Azeen Gureshi

Can I actually ask a question before you ask me something? Yeah. Just one thing.

Get some rest.

I was told that no recording of any kind is allowed.

They might take them. I'm just going to bring a notebook and my phone.

I'm going to turn this recorder off then for now.

All right, I'm outside.

Well, would you be willing to talk to me for a second?

Okay, well, how are you feeling?

I saw when we were on or going on that a break earlier in the day before you testified. I saw people were coming up to you. They recognized you.

Sorry, I'm recording if that's all right. Just to let you all know.

The New York Times obtained hundreds of documents from this whistleblower, which corroborated some of her allegations, including... The day after that, advocacy groups criticized the story.

So what's going on with Jamie and her testifying?

I remember that, not the specific event. I'm just thinking about getting a standing ovation because I don't remember that at all.

year-long assessment or six-month assessment, I think that we started recognizing in some cases that's doing more harm than good, especially when you're talking about a puberty timeline.

What happens if you require someone to be in therapy for a year, but they have no interest in that? That doesn't make sense.

So I do not think of myself as a single individual. I want to go back in history and talk about really this work arising from HIV care. And so we had an HIV youth program before we started doing gender care. And that included a population of older adolescents and young adult trans women, many trans young women of color.

And so when these young people were coming in for HIV-related services, either prevention, testing, or treatment, they were beginning to ask, hey, can you do our hormone-related care here? And so it's not widely publicized, but we began within the division to do that care in the early 90s. Okay.

Right after it was published, I don't remember the exact details surrounding that because it's been a long time. But it made sense and it was right off the bat brilliant. I mean, it made complete sense. We knew that people going through their endogenous puberty left them with changes that they would never be able to walk back.

And that was especially considering the population, right, that we're working with. We knew that historically it's identifiable trans women of color that are the targets and the victims of violence and sometimes homicide. And so if we could create a situation whereby they were not identifiable, that's lifesaving. It was like a piece that clicked into place.

And in fact, I remember saying, this is so obvious. It's kind of astonishing that somebody didn't talk about this or think of this earlier.

That's right.

So the idea—I think what they did was— what they needed to do. Like any area of medicine, when you're first starting something or introducing a new mechanism for caring for people, you probably err on the conservative side, not knowing what's going to be on the other end of that.

If you truly want to use puberty blockers to block puberty, you can't do a year of assessment when they come in right around the time of puberty. You have to do that in concert with that intervention.

One of the things that the Dutch repeatedly did was intelligence testing. And so they published IQ tests. Right. And so do we need to do intelligence testing? I don't really there was never really a compelling reason to do that, given that they had done this over and over again and found that the intelligence was the same as the population at large.

So what other things were they doing around therapy, especially if they were excluding people with mental health issues? So I'm not sure. I don't know that there's ever been information published about what were you doing in those therapy sessions? Besides, honestly, making yourself feel comfortable about the gender that the young person is asserting.

Because I have never for any certainty had or read a publication about here are the things that tell us if somebody's going to continue to assert this gender over time. Who are you assessing now that in 30 years did not assert the same identity? Who is that and how did your assessment help you with that? I think that's a really important question.

somebody is in the role of an assessor and they're supposed to also be creating a therapeutic alliance with somebody, those things are at odds with each other. And there actually has been, I'm trying, I... It sets them up as a gatekeeper.

Well, I mean, being the person that checks a box that says you can move forward with medical interventions, I think, you know, there have been some data and I don't know exact. I can't quote the exact article right now, but that has demonstrated that if. People know they're sitting with someone that's going to either check off the box or not.

If you're worried that you're going to disclose something about your life that then is going to keep you from getting what you deserve and need, you're unlikely to disclose that information. And that's a problem.

I mean, every patient in medicine gets assessed.

are huge benefits to mental health therapy. But I don't think you just can say each person needs exactly this amount of therapy. That's not how humans are. I think that if there was evidence that demonstrated a year of assessment changed the outcome for young people, then I would have been like, oh, OK, that makes sense. But there really hasn't been that.

We'd been doing the care since 1991. So yes, there's published data, but there's also experience in the field. And experience in the field is what we have when data is being collected. Our experience matters. Experience in healthcare matters, right?

We often will ask parents, you know, would you rather have a dead son than an alive daughter?

To me, it seems ridiculous to have a kid at age 12, 13, 14 deciding whether they want to have biological children when they're 20, 30, or 40.

What is the other option?