WPATH 2018: learning on multiple levels

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

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

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

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

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

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

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

Video: Transgender Moral Panic – A Brief Social History

In February 2018, I was invited to deliver a guest lecture at the University of Warwick as part of the “Hidden Histories” series.

In the last year there has been an enormous upsurge in media commentary that expresses concern about the role of trans people in public life. Gendered changing rooms, non-binary people, trans children and notions of self-definition have all come under intense scrutiny.

In the talk, I explored the background to the recent wave of media coverage. I argued that the transgender moral panic has been shaped by deep-seated cultural anxieties around sex and gender, taking in trans-exclusionary radical feminism, homophobic discourse, scientific racism, Brexit, and proposed changes to gender recognition laws.


Recommended further reading

Meg-John Barker (2017)
2017 Review: The Transgender Moral Panic

Combahee River Collective (1977)
The Combahee River Collective Statement

Emi Koyama (2000)
Whose Feminism Is It Anyway? The Unspoken Racism of the Trans Inclusion Debate

Emi Koyama (2001)
The Transfeminist Manifesto

C. Riley Snorton (2017)
Black on Both Sides: A Racial History of Trans Identity

Christan Williams and Gillian Frank (2016)
The Politics of Transphobia: Bathroom Bills and the Dialectic of Oppression


Corrections

I made two minor errors in unprepared asides during the talk, which I correct here for the sake of transparency.

  • Lily Madigan was elected to the position of Women’s Office in her constitutency Labour party at the age of 19, not 17.
  • David Davis was a co-founder of Radio Warwick (RaW), not David Davies.

 

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

 

 

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)

 

Video: (Mis)understanding Transgender Health

Regular readers (hi!) will have noticed that I’ve not been posting on this blog much at all over the past year or so. Between part-time jobs and my PhD thesis, I’ve been pretty busy – however, I’m nearing the end of thesis writing, so hopefully that might change in the near future. We’ll see!

One thing I’m hoping to do after I hand in the thesis is to talk about my findings in the public domain as much as possible. So, here’s an initial step towards that – a video from the re:publica TEN conference on Internet and society, where I was invited to talk about trans health.

The talk was aimed at a very general audience, many of whom weren’t familiar with trans issues, so there’s an extensive introduction to some of the basics as well as a discussion of one small area of findings and some related studies.

 

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.

I have seen the future of feminism, and it is beautiful

Yesterday’s social media furore over a dodgy letter to the Observer left me questioning my place within the women’s movement for the umpteenth time. However, within hours I was powerfully reminded that those who advocate an exclusive feminism are less influential and important than they might like to think.

Last night I joined a room of people committed to building a feminism that is compassionate, reflexive, inclusive of all women and sensitive to our different experiences.

Last night I found myself in a room of brown, black and white faces; gay, bi and straight; cis and trans; working class and middle class; disabled and abled. Last night I heard a teenage Muslim woman speak out about the importance of representing all faiths in activism after a question from a Jewish woman in the audience. Last night I heard from a white middle-class straight woman who has turned up to learn with an open mind. Last night I heard cis women talk about about trans rights, and felt that my identity and experience as a woman was simply not in question.

I had been invited to contribute to a panel discussion at the University of Bristol Students’ Union (UBU). Entitled How do we make the Women’s Movement intersectional?, the panel was was of UBU’s “Festival of Liberation“, which also includes events looking at the challenges faced by LGBT people, disabled people, and people of colour. I was honoured to share a panel with three truly awesome women: Susuana Antubam and Sammi Whitaker of the NUS Women’s Campaign, and Fahma Mohamed of Integrate Bristol.

Panellists at UBU's intersectional feminist event
Last night was promising and encouraging and heartwarming, and was not unusual in being so. I have seen similar scenes repeated across the country over the last few years at talks, workshops, protests and riot grrrl gigs.

This is the new feminism. A feminism that is discarding the model of monolithic female oppression and in its place building a movement around diversity and inclusion. A feminism that seeks to base both theory and action upon what different groups of women have to say about their lives and experiences, rather than imposing a top-down model of liberation drawn from academic theory. A feminism that sees cis and straight women take responsibility for supporting the work of their trans and queer sisters, white women take responsibility for supporting the work of their sisters of colour, abled women take responsibiity for supporting the work of their disabled sisters and so on.

Last night we talked about the importance of intersectionality as feminist praxis: of putting ideas into action. We talked about the importance of education: of sharing the knowledge and tools necessary for women’s liberation with people of all genders. We talked about the importance of representation: of working to ensure that women of all backgrounds feel welcome and able to attend feminist events through the use of accessible venues, ensuring diversity within organising teams and (where relevant) speakers/acts, and thinking about the language we use. We talked about the benefits of building groups around intersectional identities (such as black womanhood); groups that can then work alongside other bodies of people with a broader remit, feeding in ideas and holding them to account.

We talked about calling people out and challenging oppressive behaviour both within wider society and within the feminist movement. We also talked about being kind and prepared to forgive, and allowing people space to learn and grow. We talked about how everyone will make mistakes, because intersectional feminism is a constant experience of doing and being, rather than a closed process where you jump through a series of hoops and then become a Good Feminist who is capable of always passing judgement upon others.

We talked about our experiences of activism. Fahma talked about giving a piece of her mind to a nervous Michael Gove, resulting in a letter to every school in the country about FGM. Sammi talked about productive conversations with working class male friends, and building liberation into the very fabric of Anglia Ruskin’s fledgling Students’ Union. Susuana talked about her work on addressing lad culture as a gendered, racialised and classist phenomenon. I talked about my contributions to trans and non-binary inclusion within the NUS Women’s Campaign, and how we seek a diverse range of performers for Revolt, Coventry’s feminist punk night. We heard stories and ideas and questions from the audience, and I reflected on how we were not “experts” with a monopoly on solutions, but just one part of a wider movement.

These are just some of the things that we talked about.

So why have I been led to question my place within the women’s movement?

Because I see Julie Bindel referring to other feminists as “stupid little bellends” whilst misgendering trans women, arguing that bisexuals do not experience oppression, and stating that Muslim women who wear religious dress are necessarily oppressed. Because I see Rupert Read suggesting that trans women should not be allowed to use public toilets. Because I see Beatrix Campbell repeating and defending these ideas.

When I read things like this, I am repelled by a feminism that is harsh, bitter and exclusionary.

When feminists gaslight me by claiming repeatedly that the individuals who wrote these articles are not transphobic I am saddened and confused.

When I hear about feminists disrupting conversations at events such as AFem in order to promote an agenda that excludes trans people and sex workers, I am disappointed and worried.

When I see exclusionary events like Radfem 2013 and Femifest 2014 promoted within feminist spaces and supported by organisations like Women’s Aid and Reclaim The Night London I am alarmed and concerned.

When I see feminist women and men – including both public figures as well as personal friends and acquaintances – sign a misleading letter that condemns attempts to debate and contest the above, I wonder how voices of those who work for an inclusive and diverse feminism can possibly stand against a “letter mob” representing the discursive might of the liberal Establishment.

The stakes are high. Too many of my friends have considered suicide. Too many of my friends have died. When I talk to my trans friends and fellow activists, I hear about fragile mental health, doctors and shopkeepers refusing to provide services, threats of violence and attacks in the street. All of these things are fuelled by the dehumanisation of trans people, the idea that we require intervention to save us from the misguided path of transition, the implication that we do not deserve to exist within public spaces. These discourses are perpetuated by feminists and defended by liberals in the name of “free speech”.

I don’t believe in historical inevitability and don’t buy into progression narratives. I had a debate about trans-exclusive feminisms with Jack Halberstam recently. Jack echoed my PhD supervisor in arguing that trans-exclusive feminisms are outdated and irrelevant, long-dismissed within the academic world. But the academic world is often divorced from the reality of the feminist movement on the ground. In this reality, exclusive feminisms continue to fester.

In spite of all of this, last night reminded me of the power and appeal of the new, intersectional feminism. It is this feminism that is popular amongst young people who are more interested in working together than apart, and veteran activists with the humility to share their ideas and wisdom with newcomers on an equal footing.

This feminism requires work and nurture, but – as I argued last night – this does not need to be an entirely arduous task. Working together across our differences and ensuring that more people feel welcome and included makes us stronger. Learning new things from others can be interesting and exciting. Having the strength to learn from our mistakes solidifies friendships and alliances. Discovering a more diverse range of feminist histories, activisms and performances can be fun and empowering.

The new feminism is beautiful. Let’s keep building.