transition

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Trans Temporalities and Non-Linear Ageing

‘Transgender lives may require mixed strategies—not only healing and an achieved coherence but also the ability to represent and to inhabit temporal, gendered, and conceptual discontinuities.’
– Kadji Amin

I’ve recently ha9781138644939d a chapter published in a new book about LGBT ageing: Older Lesbian, Gay, Bisexual and Trans People: Minding the Knowledge Gaps, edited by Andrew King, Kathryn Almack, Yiu-Tung Suen and Sue Westwood. My essay is titled Trans Temporalities and Non-Linear Ageing.

This blog post includes an extract from the introduction to the chapter (updated slightly to reflect my advanced age from the time of writing – what temporal webs we academics weave), along a link at the end where you can download and read a free version of the entire essay.

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At the time of writing, I am 12 years old, 16 years old, and 32 years old.
I was born 30 years ago; in chronological terms, I have lived for 32 years. Chronological time is, however, just one means by which ageing might be understood (Baars, 1997). When we talk about age in terms of chronological time, we make a number of assumptions. Most importantly, we assume that our journey through the life course is linear, progressing from birth (at the beginning of the journey) to death (at the end). But my age can also be understood in terms of trans time. As a trans woman, I have experienced non-linear temporalities of disruption, disjuncture, and discontinuity.

By temporality, I refer to ‘the social patterning of experiences and understandings of time’ (Amin, 2014: 219, emphasis mine). Through conceptualising time as a social phenomenon, we might think about other beginnings and other ends, as well as wider temporal shifts and discontinuities across the lifecourse. It is not unusual for trans people do this: for example, through talking about age in terms of trans years in addition to years since birth. What if we were to regarding my coming out at the age of 16 as a beginning (and, for that matter, as an end to my ‘previous’ life)? In this case, I might say that I am 16 years old in trans years. This does not, of course, change my chronological age: I am both 16 and 32. Or, we might regard my commencement of hormone therapy as a beginning, in which case I am 12 (but also 16 and 32, still).

Importantly, trans years are not necessarily linked to chronological years. For instance, two different trans people who are both aged 80 in chronological years might have aged quite differently in trans years: perhaps one of them came out many decades ago, while the other has only been out for a couple of years. These individuals are likely to have had vastly different trans temporal experiences, which belie their apparently similar chronological age.

In this chapter I explore the consequences of trans temporalities for ageing. Non-linear ageing is not simply a matter of theory, but an approach which can enable us to ‘do justice to the complex ways in which people inhabit gender variance’ (Amin, 2014: 219). As Louis Bailey, Jay McNeil and Sonja J Ellis note in chapter 4 of Older Lesbian, Gay, Bisexual and Trans People, ‘Mental Health and Well-Being amongst Older Trans People’, trans people tend to face a range of specific challenges as they age, and may fear accessing mainstream forms of care, such as mental health services. It is therefore vital that academics and service providers alike understand how temporal phenomena such as trans years can shape trans identities and experiences.

I begin by outlining theories of queer and trans temporality that help to make sense of community terminology such as ‘trans years’. I then show how trans people may experience ageing in a variety of quite different ways, drawing on a range of literature as well as findings from two qualitative research projects. Finally, I detail two common features of non-linear trans ageing:anticipation, and delayed adolescence. These discussions draw primarily on evidence, issues and challenges that have been identified in Western European and North American research.

Read the full essay here.

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This is an open-access version of my book chapter – you are welcome to read and share it freely. However, if you are a student or academic, please do cite the published version of the essay, and encourage your library to purchase a copy of the book if they have not already done so.

For further reading, I recommend Trans Temporalities, a 2017 special issue of the journal Somatechnics. You can also read more from me on the topic in Chapter 5 of my book, Understanding Trans Health.

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How it feels to be a trans feminist academic in 2018

Trans feminist symbol, designed by Helen GThis piece is based on an email I wrote, in response to a message about “smear campaigns against gender critical academics” on a feminist academic mailing list.

I have updated and posted it here in the final day of the Gender Recognition Act consultation in order to give my cis readers some idea of how the past few months – and especially the last few weeks – have felt.

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I would like to say something about how it feels to be a trans feminist academic right now, with the emergence of a growing number of “gender critical” voices in academia.

In the wake of Brexit and Trump, and with the renewed growth of far-right movements across the world, it seems that everyone feels empowered to speak out about their own personal prejudice. Trans issues are no exception.

When I first came out and transitioned as a teenager, almost two decades ago, one of the scariest things for me was using public toilets. Let that sink in for a moment. I was scared simply to use the toilet – for fear that people might shout at me, drag me out, maybe even beat me up. While that fear has dissipated for me, I have not been to a public swimming pool since my mid-teens, and have not even been swimming in the sea since my early 20s. This is because I am scared. I am scared of violent men, but I am also scared of violent women. Cis violence against trans people is a reality. I have an enormous amount of admiration and respect for trans people who are able to overcome this fear.

It was hard to come out in the early 2000s. There was an enormous amount of casual transphobia in the media. Guardian columnists wrote pieces such as “Gender Benders Beware”, TV programmes such as Little Britain and the League of Gentlemen were immensely popular, and 90s films such as Silence of the Lambs and Ace Ventura remained popular with my friends. Trans women were variously represented as a pathetic joke, as burly men in self-denial, deceptive liars or outright sexual predators.

Legislation such as the Gender Recognition Act 2004 and Equality Act 2010 was yet to see the right of day. It was therefore legal for employers and service providers to know all about my gender history; it was also legal to refuse to hire me because I was trans, fire me from a job because I was trans, deny me services and kick me out of shops, pubs, post offices, leisure centres (etc etc) because I was trans.

It was not easy to come out in this environment. There were exceptionally few openly trans people involved in public life – and none of them looked, sounded or acted much like me. I certainly hadn’t knowingly met any other trans people. I delayed coming out for years because I wasn’t sure if I was “really trans” (a phenomenon common among participants in my research). I thought that I might ruin my life. It was only the knowledge that my life would likely be ruined regardless, and the sheer awfulness of the alternative – becoming a man – that persuaded me to take the enormous step of coming out.

Consequently, I was very isolated during the first few years of my transition. I find it very hard to express how intensely lonely that experience was. Fortunately, my friends (mostly cis girls my own age) were immensely supportive, but it was difficult not to have any people with similar experiences to talk with. People with a very deep, complex relationship with our gendered movement through the social world, and/or our sexed bodies, such that we knew the assignation we received at birth was not right for us. People who felt a deep, deep relief upon transitioning socially and/or changing our bodies as appropriate.

It wasn’t until my 20s that I began to slowly, gradually meet trans people my own age – and what a relief that was! We could relax completely around one another, talk about our issues and experiences, reflect on our differences as well as our similarities. It was at this time that I encountered the term “trans bladder” – used to refer to the pain and urinary infections that could follow from not being able to use toilets outside of the home. Let that sink in.

I also began to realise the wider extent of the damage caused to other trans people by both external and internalised transphobia.

Many of my trans friends have attempted suicide, sometimes on multiple occasions. The first trans person I knew to take their own life was a member of a trans youth Internet message board I frequented when I was 16. Others would follow, including a housemate, whose body I discovered shortly before I was due to head into work to teach a class. When I see “gender critical” people disputing well-established trans suicide statistics, it feels like gaslighting. I know what happens in our communities when people are not affirmed and don’t have access to adequate support.

Other trans friends have experienced severe sexual violence, often in their youth, often in very public spaces such as school playgrounds. Trans people are at particular risk of various forms of sexual assault, violence, coercion and control – for example, 28% of trans respondents to a large Stonewall survey had experienced domestic abuse within the past year alone. When I see “gender critical” people talking about the supposed violent threat that trans women pose, I think about how when trans friends of mine are raped, our first conversation about accessing support is usually about whether or not it is safe for them to go to the local rape crisis centre. This is not something we can necessarily take for granted.

When academics and journalists “come out” as “gender critical”, scaremongering about changes to the law we have been fighting for for decades, representing trans women and girls as sexual predators, debating our access to legal rights and public spaces and women’s services, I wonder if they know who we are, what our stories are, what our experiences are like. Is it simply that they don’t know any trans people, that they are ignorant? Or is there a deeper cause for their hatred? Do they realise they sound less like feminists, and more like the fundamentalist religious right? (for an example of how fundamentalist Christians and “gender critical” feminists basically employ the same language and discursive anti-trans tropes, I recommend a look at the responses from organisations to the Scottish government’s recent consultation on gender recognition).

As for the notion that anti-trans campaigners are “gender critical”, and my use of inverted commas for this term – I spent an enormous amount of time thinking about gender, sex and sexism even as a teenager. I read about the social construction of gender, and it made sense to me as a concept, but it took me a long time and a lot of theorising to figure out how to make sense of that with relation to my own body and experiences. I began to figure out that sex was a social construct too, reflecting the construction of gender, many years before I would encounter the work of Emi Koyama and Judith Butler. In my 20s, I was heavily involved in the NUS Women’s Campaign, and I am now (among other things) a gender theorist. In recent years I have been interested as a scholar and campaigner in the drawbacks and possible benefits of gender equality schemes such as Athena SWAN, and the fight to tackle staff-on-student sexual misconduct.

People who object to pro-trans legislation and oppose our access to public space do not have a monopoly on being “gender critical”, any more than those who oppose abortion rights have a monopoly on being “pro life”.

The growing number of academics who hold “gender critical” positions wield an enormous amount of power over their trans students, and have the potential to cause an enormous amount of harm. There are more and more of these trans students every year – of course there are. The exponential growth in the visible trans population is an outcome of the assertiveness of trans activists, our increasing visibility in public life, and a more positive legislative environment. It was predicted on multiple occasions many years ago – by Lynn Conway in 2001, by GIRES in 2009 and 2011. This is the outcome of an invisible population gradually becoming visible – just as the number of young people prepared to be out as lesbian, gay and bisexual also continues to rise. This growth will, eventually, flatten out – but it will be a fair while before this happens, especially if the current backlash continues.

I hope that cis people reading this post reflect on what it feels like for me to be involved in feminist and women’s groups at this time, especially as “gender critical” conversations become more common. It feels terrifying. I am petrified about where the discourse is heading within feminism as well as within the wider social world, and I am very scared about what might happen next, what violence might be perpetuated or excused in the supposed name of women’s rights.

I am hardly alone in this: I see trans friends freaking out en-masse every time I sign into social media. We know our history. Some of us survived Section 28. A precious few survived the AIDS crisis and surrounding moral panic. Many are also black, or disabled, or gay, or bi, or Jews or Muslims, or migrants. We know what happens when minority communities are scapegoated, and we know that the rise in transphobia is not an isolated phenomenon. We know that the most vulnerable among us are the easiest targets for hatred.

I worry every time I see a post goes up or message is written on a feminist Facebook group or blog or academic mailing list, every time somebody organises a feminist seminar or conference. I fear that someone will start raising “reasonable” concerns about my existence or civil rights, or lying about the supposed threat that I and others like me pose. For all that I move through the world as a woman, for all that I am a woman and have lived my entire life as a woman, for all that I am subject to sexism by clueless male colleagues and internalise the need to constantly apologise for myself at work, for all that I am harassed in public by men and fear male violence every time I leave work after dark, I start wondering what place I have in these groups. I start to wonder how many cis women think that somehow I am more privileged than them even though I am subject to both sexism and transphobia. I wonder how many feminists hate me.

When “gender critical” blog posts are written or emails are sent, I feel like I have a choice. Either I respond – and it may well take the form of an essay like this – an enormous outflow of nervous energy, fear and anger, energy that I will not get back repeating stories I am quite frankly bored of telling. Or I may attempt to remain cool and rational, encouraging calm and thoughtful debate even as I attempt to stem the rising panic inside. Or I try to ignore the message, even as it plays on my mind for the rest of the day, rest of the week, rest of the month, knowing that the environment has become a little less safe for other trans people – and especially other trans women – and especially other trans women less privileged than myself.

Or I just leave these feminist groups and mailing lists and academic collectives, which is of course what “gender critical” women would like me to do.

But not today. Today I stay. Today I fight. And I do not do this alone. For I know also that the majority of women support our cause.

As ever, I do this with my sisters.

Solidarity.

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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.

DNF13PxV4AEw4K-.jpg large

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

 

 

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WPATH 2016 poster: “A time of anticipation”

Here’s the poster I presented at this year’s WPATH Symposium:

Anticipation poster.png

You can also download a PDF version here.

The magnet is a metaphor for anticipation, which is both a product of and shapes feelings, emotions and experiences of time. This process is mediated by both trans community discourses and medical systems.

It’s very important to note that the majority of research participants had good things to say about the health professionals who helped with their transition. However, there is also a high prevelance of transphobia and cisgenderism within medical systems and clinical pathways. Anxiety and mistrust of practitioners within the trans patient population is endemic, and this is compounded by long waiting times.

My wider research looks critically at how discourses of trans health are differently understood within and between community/support spaces, activist groups and the professional sphere; however, the purpose of this particular poster was communicate some of the difficult experiences that current patients have with waiting. It sparked some productive conversations and I hope that further work will follow from this.

Sources:

Transitional Demands (Jess Bradley and Francis Myerscough)

Experiences of people from , and working with, transgender communities within the NHS – summary of findings, 2013/14 (NHS England)

Current Waiting Times & Patient Population for Gender Identity Services in the UK (UK Trans Info)

 

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No, I will not help Sundog make a documentary on trans “regret”

This afternoon I received an unsolicited email in my work account from an employee of Sundog Pictures. An excerpt follows:

I’m currently working on an idea alongside Channel 4 following transgender individuals who have come to regret their sex changes and are keen to undergo further treatment / operations to reverse the change. The doc will be insightful and sensitive and will look at the way in which transgender individuals are treated in society and whether the process before someone is permitted an operation is robust enough.

I’m currently looking for real life cases to include in my pitch document and was wondering whether you might be able to recommend people I could speak to, or places I could contact to find individuals who are currently thinking about a reverse sex change. Any help would be really appreciated.

Given the email account used, I feel that I can safely assume that I was contacted because of my academic work, which looks at discourses of trans healthcare provision. Sundog seem to hope that I will (without compensation) draw upon my community contacts and research findings to recommend participants for their television programme.

I couldn’t think of anything more inappropriate.

There’s a lot to be said about research ethics and a duty of care towards participants, but plenty has been written about that elsewhere (the BSA Statement of Ethical Practice offers a decent broad overview). So in this post I focus on the huge problems that come with the proposed topic of the documentary: that of trans “regret”.


The numbers

The mainstream media take an undue interest in trans “regret”. It’s very easy to come across such stories on daytime television and in both tabloid and broadsheet newspapers. The popularity and frequency of such stories suggests that it’s not too unusual for people who have undertaken a physical transition from male to female, or from female to male, to consider or undertake a “reverse sex change”.

In reality, research has shown time and time again that the actual rate of regret is extremely low. For instance, only 2% of respondents in the Trans Mental Health Study (the second-largest trans study undertaken in the UK) reported “major regrets” about the physical changes experienced during transition. Reported regrets from participants included:

“…not having the body that they wanted from birth, not transitioning sooner/earlier, surgery complications (especially loss of sensitivity), choice of surgeon (if surgery required revisions and repairs), losing friends and family, and the impact of transition on others.”

It’s clear therefore that “regret”, when it occurs, is likely to stem from societal and surgical issues rather than the process of physical transition in and of itself. The Trans Mental Health Study also demonstrates a clear link between physical transition and wellbeing in terms of mental health, body confidence and general life satisfaction.

With so few trans people regretting physical transition – and even less considering some kind of “de-transition” – it’s no surprise that sometimes the same individuals are trotted out time and time again to re-affirm a discourse of regret.


What’s missing from this story?

It’s pretty clear from the email I received that that the author has not done their research. Given the existence of organisations such as Trans Media Watch and All About Trans who are entirely keen to offer advice, this does not exactly inspire confidence.

For a start, transition is conflated with “sex change”, a term that is not only most frequently associated with transphobic tabloid headlines, but is also broadly meaningless. At what point can we talk about a “sex change”? When an individual undertakes hormone therapy? Chest surgery? Genital surgery? What about individuals who transition socially, but only undergo some (or even none!) of these processes? It’s not the kind of language that suggest an “insightful and sensitive” documentary can be made.

There’s a couple of more fundamental mistakes in the proposal, however. The first is the question of “whether the process before someone is permitted an operation is robust enough”. My own initial research findings suggest that if anything, the process in question is too robust – in that patients requiring surgery are typically required to wait many years before treatment is available.

The World Professional Association for Transgender Health Standards of Care require patients to undergo at least 12 months of hormone therapy prior to genital surgery. In reality, patients in England and Wales face a substantial waiting list (sometimes lasting years) before they are able to attend an NHS Gender Clinic, where two separate clinicians are required to approve a regime of hormone therapy before it can be undertaken. An additional two opinions are needed at a later date before a referral for genital surgery can take place. There are many, many opportunities and a great deal of time for patients to consider and re-consider their option – and that’s even before we take into account the horrific scale of the current crisis in surgery provision for trans women.

The current system is not constructed to facilitate transition so much as prevent the very possibility of regret. The result is increased suffering – in terms of the mental and physical health impact upon individuals who are forced to wait many years for hormones and surgery, whilst fearing (sometimes with good reason) that they will be denied treatment on spurious grounds. It’s no surprise that the Trans Mental Health Study found that “not transitioning sooner/earlier” is a major cause of “regret”, as individuals who have waited until breaking point to transition soon discover that there is still a long, long road ahead of them.

The second fundamental problem with Sundog’s proposal is their idea that trans people who aren’t too happy with their transition might be “keen to undergo further treatment / operations to reverse the change”. This is a very binaristic notion that both stems from and reinforces the notion that transition is a one-way process, from one (binary) gender to the other. In reality, there are many people for whom transition is a complex, ongoing process. For instance,  an individual who initially transitions from male to female might later feel that their identity is better understood as genderqueer, and may allow or pursue further physical changes to reflect this.


The wider political context

Given the tiny proportion of trans people who “regret” transition and the realities of service provision, the choice of a documentary about the subject appears at best to be somewhat misguided. However, the impact of insensitive coverage on this topic is such that I believe that I believe this documentary could be actively harmful, particularly as Sundog’s email asks “whether the process before someone is permitted an operation is robust enough”.

This is in part because the way in which discourses of regret are handled makes it harder for trans people to get treatment. Gender clinics in the UK require urgent intervention to make life easier for individuals who transition, not harder. Media hysteria over the possibility of regret reinforces the current system’s approach, which is to require people to demonstrate over and over again that they are trans before there is any hope of treatment.

But it’s also because discourses of regret are employed by those who campaign against trans liberation, including conservative commentators and anti-trans radical feminists who would deny funding for transition on the NHS altogether. Writers such as Julie Bindel are all too keen to use any example of individual regret to argue that transition is unnecessary mutilation, undertaken by sad, sick individuals who might have done otherwise if only they’d been given the option of, say, some form of reparative therapy.

The focus on the medical process is therefore politically loaded. Yes, some people do de-transition, and their stories are important and of worth. But these stories have yet to be told by the mainstream media in a non-sensationalised manner, in a way that doesn’t reinforce (intentionally or otherwise) a pernicious anti-trans agenda. Sundog’s proposal appears to feed right into this agenda.

This proposed documentary should not be regarded as a curiosity piece taking place in a cultural vacuum. It draws upon and will contribute to damaging and inaccurate tropes about transition. Ill-informed media accounts ultimately play a part in creating and maintaining a situation where “regret” frequently stems from the responses of friends and family, delays to transition and other negative experiences that come with transitioning in a transphobic society.

I hope therefore that any future attempts to examine trans health issues in this way will involve better research into the topic at the initial stages, and a greater sensitivity to both the personal and political consequences of exposing trans lives to media scrutiny.

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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.

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Laura Jane Grace subverts MTV with style

Having previously written a little bit about Against Me! frontwoman Laura Jane Grace’s recent appearance on MTV’s House of Style, I finally got around to watching it.

And, you know what, I really am impressed.

Grace makes the most of every moment of air time: she seems determined to convey a whole series of positive messages. It seems like the editing team who put together the short were pretty respectful of this. The whole programme is also largely free of the usual transphobic tropes, which is an achievement in and of itself.

I’m not normally a fan of this kind of thing. I don’t care how celebrities dress. I don’t care how they “choose” their “style”. I associate such programmes with shallow consumerism and damagingly limited ideas about how people should and shouldn’t express themselves.

But the messages that come from Grace are powerful, important and – to my mind – broadly feminist. Be true to your tastes and interests (“You can see like the texture of it? That’s real dirt”). Dress in a way that makes you feel good. Passing doesn’t need to be an end in and of itself. If you’re a young trans people, it’s okay – other trans people exist, in public!

Grace is self-consciously making herself into a role model. That’s not always a good thing, but the message here isn’t “be like me”, it’s “be yourself”. Sod the naysayers: this is punk as fuck.

Video embedded for readers who (like me) aren’t based in the US, and hence can’t watch this on the MTV website.

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There’s more to (public) life than being trans

A news feed informed me the other day that Against Me! frontwoman Laura Jane Grace had appeared on MTV’s House of Style to talk about her, uh, style. On one level, I suppose this is pretty typical of the vapid programming you’d expect from MTV – celebrity turns up, talks about her wardrobe, nobody learns anything of value but some mild entertainment supposedly takes place.

Except this is a big deal in one sense, because Grace is trans, and transitioning. By appearing on this kind of programme talking about her favourite clothes and showing off her collection of obscure punk records, she normalises transness.

There’s part of me that feels a bit uncomfortable about this – social inclusion is a worthy goal, but should it really come at the expense of a dull assimilation into corporate cultural mediocrity?

Still, I went looking for the video. I didn’t manage to find it because MTV really aren’t keen on British people watching American video content (and I can’t be bothered with proxies, at least not over this). However, I did come across a bunch of punks arguing about Grace’s participation in the programme. Some of them were unimpressed, arguing that the singer was engaging in shameless self-publicity. Others pointed out that Grace has stated before that she’s being public about her transition entirely so she can help young trans people who are struggling with their feelings. I sympathise with that latter position pretty strongly.

And so Laura Jane Grace is all over the media, talking to MTV (in a variety of contexts), Rolling Stone, newspapers, webcasts and suchlike about being trans. Like other prominent LGBT people who have come out in a high-profile way, she’s taking advantage of celebrity culture to talk about something real and important for a change.

So I feel okay with Grace being on MTV, and I feel okay with these appearances currently centring on her transness. But there’s still a danger of her becoming a one-dimensional public figure, and the rest of us have to take responsibility for this.

If you look at pretty much any Against Me! video on Youtube or read any piece about the band’s current musical plans you’ll find comment threads filled with people talking about Grace’s transition and/or arguing about her pronouns. No-one, even Grace’s supporters in this context, seem bothered with the idea that there might be anything to talk about other than her gender identity (obviously the rest of the band don’t get a look-in!)

You could blame Grace’s current media presence for this. But it’s not like she doesn’t have plenty else to say. She’s written songs about economic inequality, war, love, solidarity, terminal illness, drug abuse and the death of good friends. None of them have magically disappeared just because she’s since come out.

I realise that arguments over gender in comment threads are a somewhat inevitable consequence of the ongoing cultural contestation of transness. I’m also probably contributing somewhat to the issue by writing about it on a trans-oriented blog. Still, when I’m singing along to I Was A Teenage Anarchist I tend to think about what that might mean about youth, personal growth and political affiliation – stuff that’s important regardless of how the songwriter might define her gender. I hope others are able to keep sight of this.

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Shameless self-promotion!

I found myself in a studio recently with my Not Right bandmates, recording a number of the songs we’ve written together in the last year. The resulting EP is pretty rough and ready, but we feel it sums up pretty well we are as a band right now.

If you like angry female-fronted punk and/or music with trans themes, you might enjoy it!

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(Guest Post) Draft Protocol Review

A review of England’s draft protocol for gender dysphoria services by CL. You can read a copy of the draft protocol here, respond to the survey here, and read my own analysis here.

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Following the lead of an information note published by the department of health, the draft protocol confirms and compounds the problems of treating gender dysphoria on the NHS. It would at least mostly standardise treatment protocols across England, burdening everyone with the same problems: We’re all in this together, right?

The Gender Services Clinical Reference Group is aiming to implement standardised service provision by April 2013 and has given interested groups until September 30 to respond. GIRES has responded, as has Terrence Higgins Trust’s Trans* Women’s Sexual Health and Wellbeing Group, whose submission I contributed to. Our issues with the Department of Health’s Information Note are seen again here, and I’d like to focus on those in particular: the framing, tailoring and requirements of treatment.

Framing Gender Services Treatment

A problem in the protocol that has carried over from the information note and current practice, is the framing of gender dysphoria treatment as the property of psychiatric specialists. Even in updating the condition being treated to ‘gender dysphoria’ from Gender Identity Disorder, which explicitly frames the problem as one with our gender identities rather than our physical characteristics and the dysphoria resulting from them, the protocol places gender dysphoric people under the care of “a mental health professional (eg. psychiatrist or psychologist) who specialises in transsexualism/gender dysphoria and has general clinical competence in diagnosis and treatment of mental or emotional disorders.”

The logic behind this in the current protocol is not forthcoming. Perhaps it is because there’s a likelihood of additional mental health issues due to the stress of dysphoria. Realistically, it’s because dysphoric people have always been treated as mentally ill, and tradition has kept us under the exclusive care of psychiatrists.

Assessment is a large part of the GICs role: confirming that we have Gender Dysphoria and are not merely deluded about our gender identities. Gender Dysphoria strong enough to necessitate transition is rare, certainly, and doctors are warned to be warey of ‘Zebra diagnoses’ (as House of God, the inspiration for ‘Scrubs’ described them). That is, when you hear hooves, think horse, not zebra. That’s sensible advice, but if you’re in southern African plains, thinking Zebra first might not be so unreasonable. In this case, if someone is distressed by their assigned gender and sexed body, identifies strongly as another gender and feels relief when living as that gender, a diagnosis of ‘trans*’ is the most likely answer. Trusting this principle would rob the GICs of hours of questions about your childhood hobbies and masturbatory habits, but it would free up a lot of unnecessary appointments.

Scotland has already moved away from the complete ownership of Gender Services by mental health teams, allowing patients to self refer to a GIC. This saves an appointment with a GP, one with a community mental health team and allows direct access. For those who need a diagnosis, removing these two stages of waiting, where ignorance or prejudice can delay or waylay a patient, can get them that diagnosis quicker. Given the burden on admin staff and funding, a time, appointment and money saving move like that is far better than the protocol’s recommendations.

Tailoring Service

The introduction to the protocol claims that it is ‘informed by the 7th edition of the WPATH Standards of Care’ – sadly, it isn’t based on them. Some key recommendations from the 7th SOC were: HRT could be prescribed without RLE and one assessment, Lower Surgery required only one year of RLE (rather, one year of HRT). None of those recommendations are followed here, so the role of the 7th SOC’s ‘informing’ is not apparent. As Ruth points out, this is essentially just the existing Charing Cross treatment.

The protocol makes references to giving patients time to consider other options, other approaches, time to reflect and, of course, the RLE’s time to consolidate. There can be great value in this and many people seek the GIC to explore and understand their gender identity. Chances to really assess their history, feelings and situation can be very valuable. A friend in this situation said that her diagnosis brought her great relief and confirmation of her feelings.

For others though, this is unnecessary. Many others will have thought, reflected and considered extensively, almost exclusively at times, before seeking a GIC: they know who they are and what they need. For them, the numerous stages to access a GIC, double assessments and arbitrary RLE periods merely delay them, take up clinic time and appointments and cause additonal frustration as they wait for their treatment.

Clinics shouldn’t be forcing surgery on everyone at the first appointment, but the slowest common denominator approach is hardly ideal either, and unnecessary, arbitrary waiting is positively detrimental in many cases.

Requirements

Despite the 7th SOC’s ‘informing’ of the protocol (perhaps they were low on coasters?), RLE remains a key feature of the proposed gender services. The protocol is unclear about RLE requirements for HRT, but indicates that full HRT can be prescribed ‘Dependent on whether an individual has socially transitioned in the sense of living full time’ or is likely to ‘do so immanently’. Top surgery needs a year of RLE, lower surgery needs 2 years.

The problems with this are numerous:

  • It’s arbitrary. There are medical reasons for a year of HRT for lower surgery, but not for living full time in role.
  • Requirements of being employed have nothing to do with a stable, well founded gender identity.
  • Whilst individuals vary greatly, some people have considerably more difficulty being read as their gender prior to HRT, and AMAB people are more likely to recieve certain forms of harassment if people read them incorrectly. Forcing people into public facing roles to get the treatment they need puts them at direct risk of violence, harassment and discrimination.
  • What ‘real life’ is being experienced? From my own and others’ experience, I know that living full time as a woman pre HRT is vastly different to being full-time after a year on HRT. The near daily abuse and marginalisation, with incumbent stress, is not the real life I’m  experiencing now, but was a feature of living as a woman who was visibly trans*. The RLE required is entirely unrepresentative.
  • For all the regional variation and obfustication, the 2 years of RLE for surgery is well known, and patients work to it. The lengthy requirement can prompt patients to ‘start the clock’ running on RLE long before they are ready. Who knows how much suffering has come from that, or from knowing that no help will come before an arbitrary deadline?
  • Patients remain on the GIC’s book during this period: the aforementioned zebras get called in for appointments to needlessly check that they’re still serious, then sent away to wait another 5 months. This takes up appointments that could help patients who are less certain of their needs.

Overall, this protocol standardises existing Charing Cross treatment, which is already behind the times in not adjusting to WPATH’s SOC 7, and seems particularly inadequate when compared to the updated Scottish protocol. Most worryingly, its requirements standardise the appointments that add to the waiting times, administrative burden (which currently means Charing Cross are taking 2-3 months to send appointment summaries) and sense of disempowerment that service users experience. With multiple screenings, assessment and ‘time for reflection’, it is particularly unsuited to those who have a clear understanding of their identity and wish to proceed, and who have thought over their option extensively prior to seeking a referral. If this protocol is to last for any significant time, it will hold service users to standards that are already inadequate – If the next update will last, we need to fight for a protocol that truly moves treatment forward, so make sure to give your views in the protocol’s survey.