Concerts in Coventry: 24th June, 29th July

I’m involved in organising two exciting events at Coventry’s Tin Music and Arts over the coming month.

This coming Saturday sees the return of feminist club night Revolt, complete with bands, DJs, spoken word, zines and our Feminist Library. I’ll be opening the night with my band Dispute Settlement Mechanism.

For tickets and more info, click here.

Revolt #10
On Saturday 29th July we’ll be treated to a performance by CN Lester, who will be performing songs from their new album Come Home and reading from their great new book Trans Like Me.

For tickets and more info, click here.

CN Lester.png
Entry will also be available on the door on a donations basis (suggested donation £5, but no-one will be turned away for lack of funds).

 

WPATH 2016: the activist fringe

I’m currently in Amsterdam for the World Professional Association for Transgender Health (WPATH) biennial symposium. It’ll be the largest such conference that has ever been run, with 800 participants from across the globe. This will hopefully be the first of several posts exploring my experences at the conference (no promises, though!) – and I’m also planning to occasionally livetweet.

WPATH is an international body best known for publishing the Standards of Care, which offer guidance for practitioners supporting patients seeking to transition. The organisation has undergone a great deal of change over the years, reflecting wider shifts in understanding around trans people and our experiences. At present, the organisation’s wide scope incorporates a considerable range of views on how transition should and could be managed.

I’m here partly to present a poster detailing some of my research findings around patient experiences of waiting in the UK. However, as a sociologist with an interest in the evolution and negotiation of discourse and activism around trans health, I’ve been interested to see that at least two fringe conferences have been organised in Amsterdam to coincide with WPATH. I also thought it would be beneficial to share what’s going on with a wider audience – so, here goes!


GATE pre-conference

Global Action for Trans* Equality (GATE) is a loosely-organised international trans rights organisation: a genuinely diverse multinational network of activists with strong representation from the Global South. One of their key priorities has been to campaign for the depathologisation of trans, although members have also been involved in activism around other issues, such as access to care.

Over the past two days GATE held their own conference in Amsterdam to discuss trans health. The event both stood alone as an independent conference, and provided activists with an opportunity to discuss WPATH. I wasn’t able to attend in person, but have heard that a broad consensus was reached on a couple of issues related to the classification of trans in the World Health Organisation’s International Classification of Diseases (ICD).

The current version of the document – ICD-10, published back in 1992 – classifies ‘Gender Identity Disorder’ and ‘Gender Identity Disorder of Childhood’ as mental health issues. These diagnoses are widely used in gender clinics in countries such as the UK (note: these differ from the diagnosis of ‘Gender Dysphoria’ present in the American Psychiatric Association’s DSM). Recent statements from the World Health Organisation indicate that the long-awaited ICD-11 will replace diagnoses of ‘Gender Identity Disorder’ with ‘Gender Incongruence’, and move these to the sexual health section of the document.

Whilst GATE’s long-term goal is depathologisation, at present they have decided to focus upon pushing for this move from classifying trans diagnoses as mental health issues to regarding them as sexual health issues, as a compromise that should ensure continued funding for transition from insurance companies and public health organisations. In addition, they are arguing against the existence of the category ‘Gender Identity Disorder of Childhood’, on the grounds that this is an unnecessary medicalisation of gender diversity in young children, whilst the ‘adult’ category is sufficient to guide medical interventions for adolescents. This perspective feeds into a wider discussion around the category that is also recognised in the WPATH programme, with time set aside for a formal debate.

GATE activists will be attending WPATH to argue these points, and also to advocate more widely for trans-affirming approaches to treatment.


FREE PATHH

FREE PATHH is an event that will take place this Saturday (18th), concurrently with the first day of the WPATH symposium proper (a handful of formal pre-conferences are taking place on Friday). Hosted by Dutch trans activists, it is a free event that anyone can attend. FREE PATHH organisers argue that the high fees for the WPATH event mean that ordinary Dutch trans people are unable to attend this event held in their own country to learn more about their own health. As such, there is little interaction between WPATH and local Dutch trans communities.

The few transgender people who can afford to be present at this important symposium, are exceptions. They can go, because they have to be present for work or because they have enough personal financial means. (FREE PATHH)

As one of those few trans people who can attend the WPATH symposium (in my case, because I was lucky enough to gain a grant in order to do so), I feel this is a really important point. WPATH undoubtedly exists to share information amongst professionals in a formal setting; at the same time, the issues at hand require input from the very people who are directly impacted. With trans people disproportionately likely to be on low incomes, even early career professionals might find themselves effectively frozen out.

The FREE PATHH programme includes talks and workshops in Dutch and English on a range of issues related to trans health, and will be filmed for later disseminaton. At the end of the day, a panel with individuals who have attended both WPATH and FREE PATHH will summarise both events. This should be a valuable opportunity to share insights from both international and Dutch work on trans health, from professional and community perspectives.

You can read the FREE PATHH programme here.

Some tips on opposing Kenneth Zucker’s new article on trans children

This morning it came to my attention that notorious child psychologist Kenneth Zucker has co-written a chapter on trans issues for the new (6th) edition of Rutter’s Child and Adolescent Psychiatry. The chapter, entitled “Gender dysphoria and paraphilic sexual disorders” effectively draws upon flawed and outdated research to promote reparative therapy for trans children. You can read most of it via Google Books here.

Cover of Rutter's Child and Adolescent Psychiatry

Abusing children – for science!

This is a big deal because Zucker draws upon harmful theories (including Ray Blanchard’s deeply reductive typology of transsexualism) to promote the idea that issues faced by gender variant children are due to a problem with the child, rather than societal gender norms. He therefore promotes a form of treatment that (to quote his new article) encourages parents to “set limits with regard to cross-gender behaviour, and encourage same-sex peer relations and gender-typical activities” in an attempt to cure them of difference. This is the kind of treatment that leads children to internalise the idea that non-normative gendered expression is shameful or wrong.

Rutter’s Child and Adolescent Psychiatry, meanwhile, is a widely-used textbook and can be found in university libraries and on reading lists in many countries.

I’m not sure what the best way is to stop this article from influencing practice. However, some ideas could include:

  • Write to professional organisations and ask them to explicitly oppose reparative therapy for trans youth
  • Write to University libraries and courses, asking them to consider sticking with the 5th edition of Rutter’s
  • Write to University departments and ask them to teach critical texts alongside the 6th edition of Rutter’s, and/or avoid putting the new edition on reading lists
  • Borrow the book from a local library if it becomes available, and write critical comments in the margins
  • Write to the book’s editors and/or publisher and question why Zucker has been given a platform for his outdated ideas
  • Comment on this post and/or join this new Facebook page to discuss possible ways forward.

The new edition isn’t yet widely available in libraries, so now is a good time to act.

If you’re writing letters or raising awareness of this as an issue, here is some useful information on opposing the article:

  • Zucker’s approach to treatment can seriously harm children
  • Zucker’s Gender Identity Service at the Toronto-based Centre for Addiction and Mental Health was recently suspended pending investigation in the wake of a large number of complaints – his approach to treatment is now also arguably illegal in the province of Ontario
  • Zucker’s new article represents poor academic practice. He cites himself 17 times, relies upon papers at least 20 years out-of-date to make many of his arguments, and also draws strong inferences from statistically insignificant quantitative findings
  • Zucker’s considerable academic position is based in part upon a small “invisible college” of academics who regularly peer-review and cite one another, thereby gaining many publications with a high profile whilst avoiding external criticism
  • There is a considerable evidence-based case to be made against Blanchard’s work. See for instance “The Case Against Autogynephilia“, a peer reviewed article by Julia Serano.

Thanks and respect to Peter Le C for raising awareness of this issue, and to oatc for suggested edits.

Imagining a trans-inclusive Stonewall

“The meeting actually went pretty well, didn’t it?”

I heard a number of variations upon this statement echo around the pub we gathered in yesterday evening, as some 40-odd trans activists digested the day’s work. There was an undertone of incredulity: most of us had managed our expectations carefully in advance of the day. This was due in part to the fractious nature of trans communities, but also stemmed from our difficult history with Stonewall.

Back in 2008, many of us had been present at a loud, colourful demonstration outside the Victoria and Albert Museum as it hosted the annual Stonewall awards. We were there to express our displeasure at an organisation that didn’t simply exclude trans people, but seemed to keep making mistakes that caused harm to us.

A lot can happen in six years. Change has come from two directions: from continued external pressure from trans people, but also from a genuine willingness to reconsider matters from Stonewall following a shift in management in February.

In this post, I outline the themes and outcomes of a meeting held on Saturday to discuss potential options for trans inclusion in Stonewall. I will repeat some of the points made by CN Lester and Zoe O’Connell in their accounts of the day, but recommend you also have a look at what they have to say. For an idea of what is at stake, I recommend posts by Natacha Kennedy and Kat Gupta, as well as my previous writing on the topic.


A meeting with trans activists

The meeting – held in central London – was attended by a large number of trans activists who had been directly invited to the event, as well as three cis attendees: new Stonewall CEO Ruth Hunt, Jan Gooding who is Chair of trustees for the group, and a facilitator (who, incidentally, did a very good job).

A number of us felt that a more open meeting or more transparent means of securing invitation would have been beneficial. I’ve made my own views about this clear (particularly on social media) but in this post I will focus upon what we actually achieved, and what will happen next.

The event was in some ways quite diverse, and in others ways very limited in terms of representation. There were a wide variety of experiences represented, and views from across the political spectrum. There were a great range of gender identities represented, although a particularly large part of the group were trans women. There were attendees from across England and Wales, with James Morton from the Scottish Transgender Alliance present to talk about the situation in Scotland (where Stonewall is an LGBT organisation). The group was overwhelmingly white. There were a number of disabled people present, but not many with experiences of physical impairment.

Several commentators have stated that Stonewall were responsible for the make-up of the meeting, and therefore could have made more effort in terms of inviting a diverse range of participants. This is true, but I feel that trans activists also need to step up and take some responsibility here. Most of our loudest voices are white trans women like myself. We need to keep our own house in order: by reaching out to communities of trans people from under-represented groups, by “boosting the signal” and talking about the work of trans people from under-represented groups, and by ensuring that it’s not just us with places at the table.

It’s worth noting that this event was framed by Ruth as one part of a far wider consultation on Stonewall’s future engagement with trans issues. If you’re trans please ensure that your voice is heard in this. You can do so by writing to Stonewall here, or by emailing: trans@stonewall.org.uk. There will be more about the next steps of consultation later in this post.

The meeting ultimately had two purposes: to move on from the problems of the past, and examine potential options for future collaboration between Stonewall and trans communities.


An apology from Ruth Hunt

The day began with a refreshingly honest admission of fault on the part of Stonewall from Ruth. She offered a point-by-point account of how Stonewall has let trans people down over the past few years, and offered both apology and explanation for these incidents, as well as an account of how these are now being addressed.

This was not the main focus of the day, instead clearing the air from the start to enable a productive discussion. However, I feel it is important to provide a public record of this session: if we are to collectively move on from the past, then we need to remember that Stonewall has demonstrated a commitment to change.

Some of the issues discussed by Ruth included:

  • Nominating transphobic individuals for awards. This was acknowledged as a mistake, and we were assured that nominees are now scrutinised more carefully (not just for transphobia).
  • Insensitive use of language in Fit, Stonewall’s video resource for schools. Ruth explained that the inappropriate section has been removed from the DVD.
  • Stonewall’s campaign with Paddy Power, who were severely rebuked by Advertising Standards Authority for a transphobic advert in 2012. Ruth noted that Stonewall is now using its relationship with Paddy Power feed back on advertising they consider to be offensive (interventions which are not just limited to addressing homophobia) which has resulted in a number of changes being made.
  • Stonewall representatives speaking out inappropriately and/or not speaking out on trans issues whilst lobbying Government and MPs. There’s a long and complex history here that I’m not going into in this post: suffice to say that one aim of Saturday’s meeting was to ensure that this is done better in the future.

There was also significant evidence that Stonewall is undergoing major institutional change in regards to trans issues. I was pleasantly surprised to hear that Ruth had emphasised seeking a solution to the organisation’s difficult relationship with trans people when applying for the position of CEO, and that this was viewed favourably by trustees who considered her job application. Trans employees of Stonewall are reportedly more likely to be “out” and feel comfortable speaking about trans issues and concerns.


What’s on the table?

We then moved onto the main point of the event: to discuss proposals for a new relationship between Stonewall and trans people. There were four options for us to consider in group conversations, with attendees also encouraged to suggest any additional solutions that might not have been considered.

The options were:

  1. A fully inclusive LGBT Stonewall, which considers campaigning on trans issues to be a full part of its remit.
  2. Stonewall becomes nominally LGBT, but also funds and provides resources and guidance for the creation of a new, effectively autonomous trans organisation to work on trans campaigns. This organisation will eventually become independent, but can work closely with Stonewall.
  3. Stonewall remains LGB, and provides grants for a number of trans organisations so they can do their own campaigning work.
  4. Stonewall remains LGB, and works to be better ally.

Ruth explained that option (4) was not really favoured by Stonewall, particularly given the appetite for a closer relationship amongst many trans activists. The general feeling of the room reflected this, and we focussed our discussion upon the first three options.

Option (3) was largely rejected also. Criticisms raised included concerns about who would get the money, the impact of competition between smaller trans organisations, about what the conditions might be for such grants, and the amount of money and energy that would be spent by both Stonewall and trans groups on managing the system and applying for grants – money and energy that could be better spent on actual campaigning. Ruth further pointed out that Stonewall doesn’t actually have a lot of money to spare, outlining how money is currently spent on Stonewall’s employees and existing campaigns.  If the grant scheme was to go ahead, then there would likely be a knock-on effect on (for instance) campaigning in schools, and Stonewall might need to apply for extra money from funding pots that are already used by trans groups.

Options (1) and (2) both had great deal of support from within the room. Several groups suggested variations upon an “option 1.5” that sat between the two – proposals included the creation of a “trans department” within Stonewall, and semi-autonomous “sibling” organisation linked permanently to Stonewall.


Outcomes

There was a pretty clear consensus on the following points at the end of the day:

  • Barring the unexpected (e.g. widespread opposition from trans people contributing to the public consultation) Stonewall will become an LGBT organisation, in one form or another.
  • Any eventual solution should provide for joint ‘LGBT’ campaigning on shared issues, such as homophobia and transphobia in schools.
  • Any eventual solution should provide for campaigning on trans-specific issues, such as on relevant legislation (e.g. the Gender Recognition Act and amendments to the recent Marriage Act) and on addressing issues with health care.
  • Future campaigning work must be intersectional, recognising the diversity of trans experience in areas such as gender identity, race, disability and age.

 

What happens next?

  • The public consultation will continue for several months. If you’re trans, please make sure your voice is heard!
  • There will be further meetings held with people from under-represented groups. This is a vital opportunity to address the problem of diversity at Saturday’s meeting. Stonewall are planning meetings with people from a number of groups, including intersex people as well as trans people of colour, disabled trans people and young trans people. If you want to attend one of these meetings, please contact Stonewall: trans@stonewall.org.uk
  • There will be a formal proposal for trans inclusion in Stonewall made in January 2015 in the shape of a report. This will then be consulted upon internally (i.e. within Stonewall) and externally (i.e. amongst trans people).
  • A final decision on the future of Stonewall should be made in April 2015. If this involves full trans inclusion and/or the creation of a new trans group, this will take several months to implement.

It’s important to note that this is not a process that can take place overnight! The process of consultation is lengthy in order to take on board the views of as many trans people as possible. We have such a range of perspectives that there is no chance that everyone will be happy, but the aim is for change to be trans-led, and to reflect the desires and interests of as many people as possible.

Once the consultation ends, its results cannot be implement immediately either. Stonewall may need to revise its priorities and work plans, and Ruth noted that a full-scale programme of training on trans issues and awareness will be necessary for the organisation’s staff.


Personal reflections

I feel positive about the future. There is so much unnecessary suffering amongst the trans population that allies are vital, and Stonewall could be a particularly large and powerful ally.

I believe in diversity of tactics to bring about change, and Stonewall takes a particularly centrist, “insider” approach to this. It is vitally important that Stonewall is never the only voice in LGBT activism, and that other groups continue to take more radical approaches to trans campaigning. It is also important that we remain capable of critiquing Stonewall, and holding it to account. Ultimately though, I’d rather be a critical friend than an entrenched foe.

DSM-II

On Monday we released the second Dispute Settlement Mechanism EP, DSM-II. You can listen to it below. I perform on lead vocals, and also play clean bass guitar on our cover of Seven Nation Army.

NHS Vulva may be of particular interest to readers of this blog. It deals with issues of medical malpractice, transphobia in the legal system, and cultures of transition.

Provisional English Protocol for Gender Reassignment, 2013-2014

NHS England Interim Gender Protocol CPAG Approved 12-7-13 (released 15th July 2013)

Key changes to current treatment, and other points of interest:

  • GPs may refer patients directly to Gender Identity Clinics (GICs). It is not necessary for GPs to first refer patients to another specialist service (e.g. a psychiatrist). This is important because until now most GICs in England have required patients to be referred by a mental health specialist.
  • Facial hair removal will be available on the NHS. The Interim Protocol describes facial hair removal as “essential treatment for MtF patients” (p.10). It is funded by NHS England, rather than CCGs (Clinical Commissioning Groups: these replace Primary Care Trusts). Patients are (in theory) guaranteed nine facial hair removal treatments: one test patch, and nine sessions. Funding can be sought for further treatments but is not guaranteed.
  • Hair removal prior to genital surgery will be available on the NHS. Funding for this service is provided through NHS England in a similar manner to facial hair removal for MtF patients.
  • Adult treatment is available to trans people from the age of 17. The Gender Identity Development Service at the Tavistock and Portman NHS Foundation Trust will continue to provide services in London, Exeter and Leeds for trans people under the age of 18, according to its own guidelines. This means that trans people aged 17 may choose between “adult” and “young people’s” services.
  • Breast augementation, facial feminisation surgery, lipoplasty and sperm/egg storage may be funded. Breast augementation will only be funded if “there is a clear failure of breast growth in response to adequate hormone treatment”. All of these procedures are funded by CCGs rather than centrally through NHS England, which means that GICs must apply to CCGs for funding. They will be funded (or not) according to CCG policy, which may vary.
  • Patients require only one assessment from a GIC team member in order to be referred for psychotherapy or speech therapy. This is important as it has the potential to speed up access to speech therapy and additional psychotherapeutic support.
  • Patients must recieve assessment from two GIC team members in order to recieve hormone therapy. This is important because until now, some GICs in England have required assessment from more than two team members. Conversely, it reinforces the position of those clinicians who argue that two opinions is necessary before treatment can begin.
  • 12-24 months of “real life experience” is required prior to the provision of genital reassignment surgery. This is important because it means that patients can (in theory) access genital surgery within a year, in line with WPATH guidance. However, it is likely that clinics will continue to demand at least 2 years of “real life experience” prior to surgery.
  • A wait of at least 6 months is necessary prior to the provision of chest surgery for FtM patients. The guidance on this is somewhat vague, which should allow flexibility but may be exploited by more conservative GICs. The Interim Protocol states that patients who qualify for chest surgeries “may have engaged in a social role transition” (emphasis mine), and that a referral will “typically” be offered “around 9-12 months, but no less than 6 months, after the patient’s first consultation”.
  • Surgical providers are supposed to inform primary care staff (i.e. GPs and nurses) of procedural details and post-operative needs. We’ll see how this one pans out in practice!

Overall, this Protocol should result in a broad improvement in transition-related services for trans people living in England and Wales. If all goes to plan, more services will be available to more people, who will have to do less waiting for them! I offer a more in-depth discussion of these changes – and comparisons to the Scottish Protocol – here (please note that there have been changes since I wrote that post – e.g. GPs should now be able to directly refer to GICs, and facial hair removal should be provided on the NHS in England and Wales, just like Scotland) .

However, GICs may yet resist some of the measures in this document. The protocol was meant to come into force for all trans patients access transition-related services from 1 October 2013, so now is the time to hold medical providers to account.