Jess: Welcome to the Gender IQ Podcast. My name is Jess Romeo, I'm a psychiatric nurse practitioner, psychotherapist, and just an endlessly curious soul. I'm also a trans guy who specializes in working with queer and trans folks every single day in my private practice. I created this podcast because in a world that seems hell-bent on using gender identity as a wedge to divide us, I wanted this to be a space for thoughtful, unfiltered, and nuanced conversations that help us connect with one another.

If you're a healthcare or mental health provider like me, this can help you better understand the complexities of gender identity and support the needs of your trans and gender diverse clients. And if you're a fellow gender outlaw, you might find some of these conversations empowering and helpful to your own journey. But for everyone, I want this space to be a place that showcases playfulness, complexity, and just the messy humanity that we share within a topic that too often seems serious and divisive. So wherever you are on your own journey, I'm glad to have you here.

Let's dive in. Well, I'm so glad to be having this conversation, Eli. And where I always like to start these conversations is just to tell us your story. As much as you're comfortable with wherever you'd like to start, but where do you come from? How did you get to where you are?

Eli: Yeah. Yeah. I definitely have to tell you this Cliff notes version of my story. I remember when I was in my early twenties, I already was like, I have lived too much life. Like I have lived more life at this point than most people have, and that has remained true. So I will, I will keep it brief. Um, I, so I was born in Tulsa, Oklahoma. I was raised in Southwest, Missouri.

And my family is very conservative Christian. My father's family is from the deep south. My mother's family is from Oklahoma and Kansas. And so there's a lot there.

There's a lot of ancestral stuff there. that's been one of the things that has been very challenging about my gender journey is that transness wasn't a thing I was allowed to know about. It wasn't a thing that functionally existed for me in my entire young adult life. And so I was 20 actually, or like in my young 20s when I found a library book that talked about gender theory. And I was completely like blown open. I was like, this is incredible.

I did not at that moment be like, I am trans. Like I was just like, wow, this is so fascinating. And for some reason, this is the most fascinating thing I've ever heard in my life. Like that was the. yeah. So it was many, many things happened at that same time. I had a mental health situation that caused physical symptoms that dramatically reshaped my body. And I hated it. And I was like, "what? Like, this is bs," - it like - there's something about my body that I hate no matter what it looks like. And I don't know how to think about that. Right?

So like that was another sort of piece of that early puzzle. And a number of things happened. I moved to Los Angeles and moving out here allowed me to start to explore myself in a way that was more robust. And I cycled through many, different identities, which is very common for those of us who come out at not at like age three.

I cycled through tons of identities. I was like, "this is who I am. This is who I am. This is who I am." And none of them were who I was. And I sort of had all of these reasons why I wasn't trans. I I was like, I'm not trans. I'm just traumatized. I'm not trans. I just have a lot of internalized misogyny. I'm not trans. I just wish I was cool. Right? Like I had all the things.

And so my gender exploration process was really like, my whole 20s, was like the better part of a decade of me just basically being in hell, you know, and not knowing who I was and not knowing what to do. You know, just really plagued by insecurity and self-hate and like all of these really challenging emotions. It was a very painful and difficult time.

And also during that time, I decided to go back to school and I decided to study gender because it was this thing that was preoccupying me so much and I'm a total nerd. And I was like, "this is how I solve this, right? Like I study it academically." So I ended up going to UCLA and getting a degree in gender studies and a minor in LGBT studies. And all of my research and all of my work was about transness. I was looking at trans medical experiences, trans experiences of stigma and trans experiences with the law and like all the different stuff.

And I was an incredibly overachieving undergraduate. So I was like winning awards and getting scholarships and like interfacing with all these really impressive people all the time. And like, I was pushing myself way too hard and I was doing way too much, but the sort of benefit of that is that I got all of this recognition. got all of these, resources and then I graduated and I went to grad school at Berkeley to get my PhD and
all of that hard work, all of my overwork, like, got me there.

And then I just crashed and I, well, actually I totally skipped over when I actually realized I was trans. So that's the thing I should probably say while I was at UCLA. So funny. Yeah. We just know that part happened at some point, right? No, I had this moment in, when I was at UCLA, it was the very end of my twenties. I think it was right before my 29th birthday. And I was just like, think I want to try HRT. And at the time I was identifying as non-binary, I was using they/them, pronouns. And I was studying enough trans medical history that I knew that if you weren't very, very sure you wanted hormones, you could very easily be turned down for hormones. So I was terrified. Like I was so scared, but I was trying to like front that like, "I know I want this, I know this is the thing that I'm into," right? But I was like, my God, please don't give me too much. You know, like I was so scared.

I got my testosterone and I was on it for a few months and became aware that every single time something happened in my body, I was obsessed with it. Like I loved it. And that's, that sort of led to this like kitchen floor breakdown moment where I was like, "oh my god, I'm trans. Like I'm for real trans and I have like - I can't keep like pretending like I'm just like trans adjacent which is sort of what I've been doing for years."

So then I transitioned in all the ways, right, like I did the medical transition, I changed my name I changed my gender marker I just was like boom boom boom I had top surgery and that was like so that all happened in that container of undergraduate UCLA.

And so by the time I got to Berkeley, was fully, you know, I had done -  not all of the medical transition stuff I was going to do, but I'd done several. I changed my name and gender. I was very much identifying as trans and I got to Berkeley and my body said no and just like, boom, shut me down.

And I had a really intense chronic illness journey that started at that point, which ultimately was part of what led me to choose to leave the Academy was just like the violence of that space and me realizing what it had done to me to be impressive by the standards of that place. And I mean, again, like it's a huge long story, but to sort of like round it down, I was in my second year of PhD school when I was listening to a podcast.

And I heard Erica Livingston, a full spectrum birth doula, and she was talking about how we need a doula for every threshold of life. And at that moment, I was like, my god, gender doulas should be a thing that exists. But at the time I was getting my PhD, I was applying to law school. And I was just like, "this is such a cool idea for someone else to do." No concept that that was like something I would do.

But I subsequently had like eight months of very intense chronic illness journey mixed with very intense spiritual journey mixed with a lot of unknowns. I was like waiting on my acceptance to law school. Things were very sort of up in the air. And over the course of that time, I really realized that the standard or the thing that wouldn't leave me alone was a calming and that it was a thing I needed to pay attention to.

And I had a very pivotal conversation where I realized that the life I was creating with my actions wasn't a life that I wanted. Because I didn't want to be a lawyer and I didn't want to teach law school and I didn't really want to be a professor. I just wanted to be a dream that I thought was what being a professor was. But the actual day to day life of that was not the life I wanted and it wasn't something that was going to make me happy.

So I did have to finish my PhD unfortunately, but while I was finishing it, I started creating this thing, this gender doula thing. And yeah, that's that's sort of the origins. Yeah.

Jess: That's really, yeah, thank you for telling us that story.

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Jess: You know, I think it's so interesting to hear other people's journeys through understanding and realizing who they are because I was similar, like, you know, trans adjacent for a while.

I think I didn't try on quite as many external identities. I was pretty much solidly just butch lesbian for many years and kind of stuck with that. But I know my language started to shift around my relationship to the body and the gender that I'd been assigned. For a while, it was like, yeah, she, her, that's fine. Then it was, well, there's enough room within female for me, then just kind of not talking about it and being mad whenever people asked me to say what my pronouns were
for a couple of years, there was that stage.

But I think you make an interesting point about having to perform certainty to medical providers at times. I wonder if you could say a little bit more about the history of that and what you've seen as some of the implications of that on trans people and also on cis people who are trying to learn like what we're all about and how to support us.

Eli: Yeah, it's, know, again, I'm doing a little bit of an edit down because I hold a lot of knowledge about this. So in the sort of history of transmedicine in the Western world, the modern iteration of it really finds its origin in like turn of the century Germany with Magnus Hirschfeld and the Institute for Sexual Science. And I want to be very clear that this is about Western transmedicalization, right? Because that is not the only history of trans people and how they come together, right? Yeah, it's a history. But it's the one that gets talked about a lot, especially in America. And it really foregrounds whiteness in a way that is, you know, not ideal, I think, to say the least.

So it's an important thing to understand that it exists, but it's also important to understand that it is a one thread of a tapestry. So we have Magnus Hirschfeld, we have the Institute for Sexual Science, and we have this conception, this, like, conception that's being built of transness in that space. And then Magnus Hirschfeld was one of the mentors of Harry Benjamin, who's an American doctor, endocrinologist.

And Harry Benjamin was also a German - German Jewish - but he came to America and was living in America and in America he was one of the only doctors who was willing to prescribe HRT. And because of that, he, and I think, you know, I mean, we can say all day, like, what are people's motivations?

Harry Benjamin appears to be a person who
believed fervently that he was motivated by helping trans people. I guess I'll put it that way, right? I don't necessarily know that that's actually what he was motivated by and I don't necessarily - like there was a lot of transphobia that like was present in his work that was probably not clocked by him. But he did try to create sort of taxonomies of transness like to describe "this is what transness is, this is what a trans person is."

And crucially, he created this sort of idea that we have trans - like true trans people, he said true transsexuals, or like what he called, I think, like transvestites, right, which were just people who wanted to cross-dress essentially, but not like, quote unquote, actually trans, right? So he creates these ways of knowing, like this is what actual trans people say, this is, you know, how they characterize their stories, this is how they characterize their identities.

And of course, it was incredibly narrow and included quite a few intense and deep misunderstandings of transness and was also based predominantly on middle-class white people And so there's a lot. mean we could be here all day talking about the problems with this, right? But to move forward, of course this created sort of two different situations.

One was that now the doctors who were willing to prescribe HRT had this taxonomy and were like, "this is what a person will say if they actually are someone who we should be prescribing this to," right? And also trans people got ahold of the book and we're like, "okay, y'all, this is what to say if you want to get your HRT." Which I love. That's an incredible part of this story, which I mean, it has its, it's a double edged sword, right? Cause on the one hand, a lot more trans people were able to access HRT cause they now had the script that the doctor was looking for.

On the other hand, when you say something so often, people start believing that it should be true. And so unfortunately, the trans community has now - like for decades now - been dealing with this situation where we parrot these things to each other is if they are true, when in all reality, they are things that are parroted because of a survival mechanism of saying what you need to say to get your medicine.

So all of that to say part of what was performed by the quote unquote true transsexual was this like absolute unshakeable, "I am sure." And because that was sort of codified in this book and then sort of reified by all of the trans people being like, "okay, this is what you have to say. You have to be totally sure. You have to have known since you were, like, you know, two years old, you have to have always like displayed, like, the characteristics of the opposite sex, et cetera." Right? Yeah. And I'm doing air quotes for people listening on audio.

Jess: Yeah. A lot of air -  thank you. Yes. Air quotes are abundant right now.

Eli: Yes. Many, many, many air quotes. Just anything that you feel like should have an air quote, it had one.

So like that sort of created this like monstrous, like, cycle.

And when I went into, I mean, I will have been on T for 10 years in March of 2025. So very close to my 10 year T-iversary. My belief is that in terms of what it's like to transition, it changes dramatically enough that we have about two year cohorts of like, this is what it was like to transition, like, 10 years ago with several cohorts of transition ago, things were very different.

And one of the things that is different is that the idea that you could do informed consent was very, very nascent. I remember Maddie Deutsch published a paper about it that was so transgressive, and that was in 2012. And so at that time, in order to get that research, she had talked to these different clinics that were unwilling to have any identifying characteristics of themselves revealed doing informed consent was extremely under the table, right?

Jess: And just for people who know, Maddie Deutsch has been a president of WPATH and runs the Transgender Center for Excellence, I believe, at UCSF, who set a number of standards for prescribing HRT and transmedical care that are followed across the country.

Eli: Yes. Thank you for that context. That's really important. And Maddie Deutsch has also like probably been the champion of informed consent for the longest in terms of like a person who's willing to publicly put a lot of weight on it. You know, so, you know, I wasn't sure what to expect. And I went to the LGBT center and they did have informed consent, but it was still quite a process. You - like they made you watch like scary videos and like, I mean, it was like a lot, you know, like, and so my doctor was incredible. I really, really adored her and I did come to trust her, but I didn't know that first day that I walked in who I was talking to and what the context was. So that's why that was that.

Jess: Yeah, no, I think it's just such an interesting paradigm that we end up turning on ourselves and then that people who are not in our community then assume about us so that if we are not expressing that level of certainty, then they have reason to question as well. Yeah, I just remember not feeling like I was trans enough or wishing that someone else could tell me whether I was or not and that - what we think, what was talked about as being such a certainty was actually the biggest leap of faith I've ever taken. But it was also the first time that I think I knew or I understood what trusting my intuition actually meant.

Eli: Mmm, yes.

Jess: I think I've been so dissociated from what that was for so long. I was like, that's what that is.

Eli: Absolutely. And I think that's such a good point because, you know, trans people tend to live in some level of dissociation, just generally speaking, I find. I think that, yeah. And I think that for many of us that the first step that we take toward transition - regardless of if it's medical or social or whatever, but the first step we take that's going to change things for us in some way, right - is often, I think, that moment where we trust ourselves for the first time, at least on some level, even if it's so primal that we couldn't ever admit that this is what's happening, you know? But then that is an initiation. And it takes you through this gate and gives you an access - if you're willing to explore it - access to a whole new level of you and what it means to be you on this planet.

And I think that that initial moment of stepping off the ledge from like, you know, what feels safe, you know, what feels like more stable into like something that is honestly so much safer in every way, but like feels much crazier and wilder and more intense. Right. Like I think that that step is such a powerful moment for those who choose to take it.

Jess: Yeah, the image I have is almost of, you know, like I'm sitting in the ocean and I have a life jacket on and there's a boat. I don't know what the experience of getting on the boat is going to be like. I don't know if I'm going to fall or if someone's going to drop me, but what a more expansive and safe experience going forward than continuing to wade around in the ocean.

Eli: Yeah, absolutely. That makes a lot of sense.

Jess: So tell me more about this gender doula role and what is it, what can people expect from it and was it really around when you started doing it?

Eli: No. When I, so when I had the idea to become a gender do I immediately Googled it thinking surely there are people doing this and there was no one. Um, between that moment and when I officially launched my gender doula business, there was another person named Cameron Wolf who also became a gender doula and they -  but their path was through chaplaincy. And we talked a few times -  unfortunately, when I started seeing clients was January of 2020. And when they started seeing clients was shortly before that. So -  things obviously in 2020 was quite a time. And as a chaplain, their work became much more focused in hospitals. And so our trajectories have been very different. But when I started, they were the only person who was using that language to describe their work.

The thing about this work is that it is, broadly speaking, a type of support that trans folks have offered one another in community for, you know, millennia, right? Like trans people often show up for each other. We often help each other through. We often explain things that are really hard to parse by yourself, right? Like we do this work with one another.

But the idea of gender doula as like sort of an umbrella of organization is that it takes all of these different aspects of care and puts them into one sort of skill set that is accessible by anybody who can avail themselves with the services, right? And so that's the point of sort of like bringing it all together. But I do want to pay homage to the fact that like this type of support is something that has existed in community for always. And that trans people in a more informal way have always supported each other.

There's also a history in the trans community of people calling themselves things like transition companion or transition coach or, you know, gender companion or like - I've seen various things in the archives. But yeah, the reason I chose gender doula as the organizing structure, was, well, first of all, because I heard the podcast and that was how the idea came to me.

But as I was understanding more about doula work, because I did actually go on to mentor with Erica Livingston and her partner, Laura Interlindi. And I came to understand about doula work - that it is medical adjacent, but not medicine. Right? So a doula can be in the room during, for example, a birth if they're a birth doula, but they're not a doctor. Right. And that allows you a type of liminal freedom to support people in ways that are constrained by things like medical boundaries and norms, or like, for example, for a therapist, the boundaries and norms around therapy, right? Like a doula can work within the cracks of those things in a way that I find quite liberating and quite important. And so there's that piece.

And then there's also the piece of being able to, like, hold the really tender aspects of someone outside of the medical arena. And then if needed, be the interlocutor who allows those tender things to exist in the medical room, but in a way that's protected. Right? So for example, I can have a really in-depth conversation with someone about their hopes, dreams, and fears for HRT, but then I can give them the scripts to bring to the doctor so that they don't have to be that vulnerable with the doctor, but can still get the care that they need, if that makes sense.

Jess: Yes, it absolutely does. Just thinking about my family's experience and more my wife's experience. We did have a birth doula just a few months ago for the birth of our kiddo. And it was incredibly powerful. Like I couldn't have described - I couldn't have foreseen the need for it as much as we had at the time. But now I can't imagine having gone through the experience 
without her just because we always felt like we had someone on the team. And it's not that our experience with that medical center was necessarily negative. There were some negative moments, but just knowing that we had someone on our side who could advocate for us, that we didn't have to take on every single one of those conversations if we had to push back a little bit. That just took so much off and allowed it to be a much more joyful and less stressful experience. So I can imagine how powerful it is for people just on a gender journey.

Eli: Yeah, absolutely.

Jess: What are some of the things that you find yourself doing the most with some of your clients? You know, I'm trying to even imagine - having had a birth doula experience and being a trans person who works with a lot of trans people. I think I'm still - I don't know anybody who's worked with a gender doula. So I'm finding myself curious about what you're doing with folks a lot of.

Eli: That's a great question. It's always like, this is always the challenging part of every interview I do, because what I do is A, highly tailored, right, to the individual and B, very challenging to sum up. And so, um, I have had folks come to me who are just at the very beginning of being like, "I think there might be something going on with my gender," you know. And then I've had folks come to me who are like, "I medically transitioned 30 years ago and it was incredibly traumatic and I need to work that through with somebody." Right? And so like that's, and then also I've had people come to me who are like, "my partner is transitioning and I want to be a good partner, help," you know? And so there's just like the dimensions of all the different types of folks that I work with. And those are just three cases that hopefully illustrate some of the breadth, because there's also everybody in between all of those. Right?

Jess: Right.

Eli: And so it's really hard to sum up - with that said, I will say that like one of the things that is quite common for me is, working with folks to understand how they experience their gender, how they want to externalize that into the world, whether or not medical steps are a part of that. And then if so, what type of medical steps and at what speed those medical steps need to occur.

And then of course, all the things that surround those questions, like whether or not they're in a long-term relationship and how it's going to impact that if they have children and how it's going to impact parenting, you know, like all these other questions, jobs and like how to be at work while you're transitioning and things like that. So that's kind of like a broad overview of like the most common conversations I'm having.

I would say like one very common trajectory is that I will - someone will come to me they'll be unsure about hormones and so we'll talk through in a lot of detail all the different ways to use hormones. Like this is what it looks like to microdose, this is what it looks like for you know full clinical dose, these are the different adjunctive therapies that you can use to mitigate different aspects, you know. I'm like "we'll talk through all of that."

So again by the time they actually talk to a doctor, they're very confident in asking for what they need, or knowing if that doctor is even going to be able to help them or do I need to help them find a new doctor? Right? So like those are like - that's a pretty common - and then of course, once they've actually started HRT, or, you know, whatever the thing is that they're doing, then like working through the next steps, like what is it like to go through that process mentally, physically, emotionally, spiritually, right?

Like - And having someone to talk to about that to work through things like "hey this thing came up I don't know how to feel about it," you know has been a - really really supportive and helpful for my clients so that's one way that that that sort of, like, process of interfacing with medical and personal leaves itself in my work.

Jess: Mm-hmm. And that's really, I'm really glad to know that. And it's - I'm finding myself reflecting on the depth of a conversation you're able to have with someone who's in the beginning of their journey, especially in thinking about, "okay, well, how do we feel about this? How is it going to affect this? How do you think it's going to affect that" from a completely curious and neutral place? Do you know what I'm saying?

I work in a space with mental health providers, right? I am in the medical system. I'm trying to be less of the system, still on that journey, but I think it's - I've always kind of expressed a need for some, not necessarily tiptoeing, but a little bit, like being pretty careful about asking those types of questions or at least providing a lot of context or building a lot of trust before going there because it will not be perceived as neutral if you just come in there asking them.

Eli: I think that's so true. And I do think that this is like - this is one of the things that I like lay out very carefully in my contract that people signed before we worked together is like, "I - my interest is to help you. I have no interest in what you do as long as it is the thing that you need to do." Right? So like, if you want to try testosterone, you want to try estrogen, you want to try, you know, any of these things, I love that. I'll support that. If you're like, no, actually this isn't for me. Okay, great. I support that." Right?

Like, I'm going to support and I've supported people who are, you know, quote unquote, like de-transitioning. I've supported people who transition and have regret. I've supported people who are terrified of having regret. I've supported, you know, like I've supported people every all over the map. And like my only vested interest is that I am supporting you the way you need to be supported in this moment, you know, or if I am not able to do so, helping you find resources for that support. Right? And that's it.

And so like, really like in a way, I don't care what you do. What I care about is if the things you're doing are serving you and if they are the things that your specific body and self need. So -  and because there isn't like, I'm not saying there are no power dynamics in the work that I do with people, but I'm not a doctor and I can't prescribe. That power dynamic is not present, right? Like I have no control over whether or not you take hormones in any way, right? And so that does create the freedom for me to have these extremely expansive - like it creates a freedom for someone to come to me and be like, I'm terrified and me to be like, yes, so was I, you know, like, I can hold that with you.

And if the answer is - so there's some things that I do that I'll just offer for folks who are listening, if you are terrified of taking hormones, but you feel like you need to, one, get the hormones. And then every day, hold it in your hand and ask your body, "are we ready for this? Can we do this?" Make it a consent process, because that will help to ease that fear. And it will also allow you to start building, maybe even for the first time, a process of trust and consent with your body, right? And I find that to be so helpful for my folks who are really scared because they can get the hormones and they don't have to feel like they're forcing themselves to do something that feels too scary, right? They can build up to it. It can be gentle.

So that's one thing. And then the other thing is you can start very low dose with hormones and hormones work very subtly. And so if you're taking a low dose and you're taking, you know, you're just taking that amount, most people are not going to notice any change in you for minimum - I want to say at least a couple of months. So -

Jess: That sounds about right.

Eli: Just try it. See how it feels. It's okay. And if you try it and you're like, no, I hate this. It's not for me. You don't - like no one has to know that you went through that process. Like you can hold that for yourself or between you and your most trusted people. Right? Because I think another thing people get really worried that they're going to go on hormones and it's not going to be for them. And then they're going to have to tell everyone it wasn't for them. And then they're going to feel so much shame.

You don't have to tell anybody jack shit. You know, don't tell anybody anything that doesn't feel safe to tell them, you're fine. You can just try it. See if it works for you. If it doesn't, no harm, foul. Right?

So those are two of the pieces of advice that I often offer to people who are struggling in that way.

Jess: Yeah, I think that resonates a whole lot. You know, I think I remember in my first few weeks, honestly, first few days, and I did kind of standard clinical dose, right? Looking for the fastest changes possible. We were moving a few months later. I was like, if my voice can drop as much as possible before we move, that would be great. So I may not be a good case study for low dose, but I remember just feeling something different in my cells a couple days later. Nothing had changed externally, but I was like, "oh, this is what my body has been missing." And I couldn't - even those words don't quite capture what it is, but people really can start to feel a sense internally of "what is this like for me?" And kind of listen to their body's cues without any external change.

Eli: Exactly, exactly.