summer vacations maine

good evening and welcome to the museumof science i am james wetzel the adult programs coordinatorhere at the museum, and i am extremely honored to be introducingtonight's program, becoming nicole. before we get started please turnoff any and all electronic devices. and if you do need to leave the programearly, we ask you do so up the steps and through the exit inthe rear of the theater. i also wanna take this time tothank jack and susie reno and the entire reno family foundation fund formaking this symposium series possible. in addition, we were able to maketonight free due to the generosity of

the lowell institute, soa massive thank you to them as well. >> [applause]>> tonight's program and our guests are extraordinarytestaments to the diversity and intricacies of science andhuman nature that cannot be ignored. in a time where the legal rights of thelgbtq communities are being questioned, challenged andrevoked by government officials and institutions across the nation, the maines' family have increasinglybecome leaders within the community. nicole and jonas continue to shineas beacons of inspiration to those

discovering their own selfs while facedwith acts of discrimination such as hb 2 in north carolina which continuesto ignite social and public debate. the confidence authority anddedication nicole and jonas continue to show and the effortsthat they have already contributed to the transgender community continuesto inspire me personally. as well as all of the peoplethat they continue to touch with their story and their voice. amazingly, they've only just finishedtheir freshman year of college, so i am sure there's so much more to come.

as nicole states in her recent tedx talk,if you are on this planet, you are a part of the trans story. and through voices of individuals likenicole and jonas, this story will continue to be told and fought foras a pivotal part of humanity's diversity. now it is my privilege to introducean internationally recognized expert and advocate for transgender individuals andthe cofounder of the nation's first clinic to treat transgender children,including nicole. please join me in giving a verywarm welcome to dr. norman p. spack.

>> [applause] >> thank you. when i got started in all this, i hadno idea i'd be driving all the way from brookline to here and hear nothing buttransgender, transgender, transgender, bathroom, bathroom, bathroom. it's really quite amazing. before i get started, i just want to pointout somebody who's in the dark right now, but when he comes to the light you'llsee him, dr. mitch rapkin is here. anybody who knows anythingabout medicine in boston knows

that the great strength of whatthen was called the beth israel and now the beth israel deaconess hospitalis its patient-centered focus. and i, who have had family membersas patients, have been a patient, had grandchildren born there, can saythat it takes a rock to make that happen. and that rock for many,many years was dr. rapkin, and i'm so pleased andi'm a little daunted because you're an endocrinologist. >> [laugh]>> so you may know. >> [applause]>> you can't be in this field without

starting to ask some questions and we'regonna ask a lot of questions tonight. but start to think about, how far back do the issues of transgender people go? let's put it this way,it seems to be found in every culture that people don't get their heads cutoff for behaving the way they feel. in some cultures, it's absolutely admired,like the navajo, where people who have this dual-identity beforethey have a firm identity or people who have disorders of sexdevelopment, meaning that they have parts of one gender and parts ofthe other are given the highest status.

and are often involved in suchimportant things as marital disputes with the idea that theyprobably know both sides of the issue. >> [laugh]>> now in a wonderful journal article, as she was departing presidentof endocrine society, maria new wrote about a pope in the middle ages who was discoveredat autopsy to be female. >> the way they dealt with itfrom then on was to create a chair that looked a lot with a commodewith a cutout in the middle and it was a job of a seniorcardinal to go up through

the hole in the chair with his hand toverify that the pope had testicles. >> [laugh]>> for any of you who saw the movie, thedanish girl, i'm gonna pose a question. why do you think thatparticular episode took place in the weimar republicin germany between the wars? it took two things to have that happen. number one,until world war i with its horrendous shrapnel wounds, there was nosuch thing as plastic surgery. the field of plastic surgery grew and

flowered to the pointthat by the time between the wars, it became literally possible for skilled surgeons who had reconstructedpeople's everythings from the bombs and blasts to be able to do formsof genital reconstruction. that was the first,then it also took a public attitude. the weimar republic wasthe era of cabaret. it was the era of magus hirschfeld, a jewish physician whopracticing in berlin, was one of the first sexologists and

he saw a people for sexual problems. he also saw a people with gender identityproblems, referring them to surgeons, it wouldn't surprise me at all ifthe danish girl had seen dr. hirschfeld, who had to flee the nazis, of course,who had two reasons to wanna kill them. one was religion, andthe other was his crazy ideas about reconstructingpeople especially undesirables, who were only thought of forthe german death machine. so he went to bisheewhere he set up a clinic. he went to london, he set up a clinic.

he trained the late harry benjamin whoworked until he was 100 years old, and s some of you knowthe standards of care for treating transgender people was originallycalled the harry benjamin standards. because harry, practicing in hisgeneral practice in time square had so many transgender people whohave been taken advantage of by charlatans who said they could dothis that and the other thing for them. and so he set up a standards ofcare which still revised but they go on in his name to this day. i got into this in a somewhat

unusual way it took an n of one. that means when runningan adolescent medicine practice, one patient happened tobe a 24-year-old harvard graduate who had never been treated butarrives at harvard. and said, my parents, he knew his parents never really acceptedthe fact that born a female, that he affirmed a male identity andhe calls himself mark, not his birth name. and everyone at harvardplayed along with it, including the three roommates andincluding the registrar who,

this is 1985 when i saw them sowe are talking early 1980s. the registrar knew there was an issuebecause he spoke with the senior people at the health service. they said we've got to dosomething because everything was all computerized then andit would be easy now. but what the registrar didwas check he brought him in. he said mark i want you to come see me before two to three weeksbefore every semester. i wanna know every class you're taking,i want to know at what time, and

i want to know what teacher. why? because the registrar thenre-wrote the class list so no professor would say his birthname which would have been very likely would havebeen printed out instead. takes so little to make peoplefeel comfortable, right? it doesn't take a lot. it doesn't surprise me that harvard has been particularlyhelpful to trans students.

and it has written policies for its university health servicesthat have allowed for care to be provided and covered forover five or six years now. and that, when it's harvard universityhealth services, that means faculty and it means students and it meanschildren of faculty and employees and children of employees. a lot of people who can guaranteethat they would be cared for and it would be paid forwell before the more recent things. so, what started mitch,

i just wanna tell you that,one of the things that happen was that, we, andwhen i went to the endocrine division. the children have discovered that it wascommon practice and necessary for boards. for adult endocrinologist who rotate through the pediatric clinicsof children's and vice versa. and a number of the people whoare now on staff who take care of transgender people got theirfeet wet coming to our clinic. but so why did when we ask a question,

because i didn't invent any of this stuff. what i did was reallyget to know the dutch who had been doing what i endedup doing a good ten years before. and why did they take a stepthat ended up in the kind of treatment that nicole received,a kind of treatment that we consider to be ideal and still difficult to get forenough people? this came from my dear friend, nowretired lewis goran who was the founder of the dutch clinic foras they say for transsexual people. it was really for adults.

and doctor goran if you wannaknow anything medical about this field just look him up becausehe wrote 90% of the articles related to the medical consequencesof treatment etc., etc. but in this case what he did,can you imaging how difficult this would be to do today? it's the advantage of holland. holland is a small country,anybody can get to the center for care. in the center provides the care forall the trans people in holland. and they are on a totalnational health service,

total single payer planthat is the government, and everybody is on that plan. there's no going out of plan,there's no private care. this is it. and they don't take peoplefrom other countries. so it's a pure population capableof being followed forever. and, and all they care is free,prepaid for. and so he look up over his lifeexperienced with 3500 patients. and ask a question we wouldhave a hard time doing.

because of the mobilityof the us population. of what did they die? after all, we're in holland! it's one of the most sexually liberal countries in the world. it cares for their trans people. it respects and apparently they thought,respected their trans people. it seemed like the ideal placeto be if you were trans. so then they looked at what1200 of the 3500 had died.

and then he asked why? and they have those records cuz all theyhad to do was look up a central record. and lo and behold, they didn't die of allthe things that doctors talk about and worry about, well, hypolipidemia. or they had hypertension,taking testosterone or whether they had strokes orhigh dose estrogen. no. the overwhelming causesof death were suicide, drug abuse, alcoholism, homicide,

homelessness, detachments from family. in other words, they died a psychosocialdeath, which means their life sucked. and it wasn't a garden of eden for them. life was rough, even in holland. therefore, dr gorenassembled a team of people, psychologists, pediatric endocrinologistsand said the problem is we're gettingto these people too late. we're getting these people whenthey have already lived in one life and are being challenged byhaving to live in another.

and the people around them fromthe first life may not be that particularly supportive tothe life in the second gender. and therefore for many of themlife is no longer worth living. and lest you think this only goeson in holland because i'm trying to pre answer the question,why do we go so actively involved to try to helpthe kids at a very young age. well folks it goes like this ifyou're 16 to 25 years of age and your parents do not accept you for who you really think you are anddo nothing

to help you find someonewho can help them. you have a 45% chance of attempting suicide between the ages of 16 and 25. this is why the nih came chasingafter us saying, do you want a grant? >> [laugh]>> they helped us for two or three years,then we got a $6 million grant, divided among between four institutions,so the numbers will be high. to try to look at the difference betweenearly treatment and regular treatment. but i wish it were holland because we knowwe'd be able to follow these people for

the rest of their lives becausethat's what this needs. so, they decided, okay,here's the problem. the physical attributes that make it sodifficult for some people to adjust are the attributesassociated with puberty. because i'll show you a picturesoon of how easily it is for kids to look exactlythe same gender if you just dress them that way priorto the onset of puberty. it's almost like recreatingourselves from our prenatal state, when we started out asan undifferentiated gonad.

and didn't know whichway it was going to go, how the chromosomes andconscription factors would influence it. and here we are again,kid's looking basically the same. and in fact we could,if we dress them that way, they can go to whatever bathroomthey want and no one would say boo. maybe that's what we should do,is just make everyone look prepubital, and send then them wherever we want. but the whole purpose wasto use the gnrh analogs, the analogs that actuallyblock puberty at the highest

levels between the hypothalamus andthe pituitary. which is where pulsatory release ofhormones is responsible for puberty and menstrual cycles andeverything else related to sex hormones. that 's another interesting boston story,by the way. the first treatment for that was forgirls with sexual precocious puberty. what we didn't know why they weregetting puberty at three, four, five. what could be worse, right? everything, including menstrualperiods would happen. and then they'd be this tall because allthe growth would have to take place in

such a short period of time. so when the gnrh analogs came out, they were the ideal treatmentbecause up until then, high dose progesterone was being used,and it had side effects. and in a wonderful collaboration betweentwo harvard institutions that rarely collaborate with each other,the mass general and the children's. bill crowley and john crigler together to pull enough patience tostudy the use of gnrh analogs. and this day made it possible forthe dutch to see that they're safe

because this was done in the 70s,the late 70s. and the girls who are exposedto it shut their periods and everything down immediatelypuberty stopped for about 7 to 10 years they were onthat drug until they reached age 12. at age 12 the drug was taken away theywent into puberty within six months. and then they went intonormal menstrual cycles, they went into normal fertility,they got into normal motherhood and nobody's found a damnthing wrong with them. a total success story.

so the other thing is that if you use,if you started when people are starting puberty,boys at 12 to 14 and girls at 10 to 12. and you started by giving themthe hormones of the other sex, well that's a heavy thing todo to somebody that young. can you really trust that age thatthey can do something irreversible? and develop sexual characteristicsof the opposite sex that young? so this buys time. and you don't have to, at least you'redealing with a middle adolescent. when you're talking about usingthe hormones of the affirmed gender.

okay. so this is the nine yearold that i talked about. genetic male, this could have been nicole. maybe we'll have a picturethat was you in that age because by that point youwere dressing that way. and i dare you,in clothing i dare you to tell me that there's any difference between herand any of the other girls at school. but, to block her when shestarted to go through puberty, she went on the gnrh analogue to shutthem down, same thing we used with nicole

and now she's at 15 to 16 andshe has a shape. and that shape didn'tcome just from stopping. remember if we had just stopped. these are the dutch. all dutch patients whohave given us approval. so this is a dutch girl at 15. and of course if we had juststopped everything i would have had giving her female hormones,she would have actually developed male

characteristics cuz shestill has male gonads. and in here she is at 19,she's already had her surgery. she's done and i think you would agreeshe's a lovely looking young woman. >> [applause]>> and when i say, she looks female i'm not justtalking about her breasts. i'm talking about the subtle things. the softness of the skin. the body of the hair and particularly,the lack of angularity of the brow, the zygoma, which is the cheek bones,and the mandible, the chin.

all of which are soidentifiable that a forensic pathologist is capable of picking up a skull andsay this is male, this is a female. and this doesn't come with growth. this comes with the hormonesassociated with puberty. so we decided a lot laterto put a clinic together. the dutch trained us. the dutch gave us theirtesting methods and we decided to be as strict as they becausethey were having phenomenal success, and they were running sevento eight years ahead of us.

so we could go, as they say,we could go to school on that pie. that in order to be accepted forpubertal suppression, they had to be in the earliest of puberty,which means a doubling or tripling of testicular size orbreast budding. they had to be in counseling with a gendertherapist for at least six months because that person had to makethe referral and the letter. this isn't easy in many places andi have many friends who can't treat people because they can't getthe support of both custodial parents. and if it's a non-custodialparent who is a problem,

we sometimes ended going to court. and there can be no severepsychopathology, but believe me, there's plenty of anxiety, depression and minor things that are secondaryto the non-treated state. so my first patient fromoverseas came because, jackie, at age 12,previously untreated, a genetic male, had been totally abused inher city in middle england. on top of that,she had had four major suicidal attempts. and that was because in her mind,and that the policy

of the only program to evaluate andtreat trans kids happens to be in london. and their philosophy was no to nomedical treatment until 16 in spite of the fact that they had phenomenallygood psychometric testing at age 12. so the kids thought, well they're never gonna treat meif i prove that i'm qualified. well, jackie was also a challenge becauseshe had a predicted adult height of 6'5", which is a challenge that theydon't play basketball even. so we started her on analog, but we also, to cut her height down,we treated her with estrogen at 13.

and on the far right, she is 18 or 19, and a runner up, a semi-finalist in the miss england competition. and she ended up being 5'11" and then tweaked me about it because she saidshe missed out on a modeling contract. they wanted it'd be 6'1". >> [laugh]>> but then in a wonderful turn of phrase shesaid, but those models are all vacuous. >> [laugh]>> and it wasn't for her.

but it really was interesting thatno big brouhaha came over the fact that this person was born geneticallymale was winning beauty contests. but it all had to do with oneof the judges who said but she has more of her standingequipment than anyone else. so, okay, this is nicole at around 2. do you wanna hit the video, yeah. now, look at some of the toys, okay.

>> [inaudible]>> all right. [noise] now, i don't know if this is female, as in putting the dress over the head,or what. but, it all>> [noise] >> so, a couple of things that we see in children who are really committed and make a political statement about theirgender at a relatively young age, is quite commonly,as is the case with nicole,

is attempting to imitate hair,the longer hair of women, by wrapping towels around the head andthat was certainly done here. no one encouraged this and besides, nicole has a brother who was notthat we miss at the same time. [cough] this is at what age did we say this was? three, this is age three. so you might say, well, you know, it'sa boy's hair cut and a boy's t-shirt and whatever but look at the dollsbeing clutched close to the chest.

and remember,still going by a male name at that point. this is now nine years of age. by this point, nicole may not yetlegally had her name become nicole. they hadn't yet used it at school. but i'd met them for the first timetwo years behind this, at age seven. it was the first time that i had met them. and i remember quite vividly,the male name that was affixed to the medical record at that timealthough i'm trying to remember whether you asked me to call you nicole ornot.

that was kind of a planningsession of what we might do if. and this is the famouspicture from that sunday, december 2011, boston globe above the fold first with their story astold by bella english. now if anyone needs an idea,if anyone says it's okay to wait, it's okay to wait till they're 16 anddon't mess around. well, this is 14. look at how physically mature for14 jonas is. why, he has a beard,he's got an adam's apple,

he's got prominent cheek bones,mandible the whole bit. okay, in fact he may be 14, he looks 16. but the point is that's exactly whatnicole would have looked like had we not done anything. because what you're seeing in the rightis a normal male puberty of being a bit early. and on the left you'll see an identical twin who had puberty blocked at 12. it has not yet gotten any estrogen in anysexes, just on lactating at this point.

although it was just around thistime that we added estrogen in. so the dutch did have followed enough kidswho've gone through the whole protocol. blockaded 12,cross sex steroid around 15 and surgeries all all completed at 18. and then, these 55 patients about equallydivided between genetic males and females, they did a careful psychosocialevaluation of how these kids were doing at two to four years aftercompletion of all surgeries. how were they? did they fit louis gurn's population?

hell no. these kids were as good or better than psychosocially at that point than a control group ofthe same age dutch kids. so far it appears yet the results are, well, expected but still phenomenal. i'm gonna call nicole and jonas up and engage in a little by play

here. [applause] well how the hell,how are you doing? they just completed their firstyear of college and nicole has had, has been speaking a variety ofthe glad award ceremony in california. i should say in deference to the wholefamily including jonas for sure, it was no accident that the familywas invited to the whitehouse. on something that maybe you don'tall know that our president does. and every spring he has a saturdayluncheon for heroes of the glbt community.

and the family was honoredas they were by the aclu. but that had to do with the bathroomissue in maine a number of years ago andwell actually since i'm digressing you wanna just explain in a nutshell nicole what that was about. >> the bathroom? >> yeah. >> well, i began my transitionwhen i was in first grade. we decided to do moreof a gradual transition rather than sort of likean abrupt thing like

that i know a lot of trans kids do thissort of like burst into school one day. skirt, pearls, heels, purse,hair done, face beat. and it ruins kind of like what? so we decided to do more of a gradualtransition starting with growing my hair long, wearing pink andthat grew into bathrooms and name change, skirts and ending with the use ofthe mouthpiece stall girls back room. and everything was going really greatbecause we had eased not only myself into it, but also the administration, teachers,and all the other students at the school. so no one was really expected to abruptlyjust sort of understand everything.

it was really great andeveryone was cooperating. we had a question we couldall deal with it together. the only problem with the gradualtransition though was that a new student wouldn't have been there forsort of that ease into it. and that's what happened. a student had come in fourth grade,he wasn't in my class so it wasn't a deal. but in fifth grade he was,found out that i was trans, and he told his grandfatherwho was part of a radical right religious group.

>> [laugh]>> and so that wasn't really okay with him. and so on behalf of his grandfather, he followed me into the bathroomto sort of make a statement. carrying on his back the weight ofa lawsuit threatened by this group. so to cut a long story short theypulled me out of the bathroom. and they were just like, you know what? we're just going to remove the problem. we're going to put you inthis private staff bathroom.

and they sort of tried to glitzit up by saying there was even my own private mirror to like playup my vanity or something. and of course, it was a staff bathroom sothe mirror was too high for a fifth grader andi should have known that. >> [laugh]>> i should have known that. so that bathroom sucked. >> [laugh]>> and on top of that, as a complete isolation from all of my friends>> and after a while i'd reallyoverheard my parents talking

a lot about how unfair it was that i wasbeing punished and i sort of agreed. and so, in my almost like fifthgrade rebellious sort of action i started using the girls bathroom again andeveryone was fine until it happened again. and again i was in the principalsoffice with her giving me a look, and saying i wasn'tsupposed to be in there. and so from that point on they'd givenme a body guard to follow me around, make sure that i usedtheir isolation chamber. >> [laugh]>> and basically keep me in a placewhere i couldn't cause trouble.

>> and so forobvious reasons this wasn't working out. and we gave the school everyopportunity to help us, to work with us just like theyhad done for the past five years. but in sixth grade we ended up having to leave that schoolbecause they weren't cooperating. >> and we ended up filing suitagainst them on grounds of unlawful discrimination based on my genderidentity and that went to the. >> state supreme. >> first it went to the state court andthat was and we lost.

then we appealed thank you, andit went up to the state supreme court. where after about what five years->> sure. >> five years it finally won. it finally won after fiveyears of being in court. and that was the first case igot in the country actually. and so what it did,because everyone was really afraid and this it wasn't like a new thing. this was something that's beenhappening to trans kids everywhere. but the problem is courts didn't wantto you know be that first to sort

of draw a line in the sand. but fortunately we had the right people,we were there at the right time and they did the right thing,so that set a precedent. >> nicole,i remember being at a hearing in augusta, a sub-committee of the legislature,a joint committee. that was taking up an issue that wasbrought advice by one legislator. trying to amend the then quiteliberal public accommodations rules in the state that would giveprincipals and restaurant owners the right to say to somebody,you have to use, sounds familiar?

the bathroom of your biological sex. do you remember that? because->> a little, it's actually happeningagain in maine right now. they're trying to get enough signatures. >> i just want the audience toknow that up to that point, as i recall,you weren't completely out to everybody. you were selective asto who you would tell, and a whole bunch of us had gone up andgotten our three minutes.

the lead person, jennifer levi, got ten and the rest of us got likethree minutes and i remember, you said to your father that all these people are really tryingtheir best but they can't do it, i can. and you made it your business to go and visit just about all the legislatorsin maine and this is what they saw. and suddenly, forthe first time, it hit them. it hit them. if i had a daughter, and

they said i had to send her intothe men's room, where is the risk here? they think that my daughter islikely to prey on other women. this is a kind of reasoning you get fromsomeone like, i'm sorry i have to say his name, dr. paul mchugh,who claims he's never seen a transperson who convinced him that theperson had a different gender identity. he says all of the malesto females are really just gay men who founda unique way to attract men. >> they've got me pegged, darn, my secrets!

>> [laugh]>> in doing so, however, she basically outed herselfbecause that testimony was so potent that it was written up andher name was included. but she felt she had to do it. it was a pretty courageous thing to do. >> how's college, jonas? how is it without her? how is it without her constantchatter in the background? >> [laugh]>> careful

>> [laugh] >> it's peaceful, norm. >> it's really interesting because we've been together for so long and college, like you said, it was really the firsttime that nicole and i were apart for more than a couple of days or so,or when someone went on a trip. and it was a chance for me to have my own identity beyond beingnicole's brother which

through high school had beenthe title that developed with me. both at school where weshared the same friends and where everyone associated us together andalso on the state and national level, where all thesespeaking events began to pop up. i was becoming identifiableas nicole's twin brother and going to college alone was, i don't wanna say an opportunity butit was a moment where i was able just to be jonas andpeople picked that up. and that's a phenomenonthat a lot of twins have,

that ability to be becoming your own self. i think it was magnified forme because on such a grand scale, i became associated to you and it wasreally an interesting experience for me. with the book coming out,we have one bookstore in my college town. it's a very small town. we have one book store and becoming nicolewent up right in the front window. >> [laugh]>> i'm always with you, jonas. >> [laugh] yeah, that idea ofindividuality did not last for me. >> [laugh]>> but no, it was very nice to be

able to come into my own, andcollege was also a chance for me to discover things about myself beyond advocating fortransgender rights and equality. it was a good chance forme to come into my own, i guess. >> since you also were both at stateschools within the same state of maine, did you run into kids, jonas,who were aware of who you were? >> yes, i was. actually, funny story,i have a friend, he and i hanging out one day andthere were bunch of us in the room.

we're in my dorm room and he decides toplay the game, let's google our names. >> [laugh]>> he googles himself, nothing comes up. >> [laugh]>> he googles my roommate, nothing comes up. >> [laugh]>> he googles my name. at this point, none of us are reallypaying attention to what he's saying, he's just reading off random things andhe gets to me and he knows, shit! you're famous! >> [laugh]>> i've had a couple moments where,

yeah, it comes up. >> [laugh]>> but for the most part, i was surprised because it'snot something that really, until the book, a lot of peopledidn't really pick up on it. >> but, she's not in view. >> no.>> you're not at the same school. it would be quite different. [crosstalk]>> yeah, yeah. absolutely.i think it'd be something way bigger.

especially, i go to such a small school, i think it'd be something that's waymore in the forefront of my daily life. but no, i think it's a nice balance. i think it's something thatpeople recognize about me but it doesn't dominate who i am. >> nicole, one of the things thatmy colleagues and i talk about when we now have a special interestgroup of pediatric endocrine society. we were talking about has anyonereally studied what it's like for these kids to be forcibly delayed,puberty.

>> mm-hm. >> you know the reasons why,you know all that but what was it like to be in never,never land for a few years? >> i think being a twin,it was nice, especially for my parents, not having two kids go throughpuberty together at the same time. [laugh]>> no. and i think having, i think it wasjust on a psychological level. it was very nice not dealing withall those shifting hormones, at that particular moment in time forme, personally.

just because so much was going on. i was already in a really weird place. because after the move i had to hide mytransgender status from my new school, after being out for five years, and sothat was really rough for me already. so, i think timing wise,it was definitely convenient. but the actual process itself,i didn't have any problem with it at all. it didn't feel strange to me,i just think, i felt very normal. >> the other side of it is that when youstart from such a low hormonal level, from being blocked, that giving you any

hormones and in this case, the estrogens. >> mm-hm>> and some people say, it hits like a ton of rocks. >> when i started estrogen,i definitely got moody. [laugh]>> you were moody before that. >> well. [laugh]>> i just wanna get that straight. >> well.[laugh] >> what can i say?

i mean you saw the video. i was already a diva. [laugh]>> but no, i don't know. i think when i started estrogen, i don't know if i particularlynoticed it hit me very hard. and i think that's because wesort of started gradually, and sort of slowly went up in dosage. but i don't really recall orremembering any sudden changes for me, personally.

>> the other thing is many ofthe kids talk about in retrospect. >> mm-hm>> that until things are all done. it's very hard to beas involved in dating. >> in any romantic relationships until in that study from holland. yes they came out fine psychosocially butthey all admitted that it took until they had finished with the surgery forthem not to be gender dysphoric anymore. >> absolutely. >> so going after colleges formany, for some,

the beginning of dating and for some a continuation of something that theyhave started a couple of years before. >> for me acceptance for myself, when i talked about it in my tedx talk. it came a little bit before surgery, and i think that was personally,what made that decision to do it harder. because i think acceptance comes from being in an environment thatallows you to accept yourself. because i think self acceptanceis really hard to do,

when you aren't acceptedfrom an outside perspective. jones and i went to a private schoolthat was incredibly accepting. and yes, like acceptance at home islike where it starts, you need it. but, if you're just accepted at home,it's not enough cause if you're going to school all the time andyou're not accepted there then. okay.well, i guess you can be acceptedin the evening, but in the morning, you're gonna bea freaky guy and just so you know. so being accepted on both places gave mesort of fun ability to become comfortable

with myself and that's, and sothat came probably around my senior year. i mean that's when i started trying toget into the dating pool, but it was so really weird. but i mean,i guess dating's weird for anybody. >> [laugh]>> and i think after deciding to have surgery was hard because i was afraidthat gender dysphoria would come back, after just having gotten to a placewhere i had sort of accepted myself. but it was definitely the right decision,because those feelings of any gender dysphoria completely gone.

i feel, it's, i'm coming up ona year now actually in august since surgery and it kind of feels like,it's been a lot longer than a year. it's really weird. but i'm in a really goodplace with everything. so dating is that much easier. i don't know, if that's whatyou were looking for [laugh]. i realized half way through that iwas ranting and i was like well, i'm here [laugh]>> are you maintaining friendships from high school as in from home or,

maine is pretty big state,but not that big. >> well, most of it is occupied by trees. [laugh] so. >> yes, yes. actually, being home after collegefinished up has given us a chance to reconnect with a lot of friends from highschool and it's been really interesting. i think part of the reason they stayed soclose was because they were, no. i think they were just sounderstanding of who nicole was. >> and our personal struggles, i thinkthat didn't mean anything to them, really,

in the sense that didn'tdefine who we are to them. that they looked beyond that andthey saw us for just being other kids in the school, and i think that says a lot about not onlythem and the school environment, but also a standard which i think weshould all strive to meet. looking beyond that,to seeing who transgender students and their families are beyondbeing transgender. >> you know also my friends,our friends, we had the same group. our friends were so fundamental in megetting to that place of self acceptance.

so i think not staying in touchwith them at this point would be- >> which should be impossible. >> almost impossible. my two closest friends were actuallymentioned in the book, austin and lexie. and they've been incredible actually. austin is coming to my college next year. he's transferring. so we're gonna sort of resume ourwhirlwind that we had in high school. so they've been really great.

and i think having that close circleof friends is just so important, when you're going through something,as complicated as hormone therapy and this gender this for you and generalhaving people that you can talk to. and understand you regardlessof whether ro not their trans. because, my friends, it was very yes and coming out to them they were,it wasn't that big of a deal and we also got to that place where me beingtrans a wasn't my defining factor, but it was definitely somethingwe could all joke about. especially for instance,we went to the mall one time and

austin had a new boyfriend wewere all getting to know him. and he said something andi saw this opportunity and they all knew it was coming cuzthey saw this look in my eye. >> [laugh]>> and i looked right at him and i said, are you saying that cuz i'm trans? >> [laugh]>> and he just went white as a sheet. >> [laugh]>> and then, they all like broke up in laughter so having good friends isamazing, they're all incredible. >> except for your public notice,

you really would have the opportunity of never telling anybody except some very special close people about you. >> mm-hm.>> i see kids, for example, who happen to be trans, who become very active aboutglbt issues when they get to college. but actually i would haveto say that's the minority because if the kids are very muchcompleted in terms of treatment, whatever, many of themjust want to blend in. so to what extent is your career so

far a potential impediment to whether people will know you as nicole maines who happens to be trans, which at least is nicer than no nicole maines, the trans. >> yeah, exactly. >> but in any case, at least for peopleto associate you with this part of you. >> well, i think at this point, havingdone as many things as we've all done. >> i think we've all been givena certain platform and for me personally i do intend to continue touse that platform to keep speaking out and

to keep making a difference. because until we're at that pointwhere we'll tell our kids that there was a time when they didn'twant me to use the women's bathroom. until we get to that point i was like,wait, what? >> [laugh]>> then the work isn't, we're not done, we're not. we have so much more work to do. and so, i think solong as i have this platform, and as long as i have the opportunity to keepworking, that's what i'm going to do.

and as far as you know myidentity being define as trans. i'm definitely doing otherthings besides being the trans person because everybodyis not just their gender. no one's just something as humans we all have billion other things that defines us. and so, i think i'm also working on makingsure other people know i do other stuff. so?>> [applause] >> so that means that the two of

you are gonna run forpresident and vice-president. >> [laugh]>> you know, i think that would just be too complicated. >> i'd go to canada. >> [laugh]>> what would you be? the president or the vice-president? >> i'd be in canada.>> [laugh] >> so we do the, my advice? >> cool, do you know who skip.

>> come on up. >> my mom. >> kelly is a self-effacing person. i remember i need it someone to speakwith me whoever live near for london. it was send in medical school and she said i don't do this speakingin the and family weaned us. well, she took questions and she stood up from that side and she just knocked the house down.

i mean it was like where have you been? [laugh] so, anyhow>> i hope i don't disappoint today. >> [laugh]>> you want to expand on any of the thingsthat we discussed here? >> well,i think we're just a normal family. i think we just got really lucky thatthings happened the way that they did. and i have two really awesome kids,and there's a dr. spack in this world because icouldn't have made it without you. >> [applause]>> i haven't actually read the book.

i read the book when we wereworking on the book, but i find->> we were there! we were there for all of it. >> for me it's really hard to readthe book because it cannot explain how hard how much pain i was ingoing through that whole thing. and not knowing i'd besitting here today and everything is great everything is fine. but i can't tell you how manytimes i didn't think we'd ever come anywhere near this.

i couldn't have even dreamed of this,but to think that they would be okay. both of them would be okay. i had no idea. i mean there was a whole section oftime when wayne was not even on board. so i didn't know, and dr. spack wouldn'teven see us if wayne wouldn't have. it was very very hard, but. [noise] [laugh] >> prepare to take questions from the audience?

i know there are people with mics. and, would you direct the questionat a particular individual? >> yes, actually i'd love jonas and mom. >> kelly. >> i'm also known as kelly. [laugh] could you talk some about thesupport you needed going through this and also any advice you have, having supportnicole, for those of us who in the future or right now, in a position where wewill have people somewhere in our lives. who need the kind of support she does,what advise you would give

whether it's in school or teachers orjust friends, about how to support. and make it as safe as you can, but alsoi assume you all needed some support to because it's not just nicole, butit's a whole family thing as she said. is that articulate enough a question? >> absolutely, yeah, thank you. >> i hope, i like to think that i wasalways watching for both of them. but, i do think it was hard tomake sure that jonas didn't get lost in that whole shuffle. and i think anyone who has a childthat has any kind of special needs,

the other kids do kind ofget shuffled in the back. and i hope he doesn't feel that way,but it probably did happen sometimes. [laugh]>> so i can't make up for it though,i just can't make it up. >> can i have 20 bucks? >> [laugh]>> jonas maines. >> yes, great question. i think that's absolutely true. anytime there are multiple children and

one child needs special care asimportant and as vital as that is. there is this other aspect toit where it's very easy for a young child to kind of havethat what about me feeling. and i don't think, it's, because i don't want to say it's like a jealous orselfish thing. i think it's natural fora child to wanna feel the same amount of value as their sibling. growing up especially in middle school and high school is where ithink felt it the most.

i understood, there was never a time wherei was like, she doesn't deserve this. it was always, no,i understood this is what nicole needed. and under no circumstancesdid i want that to go away. i think there were times,especially with my dad, where it felt like i wasn'tgood enough for him. and i think that's my advise to parentswith siblings in any situation like this. whether it be with the trenchin the child or not would be, of course always give your childwhatever they need, always. that is not negotiable.

also it's hard but i think just giving thatextra support it's not. >> i think to add to what you askedearlier and i'm speaking for you now. >> that's fine. >> i don't think nicole would havedone quite as well without jonas. >> no.>> because was a constant support to her, constant. always watching her andalways had her back, i wouldn't say i hope i didn'tput that pressure on him.

to make him think he had to goto school and protect nicole. but we're a family, sowe kind of do that for each other and maybe it's because they're twins. or just sibling or whatever it is,he's always been there for her. he's been a great support system. for me, as far as counseling, whennicole used to get her counseling, and this may be in the books. so stop me if you'veheard it before [laugh]. >> [laugh].>> but she had a counselor around the same

time we're seeing you. and we go in andthe first half hour is my time [laugh]. i did not know what i was doing. i didn't know cuzthe counselor kept telling me, i know he's just gay, he's justgoing through to a phase right now. i've had several clients like this andthey all grew up. and i said, but wait a minute won'tyou rather be gay than transgender at least people kinda get that one. if they don't get this at all, sofor me it worked out really well.

because i was able to go in and say,my god my life's falling apart. and then also say here's whats going on,what do you think? and we could bounce these ideas offeach other, and, without her, and without you [laugh]. i can't express enough,i couldn't do it alone, there was no way. i had to have a support system ofpeople with reasonable minds that could help me through all of this. and that was certainly how i, buti don't think i slept for about 18 years. i don't think i slept cuz iknow what was gonna happen.

i know is another shoegoing to drop tomorrow. is someone going to be dead? i thought that so many times, it was->> i think that goes into the second part of the question, advice wise,is definitely i think with family members. it is absolutely vital to take itupon yourselves to educate yourselves regarding the issue. because your family member is going to bescared and they're going to be confused. and they're going to be angry,and they're gonna be sad, and they're going to immediatelylook to the family for support.

it is the responsibility and the obligation of the familyto be there for that person. >> i don't know if you've felt this but i've always felt like iwas doing this a lot. what did you say about my kid? >> [laugh]. >> back off,i always felt like i had to protect her. because i always was gettingquestions thrown at me. why is your daughter named wyatt?

it's a family name, it's a family name. >> so you must have seen a lot ofthat yourself at the school because. >> yeah, especially at school. there was a lot of timeswhere students would be, too afraid to ask the trans kidwhat being transgendered was. so i would often get approached byother students they'd be like so. >> what's up. >> is your sister a boy or a girl? >> or like, what's going on?

>> [laugh].>> yeah, and i- >> i've got 5 minutes, explain the whole thing [laugh]. >> it would often be like iwould be going to class or i would be in the bathroom and->> i need to go! >> and i was like probably nine orten myself, and i had no idea what it meant either. so, i was like,we'll get through it together man. i'll give you my best shot, andthen we'll sort of piece it together.

i don't know. >> i'll call you when i find out. >> yeah, it was really confusing forme, i didn't have all of the answers. and then, i was being approached bya lot of kids who expected me to. >> i know it was confusing for all of usbecause again, now it looks so simple. but back then, i would go online andthere was no information. and what you did find,you didn't wanna find. cuz that wasn't what you were hoping thatyour baby was going to grow up to do. you know and that's not what transgenderpeople go out to do, but online it is.

>> well, i just want the audience tounderstand that, forget about the fact that they're identical twins,that makes them unique in and of itself. but we're not seeing a lotof people coming in with because their child is at age one, two or three is literally behaving ina totally questioned way and is being consistent about that and who actually go on to continueto express that gender as puberty hits. so it's more common for us to see kidsa bit older and we don't actually

even consider kids definitely transuntil the time of potential treatment. and that because that's based on data thatprior to puberty, a lot of kids vacillate with respect to experimentingwith gender roles. but kids who say they'rein which puberty and insist that this is there gender identity. there i'm most certainly transgender and i most certainly will nevergo back the other way. that which is why the dutchshund,we do not have kids who desist. >> i was gonna add to that.

at that time too when the kids were infirst grade is that people are starting to ask why your son's wearing pink. and dressing like a girl andcarrying the kimpossible lunch box. so but you don't wanna pigeon hole themand okay if you're gonna dress that way you're gonna be transgenderthat's the end of it we're done. you can't do it that way you've gottagive them that space and that i think for jonas andi was probably that the hardest part. when parents would come to me andsay, what's up with wyatt? i'd say, wyatt likes girl stuff.

i don't know why and we are friendswith everybody in town for awhile there. he starts explaining it to everybody but you wanna make that's all i care about,i gotta make allies. i got to make sure they're safe,wherever they go and that's exhausting, it's really exhausting. >> well, you know,i just want to say, i just want to take like a moment andlike appreciate those two. because i don't think there'sa thing that they could've done better [applause] [applause]stay humble.

>> jonas wants us to move onto another question [laugh]. >> i just wanted to, something youwere saying earlier about how it's really the family's obligationto support each other. i want to add that it's hard to do whenthere's when there wasn't when we were starting. it was like you were saying,there was no information. and that's why the education is soimportant and fundamental for people to have, before a transgenderedperson comes into their life and that's what the whole, if you're on earth, you'repart on the trans story thing is about.

because you don't know when a transpersonis going to come into your life. i bet you a million dollars,if you told my father like a year before i was born that he wasgonna have a transgender daughter. he would have laughed in your face. and then, guess what, dad? sorry.that's why it's so fundamental for you to be prepared, because it's not fair to thechild to have somebody to have to wait. the world shouldn't have to catch up. they should already be there.

when we started the gems clinic in 07,we were the first in north america to have the programthat the dutch had started through, as i explained,unique personal connection. but right now, it's only ten years andthere were 60 programs. unfortunately, they are ona solid blue states, which shouldn't surprise you. so there are very largesegments of the country, where a kid remember thisis a random phenomenon. i'm convinced it's in the brain andi'm convinced that it not

influenced by external factors. so it just as likely wheni see people from kansas, i've seen people from the mormon faith,who've been kicked out. i've seen orthodox jews and on and on. but this means, that this has to go. we used to say how manypeople are trans in america? and i remember this distinctly frommed school that someone came back with a figure of 1 in 10,000. and then, i looked up and

i saw that there were 10,000 operations. 10,000 peoplehave had surgery and that's how they got tosuch a ridiculous number. well, if there are one in 10,000,i don't know why brookline high school, a school of 2400kids has four or five trans kids in it. okay, and so in other words the moreyou have an environment where people can thrive, obviously, the more people are going to comeforward and the numbers will shift. the other interesting thing is whenyou look at people under age 21,

over age 21,the numbers always seem to accentuate 3 times as many people going from maleto female as from female to male. but i think that statisticis ridiculous and probably, just reflects biases in termsof when people can do things. and do we really know, whetherthe person who is female to male is actually whether we're getting gay people, gay females, as supposed to peoplewho affirm a male identity. so i think,it's it's at least one in a thousand and it's probably closer to one in 500.

>> yes.and i guess this is to nicole and dr. spack. so i feel like a lot of the discussion hasbeen framed in terms of the sort of gender binary that you're eitheraiming at an ideal male or an ideal female sort of archetype andfor my kids and the transgender community that they have got me incontact with, i have a perception that there's a sense of a broad spectrum>> mm-hm. >> that a lot of people have this. some people really are not necessarilyaiming for one of those two end points.

i'm just kinda curious tohear about it that you said something about the spectrum. >> yeah.i am so pleased you asked that. because it right now, represents oneof the biggest challenges that we have. and of course,i tend to talk about what i know or what i can do and yetit's probably because the difference is that whenwe see kids like nicole, they're very often draggingtheir parents into the clinic. when we're now seeing people,who i call the term gender fluid.

i just can't say gender queer. it's just cultural. know that a person that has nottruly defined their gender. now, i know that i'veseen people like that. some of them ultimately do finda place for themselves, but they don't necessarily have to. but this i know, [laugh] is that this isa situation where the parents come and dragging someone and says whyare you bringing me into a doctor? and the parents are saying essentially,just make him trans.

>> [laugh]>> i just wanna know what pronouns to use. >> [laugh]>> and so, since all i do when i see people like that is say, we're herefor you if there's anything we can do. there may come a time when there arepeople who go through a gender fluidity until they find a place where they fit. and if not, be happy. >> i think for me, andi'm not a doctor, so i don't know anything of the medical things regardinggender fluidity or gender neutrality. all i can do is provide a commentary,the cultural and

familial aspects of it and i think whenyou have a child who's expressing that they don't fall on this line orthis end of the spectrum and that they're somewhere in the middle,i say cool. i mean, we don't give kids enough credit. they're smarter than we think they are. they're not going tosteer themselves wrong, when it comes to their own identity. we just have to trust thatthey know who they are. cuz we know ourselves best.

something that i say is that it's okayif you don't understand something. like that's fine,it's human nature not to understand everything because we're not all knowing. that's okay but what's importantis you can educate yourself or you can be educated on your own time. just the most important thing is torespect it on everybody else's time. and especially in this case,on your child's time, and so i think just trust thatthey know who they are. >> all right, sowe have our last question here.

>> thank you, i have a question forkelly, the mom, and i hope i am not minimizing this at all. having a trans-kid,whether having a trans kid or having a kid with add is incrediblydifficult for the parents. and if the couple cannot agree on, nevermind the treatment, buteven on the diagnosis, that's so hard. i was wondering,if that was your experience? and then my second part is, forthose parents out there who may not, who have that problem,what advice would you give them?

>> well, we did have that problembecause wayne wasn't on board. but i think i'm pretty bossy. >> [laugh]>> so i ended up getting my way. but i also did my research,i didn't just go well, wayne, she's transgender and that's that. i really did a lot of work, i mean, dr.spack and the counselors and other people that i met along the way,pediatricians. i did my research so it was reallyhard for him to argue with me about it because i knew what i was talking about,as much as i could at that time.

i think you've got to putyour own feelings aside and you've got to think about what'sgoing to be best for the kid. and even though you might have a culturalbias about something no matter what it is, you've still got to surround yourself withsome professionals that can help you do what's right for the kid. you can't let your feelingsget involved in it. and it is hard to go, like i said, i wouldhave people come to me on the playground. why is your daughter named wyatt, you know there's scary things youhave to do and talk about, but

you got to do them because in the longrun, you can't abandon the kid. you can't make them suffer becausethe two of you can't get along, and i think that in the end that's wherewayne and i ended up coming together. he finally realized that hemay not understand this but that's his problem andhe needed to work it out and he did. and the book actually,after it was written and i fought it all the way cuzi'm a private person but when it's done i realized it was reallya book of transition for both nicole and for wayne because he really changed somuch through that book and

i think we did too jonas butwe just kind of always got it in a way. i mean i didn't get it i didn't go yesthat's transgender it wasn't that but we just accepted that therewere gonna be some things that we didn't expect in this world. and for wayne that was very difficulthe i got two boys who we're gonna do our hunting thing we're gonna. >> play baseball. >> and to be fair,i don't go hunting with him anymore. >> [laugh]>> and to be fair,

we did play catch with him, andi did hit a home run better than jonas. >> and she was in heels. >> and i was in heels so. >> one time i look outside andthere's nicole in a skirt and heels andshe's helping wayne clean the turkey. so you don't know. no kid should have togo through this at all. but if you have to, you've got to atleast have your parents that love you. and to me,that was the bottom line right there.

there is no way these kids were evergonna leave that house thinking that they didn't have somebodythat loved them cuz i do. sometimes, i'm all they got,you know it as yourselves. sometimes your mom is the only thing yougot, and you gotta be able to have that. so, i think that's kinda wherehe got on board, actually. >> [applause]>> what an amazing and important conversation. thank you dr. spack, nicole, jonas, and kelly forsharing your story for with us tonight.

thank all of you for joining us,the evening is not over quite yet. we invite all of you to join us fora reception one floor down, where you will be able to pick up yourown copy of the book becoming nicole, and have it signed by nicole andjonas as well. we are also so fortunate to have severallocal lgbtq organizations present as well. they all have informational tablesdown there and representatives, so please engage them, learn about their workand continue this important conversation, thank you.