Scotland hands unprecedented power to trans patients

The big news from Scotland today is all about gay marriage. But last week, the Scottish government quietly unveiled an equally important move.

The new NHS Scotland Gender Reassignment Protocol will have a massive impact upon those who seek a medical transition. It dramatically cuts the time required for “real life experience” prior to surgery, confirms the necessity of contested interventions such as hair removal for trans women and chest surgery for trans men, enables teenagers to begin transition from 16, and – crucially – reinforces the right of trans people to refer themselves to Gender Clinics.

Some background
Last year saw the publication of the latest edition of the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC). This seventh edition of the SOC saw a number of important changes that acknowledged critiques from trans communities as well as clinicians, leading to a focus upon gender variant identities and experiences in terms of diversity, rather than pathology.

Treatment is individualized. What helps one person alleviate gender dysphoria might be very different from what helps another person. This process may or may not involve a change in gender expression or body modifications. Medical treatment options include, for example, feminization or masculinization of the body through hormone therapy and/or surgery, which are effective in alleviating gender dysphoria and are medically necessary for many people. Gender identities and expressions are diverse, and hormones and surgery are just two of many options available to assist people with achieving comfort with self and identity. (p.5)

Thus, transsexual, transgender and gender non-conforming individuals are not inherently disordered. Rather, the distress of gender dysphoria, when present, is the concern that might be diagnosable and for which various treatments are available. (p.6)

This emphasis upon individual difference and patient agency differentiates this seventh edition of the SOC from previous editions published by both WPATH and its predecessor, the Harry Benjamin International Gender Dysphoria Association. The change follows decades of lobbying from trans activists, academics and progressive professionals. We’ve gone from a world where post-doctoral researchers who happened to be trans – such as Virginia Prince – could publish research only with the approval of cis clinicians, to a world in which trans professionals like Stephen Whittle are setting the agenda.

WPATH are still far from perfect: see, for instance, the fact that they seem to think they are qualified to speak for intersex people. But, broadly speaking, the latest SOC is a definite step in the right direction.

Competing guidance
When WPATH speaks, medical providers don’t necessarily listen. Trans people are often diagnosed according to criteria set out guidance such as the American Psychological Association’s Diagnostical Statistical Manual of Mental Disorders (DSM), which treats us as mentally ill. Gender clinics in the UK often follow previous editions of the SOC, which encourage a patronising, controlling approach in practitioners.

For instance, a recent Freedom of Information request revealed that Leeds GIC “…follows the stages laid down within The Harry Benjamin International Standards of Care (this differs from the WPATH guidance), as we believe that hormone treatment is best undertaken after real life experience has begun…“: i.e. the clinic is relying upon outdated guidance, under which patients are forced to go “full-time” for some time before they are prescribed hormones. This will clearly cause difficulties for individuals who have trouble passing as cis without hormone therapy, and may leave them open to harassment or violence.

Even less regressive GICs in the UK currently do not comply with with the most recent edition of the SOC. This can be seen in the imposition of binary ideals of gender, the absence of treatment protocols for most trans adolescents, and a “real life test” of at least two years before requests for surgery are considered (as opposed to the 12 months recommended in the new SOC).

Of course, any revision of national medical practice takes time, particularly within a public body such as the NHS. Changes to the NHS care pathway in England and Wales are currently under discussion. Moreover, hormone regimes for teenagers are currently being trialled in London. I don’t know enough about the situation in Northern Ireland to write about what’s happening there.

It is against this backdrop that the new Scottish protocol has been introduced.

NHS Scotland Gender Reassignment Protocol: the headlines
The new Scottish guidance has been shaped by trans activists working with key figures within Scottish equality bodies and NHS Scotland. It won’t have an immediate impact upon the availability of services, with implementation being a long, complicated process. However, it is historic in that the published care pathway clearly empowers trans patients in a number of ways.

The Scottish Transgender Alliance highlight a number of important points from the protocol (emphasis mine):

  • people can self-refer to NHS Gender Identity Clinics (GICs) in Scotland.
  • that psychotherapy/counselling, support and information should be made available to people seeking gender reassignment and their families where needed.
  • that two gender specialist assessments and 12-months experience living in accordance with desired gender role are needed for referral for NHS funded genital surgeries and that arrangements for delivering agreed procedures are under review with the objective of ensuring that an effective, equitable and sustainable service is implemented.
  • only one gender specialist assessment is needed for referral for hair removal, speech therapy, hormone treatment and FtM chest reconstruction surgery and that these can take place in an individualised patient-centred order either prior to starting the 12-month experience or concurrently to the 12-month experience.
  • that, in addition to access to genital surgeries, access to hair removal is regarded as essential to provide for trans women and access to FtM chest reconstruction is regarded as essential to provide for trans men.
  • that surgeries which are not exclusive to gender reassignment, such as breast augmentation and facial surgeries, continue to need to be accessed via the Adult Exceptional Aesthetic Referral Protocol but there will be a more transparent and equitable panel process for making funding decisions in such cases.
  • that young people aged 16 are entitled to be assessed and treated in the same manner as adults in terms of access to hormones and surgeries.
  • that children and young people under age 16 are entitled to child and adolescent specialist assessment and treatment as per the relevant section of the WPATH Standards of Care. NOTE: at the time the protocol was created the staffing of a specialist Under 16s service at the Sandyford GIC in Glasgow was uncertain but it now looks likely that there will be a sustainable Under 16s service provided at the Sandyford GIC in Glasgow and this part of the protocol will soon be updated.

As the Scottish Transgender Alliance note, this protocol isn’t perfect, but it does represent an important step forward. If the protocol is properly implemented, trans people will no longer be forced to spend months (or even years) fighting for a referral, before waiting even longer for treatment as a GIC patient. Trans people will be able to access vital interventions such as hair removal on the NHS, and should be able to access proper counselling and therapy services.

A personal perspective
If a protocol such as this had been in place in England when I came out as a teenager, I could have gained a referral (or even referred myself!) to a GIC at the age of 16. Even with the massive waiting list for the GIC, I might have been on hormones at 17, and had surgery at 18. I wouldn’t have had to undergo anything like so many painful laser hair removal sessions, and those that I did undergo would have been paid for by the NHS.

Instead, my first GIC appointment was at the age of 19. I didn’t go on hormones until I was 20 (causing all kinds of havoc with my university grades during my final year as I underwent a second puberty) and had surgery shortly before my 22nd birthday. I paid for several laser hair removal sessions privately. One day I hope to afford a few more, as I never finished that particular treatment.

And I’m one of the lucky ones.

The future
I can’t really understand why this isn’t already all over the LGBT press, let alone the trans blogosphere. It’s a deeply important development.

The progressive nature of the new Scottish protocol provides a positive precedent for the rest of the UK. We can only hope that NHS protocols for England and Wales and for Northern Ireland follow suit. In the meanwhile, trans activists throughout the UK could do well to pay close attention to the situation in Scotland. The success of organisations such as the Scottish Transgender Alliance provide important lessons for the rest of us.

In a gender liberated world…there would be no moral panic over trans parents or trans children

And so the Bizarrely Busy Month of Trans News rolls on.

On the subject of trans parents, the Daily Mail has effectively outed a trans father; on a slightly brighter note, Green MP Caroline Lucas has tabled an Early Day Motion condemning the ongoing media witch-hunt that’s currently targeting pregnant trans guys. Kudos once again to Trans Media Watch and Jane Fae for their ongoing work on this. Meanwhile, bookmakers Paddy Power are under fire for a transphobic advert, and today saw a five-year-old trans girl splashed all over the tabloids (including front page stories in the Metro and the Sun).

Paddy Power will no doubt defend their advert (basically a “spot the tranny” competition themed around Ladies’ Day at Cheltenham) on the grounds of humour: it’s just a laugh, right? Meanwhile the tabloids will continue to defend their almost fetishistic obsession with the private lives of trans people on the grounds of “public interest”. Both actions serve to dehumanise and objectify trans people even as they build public interest in the queer freak show we supposedly offer.

This is all, of course, of massive concern to the so-called trans community. But we’re not the only ones who are affected.

In today’s front-page article, the Metro quotes “social commentator” Anne Atkins (who?) Atkins – clearly a great expert on gender diversity – says:

“Between the ages of about five and eight, I wanted to be a boy more than anything in the world. Acute though my longing was, it was relatively shortlived. I am grateful to say that there was no one around at the time to diagnose me with GID [Gender Identity Disorder]”

If I had a pound for every well-meaning cis friend who’d told me this at the beginning of my transition…well, I wouldn’t have a huge amount of money, but I’d definitely be able to afford a better toaster. But my problem with this isn’t one of cis privilege. It basically runs as follows:

What’s intrinsically wrong with a kid spending part of their childhood as a “boy” and part of their childhood as a “girl”?

What’s intrinsically wrong with the idea of a man having a baby?

What’s intrinsically wrong with (or, for that matter, funny about)  gender being complex or fluid or aligned with their body in a non-normative fashion?

I’ve not come across a single answer to any of those questions that isn’t inherently sexist in one way or another. We shouldn’t have to subscribe to an ideology of gender difference that necessitates people being placed in boxes that restrict their self-expression. We shouldn’t have to rely on old-fashioned gender roles. At the same time, we shouldn’t have to demand that “gender” be obliterated altogether. Why can’t five-year-old Zach live as a girl? Why couldn’t Anne Atkins live as a boy for a few years before settling into womanhood?

In a gender liberated world, gender expression would be free and fluid. Adults could be men, women, genderqueer, polygendered or non-gendered as they desire. Children could be children, and explore gender as one set of social possibilities amongst many. And everyone benefits, not just trans people. We’d all have more space to be ourselves.

If you think this is hopelessly utopic and ultimately impossible, try dropping by spaces such as Genderfork and Wotever, where users/attendees are pioneering gender liberated approaches to language and social interaction.

We don’t need to do away with gender, but at the same time we don’t need to subscribe to fixed, binary ideals of gender in order to live in a decent world where people value one another’s work and care for one another.

In a gender liberated world, neither the media nor the medical world would care about five-year-old trans girl, a pregnant man or a trans person at Cheltenham because it simply wouldn’t be a big deal.

The trans girl could live out her childhood as she desired and privately transition physically – or not! – at an appropriate point in her teens. The man could access appropriate care during his pregnancy without fearing the consequences of doing so. And at Cheltenham…well, isn’t the very concept of “Ladies’ Day” totally regressive?

The Sun’s hypocrisy laid bare

The Sun is in trouble. Years of journalistic malpractice are finally catching up with the venerable tabloid, with employees arrested en-masse on “suspicion” of corruption and bribery.

Associate editor Trevor Kavanagh is upset about this.  “Witch-hunt has put us behind ex-Soviet states on Press Freedom”, his editorial thunders. It goes on to detail the humiliation experienced by Sun journalists and their families:

Instead of being called in for questioning, 30 journalists have been needlessly dragged from their beds in dawn raids, arrested and held in police cells while their homes are ransacked. […]

Wives and children have been humiliated as up to 20 officers at a time rip up floorboards and sift through intimate possessions, love letters and entirely private documents. […]

Nobody has been charged with any offence, still less tried or convicted.

Yet all are now on open-ended police bail, their lives disrupted and their careers on hold and potentially ruined.

How awful! And it’s not like Sun journalists would ever do such a thing to others, is it?

But wait! what’s this we see next to Kavanagh’s article in the online edition?

(click image for full size)

That’s right, it’s the Pregnant Man! Let’s take a look at his story.

Don’t forget kids, private lives are for News International employees, not for proles! Particularly queer proles.

Of course, it could be that the Sun is simply asking for contributions because all their journalists have been arrested…

(For more constructive commentary, see this powerful post by Ralph Francis Fox, as well as analyses from Jane Fae and Christine Burns.)

“Pregnant Man” story isn’t racy enough for The Telegraph

Yesterday, I noted a number of issues with the reporting of a British man’s pregnancy and the subsequent birth of his child. It seems, however, that the story simply wasn’t exciting enough for The Telegraph, who have revised their article somewhat overnight.

(click above for full-sized image)

The story itself remains largely unchanged: there is no new information. The only difference I could pick out was the introductory paragraph, which has changed one phrase in order to turn this somewhat inaccurate but broadly inoffensive sentence:

The man, who is believed to be in his 30s, was able to carry a child after taking female hormones to reverse the effects of his female-to-male sex change treatment.

…into something which takes that extra step to question the subject’s gender.

The ‘male mother’, who is believed to be in his 30s, was able to carry a child after taking female hormones to reverse the effects of his female-to-male sex change treatment.

Somewhat bizarrely, the original story remains online, possibly because The Telegraph wouldn’t dare offend the hundreds of readers who took time to comment on how disgusting it is that trans people want to mutilate their bodies.

Yesterday I was prepared to concede that Telegraph journalists were content to merely be stupid and lazy on trans issues. It turns out, however, that they’re actually prepared to put effort into their transphobic bigotry. Well done all.

British media in a tizzy over pregnant man

It’s finally happened: someone has noticed that a trans man in this country has had a baby. Of course the mainstream media, who between them seem utterly incapable of the slightest act of research, are responding in a predictable storm of inaccuracy and mild hysteria.

The facts appear to be as follows: some fellow – who quite understandably appears to desire anonymity – decided to have a child, and contacted the Beaumont Society for advice. The Beaumont Society don’t have a lot of knowledge in this area as they predominantly help out MtF spectrum individuals and their families, so they quite sensibly referred the individual in question on to GIRES. The grateful father later got back in contact with the Beaumont Society to thank them for their help, and everyone lived happily ever after.

Of course, that really isn’t a very exciting story. So the British media have taken a few steps to spice it up a little:

1) Exoticise trans pregnancy. Apparently this is the first British man to ever give birth. Except, of course, he isn’t. He’s just the first one they’ve noticed. There are a great many trans men in this country with children, but I suppose if you give birth before having a “sex change” (by which I believe the media mean taking hormones and/or having chest surgery) it doesn’t really count. I mean, you’ve got to be covered in hair to be a “real man”, right? There are probably also several trans guys who have had children prior to transition (at least one guy I know is planning this) but if the media doesn’t know about it, it ain’t happened. Even Pink News fall foul of this one.

2) On a related note: emphasise the international significance. Only around two or three men in the world have ever given birth before! I say “around” because there’s some confusion over this. The Telegraph uncritically quotes the Beaumont Society’s Joanna Darrell, who (purportedly) stated that one trans man gave birth in the United States (Thomas Beatie) and another in Spain. Meanwhile, the Metro states that an additional American and a guy in Israel gave birth after Beatie.

3) Highlight the risks. There is no evidence that trans children are in any particular danger from being born to trans parents, but gosh-darn it there might be! Right? According to the Telegraph: “Last night medical ethics experts called for a full inquiry into the issues surrounding transgender births, saying the interests of the child should not be risked to ‘fulfil the rights of an adult’.” At the heart of this is a very topical concern with trans fertility.

4) Finally, think of the children.  A number of sources are citing Trevor Stammers, Director of Medical Ethics at St. Mary’s University College. Stammers clearly isn’t a fan of queer families:  “The fact that the medical profession is facilitating and encouraging this is a serious problem. You are hardly going to end up with a baby that’s going to have a happy, productive and optimal childhood.

Of course, Stammers himself doesn’t appear to be a medical doctor. Now there’s a surprise.

Getting down with The Guardian

The Guardian has suddenly started to cover trans issues on a regular basis. A quick peek at their archives shows a massive increase in articles which profile trans people or explore trans issues: we’re talking about an article every few days as opposed to one every month or two or – before 2009 – one or two per year.

It does make me wonder what’s sparked this. It can’t be a coincidence: there must have been some decision amongst editors to commission more pieces on trans issues and report trans news stories more often. It seems likely that this trend has been deliberately planned to tie in with Juliet Jacques’ excellent series of articles about transition, but that itself wouldn’t be a root cause. Maybe it’s a response to the growing contributions of openly trans people within the Guardian’s comment threads (such as Natacha Kennedy, who has had the opportunity to write a number of fine articles herself). Maybe it’s a deliberate move away from offering a platform to transphobic voices from within the feminist movement, although I’m sure we’ll see another horrific article from Julie Bindel again at some point.

Still, I’m happy to see this spate of trans-friendly articles, regardless of how it happened to come about. The Guardian is well-known for its centre-left approach but hasn’t always portrayed trans issues in the most positive light (see: aforementioned voices from within the feminist movement!). The newspaper’s website is widely-read, so it’s a great way to reach out to people who otherwise might not come across decent articles about trans people.

The problem is…well, the problems are basically many of those I outlined in my previous entry. Where’s the diversity? What we’ve got is a series of excellent articles by and about white trans women (except this one by none other than…Stephen Whittle, who seems to unintentionally vie with Thomas Beatie for the crown of the One Trans Man In The World). Where are the trans men, the non-white trans people, the cross-dressers, the genderqueers, the androgynes? I’m not asking for diversity for the sake of diversity: it’s just that this current level of homogeneity really is somewhat bizarre.

To be fair to The Guardian, it hasn’t been actively erasing the accounts of those it offers a platform to, so kudos to them for going against the trend and allowing individuals such as lesbian goth comedian Bethany Black to tell her story. Moreover, Juliet Jacques has been doing an impressive job of slipping in references to non-binary identities, referencing trans feminism and rubbishing the typical idea that trans people aim to “deceive” others by trying to pass. Still, this particular piece has been coupled with the picture of a woman applying make-up, and there are articles appearing in which terms like “sex change” are thrown about and transsexed people’s old names are mentioned as a matter of course.

What we’re seeing then is a strange mixture of some genuinely progressive pieces alongside the same old transphobic tropes. It seems likely that comments and complaints from trans readers have got us this far…who knows where we might end up if we keep pushing and they keep listening?

The Trans Narrative

A good friend linked to an amusing little story the other day: Cissexuality as a Default. It’s a parody of “sympathetic” articles about trans people that turns things around somewhat. It’s not too long and I highly recommend taking the time to read it.

It made me think a little about how trans people tend to be portrayed in the media. I feel it’s often positive for trans people to have a media presence: after all, prejudice and fear often arise from ignorance, and it’s quite dispiriting to feel like you’re some lone freak rather than someone with a trait that you share in common with others. However, a good deal of trans media appearance probably do more to erase our identities than anything else.

This might seem paradoxical at first, but you’ve got to ask yourself about the nature of the trans stories you see in the UK media (when those stories exist at all). They’re usually about trans women: white, middle-aged, middle-class  trans women with “feminine” interests. Occasionally, we’re presented with a young, white, middle-class trans girl, but this is a bit more rare. Sometimes our trans woman might even be from a working-class background, but this is even more unlikely. I can’t remember the last time I saw a non-white trans girl or trans woman in the media…unless we’re talking about murder victims. It’s not so surprising that some more blinkered radical feminists link being trans with economic and/or race privilege.

Moreover, the story told is usually the same, as Cissexuality as a Default deftly demonstrates. Our brave trans woman (old name highlighted) is “different” throughout her childhood but struggles to come to terms with herself, goes through a low period, and finally decides to buy loads of make-up and come out. If this story is in a magazine, she probably also had a (single) partner to come out to as well, who will either have dumped her or slowly come to terms with the change.

This narrative accounts for the lives of many, but by no means the lives of a majority, let alone the lives of all. It’s dangerous because it often seems like the only narrative available to many trans people, and it therefore actively erases the identities of those who don’t fit the story from public conciousness.

According to this narrative, trans people are always transsexed (except when they’re cross-dressers, who usually have erotic motivations anyway). They usually conform to gender norms. They “always knew” they were trans. They’re monogamous! They are/were always “straight” or “gay”…bisexuality (let alone pansexuality) seems to be a no-no. And so on, and so forth. If you’re genderqueer, you don’t exist. If you’re a feminist, you don’t exist. If you’re a trans man, you probably don’t exist, unless you’re Stephen Whittle* (and even then you’re likely only to make a token appearance). This goes for some of the most positive and progressive trans appearances in the media as well as the more obviously regressive.

No wonder then that it’s that much harder for people to understand the concept of non-binary genders. No wonder that some are surprised to hear that trans men even exist. No wonder that many feel that they’re “not trans enough” to be taken seriously because they weren’t stereotypically feminine/masculine enough during their childhood, or they weren’t depressed enough during their teens.

The thing is, this isn’t just something the media does through ignorance or stupidity. It’s an active process. In Whipping Girl, Julia Serano writes about how TV producers in the USA insist that trans women in documentary features stick to the script: we’re talking about an appropriately feminine presentation, maybe a video of them getting dressed or applying make-up, and a suitable story. Serano’s account rang true for me, as it reminded me of my own experience with a magazine that wanted to write a story about myself and my partner of the time.

We had to tell our story to a writer, who had to adapt it to the cloyingly sickly “house style” of the magazine…fair enough, I thought. I didn’t tend to go in for all “my heart leapt as soon as I saw her” business, but I’m cool with a bit of embellishment as long as the story stays true to reality. Sadly, the story didn’t stay true to reality in any way. We were asked to revise the story again and again to fit the script. No way could we have met whilst dancing to rock music. No way could I deviate from stereotypical femininity. No way could I transition for any reason than wanting to be a soft, fluffy, pink girl.

I gave up with trying to achieve any kind of honest compromise with the magazine, but I’m pretty certain they just went out and found another trans woman who would tell them the story they wanted: the media-friendly story of being trans which can be safely consumed without any worrying deconstruction of cis-normativity or sexist ideals of womanhood taking place.

Maybe things are slowly changing. I’m beginning to see somewhat decent stories about trans children appearing in the media (although interest in trans kids can have deeply unpleasant consequences if not handled with extreme sensitivity) and stuff like the recent Guardian series in which Juliet Jacques may fit all the requirements for a trans media appearance, but at least has the decency to point out how diverse trans people really are. Meanwhile two long-running teen dramas – the UK’s Hollyoaks and USA’s Degrassi are both introducing young trans male characters.  Still, we have a really long way to go.

I’m not saying that white trans women should feel guilty about telling our stories: we shouldn’t. We should, however, be ensuring that our stories are the ones that are actually getting told, and we should helping to promote the stories of those who suffer most from this narrative erasure.

* For the record, I think Stephen Whittle is awesome. I don’t agree with everything he’s ever done, but seriously, this guy has done so much to lay the groundwork for the modern trans movement in the UK and academic understanding of trans issues on a worldwide scale.