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[Music]

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and are the surgeries usually able to be

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completed in one session that is our

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goal in that was a change when what I

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took over here in the u.s. current the

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current the then standard was that

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surgeons would complete things in two

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surgeries or some revisions now we call

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them but we do those less than one in

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twenty where we have to do a revision to

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make it cosmetically acceptable and

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approximately how long does the surgery

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take if we're talking about male to

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female 3d half hours in our experience

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there are locations where it can take as

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much as seven hours to do one surgery

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yes butBut under under four hours for

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sure and then recovery time depends what

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you define as recovery and a couple of

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days to be up and walking three days in

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the hospital in the six weeks were kind

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of a so-called full recovery but three

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months before you can have sex okay

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and what a what about female to male a

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roughly same term period although I

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would say that early parts are more

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delayed there are just multiple stages

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usually in those procedures it depends

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on what they're having they're several

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different surgical options for female

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the males and they have a lot more

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complications that are possible in each

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surgery so and what do you what is the

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process for you as far as what must the

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person have kind of gone through before

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you think they're essentially ready for

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surgery you know mostly mentally ready

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for surgery ready is you know there are

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there are some who demand that it should

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be you know surgery and a beard we you

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have to realize where were the current

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model that we use is really

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pathologizing this is some sort of

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mental derangement that why would anyone

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lose their penis kind of thing then

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that's still a holdover from the 1980s

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when it was pathologized in the in the

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medina s-- the psychiatric manuals that

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are still in use today so it's really

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unlike any other surgery in history that

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we require people to get mental health

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evaluations and then we questioned their

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middle sanity and so that that gradually

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is fading is we realize that really

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what's the natural is to assign people

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in one of two camps simply based on what

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their genitals look like at birth there

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is no other measure in nature where that

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is diverted by just two choices and this

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is what we do it's a big fork in the

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road at birth and it makes no sense

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biologically well biologically you do

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have X Y chromosome and X X chromosome

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is that a proper distinction in your

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mind to separate people based on

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chromosomes absolutely it's a mess in

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fact this is what the inner the the i/os

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see struggled with the International

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Olympic Committee struggled when they

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realize in the 1980s that these East

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German women were out competing their

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peers as a result of doping you know

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they were receiving male male hormones

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to to bulk up their muscle mass they

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decided that they would they needed to

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define what was a woman and so they

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tested they chromosomally test innately

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measured hormone levels tested other

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athletes and guess what eleven of the

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women that year had y chromosomes male

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chromosomes so are they men no why are

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they not men because they didn't respond

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to testosterone they had to Stas terone

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but their bodies lack the receptors

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therefore the body develops completely

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as female from externally now internally

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they still have testes internally

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they're still producing testosterone you

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see there's no way the point being

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measuring biology there's there are nine

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different ways that you can measure

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biological sex and chromosomes would be

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the simple and the easy answer but God

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didn't make it that way this is it is

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complex and in fact when that's a very

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high

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percentage of newborns that are born

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within with genitalia that you can't

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tell if it's a boy or a girl

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so they convene ethicists and

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pediatricians and urologists all around

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to decide what it's going to be and it's

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a very arbitrary measure they simply

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look at the length of the phallus and

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mind you this could be xx individuals

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and they say well it's long enough

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you're gonna be raised as a boy and if

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it's short enough you're gonna be you're

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gonna have some surgery and be raised as

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a girl and that's how arbitrary sex

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assignment is at birth so wouldn't sex

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assignment be less arbitrary if it was

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based on chromosomes oh absolutely not

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because you'd get it wrong well for one

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if you did chromosomes at birth all

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those athletes that have female

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genitalia mind you they have vulva they

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have breasts there these are athletes

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that had Y chromosomes are you gonna

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call them men you gonna raise them as

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men because they have a Y chromosome no

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so is that is that intersex is that what

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you would refer to that us what are the

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many many conditions in intersex that's

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correct okay sex is important because

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intersex really what it is is genital

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diversity there is diversity in the

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genital and genitalia formation but most

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trans people are not intersex correct no

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but there's a good number that are okay

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so for everyone else what's going on

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with them it's not intersex it's it's

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intersex but how it depends on what you

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call

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intersex there's also another whole

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subcategory of intersex conditions that

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are not even yet defined medically but

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they have to do things like very short

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spermatic chords that loud that don't

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allow sufficient production of

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testosterone and those are not even

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defined in the intersex categories other

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words we just don't really there's

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diversity in genital formation there's

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diversity so it really hardly makes

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sense that the brain might not be

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represented by diversity so what do you

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think is going on with the vast majority

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of transgender people that you're seeing

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what what do you think is going on with

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these

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what is the cause of it well if you if

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you want to say causa that you would

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imply that that implies pathology but I

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would argue that actually what it is is

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a manifestation of the fact that gender

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identity is diverse and that most of us

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are not macho macho ten on the gender

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scale or one's you know not a perfect

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you know Barbie type figure if if you're

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a female aside most of us are somewhere

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in between

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that's our gender identity now

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transgender people are the fours and

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maybe finds the sixes or people that

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just don't they they feel that they they

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need to make that change completely

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biologically hormonal II and even

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genitalia wise so it just is what it is

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it's part of planetary diversity and

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it's been here since the beginning of

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time I mean this is nothing that's new

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but you don't think there's any

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scientific explanation for it sure there

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is

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there's there's all kinds of science

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again many many of these individuals

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have very very short chords romantic

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chords or they have very low levels of

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testosterone or they have but it's it's

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you know looking for looking for the one

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you know the the key that opens up the

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box no you know can find it not one

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single you know an today here it is you

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know it's not like that

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it's not like the the patient that comes

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in with abdominal pain and and the

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surgeon pulls a porcupine out of their

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abdomen it's not that way because

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there's just too many different

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potential explanations is that

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absolutely right

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it's as complex and as and we're just

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beginning to peel the layers of the

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onion off this is just something

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societies finally kind of grappling with

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is just this idea this artificial notion

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of maleness and femaleness it's not

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healthy in fact I'd argue with you with

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it that a lot of our problems of male

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violence it has to do not so much with

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test

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our own because male-female the male's

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run levels of testosterone that are

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sky-high they're in the thousands higher

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than a biological male then I share a

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cisgender male and and yet you rarely

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see evidence of rage and they also have

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estrogen though right no the estrogen is

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completely suppressed but Marin

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cisgender men have estrogen you have

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estrogen cisgender men have estrogen

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today cisgender females have

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testosterone and of course it does have

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a facts on behavior but it's a part of

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biology we're much more alike than we

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are different ninety-nine point seven

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percent of our DNA is identical male and

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female but but you cannot underestimate

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the significance of hormones right and

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and how that influences behavior and

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moods hormones are one big influence

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absolutely but a bigger influence is

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what is gender expectations and gender

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roles have been assigned by society when

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when when when when Westerners came to

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to the country now known as Thailand

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they call it Siam the tiny day a hundred

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years ago they said well the men and

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women were they were the women were so

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ugly they said off these women are just

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because their hair was short the clothes

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are just basically like the boys and

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they just looked around and said well

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you need to grow your hair long you need

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to put on makeup you need to have

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dresses not you know trousers and there

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we and suddenly so what we do with these

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gender roles these artificial rules as

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we push we pull the sexes apart we make

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this as the gender is so different that

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it's that it it leads it leads to angst

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I mean it's difficult it's it's these

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rules I like some of the rules but the

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rules are rules and and rules are meant

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to be broken they are these are children

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and they aren't really forced but but I

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think you'd agree isn't just societal I

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mean I think there's plenty of studies

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where you put the boy the little boy in

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the room and there's boy toys on the

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left side and girl toys on the right

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side and he gravitates toward the

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the boy toys and the girl gravitates

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toward the girl toys so you know to say

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that it's all society I'm not sure that

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that's quite accurate no you're

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absolutely right

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there's a huge amount of biology no we

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know this because and that's the whole

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point that's my whole point about these

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kids you know they had the kid they that

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that was that was they had a botched

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circumcision if you remember this he had

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a twin brother in Canada they botched

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the circumcision and then the doctor at

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the time dr. money decided we'll just

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raise that will just reinforce the kids

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you know it's all about nurture so we'll

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just reinforce and tell him he's a girl

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raised him half surgery make her a girl

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and that's how they raised and well you

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know obviously that that experiment went

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very very badly the kid ended up

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committing suicide as did his his

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brother when he he later came out as

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male and then found out the truth which

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was hidden from him for all those years

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you know hide that nature your absolute

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or ease out there and they're horrendous

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but you know we're still talking about a

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very very small percentage of children

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that that's affecting so I'm just

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wondering you know should we be taking

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those very rare cases and extending that

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to something beyond that that suddenly

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affects a hundred percent no I'm

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actually just doing the opposite I'm

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just saying what I'm saying is that you

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just you don't you don't narrowly define

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kids you embrace them and you allow them

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to you don't set these expectations

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because we really do set expectations

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for girls and boys very early her so

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know me tell me if you were raising a

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child today yeah tell me how you would

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raise that child differently than

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perhaps you did yourself or others are

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doing today sure well you know this is

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this is gonna be I sometimes give a talk

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title

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gender 30:18 and looking at how gender

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might be valued in the in the future and

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instead

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signing pink and blue and things like

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that you know it's it's it's the it's

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the easy thing to do but it's very

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difficult to ungenerous upbringing if

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you even try to do it but I think that

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we should start by what why is it

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important to ungentle to begin with

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let's start with that and then we'll go

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into the to the how well I don't think

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it's I don't think it's I don't

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necessarily say I would run gender kids

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from the beginning but I would look at

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each assignment each decision you make

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and try to uncouple it from male and

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female a bit and I don't think that's a

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bad thing I think though we've actually

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done a pretty good job of that with

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girls girls have much more fluidity

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along the gender spectrum you know girls

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can wear pants girls can act masculine

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and we don't really look where we really

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have trouble in society is with little

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boys but then again I I'm looking for

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what the problem is that you're solving

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I mean you know may I get the problem

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male but I mean let's start there well

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if you think that you did that well how

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is this gonna solve the problem of male

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violence it's the key it's okay alright

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walk me through that thing

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read my book and it's the key male you

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know it's it just starts with with

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expectations that are there so that we

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what we've done we basically been a

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society that has been in a state of

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military conflict for the last 2,000

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years and so what we the way we the

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house of Bob will be even longer than

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that no I mean doesn't violence go back

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to the origins of man essentially yes no

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yes absolutely in and so the idea that

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we see our little boys as potential

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soldiers is an unhealthy way of seeing

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them and little boys can be

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compassionate they can be sweet they can

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be emotional they can be loving some of

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its biological you know you can you can

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boys are gonna gravitate towards rough

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things maybe or trucks and and things

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that are typically we associate as being

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more menacing

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I don't think any of that's bad but I

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think that that emulating having seen

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boys as seeing very macho manifestations

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as being the pinnacle of maleness that

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is the unhealthy ideal that we need to

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slowly lose track on and but I used to

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trust that for a second see what I'm

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what I'm questioning is that it's that

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it's that what we do know it's not so

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much the attract not so much the

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bailment the the macho maleness that in

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that is unhealthy but rather the fact

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that feminine behavior in boys is what's

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severely punished but it is come down

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just to good parenting I mean I was

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raised with all the maleness you could

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imagine with sports in guns

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we had machine guns that we played with

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we had cowboys and Indians that we play

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with but I also had good parents so I

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knew the difference between right and

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wrong and just because I was playing

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with a toy gun didn't mean that I was

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gonna go use it on my neighbor right

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well that's it that's a whole other you

381
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know that's a whole lengthy discussion

382
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having two parents and being doing all

383
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that stuff but it there are there are

384
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subtle pressures for boys to be to be to

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act out and they don't have healthy

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feminine outlets that's my point is that

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you can you can if they had more

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artistic allowance if there were if

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retail stores in in dress and behavior

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allowed for more softness I think the