Well we have these wonderful protocols tease blockers to suppress puberty if it's unwanted. there are some challenges with getting these medications. Some of them are financial, some of them are cultural. What the problem is , is that the cost of blockers in this country they are not affordable to the average person. They cost about a $1000 a month depending on which kind you use. Which is for the average person they don't have that kind of pocket cash. Some insurances cover these medications. It warms my heart that Medicall actually covers blocker medications and actually all transgender care in California. So young people who are insured by Medicall can get those medications. However, that is not the case across the board with private insurance. Many insurance plans have exclusion clauses in the plan that say We will not cover any care related to gender transition. Those are the ones that we really have to battle for. People are going on the blockers erasing the clock a little bit. you are trying to prevent them from getting those secondary sexual characteristics that are going to make it more difficult to transition later in life. And so if you are erasing the clock and you are trying to mount a huge battle with the insurance industry it becomes very franatic ans very anxiety provoking for the parents for the young person and for the provider who's doing that work. From a cultural perspective one of the things that i'm seeing in my clinic is that a lot of families who are coming in for blockers are white families. They are not coming from communities of color. This is discouraging to me because on the other end we are seeing older adolescence by the time they are reaching 18 they are coming to our clinic for the necessary care that they absolutely require in order to transition but now they are all the way through puberty. they were not brought in as younger adolescent because that dialog was not happening in their world. Whether be in their community or within their family, or within their church and this is something that we desperately need to change. We have to get this conversation out across all families.