JoAnne Keatley: We have some key addresses from the community. And, let's see, our first person to speak will be James Green. James is a member of Harry Benjamin International Gender Dysphoria Association. He acted as a consultant for the Standards of Care. He is a past president and principal architect of FTM International. He works, has worked, continues to work to build Community and pride among the transgender movement, and he also has a column on PlanetOut called "Visible Man", where we can get more of James' wisdom. Okay, so Cecelia Chong is a Health Worker at the Tom Waddell Windsor Hotel Project. She is on the Board of Directors of San Francisco Pride Parade Committee, and is on the Advisory Board of Positive Living Channel on Gay.com. It is a privilege and an honor to introduce James and Cecilia. [applause]

James Green: I'm gonna - I'll tell you what we're gonna do for the next hour. First of all, I'm gonna make some opening remarks, and then I'm gonna turn it over to Cecelia, and she's gonna make some remarks. And then I'll do a little bit more remarks, and then we'll talk to each other a little bit. And then we'll open it up and let you guys join in on the conversation.

I'm gonna start out with a sort of meta-issue kind of thing. And then we'll bring it back to a Health Care focus. I was invited to speak at the Millennium March last Sunday, and I was one of four transgender speakers. I was the only FTM speaker that was included. However, by the time I got to the microphone I was told I didn't have the three minutes I was supposed to have - I had 30 seconds. And so what I said - I was told basically to just say my name and the organization I represented. And I said my name, I said my organization I represented, I said two lines from the speech which I really wanted to say. And then I just said, you know, I've been asked to cut my remarks short. Mind you, the whole time that I was doing this, they were yelling in my ear "hurry up, hurry up, hurry up." And I wasn't the only who was treated this way. A lot of, a lot of speakers were treated this way -- it was really horrible. But, and I just said I've been asked to cut my remarks short, and I just want to tell you that I'm really tired of being marginalized. And thank you, and I walked off. [applause]

So today I'm going to give you the speech that I was gonna give at the Millennium March, and if you come to the San Francisco Pride, you may hear the speech again. You may hear this speech numerous times, because I'm gonna give this speech as many times as I possibly can. [applause]

Transgender? Who is that guy? Why isn't he wearing a dress? Isn't that what transgender is all about? Transgender, that's not my issue, go on girlfriend let's get another beer. All of you who think transgender is not your issue, you need to think again about what it is we're all fighting for. About why it is that people who have made you, or anyone you know, feel shame or fear to express who you are. The transgender movement may not make gender go away. Indeed, some of us like our gender very much and want to keep it. But the transgender movement is not about perpetuating stereotypes. Transgender opens up the space between the binaries, and allows us to see what our ideas about gender and sex really are. The transgender movement calls for respect for all people based on our humanity -- independent of gender expression, economic worth, sexual orientation, race, class, age, religion, national origin, or taste in wardrobe. The transgender movement calls for a paradigm shift in the way we perceive the value of a human being. The transgender movement asks all of us to learn not to judge people based on artificial or superficial, arbitrary criteria.

I am a man who was born with a female body. I lived in a female body for 40 years. I thought I was a lesbian for 22 years. I know what it's it like to live in an androgynous zone, where people can't tell what sex you are. And sometimes that's fun, sometimes it's great to be provocative like that, and sometimes it's dangerous. Sometimes people punish you for it. And sometimes you want people to see who you are, to accept you as the way you feel. People whose gender matches their body, and that is the majority of the people, are privileged with respect to how they view gender. They get to see it as arbitrary, something that's imposed on them from the outside - like role playing. They think they know the difference between themselves and the role society asks them to play.

Transgendered people do not have the same options. Transgendered people are told over and over again that they are not who they know themselves to be. The transgender movement asks that you give up your fear of other people's identities and beliefs. The transgender movement asks that you be willing to allow other people to be different from you and still be worthy of respect.

What we want in common, you and I, is a world free from homophobia, a world free from regulations on gender expression that keep us from getting out of line. The paradigm shift I am looking for is one that moves toward a world without shame or fear of difference. A world in which people like Brandon Tina, and Tyra Hunter, and Robert Eaves, and Matthew Shepherd don't have to die because other people are uncomfortable in the face of their difference. That's the world we're trying to create. That's what the transgender movement is all about. So when we say lesbian, gay, bisexual, transgender, intersex, queer, and questioning, what we're talking about is a world where we can all be free to be ourselves.

Thank you for coming out today, and every day, to show the world how beautiful you are. [applause]

And there's just one other little introductory kind of thing I'd like to do before we all suddenly begin talking about the issues, and that is -- I'd really like to have all the trans-people in the room stand up and be acknowledged - just so we know. [applause] Thanks for coming.

Cecilia Chung: So I guess it's my turn. Thanks James, that's a really, really moving speech. And I was sitting here thinking about the same thing. Wouldn't it be nice if one day we don't have to deal with the problems that are called sexism, racism, ageism, homophobia, and we don't have to deal with gender. I'll tell you what my definition of transgender is -- it means transcending gender. That means that there's no limits to who we can be. Not by what our genitalia dictates. Not by what society dictates. Not by what our parents said I should be, and how I should behave.

When Kristen and Carla were presenting the seroprevalence studies, I was looking at all those numbers. Here I am standing here telling you I'm part of those statistics. I am one of the participants, and I'm also one who has tested HIV positive. It's been a long road to get to where I am today. And the reason why I accepted this invitation was because there are many many who are not as fortunate, and who did not survive the shame and the punishment that society put on us. And I am here to speak, and until our voice is loud enough for everybody to hear, I will continue to be that bitch screaming "Listen to me, listen to us!" [applause]

And, of course, I'd like to thank you for being here to listen to us. To tell you what we need, and to tell you how we want to be treated, and thank you. There's a lot that I want to really talk about, but the community panel has done a great job sharing their personal experiences, and so I've got my work cut out for me. What I really want to say is when you look at the resources book, and when you look at how little resources for homeless transgender clients, and how little resources for positive clients. I mean, it's great to have resources, but we need more. How can we talk about care when half of these clients don't even have a roof over their shoulders? Half of them don't even know how to feed themselves from day to day. Half of these clients don't even know how to survive. Not knowing what it's gonna be like to walk out on the street tonight to make their living.

I recently ran into two girls who just moved here last week from Pensacola. They told me that there was a transgender woman who got murdered not too long ago, and they feared for their own safety and their lives. They came to San Francisco because that's what they saw as being free. And so they decided to give everything up, jumped into their car last week and drove all the way to San Francisco, and now they're part of us. It's great to see all the support that we get in the City. And I wish there were more cities like us.

Then another part that I do is -- I go to high schools, speaking as an HIV positive person -- but that's the catch. The Unified School District has forbidden the topic of transgender being mentioned in high school. And so I've been speaking to numerous high school students, but I have to leave that part of my story out. So I told them my experiences, how I became HIV positive, but I couldn't tell them who I truly am. And that's the limit, but I have to take it, because that's my opportunity to go out and, even though it's a partial message, I do want them to hear that message.

And thank you again for this opportunity for bringing us here. For bringing so many of my sisters and brothers together, and for us to have this opportunity to share with you. And wouldn't it be great if we could get all the teachers into the room, and start telling them that, you know, when you have an adolescent in school that might want to explore their gender, what can you do to support him or her? Wouldn't it be nice if one of these days that we can get all the parents to finally realize it doesn't matter who you want to be. It matters if you can be proud of who you want to become. And let's open the floor up. [applause]

James Green: Let's talk about things that might not have been covered. Let's talk among ourselves, you and me, first.

Cecilia Chung: Great

James Green: So chime in any time you want to. One of the things I think we face a lot is that I, that doesn't always get really recognized, is that we have different bodies. Because you know, we have different bodies. And what is it like to go to the doctor when your presentation doesn't match what your body actually, your body parts really are? It's really scary to go to the doctor. And I know that in the earlier panel I think someone mentioned about, you know, front office staff is not always very nice to trans people. It can be really, really awkward, embarrassing, horrible when people are just, are not treated as, with respect as human beings.

For someone like me, you know, who has to go into a gynecologist's office. Actually I don't now, but I did. For awhile I had to go into a gynecologist's office, and get checked out. And you walk in and they go "Who are you here for?" "Well I have an appointment with the doctor." "Well, why?" In front of everyone in the waiting room, you know. "Well, it's professional, you know, I have an appointment with the doctor." "Well this is a gynecologist's office." "That's nice, I have an appointment with the doctor." So one of my favorite stories is about an MTF friend of mine who was in the Kaiser waiting room with, you know, has hundreds of people, I don't know how many hundreds of people sitting in the Kaiser waiting room. And this administrative person, or nurse person goes, "Miss Johnson it says here you're 40 years old," and yelling across the room, "and you've never had a Pap Smear." [laughter] I mean how rude is this? You know, so she says, "There's nothing to smear." [laughter] Nobody knows what to do with us, you know. We're just in this limbo land so much of the time, trying and explain ourselves to people and over and over and over -- it becomes extremely boring.

Cecilia Chung: And I shared some pretty similar experience. I actually was also a victim of assault in 1995. So actually five years ago if you tell me that I'm gonna sit here and talk to so many people, I'm gonna laugh at your face. Because at that time I was -- and I remember when I got rushed to the hospital, Peninsula Hospital. And, they didn't know what to do at first, because, you know, they take all my clothes off and then when they saw my body and my body parts, they were kind of in shock. That was the moment I that I really feel ashamed and dirty, even though I've got an artery cut and my arm was bleeding and gash of blood was coming out, and I felt like I was in the wrong place. That was my experience in this hospital outside San Francisco.

My more recent experience was actually pretty upsetting also -- was because as an HIV positive person I'm taking a lot of medication and part of the side effect is what they call Lipodystrophy. So I don't have to work out to get my definitions on my arms and legs because I've lost most of the peripheral fat on my arms and legs, and it starts building up in the mid-torso. And what happened was my, my physician suggested that maybe I should go to the Metabolic Clinic, and see if I qualified for one of the studies. So I had to go in, go through the whole screening process, and my physician says lie, lie, lie. I said I don't want to lie, you know, I'm proud of who I am, and why do I have to lie? You know, I've come such a long way. And then I found out the reason why was because they really are not equipped to really study the effects of hormones and medications on a post-operative transsexual. Because, you know, they said, you know, you're hormones is genetically altered, because you don't have the testicles anymore, and you don't have those natural hormones that your body produced. Even though that they identified me suffering from those side effects, they said they couldn't help me because of who I am. And that's really upsetting for me, because I'm sure I'm not the only HIV-positive transgender woman. And I'm sure I'm not the only one who had to deal with this kind of issues. Part of their screening process, of course, is like you know, have you ever been pregnant, and what's your menstrual cycles like? The only part that I like, of course, is when I get up on the stirrups [laughter] That makes me feel so feminine. [laughter]

James Green: There are HIV-positive trans men as well, who have the same kinds of problems. Who can't get treatment because they're taking cross, essentially cross-sex hormones. And you know, there's this propensity to think that whatever problem you have it's because you know, because you're taking these hormones. You know, and therefore, either they can't treat you or they use that as an excuse to go on and on into all the other reasons why they can't treat you -- because, you know, we just don't provide that kind of care here, because we just don't know, we don't know how to deal with you at all. There are millions of stories of people being completely mistreated. There's a guy here in the East Bay who was, he went into the Emergency Room with a bone infection in his leg, and he also happened to be pregnant. And he also had an extremely masculine presentation, and they were like flipped out. And, you know they could not deal with it, so they did not treat him at all. And then he was taken, he was in extreme pain; he was nearly suicidal with the pain and then was taken by a friend to San Francisco General where he was treated, but still rather summarily, and sent home. And he still had to go back to the East Bay Hospital, because it was nearest where he lived. He just couldn't get himself any farther, and he finally was given some treatment, but he wasn't put on the Orthopedic ward, or the Obstetrics ward, he was put in the Psych ward.

Robert Eaves, who I mentioned in my speech, died of cervical cancer -- because of his masculine appearance, no one would treat him. He lived in Florida. There is another trans man here in the Bay Area who is HIV positive, who relies on Medicare, for his, to pay for his treatment. And he can't -- he has lumps in his breast, and he cannot get surgery because they just, they simply can't deal with the fact that, you know, it's a psychological problem because he's taking hormones.

Now these are the kinds of things that we face all the time. If you can find one practitioner who will take care of you and treat you like a human being, then, you know, we consider ourselves lucky. But then, we're stuck. The only time that this stuff is taken away from people is when they are identified as trans. And I'd like to know what physicians are gonna do to help us? Apart from educating yourselves and being, you know, and being trans-positive in your practice, and helping to educate others so that we can have support systems and services like anyone else. You know, what about how we pay for these things? You know, I work for a company that has insurance coverage that says that no transsexual services pre or post-op will be paid for. And many health care practitioners would, would look at that exclusion and look at me and say, "You have a sore throat? Sorry, you're transsexual, we can't treat you." Just because of the diagnosis, because of the identity, because of the history of being transsexual it means you don't count. So we have to do something about this. And we need more help to do it.

Audience Member: Do you think the fact that transsexuals - Do you think the fact that transgenderism is alluded to the DSM 4 as a Mental Disorder, rather than being listed as a physical disorder would, is part of the problem? And do you think there's any movement to undo that? And how can we have it listed as a physical disorder?

James Green: Absolutely, there is a movement. We've been working for for like over five years to try and get a meeting with the powers that be at the APA, and it's been very, very difficult. They don't want to talk to us. I mean we're the, you know, we're the diseased ones. Why should we have anything to say about it? We're just the patient. So more and more doctors who actually do sex-reassignment and who work on this issue are actually coming to think that there is a biological component to this. However, the danger in that is the same danger that gay people feel about if they identify a gay gene. You know, some people really want it to be just a choice. And some people really want it to be, you know, an organic condition. And I don't care which one it is. The reality is we have lives that we have to manage on a day to day basis. And it's just a... I think that it would be better if we could have a physical diagnosis for this, and not have a mental component. But I do think that there are people who are genuinely gender dysphoric. And they may not be transsexuals.

Audience Member: Hi, I have a comment.

James Green: Cecilia was also gonna respond.

Cecilia Chung: It's a sort of short response that I have. And I agree absolutely with what Jim said. Has anybody read the book As Nature Made Him? Yeah, and it's one of the stories that I hope would really, really let people understand how genitals don't dictate our gender. And that's what we're doing with, you know, it's who we want to be. It's not what you tell us to be. So, how can it be a mental health issue? I'm not going to argue that there are no mental health issues that might be present, but as you know, gender dysphoria doesn't really fit in the DSM, you know. But it does accompany a lot of other psychiatric problems that we might have to deal with. For example, clinical depressions. And why wouldn't we be depressed if we feel so trapped and nobody understands, and nobody wants to listen?

Audience Member: My name is Felicia, [inaudible] I had my surgery done in 1974. I was one of the lucky girls that Blue Cross of California paid for, and right after that the clause was that no more surgery. In 1987 I became HIV positive; in 1989 I went for the "Cadillac" model of a vagina, and they turned me down. And this is - every time I called the doctor that did my surgery, and the receptionist or worker was Judy Van Maasdam, who always said, "No, we can't take care of you because you're HIV positive." And that really upsetted me most because they're the ones that put me through all this, and I'm really upset that a doctor that did my surgery would turn me down, won't even take care of, even to do breast, breast. I did my breast surgery and they're beginning to hurt, because I've had my implants for 25 years, and I don't know whether to go to a regular doctor or to go back to them. But every time I call her she tells me "No we don't take care of people with HIV."

James Green: [Inaudible] today. Harry Benjamin Standards of Care I believe include some provision for -- don't they include a provision for treating people with HIV? I mean, they don't exclude. So it's a policy -- it's not a HBGDA policy that says that HIV positive can't be treated. In fact, there are - some doctors have written some guidelines for how to work with HIV positive patients. So if the local clinic is not taking you, I would suggest finding another physician.

I'd just like to say one thing about the John Colapinto book, As Nature Made Him, the David Reimer story. It's interesting with respect to how - when this is, when this story is related to transsexual experiences it's always related to male-to-females. I mean David Reimer, a boy who was raised as a girl, was on Oprah along with Dana Rivers, the Sacramento school teacher who was fired for transitioning male to female on the job -- or trying to transition on the job. Or for transitioning at all. And the interesting thing to me is that they try to represent David Reimer's story as, you know, they try to correlate it with transsexualism but they correlate it to male to female transsexualism. You know, not -- never to female to male. When I read that story, I read my story. How this guy felt having to wear a dress every day. That's exactly the way I felt when I was growing up. Why would people treat me funny? Why were people were upset that I was different, you know? And I didn't have a penis that got burned off the way he did, to prove, to justify me for feeling this way. That's the frustration that that FTM's feel. Our story is the same as David Reimer's story, we just don't have something written on our bodies to justify us in feeling this way. So, therefore, it's "mental." And I don't agree with this. And the fact that the media is turning this into a penis story and not a female to male story, is extremely frustrating. FTM transsexuals are totally marginalized within the transgender movement. And in the entire area of transgender treatment and care.

You know the only reason I got to be an advisor, a consultant on the last iteration of Standards of Care was because the community stood up and said, you have nothing in these Standards that addresses the issues of female-to-male people. And even then I wrote them an eight page dissertation about what was wrong with their Standards, and they only took the typos that I pointed out. And it took two years later and another person with a Ph.D., not myself, to bring up -- to re-introduce some of the points that I raised and get them adopted in the latest edition. And that's very frustrating, too.

Cecilia Chung: Well, James what isn't frustrating? Being [inaudible] is a really anxious process in itself. Every day when, speaking from personal experience, walking out to the street, I have to take the risk of being judged and being persecuted by whoever knows my biological gender. And you hear whispers, "Do you know that's a guy?" Do you know that's a woman?" So what. But that's we have to deal with, and I got smart - I think I got smart - before I went to my primary care, my current primary care doctor I called her office. And I ask specifically for a referral for somebody who is transgender sensitive. Because I say what's there to lose? You know, it's over the phone, they don't know who I am, they don't have to see my face; and as soon as I can get that out of the way - if I walk in the office I know that he or she will understand where I am coming from. It took a while but I found my primary care physician who happened to be lesbian [inaudible] doctor. And I wish everyone can have that experience. Because I know a lot of friends - I've seen, before my current job, I also worked as a Substance Abuse Counselor with Baker Places, and I've had quite a few transgender clients who relate to me some of their frustrations. They might be on methadone, which means that you know their liver - it takes a tremendous toll on their liver to metabolize some of the medication. And because of that justification, her physician refused to prescribe her hormones -- telling her that that's for her own sake. Is it really? And how do we know that's really what the client really wants. You know, don't we, shouldn't we first ask what you like us to help you with, before you decide for us how we should live and how we should stay quote unquote healthy?

James Green: Giving some space in case anybody wants to jump in. Where are we time-wise?

JoAnne Keatley: We have about ten minutes.

Audience Member: I'm gonna personalize this because I think that's most honest thing to do. I'm working for the Mission Neighborhood Health Center. And my own personal cross is with just trying to understand, you know, the situation that what transgender and transsexuals face has gone from.... First thing is that I am gay, so you know, I can relate to part of the process. But also I have had to look at my own prejudices. You know, because there was a time that I felt this just doesn't make sense to me. That I couldn't understand it. Even though I had personally felt like a girl, like a woman for most of my life. I, there's a part inside me, you know, where my mind just stops and just goes - okay, but -- you know. This is something I can't understand personally, you know. And so, the reason that I'm saying this is not because I feel that I would be not equipped to provide the services or support to people who are transgender, but because I feel like there has to be a system of training people that really permits one to address those prejudices and limitations on a much deeper level. You know, that -- because I feel like what happens a lot is, you know - and I understand that there's an urgency to all of this, but when you get trained to talk about these things, or provide better services -- people are also afraid to go to those deeper places, you know. It's like well where is that coming from, you know? And it, there has to be some, there has to be an opportunity for that to occur so that we are also coming from an honest place and saying, okay, yes I want to do this. But I need to change something deep within me. And I want to see those kinds of training. You know, I think those are the kinds of trainings that are most effective.

James Green: That's great. You know, it's interesting - there's that place in heterosexual people where they cannot understand why someone would be gay. You are on the other side of that as a gay man. And so you get to hear heterosexual people saying, look I just don't get it, I think it's disgusting. And you go, you know I'm a human being, you know, and you've got that problem and you can't face it. Right? So let's train you, and you'll be all right, you know. Trans-people have the same issues with respect to both heterosexual people and homosexual people. Because it's not about sexual orientation, or sexual orientation may be heterosexual, homosexual or bisexual. And still our trans-ness, you know, differentiates us again. You know, I just ask people who are gay to think about that, that being on the other side of that thing, it's like you turn around and say this one's disgusting. I'm not disgusting, but they think I am. But this one is disgusting. You know, I mean, where, and how do you deal with that? How do you rationalize that? Is that really okay? I mean it's not, it's just asking you to look again at how we judge people.

And I think the transgender movement, I mean don't consider myself transgender. I think I've had some transgender experience for most of my life, but I'm not transgend now. And -- because my gender and by body line up. So what transgender is about breaking those boundaries. Now I can relate to transgender experiences because of my history. And I break gender boundaries, because even though I am male and masculine and heterosexual all those things line up just the way normal people want them to. So I'm also not homophobic, and, you know, and I have an unusual history, you know, that most men don't have. And that will never, ever, ever go away. My body will always be different and I will always have to deal with that stuff. So even though I say I'm not transgendered, you know, I still have to align myself, and I want to align myself with that experience in that community. So even though I look like super normal, you know, it's hard to, it's hard to come back and say it's disgusting, right? It's hard to come back and say it's disgusting. Nothing is disgusting.

I had to deal with my own prejudices, too. And I, because I remember one time going with a friend of mine, a dear friend of mine who had decided to transgender male to female. And we were gonna go, we were in Houston for a conference and we were gonna go to NASA and have a tour. And he wanted to go dressed as female. And he was in, he still had a beard; and he was, you know, he was androgynous, but he was also very masculine in a way because he still had, you know, a visible beard and all that stuff. And I was like "Oh my God, people are gonna think I'm strange." And I realized this is my dear friend, who I love. This is not some freaking weirdo person, you know. And I had like 30 seconds to take a look at my prejudices and get over it. And we went to NASA and we had a wonderful time. [laughter]

Cecilia Chung: I just want to make this a little bit more simplified; and you know, you get to see how conditions really are. If you have a mono-lingual client who come in who is nervous as hell because he doesn't speak one drop of English, what would you do with this client? How would you make him or her feel more comfortable? You will try to find an interpreter. You will find somebody who speaks his or her language. Why should there be this difference? Why should this be any different at all? You know, it's about not understanding the other person's culture and what can we do to accommodate? I think that's where caregivers should come from, and hopefully all caregivers can get to that point.

Bob Teague: We have about two more minutes, because we're about ready to.... I'm sorry, I thought it was a two minute card, it's a five minute card. I need my glasses. [laughter]

Audience Member: It came to me like, you know, a lot of people are start to realize that you know discrimination comes everywhere. I mean I run to gay bars and I think that's possible to be more comfortable in whatever, you know? And I go in there and there's these people who are gay and they're looking like, "What's she doing here?" And I walk in and like [inaudible] you know [mumbles]. It's not my fault, you know [inaudible] But I don't hate them. All I got is love. [inaudible]

James Green: I'd like to bring it back to the health care issue. We only have a couple of minutes left. Paul? I think you're absolutely fabulous. Thank you, thank you. [applause]

Audience Member: Jennifer Woodward, I was thirty years dealing with the health care establishment, and I'm twenty years post-op. I want to make a suggestion to everyone. I've got all these health care people here in the room, and I want to make a suggestion to you. One of my pet peeves and I'm trying to a get a reality check for last year, is quality care and accountability. And the simplest thing is, in my mind, for everyone independently or maybe through a central agency like the Department of Public Health set up evaluation forms, which have little identification boxes, and let people rate you as the quality of the service including the interpersonal interaction. That's probably something I'd love to hear a discussion on.

Bob Teague: Do either of you want to make some closing comments before we bring it to an end?

Cecilia Chung: I really want to take this opportunity to acknowledge the wealth of resource sitting in this room, and I really want to encourage everybody to think what you can do with this much resource. And I don't think this has happened before in San Francisco. Hopefully, this will not be the only time. We're gonna have follow-up after this right?

Bob Teague: You know actually, [oh sorry, oh excuse me] that question about follow-up after the conference is one that Cecilia raised at the very first Community Planning meeting that we had about this Conference. And in my conversations this morning with some folks here, is that there will be follow-up. What it will look like will in large part depend on you, and what kind of feedback we get from you. Everyone will get a follow-up packet mailed to you with the evaluation comments, any additional resource materials that were inadvertently omitted, as well as some of the ideas that are floating around for the next training year. So, our intent at the ADTC is to make this event be a jumping off point for the continuing of these kinds of discussions of trainings and events and your input is gonna be a very big part of what will shape how that looks.

James Green: That's great. I'd just like to close by saying how really thrilled I am that there are so many of you here. That this is so incredible. It is just an unprecedented place to begin to really look at what trans-people have to face, what we're dealing with, who we are, and how we can be integrated into society, like we should be. And still maintain our uniqueness and our identities as who we are. This is really very important that during the research about us, in the opportunities that exist, and I would just like to encourage all of you to stay conscious and stay with us and continue to help build this, a better world.

Bob Teague: Thank you, James and Cecilia. [applause] Thank you James and Cecilia.

JoAnne Keatley: I just wanted to add one thing. There was a comment earlier about when evaluating transgender patients, and about -- and wondering about whether they're really just gay. And I'm just gonna throw it out there - do you ever consider if your gay or lesbian patients are maybe just transgender? [laughter]