intersex

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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

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Gender statistic guidelines revised by HESA

The Higher Education Statistics Authority (HESA) have announced a welcome revision of their new gender and sex categories for student records within Higher Education.

I originally posted about this issue after HESA’s original proposed revisions – which appeared to ask about “legal” or “birth” sex and removed any possibility for the recognition of non-binary genders and intersex bodies – caused confusion and concern.

An impressive lobbying campaign in which trans people and allies emailed and tweeted HESA to explain our concerns has now led to a change in policy.

The revised fields contain the following categories:

SEXID (sex identifier)

1 Male
2 Female
3 Other

This replaces the current options (male, female, indeterminate) and the original proposed revision (male, female).

It is important to note that HESA acknowledge for the first time that the “other” category might be used to record non-binary genders in their advice to institutions:

The use of ‘other’ is more appropriate for people who associate with the terms intersex, androgyne, intergender, ambigender, gender fluid, polygender and gender queer.

As Jane Fae explains, this is an enormous step forward.

It’s also worth noting that institutions may, if they wish, institute additional gender options in their student record surveys (e.g. genderqueer, androgyne) and map these options onto the third category (“other”) for the sake of data provision to HESA.

GENDERID (gender identity)

Suggested question:
Is your gender identity the same as the gender you were originally assigned at birth?

01 Yes
02 No
98 Information refused

These revisions are a massive improvement, representing a step forward from the existing guidelines as well as the flawed original revisions. HESA certainly deserve credit for listening carefully and responding positively to the complaints they received.

However, there is still some ambiguity in the SEXID question. No doubt some institutions will title this question “sex” whereas some may title it “gender”, and students may still experience uncertainty when formulating a response. For instance, how are intersex individuals who define as female or genderqueer individuals who wish to note that they have been assigned a male sex meant to respond to such a question?

Moreover, it is important that trans activists based within Higher Education continue to lobby institutions to recognise gender identity within student records purely on the basis of self-definition – a matter that is largely out of HESA’s hands.

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It’s about time we listened to intersex people

An article posted yesterday on The Intersex Network highlights intersex erasure* at a recent House of Lords event.

Report on the intersex inclusive House of Lords LGBTI event ‘Human Rights for Sexual Minorities’ on 24th January 2012

Activist Anis Akhtar explains how this “LGBTI” event focused almost exclusively upon the “LGBT”, with LGBT groups speaking and topics of discussion including LGBT History Month, homophobic and transphobic hate crime in the EU, the forced sterilisation of trans people in countries such as Sweden and the complex intersection of LGBTI experiences and religion/faith.

Akhtar concludes:

“I was not surprised that the focus was LGBT but glad that a few people did say LGBTI on the day. What is paramount is that intersex people in the UK now have a voice – the use of the acronym “LGBT+” by the Liberal Democrats may be a good start.

It is extremely important to spread the word of what intersex is and what we experience due to society’s ignorance, negligence and outright discrimination towards any person who supposedly differs from the “norm.”

Intersex people stand up for LGBT and it is time that LGBTs include us as LGBTI, or intersex people stand alone and continue to fight for our own equality globally.”

Akhtar’s experience reminds me of a “trans youth” (25 and under) consultation at the Government Equalities Office during the autumn of last year; part of the process that eventually led to the creation of the trans action plan. A few of us asked why intersex issues were not also on the agenda. We were told that intersex people are “not on the [current government’s] agenda” and the Government Equalities Office did not intend to tackle intersex issues until (at least) 2015.

This is quite frankly unacceptable. Intersex people aren’t about to magically disappear, and people aren’t about to start magically respecting intersex rights.

So how can those of us who aren’t intersex provide solidarity? There’s a long history of the people within the trans rights movement co-opting intersex issues for their own ends or erasing intersex experience by claiming that trans and intersex issues are “basically the same”. This is totally unacceptable and has to stop.

What we can do is be there for intersex activists when they ask for help, just as trans people would like cis allies to stand by us without telling us how we identify or how to run our campaigns.

When UK LGBT organisations attended the House of Lords LGBTI event, why did they not join intersex activists in asking the Government Equalities Office to get its act together? When a conference that promoted infant genital mutilation was held in London during September, where were the trans people, the queers, the feminists who should have been standing shoulder-to-shoulder with the intersex activists who called a demonstration?

We need to get our act together and support others as we’d like to be supported ourselves.

*Edit 16/2/12: I today recieved the below message from a correspondent who prefers to remain anonymous, and have appended it to this post for the sake of balance. I should also clarify that whilst Anis Akhtar’s blog was not my sole source, I was not present at the event myself.

Having read your blog about the UNA House of Lords event, I must point out that intersex identities were not erased, far from it. Intersex was included in the event rationale/publicity, intersex activists were suggested and considered as potential speakers, Oii was included in the mailing list, Anis was in email correspondence with the UNA Chair (David Wardrop) and the speakers before the event, Anis spoke at the event after the Q&A and got a very appreciative thanks from the Chair and a big clap from the audience, and two of the three international speakers explicitly mentioned intersex issues in their addresses. Do you really think that amounts to erasure? I see how you might reach that conclusion if Anis’s report was the only source, so I understand why you might say that, but to be fair I do not think ‘intersex erasure at the House of Lords’ is accurate or helpful. Erasure implies an absence or at least an attempt to censor, which is the opposite of what really happened. It’s a pity you were not there to see for yourself.

I have discussed this with the UNA Vice Chair who assures me that he will support my suggestion of a follow up event where intersex issues are discussed more fully and we get an intersex activist to be a main speaker.

In the meantime, I wonder if you would be so kind as to insert a correction into your blog or remove the ‘intersex erasure’ claim? Anis’s speech was brave and important because of what it took personally for him to get there and speak despite social phobia and visual impairment, and it deserves attention on it’s own terms, not because of some spurious claim that Anis stood up to people who wanted to erase the existence of intersex people. They didn’t – Anis was welcomed and applauded wholeheartedly.

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Gender recognition under threat in UK universities

I read a very disturbing internal email this afternoon. I’m not going to quote the majority of it in order to preserve anonymity, but the central content is of concern to any current or future trans student in Higher Education.

Earlier this year, HESA [Higher Education Statistics Agency] confirmed a series of changes that they would be making to the HESA Student Record for the 2012/13 academic year, which would have an impact on some of the questions that students are asked during the application and enrolment process. A number of these changes relate to equality issues and the 2010 Equality Act and I thought it would be prudent for us to consult […]

The key changes of relevance are as follows:

(1) There is an existing field Student.GENDER which will from 2012/13 be replaced with Student.SEX. The new Student.SEX field will reflect ‘legal’ biological sex at birth and we have been advised that there will be only two valid entries for this field, either Male or Female.

(2) To complement the new Student.SEX field there will also be an additional field, Student.GENDERID, which is intended to reflect the student’s gender identity based on their own self-assessment. A response to this question, should we choose to ask it, would be optional for students. The ‘suggested question’ from the Equality Challenge Unit for eliciting this information is “Is your gender identity the same as the gender you were originally assigned at birth?” and it would be possible for students to respond with ‘Yes’, ‘No’, or ‘Information Refused’.

At my university, the current student.GENDER field allows students to identify as “female”, “male”, “other” or “prefer not to say” following intervention from trans activists and past Students’ Union welfare officers. This system, and any similarly progressive approach from other institutions, will be overturned by the new HESA guidelines.

My concerns are as follows:

1) What is “legal” sex? Is it:
(a) my birth sex? (in which case I’m male)
(b) what’s on my passport? (in which case I’m female)
(c) whether or not I have a gender recognition certificate? (in
which case I’m male)

[edit: a skim of the HESA guidelines shows that (a) is not the case, with the university apparently using the phrase “sex at birth” in error]

2) If (a) or (c), then the University is going to revert my “sex” on its forms. This will disclose I am trans to anyone using their records.

3) If (b), then anyone wishing to update their gender will have to out themselves by walking into the university administrative building and presenting their passport. I had to do this in 2005 and it caused all kinds of weird issues with the Students’ Union and my records. We changed the system in two stages (the last one is referred to in the letter) in order to prevent this from happening to anyone else.

4) The new system erases intersex people.

5) The new system erases people with a non-binary identity.

6) This whole approach has an extremely flawed methodology that will only invalidate the desired data!

I suspect my university doesn’t have much of a choice about how this is carried about, and neither will others. We urgently need to lobby HESA to reverse their policy on this.

I’ll aim to write a more coherent analysis of the situation (inc. the complex role of the Gender Recognition Act) when I’m feeling more coherent.

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EDIT: HESA notes changes to the student.GENDER field here. Information on the new (binary) gender identity code can be found here.

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Natacha Kennedy at TRED 2011

Natacha’s talk at TRED 2011. The bulk of this presentation is a witty response to Az Hakeem’s 2010 paper Deconstructing Gender in Trans-Gender Identities. Natacha herself deconstructs three central arguments present within the paper:

1) Trans people can be prevented from having genital reassignment surgery through group therapy.

2) Gender is becoming less rigid for cis people but more rigid for trans people.

3) Sex is “real” and scientifically verifiable, whereas gender is not.

The talk concludes with a brief reflection upon the work of Kenneth Zucker and the “normality” of trans and intersex phenomena.