Transgender healthcare is in the news again. It’s been widely known amongst trans people for some time, but on the 6th of January, Guardian journalist David Batty reported that the General Medical Council is investigating private trans healthcare specialist, Dr Richard Curtis. In his article, Batty paints a picture of misdiagnosis, patient regret, and inappropriate prescribing.

Those of us who follow this stuff might be forgiven for experiencing a sense of deja-vu. Dr Curtis took over the private practice of Russell Reid from 2005. In 2007, Dr Reid faced a General Medical council fitness to practice hearing which was reported on by no other than Guardian journalist, David Batty. In his reports, Batty spoke of misdiagnosis, patient regret, and inappropriate prescribing.

It’s entirely proper for the GMC to investigate allegations of misconduct, and for the press to report on it, but it’s difficult for trans people not to notice how terribly one-sided it all seems to be. The doctors who seem to end up in front of the GMC seem to be those ones who are generally well regarded by trans people, and who have a reputation for helping us when nobody else will. Press reports concentrate on regrets about procedures which have satisfaction levels beyond the dreams of most other fields of medicine, where much larger regret rates are regarded as par for the course. They rigidly stick to a narrative about a dangerous procedure which gullible people are tricked into by reckless doctors and end up bitterly regretting.

The reality experienced by trans people ourselves is not recognisable from the press reports. In reality large numbers of us are used to being ignored, abused and ridiculed by doctors when we seek treatment. We are denied referrals, denied funding, denied prescriptions and humiliated by a medical establishment which many experience as institutionally transphobic.

Batty’s recent article prompted me to take to Twitter to highlight the hypocrisy of the media in how they report trans healthcare. I wrote:

I had a misdiagnosis which led to surgery I regret, and which has caused long term problems.

Here press press press! I, a trans person, had surgery due to misdiagnosis and I regret it. Come and get it, you know you want to.

The scarring will never fade. My mutilated appendage will never be fully functional again. It’s all true. Nice and juicy! Come and get it!

I was offered surgery after only two appointments with the specialist.

Less than five minutes later, and despite my painfully obvious trolling, the phone rang. It was a newspaper noticing that I’d spoken about surgical regret and could I elaborate? They lost interest when I said it was all true, but I was talking about surgery I had on my right hand in 2011. I apologised for wasting their time.

The misdiagnosis which led to me having surgery on my hand when I shouldn’t have done, and which made the existing problem worse, won’t ever be the subject of a GMC fitness to practice hearing, nor would I want it to be. There’s nobody at fault for what happened; it’s just one of those things which falls within the limitations of modern medicine. I may ultimately lose one or more fingers because of it, but these things happen and I am simply unlucky.

But I could not have wished for a more perfect example of the double standards at work here. Prompted by this, a few trans people started sharing stories of how they had been mistreated by their doctors with me. The next morning, I made a Twitter hashtag, #TransDocFail, to share stories about mistreatment and prejudice at the hands of the medical community. I expected a few dozen. Later that day I stopped counting at 2,000 and several days later, it’s still receiving new reports. Lots of the descriptions are harrowing: people being called “abominations” by their doctors, people bleeding to death being refused treatment by A&E departments, vast numbers of GPs telling people to pull themselves together, or “sacking” them as patients, sexual assault by unnecessary and repeated genital examinations, and so on.

The reports went on and on. Trans people watched it with sadness and resignation. Non trans people stared, open mouthed, barely comprehending how the healthcare system can treat people like this with barely a whisper in the national media. If this was happening in any other area of medicine it would be a national scandal, comparable in magnitude to the Saville affair, staying in the headlines for months and prompting widespread investigations.

I’m thrilled because I managed to speak about it for 5 minutes on local radio.

The media needs to end its transphobic obsession with transition regretters, because this wilful tunnel vision is blinding it to routine and systemic abuse of transgender people when we try to access health services. The LGBT movement wouldn’t tolerate it if the bulk of LGB coverage in the press was about loud and proud ex-gays. We shouldn’t tolerate this either.

Political conferences are amazing places – for a few days you’re mixing with like minded people from all over the country, getting to talk to MPs, peers and ministers in briefing, workshop and Q&A sessions, socialising at “fringe” events, and occasionally getting to have a word in the ear of someone who can effect real change in the UK.

Of course, they’re also a bit of a nightmare for security services, especially when they’re being held by a party of government. There have been attacks on them in the past – perhaps most notably the 1984 Brighton Bombing where the Provisional IRA tried to take out the then government.

In the conferences I’ve attended, there have often been airport-style x-ray machines and metal detectors on the way in, and while people grumble about the queues, this is generally accepted as probably necessary (although obviously it wouldn’t have protected against Brighton-style attack). For a long time, the two larger parties in the UK, Labour and the Conservatives, have had “vetting”, where anyone wanting to attend has to first submit to a background check by the police (who, presumably, bring in other agencies).

Liberal Democrats haven’t traditionally had this – we take the view that all party members should be allowed to attend our conference, which unlike the other two big parties, is sovereign in policy making – votes at conference set our party policy. Ordinary members get the choice to speak in conference debates and influence the votes that set our party policy. Most memorable for me was the debate in 2010 which made our commitment to marriage equality and gender recognition reform policy.

Now we’re in government, Federal Conference Committee, the party body responsible for organising conference, has come under pressure to bring in vetting for our autumn conference. This has caused quite a lot of upset in a party that prides itself on a strong pro-civil liberties stance, but I’m not writing about that aspect (although I have participated in that debate too) right now; I’m writing about the effect it has on people who have changed their identity. In particular, I’m writing about the effect it has on trans people.

Last week, myself and Zoe (who are executive members of the LGBT+ Liberal Democrats) had a chat with the chair of the FCC about the issues facing trans people and background checks. As a result, both of us and the chair of the LGBT+ Lib Dems were invited today to a meeting of the FCC in London, just over the road from the Houses of Westminster in LD HQ, to talk about the issues trans people face when dealing with background checks by the authorities and answer questions. I spent about ten minutes speaking from notes, which I’ll include here:

Basic problem – lots of trans people are “stealth”. Consequences of previous identity being revealed to their social group are potentially devastating.

Even those of us who are “out and proud” like to keep some control for things like security checkpoints, etc.. It’s a personal safety thing, as well as dignity. In casual public encounters, people can be extremely tactless,
leading to public humiliation. Quite apart from being outed, association with former identity can be extremely traumatic. I suffer PTSD symptoms around it, and I know I’m not alone – the thought of applying to last year’s autumn conference actually gave me acute physical stress symptoms.

Police forces have a track record of institutional incompetence with regard to our identities. What is a simple administrative error to them (leaking old name) can be devastating to us. People can and do suffer violence as a result, have to leave the communities they’re in, etc.

Police track record on this is dreadful. Even when they get LGBT liaison officers involved, they generally don’t get it because most LGBT liaison officers concentrate almost entirely on the issues around sexuality, not gender identity. The mishandling of the public toilets at Pride 2008 in London which led to a trans woman being sexually assaulted was caused, in part, by an LGBT liaison officer getting things disastrously wrong.

Bottom line – convincing trans people that the police can be trusted is an impossible task because we know they can’t.

We are being asked to trade a hypothetical danger of physical harm to someone else against a very immediate danger of physical harm towards ourselves, and it’s not fair to ask people to do that.

Anything that involves a possibility of outing will result in some simply staying away. Setting up a “special channel” for people to apply wont help – the CRB have such a special channel and I know from direct personal experience that it leaks – it’s done so with me.

Some trans people are not in a position to obtain consistent personal documentation, often because of institutional or personal transphobia.

Lib Dems attract trans people because we’re a group which is systematically abused by society, government and other institutions. The world is essentially a hostile environment and so civil liberties and equality issues are very important to us.

Obviously I fleshed these out a bit, and went into details of how the Met Police LGBT Liaison officer got things so very wrong at Pride London 2008, how the Criminal Records Bureau accidentally revealed my old name when I was applying to do healthcare voluntary work a few years ago (and then wrote to the organisation asking them not to open the letter and send it back – somewhat akin to asking someone not to think of an elephant), and talked about how I’ve had friends who have had to move when “outed”.

Zoe added some details too, and afterwards we answered a few questions. Having made our case, we left them to it.

An hour or so after we left, one FCC member tweeted, “FCC very keen to find way of #ldconf being able to go ahead without accreditation, so registration opening will be delayed pending solution”

And another said, “Thanks for coming this evening. What you both said was very moving and shocking – such discrimination and abuse is unacceptable.”

I guess that means what we said has been taken very seriously, and it’s a case of waiting to see what happens now.

After chatting to the political journalist for the local paper, Cambridge First, I was asked to submit a letter about the current equal marriage consultation in the UK. The consultation also looks at gender recognition, and if you’re in the UK I would encourage you to respond (I’ll post my response here when I make it). Here’s the letter:

Last week the government launched a consultation into marriage equality in England and Wales.

Assuming legislation on equal marriage is passed in this parliament, it will mark nearly a decade since the signing into law of two sibling pieces of legislation, the 2005 Civil Partnership Act and the lesser known 2004 Gender Recognition Act. These two acts together changed the landscape for lesbian, gay, bisexual and transgender (LGBT) people in the UK, but they were both half-measures. They created a situation which satisfied neither those LGBT people seeking equal treatment before the law, nor their critics who wanted to retain the status-quo.

The Gender Recognition Act allowed transgender people to gain legal recognition of their gender. This granted them marriage and employment protection rights which other people took for granted, but at a cost – if you were in an existing marriage or civil partnership, you had to have it annulled first, otherwise your rights were kept from you. This was more than an inconvenience; it had profound consequences. A woman who would be seen as such were she naked in a gym changing room would be treated by the law as a man, including being locked up with male prisoners if she was to be given a custodial sentence by a court.

The Civil Partnership Act created a form of relationship which was “seperate-but-not-quite- equal” for same sex couples wanting to recognise their commitment to each other with a marriage. Despite civil partnerships commonly being referred to as “gay marriages” by the press and public, they do not confer the same rights as a marriage. Being regarded as next-of-kin when abroad is not assured even in countries which have full marriage equality, for example.

Couples in marriages where one partner had undergone gender transition were treated particularly unfairly by these half-finished laws. Some of the strongest marriages around were, in a cruel irony, subject to state-coerced divorce, with gender recognition being used as both the carrot and the stick for those who refused to end what had become, in effect, a same-sex marriage. Lib Dem Equalities Minister, Lynne Featherstone, described this treatment as “cruel and unusual”.

I was one of those who suffered confiscation of my marriage. One spring morning in 2009, my wife and I stood before a judge and had our marriage annulled. We had convinced ourselves that this was a matter of bureaucracy, that a few days later when we underwent a civil partnership ceremony nothing would have changed, but it wasn’t true. We left the court in tears and holding hands. Less than 2 weeks later, when a registrar pronounced us “civil partners”, it felt like the final indignity. It was very clear to us that the state regarded our relationship as second class.

We still celebrate the anniversary of our marriage, the real one. This year should have been our eleventh anniversary. It is to us, but to the state that’s a fiction; our marriage never existed – it has been erased.

The plans the government is now consulting on will end this for those who come after. Divorce will no-longer be the price for legal recognition and protection, and same sex couples will be able to be married in civil ceremonies. I am proud that Liberal Democrats in the coalition government are delivering this; we are the only one of the three main parties to have marriage equality as party policy.

I would like to see the proposals go further. While churches which don’t want to marry same-sex couples won’t have to under the proposals, lobbying by some churches has resulted in proposals that will ban those religions which do want to conduct same-sex marriages from doing so. It is an affront to religious freedom that one sect presumes to speak for all in this way. While civil partnerships will remain for those same-sex couples who want them instead of a marriage, they will not be extended to opposite-sex couples who feel such a status better reflects the nature of their relationship. Finally, those marriages which were confiscated by the state, such as mine, will not be reinstated.

I will be responding to the government’s consultation by asking them to go further; to do the job properly this time, to not give in to the bullying of a few religious figures who presume to speak for all, and to put right the grave injustice of state-mandated divorce. I urge your readers to do the same.

Those wishing to respond to the consultation can find out more at www.abouttime.org.uk

Councillor Sarah Brown – LGBT+ Liberal Democrats Transgender Working Group Chair


Thanks to “Freedom of Information Queen”, Emma Brownbill, a number of us have been in possession of the minutes of the so-called “Gender Governance Group” (or G3) from 2003 to the present. This is a group consisting of clinicians mostly working in the east midlands and north of England, as well as Scotland and Northern Ireland, who are working in the field of gender dysphoria. They’ve been meeting twice a year for the last eight years, and I imagine many trans people might wish we could be a fly on the wall in these meetings.

Well now, thanks to the wonders of the Freedom of Information Act, we can be! The whole set of minutes are vast, full of administrivia, and take a long time to read. Here, for your delectation, I have presented an excerpt. Zoe O’Connell and Emma Brownbill herself have also blogged on this, and we timed our releases to occur simultaneously. Their entries are here and here.

In general, the minutes present a bunch of people who seem to be generally well meaning, but are disturbingly ill-informed about the range of transgender identities. Their desire to maintain paternalistic style control over trans people is quite apparent, but they do seem to want to do the right thing (even if I sometimes profoundly disagree with what the right thing is – many of them seem to still be in the “prevent transition unless it’s absolutely necessary” mindset).

More recently, they seem to be on the receiving end of a trans community with patients who enter the services with high expectations and with a good understanding of their rights in law. This appears to be causing some considerable flailing amongst the G3 clinicians, and I do sense they’re getting rattled. Anyway, on with the show. It starts somewhat slowly, but do stick with it – some of this stuff is really quite shocking:

April 2004

“Local issues discussed including patients being referred from other clinics and if the assessment has to start from the beginning and if so does the patient have to go through the Real Life Experience again.”

This is the “bad old days”. This question isn’t answered, but it’s apparent from something that is said later on that the answer is quite often, “yes”.

Pickings are quite thin at first. The group is in its infancy and the meetings seem short and preoccupied with admin issues. Fast forward to:

November 2005

[Dr Kevan Wylie, specialist in gender identity disorder working at Sheffield Gender Identity Clinic] had received an email from the [Royal College of Psychiatrists] about an application to a Member of Parliament asking if they could be noted as “no gender” and wanted to know if it was a recognised condition. Kevan had discussed it at a previous meeting but no one had heard of it before and said he would bring it to the G3 meeting.

Tim Terry [vaginoplasty surgeon working at Leicester] said there was a condition called Scoptic Syndrome where they don’t want to be either sex but want to lose the penis and testes.

This is appalling. I transitioned in this month, by coincidence, so I was doing a lot of searching around online for transgender medical resources. Genderqueer and non-binary gender issues were not as prominent as they are now, but there was stuff there, and I came across it quickly. For a specialist clinician working in the area not to be aware of non-binary people is bad enough. For the body supposedly writing a UK Standards of Care document (more on this shortly) to not know of the existence of non-binary people is utterly scandalous. Sadly, this non-binary blindness and resistance to anything other than “traditional binary transition” seems to persist onwards.

By the way, “Scoptic Syndrome” appears to be something akin to dyslexia! edit: It’s a typo – see comments.

For myself, I am aware of a number of cases locally to me who can’t get referred to a gender clinic because they have non-binary identities. It seems that the old advice that you have to lie to clinicians to get treated is still valid for non-binary people. There are a few who are clueful, and we mostly know who they are. Otherwise, beware.

March 2006

[The Royal College of Psychiatrists (the people who had never heard of gender neutral people 4 months earlier, remember?) had circulated their final draft of their Standards of Care document for comment.

You read it right – despite them already apparently realising they don’t actually have much of a clue about the range of transgender identities that exist, they’re trying to put together a document that describes the care pathway in the UK. This terrifies me.

Kevan said that due to NHS waiting times Sheffield would not be intending to provide support to the prisons.

Yeah, whatever. Prisoners are expendable and stuff anyway, right? Just ask the Daily Mail. Serves them right for stealing a loaf of bread and breaking a window pane, or something.

November 2006

Kevan Wylie reported that Helen Barker, Student Doctor carried out a survey, with a small select group and asked about how they felt about complying with the ‘Real Life Experience’. It was found that overall patients felt it was very important.

Of course, patients are going to tell the people who can STOP THEIR TRANSITION AT ANY TIME the complete truth, and not what they want to hear, or anything.

Many patients had raised the issue that they had not been advised fully regarding [scrotal] hair removal prior to their [vaginoplasty] surgery.

This should be explained – if you don’t get that done, you risk vaginal hairballs. These are not funny – they can result in a permanent infection and severe surgical complications. What does “not advised fully” mean anyway? Is it the same as “not told”?

November 2007

Leeds expressed concern over surgery due to Leicester being closed to new referrals. Leicester expressed views on that they were not aware of this…

Riiiight. Left hand, meet right hand. This isn’t the only time this happens, as we shall see.

October 2008

[Northampton’s] main problem is patients who come into the service who are already taking hormones bought off the internet. This raises the issue of whether to stop the patient taking them. If this is the case it does depend on how long they have been on them and the individual case. The patient would be told if they are buying hormones it is against medical advice. [Dr Deenesh Khoosal] told the group a patient parted from their service as a way forward could not be reached as they were receiving injections from the internet.

It was noted that Nottingham would start a patient from the “start” even if they had been in the private sector, whereas Leeds will continue a patient on hormones following assessment if they are able to provide evidence that they are meeting criteria for hormone treatment. etc. Nottingham added that they would not take a patient off hormones.

This is serious. Around half of trans people are on hormones before our first appointment at a clinic, for various reasons. Being made to come off them is brutal. Discharging people because they refuse to is disgraceful.

March 2009 – This is … well

[Dr Deenesh Khoosal] spoke to the group about the issue of unintentionally creating ‘she-men’: patients who have breasys and are on hormones but don’t have final surgery as they don’t want to go any further. These patients continue to live full time as female but with male genitalia. Many of the services present at the meeting had examples of this happening.

This is the level of understanding of gender issues of some of the people treating us. Not only do they seem oblivious to non-binary identities, but they have apparently appointed themselves the genital police. If somebody is non-operative, that is no business of their gender specialist, and does not make them a “she man” or a “he woman” or any other transphobic slur.

October 2009

Orchidectomy [castration]
The Leeds service had reported that they have seen an increase in patients requesting for this. […] the team was wary about patients who only want orchidectomy.

Again, the obsession and fear about trans women keeping our penises. What is wrong with these people? They’re supposed to be helping us.

The Chief Executive for the Department of Health has recently written to every lead reminding them of their responsibilities legally with regards to trans care.

April 2010

Kevan is of the opinion that we as professionals are not gatekeepers unless there are mental health problems or for monetary making reasons.

Or if you want to keep your penis, or dare to take hormones that we didn’t prescribe, or (continued, pp. 94-106)

Entry into GIC
Leeds are recommending for a recent (within 12 months) mental health, together with evidence of physical examinations, plus full bloods.

Nottingham accepts primary care referrals and then asks GPs to carry out physical examinations

As has recently come to light, “physical examinations” means “GP inspects genitals”. The only person who inspected mine was my surgeon. There’s really no reason to insist on this. It’s degrading and unnecessary.

October 2010

York
Vast increase in size of university population, resulting in demanding youngsters being referred. Waiting list is currently four and a half years, most students only at Uni for three years. This means the service users are arriving very unhappy and then going to London for treatment.

The clinician working at York actually seems very upset about this – she’s getting almost no support from the local NHS. A waiting list of four and a half years though. Four. And. A. Half. Years.

Dr Beaini wanted clarification for a patient who has got a GRC already and they have been gender dysphoric for 25 years. Now they have asked for phalloplasty, do they need to seek second opinion or not?

Been in Leeds Gender Clinic for a while and been treated. 20-25 years gender reassignment, done mastectomy etc.

[…]

GRC is not an access to surgery. Need a one to one assessment with the patient. Readiness and robustness is a must. The way they are presenting, they are not robust enough

Yes, here is someone who has been transitioned for two decades. They’ve had mastectomy, they are legally male. They are presumably living their life, but they won’t be referred for surgery because their gender-presentation is “chaotic”. I think that at 2 decades, they might have proven that they’re serious about transition, no?

Equality Bill(SIC – it was actually the Equality Act by this point)
Glasgow would like to know how gender services are going to adapt to the changes. The bill is now allowing that anyone with gender issues are covered by the same legal as discrimination [That was almost English]. Will this have an impact on the services? The easy answer is we are covered by WPATH and standards of care. We are a medical health.

Glasgow currently have a patient who has highly intellectualised the gender issues, he is biological male and in between somewhere. No evidenced based to treat it, but knows he(SIC) rights and how can he be treated.

Equality bill only mentions the male to female or female to male.

So much wrong with this. They seem actually hurt that trans people have legal rights – surely our lives belong to them! HOW DARE a patient “intellectualise” their gender issues. Note also the continued cluelessness about genderqueer issues – “in between somewhere”.

March 2011

North East
A group of young people under 18 created a voice and demanded a service.

My god! They’re at the gate with boiling oil. These people are revolting!

Leicester
Surgery is cheaper on private than it is on the NHS.

I tried to tell my PCT this back in 2007, and they refused to believe me.

Amal reported that surgeons stopped taking mastectomy referrals and no-one told Leeds – they heard from their patients.

Again, the left hand doesn’t know what the right hand is doing.

October 2011

Leeds have struggled recently with GIRES putting pressure on them regarding hormones and real life experience. There is need to clarify RLE for future. Leeds clarified that they have two stages of RLE, the stage before hormone and assessment 6 months, RLE 2 years before surgery.

That’s right – they make people undergo social transition for 6 months with no medical support. They’re then flabbergasted when people self medicate, and increasingly arrive demanding to be treated with a modicum of human dignity. GIRES are a trans activism and research organisation. Leeds seem almost upset that their “turf” is being intruded upon by trans groups.

[On the new WPATH SoC]
RLE, eligibility and readiness – been completely removed from the SoC […] Amal gave an example of a patient from Leeds going to the GMC.

Leeds also pointed out that the DoH leaflet, doesn’t reflect what they do. When they didn’t do what it said in the leaflet, they got harassing emails which wasn’t very pleasant.

This is almost comedy gold – WPATH, the organisation responsible for publishing the global standards of care document, has moved on and realised that the way we have been treated in the past has been inappropriate. The department of health seems to have certain expectations too. Here we see clinicians realising the world is moving on without them, and desperately trying to hang on to the past.

[On the Equalities and Human Rights Commission’s recent document looking at trans healthcare in the UK]
Sheffield, Leeds or Nottingham confirmed that they haven’t been contacted for any information. The teams are not happy with this document.

Note the bemusement. It’s almost as if government departments and equality bodies are talking to trans people (I know they are – we keep in touch regularly), without honouring the unwritten rule that we belong to the medical professionals who treat us.

As I said coming in, these people seem to be generally well meaning, but the way they talk about us to each other suggests a way of looking at us that ignores our humanity and is incompatible with our equalities and rights aspirations.

These people are dinosaurs, and they haven’t realised that the comet they can see is heading straight for them.