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An open letter to Rupert Read, nurse by Loz Webb on behalf of Action for Trans Health

[content note: discussion of transmisogyny and TERFs]

Earlier this year, dosage I marched alongside Green MP Caroline Lucas at Trans* Pride Brighton, search and spoke to her briefly about the importance of improving trans healthcare, a point on which she seemed to heartily agree. I have been impressed with Lucas’ seeming commitment to the trans community, from her presence at Trans* Pride to her consultations with trans constituents, to her awareness of the dire state of trans healthcare in the UK currently.

The Greens have made a real show of their membership surpassing that of UKIP this week, and well they should – this is an impressive achievement. Unfortunately Rupert, you seem single handedly determined to use your platform as a Green Party candidate to attack trans people’s right to exist.

This problem is much larger than a few dodgy comments on Twitter, so let me first address your rejection of the term ‘cis’. You write that the notion of people being forced to use the word cis troubles you, and that some feminists share those concerns. Firstly, let me say that no-one is forcing anyone to use any particular language. It is simply that words mean things, and if you refuse to use certain neutral descriptive terms, don’t be surprised when no-one understands what you’re talking about. However, if your issue is that you believe that cis people should be called normal and trans people should be called trans, then the problem isn’t that you have a problem with random adjectives, the problem is that you think that cis people are normal and trans people aren’t. The problem is transphobia. I want to be very clear, because I can tell from your tweets that you struggle with the definition of words. The problem is not that you are plainspoken, nor that you self-identify as a philosopher. The problem is that you have a problem with transgender people.

I was intending to be a lot more polite when I started writing this open letter but, unfortunately for me, then I discovered your blog. Which, unfortunately for you, is full of transphobic hate speech. I had thought, prior to discovering your blog, that perhaps you were a bit ignorant, perhaps you’d never bothered to educate yourself about trans people, perhaps new words and concepts frightened you, similarly to how new words and concepts frighten middle age wealthy Tories in the Home Counties who estrange their LGBT children in order to punish them for coming out. In other words, I thought you were unintentionally harming trans people because of your narrow, ill-considered viewpoint.

However, it is clear in your blog, where you refuse to accept that trans women are women, and also refuse to accept that women who don’t have periods (thus including young, elderly, disabled, and intersex women) are women, and also refuse to accept that women who aren’t brought up as women (a category that includes women from other cultures where women and men have slightly or vastly different meanings, cisgender girls who are tomboys, children bought up gender neutral, survivors of abuse, and intersex children) are women. In fact, for a cisgender man (sorry mate, it’s nowt personal, it’s just that meanings of words thing again), you seem incredibly concerned with who is and who isn’t a woman. You don’t get to decide who is and who isn’t a woman. In fact, no-one except the woman in question gets to decide whether she is a woman or not. And that’s not based in some bizarre identity politics, it’s simply that no-one else knows, no-one else can possibly know – that’s how being a person works.

It seems to me that your particular brand of transmisogyny is actually about something far darker. It seems to me that you share trans-exclusionary radical feminists’ aims of seeking to refuse lifesaving transition treatment to trans people, that you sympathise with those who assault trans women for ‘deceiving’ people by not disclosing their trans status, and that you wish to deny trans people the right to be who they are. From your blog, and your adherence to trans-exclusionary radical feminism, it is clear that you oppose the rights of trans people. And until the Green Party do something about it, they must be considered a transphobic party.

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Who’s the odd one out?: Alexander the Great, case Frida Kahlo, web Virginia Wolff, Alan Turing, Paris Lees.

All of these famous LGBT people featured on posters around my campus in recent years to celebrate LGBT History Month. Although I would hardly call Paris Lees and her contemporaries Laverne Cox, Chaz Bono and Janet Mock historical figures, at least not yet! I was always quite confused about why famous LGB were found from all periods of history whilst we can only think of trans people who are alive today or in very recent history, despite ample evidence to suggest that people who don’t identify with the gender they were assigned at birth exist in all contemporary and historical societies. It creates the impression that trans people are a recent phenomenon, and divorces us from the historical struggles we have been a part of.

A major problem with compiling trans history is that the way that we talk about gender identity and sexuality now is a relatively recent thing. For much of history, what we know now as LGB and trans identities have not been considered as distinct. This has led to significant tracts of queer history – our history – being retrospectively claimed by cis LGB people alone.

Radclyffe Hall, the author at the centre of an obscenity trial for their novel The Well of Loneliness, is a case in point. Hall identified as being a congenital invert. Sexologist Kraft-Ebing defined AFAB inverts as having a “masculine soul, heaving in the female bosom”, whilst another contemporary sexologist, Havelock Ellis, defines AFAB inversion as something more similar to what we understand as lesbianism today. We don’t know which definition Hall would have preferred, or if Hall would have seen these two definitions as mutually exclusive. However, we do know that Hall chose to publish their work using their gender-neutral middle name, Radclyffe, rather than their more female-coded first name, and that Hall was called John by their closest friends and lovers. We also know that Hall pretty much exclusively dressed in clothes that would be considered masculine at the time. Yet Hall has been pretty much exclusively claimed as part of (cis) lesbian history and not trans history. Likewise we can see a similar dynamic happen with the Stonewall Riots, a riot led by trans women of colour and homeless queers, yet being claimed almost exclusively on behalf of white cis LGB historians.

When trans and gender non-conforming people are talked about, they are understood in cis-centric terms. I’ve lost count of the amount of times I have heard cis historians talk about people who were assigned female at birth dressing in men’s clothing in order to become a doctor, soldier, pirate or similar. This understanding frames their gender presentation as a means to accessing a profession, despite the fact that often there is evidence to suggest that many of these individuals dressed in male clothing much before taking on the occupation they were famous for. Chances are, these individuals were simply trans people doing what for the time was a gender appropriate profession, rather than being particularly opportunistic cis women.

Likewise a significant amount of people who pop up in the historical record as being convicted for being male sex workers may well could be understood differently from a trans perspective. In many of these cases, people were convicted on the basis that they looked to the police like men dressed in women’s clothes, and this was used as ‘proof’ of those individuals being sex workers. The understanding was that those individuals would dress as women in order to become sex workers, rather than simply being women who may or may not be involved in sex work. This framing results in those individuals being remembered as gay male sex workers, rather than as trans women.

Part of the problem is that history has been written, recorded and disseminated by cis people – the vast majority of which do not have much contact with trans culture. Cis historians are currently not equipped to recognise when a historical event of figure is of significance to the trans community. And as trans people are discriminated against today, most cis historians do not feel it valuable to learn about trans histories. This creates a vicious cycle: the less historians writing about trans histories, the harder it is to learn about them.

As such, Action for Trans Health’s resident historian, Greta Williams-Schultz, has created a short guide to historical trans figures from the UK. Within the guide you can read about historical trans people whom you might not have heard about. Some lead ordinary lives, such as Mary Mudge who worked as a dairymaid in Devon, and others were remembered as doing extraordinary feats, such as Jan Morris, a member of the first British team to climb Everest.

Many of these individuals lived before the term ‘trans’ or ‘lesbian’, ‘gay’ or ‘bisexual’ existed. There is always going to be a debate whether it is appropriate for us to claim people as trans when the concept didn’t exist when they were alive. But LGB people don’t seem to have an issue with claiming Alexander the Great as bisexual when he died approximately 2200 years before the term was invented. The fact is, cis people are seen as the default, so if we don’t claim these historical figures as our own, cis people will only do it for us.

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We know that transitioning usually has a very positive effect on trans people’s mental health. Providing care appropriate to their transition is the single most effective thing at reducing the rate of suicide attempts amongst trans people. However, some aspects of transitioning may have a negative impact on mental health, as well as being made more difficult by existing mental health problems.

A big part of this is related to how difficult it is to navigate medical care without your mental health declining. Medical professionals are poorly educated when it comes to trans people and mental illness even when the topics are completely separate, so when the two intersect it’s often impossible to find a doctor who is understanding of this and all it entails. The pathologising of trans people’s experiences makes it often dangerous to “admit” you’re mentally ill in a trans healthcare context – mental illness and trans status are often conflated and used as an excuse to not treat one or the other, which makes it hard to be open about how both are affecting you. A doctor who acts insensitively is often the best case scenario, with some people (especially those with “unstable” disorders like borderline personality disorder, bipolar or schizophrenia) being denied care altogether because their self-evaluation isn’t trusted. 
Even in the best case, the interrogation and long waiting times involved in GIC care have a negative impact on most people’s mental health. We believe that people with mental illnesses are valid narrators of their own experience and that they deserve help in navigating a system hostile to everyone, but especially to them. A helpful thing in these scenarios is hearing about what those who went before you did, whether or not they deemed it successful, and learning how this affected their experience. If you’ve dealt with the trans healthcare system while mentally ill, we’d like to hear how you navigated it, what you encountered and what wisdom, encouragement or solidarity you have for others in your position. 
We’re interested in hearing things about:
  • Self care tips
  • How you accessed counselling without it reaching GIC services or your GP 
  • How you dealt with hormonal changes affecting your mental health
  • How you dealt with invasive questioning regarding your mental illness affecting your trans experience
  • Post-surgical depression
  • Anything that helped you get through the adverse effects of doctors’ treatment of you
  • Intersections of mental health, trans, and other oppressions such as race, transmisogyny, sexuality, disability, drug use, survivorship
If you write something up and email it to publications@actionfortranshealth.org.uk we can collate them and present them as a resource. Feel free to email us submissions for our blog/website at anytime, but we are setting a deadline for inclusion in the print volume for 1st March 2015. Please share! 

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News that the Gender Recognition Panel is delaying and possibly denying legal gender recognition for a trans person because they had children whilst trans is deeply concerning. The Gender Recognition Act does not require a trans person from abstaining from sexual activity, side effects reproductive or otherwise. This news represents a potentially unlawful and clear violation of trans peoples reproductive rights.

The reasons giving for this action can be seen below:

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We have a long way to go to achieve reproductive justice for trans people. Most European countries that have an equivalent to the Gender Recognition Act require the trans person to be sterilised in order to have their gender legally recognised. Although this is not the case in the UK, this move by the Gender Recognition Panel to delay and potentially deny recognition could seen as part of a move towards the de facto requirement for sterilisation. This is particularly concerning in a time when trans people are finding it increasingly difficult to access reproductive technologies such as gamete storage and IVF through the NHS or privately. Reproductive justice for trans people needs to be central to our agenda, and crucially needs to be picked up as a key issue for feminists in the UK to be working on.

It just so happens that today (Dec 5th 2014) the Gender Recognition Panel are meeting. As far as I can tell from here, the Gender Recognition Panel has its administrative offices in Leicester, presumably at the Crown Court, but meets in London. If my information is up to date, the panel is chaired by Judge Jeremy Bennett who has an office in Sutton, London: Copthall House, 9 The Pavement, Grove Road, Sutton, SM1 1DA. It might be worth locals in Leicester or London popping down and letting the Gender Recognition Panel know what you think. (Please let us know if any of this information is incorrect).

 

 

 

 

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Today is World Aids Day, a time to remember those lost to HIV/Aids and to reflect on our responsibilities to those living with HIV/Aids and to educate ourselves and our communities about safer sex and harm reduction. Jess Bradley writes:

<content note: sex, sex work, drug use, medicalisation, injections, mental health, sexual assault>

Like a lot of trans healthcare issues, the research simply has not been done to solidly say how many trans people are living with HIV/Aids. This is a huge problem because without these statistics it essentially means we are invisible to service providers. Where people do want to carry out trans specific HIV/Aids work, the lack of empirical evidence means that there are less likely to be able to secure funding for their work.

It is possible to pick out a few studies which investigate the stats regarding HIV in the trans community. In a study of trans women across 15 different countries, Baral et al (2013),  the global average HIV prevalence for the trans women studied was 19.1%, rising slightly to 21.6% in high income countries. In another international study, Operario et al (2008) found that the crude average HIV prevalence for trans women sex workers who had sex with men was 27.3%, compared to 14.7% for trans women in general, 15.1% in male sex workers, and 4.5% for female sex workers. Neither of those studies looked at data from the UK context. However it does suggest that UK trans women, especially those who engage in sex work, are likely to be at greater HIV risk than our cisgender peers. I have yet to find any specific prevalence data specifically looking at trans men or non-binary people, which is concerning.

Before my involvement in Action for Trans* Health, I used to work for Students for Sensible Drug Policy UK and Youth Organisations for Drug Action Europe. Primarily my interest in drug policy and harm reduction came from the higher incidence of drug use and drug harms within the LGBT community. Statistics for drug use in the trans community are scarce, particularly UK specific statistics. But for people such as myself who were working on LGBT drug use, the prevalence of drug use within the trans community, in particular types of drug use which are associated with more harms, was a red flag. Its worth noting here also that self-medicating trans people are also at risk of related harms with semi-legal supplies, access to needles, and inconsistent knowledge about safe injection practices.

There is very little data about HIV prevalence for trans men. However in a US study, Kenagy and Hsieh (2010)  found that whilst trans people in general had much higher likelihood of engaging in risky sexual practices then their cisgender peers, the trans men in their study exhibited riskier sexual health practices than the trans women studied.

The trans community has higher risk factors for HIV. This is due to the higher rates of sex work, IV drug use within the trans community, and riskier sexual practices. Stated simply, this seems to locate the risk factors within the trans community itself. However, I think it is important to look at structural factors in place which are so often missing from the analysis when talking about these issues.

Trans people face significant discrimination in the workplace and as such are an under-employed population. At the same time we face significant objectification and fetishisation by cis people. Trans people’s higher engagement in sex work can be explained by the interaction between those two factors. As a former sex worker, I know its reductive to deny trans peoples agency in the face of structural issues in a way which argues that trans sex workers are forced into that line of work. Yet these structural factors are not irrelevant, we can only choose from the options available to us. It is clear that the trans community needs to build strong links with those fighting for sex workers rights, and that the voices of trans sex workers need to be raised up within our community. Building these links of solidarity between these communities can yield results in terms of HIV harm reduction. As Shannon et al. (2014) suggest, global decriminalisation of sex work is likely to cut 33-46% of HIV infection over the next decade, something that will certainly make an impact on the trans community.

Similarly, trans drug use and self-medication does not happen within a social vacuum. The stresses of living in a transphobic society can lead trans people to develop problematic drug habits, and the lack of trans- or even LGBT-specific drugs services can leave trans people out in the cold. The barriers to access services such as drugs counselling, mental health provision, or needle exchanges has a big structural impact on our lives. Similarly, long waiting times for transition related healthcare and inconsistent support from GPs lead many down the path of self medicating hormones and/or other substances. Whilst it is possible to responsibly manage the risks of self-medication and illegal drug use (either recreational or medicinal), the lack of official guidance and support doesnt help. Funding for trans-specific harm reduction work desperately needs to be found and put to good use, and the trans community needs to support calls for drug policies which are shown to reduce the health and social harms of drug use.

Trans people often engage in riskier sexual practices. I don’t know of anyone who has ever been taught about trans specific sexual health issues who hasn’t been at a workshop that we at Action for Trans Health have offered. Part of my role in Action for Trans Health involves talking to sexual health service providers about how to improve their services for trans people. Sometimes, I am pleasantly surprised by the doctors, nurses and administrative staff’s prior knowledge of trans issues (ie. knowing what a trans person is). Other times, its a uphill struggle simply starting a conversation. I have yet to go to a sexual health clinic where anyone working there has the knowledge of trans specific sexual health issues I would expect from those who will be working with trans patients on a regular basis. Clearly this lack of information and education is a significant contributing factor to why we engage in riskier sexual practices. Work in this area is urgent, and whilst us and other organisations are doing work in this area, it simply isnt enough to cover the work that needs to be done. You can help by doing a sexual health audit of your local service, or getting in touch with us at info[at]actionfortranshealth.org.uk to book us in for trans sexual health training (either for medical professionals or for trans people themselves).

However, I dont think that access to sexual health services is the only thing that should be considered here. Because of systemic transphobia in all areas of life, trans people often have low self esteem and low social equity. Sex and sexuality can be difficult for everyone to talk about, but particularly for trans people as sex is so gendered by society. Negotiating our sexual needs, especially discussions about safer sex, can be extremely difficult, something that many of our sexual partners may not realise. As a result, we often end up in situations where risky practices take place. Our partners need to be aware of our needs. The trans community needs to open itself up to a frank discussion of how we can negotiate for safe, consensual, and empowering sex. These discussions need to be had within a broader challenge to systemic transphobia.

Further Reading: 

An Open Letter to Stonewall from The Sex Worker Open University

Debating Drugs: How to make a case for legal regulation – Transform Drug Policy Foundation

Sexual Health Guide for Trans Women – Terrance Higgens Trust

Sexual Health Guide for Trans Men – Terrance Higgens Trust

 

 

 

 

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There’s a big urban myth about transition regret. The myth is that ‘most people regret transitioning’, and it’s often used by medical professionals, particularly those who are inexperienced or ignorant regarding trans healthcare, to refuse trans people treatment. Loz Webb writes.

This myth is also exploited by the cis media in order to run shock stories about ‘sex changes’ and ‘reverse sex changes’, and to push a particular anti-trans agenda that asserts that trans people, whether or not they are happy with their medical interventions, are ‘spending the taxpayers money’, as though trans people aren’t worthy to use the NHS and should be exempt from the free healthcare that everyone is entitled to purely as a result of them being trans. This anti-trans rhetoric, so prevalent in our media, undoubtedly feeds into a culture in which trans people are treated ignorantly, or as #transdocfail showed, sometimes appallingly by medical professionals, as well as contributing to the frequency of hate crimes carried out against trans people.

Last week, academic Ruth Pearce, was contacted by Sundog Pictures via the following unsolicited email:

 “I’m currently working on an idea alongside Channel 4 following transgender individuals who have come to regret their sex changes and are keen to undergo further treatment / operations to reverse the change. The doc will be insightful and sensitive and will look at the way in which transgender individuals are treated in society and whether the process before someone is permitted an operation is robust enough.

I’m currently looking for real life cases to include in my pitch document and was wondering whether you might be able to recommend people I could speak to, or places I could contact to find individuals who are currently thinking about a reverse sex change. Any help would be really appreciated.”

At Action for Trans Health, we are incredibly concerned about the motives of such a documentary, and the effect it could have on the lives and health of trans people. Despite the disproportionate representation that people who regret transitioning receive in the press, the recent Trans Mental Health Study, the largest study of its kind ever undertaken in Europe, with almost 900 respondents, asked specifically about individuals’ feelings of regret following social and/or medical transition. These are the results:

  •  In terms of social changes made during transition (coming out to friends and family, changing name, living full or part time in a gender not assigned at birth), 34% of respondents had minimal regrets and 9% had significant regrets. A small majority, 53% had no regrets.
  •  Specific regrets given included: not having the body they had wanted from birth, not transitioning earlier, losing friends and family, and the impact of transition on others.
  •  In terms of physical changes made during transition (resulting from hormone therapy and surgical interventions), the vast majority, 86%, had no regrets. Of the remainder, 10% had minor regrets and 2% had major regrets.
  •  The specific regrets given include complications relating to surgery (especially loss of sensitivity), and the choice of surgeon (if surgery resulted in complications or required revisions and repairs).

In other words, the findings indicated that transition regret tends to be related to social stigma, poor surgical quality and results, and loss of family and peer support, rather than regret around ever having transitioned in the first place. It demonstrates that while someone’s dysphoria may be relieved by transitioning, the pressures of living in a transphobic society are not. This is important, as it indicates that regret is related to the same stigmatisation, othering, and ignorance that is perpetuated by the disproportionate and negative media focus on those who detransition – it indicates that documentaries such as this have an ill effect on the health and wellbeing of trans people.

Juliet Jaques writing on transition regret for The Guardian, writes:

 ‘Personally, I’ve not known anyone to detransition: this is not to deny that there are people who genuinely regret transition and particularly surgery purely because they’ve ended up with a body that wasn’t right for them, but instances do seem rare – partly because the pathway allows people to opt out at any point, and some remain on hormones before surgery for much longer than strictly necessary whilst they consider their options.’

Juliet makes a good point. Gender Identity Clinics require you to undergo at least one year of RLE, or Real Life Experience, during which you live full time as the gender you identify as before they will even consider HRT or medical treatment of any kind. Many trans people find themselves forced to undergo two years of RLE, just in case, and this can stretch out a lot longer if the person in question is non-binary, or is not suitably gender-conforming, or has a disability, or mental illness, or does not conform to the white western imperialist model of the gender binary. RLE itself is the topic of a future blog post, but it ensures that the process before any treatment of dysphoria can take place is long and drawn out, often to the detriment of the health and physical safety of trans people trying to access healthcare.

The idea of detransition and regret also ignores the reality that for many people detransitioning is instead retransitioning – a person may discover that their gender identity changes over time, or a person who assumed that they were a trans man or a trans woman may discover that they are non-binary and wish to have a body that reflects this, or someone’s gender identity may not change at all, but they may wish to undergo further HRT or surgery to alleviate subsequent dysphoria, and all of these things are fine. The reduction of the infinite ways to be trans down to ‘sex changes’ and ‘reverse sex changes’ obscures the fact that actually, all trans people are entitled to all the treatment they need, all the time. Just like everybody else.

In her excellent open letter responding to Sundog, Ruth draws attention to the fact that Sundog use the terms ‘sex change’ and ‘reverse sex change’, which, as well as being loaded terms rarely seen in use outside the right wing press, are inaccurate, meaningless and othering. Furthermore, she points out that projects such as Trans Media Watch and All About Trans, which exist to improve the media representation of trans people, both offer clear guidance on how to respectfully talk about trans people, which Sundog could have discovered with a five minute google search.

There are a lot of important stories to tell about trans healthcare. The majority of them revolve around outdated, pathologising medical practices, unnecessary gatekeeping, ableism, racism, sexism, and transphobia. Some of them are about detransitioning or retransitioning, and yes, those stories are important, and the people who live them have experiences that are important and valid. But seeking to weaponise those stories, to ‘look at the way in which transgender individuals are treated in society and whether the process before someone is permitted an operation is robust enough’, is an act that is harmful to trans people and could be, nay, will be used to make healthcare even more difficult for us to access. And regardless of how ‘respectful and sensitive’ Sundog claim they want their documentary to be, courting a cheap bit of controversy for Channel 4 at the expense of trans people’s right to healthcare is neither respectful, nor sensitive. It’s dangerous.

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Yesterday Jess Bradley from Action for Trans Health attended “The future of LGBT ageing: Rethinking research directions” at The University of Manchester, and helped run a session on trans ageing. This article briefly discusses some of the issues that older trans people face and suggests some area for future research which has been identified by Action for Trans Health alongside suggestions which arose from discussion at the event.

Trans people face discrimination across all areas of life, which means that when compared to our cis peers, we often have less robust support networks, higher instances of mental and physical health problems, and may experience loneliness.  This is particularly a problem for older people, who may feel excluded from youth orientated LGBT spaces as well excluded from cisnormative older people’s groups . Beyond these more general issues, we have identified three main areas of interest; being trans in a care environment, healthcare issues in later life, and transition whilst being older.

Accessing care:

  • Trans people often delay seeking care due to a general distrust of the medical establishment and a perception of the institutional environment as being transphobic. This is compounded when considering that trans people in general have less financial access to high-quality care due to discrimination in employment and the costs of transition related care (when not NHS funded). However, delaying accessing care can have a negative impact on mental and physical health as well as a strain on social relations.
  • Few care providers have the necessary training to be able to cater to trans specific needs in a non-discriminatory environment. As such, trans people are often forced to educate care providers or clinicians themselves on basic trans etiquette such as not asking intrusive/irrelevant questions, not getting flustered when peoples’ bodies don’t necessarily match with gendered assumptions, and keeping patients confidentiality.
  • Trans people face higher level of domestic and personal abuse than their cis peers. This abuse can come from family, friends, or from staff in a care / clinical environment. Care workers may need to navigate very complex social situations where abusive situations may appear.

Healthcare in later life:

  •  It is now possible for trans people to change their gender markers on their NHS records when they get legal recognition of their gender. However, this means that trans people are often not automatically invited to attend some screenings (eg. prostate, cervical, and breast cancer screens) in later life which may be medically relevant to them.
  • Very little is known about the long term effect of hormone therapy on trans patients. Particular areas of concern include how hormone therapy might alter bone density or may result in blood problems later in life.
  • Very little research has been done into how hormone doses should change as patients get older, and how hormone treatments interact with various other drugs (which may be increasingly important as a person ages as they are likely to take more medications).
  • Trans people have an increased likelihood of experiencing particular health complaints depending on what medical interventions they have had. A trans-feminine person who has had bottom surgery is at increased risk of rectovaginal fistula and urinary tract infections, and a trans-masculine person on hormone therapy has increased risk of liver problems and diabetes.

Transitioning in later life

  • Many trans people may choose to wait until later in life, after family and work commitments are less pressing, to undergo any transition related healthcare. However, often older people often have more entrenched social roles and so making these changes can sometimes be more complex at this time.
  • Older people may have increased health issues, ie. heart disease or high blood pressure, which can make transition related medical interventions riskier.

Research Directions

Key areas for action may include:

  •  Longitudinal / cohort studies on the long term effects of hormone treatment on trans patients.
  • Research into the interaction between hormone therapy treatments and other medications.
  • Studies to identify effective training on the needs of trans patients for carers and clinicians.
  • Research into the effect of dementia and similar conditions on gender identity.
  • Studies on how best clinicians can best support lay carers of older trans people
  • Investigating the inclusion of a question of trans identity on large surveys conducted by the Office of National Statistics so that researchers are better placed to utilise large studies to in their work. How would this question(s) be worded, and how can people encourage accurate self-reporting?

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Action for Trans Health trustee Loz Webb talks about #transdocfail and how we are helping GIRES with developing a non-binary protocol for GICs. The first step for this is collecting data on non-binary experiences. You can help us out by completing this short survey.

I wish I could tell you that my initial feeling upon reading the transdocfail hashtag was surprise. But I can’t. As a young trans person, a non-binary trans person, as a trans person who has accessed (or sometimes tried and failed to access) mental health services, I can’t lie to you; I was not surprised. I think what I felt most overwhelmingly, was relief.

Now, that might sound like a strange thing to feel. But in the transdocfail hashtag, I saw more than a legacy of failure and of brutal injustice. I saw a glimmer of hope. Finally, this conversation was happening. And it wasn’t happening in a dimly lit bedroom, or in someone’s living room after dark, when we could be sure that the prying ears of the medical institution and the cis people who support it were far away while we were locked in safe. For so long, these conversations have happened in secret because we are afraid. Because we rely on these doctors for the lifesaving treatment that we need, and we rely on them because in a world where we are stuck between the rock of pathologising, fetishizing and sometimes outright violent doctors, and the hard place of mass unemployment, family estrangement and structural poverty, we have no other option. And crucially, they know it.

This means that it becomes incredibly difficult to be an active participant in your own treatment, as suggestions, queries or criticisms are often met with the removal of treatment as punishment:  

  • Charing Cross GIC told my psych that I was suicidal as revenge, after they discovered a negative blog post I wrote about them.#TransDocFail 
  • I am terrified of talking about my experiences because I am afraid of having treatment withdrawn by the GIC.#TransDocFail

Despite the fact that it is clear that the majority of psychiatrists understand very little about trans people and gender dysphoria:

  • My psychiatrist initially refused to refer me cos “most people regret transitioning” #TransDocFail

Or perhaps they simply enjoy torturing us, safe in the knowledge that they can bully us as much as they like, because we still need them on-side:

  •  NHS Psych told me I wanted to transition to male cos I was too ugly to live as a woman. Also told me I’d never pass as male #TransDocFail
  • Psych invented name to call me because I wouldn’t tell him my birth assigned name #TransDocFail

Most GPs have no idea what to do when presented with a trans patient, and instead of listening to the patient or spending time researching, they decide to make things up based on their own values and moral judgements:

  • The first GP I told later told me he could no longer treat me because I was trans; he later shredded my notes #TransDocFail       
  •  GP thought depression was ‘normal’ given my being trans & thus ADs pointless. Even though they alleviate the depression.#TransDocFail

GPs also have a history of deciding simply not to refer their patients to a GIC for no apparent reason:

  •  My GP repeatedly told me she’d referred me when she hadn’t. Took 11 months from asking to be referred to being referred.#TransDocFail 
  • First GIC appointment next week, first went to GP for help 44 months ago.#TransDocFail

Emergency services seem to regard trans people’s lives as lives not worth saving:

  •  Denied care for a heart condition because “I have all this gender stuff going on so it was probably in my head”#TransDocFail
  •  I rang NHS Direct to get help for partner. NHS Direct doctor spoke to them and told them to leave me as I was an “abomination” #TransDocFail

And trans people have a history of being refused treatment by experts in the field simply for not conforming to outdated, sexist stereotypes:

  •  Was refused transition treatment for being lesbian, riding motorcycles, and not wearing skirts and heels to appointments.#TransDocFail

 I will not detail any examples here, but it is important to make mention of the fact that many people reported sexual assault, including non-consensual and unnecessary genital examinations and groping of the chest or breasts, at the hands of GPs and GIC doctors.

Not surprising then, that we are incredibly reticent to make complaint when we receive any kind of medical care at all; the consequences are all too clear and incredibly frightening.

But #TransDocFail gave us the opportunity to have this conversation in public. Suddenly all these stories were being told, and more importantly, being heard. After one came another and another, no power on this earth could have stopped the flood. Years of frustration at mistreatment, assault and administrative violence came pouring out and as time passed it became clear that these stories were not ‘one offs’ which could be shrugged off as an individual doctors ignorance or misinformation. What was being revealed was a legacy of structural violence.

As a non-binary trans person, I’ve had to make the decision between getting the lifesaving treatment that I need and being open about the person I am. That is a conflict in me that has not settled, and perhaps will never settle, because I spent 24 years trying to be someone I wasn’t and running away from the person I am, and it is difficult now to sit down in a room and lie, and omit, and tell the story I know that I’m meant to tell when I can’t help but feel in my soul that I’m not being fair to myself, that I’m selling myself out, that I’ve gone through so much to know myself better than this. I have to remind myself over and over that I don’t owe authenticity to those who would weaponise it, and that I don’t need a panel of people to meet in order to know what to do with my own body. But it’s hard, because in the last few years I’ve grown accustomed to being honest with myself and it’s not something that I relish giving up. I feel like I’m sacrificing my history to buy myself a future, and I don’t think that’s right. I don’t think that’s good enough.

The Equality Network in Scotland commissioned research into how the process of transitioning impacts on the mental health and wellbeing of trans people, in which they found (I would suggest unsurprisingly) that 70% of respondents were more satisfied with their lives after transitioning, while 2% were less satisfied. Somewhat at odds with the claim that ‘most people regret transitioning’. NUS LGBT recently commissioned research into the experiences of LGBT university students, and found that 1 in 3 trans students have experienced bullying or harassment on campus, and that half of trans students have seriously considered dropping out of university. Of those who had considered dropping out, around two thirds mentioned health problems and ‘not fitting in’. The report discusses the psychological consequences of harassment, indicating that trans and homophobic bullying and harassment have long-term consequences for LGBT people. In other words, trans students are more likely to need to access mental health services as a result of the harassment they face in academic institutions. But paradoxically, these services are clearly shown to replicate the exact same bullying and harassment that trans students face at university.

The fact of the matter is, trans healthcare is in crisis, and it has been for a long time. The intervention of banks exorcising their morality in the recent furore around inhousepharmacy, seven year NHS waiting lists, mistreatment by doctors, and the refusal to treat non-binary people is forcing trans people to go private and to choose medical treatment over the weekly shop. I want to rephrase that. Trans people are being forced to choose between their right to medical care and their right to eat.

This is not acceptable.

Action for Trans Health have teamed up with GIRES to research the experiences of non-binary people who have tried to access transition related healthcare. This research will be used to develop a non-binary protocol that will be used by gender identity clinics to enable them to provide life saving treatment to non-binary trans people. The more responses we get, the more we can improve transitioning for non-binary people, and the closer we get to putting trans healthcare back where it belongs: in the hands of trans people.

So please, help us share this survey far and wide, because medical care is our right and non-binary people need you to fight alongside us right now.

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An overworked, underpaid, and demoralised health sector cannot work best for all patients, including trans patients. The Coalition Government’s attacks on NHS workers are just one part of a wider plan to weaken and sell off parts of this service which, although not perfect, is an essential service. And as the recent film Pride has shown, it is through common struggle that the bonds of solidarity are forged; when doctors, nurses and other NHS workers see trans and queer people supporting their cause, they are going to be more amenable to supporting ours. For those reasons, Action for Trans Health are calling on trans and queer activists to support the public health sector strikes that are happening week commencing 13th October.

The strike: 

Nine unions representing NHS workers are out on strike for the first time in 32 years in protest over pay and conditions. For some unions, like the Royal College of Midwives, it will be their first strike in their 132 year history. There will be a 4 hour strike from 7am – 11am on Monday 13th October, followed by 4 days of action where NHS workers actually take the breaks that are legally entitled to them. The week of action will be rounded off with a TUC organised rally in London on the 18th October.

What you can do: 

Pop down to your local picket on Monday 13th 7am – 11am to join striking workers in solidarity. Bring baked goods and hot coffee, maybe signs saying something like “Trans people support the strike” or similar. Chat to striking workers and use this opportunity to talk about health sector pay and conditions, and to talk to them about Action for Trans Health or other trans healthcare activism. More information about where local pickets will be will be posted as that information becomes available.

Join the TUC rally in London on the 18th October. The TUC are arranging travel from all areas of the country, see their website tuc.org.uk and search for your local area for more details.

Change your profile pictures, avatars, etc. to a selfie of yourself with a sign saying “trans people support the strike” / or similar. Tweet, tumblr, and use facebook to raise awareness of the strike.

If you do show your support for striking NHS workers, please let us know how. Send us your photos of you on pickets, with signs, or at the rally to info@actionfortranshealth.org.uk

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Have you had a bad experience with your GP? Do you want to check out whether anyone has made complaints to us about your GP in the past?

Action for Trans* Health are producing a “shitlist” of GPs to avoid for trans* people to avoid. If you have had a bad experience with your GP that compromised your ability to seek healthcare advice and treatment, please let us know through completing this short survey.

How will we use your information? 

The name and contact details of your GP, along with your description of what happened and the dates on which incidents occurred will be stored on our system. For legal reasons (we don’t want to get sued) these will not be published on the internet. If you want us to take further action regarding the incident (ie. offer training to the GP, support you in making a complaint, organising protests, etc.)  please provide us with your contact details and we will do our best to help you. We aim to check the list once a week for updates. All your contact details will be kept confidential.

How to find out if my GP / potential GP is on the list 

Unlike our list of member-recommended GPs, we cannot publish our GP shitlist on the internet for legal reasons. However, if you want to check to see if your GP or potential GP is on the list, and how they have responded to any interventions on our part, please email info[at]actionfortranshealth.org.uk.