Jul. 6—As the world as we know it changed on a global scale over the past 15 months, Rochester resident Liz Spafka's life changed in big ways, too.
Spafka (they/them), a 23-year-old nursing assistant at Mayo Clinic, came out as nonbinary — neither male nor female — during the past year.
They had questioned their gender pre-pandemic, but had "tabled it" because they didn't have the knowledge or resources to understand.
"During quarantine is when I decided to do something about it," they said.
They think the emphasis on self-care during stressful times contributed to their decision.
"The world has kind of sucked for a while," they said. "I might as well figure out something good in there."
Ashleigh Dowis, director of clinical services at Family Service Rochester, said coming out is a complicated process for every individual. However, the isolation of the pandemic may have allowed for more self-reflection and self-assessment.
Support from home
Individuals who didn't have support previously may have found it in an online community, or in coming together with family — as in the case of 19-year-old Madison Leske (they/them).
Leske came out as gay while attending Brigham Young University-Idaho during the summer after COVID hit. They finished the year, but BYU's "honor code" requires LGBTQ+ students to remain closeted or transfer schools. Leske came out as nonbinary over the summer.
Completing a course on religion and "family values" while at home forced Leske to consult their own deeply held values — especially when homosexuality was discussed as a "disease."
"You can't really go out and do things, so you're kind of stuck with your thoughts," they said.
At the end of the year, with their family's support, Leske "felt more ready to embrace myself and not care about what other people are going to say."
There's no hard data on how many people in the U.S. identify as transgender and/or nonbinary. The 2020 Census asked respondents to identify as "male" or "female." One 2016 study from the Williams Institute at University of California, Los Angeles' School of Law suggested that between 0.5% and 0.7% of Americans identified as transgender or gender non-conforming.
That works out to more than 1.6 million people nationwide, conservatively.
And that number has risen steadily since 2016. Gallup's regular polls put the number of transgender adults in the U.S. around 2%, with younger generations more likely to identify as LGBTQ+. A May 2021 study conducted in Pittsburgh found that nearly 1 in 10 students from more than a dozen public schools identified as gender-diverse in a voluntary survey.
For Rochester, with a population over 120,000, an estimate would fall between 600 and 2,400 individuals, without factoring in the draw of Mayo Clinic's Transgender and Intersex Specialty Care Clinic.
Finding similar stories online
Azrael Jones (he/him) "went through the whole list of pronouns" during the pandemic. The 26-year-old came out as nonbinary shortly before moving from Cincinnati to St. Charles to live with his partners.
"I got out of my dad's house and had a little more space to explore," Jones said.
In the past year, he's spent time at home, speaking to friends online, and finding people in similar situations online — especially on TikTok, "a good way to hear about people's experiences ... from ordinary people being silly on the internet."
"It seems silly to say, but it provides a lot of insight into people's lives," Jones said.
In January of 2021, British actress Abigail Thorn came out as transgender. It was the last bit of encouragement Jones needed to take the leap.
He started testosterone last week.
Few Rochester workplaces ready for greater gender diversity
The first person Liz Spafka told about identifying as nonbinary was a therapist they started seeing during the pandemic.
"She had me come up with a list of pros and cons — who I can tell, who would be safe to tell, and what would happen if they were total jerks," they said.
The workplace can be a blind spot in that respect. Although Spafka, Madison Leske and Azrael Jones are "socially" out to their friends and family, none of them had broached the topic at work by the time this article was published.
The three wonder whether conservative co-workers or patients will argue with them about their own identities, if they'll have to spend time educating people about LGBTQ+ topics, and whether there could be unforseen work-related consequences.
Spafka, a nursing assistant at Mayo Clinic, works in the only Rochester organization the Post Bulletin located with any training about its gender-diverse workforce and patient population.
The Rochester's Area Chamber of Commerce had not heard of any local businesses that had sought training or put practices in place to accommodate transgender/nonbinary employees. Neither had Rochester Community and Technical College's Business and Workforce Education team, or Rochester's Small Business Development Center (SBDC). The Rochester Diversity Council did not respond to requests for comment.
Spafka is aware that Mayo rolled out a pronoun pin initiative, but debated whether it was worth coming out to their co-workers, as they'll be leaving for grad school in Georgia at the end of the year.
As an essential worker, Spafka had to worry constantly about "how I look to other people and what's OK to talk about with my co-workers."
"I'm still kind of navigating," they said. "These people are my co-workers, not my friends — I'm not sure what's relevant."
Conservative patients are a concern, as well. Spafka works in Family Medicine, and sees plenty of older people from rural areas. Defending their identity constantly, they said, sounds exhausting.
"If I wear a 'they/them' pin into a room, I don't want to argue about it," Spafka said. "I don't want to educate every single person who comes in."
Azrael Jones, a machine operator in Winona, said his co-workers are mostly over 40, from rural towns.
"I try not to make assumptions, but from the way they talk to each other, I don't really trust them," he said.
Jones has never felt that he's been in a "safe" workplace to come out. He doesn't want to feel responsible for educating a hostile audience, but is happy to answer questions asked in good faith.
The Minnesota Human Rights Act, updated in 1993, prohibits discrimination on the basis of "sexual orientation," defined as "having or being perceived as having an emotional, physical, or sexual attachment to another person without regard to the sex of that person or having or being perceived as having an orientation for such attachment, or having or being perceived as having a self-image or identity not traditionally associated with one's biological maleness or femaleness."
In 2020, the Supreme Court ruled that the 1964 Civil Rights act protects gay, lesbian, and transgender employees from being fired based on sex.
It's unclear whether misgendering an employee counts as discrimination under Title VII. While using the wrong pronouns for a colleague or employee is insulting, there has not been a specific ruling about whether it alone could count as creating a hostile work environment, or sex-based harassment.
"I've never made my forever friends in the workplace," Jones said. "But if they used my pronouns, that would be nice. If there was a system in place, that would go a long way."
Similarly, most of Madison Leske's co-workers at Menards are older, ostensibly straight white men. Leske isn't sure how many will react well to their identity — with one exception.
Leske is out to one co-worker, who asked for their pronouns without being prompted.
Mayo Clinic's inclusion efforts: 'good ... not perfect'
Working in health care combines two hurdles for gender-diverse employees: coming out to colleagues, and making sure their medical providers treat them respectfully.
Spafka thinks the majority of providers don't know how to talk to trans and nonbinary people — even in Rochester, despite strong efforts from Mayo Clinic's Transgender and Intersex Specialty Care Clinic (TISCC) and the LGBTI MERG (Mayo Employee Resource Group).
According to Mayo's LGBTI resource group, officers have educated many divisions and departments about caring for transgender and gender-diverse patients, including neurology, lab medicine and pathology, information security and more.
"We're being asked to present to a lot of work units and we're scheduling them out as we have capacity," the employee resource group stated.
Training options by the TISCC include an hourlong training module, rotation through clinic for residents, fellows, and medical students. The clinic has also worked with diversity and inclusion committees throughout the hospital.
And Mayo's pronoun pin initiative has distributed 16,750 pins (distributed in packs of five) to Mayo's work units. Of those, 6,750 have been "She/Her" pins, 4,300 "He/Him," 2,350 "They/Them," and 3,350 have read "Ask Me."
Mayo's internal OUTList collects several hundred employees to promote visibility and connect potential mentors and mentees. It does not represent all LGBTQ+ Mayo Clinic employees, and it is not clear how many of Mayo's employees are trans/nonbinary.
"In HR, we are still working on expanded gender identity collection," said Mayo communication specialist Kabuika Kamunga.
While Mayo Clinic is "good, it's not perfect," Spafka said.
Spafka's unit in Family Medicine has not been trained on how to address transgender or nonbinary patients and employees, they said. Spafka also remembers calling Mayo as a patient, clearly seeking help as a nonbinary person beginning hormone replacement therapy. They were misgendered by the employee transferring them to the TISCC. Although they've had a good relationship with the specialty clinic, that experience lingered.
"(The employee) could have had a little bit of a thought about how to address someone who's looking into gender interventions," they said.
Training modules aren't the only way for workplaces to make everyone, regardless of gender identity or sexual orientation, feel welcome.
Jones said putting policies in place to accommodate trans and nonbinary employees would make him feel safer — "even little things, like a blank for your name and legal name, or pronouns on your badge."
He also wants to see consequences in place for refusing to respect a co-worker's name and pronouns.
"That way, short of an extremely hostile environment with co-workers, I would at least get grudging acquiescence," he said.
Outpatient therapist Kate Perry, of Family Service Rochester, added that employers can install gender-neutral bathrooms, add preferred pronouns to email signatures, and "have it be the norm when introducing new people."
Spafka said having other nearby LGBTQ+ co-workers would make them feel better about coming out — "I wouldn't feel like the only representative on my floor."
Spafka does think they'll be out in grad school.
"I want to be," they said. "I'm excited about the possibilities. Those people (won't) have a preconceived notion of me, so I can come through with myself first. I'm hopeful, even though I'm still scared about it."
Why do pronouns matter?
Using a person's correct pronouns is the most accurate and respectful way to address them in the third person. The English language commonly uses "they" as a singular pronoun for an individual whose gender is not known. Additionally, "they" and "them" are commonly adopted by nonbinary and gender-nonconforming individuals, who do not identify as male or female. The Associated Press Stylebook, which sets the writing and editing standard for most U.S. publications, embraced "they/them" as a singular, gender-neutral pronoun in 2017.
Read more at www.mypronouns.org.
LGBTQIA+ mental health group in the making
Family Service Rochester began advertising a Monday-night mental health support group for LGBTQIA+ adults in the spring. Once they reach the required number of participants, they hope to launch the initiative soon, said Ashleigh Dowis, director of clinical services.
LGBTQIA+ identities can be a source of pride and community, but can also lead to increased risk of anxiety, depression, and other mental health issues. The support group will meet from 5:30 to 7 p.m. on Mondays to discuss topics such as isolation, building healthy relationships, familial connections, and workplace concerns.
Anyone interested in joining the support group can call FSR at 507-287-2010. There is no referral necessary, and while FSR accepts all major insurances and medical assistance, they are willing to work with interested parties to ensure their services are affordable, Dowis said.