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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Something is missing from the Brexit debate

Inside Westminster, few seem to have noticed or care about the biggest question mark in the Brexit talks. 

What do we know about the government’s Brexit strategy that we didn’t before? Not much, to be honest.

Theresa May has now said explicitly what her red lines on European law and free movement of labour said implicitly: that Britain is leaving the single market. She hasn’t ruled out continuing payments from Britain to Brussels, but she has said that they won’t be “vast”. (Much of the detail of Britain’s final arrangement is going to depend on what exactly “vast” means.)  We know that security co-operation will, as expected, continue after Brexit.

What is new? It’s Theresa May’s threat to the EU27 that Britain will walk away from a bad deal and exit without one that dominates the British newspapers.

“It's May Way or the Highway” quips City AM“No deal is better than a bad deal” is the Telegraph’s splash, “Give us a deal… or we walk” is the Mirror’s. The Guardian opts for “May’s Brexit threat to Europe”,  and “May to EU: give us fair deal or you’ll be crushed” is the Times’ splash.

The Mail decides to turn the jingoism up to 11 with “Steel of the new Iron Lady” and a cartoon of Theresa May on the white cliffs of Dover stamping on an EU flag. No, really.  The FT goes for the more sedate approach: “May eases Brexit fears but warns UK will walk away from 'bad deal’” is their splash.

There’s a lot to unpack here. The government is coming under fire for David Davis’ remark that even if Parliament rejects the Brexit deal, we will leave anyway. But as far as the Article 50 process is concerned, that is how it works. You either take the deal that emerges from the Article 50 process or have a disorderly exit. There is no process within exiting the European Union for a do-over.  

The government’s threat to Brussels makes sense from a negotiating perspective. It helps the United Kingdom get a better deal if the EU is convinced that the government is willing to suffer damage if the deal isn’t to its liking. But the risk is that the damage is seen as so asymmetric – and while the direct risk for the EU27 is bad, the knock-on effects for the UK are worse – that the threat looks like a bad bluff. Although European leaders have welcomed the greater clarity, Michel Barnier, the lead negotiator, has reiterated that their order of priority is to settle the terms of divorce first, agree a transition and move to a wider deal after that, rather than the trade deal with a phased transition that May favours.

That the frontpage of the Irish edition of the Daily Mail says “May is wrong, any deal is better than no deal” should give you an idea of how far the “do what I want or I shoot myself” approach is going to take the UK with the EU27. Even a centre-right newspaper in Britain's closest ally isn't buying that Britain will really walk away from a bad deal. 

Speaking of the Irish papers, there’s a big element to yesterday’s speech that has eluded the British ones: May’s de facto abandonment of the customs union and what that means for the border between the North and the South. “May’s speech indicates Border customs controls likely to return” is the Irish Times’ splash, “Brexit open border plan “an illusion”” is the Irish Independent’s, while “Fears for jobs as ‘hard Brexit’ looms” is the Irish Examiner’s.

There is widespread agreement in Westminster, on both sides of the Irish border and in the European Union that no-one wants a return to the borders of the past. The appetite to find a solution is high on all sides. But as one diplomat reflected to me recently, just because everyone wants to find a solution, doesn’t mean there is one to be found. 

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to British politics.