There are days when I walk into a leadership meeting and I am very aware that I am trans/nonbinary.
Not ashamed. Not afraid. Just aware.
Aware that before I say a word, I may already be the first openly trans or nonbinary senior leader someone in that room has worked with. Aware of my clothes, my voice, my body, my pronouns. Aware that things other leaders get to treat as ordinary can become statements simply because I am the one doing them.
And then the meeting starts.
There are budgets to manage, people who need decisions, programs that need resources, metrics moving in the wrong direction, and patients depending on us to get something right. Someone needs to ask the uncomfortable question. Someone needs to remind the room who is missing from the conversation.
And I go back to doing what I have done for most of my life.
I lead.
That distinction matters to me. I am not a leader because I am trans. I am a leader who has learned some incredibly important things because I am gender diverse.
And I didn't suddenly become a leader when somebody gave me a director title.
Long before healthcare, I spent decades in events and experiential production. I built teams, managed budgets, built businesses, took risks, failed, figured things out, and solved impossible problems five minutes before the doors opened. I learned how to walk into a room where everything was going wrong and become the person people looked toward instead of away from.
I did not become a leader when healthcare discovered me, and I did not become one when I started gender affirming hormone therapy or had surgeries. I have been building, operating, solving, and creating conditions for people for decades.
Healthcare gave me a new place to use those skills. Gender affirming care gave me a more honest way to inhabit them. Neither created the leader. They helped me understand the leader I already was.
Today, when I enter executive spaces as a visibly nonbinary person, I bring every version of myself with me: the operator, the entrepreneur, the parent and grandparent, the queer elder, the person in recovery, the person who has built businesses and rebuilt a life, and the person who knows what it feels like when systems work beautifully and when those same systems were never designed with you in mind.
That is what visibility means to me now.
It isn't representation as decoration.
It is lived experience sitting at the table where decisions are made.
But visibility has a cost.
We talk about visibility as though it is always empowering. Sometimes it is. Sometimes it is exhausting.
And sometimes it is frightening.
I learned that in a very real way when I was doxxed.
People who objected to who I am and the work I was doing put information about me out into the world. There were threats. There was fear. Not the theoretical kind of fear we sometimes talk about when we discuss being visibly queer or trans, but the kind that makes you think about your safety, the people you love, and whether being visible is worth what it might cost.
For a moment, disappearing would have been easier.
Be quieter. Be less public. Stop putting my face next to my words. Keep my head down and just do the work.
But I also understood what disappearing would mean for me.
So I kept showing up.
That doesn't mean I wasn't afraid. I was. It doesn't mean I ignored safety or pretended the threats didn't matter. They mattered enormously.
It means I refused to let fear make the decision about who I was allowed to be.
I kept walking into the room. I kept doing the work. I kept speaking. I kept being visibly nonbinary in leadership spaces where people like me are still too rarely seen.
Visibility isn't courage because you aren't afraid. Sometimes visibility is being afraid and deciding that fear does not get the final vote.
I want to be careful here because I don't believe every trans or nonbinary person owes the world this kind of visibility. Nobody should have to put themselves in danger to become a symbol for somebody else. Safety matters. Privacy matters. Choice matters.
This was simply the choice I made for myself.
Because after everything it took to become fully visible in my own life, I wasn't willing to let someone else's hatred make me disappear again.
Jim Fielding has talked about something that has stayed with me: how much energy queer people can spend figuring out whether we are safe.
I know that feeling.
You walk into a room and, before you've even gotten to the work, part of your brain is already working.
Who is here? How are they reading me? Did somebody hesitate over my pronouns? Is that look curiosity, discomfort, or nothing at all? How much of myself is safe in this room? Do I need to make myself smaller today?
That takes energy.
Energy that isn't going toward creativity, strategy, relationships, problem-solving, or leadership.
For queer and trans people, psychological safety isn't some soft organizational extra. It can determine how much of our actual capacity we get to bring into the room.
I've experienced both sides of that.
I know what it feels like to walk into a room already braced for impact. After being doxxed and threatened, that awareness isn't imaginary for me. Sometimes there really has been something to fear.
But I also know what happens when I walk into a room where I know I am safe.
My shoulders come down.
I stop monitoring myself. I stop wondering whether my femininity is too much, whether I need to explain my identity, or whether being visibly nonbinary is going to become the most interesting thing about me that day.
And suddenly all of that energy is available for something else.
The work.
That is one of the reasons psychological safety matters so much to me as a leader.
I don't want the people who work with me spending part of their capacity protecting themselves from the room.
I want that capacity available for ideas, disagreement, curiosity, solving problems, and taking care of each other and the people we serve.
Because when someone feels safe enough to stop guarding who they are, you don't get a less professional version of them.
You finally get more of them.
If I want someone's best thinking, I have to help create a room where they don't need half of that thinking just to survive being in it.
That is what creating the conditions means to me.
And that is also why simply having a seat at the table isn't enough.
Representation matters. But representation without influence is just optics.
I don't want organizations to invite people with lived experience into leadership spaces simply so they can point to the diversity of the room. I want us there when priorities are established, budgets are built, policies are written, and somebody says, "This process works," so someone who has lived on the other side of that process can say:
No, it doesn't.
A workflow can look perfect on paper and still be nearly impossible for a patient to navigate. A policy can be technically equitable and still create enormous barriers. A program can meet every metric we designed for it while failing the people it was supposedly built to serve.
People who have had to navigate systems from the margins learn to notice those gaps.
Not because marginalized people possess some magical wisdom.
Because experience teaches you where systems break.
For a long time, I thought leadership meant demonstrating competence. Know the answer. Fix the problem. Protect the team. Work harder. Be useful. Don't let anyone discover what you don't know.
Some of that came from my professional background. Some came from entrepreneurship. Some came from survival. And some came from spending parts of my life believing that belonging was something I had to earn.
I don't believe that anymore.
Today, I think leadership is much more about conditions.
Can people tell you the truth? Can someone disagree with you without fearing retaliation? Can a person make a mistake and learn from it? Does accountability come with dignity? And when somebody walks into the room carrying an identity or experience that leadership has historically excluded, do they have to leave pieces of themselves outside the door to be taken seriously?
My job isn't to create transformation in another person.
I can't.
My job is to create the conditions where people can transform themselves.
That applies to patients. It applies to employees. It applies to organizations. And it applies to leadership.
I still get nervous. I still wonder how I am being perceived. There are still rooms where I notice that I am the only person like me.
Being visible isn't the same as being fearless.
Sometimes courage is saying, "I disagree." Sometimes it is asking the question everyone has been carefully avoiding. Sometimes it is admitting, "I don't know." Sometimes it is pushing back when efficiency starts costing people their dignity.
And sometimes courage is remarkably ordinary.
It is putting on the dress. Fixing my jewelry. Looking in the mirror. Walking into the meeting. Opening my laptop.
And getting to work.
There is something powerful in that ordinariness.
Because ultimately, I don't want a future where trans and nonbinary executives are extraordinary.
I want a future where we are boring.
Where a trans or nonbinary person running a department, leading a health system, building a company, sitting on a board, or becoming a CEO doesn't require a headline. Where nobody has to be "the first."
Where a young person doesn't look at someone like me and think:
I didn't know we were allowed to do that.
They already know.
So I stay visible.
Not because I believe everyone owes the world visibility. Visibility is my choice. It should never be the price of belonging for someone else.
I stay visible because I know what it meant when I couldn't see people like me.
I know what it means to walk into spaces wondering whether you will have to explain yourself before anyone can actually hear you.
And I know what it feels like when the room is safe.
When I don't have to scan it.
When I don't have to calculate.
When I don't have to make myself smaller.
When I can bring all of that energy to the reason I walked into the room in the first place.
That is the kind of room I want to help build for other people.
So when I have the privilege of occupying leadership space, I want to occupy it fully.
Nonbinary. Queer. Imperfect. Experienced. Still learning. Still becoming.
And still willing to sit at the table and ask who isn't there.
Because visibility in leadership isn't simply about being seen. It is about what becomes possible when people who have historically been kept outside the room finally have the authority to help shape what happens inside it.
Maybe somewhere, someone who hasn't entered that room yet will see us there.
Not as proof that the system is fixed.
But as proof that the door can open wider.
And when they arrive, I hope we have done more than save them a seat.
I hope we have changed the conditions of the room.