Breaking the Stigma and Breaking Down Barriers in LGBTQ Healthcare Access Inequalities

[Intro melody into roundtable discussion.]

Juan Carlos: And welcome to the Baylor College of Medicine Resonance podcast. I am one of your hosts, Juan Carlos Ramirez.

Snigda: And I'm your other host, Snigda Srivastava.

Juan Carlos: and today we'll be talking with Dr. Kauth, and we will be learning about his research and LGBT veteran Health, his involvement in LGBTQ Advocacy, educational career and trajectory, we’ll ask him about his involvement with the Montrose Center on the board of directors and current efforts to support the LGBTQ community here. We will also discuss issues that members of the LGBTQ community have while accessing proper health care and the role of and stigma and quality of care. So, welcome!

Juan Carlos: So, Snigda, why Dr. Kauth?

Snidga: So, as a student, a second-year medical student at Baylor, I took an elective course in the LGBT Health Care literacy, and that's how I met Dr. Kauth. He was the course director for, for that elective and through that course, I was exposed to a lot of really interesting topics regarding LGBTQ health and advocacy, including lectures on topics about Healthcare considerations for men who-have-sex-with-men, women-who-have-sex-with-women, LGBTQ youth health, and a lot of other various topics. Through this course, we also had an incredible panel with LGBTQ patients at the Montrose Center that he organized, and he's actually been a member of the board of the directors for Montrose Center for over eight years now. So, having someone who's so involved in the community and advocacy was really inspiring. We also had a panel with Baylor physicians in the LGBT community, which is awesome to see as an aspiring physician in the LGBT community and so I really loved that course, and I thought that dr. Kyle could be an excellent person to interview for this podcast.

Juan Carlos: Yeah, and he seems to be very active, you know, in many different areas and really kind of spearheading the LGBTQ here at Baylor and you know is really speaks to our like diversity and inclusion here at Baylor. It's, we all feel very loved and this is just very interesting and very necessary stuff that has to be done. But you mentioned a little bit, he does some research in LGBTQ Veteran Health. 

Snigda: Yeah, so he is also part of the VA as well. So, he's a psychiatrist there and he's also done a lot of research and has published, like publications and edited a book recently in 2018 on transgender health for mental health professionals, which was really cool. He's also an author! 

Juan Carlos: That's right! His latest book is called The Evolution of Human Pair-Bonding, Friendship, and Sexual Attraction, and this book really presents us an opportunity to see an evolutionary history of romantic love, male-female pair bonding, same-sex friendship, and sexual attraction drawing on sexuality research, gay and lesbian studies, history literature, anthropology, and evolutionary science.

Juan Carlos: Dr. Kauth’s book also talks about employing evolutionary theory as a framework, close same-sex friendship as examined as an adaptive trait that has harnessed love, affection, and sexual pleasure to navigate same-sex environments for both men and women, ultimately benefiting their reproductive success and promoting the inheritance of traits for friendship. There are certain chapters that consider the desire to form close same-sex friendships and ask if this is embedded in our biology concluding that most humans have the capacity to form loving, meaningful, and sexual relationships with men and women. Furthermore, this book takes on a unique interdisciplinary approach and is essentially, is essential for reading for those studying and working in sexuality research in anthropology and sociology, evolutionary psychology, and gay and lesbian studies. It will also, will also be an interest to marriage and family therapist as well as sex therapists. So, it's kind of an all-encompassing book. Sounds very exciting and it's only 224 pages of exciting – exciting cutting-edge research. Snigda, any thoughts?

Snigda: I think it sounds very exciting I'm really looking forward to hearing what the audience thinks.

Juan Carlos: It sounds very exciting, I mean, his book just came out in November and we're all excited to see sort of the what the community thinks about it, but it would come as no surprise that the book will be very exciting to read. Dr. Michael Kauth is, like we’ve mentioned, the director of the LGBT Health here at the department of the VA and a professor of Psychiatry and he has authored several things, and this would be also another one of those that would be nothing short of exciting. So, without further Ado, let's talk about LGBT health and Veteran health care and LGBTQ disparities with Dr. Kauth. Let's go to episode.

[Interlude melody]

Snigda: So, welcome Dr. Kauth. 

Dr. Kauth: My pleasure to be with you. 

Snigda: So, how are you? How are you doing? First of all, this is during the time of covid-19 and the whole quarantine coronavirus thing. How are you doing?

Dr. Kauth: I – I'm I'm okay. It's certainly strange times right now and I miss interacting with people face to face. That's probably the hardest part. I can, I can do my work from home, that is not nearly as satisfying as being able to interact with real people. There's just an energy around people that you don't get by talking online and seeing them on video.

Juan Carlos: Very strange times. 

Snigda: Yeah, super strange. How has that affected your work like day-to-day?

Dr. Kauth: A lot of my lot of my work at least at the VA is virtual because I work at a national level and I talk with people all over the system, and so that really hasn't changed much. That work continues. My work at Baylor though is a little different, that tends to be more face-to-face and teaching classes and interacting with students. And right now, that, that doesn't happen in that way. We don't have face-to-face meetings and lecturing and teaching is done through Zoom, which works but, it's a little weird not being in the same room with people and sometimes having a delay in the communication. It's an adjustment to be able to make that work but people I think are generally patient and willing to work it out because frankly that's the way things have to be right now.

Snigda: So, can you tell us a little about yourself and how you became involved with research and advocacy and LGBT health?

Dr. Kauth: Yeah, certainly. I'm a clinical psychologist by training. I'm a professor in the department of Psychiatry at Baylor and do teach at Baylor. Most of my work, though, has been at the VA and I've got two major roles there. I'm director of the LGBT Health Program for all of the VA and we oversee to Health Care policies and some clinical support programs and generally work to try to get clinicians to follow best practices and policy. The other major role at the VA is I'm co-director of a research and education center called the South-Central Mental Illness Research, Education, and Clinical Center or MIRECC – that's a mouthful – and our Focus there is on finding innovative ways of delivering best mental health practices in the U.S. I was, I was raised in a very small town in Kansas, a town of 4,000, and went to school as an undergraduate at Wichita State University. And that was a great experience and in kind of towards the end of my undergraduate career or maybe the beginning of my master's program in psychology, I came out as a gay man, and that was in the early mid 80s and HIV/AIDS was really hitting the east and west coast about that time. It was just beginning to reach the Midwest, in fact, it was actually already there, and people didn't know it, but it was already there, and it was really frightening people, but that HIV/AIDS certainly was affecting me and my community people, that I knew, and I began passing out condoms on campus and volunteering for organizations to increase awareness and knowledge.

Dr. Kauth: When I was in my master's program as a graduate student and doing a practicum at Community Mental Health Center, I started seeing HIV patients in part because I really wanted to, I wanted to help and in part because regular staff members were afraid of seeing those people, they were afraid of getting the virus through this having them in the office. Which was sad, but I started seeing mostly men with HIV and started to realize quickly that there wasn't a lot I could do as a therapist with meeting them weekly. What they really needed was greater social support. They needed to be connected with other people. It helps them. They were very isolated. They were afraid to tell other people that they had HIV. They were afraid of being discriminated against – all understandable. And so, what I did was I organized a support group. I was the very first support group for HIV people in Wichita, Kansas and that support group became quite popular and morphed into two other support groups of different variations. We were meeting in the basement of a Unitarian Church and that, that carry on for a little more than a year, I think, and about that time, I was ending my time in Wichita. But I was connected with other people in the community who were delivering other services to HIV people like dental services or physicians who were willing to see HIV people or funerary services. There was a guy in the Social Security Administration office who was really good at helping people with their disability claims, and we pooled our work and founded a nonprofit organization to be an umbrella for all of these services called and we called it AIDS Support Services not – not a cool name, but that's what it was and that was really rewarding and gratifying and soon after we formed the nonprofit and I left to go to school at the University of Mississippi to finish work done on my degree. While I was there, I really got my first taste of research and I spent a couple of summers working with an HIV researcher at the University of Mississippi School of Medicine in Jackson, Mississippi. And Dr. Jeff Kelly, who is a psychologist, and he was working on an idea to change social norms within large groups of people, mainly gay men who went to bars and changing social norms around using condoms using the Diffusion of Innovation model to do that. It was a great experience. Probably the most fun job I ever had because I had got to go to bars and talk to people about sex and grab free drinks from the bartender. Didn't get paid a lot. But that experience also taught me how research works. How a big research organization functions and it was very welcoming there. I realized it's not something that I wanted to lead myself but I really like to be part of research. I enjoy working with really bright people and analyzing data and writing papers and that gave me, kind of, my first taste in publishing so, that kind of got me started both in advocacy and research in this area and it told me also that you know, I can make a difference. 

Snigda: That's a really powerful story! It's awesome that you're able to, like, make such a big difference. Even as you're saying like even as someone who doesn't have like an amount of power that you would necessarily need for like policy change, but you can make like real change in the community. That's super inspiring to me also, and I guess Juan too because we're both very interested in research as well.

Juan Carlos: Anything research we’re always like ‘tell me more.’

(All laugh)

Dr. Kauth: It's a fascinating way of life. It really has the brightest people involved and that's stimulating. It's super stimulating the be part of that world. Also, a hard part and money kind of, didn't like, was that, that constant cycle of anticipating the end of your funding and preparing working on getting new funding, that part wasn't so fun. I really enjoyed working with people who are doing research and being part of the research. So, now I kind of have the best of both of those worlds. I get a hard-money paycheck from the VA and I get to work with researchers on their projects as an operational partner and helping them craft their work in a way that can help with policy and help with best practices in healthcare.

Snigda: Do you have any stories from your early advocacy work of people that you interacted with that like, really left a mark? 

Juan Carlos: Like a role model figure?

Snigda: Yeah! 

Dr. Kauth: Yeah! Several. The faculty member who was leading this HIV work at the University of Mississippi, Dr. Kelly – amazing individual and the clarity of his writing really helped me a lot and learning how to write and how to very concisely and be persuasive and communicating your ideas. He's also a very passionate person and wanted to make a difference and I really enjoyed seeing that passion. I guess also the passion of the whole team because like I said in research you have to worry about where the funding is coming from often people in research aren't getting rich. They're not making a lot of money and they're doing it because they really want to because they want to learn. They want to learn new things. They want to communicate those ideas and they want to make a difference in the system. So, and being part of and riding along with that passion was just super stimulating and super helpful. That's something I wanted to do. 

Snigda: Yeah, that's amazing. That's such a cool story. Juan, did you want to take the next question? 

Juan Carlos: So, I guess the reason she asked me is that, as a as a veteran myself, I’m kind of always interested to see what people are doing for the veteran community and it and this question is kind of based off of one of your last or recent publications in the American Journal of Public Health. I guess I’m just kind of wondering what your most fascinating ideas or questions that you have in regard to researching and LGBT and veterans in their access to health care, in your experience. 

Dr. Kauth: Yeah. What is really interesting to me is trying to figure out how stigma and discrimination, especially within the military, contributes to health disparities among LGBT veterans. There's been some great work done recently by Ilan Meyers to conceptualize a model of how the this occurs and he calls it the Minority Distress Theory and the idea behind this I think is very helpful because it helps us kind of think through these steps and how health disparities that occur but it also provides us some possible pathways of interventions and the idea is that larger kind of distal stressors like stigma within society as well as individual more proximal kinds of stressors, our personal experience with stigma and discrimination, the internalization of those experiences, both of those things individually and together contribute to maladaptive ways of coping like drinking too much, eating too much, not exercising, doing drugs to manage anxiety, and poor health seeking behaviors. It also contributes at a larger level to barriers to accessing healthcare because it’s not thought of as something that's terribly important. All of those things collectively together lead to differences in health outcomes with stigmatized populations like LGB people and T people as well. And I make that distinction because there's another group of folks who kind of expanded on that model and conceptualized the Gender Minority Stress framework that looks very similar to the Minority Stress framework that also conceptualizes how transgender individuals can end up with greater health disparities, poor mental and physical health outcomes compared to non-transgender or cisgender people. How do we intervene? How do we build up people's resilience to moderate those poor health outcomes to minimize the internalizations of these negative experiences? It's very hard at a to kind of reduce those larger societal messages of stigma and discrimination but we can, at a personal level, help people cope better and to engage in more healthy behaviors and healthier ways of coping with those stressors, even if we can't reduce the stressors themselves. 

Juan Carlos: It's wonderful. It's especially given that, you know, it's not, it's no secret right? That the military isn't that touchy-feely environment that really allows anyone who wants to seek help right? To seek it before they separate from the military and then once you separate those, those opportunities to get help are you even lessened or more lessened or more scarce, I guess you would say, and so I mean, I personally know a lot of people who revert to unfavorable coping mechanisms, and you know, it's just kind of a slippery slope from there. 

Dr. Kauth: Yeah, and this is not just an issue for the VA. A lot of people have them stick and belief that the VA sees all veterans. We do see all veterans who come to our doors, but the majority of veterans get their health care from private practitioners who, unfortunately, don't always ask about military service and they aren't aware of how military service may put people at increased risks of certain health conditions and they need to ask those questions and they need to follow up and find out that information. I think that's true for sexuality and gender identity as well. If Healthcare Providers don't ask those questions, then they don't know that somebody may be at risk of particular health conditions. They can't follow up. They can’t address those issues. You know, kind of the intersection of those identities are also important and can put people at even greater risk. So, LGBT veterans may be at even greater risk of some mental and physical health conditions compared to non-LGBT Veterans because they got that double or triple dose of stigma to deal with. 

Juan Carlos: Oh, yeah. Yeah. It's a lot to deal with mentally.

Dr. Kauth: One of the things that I've learned about advocacy is that you can't be a one-person show. You're not effective if it's only you. You are most effective if you expand your capacity, if you inspire other people to be advocates themselves and pull them and broaden the scope of your work and let them do their thing too. So, one of the one of the exciting parts of advocacy for me, at least within the VA is helping to change the culture within VA. A lot of Veterans, as you probably know, think that the military and the VA are kind of one in the same. They’re just two ends of the spectrum and they're very different and have different policies in place and slightly different cultures. But there's some of that military culture that is brought to the VA and some larger societal culture that's part of the VA and I am working to try to change that and to create a more welcoming friendly environments for people who feel stigmatized by providers to have conversations about sexuality and gender identity. So, patient know that this something that they can, and they should be talking to their Healthcare Providers about because it has health consequences and that they're getting their needs met.

Juan Carlos: Yeah. So, I think for like a veteran having someone who is openly receptive or just simply asking, you know, it's like “Yeah, great! Let's talk about it. I've been dying to talk about this” and it’s just laying it all out there. Just that act alone. I think it's therapeutic. But you're right, you know, like more physicians need to know to ask the right questions when it comes to this patient population. Yeah, and then in your advocacy, this is sort of, are their organizations or are there certain things that you've done that are now sort of in place in practice? What is or could have been the most rewarding and highlight of your advocacy?

Dr. Kauth: Uh. I'll share a couple of things. One of them met at the VA, one of them at Baylor. You know, in my work in the VA and trying to change culture, one of the things that I'm most proud of and I think we'll probably be most effective is we managed to get identified with every facility and LGBT veteran care coordinator. Some facilities have more than one and it is their job to assess the needs of LGBT veterans at that facility and work to provide all of the services that we need to be providing for those veterans at that place to connect with community organizations to educate staff and to, more generally, create a welcoming friendly environment for LGBT veterans. It's those people on the front line that will make the most difference in the system. Doing policy, issuing a policy, asking people to read it, is not going to do a lot. It's the implementation of that policy that makes the difference and it's those people at the front lines who do it. So, I'm very, very proud of that work. And what is rewarding is to get messages from those people in the field of various facilities who send us photographs of like Pride events at the VA, which they've never held before. 

Snigda: That's awesome!

Dr. Kauth: And to see it happening is really, really cool. Yeah. 

Snigda: Wow, that must have been really hard to like, get that approved.

Dr. Kauth: It is it is difficult to get changes made but it is possible. Yeah, the VA can be a really neat and flexible system sometimes, but it has a surprising amount of flexibility. There are a lot of good people in the VA who want to do the right thing. And it's not always easy to know what the right thing is. But one of the things that I've learned in my career at the VA is persistence counts and if you're persistent you will win, and you just have to keep hammering with the right message to the right people enough time and you can get your message through and you can make things change. And it is possible. 

Juan Carlos: One thing there is a military, which is kind of fitting, right? Is that saying, ‘the squeaky wheel gets the grease.’ So – 

Dr. Kauth: That’s right! (chuckles)

Juan Carlos: If you just continue and you stay persistent and you're adamant about change and it'll happen.

Dr. Kauth: Keep hammering home! This is what we need to do. This is the right thing to do for our veterans and people listen to that message. 

Juan Carlos: That's awesome.

Dr. Kauth: Yeah. Let me, let me share an advocacy story about Baylor. I mean, I came to Baylor in 2007 after Hurricane Katrina. I've been living in New Orleans prior to that and yeah, things were bad, and my husband and I decided that we couldn't stay there. We needed to move for a variety of reasons and through my job at the VA I was able to transfer my position over to Houston, which was a wonderful transition for me in a lot of ways and immediately got involved with Baylor, who seemed very eager to partner with me. I started lecturing in classes and a couple of years later, I took over the Human Sexuality class from Dr. Basinger. We've been running the course for several years because they were really interested in the topic and they felt like that this was material that wasn't being covered in some of the other courses and I agreed with them and I thought it was a cool idea and was really excited by their eagerness to do something and so, together, we wrote the course. We developed the proposal and sent to the Curriculum Committee and they approved it, which was great, and I've been offering the LGBT Health course since 2014. That's been really great, and it's been due to student excitement about the topic and wanting to learn more. I really enjoyed that, and the visibility of the course has made me a magnet in some ways that lots of students even faculty member with faculty members will come to me and ask advice or want to share ideas about expanding LGBT Health interests or activities at Baylor which has been pretty cool. It's thrilling to see like the BCM Pride Group engaged in activities or the graduate student group engaged in activities and more visibility of LGBT health issues and in other courses or other activities that are going on on campus. It's been huge explosion of activity since 2014. I don't know if that was me. I don't want to take all the credit for it. But I think the existence of visibility of that course helped make it possible – gave some room on campus for other people to decide, you know, maybe I could do this too and they did.

Juan Carlos: Well, we appreciate your modesty in the impact and implementing such big change. 

Snigda: Yeah! 

Juan Carlos: I know that, at least in our class which is about 200 students, they're very interested in how to manage LGBTQ patient encounters. And so, when you were mentioning about faculty and students’ sort of seeking out information from you, I'm sure there would be a large majority of our students now who would be interested in: 1) Is there a course? And they would probably really, really interested in doing an elective on that and then 2) following your work and advocacy, and then 3) getting involved, so – 

Snigda: Yeah, as a student that took your course, yeah you were being modest for sure, that course was actually, it taught me a lot. I was already interested in the topic and I guess maybe the people that take the course or a little self-selecting in that way, but I learned a ton from that course and it also made me a lot more optimistic about like how much we can actually impact LGBT Health as like, hopefully future Physicians, and yeah, I just honestly, I want to echo what those students said like about how you're like you are the perfect person to be teaching this course, you know? Given how much experience and knowledge you have in the field. So yeah, I love the course.

Dr. Kauth: Thank you! That's good to hear. I'm very glad to hear it. Thanks for sharing that. You know, you don't always know what impact you have on other people. Mostly, you don't know. You hope for the best, but I do see effects like you, in particular, inviting me to be part of this podcast, which is a really cool thing. And I appreciate that, and it probably wouldn't have happened if you hadn't been in my course and I've seen other people do things too that leads me to suggest that they were inspired and that's, that's really gratifying to see.

Snigda: So, when we, when we were like taking your class, we talked a lot about how you kind of mentioned this already, but stigma and a lack of proper knowledge on LGBT Health can affect the quality and access to healthcare for LGBT patients. Is there any advice that you would give students or physicians in the healthcare field to reduce those disparities?

Dr. Kauth: Providers and students are in a perfect position to be strong advocates for people who have little voice in the community. People who get into Healthcare want to help. They want to make a difference. They want to make people better. And so, they're already advocates in a way. It's just because since you're just directing this in a different way and how they can get involved is to get informed, learn more about the topic, and be knowledgeable. A very important way that they can be advocates is among their colleagues and when they hear anti-LGBT statements, even jokes, say, “You know, that's not okay. I don't believe that. I don't want to hear it. I think that's wrong. That's not the way I practice or live my life” or whatever to feel, whatever it is that you say that kind of put a stop to those statements. As a colleague, that has a very powerful message amongst your colleagues. So, I encourage people to do that behind-the-scenes. Other things that Healthcare Providers can do and stuents can do is get involved in LGBT issues and they can do that in a number of ways: participating in events like Pride events, volunteering your time in LGBT organizations, giving lectures, volunteering in other ways. Giving money is helpful, and in your practices, being sure to include resources and information that's important to the LGBT community. I like to tell the story in the class because it's sad but it's true. I’ve been in Houston since 2007 and seen a number of healthcare providers myself for different reasons and out of those probably 10 or 11 different Primary Care Providers, only one of them ever had LGBT patients and some of those providers had advertised themselves as friendly to the LGBT community. So, I found that really surprising and odd. If there isn't material or information in the environment that recognizes LGBT people, they're not going to feel that they are respected there. And so, all of those things together can help make a difference and are, you know, relatively easy things to do. If you do just one of those things you can, you can make a difference. 

Snigda: Yeah. I'm always amazed at like, how much of a difference even a small thing like a pamphlet can make or a poster just to make people feel like comfortable sharing what they're going, with like going through. 

Dr. Kauth: Yeah, absolutely. And that reminds me of a story about the VA but one of the things that we have done was try to increase the presence of LGBT in the Healthcare environment. And there was one primary care provider who told me, this was a couple of years ago, he had one of our posters as a screensaver on his monitor. They don't allow this anymore, but they did at the time and the message on that that poster that was on his monitor was “We serve all who serve.” And it had a rainbow dog tag as part of the poster and you know, a patient that he had been seeing for a long time in his office and saw that screensaver and said, “You know, I have to tell you I'm a lesbian” and he was a little taken aback because he first he hadn't asked about her sexuality before and so he felt bad that he hadn't done that. And he was a little taken aback because it was the screensaver that made her feel comfortable that this was a space where she could talk about her sexuality and she hadn't been able to do that before. 

Snigda: That's incredible. 

Dr. Kauth: So, it can be a very small thing like that, that communicates to people that this is a safe space. This is something that is okay. I can talk about these issues.

Snigda: That's yes, that's amazing. Uh, I did some work as an RA in undergrad with advocacy and I also kind of noticed that like, just like, passive things like that, like a poster on the wall could make such a big difference like someone might not even realize that they're going through something and they'll see a poster and they’ll be like “hey, wait a minute, that’s like me” and that can really get things going. It's pretty amazing.

Dr. Kauth: Yeah. Absolutely. 

Juan Carlos: Posters and pamphlets, I mean, they do an awesome job. They sound great. I'm more interested in the active stuff and you mentioned that there's a lot of active advocacy just so that we can try to prepare for future events and maybe have the podcast cover the events, what are the biggest events that we do here at Baylor?

Dr. Kauth: Yeah. There are Pride events that occur in June. This season probably won't be face-to-face activities on campus, and I don't know yet how those are going to be morphed into something that's online and virtual that can still involve people. It's unclear. But I've noticed that around the city, around the country, face-to-face events are being canceled. And that's, that's a little sad. Yeah, but those kinds of annual events are places where people can get more involved and visible. I'll tell you one of the most powerful things, I think, that has been happening for students is in new student orientation for first-year students who are coming in. There are a series of group discussions organized around different topics that have included wide range of topics and especially LGBT health and they offer these at different times so they can involve different groups. You all may have participated in some of those. I don't know. I've been involved for the last couple of years in leading some of those small groups, but it's not just me. There are other faculty members who have come in and led those groups too and I think it's a great way of introducing to students the connection between sexual orientation and gender identity and health issues and why those are important health issues and how to think about health in those ways and how to create a more affirming kind of clinical practice. So, very early on, kind of, lays the groundwork for students thinking about LGBT health issues in a very affirming kind of way. Hopefully they get more content information later on in their training. I don't know but it's a great foundation to begin with and so I encourage other faculty members and all of the incoming students to take part in those kinds of activities.

Juan Carlos: Well, yes. Yes. I guess I meant when this COVID, you know, lockdown gets sorted.

Snigda: Yeah, so BCM Pride has a few events that they do every so often like every two or three months. They recently had like a like a Valentine's party where they had a lot of like baked goods and there was like a tea party. It was, it was great. That was super fun. But yeah, they if you, I think if you join the BCM Pride Facebook page, they do a lot of advertising on there. So, if anyone's interested who's listening, that would be somewhere to check out. Yeah. Dr. Kauth, I think you wanted to say something. 

Dr. Kauth: Well, I would just add to that, that of course, you don't have to be an LGBT person to participate in LGBT activities or in BCM Pride. You can be an ally and allies are incredibly important. So, there are far more allies than there are LGBT people. 

Snigda: Right! So, I think we've covered a lot of really interesting themes about LGBT health and advocacy. Dr. Kauth, is there anything else that you would like to share with our audience?

Dr. Kauth: Uh, let’s see… I did want to, I did want to share this, that while back here, you had asked about mentor role models who really helped put me on an academic path. And this was a Social Psychologist at the University of Mississippi, Dr. Dan Landis, who taught the human sexuality course for undergraduate and graduate students, and I hadn't thought of myself as an academic up to that point, but he was very much an academic and focused on human sexuality. I enjoyed taking the class as a graduate student. I actually was a teaching assistant for a year after that and we, Dr. Landis and I became close and one of those years he decided that he wanted to put together a proposal for protecting human sexuality and invited me to help draft it, and the textbook never got published. The publisher didn't pick it up, but the experience taught me that I could write and I had something to say and it was a lot of fun, especially writing about human sexuality kinds of issues and so, I really valued that experience. It taught me that it was important to make connections with faculty members who are working in areas of your interest. They're real people and they have lots of, lots of information and experiences to share and can provide you opportunities that you hadn't ever thought about and those opportunities will open up new doors for you that you hadn't considered and so writing those, writing those chapters convinced me that I could write other chapters, I could publish, I could write a book, and eventually, I did. I published my first book in 2000 on Theory of Sexual Attraction and I am now working on my fourth book that will come out later this year. It is going to be called The Evolution of Human Pair-Bonding, Friendship, and Sexual Attraction that will be published by Rutledge and it is such a rewarding experience to do something like that. But I credit Dr. Landis for putting me on that pathway with showing me that this was something that that I could do. 

Snigda: That's so inspiring to hear and yeah, it's really optimistic for some students just starting out to see someone who's been able to like really make such a big difference and has still like maintained so much like modesty in spite of all the success. But yeah, this is this is really inspiring for me. 

Dr. Kauth: Well, and I have to say, if you want to make a difference, you can't do it for yourself. If it's only about yourself and getting that positive feedback, you will not end up helping people, you'll just be looking for that kind of positive feedback, the positive interaction. Like I said earlier, you can't know what effect that you have on people. You have to hope for the best and let them do their own thing. What you can do though is, you can plant seeds with other people. You can, you can give them information that can Inspire them that can help them see things in a different way and that's the best you can do and then look to see what effect that has and that's its own reward and looking back and seeing how you have affected other people at a distance. They've gone off and done their own thing and they made a difference themselves, but it's a very delayed kind of gratification and you have to be willing to accept that in order to I think to be an effective change leader. 

Juan Carlos: So, I have a kind of question, just out of curiosity. Currently at the moment, we're kind of going through learning disabilities and autism spectrum disorders, and I have been chatting with a colleague of mine Priscilla Bigner who does work in mental health counseling and aspiring clinical psychologist, and so, we know that kind of autism spectrum disorder are more likely to, sort of, be transgender and identify as non-conforming, but would you be able to comment on what research has been done into dealing with sort of autism spectrum disorder and transgender?

Dr. Kauth: Uh, certainly. Research has shown that people who often identify as transgender or gender-diverse have a higher prevalence of learning disorders and tend to be more on the autism spectrum. Why that is, is not clear. The connection between the two is not clear. It could be a process that is parallel to gender identity issues and just happens to co-occur. I don't know that there's any kind of causal connection and similar to research and things like attraction among people. There are a lot of things that are associated with a prevalence of same-sex attraction that, how are those things causal and how they're connected isn't always clear and I'm not sure that we can make a lot of that information just yet. I think it’s; I think that the process of how people think about their gender identity, their internal sense of self is, probably both a biologic process and a social process and there are things that happen within our bodies allow us or kind of shift our thinking into “this is part of me, or this is not part of me.” And this is consistent with how I think about myself or not consistent with how I think about myself and then in society we get messages about how we should interpret those basic and biologic senses of this is consistent with who I am, this is not consistent with who I am, and in terms of how we think about our gender. But we don't really know what the causal connection is to why some people have a gender identity that's congruent with their sex assigned at birth and why some people have a gender identity that's not congruent with their sex assigned at birth. It’s probably a very complex process where we're only able to find like associations at this point or things that kind of occur together with people who have a transgender identity. I know that doesn't really answer your question that that's really the best that we know at this time. These are things that tend to go together and that's all we know. 

Juan Carlos: But yeah, you know, it's just, these are things that we kind of think about as we're learning, and we learn about gender identity and that development and then disorders and cognitive development. So, if one isn't aware that they're developing this way, you know, there's, you're kind of prone to not being able to identify in a certain gender. And then that will likely predispose you to some increase risk of – 

Dr. Kauth: Sure! Sure. You know, I would add to that, we really don't know a lot about causes of sexual attraction. Why are some people gay, some people bisexual? Why are people heterosexual? We don't really know. The current research tells us that there are some things that tend to be associated with same-sex attraction, but they're probably not causal factors; that they're just correlative factors. However, there's been like zero research on causes of heterosexual attraction because that's the normative attraction and in society, we don't feel like it's important to investigate things that are normal or typical. They need no explanation because they just are, and that's really the wrong way to think about it and it's an empirical question. How did we get this? What causes this? To understand how we are who we are. 

Snigda: Yeah. I think that really gets to the whole idea of like baselines, I guess and how we decide what a baseline is. And yeah, it just makes me think a lot but that's, that's super interesting and I'm definitely gonna look out for your book what it does come out. It sounds really fascinating.

Juan Carlos: Well, you seem to have a way with words and shifting paradigms at an Institutional level. So, hopefully we will see kind of a wave of change going into in favor of the contents of your book.

Snigda: Alright! Well, any last thoughts?

Dr. Kauth: No, it's been a pleasure talking with both of you. I've really enjoyed it. And this has been a wonderful experience and I'm excited to have the opportunity to share my work with other people and glad that you're interested. Thank you. 

Snigda: Thanks so much! 

Juan Carlos: It has been a pleasure having you on the podcast show, Dr. Kauth. Hopefully, we'll have you on again and discuss your books and future endeavors and successes and thank you so much!

Dr. Kauth: Thank you.

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