Dr. Gero

Want to be a good ally but aren’t sure about the proper terms or even how to ask about pronouns? Dr. Joy Gero, Program Manager for LGBTQIA+ Health, UPMC Health Services Division answers some of the questions you may have been afraid to ask.

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-This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.

– Understanding LGBTQ+ Identities. Welcome to the UPMC HealthBeat Podcast. I’m Tonia Caruso, and joining us today is Dr. Joy Gero. She’s the program manager for LGBTQ Health with the UPMC Health Services Division. Thank you so much for joining us.

– Yeah, thank you. Thanks for having me.

– So why, in general, is this such an important topic?

– I think that this is a really important topic for us to start to discuss because LGBTQ people have experienced trauma in medical health care situations and in a lot of their different experiences in the world. And so I think to start to help be supportive and active allies, I think it’s important to start to talk about these concepts and have us get into this, to figure out what we can do to help support LGBTQ people in our lives.

– Right, so, so much work is underway in the health system, but really, as we’re talking today, we’re trying to reach people in the community just to explain to them what these identities are all about. Lots of people have good intentions, but maybe just don’t have the knowledge.

– Yeah, absolutely. And I think that one way that we can just start this off is to start to think about the idea that the different identities that we’ll talk about today are really a part of human experience that all of us, you and I, everyone listening or watching, and indeed humans in the world have experiences of gender identity, sexual orientation, gender expression, sex assigned at birth, all of these different things we’ll be talking about today. So understanding that as a level set, I think is a really good kind of foundational jumping-off point for us.

– And if you’re heterosexual, you might not think of these at all.

– Right. Right. And I think because that’s the case for lots of heterosexual and cisgender folks, the reality is that you think that, “Oh, that’s just something that LGBTQ people have, right? It’s not something that I have.” But it’s like, no, heterosexuality is a sexual orientation. So that is a sexual orientation that folks have, right, that we sometimes will interchangeably call straight. That’s still a sexual orientation. Similarly, having a gender identity, I am someone whose sex assigned at birth when I was a little baby, they said, it’s a girl. I still identify as female and a woman. And so I am cisgender versus someone who is transgender. That’s still a gender identity. Just because I’m not transgender doesn’t mean I don’t have a gender identity.

– Right. So many definitions. Let’s get started.

– OK.


– Yeah. When we start to think about that, the L stands for lesbian, G stands for gay, B for bisexual, T for transgender, and then the Q that we’ll use in this sometimes stands for either queer or questioning. That plus is all the other parts of the alphabet that aren’t represented by the LGBTQ+. And so, some of those things might be like intersex, asexual, you’d have two-spirit is another one. There’s lots of other things that we can add to that abbreviation.

– And a lot of these terms have been reclaimed by the community.

– For sure.

– Correct?

– Oh, yeah. Queer is a really great example. So, I mean, that was really thought of as a slur. Even now, not everyone who’s part of the LGBTQ community necessarily connects to that word. It was reclaimed during the AIDS and HIV crisis with a group of LGBTQ people coming together and fighting on behalf of mainly men who were dying of AIDS, and they called themselves “Queer Nation.” That’s a word that I use to describe myself. So I’ll interchangeably say that I’m a lesbian, but I’ll also say I’m a queer woman. And one of the reasons I use that term is because it’s a way for me to link to all of my siblings under the rainbow instead of just saying, like, “I only connect to women who are interested in other women.” I feel connected to the larger community as a whole. And so I choose to use that word. It’s one of those words, though, that if a person doesn’t use it to self-describe, it’s probably not a word we should use for somebody else because it could be misinterpreted.

– Right.

– But, yeah, it’s a good example of a reclaimed word, for sure.

– OK.

– Yeah.

– All right, so that’s the broader definition. And let’s talk now about some of the other avenues, if you will. Sex versus gender, they’re not the same thing, correct?

– They’re not the same thing, no. And I think that one of the ways to start to decouple the concepts, I think, is to start to say “sex assigned at birth.” Even if we just see the word “sex” written, if it’s not talking about a sexual act, I just add “sex assigned at birth.”

– Sex assigned at birth.

– Yeah. And gender as gender identity. Now, if you see these words, sex and gender in, for instance, legal terms, they’re interchangeably used sometimes in different states and commonwealths. So the Commonwealth of Pennsylvania will interchangeably use sex and gender. But in the medical world, we want to be more, and really any place where we’re respecting LGBTQ people, we want to be more mindful of kind of decoupling those two ideas. So I think of sex as sex assigned at birth. So that idea of, that first few moments we come out of our moms and the doctor’s like, “It’s a boy,” or, “It’s a girl.” And sometimes they say, “We’re not sure, the reproductive organs and then genitalia isn’t telling us enough. Maybe we want to do some hormone testing or chromosome testing.” And then we may, what they might say is, “This person is intersex.” And so that means that there’s a mixture of what we think of as male and female or boy and girl characteristics. And they’re about as common in our population as natural redheads. So that’s a thing that I like to think about is as many times as you see a natural redhead in a day, you’re seeing someone who is perhaps intersex in a day. And so that idea of sex assigned at birth — now, not everybody likes that term, but I think for, when we’re thinking in medical health care, it’s important for us to understand that, to help our clinical staff make good medical decisions. And then gender, again, is this idea of gender identity, which I know we’ll talk about in a little bit, but I think that’s a way to start to decouple those words is just to add, “sex assigned at birth,” “gender identity.” Yeah.

– Sexual orientation is different than that.

– Correct. Yeah. So sexual orientation is about how we are physically, sexually, romantically attracted to men, women, both, humans in general. And under that umbrella, again, that includes heterosexual orientation, right?

– Right.

– So folks who are, identify as female and feel attracted to men and people that identify as male and feel attracted to women. We would think of that as a sexual orientation as well.

– We start to hear terms of pansexual, asexual. Tell me about that.

– Yeah. Yeah. So pansexual is this idea of, you often see this in younger generations, particularly who aren’t as interested in identifying as bisexual because to them, that means I am attracted to males and females, and it’s not really holding the idea of, for instance, people that are non-binary or sort of more of the gender diversity that we might see in population. So I think of people who are pansexual as being attracted to humans, regardless of how they appear, what kinds of organs they might have, et cetera, et cetera.

– What is the difference between gender identity and gender expression?

– Yeah. Great, great question. So I think to start understanding gender expression, I think it’s important to think about just gender roles. So the idea that we appear, our obstetrician says, “It’s a boy” or “It’s a girl,” we continue through into adolescence and adulthood appearing as what we think of as typically male or female. And then there’s an expectation of the kinds of roles that we have in our world and our families, which could include the way that we dress, how we hold space in the world, things like that. And so that starts to go to this concept of gender expression. So gender expression is how we wear our hair, if we wear makeup, what kinds of clothing that we wear. It could be how we hold space in the world, how we move, jewelry that we choose to wear or don’t wear. All of those things can be gender expression. And it’s an important concept to understand, I think, for two reasons: one, because oftentimes when we think of a person as “looking gay” or “looking trans,” right, what we’re really saying is their gender expression doesn’t match what we think of as connecting to how they appear as male or female. And that is not a particularly helpful way to actually assess whether or not someone is part of the trans or LGB communities because it’s an independent data point. There’s lots of people who are trans who pass as the gender or sex that they feel most connected to. There’s lots of people who are lesbian, gay, bisexual, who connect with typical gender norms. Gender identity, then, is our deepest sense of ourselves as male, female, a mixture of both, or neither. And under that umbrella are people that appear and feel more connected to what we think of as masculinity, or male, or men being a man, people that more feel connected to femininity or femaleness, or being a woman, and then a whole bunch of purple in the middle, right, of all different kinds of nuanced, different ways of sort of thinking of themselves, which we often kind of lump under that category of non-binary. And that gender identity is basically anyone who is not kind of pulled to the poles of male or female, right? So if you think about a male, for whatever reason, being blue and female being pink, right, the non-binary identity is all of the shades of purple in the middle, but there are other names that people might use to describe themselves, such as like gender-queer. They might, instead of saying they’re non-binary, they might say they’re trans-masculine or trans-feminine versus being a trans man or a woman. So those kinds of things are ways of thinking about it.

– Transgender. I feel like there’s more awareness these days, and that plays into the pronouns.

– We’re cisgender, that means our sex assigned at birth and our gender identity align. If we’re transgender, then our sex assigned at birth and our gender identity are not aligned in some way. That’s kind of the easiest way to think about it. It’s a concept for us in western culture that feels really new, but it’s not. It’s not new. So if you look back at Native American populations, we can trace back to the 1400s this idea that, First Nation populations had a conceptualization of male, female, and something else, or something more. In modern English, we call that concept “two-spirit.” Now, that predates the 1400s. That’s been around way before that. That’s just when white folks showed up and started writing things down, but that idea is actually really common. We can also see in like burial sites in the Middle East, particularly in like Iran and places like that, where there are people buried with boy things, people buried with girl things, and people buried with boy and girl things as far back as 800 BCE. So this is not a new concept. Then, if you think about in places that were colonized by western culture and have been decolonized, we start to see these expressions of gender diversity reassert themselves in culture. So you can see this, for instance, in India. That was colonized by the United Kingdom, they had been decolonized, and now this comes back. So I think that’s important to recognize because it can, because this is evolving in western culture and because the language of trans folks continues to evolve, how they talk about themselves, how they want other people to talk about them, it can feel like, “Oh, this is totally new, we’ve never seen this before.” But it’s new in western culture, and particularly in the United States where western culture is, I think, our typical experience here. And so, trans folks have been around for a long, long time.

– And why is it important, or is it important when you meet someone to find out where they are on the spectrum? Or is it none of our business? Where’s that line of respectfulness?

– Yeah.

– Tell me what to do. What should I be asking folks?

– It’s such a good question. And I think what’s difficult about it is that when we think about this, what we’re up against culturally is that most of us, so I’m in my 40s, right, most of us were inculturated during “Don’t Ask, Don’t Tell.” So this idea that you can be gay, but we’re not going to ask you any questions about it, and you don’t need to tell us. Now, obviously that was particular, it was a policy for military folks, right? But it did permeate the culture of the ’90s and beyond, where it was this idea of, you can be gay, we’re going to start accepting that as a thing that might happen, but we’re not going to talk about it. We don’t want you to talk about it. We’re not going to ask you questions about it. And so, then, it begins to, like, connect to this idea that asking is rude and that it’s something that we shouldn’t do and it’s taboo. So is it good, or would I recommend that we, introduce ourselves and if someone’s not like, “Hey, I’m partnering with,” that we ask questions? No. I do think it’s helpful to start to think about the idea that, “I am meeting this person for the first time. I don’t know anything about them. I’m not going to assume that they’re heterosexual or homosexual. I’m not going to assume that they’re cisgender or transgender.” It sort of remains to be seen. So if you’re a parent, maybe you want to teach your children to start talking about their own pronouns and asking other people about their pronouns so that if they are trans or if they have a friend who’s trans, it’s normalized in the family as an example, right? You can imagine teachers wanting to start to do that, people in health care, leaders and organizations. And so there’s ways in which, and different techniques people might use to start to do those things. So I often will introduce myself as saying, “My name is Joy, whatever the role I’m in in that meeting, I use she/her pronouns,” as an example. In my email signature, my pronouns are in my email signature. That is a way for me to start to communicate to other people that I am interested in hearing their pronouns as well.

– And let’s sort of give really the broader scope of pronouns. What they are? Why they’re important? And really, then, how we ask someone?

– Yeah, yeah, sure, sure. So personal pronouns are just that, right? We all feel connected to a set of them. For those of us who are cisgender, so our sex assigned at birth and our gender identity align, we probably have used the same pronouns that have been used toward us since we were little kids. For those of us who are trans, those pronouns, what we feel most connected to, has evolved over time. And so that’s the important thing. And the reason I think it’s important that we start to put the term preferred as a moniker or a prefix to pronouns, preferred should be on the quit list, right? They’re not preferred pronouns, they’re personal pronouns. All of us have personal pronouns. So I use she/her. There are people that use he/him. There are people that use they/them. And then there’s multiple other examples that you might see. One of the other most common things that you might see, nowadays, is someone who uses she/them, or he/them, which means that they interchangeably use she/her pronouns or they/them pronouns. Right. So they’re trans-feminine. They may use both. Or trans-masculine people might use he/him pronouns or they/them pronouns. So that’s a way that you, that’s another common thing that you’re seeing nowadays.

– So is it fine for me to say? How do I ask, “What pronouns do you use?” I don’t want to say preferred now. So what pronouns do you use?

– I would say, “What pronouns do you use?” So the way that I try to do that in a way that feels socially connected to the situation is I introduce the pronouns that I use first. And then I say, “What pronouns do you use?” Another thing that I do is, if I don’t know someone’s pronouns, I default to using they/them pronouns if I’m talking about someone. So I do that for two reasons. One, because it’s, instead of, how it used to be accepted practice to see like he/she in writing when we’re just kind of talking about any human?

– Right.

– To me, the accepted practice has really moved toward just saying they, and that just means any human. So that’s one of the reasons why it’s a way of kind of saying like, “Hey, there’s a diversity of how folks think about themselves, let’s think about the diversity.” That the second reason I do it is because it helps me when someone uses they/them pronouns to get better at doing it on an ongoing basis. So if I use that as the default, if someone hasn’t told me their pronouns, then when I have to do it for someone who’s not binary, that that is where they feel most connected, it makes it easier to do that in my speech.

– What happens if you make a mistake?

– We should just apologize. And the apology should be as normal and sincere, but not like such an incredible emotional outpouring that suddenly the person who we mis-gendered is needing to caretake us. So an example that I often give is, my first name is actually Jennifer. Literally nobody calls me that, except for my mother and the bank. And so if someone calls me Jennifer at an end of a meeting because they read my badge and it says Jennifer, I just simply correct them and say, “Hey, I go by my middle name, which is Joy.” And they say, “Oh, OK, sorry about that.” And they might feel a little awkward, but they just move on. Suddenly, if it’s a person of trans experience, we either don’t say anything ’cause we’re afraid of saying the wrong thing. I think instead, it’s just saying like, “Hey, I’m so sorry. I know you use they/them pronouns. I’m going to do better about that. Please know this, things like that are really important to me.”

– As we wrap up, what are the key messages? What do you want folks to know?

– We have to be able to talk about these things. And so I think that having this conversation today and having conversations like this are so important. I think particularly having them with the podium of UPMC is even more important because what the research says and what the data says is this is part of human experience. It is not going away, and it does not need to be repressed or cured or anything. Trans folks are folks. People who are not heterosexual are people. And those two experiences are valid, and they’re part of the human experience and have been throughout all of the world history that we see.

– Well, Dr. Joy Gero, such a good conversation. We’re happy that you will come back and join us again, and we will discuss some more issues. Thank you for your time today.

– Yeah, thank you. I appreciate being here.

– You’re welcome.

– Yeah.

– I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.

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