Uncertainty over which pronouns to use with gender diverse patients can spark anxiety for medical professionals and new acquaintances alike. But that anxiety is no match for the trauma felt by transgender, intersex and other gender diverse patients who deal with being misgendered every day. Host Lee Hawkins is joined by a panel of Mayo Clinic experts to unpack the medical importance of pronouns and why best practices in equity, inclusion, and diversity cannot be honored without using them properly.
“To be honest, if I didn’t have chronic health conditions where I do have to go to the doctor’s office very often, I would probably avoid it, because no one likes to be misgendered. No one likes to feel that anxiety. I really don’t like feeling that anxiety, especially since now that I’m farther along in doing things that do affect my gender, like wearing clothing that I feel affirms my gender, like surgery, my haircut in ways that affirm my gender. And then still being misgendered in a doctor’s office really negates all that validation that I do have, even in my queer community, even within myself.” – Jennifer Koehler
“The problem is, at the end of the day, patients get misgendered. But we have to step back and look at the cause. And I think at least within my generation of physicians, there is definitely an intention in to educate themselves, but there’s lack of education and it’s not emphasized in the in a lot of curricula.” – Fadi W. Adel, M.D.
“I think what I try to push people to think about in these conversations is that whether you intentionally do it or not, when you misgender people, when you dead name people, when you make people feel that they don’t belong because of who they are intrinsically, you’re automatically differing them, you’re automatically oppressing them.” – Patrick Decker-Tonnesen
Read the transcript:
Lee Hawkins: Welcome to the Mayo Clinic Rise For Equity Podcast. I’m Lee Hawkins, your host. And in this episode we’re talking about gender diversity and the use of proper pronouns and fostering atmospheres of equality and equity and diversity and inclusion in the health care field and beyond. We have three special guests that I want to welcome. Hello, everybody. First, we have Jennifer Koehler, who is a research technologist at Mayo Clinic, Dr. Fadi Adel who is a cardiology fellow at Mayo Clinic. And Patrick Decker-Tonnesen, who is an equity inclusion and diversity advisor with Mayo Clinic. Welcome to you all. Thank you for participating in this episode. And we’re going to get a chance to discuss pronouns and the patient experience in particular within the LGBTQIA community. Preparing for this podcast, first of all, has been really been a learning experience for me because I feel like there are many people, including myself and including many medical professionals, who are coming in at a level at which there’s so much to learn about how to respect and support our peers and our colleagues. So we thank you for your participation in helping everybody navigate through this. I want to start with Jennifer and then broaden the conversation, because in my first chat with Jennifer, they gave me a chilling account of what it can feel like to be nonbinary and walk into a doctor’s office and be consistently misgendered. Tell me how that feels.
Jennifer Koehler : Yeah. So in my time going to the doctor’s office, over the time that I’ve been out both to myself and my medical charts. My medical chart has my pronouns, which are they/them. I have only been correctly gendered twice where my pronouns are actually used in the medical setting. And this also includes doctor’s notes because as a patient I do read my doctor’s notes and it usually feels like I’m not generally being seen. I don’t feel very safe. I have something called gender dysphoria, so I do feel a lot of anxiety when I am this gender because that’s something I feel. That’s why I am non-binary. It’s part of me being non-binary as a personal thing. And so it’s hard to feel very comfortable. It’s hard to talk about trans health care issues, which I do experience, things like the fact that I would find before and seeking out something like the trans and intersex specialty care clinic. It would be hard to talk about that to a doctor that doesn’t even properly gender me. So it’d be hard for me to seek care and it would be harder for me to even feel seen as I’m seeking something very simple, like care for my migraines, which isn’t even necessarily related to my gender, but I still want to be seen as a whole person in that context, as I am seeking care.
Lee Hawkins: And you identify as non-binary as you said, please explain what that means to you.
Jennifer Koehler : So for me, non-binary means that I don’t really identify with the gender like male or female. I feel like I’m not even somewhere in between, but I just kind of somewhere falling off the spectrum. We always talk about how gender is a spectrum, and I sometimes feel like it’s a little galaxy and I’m somewhere just off of center when it comes to male and female. And when I was growing up, I was very much pushed towards being my assigned gender at birth and my assigned sex at birth. And so for me, it was just feeling this deep incongruence with that and also with my body and how I was being perceived by other people.
Lee Hawkins: How did you find out that you were non-binary and how did you come to that realization? How did you get to that point?
Jennifer Koehler : I think like most people, non-binary can sometimes be a new term, and that’s the way it was for me. I grew up in a smaller city town, Elk River, Minnesota, and I didn’t know that non-binary was a thing when I was in high school. So it was only until I went to college and actually had a LGBTQ-plus community that I could talk to you about things, that I was able to first come out about my sexual orientation to other people and actually have conversations with another friend who was non-binary, and then, like many queer people in my generation, I also went out the Internet rabbit hole of googling things and trying to find words that matched how I was feeling inside while having those conversations and realizing that a lot of thoughts and feelings that I’d had as a child are things that actually other people experience too. And there’s actually a word or a group that’s associated with that. And it’s not something that people who are cis women experience. It’s something that makes me trans, it’s something that makes me non-binary. And there’s something I can do to alleviate some of the anxiety I have around that and have a community of people who feel the same way that I can talk to you about it.
Lee Hawkins: Okay, so you reach this point and then in my first conversation with you, you told me that despite visiting a doctor office once a week, the pronouns have only been used correctly twice.
Jennifer Koehler : Yes.
Lee Hawkins: So that’s a lot?
Jennifer Koehler : Yeah.
Lee Hawkins: How does that make you feel?
Jennifer Koehler : It’s really frustrating and anxiety provoking. To be honest, if I didn’t have chronic health conditions where I do have to go to the doctor’s office very often, I would probably avoid it because no one likes to be misgendered. No one likes to feel that anxiety. I really don’t like feeling that anxiety, especially since now that I’m farther along in doing things that do affect my gender, like wearing clothing that I feel affirms my gender, like doing my haircut in ways that affirm my gender and then still being misgendered in a doctor’s office really negates all that validation that I do have, even in my queer community, even within myself. So it’d be a lot harder, honestly, to go to a doctor’s office if I did have to go on a regular basis for my chronic illnesses. And it makes it even worse that I do have to go while I’m usually in pain or seeking needed medical attention and usually just end up feeling more anxious.
Lee Hawkins: I want to bring the others into the conversation. But first, I think it’s important to note that in speaking with Jennifer, they told me that there are people that are trans and non-binary people who specifically avoid doctor’s appointments. Can you explain that? Because that’s a good backdrop for us then to go into the broader discussion.
Jennifer Koehler : I have a lot of queer and specifically gender non-conforming or trans friends who have had somewhat negative experiences or even just like one negative experience and then have gone through some transitions.
Lee Hawkins: What are some of the negative experiences?
Jennifer Koehler : Like switching their sexual orientation to be bisexual and then being approached about taking an HIV test only because they switched their sexual orientation. I also know people who have been repeatedly dead named. I haven’t had that experience, but that’s because I haven’t changed my name. But I know people who have and then go to the E.R. and get dead named repeatedly while they’re seeking care.
Lee Hawkins: What is dead named?
Jennifer Koehler : To be dead named is being referred to by your pre transition name. So for a lot of trans people, it’s very hard to legally change your name. It’s a really long process. It usually involves a court date. So people usually will put down a preferred name on their medical chart, but that won’t be the same as necessarily the name on their birth certificate. And subsequently, some of the names on their medical records. But it can usually be indicated on their chart. And sometimes when people go to the doctor’s office, they can be dead named as a result of that experience. So if you’re, for instance, a trans woman and you get referred to by your dead name, that could out you to the entire waiting room.
Lee Hawkins: And so that is on top of the anxiety that you could already be dealing with as a result of a chronic illness or something, then it’s another triggering event that affects people in all kinds of ways. I want to bring you two in. What are the reasons behind misgendering or that failure to use proper pronouns or just to show respect to gender diversity? Is it always intentional?
Patrick Decker-Tonnesen : I think I think the vast majority of the time when folks misgender or mis-pronoun or dead name other people, I don’t think most of the time it’s from a place of evil or bad intention. But I do think that the limits of our ability to understand gender as a social construction in the human context is really the backdrop for why so many people, I believe, not only don’t understand that non-binary exists and is real or being trans is, but further they can’t break out of the binary of just a man and a woman.
Lee Hawkins: Dr. Adel, you’ve done a lot of work in trying to foster EID at Mayo and we talked earlier about coming to Rochester. You were a little bit hesitant at first, right? Tell me about that. And then this notion that you said, rather than avoid it, I’m going to go and change it.
Fadi Adel: Yes. So I grew up in Baghdad, in the Middle East, and then I moved to Texas, did my undergrad there, and then med school. I was in San Antonio. And it wasn’t until med school that I came out to my peers and my family. And in med school, thankfully, I was surrounded by friends who were also passionate about LGBTQIA health. And so we were able to start a student run free clinic for LGBTQIA patients who were uninsured. And you would imagine in Texas there’s a demand for it, unfortunately. So afterwards, when I was applying for residency, I was looking at different places and I interviewed at Mayo and loved my interview. And when I was ranking the programs, it was a no brainer for me to rank Mayo as my number one program. But there was that deep sense that what is a gay, cisgender, nonwhite doing in Minnesota as a single person and especially in Rochester. It’s a very small town, around 114,000 people. It’s not necessarily the ideal place for my demographic. And so that was a little bit of a struggle.
But I eventually I was like, you know, I love the program. That’s fine. I’ll go in. And I spent the first year trying to absorb, you know, training and the environment. And I could sense that there was implicit support for LGBTQIA persons at Mayo, but not explicitly, let alone the fact that we didn’t have any education formally in terms of LGBTQIA related health, including no pronouns education at all. So that perhaps contributes to the problem that Jennifer and a lot of other patients have confronted, unfortunately. So after identifying that need, I reached out to the leadership (some of whom) were incredibly supportive of the efforts. And they were like, yes we’re behind you to start a group to try to change things.
I was fortunate to have the support of my colleagues and the leadership. So we basically started with doing a single center internal medicine focused survey, understanding the knowledge and the applicability of skills of the resident at Mayo, in terms of LGBTQIA health. And it it’s not surprising that there were a lot of gaps in terms of LGBTQIA, in terms of specifically physical exam management resources for transgender and gender nonbinary patients, and a huge proportion, more than 70% actually were uncomfortable doing physical exams on gender nonbinary or transgender patients.
Lee Hawkins: Okay, let’s back up on that, because where does that come from?
Fadi Adel: Lack of interest. Lack of education. So that also supports the notion that, we’re talking about, which is that, you know, there is a gap in education. The problem is, at the end of the day, patients get misgendered. But we have to step back and look at the cause. And I think at least within my generation of physicians, there is definitely an intention in to educate themselves, but there’s lack of education and it’s not emphasized in the in a lot of curricula. It’s not just for Mayo. And Mayo is one of the top programs in the country. So we actually try to move forward in a lot of things. But I think it speaks to how much we need to how much more we need to do to fix this issue. So thankfully, we pushed for more education and now it’s there is dedicated curriculum for LGBTQIA health within Mayo for the Internal Medicine Residency Program. We were able to establish a social group to foster collegiality and environment for LGBTQIA trainees within Mayo and people felt seen and that also honestly helps with recruitment.
When people were applying for their telemedicine residency program, I was able to connect with potential applicants who were LGBTQIA and who were in my shoes before I applied. Being hesitant coming to Mayo for that one reason. So I think we’re making progress. But of course, there is still unfortunately, a lot to be done, as Jennifer had expressed that they still encounter a lot of discrimination at Mayo. And I think the gist is for trainees, be aggressive, be explicit about your passion, be upfront, mobilize, seek help from leadership and keep educating yourself.
And understand that there are going to be situations where you people make mistakes. What’s powerful is the love and the support, the idea of the intention. You know, as an African-American, I can’t tell you how many times, especially during George Floyd, that people were anxious about even discussing it. And I would say: let’s talk about it. And that’s the idea is people showing the respect, which you obviously do. And I think it’s important that the education component of this and the role that you play in that be explained because you said that you do training, right, Patrick? What are some of the things you hit on in your training at Mayo?
Patrick Decker-Tonnesen : Yeah, that’s a great question. And I think truly for each group, it’s going to be different. And I think when I when I enter space and I’m doing a training, for example, on the topic of pronouns or working with LGBTQIA folks, it’s really critical that I get a sense of where people are and 99% of the time people have heard of the terms like pronouns or non-binary or LGBTQ more broadly, but 99% of the time they aren’t that educated about it, especially if they don’t identify as being part of those communities. So I think meeting folks where they are is important. However, and this is part of my, I think my rebellious nature – a lot of times to folks in these conversations, I’ll explain, you know, why it’s important to state your pronouns if you are a cis gender and how it helps build an inclusive space, but people push back because they don’t think it’s relevant for them to share their pronouns if they are cis-gender.
I think what I try to push people to think about in these conversations is that whether you intentionally do it or not, when you misgender people, when you dead name people, when you make people feel that they don’t belong because of who they are intrinsically, you’re automatically differing them, you’re automatically oppressing them. And folks of different backgrounds, especially in the LGBTQIA community, or folks who are gender diverse, have much lower health outcomes, much more negative experiences overall in the health care industry.
Lee Hawkins: And you mentioned mental health and suicide rates, particularly for young people, people of color, who are dealing with intersectionality in the context of gender diversity. How serious is it?
Patrick Decker-Tonnesen : It’s very serious. And I think something that is unnerving about this topic is that identify as a cisgender, white gay man. However, I’m lumped into the same population as a queer trans woman of color. Our life experiences could not potentially be more different. We might not have similar health related needs or concerns at all, but we’re lumped together. So the problem with that is that we are being asked, as members of LGBTQIA community to advocate for each other while also navigating our own trauma and stresses that we experience in health care. So, yeah, specially folks of color who are trans or gender diverse or in the LGBTQIA community, their suicide rates are higher, their levels of homelessness are higher. Their access to education is lower. So many things are working against them. And for any cis gendered, able bodied, straight person who listens to this, if you can do anything for people who are who are nonbinary or gender diverse, it’s taking the time to listen to them and actually respectfully learn their correct pronouns, learn their correct preferred name, and make the efforts to not disregard those things for them.
Lee Hawkins: We’re being a little benevolent when we say that everybody’s good hearted and that sometimes people just make mistakes because we are in a moment right now a political moment where this has been really looked at as more of a political or partisan issue as opposed to a human issue. Is that hard? Does it make your job harder when people come into this training session and they say, oh, this is just a bunch of woke political correctness? Have you experienced that?
Patrick Decker-Tonnesen : Without a doubt. Every training I do, there’s people who when I bring up the topic, just the topic, they roll their eyes or they instantly disengage, look at their phones. Because when they hear LGBTQIA or they hear gender diversity, it stands for political representation. And like you’re saying, that’s absolutely not true. It couldn’t be farther from the truth. It’s simple human care, it’s taking care of people. But I think people want to make these things political because they’re ignorant, they lack knowledge or they’re even fearful. They just don’t understand. They don’t understand because our society has so ingrained this social construction of gender into our mindset. It’s so hard to break. And that’s really just sad.
Lee Hawkins: And it’s us against them in that way, right? When really it’s about showing basic respect. Jennifer, you once had a mentor who refused to use your pronouns. Tell me about that experience.
Jennifer Koehler : Yeah. So I reached out to a mentoring program through the Research Technologists Group at Mayo Clinic, and I got assigned a mentor and I was excited, and I was like, oh, by the way, these are my pronouns, I use they/them pronouns. And I was pretty flat out told that this person was too old to use those types of pronouns. They weren’t going to be able to use those types of pronouns. And that was kind of the end of that discussion, which was pretty hard to hear at the time. And I mean, my parents are in their sixties and they’ve struggled quite a bit with my pronouns. I have a lot of grace for people who struggle with pronouns because as someone who has switched my pronouns over my life, I haven’t always gone by they/them pronouns. I understand people who struggle with that, and it’s not always intentional, but that sort of flat out refusal to accept that really it says that non-binary people are going too far. My identity is a little bit too far. It’s a little bit too much. And at the end of the day, that did deprive me of a mentoring opportunity, which was kind of hard at the time, and I don’t think that that was that person’s intention, but that was also the result, which is pretty difficult to go through was my first year at Mayo Clinic at the time, but I think we have to recognize that is something that happens and that’s something that our institutions aren’t always equipped on how to approach mentors who might deal with gender diverse candidates. And we don’t have those conversations. And a lot of people really do see a lot of non-binary people as other people because they don’t encounter them.
Lee Hawkins: Dr. Adel what kind of example do you seek to set right now as a medical professional, as someone who is committed?
Fadi Adel: I was encouraged by one of my mentors to think about the future of health care and how I would like to see it from my perspective as a gay man and as hopefully a future leader in the medical field. And what I envision is having the standard be changed. So, for example, now when we when we introduce patients to each other, we’re saying this is a 55 year old man. We don’t use cis or trans man. And I think we need to be cognizant of that. We now have a better understanding that gender is not as black and white that we used to think.
Lee Hawkins: The pronouns can now be put on the chart.
Fadi Adel: Absolutely. So that’s another thing. You hit the nail on the head with this one – we should introduce them as cis or trans or however they choose to identify and we use we should use their preferred pronouns. The other big thing is in internal medicine, and as part of medical subspecialties we do ask about the patient’s sexual history. And when we ask about their sexual history, we simply ask, are you sexually active? And we kind of stop right there and we assume that if they’re a cis man, they’re that they’re active with cis woman and vice versa. We don’t we don’t discuss any further which is really unfortunate because we miss really helping the patient get the best health care that they can. So I think these are only a few things that we can do right now and it doesn’t even have to be in the far future. And hopefully we all get to get there at some point.
Lee Hawkins: Jennifer in a previous conversation, I asked if there were queer podcasts that I could listen to in preparation for this panel and for my life going forward in general, just to become better informed. And I want to read the response that they gave. My favorite episode is called Q was Growing Up because it tells the story of a trans childhood full of joy, which I personally appreciate. People don’t realize that for trans people there is euphoria that comes with small changes that match one’s internal gender identity. This is often overshadowed by stories of trans pain, trauma and isolation. Was that moment that the pronouns were used correctly an example of a health care professional inspiring joy?
Jennifer Koehler : Yes. Usually when I’m in spaces where my pronouns are used or I’m in a care setting where my pronouns are used, it’s like a moment where I feel seen and taken care of. And that is a moment of joy for me. I shared with you that I had a surgery recently. I had surgery, which went very great for me and my nurse correctly gendered me the entire time, she was one of the best nurses I’ve ever had. And not only was she great at her job, but the fact that she correctly gendered me and used my personal pronouns made that experience so much more incredible for me. Even though I was in pain, I was right out of the O.R. I was so happy. I felt so seen. And I think sometimes we talk about what health care looks like when it’s done wrong, especially in the context of trans people. We talk about what it means to be misgendered, what it means to have to educate your doctor if they don’t understand certain aspects of trans care. And people often don’t realize why pronouns matter. And it’s because it does affirm our identity and who doesn’t want to be validated in who they are? I mean, I do. And so when someone uses my pronouns, what they are doing is they’re saying, I see you and I know that you exist as a non-binary person. And at a time when a lot of the things in the news, in the world sometimes do tell me that I don’t exist. That’s a very lovely and affirming thing to do when you’re giving me care as a patient.
Lee Hawkins: What’s powerful is that we’re sitting here having this conversation with the backing of Mayo Clinic. And so it means that there is progress, that there’s plenty of progress, and there are actionable things that people can do from the time they stop listening to this podcast. What are those things? You want to go first, Patrick?
Patrick Decker-Tonnesen : Yeah, sure. I think there’s a huge need for self-education and I know a common thing that we say in the diversity education space is if you’re not sure about a topic or a conversation or a different group or a population of people, Google it. Google is available and accessible to everyone. Type in non-binary, type in the social construction of gender. And I think that simple little act can go a long way.
Lee Hawkins: Just to interject, I think it’s important to say that most of the people who I have met in dealing with Mayo Clinic, these are very committed people who have worked their whole lives to become to reach the pinnacle. And they are serious about their patients. What I think is powerful about that is that now there’s an opportunity for people to see when they’re feeling their patients, if they’re not observing this. So there’s the altruistic side, but there’s the capitalistic side because this is a business and if people don’t feel comfortable, it’s going to affect the business and maybe even liability, right. Are we at that place now?
Fadi Adel: I mean, I completely agree. I think there’s still a lot of progress to be made. But like you said, the fact that we’re sitting here chatting about this openly speaks to the fact that Mayo intends to make serious progress on these issues. So I completely agree. And I think one of the takeaways, if I were to offer, I would say definitely in terms of education, educate yourselves. And if you’re in a position that allows you to shape the curriculum in any way, shape or form, please do make sure that there is inclusion of the LGBTQIA health topics and fostering an environment that allows your LGBTQIA personnel to thrive. As Jennifer said, when we feel seen, we thrive. We do better. And be bold. If you educate yourself, be humble. And yeah, that’s all I want.
Lee Hawkins: Jennifer, what is it that you would like to see the medical community do? What actionable measures can the industry take to get to where it needs to be?
Jennifer Koehler : I think that where we are right now is a place where a lot of trans medical care hasn’t been included in the medical care system for a very long time. And what we need are some doctors and physicians and also health care administrators and people who are in charge of things like Epic to recognize that some of these systems aren’t created for patients like me, and that doctors don’t always think that they’re going to have a trans patient. And so they’re sometimes underprepared. They do get one because they’re not educated. So I agree that taking that initiative with education, if you’re an internal medicine physician, do you know what binding is? Do you know how to treat a patient who comes in and is actively binding?
Lee Hawkins: Explain binding.
Jennifer Koehler : So binding is something I engaged in and that’s usually the thing I can speak to the most. It’s usually done with a compression chest to relieve chest dysphoria, so it compresses your chest and makes it look more masculine. Some people bind for their entire lives. Some people like me bind for a short period with the hopes of surgery. It can cause a lot of physical discomfort. It can cause a lot of pain and chest issues, tissue damage, neurological pain. But a lot of people don’t stop binding because of this. And very few people actually reach out to their doctors. When I was thinking about binding, I went online in search of trans community resources about how to go about binding in a safe way because, and even when my doctor found out that I was wearing what’s known as trans tape, which is a way to bind, my internal provider didn’t know what that was or what it meant.
So that really created a gap in care that I could have been provided because I did have blisters as a result of that, but it was beneficial enough to my mental health that I was going to continue anyways. And when we think about those gaps in education, that’s a very serious gap. And there is very little understanding in that area. So how are we going to treat these patients? How are we going to deal with things that such as trans broken arm syndrome, which is a term commonly referred to in the trans community about trans patients who go in and some of their medical conditions are assumed to be due to the fact that they’re trans due to the fact that they have gender dysphoria. If these are common terms that are associated with our medical community, how are we going to address that in the way that we treat our patients, the way that we educate our doctors about the fact that this is something that some people might assume when they go to the doctor. How are these the steps that I feel like we need to take to address people who have been cut out of the system and have turned to other resources instead.
Lee Hawkins: And what’s really alarming is that there was only one study or a few studies.
Jennifer Koehler : There were two papers.
Lee Hawkins: Done on binding.
Jennifer Koehler : On binding. And the health effects of binding.
Lee Hawkins: And despite the prevalence of the issue and how many people are going through this experience so that exposes the disparities in the research.
Jennifer Koehler : The first one was published in 2016 and until that point there had been no research into binding and it was mostly about care seeking. So it wasn’t even about the physical effects of binding and what could be done as a result of that. It was about whether or not trans people or non-binary people were actually seeking care.
Lee Hawkins: So maybe this is another opportunity for us to see the various ways that the body of research, the care, that everything can be improved and brought to the next level for the next generation. Because I don’t believe that you’re going away and I’m sure there are many, many millions of people coming behind from generations who are unapologetic about wanting gender diversity to be respected. So this is something that whether people are ready for it or not, it’s here.
Jennifer Koehler : And if people like you are out there, we will go to those doctors. Dr. Dupree, you mentioned I have referenced her as a as a good doctor for LGBTQ people in Rochester, because I know and people have asked, like, is there anyone? And so, like, when we hear about someone who is doing a good job, queer people know this. Gender diverse people know this. And we will go to those people who will give us gender affirming care.
Lee Hawkins: Because you’re familiar with the complexities and the nuances that of culture and what it means when people come in and not have to worry about that extra layer of education. So it means the world. Is there anything that I didn’t ask that I should have asked to put this in proper perspective, especially in terms of statistics or anything like that? Or do you feel that we hit it off? Well, of course we didn’t. But there’s more to be done, and we will be doing more, hopefully.
Patrick Decker-Tonnesen : I just want to add one thing, and I think in this context of talking about research, this is really critical. I think right now we are at an important moment where research, especially regarding youth who are gender diverse, is really being attacked from everywhere. So I think we need more folks to do research on youth who are gender diverse because the less research we have, the more likely it is that gender affirming care for youth is going to continue to be attacked and continue to be taken out of the system. So I think that’s almost a plea to folks to take up that call.
Lee Hawkins: And we’ve seen this throughout history. People become hostile to things for decades. And then there’s a critical mass and then things change over time. But we have an opportunity to prevent injustice now and medical injustice that ends up with people being injured, right?
Fadi Adel: Absolutely. Now, I wanted to add to the same point that Patrick mentioned, which is the dearth of research in terms of LGBTIA health, especially in gender non-conforming patients and gender nonbinary and trans patients. And I can speak from cardiology standpoint, we don’t have a lot of knowledge yet when it comes to such patients. And for it to give you an example, when we do stress testing on a patient, especially stress echo, we have certain parameters that we use that are specifically based on cis men and cis women. But when we encounter a patient that doesn’t fit with that, with either of those buckets, we sometimes struggle in terms of interpretation. So I think I think that definitely there are a lot of important gaps that need to be addressed in research.
Lee Hawkins: And once again, I want to thank you all. You’re just excellent. This has been a really educational experience for me and I’m sure many others. So thank you very much.
Jennifer Koehler : Thank you.
Lee Hawkins: This has been Mayo Clinic’s Rise for Equity podcast. I’m Lee Hawkins. We’ll see you next time.