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.

Show Hide image

Let's seize our chance of a progressive alliance in Richmond - or we'll all be losers

Labour MPs have been brave to talk about standing aside. 

Earlier this week something quite remarkable happened. Three Labour MPs, from across the party’s political spectrum, came together to urge their party to consider not fielding a candidate in the Richmond Park by-election. In the face of a powerful central party machine, it was extremely brave of them to do what was, until very recently, almost unthinkable: suggest that people vote for a party that wasn’t their own.
Just after the piece from Lisa Nandy, Clive Lewis and Jonathan Reynolds was published, I headed down to the Richmond Park constituency to meet local Green members. It felt like a big moment – an opportunity to be part of something truly ground-breaking – and we had a healthy discussion about the options on the table. Rightly, the decision about whether to stand in elections is always down to local parties, and ultimately the sense from the local members present was that it would be difficult  not to field a candidate unless Labour did the same. Sadly, even as we spoke, the Labour party hierarchy was busily pouring cold water on the idea of working together to beat the Conservatives. The old politics dies hard - and it will not die unless and until all parties are prepared to balance local priorities with the bigger picture.
A pact of any kind would not simply be about some parties standing down or aside. It would be about us all, collectively, standing together and stepping forward in a united bid to be better than what is currently on offer. And it would be a chance to show that building trust now, not just banking it for the future, can cement a better deal for local residents. There could be reciprocal commitments for local elections, for example, creating further opportunities for progressive voices to come to the fore.
While we’ve been debating the merits of this progressive pact in public, the Conservatives and Ukip have, quietly, formed an alliance of their own around Zac Goldsmith. In this regressive alliance, the right is rallying around a candidate who voted to pull Britain out of Europe against the wishes of his constituency, a man who shocked many by running a divisive and nasty campaign to be mayor of London. There’s a sad irony in the fact it’s the voices of division that are proving so effective at advancing their shared goals, while proponents of co-operation cannot get off the starting line.
Leadership is as much about listening as anything else. What I heard on Wednesday was a local party that is passionate about talking to people and sharing what the Greens have to offer. They are proud members of our party for a reason – because they know we stand for something unique, and they have high hopes of winning local elections in the area.  No doubt the leaders of the other progressive parties are hearing the same.
Forming a progressive alliance would be the start of something big. At the core of any such agreement must be a commitment to electoral reform - and breaking open politics for good. No longer could parties choose to listen only to a handful of swing voters in key constituencies, to the exclusion of everyone else. Not many people enjoy talking about the voting system – for most, it’s boring – but as people increasingly clamour for more power in their hands, this could really have been a moment to seize.
Time is running out to select a genuine "unity" candidate through an open primary process. I admit that the most likely alternative - uniting behind a Liberal Democrat candidate in Richmond Park - doesn’t sit easily with me, especially after their role in the vindictive Coalition government.  But politics is about making difficult choices at the right moment, and this is one I wanted to actively explore, because the situation we’re in is just so dire. There is a difference between the Conservatives and the Lib Dems. Failing to realise that plays into the hands of Theresa May more than anyone else.
And, to be frank, I'm deeply worried. Just look at one very specific, very local issue and you’ll perhaps understand where I'm coming from. It’s the state of the NHS in Brighton and Hove – it’s a system that’s been so cut up by marketisation and so woefully underfunded that it’s at breaking point. Our hospital is in special measures, six GP surgeries have shut down and private firms have been operating ambulances without a license. Just imagine what that health service will look like in ten years, with a Conservative party still in charge after beating a divided left at another general election.
And then there is Brexit. We’re hurtling down a very dangerous road – which could see us out of the EU, with closed borders and an economy in tatters. It’s my belief that a vote for a non-Brexiteer in Richmond Park would be a hammer blow to Conservatives at a time when they’re trying to remould the country in their own image after a narrow win for the Leave side in the referendum.
The Green party will fight a passionate and organised campaign in Richmond Park – I was blown away by the commitment of members, and I know they’ll be hitting the ground running this weekend. On the ballot on 1 December there will only be one party saying no to new runways, rejecting nuclear weapons and nuclear power and proposing a radical overhaul of our politics and democracy. I’ll go to the constituency to campaign because we are a fundamentally unique party – saying things that others refuse to say – but I won’t pretend that I don’t wish we could have done things differently.

I believe that moments like this don’t come along very often – but they require the will of all parties involved to realise their potential. Ultimately, until other leaders of progressive parties face the electoral facts, we are all losers, no matter who wins in Richmond Park.


Caroline Lucas is the MP for Brighton Pavilion.