so behavioral health clinician and karen aguilar our hearts and heroes award winner, tamika godwin who is a peer patient navigator. how that's important because that's our model. the people who work at our program, by and large, identify as transgender or transgender binary and many of us have had the patients our having and so we're experts in that way and in experts in terms of knowledge. the people doing surgeries for us are at zuckerberg and people we contract with because there's so few gender surgeons in the united states and we're lucky to have a few in the bay area. our referrals have now -- they've started to get steady and moving back up is what they're seem like but i'll let you talk about that. >> i can demonstrate this and it's a pleasure to present for you. the numbers are increasing annually and though the orange bar which are the surgeries completed are less over time a lot of is because the program takes great care to make sure the patients are prepared for surgery so everybody goes through the education preparation program and through a rigorous assessment of their me