who I, you know, I, you know, I always joke that my mom being a black woman with a college degree, who was born in 1937, everywhere she went for the first half of her life, she was the first black woman to do whatever that was. You know, just cause it was, that's where America was.\r\n\r\n[00:03:48] W. Kamau Bell:<\/strong> You're the first black woman to take a left turn on the street. You know, it's just cause of the way that America's set up. And sometimes that, that history can be a burden, it can feel burdensome. I just want to do my thing. How do you live with that history when you're also just a person?\r\n\r\n[00:04:02] Nava Mau:<\/strong> You know, I think that the reality is that I don't feel like a first.\r\n\r\n[00:04:10] Nava Mau:<\/strong> I do all that I do within community. I started out with a short film that was crowdfunded on a micro budget, and I was not the only trans woman working on that project. I, have always worked in community organizations and my mentors have been, you know, trans women. And so we've always been here and we always will.\r\n\r\n[00:04:36] Nava Mau:<\/strong> And any sort of recognition As one of us being the first is actually just the perspective of a cis person seeing us for the first time, but we've seen ourselves all along.\r\n\r\n[00:04:48] W. Kamau Bell:<\/strong> Yeah. No. And and Dr. Lacey, you're in this position of being a doctor, but it's also, and this is another thing I think that as black folks, we also have to be activists no matter what our job is.\r\n\r\n[00:05:01] W. Kamau Bell:<\/strong> It seems like that, you know, that's that you can't just show up and do your job. You have to show up and do your job and also. Do the job of liberating your people and liberating other people. How do you balance those two things?\r\n\r\n[00:05:11] Dr. Susan Lacy:<\/strong> Yeah. And just the other little Oakland shout out is I grew up in Sonoma County, so I spent plenty of time.\r\n\r\n[00:05:18] Dr. Susan Lacy:<\/strong> Yeah. So I grew up in Santa Rosa and so I spent, you know, time in Oakland as well. So that's cool that we're all sort of have that connection. Yeah. It's interesting. It, yeah. It's one of those things where. When I, and we can talk about this more, but I started providing trans hormone care about eight years ago.\r\n\r\n[00:05:37] Dr. Susan Lacy:<\/strong> I've always really been interested in hormone management. That's something that I find very interesting. And so when you do this, you sort of, what I did, I sort of said, okay this is what we're going to do. And so I just sort of, I sometimes say it's kind of an accidental activist because I didn't really Go into it thinking, you know, Oh this is going to be something that I'm going to, you know, get out there and be in the forefront.\r\n\r\n[00:05:58] Dr. Susan Lacy:<\/strong> I just was interested in taking care of people. And then the more people I took care of, the more people needed care. And so then people start asking you about it, and then you start giving lectures or doing educational stuff with medical students and residents. And, you know, 1 thing just sort of leads to another.\r\n\r\n[00:06:15] Dr. Susan Lacy:<\/strong> So then you sort of have the point of, OK, now you're the person, now you're the point person, now you're the activist. And I'm like, I'm just trying to do this and take care of people and do my job basically.\r\n\r\n[00:06:24] W. Kamau Bell:<\/strong> Thank you, Nava. I see you nodding your head a lot. I want to know what is behind all those head nods?\r\n\r\n[00:06:29] W. Kamau Bell:<\/strong> I see. As Dr. Lacey was talking.\r\n\r\n[00:06:31] Nava Mau:<\/strong> I'm an active listener first and foremost just taking it in but I really, it does resonate with me everything you just said, Dr. Lacey you know, we end up doing work that becomes politicized and for me, creative work starts from my heart.\r\n\r\n[00:06:50] Nava Mau:<\/strong> You know, it starts in my body. It's not something that I, I do to become part of some sort of legislative battle. That's not, you know what I mean? That's not what drives me, you know, freedom is ultimately what I strive for, whether that's freedom of expression or freedom to, to exist. And any sort of political battle that gets placed on top of that work, I really see that as coming externally. And it's like an added layer that we have to deal with, but that's not what the real work is actually about.\r\n\r\n[00:07:27] Dr. Susan Lacy:<\/strong> Yeah. And I would say as well, you know, like I said, I started about eight years ago and it wasn't, there was very little sort of political discussion.\r\n\r\n[00:07:36] Dr. Susan Lacy:<\/strong> It was, you know, a little bit, but, you know, in the last several years, all of a sudden, it's turned into this huge political issue, which is sort of strange. I mean, we understand why that happens, but it's a little bit strange because it's not like people haven't been providing this care. So for me, it's eight years ago, I was providing this care and there were no issues.\r\n\r\n[00:07:58] Dr. Susan Lacy:<\/strong> And then all of a sudden it's an issue and you're kind of, you know, I mean, I understand why it happens, but you also kind of go people have been doing this for a long time. And a lot of patients have been receiving care for a long time. Nothing has really changed except for sort of the visibility.\r\n\r\n[00:08:16] Dr. Susan Lacy:<\/strong> And some of that is many, is very much manufactured to create conflict.\r\n\r\n[00:08:21] W. Kamau Bell:<\/strong> Speaking of manufactured creating manufactured visibility to create conflict, I feel like it's a currently in the news and representative Nancy Mace is walking around the halls of Congress, putting the sign biological over the women's bathroom in Congress, directly targeting Sarah McBride, I believe her name is, the just newly elected congressperson.\r\n\r\n[00:08:43] W. Kamau Bell:<\/strong> What goes through your mind, what goes through your body when you see this, you know, see things like that happening? Where this clearly, this congressperson is actively weaponizing is what I would say, this idea just as a way to get attention.\r\n\r\n[00:08:56] Dr. Susan Lacy:<\/strong> I mean, I, you know, that the whole issue again is somewhat, it's artificial manufactured because, you know, she didn't know who that this person identified as trans. She wouldn't have any idea that there was somebody trans in the bathroom with her, right? And you know, it becomes an issue of fake outrage. And, you know, one of the things that I always say about bathrooms is so tricky, is I have patients who maybe have been on masculinizing therapy for, you know, 10 years, have a full beard, have had top surgery. And now, if they walked into a room and you had to ask the average person to identify their sex and gender, most people would identify, definitely identify this as a male person. And now this person has to decide do I go into the bathroom that legally I'm supposed to go into? Or do I go, do I go into the bathroom that people are going to feel comfortable with me in?\r\n\r\n[00:09:48] Dr. Susan Lacy:<\/strong> And it creates a scenario in which everybody is a policeman, you know, everybody is sort of judging this person's identity by what they look like on the outside. And, you know, that's so problematic because first off, why does it matter? But secondarily, it really is tricky for people who are trying to make a value judgment of where they feel comfortable being, and are they going to be safe?\r\n\r\n[00:10:10] Dr. Susan Lacy:<\/strong> And, you know, it, again, it's an argument about something that is, you know, No, not was never a problem. It isn't a problem, but it's a way to create outrage.\r\n\r\n[00:10:20] W. Kamau Bell:<\/strong> Yeah. Nava , have any thoughts on that?\r\n\r\n[00:10:23] Nava Mau:<\/strong> Yeah I think it's manufactured outrage for sure. It, I think also is an extension of the surveillance state and any kinds of efforts to legislate and police access to public bathrooms are only meant to normalize the policing of people's bodies. And to normalize what will come of enforcement of any kind of bathroom bills, like, how are people going to be verified as suitable to use any one bathroom or the other? This is, these kinds of bills are going to affect cis people, you know, just as much and sometimes more so than trans people. How people's genitals are going to be verified? How, are people going to have to carry ID at all times? That's police state stuff. And this is just one of the ways that the conservative government right now is trying to amplify the police state.\r\n\r\n[00:11:22] W. Kamau Bell:<\/strong> Dr. Lacey, let's talk about the case that you're a plaintiff in that is going to the Supreme Court, which is just I don't often talk to people who are going to the Supreme Court. So first of all, yay, quite an accomplishment, even though it's gotta be scary. Can you talk about what your feeling is around going to the Supreme court and also tell us about the case.\r\n\r\n[00:11:43] Dr. Susan Lacy:<\/strong> Yeah. First let me say I'm not the person that's doing all the hard work, of course, you know. And so basically in a brief summary, back two years ago, I went to a meeting here where I live in Memphis, Tennessee, talking about this law that was being argued about in the state legislature about limiting trans care for minors. And then I met some of the ACLU leaders in the state. And then once the law was passed, the law was passed that bans trans care for for minors. They reached out to me and we talked and discussed, you know, their, the ACLU along with Lamda Legal filed suit against the state to prevent this law from going into effect.\r\n\r\n[00:12:25] Dr. Susan Lacy:<\/strong> And so that's where it all started. And so ultimately the law was initially overturned by a local, you know, state judge, and then it was appealed to the appellate court who ultimately allowed the law to go into effect. And then it was the decision was appealed to the Supreme Court and they chose to take the case. It's a little bizarre and it's a little strange and all my lawyer friends are like, do you know how rare that is? I said, yeah, it is. But I mean, from my standpoint, it's just a matter of being willing to put my name out there and my experience and stand up for these patients. And, you know, continue moving forward in that direction.\r\n\r\n[00:13:03] W. Kamau Bell:<\/strong> You say that like it's an easy decision to make, but I'm sure that you had to like, talk to your family and your friends because that puts you you know, in the cross hairs of people who are looking to, you know, weaponize this information and looking to find and find targets, you know, and as a black woman that's a, that's an often a favorite target of people like that.\r\n\r\n[00:13:23] W. Kamau Bell:<\/strong> So I would imagine you had to sort of, there was some sort of gut check or talking to your people and what was that like?\r\n\r\n[00:13:30] Dr. Susan Lacy:<\/strong> Yeah, I mean, it's interesting. So I started, like I said, providing trans care about eight years ago. About a year afterwards, one of, I have four children, all assigned male at birth, and I have a set of fraternal twins that are in the middle.\r\n\r\n[00:13:44] Dr. Susan Lacy:<\/strong> They're 23 now. And so one of my children came to me and came out as trans and that It was a little, not surprising exactly, but it definitely was not something that we'd ever really talked about. It also wasn't something we'd ever really had any issue with. My ex husband's a pediatrician, and so both of us were like, okay, great.\r\n\r\n[00:14:02] Dr. Susan Lacy:<\/strong> You know, at that point I'd been providing care for a year, so you know, it was, I was very familiar. But then I thought about it from my child's standpoint, not so much in the enactment of this law, because my child is now over 18, but, you know, obviously just seeing these patients and dealing with the families, dealing with the parents a lot, which Is you know nice because I come at it from a perspective of both a doctor and a parent and so I talked to my children.\r\n\r\n[00:14:27] Dr. Susan Lacy:<\/strong> My children are like way more like gung ho activists than I am even sometimes So they are all supported and my ex husband and we've had conversations about things like this before and you know we just all kind of feel very strongly that you have to be smart you have to be safe, but The whole point of intimidation is to silence people and to make people afraid.\r\n\r\n[00:14:51] Dr. Susan Lacy:<\/strong> And yeah. And so I just, you know, it wasn't really a difficult decision. I mean, 1 of the things is I'm independent. I have my own practice. And while I have a faculty appointment at the University of Tennessee, I'm not employed by the university. And a lot of people that are medical professionals are sort of limited in what they.\r\n\r\n[00:15:12] Dr. Susan Lacy:<\/strong> can do. And so I was sort of somebody who had that ability. And you know, it was, it really wasn't a difficult decision. My, my family was all very supportive and I have a lot of friends and even Memphis, you know, we think of it, those of you who've never really been to the South or haven't spent much time here, you think of it as being very different, but Memphis itself is a pretty supportive environment and there's a very robust community and I have a lot of friends.\r\n\r\n[00:15:38] Dr. Susan Lacy:<\/strong> And so I've felt pretty supported in general.\r\n\r\n[00:15:43] W. Kamau Bell:<\/strong> So Nava, when you hear that I would imagine hearing that that that the doctor's trans child had two doctors, his parents, one who's a pediatrician and one who's in the middle of who actually works in gender affirming care, that's gotta be, not every trans child has that good fortune.\r\n\r\n[00:15:59] W. Kamau Bell:<\/strong> What do you think when you hear that?\r\n\r\n[00:16:01] Nava Mau:<\/strong> Yeah, I mean, what a blessing. What a blessing to have that family. I think that so often what we see is rejection of trans children. And and what we've seen over and over again is that it makes all the difference in the world for a child to be accepted and loved by their parents. So I'm so glad they had you both.\r\n\r\n[00:16:25] Dr. Susan Lacy:<\/strong> Yeah, no, it was great. And my, of course my. Other children were very supportive as well, but, you know, I end up with my kids because now I can't treat minors, of course, although even when I did, and I'm sure you'll ask me about that, I there were always, it was always, it's always done with parental consent for minors, so the parents were part of that conversation, but I have a lot of, you know, young people that are, let's say, 18 to 25, let's just say, and, you know, there's a little bit of feeling that, you know, if they don't have parental support, they're They rely on us and 1 of the things that's great is my staff is very supportive and, you know, you know, we try and really create our office to be a really relaxed and comfortable safe space so that they can come in and feel.\r\n\r\n[00:17:09] Dr. Susan Lacy:<\/strong> Even if they don't get that support from somewhere, they're going to, you know, they have a couple of mamas here that are supporting them. And you know, that happens a lot as well.\r\n\r\n[00:17:17] W. Kamau Bell:<\/strong> Yeah, even the name of your practice, it's called MORE, M O R E, and it says on the website that the philosophy is to provide more dot.\r\n\r\n[00:17:25] W. Kamau Bell:<\/strong> So what does that mean? How does that sentence end? What is the more?\r\n\r\n[00:17:29] Dr. Susan Lacy:<\/strong> You know, the, and we've gone through some different iterations. So the original name is modern gynecology and reproductive health. We now go by more 901 because the more pieces become even more relevant.\r\n\r\n[00:17:39] Dr. Susan Lacy:<\/strong> But I think one of the things that I see a lot, and it's not just with my trans patients, I deal with, I treat a lot of patients for hormonal management, like menopausal patients, even a few CIS male patients, but what I hear is not dissimilar, which is. I'm going and I'm talking to these doctors, these menopausal women, they come and I said, I'm miserable.\r\n\r\n[00:18:00] Dr. Susan Lacy:<\/strong> My brain's not operating. I'm foggy. I'm not focused. And I can't get people to take me seriously. And unfortunately, I think You know in healthcare, there's such a doctors are getting busier and time is getting less and less. And and that's very hard on the physicians as well. And so one of the things that we just want to do is be a space where, you know, we'll provide you more time, more compassion, more consideration, more opportunity to make sure that your concerns are heard.\r\n\r\n[00:18:30] Dr. Susan Lacy:<\/strong> So all of those types of things, no matter what the issue is. Because it might be an 18 year old trans person starting their medication and it might be a 50, you know, 45 year old woman is going through menopause and her kids are getting ready to go to high school and college and she's pulling her hair out and it doesn't really matter.\r\n\r\n[00:18:48] Dr. Susan Lacy:<\/strong> That person just needs the opportunity to be heard and then have an approach that does everything they can to address their concerns. And and so that's really kind of the philosophy is to just provide those things that maybe you're not getting somewhere else.\r\n\r\n[00:19:02] W. Kamau Bell:<\/strong> So let's, we're going to do some definition of terms just for the people in the audience who may not know some of these things.\r\n\r\n[00:19:08] W. Kamau Bell:<\/strong> Also, so I could love to have you both sort of comment on what the actual meaning is versus the dictionary definition. So transgender is defined as having a gender identity that differs from the sex you were designated at birth. What does that actually mean? Nava to you as a person who lives this life and is not a dictionary.\r\n\r\n[00:19:25] W. Kamau Bell:<\/strong> And what does that mean to you, Dr. Lacey, as someone who's practicing this health care? What does gender identity mean to each of you and why is that important?\r\n\r\n[00:19:33] Nava Mau:<\/strong> I mean, I think if now we got to define gender identity,\r\n\r\n[00:19:42] Nava Mau:<\/strong> Because we all have a gender identity. I think that is something people may not understand or know about themselves. And it's just that in our world, in our you know, heteronormative, cisnormative world, cis people often have not ever had to interrogate their own gender identity. And it's only people who deviate from the norm.\r\n\r\n[00:20:08] Nava Mau:<\/strong> Thank you. that are forced to have to contend with that. So that's, I think, where the need for terminology came from, for trans people to be able to identify ourselves and to explain our experience to other people. But at the end of the day, we all have a gender identity. And you know, my gender identity, in one sense, it is woman.\r\n\r\n[00:20:29] Nava Mau:<\/strong> The same way that a cis woman's gender identity It can be woman. There's the type of woman that I am, which is a trans woman which I think gives more detail and is more specific to my gender experience. And and I actually, that definition of transgender that we've kind of landed on, generally, feels very useful to me.\r\n\r\n[00:20:55] Nava Mau:<\/strong> It's broad enough and yet specific enough because I think that there are non binary people now who have come into the public consciousness. And again, we've always been here as trans people. And so non binary people have always existed. It's just that the term for non binary, I think really surged into more common.\r\n\r\n[00:21:21] Nava Mau:<\/strong> Consciousness in the past few decades you know, it's, I think it's up to every person to decide whether or not they identify as transgender. And I think that definition kind of allows for that.\r\n\r\n[00:21:33] Dr. Susan Lacy:<\/strong> Yeah, you know, the term, I mean, you all may know this, but the term trans and cis is basically a chemical term.\r\n\r\n[00:21:40] W. Kamau Bell:<\/strong> I don't actually know that. I just want to be clear. I want to own my ignorance. I did not know that.\r\n\r\n[00:21:46] Dr. Susan Lacy:<\/strong> In chemistry and when you're talking about chemical bonds and chemical compositions, if the, for simplistically, if the bond or the chemical composition or the chemical piece, let's just say is on the same side, is on the same side, it's cis and if it's on the opposite side, it's trans.\r\n\r\n[00:22:04] Dr. Susan Lacy:<\/strong> And so that's where the term came from, meaning cisgender, meaning your gender and your sex align and transgender meaning that they are different or opposite. So it does. So that's about those little prefixes are scientifically based in terms of where the language came from. Yeah, and I think that, you know, as somebody who came to providing this care, you know, midway through my career, I think that the language is changing constantly.\r\n\r\n[00:22:37] Dr. Susan Lacy:<\/strong> And I always say, listen this is an area where language is changing and we need to allow ourselves to be led and informed by the people who it affects. And but I think that it is good terminology because it's fairly simple. It's amazing how hard it is sometimes for people to understand because they just get really caught up in that. They also get very caught up in what, how that relates to sexuality, which obviously, you know, is a very different thing. And you know, I think, but I think that terminology is good. I mean, in terms of being fairly simple and something that people can understand.\r\n\r\n[00:23:12] W. Kamau Bell:<\/strong> Yeah. I mean, I think that, you know, I feel like so much of this, like you said, boils down to people's inability or disinterest in learning new things after a certain point in life.\r\n\r\n[00:23:22] W. Kamau Bell:<\/strong> Nava, I think you mentioned the phrase gender dysphoria and everything we're saying, I think applies to gender dysphoria in this part of the conversation, but can we just get like a, and Dr. Lacey, if you want to take it as the scientist, just what gender dysphoria is for people who aren't sure about that.\r\n\r\n[00:23:37] Dr. Susan Lacy:<\/strong> Yeah I mean, the medical diagnosis, if you use, you know, for, you know, a diagnosis for treatment. First, there is no psychiatric diagnosis anymore for gender dysphoria. It's been removed from the DSM, I can't remember which one it is, but it's a diagnostic statistic manual for psychiatry, for psychological illnesses.\r\n\r\n[00:23:57] Dr. Susan Lacy:<\/strong> So it is no longer part of that. But as a medical diagnosis, basically where you have sort of ongoing fixed stress, anxiety negative thoughts related to the disconnect between sex and gender is probably the best way to describe it. And we were talking about minors. It has to be of six months duration or more. So you have to have had this again , it kind of goes back to what we were talking about and not immediacy of the treatment is there, there is sort of a time frame built in that it has to have existed for a period of time in order to qualify and categorize as gender dysphoria.\r\n\r\n[00:24:34] W. Kamau Bell:<\/strong> Nava, what are your thoughts? And so I know you are a peer counselor for LGBTQ youth survivors of violence. Can you talk about the time there and also gender dysphoria when you hear that term, what you think?\r\n\r\n[00:24:45] Nava Mau:<\/strong> Yeah that, that was a beautiful explanation, Dr. Lacey. I think that I can, I think I can maybe offer an expansion also on what anxiety can be. You know, it's not just discomfort. You know, it can really be incapacitating. I remember clothing was always growing up clothing was always such a battle and we could not figure out why, you know, and I ended up having body image, severe body image issues. And I developed an eating disorder that I had to deal with for about 10 years.\r\n\r\n[00:25:21] Nava Mau:<\/strong> I went into treatment. I dropped out of school. And later on, I realized how much of that probably had to do with the baseline of dysphoria. And I , there's just, I can't even, I almost can't even put myself back in the place of what my day was like before I transitioned, or early transition, when my dysphoria was so high.\r\n\r\n[00:25:46] Nava Mau:<\/strong> It's every moment kind of throws you off cause you're expecting, you know, the mirror surprises you and your own body sort of betrays you. And so it's like this constant like hitting a wall. And yeah I don't know if people can't understand what that means. I would hope that they can just trust that we're telling the truth but my work with survivors was, you know, some of the most meaningful and fulfilling work I've ever done in my entire life. I got to work with people from all walks of life and in, in lots of different points of their journey in terms of transition, in terms of identity and also in terms of whatever violence they were dealing with.\r\n\r\n[00:26:38] Nava Mau:<\/strong> And what was most meaningful about being a counselor was that it was a healing space. It was a generative space. It was a space where we got to explore options, where we got to discover resources. We got to practice tools and skills. And and so every single person that I worked with, I can say that, that we got at least from point A to point B and a handful of them we got from A to C.\r\n\r\n[00:27:09] Nava Mau:<\/strong> And and so to witness that kind of movement it is, it was so inspiring and it's something I'll carry with me forever and I think is also a beautiful poetic allusion to what it means to transition, you know, whether you go from A to B or A to C. That, that work to me is all the same.\r\n\r\n[00:27:27] W. Kamau Bell:<\/strong> Yeah. I just want to just, you said at some point, if you don't believe this, trust us. You said, if you don't, if that doesn't make sense, you just trust us. But I just want to say. Anybody, I feel like we all separate from trans folks just as humans have had moments of I don't feel like myself, or I don't like what I see in the mirror. And not to say it is the same as gender dysphoria, but I think that anybody who is denying the realities of gender dysphoria is also denying themselves. But also, you live in a world where I think about my mom, again, who's 87, she's been colored, Negro, African American, Black. You know what I mean?\r\n\r\n[00:28:00] W. Kamau Bell:<\/strong> So like we are very used to in society going like these words don't fit anymore. Let's figure out some new words that fit better. So I think that's the way I always think about is that we are very used to, you know, learning new words if we want to, and we just have, it's the want we have to create.\r\n\r\n[00:28:18] W. Kamau Bell:<\/strong> Yeah. So let's talk about the kind of work you do and both of you can weigh on this, Dr. Lacey, but just the idea of I think there's a lot of misinformation about what medical interventions are for gender identity. And you said you can't treat children anymore, but there's a lot of, there's a ton of misinformation about kids going to doctors and telling them whatever, and the doctor just doing it and you know, all sorts of medical.\r\n\r\n[00:28:42] W. Kamau Bell:<\/strong> Let's talk about what actually that's what medical intervention interventions there are available, who they're available for in a place where they are legal and like where you're at. And and then also, Nava, let's start with you, Nava. What did it mean to you? You said you transitioned in Oakland. What did it mean to you to be able to do that in Oakland?\r\n\r\n[00:28:59] Nava Mau:<\/strong> Yeah, I you know, I always say that I actually transitioned twice. I, in college, when I was 19, I started identifying as genderqueer. And then later when I lived in Oakland, I transitioned again. And I came into my womanhood. And that was when I first made a medical transition. And I did not expect it to happen.\r\n\r\n[00:29:24] Nava Mau:<\/strong> I remember the weight of dysphoria just really starting to crush me and me feeling so disappointed in myself. That I couldn't pick myself back up and it was very disorienting. I had graduated from college and I was now trying to fit myself into a very binary world. And it was clearly not working.\r\n\r\n[00:29:51] Nava Mau:<\/strong> And so it took me having to take it one step at a time. And then once I discovered that transition was even possible, it, then it's like the fog lifted. It happened almost immediately. And then my life changed. I started to be, you know, assumed to be a cis woman in daily public life, and that was not something I had ever expected or prepared for.\r\n\r\n[00:30:20] Nava Mau:<\/strong> And and so it was just a lot of change, but it was like the grass really was greener on the other side. And transition is what allowed me to, you know, launch my career. I was able to finally write. I directed a film. I could envision my future. I was, I had been so stuck in, just getting through every single day and having to push through the muck of dysphoria before I transitioned. And so I just would not be able to be who I am and do the work that I do, let alone, you know, be a part of other people's lives the way that I am if I had not transitioned.\r\n\r\n[00:31:06] W. Kamau Bell:<\/strong> What do you think when you hear that Dr. Lacey with all the work you do?\r\n\r\n[00:31:10] Dr. Susan Lacy:<\/strong> Yeah, no, there's, that's, there's, I've jotted myself down a few things to dovetail because it's so important and so similar to things that I hear and, you know, I always like to also say that my experience is It's not, I mean, it's not a first person experience, right?\r\n\r\n[00:31:27] Dr. Susan Lacy:<\/strong> I am a mother and I have patients. I think the thing that's interesting is I've seen, you know, now I've treated probably somewhere in the range of 700- 800 people, I mean, give or take thousands and thousands of visits. So I get, you know, I get a lot of experience from a lot of different people, which is, you know, interesting to sort of distill.\r\n\r\n[00:31:47] Dr. Susan Lacy:<\/strong> First let me sort of address the issue of the process of care. The thing is, when patients first come in to see me, no matter how old they are, the first step is to understand kind of what their journey has been until this point. That's super important. What are their expectations? What have they read? You know, when these younger people come in who are very savvy and connected to all the access of YouTube, social media, TikTok, Instagram, everything, they, you know, I have to understand what their expectations are. And with minors, and I had never treated pre pubertal minors because I think that's something that you really do need a pediatric endocrinologist.\r\n\r\n[00:32:26] Dr. Susan Lacy:<\/strong> Most of my minors were 16 to 18, sometimes a little bit younger. First off, they always had parental consent. Secondarily, we always required them to have a therapist assessment. Everybody that does trans care, particularly for minors, is all on the same page. We're not trying to make it obsessive. You know, that can require sometimes puberty blockers hormone blockers, and then adding the hormones that are appropriate for that person.\r\n\r\n[00:32:54] Dr. Susan Lacy:<\/strong> But that's a process. And so the most important thing, which I thought was really great, you said, Nava was it is a process and it is a transition. And when I see these patients, sometimes I have to remind them that we got to take it one step at a time. And the first step of the journey is obvious, is often the hardest, which is coming to even come in to see me, right?\r\n\r\n[00:33:14] Dr. Susan Lacy:<\/strong> That can be years and years. Then the next step is now we're going to talk about the hormonal piece, and we're going to focus on that for a while, because I think that's really crucial. And then, it isn't for everybody. For some people that's not necessary, but for those that are sitting in my office, of course, that's a big part of it.\r\n\r\n[00:33:31] Dr. Susan Lacy:<\/strong> And then, once we've gone through that, then we can maybe start talking about some surgical interventions. But that doesn't happen off the jump. And it doesn't happen with minors, ever. I mean, there are rare exceptions. The concept that somebody's walking into my office, at 15 years old and we're scheduling them for surgery the next week is so not what happens under any circumstances.\r\n\r\n[00:33:55] Dr. Susan Lacy:<\/strong> And you know, that's it. So that's the one thing is the process. The second thing that you said that I thought was so Interesting, cause it was one of those things, the scientists in me really responded to when I started providing care is that fog lifting. And I sold this for a patient with permission because I've been trying to find a good explanation.\r\n\r\n[00:34:14] Dr. Susan Lacy:<\/strong> And this was about a month ago at a patient who said, I felt like I was a Mac trying to operate on a Windows operating system, so great. I was like, Oh, I said, can I steal this? Cause I'm gonna use it every time now. But. That was the thing that really was so compelling when I started providing care was that the patients would come back and they were different ages, different races, masculinized hormone, feminizing hormone therapy, non binary. And they would say, I finally feel like my brain's operating right. I finally feel like I can think clearly. And when I tell other physicians that and other healthcare providers, it is always a little bit of a light bulb moment. It's almost you know, I've done a lot of lectures and they're sitting there kind of half listening. And then they all perk up and I'm like, this is a brain chemistry thing, at least in many patients and many people. And so when you, when they, when people finally feel like their brain is operating correctly, then it leads to that access to their emotions and allows you, like you said, now to be more creative, to be more yourself.\r\n\r\n[00:35:14] Dr. Susan Lacy:<\/strong> And so many people tell me, \"Oh I finally feel like I maybe cry more. But it's because I'm tapped into my emotions, like I'm tapped into who I really am,\" and then it allows them to live and be more fulfilled person. So when I look at it that way, I just, I'm like, I don't, it's hard for me to understand the objection to care because when you see people go from somebody who felt really restricted and really like they were fighting against themselves to being able to be somebody who is flourishing in their career. It's just like an amazing thing to be able to be part of.\r\n\r\n[00:35:48] W. Kamau Bell:<\/strong> I don't mean to call you out, Nava, but there was a lot of head nodding. There was a lot of head nodding, a lot of active listening.\r\n\r\n[00:35:55] Nava Mau:<\/strong> I'm like, Oh, you're such a good doctor. Yeah, it's it really, it, that, the operating system metaphor I think is so apt.\r\n\r\n[00:36:09] Nava Mau:<\/strong> That is what it feels like. And I, yeah, I don't know. I think I was feeling just a sense of awe and pride at how trans people make it through. You know, like I did go to college before I transitioned. And so it's like our brains still work and we still get through, but it's even more impressive that we managed to do that any of that prior to transition, because you're right.\r\n\r\n[00:36:41] Nava Mau:<\/strong> There is just something that clears up and a path that, that opens after transition. And I think That is what I wish more people who maybe are ignorant or even you know, have negative opinions over, over transition and trans people in general, is that I transitioned because I was so out of sorts physically and mentally and I was so restricted that word also stood out to me from what you were saying.\r\n\r\n[00:37:19] Nava Mau:<\/strong> And why wouldn't we all want a community, a society where people are invited to and supported in thriving? You know, that only betters everyone. And I think that is ultimately what we're talking about here is people's abilities to survive and thrive.\r\n\r\n[00:37:43] Dr. Susan Lacy:<\/strong> Yeah. And one other thing I was going to say, you know, the other half that I wear, which I do a lot of is hormonal management for CIS patients, predominantly like perimenopausal menopausal women, some men as well that age and the newest drug that came out for menopausal women affects an area in the brain where their receptor estrogen receptors that are depleted.\r\n\r\n[00:38:06] Dr. Susan Lacy:<\/strong> And these women come in and they say, of course, the things we hear about hot flashes, and that's all of those things. But a lot of it is brain fog and focus and of course energy and so we're sitting here making medications now to deal with the fact that we have a hormone deficiency in the brain that is affecting people. So how can we not understand that there's an effect on the brain of hormones and, you know, we are maybe not capable yet of really understanding complexity. That is kind of, you know, it's in some ways it's a similar story, you know, I hear the similar thing. And it's been really fascinating for me as somebody who has always found hormones interesting to have to see how the two have intersected and impacted on one another in a lot of ways.\r\n\r\n[00:38:54] W. Kamau Bell:<\/strong> You know, I want to just end this on talking about the future. I mean, you know, this country is in a, as I don't know if it's even at a crossroads anymore. We're headed a certain direction there. You know, the outcome of the case that you're a plaintiff in Dr. Lacey, there's in the hands of nine Supreme court justices. And then also we have a president elect who has said he'll sign an executive order telling every federal agency to cease the promotion of sex or gender transition at any age. Now just because our leaders say this doesn't mean that we have to sit back and let this all happen. Can we talk about what you would want people listening to this right now to do to help support the rights of transgender youth and transgender folks overall?\r\n\r\n[00:39:33] W. Kamau Bell:<\/strong> And let's start with you, Dr. Lacey.\r\n\r\n[00:39:36] Dr. Susan Lacy:<\/strong> Oh yeah, that's a big question. I mean, I think the most important thing is to be open minded and listen to people and believe them, you know, if you, that's where it all starts. I mean, just you see if somebody has a gay family member or a trans family member, all of a sudden they become a lot more, you know, thoughtful and open because they've seen it and it's no longer other.\r\n\r\n[00:40:03] Dr. Susan Lacy:<\/strong> And so I think that's the thing. That's the most important thing. I mean, I think that, you know, it is a really slippery slope to be able to legislate what medication someone can take and say this person can take, like my menopausal patient can take it, but my trans patient can't you know, I mean, unfortunately I'm concerned about that, you know, it's not going to be possible to actually legislate and say that, particularly with adults.\r\n\r\n[00:40:30] Dr. Susan Lacy:<\/strong> You can't be prescribed a medication to be used for you know, for whatever the purpose is, if that medication exists and is available I think that, you know, we're hopeful that we won't come to that, but, you know, I think that we're going to need more and more, you know, allies. And when I say allies, it's really not enough to just sort of passively support.\r\n\r\n[00:40:53] Dr. Susan Lacy:<\/strong> We're going to need people to be more vocally out there and supporting it and supporting their you know, trans patient and, you know, I have a story I'll tell you, I like analogies and stories, but I have a story where I have a very good friend who's an orthopedic surgeon. I've had ACL surgery, I've had a thumb surgery.\r\n\r\n[00:41:10] Dr. Susan Lacy:<\/strong> And he was telling me one day about how he had a patient he'd seen for years who came in for a knee replacement. And when they went to do the knee replacement, this person was under anesthesia and they went to put a catheter in and maybe they didn't realize they were gonna have a catheter and they realized this person was a trans man.\r\n\r\n[00:41:27] Dr. Susan Lacy:<\/strong> He didn't know. Nobody knew. And I kind of looked at him and I said that's your fault. You know, I said, I'm going to call you on that. I said, because what a terrible, scary place for someone to be. What is more vulnerable than being under anesthesia in an operating room? Like where you have no control. And all of a sudden these people in the operating room discover this about you. I mean, I said, that's a failure on the physician's end and I, you know, he's a good friend of mine. We had a good conversation. I said, so you need to ask everybody this question. That's one of my missions is like, these need to be part of every EMR, ask everybody.\r\n\r\n[00:42:01] Dr. Susan Lacy:<\/strong> And I said, so that you are making sure that you are doing what's best for your patients. You're orthopedic surgery, you're not providing hormones, you're not doing trans care, you're not doing gender confirming surgery, you're doing a knee replacement. And so that's really, I think, going to be very important is for, you know, in the healthcare sphere to make sure that we are asking people and understanding where they come from because they still, even if it's not coming to me for hormone management, they still need general health care, right?\r\n\r\n[00:42:30] Dr. Susan Lacy:<\/strong> And you know, that's one of the areas that I'm very, you know, I feel very strongly about. What happens? I mean, I think we're going to have to see. I don't really know the answer to that. I do think it's going to be extremely difficult to take away the ability to get medical care for adults.\r\n\r\n[00:42:47] Dr. Susan Lacy:<\/strong> Not saying it's impossible, but I think it's an extremely slippery slope because if that happens and you can legislate anything, you can say you can't be treated with contraception. You can't be treated. You can't, you can legislate anything if that's possible.\r\n\r\n[00:43:00] W. Kamau Bell:<\/strong> Thank you. Nava, what do you think about the future?\r\n\r\n[00:43:03] W. Kamau Bell:<\/strong> What homework can we give the people listening to this?\r\n\r\n[00:43:07] Nava Mau:<\/strong> I think that we cannot abandon each other. Step one in doing that is not abandoning yourself. You know, so much of what it takes to resist an environment that is oppressive, that is repressive, is about trusting what you actually know, what you actually know in your soul, what you actually know from your own upbringing and from what you can feel when you're with people in person in front of you. And that is the human spirit. We have to hold onto that. We cannot let that be extinguished. And if we are able to hold on to that, that, that light will never be, that light will never be extinguished. You know, we have to trust that and not all of the thank you for the reminder that we're on the ACLU podcast. All of the nonsense. I'm going to say nonsense.\r\n\r\n[00:44:08] W. Kamau Bell:<\/strong> That's the legal term. Nonsense.\r\n\r\n[00:44:11] Nava Mau:<\/strong> That, that is thrown our way that is meant to distract us. That is meant to disorient us and is meant to divide us. We have to resist all of that on a psychological and on a spiritual level.\r\n\r\n[00:44:25] W. Kamau Bell:<\/strong> I just want to say thank you to both of you for taking time out of your busy schedules and out of your advocacy and out of your, and out of your lives to do this.\r\n\r\n[00:44:33] W. Kamau Bell:<\/strong> I really appreciate it. Thank you for being open to having this conversation with me and also having this conversation with each other. I think it was really great to hear this conversation from. This different perspectives, but pulling in the same direction. So I think it's really helpful for people to hear that.\r\n\r\n[00:44:48] W. Kamau Bell:<\/strong> And yeah, thank you for joining me today and we can keep going on and there's more work to do and more to talk about, and we will certainly keep going and thank you for being an example to me to remember how to better support all of my community.\r\n\r\n[00:45:02] Dr. Susan Lacy:<\/strong> Thank you so much.\r\n\r\n[00:45:03] Nava Mau:<\/strong> Thank you.\r\n\r\n[00:45:07] W. Kamau Bell:<\/strong> Thanks so much for listening. If you enjoyed this episode of At Liberty, please subscribe wherever you get your podcasts and rate and review the show. We really appreciate the feedback and just give us five stars or whatever the top review is. Just come on. This is ACLU. Don't be weird. Until next time, I'm W. Kamau Bell. At Liberty is a production of the ACLU. This episode was produced by the ACLU's Jessica Herman Whites, Gwen Schroeder, and Cindy Tsai. And who knows best productions, W. Kamau Bell. That's me, and Kelly Rafferty, Ph. D., and my wife, Melissa Hudson Bell, Ph. D. The show's recorded at Skyline Studios. I'm looking at Brian right now with my loving eyes. And it was edited by the folks at Ultraviolet Audio. And remember friends don't let friends give up the fight.","components":[{"acf_fc_layout":"text","text":{"text":"You may recognize W. Kamau Bell from his three-time Emmy Award-winning docuseries United Shades of America<\/em>, or from his Substack Who\u2019s With Me<\/em>, or from his commercials for the ACLU. If you're a long-<\/strong>time ACLU supporter, you'll know Bell has worked with us for more than a decade as our Artist Ambassador for Racial Justice. We're excited to have him as our interim host for our At Liberty <\/em>podcast, where he will host conversations with leaders, legal experts, artists, and storytellers dedicated to the fight for civil rights and civil liberties.\r\n\r\nIn this episode, Kamau discusses how gender-affirming health care can save lives with activist and Emmy-nominated actress Nava Mau and Dr. Susan Lacy, a board-certified gynecologist who has provided the care at her Memphis clinic for decades. They get into how the transgender community accesses this health care, why it\u2019s vital to them, the misconceptions around it, and why \u2014 on the heels of a Supreme Court case that could threaten access \u2014 we all need to get involved. The case, U.S. v. Skrmetti<\/em>, centers on when, where, and how the government can discriminate against transgender people and the health care they receive. Mau and Dr. Lacy, a plaintiff in the case representing herself and her patients, address what\u2019s at stake and what practical next steps we can take to help protect transgender rights from an avalanche of legal and legislative battles."}}],"we_want_to_hear_from_you":"","participants":[132234,193981,193972],"links":{"spotify":"https:\/\/open.spotify.com\/episode\/5DjMMA7OJUn8wL2nnzpNie?si=W-IKjfYxTZCGvB5TsFa7lQ","apple_podcasts":"https:\/\/podcasts.apple.com\/us\/podcast\/the-truth-about-gender-affirming-care-with-w-kamau\/id1396174920?i=1000679139046"},"related_news_articles":[194001,40499,190291,188110],"issues":[46771,46781,46775,46773,46569,46567],"related_content_cases":[107233],"related_affiliates":[336]},"yoast_head":"\nAmerican Civil Liberties Union<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The Truth About Gender-Affirming Care with W. 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