I will die a man

grvsmth

Back in 2004 I lost my father, who had been there for me since I was born. In May I unexpectedly lost Ed Kossoy, the man who joined my mother in raising me from when I was twelve. If you think saying goodbye to one father makes you think about your own mortality, you can imagine what it’s like with two.

There have been other deaths near me recently as well: a thirty-year-old neighbor dropped dead of a heart attack; another acquaintance died of a freak (i.e. non-car-related) accident. Friends have told me about losing loved ones in painful ways. Even pets: two years ago one of our cats died after a long illness.

I’m not a kid anymore, and sometimes I have weird health issues and I wonder, could this be it? Of course I hope I’ll be around for many years to come, but my time will come eventually. And I know several transgender people who have decided to transition when they were confronted with the fact that some day they will die. As I understand it, they realized that they really didn’t want to live as men their entire lives, and that if they didn’t transition they might just die as men. That was their choice for themselves.

For myself, I’ve seen two men I love die, and I think it’s okay. When the time comes for me to go, I’ll be a man like them.

Does this mean that I no longer feel any desire to be a woman? Far from it. I feel it every day, as much as many who have transitioned. But I also feel a desire to be a man. Not some caricature of manliness, but a thoughtful, problem-solving man like my dad and Ed both were. A strong and loving man. Long ago I realized that I can’t be both, and chose to be a man.

I still plan on cross-dressing on a regular basis for as long as I can. You may some day see an elegant old lady walking down the street, and it’ll be me. But then in a few hours I’ll go home and change back. I hope that I don’t die in the dressing room at Macy’s, but there are certainly more embarrassing ways to die. And of course the most embarrassing way of all is to die after a lifetime of hiding yourself in fear. Whatever happens, it won’t be that for me.

Why HRC, GLAAD and TLC’s advocacy hurts the transgender community

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Today I got an email from the Human Rights Campaign saying, “Tell ABC: Your new comedy is no laughing matter.” It’s about this new television show called “Work It.” HRC says,

As part of their winter line-up, ABC is releasing a new comedy called “Work It,” featuring two men who dress as women in order to get jobs. The problem is that the premise reinforces false, hurtful stereotypes about transgender people. This kind of programming only mocks those who don’t adhere to society’s gender norms. Tell ABC’s president to can “Work It” now.

The link in HRC’s email goes to a petition asking ABC “not to air a show that reinforces negative and damaging stereotypes about transgender people.” On their website, HRC says that their president Joe Solomonese “contacted ABC Entertainment Group President Paul Lee today to request a meeting to discuss the very real challenges transgender Americans face in the work place – with the goal of ensuring “Work It” can be a light-hearted comedy that doesn’t belittle or mock these obstacles; or reinforce negative and potentially damaging stereotypes.”

With a little googling, I found a trailer for the new series, and articles at The Wrap and the Hollywood Reporter. These both said that not only HRC, but the Gay and Lesbian Alliance Against Discrimination were up in arms about the new show.

On GLAAD’s website, I found a blog post attempting to explain “Why ABC’s New Sitcom Work It Hurts the Transgender Community.” That blog post linked to a Huffington Post article by Mark Daniel Snyder of the Transgender Law Center saying, “We owe it to our constituents to speak out anywhere we see an injustice, no matter how big or how small.”

I don’t particularly feel that this show is harmful to transgender people. I’ll explain my reaction in more detail later, but for now I want to focus on the advocacy messages.

Note that in the HRC website and email, and the statements in the media, we do not hear from a single trans person. HRC president Joe Solomonese is not transgender, and I’m pretty sure that neither is GLAAD Acting President Mike Thompson or Matt Kane, their Associate Director of Entertainment Media. The transgender Huffington Post bloggers who’ve discussed this issue, Emerson Whitney and Mark Daniel Snyder, are both female-to-male, as is Transgender Law Center Executive Director Masen Davis, quoted in the Advocate.

It took a lot of digging to find any public statements by male-to-female transgender people, and there was a negative one by Kelli Busey and one withholding judgment by Jillian Page. The only expert on transgender workplace diversity I know of, Jillian Weiss, has produced a single tweet, “@kellibusey I like your guest post on care2.”

What I find a lot more disturbing than yet another crappy sitcom is reading pronouncements by a bunch of gay men and FTMs about what MTF transgender people feel and think and want, at best referencing yet another problematic convenience-sample survey, without a single MTF voice to be heard. Do Joe Solomonese and Matt Kane and Mark Daniel Snyder know any MTFs? Emerson Whitney at least quoted Kelli Busey; why couldn’t Mike Thompson or Mason Davis?

I’ll tell you what hurts the transgender community. It’s the pretense that we are united by anything other than the hatred we get from outside. It’s the idea that we all care about the same things, feel the same way, react the same way. It’s the constant stream of shoddy convenience-sample survey reports that allow some gay guy who read The Celluloid Closet or some FTM who read Marjorie Garber to set themselves up as authorities about What Hurts the Community. It’s the idea that this is a problem ABC can solve by meeting with Joe Solomonese instead of, say, an actual transgender person, maybe even an actor or producer.

I’m thinking of starting a petition.

The value of finality

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In my last post I mentioned the other big finding in Dan Gilbert’s work: that people only get that satisfaction if they think the choice is final. When they knew they could change their minds about the painting, they were less happy with it. This explains a lot about the way decisions and commitments are made. If you’ve made a very difficult choice that affects every aspect of your life, like marriage, a job or a child, you’re going to have mixed feelings about it, and from time to time feel a desire to change your choice. The easier it is to make that change, the more time you’ll spend thinking about it, and the less time you’ll spend adapting to the choice you made. In the end that means more satisfaction.

The implications for “transition optional” transgender people are clear: we will have difficulty making peace with our choices unless we’ve ruled out the other choices. This makes it easier to understand the origins of transgender dogma. If you believe that it’s your destiny to live as a woman no matter how many people insist you’re a man, you’re going to think less about the choice you’ve already made. On the other hand, if you believe that you’re “just a crossdresser,” you’ll be less likely to think maybe you should transition after all.

The result is that we get a lot of people claiming to be “transition or die” or “transition and be miserable” when in fact we’re transition optional. We do this for our own sanity, our own peace of mind. But that doesn’t mean it’s without problems.

The “transition optional” group is larger than you might think

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In my last post I noted that we can divide people with transgender feelings into five groups. Some will commit suicide if they don’t transition, and some will be miserable. A third group will commit suicide if they *do* transition, and a fourth group will be miserable.

The fifth group, in which I count myself, has the ability to live in either gender without being miserable or suicidal. Or else they would be miserable or suicidal in any gender lifestyle, so transition would not make a difference.

A reader told me that she had heard of a study indicating that our “transition optional” group is the largest of these five. I’d like to see that study, but I’m skeptical that it actually shows that. As I’ve said before, we don’t have any kind of transgender population census, so any prevalence figures are likely to be completely inaccurate.

I do have a theory that predicts that the “transition optional” group is large, though. It comes from Harvard psychologist Dan Gilbert, who has done research on happiness. I strongly recommend reading his book, Stumbling on Happiness, which is an easy read. You can get the short version from Gilbert’s engaging TED talk.

There were two big things I took away from Gilbert’s work. The first is that we humans are capable of making the best of all kinds of situations. When the subjects thought they were stuck with their third-choice painting, they learned to appreciate it more; when they thought they were not going to have their second-choice painting, they lost interest in it.

This suggests to me that the “transition optional” group is bigger than we think. I personally can think of a few things that might have been better in my life if I had transitioned, like shaving, but since I know those things aren’t going to change I try to make the best of them and focus on the good things, like strength. I’d imagine that if I had decided to transition back in 1995, I’d be trying to make the best of hormones or whatever, and focusing on the positive aspects of post-transition life.

I’ll talk about the second big thing later.

Transition or die

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One of the strongest arguments in favor of gender transition is that the person may commit suicide. They may also engage in other self-destructive behaviors like cutting or drug abuse, which carry the risk of accidental death. If the risk of self-destructive behavior is high for a person, I think most people would agree that transition is the better option.

A major problem, though, is that there are people who commit suicide after transition. As with all suicides, it is impossible to know in any given case whether a person’s transition was a factor in their decision to kill themselves, but in some cases at least it is clear that transition made them less satisfied with their lives. If we accept that the risk of suicide after transition is higher for a person, then we can agree that not transitioning is the better option.

There are others who might not commit suicide, but who are miserable in their assigned gender and have exhausted all options for improvement. Most people would probably agree that transition is appropriate. A fourth group would probably not commit suicide if they transitioned, but they would be miserable. Most people would probably agree that transition is not appropriate.

Then there is a group who would be equally satisfied with either option. I would probably put myself in the fifth, “transition optional” group. I have chosen not to transition, but if I were to wake up one day in the body of a postoperative transsexual, I would live that life and try to enjoy it to the fullest.

I should point out here that I’ve made all these groups the same size. I do not mean to suggest that they all contain the same number of people. I don’t know how many people are in any of these groups.

I want to stress that all of us on this spectrum have the same transgender feelings. We all feel a desire to be a different gender from the one they were assigned. Some may feel that desire stronger than others, and some may feel a competing desire to remain in their assigned gender, but on the basis of feelings we are all transgender.

My comment on transgender data collection

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Comment on Notice of Availability of Proposed Data Collection Standards for Race, Ethnicity, Primary Language, Sex, and Disability Status Required by Section 4302 of the Affordable Care Act (Document ID HHS-OMH-2011-0013-0001)

The deadline to submit your comment is Monday, August 1, 2011!

As a transgender person and a social scientist, I am excited to hear that HHS will be collecting information relating to transgender phenomena. These activities have the potential to bring us valuable information about the prevalence of transgender feelings, thoughts, beliefs and actions in the general population, beyond an often self-selected community that identifies as transgender and participates in the existing surveys. As a social scientist I have some longstanding concerns about the collection and presentation of survey data about transgender individuals, and I hope that your work will improve the situation. Here are some recommendations that I have, for the process of deciding what data to collect and how, and for the data collection itself.

In my experience, many organizations and agencies working with transgender communities repeatedly and consistently make generalizations about transgender populations that are unsupported by any data. For example, the Transgender Law Center found 194 transpeople through unrepresentative “convenience” techniques, of whom 114 reported annual incomes of less than $15,333. A cover article in the San Francisco Bay Guardian summarized it as, “In other words, more than half of local transgender people live in poverty” – an incorrect characterization that was not disputed by the study authors. As any introductory statistics textbook will tell you, prevalence in a convenience sample tells you nothing about prevalence in the general population. No one knows if the sample was representative of “local transgender people.” Presenting it as representative is misleading to the public and can lead to inappropriate funding allocations and badly targeted health initiatives, and possibly even a backlash against transgender people.

I believe that convenience samples can be very useful, for example to show the existence of job discrimination, poverty and prostitution in our community. There is a limit to their usefulness, however, and they are consistently used beyond that limit by social service providers and community advocates. The result is to spread unreliable information, and quite probably to waste taxpayer money and charitable contributions.

Reports like this are often accompanied by a disclaimer; the Bay Guardian article said, “TLC doesn’t claim the study is strictly scientific — all respondents were identified through trans organizations or outreach workers.” Unfortunately, they almost always go on to report the data as if the disclaimer were meaningless: the next sentence reads, “But the data give a fairly good picture of how hard it is for transgender people to find and keep decent jobs, even in the city that is supposed to be most accepting of them.” The reporting of percentages invites this kind of lip service to sampling procedure. Percentages are meaningless in these situations, but they are always reported, and the effect is to dismiss the disclaimer as a formality, encouraging media reporters to do the same.

On your website I see that you anticipate that the Williams Institute and the Fenway Institute will play a strong role in helping you formulate procedures for collecting information on transgender communities. I agree that they have done a lot of good work, and I support their inclusion in any round tables that you convene. However, both institutes have a history of presenting convenience samples as representative. I strongly recommend that you balance their participation with people who are knowledgeable about the appropriate use of sampling.

I am a strong advocate of qualitative research as a means of finding out problems that exist in the world. There are several advocates from the transgender community who have done quality ethnographic and autoethnographic work. One that I know personally is Gail Kramer, who has written the books My Husband Betty and She’s Not the Man I Married under the pseudonym Helen Boyd. I urge you to include in your Roundtables at least one qualitative researcher like Helen.

To my knowledge, only one researcher has done a representative sample of any segment of the transgender community. That is Niklas Långström of the Karolinska Institutet in Sweden. I strongly recommend that Långström, or someone familiar with his survey, be part of your Roundtables. I am also willing to participate, as a transgender person interested in these issues and as a social scientist who has used representative sampling in my professional work.

The curious incident of the healthy transwoman

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I’ve noticed that transgender health researchers tend to focus on people with health problems, and that makes sense. Consequently, I’ve often felt a bit guilty talking about transgender health issues. I don’t have a sexually transmitted disease, the worst thing I’m addicted to is sugar, I’ve never been bashed, and I’m not depressed or suicidal. So why should I talk about my health? Why would any researcher want to study someone like me?

The answer comes from Sherlock Holmes, in the story “The Silver Blaze”:

Gregory ( Scotland Yard detective): “Is there any other point to which you
would wish to draw my attention?”
Holmes: “To the curious incident of the dog in the night-time .”
Gregory: “The dog did nothing in the night-time .”
Holmes: “That was the curious incident.”

There’s a fancy word for this: negative evidence. Often, the absence of a salient event can tell you more about the causes of a problem than a hundred events.

I see this all the time in my computer consulting business. If a customer is not getting an image on their computer monitor, it could be caused by a fault in the motherboard, the video card, the video cable, or the monitor. I can turn on the computer and get a blank screen a hundred times, but that doesn’t help me figure out which component is causing the problem.

If I can get a picture even once, however, I can isolate the problem. If I hook the computer up to a different monitor and the display comes on, I know that the monitor is the problem. If I put in a different video card, I know the customer needs a new video card.

This method can work with transgender health as well. We are a diverse group, and there may be something in family background or upbringing that can make the difference between health and sickness.

There are many choices that we make in our lives, and those choices may affect our health. We need to know the consequences of those choices. Even if that knowledge doesn’t ultimately change our decisions, it can prepare us and allow us to plan better.

That is why we need to hear about a whole range of transgender people, not just those that the researchers were able to track down.

The consequences of sampling bias

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I wanted to go into a bit more detail about something I’ve mentioned before: that the use of non-representative samples can cause problems down the line. To illustrate this, I want to examine the claims of health disparities that Emilia Dunham lists in her Bay Windows article.

  1. Transgender people take more hormones and have have more surgeries than average.
  2. Transgender people smoke at a 30% prevalence rate, and use other substances to cope with the stress from discrimination.
  3. We’re more likely to suffer from depression and anxiety, and more likely to live with HIV.
  4. 61 – 64% of transgender people have been physically or sexually assaulted.
  5. 41% of transgender people have attempted suicide.
  6. All these percentages skyrocket for transgender people of color and low-income folks.
  7. A startling 1 in 5 transgender people have experienced complete refusal of services from healthcare providers.
  8. If transgender people aren’t referred to with correct names or pronouns or are treated with coldness, they may avoid the office.

Of these statements, only the last one is an existential statement. All the others are statements of prevalence or likelihood that are not generalizable without a representative sample. In my impression, some of them are more likely to be true of the entire transgender population than others. There are chains of causation from transgender actions to these disparities, and the chains are not all the same. Here are some possible causal chains. They are not the only possible ones, but they are the ones that seem likely to me.

First there are the inherent consequences of transgender actions: more hormones and surgery. If you’re only concerned with transpeople who choose to take hormones and undergo surgery, then of course this is true. But if you believe that not all transpeople choose hormones or surgery, and you don’t know how many do, then you have no way of knowing how great these disparities are.

Then there is harassment based on perceptible differences: physical and sexual assault. A lot of this has to do with passing – as one gender or another, not necessarily the one you prefer. The passing does not have to be total: a transperson can avoid a lot of harassment simply by avoiding being noticed. However, note that there is a feedback loop here regarding socioeconomic status: wealthier transpeople can afford higher quality hormones, surgery, hair removal or attachment, clothes, padding, cosmetics and training that can give them (us) a better chance of passing as the target gender.

There is also discrimination based on records or perceptible differences: refusal of healthcare service. There can also be housing, consumer and job discrimination, which can affect some of the factors below.

A transgender person has a number of potential reactions to the harassment or discrimination described above, including: avoidance of healthcare providers, depression, anxiety, substance abuse, suicide attempts. Out of fear of discovery, many transpeople engage in hidden sexual activities, where there is a greater risk of HIV infection.

Completing the vicious cycle I described above are the consequences of poverty, which may in turn result from discrimination: there is greater likelihood of harassment and discrimination (and the consequences that follow from that harassment and discrimination) and sex work (which increases the likelihood of HIV infection).

I know from personal experience, from friends’ anecdotes and from online reading that these disparities do not affect all transgender people. Some people do not choose hormones, some do not choose surgery. Some never take publicly visible transgender actions, and others pass well enough, so they are never harassed or discriminated against. Some are able to deal with the harassment or discrimination they experience without resorting to depression, anxiety or substance abuse, or attempting suicide (which is not a judgment against those who are unable). Some are able to avoid unprotected sex. Some are wealthy enough to avoid the consequences of poverty.

Here’s the problem with sampling: Dunham and other researchers have no way of knowing for sure whether they’ve oversampled from those who choose hormones and/or surgery; those who take publicly visible transgender actions; those who don’t pass enough of the time to avoid harassment or discrimination; those who already have tendencies towards depression, anxiety, substance abuse, suicide or casual sex, for unrelated reasons; and those who have lower incomes. After all, these are precisely the populations that public health researchers are more likely to come into contact with. Without representative samples, they can never prove that these disparities exist to the extent that they claim.

Now I want you to imagine that these researchers actually have been oversampling these higher-risk populations. On one level the consequences are minimal: if these are the populations with the greatest need, then it’s just another way to spend public health dollars on the people who need them the most. But on the image level and the credibility level, there are problems.

I’ve seen on the Web and on television that some people have a stereotype of “tranny” that combines all these factors: a drug-addicted, unpassable, mentally ill hooker with bad plastic surgery. Some people use that stereotype to justify harassment and discrimination against transgender people, and some family members fight against accepting their relative’s transgender feelings because they fear that this will be their fate. These kinds of unsupported survey results feed into those stereotypes.

What if at some point someone does succeed in doing a representative survey, and finds that the drug-addicted, cigarette-smoking sex workers are a small portion of the transgender population, and that the average transgender person is a drug- and disease-free, well-adjusted, successful computer technician making $60,000 a year? What if all the transgender health money was actually better spent on overlapping programs that would serve the needy population just as well? I think someone might feel cheated, and I think there might be a backlash.

There’s also the possibility that we might be missing out on some valuable information. What if we found that there were people who had the exact same background, and the exact same transgender feelings, but one group became drug-addicted HIV-positive hookers and the other became successful computer technicians? We could examine the populations and see what made the difference between health and sickness. It might not be the obvious solution.

This is why we need representative sampling, and this is why you need to comment on the proposal and tell that to Secretary Sebelius.

A critical opportunity in transgender research

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The Department of Health and Human Services has just made a big announcement: they will begin collecting data on LGBT issues, including transgender issues. The goal is to document disparities in health care, as well as plain old disparities in health, so that they can be addressed in the future. The plan is to have two roundtables on “gender identity data collection” with “key experts” this summer and fall, and then the “Data Council” will present a strategy next spring.  The department will also collect public comment in various ways, one being through a website called regulations.gov, which is currently down.

If done right, this could be a tremendous help to understanding transgender issues.  “The first step is to make sure we are asking the right questions,” HHS Secretary Kathleen Sebelius told the Washington Post. “Sound data collection takes careful planning to ensure that accurate and actionable data is being recorded.”  As I’ve written before, current research on transgender feelings and actions is severely hampered by the lack of any kind of representative sample.  Just to give you a quick sense, here are ten very basic questions that nobody knows the answer to:

  • How many transgender people are there?
  • How common are the various transgender thoughts, feelings and beliefs?
  • How common are transgender actions like cross-dressing, body modifications, and “soft mods” like shaving?
  • How common are transgender name and pronoun changes?
  • How common are part-time cross-living and full time transition?
  • How often are sexual activities part of transgender activities?
  • How common are diseases and destructive habits among transgender populations?
  • How many transgender people are in long-term relationships?
  • How often are various subgroups targeted by violence and discrimination?
  • How satisfied are transsexuals twenty, thirty or forty years post-transition?

Unfortunately, transgender research is dominated by two camps, the pathologists who make unfounded generalizations based on case studies of their own patients, and the social service providers who make unfounded generalizations based on service recipients, Internet surveys and word of mouth.  Neither of them seem to have understood the idea that while convenience samples can provide the basis for many useful existential statements, prevalence statements based on unrepresentative samples are worthless.

At this point it looks like the roundtables will be heavily influenced by social service providers who only pay lip service to the limitations of their research.  The Plan says, “While HHS is in the beginning stages of developing data collection on gender identity, many researchers (e.g., Williams Institute at the University of California Los Angeles and the Center for Population Research in LGBT Health at the Fenway Institute) have been working on such data collection for several years.”  The Williams Institute produces reports like “Bias in the Workplace” (PDF), an important summary of numerous studies investigating workplace discrimination that repeatedly acknowledges that the studies are based on convenience samples – and then goes ahead and repeats percentage results as though they meant something.

The Fenway Institute employs transgender health advocate Emilia Dunham as a Program Associate, and she also hosted a webinar on the issue.  It seems quite likely that she will be one of the experts at the roundtables.  But in an otherwise solid article for Bay Windows presenting these changes at Health and Human Services, Dunham uncritically repeated several of these unsupported percentages.

There is a very short list of Experts who I think should be on these Roundtables.  The strongest research into transgender issues has been qualitative research: listening, reading and introspection, finding existential statements but not making unsupported claims of prevalence.  I’ve said before that the best qualitative researcher in the transgender community is Helen Boyd, author of My Husband Betty.  At Helen’s recommendation I’ve also read a few things by Raven Kaldera that have been pretty good, particularly his post on female transvestites (which has somehow disappeared from his website).

There is only one person out there who has ever collected data from a representative sample of any transgender community, and that’s Niklas Långström of the Karolinska Institutet in Sweden.  He’s not focused on the transgender community, and he’s associated with the pathologist Kenneth Zucker (who is not someone we want involved), but he does know how to do a national survey, and it would be worth every penny for HHS to fly him over from Stockholm for the Roundtables.

If they can’t get Långström, then I want to be on that Roundtable.  I don’t have a degree in psychology or public health, but I did take an elementary course in statistics, and I learned what you have to do in order to make a generalization.  But what matters more than any qualification is that I care about doing this right.  If they can’t find anyone else who does, I want to be there.

Am I missing anyone? Are you doing quality quantitative research? Please let me know.

The closet corrodes your soul

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I’ve talked before about the value of being out of the closet – the global political value.  But being out can be valuable in a more direct, immediate way.  It can save us from the closet.

When I first started cross-dressing, I knew that it was not acceptable.  I had heard so many people making fun of transvestites that I didn’t think that anyone would value or support me if I told them I was one.  For over a year I did my cross-dressing in secrecy and isolation.

One day my mother came into my room and said, “This closet is a mess!  I’ve given you so many chances to clean it up.  Now I’m going to do it.”

I said, “Okay, Mom, but just don’t open the top drawer.”

“What’s in the top drawer?”

“Just don’t look in it.”

“Angus, what’s in the top drawer?”

After a few more rounds of this, I told her.  Her response was not as bad as it could have been (the horror stories we’ve heard about teenagers being rejected by their parents, thrown out of the house, beaten, or even killed), but it was not encouraging.  I won’t go into too much detail, since she apologized for it many years ago, but she was ashamed, and worried that I might be gay.  She insisted that I go to therapy, which was probably a good idea, but I didn’t even mention cross-dressing to the first therapist.  The second one was helpful in various ways, but not with regards to this issue.

I avoided talking to my mom about cross-dressing after that, until I came out in general.  That meant that I was pretty much alone in the closet for another fourteen years.  And that time was hell.  I don’t know which was worse, the feeling of shame when I cross-dressed, or the feeling of relief when I purged.  Every time the topic came up in general conversations with anyone other than my mother I had to remain silent, afraid that I would be ostracized if anyone found out.  The chronic fear of being found out was a source of discomfort throughout my teen and college years.

Since I’ve come out, I know that there is a group of people that I can rely on, who have shown me that they support me no matter what I’m wearing.  I don’t need to feel ashamed around them.  Even if I don’t feel comfortable telling absolutely everyone, it’s still liberating to know that there are many people who don’t judge me for my gender expression.

Unfortunately, it took a long time for me to feel comfortable coming out.  I had to tell one person at a  time, until I knew that there were enough people who supported me.  This is why one of my goals is to encourage widespread, open, vocal support of non-conforming gender expression, so that the teenagers of tomorrow can live outside the closet.

A simple thing you can do for trans people is to say something supportive every time the topic comes up.  You can do this for gay men, lesbians, bisexuals, cyclists, or any disenfranchised group.  You might want to have a handy phrase or two ready ahead of time.  And if you can’t think of anything supportive to say, educate yourself!