A couple of days ago I joined Katy Montgomerie’s livestream to work through the current NHS England consultation on child and adolescent gender services. We discussed the background to the consultation, what the questions mean, and what some of the major issues are.
You can take part in the consultation here. It is open until 4th December 2022. Filling it in is a bit of an intense experience, but if you fancy some friendly company and catty cameos, I hope our video will help.
Three weeks ago, I wrote to the NHS England Gender Programme Board (of which I am a former “patient public voice” member) to raise urgent concerns about their consultation on a new interim service specification for children and adolescents.
The proposed service specification is deeply transphobic on numerous levels – from the dearth of relevant treatment pathways, to the assertion that being trans is likely a “phase”.
It is also probable that if implemented, this service specification will impact other young people more widely – especially girls and LGBTIQ+ youth – by undermining principles of autonomy and respect.
The consultation is open to anyone. If you have the time and energy, there is a guide to participating in the consultation here, prepared jointly by Gendered Intelligence, Stonewall, Mermaids, and the Trans Learning Partnership. If you are a community member, a healthcare practitioner, a researcher, or work with a relevant charity, it would be particularly useful for NHS England to hear from you.
Other things you could do to oppose the proposals include: organising a demonstration, raising awareness of this issue on social media, and/or writing to your MP or trade union and asking them to place pressure on NHS England to reconsider.
To date, I have not received a reply from NHS England. Given the danger the proposed service specification poses to the safety of young people, I have now decided to make my letter to them public.
I am emailing to share my great alarm at the proposed service specifications for child and adolescent gender dysphoria services. It is my expert opinion that, if implemented, these proposals will cause great harm to young people. Moreover, in opening such poorly designed and unevidenced specifications to consultation and media commentary, NHS England has already caused harm.
The fact that this consultation is happening at all represents an enormous failure on the part of every professional involved.
I stepped down from the Gender Programme Board earlier this month due to clashes with my teaching schedule. However, given the severity of this situation, I would be remiss in my ethical duties if I did not also email you directly to share my concerns.
My three main areas of concern are:
Social transition should not be subject to medical oversight. This would represent a gross abuse of power on the part of commissioners and practitioners. Choosing to wear different clothes, and possibly use a different name and/or pronouns – is a personal, non-medical decision related to a person exploring their identity and/or coming out. Preventing a young person from choosing a social transition amounts to an attempted conversion practice.
Punishing young people and their families by subjecting them to investigation if they access private services will not help them access healthcare. Young trans people who access private healthcare in the UK or abroad generally due so due to the severity of NHS failures. It will increase the likelihood of young people hiding the fact they are accessing external treatment from NHS clinicians, and of people turning to black-market hormone providers rather than private doctors. I am not sure that members of the Gender Programme Board are fully aware of how prevalent and dangerous the home-made substances already in circulation can be.
Requiring that young people become research subjects as a condition of accessing treatment is completely unethical. This is a well-established principle in the trans health literature. There is no way in which you can truly obtain informed consent for research participation from individuals who will be denied healthcare if they refuse to participate. I fully support the expansion of NHS-funded research into trans healthcare, but participants must not be recruited through coercion.
I will end by inviting all recipients of this email to reflect on what they do not experience, and what they do not know.
Most members of the Gender Programme Board have not experienced gender incongruence or gender dysphoria.
Most members of the Gender Programme Board are not members of a trans community. It is likely therefore that you – even if you are a clinician – have never found yourself in a position where you are confronted with the true impact of NHS failings on young trans people who rely on community support. You do not know what it is like to be trying to look after many extremely damaged members of your community dealing with complex trauma and self-harm from people who have been repeatedly abused by NHS clinicians and processes. We, in the community, are the ones left picking up the pieces of your failings, finding ourselves on constant suicide watch and scrabbling to keep people alive. Invitations onto bodies such as the Gender Programme Board, where we are expected to be polite while fighting for scraps – only to be ignored – do not right these overwhelming wrongs.
My book Understanding Trans Health is cited prominently in the new Philosophy Tube video on complaint, systematic inflexibility, and England’s NHS trans health crisis.
It’s a great video, which manages to capture the sheer horror of NHS failings while still delivering silly jokes, ridiculous costumes, and a strong analysis. In addition to drawing on my work, Philosophy Tube’s Abigail Thorne consulted me on the script for this episode, and I appreciated the opportunity to use my research in this way.
I am personally more optimistic than Abigail about the opportunities offered by the four NHS England ‘pilot’ clinics. These are beginning to slash waiting times, and several are now effectively run by trans people, for trans people. However, I do think it’s important to still critique the very logic that underpins many trans healthcare systems, especially the highly questionable ways in which the medical diagnosis of ‘gender dysphoria’ is constructed, and used to try and control us.
You can buy Understanding Trans Health directly from Policy Press here. It’s also available from all major booksellers, plus many independent queer book stores (e.g. Leeds’ brilliant The Bookish Type). I have also written to my publisher for permission to put a chapter of the book online for free – watch this space! In the meantime, free links to much of my other academic writing can be found here.
For the first time in four years (or more!) I don’t have any forthcoming talks booked at the moment.
Honestly, it’s a bit of a relief. I’ve been deeply honoured and humbled by the interest in my work in recent years, but have also frequently found myself exhausted and overwhelmed by it. It takes time to plan a talk, and it takes a great deal of emotional energy to speak about topics such as institutional sexism or transphobia. Especially in the years prior to the Covid-19 pandemic, I felt like I was almost constantly travelling to speak.
In theory, it was exactly the kind of attention I wanted for my research. In practice, I’ve had to spend a lot of time teaching myself to say “no”. I came to understand why various academics I asked to speak at events often didn’t even answer their emails. I suspect they simply didn’t have the ability to read them all, let alone answer. Meanwhile, there are plenty of researchers – especially “early career” academics – who don’t receive anything like the attention they deserve for their work.
I think academics especially have a strange, unhealthy approach to talks and conference presentations. After I began working in a full-time, salaried role for the first time in 2017 (who needs job security or sick pay in their 20s?!?) speaking about my research became sort of part of my job, but was rarely accounted for in any kind of formal work load. Talks generally don’t “count” like academic publications. At the same time, a lot of us find them an immensely useful way to share and learn about cutting-edge studies, and they can be so important for reaching beyond the academy and sharing findings with general audiences.
As a result, you will definitely see me announcing more talks soon. But I am trying to get better at working within my capacity. Part of this involves recommending other speakers who I know will benefit from the opportunity – that is, when I have time to reply to my external emails.
I will, as ever, be bouncing around with a bass. If you live in or near Leeds, you should totally come and see us. If not, watch this space – we have a few other gigs coming up around around the UK, and some new music on the way…
I’m playing Leamington, Coventry, and Derby with wormboys this week!
I kept back posting about this after contracting a nasty bout of covid, but since I am now (mercifully!) better, our mini-tour is going ahead.
The dates are:
14th July – St Patrick’s Irish Club, Leamington. Doors 8pm. 15th July – Tin Music and Arts, Coventry. Doors 7:30pm. Advance tickets here. 16th July – Dubrek Studios, Derby.
We’d love it if you came to share the joy of noisy pop music with us! However, there is still a global pandemic on (no matter what the assorted mess of Conservative leadership candidates might like us to think) – so if you’re coming, please look after each other by testing before the gig and wearing a mask.
I discovered recently that my friend Elli had passed away. She was just a few years older than me. I believe she lived a difficult life, but was always true to herself, and was good and kind to others. And meeting her as a teenager changed my world.
I first encountered Elli during the long, messy process of coming out to myself. We were both members of a small online community, created by a young trans person for other young trans people. There were a few of us there in our mid-late teens and early 20s, most of us struggling to imagine what it would be like to live authentically. There were a small handful of “allies” (at least two of whom would later coming out as trans and/or genderqueer themselves). And there were a couple of people who had already transitioned, including Elli.
I don’t think there is a word for people like Elli in the straight world, which can make it hard to express how important she was, even to myself. She was my not-very-much-older Elder. She was my possibility model. She helped to crack my egg. She was a nexus of social contagion, a superspreader in the psychic epidemic, a key trigger for my rapid onset.
Elli was a friendly, patient, community-minded person who showed up for others. She showed us that it was possible to be true to ourselves, to build a life on another side of the sex divide. She was honest and realistic about how difficult things could be, and full of constant reminders that there was, is, and will always be more to life than being queer. She loved ferrets and cats and anime, especially Naruto, because she was a massive nerd.
Elli wasn’t famous or well known. She wasn’t involved in any significant moment of history. She had small friendship circles online and offline. This, though, is how we build queer and trans community: through countless acts of care and mutual aid, rather than grand gestures.
I found out Elli had died through a mutual friend from the same old community. She had found out through Facebook – she went to look at Elli’s profile, and realised Elli had died months before.
I was horrified. I had spoken with Elli regularly while she was severely ill with covid, reaching out to tell her how much I cared about her, and share numerous pictures of my cat. We hadn’t spoken that regularly for the last decade, but it felt like every now and then we would touch base and check in on one another. I don’t use Facebook very often these days, but it can be a good way to find where long-term, long-distance friends like Elli are doing. After a lot of hardship, I’d been really excited to find out she had a new job where she felt happy and fulfilled, and a new apartment which she made into a real home. And when got sick, I decided to message her until she recovered.
Except. After she started getting better, after she got home from the hospital, I stopped messaging. I was busy and distracted, getting ready to start my new job at Glasgow. I’m aware that I’m a possibility model myself, now, and there’s a lot that comes with that. I regularly receive messages from people who say I helped then to come out, to be themselves, through being a visibly trans woman, and visibly “successful” in my chosen fields of work and activism. I am perpetually busy, and tired, and distracted.
I saw the occasional Facebook update from Elli suggesting a gradual recovery. And so, like before, I dropped contact, assuming that we’d chat again in a few weeks or months.
And of course, the algorithm never told me that she was no longer with us.
I’m not sure if there is a clear moral to all of this. I am trying not to blame myself – how could I know? And Facebook was the very medium by which we remained in touch long after our original community was no longer active.
These days I feel pulled in all directions by friends from different times and places, people I once knew well, people I wish I was better at staying in touch with, people who assume some kind of parasocial relationship with me on the basis of my public profile. Social media feels like the only reasonable way to stay on top of it all. Yet I regret relying on social media – and especially the exceptionally unreliable medium of the feed – to keep up with Elli. I could have just…messaged her, or checked how she was doing.
It feels like there are two stories here. But perhaps they are the same story.
My experiences of trans community life are pierced through with chance and tragedy: life-changing encounters, terrible losses, and the all-encompassing importance of the Internet. Elli is far, far from the first trans friend of mine to die young. I also know she won’t be the last. When you live in a community where healthcare and socio-economic inequalities are endemic, you are always surrounded by people who are very ill. That’s an inevitable consequence of the forces stacked against us. The least we can do for one another is to collectively find joy and meaning in the life we have, using whatever tools we have at our disposal.
I want to live up to Elli’s memory, and to everything that she gave me. I hope I can be a better friend to others, but also forgive myself for being just one person, in one place, with a limited amount of time available to me. And while I’m at it, you’d better believe I’m going to keep cracking eggs.