Podcasts about queer meducation

Kerin “KB” Berger (she/her) is a physician assistant (PA) practicing in Los Angeles, California. She graduated from Quinnipiac University PA program in 2015 with a master's in health sciences. She works full-time at the LA LGBT Center in the sexual health and education department. Additionally, she performs high resolution anoscopy for anal cancer prevention. Kerin is an adjunct professor at Charles Drew University (CDU) PA program where she implemented the LGBTQI and nonbinary curriculum. Kerin travels around the U.S. speaking to medical professionals, students, mental health clinicians, community members and advocates. She lives in West Hollywood with her wife, Jordan and her dog, Rilo. She loves to cycle, travel, and drink old fashions. Episode Highlights KB explains what a Physician Assistant (PA) is and how it's different from a doctor or a nurse. She shares how she got interested in medicine by being interested in science. KB talks about her podcast “Queer Meducation” and her inspiration to start it to bridge the medical and queer communities. She felt like her medical education didn't prepare her to work her best with the sexual health of queer folks. Later on she was invited to come give a presentation on queer health to medical professionals, and this gave her insight to the level of ignorance and inspired her to do more. She shares ideas about how queer folks can find queer and friendly medical practitioners. (GLMA) KB shares tells us what kinds of health issues queer folks might be overlooking and encourages us to pay a bit more attention to.  Web links Find more at  QueerMeducation.com  iTunes,  Instagram, Facebook &  Twitter GLMA - Health Professionals Advancing LGBTQ Equalilty   Grab your FREE Guide - Needs, Boundaries & Self-Care for Queer Folks.  Download it here. Join the Queer Spirit Community Facebook group to continue the conversation and stay up to date on new episodes.  And follow us on Instagram!  Join our mailing list  to get news and podcast updates sent directly to you.

Healthcare in the trans and LGBTQ community can be scary. When I started my transition I had a lot of questions and didn’t really have a knowledgable healthcare provider to turn to. Unfortunately like many of us I had to educate my healthcare provider on trans healthcare. Join me as I interview Karin “KB” Berger a Physician Assistant that works for the LA LGBTQ Center. Hopefully some of your questions will be answered from this episode. If your questions weren’t answered please message either myself at Kayden@transcasterradio.comor KB at queermeducation@gmail.comHope you enjoy!     Check out Queer MEDucation at www.queermeducation.com. Also check them out at Facebook, Twitter and Instagram at QueerMeducation.

A special episode of Queer MEDucation featuring co-editors of the recently published book Headcase: LGBTQ Writers and Artists on Mental Health and Wellness. We speak with Stephanie Schroeder and Teresa Theophano about the importance of documenting personal accounts of LGBTQI and nonbinary mental health challenges.***Full transcription www.queermeducation.com***

In this episode we explore Anal Health. Thanks to Kerin "KB" Berger Founder of Queer MEDucation who answers our questions specifically around Anal Sex, the risks involved, and how to do it safely. Kerin "KB" Berger is the founder of Queer MEDucation, a website and podcast about improving the quality of health care for LGBTQI+GNC people. Kerin is a Physician Assistant licensed under the National Certification Commission of Physician Assistants (NCCPA) and the Physician Assistant Board of California. Kerin’s clinical practice includes queer health, sexual health, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), HIV care, and dermatology. The Queer Meducation podcast is a series of interviews with medial experts, mental health professionals, students, advocates, community members and allies that are passionate about improving the health and well being of queer people. I highly recommend that you check it out! If you enjoyed our intimate conversation then feel free to leave a comment at the bottom of this page or rate us highly over on iTunes!   Resources Feel free to connect with Kerin over on the Queer MEDucation website & social media profiles: Website: www.queermeducation.comMake sure to check out the Queer MEDucation Podcast over on iTunes. Instagram: @QueerMEDucationFacebook: @QueerMEDucation The American Sexual Health Association: ashasexualhealth.org Centre for Disease Control: cdc.gov Got any resources on anal health that you’d love to share? Add them to the comments or tweet them to us @uncomfy_podcast and we’ll add them to this page! 

Check out our crossover podcast episode with Queer Meducation! Queer Meducation is a platform to educate medical professionals and the public on LGTBQI and nonbinary healthcare. On our episode, KB and I discuss HIV meds then and now! Thanks to the host KB for such a fun episode! How do I motivate students to come to class prepared?? Resources: https://www.bellarmine.edu/docs/default-source/faculty-development-docs/10-motivating-students-to-come-prepared-to-class.pdf?sfvrsn=62a09081_2 Dirksen, J. (2012). Design for how people learn. Berkeley, CA: New Riders. http://otl.du.edu/teaching-resources/motivating-students-to-do-the-readings/ https://teach.its.uiowa.edu/sites/teach.its.uiowa.edu/files/docs/docs/Motivating_Students_to_Prepare_for_Class_ed.pdf Up to 70% of learners do not come to class prepared!Students often begin the semester prepared due to concerns of being called on or out of respect for instructor, but this typically gradually drops off throughout the course. Motivating students involves influencing human behavior, which is complex and challenging. There are so many factors we cannot control, so let’s focus on those that we can! >>>>> Find the full tip and episode information at www.twopillspodcast.com

Research On Aging LGBTQI and Nonbinary People ft. Jason Flatt, PhD, MPH ***DISCLAIMER: KB ONLY*** This podcast is a series of interviews with medical providers, mental health professionals, community members and advocates. Each interview represents the opinions of the individual. Individuals may use different terminology than what you’re used to. The intention is to educate not discriminate, and we welcome positive and constructive feedback. Please keep in mind; this is not a replacement for medical care or advice. I am simply presenting my views along with educational information that will be both evidence based research and external networks that have an impact on LGBTQI and nonbinary health care. Consult your provider for any medical or mental health concerns. My name is Kerin “KB” Berger and welcome to Queer MEDucation! ***INTRO MUSIC*** ***INTRO TO EPISODE: KB ONLY*** Thank you for joining us for our fourth episode of Queer MEDucation. When you get the chance, please leave a little review for us on iTunes, Stitcher, Google Play or wherever you get your podcasts. We are so grateful for the love and support, but also to all those dedicating their lives to the health and well being of LGBTQI and nonbinary individuals. Thank you. And special thanks to Erica Berger-Hausthor and her associates for their kindness and their dedication to the aging LGBTQI and nonbinary communities. Erica Berger-Hausthor is a lawyer practicing estate planning and elder care law in Orlando, Fl. They recently visited the LGBT Center in Orlando, Fl to present to a group of twenty five aging LGBTQI and nonbinary on end of life legal concerns and documentation. Not only did they educate the folx on queer end of life planning, but they drafted advanced directives free of charge. Although the world seems like a bizarre and negative place these days, it’s important to focus on the positivity instilled in our guests, community members, advocates and allies.  Did you know only 25% of aging LGBTQI and nonbinary individuals are in a legal partnership? Not only that but a quarter of the aging queer individuals have concerns about who is going to take care of them when they can no longer care for themselves. Talk about marginalized population: the first large population based study funded by the NIH on the aging queer population was published in 2011 under President Obama. Aging LGBTQI and nonbinary people are defined as “a population of sexual and gender minorities over the age of 50” according to the NIH. Studies show there are between 1.75-4 million queer aging adults. Now, I live in LA. Housing is a HUGE problem for everyone, especially our aging LGBTQI and nonbinary population. In this week’s, episode we talk to Dr. Jason Flatt about his research at UC: San Francisco on the aging LGBTQI and nonbinary population. Jason has his hands in many pots but a with a single mission of understanding and improving the lives of aging queer adults. Please enjoy! ***INTERVIEW: KB AND JASON FLATT (JF)*** KB:                 Hey, what's up? It's KB. I'm here with a very special guest. I'm going to let them introduce themselves. JF:                   Hi KB! This is Jason Flat. I'm an assistant professor, uh, the University of California, San Francisco. My focus area has been on LGBTQ, older adults, really thinking about aging as well as dementia risk and even issues around sort of ensuring that our aging community has access to affordable and inclusive housing. KB:                 And what are your credentials, Jason? JF:                   Yeah, so I have a PhD. It's in public health. It's with a focus in behavioral and community health. So that's really focused on like understanding health behaviors and understanding aspects that are important in late life. So I have a graduate certificate in Gerontology with a focus in mental health. And I also, I actually am a master certified health education specialist. So I bring in some of, uh, my previous training and experience in being a health educator to my work. During a lot of my training I focused on, so my dissertation, which was in 2013, focused on social relationships and cognitive health. I've expanded my work really to think more about the needs of LGBTQ seniors. And, uh, I did some training in epidemiology, really understanding risk factors for disease in late life and some work in neuro imaging. So now as an assistant professor, I'm focused on, I have a career development award from the National Institute on Aging to look at dementia risk among LGBTQ older adults are, we use the term sexual and gender minority. KB:                 Sounds like you have a pretty diverse academic background. How did you get to where you are today? JF:                   A lot of this was driven by life experiences and a bit of, I would say my passion, but also I really believe in following things that I find rewarding and that I'm good at. So I started off really my focus in undergrad was around, I thought I wanted to be a medical doctor, but at the time I was actually coming to terms with my sexuality and finally having, you know, not being in high school, having some freedom to explore my own identity. Uh, I knew it wasn't the right time for me to be studying as much, but I was always very interested in health. So I ended up getting a bachelor's degree in health science with a focus on community health. And this was back over, uh, 16 almost 17 years ago. And there wasn't a huge focus on public health at the time. So I was really more of a health educator and a lot of my focus was on tobacco prevention among high risk groups. So I worked with the American Cancer Society as an intern and did a lot of health education outreach to blue collar workers, to high school students, any of the high risk groups that might be, you know, using tobacco. And I really found that rewarding, and so that prompted me to go get a master's in public health. And I did that at the University of South Carolina in Columbia. And it was a focus in health promotion, education and behavior. And there I was also, what drove my interest in aging a little bit was in high school I worked at an assisted living facility doing social activities on the weekends. So I was having to get up at like 6:00 AM and get to the assisted living facility to call Bingo at 9:00 AM KB:                 Very important. JF:                   Yeah, it was awesome. Coffee Talk, ice cream, socials, booking entertainment. It's probably one of the most rewarding jobs that I had. And so, uh, while I focused and sort of substance use and abuse and tobacco use for awhile, I worked actually in work site wellness. I decided, you know, in 2009 to go back and get my PhD. And so I did that at the University of Pittsburgh and I did some soul searching on sort of what was the most rewarding but also a population that I really cared about. And that's what drove me to kind of a focus in like gerontology. So I did that a lot of training and understanding dementia risk and mental health concerns in late life. So the importance of sort of, uh, other people, the value of being engaged in life, what brings people meaning and purpose. So I did some additional training, which eventually drove me. I got married to my husband in, uh, 2014 we really wanted to explore, you know, one living in a very inclusive environment, but also just to explore, you know, sort of our futures together. So we moved to San Francisco. So that was, you know, in 2015 that we moved here through just kind of me wanting to find ways that I can contribute. I ended up moving my work into understanding the needs specifically for LGBTQ people. It was definitely a, uh, additional time where I did some soul searching, right. So I, I had struggled a bit with, you know, moving to the area and people sort of being like, well, you're gay, you should focus on this area. And I, and I had experienced that even in my PhD training. You know, there was a, uh, a thought that I should also be doing, you know, sexual and gender minority work because I was a gay man. I resisted it for a while cause I, I felt a concern that I maybe was taking... One: I felt like very privileged. I'm a very fortunate, you know, I'm a gay white man. I have a lot of freaking privilege. And I also was concerned about taking advantage of that privilege but also to advance my career and potentially take advantage of a community that I actually really care a lot about. So I did some major soul searching and actually got a small grant from UCSF. It's a, so we call them the National Institute on Aging funds, these resource centers for minority aging research. And it was very fortunate that in like, I think 2016 the National Institute for Minority Health Disparities named LGBTQ people as a disadvantaged group that was vulnerable. And so they use the term sexual and gender minority. So that meant that there was, you know, an interest for these centers to focus on the needs of older LGBTQ people. And so I applied to one of the centers that UCSF, the Center for Aging and Diverse Communities, and I got my first grant to explore this work. It was also funded through, USCF has a Pepper Center, it's like the Claude Pepper Center, which is focused on aging as well and they all sort of supported this project. And the purpose of the project really was for me to explore what is, what are LGBTQ seniors concerns around dementia, but also to explore sort of life course. What were the experiences that these seniors had over their life that maybe could be considered protective, you know, sort of to help them be resilient in the face of aging concerns, but also to look at risk factors. And I wanted to understand, you know, were there unique risk factors? Uh, for instance, the literature showed higher rates of depression among LGBTQ people and we know that depression can be a two to three fold increase in your risk for dementia if you have depression, especially in late life. So I wanted to explore that, but also thinking of other minority populations, we know that there's a history of the LGBTQ older people facing discrimination and there's been work among racial ethnic minorities showing that discrimination leads to cognitive, you know, health problems and leave life. I started to really explore that and I did 20 interviews with LGBTQ seniors across, you know, living in San Francisco and in the bay area. And thanks to my community partners, I partnered with Open House here in San Francisco and I'll talk more about them, but also I partnered with Lavender Seniors in the Oakland, like the East Bay. And they helped me get the word out to seniors about participating in a two hour interview. And I really focused on recruiting racial, ethnic minorities as well as trying to identify trans seniors, uh, and other gender minorities. So I ended up interviewing two intersex older adults. These interviews changed my life, honestly, they were, um, I spent two hours or more with these incredible people who told me about their life story, told me about challenges they had overcome, told me about the, you know, how they fought for rights or, you know, even told me about really horrible experiences that they had encountered in their life of being, you know, uh, an LGBTQ person. Those experiences, you know, when I was thinking about, I said I was doing some soul searching I realized like, wow, everything I've learned, all of the topics, my commitment to aging and research have prepared me to do this work. Not only was I committed based on, you know, the stories I heard, but I felt like I as a gay man, had a connection to this community and that my skillset could be used to help. So that was in 2016 and since then I really have decided to commit my research and my, you know, my health education work and my teaching to this area. KB:                 That's incredible. What was the demographic breakdown of those 20 individuals? JF:                   A third of them identified as a racial ethnic minority, and I included, that was sort of diverse, So it included a American Indian, it included Asian Americans, Black, Latino. So for that sense it was pretty diverse. I also interviewed two intersex older adults. I was able to identify to trans older people as well as I recruited bisexual, gay, gay men living with HIV, lesbian and gender nonconforming. KB:                 Wow. So you, I mean, you really had a nice spectrum in those 20 individuals. JF:                   Yeah. Well, it was like a focus, you know with qualitative research you can do more of like a purposive recruitment so I was specifically trying, I thought some people have tried to pigeon hole me into like, well just study gay men or just study this group. And I really was more interested in, while our community has major differences, and sometimes things that really divide us, there was also some similarities and so I wanted to focus more on the broader needs of the community versus just for a specific group. KB:                 What was the push for, from other individuals to focus on a particular group? JF:                   I don't know if it's like this ideological... I am not really sure where it comes from. You know, if it's the thought that like, Oh, you should study a group that you're closest to that maybe you can add as much because I would not a, you know, I don't identify as a gender minority and it's true, I don't understand completely the experiences of other groups, but I don't think that that means I can't help. Right. And, yeah. So I've just framed it as like, I'm not, maybe it's like my own, like I don't care , what you say. And I'm very careful to make sure that that doesn't mean I should speak for those communities. So that's important to remember, but that doesn't mean that I can't help and help them be more informed, their community's needs. KB:                 Right. And I think with research, if you really break it down, you're just giving a voice to people. JF:                   Yeah. KB:                 You're just collecting information, drawing conclusions and telling, especially with qualitative information. Um, it's just an, it's just storytelling in a way. JF:                   Exactly. Exactly. And so you're putting a voice, you know, you're basically documenting in some way peoples experiences and their stories. Right. KB:                 With those 20 individuals, what did you, what were some conclusions that were drawn or, or I guess I should back up. What were some of, uh, questions that were presented to these individuals? JF:                   So it focused a lot on life. I wanted to know about childhood, relationship status, educational experiences, so really driven by sort of like a life course perspective. So I wanted to know like a structural factors that might have impacted their life. So things like education and economics and family, housing. Yes, exactly. Like all of the like formative stuff as well as you know, I wanted to talk about what was there, you know, coming out or kind of identity, experiences with their identity. So we dived into that. Uh, when they move to the bay area, what that was like a bit about experiences with discrimination, which there were incredible, like I was blown away. So these were people that were 60 and older. So you know, 40 years ago, maybe less people were being thrown in jail for being gay or identity, identifying as a, you know, a gender minority as well as some of those individuals were ostracized by the LGBTQ community. They weren't allowed to go to the gay bar. They weren't embraced by, you know, other groups. And then we learned of many, some of the Trans individuals that I had interviewed talked about like their family, not allowing them to be a part of, you know, if you want to come for the holidays you need to wear your boy clothes. Just experiences like that that I was just like, ahh, to hear, you know, to not be welcomed throughout, you know, a large part of your life as part of your family. So we touched on those experiences. I dived into some of what I wanted to learn about was even around victimization and trauma, which had to be a very careful, not everyone wanted to go there, which was fine. And obviously all of this was kept very confidential, de-identified, no one would know who they were. I changed, you know, the names of people, even events that they would list I would change the exact details so no one would be able to directly link what was said to them. But yeah, I was blown away, honestly. And not actually even drove one of the unique pieces and some of my work has started to look into the health needs of intersex adult. I was blown away. I interviewed two intersex older adults and I was just, the challenges, the trauma, the life adversity, issues with housing issues, with relationships, uh, not being welcomed into the LGBTQ community even. I was like, wow, more needs to happen. KB:                 For some intersex individuals, they are literally discriminated against as soon as they are born. JF:                   Exactly. Exactly. Yeah. So that's prompted me actually to, we have a, you'll learn, people will probably be thinking, ah, man, this guy has a lot of different projects, but I partnered with Interact advocates for intersex youth. We roll out one of the, first, it was a study looking at the health needs of intersex adult. Uh, so 205 people completed a survey that we developed with community members, with actual intersex people, uh, so that we could start to inform the medical community about the needs of intersex people. So it was, I mean we ask questions from health concerns, quality of life, mental how, but one of the big focuses of this survey was to look at healthcare experiences. Uh, how, how often are they having educate their health care provider on how to provide competent care? Right. Almost all the time, I think it was close to like 80%, right? We're saying like, I have to educate my healthcare provider on my needs or the fact of being a, many people need to have hormone therapy to stay healthy. And so they've often had to advocate on behalf of themselves in ways that just some of us would find impossible. KB:                 And as somebody who went through a medical training program you're taught all about the pathophysiology, the clinical impression, the medical treatment JF:                   Uh huh KB:                 So it's there. JF:                   Yeah. KB:                 So what's the problem? JF:                   Well, I think it's larger societal KB:                 Stigma. JF:                   It's discrimination. If we really just want to call it what it is, you're discriminating against a, a minority, uh, you know, gender or sexual minority and you are not going to give them the health care that they need. You're going to basically decide what they KB:                 Right JF:                   ...without completely, and I'm not saying every, every health care provider does that KB:                 Of course, JF:                   But I think it's more mainstream than we realize and so there's a need to really make some changes and that's what we're hoping to do with Interact. And I'm also working with a medical Suegee Tamar-Mattis who has done a lot of advocacy in this area, but now really wants to make an impact research wise, thinking about the health and health care needs of Intersex people. So we're starting to do some of that work KB:                 Sounds like have going on, which is incredible because all the things you're doing, in many respects have never been done before. JF:                   Yeah. KB:                 Or they've been done maybe in smaller quantities and smaller population groups. JF:                   Hmm. KB:                 I'm curious, when you publish the qualitative study for the 20 aging individuals, do you publish? All of... JF:                   It hasn't been published yet! KB:                 Oh, okay. Okay. JF:                   I presented on it a bit. I published on some similar areas, but we're in the process of getting that one published. We're going to probably send it to... A lot of the focus was on risk for dementia or Alzheimer's disease. So we're probably going to send it to one of the dementia journals. KB:                 Can you share some conclusions or is that confidential? JF:                   Yeah, sure. I mean what we basically found were, you know, people are concerned about dementia risk and their memory. Uh, there were a lot of the talks of that. There's also an interest in doing preventative behaviors, so that may be being more engaged in activities, doing cognitive stimulating, kind of like a luminosity or one of those kind of, you know, doing crossword puzzles or doing something that's, you know, brain games. So there was an interest in that. There's an interest in improving health so many talked about nutrition and thinking about aspects that are going to help their heart but also their brain. So there were talks on that. There was, what was unique was that many hadn't planned for what might happen. And so we talked quite a bit about the need for advanced care directives. Are you hearing my dog cry? KB:                 I'm hearing the dog cry. JF:                   Okay. I will. Tuna get over it. KB:                 It's all good. There's room for tuna and the interview. JF:                   Yeah, come on. Tuna. There's little tuna. KB:                 Awwww, Hi Tuna. So cute. So I am curious to know if you know with your experience kind of evolving into this specific specialty, were there particular differences in the LGBTQI aging population compared to prior research that you've done with non-LGBTQI aging populations? JF:                   I think what's unique is, Honestly, what I had studied a lot around was like access to social resources. And what really stood out to me is that there are a lot of deficits for LGBTQI seniors and access to social resources. So this includes things like, we think of it, you know, the academic term is like social support. So LGBTQI seniors are off, you know, most of them were single, did not have a partner. I would say a more than 90% of the ones that I interviewed and that was not a requirement to participate. So this was just me purposively like recruiting just diverse seniors who met the age requirement and no one had a partner pretty much KB:                 Which is very different than the average population. JF:                   Yes. KB:                 Or the general population. JF:                   Exactly. Very different. Income limitations were pretty huge. There were some that had more financial means, but on average many had a very fixed and income fitting into the you like that social support piece. Many did not have a very strong like support network. So if they had a health problem, if they needed a ride to the doctor, right. These were struggles! Uh, that I don't think other, you know, non LGBTQI have as much of a problem with they can rely on, you know, we do have in the U.S. a huge issue with like these nuclear families where they're spread all out throughout the U.S. but for even LGBTQI seniors, they didn't even have family members that necessarily they could rely on, they don't have children often to help them. And if their children lived in the city, they couldn't, like the piece with, uh, family members were like in the city, it was like they couldn't rely even on their children if they were in the city to necessarily help out. So I thought that was, you know, those really stood out as sort of these gaps for the community, especially as they're getting older and may need more help. They don't have it, they don't have resources. So that's why I've started working with community partners like Open House who is meeting that gap for LGBTQI seniors. KB:                 So what does open house do to manage that gap? JF:                   So Open House is, it's a nonprofit organization in San Francisco. It is led by Karyn Skultety, who is, uh, uh, has a doctorate in psychology and they focus on, one of their main missions is around providing housing to LGBTQ seniors. But they do even more than that there. They provide community programming. They can help seniors find resources, whether that's economic or social. Uh, they can link them to health services. They have a large team, they have social workers that are doing care management. One of the unique pieces that Open House is doing in the city is around housing. So they have 55 Laguna, which is the first LGBTQ inclusive housing that's affordable for LGBTQ seniors in the city. And it's very close to the Castro as well as conveniently located. It's right down the street from San Francisco's LGBT Center. They also have access to grocery stores nearby. So it's very conveniently located and the exciting news is that they're opening their second high rise in 2019, uh, 95 Laguna or the Marcy Edelman and Jeanette. It's, a, named after the founders, uh, Marcy Edelman and I have to get Jeanette's last name (Gurevitch), but uh, it's named after them. They were, uh, basically a psychologist and a social worker that were focusing, you know, many years ago on the needs of LGBTQ seniors and their work has just been extended to now, there's a nonprofit, you know, that's really meeting these needs. But soon they're going to have over a, you know, a hundred units for LGBTQ seniors to live in so it's really amazing. I'm doing more work with them that we're actually working on a with On Lok. So On Lok is a nonprofit in the city that provides services to older adults. Uh, their history was initially working with the Chinese community, provide care to aging individuals and their families through adult day social programs and also what we call P.A.C.E: Program for All Inclusive Care for the Elderly. And uh, so now they're partnering with Open House and I'm working with them as well, doing some doing a needs assessment to learn about how can we develop one of the first adult day social programs for LGBTQ seniors. KB:                 Can you expand a little bit on the importance or the correlation between the aging LGBT and housing crisis? JF:                   So what we're seeing is, you know, there's this common, and I think society needs to really think about where this is coming from, but there's this common thought that LGBTQ seniors are better off than their non-LGBTQ counterparts. This thought that like they make more income because they didn't have children. This thought that maybe they have more education and this is really a huge bias. And one, we know that the most well representative members of the community are gay men and typically gay, white men, right? And that doesn't reflect everyone's experience. And so what we're actually finding is, as I said, there's these huge gaps in the social resources for LGBTQ seniors, including white gay men. So it is not, you know, this stereotype or kind of perception is not, does not apply to everyone. Um, and it's probably just a few and some of the bias in recruitment and research in the past. But what we've seen is that are LGBTQ seniors have major income limitations. Many of them may be on disability or are, you know, not working any longer and have to rely on social security, which the amount that they receive is very little, especially when you think that most LGBTQ people move to urban environments because of the acceptibility, um, the opportunity to find others that were like minded or more open minded. Right. And so this is a history of sort of, if we think about LGBTQ rights and some of the historical aspects that our communities faced: the aids epidemic and some of the other, you know, fighting for rights and where trans people could feel safe, they move to urban environments. And this is where they built their chosen families and all of their support networks. And what we're seeing across the nation, you know, they, they talk historically about, there was this, they call it like white flight: this history of a very affluent, you know, individuals leaving cities because they wanted to move to the suburbs. Well those with less for like, well this is a great opportunity for us to move to the urban environments because it's going to be affordable. And so there's sort of this history now of well now people want to move back to cities. Um, and so this has caused the cost of housing to skyrocket, KB:                 Especially in San Francisco. JF:                   Especially in San Francisco, also New York City. KB:                 And in LA too. We're having lots of problems. JF:                   We're even seeing it in place at small places like Portland KB:                 ...and Denver, JF:                   Denver. KB:                 Austin, yeah. JF:                   Yeah. Everyone wants to be back in the city. There's this maybe realization of one. I think everyone having cars as an aid computes impossible. So everyone wants to live closer to work. This has caused the cost of housing and urban settings to increase in a way that is like insane. And guess who's taking some of the brunt of it are, you know, the people that were living in cities that, you know, a long time ago, uh, when there was this, you know, so this includes LGBTQ seniors, especially those in San Francisco and New York, LA, some of the larger cities. We're having problems with landlords evicting people because they know they can charge more rent. People are on very fixed incomes, they also have health challenges. They don't have the support they need to age in place. And so this is causing major challenges KB:                 And rent controlled apartments are being sold or passed down to families and they're selling them for a gagillion dollars JF:                   Or this airbnb movement where people are like, I'm going to kick you out and now put my apartment on airbnb because I can make you know, four times the amount of money that are, I was making. So, you know, with all of this, and I think also tech, you know, with the, you know, the rise in tech and tech moving to urban environments, especially San Francisco, that it's caused, you know, a lot of these challenges for allowing, especially LGBTQ seniors to age in place and stay in their communities. So we had to think of solutions to help make sure that they're not forced to leave. KB:                 Well, it's great to know that there's people doing the work and, and you're doing the work and you're partnering with people who are doing the little work, which is incredible. Are there any challenges that you've faced pursuing this particular type of research? JF:                   There are, you know, especially in, so I had already mentioned that there was this bias and I think that was coming from some of my experiences, basically saying that lgbt, they couldn't see why LGBTQ seniors would be considered a disadvantage group. So I had to do a lot, lot of educating. Even my colleagues, you know, had this bias that basically LGBTQ people were white gay men with, you know, what do we call it, this terminology "DINKS": double income, no kids, right? KB:                 I just learned this. I guess I'm a little behind the time, but now I like I'm hearing it everywhere. JF:                   That was the common misperception that that's what the community was like and why do they need any help? And that bias was really hard. And I think a lot of people still think this, you know, across the nation. So part of what we've had to do is educate them that that's not the case. And that's what maybe you see in the media or those who are getting a lot of the attention. But not everyone is Neil Patrick Harris, you know, and living it up and you know, has more resources than the average individual. KB:                 People also don't realize that individuals that survived the AIDS and HIV crisis, their goal at the time was to survive. JF:                   Yes. KB:                 Whether you are a positive or negative and the people that did survive weren't thinking about their retirement or their 401K or their life 30 years down the road. JF:                   Yeah. KB:                 Because they just needed to worry about today JF:                   And people don't know about some of the economic things for this unity as well. So what for many individuals living with HIV, uh, they were especially at least here in San Francisco because of discrimination and such people couldn't work. So many of them were eligible for disability and so they'd been living on disability. Well, what happens when they turn 65 and some, you know, depending on what the rules are for social security, they then have to go on social security because of entitlement based on age. And it's much less than what people were getting with disability. So now, as they're getting older, you know, they've been become accustomed to a certain amount of money they were getting monthly, which is still not very much. And then even, you know, three to $400 decrease in your benefits is huge! That may be your food for the month or that may be part of your rent. So then it, you know, for those individuals it makes it even more impossible to age in place and stay, you know, where they want to be. KB:                 What are some uplifting, positive stories that maybe you can share with the listeners? JF:                   Well, I had met him like I've met these trail blazers, right? And these trailblazers, I mean I've met people that are, you know, resilient, overcoming challenges in a way that they've, they've stayed healthy, they've overcome it, they fought for the rights of others, they're educating, they're helping each other. So the example would be, I've done some qualitative work as well at Open House's 55 Laguna theirfirst LGBTQ senior high rise. And what we're seeing is like we're rebuilding community. There was a, an example, one of the, the people living at 55 Laguna fell and broke their hip and a typical place they may become extremely, you know, living in their own independent apartment in the city, they likely would become very isolated and may not be able to care for themselves; get food, be able to, you know, maintain hygiene and even some of the daily things we need to do that we take for granted. Like doing your own laundry or cleaning your apartment. So we saw at 55 Laguna just from interviewing people the whole floor came around and supported this person. They were bringing meals. If they made dinner, they made an extra plate for this person. They would stop by when they were going to the grocery store and be like, what do you need? How can we help you? Providing, you know, of emotional support, stopping in and just spending some time with this person, seeing how they're doing, you know? And then there's just the advocacy work; getting to work with community members that are, I mean, making very little income wise and in one of the most expensive cities in America. Right. And they're helping LGBTQ seniors every day to make their life better. So to get to just know some of the people at open house like Karyn Skultety, Michelle Alcedo, Ariel, Jesse, Sylvia, these are just a few of, you know, getting to meet some of these amazing people that are changing the lives of LGBTQ seniors. I, as I said, it's so important. I'm not alone in doing this work and so that to me is probably the most rewarding. I'm meeting like LGBTQ seniors that volunteer at the front desk and are helping the community, answering phones, directing people to resources, 95 Laguna just actually their lotteries coming, they're revealing the results on Tuesday and the number of volunteers that were helping LGBTQ seniors sign up for the housing lottery... I was just like alright, we, we are going to help our community. There are people that are committed volunteering their time to help LGBTQ seniors. And I have a picture, also a group had donated, 90, over 90 present, uh, at the holidays to isolated LGBTQ seniors. It was like incredible. KB:                 What a beautiful thing. JF:                   Yeah. It's, it's just been like each, you know, each day I work in this area, I'm like, this is what I'm supposed to be doing. This is like, not only personally rewarding, but to even have a little, you know, a small opportunity to make an impact in the lives of a community that I respect, that I am grateful everyday for what they've done for us. Uh, around LGBTQ rights. I've met some of the trans women that were at the Compton's cafeteria, you know, fighting for trans Rights in San Francisco. I've met, you know, people that have been, that knew Harvey Milk and were there during, you know, the LGBTQ movement in San Francisco. I'm just like, ah, this is amazing to get to even talk to one of these people. Um, so I hope that more and more LGBTQ people my age and younger start to realize how much this community has done for us and the importance of learning from our elders, but also really respecting them and being grateful that they've made an impact on changing laws, helping...I wouldn't be able to study LGBTQ health right now if it wasn't for what they had done. KB:                 And it's beautiful to see that you're dedicating your studies and career to this particular group; I would imagine, never expecting to be where you are today based on where you started. JF:                   Oh no! I didn't think that this would be... you know, but I didn't get her alone. You know, it's a, I'm at the UCSF School of Nursing. I've had an amazing mentor, Julene Johnson who, um, she's the Associate Dean of Research and I'm at the Institute for Health and Aging. And then I'm affiliated with like the Institute for Health Policy Studies. I'm a member of the faculty on a group, it's called Health Force that does training for health care professionals. I'm a member of a HRSA funded health workforce research center on longterm care. So I'm get to work with amazing colleagues like Joanne Spetz, who's one of the experts in the economics of nursing and the nursing workforce. I'm a scholar with our clinical and translational science institute. Now I'm working, I'm a volunteer researcher at Kaiser Division of Research plus, I've already talked about the Center for Aging and Diverse Communities and the Claude Pepper Center at UCSF. You know, I've talked a little bit about researchers not being supportive of the area, but on it, you know, me listing off seven or eight groups that I'm affiliated with, shows like there, there's a lot of support and I think that, yeah, it's happening and I, and I think it'll continue to happen. KB:                 Can you describe a network of maybe other researchers doing similar work to you, maybe in other areas of the country or the world? JF:                   So one of the big groups, at least in aging, is the Gerontological Society of America has a, what they call the Rainbow Research Group. And so this is a group of people in the field of Gerontology that are all doing, you know, work in this space. It's been just like amazing to get to, ahh, work with these people. There's also the American Society on Aging has a group that does work, LGBT Aging Issues Network. We're actually inviting, uh, speakers from other institutions. So for instance, we're going to have Ilan. Meyer from UCLA is Williams Institute. KB:                 Awesome! JF:                   Yeah. So Ilan's is going to come and actually give a talk on his work in Minority Stress and understanding, you know, for LGBTQ people or how minority stress in a sense gets under the skin and impacts health. So we'll have that. Um, I'm also a part of, so there's the National Institute on Aging has a group focused on broader disparities for minority populations and this is open to people with terminal degrees that are doing research. So they are probably a professor in some sort of doing research and it's called the Butler William Scholars Program and it focuses on minority aging. And I, I've been a scholar in the past with that. KB:                 So it sounds like there's a lot of research and opportunities kind of coming up. JF:                   There are, there's actually like the, what I think some of this created was like the National Institutes of health has a sexual and gender minority, a research program. and so it's led by Karen Parker, who's a researcher at the NIH that's also helping to create a network of researchers focused on LGBTQ health. So we have that work happening. Uh, and actually there's going to be a regional workshop, uh, in LA at UCLA in like late February. They haven't announced the open call. Um, but I'll definitely make sure to send that to you so you could share with people that are interested in research and wanting to learn more. Yeah, I'm giving a talk on how to, as a junior person, how did I get my career started in LGBTQ health? So... KB:                 Excellent. So I think a lot of people assume you have to be a researcher or a scientist or in academia to participate in research. What can the community do to be involved in such research? JF:                   I think it's like looking for oppor... So one of the groups I also work with is the Pride Study. So it's the Pride Study, I think it's dot org. It's actually an online platform focused on really learning about the needs of Lgbtq people. And then another national effort is the All of Us Study, which is focused on everyone. Um, but we're really encouraging LGBTQ and gender nonconforming individual to consider being a part of that. It's a larger focus actually with the Affordable Care Act that helped to make this happen where we're trying to learn about the needs of everyone and using some precision medicine efforts so that we can start learning what type of care works well for LGBTQ people. What are some of the health concerns as well as maybe some of the potential treatments that might be ideal for our community. So I would definitely encourage, you know, if you're interested in research getting involved in either the Pride Study or the All of Us Study. I also think it's volunteering, whether that's volunteering to help researchers or volunteering to do work in the community with LGBTQ people, whether that's youth or older adults or people that maybe have more challenges. But being a part of that will help, you know, improve the lives of our community, but also can be very rewarding. KB:                 That's amazing. And I appreciate all the work you're doing. I always like to end the interview by asking the person why they feel like their job is important. JF:                   Why do I feel like my job is important? Let me think. I mean for me it's like such a like personally rewarding career to have, but I think why it's important, especially with what I'm doing in aging is like the system of the... we have seen for LGBTQ people, especially those that are older, that they've been made invisible. And this happens from both their own community but also, you know, broader society. So my hope is that my work will make our LGBTQ seniors more visible, but also to help educate healthcare professionals, researchers, the public about this community and their needs and ways that we should be helping to improve their lives. Whether it's advocating for new policies, advocating for better care, advocating for training, or you know, even as I've said, some of the basic living needs, so advocating to ensure that we have affordable and inclusive housing. So I'm, you know, really hoping the, this work, um, helps in some way to do that. ***END INTERVIEW*** ***CONCLUSION: KB ONLY*** For information about future episodes or to contact us, please visit us at our website www.queermeducation.com or email us at queermeducation@gmail.com ***OUTRO MUSIC***

Transgender and Nonbinary Affirming Surgery ft. Kayla McLaughlin, PA-C ***DISCLAIMER: KB ONLY*** This podcast is a series of interviews with medical providers, mental health professionals, community members and advocates. Each interview represents the opinions of the individual. Individuals may use different terminology than what you’re used to. The intention is to educate not discriminate, and we welcome positive and constructive feedback. Please keep in mind; this is not a replacement for medical care or advice. I am simply presenting my views along with educational information that will be both evidence based research and external networks that have an impact on LGBTQI and nonbinary health care. Consult your provider for any medical or mental health concerns. My name is Kerin “KB” Berger and welcome to Queer MEDucation! ***INTRO MUSIC***  ***INTRO TO EPISODE: KB ONLY*** Welcome back to Queer MEDucation. Special thanks to our friends Jessie and Cal from Salon Benders for joining us on last week’s episode. Salon Benders’ is more than just a salon. They believe transformation is an inclusive process affecting all gender identities. They draw inspiration from gender minority narratives and resilience. And guess what: they’re hiring full and part time stylists, cosmetologists, and barbers to lovingly serve our impeccable community. For more information, visit www.salonbenders.com/jobs Transgender and nonbinary affirming care is a hot topic these days. There are many steps to transition, every individuals transition process looks different, and generally speaking, transition is time consuming and costly. So what are the procedures available for surgical transition? In today’s episode we talk to a physician assistant working in gender affirming surgery. Some of the information is, some might say…medical. No problem! Please visit queermeducation.com for show notes, which includes references for medical terminology, anatomy 101, and visual animations of each procedure,. For those completely new to surgical transition related topics, you may want to take a peak at the references first, so you can enjoy the interview even more. Please enjoy! ***INTERVIEW: KB AND KAYLA MCLAUGHLIN*** KB:                 Hey, what's up? It's KB. I have a very special guest today. I'm just going to let her introduce herself. Kayla:             Hi, my name is Kayla McLaughlin and I am a physician assistant in southern California at Kaiser Permanente and I do gender affirming surgery, including complex bottom surgeries and facial feminization. KB:                 How did you get into that work? Kayla:             Actually, I kind of sort of fell into it, so whenever I was in my clinical year of PA school I did a focus on cultural medicine, so I modeled my clinical year to kind of go to a bunch of different minority groups across the United States and kind of study how marginalized populations sort of fit into the western medicine model. Uh, so I did pediatrics in Yuma, Arizona with kids who were children of undocumented folks or children that are undocumented. So a lot of, you know, meeting a five year old that's never had a vaccine or never been to the doctor than I did psychiatry and a Mormon camp in Utah. So how, like hyper-religious people sort of accepts psychiatric care whenever there's actual disease and pathology present. And Dermatology with migrant field workers and etc., things like that. So when I graduated, my mentor in PA school actually was already working at the LGBT Center, which is where I got my first job, uh, the Los Angeles LGBT Center. So my first job as a pa was in HIV research, which I didn't really know anything about, but it was a very nice introduction to medicine because it was sort of like a slow warm up to seeing patients; you know, you're seeing healthy patients and following a very strict protocols and not prescribing any medicine other than your study meds. So that was great. But I just really liked that work and I found it really interesting; and it had, it had never really dawned on me before that LGBT people were a group that were marginalized medically, that there was anything like special or unique about them in terms of medicine. So I did that for a while and then able was able to move up to the transgender healthcare program at the LGBT center. So basically doing primary care and like endocrine services and gynecology and things like that for transgender folks, which I loved that. And that was a great position to have and then a position came open at the place where I work now, which is Kaiser. Their gender affirming surgery team, so I didn't really have any surgery experience prior to applying and I almost didn't apply because I thought like, I don't have the basic qualifications for this job. Um, but I was the only candidate they interviewed the head trans experience. So I started there in February and basically started what would sort of be like a crash course in surgery since then. So it's a combination of basically cranial facial plastic surgery and urology. KB:                 Interesting. Did your background in trans health have an impact on the, um, like the learning and teaching of the surgeons or did most of the surgeons have direct experience? Kayla:             Yeah. So once they started the program, I think a lot of the surgeons definitely sort of went all in with learning all about the ins and outs of the surgery. Like they went all over the world and trained basically with anyone you can think of that was having good results, which was amazing. But in terms of having like being able to have a PA, who basically, they can have a shorthand with immediately in terms of the cultural competency, um, even in the interview that surgeon, uh, that I work with, she was like, you know, the surgery is the easy part that we can teach you. The experience of these patients is something that, you know, I can't, I can't say to you, I can't really, um, teach that to you. You need to just like having that experience. So I would say that yeah, there's, there's times where I'm learning from them and they're learning from me for sure. KB:                 Yeah. I think that's amazing. I think as PAs we go through our clinical rotations, um, and really any medical professional or clinical training, we go through all the rotations. So we really have a wide range of medical experience, but nobody can teach you how to be culturally competent or compassionate at the bedside. And with our trans folks, it's just crucial because there's been so many negative experiences and that have directly affected their health care. So I'm sure they're grateful to have that program at Kaiser now. Do you miss doing general trans care or are you really enjoyed it? Kayla:             I do! I feel like so by the time that someone gets to a surgical consult, they have had a many evaluations with their primary care and mental health and they're, you know, generally a very healthy person that's ready for surgery. So it's like a very neat and tidy kind of situation. Whereas, um, and it's something that they've, they've been looking forward to for a long time, but I feel like when I would meet a trans person, a trans patient for the first time and like, I'm the first person clinically that were ever like, really telling their story to. And I'm the first person who prescribed them hormones. I mean, I feel like that experience was so much more emotional for people and so much more. I mean this is still very emotional, but it's like they've been in this process and their transition for a long time at this point. Whereas whenever someone is like, you know, 70 years old and has never told someone any of these things and then, you know, they're saying that to me. So I do miss that. Yeah. KB:                 So, um, tell us a little bit about the surgeries that you all perform. Kayla:             So the surgeries that, uh, I am a directly a part of, so there is our complex bottom surgery programs, so that includes vaginoplasty and there is a full depth vaginoplasty and also a zero depth vaginoplasty. And then we do phalloplasty, which is a stage procedure. So that's where of an umbrella term that includes all the way up to the, uh, you know, graft of getting the phallus put on, um, and then the steps prior to that, which is a metoidioplasty, the clitoral release. Um, folks can also have a combination hysterectomies and oophorectomy, uh, during that procedure. And then I also help out with the facial feminization surgery. KB:                 So what is your role as a PA, on, in the surgical team? Kayla:             So for our surgical team, the reason that they needed a PA or, or saw a PA out was that the surgeons have their other specialties essentially. So, um, our surgical team consists of craniofacial surgeons, plastic surgeons and urologists that have their other practices. So when we would have, there was no like consistent medical person, like they're waiting for in case there was questions or complications or anything like that. So I'm sort of like the steady state that's there, you know, 8-5 throughout the week. So we have clinic two days a week that I, I support that clinic with the surgeons were patients come in for their surgical consults, pre-ops and postops. Um, I assist in the OR two days a week, um, and then help with like admitting the patient, doing the pre op orders. For the patient while they're inpatient, I manage their care also. So any, um, and, and you know, some of our patients stay for two days and some stay for like, seven days. Um, so managing them and then also on Fridays I have my own clinic where it can kind of be just like anything and everything. So checking both hair status below before they can get a vaginoplasty, counseling patients, just any kind of difficulties they might be having post-op. We do a lot of sexual health and sex education, so that kind of stuff. Yeah. KB:                 Cool. So it sounds like you kind of have your hand in so many different pots and Kayla:             Yeah. Everyday it's kinda different. KB:                 Yeah. That's fun. Do you like surgery? Kayla:             I do. It can be intense. It's uh, it's, it's hard because it's like it's intense and also not, you know, it becomes very routine. The surgeons you work with also set the tone of the room and everyone that I work with is very chill. We're able to like, it's always a teaching moment or you know, there's never like a. I know like I just remember in rotations like hearing horror stories from some of my peers were like just get screamed at by surgeons and stuff and this certainly isn't the vibe here. So yeah. Yeah, I like it. KB:                 I did one rotation, I trained on the east coast and my surgery rotation the first time was like: I walked into the ER or in the OR, and the nurse just basically yelled at me for no reason. And then I did a rotation in, um, in Houston, Texas and everybody clapped when I walked in the first time. So I think there is a sense of like chill vibe on the west coast, Kayla:             Yeah, definitely. KB:                 So, tell the listeners a little bit about what makes somebody a candidate for surgical transition. Kayla:             So for someone to be a candidate for surgical transition, we basically follow the guidelines set forth by WPATH. So someone who is in the process of transitioning is in care with a primary care physician, has been evaluated by mental health and gotten mental health clearance. And depending on the surgery, sometimes you need one letter, sometimes you need two letters. So one letter surgeries. and this is a letter of support from a mental health professional, so facial feminization surgery and top surgery required one letter whereas a hysterectomy or the. I'm sorry, the phalloplasty and the vaginoplasty required to KB:                 And when you say separate, do you mean two separate, um, clinicians? Kayla:             Yes, two separate, separate clinicians. Um, but they can get the letter after one session so it's not someone that they have to like have been in care with for a long, long tIme. KB:                 Okay. When you say mental health professional, just so the listeners are clear, is that a psychologist, a social worker or a psychiatrist? Kayla:             So it'd be any, any and all of those. So we have LCSW and there are psychiatrists and psychologists, so anyone. So if the patient has a prior relationship with a mental health provider, that person can certainly write their letter. And basically, all they're evaluating for any preoperative depression; um, if someone is in a situation financially to be able to take the time off of work; if the home they're going to post operatively is safe and clean for them to recover and things like that. Um, so it's not really like assessing their "transness" and making sure that like surgery is the best goal for this patient at this time. And not even saying that it's not. If it's not now that as, it won't be later, but yeah. KB:                 Yeah, no, but I think it's really important to kind of bring that point up that the letters to me, sound like they are only to benefit the person's success post up. And sometimes, yeah, if you don't have good care post-op, um, if you're not financially stable to not be in work, I mean surgery is a big deal for anybody regardless of what the procedure they're going through. So I think that's a really good point. Does WPATH require that, like, in their protocols? Kayla:             So it's um, it's different for... So for facial feminization surgery there's actually no guidelines. They leave that very open ended I think intentionally because that is a very sort of vague and subjective sort of, um, surgery, surgical approach, transition. Whereas for bottom surgery, I believe that two letters of recommendation along with one year of living in that gender, those are, those are pretty much requirements. Hormones are also a requirement. But if you read the fine print WPATH they say that if the patient is unable or unwilling to take hormones, then that can be a requirement that is not fulfilled and they can still proceed with surgery. So someone who has a history of blood clots that is not going to take estrogen, that doesn't mean that they can never have a vaginoplasty. KB:                 Interesting. I think with top surgery, like why path kind of change things the last tIme they revised to say that you didn't necessarily have to be on hormone replacement to get top surgery. Kayla:             Yes, which is a great point because what happens is if somebody, for example, has a very large chest and then they start taking testosterone, we know that the effects of testosterone are pretty immediate and apparent. So their social transition becomes very difficult if they're growing a beard and a very deep voice and they still have very large breasts. So in order to make it easier for this person, we can do the top surgery first and then they can start the hormones if they, if they choose to. KB:                 Okay. So that's kind of an option and part of the evaluation? Kayla:             Yeah. KB:                 Oh, that's great. Yeah. And plus it probably decreases the time period that they're binding and hunching... Kayla:             And in addition there are, you know, that also helps with nonbinary folks who might not ever want to take testosterone that definitely want to have top surgery and should have top surgery. So I think eliminating that requirement. Um, it was very insightful. KB:                 What does pre-op involve besides the letters? Any other medical workup? Kayla:             -Yeah, so pre-op, whenever the patients come for the consult, pretty much all of their labs and everything are already taken care of. So they have to have been seen by their PCP within the last year, had a physical exam, labs, if they are on hormones, those hormones have to be within a therapeutic range. Um, so for estrogen less than 200 and for testosterone; I forget what number is it? I think it's 500? Something I should know. KB:                 We'll put it in the show notes. Kayla:             Yeah, yeah, yeah. Um, and uh, so, but in any other medical conditions that they have, um, medical or behavioral health issues have to be, um, well controlled. So if someone also is diabetic or hypertensive, those things have to be under control or at least, um, you know, they're working on it with their PCP. And then, so, because what's interesting is, from the time of consult to the time of surgery, it's sometimes like a year later, um, because when we see patients for vaginoplasty specifically, they have to start electrolysis essentially after that. So one thing is that you get the referral for electrolysis or electrolysis is covered for vaginoplasty because we can't have any hair growing inside of the vagina; and that process takes about nine months to a year. So we used to tell patients about six months to have all the hair cleared, but we've found that it's taking more like a year for that to happen. KB:                 How often do you do the electrolysis? Every four to six weeks? Kayla:             So we, the hair cycle is about every six weeks. Um, but people can go once, you know, people go once a week for like four hours or once a week for one hour every two weeks. Yeah. So it's kind of up to the person and their schedule and the electrolysis is not, it's, it's quite painful. So kind of how much someone can tolerate in one sitting. Um, because they can use like a lidocaine topical but if they want to buy injections from the electrolysis place that they go to, it's like, I think it's $100 a session. So yeah. So it's really, it really depends on the person's time and availability and tolerance. KB:                 Right. That's a great point. Is there a particular age recommendation or requirement for any sort of gender affirming surgery? Do you know? Kayla:             No, I think that, well I believe it has to be over 18 for the vaginoplasty and phalloplasty. That could change. Yeah. I know for top surgery we've, we've done some and there have been some done for teenagers. KB:                 Yeah. I think it's going to be really interesting to see the evolution of pre-pubertal transition and how that's going to affect the need for surgery and the overall success of the surgeries in the future. I think it's going to be... Kayla:             Well, one interesting thing is that um, so someone who starts a transition pre-pubertal, pre-puberty, so we do have penile inversion vaginoplasty and that's, like, the most common technique in United States, where you basically use the tissue from the scrotum and penis and invert that to make a vagina. If someone has been on blockers from before puberty, that skin kind of doesn't exist. So I mean if it exists, but it's not in, it's not enough. So we'll be using a lot more, like, graphs. There's also the colovaginoplasty, which is whenever they take a piece of colon that has sort of, you know, people don't really do that anymore because then you get into like an abdominal surgery that's just whole other can of worms. But that might be like the most viable option for someone who doesn't have a, the penile skin change. It might change those things KB:                 For sure. Yeah I think it's just so fascinating, like, where medicine's going to go in this particular field. So since you kind of started talking a little bit about gender affirming surgery, I'd love to hear more about a little more in depth about vaginoplasty and maybe just kind of the steps during the surgery... Kayla:             Sure. So, uh, like I said Before, we do a penile version vaginoplasty. And what that means is that we basically deconstruct the tissue that already exists and reconstruct it, eliminating some of the parts that we're not going to use. So one of the first steps is essentially degloving the penis, so taking the skin off and then we have the components of the phallus which are the erectile tissue, the urethra, the neurovascular bundle, which is on the dorsal side; so if you were standing up and looking down at the penis and scrotum and testicles. So the first thing is that we're going to take what's called a scrotal cap, so we take like a diamond shaped piece of skin off of the scrotum and set that aside because we're going to use that later and I'll get to that in a minute. Um, and then we basically do the orchiectomy, which is whenever we remove the testicles. So that is a permanent part of the procedure. Once someone's testicles are, like, in the dish, then they are no longer able to have biological children. So patients are council about making sperm and stuff like that beforehand. So then once we have done that, we're going to deconstruct the components of the penis. So we're going to take the erectile tissue. Um, so the bulbospongiosus muscle that we don't need to, that won't be needed anymore postoperatively and that's really kind of the only tissue that's like straight up discarded. So we take that and then we shorten the urethra. So the urethra has to be put into a position where when someone sits down, the urinary stream is going to go straight down into the toilet as opposed to like forward or backwards or to the left or to the right. Um, so we shortened the urethra and then we have the long skinny strands of nerves that are basically what's the neurovascular bundle. And this is hard to like describe with only audio. I'm like using my hands, but I know no one can see me. . So you have the long skinny strands of nerves and blood vessels that are attached to the body and we'd never disconnect us from the body because then they would not, you know, be of any use. So. and they, so it's sort of like you have like all these like, um, nerves that go to the end and the glans. So we have the head of the penis and sort of remains as it is. The head of the penis at that point is then cut down and folded in a way to look like a clitoris, and then we sort of just bundle those nerves up and put them in place where they should be. So the clitoris is a pinpoint area of erogenous sensation that when you're standing up and with your legs together, it can't be seen from the front and if you're sitting down, you're not sitting on top of it to cross your legs. It's not something that she'd be like bulging or too sensitive. So we put that in the correct position and then the skin that is basically under the corona of the, of the glans becomes labia minora. And then the remaining tissue from the scrotum becomes the labia majora. So to create the actual vaginal space, we go anterior to the rectum and posterior to the bladder. So we're in this very tiny space that really kind of doesn't exist, but we make this space and the depth of this space is very much dependent on that person's anatomy. And so within the pelvis you have the organs that I was just talking about and then superior to that is the, um, the peritoneum, so you have like the peritoneal reflection and inside of that cavity is, like, the guts, so we can't break into that space essentially. So the length of someone's vagina is dependent on how long their pelvis is, essentially. So someone who's like 6'2" will have a longer vagina than someone who like 5'3", but they... That's my baby crying. But what they, um, they all are relative to that person's body size, if that makes sense. So that part of the surgery is pretty much like the major part of the surgery because that's where like some major complications can take place. So what you don't want to do is go into the rectum, obviously. You would make a rectovaginal fistula. If that happens in intraoperative, that can be corrected In the moment where they will just use some tissue to kind of cover that hole that they've made. And then on the anterior side going into the bladder. Both of those things are very, very rare complications and happen less than one percent of time in surgeons that do this all the time. So once we create that space, we then take the skin that is still attached to the mons, where the skin that came from the penis and we, so that scrotal cap to the end of it because you basically have like a straw, but we needed to have a cap at the end of it so you don't have like an open ended vagina. So we, sew the half to the end and then we kind of like flip it inside out like a sock and then pull it down, put it into that space. We then pack it. So we put gauze that's impregnated with a lubricant and bacitracin into that space to get the skin to attach to the walls, the raw skin that's inside that we made the space. Um, and then we put a catheter in the patient. They have two JP drains in the mons that go down into the labia to drain any blood that could still be coming out post up. And then we sew the labia shut. So it's a pressure dressing, so everything, any bleeding is coming up and out as opposed to like in the labia. They keep their prostate, which is important to note. So, um, if you, so the bladder, the ureter or the urethra goes through the prostate. So if you take someone's prostate, especially a young person or anybody, they're going to have incontinence issues which can very much affect a person's life. So it is better to leave the prostate in place. Um, so we remind people all the time that, you know, many, many years from now, whenever you are no longer our patient or maybe like, you know, you don't, we don't have the electronic medical record, it's important to remind your providers that you do have a prostate and the prostate exams can be done through the vagina. So the prostate will be anterior to the vaginal wall, to the anterior vaginal wall. KB:                 And, generally the prostate, if, if their own hormone replacement it will get smaller over time, but it doesn't mean they don't need a prostate exam to assess for any cancers or growths or irregularities. Kayla:             Yeah. So prostate exams are important. And also PSA, so I, I believe that like the last time I looked, there aren't many cases of trans females that are on hormones that get prostate cancer and if they did get prostate cancer it would be a particularly bad one because that means it would have broken through all of that estrogen. KB:                 Right. Kayla:             So we're interested to see down the road how, how surgeons will approach prostate removal and stuff like that with someone that's post op. KB:                 So then they're hospitalized for a couple of days? Kayla:             They stayed for seven days. So for a lot of folks, this can be for different medical centers, um just want them to be nearby because if there is a complication, especially if you know California, I mean people drive very far to get to their medical centers if you know, if you're in like Philadelphia or something where, you know, people live in the city. But we have folks that are like two or three hours away. So we just have them stay to keep them comfortable, um, to just kind of monitor them. But I will say for the most part people are pretty bored because they're not in pain, they can't really see anything that happened in the surgery because they have like all this bandaging and stuff on and they've been off of their hormones for about five weeks at this point. They're like coming down off the anesthesia so it can really be a tough time for people while they're in the hospital. That's why we recommend the people that come in to support you, make sure that they're people who are actually supportive and don't stress you out. And uh, we have uh, a social worker on our team who sees the patient every single day and just as a support system for them. But yeah, so they go home on the seventh day, Day 6 is where whenever we take out all of that stuff. Um, so the catheter and the packing and the drains and all that stuff. KB:                 And generally, how are people feeling? Kayla:             They feel great. Yeah. So those are odd sensations, like to get a catheter removed and the vaginal packing out and all that stuff, especially on a site that was operated on. I think a lot of people, if you think about like when people wake up from plastic surgery like on tv shows and stuff where it's like, you know, they're in so much pain, it's not, it's not quite like that. So yeah, when we take out all that stuff people are very relieved because it's just a lot of stuff to have. Like we have the drains and the packing and the catheter and you know, a lot of times like they haven't had a bowel movement yet, so it's, it's very relieving to get all of those things take. KB:                 Everybody on the surgical, the med-surg floor or the surgical ICU is trained in competent trans care and GNC care? Kayla:             Our actual entire medical center was trained. If you work in the cafeteria, if you are, an environmental services, every single person was trained in a trans care. Yeah. KB:                 Awesome. That's great. I mean the hospitals in general can be very triggering places for people, so it's great to hear. Kayla:             Yeah. Yeah. Especially because there's difficulties, there's unforeseen things that come up, like how do you identify as transgender patient in the hospital without like putting a sign on the door, like there's a trans person in there, you know what I mean? Like you want everyone to know without being like ridiculous. Um, and then complications or difficulties with the electronic medical record, you know, it's like difficult to have someone's preferred name and in their chart or if they haven't been able to change their gender yet. Like if somebody even from even something that's like delivering a food tray doesn't know that people on the phone and things like that. So. So those are things that we are actively brainstorming kind of all the time. KB:                 I mean, do you get feedback from patients post op? Kayla:             Yeah. Um, so everyone has, I mean seems to have a very great experience. But there, there's just time sometimes when people are, are mis-gendered, not by someone on purpose. It's just those things that kind of happen. So for example, if someone from the cafeteria calls the patient and someone answers the phone, they and you know, people are trying to be very polite and you want to say like sir or madam and things like that. So, but yeah, so people give us good ideas of like, hey, maybe maybe like just don't say sir or don't say don't say those things whenever you're on the with a patient. KB:                 Right, right. Yeah. After they leave the hospital, when you see them next? Kayla:             So then they come in and about a week later for their first follow up where we were just kinda take a look and see how they're doing, see the, assess the swelling or how their urination and stuff like that is going. And then also dilation. Um, so they have to dilate the vagina postoperatively. And so we just ask to see or ask them how that's going. It's kind of, we don't do any kind of internal exam for a few weeks, so we let everything heel inside. KB:                 Tell everyone out there about dilation and how important that is. Kayla:             Yes. So dilation is essentially whenever...so someone who comes into the hospital and has a vaginoplasty surgery basically anywhere will be given a set of dilators and dilators essentially look like dildos, they are like along phallus-like structure or device that is used to keep the vaginal canal open to the depth that was achieved during surgery. And then to also help to widen it. So there are dots on the dilator. So that's also like a tool of measurement. So the very first time the dilator is inserted into the patient is by either one of the surgeons or myself and we put the dilator in and basically assess depth of someone's vagina. Um, and then that is the depth that they need to get to every time. So someone inserts the dilator, um, into the vaginal canal and they hold that there for 15 minutes to the back wall of the vagina. So basically like pressing, pressing that in. Because if the vagina is not dilated it will tend to close. And if a vaginal canal, if a neo vaginal canal closes and a neo vaginal means postoperative like uh, um, and that term is actually used for like cis females who were born without a vagina. If it closes, it's very, very difficult to open that space, if not impossible. So dilation is very important. There's a schedule so they kind of move up in the size of the dilators over time. So dilation in the beginning is with a smaller dilator, but it's less frequent. And then as time goes on they dilate less with a larger dilator. We do know that there are post op trans females out there that don't dilate, that were never told to really and their vaginas stay open, but sometimes they don't. And we also know that sometimes people can substitute where they do substitute sex for dilation. So if they have intercourse, typically intercourse is not like 15 minutes of sustained pressure to the back wall of the vagina. So it is a little bit different. and also like maybe the partners phallus isn't the same size as the dilator and things like that. So we don't really know if, you know, if people don't dilate, will their vagina 100% close? We don't know. But we just tell people that's, that's what we strongly strongly, strongly recommend KB:                 Right because what we do know is dilation can have a better outcome essentially. Kayla:             Yes, yes. KB:                 For, and that's all because you know, the type of surgery, you're essentially, the inside of the vaginal canal is skin. So if you just think about how skin heals, there's a healing process and scar tissue is going to form and scar tissue tightens up. So it makes sense. Awesome. Kayla:             We have the, uh, the pelvic floor muscles which are very strong. and cis-females we can have some times where people have painful intercourse or pain with going to the bathroom and things like that. So I actually recommend to our trans females, like things like kegels and stuff like that are actually not a great idea because the key to a healthy pelvic floor is learning how to relax the pelvic floor. So not squeezing around the dilator, not tensing whenever you're having intercourse and things like that because then they're, they're basically like occluding part of the vagina, KB:                 Right, because they're increasing the capacity of the pelvic floor muscles essentially. Interesting. Kayla:             Exactly. KB:                 And then um, how many other post op appointments do they have? Kayla:             So they stay with us for about a year after surgery and that's just, it becomes pretty routine. So it's kind of come in and we do just a regular checkup and then I'm like a warm handoff to gynecology KB:                 And gynecologists are also trained at where you're working. Can you tell us a little bit about some other procedures for male to female gender affirming surgery. Kayla:             Um, so for male to female there is also a facial feminization surgery. And facial feminization is an umbrella term used to describe many or a group of surgeries. So typically what we're talking about was when you want to feminize someone's face, you can divide the face into thirds. So basically like the eyebrows up, nose, eyes and cheek, and then below the nose. So what tends to appear the most masculine in a trans female is the forehead, so the brow bone that is between the eyebrows and above the eyebrows and you know, of the eyebrows and can be sort of pronounced. Someone's nose is typically not gendered. Um, people who are female or male can have bIg small noses or like a bumpy nose and things like that. So that's usually not a part of feminizing someone's face. The jaw is something that can also be feminized. So the width and the length of someone's chin. And then also the pronounced angle, someone's jaw. So to do facial feminization surgery, the bulk of the work is in the forehead and the jaw. And basically to access the forehead we do what's called a coronal incision where we just go from ear to ear, like where a headband would be on someone's head. Um, and then, uh, to access the forehead to kind of take the skin down. And then that frontal sinus, we will either shave that down with like burring or you can do what's called frontal bar setback where you essentially like make the frontal bar a little bit smaller and then recess it back into the space. So essentially you just make beforehand smaller, less, less pronounced. So what some people have said post op is like, wow, I really have to wear sunglasses all the time now because I used to have like this covering over my eyes essentially. And so it really helps to feminize the face and the forehead. And then it opens up someone's eyes a lot too. Um, it really kind of opens up the face. And then with the chin, uh, it's, it's best to try to do like an intraoral approach, so through the couth, so there's no incision on the outside and basically either shaving or burring or like cutting the chin to make it less tall and less wide. And then we can also go to the back of the mouth and get to the angle of the mandible and then make that not quite as pronounced. KB:                 From start to finish, of like pre-op to post up, how long does that whole process take? Several months. Kayla:             Um, yeah. So not as long as there's no hair removal requirement or anything like that. It's basically just once the patient is definitely ready to go. And once their surgeon has availability. KB:                 And you said that is covered by insurance? Kayla:             Yeah. KB:                 Awesome. Kayla:             So that can be a little bit more difficult because, you know, with a vaginoplasty or phalloplasty, you're going from like, a to b. Whereas with a facial feminization surgery it's much more in the obscure sort of like what is a feminine face? Um, there are many beautiful women that have masculine phases. Uh, the purpose of the procedures not to be like a rejuvenating surgery, so we can't do and we know those facelift or anything like that involved. So it does, it does include some more like decision making in the abstract of what it means to have a feminine face or masculine face. So yes, but yes it is covered. KB:                 That's interesting. And then what other procedures are involved that you all do? Do you do augmentation breast or chest augmentation? Kayla:             I'm not involved with that. I know that the current guidelines are if after two years of hormones, if the patient basically doesn't have like a mammary fold where um, it's like they have less than A cup and that can be covered for breast augmentation to a certain size. Um, and that's why we always recommend that, I would say this to patients beforehand, like, wait, be on hormones for a little while before you go for we surgeries like that because you will face may change a little bit. Like obviously the bony structure of your face won't change, but your face may changed in a way that you aren't so bothered by certain parts of it or you know. Your breasts may grow and things like that. KB:                 And do you do tracheal shaves over there? Kayla:             Yes. Yeah. So that can be a separate procedure that someone can kind of do outpatient or can be a part of the facial feminization surgery. KB:                 So really like this whole process can take anywhere from two to three to four years, depending on the insurance, the budget, um, having the right surgeon and access and what not. Kayla:             Yeah. Yeah. KB:                 But it's so great that you all have everything right there and that's what's great about, you know, going, knowing where you're going is really important for trans folks to know because there's only so many surgeons out there that have done many surgeries. So doing your research and talking to people in the community is super important when deciding where to get surgery, um done, location wise. Cool. Anything else about your experiences with gender affirming surgeries with, Um, trans females that we didn't talk about? Kayla:             No, It's just such a, it's such a gift to be a part of the team that does this. And the reason is because one: the patients are so motivated and they're like the only walking into the hospital who who are about to have surgery that are like stoked, to be where it's like them and pregnant people are the only people that want to be in the hospital. So in that sense, it's like, it's great for me because I'm dealing with people that are like, they're very happy to see me, they're very happy to be here, you know, any boundaries or anything like that we had to serve in terms of like if they were a smoker, if their A1C was high, like they're on it and they participate in their care. And so I mean for me it makes my job pretty easy and uh, but yeah, that, that's just one part of it that's like, it's so, so great. KB:                 Kayla was just saying about an A1C and smoking a high a one c is indicative of pre-diabetes or diabetes and smoking can completely constrict the vessels in the skin and both things can have a negative effect on your healing. So in any particular surgical situation you want to not smoke and um, if you can control your diabetes as much as possible, it will be ideal for your overall prognosis because, um, you'll heal much slower otherwise. So. Cool. Let's transition to the transmale surgical procedures for our trans men. Kayla:             The current clinical options, surgical options for trans men include and not just where I am, but just sort of in general is a metoidioplasty, which is essentially the clitoral release, which can include a urethral lengthening and a vaginectomy with a hysterectomy, and oophorectomy, so and we'll go back to that in a second. And then also phalloplasty, which refers to actually having a phallus or penis created from a skin graft taken from your body and then attached to your body with nerves and the urethra and all that stuff. So with this surgery there's a lot more, a sort of more options and like boxes to check and things like that. So someone who wants to proceed with complex bottom surgery as a trans male, the simplest thing that they could do if this was what they wanted to do is what's called a clitoral release. So essentially detaching the suspensory ligament from the clitoris, which allows it to drop and grow a little bit further. So the clitoris will grow with exposure to testosterone to basically become a phallus. So a clitoris is essentially a phallus, but you're sort of limited in how much it's going to grow because it's held by a ligament place. So once we cut that ligament, it can become a little bit longer and I'm sort of drops down a little bit. Typically that is not enough for someone to be able to stand to pee because it's not going to project pee off of the body enough to get it into a toilet. Um, sometimes people have a very large response to the testosterone so that procedure would be enough. But for most people, if their goal is to stand to urinate or to have penetrative intercourse, then moving forward with a full phalloplasty, with a skin graft and everything is probably their ideal choice. So the steps included in that would be, so people can do like a staged procedure where they do that setup part where we basically do the clitoral part hysterectomy and oophorectomy to taking out the uterus and ovaries. And actually a trans male can leave their ovaries if they want to. They don't ever have to take their ovaries out, but to do the phalloplasty who would take the uterus and the cervix and the vaginal canal just because we. It would be very difficult to access them later if there was ever, you couldn't even evaluate them, really for cancer postop. And so doing the hysterectomy and then also a vaginectomy, so that is essentially when we take out the vaginal canal by either like cauterizing and closing it in that way and then lengthening the urethra. So the urethra where it sits in a trans male is centered and goes down into the toilet, the urinary stream. We now need it to kind of come up closer to the pubic bone. So we lengthen that urethra up to the tip of the phallus that was released with tissue from the labia minora. Yeah. It gets really complicated to explain, but basIcally lengthening the urethra. So if you want to lengthen the urethra, it's pretty much a requirement to also have a vaginectomy because you don't want this space behind the urethra that was just made because if there's any back flow or urinary issues then you have like this vaginal canal that's not, like, providing support for that new urethra. So there are some people who have like, I've heard of that before where people want to have their clitoris lengthened and to be a phallus but then also to keep their vagina so, but it's just for the best urinary outcome it would be to close the vagina, lengthen the urethra and then to the tip of the phallus. So that essentially lays the groundwork for the phalloplasty, that would be the second stage. KB:                 How long do you have to wait in between procedures? Kayla:             So, between two anesthetic events, if you can, if you have a choice, it would be like three months. Typically they say probably about like six months just because of scheduling and things like that and just make sure that everything was well healed. So yes, usually around that amount. So important to know is after that first stage, what makes this surgery a little more complicated is that there is what's called an SP catheter in. So all that area down below that we operated on, we don't want someone to be urinating through that space yet because the urethra is healing. So there is a catheter directly in the bladder, like coming out of where your mons is essentially and they keep that for a few weeks and that's how they train their bladder. And then once we know that everything, well is well healed below, then we'll take the catheter out and then they can pee from below And what makes it easier, so after you have a metoidioplasty it's a lot easier to use a stand to pee device than previously. Yeah. So people are very excited about that because even if they can't pee with their own organs standing using a stand to pee device is much easier. So. So people have had success with that. KB:                 I know there's a little bit of controversy about like if people should have phalloplast. Is it ready? Is the surgery optimal? I know you know, friends of mine have really toyed with that idea. Can you tell us maybe a little bit about like the complications you've seen, the successes you've seen? Kayla:             So complications are usually going to come from something urological. So it's basically bladder mechanics. If you think about the bladder of a trans male, the urethra comes basically a very short distance and it goes straight down. So now what we've done is sort of make it go at a right angle. It has to go up and then around two bends and then down the length of the phallus. So sometimes the bladder has a difficult time with that. And then also the urethra, there can be what's called the stricture, which is a narrowing of the urethra. And that can happen at any point where there was a connection and if that happens and someone is not able to get pee out of their body, then that's obviously not great. So essentially those kinds of things. So urinary strictures, um, so someone who is a, who is going to consider phalloplasty, it is more of an intense process. They have to sort of be very aware of what's going on below and if there's urine leaking from somewhere and to be ready for those complications, that they do arise. So sometimes people have had to have an, you know, just sort of historically multiple procedures afterwards where you could have loss of the graft and things like that. And then the graft site itself, you know, that's also a surgical site that needs to be taken care of and can be infected and things like that. So really sort of like having a good support system and someone who is really there to help you and drive you to appointments. Things like that is really important. KB:                 Do you know the percentage rate of complication? Kayla:             I believe that like for all phalloplasties that have ever happened, it's like 50% of the time there's at least one complication. And the good news is there's a lot of complications that are not a huge deal. Like you can have a small infection in like an incision site or where the SP tube is or you could have, you know, like a urinary structure that can just be dilated in an outpatient, in an exam room, things like that. Or you can have some major complications which would be, you know, a structure or a fistula, a urinary fistula and things like that. KB:                 Yeah, any , um, positive stories like people who've been really happy with their procedures? Kayla:             Everyone's very happy. Yeah. So even when people have complications, I mean it's something that they feel like they're very prepared for and that really shows how worth it it is for them. So people who are able to, one thing that we hear a lot is like I can go to the gym and I walk into the locker room and I don't have to feel odd about changing. I can just like use the bathroom and I don't have to be nervous that someone is like suspecting that I'm not supposed to be here or something like that. So being able to standing to pee is a big deal. Also just it helps people with. So in affirming their gender in terms of having their new anatomy, sex can be really awesome because they are not just worried about having a vagina and they can participate in sex in a way that is, you know, meaningful and you know, without dysphoria. Yeah. KB:                 Yeah. I mean I think um, any surgery and even just medical intervention, really understanding, um, the, what you're doing. So when you, for example, start somebody on hormone replacement therapy, like really explaining the positives of it but also things that might happen along the way, things that we really don't know are going to happen along the way. And I think at the same goes for surgery and sometimes people are just so excited and you just want to give them everything they want. But the reality really, you know, 50% complication rate is fairly high. So I think just explaining that and as long as people are a 100% ready and onboard, you know that's super exciting that they're happy with the procedures regardless of all that stuff. Do you do top surgery? Kayla:             I do not. So that is something that is not restricted to like a gender surgery team. So a lot of people throughout our medical center do that and just sort of plastic surgeons in general. I have heard and read a few things recently about how they will now or something to contemplate is facial masculinization, which when some one first said that to me I was like: no because I feel like, like what would that even be? And I feel like a lot of trans males like do appear very masculine. I don't know. So. But yeah, so I've heard a lot about the facial masculinization sort of being, coming down the pipeline is something that people will be requesting. KB:                 For anybody who's out there who's interested in going into this particular field: Do you have any clinical pearls or suggestions on how to be a good first assist or how to find these opportunities? Kayla:             I would say make the most of your rotations. If you're a student, so we all kind of rotate through surgery in different capacities. So I did general surgery and then I also did gyn-onc so I was able to do kind two surgical rotations and just retaining that staff because once you learn the basic fundamentals of like how do I scrub it and sterile technique and all that stuff. Like you will always know that and be a good first assist is just to, well I'm in a fortunate position where I work with her, a few surgeons, whereas other people in my medical center that are like the general surgery PA so like they could work with a different surgeon every single day of the week. So for that that will maybe be a little difficult because everyone has their own vibe and has their own way of doing things. But I would just, yeah, when you're at school, try to memorize all the instruments and get familiar with procedures. One thing that somebody told me that really did help me was the first time you watch a procedure or assistant procedure, watch it as if you have to do it yourself later. Like you have to do it by yourself later and really try to memorIze the steps because if you're, if you keep thinking about it in a way that's like, oh, I'm not going to do that step, ever. But like, I don't know, maybe someday you will or you know. So to be able to learn the steps of the procedure and also to always, um, just want to make the surgeon look good. Also. So like your anticipating what's next, knowing what they're going to need. Keeping our surgical area clear. You're always being at the surgical site and not being distracted by what's going on in the room. And... Wear compression socks. KB:                 That's great advice. Do you have any advice for patients and how they can advocate for their trans surgery care? Kayla:             Um, I would say that just want to research the physicians that you're going to see. So a lot of people, there's a lot of information out there. All doctors nowadays are like reviewed all the time. If you meet someone and you like them and you trust them and they feel like they are genuinely interested in care, then that's great. And if it doesn't then you know, maybe that's not a good fit for you. I would also say that there, I mean I'm not in this, not in this experience, I don't know what it feels like, but to have a sense of urgency, like people who they just want to get it done. So they will go like, you know, out of the country or they'll go for someone and maybe it's a little less expensive or something like that. Like you kind of, you only have one go kind of. So just make sure it's right and that it's the right time for you, that you have all those things like so you're not going to, you know, lose your apartment if you don't, if you take the time off work to do you need or if your work isn't supportive, you know, just try to get those things. I mean that's, that's really difficult to say. It's like easier said than done. KB:                 But it's like anything else, if you're going to do it, do it right and this is your body and this is all you got so I think that's really great advice. Kayla, this was awesome. This information is super hard to find and you know, you can go to trans conferences and see the photos. Um, but to hear somebody who kind of does this work every single day kind of outside of a powerpoint presentation is really kick ass. So I really appreciate you taking the time to chat with us. Kayla:             I'm glad to asked. And I'm always happy to share information. I'm totally accessible all the time. I get emails from students and stuff like that and patients through my or not my own patients, but like through linkedin and stuff. Yeah, because it is difficult to find. Even for me it's like whenever I'm trying to find like, oh, what should I do in this situation like there is no Uptodate, there is no, there is no information. So it's sort of just like, you know... KB:                 Yeah so we all have to spread the info amongst ourselves so we can learn ***END INTERVIEW***  ***CONCLUSION: KB ONLY*** For information about future episodes or to contact us, please visit us at our website www.queermeducation.com or email us at queermeducation@gmail.com ***OUTRO MUSIC***

Health and Hair ft. Jessie Santiago and Cal Bigari ***DISCLAIMER: KB ONLY*** This podcast is a series of interviews with medical providers, mental health professionals, community members and advocates. Each interview represents the opinions of the individual. Individuals may use different terminology than what you’re used to. The intention is to educate not discriminate, and we welcome positive and constructive feedback. Please keep in mind; this is not a replacement for medical care or advice. I am simply presenting my views along with educational information that will be both evidence based research and external networks that have an impact on LGBTQI and nonbinary health care. Consult your provider for any medical or mental health concerns. My name is Kerin “KB” Berger and welcome to Queer MEDucation! ***INTRO MUSIC***  ***INTRO TO EPISODE: KB ONLY*** Welcome back to Queer MEDucation. Special thanks to our friends at Kaleidoscope Health. For LGBTQ and nonbinary folks, accessing healthcare presents a number of challenges. Knowing that your provider is a safe space can be a game changer. Show support for your LGBTQI and nonbinary patients and colleagues by wearing a Kaleidoscope Health pin on your white coat, daily attire or ID badge. Order pins at www.kaledioscopehealth.org Today’s episode focuses on the relationship between LGBTQI and nonbinary health and hair. Have you ever felt uncomfortable getting your hair cut? Have you ever walked into a barbershop and they didn’t know what to do with you? Was getting your haircut ever triggering? In this week’s episode we chat with the owners’ of Salon Benders’ about creating affirming spaces that encompass bravery. As a queer person, getting your hair cut is so much more than a hair cut. The physical and mental health outcomes are tremendous. Please enjoy. ***INTERVIEW: KB, JESSIE SANTIAGO, AND CAL BIGARI*** KB:                 I'm here with some friends from Salon Benders'. Why don't you introduce yourselves? CB:                  Hey, I'm Cal and my pronouns are he, him, his and I am co-founder of Salon Benders. JS:                   And I am Jessica Santiago and the other founder of Salon Benders. Pronouns she/her. KB:                 Well, thanks for being on the show today. Can you tell us a little bit about what Salon Benders is and what that means? JS:                   Yeah, so basically we are a space that is, I'm queer and trans competent and we do hair for everyone. Um, but we, we like to call ourselves a straight friendly place instead of the place. Um, so we basically, you know, try to keep up with all of the lingo and tried to keep up with all the, um, all of the stuff that you know is important. Um, yeah. And so, and also like trends and styles too. Like, um, having somebody come in here and say, this is my gender expression and I'm not quite like, um, I had someone yesterday, like, I'm not quite femme. I'm not quite masculine. I'm not quite, I'm kind of somewhere in between, but I want to look like this. And to be able to say that to someone and for them to not have any questions of like, well, what does that mean? Um, I think that that's really, that's really powerful. And that's kind of, you know, that's my end of Benders' and my responsibility is really like nailing people's image and helping them express themselves, um, and the way that feels really valuable or valid to them now. KB:                 That's awesome. CB:                  So, Jessie is the greatest hairstylist who has ever touched KB, CB, JS:    CB:                  She's amazing and, so good at what she doesn. Um, and when we started talking about the concept, um, it just was, was perfect because what she does is, is excellence. Um, and uh, and she is a gender been bender herself. She is very, she/her., but she is fierce She is loud. Um, she has all of the things that we tell women not to be. And I love it. And it's amazing. UMM. And so, so we came together and created, um, Salon Benders, which is a place of, of excellence for a community of excellence. Um, and it's a place where expression and love, uh, is really the heart of everything that we do. So JS:                   He might cry. CB:                  I probably will several times KB:                 Cry away, if I could give you a tissues I would CB:                  I'm loud and ugly crier. So that's a good thing is yes, KB:                 Next time on the pre checklist. I'll put tissue box please. CB:                  We do have tissues in the salon because I'm not the only one that cries. Okay. How many people have cried here to today? JS:                   Two. CB:                  Okay. Well actually if we can double that. KB:                 Probably happy tears. I would imagine. JS:                   Mostly happy tears and like some sometimes just like an overwhelming amount of gratitude just was like, oh my God, I can't believe I work here. KB:                 For sure. For sure. CB:                  It's a form of expression. So sometimes the expression comes through tears and giggles and yeah. You know? KB:                 Yeah. So how did you all come up with this concept of a queer friendly, trans friendly salon? Like what did you, why did you think it was important? Where did it come from? JS:                   Well, okay. It's kind of in story form. Um, so I worked at a hair salon. I worked in Manhattan Beach, California, which is kind of like, um, it's kind of, I should be very careful. It's conservative, it's a conservative town in my opinion. And um, and so I was, I was having conversations that were just not super valid to my experience of life and just like, you know what I called them like rich people problems, like, oh, I can't, I couldn't drive my Bentley today because it, so I'm driving my Range Rover, whatever. And I'm like, what? Like, and that kind of conversation was just starting to like really, really challenged me. So I would come home from work and would lay on the couch and be like, I can't do this anymore. I'm going to quit doing hair. Like I can't, I just can't do this anymore. And he would say to me often, like, you're, what you're doing is so important. Like you're doing, you're helping people with their image and all of these things. And I'm like, but am I like, is that a real thing? And it was kind of his idea. He was like, why don't you market yourself to more queer and trans folks instead of, you know, the folks that you have been working on. I think that you would like have more of a joyful experience. And I just kind of judged that. I was like, I don't think that that I can do that because I'm not trans and I, how can I possibly speak or help someone with a trans experience if I don't have one myself? And, uh, he's just like my biggest cheerleader ever. And he's like, well, you're good at what you do and you don't have to have a trans experience to give a really amazing haircut and to listen to how someone wants to be. How has someone, how the way somebody wants to express themselves, you know, you can listen to that and you can that. And I'm like, yeah, you're right, I can do that. And so it was really just the real conversation that he mentioned that we were like, okay, that's where it really started is that tiny little car. You remember that conversation? We had car. CB:                  I do. Yeah. And I, I mean, it wasn't, it wasn't just like the Bentley conversations and whatnot. It was like fat shaming and body shaming and expression shaming that was really, you know, packaged up in that. And we started talking about expression and how, you know, she's got a huge background of, um, of meditation and wellness and spirituality in that sense. And that is what the essence of her hair practice is, is about expressing something beautiful that is inside and allowing it to be shown on the outside, whereas that wasn't, that wasn't really truly being captured or appreciated in her, um, in her realm. And I said, there's a community. KB:                 So I guess what's, what's your role in all this, Cal? Like where, how did you decide to come together with this vision, this inspiration, build what you're building now? CB:                  Like Jesse said, seeing an amazing resource and, um, and the capacity to serve a community that is really underserved and my own experience as a, as a trans masculine person. So I was raised and identified female for a very long time. Um, and then once I started my transition and started growing a beard and grooming myself, I didn't know how to navigate. I was terrified of barbershops, like barbershops really affirmed my gender identity, but it was also horrifying to me because there was so much gender performance that was happening there and there was so much masculinity and I didn't yet, um, I wasn't taught that, you know, I wasn't taught how to groom my beard and I wasn't taught the social cues of like, I was still trying to talk to people in the men's bathroom and they're like, no, no, no, you don't talk to anyone. That is totally against the rules here. So going into a place that was like totally male dominated, like I learned, I learned, okay, don't, don't speak, say as few words as possible. I also had a high voice and a different growth pattern of my facial hair that I was afraid of being clocked. So I have, um, you know, a lot of fear about being in this space and, um, and just saw a huge opportunity. KB:                 What, what is gender performing? Can you, I don't think I've ever heard that term before. You used it in the context of the barbershop. CB:                  Uh, gender performance. I don't know if I'll do it justice, but I'll communicated as I know it. Um, we're all constantly performing gender in some way or another as been told. Um, don't do that. That's not ladylike. You're, you've been cued that you're not performing gender "properly". Right. Um, so I think as a, as a trans person, gender performance feels like something that has to be taught, um, are for me as a trans person, I had to relearn my gender performance because I was taught to perform in a certain way, sit with your legs, cross, don't speak too loud, don't eat so messy. Um, a lot of things about like taking up space that women are not supposed to do. Um, so I had to learn a different, a different way to, um, to be perceived as male in my community. And I still don't perform gender, um, properly, if you will. And so I'm generally perceive as a gay man. Um, and then they're really confused when I have this beautiful feminine partner. Um, they're like, wait, but I thought you were a homosexual. I'm like, CB:                  It's like the best part. It's so fun. JS:                   I think your boyfriend is gay. Yeah. So what if he is. CB:                  Because they're reading my gender performance as feminine. JS:                   Right. CB:                  Um, I'm perceived as gay, we clack feminine with gay and it's just all fun to play with and in my perspective too. So, um, I don't know. Did that answer your question? KB:                 Totally! I mean, I guess so. So then your personal experiences, your communication with Jessie, you had this conversation and then you then what? I mean you just decided to, okay, we're going to quit our jobs and, and when did you really decide to kind of go for it? JS:                   Yeah, what you just said was like, I mean, it really is a decision. Like we, um, we decided, uh, in February (2018) we decided in February that we were going to do, this was the right after my birthday. And he was like, let's just do it. And I was like, okay, first things first we got to find a space. So from February to April, we searched for a space and that was our very first thing that we did. Um, we just kind of like roll the ball and started looking at rental spaces, commercial spaces. Neither of us had ever owned a business. We had no clue, what Everyone:        JS:                   We still have no clue what we're doing. We're like, how is this still open today? So they just decided, um, to start to and I was just like, let's just go step by step. Like we have a space. Then the next thing we do is decorate it or build it out. And the next thing we do is, you know, um, uh, business licenses and cosmetology licenses and all of these other things and like, so step by step it, I like in this thing to having a child. Nobody was given a manual. Nope. Even if you study child psychology or you studied early childhood development when you were a kid, like all bets are off, right? The heck you're doing. And I think it's the same as owning a business. Like you can study business all day long. I've been cutting hair for 17 years. I know how to do that. But like even if you, you study business, you still will need to know, like, you still have no idea what you're getting ready to get into. So we just decided and we let it teach us. And we're still kind of letting it teach us. KB:                 The concept of your space and what you were looking for, and you know, was it just any old place or was it a symbolic? I feel like that's a huge decision to make and you have to almost have a very specific vision for, for what's, to build a space like what you're building. CB:                  Oh my God, I love this things that we're in. The coolest thing, well let's say it was really important for both of us, um, to have a community driven space, a space that felt comfortable for people to just chill at, a place for people to not have to gender perform necessarily, um, or to perform in whatever way they wanted to. So, um, and just feel really comfortable in their expression. So we wanted a place that felt really ooey gooey and really nice and comfy. Um, and we found this space and that's a whole other story. But this, this space is a, we call it the teapot because it has a giant teapot on top JS:                   It's a hundred year old building. CB:                  Yup. It has a crazy rich history and it has been through its own transformation, um, many, many transformations. But essentially it was going to be ripped down. Um, the city had deemed it a public nuisance. There was, um, a whole bunch of folks, um, making their home in here, um, JS:                   AKA squatting. CB:                  Yup, they were squatting. Um, yeah, so they were, they were going to knock it down and our landlords actually purchased the building and um, and with the historic committee renovated it back up to its original. Um, it's whole original, beautiful, like in its best self. And that just was so perfect for us because, um, because of what that means for, for the Queer and Trans specifically community is like, we see that the Trans Community and the, I'm giving this really big overarching umbrella and we know there's a lot of like variation within this, but a lot of oftentimes the trans community is this kind of forgotten community that is not given the power, um, or recognition that it actually has. Right. And that's what happened to this space was no one was paying attention to it and no one was tending to it and no one was telling it. It was beautiful and powerful and amazing. And so it looked like trash. You know, it was, it was really falling apart and it wasn't in its power. Um, and of course it has these beautiful bones. It has this immense power and all it needed was, was folks to come and, and say, we see you, we got you, and we're going to help you build up. And there's a really beautiful power parallel there. Um, I think when this community is really honored for the power that it has, we believe that the capacity that we have to change the world and make the world a better place is UNfreaking believable. Like it's just an unreal, just like this space, what it's turned into. KB:                 I love that comparison, that, that transformation idea of the physical space, the physical person and all the, you know, the bones need, needs some tender loving care. But ultimately with some TLC can see how beautiful it can fall becoming. Yeah. I love, I love that comparison. That's awesome. JS:                   It's kind of perfect. That this is our, I mean like I see this, this space as our first space. Like I actually like Salon Bendors and needed this to be its first space because of all of the symbolism and all of their amazing ooey gooey energy that's in here. Um, and if we don't happen to keep this space, we know that, that we want to bring that energy with us in our next place. And if we open up to Benders or three Benders or however many, we still want to keep kind of like that, that, um, unique feel to the space. So even if it's like, you know, a new modern place or something like that, but keeping some kind of like really unique vibe to it because this is such a unique concept, you know? KB:                 Definitely. JS:                   Our building has to also kind of reflect that a little bit wherever we are. KB:                 Yeah. And I think it probably always will, whether it's modern or historic or contemporary it, you know, it's all about what's on the inside really. So I love the, and CB:                  I want to say one other thing that's on the inside that is really freaking awesome is beautiful, beautiful wood, um, hand crafted built by queer women. JS:                   Basically everything in here was, uh, created, built, made, um, sewn together. Like literally I designed every single thing in here. Um, was, was made by Queers and Trans folks, space for whole, we gave work to, to our own community and we searched high and low for them. KB:                 Yeah. Was that a hard thing to find? JS:                   No. Yeah. I mean it was, it at first it was, I was like, what, how am I going to find the like a wood worker or contractor? I mean how am I going to find all of these people in our community? And it just took literally asking like I had never really asked my community for anything and said like, Hey, I need this. And as soon as I did, people started showing up. So I thought it was going to be harder than it actually was. Okay. KB:                 Interesting because we think of like social media as the ultimate outlet of finding things and Google and all that stuff. But it's, it sounds to me like something that's unique about the queer community is the word of mouth and the smallness of it in a way where, you know, I know my personal experience of starting this podcast and this idea, anybody that I asked to be part of it is excited and they're excited because when you talk about it, you, you feel something different that maybe you know, a non queer person may not understand or feel. And that's the beautiful part about the community aspect. JS:                   Totally. Yeah, we have an amazing community with some amazing, amazing people inside of it. And like we have to, we have to build each other up KB:                 For sure. JS:                   And bring that brilliance out. And it's, it's the same thing that we're doing with hair. You feel like, oh you come in here and you feel like your hair's fine. Great. Let me, let me hook you up. KB:                 Yeah, totally. How you do think hair and health kind of go together and, and what that means maybe for you personally or maybe for some of your clients? JS:                   My Gosh, I just got goosebumps. I feel like this question is so loaded. KB:                 It's super loaded. Like I feel my own experience, you know, you know, asking that question. So I'd love to hear you know, you as the doers. JS:                   What a brilliant question. Thank you for that. Um, yeah, so I think there's two, there's two elements to this for, for me. Um, the way that I think that hair and health kind of come together is, is physically so I can actually physically feel in someone's hair if there is some health stuff happening, I can't diagnose anything. But after 17 years of doing hair, you kind of, you can kind of gather like, oh, this person could be in poor health for whatever reason. I don't know, but you can, you can tell these things. And then there's, there's emotional and mental health around that too. Um, and I mean I have a million stories that I can tell that kind of will sum this up. But really it's all about like you have to really look at the history of hair to really understand this. Every other culture, I mean every other culture besides American culture has some kind of depth to their hair. They have some kind of cultural like ritual or something around their hair. Like if they're unhealthy, they shaved their head and they, they cleanse themselves completely from the inside out and they're like, when my hair grows back and it is down to my hip, so we be healthy, again, like there's like all of these, these different, these different kind of like cultural things that other countries do. And Americans just use their hair like, uh, this, you know, superficial best assessory or KB:                 Right, almost like a luxury if you're going to a certain location, especially living in Los Angeles, you know, to get a trim costs sometimes $150 and it could barrier almost people JS:                   Exactly. When I think that we'd make it a little bit more accessible. Your hairstyle is, can actually provide you with some insight that you, you know, that you, you might need. Like I, I could, you know, today I was doing someone's hair and I was like, are you eating enough protein? And she's like, you know what? I stopped eating meat a long time ago and I've been feeling really lethargic and I could feel it in her hair. It was like I had done her hair before and it wasn't that brittle. It wasn't that dry. And this time around I was like, hmm. You know, and, and just that little tiny insight, I don't know, like I have no idea what's going on, but I just asked a question, you know, about her protein because our hair is made of protein. So if it's drying brittle, there could be some protein things happen in your body. And it just so happens she's like, you know what? That was what I needed to hear because I thought it was, I was, you know, bringing in enough protein, I don't want to have animal protein, but now I know I can up my dosage a little bit, you know, whatever. For my protein shake and just like, so I think there's so many ways that hair and health come together. Like I said, physically, emotionally and spiritually even and all of the things I think that like doing hair is, is so beneficial for my health and for others. Yeah. I don't know, that was not a rant. Everyone:        KB:                 The best rant. CB:                  I almost, I feel like I just heard a couple of stories that I feel it would be really amazing to share just talking about like we're queer hair and, and mental health and what some of those like cuts and things JS:                   I did, I did a haircut yesterday that it was just, I can't stop thinking about it still right now. And um, so this person comes in and she has very long hair and it's, she's, she's sits down in my chair and she just goes to cut my hair off. I mean like cut my hair off. And I was like, okay, well do you have a picture? Shows me like literally a pixie cut, like going from hair down to her hips to like the shortest hair and like right then and there, that is my first indicator of what's going on, you know, like what's happening. Why? So I sat with her for 45 minutes before her haircut and had a full on therapy session with her to see where she was and where she wanted to be like. And basically the whole thing was I have been under this hair because I have been afraid that I wasn't going to get the job that I needed and wanted. My security was literally going to be, um, I was going to have, I was not going to be able to eat if I had short hair. This is literally how her brain was going together. I needed it. This, I need this job so I'm going to grow my hair out and seem femme because I'm around people that do not like women with short hair. And she had been living like this for so long, so long and she was like, but my insides feel more masculine, although I identify as female. But my image just does isn't matching up. So it was a three hour haircut by the way. Three and a half hour haircut. And we cried many, many, many times. And we laughed. And it was like when she left, it was, I mean I just went home and just like floated KB:                 Spiritual. JS:                   Yeah, it really, it really was. And she left and she was like, she hugged me like a hundred times and was like, I love my hair. And almost like I don't give it a crap if I go to work tomorrow and nobody likes my hair because I am back, I'm back. You can see it and feel it. And I mean like, and, and honestly, this is one of so many stories, but now what was one of the fresh ones? JS, CB:            So good. So good. So rich. KB:                 Yeah. Well, I mean I, my personal story about hair and health is, I never knew what it meant to have a real relationship with a hairstylist until I knew what it meant to have a real relationship with hairstylists. Like, you know, my mom would schedule me appointments, I'd go to them, sometimes I'd let my hair grow forever. I had really, really, really long hair always. Um, and um, for me it was just kind of a task versus an experience. And when I was in Grad School, for, to be a PA, I, um, I looked up a place and looked up like queer LGBT hair people and I found Susan. And I show up to see Susan and I, my hair is down to like my mid back and I'm like, I'm ready to chop it. And I had a conversation with somebody fairly recently who expressed her experience with chopping her hair off and saying that it felt like her security blanket through my own personal stuff that I was going through. I was like, I do not want a security blanket right now. And I was always really scared to cut my hair off. I don't even really know why consciously if it was societal or my own insecurities or whatever. But um, honestly Susan changed my life every time I'd go to see her, I was excited to be there. It wasn't a task. It was a pleasure. And she listened to me. She, I mean, you're right, like touching somebody's hair, washing their hair, feeling there, the connection to their brain. I mean, it's so powerful. Um, so I, I honestly can't even imagine doing the work that you do crying every single day. JS:                   I joke about it. I'm like, okay, today's going to be the day that I go to work and I don't cry. Like it hasn't happened yet. JS, CB:            KB:                 And then the question is, when you were working in a different setting, were you having those experiences and, you know, what makes this so different I guess is the real question? JS:                   Absolutely. Yeah. No, I wasn't having these experiences. In fact, yeah, there were, there were tears but they were not tears of joy. They were tears of frustration and you know, and I like, I worked with some great people. Um, I had, uh, I had a really, really kind coworkers who I love so much and really great, amazing clients. I had like, I feel like I gathered around like the best of the best of the, of the South Bay clients and I had like a tiny little bubble. But what was happening was I wasn't seeing anyone new I, I felt like I was, I was in a bubble of where those people were sweet and kind and nice, but they weren't relating to the things that I was relating to. Like when I said that I had a trans boyfriend, I had to literally explain to every single person what that meant, which was an honor to me to be able to like share that, you know? And I was like, this is important so we should talk about it. And then at the same time, it's kind of like, at some point, I kind of want to go to work and just be like, this is my boyfriend. You know what I mean? Like I don't know. So I wasn't having the same experiences of having these mind blowing like every single day, every day, mind blowing hair appointments. It was like, hey, this person coming in for their six week hair appointment. And it was always like dynamic and lovely and beautiful and amazing. But that little, those little sprinkles on top, we're not there yet. CB:                  Like every time there's a new person on the book, it's like, oh my God, I wonder who they're going to be and what their story is going to be. JS:                   And like, oh, it's so excited. So excited. Do another person. No. Do you know that person? Oh my God. Who are they? How do they find those? What's their story? CB:                  Everyone is like a superstar that we just cannot wait to get to know. KB:                 And Cal, if you don't mind sharing the first time, maybe you had a particular getting your haircut that was meaningful or life changing or something different than just a regular haircut. CB:                  Yeah. Um, well I think I cut my hair and my mom gave me a bowl cut when I was very young. She was great. My mom and my mom is incredible. She's like one of my biggest supporters. Um, and as soon as I was able to say like, I want short hair, she was just like, okay, great and did it. Um, so there wasn't like a lot of drama and trauma around it. I was so happy. Um, I wanted to grow up to be Michael Jordan, so I was really hoping that that haircut was going to help. Uh, you know, I mean, I'm still working, I'm a b-ball skills, but I think what, what really, like the haircut experience that really has influenced me with Benders is when I first started my transition, I was so incredibly blessed to be in a community of amazing trans men. Um, I sought them out and found them immediately and ended up living with, uh, three other trans guys who really transformed and, and, and they taught me how to grow up into my own manhood. Um, and we would, um, we would sit around and cut each other's hair in exchange for six packs of beer. Um, the haircuts in the later in the evening were worse than the ones earlier in the evening. KB:                 Oh, just, just more creative. Everyone:        CB:                  Absolutely. Yes, absolutely. Um, a little more flair, but it was, it was, you know, like we talked about incredibly intimate and in a great way for us to take care of each other. Um, we generally would do this on the same night that we would call it a T party. We would give each other our testosterone shots and do hair cuts for each other. And it was really like the things that we were scared to do, we would do for each other and we would do together. Um, it was really something. Yeah, I love those men. KB:                 That's beautiful. I see my, my goal is that every person on the planet has a story like that person or place or, or something that you are so comfortable, you don't even have to think about how comfortable you are. Yeah. So that's awesome that you found that. CB:                  And I just want to share one thing. Like I think that, um, you know, where I just want to like call out that we're having a very like assigned female at birth heavy conversation. And I also want to talk about Salon Benders is, is really one of, one of the most impeccable things that Jessie is at is she's a hard femme and she works really well with them and them. I mean, she does all sorts of expression. But one of the things that's really beautiful for her to, for me to watch her do is working with the Trans Feminine community. And really our, our space does, you know, we welcome all and, and we really hold femininity in a, in a, in a really strong, um, an elevated position. It's really important because just as much as it is powerful for somebody who's been told that they need to have long hair to get it cut, for someone who has not been taught how to care for their hair or their skin or their makeup or their, their, their presentation when they are able to come into a space and she says, bring your curling iron, bring your makeup, bring, bring your tools and I will show you how to use them. JS:                   Well, the fact, here's the thing, what's m stem folks, right? I mean it takes, I don't know, I'm probably, well, this is a generalization. It can sometimes take a little bit longer to do "femme things", right? CB:                  Like there's a different expectation. There's a higher expectation of, okay, you're going to be putting yourself together. JS:                   Right. And I think that like even cis women, have no idea how to care for their skin and how to care for their hair. Often time, you know, I feel like I have a lot of, um, a lot of compassion for the Trans Feminine Community because I taught, um, I started off teaching cis women how to do their makeup and skincare and like, like trans women would come in and say like, Oh, you know, shame themselves, like, I should know more about this. And you know, like I, I really am bad at my makeup and I really don't have any like routines. I don't even know what to buy. I'm like, sister, nobody does. Like, it's not as trans woman thing that you don't know how to like get her for your skin and hair. It's, you know, and so that right there is like really something that I like to, I like to talk to, to Trans Feminine folks about is that you don't need to be ashamed that you don't understand how to do your makeup and hair. Um, because most of us we have to learn somewhere and most of us did your, you know, did your mom, my mother didn't sit me down and say, this is how you do a wing tip eyeliner. They be like, what is a wing tip eyeliner? Like what are you talking about? KB:                 No idea. CB:                  And I still don't know. JS:                   Exactly. And that's, I mean, and so like I just, I feel like I'm, I really revel in my femininity. I love being female. I love the fact that like I, and the way that I am female, I like to walk into a room today. Literally I have a dress and boots on and I think like, I love that I actually got a compliment today. I was on my bike with my fanny pack on and my hat and someone said, you look adorable and sexy at the same time. And I'm like score. Like I'm killing it today. So I don't know. I just feel like the, I like to play around in femininity, whether it's someone who has short hair, someone who has long hair, someone who wears makeup, someone who doesn't wear makeup. I like to meet people where they are CB:                  It's about expressions. You want to know how to do a wing tip eyeliner, great. And if you don't, great. KB:                 Yeah, I mean I think, I think you hit the nail on the head with, you got up today, put yourself together in the way that you wanted to and you, not only did other people perceive your confidence and your beauty and your hotness, but you owned that enough where somebody noticed it. And I think that's a huge part of people feeling comfortable either with the right haircut or the wing tip or the right or the right skincare. And you know, again, creating that space where they never had the opportunity to either ask people or feel comfortable saying, I really just don't know how to do this. Please help me. Because you're constantly be, there's all this negative energy. And this negativity behind superficiality, unfortunately. And, and, and for the queer community, I think owning your expression is, is, is so much more than your physical self. CB:                  When it comes from that space of owning it and expressing it, it's not from a place of shame of I was told that I have to do this or I want to whatever. It's like truly who are you and what, what do you want the world to see of you? And how can we help? It doesn't matter where you came from or what somebody told you. It's, it's what, who, who are you, that's, that's the whole point. KB:                 Right. Exactly. And I think, I think one thing that I'm picking up is that it doesn't really matter how you identify. Um, it's understanding how you identify and understanding that it's a process of course, but you know, for you, Jessie, you love being a woman. You feel woman, but it's all your feeling. I mean, nobody can replicate that feeling. And, and I think the problem with all the negativity in the world is, unfortunately, it, it just brings everyone down. JS:                   Totally. And it doesn't allow you to play in your expression the there's not, if you're not, you do not live as a man or as a woman. It's kind of like, well you know, well like I was having a conversation with my sister that I still am thinking about and she's like, but femininity is this and masculinity is this. Like she's like, when I think of Marilyn Monroe, I think of pure femininity. When I think of Marilyn Monroe, I'm like that's a bad bitch. Like she was a curvy girl that was like, I don't give a shit what anybody says. This is who I'm going to be. This is how good and like to me that is also feminine. But I see her see femininity differently than than my sister and also everyone else in the world. So I like to just ask people like describe to me how you feel. And it doesn't necessarily have to do with masculine and feminine. You can be colors for all I care, flavors of ice cream. Like I can pick up people's expression and how they want to look just by having like a conversation. No one asks you that, hey, how did you want to be perceived today to today? Because tomorrow could be a totally different thing. And just asking someone that question has unlocked so many conversations in my chair, at least it's been pretty spectacular. KB:                 And that's what's awesome about being alive is figuring all that stuff out. JS:                   Isn't that the point? KB:                 And if you want to pretend to know what femininity is all the power to you, mark. And we did a great job. They taught everybody how we're supposed to be the movies, all that jazz. But in reality, when you're at home alone thinking about it, that's what's really meaningful. So yeah. So can you tell us a little bit, I'm going to shift gears a little bit. Tell us a little bit about not only the hair side of things, but some of it, some other things that you're doing over at, at Benders. CB:                  Yeah. Um, we have some amazing things happening and one of the many amazing things which we have invited many people from the community who are excellent in their craft to come and share their knowledge with our amazing community. So we have a beautiful backyard space. It is absolutely stunning. It has all the who we can me feels, um, that the inside of the salon has. And it feels like a wonderful little community space. And we've had a number of events back there. We've run a queer self defense class, a clothing swap. Um, yeah, we have a bike ride that we do on the first wait second, second Tuesday of every month. Yes. We have a kickball team? Yeah, we have a kickball team. So we're healing some sports team trauma wounds together. Yeah. KB:                 Yeah. That's a whole different episode. I think. JS :                  We did a GSA art show. CB:                  That was amazing to me. That's a whole other... JS:                   12 year olds coming in telling, uh, telling us about their coming out stories, um, doing arts singing. CB:                  …who are also mentored by 20 year olds who have been coming into this space so they have more on this...Anyway, there's, there's so much. Anyway, there are young queer artists. So are we. We love art. We love meditation. We were forms of expression that, um, are holistic and enriching. And, um, and you know, I, I know that like being in the bars as another sense of community, we do have our community and I'm not shaming or hating on that. That is a whole other side. But we want to kind of come out into the light and say like, let's offer something else, too, is if you only place... JS:                   Because there's tons of bars, there's, yeah, I mean I can count five bars on Broadway, CB:                  Right, within five blocks JS:                   Exactly. I can't tell you one clear space that isn't centered around alcohol. CB:                  And so that's the lgbt center. Oh yeah, yeah, yeah, of course. Yeah. Which we, we love the center and we kind of share resources with them. So. Awesome. Anyway, um, yeah, if you were running some community events, we have them on our calendar. Um, and we essentially, we know how powerful it is to have space and that will, now that we have space, we want to share it with our community who took part in getting us to where we are. KB:                 I'm a cup is half full kind of gal, but I am curious to know if you've had any negative push back when you were starting Benders from, you know, family, friends, community or any kind of challenges that maybe were unexpected, um, with your excitement about this vision. JS :                  Yeah, I'd like to start off with that. I like, I like the sandwich technique, so there's, you know, the positive, negative, positive. So I'm going to start off with a positive. Our parents think we're freaking rock stars. Okay. So we told our parents and both of them are like our moms, both of our moms were like, yes. Oh my gosh. Yes, yes, yes, yes, yes. So that was kind of awesome. And just to have the support of your mother when you're thinking about changing your whole entire life around that gave both of us. Yeah. CB:                  Priceless. JS:                   I mean, such, such an amazing thing. So, um, but I got a lot, I actually did get a lot of, um, I don't know if I would call it negative feedback, but I got a lot of, um, I experienced a lot of doubt. So I started talking to my, some of my clients, some of my clients were amazing and so supportive and some of them come to Benders now I'm all the way from, you know, 20 miles away, which is not that far. You drive with traffic, it's getting crazy out here. So, but then there was like a breadth, the client and, and people that were like, so you really think that's actually gonna like take off? Like how are you actually going to make money doing that? That literally was my, that was like the number one question was like, how are you actually going to make money doing that? Like, so are you going to, oh, I like this one too. Are you going to let quote unquote regular people go there? Um, what regular people, they really are not going to be successful. Like, so that was, um, I mean, and I still, I still to this day get that question. Um, and yeah, so I have had, I personally have had some kind of like some, some serious doubt. Um, and, and then that's like, to me out a little bit, I can't even mind. Like there was definite, there were, there were definitely times where I would be sitting across from like three cis white dudes. Sorry. But it's true on it that are like, so y'all tell me exactly what your, you know, what your plans are. And I'm like, oh no, like do some cool shit. Like, you know, like, and they're like, yeah, that's not going to work but you're not going to be able to do that. Um, and we, I don't know that this is true 100% true, but I feel also that like when we were looking for spaces, um, when we would actually say like, this is what we're doing. I think that there were some people, landlords that were kind of like a, I don't know if we want to rent you. Not, not, maybe cause we look young maybe because this is our first business. Maybe because it was the business model, I don't know. But we definitely did get some pushback, in some, and some nos, from several people before our yes. CB:                  And, and I would also say I think when, when probed, when I would probe people about it a lot of, particularly though there were a lot of like gay identifying people who said Long Beach doesn't need that. Oh yeah. That was another thing too. Like, oh we don't need that. Like every place is a gay place in Long Beach or like, well there's plenty of gay friendly things and gay owned businesses but queer and trans is a different, you know, it's a whole different, there is, there is a lot of gay male spaces. Right? JS:                   Right. But in Long Beach there is, there is zero queer and trans places that would not have found CB:                  Not true. Wide Eyes Open Palms is the exception of that right now. There's a queer coffee shop. JS:                   Yep. So two queer places. Everyone:        CB:                  And Long Beach is really queer. JS:                   And so people were like, yeah, you're not going to really need that. But you know, it seems that there is a need for this where it's, you know, CB:                  People are not coming here saying they were looking. JS:                   So where did you find this? Oh, we yelped queer hair salons, and I've been yelping forever, and finally something popped up. KB:                 Yeah. I mean, again, like I did the same thing a couple of weeks ago before I met you guys. I looked up queer salons in LA and there's one, that I know of and that's where every queer person that goes to a salon goes to whether you're a celebrity or regular person. JS :                  Exactly. Yep. Exactly. KB:                 It's, it's such an interesting, um, concept that's hard to explain, I think to the general population, the reasoning behind why spaces are important. Um, and I think it also comes back to the question of my normal versus your normal versus other people's normals and other people never really being questioned at the fact that my normal might be different than your normal. Um, and I think once you plant that seed, it's a little bit easier to have, to build on those conversations. It's so important to have queer spaces and it's hard to explain that. Speaker 4:       Yeah. And one of the things that we like to say about our space too is that like, we do realize that it's really, really important to have when your spaces, and I,, personally think it's, it's equally as important to have a message of integration. So I like in our space, we actually do not, um, we do not call ourselves or identify as a safe space. We like to identify as a brave space. And so we like to ask people to come in here regardless of their orientation or their gender expression or who they are and come in with, with bravery on their backs if they can and be brave enough to show up as themselves and have, you know, conversations with people that may or may not look like that, you know, somebody that may or may not look "normal" to them, you know, whether they're gay, straight, queer, whatever, whatever that have a conversation, um, about, about themselves and listen to someone else. And so that, that takes some courage to do that. It takes some courage for as a straight person to walk in here and say, Hey, I like what you're doing. Can I get my haircut here? KB:                 Sure New Speaker:  That takes courage. It takes courage for, you know, someone who's, uh, who's, um, not yet currently out as trans to come in here and say, hey, I, you know, I know I look like this, but this is actually my, the name that I want to go by and I would like for you to do my hair that takes courage. So you must be brave to kind of, you know, to walk through this space, kind of, you know, saying that and I, I think that it is important for us to have queer spaces AND we want to integrate too. CB:                  And, and I think the piece that like, it is a piece of, of, of integration and the place has been intentionally designed to make queers comfortable. There is one bathroom. JS:                   Yup. Yeah. CB:                  The literature is queer. Um, you know... JS:                   We cater to people... New Speaker:  We ask people to display their pronouns. We display our own pronouns. We do the thing, you know, if, if your a credit card has a different name on it, ain't nobody going to give some weird look or whatever, you know, just this, these, there are barriers to full access to quality service that knocked down their capacity of being brave because if I've been, if I've, if I've been, you know, kind of smacked around three times, by the time I'm sitting down in my chair, you're saying your name is what, and they have to choose which bathroom they're going to go to. And there's a vogue magazine with a Victoria secret model on the Friday. KB:                 Boooo, booo Victoria Secret. JS:                   Exactly right. Like, have any magazines in our space at all. We do not even have one magazine. CB:                  And then there spaces that have things like this and they're saying, oh, we're LGBT friendly because they want LGBT dollars. JS:                   They're saying, I'm going to stop, get flag out on the front of here and, and totally say I'm okay with everybody, but there's still misgendering people and they're still not, you know, fully affirming someone's true, you know, or uh, or even trying to affirm. CB:                  Sure. JS:                   It's an expression. CB:                  The intention is there and we do. We know that that is powerful because in a day and age where your, your politicians may not be taking care of your community, we get to vote in all other sorts of ways. We need to vote with our commerce. We get to vote to with, with our expression, we get to vote to say, I like this business. I would like to like it to stay there. JS:                   I want to spend my money now. CB:                  So we, we've, we want to be very, very open about what our values are and say when here supporting us this is what you're supporting. You're supporting the queers who built this, you're supporting the families who run this. Um, you're supporting expression and, and bravery. KB:                 Yeah. I mean I think it's so multilayered. I think, you know, the biggest thing that I heard from that is you're empowering people and we're constantly being shoved deeper and deeper down, so when we try to get up, it's like, so hard to see the light. Everyone:        Yeah. You get tired of getting up. KB:                 Because you don't have the same resources as the person next to you. And that's very real. But what I love about what you're doing is you are teaching people to feel empowered and confident and confident in who they are. Um, not only physically on the outside but really just how, who they are on the inside and to express that. But it's hard. It's hard out there. JS :                  I was telling that the person that I was cutting their hair last night, um, about like when she was wanting to cut her hair really short and she's like, I did this so I wasn't visible. And I said, let's talk about your visibility, about how important your visibility is. And I had this whole conversation with her and I said, look, your visibility is important because of the people, the young kids that were in here just last night that got to come into our business and see a trans person. And as a queer woman of color, only in this amazing space, those kids saw my visibility could have changed someone's life yesterday or the day when those kids came in here. And same with Cal. Some, you know, trans folks are going to look at him and say, look like it trans child and look at, that's what trends could look like. That's what queer women of color could look like. That's why visibility is important, KB:                 Right? As great as this time is in terms of quote trans visibility, now we have to remind ourselves that what we see out there isn't representative of all trans people and it can become the norm just like everything else is, you know, put into little boxes. You know, there's so much more to the community than what you see on TV. JS :                  Right? Exactly. This is what it could look like and then you can make your own expression. You can make your own, you know, whatever it is that you want, whatever it is, however you want to be, you can create that for yourself. And that's basically the message that I, I really want to share with my community and also like with the children of my community to like, whatever you want, however you want, however you want to look. That is possible. All of the things are possible. CB:                  We have to figure out how to, how to knock that down together to do it with, you know, JS:                   At least we can talk about it openly. Like, yeah, so important. KB:                 If we can affect one person telling him it's just going to keep growing and growing. So that's exactly. So what's the future of Salon Benders? CB:                  First thing that is very exciting, which is great to talk about barriers is this week we do have, um, we do have a brand of excellence and we have put a lot of money into this business. And so our prices reflect that quality that, uh, that is the worth of what we do. And we know that not everyone in our community can access that. So what we're so excited about is I have just started an apprenticeship program. Um, so starting in the new year, I will be able to provide low cost cuts, um, for folks one or two days a week. Um, so that will, uh, be a really exciting addition and we're, we're really excited to pilot it because we know one of, one of the big things that affects our community is employability. Um, and we do believe that cutting hair is an amazing trade and skill. Um, and we'd like to pilot this to potentially in the future be a teaching salon as well, so we can help employ, um, other amazing people from our community. Um, JS:                   So Cal will be my first different apprentice. KB:                 Live and learn both of you. JS and CB:      That's right. Yeah. JS:                   That's coming up in the future, which is really, really awesome. Yeah. We're hearing the call for exercise and so we're queer movement and I just love that just having more, um, more physical activity happening together as a, um, as a group and um, KB:                 ...and not being shamed for it. Everyone:        All sorts of different body shake pay. Exactly. Yeah. CB:                  All of it is kind of transformable and it's based on what the community has come forth and saying, this is what I want to provide, or this is what I want to see. So check back with our website salonbenders.com. There's a calendar page that you can click into and see what we're doing. You can follow us on facebook or Instagram, um, @salonbenders and we're actually a farre better at communicating events via those, uh, those, those, um, platforms. JS :                  So the other thing too about the future I think is, um, my hope for the future of Benders is that we grow. I want people to bite my idea, our idea. I want people to steal this. I really do. Or I want somebody to just say, hey, I want to open a Salon Benders and perhaps we can become a franchise. Um, I want to, for me personally, I would like to, um, teach what we're doing here. Um, maybe in a public speaking for like, whether it's, whether it's for hairstylists all over, at hair shows or even just in like a beauty colleges coming in and talking about like, um, like LGBT hair, um, LGBTQIA hair, you know, um, I would like to definitely share this message as much as possible, which is why, you know, this, this podcast is really like, we're like, yeah, absolutely. I, we hope some hairstylist or many hairstylists hear this and say, Oh, I don't even know about that and get in contact with us. CB:                  And it's something that we're already doing. So we, we have already, we've already done some training for, um, for a couple of stylists, which has been really, really, really monumental. Um, and actually Kerin and I met, um, through, uh, I did some, uh, education to up and coming physicians assistants, practitioner... KB:                 Physician assistants. CB:                  ...and see, so it's something that we're already doing and we would really like to do more, and we really appreciate having Salon Benders as a platform to do education, to bridge the gap and bringing, um, more, more practitioners in many fields who are excellent in their fields, competency in queer and trans issues, and serving this community with greater care. KB:                 And you know, what I've learned is that once you start the conversation, people want to listen and they might be nervous or not know what you're talking about at first, but as long as you continue the conversation; You're right, you set an example, um, you know, for others to, to be great. So, yeah. And it's a tough time right now. I think it's hard to maintain positivity, but meeting individuals like you have really helped me to keep myself in line with all the beautiful things that are going on in the world as well. JS :                  We appreciate it. CB:                  Every shadow comes from a light baby. JS:                   The bigger the shadown, the bigger the light. Everyone:        Yeah. Yup. You know. Awesome JS :                  We really do appreciate that. Like, I, it's not that right there is worth everything. Yeah, exactly. It's just, you know, we can just touch one heart that's enough. KB:                 Exactly that. Exactly. I mean, it's tough out there. Yep. Yeah. We just beat ourselves. JS:                   We have to stick together. KB:                 Exactly. JS:                   We have to empower one another? It's not, it's like not an option right now. It's just not. We have to tell each other, how much we love each other, and how amazing we are and remind ourselves and our community how, how powerful we are. CB:                  We're awesome. JS:                   We're awesome. CB:                  We're awesome. JS:                   Best community ever. ***END INTERVIEW*** ***CONCLUSION: KB ONLY*** For information about future episodes or to contact us, please visit us at our website www.queermeducation.com or email us at queermeducation@gmail.com ***OUTRO MUSIC***  

Sex Positive Primary Care ft. David Alajajian, MD ***DISCLAIMER: KB ONLY*** This podcast is a series of interviews with medical providers, mental health professionals, community members and advocates. Each interview represents the opinions of the individual. Individuals may use different terminology than what you’re used to. The intention is to educate not discriminate, and we welcome positive and constructive feedback. Please keep in mind; this is not a replacement for medical care or advice. I am simply presenting my views along with educational information that will be both evidence based research and external networks that have an impact on LGBTQI and nonbinary health care. Consult your provider for any medical or mental health concerns. My name is Kerin “KB” Berger and welcome to Queer MEDucation! ***INTRO MUSIC*** ***INTRO TO EPISODE: KB ONLY*** Hello and welcome to our pilot episode of Queer MEDucation, a platform to educate medical professionals and the general population on LGBTQI and nonbinary health care. So many LGBTQI and nonbinary individuals are constantly asked sexual history and past medical history questions that are not applicable. Today’s episode will highlight creating a sex positive environment in a primary care setting with a physician practicing in Los Angeles, California. Thank you for joining us and I hope you enjoy this interview. ***INTERVIEW: KB AND DAVID ALAJAJIAN*** KB:                  Hey, what's up? It's KB. I'm here with a very special guest today. I'm going to allow this person to introduce themselves. DA:                  Hey. I'm David, Alajajian. I'm a primary care doctor, internal medicine and I specialize in taking care of the LGBT population. KB:                  Awesome. And where are you practicing currently? DA:                  I work at a practice called Pacific Oaks medical group. It's technically in Beverly Hills, close to West Hollywood. KB:                  How long have you been there? DA:                  Um, it's about a year and a half now. KB:                  Awesome. And tell us a little bit about Pacific Oaks and kind of how you got from your training to that particular setting. DA:                  Um, so I did internal medicine residency at, um, a residency program in Long Island, at Northwell Health, um, Hofstra Northwell School of Medicine to be exact. And I was looking to move back to Los Angeles with my partner at the time. And, um, I signed up with a recruiter and I had just told them, hey, I'm looking for a primary care practice because I'm passionate about preventative medicine. And they said, well, here, we'll set you up with a bunch of interviews. And, um, they said, you know, one day they called me and they said, well, you know, there's this practice that's been around since the 80s, and, uh, we're having problems finding the ideal person for this practice because a lot of people are uncomfortable working with gay population. Would you feel comfortable, um, interviewing with them and I just lit up and I said, you know what, um, this would maybe be a perfect match for me because not only would I feel comfortable, I feel like there's a lot of life experiences that I've had that I would find as an asset to that practice. So when I went and interviewed there, I learned that Pacific Oaks was actually, um, started in 1979 by a couple of doctors who, um, uh, felt like the needs of the gay community weren't being met by some other practices, that there was a lot of discrimination. People wouldn't handle HIV positive blood at the time. And it had, you know, uh, blossomed during the AIDS crisis and now still lives on. Um, although with some different directions. KB:                  Did you ever see yourself kind of going in that direction or even know about this particular specialty? DA:                  You know, I really didn't know that this was even a career option going through medical school and through residency because I felt that there was a paucity of experiences for me to to see lgbt medicine and then to also see mentors and role models in those roles. So it was really very life changing for me, um, to discover this. And I was kind of surprised that I'd never been exposed to it in any capacity. KB:                  Yeah. And I think that's pretty common. Um, as most of our listeners have gotten through medical profession professional training, um, that people just didn't really know that this even existed or exists in very particular settings. Um, but I think that's changing more and more now. Hence how your recruiter found you, which is amazing. DA:                  Yeah. KB:                  If you don't mind telling the listeners a little bit about your background prior to medical school, like your journey to becoming a physician. DA:                  Um, so, um, I grew up in a very sort of traditional Armenian family where it was expected that you were going to go into some form of the sciences. And so I, um, and there was a very heavy sort of emphasis on, um, going into something that has like an academic leaning towards it. And, um, I did my undergrad at UC Berkeley where I studied molecular and cell biology and I also found things like virology and immunology really, really cool. You know, how the immune system fights against different, uh, pathogens and stuff like that. And that made me want to work at a lab at UCLA for a couple of years where I did, um, immunotherapy research. And I realized that there's really cool information out there, but I didn't, uh, get that human interaction that I was really longing for working in a lab. I really wanted to be able to take all the cool scientific innovations and be able to translate that to people and see how that could change people's lives and see how that fits into people's lives. So that's what kind of, um, uh, made me want to go to med school. KB:                  And were you, um, out during your training? During medical school and residency? DA:                  Yes, I was, but, um, uh, I guess there's different sort of degrees of out and in retrospect I'm realizing that I was struggling, um, uh, through being 100% comfortable with all aspects of my life at that time. Yeah. KB:                  Meaning like separate from medicine and your training? DA:                  Yeah, I, um, so for example, um, if I were put on the spot, I would identify as gay, uh, but I'd be concerned about people's in, um, reactions, uh, while I was going through training. And so I tried to keep my personal life pretty private. KB:                  I see. Yeah. Did you ever have any negative experiences or is more just a feeling of sticking out in a negative way? DA:                  What I felt going through medical school and then going through residency was, um, um, you know, medicine is a very conservative field in general and there are certain, there are certain perspectives and viewpoints, um, that permeate the medical field, um, that aren't as sex positive as, um, uh, um, I would have liked it to have been, there weren't as many, um, lgbt mentors for me and I did hear a lot of negative comments and, um, the, some of that probably comes from lack of education. Uh, but I do think that there's a lot to be done in terms of medical education and graduate measured medical education in terms of building cultural competency. Um, I think the medical field approaches gay people in a medicalized or problemize sort of way. Um, so how does, how does, how do certain behaviors pose an STD risk? How is this a high risk population? Not how is this a community? How do they interact when they're not here? And that could be stigmatizing, that could be oppressive. And there was a lot of opportunities here to turn that around. So KB:                  Absolutely. I think like one thing that Queer MEDucation tries to do via instagram and this podcast is to try to destigmatize, um, not only the queer community but also the medical community. I mean, I think you're a 100% right. It's, you know, I've heard stories and been in clinics where you'd have a patient who is HIV positive and everybody has to know that that person is HIV positive. When reality is that the most basic OSHA training will tell you to take precautions around anybody. And as we know through our training and our, our, our experiences is that most people who are HIV positive are undetectable and not transmissible anyway, where sometimes you go into these medical settings and you're surprised that physicians and, and, and uh, nurse practitioners and dos and nps are not aware of that. It's, it's shocking, DA:                  Right, it is. And I remember being in groups of medical students or groups of residency groups and being prepared that, you know, you're about to enter the room of an HIV positive person, they're gay, um, make sure you, um, you know, make sure you censor yourself in a certain way and prepare yourself. You're about to meet people that, you know, we don't know a hundred almost. We don't a hundred percent approve their behaviors or something like that. And so the cultural competency was sort of presented in a way how to avoid a PR disaster, not how to understand and be part of other patients, which is pretty concerning. Um, uh, for the medical professional, the profession in general is just sort of the way that we distance ourselves from patients, um, can be, it's a little unfortunate. KB:                  It is unfortunate and so much of a, where that's created is from, um, ignorance but also lack of resources and you know, completely ignoring the problem in the eighties and nineties to the point where the community really stepped up. Um, and it was just immediately stigmatized in medicine and it's still continuing, which is sort of baffling being in 2018. DA:                  Right. And, and there's this perspective from the, from the viewpoint of doctors that when there's gaps, when we have to build bridges, it's the patient's gap. There's a, there's a lack of education, a lack of knowledge. They need to be taught. So for example, the lgbt community needs to be taught about std risks because they don't know enough. So doctors need to reach out and teach them that their behaviors are wrong or need to be remediated in some way. Or this resident, um, me, for example, I was pulled apart, um, um, from the group various times during my training and told that my mannerisms or my communication style or the way that I was dressing wasn't what their standards of, or their vision of what a doctor should be like. And a lot of these are very heavily influenced by heteronormative values. They're not, they don't necessarily have a scientific basis. Um, and it, if not sort of corrected, it could be discriminatory, you know? KB:                  So it sounds like, it was. I'm sorry to hear that. Yeah. One of my rotations I used to wear, um, I used to wear ties and uh, when I went to my pediatrics rotation, I'd dress up really fun because they were kids and they were fun and the kids, they just loved it. And you could see the parents, some of the parents would kind of give you some interesting looks because I had pretty short hair and was more of a uh, quote masculine dresser at the time. And the kids, they would just ask very simple questions, why are you dressed like a boy? And I would say because I like to, and then we would just move on with our lives. It was such a beautiful thing. DA:                  That is beautiful. KB:                  Yeah. And I think it's really interesting what you're saying like this, just bringing it back, you know, because we're, you know, generally medical and is that, where is this standard coming from? Is it even relevant? And what is the necessity to conform to this sort of a white coat, um, standard? DA:                  Where do you doctors and other medical health professionals have to, in bridging that gap, have to educate themselves about the different communities that they're treating. You know, maybe medical students should get extra credit for going to a gay bar or something like that, just to see what the environments are like and what the situations are like. Um, uh, because a lot of it comes from a place of ignorance or lack of knowledge. And so when we do talk about that lack of knowledge, patient education, I think it's more, you know, doctor education to be honest. KB:                  For sure, for sure. No, I think you bring up a great point. I mean, I think historically, um, medical providers were just put on a pedestal and um, you know, kind of the all knowing beings and, and you know, things change so quickly. We have so much information now that it's almost hard to keep up as medical professionals. Whereas 60 years ago, you know, we didn't have half the technology, so it was a little bit easier to say, you know, I'm 100% sure the answer is this or that when we just, we have so much now. Um, so I feel like it's, it's, it's an interesting time to be a medical professional. And I know we've talked to this when we hung out last week, but this concept of shifting the mentality of we don't necessarily know everything and that's the point of all of us learning together. What has been like your, your transition to this very different sort of practice and how has that been for you? DA:                  So initially when I started working at Pacific Oaks, I realized too, that I am treating people who are in the same lifestyle demographic age as I am. And that was a very new experience to me because I was much more used to treating, uh, patients who are much older than myself and also, uh, uh, people with a lot more comorbidities. Um, I'm the a lot more disease states. Um, and suddenly I'm seeing young, healthy, um, gay, bisexual, lesbian patients who are just getting preventative medicine and are coming here for advice and those sort of standards that I was brought up in, in residency, um, standards of professionalism suddenly came into question because I would have patients go to my boss and complain and say, you know, we think this new doctor that you hired is a little bit stuck up and a little bit, um, a little bit dry, you know, um, he seems to be our age and relatable, but we can't really get into conversations with him, like real life things and sort of a switch went off in my head and I realized, you know, the way that I talk to friends and the way that I talk to family, if I just bring that into the clinic and just be real with my patients, it's going to go a lot further than me to be sterile and detached the way I'd been taught to be. And there was a complete transformation. And, um, how I, um, interacted with my patients in how I was received and people started opening up to me. People started telling me things that I never thought that they would share with anyone, very personal things. And I was actually in the position where I could research this stuff and actually give them good advice about what to do, um, in real life scenarios. So it was amazing because I suddenly felt that work is bleeding into life and, um, and I can really tap into, um, um, my passion for taking care of this community but also my interest and, um, uh, my own personal life experiences. So that was really cool. KB:                  That's awesome. And, um, since you've kind of switched, how has that been with your patient interactions? DA:                  Um, I think very, very, very positive. I think that, um, uh, people always, especially in a primary care doctor who you establish a long term relationship with you, we're looking for trust. Um, uh, I feel especially when you're in, um, the lgbt community or any marginalized community where you've had certain experiences where people haven't 100% made you feel comfortable. Um, whenever you feel comfortable in sharing some of the things that you, you know, you're not going to be judged about, um, there's more trust with your doctor. And, um, with that honesty and trust comes more information and um, um, that's where, that's where the magic really happens. KB:                  I completely agree. I mean, I think like the, you know, we all learn medicine the same way. There's standards, there's protocols. Um, but people don't, your patients don't see you because you were number one in your class or you had the highest board score. Um, they see you and continue to see you because they develop a relationship with you and, uh, uh, trust with you. That is very special. I think. So I think people forget that sometimes. Probably, you know, when you're immersed in that academic setting like you were describing, it's, you know, you're almost trained like, this is how I'm supposed to be some sort of robot. And then you get out there and patients give you feedback. Like you got it. It's like mind blowing. And, and how positive that was for you as a professionals. Sounds incredible. DA:                  Oh yeah, definitely that sense of satisfaction and that sense of, oh my gosh, you know, I was the person that, that person needed at that moment. It's huge. It really propels you. It's, it could be really addicting to people describe medicine as being an addicting, especially primary care as being, having this addicting quality to it where you never really come home from work. And I'm having the pleasure of finally experiencing that. KB:                  Yeah, that's awesome. It, it's definitely the medical dream, that's for sure. Um, so, um, tell our listeners a little bit about kind of the, uh, practice and maybe I'm kind of how you create that sex positive or just general openness at Pacific Oaks. DA:                  So what I've noticed is that, um, just given our life experiences and, um, the environments that we all grew up and, um, being part of a sexual minority was normalized only to a certain extent. So you see gay characters, lesbian characters, um, gender nonconforming characters in movies, and they typically fit into certain roles and you don't see the whole spectrum of the diversity, especially the diversity of sexual expression, Um, um, just by going through life. And so people have learned, um, and are in the process of unlearning how to censor themselves and censor themselves with their doctor. And so my strategy and trying to elicit kind of that diversity is bringing up scenarios and examples. So for example, if I think that someone is highly sexually active and um, um, has had multiple partners, I'll bring up an example, and, I'll say, you know, sometimes people go to places like white party or another sex party and they'll have sex with like 20 different people. Um, but I'll see those patients commonly and then I'll std test them the following week. Do you fall into this category? And it kind of normalizes it. I feel like it giving it breath like that, giving it life like that, um, makes the person to understand, hey, I know I'm from planet earth. I know the situations you're in, the people that, you know, they also come to me, so don't feel weird about this because people are concerned that they're going to be judged for their behaviors or that their behaviors are unusual. I want them to know that it's totally usual. It's very usual. KB:                  For sure. For sure. And it's hard to know, you know, because I work in a sexual health clinic so people come in and they know what they're comfortable talking about, of course in it, in context to the provider that they feel comfortable with. But um, you know, I think in primary care is sometimes it is a little bit more challenging to open up that conversation when you have a whole bunch of other things to get through, like all of your screenings and, and what not. Um, so I think that's really a great tactic to kind of make it, um, uh, applicable to just the regular world setting. DA:                  Yeah. I can't tell you how often I 'll get a new patient and they're here just for a regular health screening, a yearly physical. And I bring up something like, um, you know, sexual practices. And I ask them, well, do you need to be on PREP for example? And just the fact that I know about PREP that I even mentioned it so casually an entire dialogue, we'll start from that and the purpose of the visit will completely change and it'll just become a sexual health visit. And at the end of that, I'll get a comment like I never felt so comfortable sharing with my doctor. Um, all my sexual health stuff, I can't believe that you brought that up. And that's kind of unfortunate that other doctor's offices, it's not, you know, we learned so much in medical school and in training about how to elicit sexual history, but I think there's an art form to it and everyone has their own style. KB:                  Absolutely. Absolutely. So there's lots of different listeners out there. Why don't you tell them a little bit about PREP since you brought it up and you know why that would be pertinent, pertinent questioning in your particular practice. DA:                  So PREP is a medication. It's a combination. It's actually a combination of two medications in one pill that was previously, or it's still part of HIV treatment, but that one pill by itself is now used, um, as a once a day medication to help lower the risk of HIV transmission and people who are considered, uh, to be at risk. Um, so taking PREP once a day, um, uh, um, you know, over a period of time and being exposed to HIV, you know, lowers, the risk of, um, uh, actually getting HIV and um, it's a very, it's a very great sort of breakthrough in that, um, our hope is that it's going to help along with other things. Um, eliminate, eradicate lower the overall global HIV burden, which is huge. KB:                  For sure. And what patients would you kind of bring that up with or what gives you the sense that a patient might be a good candidate for PREP? DA:                  So in some of the, in some of the studies looking at PREP, um, uh, people who were prescribed PREP, um, you really saw that people were very good at, um, uh, having insight into their own sort of HIV risk. So when they looked at PREP compliance and then they looked at sexual behavior, they saw that people were very good at gauging just how much they were putting themselves at risk. And so, um, so I go by the patients, you know, own personal sexual history. And where I start to advise is when I see that there's a lot of condomless sex with partners who's HIV status is unknown. Um, uh, yeah, the multiple, multiple sexual partners with um, uh, people with unknown HIV status. And I'll add a little amendment to that is that, you know, we, we were taught in medical school to, you know, sort of advise people to, you know, ask your sexual partners about their most recent std testing. And I've found that it's not all always the most effective way for them to get good sexual histories from their partners because sometimes it's a conversation ender, you know, when you ask somebody, hey, have you been HIV tested? You might get a yes and then that's it. That's a conversation ender. There's not a lot of quality to that conversation. So I've also been advising people to, you know, ask more detailed questions. When did you get tested? Um, uh, why did you get tested? How many people have you been with since last time that you got testing? Um, which adds a little bit more contoured to that territory. I feel KB:                  Definitely. And there's so many different, uh, ways to provide your partners with, um, a std and HIV information. Now I'm like, I know there's apps out there where you can have all your testing, a lot of clinics, um, use different resources like Health Vana or other kinds of standardized, um, services so that people can actually pull up results with the date and the information. Um, so partners can kind of be on the same page. DA:                  Yeah. And there's anonymous texting services that text, uh, multiple partners telling them that they may have been exposed to an STI, um, you know, sort of prompting them to go get tested then or treatment. KB:                  And I want to commend you on, um, the way you talked about prep because I think again, when you're in your medical school or, or medical training programs, when you, generally, most of them are present Truvada in the context of your infectious disease, a lecture when you're talking about men who have sex with men. Um, and, and the reality is that anyone who's having condomless sex with multiple partners is at risk for HIV. It doesn't matter how you identify, um, uh, with your, your sexual orientation or your gender identity. Um, really the risk comes from the type of sex that you're having, how much sex you're having and the partners that you're having. Um, so, so I, I thank you for, for being very, um, uh, politically correct when talking about that because I think so many people, just, even when you read the CDC, you know, it all, it says, you know what men who have sex with men, men who have sex with men, IV drug users, sex workers, and it's like, well, 20% of new diagnoses are cisgender heterosexual women. And, um, just because, and, and I know we can, we talked about this will be hung out, but just because somebody says that they're married doesn't mean that they're monogamous. So that's a whole other conversation piece. DA:                  And also, you know, in terms of, um, you mentioned, um, new HIV diagnoses and cisgender women. Um, I also really bring up the conversation of, you know, how safe people feel in their relationships, especially when we're talking about, um, sex workers, people who are non monogamous, you know, are they being forced into these situations? Do they feel like they're, uh, how empowered do they feel in these situations? Um, in terms of, um, you know, the topic of consent, um, I think it always has to accompany the safe sex conversation. Um, uh, so, so, so that's another piece. KB:                  Definitely. What are some recommendations for some of your clients who maybe have multiple partners or maybe are having more condomless sex besides, uh, pre exposure prophylaxis? What are some other medical recommendations you would make for those people? DA:                  So, I'm so happy you asked this question because going through residency, I was taught to advice people to, um, minimize the number of partners they have as much as possible. And I always found that recommendation to be lacking a, because I don't think that it has a sex positive leading, you know, sex positivity is about encouraging different sexual experiences and trying to promote their safety at the same time, not trying to make sexual experiences heteronormative, um, necessarily monogamous necessarily for procreation, but also that sex is pleasurable and it's a vital part of people's health, wellbeing and happiness. And so there's a little bit of a conflict there. And so how do you turn that into a politically correct medical recommendation? You know, uh, this end, the spectrum is from have no sex whatsoever because there is an infinitesimal, std risk associated with any sex versus have very risky sex. Um, without being tested. So my recommendation is, um, finding good ways of having very open dialogues with new sex partners. And my firm belief is that sex is safer, um, more consensual and more pleasurable if there's a lot of dialogue and communication about, you know, the, the, you know, what's on the table, what's not on the table, you know, um, what risk is this associated with and what's your status going into it? And what do you plan to do coming out of it? So I encourage my patients to have those types of open dialogues. Um, and the way an open dialogue starts like that is by setting a good example. So I tell people, you know, volunteer your own personal information first, um, show that you care about your sex partners, health and wellbeing, you know, tell them, hey, listen, I got tested August 22nd. Um, my gonorrhea and chlamydia were negative then, but I've had one partner since then. I don't suspect that I got anything from that partner, but you never know. And now it's November. And, um, let's have, you know, we're planning on having oral sex. Um, I don't typically have anal sex, but if we do, I'm going to use a condom. Something very detailed like that. Um, uh, in order to give your partner as much information as you can and also show that you care about their wellbeing. Um, so, so, so that's my top sort of recommendation in terms of how to have the safe sex talk. KB:                  I love that. Do you find that patients are receptive or come back with, you know, positive and or negative feedback with that information? DA:                  So some patients receive that information very well. I had a very honest conversation with a patient this past week who is HIV positive and he revealed to me that he was very anxious about having the HIV positive conversation with the types of sex partners, uh, that he's having because, um, A: um, uh, HIV positive people are still unfortunately sometimes stigmatized or treated differently when they revealed their status. And B: there's very little information out there about, um, uh, not, I should rephrase that. There is information out there, but the widespread knowledge about, you know, undetectable status meaning untransmissable the level of trust you need with someone before, um, you could trust it, they're undetectable. Um, is, is, is it different sort of conversation. And so it wasn't as well received, but it opened up this whole dialogue about, um, how do I feel accepted as an HIV positive person among my sex partners? And it, it, it, it got the gears grinding a little bit so, so I found it to be very, very positive. KB:                  That's awesome. I mean, unfortunately, yes, there's still a huge stigma. Um, and that's one of the things we're trying to do through this platform is really to dissolve that as much as possible because people that work in this particular field, that have worked in this particular field know that people who are undetectable, who've been in relationships for many years with HIV negative people, um, that the HIV negative people never seroconverted. So we've, this information has been kind of known for awhile if you worked in the field, but now the CDC is finally expressed that. That expression, unfortunately, and fortunately by organizations like the CDC will help destigmatize. Definitely. Yeah. Um, so any other medical recommendations for our patients that you'd recommend? I mean, for example, I know for y'all through the CDC, for men who have sex with bed or men who have sex with that of women, um, certain vaccinations are recommended. Um, how do you go about making sort of, uh, alternative preventative recommendations with your patient population? DA:                  So a couple of, um, avenues that I feel, um, are lacking in terms of preventative care for these populations. One is, um, Gardasil or the, um, the vaccination to prevent HPV or the virus that causes genital warts, rectal and throat cancer. Um, um, seems to have really over the past 10 to 20 years, um, reached, um, the female population in terms of preventing cervical cancer. But, um, many men have missed this vaccination, especially men who are having multiple male, um, sex partners. And so I bring this conversation up because now there's a new recommendation to extend the vaccination period up to, um, the mid forties. Um, uh, I don't know if insurances are 100% following suit. Um, which is a little bit problematic, but for a patient population, I'm here in Los Angeles. I always put it in it in these terms. We live in a city where we pay $140 for a yoga class or we paid $12 for an energy drink. So if you think about your, if you think of your longterm health and how this vaccination is going to prevent cancer, I think that, um, um, even if insurance is ended up or the payers and if not not covering the expenses, you know, it might be worth the investment to be protected against, um, the ninth, the strains of HPV. Um, so that's one, uh, um, a recommendation did I kind of have a dialogue about, uh, the other one is hepatitis A vaccination, which, Uh, there was a recent outbreak in San Diego, um, about a year ago, um, and the homeless population. But, um, uh, because of its fecal oral transmission, um, actually anyone who has oral, anal intercourse, it should be vaccinated for hepatitis A. And again, um, if you're traveling to areas that are prone to hepatitis A, it might be a win win. Um, so, uh, people often traveled to South America or Southeast Asia and um, um, it's a sort of good to hit two birds with one stone. So those are a couple of things that I bring up in my conversations pretty regularly. KB:                  Yeah. Is Hepatitis A something you would get, um, or let the listeners know what, you know, is that something you would get, is that part of your regular vaccination schedule as a kid or is that something you have to seek out? DA:                  So I've found, um, that um, despite recommendations, um, many people have missed hepatitis A vaccines. They would, so you would a, you would, you would standardly not get this as a kid. You would not get it growing up as a kid, you would, no one would have said, oh, you're a five. Let's give you the hepatitis A vaccine. So no on that one. And second of all, a lot of people have not gotten the hepatitis B vaccination or gotten screened for Hepatitis C. There is a recommendation that if you were a baby boomer and to be screened for Hepatitis C, but, um, oftentimes when you go to your, um, um, std, checks you get gonorrhea, chlamydia, syphilis checked. Um, Hepatitis A, B, C, it's hit and miss depending on where you go and who you see. Yeah, KB:                  For sure. And how does, um, Hepatitis A, B and c correlate to, um, sexual health? DA:                  Um, so hepatitis A, hepatitis B and C are, um, sexually transmitted. They could also be transmitted through blood. Uh, but the way that we talk about it as we talk about their sexual transmission, and so, um, uh, bodily bodily fluids like semen can transmit these viruses, which I end up infecting your liver. And longterm, they could cause liver failure, liver, liver cancer, and longterm consequences. But found out early they could be treated. Uh, hepatitis C could be cured. Uh, but hepatitis B has a vaccine that prevents you from getting it at all. Um, there's an interesting thing with hepatitis B and PREP because PREP has this effect of if you're infected with hepatitis B at the time that you stopped taking your PREP, you're in, you're in danger. So, so that's an important thing to have tested if you haven't already and you happened to be on PREP. KB:                  Yeah. So a lot of times with the routine starting, um, labs that you'll get when you do start prep, um, not only will you get a metabolic panel and sti testing, but you also get a hepatitis panel, which will include a hepatitis B screening for infection, um, in addition to A and C as well. But, um, what, um, what David's talking about is when you are on PREP and, and, uh, so, so Truvada is also used to treat hepatitis B. If you go off of your Truvada, not knowingly having hepatitis B, you can have what's called a rebound infection and it actually can cause a death. So a very important, um, to talk to your provider when you are starting prep to make sure of the testing that you're actually getting is appropriate. So that's a really good point. Yeah. DA:                  And I've seen that situation, the rebound, um, um, and, and it's quite severe. So it's important to, to, to bear in mind where when you, especially now that prep is being offered by some online services. I'm not sure how thorough their screening and informed consent processes, but it's very important to bear that in mind. KB:                  Yeah. And also I've had patients come in who start prep, um, through the, um, some online services, which are obviously some are better than others. And there with the followup was actually lacking, meaning they had a positive result and then did not find out for a little bit. So really important to stay on top of your own health before anybody else's. DA:                  Absolutely. KB:                  Um, so, um, you know, I know we talked a lot about, um, kind of sex in general. I did want to touch a little bit about, um, maybe different communities that you're seeing that aren't necessarily discussed, you know, on the CDC or whatever his website. Um, I know that you have told me a little bit that some of the patients populations that you see as part of the poly community. And I kind of wanted to kinda hear a little more about that and tell our listeners a little more about that. DA:                  So, you know, I do see a lot of patients who, um, uh, don't fall into the sort of heteronormative sort of, um, uh, cultural norms that we're all familiar with and um, seek out a more sort of sex positive environment for their primary care and in a lot of aspects, um, uh, they share a lot of things in with the gay community. It's great that there's the, the medical term MSM or men who have sex with men because, um, although we might not see this sort of popularized in the media, there is the gay community men who have sex with men, but there's a large number of men who identify as street who have male partners occasionally. And so hence that term. Um, of course that term doesn't give justice to the LGBT community and all their struggles in history and what not. But it's important to recognize and realize that, um, there is sort of a very heterogeneous, um, population of people out there practicing many different kinds of sexualities. And so I see polyamorous couples, um, who identify as straight and they may have, um, male or female, uh, partners. Um, and, uh, in terms of std risk, std screening, std education, it's important to sort of evoke all this knowledge that we've learned from treating the gay community and extended to, um, uh, an increasing proportion of the street community. KB:                  Yeah. Again, and I think, you know, one thing that I've, uh, you know, as a patient myself, notice when I'm in, you know, and, uh, um, somebody taking a medical history on me and they'll ask, you know, are you single? Are you married? And do you know if I say, Hey, I'm married more often than not. Um, the, the conversation completely shifts assumingly, that I am monogamous, for example. Um, so, and, and so many people are not. And, um, I think, you know, especially in the primary primary care setting, you have such an opportunity to not only protect the patient in front of you but also their po, their marriage partner, especially if they're in a poly relationship. I mean, I think you have a dual duty there DA:                  Right and sometimes one of the partners is monogamous with their husband or wife, but maybe their husband or wife. Um, I had a patient and I, I kinda, I kind of find this unfortunate that, you know, the way that this information is presented to the provider is little apologetic and almost, you know, explaining once often think, you know, before our visit is over, I just wanted to let you know that my husband has a boyfriend. And I said, that's totally fine that you could share that with me. But I just wondered, I wish that we could create an environment where that information is, you know, people feel more comfortable expressing that information. And you know, I kind of internalize that experience and said, you know, I should ask a little bit more direct questions I should ask. You know, we always worry about offending and saying, you know, like, well, you're married. Does that mean you only have sex with your husband? But we need to really get over that and say, and be able to ask those questions because so many people, um, uh, live a very different spectrum of lifestyles then that we were accustomed to just growing up. And it's just the reality, KB:                  Right? And it's, you know, it's so amazing how media has such a big effect. You know, what you see on tv isn't necessarily the norm to everybody. Um, yeah. You know, depending on how you live and what your life is like. So it's, it's the same when it comes to sex and marriage and all that. Um, but I think it's so important to protect your partners, uh, especially if your ear married or in a relationship with someone else and you're open and they think it's crucial to be able to present the conversation of sexual history in a way that, um, because we're so used to getting defensive about it by nature of our expression in our experiences, but being able to, um, really presented as a, I'm asking these questions because I need to know them so we can better your health outcomes. DA:                  Yeah. And I think part of that is maybe just more normalizing the concept of sexual networks and, um, you know, just putting that out there and saying that, hey, everyone has their sexual network. Um, it's not infinitely large the way that, you know, it's been depicted in the media that the gay community has this infinitely large sexual network. The literally all have sex with each other. That's not true. Um, they're limited and they're not infinitely small where it's just a husband and a wife. The way you know, tv would like you to think, it's just, it's everything in between. KB:                  Exactly. And that's what makes medicine so exciting, um, to me at least, is that you never know what's going to come in the room. And that's part of, you know, not only do we like to take care of people, but I think we also are problem solvers at heart and, and, and in mind. So, you know, the more differences the better. Right. DA:                  Absolutely. KB:                  Yeah. Um, is there any other particular populations or groups of individuals that you see that you kind of want the listeners to know about or have more recommendations about? DA:                  Um, so, um, I think that we covered, um, you know, a few different sexual minorities. One, a group of people that, you know, I would typically not lump into sexual minority is half of our population is women and women's health is a huge, um, um, area. Um, that is, I guess for lack of a better word, lacking. Um, and you know, now that there's, you know, fears about a funding for planned parenthood, um, I'm seeing more women, um, in need for basic primary care, uh, including, you know, just pap smears, mammograms, breast exams, and, um, I think that women's health, um, is an area that I'm very unfortunately is now becoming a health disparity and, um, uh, you know, half of our population is becoming a sexual minority. Uh, just kind of bizarre, but that's a, that's a big a population that I take care of is just women for their, uh, women's health issues. Um, KB:                  When you say women, do you mean like cisgender heterosexual women or DA:                  They're heterosexual women, but also just women, women who need their annual pap smears, mammograms, um, um, std checks and, um, everything else that's, we know, women's health related. KB:                  Yeah, for sure. I think that's a really great point. Um, even in our clinic we've noticed, I think since planned parenthood as has, maybe the funding has gone down, people can't afford to go there anymore. Um, and they've been coming to see us a lot more. Um, and you're right, the resources are totally lacking. I mean, one example of, of a, I feel a disparity is in the topic of bacterial vaginosis. I mean, we've known about it forever. It's a chronic problem sometimes for, for, um, anyone who has a vagina basically. And, um, there's no research being done on how to fix this problem that is a continuously a problem. So, um, yeah, I think that's a great point. And hopefully, um, the funding, you know, unfortunately it takes a public health problems to get the funding. Um, I mean, I think we're seeing this with std rates, but unfortunately I don't think the funding's coming out of that, but yeah... DA:                  And that's what happens is, um, um, uh, groups become, you know, blamed for these outbreaks and um, above the, uh, moralistic sort of messages usually tied to it with them, which, um, and it comes down to economics. Really? Yeah. Shot costs $400. And insurance doesn't pay for it. You know, you can't turn around and say, Oh, it's your community that's causing a syphilis outbreak. It might be that, oh, we didn't prioritize it. We didn't value it as a society and we didn't take care of it. KB:                  Absolutely. While we're seeing that right now, that's for sure. I think I saw about four cases of secondary syphilis on Fridays clinic and it's just everywhere right now. DA:                  It's alarming, but, but, but what's even more alarming is, uh, you know, uh, I mean you work in a different setting than I do, but I commonly run into the problem where, um, uh, people's insurances deny, um, that the injection that's curative of um, uh, syphilis and, um, uh, people are finding that they have to pay out of pocket or try to search around for a limited resources, a free clinics and, um, um, stayed with the disease state longer than they should. So. KB:                  Right. Which is this making everything worse in terms of health outcomes for our patients. So do you have any particular advice for other primary care or internal medicine practitioners on how to create more of a sex positive environment for their practice? DA:                  Yes. So, um, I would say having done this for only about a year and a half, um, I have learned a lot, even coming from the LGBT community, I had a lot to learn and I still have a lot to learn. But having images, um, you know, even, um, non traditional couples, um, in, um, I didn't know in your lobby, in your hallways, um, having, um, thinks about resources posted on bulletin boards, uh, creates a more sex positive environment. I'm talking about sex in a very de stigmatized way in a very normalized way, creates a sex positive environment and um, uh, but you know, get close to your patients. You don't have to distance yourself. You know, it's one thing to be diplomatic and polite. It's another thing to be distant and cold and clinical, um, or sterile. So, and there's a fine line there. KB:                  For sure. For sure. Um, so just to kind of wrap things up, why do you feel like your job is important? Loaded question. DA:                  Yeah, I think that my job is important because I reach out to, um, a group of people who otherwise wouldn't get the same information, the same care delivered in the same way. Um, and at a time where there's a big need for it. Stds are on the rise. Um, the need for taking care of, um, uh, this group of people is becoming more and more and more. And um, historically, uh, um, uh, the group's been marginalized and stigmatized by the medical community and I think we owe it to them. ***END INTERVIEW*** ***CONCLUSION: KB ONLY*** For information about future episodes or to contact us, please visit us at our website www.queermeducation.com or email us at queermeducation@gmail.com ***OUTRO MUSIC*** 

Hello Queer MEDies! Hello and welcome to the introductory episode of Queer MEDucation. I am your host Kerin “KB” Berger. I am a Physician Assistant practicing in Los Angeles California. My pronouns are She/Her/Hers and I identity as a queer woman. I am excited to launch the very first season of Queer MEDucation. This podcast is a series of expert interviews featuring medical providers, mental health professionals, advocates, and community members. There is a huge gap between the medical community and the queer community in terms of competency, research, general knowledge, and overall resources. My goal with this podcast is to bridge that gap by educating medical professionals and the general population on LGBTQI+GNC health and well-being. This season will feature a slew of individuals and organizations that dedicate their lives to improving health and mental health outcomes. We will discuss how to create sex positive primary are with a physician practicing in Los Angeles. We will dive into HIV medications with a clinical pharmacist and discuss treatment protocols from the 1980s to today. We will chat with a PA working in gender affirming surgery and learn the many options of surgical transition. We have the pleasure of conversing with the founders of a queer hair salon in Long Beach California where we evaluate the relationship between physical and mental health and hair. I am excited and privileged to introduce Season 1 of Queer MEDucation. Please tune every week for new episodes. For information about upcoming episodes, visit us at queermeducation.com. You can find us on iTunes and anywhere else you access your favorite podcasts. Subscribe to our newsletter or follow us on Instagram and twitter @queermeducation. Please enjoy. Love, KB