A rabbi walks into a hospital room. “You’re the rabbi?” the elderly Jewish patient asks, looking the person up and down. The rabbi says yes.

“Are you married?” the patient asks. The rabbi says yes again.

“And what does your husband do?” the patient asks.

“My husband is a woman and she is a juggler,” the rabbi responds proudly.

This is a scenario that occurred repeatedly when rabbinical student Dev Noily was working as a hospital chaplain in a Jewish neighborhood of Philadelphia about a decade ago. Noily identifies as queer. But that really was not what Noily was there to discuss with the ill and the dying.

Noily, now senior rabbi at Kehilla Community Synagogue in Piedmont, soon decided to stop bringing up gender identity: “Instead of always correcting, always insisting that people see me the way I see myself, I focused on: What am I doing in this situation? How am I serving this moment, and is it in service of this moment in my spiritual role here to make that an issue?”

About five years ago, Noily stopped using traditional personal pronouns altogether, and, more recently took a further step: using the pronouns “they,” “them” and “their” instead of “she,” “her” and “hers.”

The emergence of “they” as a gender-neutral, singular pronoun is part of the national conversation about gender inclusion; for many gay, queer or transgender people, being described as a “he” or a “she” just doesn’t fit their identity. Noily may be the first rabbi in the country to adopt its use.

Born and raised in the San Fernando Valley, Noily, 55, was identified as female at birth and came out as queer after moving to the Bay Area after high school. Noily was ordained in 2009 by the Reconstructionist Rabbinical College in Philadelphia, and they are the parent, with their longtime partner, of a 17-year-old son.

“I think that many cultures recognize that gender is a spectrum. I don’t know that binary is helpful at all in understanding human gender,” Noily said last week in their book-lined office at Kehilla.

Noily clarified that “using ‘they’ doesn’t represent a gender transition but rather, a gender alignment and affirmation.

“My gender identity hasn’t changed much over the course of my life,” Noily said. “What has changed is the way I’ve been able to understand and express myself, with the help of the queer and trans communities, against the grain of social constructions that have misgendered me all of my life.”

The linguistic shift coincides with the appearance of the first generation of transgender rabbis and congregational leaders. While the exact number of out transgender rabbis and leaders is not known — estimates are less than a dozen across the nation — four of them live in the Bay Area with a fifth arriving soon. All support the option of using “they,” and have made their own decision about which pronoun to use for themselves.

Rabbi Elliot Kukla, who in 2006 became the first out transgender male to be ordained, at Hebrew Union College-Jewish Institute of Religion in Los Angeles, continues to use the pronoun “he.” So does Rabbi Reuben Zellman, director of music at Congregation Beth El in Berkeley, the first openly transgender student accepted to rabbinical school in 2003 and the second to be ordained (Hebrew Union College, 2010). Jhos Singer, maggid and congregational leader at the Renewal congregation Chochmat HaLev in Berkeley, is a married trans male like Zellman and Kukla and also uses “he.” Newly ordained Rabbi Gray Myrseth, who will be replacing Noily as Kehilla’s school director in July, identifies as nonbinary and transmasculine and uses the pronouns “they” and “them.”

“We’re not the only place by far that has out clergy who identify in that wider gender spectrum, but the Bay Area happens to have a high concentration of trans and gender-fluid spiritual leaders, and a high level of consciousness around queer issues and identities in general,” said Singer.

The Bay Area is known for social innovation, and the willingness of some congregations to embrace these new spiritual leaders shows up in other ways as well. In 2015, for example, a local story received national attention when an East Bay rabbi-educator created a new ritual for the coming out of a trans boy at his bar mitzvah.

“The Bay Area Jewish community has a long history of being a center of gender diversity,” noted Jacob Klein, who works in the San Francisco office of Keshet, a national organization that advocates for full LGBTQ equality and inclusion in Jewish life.

“From early projects with local bases like TransTorah, Jewish Mosaic and Nehirim, to progressive institutions like Keshet, Kehilla Community Synagogue and the Graduate Theological Union, to the DIY self-made scenes of the East Bay Jewish queers, the Bay Area is rich with people rethinking and re-creating our understandings of gender,” said Klein, who uses “they.” “Whether we’re the epicenter is up to debate, but we’re definitely leaders in incorporating the full spectrum of gender identity into Jewish community and practice that communities across the country look to for inspiration.”

Kukla, 42, who counsels the grieving, ill and dying through the Bay Area Jewish Healing Center, describes himself as “someone who doesn’t present as clearly male or clearly female.”

“I’m very comfortable in my own skin, but I can’t even walk comfortably through an airport in, say, Kansas City. I will be pulled out of the line for an extra security check because I look ‘other’ no matter what kind of ID I have,” Kukla said.

“Replacing ‘he/she’ with ‘they’ is a natural evolution of language to meet what we need, for people who don’t identify fully as either male or female. We finally have language to give voice to that experience,” he said.

The linguistic choice is increasingly accepted by educational institutions, including seminaries. At Hebrew Union College, where the first trans rabbinical students were accepted and ordained, “We respect the individual preference of our students and applicants regarding their choice of pronoun,” a spokesperson said.

Other colleges and universities are getting on the bandwagon. As of 2016, 14 states and the District of Columbia protect students from discrimination based on their sexual orientation and gender identity; some of these states and school districts require schools to use a student’s preferred name and gender pronoun. Several state athletic associations as well as the National Collegiate Athletic Association have adopted policies permitting college students to play according to their chosen gender identity, subject to some medical requirements. The NCAA policy also requires schools to use a transgender student’s preferred name and pronoun.

The gender-neutral, singular “they” is winning the battle of the pronoun in other fields as well. The Washington Post adopted the usage in its style guide in 2015; at the New York Times, however, the policy is still unclear.

In January 2016 the singular “they” was voted Word of the Year at the American Dialect Society’s annual meeting. And just last week the Associated Press — that ultimate arbiter of print journalism correctness — included the singular, gender-neutral “they” in its latest style guide — while urging reporters to write around it if possible.

Zellman, 38, argues that it is just a matter of time before society gets more comfortable with the terms. As an undergraduate linguistics major at UC Berkeley, Zellman had an interest in the queer community’s earlier experiments with invented pronouns such as “ze” and “hir.” Neither of them caught on.

“The word ‘they’ is more natural,” he said. “Maybe it’s a plural word now, but language changes. That’s how it works; it’s constantly in development.”

Both Zellman and Kukla say the gender-neutral pronoun does not obviate the need for the standard ones.

“We absolutely still need ‘he’ and ‘she,’ ” Kukla said. “I have no interest in obliterating gender; I’m interested in proliferating gender. I don’t see myself as a straightforward man but as a trans man with a lot of femininity, one of the beautiful shades of ‘he.’ Adding ‘they’ is just bonus added.”

The concern with gender language is an expression of the broader social issue of expanding the rabbinate. Women first broke through the gender barrier in 1972, with the Reform movement’s ordination of Rabbi Sally Priesand. The first openly gay and lesbian rabbis were ordained in the Reconstructionist movement in 1984, followed by the Reform movement in 1990. And the Reform, Reconstructionist and Conservative seminaries have accepted and ordained trans people as rabbis.

Rabbi Becky Silverstein, education director at the Pasadena Jewish Temple and Center, uses a feminine first name and the masculine pronoun. Hired in 2014, he is the first openly trans rabbi at a Conservative congregation in California, and believes he is one of the first trans-identified rabbis affiliated with the Conservative movement overall.

No Orthodox institution has yet ordained an openly trans rabbi, said Miryam Kabakov, executive director of Eshel, a national organization for LGBTQ Jews and their families in Orthodox communities.

“But I think it’s what’s next. It’s going to come up eventually,” she said.

In 1983, Rabbi Eric Weiss, CEO and president of the Bay Area Jewish Healing Center in San Francisco, was the first openly gay man admitted to HUC. In 2007, he became the first to hire an openly trans rabbi for a position with a Jewish agency. That was Kukla.

Thanks to Weiss and a supportive board at the healing center, Kukla has been employed for seven years in a job he loves. But, he said, “I’ve faced a lot of transphobia in the wider Jewish world.”

He has experienced general suspicion, incomprehension, and a sense that he was seen as a threat. “There are people checking you out in the bathroom.”

As gender pioneers in Jewish leadership, Kukla and Zellman have fielded emails, calls and queries from people all over the world.

They were from “trans and genderqueer people who really wanted to participate in the Jewish community but had to struggle to be accepted, to find a comfortable place, and to figure out how to talk to their Jewish community so they could be who they truly were and feel supported and accepted,” Zellman said. Questions also came from people who came in contact with them — rabbis, camp counselors, teachers, priests and ministers.

In response, the two friends created a website called TransTorah.org. Its mission statement: “to help people of all genders to fully access and transform Jewish tradition, and to help Jewish communities be welcoming sanctuaries for people of all genders.” Singer and four other colleagues were co-founders.

The group collected texts and blessings to share, contributed essays to the website, even created or adapted Jewish rituals for life events that a trans, queer or gender-nonconforming person might face.

“Such as going to the mikvah, or reciting the Shehechiyanu before having some kind of life-altering, body-altering experience, whether surgical or beginning hormones,” said Singer. “These are new traditions being designed by people who are well-steeped in Jewish tradition, drawing from existing sources. In some cases, it’s taking an existing blessing and just saying ‘This is a new place to apply that.’ ”

Singer, 58, has swum in the waters of transformation throughout his life; most notably, he bore a child before his transition. Writing in 2010, Singer described himself as one who was “born in a female body” but who “lived outside the norms of femininity. I have been a tomboy, a firefighter, a butch dyke rock drummer, a deckhand, a neo-Hasidic androgyne, a Jewish lesbian spiritual leader and, finally, a married-with-children transman rabbi-maggid serving a small congregation.” Today, both in his congregational work and as a Jewish educator at the JCC of San Francisco, Singer parses Jewish text and historic experiences to explore its relevance to contemporary Jewish identity.

TransTorah has also brought to light a range of classical rabbinic texts indicating that gender diversity is far from new in Jewish thought. The Jewish creation story specifies that God created male and female, but later texts contain hundreds of references to observed gender variations among humans. A document compiled by Kukla as part of his master’s thesis at HUC in 2006, posted on the TransTorah site, lists six variations discussed by the rabbis of the Talmud, from males and females with procreative ability, to males and females unable to procreate and sometimes showing characteristics of the other, to those born with differences in their reproductive organs. Of particular interest to the gender-nonconforming community are those called androgynos — who in modern English are called intersex — born with both male and female sex characteristics, and tumtum — people whose sexual characteristics are indeterminate or obscured.

In many of these texts, the rabbis debated family and marital arrangements with these gender variants.

“It gets wild … as they debate all possible scenarios,” Singer said. “But I don’t remember ever seeing anything that says they’re an abomination and should be taken outside the city gates and stoned to death. There’s a place for them in the community; they are accepted as creatures of God. One midrash actually proclaims that the androgynos is neither male nor female, but a creature unto itself — a third gender, by our modern standards.”

Noily, who has used the resource for a Queer Torah class at Kehilla, said that TransTorah has done tremendous work “lifting up these ancient Jewish texts that talked about multiple genders and sexes, making those texts accessible, and teaching them in ways that speak to the contemporary experience of trans people.”

While the information has always been there, it has largely been skipped over by the patriarchal norms of Jewish practice for nearly 2,000 years, Noily said.

Studying texts that show “more than two flavors of human being,” Singer said, is a profoundly affirming act.

“We thrive on tradition in Judaism,” he said. “And to think: Wow, those ancient rabbis really had my back … I feel sane, I feel included. Not me exactly, but my forebears. They’re there.

“We’re the people who didn’t quite fit. Mom and Dad and family are really important, but some people are just going to come through a little different, and have a different role to play, or a different perspective. We’re God’s minority opinion.”

Noily admits that while their own circumstances are supportive, “there’s still a lot of pushback in the Jewish world around trans people in general. Communities have had more time to process what it means to have women clergy, and even gay clergy, than they have had for trans clergy, and there are differences in the way that trans men and trans women are treated, due to continuing misogyny.”

Like his cohorts, Zellman believes that they have a contribution to make to the entire Jewish community.

“I really do believe that if we can embrace what is at the heart of a trans or genderqueer experience, we would all be a lot better off,” he said. “Trans people have had to look at ourselves very carefully and say, Who am I really, and who would I be if I could throw off all the expectations that people have of me? Who would I be if I could focus on who God made me to be, and not who society made me to be? What could I do, what could I contribute, what could I create or discover? What help could I give to the world?”