Dr. Joy Gero, Program Manager of LGBTQ Health at UPMC talks about what you should and should not say when someone comes out to you, as well as other ways to be a good ally.

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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.

– It can be an extremely challenging time. So how do you support someone who’s coming out? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat podcast, and joining us right now as Dr. Joy Gero. She is the program manager for LGBTQ+ Health with UPMC’s Health Services Division. Thanks again for joining us.

– Yeah, thanks for having me back.

– We are so glad that you are back. And, really, this series focusing on LGBTQ+ health, why is it so important?

– I mean, it’s important because I think that having health care providers talk about what we know about caring for LGBTQ people and supporting them in our communities is a way to normalize this as a part of the human experience. And so I think that us having these kinds of conversations is one way to do that. Every time we have these conversations under the umbrella of health care, people start to recognize this is part of people’s truth in their lives.

– I can’t even imagine the emotion and maybe the stress and the pressure of someone who is about to come out. So what’s sort of the mindset? Can you talk a little bit about making that decision and what folks go through while making that decision?

– Yeah, sure. I mean, I think even now this is difficult for lots of people to understand, but there are circumstances even now in 2021, when coming out means or potentially can mean losing support of loved ones, perhaps family members, losing career opportunities, losing financial security. So that can be both in terms of job, but it also can be like for college students to think about their parents no longer supporting them at college. So there’s a material cost. And then there’s the emotional cost of giving up your heterosexual or cisgender privilege. Because, you know, this, often if you’re part of the LGBTQ community, if you don’t speak it out, people don’t really know. There can be some assumption or belief, but we don’t necessarily know that’s happening, right? Unless a person decides to disclose that. It’s also about, I think, which we can talk about this a little bit more, it’s also about the idea of identity development. So because we have such a binary way of looking at sexuality and gender identity, that isn’t the way that most people come out — that people say to themselves around either attraction or identity, when we’re talking about gender, that they’re like, “Oh, this is who I am 100%.” They start to recognize, “There’s something about me that’s different,” and then it’s a journey. But that can be really stressful for folks because we know what cisgender and heterosexual populations can often interpret that as is, it’s a phase, or the person’s being flaky, when in reality that is a natural part of identity development.

– If someone is coming out to you, what sort of mindset or approach should we have? Especially if you really want to be an ally — and talk about that from even the parental perspective, and then as just a friend coming out to a friend.

– Yeah, sure. So I think parents, and I think when we’re talking about children, adolescents, and young adults coming out, one of the messages that I think is really important that I give to loved ones, as well as to people who may I might be interacting with in clinical practice as a psychologist, is the idea that the person, what they’re disclosing to me is they fit somewhere under the rainbow, you know? And so I want to validate that, and I also want to make sure that they understand that where they think they fit under the rainbow right now may look different over time. And that is a part of this experience of coming out. And so that can be difficult, actually, because the message that we often get, again, because this can be a topic that’s so politicized, it’s either like you’re against it, or you’re for it, and you just accept where the person is no matter what they say, you know? And so how do you accept what the person is saying and validate what the person is saying, but also give them space to recognize that where they are right now might look different to where they are, like, let’s say six months or two years down the road? So an example from my own life is, I’m in my 40s. When I was in high school, I came out as bisexual. I now identify as a lesbian. I think that there’s lots of people that have that story. There’s other people that have this story where they come out as bisexual, and that is their truth through their life — that’s sort of where they arrive. Same with gender ID. You can have folks who come out as nonbinary or transmasculine, and then later on, they think of themselves as a man or a trans man, however they are thinking about that, you know?

– How difficult, when you came out, was that something you agonized a long time over, or did you know, and when did you know it was appropriate?

– Right, right. So in some ways it was, and I think this is a common experience around sexual orientation, where you initially think that, like everybody, so I just thought every girl had crushes on girls, right? And then, like, I had some inkling sometime later in high school, where it was like, “That’s not how everybody feels, Gero.” And so then it was the idea of like, “OK.” And initially this was a disclosure I made to close friends, many of whom did something that I think we sometimes think of as very validating, but actually can be sort of invalidating to people, where they were basically like, “We know.” They were like, “We weren’t under the impression that you were straight,” right? That is a common approach that sometimes people have. I’m not saying it’s bad, but it sometimes can feel invalidating to the person because they feel like, “I’ve been agonizing over this for so long, and my friends just all told me that they’ve known for years. What is going on?” So a way to say that a little bit differently might be to say, “I had a suspicion, and I’m really glad that you’re telling me.” Right? So you don’t seem so like, “I knew way before you did,” you know?

– It could kind of minimize that.

– Exactly. Exactly. Yeah. And I think that it’s the idea of it is, regardless of what we think and how far we think we’ve progressed, it still can be so incredibly fraught and stressful for the person who is part of the LGBTQ community to disclose that to other people.

– So, you already said, don’t minimize it. What are some other do’s and don’ts? Especially if you want to be a good ally, and someone comes to you and tells you, what are the things you should say, and what are the things that you should stay away from?”

– Right. So, a couple of things. I think, let’s talk about sexual orientation and gender identity a little bit separately. So when we’re thinking about sexual orientation, focusing on the person who is telling you this versus how their romantic relationships or their relationships might change. So it’s common to want to get into the weeds about who you’re going to date, and dot, dot, dot, who you might become intimate with, right? That is actually a very common experience where people start asking you a lot of nitty-gritty questions that you would never ask anyone in social situations if they did not disclose sexuality to you. It’s not open season to start asking those kinds of questions. So, instead, I think it’s more about like, “Thank you so much for telling me this. I can imagine this was a really tough thing to start telling other folks.” And then maybe asking some questions about who they’re planning to tell. The coming-out process can take a while. And so sometimes what people do is they come out to very close friends and/or family, but they’re not going to be out in their work. They’re not coming out in school. Then when we’re talking about gender identity, I think that the part of that that’s important is, if the person is saying, like, “I am nonbinary,” or, “I am transgender,” however it is they’re describing that, asking them some questions so that they don’t then have to make every disclosure without some prompting from you. So saying, like, “Do you want me to call you a different name?” Are there a different set of pronouns you want me to use?” You know, sometimes folks say no. I just was on a phone call earlier today, and a colleague was telling me about someone they know who is trans who hasn’t changed their name or pronouns, but just wants to dress a little bit differently. So I think keeping the conversation open and saying, “Hey, if you don’t want me to call you a different name or use different pronouns now, if that changes, please let me know. I am interested in making sure that you feel comfortable.” As an example is some of the things that I would recommend doing. I think, again, getting back to what parents are to say, I think for them to say something like, “I hear you. Thank you so much for telling me this. Wherever you end up under the rainbow — so if you are telling me your pronouns now are he/him, and later you tell me they’re they/them, if you want me to call you Fallon now and something else later, if you’re telling me you’re bisexual now or pansexual now, and later on you tell me you’re a lesbian or you’re queer, whatever you say, just know that I’m going to accept whatever that looks like.” And to try to make an understanding that you’re going to accept the journey, but that you’re not saying it’s a phase. Right? Are there people who for a short time feel this way, and then it like maybe goes away? I’ve never seen that. That doesn’t mean it doesn’t happen, right? Human experience is very diverse. I’ve never seen that. But it’s possible. And I think, even then, I mean, if we’re talking about supporting adolescents, anytime you tell an adolescent that something is a phase, that doesn’t usually go well as like a parenting strategy. So I would avoid that regardless of what the content is.

– And so once someone does come out to you, what other ways can you support them?

– So I would, if it’s a friend or a loved one, I mean, one of the things that I would do is to continue to check in about, like, kind of updates or changes to how they might be thinking about themselves. So if it’s a younger person and they’re talking about sexual orientation with me, I might ask them like, “Have you started to date? What has that been looking like for you?” Or, “Do you feel like you have a lot of friends who are being supportive? Is your family being supportive?” Right? Whatever that might look like, that might be sort of the check-in. Some of the same things about support systems for folks who have disclosed a transgender gender identity, but I also might be thinking a little bit more about like, “Hey, you know, just checking in. Are we still using they/them pronouns?” Has your name, like, have you thought more about your name? Do you still, are you still going by your birth name, or have you made another change?” Things like that. And then I also think there’s something to be said about doing things to maybe passively communicate to loved ones, right? So an example is maybe you have some loved ones who are part of the LGBTQ community, and so you post something on National Coming Out Day, which is Oct. 11, to say, like, “Hey, this is National Coming Out Day. I’m straight and cisgender, but I’m also an ally. Sending love to all of my friends and family who are part of the LGBTQ+ community.” That’s an example, right? So that’s not actively, you’re not calling that one person up and being like, “Hey!” You know? But you’re passively communicating using this really powerful tool that we have at our fingertips in social media to anyone. And then that also allows there to be openness to other folks in your life to come out to you who maybe didn’t realize that they had an ally. So I think there’s value to that on multiple levels.

– Do you feel like — in this day and age, there is so much more awareness about LGBTQ+ issues, and do you feel like gay is now normalized, and so do you think it’s harder for people that are elsewhere on the spectrum —

– Sure.

– to come out? Why is it, and how is it? What do you want to explain about how people can evolve and transition?

– Right. I mean, I think because in western culture, particularly in the United States, we still have an idea around both a gender binary and that sexual orientation is fixed, and that it’s, like, narrowly defined. Like, you can be gay, you can be straight. Under that umbrella of gay, you can be a gay man, you can be a lesbian, you can be bisexual. We’re done, right? I think the idea of recognizing that there’s more of a spectrum for both is really tough for us in western culture. ‘Cause we like labels, you know? And I think that is something that helps, for non-community members, it helps non-LGBTQ people to have an understanding of what we’re talking about, right? The label is often, in some ways, it’s important for the person to be seen. So there’s something important, right, for me to be seen as a queer woman or a lesbian, to use those words. But there’s another part of it where, like, I’m trying to describe that to somebody else who doesn’t have an understanding of my internal experience. So those two things, I think, converge and create this complexity, right? So on one hand, we’re taught that everything’s a neat category. On the other hand, for people who are not heterosexual or cisgender, there’s really a spectrum of how we may feel. And so we try to, when we’re first coming out, like, define this so that we can communicate to others and help us feel seen to say this is the category that I fit into. But then, as we sort of are in that space, now exploring what maybe gender identity means or sexual orientation means, we sometimes come to find out, “Hey, this doesn’t totally fit me.” And then we may choose to align sort of differently with a different category or label because it better describes what our experience is, but we didn’t necessarily know.

– As we wrap, in general, are you more hopeful, or really just look at, there’s so much more work to do?

– So I am a — — it’s a really good question. I am a pragmatist who is also very positive. My general mood is Labrador puppy. Like, that’s how I think about myself.

– No, we hadn’t noticed here.

– Yeah, yeah, so, I mean, I think that there’s a part of me that feels like where we are now versus where we were when I was in my 20s, we’ve done so much work. So many things have shifted over time. There’s also a lot of other things that need to be done. Certainly as you alluded to earlier, right? If the part of the community that you occupy is around sexual orientation, you’re in a lot better of a position. If the place and the community that you occupy is about gender identity, there’s a lot more things happening in the United States to negatively impact folks with a transgender or nonbinary gender identity. And, I think as we look to younger and younger generations, what we see is the idea around gender diversity and transgender identity, around sexual orientation, and being part of the LGBTQ+ community, that’s common for a lot of children, and adolescents, and young adults. And so I do think that there’s hope from that perspective, and there’s hope when we start to see people who maybe were closed in the past become more open. So I’ve had many experiences with older people in my life, in their 80s and beyond, who have a lot of love and acceptance for me and other folks that fit under the rainbow. And that’s something that I think probably decades ago, we wouldn’t have thought was a possibility, and it’s much more likely to be the case now.

– Well, some great information as always. Do come back. We’ll talk about some other subjects.

– Yeah, for sure.

– Thank you for your time.

– Yeah, thank you. Have a great day.

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

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