Trans Pregnancy: new articles on conception and pregnancy loss

Cross-posted from the Trans Pregnancy project blog.

We are delighted to announce that the first two peer-reviewed articles on findings from our research interviews are now available. Both draw on an analysis of 51 interviews with people who had concieved. One looks at experiences of pregnancy loss among a subset of research participants, and the other explores routes to conception.

More information on each of these articles can be found below, along with links to open-access versions which are free to read.

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Men, trans/masculine, and non-binary people’s experiences of pregnancy loss: an international qualitative study

Abstract text for the article. Follow the link to read it.

Published in BMC Pregnancy and Childbirth (BioMed Central). The article is fully open-access and free to read.

This article examines male, trans/masculine and non-binary gestational parents’ experiences of pregnancy loss, an experience that more broadly affects millions of people every year. We found that, like cisgender parents, our research participants often faced grief following a pregnancy loss, and like heterosexual cisgender men in particular, they often faced barriers to support.

However, the research participants also reported experiences specific to pregnancy loss among male, trans/masculine and non-binary gestational parents, including difficulties in accessing inclusive healthcare, and resistance to “failed” or “wrong” body narratives. We therefore make recommendations for healthcare providers regarding the importance of appropriate language, and the need to sensitively attend to emotions attached both to the loss itself and to the possible desire to attempt another pregnancy.

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Men, trans/masculine, and non-binary people negotiating conception: Normative resistance and inventive pragmatism

Abstract text for the article. This can be read by following one of the links to the full article.

Published in the International Journal of Trangender Health (formerly the International Journal of Transgenderism). An open-access version of the article can be read for free here.

This article explores how men, trans/masculine and non-binary people navigated different social norms and/or practical obstacles to conception. It shows that individuals engage in diverse practices that normalise their experiences of conception, while also highlighting the unique needs and challenges they can face.

The article will also form part of a special issue of the International Journal of Transgender Health that we are editing which will be published in full in early 2021. This special issue will more broadly explore issues of fertility, reproduction, and sexual autonomy among trans and non-binary people. Two other great articles from the special issue have also already seen advance publication:

Administering gender: Trans men’s sexual and reproductive challenges in Argentina, by Andrés Mendieta & Salvador Vidal-Ortiz.

“Just because I don’t bleed, doesn’t mean I don’t go through it”: Expanding knowledge on trans and nonbinary menstruators, by A.J. Lowik.

There is of course a lot more to come – watch this space for more new research findings from both ourselves and our colleagues in the field.

Statement on Equality Minister’s comments

This statement, which I helped to draft, is cross-posted from Spectra.

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As providers of health and wellbeing services for vulnerable people, we are dismayed by Women and Equality Minister Liz Truss’ poorly-informed comments on transgender issues.

Nobody’s fundamental rights should be subject to ‘checks and balances’, as the Minister suggests. Single-sex spaces are already protected under the Equality Act; trans and non-binary people deserve the same access to relevant services and provisions as everyone else.

Trans and non-binary people face discrimination and exclusion in all areas of life. They are disproportionately likely to experience sexual violence and domestic abuse, plus encounter severe difficulties in accessing healthcare, housing, education, jobs, and benefits. This is especially the case for trans women and girls, plus trans and non-binary people of colour.

Trans and non-binary people of all ages require support in accessing services, and making informed decisions about their own lives and bodies. The Minister’s statement that young people need to be ‘protected’ from making ‘irreversible’ decisions appears to contradict existing legal precedents.

These include the principle of Gillick competence, and the Fraser guidelines, which together protect the rights of minors to make their own decisions around medical treatment, if they can demonstrate appropriate capacity to consent.

Any move to undermine these principles will have deeply concerning implications for all minors. In particular, young people’s confidential access to contraception, sexual health services, abortion services, counselling and therapy will be at risk. Rather than positioning trans and non-binary people as a problem, the Minister, along with the Women and Equalities Committee, should focus on ensuring that the Government delivers on the recommendations of the 2015 Transgender Equality Inquiry.

These include the expansion of healthcare provision, and reform of the Gender Recognition Act 2004 to ensure full legal recognition for trans and non-binary people of all genders, on the basis of self-determination.

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A brief personal addition. Our communities and activist networks are stronger, louder, and more visible than ever. We will stand resolute against any attempt to roll back the legal rights of trans people and/or young people. If the Minister follows through on her threats, she will find she has severely underestimated us. We will fight and we will win.

 

Trans health and rainbow futures: learning from Aotearoa New Zealand

This will be the first in a short series of posts on my recent trip to Aotearoa. See also: Part 2: Rainbow resources from Aotearoa.

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Poster in the RainbowYOUTH centre

I recently returned from a month-long journey to Aotearoa New Zealand. This trip was funded by a Rockefeller Foundation Fellowship with the School of Sociology and Social Policy at the University of Leeds.

My aim was to learn more about trans health services and community advocacy, while also sharing findings from my own research in a European context. I feel deeply privileged to have had the opportunity to meet many amazing people, who are doing a great deal of incredible work.

In this post, I share a number of resources and reflections from the trip. However, this is just the tip of the iceberg – I have no doubt that will no doubt that the experiences from the Fellowship will inform my research and thinking for many years to come.

Before I begin, I should quickly acknowledge that many readers of this blog will be unfamiliar with the word “Aotearoa”. This is a term from te reo Māori (the Māori language): it’s the current name for the islands known as “New Zealand” in English. Both are official names for the country that governs this land. For simplicity (and out of respect Māori history and culture, which long predates the arrival of Pākehā, or white European settlers) I use mostly use Aotearoa alone for the remainder of this post.


Whanganui-a-Tara / Wellington: the Gender Centre and Aunty Dana’s Op Shop

20190426_141647After a brief visit to Auckland (where I recovered from the long flight) I began my trip in earnest with a visit to the capital city of Aotearoa New Zealand, on the south-west tip of the North Island. I was told that you can’t beat Wellington on a good day – certainly, the bay of Whanganui-a-Tara is one of the mostly stunningly beautiful places I’ve ever had the fortune to visit.

My first priority was a visit to the Gender Centre. This amazing new community resource, which was founded only last year and is currently based the front room of the 128 Radical Social Centre. It is run by members of Gender Minorities Aotearoa, a group who campaign and provide information for transgender, takatāpui, and intersex people. Takatāpui is a term in te reo which “embraces all Māori with diverse gender identities and sexualities“.

Photos of 128 Radical Social Centre and the Gender Centre, taken with permission.

The Gender Centre includes a small office space, where people working for Gender Minorities Aotearoa can work on current campaigns and meet with visitors. Anyone can drop by to ask for advice or support, or pick up information. For example, the organisation has recently started running a free binder scheme. Materials on display included forms for name and gender changes, advice on accessing healthcare services, and information on the BDMRR bill.

BDMRR stands for Births, Deaths, Marriages, and Relationships Registration. Groups such as Gender Minorities Aotearoa are campaigning for non-binary recognition, and to make it possible for people to legally change the gender marker on their birth certificate without going through an expensive process involving medical oversight. Unfortunately, proposed changes have been delayed by the actions of anti-trans hate groups. UK readers will recognise the similarities with the campaign of misinformation waged against proposed changes to the Gender Recognition Act. This is not a coincidence. Anti-trans groups in Aotearoa are directly influenced by the language, aesthetics and (in some cases) the direct interventions of UK anti-trans campaigners, in what can be understood as a form of neo-colonialism.

While I was at the 128 Radical Social Centre I also visited Aunty Dana’s Op Shop. This is a second-hand clothing and accessories store run by trans and non-binary volunteers and open to people of all genders, with proceeds donated to Gender Minorities Aotearoa. It’s such a great way to raise money for campaigning, while providing an important resource and social space. It can also serve as a less scary space than the Gender Centre for people who are just coming out and looking for support. I had a great time browsing the shelves and chatting with the volunteer who was working there that afternoon.

Photos of Aunty Dana’s Op Shop. Taken with permission.

You can watch a fantastic video about the Op Shop here:


While I was in Whanganui-a-Tara I also took the opportunity to visit a trans and non-binary artists showcase at the NZ Games Festival and meet with some brilliant academics and students working on LGBTIQ research at Victoria University of Wellington. I will be sure to share their work as it is published!


Ōtautahi / Christchurch: queer art and affirmative care

I next travelled to Ōtautahi / Christchurch, taking a train down the east coast of the South Island. During this trip I began to understand the extent of the damage caused by 2010 and 2011 Canterbury earthquakes. There was evidence of huge landslides and roads were still being rebuilt. Several metres of new coastline were visible for many miles, clearly identifiable through rocks bleached white by dead organisms that once lived under the waves. The city itself is still being rebuilt. Huge building projects and areas of empty land can be found throughout the central business district, a reminder of the unforgiving power of the Earth.

Photos: day and night – urban art and public protest.

It was apparent that the people of Ōtautahi were still recovering from tragedy even before the horror of the recent neo-Nazi mosque shootings. Nevertheless, the city struck me as a great centre of culture. I am grateful to have had the opportunity to meet some amazing queer and feminist artists and heard about both radical public interventions and commissioned works. If you want to learn more about this, the websites of Jennifer Shields and Audrey Baldwin are great places to start.

During this visit, I learned about a fantastic initiative to build and publicise new public health pathways for gender-affirming care in the Canterbury region. Until recently, services such as specialist counselling, hormone therapy and surgical referrals were only available on an ad-hoc basis, and information was not easy to find. Relevant information on what services are available and how they can be accessed is now easily available, thanks to the work of the Ko Awatea gender-affirming care co-design group.

These services are still not perfect – several interventions are not publicly funded, and they still involve a certain level of medical gatekeeping. However, they represent an important step forward. Notably, I was informed that these achievements can be credited to the willingness of particularly motivated medical providers, who were prepared to put energy into working directly with trans community representatives to work for reform.


Tāmaki Makaurau / Auckland: RainbowYOUTH

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The next stage in my journey was a visit Kirikiriroa / Hamilton, back on the north island. I was here for the Aotearoa New Zealand Trans Health Symposium. This will be the subject of a future blog post, so I am going to finish this piece with a look at an organisation based in Aotearoa’s largest city.

In finish my journey with a return to Tāmaki Makaurau / Auckland, meeting a number of community workers, activists and academics living and working in the city. I was especially honoured to visit the RainbowYOUTH offices and drop-in centre: a spacious explosion of colour located in an otherwise unobtrusive side street on the edge of the queer distract around K Road.

RainbowYOUTH are an organisation run by and for queer and gender diverse youth, with a remarkably long and successful history. They are currently celebrating their 30th anniversary, having been founded in 1989. The organisation’s members and executive board are all aged 27 or under. Executive advisors aged over 27 are invited to attend and speak at board meetings, but do not have voting rights. I was really impressed by this commitment to centring youth perspectives in support work and activism, something which has been missing from the UK since the dissolation of Queer Youth Network.

I was also interested in how common the language of “rainbow” community was in Aotearoa, as an addition and alternative to acronyms such as LGBTIQ. I like the way this word avoids the “alphabet soup” and potential exclusions tone of the acronym. I can also see how – like the term “gender minorities” – it can work to be inclusive both of intersex people and of takatāpui in a way that is more expansive than just attempting to rework the Western/anglophone framework of “LGBT”.

Photos of the RainbowYOUTH centre. Taken with permission.

The RainbowYOUTH centre was a wonderful building. For a long time, the organisation ran out of a very small office on Karangahape Road, but in recent years an increase in income and activity enabled a move to the new space. This features several offices, a therapy room, a large social space with a TV and gaming consoles, a library, a community wardrobe, free hygiene packs for people in difficult circumstances, and once again a whole range of resources and information. I can see how the very existence of this space is helping to create new possibilities for a generation of young people who I hope will achieve things that currently remain unthinkable.

I left Aotearoa incredibly inspired by the work and imagination of everyone I met, and am hugely grateful to everyone who helped with advice and organisation, made time to speak with me, and shared ideas and information. Ngā mihi nui!

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A slow, painful grind: WPATH 2018 conference report

IWPATH_BuenoAr_Logo_reverse.jpgn the first week of November I attended the 2018 WPATH Symposium in Buenos Aires, Argentina. This biennial event is one of the largest trans studies conferences in the world, with around 800 academics, activists, healthcare practitioners and researchers coming together to exchange knowledge.

Most of the conference consisted of parallel sessions: approximately eight or nine speaker panels occurring simultaneously in different parts of the conference venue. So it is impossible for anyone to take part in the majority of conference events. Nevertheless, I attended as many sessions as possible, and livetweeted from most of these. Links to Twitter summaries of the sessions I attended can be found at the end of this post.

In this post, I comment primarily on my observations of the conference as a sociologist and trans professional.


Opportunities and inclusion

As I anticipated, WPATH 2018 was full of contradictions.

On the one hand, it was exciting to join and learn from so many academics, healthcare practitioners and human rights experts working in the field of trans health. As I report in the Twitter summaries below, the conference provided a great opportunity to participate in debates over new ideas and standards of care, and hear about cutting-edge research findings and advances in clinical practice. It was an especial privilege to learn first-hand about the implementation and impact of Argentina’s pioneering Gender Identity Law, a topic I expand upon later in this post, but hope to write about in more detail in the near future.

I was also glad to have the opportunity to present a paper on research ethics and a poster with initial findings from the Trans Pregnancy project to an international audience.

It was excellent to see that the conference organisers acknowledged and responded to some of the feedback from trans delegates in previous years. Gender-neutral toilet blocks were present on every floor of the conference venue, and pronoun stickers were provided to accompany name badges. The provision of a “trans hospitality suite” enabled trans attendees to relax in a more comfortable environment, and also arrange our own ad-hoc meetings and events. This was inevitably re-branded by its users as an “intersex and trans” room in recognition of the importance of this space also to intersex delegates; I hope conference organisers will learn from this for future events.

This year’s Symposium also benefited from a clear code of conduct and language guide, previously introduced for the 2017 USPATH and EPATH conferences.


Microaggressions and objectification

On the other hand, the cis-centric atmosphere of the event felt like a slow, painful, constant grind. As with previous WPATH conferences, the event was punctuated by constant microaggressions (and, on occasion, outright “macro”aggression); these were damaging to intersex people, people of colour and delegates from the Global South as well as trans attendees. Examples include individuals advocating for intersex genital mutilation, off-colour jokes about trans suicide, the use of outdated language, and misgendering of research participants.

Some research seemed entirely voyeuristic: for example, one poster from the Netherlands purported to report on differing levels of jealousy towards sexual competitors among “mtof and ftom transgenders”. It was often unclear how consent was obtained (if at all) for the use of personal information about research participants and/or patients. This was particularly concerning when numerous posters and powerpoint slides included unnecessary photographs of intersex and/or trans genitalia (a “WPATH conference bingo” grid circulated among intersex and trans attendees of the event included a square for “unexpected genitals”).

As a trans attendee, I felt deeply objectified by the tone and content of this material. It felt dehumanising, and I felt like a thing, subject to the harsh gaze of an abstract, dehumanising curiosity. Yet I was disturbed not only by those engaging in such work, but also in the response of many of their peers. Numerous practitioners and researchers who seemed broadly sympathetic to trans rights and affirmative in their own work often said nothing to counter transphobia, cisgenderism and endosexism in the work of others. It is difficult for intersex and trans people to explain how painful this situation is when most of our colleagues and the senior figures in the field are not intersex or trans; we know that our projects and careers alike may suffer if we speak out too openly or too harshly. I encourage fellow members of WPATH to reflect on their potential complicity in this situation, and consider how we might collectively work to change it.


Tokenism and colonialism

The choice to locate the conference in Buenos Aires felt deeply tokenistic, with numerous attendees from the Global South arguing that this represented a colonial attitude. The vast majority of conference attendees were from the United States or Western Europe. The price of the conference was a significant barrier to many attendees, amounting to the equivalent of the average monthly income in Buenos Aires. The choice to host the event in an expensive Hilton hotel felt like it was taken primarily for the benefit of (the more wealthy) attendees from the West to the detriment of local intersex and trans people, some of whom reported that they risked being profiled by the police if they tried to enter the wealthy area of the city in which the hotel was located.

The sessions on clinical practice in Argentina and human rights in Latin American were some of the most interesting I sat in on, but also least well-attended. I later heard that on one occasion a high-profile lawyer invited to speak on the topic of Argentina’s Gender Identity Law addressed a near-empty room, due to clashes with sessions that focused on Western bioethics, research and medical practice. This sense of tokenism was compounded through the choice to hold the conference in English (the official language of WPATH), with funded translation into Spanish available in a maximum of two rooms at any one time. Some of the conference organisers later stated that they had been worried about the finances of the event, but this felt like a strange claim in the wake of a lavish gala dinner with dancers, DJs, and multiple buffets serving food from various regions of Argentina. As human rights expert and executive director of GATE Mauro Cabral declared in the closing plenary of the conference, “When WPATH decided to come to Argentina, with the most progressive gender identity law in the world, I was excited. But we could only talk among ourselves. You came to this country because of the weather, steak and wine, but not to learn from us”.

While these issues are primarily structural ones that need to be formally addressed by WPATH, the onus is also upon individuals from Western and/or Anglophone countries to take action and reflect upon our relative power and privilege in attending these events. In addition to vocally supporting my colleagues from the Global South, one aspect of my own practice I feel I can address is my use of language in planning talks. For example, I could have undertaken a little extra work to ensure that my slides were bilingual, listing bullet points in Spanish as well as in English. I hope to draw on this lesson in preparing for future international events.


TPATH, human rights monitors, and lessons from Argentina

My experience of WPATH 2018 was improved enormously by the presence of other trans people working in the field of trans health, as well as the intersex activists and human rights experts who came to monitor WPATH’s historic antipathy towards intersex rights. Many of us are members of TPATH (the Transgender Professional Association for Transgender Health), a new and as-yet loosely affiliated group of trans people working in trans health that I helped to co-found during the 2016 WPATH Symposium in Amsterdam. Numerous others were part of a 50-strong delegation of intersex and trans human rights monitors from all parts of the world, who attended in order to conduct a collective human rights audit of the conference.

It was with these individuals that I found myself having the deepest conversations, these individuals with whom I heard the most fascinating research findings and the most rigorous analyses. We also shared a strong sense of solidarity in the face of the many problems apparent at WPATH 2018.

That said, the most important event I attended took place outside of the WPATH event: in Casa Jáuregui, a historic queer cultural centre many blocks away from the Hilton. Here, Frente de Trans Masculinidades (the Transmasculine Front) and other activists based in Buenos Aires hosted a meeting with TPATH members from the Bahamas, Aotearoa/New Zealand, Norway, South Africa, the UK and the USA. We shared information on our various areas of work, and the local activists talked at length about the history, implementation and practical impact of the Gender Recognition Law.

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Argentinian activists host TPATH members at Casa Jáuregui.

While it is important not to deny the significant challenges faced by trans people in Argentina, which include harassment by authorities, economic marginalisation and many forms of violence and discrimination, many of us were struck by how much has been achieved by activists in Argentina and (consequently) how advanced trans rights are in this country. The Gender Identity Law has been carefully written to enable flexibility; this has meant, for example, that it was interpreted to enable non-binary recognition by a judge as recently as last week. It also guarantees access to healthcare, which has meant that every possible medical intervention is available to trans people, either for free or through relatively inexpensive health insurance (in theory, that is: in practice, various legal battles have been necessary). This has been of benefit to cis women and queer people as well as trans people: for instance, through enabling easier access to hysterectomies or breast reductions.

During the meeting, the local activists described gender-affirming medical interventions that most of us had never even considered, such as beard hair implants for transmasculine individuals who cannot or would prefer not to use testosterone. Moreover, while long waiting lists exist for some procedures such as surgeries, those of us attending from European countries and (especially) Aotearoa/New Zealand were astonished by how much shorter they were than equivalent waiting times in our own countries, in part due to the absence of unnecessary gatekeeping procedures and treatment bottlenecks.

I was profoundly moved by the opportunity to attend this meeting, and regretted that so much of my time in Buenos Aires was spent in the sterile environment of the Hilton. However, I was also glad to have the opportunity to work with others to challenge the hierarchies and cisgenderist assumptions inherent in WPATH. We undertook many small interventions: asking questions about ethics, consent and power dynamics in the sessions we attended, raising concerns in private conversations, reporting blatant contraventions of the WPATH code of conduct. I was also pleased to hear many of my colleagues openly critiquing problematic issues identified during an update on the progress of the forthcoming Version 8 WPATH Standards of Care, and take part in attempts to hold our professional body to account during a member’s meeting on the final day.

Overall, I found WPATH 2018 to be a very tiring, draining and frequently unpleasant experience. However, I do not regret attending. I am grateful to have had the opportunity to learn so much from so many. I am also glad to have played a small role in supporting my intersex and trans colleagues and my colleagues from the Global South in attempting to help transform WPATH so it is more transparent, more accountable, and less colonial in attitude and in action.


Session summaries

The following links are to Twitter threads in which I summarise plenaries, talks and mini-symposia I attended at WPATH 2018.

Saturday 3rd November

Opening session and President’s Plenary

Keynote: Employment discrimination against trans people (Sam Winter)

Keynote: Trans legal history in Latin America (Tamara Adrian)


Sunday 4th November

Mini-Symposium: The Argentinian experience of public transgender health after the implantation of the Gender Identity Law

Oral presentations: Services in different parts of the world (Australia, Southern Africa, Scotland)

Mini-Symposium: Trans refugees: escape into invisibility

Mini-Symposium: Latin American perspectives on depathologization of trans and travesti identities

Plenary: Show hospitality to strangers: intersex issues in the time of gender identity laws (Mauro Cabral and respondents)
Note: this was listed as a plenary session in the programme, but actually took place alongside multiple parallel sessions. Consequently, this talk was under-attended by Western healthcare practitioners in much the same way as the Latin American sessions.


Monday 5th November

Oral presentations: Suicidal and non-suicidal behavior

Mini-Symposium: Ethical considerations in transgender health research

Oral presentations: Fertility

Oral presentations: Reproduction


Tuesday 6th November

Mini-Symposium: Child and adolescent medicine Mini-Symposium: Child and adolescent medicine

Plenary: SOC 8 update

Plenary: SOC 8 Q&A

WPATH 2018: learning on multiple levels

Today I arrived in Argentina for the WPATH Symposium in Buenos Aires. It will be my second WPATH Symposium, after I attended the previous event in Amsterdam in 2016.

I’m attending the conference in a number of capacities. Firstly, I will be representing the Trans Pregnancy project. I will be presenting a poster on some of our initial research findings, which I will share on this blog also in the next few days. I am also planning to attend a number of talks by other researchers working on trans people’s experiences of fertility, pregnancy and childbirth. Look out for tweets about two of these sessions from the Trans Pregnancy Twitter account on Monday 5th November.

Secondly, I will be presenting as part of a mini-symposium on research ethics alongside colleagues from Canada, New Zealand and the United States. This will also be on Monday 5th November, and I will be talking about how clinical research can have unintended and undesirable consequences for patients/participants if power dynamics are not taken into account.

Finally, I’m hoping to continue my long term project of learning more about how trans healthcare operates in different parts of the world, and sharing that knowledge with others in turn. In addition to attending sessions on research and clinical practice regarding trans-specific healthcare in various contexts, I also aim to learn more about activism, health advocacy and the law in various parts of the world, especially Argentina and other Latin American countries. I will be writing about this on my personal Twitter account, and hopefully also this blog.

I’m excited and honoured to be at this event, but also trepidatious, as I found the 2016 event pretty overwhelming. I learned an incredible amount in a very short period of time and was inspired by the world of many academics and practitioners from around the world. At the same time, as a trans studies scholar who happens to also be trans myself, I felt that a background hum of cisgenderism permeated the event, sometimes shifting into outright transphobia. Examples include pathologising language and misgendering within conference presentations, binary gendered toilets, and racist presentations that exoticised trans women of colour. A number of intersex conference attendees also protested against a number of surgical posters which graphically depicted infant genital operations.

WPATH itself has a very mixed history and reputation within trans communities. As I examine in my book, WPATH’s Standards of Care have worked to both open up and close down possibilities for people seeking medical interventions to facilitate a medical transition. In recent months, the organisation has issued welcome statements in opposition to both the Trump administration’s attempts to redefine gender and unfounded claims regarding “rapid onset gender dysphoria”. There is also now code of conduct for WPATH events which may help to address some of the worst examples of transphobia (and racism, sexism etc) at conferences. However, WPATH is also highly undemocratic and has recently appointed a treasurer who misgenders trans patients and promotes discredited psuedo-scientific concepts such as “autogynephilia”.

In this context of controversy and heated debate, it is important not simply to understand trans health, but also to understand the processes of knowledge production that inform trans health in theory and in practice. As a sociologist, this is something I will be very interested in at this year’s symposium, and I hope to share my thoughts and reflections in coming days.

Family Planning workshop at Trans Health Matters (23 October)

In a couple of weeks I will be attending the Trans Health Matters conference, which is held at Resource for London on Tuesday 23 October.

You can read about and book tickets for Trans Health Matters 2018 here.

Co-hosted by holistic sexual health centres cliniQ (London) and Clinic T (Brighton), this event offers an insight into cutting edge practice and research, particularly with regards to sexual and mental health.

I will be speaking at a workshop entitled Trans Family Planning: Contraception, Fertility, Pregnancy and Childbirth, alongside Kate Nambiar, Michael Toze and Francis Ray White.

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Resource for London, Holloway Road

Trans people often find there is a lack of information available on their own fertility, or that they have been misinformed about the reproductive capacity of their own bodies. Similarly, trans people wishing to form families continue to face social, legal and medical barriers to parenthood. The workshop will comprise three short interventions, reflecting on current challenges and opportunities for trans reproductive autonomy, and an opportunity for attendees to reflect on how this might relate to their own work.

Kate Nambiar is a medical doctor and researcher who works at Clinic T. She will be discussing issues around contraception for trans people.

Michael Toze is a Research Fellow in the School of Health and Social Care at the University of Lincoln. He will talk about UK medical practice and law with regards to trans fertility, parenthood, and sterilisation procedures.

Francis Ray White is a Senior Lecturer in Sociology at the University of Westminster, and I am a Research Fellow in the School of Sociology and Social Policy at the University of Leeds. We will be discussing intial findings from the Trans Pregnancy Project.

 

Forthcoming talk: The Transgender Moral Panic

I’ve been invited to give a guest lecture at the University of Warwick next week, on Thursday 8th February.

This will be part of the “Hidden Histories” alternative lecture series, organised by Warwick Students’ Union with support from a number of academic departments.

The talk will take place from 7pm in S0.21 (Social Science Building), and is open to all. I will speak for around an hour and there will be time for questions and discussions.

Here’s the blurb from the Facebook event page:

The Transgender Moral Panic: A Brief Social History

Over the last few months, there has been an enormous upsurge in media commentary that expresses concern about the role of trans people in public life. Gendered changing rooms, non-binary people, trans children and notions of self-definition have all come under intense scrutiny, with psychologist Meg-John Barker describing 2017 as “the year of the transgender moral panic”.

For the 2nd lecture in our Hidden Histories series, Ruth Pearce will explore the background to the recent wave of media interest, taking in radical feminist theories, scientific racism and proposed changes to UK law. She will show how the transgender moral panic has been shaped by deep-seated cultural anxieties around sex and gender, brought to the fore by the precarious successes of the trans liberation movement.

Ruth Pearce is a trans feminist scholar. Her research primarily examines discourses, practices and experiences of trans health. Her PhD was awarded by the University of Warwick in 2016. Her thesis looked at how trans health is differently understood within trans communities, activist groups and professional literatures, with a range of meanings and practices contested within and between these spaces.

Come along for what is set to be a fascinating event exploring a topic which is generally erased from mainstream curricula. Refreshments will be provided!

Hidden Histories banner

Ethical guidance on studying trans health, for researchers and ethics boards

I recently co-authored an article on research ethics for the journal Transgender Health. It’s based on an extensive review of literature on the topic, and written by an international team of scholars and health practitioners with extensive experience of conducting research in this field.

Transgender Health is an open access journal, so the article is freely available for anyone to read and share.

I’ve copied the abstract out below: please click on the title for full access.


Guidance and Ethical Considerations for Undertaking Transgender Health Research and Institutional Review Boards Adjudicating this Research

The purpose of this review is to create a set of provisional criteria for Institutional Review Boards (IRBs) to refer to when assessing the ethical orientation of transgender health research proposals. We began by searching for literature on this topic using databases and the reference lists of key articles, resulting in a preliminary set of criteria. We then collaborated to develop the following nine guidelines:

(1) Whenever possible, research should be grounded, from inception to dissemination, in a meaningful collaboration with community stakeholders;

(2) language and framing of transgender health research should be non-stigmatizing;

(3) research should be disseminated back to the community;

(4) the diversity of the transgender and gender diverse (TGGD) community should be accurately reflected and sensitively reflected;

(5) informed consent must be meaningful, without coercion or undue influence;

(6) the protection of participant confidentiality should be paramount;

(7) alternative consent procedures should be considered for TGGD minors;

(8) research should align with current professional standards that refute conversion, reorientation, or reparative therapy; and

(9) IRBs should guard against the temptation to avoid, limit, or delay research on this subject.

Trans health in Canada: reflections and resources from CPATH

At the end of October I attended the CPATH 2017 (Canadian Professional Association for Transgender Health) conference in Vancouver. It was a fascinating event from which I learned a great deal. I’m keen to share some of my thoughts and experiences with others, as I feel there is a great deal that trans health researchers, practitioners and activists can learn from the progress that’s been made in Canada, as well as the limitations of that progress.

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Poster: “In Our Dream B.C….”, by Drawing Change. Based on Trans Care BC consultation with gender creative, trans, and two-spirit youth and their families..

In this post, I reflect briefly on my impressions of the conference, and link to Twitter threads I wrote during various sessions. You can also read my initial thoughts on the conference here.


CPATH took a broadly holistic approach to trans health

Over 300 people took part in the three-day CPATH 2017 conference and two-day pre-conference. In attendance were GPs, nurses, endocrinologists, psychologists, psychiatrists, therapists and counsellors, social workers, healthcare administrators, peer and parent support group facilitators, academic researchers, lawyers, politicians, and various trans campaigners.

CPATH 2017 treated “health” as a social phenomenon as well as a purely embodied matter, and this made for some very productive conversations. For example, numerous sessions explored how trans healthcare might best be provided in the context of primary health. Gender identity services are frequently provided by GPs with support from external specialists, a model of care that is currently under consideration for England. In some Canadian Provinces, organisations such as Trans Care BC help to connect providers in primary care to relevant specialists, and support trans people in obtaining interventions such as hormone therapy and surgeries.

This approach enables continuity of care in a local context, with family doctors enabled to provide trans-specific care for their patients alongside everyday services. It reduces barriers to access such as waiting times and the necessity of long-distance travel. It also enables GPs to help their trans patients access a wider range of specialist services: for instance, trans people with mental health issues might benefit from a referral to a peer support group as well as or instead of formal therapy (depending on patient desire and need). Many practitioners provide services on the basis of informed consent, rather than using mental health assessments as gatekeeping measures. It was heartening to see generalist and specialist healthcare professionals, social workers, trans activists and others engaged in open discussions about how best to manage care through this kind of system.

I was also particularly struck (and moved) by a session entitled Trans and Two Spirit Youth Speak Back! The 40 or so adults in attendance – mostly healthcare professionals or researchers of one stripe or another – were asked not to speak at all during this workshop. We were instead invited to listen to the stories and experiences of trans and two-spirit young people, who sat dotted around the room and answered pre-prepared questions delivered by a youth group facilitator. This session structurally prioritised the voices of young trans people who are so often silenced, and also offered an opportunity for us to hear how the healthcare needs and challenges faced by these individuals were shaped by their cultural heritage, family life, schools and peer groups.


CPATH took intersectional trans voices seriously

Trans and Two Spirit Youth Speak Back! was just one example of how trans voices were frequently centred at CPATH 2017. As an attendee from the UK, I was very impressed by this! Our trans healthcare conferences, seminars and workshops tend to be organised by and for community groups, researchers or healthcare providers, with relatively little overlap between attendees at these events. Very few practitioners are (openly) trans, meaning that trans people tend to talk to one another at community and research events, but are heard less often at healthcare conferences for doctors, nurses and mental health specialists. Moreover, the speaker line-ups at all these events tend to overwhelmingly prioritise the most privileged individuals, such as white people and men. The only possible exception is cliniQ’s Trans Health Matters conference, and that event too feels like it’s taking the first steps towards something better.

During the opening plenary of the CPATH conference proper, we were informed that around one third of speakers at the event were trans, and around a tenth were Indigenous (i.e. of First Nations heritage). I’m not sure how many people of colour were represented at the event more generally, but the all-white panels which are a norm at UK events seemed few and far between.

Importantly, the trans women, trans men, non-binary and two-spirit platformed as speakers and workshop facilitators were usually also professionals. We weren’t simply present at CPATH to represent a “patient perspective”: rather, we were the experts. This reflects the hard work of individuals in pursuing a career, and the collective work of CPATH in supporting trans professionals; it also reflects the actions of local providers in various parts of Canada who have made an active effort to employ trans people, or secure funding for partnerships with trans-led organisations.

In my previous post I noted that the opening plenary of the conference proper centred Indigenous voices. This included a formal welcome from Musqueam Elder Jewel Thomas, and talks by trans and two-spirit Indigenous educators from different parts of North America. I was happy to see that the plenary session on the second day of the conference continued to centre the voices of individuals who tend to be marginalised within even trans spaces. Two-spirit physician Dr James Makokis and Latina trans activist Betty Iglesias – who discussed issues faced by trans sex workers and migrants – were platformed alongside an Member of Parliament from Canada’s ruling Liberal Party, resulting in a thoughtful and challenging debate.


CPATH (and the rest of us) still have a lot of work still to do

I left CPATH with a very positive impression, but Canada is by no means the promised land for trans health. Professionals and patient representatives alike frequently discussed the challenges they faced in providing gender-affirming services. Transphobia and cisgenderism are still very much prevalent within healthcare provision and legal frameworks, particularly outside of urban areas: there is therefore a great need for better education among trainees and further reform of laws and guidelines. Limited funding and different approaches across the country’s Provinces and Territories also mean that not everyone has the same access to treatment, and waiting lists persist for publicly-funded care. These are challenges that exist across the world, and may benefit from greater international collaboration and strategy-sharing.

At the end of the first day of the conference proper, there was a reception specifically for trans people attending the conference. I later reflected on the experience of attending this reception in conversation with a genderqueer colleague; both of us felt ourselves relaxing enormously upon entering the trans-only space. For all the positives of CPATH, it was a huge relief to step away from cisgenderist expectations and microaggressions that quietly persisted throughout the conference proper. These included a range of unspoken ideas about how we should dress, act, and talk “professionally”, limitations on our ability to name transphobia within healthcare settings without fearing repercussions, and the occasional terrible intervention from self-righteous cis professionals.

As ever, facing down these challenges is hardest for the most marginalised trans people, including (for instance) disabled individuals, sex workers, migrants, and people of colour. I was aware that while CPATH 2017 took a broadly intersectional approach, instances of ableism, racism, sexism and so on persisted: and this could take the form of unexamined prejudices on the part of more privileged trans people too. Moreover, white people were still heavily overrepresented among conference attendees; a phenomenon that was particularly noticeable at an event held in a city as diverse as Vancouver.

What I’m taking from this is a reminder that equality work is never “done”; rather, it is something that we should strive to always “do”. We should aim constant improvement in our relations to one another rather than assuming that solidarity and equality are things that we can simply achieve. It is in this spirit that I’ve attempted to use my own privilege as an academic to bring back lessons from Canada for the UK and beyond.

So, I’ll end this post with a serious of links to Twitter threads from the event. I livetweeted extensively from CPATH 2017, sharing summaries of the numerous talks and workshops I attended. This is by no means a comprehensive summary of any of the sessions I was at, let alone the wider conference (as numerous parallel sessions took place simultaneously). However, I hope the ideas and approaches will be as useful and interesting to you as they are to me.


Pre-conference (training) Twitter threads

Day 1:

Introduction to Gender-Affirming Practice

Pre-puberty/Puberty: Addressing On-coming Puberty

 

Day 2:

Adolescence: Moving Forward With Gender-affirming Care for Youth

Cross Country Health Clinic Practice Panel: Models of Care and Clinical Practices

 

Conference Twitter threads

Day 1:

Plenary: Centering Indigeneity and Decolonizing Gender

Interpersonal Communication Needs of Transgender People

Ethical Guidelines for Research Involving Trans People: Launch of a New Resource

Investigating the Medicalization of Trans Identity

Primary Care Approaches to Caring for Trans Youth

 

Day 2:

Plenary: Fostering Safety and Inclusion in Service Provision, Systems and Sectors

Non-binary Inclusion in Systems of Care

Trans Data Collection and Privacy

Legal, Ethical, Clinical Challenges: Youth Consent to Gender Affirming Medical Care

 

Day 3:

Pregnancy and Birth

Plenary: Supporting Older Trans People

 

 

CPATH: diversity, inclusion and decolonisation in trans health

I’m currently attending the CPATH (Canadian Professional Association for Transgender Health) conference in Vancouver. It’s a fascinating event which I’m hoping to write about more in the coming days. I’ll also be livetweeting whenever possible.

The first two days of the event are a “pre-conference” training session aimed largely at healthcare professionals, followed by a more standard three-day conference over the weekend. I’m fortunate enough to be attending the whole thing, funded through the ESRC-sponsored Trans Pregnancy project. I’m here to learn about how gender-affirming care is being practiced in North America, and to connect with people working in reproductive health and in supporting transition.

What’s really struck me so far is how much more intersectional and inclusive of actual trans people this event is when compared to professional events in Western Europe, particularly last year’s WPATH conference.

I was struck at the how the first pre-conference session I attended – billed as an introduction to gender-affirming care – had questions of diversity, power, and consent absolutely embedded into the presentations. Attendees were encouraged to reflect critically on their own privilege and social position, and that of key writers and trend-setters in the field. We discussed how social determinants of health (such as wealth, education, citizenship etc) play a huge role in determining inequalities within trans populations as well as between trans people and the cis majority.

These are pretty standard topics within sociology, but even so I felt the session was very well-presented and I learned a lot from the informative but open and deeply self-aware approach taken by the two presenters, Gwen Haworth and Jenn Matsui De Roo. It was immensely refreshing to see this kind of conversation take place in an event attended largely by healthcare providers. Too often, I feel clinical providers and researchers in the UK find themselves at loggerheads with trans patients. Often this may be because they haven’t thought to take a step back and consider the cultural context of their patient’s life and the systemic issues that this person might have encountered, let alone the deeply unequal power dynamic of the clinical encounter.

It was also really important for me as a non-clinician to take the time to listen to the stories and experiences of healthcare professionals, and learn more about the energy and care they put into the vital work that they do. I fear too many sociologists looking into issues around healthcare don’t actually attend medical conferences, and as such miss out from directly hearing about professional views and experiences.

I was also delighted to see that the space is pretty trans-friendly. People are generally sensitive around language, there are gender-neutral toilet blocks, pronoun stickers, and there’s also a “safer space” quiet room. At the WPATH conference last year, a number of trans attendees were attempting to make all of these things happen through forms of quiet guerilla disruption, for instance through putting holographic stickers on the toilets that switched between “male” and “female” images. At CPATH, trans language, trans culture and trans needs feel like part of the fabric of the event.

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My CPATH 2017 Conference name badge.
Under my name is a sticker reading “preferred pronoun: she/her”.

Finally, it’s good to see that there’s a serious decolonial agenda at CPATH. The conference booklet acknowledges that Vancouver is built on unceded lands; there are numerous sessions led by indigenous practitioners, researchers and activists; indigenous perspectives and issues are regularly discussed by non-indigenous attendees; and the introductory plenary for the conference proper on Friday will feature an opening speech and talks from indigenous activists and healthcare providers.

Of course, while all of this looks good for CPATH, the progressive appearance of the conference can hide the struggles that make real inclusion and recognition possible. I’ve heard that the opening plenary was the outcome of a struggle over indigenous representation after a number of papers were rejected. So, however good CPATH looks to me as a (white, British) outsider, it’s important to acknowledge the ongoing, silent (silenced) work that so often takes place behind the scenes to make this happen.