Welcome to ASRM Today, a podcast that takes a deeper dive into the current topics in reproductive medicine. I'm Jeffrey Hayes and today on the show we continue our season-long discussion of LGBTQ plus issues in reproductive medicine by diving into some of the psychosocial aspects of the topic. Joining me for this discussion is my co-host, Dr. Lowell Kuh.
How are you today, good sir? Doing great, thanks. Glad to be here. So excited to talk with these excellent experts today.
Absolutely. Our guests today are Dr. Julie Bindeman, who graduated from George Washington University and is the co-owner of Integrative Therapy of Greater Washington, a private psychotherapy practice located in Rockville, Maryland. As a result of her own reproductive story, she pursued postgraduate training in reproductive psychology, where she actively writes, lectures, and presents on the topic and its full spectrum.
She has been on several committees for the Mental Health Professional Group of the American Society for Reproductive Medicine and served on MHPG's executive committee, with her chair year being October 2024 to October 2025. In 2024, she received the Volunteer of the Year Award with Rainbow Families, a nonprofit in Washington, DC that supports LGBTQ families and family formation. Also in 2024, she received a Service Milestone Award from the American Society for Reproductive Medicine in recognition of her volunteer efforts.
Dr. Bindeman, thank you so much for coming on the show today. Thanks so much for having me. Wonderful.
Also joining us is Dr. Daniel Kaplan, who is a clinical psychologist in New York City and a clinical assistant professor in the Department of Psychiatry at the NYU School of Medicine. Dr. Kaplan is a fellow of the Academy for Cognitive Therapy. She has designed and taught graduate level courses at Northwestern University, the Furkoff Graduate School at Yeshiva University, and the NYU Psychiatry Residency Program.
She is an active member of the American Society for Reproductive Medicine's Mental Health Professional Group, through which she has served on multiple committees and task forces. Dr. Kaplan is the group's immediate past representative to the Society for Assisted Reproductive Technology. She also writes and presents on issues related to CBT supervision, reproductive psychology, and perinatal mood and anxiety disorders.
She has coauthored a volume on cognitive behavioral therapy supervision and has written book chapters on perinatal anxiety, perinatal depression, and vicarious traumatization. Most recently, she was the editor of the book Cultural Responsiveness in Assisted Reproductive Technology, Best Practices for Clinics and Affiliated Providers. Dr. Kaplan, welcome to ASRM today.
Thank you so much. Thank you for getting through that mouthful of a bio. Well, it's wonderful to have you both here.
I'll start off with this question for you. What unique psychological and social considerations do LGBTQ plus individuals and couples often face when deciding to build a family, say as compared to heterosexual or cisgender families? To jump in, and I know Dr. Kaplan, you've got a lot of wisdom to share too, but LGBTQ couples or individuals that are seeking out to build a family are doing so in the most intentional way. So I like to say to them, there are no oopsies in their family building process.
So, okay. Yeah. So in a sense, when we're talking about unique psychosocial considerations, you're starting from the most positive place, which skipping ahead, because we'll keep coming back to this, is that the outcomes for children born in these families are wonderful.
They know they are wanted, they know they are loved, their parents are parenting them in the most intentional, thoughtful ways. It's great news across the board. What I will also add, speaking only for myself, is that I live in the bubble, in the bubble, in the bubble.
I live in New York. I live in a very progressive part of New York. My kids are growing up with friends, with two moms and two dads and one mom and trans kids.
And even those kids are not taught from the very beginning how they are going to have their children. So if we wind way back to things like sex education curricula in schools, many of them are abstinence only. Many of them focus entirely on cisgender, heterosexual sex and reproduction.
There's a wonderful article about LGBTQ teens and their experience of sex education, and it's called Here's Your Anatomy, Good Luck. So I think that where we begin is with a fundamental need for LGBTQ individuals to understand how their babies are made, what's available to them. I've also seen so many couples who, when we talk about their reproductive story, the idea of how, if at all, they might have seen themselves as a parent, and they will say to me, once they learned about themselves and learned that they were gay, they were queer, they were lesbian, they were trans, the idea of having children left entirely.
And they felt like they had to get on board with this idea of never having children or trying to adopt, which can be very, very difficult for queer families. So then they might find a partner and be like, oh, but I want a parent with this partner. And then the two of them are able to figure it out as, okay, do we either need to save a whole lot of money for us to do this? Or do we need to save even more of a whole lot of money to do this? Because there are so many ways in which we can create a family.
The downside is that they are not free, like cisgender heterosexual couples have. That's fantastic. You know, I love that, how you say that these babies are born into families who are absolutely loving and have dreamed about them.
I love that. That's beautiful. And you had mentioned how in society, sex and is an aspect of our society that should probably be revamped to sort of be more modernized and to be more inclusive.
And so how do societal attitudes and maybe family and origin relationships influence the mental health and well-being of LGBTQ plus people? Dr. Koo kind of cut out there. Let me, I'll finish the question for him. No, no, that's okay.
For LGBTQ plus people during the family building process. It's a great question. I think that among other things we have to take into account that depending on your family of origin, your culture of origin, your religious background, family building might be the first time where you are saying to your family, Hey, my partner is of my sex or my gender.
Yeah. It may be the first time if you are trans that you are coming out as trans in your community. There are many things that are individual specific.
There are many things that are family specific, but culture matters. So I think that the answers that we're giving, we're always giving through the lens of different people, different histories, different environments. Yeah.
And also history, right? Like if we're thinking about the history of the LGBTQ plus community, it has never been a community that has been welcomed with the rolling red carpet, which is such a shame because some of my closest friends are part of the community too. And so we have that also going into everything that's already a lens. So that might also be a lens in terms of what medical care have they perceived or that have they received in the past? And how did the provider respond to their gender identity, their sexual orientation, or their assumptions that were being made, or were they not being asked or properly consented for different kinds of procedures or exams.
So it might be too that we have, if we're talking about a couple, then it's two unique histories, two unique cultural lenses that are coming together to form their own. And it means two different sets of experiences with the medical system. Yeah.
May I just share an anecdote about that? Because I'm thinking Dr. Vindman, you reminded me of a patient who I saw in therapy for a completely unrelated issue. And she told me very far into therapy that she was partnered with a trans man. And when I said to her, okay, great, cool.
Why didn't this come up before? Was it relevant? She said, well, first of all, it wasn't because we're talking about something unrelated to my relationship. Second of all, when I went in for my last GYN exam, and I mentioned to my own gynecologist that I was partnered with a trans man, my exam stopped. And she kept asking me things like, did he have gender confirmation surgery? And how old was he when he came out as trans? And she said, well, I'm really just here for an annual exam.
So the likelihood that when that couple went on, as they very much wanted to, to pursue family building, that they would walk into a reproductive endocrinologist office, if that was the path that they chose, trusting that their story would be understood was decreased by that interaction. And it diminished her trust in me before it was relevant in my office. Yeah, yeah.
When also we're talking about legal issues, and I'm not a lawyer, I just like to say I'm the daughter of two lawyers. So it's not a way to earn a degree. But with Obergefell, I think part of what the hope was, is that Obergefell would also have parental assumption.
So cisgender couples, even if it's not their own gametes, will have parental assumption, just because of how they present. So if they're married, it is assumed that the female appearing person is the mother and the male appearing person is the father irrespective of whose gametes were actually used, right, which means that both are on the birth certificate, regardless of whose gametes were used. This is not the same for LGBTQ couples.
It means that in order to stay as safe as they can, they have to go through additional legal hurdles so that the non-gestating partner can be seen as the actual parent or not even non-gestating, like if both partners are not just gestating, then all need to sign various kinds of legal documents so that they are recognized as parents of this child. Right. So shout out here to the Legal Professionals Group for ASRM and shout out to Quad A, the Academy of Adoptive and Assisted Reproduction Attorneys.
The only other thing that I will add to this, because Dr. Bindeman is exactly right, is in addition to all the other complexity, it varies state by state. So have your lawyer on speed dial. We're talking a lot about these stressors that are outside of the clinic.
What are some common ones that happen when they actually get into the process? Oh, I love that you asked that. Thank you. Because I have such a wish list on this one, but Dr. Bindeman, do you want to start? No, go for it.
Okay. So let's start with everybody's least favorite part of every job, which is paperwork, right? Clinic paperwork often presumes a male partner and a female partner. It presumes a partner at all.
So clinic forms are often challenging for LGBTQ individuals and families because they say husband and wife or intended mother and intended father. The pictures of families that we see on the walls, we know overall tend to be overwhelmingly white, first of all. Intersectionality also matters here.
You can be white and trans or black and trans or disabled and trans. And all of those things impact what it's like to go into a clinic. Questions of who's providing gametes.
If a trans man walks in and wants to carry a pregnancy, if a trans woman walks in and wants to donate sperm, or in fact, that's wrong, wants to use his, her own sperm for the, for the creation of her own child. Not all clinics are fully up to date and understanding what that means and what is required. So language matters.
Words on forms matter. What you see in a waiting room matters. The equipment that we have to do exams matters.
And so if you are a, an in-house clinic provider and you're listening to this, take a walk through as if you are trans and see what your equipment looks like. Read through as if you are in a same gender partnership and see what your forms look like. Think about what happens if you're in a wheelchair and see if people can get on your exam table because LGBTQ families comprise all of those categories.
Yeah, absolutely. I think another stressor that a lot of people I've worked with encounter is that they may not have the, the people that are going through family building with them tend to be their cisgender heterosexual counterparts. They may have a couple of, of queer families also trying to build their family, but for the most part, there's not that support system that's in place.
And for many people, they haven't seen examples of what does queer parenting even look like. So what comes into their head is how they've been parented, which oftentimes is by a cisgender heterosexual couple. And those are not the ways that the couple, the individual wishes to parent their own child.
You know, when I think of parenting, I think just with love, with positivity, with their future, the children's futures in mind. And yeah, so I love that, how you talked about families, how they bring up their children. And we were wondering like, and how do the children in LGBTQ plus families understand and navigate family identity? And what factors contribute most to positive psychosocial outcomes for them? Our colleague, Susan, oh, also this happens all the time.
I see her last name and I can't pull it. Dani, can you remind me? Yeah. Thank you.
Gallenbach has done extensive research looking at same-sex parents and outcomes for children. And the coolest thing from this research is that it actually shows that kids who have parents that are within the LGBTQ community tend to actually fare better than their children of heterosexual counterparts. So I want to start with that.
There's so many ideas that, you know, if you have queer parents, well, that's going to automatically turn children queer. It's really not how that works, but there's so much mythology about what a queer parent is, looks like, and how their children turn out. So that's where I really wanted to start.
In terms of their kids, there is no opportunity to hide the fact that this child was donor conceived. At least I should say for most couples, there is no opportunity. And so they're already thinking about, okay, what is my child's origin story? And how are we going to share it? And what is that going to look like? And how do we have books so that our child feels represented in those stories? Not just, oh, we're telling you this, but no, look, we've got books, which means that there are other people out there too.
And just having it be something that is an immutable part of that child, in the same way that hair color is pretty immutable. I mean, unless you dye it when you're a teen. And other aspects of humans are just very immutable.
So if we're looking at that as, okay, this is a constant part of someone, then how they relate to that part might change as they get older. They might embrace it a little more. They might distance themselves from it a little more.
They might want a relationship with the donor. They might not want any information about the donor. They might change their minds too.
And so it can be more complicated, I think, for the parent who didn't contribute genetic piece to the pregnancy, who then feels a little more pushed aside if and when a child does explore that other part of themselves. And I like for people to remember that there's so many ways in which parenting happens. It doesn't all have to be genetic or biological.
And so what I tend to say to couples, I'll kind of bring up an adolescent who's doing the equivalent to a cisgender couple's child in adolescence, which is, I hate you, I wish I was never born. And what a child of a queer family might say is, well, you're not really my mother, because I don't have any of your genetics. And so I say to my clients, so after you get that knife out of your heart, you know, take a couple of breaths, and you can say something to the extent of, you're right.
Genetically, I am not your mother. However, I have been with you since day one. I have changed your diapers.
I've stayed up at night with you when you're sick. I've nursed you back to health. I've helped you with homework.
I fed you. We've had really great times together. I'm someone you can come and confide in.
So all of those pieces, that's what makes me your mother. Not that I have a genetic or don't have a genetic connection to you. So yes, and correct.
The only other piece of this that I will point out is that what the data show really, maybe surprisingly, maybe not, is that it is actually closeness to your parents and your parents. I mean, the people who get spit up on by you in the middle of the night. That predicts donor-conceived kids' openness to searching for their genetic parent, right? So it's not, oh, this kid doesn't love me, and that's why they want to know who the donor was.
It's this kid feels held, supported, seen by me, so it's safe for them to go out and get curious about part of how they became who they are. So there really is both. And what I would just add to that is two things.
One is that language changes over time, right? When I was trained, it was, it's not a partner, it's a part, it's not a parent, it's a donor. As donor-conceived people get older, they are finding their own language, and I think that's great, right? My donor mom, my bio mom, my donor dad, my dad. So if you are a parent listening to this, I would say take a deep breath.
That's okay. It doesn't mean that your child does not feel like your child. It means they feel safe and comfortable enough in your care to explore all of who they are and how they got to be there.
Oh, 100%. Yeah. In terms of the coping strategies, because I want to make sure that we do talk a little bit about some coping strategies.
Of course, yes. Kind of what we do, right, Dr. Kaplan? Most of the day. Yes.
So I think it's really important to be able to see yourselves in others. So finding a support group, I don't mean that in a clinical kind of sense whatsoever, but just other families that are going through the same things that you are. I think it's really helpful when you're trying to conceive to find that support.
And if you're living in a community where it is really hard to be open and queer, you might find that support online. So know too that that is a place where you can get support, a place where you can be validated. So I think in terms of any kind of family building, it's really useful to see that I'm not the only one.
I'm not alone in this. That's what I tend to hear from people so much is I feel alone. In terms of others, I think too, thinking about other coping strategies, I think thinking to the future is also something that can be really, really useful.
So let's imagine yourself holding the baby. What does that look like? What does that feel like? What does that smell like? Imagine yourself rocking in the chair, it's the middle of the night and you're feeding the baby. Again, what does that look like? How do you envision it in your head and not just babies, but going through the lifespan? Yeah, and I would say Dr. Bindun and I, first of all, full disclosure, are close colleagues.
We practice very differently. Yes. So one of the skills that I tend to use comes from a tradition called dialectical behavior therapy, and DBT really relies heavily on the idea that two opposite things can be equally true.
So there is a both-endedness to third-party reproduction. Your family is just like every other family in terms of having to register your kid for kindergarten, and there are ways in which you are not like other families. Love makes a family, and genetics makes a family, and you might see it one way, and your kid might see it another way.
So part of the truth doesn't have to be a threat to the other part of the truth. So I tend to pull in a lot of both-end thinking. Well, thank you all both very much.
We're out of time. I could talk to you all for hours about this. We'll have to have you both back on soon.
I want to thank my guest today, Danielle Kaplan and Julie Bindemann. Thank you both for taking time out to be on the show today. Thank you.
It was a pleasure. Fantastic. And as always, Dr. Koo, thank you for piping in remotely.
Thank you, guys. I love it. And I love the sentiment that both ends of a discussion can be right.
I need to remember that when I have a discussion with my own wife about certain topics. So very, very good things to remember. Thank you both so much.
Fantastic. Well, if you want to keep up with ASRM Today, please subscribe to our podcast feed, which you can do through any of the podcast platforms that are out there. If you have questions for us about this show, asrm at asrm.org. And until next time, I'm Jeffrey Hayes.
And I'm Lowell Koo. We'll see you then. This is ASRM Today.
This concludes this episode of ASRM Today. For show notes, author information and discussions, go to asrmtoday.org. This material is copyrighted by the American Society for Reproductive Medicine and may not be reproduced or used without express consent from ASRM. ASRM Today series podcasts are supported in part by the ASRM Corporate Member Council.
The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and its affiliates. These are provided as a source of general information and are not a substitute for consultation with a physician.
