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You're listening to Transmission. I'm Brody and my pronouns are they, them and I am going solo today with Transmission and I am joined in the studio with the incredible Tara who has been on the show before. And I have invited Tara back to chat all things trans mental health and things like that because it is Mental health week from the 5th until the 10th of October. So I thought I would have some pals in to chat all things mental health which I absolutely love talking about. And so Tara, how are you this morning?

I am feeling really awake.

And what are your pronouns, Tara?

My pronouns are they and them.

Amazing. Sorry your mic is being a bit dodgy. I also have recorded an interview as well and the interview was with Kai Swartzer who is an incredible researcher in the trans neurodivergent and eating disorder space. So I'm going to play the interview first and just a content warning before I continue that the interview does touch on sensitive topics like eating disorders and mental health. So if you are nervous that you may get triggered by these things, it doesn't go too in depth and there's nothing no scary talk in there. So if you are, I don't know if you have susceptible to these issues, please just like tune out or listen with caution and remember there is helplines available which I will mention at the end of the show. So I'm going to go into my interview that I recorded with Kai Swartzer who as I said is an incredible trans researcher in the space of neurodivergent and eating disorders and mental health in general. So it was an incredible interview and I could have talked for ages with Kai because we were just info dumping which was incredible and I love to info dump as most people know. So I'm going to kick off with this interview that I recorded with Kai and we shall be back. You're listening to Transmission and I'm Brody.

Today on Transmission I have the absolute pleasure to chat with Kai Swartzer about their research and mental health and eating disorders essentially. How are you tonight, Kai?

I'm not too bad, how are you?

Good, thank you. And first off I just want to go through check your pronouns. I use they, them pronouns.

What about you?

I use he.

They pronounce amazing.

And so can you tell me a little bit about yourself, Kai, and what you do within the research space and the advocacy space essentially?

Sure. So I'm a PhD candidate at the University of Western Australia and the Kids Research Institute Australia, and my PhD project is a series of studies with the end product being Australian first guidelines for treating eating disorders in trans and gender Diverse people. So my research kind of branches across a couple different things. Essentially it's predominantly about gender diversity, neurodivergence and eating disorders and different ways that those things intersect with each other.

I think that is amazing.

Like as someone with lived experience of all of those things, I, as I said to you, when I message you, I'm like, I've been a fan of reading your research and your Instagram for such a long time and I think it's such important research and it's. I'm glad that it's fine, the conversation is finally happening around these things because the intersections of all of this are very large and very. And if they aren't focused on, can be very detrimental to one receiving treatment and things like that. To start off with, what is the research that you're currently working on at the moment? So obviously your PhD, but on your website there is a lot of research you're working on and it's quite impressive actually. Just like, quick rundown on what your favourite research at the moment.

Yeah, so I guess when it comes to research on eating disorders, I guess my research looks at the eating and the exercise component. And probably the study I'm most excited about is a study I've been involved in for about a year now where we have been trying to determine whether it's safe to exercise in a chest binder. And so we just finished the analysis on this very complicated lab study in an exercise physiology lab where we blinded the researchers so they didn't know if people were working, wearing a binder or not. And we got people to run on treadmills and have blood tests and all these things in binders and not in binders. And yeah, it's, it's a really interesting area because people have been binding for a long time, but that's it. No research to determine whether it's safe or not. And something we found in one of my previous studies was that a lot of people were saying they were restricting what they ate because they couldn't exercise. And the reason they couldn't exercise was because of binding, binding and we thought is there any proof that it's unsafe to find when you exercise? And we weren't able to find any data that said it was or that it wasn't.

Wow.

We better look into that. And so hopefully we'll have those findings out relatively soon. But I guess that's, that's one of the areas that's pretty neat. I care a lot about not just preventing and improving mental health and people who are struggling, but also how do we make people's lives better. Better who are already doing okay.

Yeah, that's it. And I think it's so important because as you said, like people will restrict eating because they can't exercise and because they wear a binder. That's so cool. We'll have to have you back on the show another time to chat about this research. To start off with, let's get into the reasoning I've asked you on the show today. So I background in me is I have a long lived experience of eating disorders and mental health issues as well as I was late diagnosed autistic and adhd. And I, I am a non binary person. So this is something that aligns greatly with my passions in this world. I think if we start off with throughout all of your research, what kind of has been the prevalence or intersection of eating disorders within the trans community and what has your has research shown? That is I guess the reasoning behind all of this.

Yeah. So my, my second PhD study which we're still working on, we launched the survey at World Pride a few years ago and we got this massive sample of queer people from around the world. And my analysis is the subset of the people who are trans and gender diverse. And so we found that in my roughly 2,500 trans people, essentially all of them had some level of disordered eating behaviours. And about a third of them, when we did like a standardised eating disorder measure were in the clinical range for an eating disorder. So sort of they were, they would have been able to get treatment on an eating disorder care plan with Medicare based on that score. Yeah. And one in three is very high. The general population is about one in 13. So yeah, it's substantially higher. And then within that sort of one third of participants, only about one in five of those reported that they'd been diagnosed with an eating disorder. So there was this pretty substantial gap between the people who clearly warranted and needed support and the people who were actually receiving it.

And throughout that kind of research did you find that the folks who needed support who weren't receiving it did you have any conversations around like the stigma and the stereotypes of an eating disorder person suffering with an eating disorder? Did you find that kind of impacted people receiving help for eating disorders or really long ended question.

In some of the, in some of the qualitative studies that we've done where we've spoken more directly to people about their lived experience, there is certainly this attitude, or at least this image that we have of who is the person who's affected by an eating disorder, which is usually a teenage, young, cisgender white woman who is neurotypical, has no like disabilities. And that's just not accurate to the reality. Well, like the majority of people living with an eating disorder are women. Statistically, proportionally the most at risk group are trans people, not cisgender young women. And sometimes what that then results in is that people who don't fit that image don't recognise their own needs or consider that they might have an eating disorder.

Yeah.

And the challenges, also the treatment is designed for that group.

Yeah, that's it. That's what I was going to say. There's like, especially this is all from my own experiences, but I feel like eating disorder treatment is receiving any kind of help for an eating disorder is essentially tied up with like commitments of normative gender expression or performance, whatever expectations. And it's really difficult when you, if you don't fit in the box of what someone suffering with an eating disorder is, it one, one stops you from wanting to seek the help and two, when you do receive the help, you're in a weird place where you're a trans or gender diverse person and they're all CIS females or young women, things like that. And it makes it really, really complicated. What challenges have you found that trans folk face when accessing support for eating disorders or mental health issues in general? And do you have any solutions for bettering this?

Because I do.

Yeah. So my, my first PhD study, which I'm at the very end of writing up right now to hopefully publish soon, is specifically looking at people's experiences of treatment and the outcomes of treatment for trans people. And generally what we find is that trans people don't do as well in treatment in terms of their outcomes as cisgender participants. Often they have similar levels of improvement in disorder, usually eating on a measure which asks about how often they've engaged in restriction or bingeing purging. But if you're in an inpatient treatment setting, that is going to go down because someone's watching you at all times. But when we look at what we decided to do in this study was to look at the disordered eating, whether that improved, but also if their mental health improved while in treatment. And what we found was, of the studies that we had available to us, only one of them had improvement in mental health that was comparable to the cisgender group. And all the other studies, trans people didn't get better to the same extent in terms of depression, anxiety and suicidality. And actually some of the studies found that suicidality did not change from admission to discharge, so it wasn't improving their distress at all. And then when we looked at the lived experience accounts and qualitative studies, there was a range of issues with treatment that were really serious and substantial. I think some of the big ones are just, if treatment's not affirming of someone's gender, then it's going to be harmful. People being misgendered constantly, system of hospitals and so forth. It doesn't allow for preferred name and pronouns. In a study I published at the start of this year, someone, one of the participants who was a healthcare provider, stated that they felt that they were actively making people worse by having them in inpatient treatment because of having to have a hospital band with the wrong name and a legal gender marker on it at all times. But I think the treatment issue that's the most glaring to me is just the foundational fundamental base of eating disorder treatment is this idea of body acceptance, which is essentially learning to accept the body exactly as it is without making changes to it through disordered eating or other means, which is kind of built on the idea that the person will have some kind of body dysmorphia and needs to, like, learn to accept their body without changing it. Yeah, that doesn't work. If someone's gender diverse and is experiencing gender dysphoria and needs change through gender affirming medical care to be comfortable in their body. And what ends up happening is that when we use that approach with trans people, we are engaging in conversion practises, basically.

Yeah.

Like it. Like the. The definition of conversion practises is to make any attempt to suppress change or eliminate someone's gender identity or sexual orientation. And if we are forcing people to do things like mirror exposure or telling them their gender identity isn't real, or it's the symptom of their eating disorder or any of the other kind of treatments that are used for body dysmorphia, then we are causing serious and traumatic harm to people. Yeah. And that's unfortunately a very common experience, given that that is Kind of the basis on which all treatment is built.

Yeah, 100%. And if you look at it from a holistic picture, like you can't, especially with trans and gender diverse, diverse folks, you can't treat the eating disorder if you're not treating everything else that attributes to that. And this is like my own lived experience is like my eating disorder didn't get better until I started expressing who I am. Like my non binary self until I explored that more. And I think that for me that's a real like signal that like I couldn't quotation mark recover because I had so many more holistic issues going on. Not issues, but like holistic experiences that I needed to address. And I think that's. That stems into the systematic issue of eating disorder treatment. I have so much to say about this and I wish I had more time because I could talk for ages with you. I think it's yeah. Stems into the systematic issues of the health system not being able to have preferred name all those kind of things and being misgendered or being told when like for example, when you're admitted, smart experience. But when being told I can't go to a war, can't be admitted because I don't, I can't go to any wards because I'm not male or female. And that stems so much into so many issues within the wider system. And I think it's important that we have these conversations to address change because the intersections of eating disorders and trans folks and put neurodivergence in there is huge and it really needs to be spoken about and there needs to be alternative treatments that aren't essentially conversion or CBT because don't even get me started on cbt. Sorry, that was a long winded ramble either. I think I said to you when I message you, I'm like, I could get really rambling and passionate about this because it happens. I one of. I know from your Instagram I have there is a I guess study or something you're doing about how how tattoo artists help trans folks with eating disorders recover or just in general trans folks. Can you tell me a bit more about that because I think that is really cool.

Sure. So I'm not directly involved in the study in any way, but a colleague and a co author published a study earlier this year that was kind of looking at tattooing and its role in recovery from an eating disorder. And the majority of the sample were trans people. And yeah, the person who's the lead on that, their name's Scout Silverstein. And they're an incredible US based researcher in this area. And essentially tattoos are good for people's mental health. And that comes across in a lot of the research that people who have tattoos tend to have higher self esteem, lower depression, lower anxiety, and believe it or not, lower impulsivity. Which seems to surprise people because they seem to think people get tattoos on impulse all the time. But the kind of core idea of this study, what they found was that tattooing can be what we call a form of adaptive appearance investment. And that's like fancy psychology terminology for essentially like window dressing. The body wanting that's good for people's body image is things like dying hair, getting tattoos. And that's because you're kind of, if you imagine it like, you know, decorating the house, it can make the house feel more like home, essentially. And so tattooing is one of the ways in which people can connect with their body in a healthier way and make it feel more like home.

Yeah, that's really cool. And I'm just noticing the time, but I. In an ideal world, with especially focusing on eating disorder and trans folks with an eating disorder treatment, essentially in an ideal world, what do you think should be, what do you think should happen within this space? Like, do you think? I have many ideas and I just want to know your perspective. In an ideal world, what would you like to happen?

I think definitely possible for treatment to exist that is gender affirming and that can help gender diverse people. And there is treatment out there that is currently doing that. I've seen one study where trans people got better at the same rate as the cisgender participants and had really high rates of treatment satisfaction reported as well. And I think, at least so far from what I can tell, some of the key things that make treatment work are integrating and incorporating gender affirming medical care into treatment. So not waiting till the person is recovered to be considered well enough to have gender affirming medical care and not making people kind of engage with it completely separate from their treatment, but actually having it be a planned part of how they like formulate the treatment plan. Making a lot of adaptations to the treatment model that are specific to trans people. So treating gender dysphoria and body dysmorphia as two very separate things that need different treatment approaches and pretty much every different treatment modality we have, there are a range of different adaptations we can make to it that make it more gender affirming. I think the actual criteria for eating disorder admission are not appropriately designed with trans people. In mind.

No comment there. I'm in Queensland and you know.

Yeah. Some of the data we have around this is that like trans people tend to reach what we call medical instability. So like needing hospitalisation for medical reasons at higher body weights but are equally as unwell as people who are typically considered underweight. Which means the admission criteria that rely on BMI are disproportionately harming trans people, as is the the case with the eating disorder care plans. Ideas about BMI as well. And trans people are drastically more likely to have avoided restrictive food intake disorder compared to other eating disorders, which is one that isn't covered by the eating disorder care plan and sits in a very weird place in terms of being able to access treatment. So I think I'd love to see the eating sort of care plans have our fit on them or have other avenues for accessing treatment that are affordable but accessible. Yeah, trans people.

No, I 100 agree and there's so many things that I would love to happen within this space but like working within the system and working with what we've got. I think there is progress, there is folks who want to change this and who are affirming and I think it's really important that we continue to have researchers like you, advocates who are in the space who are standing up for those who get traumatised by the system time and time again. I think that's really powerful and really important.

Yeah.

Thank you so much for your time, Kai. I really appreciate it. I have so many more questions to ask you, but as it is a hour long show, I don't have all the time to fit in. But I'd love to have you back at another time to chat more about, especially about the neurodivergent intersection with trans and gender diverse folks. Because I'm planning an episode in a few weeks about that. So I'd love to have you back and chat more about this. So thank you so much for your time and I really, really appreciate it.

Thank you. Thank you for having me.

Q Life is Australia's first nationally oriented counselling and referral service for lesbian, gay, bisexual, transgender and intersex or LGBTI people. QLife provides peer supported telephone and web based services to diverse people of all ages. They help callers with a range of issues relating to sexuality and gender, including coming out, as well as more general issues such as relationship problems. So remember, you can call the Q lifeline daily from 5.30pm till 10.30pm on 1-800-184527 and for online chat and support.

Go to qlife.orgau I'm Brodie and you're listening to Transmission. You have also heard my interview that I did with the incredible Kai Swartzer about eating disorders and the prevalence of that within the gender diverse, the trans and gender diverse community. And I'm also joined in the studio by the incredible Tara, who has been on the show before a few weeks ago. And Tara and I, because it's Mental Health Week, we're just going to have some chats about trans and gender diverse mental health and what, what we do in the space and what should happen in the space. And so I'm just going to introduce. Let Tara introduce themselves again because there was technical difficulties before. So, yeah, Tara, could you please introduce yourself and your pronouns, please.

Yeah, sure. Hi.

Can you.

You hear me?

Yes, that's a lot better.

Beautiful. My name is Tara. My pronouns are they and them.

Amazing. And Tara, what do you do within the space of trans mental health and stuff like that or just the wider of what you do?

Yeah, that's a really good question. I am an accredited social worker and sex therapist in private practise full time as of this week, which is amazing. The work that I do is centred around working with neurodivergent and queer and trans folks around things like sexuality and gender identity and expression. So I predominantly end up working with a bunch of neurodivergent trans folks who are my favourite people to work with.

Oh, I love that. And I think I mentioned in my interview earlier, and we've spoken about this before, like the prevalence of neurodivergent folks and trans and gender diverse. It really goes hand in hand and there is a lot of research into it and I think it's a really important thing to be talking about as well because as I said, they go hand in hand. The intersections there are huge and I think that gets forgotten about a lot.

It does.

Which is wild to me because all I see is our intersectionality, honestly.

And I think it's. Yeah, it's really important especially to focus on the mental health of that as well, because if from my experience as a neurodiver, late diagnosed neurodivergent person, I think I, it would have helped me amazingly with my mental health earlier on if I had known these things about me, if I had been on the appropriate medication and stuff like that. So, yeah, I think it's really powerful. And Tara, you are doing some group kind of things soon, aren't you?

Yes, some group ish related things.

Group ish, yeah.

Do you Want to quickly talk about what they are and how that can improve mental health of the trans and gender diverse community?

Sure.

Are we talking about the sex ed group? Just.

Yes.

Check my understanding.

Yes.

Beautiful. I am running an in person workshop at the start of November based in Windsor in Meanjin, that is kind of all to do with talking pretty bluntly and pretty educationally, if that's the word. There we go.

It works. Cool bins.

Coolest of beans. Sorry folks, it's. It's actually just like the coolest phrase to ever exist.

Yes.

I'm running a workshop at the start of November for the LGBTQIA + community for anyone who is kind of wanting to learn about sex ed from a trans and gender diverse lens because we don't get like specialised sex education. And so I thought it would be a really cool opportunity to get a bunch of folks together, do some, you know, sex ed that's targeted to us as a community, but then also provide a bit of a space for like peer learning and sharing and just kind of like community vibes.

Yeah, that's it. And I think, I know we've had this discussion before about how important peer learning is and I guess fostering communities within our trans and gender diverse like people. I think that is so important and so powerful to be able to facilitate these things as well and have those tricky conversations that we may never have gotten before.

Yeah, yeah.

And I think from that, like, I know my experience when I've done groups before, like I met my best friend through a therapy group and even though we weren't meant to be friends, but no one needs to know that it's been 10 years now, I meeting those people who you're like, oh, wow, I get you. Like we are, we're in this together. So I think having stuff like that is so powerful and it allows in a peer led way, relationships and friendships to form in a somewhat safe way, I guess.

Yeah. And it's a hell of a lot more meaningful than me just like yapping on at everyone for two hours. Right. I think it's always going to be more, I can't think of the word, but it's always going to be, I think a way more like it's always just going to be better hearing it from like other folks in community. And even though I am one of those other people folks, I also hold like a bit of a position of like a bit of position of power because of the job that I do. So I try to lower that pretty considerably. And part of lowering that power, Imbalance is sort of acknowledging that what I have to say isn't like I'm not an expert in anything, right? I'm. I'm just a little guy.

That's it.

I'm just a little guy.

And before we continue chatting, I just want to mention that we got a subscriber during that time which is very exciting. So thank you Nigel from Mansfield for subscribing to four Triple Z. And without our subscribers we couldn't be on the air, we couldn't be having these tricky conversations, we couldn't be here on transmission if it wasn't for our subscribers. So if you are keen to subscribe, you can go to 4zzz.orgauforward/support. And yeah, you can subscribe to keep us on air, keep us having trans radio, trans powered radio and having these conversations that you may not hear else elsewhere. And with your experience and doing these types of things like you've got, you have lots of experience within the community service and like the kind of wider industry, specifically with trans and gender diverse folks. If there is one thing that you would love to see happen within accessing mental health support in the community or things like that, what would that be?

I would love to see our community not have to sort of almost justify their existence every time they approach a community service for support. I don't think that it's our job at all to be teaching people about what it means to be us. So I think some industry wide training and education on what it means to be a trans person, what it means to be a gender diverse and live outside the binary would be immensely valuable because it, it's not. It takes so much emotional labour to explain that to people anyway and it feels really rich to be going to services when we're asking for support and we end up being the one that's weirdly emotionally supporting the people that are.

Supposed to support us. That's really.

That's real.

Yeah, very real.

And I think this phrase is used quite often but nothing about us, without us. And I think that really needs to be focused on especially in the wider mental health and community services industry, I guess where. Or even just in the wider community where we need to be centre of this, the lived experience needs to be there and we need to be asked like what we think and what needs to happen without doing too much emotional labour for silly reasons.

So big agree.

And we are running out of time for this show during Mental Health Week. So that's running from the 5th until the 10th of October, ironically enough. I'm born on World Mental Health Day, which I think is quite hilarious. And yeah, so next week's show, there is a really cool interview from one of the artists, two of the artists who are playing at this show, but one of the artists are the incredible. Liz got to interview Jasmine Forte last week and that will be on the show next week. So I just want to say thank you to Tara and thank you to Kai down in Western Australia for the incredible interview. And yeah, so you're listening to Transmission on 4zzz. Catch us all next week, friends.

Bye.

Thank you so much for listening to Transmission. See you next Tuesday, 9:10am on 420 Triple Z.