NASW Social Work Talks - EP21: Transgender Issues

Episode Date: January 8, 2019

Zander Keig, MSW, LCSW, is a clinical social work case manager on the U.S. Navy Medicine West Regional Transgender Care Team. He's a U.S. Coast Guard veteran and co-author of three books and several journal articles. He is also a transsexual man who transitioned in 2005. His peers at the NASW California chapter named him Social Worker of the Year in 2018. He is chair of NASW's National Committee on Lesbian, Gay, Bisexual, and Transgender Issues. See the show notes for resources

I'm Kat McDonald and this is NASW Social Work Talks. Today we're speaking with Xander Kegg, a licensed clinical social worker currently working as the clinical social work case manager on the Navy Medicine West Regional Transgender Care Team. Kegg holds a master's in conflict analysis and resolution from Nova Southeastern University, a master of theological studies from the Pacific School of Religion, and an MSW from San Diego State University. In 2018, his peers at the NASW California chapter named him Social Worker of the Year. Kegg is a U.S. Coast Guard veteran, a co-author of three books and several journal articles, and he's also a transsexual man

who transitioned in 2005. Xander Kegg, thank you so much for joining us today. absolutely and thank you for um wanting to talk with me can you start by telling us what attracted you to the social work field when i was in my early teens i had the uh opportunity to spend about a year and a half in a group home in that setting i had the opportunity to interact with a lot of different professionals and a couple of them were social workers one person in particular. Her name was Sue. She was probably, I mean, I don't mean to be hyperbolic, but I think she saved my life, at least from maybe venturing off into a life of crime or drug addiction. She reined me in in a way that reached me that no other person had been able to do. And it put me on

a semi-right track so that I could end up being a contributing member of society and a good citizen and then a professional. But I was not necessarily headed in that direction when I encountered her at that young age. And I think it was just the way in which she worked with me. It just set sort of a memory in my mind that I would revisit over and over again. You know, I would just come across individuals that were doing social work and I just liked what they were doing. I liked what they were about. I liked the types of ideas that they interjected into conversations. And so when I was thinking about what I wanted to do as a next career, it's not my first career, I looked into psychology and marriage and family therapy. And what really grabbed

me was that I liked the NASW Code of Ethics. That's what really grabbed me. I couldn't find anything equivalent to that in the other professional associations. And I just liked what it had to say, and how it viewed the world, and it aligned with my views of the world and how to work with people and see people and treat people. I never thought of the Code of Ethics as being something that would draw someone to the profession. That's very cool. They're profound. I mean, we really are alone, at least from my perspective, alone in our worldview in how we work with people as whole people, and we start where they're starting. It's a very different perspective. It's a different lens.

So tell us about your work as an advocate for people who are transgender. How did you get started, and where has it led you? That started when I was a college student, and I was a nontraditional college student. It just turned 30 when I entered college, and I was working in the GLBT student services office, as a work-study student. So that's what brought me into a broader knowledge of understanding transgender people and the movement and transition. Up to that point, I had very scant introductions to the topic and to the people, mostly through gay community with like drag performers, female impersonators, trans women. But I had never, to my knowledge, had encountered a

trans man beforehand. Turns out that I had, I just didn't really put it all together. So here I am, I'm 30, I'm working in the GLBT student services office. We have a library and I come across a book, Stonebutch Blues by Les Feinberg. That was the first book that I ever read that had a transgender male character in it. And it sort of sent me off into an investigative journey of wanting to know more and more at that point, not considering that it was anything of personal value to me that that would be my life one day. It was more, I was a lesbian at the time and I was more just interested in it as these are people that are part of our community and I'm working in this office. And so I want to be able to provide competent services. I don't think I

used that language back then, but in hindsight, while I was an employee in that office, we had the opportunity to do a lot of events for the campus. So we had lots of events in the month of November for Transgender Awareness Month, we called it. So I was working in that office for three years. So for three years in a row, we had all these events that were focused on transgender people. We invited people to campus from around the country. We had local people come. We had panels. We had performers. So we had people like Kate Bornstein, who's very well known within the community and outside of the community. She came to our campus and did a whole, you know, one woman show and a Q&A. And so it was through working in the GLBT student services office in Denver,

Colorado at Metropolitan State College of Denver between 1996 and 1999 that I had this experience. So it's interesting to place it in that context because it wasn't until just a couple of years ago that the San Diego State University, which is where I got my MSW, even instituted having an LGBT student services office. So we're talking mid-1990s, and the office had already been around for a couple of years. They just celebrated their 25th anniversary this year. So it was cutting edge. So here I was in this environment of Denver, Colorado, working in that office. And so that was where I got the exposure. I had already been doing what I would have classified at the time like gay community activism and advocacy for close to a decade up to that point. But the trans

advocacy piece for me kicked in in 2000. And that was while I was a graduate student at Nova Southeastern University in Fort Lauderdale, Florida. And I was doing an internship. We convened groups of high school students for a weekend retreat experience where we engaged them in small group and large group activities around gaining more knowledge in who you are as a person, who you are as part of your ethnicity, your race, your sexual orientation. They were called any towns if people are familiar with that. It was in that environment that I was asked to do workshops specifically on educating those students on what gender identity was and what transgender meant. And so that's where it started. And I haven't stopped since. And I've done, I've been doing a lot of things since

So I'm presenting at conferences, sitting on boards for things like FTM International, Transgender American Veterans Association, TransMentors International, starting up local discussion and support groups in San Francisco, San Diego, and being part of professional organizations and associations. And of your work right now, what are you most excited about? You know, I did a project recently where I put a list on my website. I put a list of all of the clinics around the country that I could find that are just specifically youth clinics. So basically children's hospitals around the country, primarily, that have a clinic associated with them for transgender youth. So these are kids who are, you know, who are coming out and identifying as transgender and accessing various psychotherapeutic and medical interventions. When I first created the list, there were, I found something like somewhere between 40 and 45 clinics. And then people started sending me more resources. And now I think there's somewhere close to 65 unique clinics across the country just for youth. that many clinics exist and they are providing services in their communities. And it spans, I mean, it spans across the country. So it's not as if like half of them are in California. I mean, they're all over the place. That's an indication that a lot of groundwork has been laid and more

and more medical settings are coming on board with providing care and that the providers are working with the community. So there are networks of social workers and marriage and family therapists and psychologists that are working with the kids out in the community. And they're networking with the parent groups. And they're working in conjunction with these clinics at the Children's Hospital. So there's these growing networks around the country. And then a bunch of them are coming together at these national conferences that are catering to the parents and and other family members of these trans kids. That to me is a really, it's not even a hopeful sign. It's beyond hopeful at this point, right? It's just the way it is. But it's almost as if

it just happened overnight. It didn't. But I went from thinking there must be a couple of clinics somewhere around the country. I knew about half a dozen of them. And when I started my internet search and I kept finding another and another and another, it was like, wow, that's pretty amazing. I know it's controversial, this idea of, you know, children and transgender identity and gender transition and what should be made available to them. But outside of that, you know, I don't want to weigh in on those issues. What I want to say, though, is that these clinics do exist. These kids exist. And the parents are finding a place to take their kids to get competent care. And the communities are supporting them. And there are these conferences that are supporting those clinicians and those families. So it's a huge system that's coming, that has come together and will just continue to grow. yeah and adolescence is a time when you're trying to create or form your identity understand who you are that's what adolescents do absolutely it's hard enough to be an adolescent you know i wish we could just hibernate through adolescence but let's make sure that we can provide all that's

available and necessary to meet the needs whatever they are so that so that those those bumps in that road don't have to be insurmountable. Yeah. And it sounds like you're finding there are also supports for parents who want to help their kids go through this process. Yeah. There's one national network that I'm the most familiar with called Trans Youth Family Allies. So they provide resources for parents. They also provide resources for educators and and also for providers, so behavioral health and medical providers. So what can be helpful is a parent can go to the imatypha.org website and find educator and provider resources

and then advocate for their child in their school and with their health care providers. Then there are also some local resources, like here in San Diego, So we have the trans family support group at transfamilysos.org. And so they're basically like this national organization of trans and family allies, but they're in the local area. They serve San Diego County families. Kathy Mollig is the founder and executive director.

And what she does, she works with the parents to advocate in the schools and with their providers. She also helps them navigate through accessing insurance companies to get care. she does public presentations she holds meetings where parents come together and talk if people are familiar with p flag parents and friends of lesbians and gays trans youth family allies initially was a project within p flag and then broke off and so it's it's i wouldn't say it's directly following their model but it's similar in the way that these are parent groups and parent organizations, organizations run by parents. And then they provide resources

for other parents, but then they also provide resources for the youth. When the parents meet, they bring their kids and the kids get together and either have a discussion if they're a little bit older, or maybe just like a play group if they're a little bit younger. And then when they go to the national conferences like Gender Odyssey, they have a family component where these families can come together and interact with providers all over the country that are providing, doing surgeries, doing hormones, doing research, providing therapy, teaching in mental health programs. So they're all interacting. Gender Spectrum up in Berkeley, California, they also have a national conference. There's a conference out in Philadelphia called

Transgender Wellness Conference. That's an annual conference with a family component. And there's others around the country. There's so many. Thanks for those. And we'll link to those resources in our show notes as well. So can you talk a little bit about the history of the movement for transgender equality and acceptance in the United States? Let me see. So what I'm more familiar with is a more contemporary workings of FTM or female to male or trans male community building and organizing that was mostly started by a guy named Reed Erickson, who was a very wealthy trans man. He had inherited his family's business and fortune and founded an educational resource called Erickson Education Foundation, and they started providing

educational resources to individuals and and you know professionals and media requests and schools and whoever was asking for the information about what what are transgender people or was probably transsexual at the time what are transsexual people what does it mean who are they those kinds of things so they so it was and that was i believe in the mid to late 60s since then there have been multiple organizations that have been formed that were providing support, either social support and or guidance for like how to access what you needed to access from everything like where do you find the doctors who are going to prescribe the hormones? Where do you find the physicians or surgeons that are going to be performing the surgeries? How do you change

your documentation? It wasn't that easy to figure out back in those days. How do you change your certificate how do you change your identification cards whereas now i mean you can just go to the internet you could find that information really quickly there was no internet then there were these loose knit networks of people working underground that you could connect in with if you happen to find out that they even exist by maybe seeing a little advertisement in a magazine somewhere some obscure magazine so it i think what we have today um is a result of that which is we have Transgender Law Center based out of Oakland, California, that's directly involved in the California area, at least, of implementing new policies and getting laws passed. And then

there are national groups that are doing that. But it's all very more modern, some of the making new laws. And we're still not there yet. We still don't have, say, gender identity and expression isn't necessarily included in every national law that protects based on discrimination, right? They're still working on those. Now that we have the internet, it's hard to remember what life would be like without it. And just thinking about get all the information that you would need as a transgender person, all of that information would have been out of sight or not even, wouldn't have been written down anywhere maybe. No, I mean, back in the day, there was a magazine called Tapestry, and it was primarily featuring and focused on, you know, the trans

female world. But there was a trans man in the 80s, Lou Sullivan, and he wanted to organize people around the country and around the world. And he was successful by placing little ads in that Tapestry magazine. And every once in a while, somebody would stumble upon it, either a trans man or somebody who knew a trans man and say, oh, hey, get in touch with this guy Lou out in San Francisco and it took a number of years but what resulted was an organization called FTM International they were the only gig in town for a while there until another organization American Boys came on online a few years later and they don't exist anymore at all so some things have come up and gone away and they were finding each other through these little ads in like magazines

like that I mean it I mean I'm 52 so I spent most of my life without the internet so I do remember just as a, you know, young, in my case, you know, young lesbian trying to find peers to interact with. And I was part of a pen pal program. So that's when I was like 15, 16 years old, that tells you that's what was available. What are some of the biggest challenges that transgender people are facing today? You know, it depends on a lot of factors. There are a number of reasons why people might, for instance, might not be getting access to health care in order to either begin or to maintain their gender transition. So it may be that they don't have insurance at all, and they don't know that they possibly are eligible for Medicaid, and nobody around them

knows it or is telling them. And through Medicaid, they may actually be able to access the care that they need in particular locations. Like, say, Planned Parenthoods around the country, some of them are offering cross-sex hormone therapy. So, in some cases, it's not a lack of services that are available. It's a lack of awareness of the services. There's also issues, you know, not every state permits a person to amend their birth certificate. If you can't amend your birth certificate, what happens, let's say, if you're going on a particular kind of a job interview where you need to be able to show that kind of identity document? What if you want to get a passport because you want to travel, but your birth certificate says, let's say it says

female on it, but you're presenting very male because you're already on hormones and maybe you have facial hair. How is that misalignment? How are you going to work that? How are you going to interact with, say, TSA at the airport when you have this mismatch in how you present and what your documentation says. So not everybody knows how to go about getting a passport, but they're readily available. They don't require any hormones or any surgeries, just a simple letter from a physician along with an application to get a passport. Now, it's not affordable for some people. So you have issues with finances, right? So there's issues with either lack of healthcare or lack of information about the access to healthcare, lack of resources, financial resources

in particular, and then how to, you know, get things like a passport or a new identification card, which is not necessarily free unless you qualify for a free one, but then you've got to go somewhere where somebody knows that you need this special form that goes to the DMV, right? So that's why, you know, they need many, many more social workers embedded into these programs. If I had one critique of all the various clinics around the country that provide health care and behavioral health care services to trans teens and adults is that they do not, many of them, have social workers working as, say, case managers, clinical case managers, who can provide the clients and the patients with the resources that are specific to their circumstances and

their location. It's so important to be able to know where to find those resources and how to implement them. People are dealing with that. They're dealing with thinking that they don't have access to something that they may actually have access to. I talked with somebody recently who was under the impression that they couldn't get, say, top surgery or chest reconstruction or double mastectomy with reconstruction. They couldn't get that surgery because 20 years ago, they couldn't get it. And they didn't realize that things had changed and that they could get it now. So it's good for people to know where to go, to go to, say, the National Center for Transgender Equality's website to find all the resources on how to change your identity documents in every state in the country. National Center for Transgender Equality's website has that information.

You know, WPATH, the World Professional Association for Transgender Health, you can go on that website, look in the directory and find all kinds of providers from endocrinologists to urologists and gynecologists and behavioral health specialists. you know, in your area or hopefully close enough that you can connect in with people. So there are these, basically these free resources on the internet that will lead you to the people in the places where you can get the services that you need. So it's like a combination of there are some places in the country where there are fewer resources than others. And then there are issues of people not having the knowledge of what the resources in their area are. I think I'm a little, I'm very fortunate living in California that these things are just sort of given that I work for the federal government and I am protected currently and have been. So I haven't had to give that much thought.

I'm not as familiar as perhaps I should be on those bigger things. I focus more on the issues of how to get people what they need, when they need it, so that they can progress. Can you talk about some of the bigger victories or advances that you've seen for transgender people? I think the open service for transgender service members in the military, I think that is something I could have never predicted. I wouldn't have seen that coming. That's a huge change. It may change again, but for right now, it's holding steady and people are on active duty, are doing gender transitions. The fact that there are so many more individuals that are in the public eye, like transgender people who are in popular television shows, for instance, like Orange is the New Black, with Laverne Cox.

um like the fact that there's more of that kind of visibility and it's not in a like a freakish way you know it's more like yeah here's this woman she's an actress here's her story like sort of run of the mill i think that's a form of an advancement like i said earlier with all those youth clinics there's also a network of clinics for adults and so i i think that's fantastic that there are more and more places that people can go the fact that there's about two dozen or more conferences around the country that focus on transgender people's issues and needs and the research that's being done for us with us on us in in all these different settings like all that comes together at these conferences and those are great places for people to go and

network and learn more information about who's in the community and what's going on and what's available lawyers will show up doctors will show up your average trans person who's just sort of living in a town somewhere can show up. There's no barriers to who shows up. There's scholarships available for people. There's stipends for travel in some cases. So they make them available for people, which is really nice. I think just the normalization, I think that maybe social media is primarily responsible for this, that transgender people, the community of transgender people, the history is becoming more and more public knowledge. For people that I know who started their journey 30, 40 years ago and were, I wouldn't say they were hiding out, but they had

to be a little more careful. And there are still people who feel that that's true for them, even in this country and other countries, of course, it's true. But they're just, people just live in their life now and there are there's more recourse if you're having difficulties navigating through maybe your school or your workplace or there's there if you can't get issues resolved there there are other options you know you can there's things you can do to change those circumstances it might not be pleasant but at least there are systems set up in place to hold people accountable for being discriminatory I'm glad that those systems are are in place

and more and more coming on board to provide that that resource for people so what can social workers do to educate themselves about issues that transgender people face and how to support them on the NASW website there There is a practice area drop-down, and LGBT is one of those drop-down items. And they can go through there and learn what are official NASW thoughts and statements on the issue. There are other professional organizations that are multidisciplinary. So I mentioned one just a little bit ago, WPATH, or World Professional Association for Transgender Health. People can become members of that organization and network via like a Google email listserv, and then also attend the biannual conference for USPATH, which is the United States chapter of WPATH.

that's probably the preeminent professional association for individuals that are working with trans patients and clients and many of the members are transgender themselves and providers either physicians or psychologists or lcsw's family therapists nurse practitioners so there's there's a it's a good network it's an international organization there are the conferences of course there's the trans wellness conference there's the gender odyssey professionals conference there's the gender spectrum conference that has a professional track there's a book that came out it's an edited volume put together by two psychologists from the va it's called adult transgender care an interdisciplinary approach for training mental health professionals it just

came out last year or this year actually from Rutledge and there are psychologists and social workers that contributed to that book I contributed to chapter 12 and that's basically all the resources that are available here all the different organizations listservs social media sites to get you started that's great and I will include links to all of these resources in the show notes so people can find them. And then finally, I wanted to ask you about a quote that you have on your website. Do not be troubled by with such things as correct gender. Allow an authentic gender to unfold. Do not control it. Remember that in all transitions, nothing endures and everything continues. Can you unpack that for us? Okay, so in 2007, I had this idea to start a blog. I called

it the Tao of Transition. My idea was I was going to take Taoist philosophical principles and apply them or use them as a frame in which to discuss not only my personal journey, but just the journey itself of the transitioning of gender. This idea comes from two places, this idea of correct gender and authentic gender, applying a Taoist principle to just not holding attention on this idea of correctness, right? Being the correct kind of person, whatever it is, a correct woman, a correct man right like what does that even mean um to just be you be authentically you what was happening at the time was that i was i was leading a um uh ftm or female to male or trans male discussion and support group and people would come to the group and inevitably they would

have some variation on this question how do i do this right what's the correct way to do this And so it got me thinking about, you know, they're like, what do I need to do first? And it's like, turns out, everybody has a different gender transition trajectory. People do things in different orders, and they come to the understanding of who they are and what they're going to do from different places. And so there is no such thing really as a correct gender. There's no such thing as the correct transition, right? So it was a way of trying to put into terms in this context of this blog that I was starting. I think I wrote like maybe four posts and then I got busy with life. And this idea that nothing endures and everything continues, it's because any notion that we might have about who we've been and who we will be are just that notions. We have no control over that in some ways. We're not at the helm of our own journey in some ways.

You know, our life will continue on and changes will come inevitably, as they always do. And we have choice in how we respond to those changes, but they are inevitable. But at the same time, as long as we're alive and conscious and moving through the world, our life is continuing. But where we maybe saw our life going, that might change. Who we saw ourselves to be, that could change, right? Those things may not endure. So many times what I'll hear people say is, I'm going to do a gender transition. I'm going to take hormones. I'm going to have surgeries. I'm going to change all my legal documentation. But I'm not really going to change. I'm still going to be me. And I'm like, wow, good luck with that. Because the minute people start to see you and perceive you differently and interpret who you are differently based on whether your voice is high or low, and whether you look or sound like a male or a female in the world, they begin to treat you differently. and being treated differently impacts how you then navigate the world and how you see everything and how you experience everything. And so it does change how profoundly that's probably unique to the individual. My hope was that people could release themselves from the anxiety of trying to quote, do it right. That as long as people are doing things legally and under doctor care and are following instructions for how to care for yourself just in general you know like

ceasing nicotine and lowering your intake of alcohol and and you know these kinds of things like those things will impact your transition also so to be just be attentive to all the things that we should be attentive to anyway about our health our physical health our mental health our social health our spiritual health you know our relationships and don't make everything about this thing called gender and transition because it it can kind of happen that way when you go through a second puberty everything can get very sort of narrowed down to this is the only important thing in the world and it can drive the people around us a little nutty that's the basic idea so is there anything that you wanted to add as we close our conversation anything i i should have asked

that didn't? The message that I want to leave, you know, the listeners with is that because there's no one way to do transition, there's also no one way to be a trans person. And so as social workers, if we encounter a trans person, whether they're a member of our family, or they are somebody we work with, or somebody that is, you know, under our care as a patient or a client, that's all we know about transness, period. That one person's experience. It's not necessarily applicable. It's not like it's a template for all trans people. We're all very different. Our lives have been very different. They're currently very different. So I would caution people to not get too confident or complacent in thinking that they have this one client or one family member and

they've read a book or visited one Facebook page and they know everything they need to know about what it means to be trans. I can't even tell you how many times I have had clinicians correct me about me not doing it right and kind of going, what? I don't even know what you're talking about. Like you're telling me I'm not doing it right. This is how I'm doing it, right? So social workers, especially LCSWs in particular, are called upon by our clients to write letters that say, this person is able to make an informed decision. They're consenting to moving forward with, say, starting cross-sectional hormone therapy or getting, you know, a particular surgical procedure performed. And those are not cookie cutter, you know, assessments and letters, right? I mean,

some people can use them that way. I don't. I don't endorse that. I am a member of WPATH. And so I know that they have some basic, the standards of care that are written specifically for the provider, the clinician or the physician or the nurse practitioner or whomever is working with the patient or the client. Like these are the standards of care that comes from WPATH. It's a WPATH.org. It's a free PDF document that people can look at and it tells you what kind of criteria needs to be met for various things. And the LCSW that's working with these clients is going to be called upon to make assessments. And we need to be able to do that in relation to that person sitting in front of us. It's no different from, you know, person in their environment, you know,

the PIE, that's exactly, that's our frame. And we have to use it with these patients as well. We can't, we can't compare them to each other. I hear that happening, you know, oh, well, this patient, this client isn't as far along as this client. Well, what does that mean? What does far along mean they have two very different trajectories perhaps maybe they're they're wanting different things there's no such thing as far along right so to to maybe not think in those terms to to work with that particular client in that setting with their particular needs at that time to be very conscientious about that that's that's one thing i'd want to you know people should definitely go They'll read the standards of care if they are working with trans patients and clients.

Thank you so much for talking with us today. Thank you again. Absolutely. You have been listening to NASW Social Work Talks, a production of the National Association of Social Workers. We encourage you to visit NASW's website for more information about our efforts to enhance the professional growth and development of our members, to create and maintain professional standards, and to advance sound social policies. You can learn more at www.socialworkers.org. And don't forget to subscribe to NASW Social Work Talks wherever you get your podcasts. Thanks again for joining us.

We look forward to seeing you next episode. Thank you.