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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What has happened to the Liberal Democrats?

As Brexit nears, Vince Cable is struggling – but his is a poisoned inheritance.

During the coalition years, Iain Duncan Smith came up with a plan: if unemployed people went on a demonstration, and the police stopped them for any reason, the officer should pass their names on to the Department for Work and Pensions, which could then freeze their benefits. After all, the minister’s reasoning went, if you had time to protest, you weren’t actively seeking work.

This was just one of the many David Cameron-era Tory proposals that the Liberal Democrats quashed before it ever saw the light of day. Every Lib Dem who worked in the coalition, whether as a minister or a special adviser, has a horror story about a policy they stopped or watered down – and usually the papers to prove it, too.

And so from time to time, Vince Cable’s team needs to respond to a news story by plundering their archives for anti-Tory material. A month or so ago, a former Lib Dem staffer got a phone call from the party’s press operation: could someone answer some questions about their time in government? To which the ex-staffer said: OK, but since you’re calling on a withheld number, you’ll need to get someone to vouch for you.

Perhaps, the former staffer suggested, Phil Reilly, the Lib Dems’ communications chief and a veteran of the party machine, was around? No, came the answer, he has moved on. What about Sam Barratt? Out at a meeting. Was Paul Haydon there? No. Haydon – who worked for the party’s last member of the European parliament, Catherine Bearder, before joining the press office – had moved on, too. After a while, this ex-staffer gave up and put the phone down.

The really troubling thing about this story is that I have heard it three times from three former Liberal Democrat aides. The names change, of course, but the point of the story – that the party machine has been stripped of much of its institutional memory – stays the same. The culprit, according to the staffers who have spoken to me, is Vince Cable. And the exodus is not just from the press office: the party’s chief executive, Tim Gordon, is among the heavyweights to have departed since the 2017 election.

Is this fair? Tim Farron, Cable’s predecessor as party leader, did not share Nick Clegg’s politics, but he recognised that he was inheriting a high-quality backroom team and strove to keep the main players in place. Reilly, who is now at the National Film and Television School, wrote not only Clegg’s concession speech at the general election in 2015, but Farron’s acceptance speech as leader a few months later.

The Liberal Democrats’ curse is that they have to fight for every minute of press and television coverage, so the depletion of their experienced media team is particularly challenging. But their problems go beyond the question of who works at the George Street headquarters in London. As party veterans note, Cable leads a parliamentary group whose continued existence is as uncertain as it was when Paddy Ashdown first became its leader in 1988. The difference is that Ashdown had a gift for identifying issues that the main political parties had neglected. That gave him a greater media profile than his party’s standing warranted.

There is no shortage of liberal and green issues on which Cable could be more vocal: the right to die, for instance, or the legalisation of cannabis. He could even take a leaf from Ashdown’s playbook and set out a bolder approach on income tax than either Theresa May or Jeremy Corbyn. While none of these issues command anything resembling majority support, they are distinctly more popular than the Liberal Democrats. They would also get the party talked about more often. At present, it is being ignored.

These complaints will receive a greater airing if the Lib Dems have a disappointing night at the local elections on 3 May. The party hopes to gain ground in Manchester and retain the Watford mayoralty, but fears it will lose control of the council in Sutton, south-west London. It expects to make little headway overall.

So what else could be done? If you gather three Liberal Democrats in a room, you will hear at least five opinions about what Cable is getting wrong. But the party’s problems neither start nor end with its leader. Cable inherits two difficult legacies: first, thanks to Farron, his party is committed to an all-out war against Brexit. In 2016, that policy successfully gave a shattered party a reason to exist, and some hoped that the Lib Dems could recover ground by wooing disgruntled Remainers. Last year’s general election changed the game, however. The two big parties took their highest share of the vote since 1970, squeezing the Lib Dems to a dozen MPs. That simply doesn’t give the party the numbers to “stop Brexit” – therefore, they feel to many like a wasted vote.

Why not drop the commitment to a second in/out EU referendum? Because one of Farron’s successes was attracting pro-European new members – and thanks to the party’s ultra-democratic constitution, these hardcore Remainers can keep that commitment in place for as long as they wish.

The legacy of coalition is even more difficult to address. In policy terms, the Lib Dems can point to great achievements in government: across every department, there are examples of Duncan Smith-style cruelties that the party prevented.

Yet there is no electoral coalition to be won from voters who are pleased and grateful that hypothetical horrors didn’t come to pass. More than half of voters still regard the Lib Dems’ participation in coalition as a reason not to back the party. That might change as the memories fade, but for now the party’s last spell in government is a significant barrier to gaining the chance to have another one. Even a fresh, young and charismatic leader – with a superb, experienced team – would struggle with such a poisoned inheritance. 

Stephen Bush is special correspondent at the New Statesman and the PSA's Journalist of the Year. His daily briefing, Morning Call, provides a quick and essential guide to domestic and global politics.

This article first appeared in the 27 April 2018 issue of the New Statesman, The Corbyn ultimatum