#transdocfail: moving forward with a new non-binary protocol

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  • I am terrified of talking about my experiences because I am afraid of having treatment withdrawn by the GIC.#TransDocFail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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