NEW YORK — Five days a week Cantor Laura Stein trades her tallit for a pride-flag patterned ID lanyard. Greeted by a giant glass bowl of condoms sitting on the check-in desk, she walks through the waiting room at New York’s Mount Sinai Hospital and down the narrow corridor, past closed exam rooms to a niche where seven computers sit on seven desks.

Stein, a cantor at the Free Synagogue in Flushing, New York, is also a full-time social worker here at the Mount Sinai Hospital Center for Transgender Medicine and Surgery (CTMS). In the synagogue, Stein uses her musical language to forge connections and help people find their spiritual wholeness. In the hospital, she works within the LGBTQ community to advocate for patients who seek wholeness through gender identity formation and affirming surgeries.

“The Jewish values with which I was raised impel me to devote my life to tikkun olam and the pursuit of justice. The privilege of accompanying people on their journeys of spiritual health, mental health and overall wholeness is the greatest gift. I do it all in an effort to make the world a little bit brighter. As a Jew, I really feel that that’s my responsibility,” said Stein, who identifies as a lesbian.

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Stein, 31, was raised in Scarsdale, New York, the daughter of a surgeon and an arts education teacher. She said it was a loving, warm and close-knit family deeply rooted in Jewish values.

“There was a very strong culture in my family of inclusion, equality, and welcoming the stranger. There was always a sense of giving back and we were very rooted in a sense of right and wrong,” she said.

While they didn’t keep kosher, she, her older sister and parents observed the holidays and were active members of the Westchester Reform Temple. Her rabbi was Rabbi Rick Jacobs, who now heads the Union of Reform Judaism (URJ). Growing up Stein spent countless hours at synagogue; Friday night services, Saturday morning services and even an internship at one point. Summers were spent at URJ’s Kutz camp in Warwick, New York.

Yet, in spite of her synagogue and home being open and supportive, she said she kept a part of her concealed throughout adolescence.

“I remember in high school, lying in bed, whispering to myself ‘I hope I’m not a lesbian.’ I was 15. I learned to silence that part of me,” she said.

It wasn’t that her parents wouldn’t have been supportive. Time and again they told her she could come to them no matter the issue. It wasn’t that her synagogue would have shunned her. It was, she said, lively and progressive.

What kept Stein from coming out was the fact of not seeing herself represented anywhere.

“At home I never had friends whose parents were queer, my parents didn’t have friends who were queer. There was no one in leadership at the synagogue that was queer,” she said. “It wasn’t that anyone said you can’t play on the soccer team because you are a lesbian. It was more in the way questions were asked; in the way you learned what answers were acceptable. I remember coming home from camp one summer when I was nine and being asked, ‘Which boy did you have a crush on this summer?’ Not, ‘Did you have a crush on someone this summer?’”

Living the tikkun

Years later Stein said she learned how seemingly innocuous questions on patient intake forms might unintentionally “other” someone. For example, asking military service — because that might mean additional benefits — might make someone uncomfortable because of a belief that the military is not particularly welcoming to the transgender community.

Of course learning how to ask nuanced questions and listen to the answers came over time, starting with her four years as an undergraduate at Washington University in St. Louis. Though she wrote her application essay about wanting to become a cantor, she majored in Spanish literature and spent time abroad in Chile and Peru. By the time she arrived at HUC-JIR cantorial school she felt well rounded and eager to learn.

However, during her second year in cantorial school she began second-guessing her lifelong dream. Perhaps she’d made the wrong choice, Stein said.

“I felt the need to dive in a little deeper to connect with people. I felt our work is meant for a greater purpose. I wanted to expand my reach beyond the Jewish community. I felt a calling a little beyond the synagogue,” she said.

Stein wanted to do more to encourage people’s spiritual health — to figure out what being Jewish actually means for each individual. She ruminated about what living an authentic life meant.

“There is nothing worse than feeling you can’t embody the identity of the person you know yourself to be. When that happens you can feel isolated,” she said.

And so, realizing she could practice tikkun olam beyond the pulpit, Stein walked to New York University and applied to its social work program. Getting a masters degree in social work would complement her work as a cantor.

“How can I embody my clergy role with integrity if I’m not engaging with the values I espouse from the bimah [dais] every day, on the ground?” she said.

Not long after completing her program she began working at CTMS, one of the first centers of its kind nationwide. In 2017 the center saw more than 1,000 people on an outpatient basis, and conducted about 500 surgeries in the past two years. The center does initial assessment and screening to hormonal therapy, surgery, post-transition care, getting affordable care, gynecology, urology, endocrinology, nursing and social work.

“We really have to earn patients’ trust, and it can be very difficult. Transgender people don’t have the privilege of moving through the world without their gender identity being front and center. Bias or prejudice comes with every interaction out there,” Stein said.

With a little help from their friends, family, and clergy

By the time patients take the elevator to the 12th floor of this squat brown building located a few blocks from Manhattan’s Garment District, they may have endured a lifetime of bias, prejudice and exclusion.

According to the Human Rights Campaign, HRC, there are at least 700,000 transgender people in the United States, or about 0.3 percent of the population. There is still an overall lack of legal protection — only about 18 states and Washington, DC, prohibit employment and housing discrimination based on gender identity, according to HRC. Additionally, only 15 states and Washington, DC, prohibit discrimination based on gender identity in education. The community faces high rates of unemployment, poverty and anti-transgender violence.

“The work we do is not just helping the patients through the process, but working with their support systems to ensure that the patient and their network have everything they need to make the transition as successful as possible,” Stein said.

Some patients have caregivers and support systems with them every step of the way. But for those with weaker ties, ensuring familial and social support can mean the difference between getting gender affirming surgery and not getting the surgery.

Sitting in her office, Stein gets off the phone with the parent of a transgender patient. Initially the parent agreed to provide post-operative care, but was now withdrawing that promise — in part because they no longer accepted their child’s transgender identity. It was a decision that left Stein and the center’s coordinator scrambling to find a nursing facility for the patient.

Stein contrasts the situation with another where she met with a transgender teen and his parent. The depth of the parent’s support buoyed Stein — it was clear he would do whatever it took for his child to live a full and complete life.

“Social workers are faced with assisting patients with the stresses of the medical care made worse by societal discrimination and by the loss of family and community supports that others with medical needs typically have in place,” said Dr. Joshua Safer, executive director for CTMS.

According to Safer, it’s only in the last couple of decades that the medical establishment has moved away from the belief that transgender people suffer from mental health issues. It is now understood to be a physical and biological issue: gender identity comes from the way the brain is hard wired, Safer said.

Today gender dysphoria is a diagnosis with an insurance code, meaning gender affirmation surgery is covered by insurance.

While the medical community has progressed, the acceptance of transgender people in the Jewish community has a long way to go, especially for Jews from more religious backgrounds, Safer and Stein said.

“Western medicine is well respected by Western religions and it would make sense to me for religious leadership to find ways to make acceptance of the transgender community happen. Recognizing gender identity as biological was game changing in the medical establishment, and I want it to be that within religion,” said Safer.

Reform Judaism is the most progressive when it comes to accepting gender identity as biological. In 1978 the Central Conference of American Rabbis said that a person who had sex reassignment surgery could marry according to Jewish tradition. In 2003 the first openly transgender person was accepted to the Reform movement’s clergy school, HUC-JIR, and ordained.

Conservative Judaism has more mixed views on the issue, though a 2003 rabbinic ruling said sex reassignment surgery is permissible to treat gender dysphoria. In the Orthodox community there is little to no acceptance that sexual reassignment surgery changes one’s halachic sex designation from birth.

That kind of thinking doesn’t sit right with Stein.

“There is a line in scripture, and I’m paraphrasing, about not dressing like a woman if you are a man. But it’s about tricking someone. Just as you can’t put on a white coat, say you’re a doctor and treat someone. You can’t say you are someone if you’re not. That’s not what this is. It’s about being who you say you are. As a clergy person, my job is to help people live the best version of themselves, and what that is, isn’t up to me,” she said.

Prepping for surgery

The door to the conference room opens, and one of the center’s primary care doctors enters bearing two piping hot pizza pies. It’s time for the weekly team meeting. Patients who choose gender-affirming surgery can’t get clearance for surgery until all their aftercare plans are secured.

Stein works with her patients to secure them a safe place to recover and a caregiver who can provide all the support they need during the healing process. Additionally, she and the others at CTMS help patients begin hormone replacement therapy, set them up with lawyers to do legal name changes, help them find housing, get them health insurance, and aid in any other public assistance issue.

While most of Stein’s patients are between 20 and 40 years old, she has one elderly woman who calls almost every day to see if she can get approval for surgery.

“People come into their own through their whole lives. I look back with so much pain in my heart for that little girl whispering to herself in the dark,” Stein said. “I wish I had had those role models. There is nothing sadder than people not giving themselves permission to be who they are.”