Tangle - Treating transgender youth with Dr. Erica Anderson

Episode Date: March 28, 2021

On today's Tangle podcast, we sit down with Dr. Erica Anderson, a psychologist and clinician who works with transgender youth. Anderson's particular expertise is in the psychological aspects of gender and gender identity formation, and their relationship to individual development. She is also an expert in evaluating patients with psychological disorders and separating these conditions from gender issues. During our conversation, we have Dr. Anderson explain the basics of what it means to be transgender, the challenging work of her day-to-day, how to tell the difference between a child "going through a phase" and a child experiencing gender incongruence, and all of the other questions you have probably wanted to ask about some hot button trans-related issues.If you enjoy this podcast, please be sure to give it a 5-star rating.You can subscribe to the Tangle newsletter here: https://www.readtangle.com/--- Send in a voice message: https://podcasters.spotify.com/pod/show/tanglenews/message Hosted on Acast. See acast.com/privacy for more information.

Based on Charles Yu's award-winning book, Interior Chinatown follows the story of Willis Wu, a background character trapped in a police procedural who dreams about a world beyond Chinatown. When he inadvertently becomes a witness to a crime, Willis begins to unravel a criminal web, his family's buried history, and what it feels like to be in the spotlight.

Interior Chinatown is streaming November 19th, only on Disney+. Chinatown is streaming November 19th, only on Disney+. From executive producer Isaac Saul, this is Tangle. Good morning, good afternoon, and good evening to my Tangle listeners, and welcome to the Tangle podcast, a place where you get views from across the political spectrum, some reasonable debate, and independent thinking without that hysterical nonsense you find everywhere else. We are sitting down with Dr. Erica Anderson, a Bay Area-based gender clinician who works with transgender and gender non-conforming youth. She is a psychologist who provides evaluations and consultations to the

physicians and team members of the UCSF Child and Adolescent Gender Center Clinic. She also counsels patients and their families, and she happens to be a trans woman, giving her some very unique insight into her work and the life experiences of her patients. Dr. Anderson, thank you so much for being here. It's a pleasure. Before we jump in, I just want to set the table a little bit for this conversation. I have asked you on today because I've written a bit about some trans issues in the political context, and I'm a political reporter, I have a politics newsletter, and I understand a lot of the politics around trans issues, but I am not an expert on what it's like to be transgender, what it's like for trans youth,

a lot of the medical stuff that goes into these sorts of decisions and political issues that we're talking about, and you are, I have a list of credentials here that is extremely long. It would probably take me about a half an hour to read, but you sit on the board of some very important organizations related to trans issues. You advise all sorts of powerful organizations about how to act in some of these more nuanced, difficult situations. And in response to my writing, I've got a lot of questions and passionate feedback from my readers who exist across the political spectrum. And so I wanted to bring on somebody who was an expert on this stuff, who could go through some of these things and talk

about the really sticky stuff with some nuance and shed some new light and teach me a lot because I have a lot to learn too. And so I guess maybe a good place to start would just be if you can maybe tell us a little bit about your story and how you got into this work. Sure. I'm a clinical psychologist for many years and was originally a university professor years ago in clinical and health psychology. I had a career running healthcare companies for about 20 years, some of which are national names. Then I kind of returned to the academy to be a professor. I was a professor of management at the University in the East for a few years and then was coming to terms with my own gender identity and finally determined I was going

to go ahead and transition. And so embarked upon my gender transition, working with a gender specialist psychologist who had worked with other trans people and physicians and came under their care and advisement and made my transition, decided I needed to live in a more progressive area. So I obtained a position at a university in California and have been out here for 10 years doing a variety of things. And currently, as you observed, I'm at the University of California, San Francisco, in the Child Mental Health and Gender Center, where we work with transgender, gender creative and non-binary youth. And I have a private practice. And as you, I think,

are aware now, I do a lot of other interesting things. And I'm, you know, an educator, clinician, And I'm an educator, clinician, advocate of trans issues. how you define a lot of these things, because I know the work and the medical definition and this field is constantly evolving. But maybe we could just start with what is transgender? What does it mean to be transgender? And sort of, I guess, related to that, the differentiation between gender and sex? Sure. Well, the words transgender and cisgender, which are thrown around a lot these days, actually come from ancient Greece, Koine Greece, Koine Greek, which the word fragments, trans means across. And we have that word fragment in lots of words in English and other languages. And cis means the same, same side. So trans means someone who has come to an understanding of themselves that is different than the sex that was assigned to them at birth.

And I'll get into these categories a little more. But the traditional understanding of sex and gender is that they're aligned and that you are born either male or female and you grow up to be an adult version of a male or a female you go through puberty and that gender development is pretty much programmed by biology and you you just get older we call that the sort of traditional binary construction of gender, the dominant gender schema of gender, which has prevailed until recent years and still is the expectation by people in society in general, even though the science of it and what we've learned is quite a contrast to the idea that there are only two

sexes or genders. The difference we have between sex and gender, sex is the assignment you get at birth. A term goes on your birth certificate, you're either male or female and uh and then we go from there the traditional understanding was that there there were only two sexes but if you actually uh dig into the science of it there are people who we call now intersex who are somewhere in between, and there are variations of these conditions. There's quite a number of them that mean that the traditional expectation in Mendelian genetics that, you know, males are XY chromosome on 46 and females are XX. are XX. We now know that there are many variations of those chromosomes, some of which result in differences that are evident at birth, and some of which are conditions that are more metabolic or hormonal that aren't evident until later, like at the onset of puberty. So even though we historically have said there's only two sexes, that's not even true. That, you know,

the zygote in utero has actually all the biological material to develop either a male body or a female body or some condition which might result in a body that's not a stereotype male or female body. So basic building block is sex. Then we know that there's sexual orientation or attractions. And, you know, it's not binary there either, because, you know, if it was binary, then everyone would be either gay or straight. But we know that there are people who are bisexual. And we know that sexual attractions people who are bisexual and we know that sexual attractions can be very fluid across the lifespan so you know there's sexual orientation and then then we come to we come to gender and when we come to gender we have to recognize that gender is is your sense of who you are male female or non-binary non-binary, or some other version. And you can

have a gender identity that is one of those choices or an idiosyncratic version. And you can also have gender expression. And gender expression, to elaborate a little bit, is what we generally think of as masculine or feminine or some combination. The term androgynous is often used to reflect someone who is in effect expressing themselves in some way different than a stereotype male or stereotype female way. Gender identity, back to gender identity, is the core variable that we're thinking about when we talk about transgender. Because we know that there are some people who at some point in their lives, often it's young. And I work with many of the youth who have a gender different than the sex assigned at birth.

You know, teenage, young adult, even later. And the technical definition is often that of what we call gender dysphoria. Dysphoria means difference or disparity. That's in the DSM, current five edition, the Diagnostic and Statistical Manual in Psychiatry. And gender dysphoria is defined as a marked incongruence between one's felt gender and one's sex, in parentheses, gender as assigned at birth. A lot of people equate gender and sex. I'm trying to help us understand that they're not the same and that people can have variations of both. Thank you very much. I mean, that was extensive and exactly what I was looking for. I'm interested, I mean, you mentioned obviously a few times now that it seems like the predominant kind of patient

that you work with is younger patients. And so when a child comes in to you or comes into your clinic and is saying, say they are someone whose sex at birth was a boy, and they're saying they feel like a girl or they feel like they have been assigned the wrong sex at birth, what kinds of questions come up in that interview and that work that you do with a patient like that? I mean, how do you as a clinician explore this in somebody who could be as young as 8 or 10 or 12 years old? So I practice what we call the gender affirmative model. And in that model, we try to avoid having any bias whatsoever. And we try to create a circumstance in which a child will reveal themselves to us. Some of that revelation is how they behave. Some of it is their, you know, what words they use.

Some of it is how they present themselves. That might be a situation where they are choosing things that express a gender different than the sex that was assigned at birth. For example, young children who play with toys or are attracted to clothing that is typically associated with the stereotype gender different than their sex as assigned at birth. So all of those things, we're looking for a child who is pretty insistent about this felt identity on their part, that they're consistent about it. They don't waver one day to the next or one week to the next. And then that this marked incongruence, if you will, or difference is asserted over time or as persistent as we often say. And that this then yields the conclusion that this is an enduring aspect of who this child is.

And, you know, we can ask them about it. If they're young, we might do some play therapy or ask them to draw or play. And, you know, a lot of kids who are trans, I would say young, are pretty clear, pretty insistent. And it's pretty compelling. and it's pretty compelling. So that's a part of it. If kids have questions, many kids do. Some kids have some really curious, even idiosyncratic questions or ways of thinking about it. I had one possibly trans boy who was evaluated. And when I asked her, why do you think you're a boy? Or

why do you want to be a boy? This child said, well, boys just have it better, don't they? And, you know, some parents hearing questions like that are sort of aghast. And probably few of us want to answer that question. Do boys have it better in this day and age? And then, you know, kids have their own ways of explaining things. Again, depending on their maturity and their cognitive level, you know, they might say very basic things like, you know, this is just who I am or I'm more like, you know, this is just who I am, or I'm more like, you know, person in their family, that's the gender that they identify in, or whatever, or they're modeling themselves after someone in a different gender. So I think for a lot of people, they-conforming gender identity. And they think

that's just a kid being a kid going through these changes, experimenting, playing, imitating something they don't understand maybe. And they feel a certain level of like, we don't know this person has to grow up and fully develop. And I'm wondering what's like the scientific medical view from your perspective on that? I mean, how do we navigate the difference between something that, as you say, is really compelling versus something that is just, you know, a phase, someone might say. Right. Well, I agree with that statement. I mean, there's ample evidence to confirm that young children do experiment with play and fantasy in social roles. So that's typical, ordinary, where it moves out of just typical play or experimentation into the obvious question of whether their identity is different than the sex assigned at birth is when it's enduring. And in play, playing house might take on different gender roles.

Having fantasy play with toys, with stuffed animals, or even their real pets, or with other kids, you know, can experiment all over. But when it's consistent and it persists over a long period of time and it doesn't vary, then you've got a pattern. You know, scientists always like to talk about, you know, identifying patterns or trends. And, you know, I'm fond of saying, cause I'm a scientist and I've taught some of the psychological science, two data points do not a trend make. Three data points, maybe it's a trend, maybe not. It's still only three data points. But if you've got, you know, six, eight, 10, 12 data points, you know, witness what we're doing with COVID.

You know, we're trying to track, you know, trends in terms of COVID, you know, region by region. And the scientists are talking about things like, you know, trending up, trending down on variables. So, you know, we want to have the sense that it's not just the potential of a trend, it's a trend. And that's where this whole notion of enduring consistent identity that the child is asserting quite clearly, compellingly, as I said earlier. I imagine in this field of work, you often are encountering a child who is going through, you know, a gender dysphoria or whatever. you know, a gender dysphoria or whatever, and a parent who is viewing that gender confusion or that gender identification or expression in a negative way, either because of the generational divide that exists oftentimes around trans issues or out of fear for the child or out of concern that maybe, you know, something like we're talking about that could be a phase is being confused for something, you know, more lasting, more enduring.

And I'm wondering as a clinician, I mean, how do you navigate this question of when a child is old enough to be making these decisions versus when it's the parent's right to be making the decision for the child? Well, I think we've got two big questions there. One is, how do I navigate with parents who may not agree or where there might be some lack of consensus about what's true about a child? I repeat all the time to parents that our job is to learn about what's true about your child. And if we can establish what's true about your child, and we can have consensus about what's true about your child, then we have a basis for discussion about what, if anything, do we do about it. It is very common for people to disagree about their perception of a

child. And as you imply, it might come from ignorance. It might come from prejudice, which is arguably worse. And it might come from a lack of understanding that such children can have a transgender identity, may have gender dysphoria, and it may be something that really needs attention versus just to be watchful and, you know, kind of monitor a child's development, presuming that, as you say, it's a phase or they'll get over it. I mean, I have in this year already encountered at least three families where the difference between the one parent and the others is so dramatic that they are, they're divorcing and going to court. whether a child is going to be permitted to have even evaluation by someone like me, let alone gender-affirming interventions, because the difference of view of the two parents is so striking

that they are, in effect, fighting it out over the potential of being affirming in a child's gender that's asserted to be different than sex is assigned at birth. So yeah, there are lots of differences. I'm a big believer in letting all the conversation happen, that it's just fine for parents to have reservations, let's examine them. It's the job of a parent. I have two grown children. I've been a parent. I know how conscientious many parents are with the challenging parts of childhood.

And, you know, it's our job as parents to watch out for our children and to help them grow up healthy and happy and make the best decisions that they can make at each turn and to help them avoid making bad decisions. And that's a part of the dialogue often with maybe an older teenager who is asserting a transgender identity and very insistent that their parents support them and some parents being very skeptical. And there's a lot of communication that has to happen when those situations arise. So I feel like one of the most controversial topics around this specific instance that we're

discussing is about giving pre-puberty, pre-pubescent children medical treatment, you know, whether it's hormones or suppressing things, or I guess generally just medical intervention. And I think of all the things I've written about, this is the thing that provokes the strongest response from people. And to be totally frank, I mean, it's not hard to relate to some of those concerns. I mean, it often feels like you're making a permanent or lifelong decision for a child when they're very young, and it feels so monumental for a 10 or 12 or 14-year-old child to be making. Well, what's really important to recognize is how that issue is framed. There's a lot of accusations flying around, including in state legislatures, by people who don't really know the subject matter, and politicians who assert that we shouldn't be giving hormones or surgeries, even more compellingly wrong, to, as you say, prepubescent children. We don't.

We don't give hormones to children before puberty. That's a mistaken understanding of what happens. With children prior to puberty who might be trans or we're wondering if they might be trans, we have no medical interventions that are conducted. We're basically supporting them in their psychosocial development. Some families who are persuaded their child is trans and the experts are in agreement with them might allow their child to socially transition, but that is a totally reversible choice. So there are no irreversible decisions made for children prior to puberty. At puberty, for a child who has been clearly transgender for a period of years, we might introduce a medical pauses puberty for that individual child for a period of time. But that intervention is only used as a single intervention, or as they say, monotherapy, for a few years, you know, into teenage years. Every human has to go through puberty to finish their development for bone mineralization,

bone growth, and eventually brain development. So everyone has to go through puberty. So pausing puberty can only be temporary, so to speak, a few years, two to four years, something like that. And then one has to go through puberty. So then the question is, which puberty? And then one has to go through puberty. So then the question is, which puberty? And where we hear about kids being given hormones, it's teenagers who have demonstrated to everyone's concurrence that they're transgender, and aligns with their identity. And it is important and helpful to their development to do so. The kids who go from puberty blockers to cross-sex hormones, as it's characterized, and are supported, provided psychological support as well as medical support,

typically do very well. And the studies that have been done show that these are the kids who have an enduring transgender identity after a period of time. Whereas many kids are troubled and many kids, trans kids who are not supported, have psychological issues. These kids resemble the general population in terms of the incidence and prevalence of psychological problems. So basically, they become normal kids and they develop into adulthood in their affirmed gender. Yeah, I wanted to ask you about that too. I mean, I think one thing a lot of people, myself included, don't totally have a grasp of is what does this positive outcome

look like for a patient? Because I think so many of the stories that are often elevated are about people who transition and regret it or something like that. I mean, I see a lot of that pop up from the people advocating against certain medical interventions, but I'm interested in hearing too, I mean, as a clinician, what it looks like to you when you see a patient successfully go through this transition. I mean, how does, how do things change for them on a practical level? Because I don't think a lot of people, and certainly I don't totally understand what that looks like. Well, to the extent we concede that gender dysphoria is distressing to the individual,

and it is, there can be varying levels of distress, but it can be highly distressing to some. And I think you're generally familiar with the fact that transgender people in America suffer from higher rates of self-injurious behavior and suicide ideation and suicide attempts than the general population. Some of that can be explained perhaps by the concept of minority threats, that being a trans person in this society is very difficult. Based on Charles Yu's award-winning book, Interior Chinatown follows the story of Willis Wu, a background character trapped in a police procedural who dreams about a world beyond

Chinatown. When he inadvertently becomes a witness to a crime, Willis begins to unravel a criminal web, his family's buried history, and what it feels like to be in the spotlight. Interior Chinatown is streaming November 19th, only on Disney+. And just like being a minority in any of the other ways that we know that occurs, there are certain stressors that one faces that dominant culture people do not. So some of it is the level of distress that people have had brought into this process, which is then addressed presumably by someone like me, a psychologist or gender therapist. dress, presumably, by someone like me, a psychologist or gender therapist. And then the medical interventions, which are for the proper patient, are desired and are affirming.

And as a young person, I'm thinking now of teenagers who go on to cross-sex hormones, they begin to resemble their peers in the gender that they identify in. And so they're accepted more and more easily by peers in our society. They feel better about themselves and their level of overall distress drops significantly. So actually, in some cases, some trans people who fully transition would say they no longer have gender dysphoria. They're not confused about their gender. They're affirmed in the gender they identify in. They've gotten the support medically and psychologically, and they're doing fine. I will tell you, I have plenty of opportunities to write letters of support for older teenagers and adults who

are going for gender-affirming surgeries. And for some of them, I'm saying about them after I evaluate them, this person is thriving and they will do even better when they obtain this gender-affirming surgery to complete their medical transition. Yeah. And I feel like there's a level of treatment and thought that goes into this that often doesn't come out in a lot of the political conversations that happen around it. And as a clinician, I'm also wondering, you're evaluating a child, You know, as a clinician, I'm also wondering, you know, you're evaluating a child. What are the sort of the risk reward scenarios that you run into where, you know, you're deciding whether to delay puberty, you're deciding whether a child needs to be affirmed in a way where they can start comfortably presenting their gender that they

identify with to their peers. Are there these bridges that you cross where you have to weigh, you know, a certain level of risk that this might be a wrong turn at certain points? Because that feels like, you know, there's so much about this that I imagine for a child is changing, even if the central issue of their gender is not. Because as you're saying, a lot of this treatment is based around the continuous sense of a gender identity that one of your patients might have. A day does not go by when I don't wonder to myself about individual patients, how confident do I feel in their affirmed gender? And I am very much aware of a desire on my part to avoid guiding them in any way that's

not appropriate for them. So I am very careful to say to patients really of every age, and I work with all ages, I don't want to make any decisions for you. It's not for me to decide what your gender is, but I can help you. And as you become more clear about it, I can guide you and support you in the decisions that are going to be coming up.

And in that regard, of course, with the young person, I'm saying this to their parents as well. You know, because before the age of majority, kids have to get parental consent for the interventions we're talking about, puberty blockers or hormones. So it's a process of feeling confident, all of us, watching that trend, the level of persistence over time, and avoiding any missteps. One of the things that I think is very difficult in this work, and I'm a psychologist for 40 years, so I've seen a lot of different things in terms of mental health and psychological issues. Is parsing the issues that are going on with an individual child, they may have co-occurring psychological issues or disorders, even psychiatric problems, some of which probably predate or may predate the

presentation of their gender identity as different than what people thought. And in the case of someone who has pretty significant co-occurring issues, there's always the question of, well, you know, did those things cause them to acquire a gender identity different than sex as assigned at birth? Or is that a reflection of the distress they feel about their gender? Or is it possibly that they're just all occurring at the same time? And, you know, transgender people are subject to the whole range of psychological problems that the general population is, including predispositions to, you know, sort of more genetically predisposed illnesses. You know, major depression has a genetic predisposition, bipolar illness, schizophrenia, etc. So these things can be happening with the

child. And all the complexity that occurs in co-occurring medical and co-occurring psychiatric conditions is present here with the added complication that gender isn't a simple disease with an etiology, of course, and a consistent set of treatment protocols. So, you know, understanding the interrelationship or lack thereof of coexisting issues with a child is paramount. I want to pivot really quick out of this into a little bit of a different lane, but I think a place that I'm sure you can speak to. And that's the issue of transgender athletes, which is something that in my world, in the political world, is a huge flashpoint and is a constant talking point for both sides when it comes to sort of, you know, what's fair and how

things should be done. And there are obviously right now a lot of legislation all across the country that's popping up to sort of address this issue coming from both sides of the aisle. And I think the dominant conversation that seems to happen is the issue of trans women in women's sports. And there is certainly a political divide on this. And I think even on the left, there a political divide on this. And I think even on the left, there is a divide on this. But the general argument is sort of between one side saying that having trans women participate in women's sports is unfair to the sex assigned at birth

women who are participating and are often at a physical disadvantage when they are matched up with a trans woman. And this is not something that I think is an easy issue to solve, but I am extremely curious to hear what your take is on how to navigate something like that, that sort of brings out some of the nuances of this issue. And, you know, if there's a solution to it that you've seen or that you've advocated for in terms of how we might be able to draft rules or legislation or guidance for high schools and colleges and professional sports to both be inclusive of trans athletes and fair to whatever the athletes of a certain sport or league as a whole. Yeah. Well, it is a complex issue, as we agree. It's interesting that today, as we tape this

discussion, the governor in Arkansas signed such a bill prohibiting trans girls from competing in athletics in the state of Arkansas. And there are a lot of these bills, as you say, being considered in state legislatures. The trans advocates often see these as ways to discriminate against transgender people. It's predominantly transgender females that are the target of these bills. There is a prospective avenue of solution here that is understood by most people. And that is, you think about the fact that testosterone is a performance enhancing drug

and that performance enhancing drugs have been detected for years now in elite athletes. And there've been prohibitions against using them. What people need to understand is that every human that's healthy, you know, from puberty on through middle age has both sex hormones in it, testosterone and estrogen. But the levels of those vary a lot based on the sex of the person, the puberty that they went through, and their age. So what happens with puberty blockers and cross-sex hormones is for an older teenager who's been given those things, their levels of the sex hormones are in the same range as those who were born in that gender or sex. So that's the target range. And these ranges have been well known to endocrinologists for many, many years.

And it's possible to detect them with a simple laboratory test. So just as we get lab tests to see how's our cholesterol and this and that, you know, you can do it to test your hormones. I happen to know the endocrinologist who's a colleague of mine who is tapped by the International Olympic Committee to advise them on this very subject. And I think we will have some guidance in the near term. The International Olympic Committee has been very clear they're not going to prohibit wholesale trans athletes and that they are trying to be inclusive. I think the NCAA will probably do the same thing, but they will probably have some testing requirements. And so what some of these bills purport to do

is to differentiate between people who are male and female based on what their assignment was at birth. But that's really not so important because, as we know, the intra-sex differences in every factor you can think of are as wide or greater than the across-sex differences on traits. And so you can have a genetic female who has a higher level of testosterone at age 15 or 16 than some genetic males. And so would we then decide that, okay, if someone who's not trans, who's cis, has a level of testosterone above a certain level, would we then prohibit them from competing in girls' athletics? I'm not sure that any of these legislators would dare go

so far as to say that, but to be objective about it, we have to have some rigorous evaluation. And as I'm suggesting, it's probably going to be on the basis of scientific factors like levels of hormones. I guess I'm curious about that problem that you've just presented though, right? I mean, I think I'm understanding this right, that's certain trans inclusive bills or rules would require a trans athlete to meet a certain, you know, testosterone hormonal level or range. But if there was a cis athlete who was outside that range, I mean, to be trans inclusive, how do we navigate that athlete? What do we do with them?

Well, if you want to be rigorously honest, we'd say all athletes should be subjected to the testing. And if there are standards, they should apply across the board. Right. It's fascinating the way it plays out from there. Look, we're jumping around a little bit and there's a lot of interesting avenues to apply to some real world situations or conversations or navigating things in your day-to-day work and, or at least in your advocacy. And I'm wondering why and how has it been useful for you? And I'd love to just hear a little bit more about that and what kind of situations it becomes useful in. Well, that was very early in my life,

during the period when most people are thinking of going to university and graduate school, and I did, and I had a serious personal interest in theology and philosophy, so I went and studied, and I ended up getting a master's degree. It's something that doesn't come up very often in a formal way. But when I encounter families where part of the challenge for them is overcoming religious teachings that are somewhat doctrinaire and rigid and inflexible, and they're trying to be supportive to their trans child. It's funny that we're into this point right now, because earlier today, I was on a Zoom call to prepare for a professional meeting where

a family with a trans child are going to tell their story. And the mother was telling us in a thing we taped that part of her challenge was she comes from a conservative Christian family. And so when she told her family that, you know, their child seemed to be likely transgender, she was told by multiple family members, well, you know, go to church and pray about it. And, and she was pretty clear with us in this session that that didn't help her. It didn't help her with the challenges she was facing with trying to know how to love and support their transgender child. And so, one of the things that I know a lot about is what's called systematic theology. And in the Christian theological tradition, it's the area of theology from which doctrine is derived. And so, you know, I learned how doctrine was created, how the basic principles of a certain religious group or practice were derived.

And it's not what people think. It's a little more organic and a little more embedded in not only the language that's been used, but the culture in which the language is used. culture in which the language is used. And so, you know, people who even are sincerely religious don't realize sometimes that the things that they think are really quite derivative of the original teachings in their tradition. And so, because I do know about these things, I can sometimes help people to realize that, well, the more basic principle in your religious is not, are there two sexes or not? And it is no longer, you know, does the earth revolve around the sun? And that, in fact, sometimes religious traditions are a little behind current scientific understanding. So we need to recognize that this isn't quite a simple problem to solve by just saying, you know, go to church and pray

more about it. Before I let you go, and we're coming up on about an hour here, and I know you're very busy, and I'd love to just hear, I guess, to be a little forward looking. I mean, one of the things that strikes me about these conversations that's really interesting is just how quickly they're changing and how much more in touch with this stuff the younger generation is. I mean, I have younger cousins and I talk to them about their friends and school and issues related to the LGBT community. And they're just so, they just don't, they're not phased by this stuff. They seem to understand it better than a lot of adults I know do. And I imagine in your field that the work must be changing.

field that the work must be changing. And I'm wondering, you know, looking out 10, 20, 30 years from now, what kinds of changes you're imagining are going to happen around these conversations or what kind of collective understanding in society you hope to see change in the decades to come? Because it feels like in the last 10 years, we've moved a lot as a culture and a society, both towards accepting this, but also understanding it and, you know, having medical treatment for it and having specific kinds of interventions and clinicians and people like you who are addressing this and helping people navigate these things. So I'm just curious, you know, what you see coming down the pike, I guess. Well, there was a recent Gallup poll, which was well publicized by NBC, which revealed in a large study, as Gallup has wanted to do, of generations, that the acceptance of gender minority,

sexual minority identities is growing generation by generation, just as you imply, and that more and more young people are exploring their gender, exploring their sexuality in a way that we didn't hear about a long time ago. And just to expand the arc that you're wanting us to talk about. So the arc of my career is rather dramatic, if you accept something I'm just going to tell you, which is the very first diagnostic and statistical manual in psychiatry that I was taught. Now, some years ago, had homosexuality in it as a psychiatric disorder. Now, few around in American society today would still think that homosexuality by itself or being gay constitutes a psychiatric disorder. But many people still think that being transgender is inherently

a psychiatric disorder. In fact, my college textbook, the sexuality textbook, said about transgender people, it didn't use the word transgender, that's a newer term, but transsexuals were suffering from a deep-seated psychiatric disorder. We now are about to embrace through the international classification of diseases a recognition that gender incongruence, that's the term of art used by ICD or the World Health Organization, the new term gender incongruence is moving from the psychiatric section to the sexual health section and de facto being depathologized and there is a government publication i can tell you about it later if you want to offer it to your readers which a few years ago was published by the substance abuse and mental health services administration in the u.s government which said which a few years ago was published by the Substance Abuse and Mental Health Services

Administration in the U.S. government, which said, in effect, in its summary, differences in sexual orientation and gender identity are normal variations in human beings. That is a rather breathtaking change from the point I described a moment ago, 40 years ago, to now. But it's going to take generations for that to filter through the whole society. There's still going to be people in the near-term future who still look askance at people who are trans and assume they have something wrong with them. And so the younger generation, which is pretty much now wholesale accepted that there's a spectrum of gender and that there isn't just the binary construction of gender of male or female, but that there are

variations. As you say, it's kind of no big deal for them. Just like, you know, it's kind of no big deal for them just like you know it became kind of no big deal in america for people to be gay or lesbian but uh it's going to take a couple of generations for that to happen with with being trans and there's going to be a lot of culture wars because the whole notion that people who are different than us are no better, no worse than us, seems to be a battleground today. Dr. Erica Anderson, thank you so much for the time, for coming on, for sharing some of your wisdom. I really appreciate it. If people want to keep up with you or follow your work or, you know, in general, stay tied into and dialed into this issue, do you have any suggestions on where they might be able to do that? Well, I am on social media. If they Google me, they'll find me. And I'm probably

going to have a larger profile on a couple of the social media sites in the near future due to some other things that are coming up for me. Awesome. Thank you so much, Dr. Anderson. I appreciate the time and I hope to have you back on sometime soon. Thanks a lot, Isaac. Today's podcast was produced by Tangle Media in partnership with our friends over at Impostor Radio. If you enjoyed the podcast, be sure to give it a five-star rating, share it with your friends, and go check out readtangle.com for more. Thanks for watching! trapped in a police procedural who dreams about a world beyond Chinatown. When he inadvertently becomes a witness to a crime, Willis begins to unravel a criminal web, his family's buried history, and what it feels like to be in the spotlight. Interior Chinatown is streaming

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