As the #transdocfail hashtag showed, many trans people are afraid of their doctors

Trans patients should not have to please medical staff before they can access treatment, writes Charlie Hallam.

There are a group of people in the UK who experience horrific abuse at the hands of people who are ostensibly responsible for their care. You might think that after the horrific revelations of the last few months that I am referring to children who are abused by those charged with caring for them, but no. I’m talking about trans* people. If you are a trans* person, not only are you required to live and behave a certain way to access treatment, but the situation is compounded by the fact that many trans* people are reliant for life saving treatment on the very doctors who perpetrate this abuse. They are prevented from speaking out to try and improve the system through the fear that if they are honest, they will forever be denied the treatment they need.

In most areas of medicine, the first stage when you identify that something is wrong is to visit your GP, discuss the problem, work out if treatment is necessary and then discuss with your doctor about what that treatment should be. From the stories shared on yesterday’s twitter hashtag #transdocfail, and from the stories I’ve heard from my partner and trans* friends, doing this with gender dysphoria would be the single worst thing to do.

Trans* people are scared of their doctors.

My partner came out and transitioned socially last spring, and our circle of friends includes a number of trans* people, some trans men, some trans women and at least one person who considers hirself agender. We know people who have finished the process of medical transition, people who are the middle of the process, and people who have transitioned and are receiving continuing care.

Bad experiences with GPs at the start of the process and experiencing difficulties in obtaining a referral to specialist services were a common theme on yesterday’s hashtag. Many people reported being dismissed in various ways at their first appointment, one being laughed out of the office, and another told, I'm not going to refer you (to GIC) because I don't believe in all that". In the last few months, I have myself heard an obviously female patient called up with what was clearly their male, pre-transition, name. Despite these obvious and apparently simple to fix problems, so many trans* stories about doctor’s failing patients end with the line, ‘but I daren’t say anything in case the clinic find out, object and decide that I’m not eligible for care.’

Half way through yesterday afternoon, I noticed a new presence on the hashtag – an anonymous account, @TransDocFailAno, where trans* people could submit their experiences via a tumblr to avoid having to out themselves to do so. Indeed, the only reason I am writing this article rather than any of the trans* people I know is that none of them are willing to do so. I checked.

One of the most difficult hoops to jump through is that of needing to spend a year living as the gender you wish to transition to before you are able to access any treatment at all. This is fraught with problems. Most people choose to start their year of ‘real life experience’ when they move from one setting to another in order to minimise the chances of someone using their old name or pronoun, but this isn’t possible for everyone. One of the things trans* people often prepare themselves for when starting to transition is the possibility of losing everything they’ve worked for so far, and stories abound of trans people losing partners, children, jobs, homes and lives as a result of social transition. However, the NHS still treat social transition as reversible, and a necessary prerequisite for the apparently irreversible hormone therapy to help trans* people pass as their proper gender.

I could go on for pages about the problems faced by trans* people accessing treatment, but at the core are two main problems. The first is the fact that gender is seen always and exclusively as a binary. It is assumed that if you were assigned male at birth and are not male, that in asking for any form of treatment you are asking the medical staff to make you as close to their idea of cis female as possible. For some people that’s what they need, but for others their gender identity doesn’t resemble what their doctors think of as correct, and the pressure that can be laid on them to conform to what is expected can be immense, and treatment that they need to eliminate their dysphoria can be denied because, for example, a trans woman would like to have a pixie cut, yet their doctor believes that all women should have long hair in order to present as properly female. There are a significant number of people who feel that their gender doesn’t fit neatly into either male or female, and would like medical help to change their presentation to more accurately fit their gender. At the moment, it seems that the only option available for these people is to lie, as if they tell their doctors the truth, it may be taken as evidence that they are not serious about transitioning, and they could forever lose the chance to access the medical care they need to cure their dysphoria.

The second problem is that so much of the process seems to serve the sole purpose of stopping you from making ‘a hideous mistake’. The process is lengthened by multiple appointments with psychiatrists and therapists whose role is to assess the mental health and sanity of those seeking treatment. Tweets yesterday on the @TransDocFailAno account and the #transdocfail hashtag made it clear that, for many medical professionals, depression and other mental health problems were considered to be barriers to treatment that in some cases were used as excuses to delay treatment for dysphoria, and in other cases only the dysphoria was treated and other mental health problems ignored. Mental health issues blocking treatment for dysphoria is dangerous when dysphoria creates those mental health issues, and depression is immensely common in trans* people.

As someone who writes regularly on the subject and is openly trans*, the Lib Dem councillor for Cambridge, Sarah Brown says, “The media are typically invested in presenting a rigid narrative about how trans people interact with medicine. The stories trans people would like to tell, stories of outrageous levels of systemic abuse and transphobia, don't fit this narrative and so go ignored and unreported. Social media is changing this. The stories trans people have to tell are reaching people who seldom hear them, and people are often appalled by what they hear. We can't even begin to tackle widespread medical abuse of trans people until there is wider awareness of just how bad it is.”

Reading this one sided article, one could be forgiven for thinking that all trans* people are on a one way road to misery and that transitioning is not worth it. I urge you, if you are worried about this, to check out the We Happy Trans project. Trans* people consider transitioning well worth doing it because in some cases the alternative is suicide. Just because the system is not yet perfect, it does not mean that trans* people should not seek treatment they think will improve their lives.

A hair cut should not lead to medical treatment being denied. Photograph: untitled by . ally/flickr. CC-BY

Fearless in the face of yarn, yet terrified of spiders, Charlie Hallam is a Sheffield blogger and activist. She can be found waffling about politics and yarn as @fearlessknits on Twitter.

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MP Michelle Thomson's full speech on rape at 14: "I am a survivor"

The MP was attacked as a teenager. 

On Thursday, the independent MP for Edinburgh West Michelle Thomson used a debate marking the UN’s International Day for the Elimination of Violence against Women to describe her own experience of rape. Thomson, 51, said she wanted to break the taboo among her generation about speaking about the subject.

MPs listening were visibly moved by the speech, and afterwards Thomson tweeted she was "overwhelmed" by the response. 

Here is her speech in full:

I am going to relay an event that happened to me many years ago. I want to give a very personal perspective to help people, both in this place and outside, understand one element of sexual violence against women.

When I was 14, I was raped. As is common, it was by somebody who was known to me. He had offered to walk me home from a youth event. In those days, everybody walked everywhere - it was quite common. It was early evening. It was not dark. I was wearing— I am imagining and guessing—jeans and a sweatshirt. I knew my way around where I lived - I was very comfortable - and we went a slightly differently way, but I did not think anything of it. He told me that he wanted to show me something in a wooded area. At that point, I must admit that I was alarmed. I did have a warning bell, but I overrode that warning bell because I knew him and, therefore, there was a level of trust in place. To be honest, looking back at that point, I do not think I knew what rape was. It was not something that was talked about. My mother never talked to me about it, and I did not hear other girls or women talking about it.

It was mercifully quick and I remember first of all feeling surprise, then fear, then horror as I realised that I quite simply could not escape, because obviously he was stronger than me. There was no sense, even initially, of any sexual desire from him, which, looking back again, I suppose I find odd. My senses were absolutely numbed, and thinking about it now, 37 years later, I cannot remember hearing anything when I replay it in my mind. As a former professional musician who is very auditory, I find that quite telling. I now understand that your subconscious brain—not your conscious brain—decides on your behalf how you should respond: whether you take flight, whether you fight or whether you freeze. And I froze, I must be honest.

Afterwards I walked home alone. I was crying, I was cold and I was shivering. I now realise, of course, that that was the shock response. I did not tell my mother. I did not tell my father. I did not tell my friends. And I did not tell the police. I bottled it all up inside me. I hoped briefly—and appallingly—that I might be pregnant so that that would force a situation to help me control it. Of course, without support, the capacity and resources that I had within me to process it were very limited.

I was very ashamed. I was ashamed that I had “allowed this to happen to me”. I had a whole range of internal conversations: “I should have known. Why did I go that way? Why did I walk home with him? Why didn’t I understand the danger? I deserved it because I was too this, too that.” I felt that I was spoiled and impure, and I really felt revulsion towards myself.

Of course, I detached from the child that I had been up until then. Although in reality, at the age of 14, that was probably the start of my sexual awakening, at that time, remembering back, sex was “something that men did to women”, and perhaps this incident reinforced that early belief.​
I briefly sought favour elsewhere and I now understand that even a brief period of hypersexuality is about trying to make sense of an incident and reframing the most intimate of acts. My oldest friends, with whom I am still friends, must have sensed a change in me, but because I never told them they did not know of the cause. I allowed myself to drift away from them for quite a few years. Indeed, I found myself taking time off school and staying at home on my own, listening to music and reading and so on.

I did have a boyfriend in the later years of school and he was very supportive when I told him about it, but I could not make sense of my response - and it is my response that gives weight to the event. I carried that guilt, anger, fear, sadness and bitterness for years.

When I got married 12 years later, I felt that I had a duty tell my husband. I wanted him to understand why there was this swaddled kernel of extreme emotion at the very heart of me, which I knew he could sense. But for many years I simply could not say the words without crying—I could not say the words. It was only in my mid-40s that I took some steps to go and get help.

It had a huge effect on me and it fundamentally - and fatally - undermined my self-esteem, my confidence and my sense of self-worth. Despite this, I am blessed in my life: I have been happily married for 25 years. But if this was the effect of one small, albeit significant, event in my life stage, how must it be for those women who are carrying it on a day-by-day basis?

I thought carefully about whether I should speak about this today, and it was people’s intake of breath and the comment, “What? You’re going to talk about this?”, that motivated me to do it, because there is still a taboo about sharing this kind of information. Certainly for people of my generation, it is truly shocking to talk in public about this sort of thing.

As has been said, rape does not just affect the woman; it affects the family as well. Before my mother died early of cancer, I really wanted to tell her, but I could not bring myself to do it. I have a daughter and if something happened to her and she could not share it with me, I would be appalled. It was possibly cowardly, but it was an act of love that meant that I protected my mother.

As an adult, of course I now know that rape is not about sex at all - it is all about power and control, and it is a crime of violence. I still pick up on when the myths of rape are perpetuated form a male perspective: “Surely you could have fought him off. Did you scream loudly enough?” And the suggestion by some men that a woman is giving subtle hints or is making it up is outrageous. Those assumptions put the woman at the heart of cause, when she should be at the heart of effect. A rape happens when a man makes a decision to hurt someone he feels he can control. Rapes happen because of the rapist, not because of the victim.

We women in our society have to stand up for each other. We have to be courageous. We have to call things out and say where things are wrong. We have to support and nurture our sisters as we do with our sons. Like many women of my age, I have on occasion encountered other aggressive actions towards me, both in business and in politics. But one thing that I realise now is that I am not scared and he was. I am not scared. I am not a victim. I am a survivor.

Julia Rampen is the editor of The Staggers, The New Statesman's online rolling politics blog. She was previously deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.