By Gene Beresin, Executive Director and Khadijah Booth Watkins, Associate Director

Posted in: Multimedia, Podcast

Topics: LGBTQ+, Parenting

 

In this Pride Month episode of Shrinking it Down: Mental Health Made Simple, Gene and Khadijah are joined by Dr. Alex Keuroghlian for a wide-ranging, candid conversation about supporting LGBTQ+ youth. As Chair of the Department of Psychiatry at MaineHealth and former founding director of the MGH Psychiatry Gender Identity Program, Dr. Keuroghlian draws on nearly a decade leading the National LGBTQIA+ Health Education Center and his own published research to discuss the environments and policy climate that put LGBTQ+ young people at risk, what it actually looks like when a child comes out, and how families can repair when a conversation doesn’t go as hoped. Citing research showing that strong family support is the greatest predictor of good mental health, academic performance, and housing security for youth down the road, Dr. Keuroghlian makes a compelling case for the power of family acceptance. This episode explores that power, the value of parents sharing their own stories, and the warning signs caregivers should watch for — offering insight, hope, and practical guidance for anyone who wants the LGBTQ+ kids in their life to feel loved, supported, and free to be who they are. Tune in now!

Media List

• Dr. Alex Keuroghlian (MaineHealth)
• PFLAG (National advocacy group for friends and family of LGBTQIA+ people)
• The Trevor Project
• Human Rights Campaign
• What to Look for, When to Worry, What to Do (MGH Clay Center)

Episode Transcript

SPEAKERS: Gene Beresin, MD, MA; Khadijah Booth Watkins, MD, MPH; Alex Keuroghlian, MD MSc MPH

[INTRO MUSIC PLAYS]

[00:00:28:05 – 00:00:31:23]

Gene Welcome back to Shrinking It Down, mental health made simple. I’m Gene Beresin.

[00:00:31:23 – 00:00:33:23]

Khadijah

 And I’m Khadijah Booth Watkins.

[00:00:33:23 – 00:01:19:09]

Gene

We’re two child and adolescent psychiatrists at the Clay Center for Young Healthy Minds at the Massachusetts General Hospital. Now for many LGBTQ+ young people, the most important challenge isn’t what’s happening in the world. It’s really what’s happening at home. This doesn’t negate the value of social acceptance and inclusion in society. But research tells us again and again that family acceptance is one of the most powerful protective factors for LGBTQ+ youth mental health. And yet, so many parents and caregivers feel genuinely uncertain about how to provide this support. Not because they don’t love their kids, but they just don’t know where to start.

[00:01:19:09 – 00:01:48:09]

Khadijah

 Today we’re talking about what it actually looks like to support LGBTQ youth. Not just in theory, but in real life, which can sometimes be messy. But these are always meaningful moments that happen between parents and kids. So we’ll get into how families can create the kind of safety that makes honest conversations possible. What to do when those conversations are hard and why identity and all of its dimensions matter so much for young people’s wellbeing. Here to help us navigate all of this is Dr. Alex Keuroghlian.

[00:01:48:09 – 00:02:38:08]

Gene

 So Dr. Alex Keuroghlian. He’s chair of the Department of Psychiatry at MaineHealth and chief of MaineHealth Behavioral Health. And in a former life, which I was proud to be a part of, he was previously director of the Division of Public and Community Psychiatry at Mass General Hospital. He was founding director of the MGH Psychiatry Gender Identity Program and associate professor of psychiatry at Harvard Medical School. Now for nearly a decade, he led the National LGBTQIA+ Health Education Center, a federally funded initiative to improve health for LGBTQIA people nationwide. He’s authored over 190 scholarly publications, edited two landmark textbooks on transgender and gender diverse healthcare. So welcome, Alex.

[00:02:38:08 – 00:02:40:15]

Dr. Alex Keuroghlian

 Thank you for having me. Great to see you two again.

[00:02:40:15 – 00:02:56:14]

Gene

 So could you introduce the work you do with MaineHealth and the Healthy Communities Initiative or anything else that you feel that’s important and should be shared as a – I remember as a work you did at the Fenway Health Center when you were at MGH.

[00:02:56:14 – 00:05:57:04]

Dr. Alex Keuroghlian

 Yeah, happy to. Thanks so much for having me and for focusing on this really important topic. My role now is as chair of the Department of Psychiatry and Chief of Behavioral Health System. So it’s broader in scope, topically than perhaps what I was doing before. But in terms of the focus of today’s podcast, for the decade prior to coming here, as you mentioned, I was directing the National LGBTQIA+ Health Education Center. This is a federally funded center that’s existed since 2011, was competitively renewed several times at the Fenway Institute in Boston. It has focused on education training, technical assistance, capacity building, implementation science to improve health outcomes and develop programs and services that are responsive to the health needs of LGBTQIA+ people across the country with a primary focus on federally qualified health centers. So we worked with all 1400 federally qualified health centers in the United States and every US state in urban and rural communities in every racial, ethnic, linguistic community you can imagine. And we also ended up by virtue of working with the federal government in the US, doing a lot with the US State Department and ministries of health and governments around the world to improve conditions both health related and beyond for LGBTQIA+ people of all ages. And so through that role, ended up working in Uganda, Jamaica, Ethiopia, the Philippines, Korea, Poland, Slovenia, Spain, Belgium, all over the world and it was amazing to see the same struggles come up for sexually and gender diverse people of all ages, children, adolescents and adults around the world in different cultural contexts. So we were able to do a lot of partnering with local communities, with local health practices and systems and think about social drivers of health that impact the needs of LGBTQIA+ youth and that process ended up doing a lot of research focused on mental health outcomes for LGBTQIA+ youth. For example, we did a number of the foundational studies focused on mental health associations of a gender affirming care approach. So we published studies showing the mental health benefits of social gender affirmation for youth of pubertal suppression for trans and gender diverse youth of gender affirming hormone therapy for trans and gender diverse adolescents of things like gender affirming care removal and gender affirming surgery among adults and published a lot of guidelines for gender affirmation in the peer reviewed literature and a number of those ended up being the basis for the World Professional Association for Trans Gender Health Standards of Care version eight, the current standard that’s used by governments by health systems and practices around the world.

[00:05:57:04 – 00:06:27:11]

Gene

 So let’s start with the big picture. And when I say the big picture, I mean in terms of development, when we talk about gender identity and sexual orientation as part of a young person’s development, where would you say this fits into the broader story of identity formation alongside culture, religion, race, ethnicity? And why has this particular dimension of identity been seriously neglected in parenting conversations?

[00:06:27:11 – 00:09:03:20]

Dr. Alex Keuroghlian

 Yeah, it’s a great question and a profound one. Gender identity, sexual orientation are core fundamental parts of a person’s identity that begin to emerge and evolve in childhood and adolescence for many people. Some people first realized they’re sexually diverse or gender diverse in adulthood. We published a study looking at age of realization of gender identity for transgender and gender diverse people. And most people, the largest proportion, I should say, of the 28,000 people across the United States who participated in the study, the largest proportion realized that they were transgender or gender diverse in childhood. The next largest proportion realized in adolescence, and you know, a fair proportion realize in adulthood, but it really is in childhood and in adolescence that most people realize they’re sexually or gender diverse in some way if they are. The same way straight people or cisgender people first realize their sexual orientation or gender identity typically before becoming adults. And not that it’s a static thing, it’s something that can also evolve throughout somebody’s life. For this reason, a lot of the work we did the last decade was focused on sexual orientation and gender identity data collection with patients and how to do this effectively so we did that for the federal government we implemented what’s called SOGI patient data collection for all 1400 federally qualified health centers across the country and developed guidance, including a paper we published in the Journal of the American Medical Informatics Association on pediatric sexual orientation and gender identity data collection with developmentally appropriate scripting at different ages to ask both about gender identity and about sexual orientation. Gender identity emerges, you all know this better than I do, I just play, you know, a child psychiatrist on TV I’m not really one, but emerges as young as two to three years old. So it’s recommended to have as part of a standard pediatric practice screening question to ask children, even as young as three years old some kids feel like a girl some kids feel like a boy, some kids feel like something else what do you feel like there’s no right or wrong answer. And sexual orientation, the recommendation has been to ask later typically around puberty when we start having conversations about sexual health and sexuality with young adolescents. That being said, in recent years with some more openness, you’ll have an eight or nine-year-old child come out and say I’m gay or I’m queer and there you have it, so we can emerge younger than that as well.

[00:09:03:20 – 00:09:25:02]

Gene

 So when do we have conversations? I mean, when would you suggest that we actually start talking with our kids about their gender identity? I mean, obviously, it’s developmentally based, I mean, you’re not going to talk to a four-year-old the same way you’re going to talk to a 14-year-old, but when do you start?

[00:09:25:02 – 00:12:07:06]

Dr. Alex Keuroghlian

 Yeah, well, I might frame it as not making any assumptions, first of all, about the gender identity of your child. So not going into it with preconceived notions based on anatomy or genetics about what a child’s gender identity is going to be because when we talk about gender identity, what are we referring to? It’s a person’s core inner sense of being a girl, woman, boy, man, both neither beyond or having no gender at all. And trans and gender diverse people have a gender identity that doesn’t align with society’s expectations based on the sex they were assigned when they were born. So when babies are born in most countries and cultures around the world, they’re assigned one of two sexes, typically based on physical anatomy or genetics, right? And these babies grow up, become children, adolescents, and adults who may have a gender identity that does not align with society’s expectations based on the sex they were assigned when they were born. So I would, and this is a hard thing to do because gender is so deeply ingrained in our society and in our norms, and we’ve been socialized over millennia to think about this in a very specific way. That being said, if you look at countries and cultures around the world, there have been times in history and places where more room is made for the naturally occurring gender diversity that exists among humans. And if you look at the Hijra community in India, for example, for many centuries, most of whom these days now also identify as transgender women or in indigenous communities in the Americas, two-spirit experience has been something that has been embraced and that room has been made in. It’s just now in what you might call contemporary Western culture that we’re starting to make room for this naturally occurring gender diversity that’s always existed. So I want to start by just acknowledging that this is, you know, a new framework for a lot of parents and families to adopt. Not having expectations that your child is going to fit gender norms in any predictable way is important. Often when we see families for the first time, they’re coming in because their child perhaps has a gender expression, a way that they present or communicate their gender, that is not what the family expected. And it’s really important for us when working with families to explain and share that this is all healthy and normal and within the natural range of human diversity with regard to gender. I

[00:12:08:06 – 00:13:59:03]

Dr. Alex Keuroghlian

 think there is in some ways more risk related to making a big deal of it for young children than there is in embracing and accepting it. That being said, kids live in a society where they may encounter bias or stigma in this way and it’s really important to work with schools and communities to create supportive environments. One of the studies that we conducted and published in the Journal of Adolescent Health looked at the relationship of social gender affirmation to mental health outcomes in adulthood. And we found that people who were socially affirmed in their gender identity, we’re not talking about pubertal suppression or hormones or anything like that yet, but socially affirmed in their gender identity as children or as adolescents, had just as good mental health outcomes in adulthood, as did trans or gender diverse people who are not socially affirmed until adulthood. In fact, you have lower odds of a cannabis use disorder in adulthood, if you were socially affirmed before age 10 than if you were not socially affirmed until you were an adult. That being said, we did find that people who are socially affirmed in their gender identity as teenagers had worse mental health outcomes in adulthood if they experienced K through 12 harassment, verbal, physical, sexual harassment. And if we controlled for that kind of K through 12 harassment, they had just as good mental health outcomes in adulthood as anyone else did. So this really speaks against this idea of watchful waiting, this idea that children and adolescents can’t possibly know what their gender identity is. So let’s not let them be socially affirmed until they’re older than 18 and then they can make their own decisions for themselves. But we do need to work with schools and communities to create safe learning environments for these kids to thrive, then they’ll have just as good mental health outcomes in adulthood.

[00:13:59:03 – 00:15:16:12]

Khadijah

 I think that really speaks to, I think, what we talked about earlier about the immense value of acceptance, especially as it starts earlier. Ideally, that would be with the family, which and how powerful family acceptance is. And I think the other thing I think that comes up here is that how we at the Clay Center really promote having conversations early and having them often so that we do kind of take away the grandness of having these conversations or taking away the, we only have conversations when something is going wrong or something is not well, but we can really normalize having conversations. But before we even get to the coming out conversation, let’s spend a little time talking about the conditions that put our LGBTQ youth at risk in the first place. What are the environments, whether it’s at home or at school or in this bigger political climate that we’re in, that makes our young people vulnerable? I mean, if you could share with us also, what are the social and emotional forces that most significantly impact our youth in these environments? Because I think it’s fair to say that the things that make our kids, I think, most vulnerable really is the environment. See, these environments that are not welcoming, that are not open, that are discriminatory, and that are often hostile. And so how do we create environments that don’t look like this so that our kids can thrive?

[00:15:16:12 – 00:18:43:12]

Dr. Alex Keuroghlian

 Yeah, it’s a great question. And I would say a couple of things. There’s a deeply ingrained belief in society that being trans or gender diverse or being sexually diverse in some way is, and this was true for sexual orientation until very recently, it’s still there when you scratch beneath the surface. In many contexts, that is inherently some kind of mental health problem in and of itself. That is still a very just beneath the surface notion that’s out there. And for gender diversity, that’s very overt still. This idea that being trans or gender diverse is some kind of mental health problem inherently, and that we need to adopt a corrective approach for this. We recently, meaning within the last couple months, had a Supreme Court ruling that basically bans banning conversion efforts for sexual orientation and gender identity. So many states across the country have had state level bans on gender identity or sexual orientation conversion efforts. And those were hard fought policies that advocacy communities had engendered across many US states and the Supreme Court ruling said that actually you can’t ban conversion efforts that seek to change a person’s gender identity or sexual orientation. Now the fact that that ruling came from the Supreme Court and that that case was even presented before the Supreme Court indicates how prevalent those beliefs are that this is something, ideally, we would be able to change in children, adolescents and adults. So the shift to acceptance is really important when you talk about societal forces. It’s, I think, the fact that this is something very novel for a lot of families and communities, something that doesn’t align with traditions in many families and in mainstream society. And we have to be responsive as the mental health field to do what we know based on the evidence is best for for youth, which is to embrace and support and accept them in their identities. But that’s, I think, there are cultural forces in that regard. There are political forces we’ve seen in the last year and a half, huge rollbacks and access to gender affirming medical care for minors across the country and for adults in some cases as well. So knowing that you can’t access evidence based medically necessary treatment that has been shown to greatly improve mental health and greatly decrease the risk of things like suicide attempts is really concerning, right? And families are stuck in many cases without medically necessary treatment locally available to them. There are many families who are moving from one part of the country to another in order to be able to access health care services for their children that they were able to access less than two years ago. I think lack of access to necessary care is something that stresses families quite a bit. And if we think about the context that children and adolescents find themselves in, within schools certainly bullying is a huge problem and epidemic for LGBTQI+ youth.

[00:18:44:20 – 00:20:14:01]

Dr. Alex Keuroghlian

Permission to participate in sports that align with one’s gender identity is battle nationally with very well coordinated, politically motivated movement to keep trans and gender diverse kids out of sports. And we hear this couched in terms of supposed harm to the cisgender kids in those sports without any discussion about the impact that exclusion and discrimination has on already vulnerable, trans and gender diverse kids, and without any discussion of the rights of all children to be able to have physical activity and movement and health and to learn team building and and, you know, all the great things that come from sports participation and, you know, these arguments are arguments that were used decades ago to keep people of color out of sports, and it’s kind of an old playbook in that way. And, you know, to that point I think it’s really important to name the intersectionality where LGBTQI+ youth of color are experienced compounded discrimination victimization hate crimes. And as a result of what we call minority stress stressors related to societal stigma and discrimination, LGBTQI+ youth of color experience even worse disparities in terms of mental health outcomes because of the compounded intersectional discrimination and oppression.

[00:20:14:01 – 00:20:46:10]

Gene

 So bringing this back home, what can this comes up in my work all the time. Parents and caregivers say to me, well, what can I do to create an environment that’s safe so that they can come out, they can be accepted. And, and, and, but it so it emphasizes their strengths, and they can really be who they are, at least here at home, society may be dangerous, they acknowledge that, but we want them to feel loved and accepted here.

[00:20:46:10 – 00:22:09:16]

Dr. Alex Keuroghlian

 Yeah, absolutely. So I think it’s really important to your point to be explicit within a family with a child that this is a home where we accept everybody for who they are, for who they love, I think you can create an environment in which questions of sexual and gender diversity are openly discussed and clear communication of the fact that people come in many forms and variations and that we accept everybody for who they are I think had a family that has friends who are sexually and gender diverse send of big message that of acceptance to the children within that family. And I think it’s helpful to say even directly to a child, we’re going to love you, no matter who you love, who you’re attracted to who you are. We love you, whether you know, feel like identify as a boy as a girl or something else. Just hearing that at all goes a very long way. And, you know, I think even tying what happens in the family to what’s happening societally, the way in which social issues related to sexual and gender diversity are discussed within the home sends a very quick signal to kids about whether this is a safe environment for them to disclose their own identity and their own lived experience.

[00:22:09:16 – 00:23:13:08]

Khadijah

 We have to going back to the idea of having conversations early and often really put forth the effort as caregivers or or or anyone really who’s responsible for the well being of a child create these environments in advance so that when the time comes for whatever conversation they want to have, they feel like it’s a safe place. They’ll be accepted they’ll at the end of the day, no matter what will be loved. And practically speaking, because I think a lot of caregivers want to know like, you know, what do I do so if you have a child, they come out to you, you’re the parent. What do you do right then and there in that conversation I imagine there’s a myriad of emotions whether there’s shock whether there’s surprise. But what do you do in that conversation in real time. And also speaking as a parent, we don’t always get it right and sometimes we fumble we say the wrong things we, you know, our emotions get the best of us. In these situations, you know, when you’re having this conversation and doesn’t go as you had hoped, is there opportunity for repair or a do over or to make it right. And if so, what does that look like.

[00:23:13:08 – 00:27:33:17]

Dr. Alex Keuroghlian

Yeah, absolutely. There’s an opportunity to make it right over time I think more often than not. These initial conversations with a child and a family. Don’t go smoothly or the way maybe the child was hoping for and it’s over time that families can heal and mend and come together. What one might ideally say if a child comes out as LGBTQI+ with one identity or another is to say, Thank you so much for letting me know. I love you so much. I’m here to support you. I’m proud of you, and know that you’re always loved here at home, and you have a wonderful life ahead of you with a family who loves you dearly, something like that would be, I think, you know, ideal and reassuring for a child to hear. And I think curiosity about how this has been challenging for the child, what they’re experiencing outside of the home, asking how you can best support the child, what they need from you and checking in regularly and often like you said is really important so that that would be, I think, ideal scenario that more often than not is not what happens. I think in many cases, families will be surprised, confused. They may find that they’re very afraid. They’re angry. They’re embarrassed or ashamed that they don’t know enough. They may wonder why their child didn’t tell them earlier. That comes up as well. Like, why they didn’t. Why didn’t I realize this? Why didn’t I notice this earlier? And why didn’t I hear this four years ago? So it’s really important to educate oneself as a parent or guardian or caretaker, right? So there are a lot of resources you can access. PFLAG is a wonderful organization by chapters around the country that’s entirely devoted to parents and families of LGBTQI+ youth. And there’s a lot of support from other parents of LGBTQI+ youth through PFLAG. So I would highly recommend that people check out PFLAG online and connect with their local chapter. It can take time for a parent to come around to understanding and accepting who their child is. That child has often had years to figure this out for themselves and has been sitting with it. The parent has not been internally coming to terms with this all that time. So it can often take quite a long time for parents to fully come around. It’s really helpful to, and this is expertise you both have more than I do, engage in family therapy when possible. And for parents to also have a place where they can process this and work through it separate from their kids because they’re going to be wondering and saying a lot of things as they work through it and get up to speed and get comfortable with it that may not be helpful to say or work out in front of their kids too. So there’s I think some intentionality around conversations with the child or in family therapy with the child and then what work the parent needs to do separately as well. And other parents and guardians can be incredibly helpful. I remember when I was working at Fenway Health, there was, this would happen a lot, they had a support group for parents of trans and gender diverse youth. There was one dad who was so opposed to his child accessing gender-affirming care as an adolescent at Fenway Health and he was eventually dragged to the parents support group with other parents of trans and gender diverse youth and saw that they were reasonable people he could be friends with and who might be in his community. And these parents were further along supporting their trans and gender diverse kids and it blew his mind that people he thought were reasonable could be at all supportive of this and then he ended up going to dinner with one of the families after that support group and this dad ended up becoming the staunchest advocate and supporter of his child, you might have imagined and ended up then supporting other families who are new on this journey. So community with parents who similarly have LGBTQ+ youth is transformative in many ways.

[00:27:33:17 – 00:28:03:23]

Khadijah

 What about the parent who maybe like you said maybe confused or angry or having their own emotional kind of reaction and maybe they’re saying things with the kid in this conversation that they really should have saved to process with, you know, a spouse or a friend. What does that repair look like because words stick around like they they can they can they can be really hurtful even sometimes if parents didn’t intend for it to be hurtful they can sometimes come across as invalidating or dismissive. What does repair look like?

[00:28:03:23 – 00:31:37:07]

Dr. Alex Keuroghlian

 Yeah, yeah, I mean this happens really often where parents say, maybe you’re just confused. You know, you’re you’re you haven’t tried dating girls enough or dating boys enough. This is just a phase. It’s a trend. It’ll pass. Or, you know, even more hostile things overtly like get out of my house, or, you know, you’re not part of this family. If this is what you want to do, or who you claim you are. So it’s it’s very painful and traumatic and destructive for youth to experience that kind of reaction from parents. And it can take a long time, realistically to to heal and mend children, adolescents desperately want the approval and support of their families, it matters so much to them and it’s terrifying to be in a home that fundamentally rejects you for who you are. I think more than parents who have that kind of reaction often realize these kids are leaving the Golden Gate of Return open. So there’s there is always hope to repair. And, you know, I just for some self-disclosure I had a similar experience with my, you know, with my father when I was younger and I came out and it took years and all the wrong things were said, and eventually we got to a great loving place where he is fully accepting my husband is his favorite person on the planet and that can happen right but it’s really hard to see that when you’re a kid and you’re in the eye of the storm with your family in that way. So it’s, I would say to the children of those situations, it’s important to hope for the best but expect the worst possible response as well if you think that that’s possible, and to come up with a plan for how you’ll get through that period. And for parents, if you know, first of all that for them to have a happy healthy thriving child, their acceptance of that child is the most important thing. So if you want to, if you want a healthy happy kid, work on getting to a place of acceptance and support for them as quickly as you can, and acknowledge the damage that you may have caused. I think maybe even before you get there and have an appreciation for that. You want to approach with curiosity listening to understand your child’s experience, ask questions in a gentle way to really put yourself in your child’s shoes and understand their own experience. And, you know, get to a place where you can ideally apologize for the hurt you caused and and own that. And if you do so, there’s a very good chance you’ll have your child back in your life. And, you know, one thing that families often realize on that path to healing and mending. And this was the case for me when I was younger. It’s, it’s ultimately the parent who really misses out, you know, like, they miss out on having this amazing young person, unique person in their life and missing out on all the milestones and all the joy that comes with that. So that’s often what happens. I think parents realize that what they were doing, maybe to protect their child out of their own fear and lack of understanding ended up resulting in them experiencing a certain emptiness and distance that they regret.

[00:31:37:07 – 00:32:02:05]

Gene

 And so one other one spin off of that is what’s what do you recommend in terms of a family member, parent caregiver, sharing their own personal narratives, their own experiences growing up, their own struggles with identity, including their biases, I mean, kind of being more transparent about themselves. What do you what do you think about that?

[00:32:02:05 – 00:33:18:05]

Dr. Alex Keuroghlian

 Yeah, I think that’s a really beautiful and brave thing to do. And it helps the child understand why their parent is struggling with this, right. And that maybe that’s a lot for any child developmentally to, you know, to understand that their parents grew up at a different time in a different culture under different circumstances, and that there’s a process and a journey to getting around to understanding their child’s experience in a, in a new era, in a different environment and that their child is fundamentally different from that, right, like your child is not a carbon copy of you or a clone of you, this is a different human. And what’s what was right for you and good for you may not be what’s right for them or good for them. They’re they’re fundamentally differentiated from you. But I think sharing that the vulnerability to do so as a parent caregiver guardian is is vital. And it’s not to excuse maybe a reaction at first that was hurtful, but it’s to contextualize and, and explain it and bring clarity. And I think even mustering the readiness to do that as a parent helps you understand maybe why you reacted that way to your child in the first place and, and communicating that can can help everybody move forward.

[00:33:18:05 – 00:33:46:01]

Khadijah

 What are some of the early, I guess warning signs like what are some signals or clues that parents or caregivers might might pick up on that their kid is struggling, even if the kid doesn’t say so. You know, here at the place and we talked a lot about three W’s like what to look for when to worry and what to do and so, you know, as a caregiver and focusing and thinking about our young people. If there is cause to worry what comparison caregivers do like what what what should they do if they they’re worried.

[00:33:46:01 – 00:36:15:11]

Dr. Alex Keuroghlian

 Yeah, well I think there are two parts that to how I would answer that great question. One is that you want to create environment at home, where there are like we were saying earlier, there are no assumptions or expectations about who your child is right so like, there’s no you, it really requires being very aware of one’s own biases right but your messaging in every way you can intentionally that there are no default assumptions about what a child’s gender identity is what their gender expression should be what their sexual orientation should be. So that that should be there in the first place. And often, you know, a parent will notice that their child has gender expression that doesn’t align with their expectations. And the child may seem anxious about that, or distressed in some way and parent may have a hypothesis that it’s related to some kind of gender expansiveness, or the child may seem totally happy go lucky and fine and not at all bothered right so then it’s not so much of a warning and it’s more communication reassurance that the child is loved and accepted within the family, no matter what. I think if there are certain developmentally expected milestones that are not coming up I would imagine for example with an adolescent, where their peers are expressing interest in, you know, in terms of attraction to others and that’s not coming up in any way that you can tell, or they’re describing some bullying at school, for example, or ways in which they’re being socially excluded those would be warning signs that they’re not accepted as who they are. Now, I’ll say not being interested in dating or not seeming to be attracted to others is not inherently a warning sign right there are asexual aromantic youth and people as well that’s that’s not you know that’s not a concern. But I think having open conversations with youth about who they are, if they’re experiencing attractions to others, if so to whom and really reinforcing that they’re accepted and loved in the family, no matter what is going on can go a very long way.

[00:36:15:11 – 00:37:15:18]

Gene

 Okay, you know, we’re a little short on time but I got to go here. I mean, and I won’t get too political but because I’ll get myself in trouble. Despite how far we’ve come in our society, there are plenty of forces, both overt and covert, that make it unsafe to be LGBTQIA+. And as parents, caregivers, health professionals, policymakers, what can we do to make our society more accepting, more inclusive, and less discriminatory because discrimination, and again I won’t get too political about this but it’s very hard for me not to. It’s alive and well. So what do you think, Alex? I mean, what should we be doing in a progressive way to make at least our society a safer place?

[00:37:15:18 – 00:38:14:01]

Dr. Alex Keuroghlian

 Yeah, great question. I think it starts locally. And that’s been my big lesson the last couple years is the power of local community and local engagement to transform society so I would, if you haven’t already, or even if you have, reach out to and support the LGBTQI+ people in your family. Reach out to and support the LGBTQI+ people in your neighborhood, in your community. You can volunteer with your local LGBTQI+ community organization or LGBTQI+ community health center. There are plenty of national organizations that are focused on the rights and health of LGBTQI+ people, the Human Rights Campaign, the Trevor Project, because there are many ways to get involved and contribute your energy and time.

[00:38:15:19 – 00:38:52:08]

Dr. Alex Keuroghlian

 You can also advocate with your local policymakers for certain basic rights of LGBTQI+ people, whether with the school board for transgender and gender diverse youth to be able to compete in sports in alignment with their gender identity, advocating locally for access to responsive healthcare for sexually and gender diverse people. There’s a lot that we can do. And I think if even a somewhat larger proportion of people in the US got proactively involved in those ways, the country would be a very different place.

[00:38:52:08 – 00:39:15:16]

Gene

 So to wrap up, let me ask, do you want to ask the last question, Khadijah? As a wrap up? Okay. So I mean, if there’s one small thing parents or caregivers should start doing today to support their child’s mental health, in particular, their gender identity, what would you recommend? Where should we start?

[00:39:15:16 – 00:39:35:07]

Dr. Alex Keuroghlian

 Tell your child that you love and accept them, no matter what, no matter what their gender identity is, no matter who they’re attracted to or who they love, that they always have a home with you, and that they’re special, they have value in the world, and that they have a wonderful future ahead of them.

[00:39:35:07 – 00:40:04:08]

Khadijah

 I think as providers and people in the field, it’s really important for us to really impress upon parents, so I don’t think they often know how big an impact acceptance within the family has, like in the here and now and long term. And I think, you know, to know that really can sometimes I think shape how people may respond and react to knowing how big of an impact and influence they’re going to have on the trajectory of their child.

[00:40:04:08 – 00:40:48:05]

Dr. Alex Keuroghlian

Absolutely. There was a study that showed that strong family support was the greatest predictor of good mental health for youth, for academic performance for youth, or housing security for youth down the road. So, parents need to understand the power of their acceptance for their child to have all the outcomes that they want their child to have. If you want a kid who’s mentally healthy, socially well adjusted, knocking it out of the park at school, has a great socioeconomic future ahead of them, accept them in their gender identity, accept them in their sexual orientation. That is the biggest gift you can give them.

[00:40:48:05 – 00:41:09:13]

Khadijah

 I think it’s hard because especially when we’re thinking about teenagers, they don’t often spend as much time at home, they don’t necessarily seem to want their parents’ opinion, approval or anything, but I think, you know, really to help them see that that is actually, you know, not the case. Like, and I think you said it earlier, kids are always looking to be accepted and approved by their parents, even if they pretend that they don’t.

[00:41:09:13 – 00:41:12:01]

GENE

 And that we can find them between the cracks.

[00:41:12:01 – 00:41:19:11]

Dr. Alex Keuroghlian

 And you know this better than I do, that kids are picking up on everything, whether they’re telling you they’re noting what you’re saying and doing or not.

[00:41:19:11 – 00:41:36:03]

GENE

 And if not now, you know, they’ll come a time. I mean, I remember when my kids were teenagers and they were separating, they were autonomous, they were, you know, like, not talking. And then, you know, about the time they were juniors in college, they come back, you know.

[00:41:36:03 – 00:42:27:13]

Dr. Alex Keuroghlian

 I remember being a kid, a child and an adolescent and clocking every biased thing I heard about queer people and how painful and how terrifying it was to hear those things as a kid. And just thinking there’s no, there’s no life for me, there’s no future for me. How does one even function in this world that’s so hostile? And then grasping on to every indication from my local community or the culture at large that some queer person somewhere had been accepted in some way, right? But none of that was externally expressed by me. Nobody knew I was paying any attention to any of that. So it’s really helpful to think back to what it’s like when you’re a kid on any topic and how much that matters. And to know you have that power to sound down in your voice is fine.

[00:42:27:13 – 00:42:48:14]

GENE

 Well, thanks so much. This is incredible. And we’ll be airing this podcast for Gay Pride Month, which is this month. So thanks for you at home. And if you like what you’ve heard today, consider leaving us a review. And as always, we hope that our conversation will help you to have yours. I’m Gene Beresin.

[00:42:48:14 – 00:42:51:07]

Khadijah

 And I’m Khadijah Booth Watkins. Until next time.

[OUTRO MUSIC ENDS]

Episode music by Gene Beresin

Episode produced by Masha Mesyef