S3E17: Understanding Self Identity

Harjit: I didn't eat anything for breakfast. I'm hungry.

Bushra: This is my breakfast. I woke up 30 minutes ago.

Harjit: What is that?

Laurel: Yes, I ate a banana, because I got a bunch of bananas, and I'm trying to be better about eating them before they get gross.

Harjit: Oh, good idea, potassium.

Laurel: Important.

Harjit: Are you all ready? It's early in the morning? Welcome to the "Bundle of Hers." This is your girl, Harjit Kaur. And in this studio today, we have Bushra.

Bushra: What up, what up?

Harjit: And we have a very special guest, I'm so excited, Laurel. They are a first-year medical student. Hi, Laurel.

Laurel: Hey, thanks for having me.

Harjit: I'm really excited about today's topic, something that we always discuss on the "Bundle of Hers" is kind of coming into our own identities. And one identity that I think is integral to every individual's life is their gender identity. And that's kind of the topic that I wanted to talk about today, and that's why we have you as a guest. So we'll first start with our pronouns just so we can have a baseline of what we should identify each other as. So my pronouns are she, her, hers, and we're "Bundle of Hers."

Laurel: Perfect.

Harjit: I get so excited about that.

Bushra: My pronouns are also she and her and hers.

Laurel: And then I use they, them, theirs pronouns. Grammatically, you've heard the phrase "to each their own." So actually, singular they has been around longer than singular you. That's a fun fact.

Harjit: Oh, I love that. That makes sense, actually. That's really cool. And I think that's kind of, like, what I want to start the conversation around is definitions so we kind of know, as we move forward and we use these words, what they mean to us and kind of our understanding. So when we think of gender, we have a gender identity. That's basically how we identify on the scale of . . . would you say on the scale of a binary scale or it can even go further than that? Because there's genderqueer.

Laurel: Right. And so, as a nonbinary person, I don't think of myself in the middle of a line. I think of myself somewhere in the galaxy of gender. And so I think that, when you're talking about gender identity, it's more of a color wheel than it is a scale, because like you said, there are just so many different people, and cultures, you know, articulate and experience gender differently. It is complicated. And that's why, like, anything else with your identity, it's a deeply personal thing.

Harjit: Yes. And then we also have biological sex that are the chromosomes we are born with. And those two aren't just one or two things. It can be several different things. And then there's gender expression, how we appear to the world. Would you say that's a good way to say that?

Laurel: I think it's tricky, because for me, everything to do with gender is a very self-directed process. So when I think gender expression, I don't necessarily think how other people perceive me. I think, "Okay, what am I choosing to convey to other people?"

Harjit: Oh, yeah, that's beautiful.

Laurel: And so, for me, I think the important distinction is . . . so I would say, in terms of gender, I'm on the more masculine side of things, but I like a lot of feminine articles of clothing. I think crop tops 2020, you know, crop tops every year. And so the understanding of gender versus expression can be who you are versus how you take that identity into the world.

Harjit: Yeah, that's great. Thank you so much, Laurel. And then there's also, kind of going back to gender identity, just some cultures, which you have also brought up, have more than just male and female or, like, woman and man. There's like third genders, fourth genders, fifth genders, depending on cultural context. I'm from an Indian background, and we have a third gender that we've always identified for years and years. It's been complicated in the last couple of decades due to politics. People actually like saying it and it being there, but that's something that's existed for thousands of years in our culture as well. And, Laurel, I just wanted to jump in and kind of talk to you a little bit about your story. How did you form your gender identity? Where are you at right now? And where do you see yourself going with that?

Laurel: That's a big question. The full journey of Laurel Hiatt, the person, the myth, the legend. So I think important context is that I was raised in a conservative religious home where my initial ideas of gender were very binary and very established. So we talked about biological sex or natal sex. I was assigned female at birth, meaning that when I was born, the doctors looked at me and they went, "Okay, check, female." And I came from a family where higher education wasn't really a thing. Both of my parents grew up rural farm communities. So I grew up thinking, you know, "Okay, I'm going to have eight kids. I'm going to be a great mom." Like, these are the expectations that others hold for me. And at the time, I held for myself. And I think that something important when you talk about gender, and specifically transgender individuals are people who do not identify with the sex or gender assigned to them, is the concept of dysphoria, where dysphoria in its simplest terms is basically just a discomfort kind of surrounding gender.

And so there's a couple different types. For instance, social dysphoria, when people use the wrong pronouns for me, or I grew up, I'm the youngest in my family, and so my parents would proudly talk about their youngest daughter, and there's a bit of a twinge there. I'm like, "I don't know who that is." Socially, it feels wrong. Physically, as I got older, you know, body parts are weird, and we gender body parts really strongly despite the fact that everyone has really different body types, and there's more variation across bodies than, you know, the two little stick figures outside of bathrooms.

But anyway, so I basically grew up in a lot of flux but very religious, and I had a hard time conceptualizing myself until when I went to high school, ended up involved with the LGBTQ community at my high school. I also used either bisexual or pansexual. So, for me, I experienced attraction to people with different genders. So I understood that really before I understood my own gender identity. Basically started spending time with people of different experiences and identities, and I started developing the language for myself.

And I snuck out of my parent's house at 6 a.m. to go to a queer summit, because that was my form of being a rebellious teenager, and I met a person who is nonbinary for the first time. And I looked at this person, and they were so pivotal for my self-development, because I realized, like, that can be a possibility for me. So there was a lot of conflict between myself and religion, and I didn't talk to my parents for about a year. There's a lot there, but basically, I came to the realization that I think a lot of transpeople come to you, which is you can either be yourself or die trying. And that was a worthy endeavor for me.

Harjit: I think it's so strong and courageous of you. You know, growing up, you knew that there was just this discomfort, and then you kind of seek that path for you. I really believe that things align for us if we really believe them, and it's, like, you found this person who kind of helped you, like, understand this new world that maybe you weren't exposed to when you were younger. I think that's really beautiful, but I also think, inherently, you already knew that "I don't fit into what, you know, I've been taught," basically. You didn't need to have a person to change your view on that. You just knew inherently, you know.

Bushra: Internally, yeah.

Harjit: I think that's a really important point, because it's from within. It's our identities. We know who we are going to be, right?

Laurel: Yes.

Bushra: Also, just to kind of add on top of what Harjit was saying, you sought out your own community, which I think is very important for people who kind of feel like outliers and they're the only person who feels a certain way or is going through a struggle to find that community to kind of strengthen them and to learn from. So I thought that was a very poignant part of your story too.

Laurel: It is a very essential thing that you pointed out, which is that I have been me since I was me, right. Research currently indicates that, usually, a child has really solid grasp of their gender by the time they're about three years old. So it wasn't an outside force that caused any change in me. It was seeking out my community that, basically, honestly, you know, gave me hope in the framework for "I don't need to be in this marsh of confusion." Like, there's others like me, and we can form a community, and we can work for collective betterment, which is what I've tried to do in the years since.

Harjit: I knew about your gender identity the very first day I met you, because you were so open with it. And I want to know, like, what makes you that way?

Laurel: Something, I think, that is talked about, like I said, is gender dysphoria, but there's something called gender euphoria that is pretty important. I think both for cisgender people or people who identify with the sex and gender assigned to them and transpeople, it's instead of the feeling of wrongness, it's that feeling of rightness. And so, for me, I did what every little baby transpeople does, right, where I put on the clothes that I wasn't supposed to wear, and it just felt so correct for me. And I'm really fortunate that I have a significant other who I have been with since high school who has been my cheerleader every step of the way. And in high school, it was something where I really only felt comfortable in queer spaces. In my undergrad, I basically got more and more confident, I guess, in taking up the space necessary. Because I understand my identity is inherently something that is new for a lot of people.

But to me, it's person with a name that is difficult to pronounce, like you deserve that respect. You deserve to be fully present socially and physically in the space that you're in. So, for me, it was something that in my undergrad I started getting. I got pronoun buttons. I was involved in speaking in a lot of classrooms, because I abide by the mantra, to be the person you needed when you were younger. And so, for me, I try really hard to be a visible presence so that people can look to me and know like, "Okay, I can do that too," which has been, honestly, incredibly empowering, because I've had people younger than me, you know, at my college, like in my state, people who I've done some forms of national advocacy. And I've had people from across the country, like, email me and be like, "Hey, I really want to come out as nonbinary to my professors. How do I do that?"

And so, for me, it's kind of been a slow uptick, I think, every year. And actually, 2020, my New Year's resolution is basically to correct people every time they get my pronouns wrong, because pronouns aren't the most important thing by far, right. Like, there's a lot of other aspects of being a nonbinary person or a transperson. But to me, it's a simple signal that shows that people are seeing me the way that I am and deserved to be seen.

Harjit: Yeah. And also, Laurel, I think that language is so integral to culture. So if you want to shift that culture to a more inclusive, we have to change our language. Like, I think it's so powerful. So, yeah, it's also a simple thing, but it's also a very profound thing.

Bushra: So, for me, the idea of gender started shifting for me in . . . not in high school, in college, that there's, you know, more than two genders that people can identify with. One thing that I always struggled with is the onus upon me to figure out somebody's gender, or is it on them to tell me what their pronouns are?

Laurel: I think that, generally speaking, transpeople are pretty reasonable human beings, where usually a transperson is not going to be upset if a person is not aware and makes a mistake. I think the caveat there is I think that it's every person's responsibility, especially physician's responsibility, to make it clear that they are a person who is open to being corrected or open to receiving information. So I personally just have kind of wired myself until I have a very clear marker, I usually don't assume someone's gender, because I've met lots of people who are very feminine, people who are very masculine who don't identify as a binary person or with, you know.

I think that looks can be deceiving, especially, you know, even including a lot of cispeople. Like, a person's appearance is not necessarily evident. So I typically will use they/them pronouns or use a person's name until I have a somewhat clear indication. But I think the average person who is not, you know, in trans-predominant spaces, as long as you are making sure to accept information as it comes to you, then that's really the way to be successful.

Harjit: Kind of just to, like, talk a little bit more about my story around gender identity, we have three daughters in my family and I'm the youngest. And, like, I knew before anything that I was a girl, and like, I had certain responsibilities that I had to fill because of my"gender roles," you know. I've struggled a lot with . . . I always wanted to adopt masculine roles, because I wanted to prove to the world that, "Oh, because I'm a woman doesn't mean I'm, like, weak or, like, I can't be, you know, X, Y, Z in the future." And I think it really messed with my head. Growing up, like, there was a lot of feminine things I loved, but I would always go away from them, because I was like, "I just need to prove. I can, like, follow my dreams." And for me to follow my dreams, I always thought I needed to be a boy. There was masculine things I like, there was feminine things I like. I identify as a woman, so I identify in the gender binary, right?

I think it really affects every single person, this binary, like this is for men or this is for women, right? It becomes a really hard world to live in, because then, you always have this struggle like, "This is what I want to do, but this is what people think I should do, and this is, like, how I should be." If you imagine living every single day of your life in that struggle, I think it's really difficult for a lot of children, right. The ideas of gender really, really, really impact human beings and cause a lot of distress.

Laurel: Yeah. I think every person can benefit just from a little bit of introspection. And what does gender mean to you and what role does it play in your life? Because for instance, my significant other, my fiancé is a cis-man, so assigned male, identifies as a man, is very comfortable with that, but at the same time, in being involved with me, a transperson and a nonbinary person, he is identified a lot of things where he, I love him dearly, he cries at the drop of a hat, right. And he's not worried about that, because the pressure to not cry, to be masculine, really doesn't have any importance to him. So he is able to pursue things regardless of expectations, self-imposed or otherwise. Personally, I think it's really important for children who are, you know, in their most vulnerable impressionable stages for them to have the freedom to explore what feels right to them because it's innate. So your kid is going to be however they're going to be.

Harjit: Right.

Laurel: So it's better for them to have the safety and comfort to develop themselves when they're children, as opposed to a lot of people in the trans community joke that your 20s are more like your teens.

Harjit: Right.

Laurel: Because if you're medically transitioning, you might go through a second puberty, but also, just developmentally, it's the first time in your life as a transperson, usually as an adult, where you're able to actually identify, "Okay, what are the things I'm interested in?" Because not everyone has this experience, but I know I did, and I know a lot of other transpeople do, where the opposite of what you said where you pushed against feminine things to assert yourself. A lot of transpeople have this kind of reactionary experience where they lean into what they were assigned. You know, that's what's expected of them and it feels wrong, so you're like, "Okay, maybe if I do it 300%, it'll turn out that it's fine and I don't need to worry about it." And so, a lot of times, it is not until years later that you are given the opportunity to deconstruct who you are and what actually drives you.

Harjit: Yeah. When you say that, I think that it's so powerful for us to discover ourselves. We talk a lot about questioning everything that we do, questioning everything that we're taught. And I think that if children had the opportunity from a very young age, I think this world would be very different if we could just be who we wanted to be. And I think that's our goal, you know, as future providers. And, Laurel, I just want to know a little bit more. Now you're in medical school. We're all in medical school together. How has your experience been around gender identity here?

Laurel: For me, it's been interesting. So, for reference, I have PCOS, polycystic ovarian syndrome, which is associated with, you know, really high testosterone, masculinizing features, and actually, there's a relationship where a lot of people assigned female at birth with PCOS often have gender variance. Really interesting. So I came in . . .

Harjit: Oh, I didn't know that.

Laurel: Yeah. So I came to medical school with an understanding that, both in terms of sex and gender, I don't really fit into what is considered the norm. And the thing about medical school is that it's trying to teach you two completely opposing things at the same time, which is we're learning to pick up clues, we're learning that, you know, when you hear hoof, beats, you know, think horse, right. Like, we're told to pick up on what is the most common, what is the most obvious, so we can be efficient, but at the same time, we're being encouraged to, you know, remember the comprehensive fullness of people and that sometimes it is the zebra, sometimes the unexpected happens.

And so I think, for me, it's something where my default is always to look for the exceptions, look for the rare cases, because I know I am in certain facets. And so, for medical school, it's been something where I continually try to bring up, you know, who's not in the room, what we're not talking about, because I think that, in order to be a successful physician, you need to be ready for every patient that walks into your office, not just the 95% of patients. So that's how it's been academically.

I think, personally, it's been interesting being a person who came from a university in the south. And so religious space, but a university that still had a lot of progressive circles to the University of Utah, Salt Lake in Utah, where I understand that people in our medical school are coming from really different experiences, where some of them have been really active in LGBT health care before and some of them really don't know anyone who's queer of any variety. And so it's been an opportunity to have a lot of long conversations, but I view myself as an educator, and it's the reason I went into medicine was for the well-being of transpeople, myself and others. And so I have appreciated the opportunity to have hard conversations with the students around me.

Bushra: I think, just from my perspective as a woman of color and those challenges, I think it comes with some difficulty to challenge a majority on things that they have learned throughout their life that they've grown up with and that they haven't necessarily been challenged on. I think that's a huge feat to take on, and I just wanted to say, like, I commend your work and it's very important and it's also very stressful at times, I would imagine. And so I think it's a wonderful thing that you're doing.

Laurel: Thank you. I think that, for me, part of what has been motivating for me is that, you know, in my class and in our school of medicine, generally, there's so many other people doing amazing work, specifically there are some women of color, and you know, in my year, who are inspirational to me and, like, their resilience. And so I think that it's the coalition building of looking to someone else and recognizing the work that they do and using that to kind of fuel your own motivation. So I appreciate all of the people I've been able to spend time with.

Bushra: Yeah.

Harjit: So when I was a first-year medical student, around the same time, I was thinking a lot about gender and how, as health care providers, we kind of perpetuate oppressive cycles. So I wrote this piece and I will tell you that, like, it kind of really helps me understand, like, how much distress I have having that power of "picking people's gender." So I wrote this.

"I had spent so many years of my childhood trying to push out all the feminine parts of me so I could be the son that was wanted. And that really impacted me and still does to this day. When I was a senior in bioengineering, we created this electrical lightboard, and all the women randomly ended up in the leadership group. We had to design the board. We chose to make a flower. I love flowers, but I was vocal about doing another background. A simple thing as a flower bothered me, because I wanted us to be taken seriously. There were gaps in my mindset created by what I was told to be and what I wanted to be. Comments were made, but we did it anyway. And it made me happy. One day, I'm going to be a health care professional and might be the one who announces to the world whether a son or daughter is born. That scares me. I do not want to facilitate the boxing of a gender, a mindset, of an identity.

These are the things I hope to work towards. They give me strength to move forward even when things are hard. I imagine a soft world where, when I have the words to speak, I can say, 'I'm Harjit. I'm a woman who loves flowers, who loves to build things, who loves to.'"

And I think that I was really sad that day because I realized that, being health care professionals, we have a lot of power. We have a lot of power over individual lives. And to imagine that we are the first people that assign people's "gender," yes, we're assigning their sex, but then the automatic assumption is that's going to be their gender, right. That really, really scares me. So what can we do as future health care professionals?

Bushra: There would need to be, like, a cultural shift within medicine, which I'm sure you guys all know, it's kind of hard to change a mindset like that. The way that I look at it, it may come down to, like, individual practice as physicians to slowly incorporate things into your own practice, create kind of awareness surrounding, not just gender, but literally, you know, anything that could impact people's lives. I just think it's a hard thing to deconstruct a whole system, but it has to start somewhere, and I always tend to think that it starts at an individual level instead of from the top down.

Laurel: I think it's exposure and just that, like, kernel of education that, like you said, it's hard from the top down. But I think, as an individual, you can find the opportunities to at least make the space directly around you a little bit better, because I think the ripple effect is pivotal. So much of medicine is, you know, legacy-based. It's, "This is how we've done it for 100 years, so this is the way to be a physician." But the same way that we are constantly holding ourselves to practice best standards as medicine evolves, I think that we need to do the same as communities we treat evolve or become more in need of a different kind of care.

Bushra: I love that you mentioned that a lot of medicine is legacy-based, because it is, and we do things just because that's the way that they were done in the past. And I think there's a lot of power in organizing and fighting for the things that you think are important for yourselves and for your mental health. And we can challenge those things that have been done just because they've been done in the past for decades.

Laurel: I think that, you know, the steps we take that are better for ourselves are also going to be the changes that are better for all of us as communities. And so I think that it's understanding that we all have shared interest that we all want to be better physicians and we all want our patients to have better health care. And that can look a million different ways, but it's rooted in similar values of, you know, respect and education and inclusion, I think, is, you know, what we need.

Harjit: Right. What you want to be remembered for, what is kind of the legacy that you want to leave or the impact that you want to leave with their life?

Laurel: You know that I am able to be, like I said, a visible transperson so other people who don't see themselves in medicine who maybe don't see themselves represented in anything know that they deserve to take up space, and the people who maybe do see themselves represented are aware of the fact that they can work with the people around them to make a more inclusive environment for everyone. I think I want to be known even more so for being a physician, for being an advocate to my own community and the others around me.

Harjit: That's so wonderful and I think is something that I kind of, like, align with as well with my values and what I hope to seek. We are so grateful that you were on this episode with us and spoke to us a little bit more about your story, you know, gave your thoughts on this wonderful topic that I hope we continue to have many, many conversations about. So thanks so much, Laurel.

Laurel: Thanks for having me.

Harjit: I hope you had fun.

Laurel: Yeah.

Bushra: Thanks for tuning in to our conversation with Laurel. Follow us on Instagram, @bundleofhers. Leave some comments on Spotify . . . or not Spotify, Apple, right? They can leave comments on there?

Harjit: They can leave comments on Apple . . . no, Apple Podcasts.

Bushra: Okay, I'll just . . . never mind. Please leave comments wherever comments are possible and whatever medium you're choosing to listen to this podcast at. Until next time, bye-bye.

Harjit: Yay.