It’s Time for the Media to Change the Record on Trans Healthcare

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.

My Speech to the LGBT+ Lib Dems/Stonewall Fringe

This is the speech I gave as part of the panel in the LGBT+ Lib Dems/Stonewall Fringe at the Lib Dem autumn conference in Brighton.

I want to talk a little bit about the nature of homophobia. This is an area where one has to choose words carefully, but if you’ll bear with me for a minute, I’ll attempt a working definition of homophobia as the hatred of someone who experiences same sex attraction, or who is perceived to experience same sex attraction.

The point about perception is important, because not only do you not have to be homosexual to experience homophobia: bisexual people experience it too, for example. You don’t even need to experience same sex attraction. You can be entirely and conventionally heterosexual in your sexual behaviour and desires, and still be a victim of homophobia.

Indeed, plenty of people are on the receiving end of homophobia before they are sexually active at all – we all know that homophobic bullying happens to kids from a very young age.

Actual sexual behaviour isn’t really a causative factor in most homophobic abuse. I have experienced homophobic abuse in public, and I, like most people, don’t actually have sex in public. As an elected representative of the people, that sort of thing is frowned upon.

So when someone screams “faggot!” or “dkye!” at someone in the street, what are they actually keying off that triggers that homophobic reaction? What is it about certain people that homophobic bigots decide to home in on? Gay, lesbian and bisexual people are just like everyone else, apart from the sex thing, right? Right?

Well, no. Spend even a short amount of time in LGBT circles and it becomes pretty obvious that there is something different, not about everyone, but about a lot of people.

I’m going to suggest that what a lot of people are picking up on, and reacting with homophobia towards, is something they perceive as transgressive about the target of their abuse. It could be the way they look, or the way they talk, or the things they’re doing, or whatever. I’m going to further suggest that the apparent transgressions that are being picked up on are, in fact, perceived transgressions of gendered behaviour.

About gay men, homophobes use words like, “mincing”, “flamboyant”, “limp wristed”, “camp”, “ducky”, “effeminate”. Jokes about airline stewards and their handbags are often made. If you’re a lesbian woman, as I am, you might get homophobes telling you that you’re ugly, that you need to shave, that you should get back in the kitchen, that you “wear comfortable shoes” (I do actually wear comfortable shoes – life’s too short not to). If we have short hair or don’t wear any makeup, they pick up on that.

So I’m going to say something perhaps a little bit controversial here. Much, probably most, homophobia which gets directed at people is about what we might call non cisnormativity. Most homophobia is, in fact, rooted in and emergent out of, transphobia.

So what’s transphobia? I’ll attempt a working definition again. Transphobia is the hatred of people who identity, or who are perceived to identify, in a way that is commonly associated with a gender other than the one they are assigned at birth. You don’t need t be trans to experience transphobia. Someone just has to decide that you are not meeting their standards of what a real man, or a real woman should be.

A lot of the abuse that gets hurled is the same as for homophobia, because really transphobia and homophobia are two sides of the same coin. Trans women, for example, will often get called “ducky” and “sissy” and “faggot”, just as gay men will. Trans men will often have “dyke” hurled at them by an abuser. We’re all basically being abused for the same thing – that is we are transgressing what someone regards as acceptable gendered behaviour.

I’m not stopping here though, because I think transphobia itself is a manifestation of a deeper gendered neurosis in our society, and that is misogyny – hatred of women and the feminine.

Think about it: if someone comes out as gay at work and gets abused as a result, a lot of the abuse will centre around whether they are the one who takes on the so-called “female role” in sex. To be penetrated is to have sex like a woman, and that is degrading and not something a “proper man” would permit himself to be subjected to.

It’s similar with women who have sex with women, and indeed with trans men. Both groups are seen as trying to “better” themselves in ways that they aren’t really “entitled to”. Lesbians are derided as never being able to truly satisfy a woman. Only a proper man can do that. We just need to experience the real thing, so the story goes, and we will be straightened out into well adjusted heterosexual women, barefoot and pregnant in the kitchen.

I’m reminded of a sketch on the Catherine Tate show. You know the one – she plays a passive aggressive woman who gets into a trivial situation and starts screaming, “Man! Man!”. In one episode there is a slight twist. Her car breaks down, and she starts her usual mantra. A woman comes along and offers to help and once again she starts yelling for a man. The other woman says, “it’s OK, I’m a lesbian”, and proceeds to fix the car.

Comedy like this reflects society’ attitudes towards LGBT people. We’re a bunch of men who taint ourselves with the effeminate, and a bunch of women who try to shed what’s seen as pathetic femininity to be proper people, i.e. men.

Homophobia is rooted in transphobia, and transphobia is rooted in misogyny, and if we are to challenge any of this we desperately need to engage in joined up thinking. There’s a school of thought that LGB people will gain acceptance if we can convince the homophobes that we’re just like the rest of them, apart from what we do in the bedroom. For some of us, that might be true, but for a lot of us it isn’t. I think this approach to try and address homophobic bullying and abuse is largely futile because it doesn’t deal with the core problem. Some people will always express behaviour which is seen as not gender normative. Our message needs to be that there is nothing wrong with that, and furthermore there is nothing wrong with femininity either.

We need to get our own houses in order. When we see transphobia in the LGB community, we need to challenge it. When we see misogyny an sexism in any part of our community, we need to challenge that. Every time a drag queen refers to women as “fish”, every time the LGB establishment turns a blind eye to transphobia in its own ranks, we serve to further the attitudes that underly homophobia bullying. We need to get this right ourselves, because if we don’t, who will?

Policing The Land – in honour of #LDConf

Sound the blues and twos, eh boys and sound them far and wide!
Liberals want to congregate, but don’t let them inside!
We know they passed a motion; it’s pathetic that they tried.
Conference is not for these people.

The land! The land! Don’t let them on the land!
The land! The land! Inside the Brighton Grand.
Your name’s not down, your face don’t fit. Just tell it to the hand.
Conference is not for some people.

Hear the baffled voices on the left and on the right.
Liberals are just awkward sods, why do they have to fight?
It doesn’t affect me and mine, so it will be alright.
Conference is not for such people.

The land! The land! Don’t let them on the land!
The land! The land! Inside the Brighton Grand.
Your name’s not down, your face don’t fit. Just tell it to the hand.
Conference is not for some people.

Clear away the protestors, they don’t look very nice.
If they won’t go, then kettle ’em: squeeze them like a vice.
Their leaders shouldn’t make a fuss; not fighters, more like mice.
Conference is just for nice people.

The land! The land! Don’t let them on the land!
The land! The land! Inside the Brighton Grand.
Your name’s not down, your face don’t fit. Just tell it to the hand.
Conference is not for some people.

Security theatre marches on, all hail the corporate state!
Contracting with G4S, securing your debate!
No liquids, flags or dissent please. You’re trans? Whatever mate.
Conference is not for the people.

By Sarah Brown, @auntysarah

My Response to the Home Office Marriage Equality Consultation

The marriage equality consultation closes this week. I have waited until this week to submit my response in order to respond from a position of being aware of issues that have arisen as a result of public debate around the consultation.

However, the consultation closes in 3 days. The homophobes have been out in force and have, as I understand it, swamped the process with negative responses suggesting that the existing discriminatory situation should remain. Many of these objections are based on the idea that marriage is “owned” by churches. This is, of course, nonsense. Marriage predates any currently practiced religion as a concept and civil marriages have outnumbered religious marriages in this country for some time.

Indeed, while a push by certain churches to claim ownership of marriage as a religious, and not civil institution, might be intellectually respectable (even if I don’t for one second agree with it), it is deeply unfortunate that this push comes after years of marriage quite clearly being a civil institution for most people entering into it, and at a time where the government is consulting on extending civil marriage to same sex couples. It’s deeply unfortunate because the genuine concern of these churches ends up looking really, really homophobic, which I expect they’re mortified about.

Finally, the government has made it quite clear that they are not proposing to allow religious same sex marriage (this is something I disagree with, but I understand their need to propose what will get through both houses of Parliament), and that the consultation is about how same sex marriage will now be introduced, and not if it will. This means that the thousands of astroturfed responses suggesting it shouldn’t be allowed at all are basically trolling.

This is why it’s really important to get some sensible responses to the consultation from people who are in a position of being able to take advantage of LGBT-friendly reform to marriage and gender recognition law:

  • If you are gay, lesbian or bisexual, and might one day want to benefit from state recognition of your relationship, this consultation is about you.
  • If you might ever be a participant in the gender recognition process (either you’re trans, or you might one day be in a relationship with someone who is), this consultation is about you.
  • If you are married and feel that it’s a patriarchal institution which you disagree with, but you need to be able to operate a joint account with your partner in an uncomplicated way and would rather have a civil partnership, this consultation is about you.

Please answer it. Do it now, or do it tomorrow or the day after, but don’t wait any longer than that because it will be too late. You can do it online – it takes five minutes. Please just do it.

Anyway, here are my answers. Please feel free to use them as a template

Question 1. Do you agree or disagree that all couples, regardless of their gender, should be able to have a civil marriage ceremony?

Agree

Question 2. Please explain the reasons for your answer, limiting your response to 1,225 characters (approx 200 words):

There is a discrimination issue that needs to be addressed: the current situation where marriage exists for opposite sex couples and civil partnership exists for same sex couples represents segregation in society along sexual orientation grounds. This can make non heterosexual people feel like “second class citizens”.

Those who do not identify as either male or female are not served by either institution and must misrepresent themselves to gain access to one of them at present.

I have been through the GRA dissolution/conversion to civil partnership process. I regard my marriage as having been taken from me under duress and feel a great injustice has been done to myself, my wife and those like us. This must not be allowed to continue.

Question 3. If you identify as being lesbian, gay, bisexual or transsexual would you wish to have a civil marriage ceremony?

Agree

Question 4. If you represent a group of individuals who identify as being lesbian, gay, bisexual or transsexual would those you represent wish to have a civil marriage ceremony?

N/A

Question 5. The government does not propose to open up religious marriage to same-sex couples. Do you agree or disagree with this proposal?

Disagree – religious marriage should be opened up to same-sex couples

Question 6. Do you agree or disagree with keeping the option of civil partnerships once civil marriage is made available to same-sex couples?

Agree

Question 7. If you identify as being lesbian, gay or bisexual and were considering making a legal commitment to your partner, would you prefer to have a civil partnership or a civil marriage?

Civil marriage

Question 8. The government is not considering opening up civil partnerships to opposite-sex couples because we have been unable to identify a need for this. However, we appreciate that there are a number of views on this issue.

Disagree – civil partnerships should be opened up to opposite-sex couples

Question 9. If you are in a civil partnership would you wish to take advantage of this policy and convert your civil partnership into a marriage?

Yes

Question 10. We would not propose introducing a time limit on the ability to convert a civil partnership into a marriage.

Agree – there shouldn’t be a time limit

Question 11. Do you think there should be an option to have a civil ceremony on conversion of a civil partnership into a marriage?

Yes, there should be an option

Question 12. If you are a married transsexual person, would you want to take advantage of this policy and remain in your marriage while obtaining a full Gender Recognition Certificate?

Yes

Question 13. If you are the spouse of a transsexual person, would you want to take advantage of this policy and remain in your marriage whilst your spouse obtained a full Gender Recognition Certificate?

N/A

Question 14. Do you have any comments on the assumptions or issues outlined above? If so, please provide details in the space below, limiting your response to 1,225 characters (approx 200 words).

Religious same sex marriage should be available to those organisations which want it. Equalities legislation should not be used to force unwilling organisations to conduct religious same sex marriage.

Because marriage equality and the existence of same sex civil unions varies hugely internationally, the recognition of relationships originating outside the UK should be done in as flexible a way as possible. Same sex couples coming to the UK from countries where no same sex union recognition exists at all should be allowed to be regarded as married for immigration purposes if that is the defacto nature of their relationship.
 
Question 15. Are you aware of any costs or benefits that exist to either the public or private sector, or individuals that we have not accounted for in the impact assessment? If so, please provide details in the space below, limiting your response to 1,225 characters (approx 200 words).

Those of us who underwent the GRA dissolution process have already had to pay to have our existing marriages dissolved and to be re-registered as civil partners. We should not have to pay again to put this injustice right.

Some who have undergone dissolution under the GRA, and are now civil partners, may have had pension contributions adversely affected. These should be reinstated as if the marriage was continuous.

Question 16. Do you have any other comments on the proposals within this consultation? If so, please provide details in the space below, limiting your response to 1,225 characters (approx 200 words).

Civil partnerships should be made available regardless of gender. This is both for equality reasons, and to prevent coercive dissolution of civil partnerships where one or both partners are transsexual and wish to undergo gender recognition.

The marriages confiscated under the GRA, and converted into civil partnerships, should be allowed to be reinstated. This is correcting an injustice and the reinstatement should be effective from the date of the original marriage. Marriage certificates should be reissued in either the current names and genders of the partners, or the former ones (provide the option). If this is not done, those who undergo gender recognition in future will have their marriages recognised, but those of us who have already undergone it won’t, creating a “lost decade”.

If birth certificates can be reissued, so can marriage certificates. This is hugely important to those of us who want our marriages back.

The GRA dissolution process is bureaucratic and works very poorly. Conversion between civil partnerships and marriage should be made simple. It should be as easy as applying for a passport.

Those in marriages should be allowed to convert to a civil partnership if they wish.

Political Conference Background Checks – Putting Our Case to the Lib Dem Federal Conference Committee

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.

My Equal Marriage Letter

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


Gender Governance Group – Be Very Afraid

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.

Aggressive Secular Workplace Discrimination?

There seems to be a growing view amongst some in various religious communities that asking them to comply with equalities legislation in the exercise of their job or public service, or asking that they not impose their religion on others, constitutes some form of discrimination.

I view this as absurd. It is absolutely not the purpose of anti-discrimination legislation to protect the right of groups to themselves engage in discrimination. This much is self-evident; anti discrimination legislation which tried to accommodate this would be an absurdity and constitute an unworkable collection of cascading self-contradiction. Just imagine:

You can’t discriminate against the gays unless you find them really, really icky, and really want to.

Because for some reason, this always seems to come back to some sort of obsession with homosexuality. Personally, I think thinking about gay sex as often as some of these people seem to is really unhealthy, and I say that as a homosexual person, but I digress.

There’s a new report out. It’s called Clearing the Ground and it’s published by “Christians in Parliament”, who are apparently “an official All-Party Parliamentary Group”. The report is described as a, “preliminary report into the freedom of Christians in the UK”, and is the result of the committee being “tasked with considering the question: Are Christians marginalised in the UK?”

Anyway, flicking through, as one does, one can find the following gem:

The Department of Health’s practical guide on religion and belief offers the following guidance:

“Members of some religions … are expected to preach and to try to convert other people. In a workplace environment this can cause many problems, as non-religious people and those from other religions or beliefs could feel harassed and intimidated by this behaviour… To avoid misunderstandings and complaints on this issue, it should be made clear to everyone from the first day of training and/or employment, and regularly restated, that such behaviour, notwithstanding religious beliefs, could be construed as harassment under the disciplinary and grievance procedures.”

Dr Richard Scott gave evidence to the inquiry which suggests that the implementation of this guidance is not always applied with consistency, and sometimes with greater restriction on religious belief than envisioned or permitted under the law. There is also a lack of logic in the guidance because someone who is prevented in the workplace from manifesting their belief, either through prayer or witnessing, may consider themselves harassed on account of their beliefs.

Let’s examine this. To my mind, the DoH’s guidance seems eminently sensible. If you’re working together in some sort of workplace, where your religion is incidental to the task at hand, asking your co-workers if they want to “talk about Jesus” or making a show of praying is likely to make people uncomfortable, and make them feel like you’re pushing your religion on them. In an entirely hypothetical situation where someone who is repeatedly singled out for being asked if they want to talk about Jesus, and happen to be the only out gay person in the office (I’m sure this never happens), they might reasonably feel harassed, and would likely consider taking the issue up with HR.

However, the response seems to be saying that this guideline doesn’t mean you shouldn’t pray overtly or engage in unwanted proselytisation in the workplace at all. It’s clear that myself and Dr Richard Scott are seeing this, apparently simple, guidance and coming to two completely different conclusions. Given that Dr Scott got into trouble with the GMC for proselytising to a vulnerable patient, this is perhaps not entirely surprising. Let’s look at what Dr Scott says again:

There is also a lack of logic in the guidance because someone who is prevented in the workplace from manifesting their belief, either through prayer or witnessing, may consider themselves harassed on account of their beliefs.

This looks like a clear case of wanting equalities law to treat religion as a special case, where it has carte-blanche to do unto others as it would not wish to be done unto itself.

Do these people simply not understand that equalities law applies to everybody? I’ll make this as simple as I can:

  • I’m a gay woman (protected by equalities law).
  • In private, I sometimes have sexyladytimes with my partners
  • Note this is in private
  • If I tell my co-workers in detail about my sexyladytimes, that is inappropriate, and I would expect disciplinary action for it.
  • If I go round asking random women in my working environment if they want sexyladytimes with me, that is sexual harassment and I would expect to be subject to disciplinary action, and possibly arrested.

If I don’t get to force homosexuality on you, you don’t get to force religion on me. I have to wonder if people who think like Dr Scott really don’t understand this, or whether they understand it entirely, and are just raging hypocrites.