Transcript: Trans in America

MS. JOHNSON: Good morning, and welcome to Washington Post Live. I’m Akilah Johnson, a health reporter here at The Post.

A new survey by The Washington Post and KFF released this week is full of surprising new information about the lived experiences of trans adults in America. I'm delighted today to be joined by Minneapolis City Council president Andrea Jenkins and Montana State Representative Zooey Zephyr.

Andrea, Zooey, welcome to Washington Post Live.

MS. JENKINS: Good morning, Akilah.

MS. JOHNSON: Well, one of the main takeaways from the survey is that transgender Americans experience stigma and systemic inequalities in many aspects of their lives, including education, work, access to health care. So, Zooey, I want to go ahead and start with you, and I want to talk about some of the moments that you have bumped up against, some of these systemic barriers going, you know, about your day-to-day life, and I'm wondering if you could talk to us about those experiences.

REP. ZEPHYR: Yeah. So, I find those systemic barriers, you know, thinking in the capital specifically, it's the way people will view themselves as accepting or as if they're--they don't really have a problem with trans people, but then the moment you explain a need or explain why allowing someone to intentionally misgender you or taking away your access to health care will harm you, they put the wall up. They don't let you articulate your needs, and they don't listen. That's been the biggest experience for me in the capitol.

MS. JOHNSON: And so then, Andrea, you know, you have spoken about housing insecurities and employment problems within the trans community, and I'm wondering if you could talk to us this morning about those issues and how they perpetuate inequalities for trans men and women, housing and employment specifically.

MS. JENKINS: Certainly. You know, I look at the statistics around homeless youth, and about 42 percent of all homeless youth identify as LGBTQIA+, and the majority of those folks are trans and gender nonconforming. And so, we see violence against trans and gender-nonconforming people, particularly people of color. And research and my personal belief is that if people don't have access to safe and affordable housing, then they find themselves oftentimes on the streets late at night, which is when a lot of this violence is happening. And so, employment is tied to that because if you are not able to access full-time employment, with a living wage, then you certainly are not able to access housing. And there's discrimination in housing against trans and gender and nonconforming people as well as in the employment sector. So, we have to break down those barriers to employment as well as to access to safe and affordable housing.

MS. JOHNSON: And so, Zooey, one of the things that you recently did is introduce a bill outlawing transgender--the transgender panic defense, and I'm wondering if you could talk to us a little bit about that bill and what you're hoping to change as a result of it. So, let's just start maybe at the beginning, and for folks who may not know, talk to us a little bit about the transgender panic defense and the significance of this bill outlawing that.

REP. ZEPHYR: So, the gay and trans panic defense is essentially a loophole argument that is used in court where someone tries to mitigate the circumstances of their crime by saying that the reason they assaulted or murdered someone who was LGBTQ is because they were shocked to discover that the person was who they are. It's a crime-of-passion defense that uses queer identities as a rationale for murder, and obviously, that's not something that should be allowable.

I brought that forward because Montana is one of the states where that is still an allowable defense, and it felt like a way I could step up to my community--or step up for my community and also show the way in which the Republican narratives around protecting children or protecting people fall short when they decide to vote a bill like that down.

MS. JOHNSON: You know, it's interesting because we were just having a conversation about housing and employment discrimination. And so, I mean, Zooey, you were talking about the most egregious forms of harm, right? Murder. But I guess I am also wondering if we can circle back around and maybe tie some of this together in terms of how do we see this idea of, right, panic manifests when folks are looking for secure housing, when they are looking for employment. And so, how does that kind of manifest in day-to-day activities and lives and systemic barrier before it escalates and elevates to the most egregious forms of harm, which is what you're talking about, Zooey? Right? Which is murder and death? Because there are steps, I'm assuming, before you get there.

[Pause]

REP. ZEPHYR: Thank you. What I would say is that there are multiple things that lead to this. There are steps for trans people that we see the escalation. There are also steps in the legislation.

We heard legislation in this session that passed the House, which allowed realtors to not be punished by their board if they have been saying harmful or discriminatory things in their practice. We heard bills that allow for intentional misgendering and bullying in schools and prevent schools from doing anything about that. We see it banning health care. All of these things are a brick-by-brick in the barrier for trans people to live authentic lives and to be themselves without fearer of harm.

And so, if you are a trans person who is experiencing bullying in school, who's trying to start a family and being told you can't adopt a child; you're being told that you're not going to--a realtor's not going to listen to you, it becomes harder and harder to find the kind of job you want, to find the kind of home and put down roots in the community you want to live in. And if you struggle to put down roots, you're going to find yourself in the margins, and in the margins are where that harm happens and where it escalates quickly.

MS. JOHNSON: And so, you know, in a city like Minneapolis--all right. So, we're talking that that isn't a state like in Montana, but I guess I'm wondering, you know, how, Andrea, if you can kind of unpack that a little bit as well in where you are in Minneapolis, how you see some of that manifestation in terms of the way these barriers play out day-to-day and what you are doing to keep that from happening in Minneapolis.

MS. JENKINS: Sure. Well, you know, one of the things that I'm really thrilled about, just two weeks ago, I attended a press conference and an executive order by the governor of the state of Minnesota affirming Minnesota as a welcoming state for trans and gender-nonconforming people who have been banned from access to health care in other states.

Prior to that, about a month prior to that, myself and along with the mayor of Minneapolis signed an executive order making Minneapolis a safe and welcoming, affirming city for people seeking gender-affirming health care without fear of being extradited from their states or being criminally charged for just trying to live their lives. And so, you know, I think that is the importance of representation, to be in these spaces where laws and ordinances are being made.

Just yesterday, at the city council meeting where I chair, we introduced a resolution recognizing Transgender Day of Visibility.

So, I think being in these spaces, creating that kind of welcoming environment, bringing awareness to these issues makes life safer for trans and gender-nonconforming people. It creates more awareness in the broader community about the challenges that trans and gender-nonconforming people face, non-binary people face. And so, it's critically important for us to be in those spaces. I think representation matters, and those are the kinds of things that I am doing to try to address these issues.

In fact, I'm working with some folks right now along with the ACLU to create a resolution affirming the rights of drag performers and drag artists to exist and, you know, creating Minneapolis as a welcoming city for drag performers to come and earn a living.

I mean, you know, we talked about people being shut out of the employment network, and now, you know, creative people have made ways to survive and earn income through drag performance, which has been a staple in the LGBTQIA+ community for years and years and years. And now even those opportunities are trying to be excluded from our daily lives.

And so, you know, we want to make this a welcoming city. I think it brings awareness to these issues and also challenges other communities to do the same.

MS. JOHNSON: You know, it's interesting. So, the survey--the survey also shows that trans adults are more than twice as likely to have experienced serious mental health struggles, yet most trans adults say that transitioning made them more satisfied with their lives.

And so, you know, Zooey, I'm wondering if we can unpack that a little bit. You know, we saw in the introductory video where you were talking about transitioning and the joy that it infused in your life, and so, you know, you're from a very red state. So just talk to us a little bit about your experience as being openly trans in that type of environment.

REP. ZEPHYR: So, I will reiterate what I said in my opening that transition has brought me joy and a fullness in my life.

When we heard the SB99 this session that was a built to ban gender-affirming care, a therapist came in who works with trans youth and said that what you see in transition is people coming alive into themselves for the first time, and that's true for me.

And I think one of the important things and one of the reasons we get to have that joy, because it's finally who we are and we get to be ourselves, obviously there's a lot of harm and distress in the legislative climate, both in my state and nationally.

I think it is also important to note that a lot of that harm and that mental distress comes from legislative attacks that aren't necessarily reflective of the love and acceptance we feel in our communities. I knocked the vast majority of doors in my district multiple times, and I was met with kindness and love at every door, every single door. And to me, that shows that acceptance is all around us, despite what these attacks say.

That said, given the attacks and what they--what they will do for our ability to live and also given that the attacks amplify the violence from extreme people on the right, there is a real threat to trans people moving through our daily lives, even with that broad acceptance growing.

MS. JOHNSON: You know, and I want to go to one of our audience questions. And so, Andrea, I'm wondering if we can start with you, and so this is from Christopher in Washington and so speaking about, you know, acceptance.

And so, he is wondering, what steps can mainstream or middle-of-the-road Americans do to help further legitimize and make even more widely accepted trans people in America? So, kind of how can he--how can he be a better ally, I guess, is ultimately what's at the root of that question.

MS. JENKINS: Certainly. You know, I think there's a number of ways. I see a lot of people now, particularly in my community but all over, starting meetings with identifying their pronouns, even if they are cisgender people, have on their email signatures their pronouns, which I think is a way to--a small and subtle way but certainly a way to help with this seemingly very challenging issue of people respecting pronouns.

I think listening to trans people and trying to, you know, understand where they're coming from--I did want to just revert a little bit back to the question that Zooey talked about--Representative Zephyr--about--you know, I conducted a transgender oral history project, and I interviewed about 194 trans and gender-nonconforming people. And to a person, everybody talked about, you know, they had experience being kicked out of their homes, severing relationships with their children, being denied job opportunities, et cetera, but almost to a person, people talked about the joy that they felt in being able to live their most authentic lives.

And so, you know, I think to be a positive ally is to understand and recognize that, to shut down transphobic jokes when you hear them, to really, I think, just recognize the humanity of trans and gender-nonconforming people and be fully accepting.

I talk to trans and gender-nonconforming people a lot. I think the extent to which you accept and love yourself also translates into the respect that you receive from other people. And so, I think those are a few ways to be better allies. Educate yourself about the issues that are impacting trans and gender-nonconforming people. Don't ask people about "What's your real name?" That's very insulting. You know, don't ask people about their medical transition.

I think the survey, the Kaiser Family Foundation survey that you guys just completed yesterday, talks about the fact that probably 50 percent of trans and gender-nonconforming people never seek medical intervention during their transition journey. And so, that is not the go-to response. And I think most people--or a lot of people, I should say, really experience the social transition as the most challenging part of the journey, you know, even when--

MS. JOHNSON: So, it's interesting--

MS. JENKINS: Go ahead. I'm sorry.

MS. JOHNSON: We're getting close on time, and there's one question that I want to get in talking about, you know, social transition and transition, and it's from a grandmother who is wondering how best to support her four-year-old grandchild.

And so, this is from Laura in New York who said, "My four-year-old grandson prefers to wear dresses, the sparklier the better. Should I assume he's transgender? It doesn't matter to me what he wears. At the same time, I worry he will become a target of bullying and maybe even physical violence. How can I best support him?"

So, Zooey, I'm wondering if you might be able to offer this grandmother a little bit of--some advice and some guidance on how to support her for your four-year-old grandson.

REP. ZEPHYR: Yeah. I would say support looks easy at that age.

First off, don't make assumptions. You know, when we talk about the standards of care today and how people are known to be trans and, you know, when children are going to see therapists, one of the things they talk about as the diagnostic material is, is the child consistent, insistent, and persistent about being trans? About being trans. That is not wearing a dress. That is not having more friends of the opposite sex, necessarily.

So, I would say at that age, don't make an assumption. If someone wants to wear a dress, wear a dress. If they want to wear jeans, wear jeans, paint their nails, et cetera. Be there to support your child in the things they want to do and care for them, and then as they grow up, if they say, you know, "I'm actually--I want to go by a new name now," that social transition is something that can happen. But don't lead with that. Don't make that assumption. Let people be who they are. That's been the message of the LGBTQ community for decades, and it's our message today. Let us be who we are. Let us dictate ourselves to you.

MS. JOHNSON: And you mentioned three words. I want you to repeat those three words in case anybody is watching out there so we can drum that in and get some muscle memory going.

REP. ZEPHYR: Consistent, insistent, and persistent, and that is the tools that medical providers use when they're talking to youth and assessing whether or not they're transgender.

MS. JOHNSON: Awesome. Thank you both so much for spending some time with us again this morning, and so we are just about out of time, and I think we're going to have to leave it there today. But again, I really appreciate you all taking some time out of your morning to join us for this conversation.

REP. ZEPHYR: Thank you so much for having us.

MS. JENKINS: Thank you for the opportunity.

MS. JOHNSON: Absolutely, absolutely.

And so, now, I would like to bring in Ashley Kirzinger, director of Survey Methodology at KFF, and Fenit Nirappil, fellow health reporter here at The Post, for a conversation about this survey. And in case anybody is wondering, it's in today's Washington Post. Go pick it up. It's on the front page.

So, Ashley, Fenit, thank you for joining us, and welcome.

MR. NIRAPPIL: Thank you.

DR. KIRZINGER: Yeah. Happy to be here.

MS. JOHNSON: Perfect. Ashley, I want to go ahead and start with you, and I'm wondering if you could tell us a little bit about the survey, how it came into existence, what prompted KFF to get involved with this robust dataset about trans folks in America.

DR. KIRZINGER: Yeah, absolutely. So, this is actually the 36th partnership survey between KFF and The Washington Post. It's a survey project that has gone on for decades and has always focused on amplifying the voices of groups that are often left out of public debate and policy conversations.

So, we were discussing possible topics for this project this year, and it just seemed like understanding the experiences and hearing from trans adults seemed to fit perfectly into the goals for this project. Only about 1 percent of adults living in the U.S. identify as transgender or trans, but as we just heard, this group experiences discrimination and systemic inequality at many aspects of their lives, including access to health care. Yet most of surveys that we hear about aren't able to report on the experiences of trans individuals because they account for such a small share of the overall population.

So, how do we survey them? So we went to some of the largest survey firms in this country and asked them if we could recontact people that they had recently interviewed from some of their scientific representative surveys, and we were thrilled when they all eagerly said yes. So, we combined those recontacts with some recontacts from KFF telephone surveys to get at the people that may be less willing to participate in a survey online and would rather talk to a live interviewer over the phone and were able to get a representative sample of more than 500 trans individuals.

The next step was maybe more difficult because we wanted to ask them so many questions. The KFF researchers and Post journalists had so many questions that we wanted to ask them, but we didn't want to keep them on the phone for like an hour-long survey. So we had to really focus our survey, but we really think that it really got, you know, at many aspects of the trans experience in the U.S.

MS. JOHNSON: Absolutely. And so, Fenit, you were one of the key reporters on, you know, reporting out the survey results. And so, I'm interested in knowing what surprised you most. What were one of the findings and one of the things that you unearthed throughout this reporting that really kind of stopped and made you think a little bit?

MR. NIRAPPIL: Yeah. So we've heard from trans people for decades about the discrimination that they run into and the problems accessing the health care system. I think one of the things that really stood out to me is it doesn't always fall in easy, predictable, partisan lines. We didn't find all that much difference in the people who were reporting challenges in finding a health care provider who treats them with dignity in states won by Donald Trump in 2020 versus states won by Joe Biden, and we also found that people who were living in urban areas were actually more likely than people living in suburban and rural areas to report challenges with the health care system.

I think one of the reasons here is that, you know, an urban area, it can be large. That means that you have a lot more access to people who are supportive, but then it can also mean more opportunities for bigotry too. So our survey, unsurprisingly, did find challenges that people have with the health care system, but also more than half of people said that they did come into contact with providers who knew about effective care for trans people. And more than half found providers who treat them with dignity.

So, it's a reminder that there is a lot of discrimination out there, but also, there's a lot of welcoming health care too. And that's important because the concern is if trans people aren't seeking medical care or preventative care because of negative experiences with the doctor, that can lead to all kinds of health disparities.

So, one of the things I consistently heard while reporting the story is that what--you really need to find that right doctor, the right nurse practitioner, or other health care providers to rely on your community because oftentimes people within the community will know through trial and error what places are welcoming and which ones are not.

MS. JOHNSON: So, it sounds like something we just heard in the last segment, which is don't make any assumptions about anything, right? Like Representative Zephyr said that--

MR. NIRAPPIL: Exactly.

MS. JOHNSON: --you know, underscored that, don't assume. And so, Ashley, I know you just talked to us a little bit about methodology, and you mentioned questions, and that there were so many questions that you couldn't kind of--you had some trouble narrowing it down. So, talk to us a little bit about the questions on the survey, and how did you come up with what to ask, and then how did you narrow that field of inquiry down?

DR. KIRZINGER: Yeah, absolutely. So, as I mentioned, like this is such a strong collaboration with The Post reporters. So there were lots of Zoom calls and conversations and talking about what we were most interested in examining. Especially, you know, there have been surveys that have included trans individuals in them, but they haven't really been entirely dedicated to the trans experience.

So, we started like at childhood, right? So, like how was your growing up? What kind of experiences did you have? One of the most interesting findings in that section is that we find that trans adults report really negative experiences during their childhood, but those are somewhat mitigated if they have a trusted adult that they can rely on, so someone to talk to, someone that they can share their experiences with. If they have one of those trusted adults, they're less likely to report negative mental health during their childhood. They're less likely to report experiencing homelessness, something that was just spoken about, and so that's one part of it.

We went to examining incidences of discrimination and attacks. Unfortunately, we find significant shares of trans adults, unsurprisingly, based on what we've seen in the news, report being verbally attacked. One in four report being physically attacked, including three in ten trans people of color. And then, we asked about access to mental health care. We talk about experiences with health care providers. So really, we--a really expansive survey, but we really could have kept them on the phone or online for much longer.

MS. JOHNSON: And so, Ashley, you know, what did the survey tell us about pronouns in the trans community? Are "they/them" pronouns more commonly preferred than "she/her," "he/him"? Talk to us a little bit about what the survey unveiled about pronouns.

DR. KIRZINGER: Yeah. This was actually one of the more surprising parts that I found in the data is that typically when we talk about trans adults, we're talking about trans men, trans women, but we found that large shares identify more as transgender nonconforming or trans non-binary. And large shares--half say that they prefer using "they/them" pronouns, so, you know, moving outside of like the binary of gender discussions and really talking more of it about a spectrum, right? It's not that they are transitioning from male to female. It's that they're transitioning from male to something else, and it doesn't necessarily have to be female, and it could be male and female. But it's not set in that binary that we normally use when just describing gender.

MS. JOHNSON: You know, and so, Fenit, one of the things you published today in your piece is talking about medical discrimination, right?

MR. NIRAPPIL: Yes.

MS. JOHNSON: And so, I'm wondering if we can kind of maybe stick on the--and I promise I'm coming back around to how this relates to pronouns, but when we think about medical discrimination and how the trans community interacts with the health care system and the types of discrimination that they face when they are seeking to access health care, I guess I'm wondering if you could talk to us a little bit about your reporting and what were some of kind of the key takeaways when it comes to trans people trying to engage with the health care system.

MR. NIRAPPIL: Right. I think to start one important piece of context when we're talking about trans people and access to health care is going back to what Andrea Jenkins said earlier: Not everyone seeks medical interventions as part of gender-affirming care. It's about one in three who sought hormone therapy, and it's about only one in six who've sought gender-affirming surgeries. So, a lot of times, the discrimination that people are up against is just while doing routine medical visits.

So, some of our survey findings include that just 10 percent say they've come into contact with someone who knows a lot about caring for trans people. About four in ten say it's somewhat or very difficult to find a health care provider who treats them with dignity, and just over half of trans adults say it's easy to find health care providers they can afford.

When you look at issues--when you look at issues like whether doctors use their preferred pronouns, it's about one in three who don't have--who don't come into contact with the providers who treat--who respect their gender identity.

And so, when I was talking to trans people for this story, I learned that it can be very nuanced in their experiences. Sometimes the provider is trying to come across as like well meaning, but they fall short. They misgender them. They ask invasive and uncomfortable questions, and really one of the more common experiences I've heard is that providers can be very quick to blame gender-affirming care for whatever malady a person is coming in with. Like, one person told me about coming in with a skin rash and then the doctor being quick to say like, "Oh, it must be the hormone therapy. You should stop it." And like, that is a key part of their health care, and it's often treated as like just cosmetic or optional.

MS. JOHNSON: Did any of the folks that you spoke to then talk about how does that shape their relationship in seeking care and shape their relationship with the health care system? Are they less likely to then go engage in some of those preventative measures, preventative health care measures that are so necessary?

MR. NIRAPPIL: Right. Those negative experiences with a health care system can dissuade people from seeking out medical care for anything.

One person I talked to said that after negative experiences on their college campus and people always assuming that they were a cisgender, heterosexual woman, even though they're transgender or non-binary, meant that they avoided going to the doctor for the first few years after graduating, and then when they sought the kind of gynecological care, they had to go to a women's hospital and was constantly met with the reminders that this health--that this kind of health care was designed with cisgender women in mind, like pink bras hanging out, pink gowns, signs saying "Fight Like a Girl."

That person also recognizes that we should respect the need for women's specific care, but the idea is that you also wanted to be in an inclusive environment because not everyone who comes in seeking care is going to be a cisgender woman.

MS. JOHNSON: Absolutely.

Ashley, you know, how might policy changes impact access that trans people have to health care in the future?

DR. KIRZINGER: Yeah. You know, just following up on what was just talking about, you know, the idea that like three in ten trans adults say that they had to educate their health care provider on how to treat them is just, you know, remarkable to me. It just makes me think about like you're going into a health care provider. You're asked sensitive questions asking about your health and then not being treated with respect and then having to educate them on trans issues. It seems really remarkable.

We also asked about their health insurance coverage, and many have reported having to change jobs in order to get insurance that would provide gender-affirming care, a lack of coverage, because of the types of jobs that they're in and those sorts of items as well. So, you know, it's all the way from their experiences with their health care providers, but they're also their health insurance coverage, and it impacts every aspect of their lives.

MS. JOHNSON: You know, Fenit, before we run out of time, I want to ask, what do you hope people will take away from the results of this survey and from your reporting on it? You know, what's the impression that you hope it will leave with readers and the general public?

MR. NIRAPPIL: I think there's a lot of the discourse around trans issues right now that makes people think that, oh, is the trans identity going too far, people being quick to identify as transgender. One of the big findings of this survey is that people face a lot of discrimination in life. People face a lot of challenges, including from routine medical visits. It raised the question of like, do you really think people are just being cavalier about this, are choosing to do this just to fit in or as part of some fad?

One of the keys is that a lot of people are still happy after their transition, despite all of the discrimination and the bigotry that they face. So, I just hope that when we're in this moment, when there's a wave of bills targeting transgender people, that people look to the perspectives of transgender people, and our survey is able to do that.

MS. JOHNSON: Absolutely.

We are just about out of time, and we will have to leave it there. Ashley, Fenit, thank you so much for being here with us today.

MR. NIRAPPIL: Thank you for having us.

MS. JOHNSON: And thanks to all of you for watching. To learn more about our upcoming programs and to register for upcoming events, go to WashingtonPostLive.com.

I am Akilah Johnson, and thank you again.

[End recorded session]