Parenthood brings huge life changes — all of which can be more challenging if you don’t fit the traditional, heterosexual family mold. Author Krys Malcolm Belc discusses his book reflecting on his experience as a trans parent from pregnancy and beyond. Mayo Clinic’s Dr. Caroline Davidge-Pitts explains how health care professionals can support gender diverse patients.
We talked with:
- Krys Malcolm Belc is the author of “The Natural Mother of the Child: A Memoir of Nonbinary Parenting.” His essays have been featured in Granta, Guernica, The Rumpus and elsewhere.
- Caroline Davidge-Pitts, M.D., is an associate professor of medicine and associate practice chair of the Division of Endocrinology, Diabetes, and Nutrition at Mayo Clinic Rochester. She is the medical director of the Transgender and Intersex Specialty Care Clinic.
We talked about:
In this episode, Dr. Millstine and her guests discuss:
- Navigating nontraditional parenthood. From defying your parents’ expectations to strange looks from strangers to having to adopt your own children, Krys talks about his experience with fertility treatment, pregnancy care and parenting as a transmasculine parent.
- Navigating the health care system. How can health care providers make parenthood more accessible and comfortable for gender diverse people? Krys and Dr. Davidge-Pitts have some ideas.
Can’t get enough?
- Purchase Krys’ book “The Natural Mother of the Child: A Memoir of Nonbinary Parenting.”
- Want to read more on the topic? Check out these articles:
- If you’ve got ideas or book suggestions, email us at email@example.com.
- We invite you to complete the following survey as part of a research study at Mayo Clinic. Your responses are anonymous. Your participation in this survey as well as its completion are voluntary.
Read the transcript:
Dr. Denise Millstine: Welcome to the “Read. Talk. Grow.” podcast, where we explore women’s health topics through books. In the same way that books can transport us to a different time, place or culture, “Read. Talk. Grow.” demonstrates how books can also give a new appreciation for health experiences and provide a platform from which women’s health can be discussed.At “Read. Talk. Grow.” we use books to learn about health conditions in the hopes that we can all lead happier, healthier lives.
I’m your host, Dr. Denise Millstine. I’m an assistant professor of medicine at Mayo Clinic in Arizona, where I practice women’s health, internal medicine and integrative medicine. I am always reading and I love discussing books with my patients, my professional colleagues, and now with you.
Today’s guests are Krys Malcolm Belc, who’s the author of “The Natural Mother of the Child: A Memoir of Nonbinary Parenthood.” His essays have been featured in Granta, Guernica, The Rumpus, and elsewhere. Krys lives in Philadelphia with his partner and their young children.
My other guest is Dr. Caroline Davidge-Pitts, who is an associate professor of medicine and associate practice chair of the Division of Endocrinology, Diabetes and Nutrition at Mayo Clinic in Rochester. She’s the medical director of the Transgender and Intersex Specialty Care Clinic and is a leader in national groups focused on these topics. Her research interests center around long-term effects of gender affirming hormone therapy, and she works to improve medical education on transgender health. Welcome you both to the show.
Krys Malcolm Belc: Thank you so much.
Dr. Caroline Davidge-Pitts: Thanks for having us.
Dr. Denise Millstine: Krys, last year I was on NetGalley and I saw that your audio book of “The Natural Mother of the Child” was available, so I requested it, and your publisher was kind enough to grant me access to it. I experienced your book as an audiobook, which you actually read.
Just this week, in preparation for talking with you, I read the physical book, and I have to say it’s a very different experience. Before we delve into the healthcare topics, give us a little insight into how different your book is as an audiobook compared to the really creative and amazing format in its physical form.
Krys Malcolm Belc: When I was writing the book I was really thinking of it in the form of a scrapbook or a family photo book where I was compiling family documents and all the legal documents that had accumulated in my family from adopting our children. Then I legally changed my name in 2017, and my partner and I had gotten married a couple of times because of the changing marriage laws.
I really compiled it as a compendium of documents and wrote around and against the documents. Then I love audiobooks and I was very excited that my book sold in audio, but it was a very different experience recording the audio.
I really just read it straight through and if you purchase the audiobook you can get a PDF of some of the images, but it just doesn’t quite align the same way. I do think that readers’ experience probably varies quite a lot. I’ll say that in the audio version you are getting my voice, and that was really important to me that a trans reader read the book. I like that it’s me because I think I’m good at reading, but also anyone with a very stereotypical transmasculine voice. I was glad to be able to do that and bring that extra layer. But ultimately, I think the pictures are really essential to understanding the full scope of the book.
Dr. Denise Millstine: I enjoyed it as an audiobook. I just didn’t appreciate how different it was going to be in its physical form. So thank you for giving us some insight. I’m a huge audiobook reader because it just is an efficient way for me to read while I’m getting other things done, so I really thought it was wonderful, truly in both forms.
Dr. Davidge-Pitts, your work centers on the care of transgender and intersex patients. Tell us how you came to work in these arenas because we all know the world needs more people like you.
Dr. Caroline Davidge-Pitts: Absolutely. As much of it probably was in your introduction, but I’m South African, so excuse the accent, but yeah, so we moved to the U.S. in 2008 when I did residency. So prior to that I’d obviously spent my whole life in South Africa, and I remember clearly through medical school, having experiences in very rural, low income communities.
I have this very stand-out event in my mind as a medical student just coming onto the wards. I remember in one of our emergency department visits, I met a trans woman who had come to the clinic for the E.D. for other reasons, but, she was clearly struggling with a lot of health issues related to having lower income status and then also being gender diverse in probably a community of that time that was very unaccepting and also not having the access to care clearly that she needed with respect to hormone therapy.
I thought to myself at that time: “I would love to help this person so much more than this particular moment in the E.D.” I’ve always loved reproductive health. As I continued my journey in medical school, I was also exposed to a lot of what Caster Semenya, who’s a South African runner, had gone through as part of her process to become a competitive runner.
It was such a pivotal moment for me at that time as well, because I thought to myself: “Gosh, I would love to be on a panel of experts for Caster so that I can advocate for her and what she is looking to do in her athletic career. These moments really shaped me, even though they were such discrete moments.
I was so fortunate when I completed my fellowship here at Mayo that my colleague Todd Nippoldt was starting our transgender clinic in 2015. I remember speaking to our chair at that time and I said: “This is what I want to do… This.” I have been involved with our trans clinic now since 2015, since it opened, and we have now seen over 1,500 patients at this point. We provide a full service, under one roof, with respect to gender care, and it has been the best decision and the best career path for me as possible and it’s been a true honor.
Dr. Denise Millstine: Krys, the book’s subtitle is “A Memoir of Non-Binary Parenthood,” but you start your experience with the fertility clinic sitting there with your older son Sean, and you move through the medical aspects of your pregnancy, which are traumatic and really medicalized. You say, “No one ever mentions the pregnancy or the child. They talk about your results or the scan.” What do you want our listeners to know about approaching that process? Things they should be thinking about as they start the fertility journey?
Krys Malcolm Belc: It’s so interesting to think about now just because I was writing the book quite some time ago, it takes a couple of years for books to be published and then out in the world, and the book came out in 2021, so when I got pregnant with my son Samson in 2012 and had him in 2013, I was not seeking fertility care because I was infertile. I didn’t have any fertility problems that were known. That clinic has a pretty large-scale reproductive endocrinology clinic that I think they have a lot of queer clients, but generally that wouldn’t be the bulk of the practice, so I felt very much like I was being treated similarly to folks who had been trying to get pregnant for a very long time, and that just wasn’t the case I was in.
We just needed assisted fertility because we needed sperm. I’m married to a cis woman, so we both have uterus and eggs. But then later on, I’m now 36 weeks pregnant at the moment and I actually found out when I tried to conceive this time that I had diminished ovarian reserve, so my endocrinologist who’s the same one that I saw 10 years ago, did not think that I had a very good chance of getting pregnant with my own eggs this time.
I’m actually pregnant with Anna’s baby. Most people would call reciprocal IVF. My insurance at the time covered egg donation from a live donor to treat infertility, so I was extremely fortunate to be able to access that medical care, and I was very grateful that my care was medicalized because I had a medical need for it.
I guess at the end of the day, it’s difficult because you can’t control the scale of the practice that you’re using, and I saw an endocrinologist who is very trans and queer-confident, so that was my primary goal. But that doesn’t really change the attitudes of that nursing staff or the front desk staff. They’re just seeing so many people for monitoring every day that it just was not particularly catered to when I first got the care.
I will say that I think it was a little different the second time because I had been on testosterone for a number of years and was male presenting in a way that perhaps the first time I had not been. I was more androgynous, and I do think that the staff was — I don’t know if I would say nicer to me, but they all remembered my name, which I don’t think would be true. You have plenty of women coming for blood work in the morning, and one dude, you’re going to remember the guy’s name. So I did feel like it was a little bit more catered towards me.
Probably just because of the beard and my voice and stuff like that. But I do think that ultimately when I talk with healthcare providers about the healthcare that I’ve received, I really think individualizing the way that you’re addressing people is going to solve a lot of the problems that come up, whether that’s not treating someone who doesn’t have a fertility diagnosis as if they’re infertile and acting like it’s this opaque procedure that they can’t get excited about or whatever the case may be, which is how I felt with the first kid, or in the pediatrician’s office not calling people mom and dad. If you’re not sure, just take a second to look at the person’s name because it appears under the child’s name. I think anything you can do to individualize how you’re addressing someone is going to stop a lot of those problems and will probably save time because it takes two seconds to prepare on the front end versus fixing the problems on the back end.
Dr. Caroline Davidge-Pitts: Krys, I totally agree with you. When we had initially formed our clinic here, we had developed this bubble where everyone was affirming, the front desk staff was trained, and, we had a lot of good feedback that things were going well, but you realize that you can’t live in this bubble in healthcare and that what if what if our patients were coming for abdominal pain?
They’re not going to necessarily come to our corridor, at endocrinology, where everything is really well thought out. In the last five years or so it’s been a really big initiative of ours to extend that education on all these types of things that you’ve just brought up on a larger scale and the challenges that come with that.
If you think about the O.R. the unit where you recover after surgery and how many people are involved in each of these person-to-person interactions, it’s a huge challenge, especially when you have a larger institution. It’s all the more reason that we need to continue to advocate that this will be done because we want that experience to be the same for any person coming for healthcare, no matter where they go in that healthcare institutional clinic.
Dr. Denise Millstine: Well, congratulations. This is so exciting.
Krys Malcolm Belc: Thanks so much. What’s one more? You know?
Dr. Denise Millstine: This is now your fourth and a pretty big gap between this one and is it ZZ?
Krys Malcolm Belc: Yeah, ZZ is about to turn 7, so it’s been a minute. I don’t remember how to hold a baby or do any of the things. My partner is a labor and delivery nurse, so she is a baby expert, but I am far from that. I’m hoping that we ease back into it pretty seamlessly this time.
Dr. Denise Millstine: I think on the fourth it’s kind of like riding a bike. I’m sure you’re going to be up to skills within moments of the baby coming into the world. In the book, with your first pregnancy, you mentioned moving to a neighborhood and one of the neighbors said to a friend of yours, I think the man in that couple is pregnant.
I imagine that’s a comment or something that maybe the world is more open-minded now, hopefully. Tell us a little bit about what that’s like and how you’ve learned to navigate those comments or those glances.
Krys Malcolm Belc: This time is very different. We still live in the same home and neighborhood that we did the first time, so people kind of know me now. I moved there in my third trimester with my first pregnancy, and I moved from an area of Philadelphia that’s extremely queer to this neighborhood, which is a little bit different.
But I think this time I was much more proactive about getting out ahead of it and telling everyone before I was visibly pregnant like: “We’re having a fourth baby and I’m the one who’s pregnant.” Just so it would not be surprising because now I have school-age children, so I’m just in touch with a lot more neighbors and people in the community.
It was a little bit difficult. I recently left an office job at a medical clinic that I had had for about three years on a very large team, so the people that I worked with every day again I got out ahead of it and was telling everyone that Anna and I are having another baby and I’m the pregnant one just so that it wasn’t strange when I started looking pregnant.
But in terms of the nursing staff that I didn’t know everyone’s name and they wouldn’t necessarily know my name, I was just some guy who had a desk job there, I was like, “I guess it’s just going to be slightly confusing for people and that’s going to have to be fine.”
I remember seeing Anna, being pregnant twice, how she described it as like a very public thing where people would frequently comment on her body and come up and talk to her, and when she was working her patients would ask, “How far along are you and is it a boy or a girl?” They would just start conversations. Not one person has talked to me in public about it.
I’ve never had a single person bring it up this time, and I’m like a fairly small-framed person. So I think it’s obvious that I’m pregnant. I’m just not just like a fat guy and not a beer belly. I think I’m very obviously pregnant, but I think living in a major city where there’s lots of queer and trans folks, I think people are afraid to be wrong or to say something wrong, so nobody says anything, which I honestly I’m pretty happy with.
I think that last time when I was a little bit more androgynous presenting, I did have more people kind of chat me up about it, and that felt slightly uncomfortable to me, which I think is not an experience limited to trans people at all. I think a lot of people are uncomfortable with the idea that their body exists for public consumption for this time, so I feel super fortunate.
I have felt nervous that I would have to seek medical care for some other reason like whether it was a tooth breaking or I had to go to urgent care because I was in an accident. That has been a big anxiety for me that I would have to present for medical care that was not related to the pregnancy, because I think that’s a space where I felt pretty uncomfortable in the past.
But that has luckily not happened. My health luck has been really great during pregnancy, so I haven’t had to go to a place where I would have to actually explain the pregnancy. It’s just been closed in my community in a way that’s been really nice.
Dr. Denise Millstine: I think it’s interesting. There’s, I guess, a couple of ways or several ways to see that. When Anna was pregnant people would say, “How far along are you?” In some way they’re sharing her joy. Perhaps at some points it’s people being nosy, but it’s probably speaking to your personality that even though you’re an author and have put your memoir publicly into the world, you’re not necessarily wanting people in your personal business, but I suspect there are other transgender males who are pregnant who would like people to share their joy with them because it takes effort and it’s an exciting time.
Krys Malcolm Belc: I would imagine that that’s really difficult. I feel lucky that I have a pretty social life, so I have people to share it with. It’s also so far from my first child. My first parenting experience was with Anna giving birth to Sean, and we had a baby shower.
It was much more life changing. Not that a fourth baby isn’t life changing, but it was much more of a public and monumental event that we were the first of our friends to have children because we were in our twenties. This time I don’t know anyone who lives in my neighborhood who has four children.
All my kids’ friends are only two children and three is a lot. I think regardless of how a fourth baby came around, I’m one of six, and I think by the fourth one, nobody was really making a huge deal out of my mom having a baby, so I feel like it’s a mixture of those like I’m-afraid-to-say-something-awkward-to-this-trans-guy-who-I-think-is-pregnant-but-I’m-not-100%-sure, and also, “These people already have a bunch of kids, and this is kind of old news for them.”
Dr. Denise Millstine: There they go again. Caroline, talk a bit about how you help your patients select birth centers or how to get care during pregnancy.
Dr. Caroline Davidge-Pitts: I might back up first a little bit on that question because I think one of the struggles I see with healthcare providers in general is they really struggle to get past really basic questions when it comes to fertility, contraception and family planning. The question might be, something that people might learn in med school is, are you thinking about having a family one day and that’s very much a yes or no answer and really doesn’t get into the specifics of what that family might look like. I challenge a lot of healthcare providers to really try, obviously, if it’s appropriate, to get into more specifics about how someone envisions their family someday. A little bit to what Krys was saying. When someone says that they would like a kid, do they want a kid with their own biological material or are they thinking about more of an adoption process?
You would have a very different conversation with someone about that depending on which way they would answer. Then who’s going to carry the child? What does feeding the child look like for your family? All these different layers of how we love the modern family and how every family can be different and that’s something to be celebrated and so great.
But as a healthcare provider you can’t help that person and their family if you don’t really understand where they envision that moving forward. Here at Mayo, we started to see a lot of issues with our transmasculine patients who are pregnant in the sense that they were fearful of getting care. So Krys, you mentioned how, for your general healthcare needs, that might be an uncomfortable space.
We were unfortunately starting to see pregnant patients coming in really late in pregnancy because they really just weren’t sure how to even navigate a healthcare system where they presented very masculine. We actually had a full meeting with our birthing center and trying to figure out how we can we support our transmasculine patients so that both they and the baby are healthy, and we ended up making patient education material that we’ve now given out to all our family medicine providers, OB-GYNs.
We’ve provided an education, and so we’re really trying to have specific information for both patients and healthcare providers so that we can support this group, because if we can reduce that fear, if we as healthcare providers can make a comfortable space for everybody who is pregnant, then that’s only going to lead to successful outcomes for everybody.
Dr. Denise Millstine: Let’s talk about the parental figures in your life. Krys, you talk about your father, your in-laws, some of whom didn’t entirely embrace your life as a transgender man. You write about it with grace, but certainly it’s not a unique experience to you. Talk a little bit about that.
Krys Malcolm Belc: In the book I write about both Anna’s parents and my parents. Her mom actually died in the book. I write about her mom dying of brain cancer a little bit because I think one of the key things about writing a memoir about having a baby and being a parent is other stuff’s happening to you. There’s stuff happening in the world and other people’s problems are kind of coming into your life. Anna was raised in Poland and came to the U.S. in middle school and I think was from a very insular and religious family that didn’t really get what was happening with her family. It was like, “All right, well, you’re telling us you’re gay and now you’re with this lady, but now you’re telling us that it’s not a lady anymore, and that’s just a lot to wrap our minds around that.”
Although her parents were excited for us to have children, I think they had a lot of fears about what that would mean for them, not having completely understood the context in which we were raising our kids in which it’s not it’s not really the biggest problem in their life. They’re concerned about whether they’re going to get enough video game time. They’re just not worried about whether their parents are trans or not. I think with my parents, it’s very interesting because growing up as the oldest of six kids it’s like, yes, I had some difficulty telling them about my queerness and having them understand and accept the level to which I was masculine.
Then my decision to take hormones, and to present more as male. But I do think that having children has healed a lot of the old problems because they’re like very actively involved grandparents and they were very excited to have grandchildren. My family of origin has a lot of folks who came to the family and ways other than through the nuclear family structure.
They were like, “Yeah, we don’t care who is related to whom, or any of that. We’re good. We’re just excited.” I’m the only one of my siblings who has children. So it’s like that, you know, that they’re the only grandchildren in the family and that’s super exciting. I do think that it’s been a little bit of an adjustment for my parents to watch me parent my children in a way that’s obviously aware of the things that I think I wish I had had.
There are a lot of things that in my childhood were really great. It was very active and rambunctious and just loud, and I love that. Every day felt like a holiday. There were so many of us. That was a really fun part of growing up. I did feel very restricted at my gender presentation, and my family’s religious, so I was kind of in that religious tradition.
Then my kids have had a lot more flexibility in what they’re allowed to wear and how they’re allowed to think about their own gender and relationships to each other, and they have always called me by my first name, which I’m sure horrified my parents at first. They’ve had to adjust, but I do think that although in writing about the way that they parented me as a child, there’s obvious wishes that I had, like that things had been different.
I think that they’ve been amazing parents to an adult, like really a great model of how to accept that your child is an adult and they’re going to make adult decisions, and if you want them in your life, then you’re just going to have to roll with those. If I was making a truly terrible or dangerous decision, I know they’d say something, but if it’s like Krys is going to just let his kids wear a dress even though they’re assigned male at birth, and we’re just going to have to not say anything. Because if we say something we won’t have the relationship that we have anymore. That has been really nice and it’s been really great and healing to see that they have been flexible in a way that they certainly were not when I was growing up.
Dr. Denise Millstine: We make a lot of assumptions about how people will respond and how willing they would be to change, but you’re describing a situation where while it’s not perfect from the get go, giving people the chance and the grace to come along with how things might be different than they thought they were going to be, they too can be loving, supportive, engaged and excited about the expanding family.
So, Krys, you mentioned a bit about starting testosterone after you had Samson. Caroline, this is a process that you walk many, many people through. Talk a little bit about that.
Dr. Caroline Davidge-Pitts: At Mayo Clinic we follow something called the WPATH Standards of Care, which is fairly large documents that outlines, you could say, best practices for healthcare centered around transgender and gender diverse health. There’s actually an updated status of care that was just released within the last week or so that outlines what’s deemed criteria for initiation of hormone therapy and then also surgical care, whatever that surgical care might look like.
I would say from a hormone therapy standpoint, we really try to break down the barriers with respect to access to hormone therapy, and so as long as someone doesn’t have any medical or mental health issues that could be interfered with by hormones, which is actually not many, and we’ve shown that that individual has persistent gender incongruence, then we really, as I said, try to break down those barriers to access.
Of course, in the medical side, we do that full medical evaluation for anything that could be exacerbated by hormone therapy. If nothing is found and that individual has gender incongruence, then we usually can proceed with hormone therapy at that time. Here at Mayo we do have a lot of behavioral health support. This really optimizes the journey for that individual.
So we realize that an individual thinking about their embodiment goals, it’s one path when we’re thinking about those physical changes that will occur, but we realize, of course, that there are all of the social aspects of things. Coming out to friends and family and how does that change relationships and how do you tell your kids, if you have kids already?
We really try to embody that team environment where we can support all our patients depending on what their goals are going to be. We actually have a close relationship with our patients on hormones. We will see them every three months or that first year, and we’ll ensure each time at that visit that things are going as planned and that there are no concerns.
When it comes to fertility and family, then when we have to have more discussions, we always at the start will have a discussion about how hormones impact fertility and what it would look like if someone chooses not to let’s say pursue fertility at that time and may want to do it later in their life.
Then, of course, what it would look like for that individual depending on their family needs, if they may or may not need to stop their homelands for a period of time. Once again, how can we support that person, number one, if they have to come off their hormones? That can be a very stressful event for individuals, particularly who’ve been on hormones for a while.
Then also ensuring that individuals who are pregnant, whether it’s planned or not, that that doesn’t also exacerbate some dysphoria during that time. So supporting them through the pregnancy and birthing and feeding, it’s just really making sure we’re the partners to those individuals the whole way through.
Dr. Denise Millstine: I just want to highlight one of the first things that you said, which is that the guidelines were just updated. So if someone is seeking initiation of hormone therapy, they would probably want to make sure that their team is utilizing the late 2022 guidelines and not anything that was prior to that because it’s something that gets updated fairly frequently.
Dr. Caroline Davidge-Pitts: The last one was actually just about 10 years ago, so it was definitely due for an update.
Dr. Denise Millstine: So we have to talk about the legal aspects of having to adopt your own children. In the book you go through the documents, you go through the second parent adoption and how complicated that is. Even though you and Anna have always been the parents of these three children, soon to be four. Talk a bit about that, Krys.
Krys Malcolm Belc: It’s really interesting. This is something that varies greatly from state to state from my understanding, but a birth certificate does not convey parentage. A queer couple who are not both the genetic parents of a child, and as far as I understand it, every state needs to go through some process to secure actual legal rights, and in most states you still need an attorney because it’s like a court appearance and a lot of filings, I think some states like New York and Washington State and California have tried to make it easier where people can do it without the cost, especially, and the hassle of the legal process.
But we have always used an attorney and filed in court to do that and showed up for Adoption Day with a lot of other kinds of families doing adoption. It’s a celebratory day here in Philadelphia, Adoption Day for everyone. But it’s also like, “Yeah, but we’re also spending all this money on doing this.” I had been lucky with our first three children. I was a public school teacher and my union benefits covered adoption costs, so my legal fees were mostly covered. I just had to pay court filing fees.
I’m no longer a public school teacher, so it’s going to be significantly more expensive this time. It’s interesting because I think that a lot of queer families that I’ve talked to, the parents will be very offended by the machinations of the court coming into their lives, especially in states where there’s like a home visit with a social worker or any of that kind of stuff.
I personally, because my children are known donor conceived, so we’re in touch with the person who’s their biological dad. I don’t want him to have responsibilities towards these children, and I don’t think of him as a parent figure because he’s not actively parenting my children, but they’re allowed to conceive of him in whatever way that they want and I wouldn’t be offended if they considered him family. I have a slightly more expansive view of what his role might be in their adult lives, if that’s what they want or their lives now. They’re not particularly interested right now, but if they developed an interest, I would be open to that. I haven’t felt offended by it because he needs to be protected too. He needs the assurances of the system that we’re not going to come after him for child support or my kids are not going to ask for college tuition or what have you.
But it is a really surreal process to appear in court with your family and be like, yes, we’re adopting our children, but we have been taking care of them the whole time. Nothing is really changing as a result of this.
The fact is, based on the dynamics that I describe in the book and talked a little bit about earlier, we were very motivated and slightly fearful with Anna’s biological children that if something happened to her, that her parents would try to take our children. So, we were very, very, very motivated to do that, and then my biological child, Sam said, wasn’t adopted until he was like almost three because we were like, “Whatever, we’ll get to it when we get to it.”
It is, I think, a process that is overly expensive. It’s inaccessible for a lot of queer families who, the cost of fertility treatment, pregnancy and birth in America, child care. They’re all great barriers to lower income people accessing parenting to begin with, but then anything additional that’s going to cost thousands of dollars. A lot of families don’t really get to it because it’s too expensive.
That’s a huge problem. It should not be stigmatizing. It should be something that should be very accessible and affordable for families. It’s really not where I live. It’s not accessible, it’s not affordable, and it’s slightly intrusive. I wish it was different, but I understand why it exists. In a way.
Dr. Denise Millstine: Navigating just even the legal aspects of your life takes a lot more intention and attention than mine has as a cisgender heterosexual person. I’m sure that Caroline, you have had to walk through this with your patients, not only in terms of parental rights, but Krys, you mentioned getting married twice. The first time because you wanted to legally be married in a place that recognized your marriage as a marriage. But Caroline, tell us a little bit about some of the legal aspects of how you help your patients.
Dr. Caroline Davidge-Pitts: From an endocrinologist standpoint, we will often provide letters whether the individual wants to change their name on social security or passport or driver’s license, birth certificate. We provide a lot of documentation for our patients in that way. We’re lucky here in Minnesota, a very affirming state in general, and so we usually don’t run into too much trouble helping our patients with that.
The other legal part that we often get involved with is when insurance companies have such variable coverage of certain services, particularly, for example, surgical services such as facial surgery. Sometimes we will also help advocate for our patients to be able to get these lifesaving and very medically necessary surgeries covered, and we will often utilize legal advocates and legal services to help with their case to get that covered.
Once again, that just really speaks to our behavioral health team, social work really being involved from the start because we can really try and help with all these additional services that are often needed.
Dr. Denise Millstine: The surgeries get lumped into a more cosmetic bucket of healthcare instead of really, like you said, being medically necessary. It takes advocacy. All right. I promised we’d talk about the food. You start with wah wah as Sean’s being born, and then there is everything, all the snacks, the milkshakes, the caramel that is clearly a big part of your life. Krys, talk to us about what an amazing cook you must be.
Krys Malcolm Belc: I really love food a lot. A lot of the writing I’ve been doing recently is much more like straight writing because I found that when I was writing the book some of the subject matter is a little heavy and it’s about ambivalence about parenting that I think somewhat has to do with gender, but it also is something that a lot of people who just experience parenting regardless of their gender.
But every time I would try to provide any levity or shake things up, I’d be like, “Well, I also baked the cake? I was right about that.” I feel like it’s something that I gravitate towards and I’m trying to bring joy into my writing and I find that a lot of the activities of daily parenting with young children, because my kids are very young and I wrote the book, my oldest is now 10, so I’m in a slightly different phase of parenting where you do more varied activities and some of them are like having real adult conversations and things like that.
But when they’re little, you’re like changing diapers and cleaning up after them over and over again and going on walks just so they won’t mess up your house again. The only thing that I like doing out of all those things is cooking. I don’t want to just complain about these kids because they didn’t ask to be here.
The book makes it clear that I went out of my way to bring them here. I want to also focus on the things that bring me joy in what I’m doing and preparing everybody’s meals is one of those things. The caveat is that my kids are deeply spoiled in what they eat. They’re not picky.
They just have high standards because they get a lot of my cooking. I’ve explained to them that when someone has a baby, they’re pretty incapacitated for a little while. So your mom’s going to be on dinner duty for a few weeks. When the baby comes in, they’re like, “Oh, no, this is not this is not ideal for us!”
I really think that a lot of trans writing in general tends to be very serious and focused. It makes a lot of sense that the writing will focus on barriers to medical care barriers, to social acceptance, but I think joy is something that people also want to read about, so that was why I wrote about cooking, because it’s what I like to do.
Dr. Denise Millstine: That’s really the intention of this podcast, is that even though many of the topics that we discuss are difficult, challenging, typically private or intimate, that you could take a book like yours and read it cover to cover because it really carries you through, whether it’s the food or many of the things that if you haven’t walked this journey, you just don’t know you didn’t know.
I am so grateful to you for putting the book into the world and bringing the topic of non-binary parenthood out to those of us who are readers and are open to exploring that topic. I want to thank you both for being here on the podcast, for bringing your wisdom, your experience, and of course, your work to us. Thank you very much.
Krys Malcolm Belc: Thank you so much for having me. Caroline, it was really interesting to hear about the work that you’re doing. I especially was interested in the integration of behavioral healthcare because I feel like I’m very privileged having a healthcare person as my partner to find healthcare. Like I can ask her and she can ask people, but with behavioral healthcare, I feel like it’s been pretty difficult actually, to find providers wherever I’ve lived, so it’s so helpful to have them integrated in your practice.
Dr. Caroline Davidge-Pitts: Absolutely. I’m so appreciative of our behavioral health team and how they support me. We’ve grown this greater and greater and larger and larger resource list for our patients, which is all thanks to them and their hard work and their advocacy with lawyers and finding community providers for our patients who live far away, so absolutely. I think, certainly in our clinic, they’re not a gatekeeping process or a barrier anyway. They are so integral to how we can help our patients, so I appreciate you saying that. Thank you. Honestly, such an honor to meet you.
Dr. Denise Millstine: Thank you both again. I look forward to talking books, hopefully with you again sometime in the future.
Thank you for joining us to talk books and health today on “Read. Talk. Grow.” To continue the conversation and send comments, visit the show notes or email us at firstname.lastname@example.org. “Read. Talk. Grow.” is a production of Mayo Clinic Press.Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
The podcast is for informational purposes only and is not designed to replace a physician’s medical assessment and judgment. Information presented is not intended as medical advice. Please contact a healthcare professional for medical assistance with specific questions pertaining to your own health if needed. Keep reading everyone.