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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Article 50 deadline: Nick Clegg urges Remainers to "defy Brexit bullies and speak up"

The former deputy Prime Minister argued Brexiteers were trying to silence the 48 per cent. 

On Wednesday 29 March, at 12.30pm, Britain's ambassador to the EU, Tim Barrow, will hand deliver a letter to the European Council President, Donald Tusk. On that sheet of paper will be the words triggering Article 50. Nine months after Britain voted for Brexit, it will formally begin the process of leaving the EU.

For grieving Remainers, the delivery of the letter abruptly marks the end of the denial stage. But what happens next?

Speaking at an Open Britain event, former Deputy Prime Minister and Lib Dem Leader Nick Clegg had an answer. Responding to the concerns of a scientist in the audience, he declared:

“The most important thing of all is people like you make your voice heard. What the hysterical aggression from the Brexiteers means is they want to silence you.

"That’s why they attack everyone. The Bank of England - how dare you speak about the British economy? How dare judges make a judgement? How dare Remainers still believe they want to be part of the EU? 

"What they systematically try to do is bully and delegitimise anyone who disagrees with their narrow world view.

"It’s a ludicrous thing when 16.1m people - that’s more than have ever voted for a party in a general election - voted for a different future, when 70 per cent of youngsters have voted for a different future.

"It is astonishing these people, how they give themselves the right to say: 'You have no voice, how dare you stick to your views how dare you stick to your dreams and aspirations?'

That’s the most important thing of all. You don’t get bored, you don’t get miserable, you don’t glum, you continue to speak up. What they hope is you’ll just go home, the most important thing is people continue to speak up."

He urged those affected by Brexit to lobby their MPs, and force them to raise the issue in Parliament. 

After Article 50 is triggered, the UK positioning is over, and the EU negotiators will set out their response. As well as the official negotiating team, MEPs and leaders of EU27 countries are likely to give their views - and with elections scheduled in France and Germany, some will be responding to the pressures of domestic politics first. 

For those Remainers who feel politically homeless, there are several groups that have sprung up to campaign against a hard Brexit:

Open Britain is in many ways the successor to the Remain campaign, with a cross-party group of MPs and a focus on retaining access to the single market and holding the government to account. 

Another Europe is Possible was the alternative, left-wing Remain campaign. It continues to organise protests and events.

March for Europe is a cross-Europe Facebook community which also organises events.

The People's Challenge was a crowd-funded campaign which, alongside the more famous Gina Miller, successfully challenged the government in court and forced it to give Parliament a vote on triggering Article 50.

The3million is a pressure group set up to represent EU citizens in the UK.

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.