transsexual

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A slow, painful grind: WPATH 2018 conference report

IWPATH_BuenoAr_Logo_reverse.jpgn the first week of November I attended the 2018 WPATH Symposium in Buenos Aires, Argentina. This biennial event is one of the largest trans studies conferences in the world, with around 800 academics, activists, healthcare practitioners and researchers coming together to exchange knowledge.

Most of the conference consisted of parallel sessions: approximately eight or nine speaker panels occurring simultaneously in different parts of the conference venue. So it is impossible for anyone to take part in the majority of conference events. Nevertheless, I attended as many sessions as possible, and livetweeted from most of these. Links to Twitter summaries of the sessions I attended can be found at the end of this post.

In this post, I comment primarily on my observations of the conference as a sociologist and trans professional.


Opportunities and inclusion

As I anticipated, WPATH 2018 was full of contradictions.

On the one hand, it was exciting to join and learn from so many academics, healthcare practitioners and human rights experts working in the field of trans health. As I report in the Twitter summaries below, the conference provided a great opportunity to participate in debates over new ideas and standards of care, and hear about cutting-edge research findings and advances in clinical practice. It was an especial privilege to learn first-hand about the implementation and impact of Argentina’s pioneering Gender Identity Law, a topic I expand upon later in this post, but hope to write about in more detail in the near future.

I was also glad to have the opportunity to present a paper on research ethics and a poster with initial findings from the Trans Pregnancy project to an international audience.

It was excellent to see that the conference organisers acknowledged and responded to some of the feedback from trans delegates in previous years. Gender-neutral toilet blocks were present on every floor of the conference venue, and pronoun stickers were provided to accompany name badges. The provision of a “trans hospitality suite” enabled trans attendees to relax in a more comfortable environment, and also arrange our own ad-hoc meetings and events. This was inevitably re-branded by its users as an “intersex and trans” room in recognition of the importance of this space also to intersex delegates; I hope conference organisers will learn from this for future events.

This year’s Symposium also benefited from a clear code of conduct and language guide, previously introduced for the 2017 USPATH and EPATH conferences.


Microaggressions and objectification

On the other hand, the cis-centric atmosphere of the event felt like a slow, painful, constant grind. As with previous WPATH conferences, the event was punctuated by constant microaggressions (and, on occasion, outright “macro”aggression); these were damaging to intersex people, people of colour and delegates from the Global South as well as trans attendees. Examples include individuals advocating for intersex genital mutilation, off-colour jokes about trans suicide, the use of outdated language, and misgendering of research participants.

Some research seemed entirely voyeuristic: for example, one poster from the Netherlands purported to report on differing levels of jealousy towards sexual competitors among “mtof and ftom transgenders”. It was often unclear how consent was obtained (if at all) for the use of personal information about research participants and/or patients. This was particularly concerning when numerous posters and powerpoint slides included unnecessary photographs of intersex and/or trans genitalia (a “WPATH conference bingo” grid circulated among intersex and trans attendees of the event included a square for “unexpected genitals”).

As a trans attendee, I felt deeply objectified by the tone and content of this material. It felt dehumanising, and I felt like a thing, subject to the harsh gaze of an abstract, dehumanising curiosity. Yet I was disturbed not only by those engaging in such work, but also in the response of many of their peers. Numerous practitioners and researchers who seemed broadly sympathetic to trans rights and affirmative in their own work often said nothing to counter transphobia, cisgenderism and endosexism in the work of others. It is difficult for intersex and trans people to explain how painful this situation is when most of our colleagues and the senior figures in the field are not intersex or trans; we know that our projects and careers alike may suffer if we speak out too openly or too harshly. I encourage fellow members of WPATH to reflect on their potential complicity in this situation, and consider how we might collectively work to change it.


Tokenism and colonialism

The choice to locate the conference in Buenos Aires felt deeply tokenistic, with numerous attendees from the Global South arguing that this represented a colonial attitude. The vast majority of conference attendees were from the United States or Western Europe. The price of the conference was a significant barrier to many attendees, amounting to the equivalent of the average monthly income in Buenos Aires. The choice to host the event in an expensive Hilton hotel felt like it was taken primarily for the benefit of (the more wealthy) attendees from the West to the detriment of local intersex and trans people, some of whom reported that they risked being profiled by the police if they tried to enter the wealthy area of the city in which the hotel was located.

The sessions on clinical practice in Argentina and human rights in Latin American were some of the most interesting I sat in on, but also least well-attended. I later heard that on one occasion a high-profile lawyer invited to speak on the topic of Argentina’s Gender Identity Law addressed a near-empty room, due to clashes with sessions that focused on Western bioethics, research and medical practice. This sense of tokenism was compounded through the choice to hold the conference in English (the official language of WPATH), with funded translation into Spanish available in a maximum of two rooms at any one time. Some of the conference organisers later stated that they had been worried about the finances of the event, but this felt like a strange claim in the wake of a lavish gala dinner with dancers, DJs, and multiple buffets serving food from various regions of Argentina. As human rights expert and executive director of GATE Mauro Cabral declared in the closing plenary of the conference, “When WPATH decided to come to Argentina, with the most progressive gender identity law in the world, I was excited. But we could only talk among ourselves. You came to this country because of the weather, steak and wine, but not to learn from us”.

While these issues are primarily structural ones that need to be formally addressed by WPATH, the onus is also upon individuals from Western and/or Anglophone countries to take action and reflect upon our relative power and privilege in attending these events. In addition to vocally supporting my colleagues from the Global South, one aspect of my own practice I feel I can address is my use of language in planning talks. For example, I could have undertaken a little extra work to ensure that my slides were bilingual, listing bullet points in Spanish as well as in English. I hope to draw on this lesson in preparing for future international events.


TPATH, human rights monitors, and lessons from Argentina

My experience of WPATH 2018 was improved enormously by the presence of other trans people working in the field of trans health, as well as the intersex activists and human rights experts who came to monitor WPATH’s historic antipathy towards intersex rights. Many of us are members of TPATH (the Transgender Professional Association for Transgender Health), a new and as-yet loosely affiliated group of trans people working in trans health that I helped to co-found during the 2016 WPATH Symposium in Amsterdam. Numerous others were part of a 50-strong delegation of intersex and trans human rights monitors from all parts of the world, who attended in order to conduct a collective human rights audit of the conference.

It was with these individuals that I found myself having the deepest conversations, these individuals with whom I heard the most fascinating research findings and the most rigorous analyses. We also shared a strong sense of solidarity in the face of the many problems apparent at WPATH 2018.

That said, the most important event I attended took place outside of the WPATH event: in Casa Jáuregui, a historic queer cultural centre many blocks away from the Hilton. Here, Frente de Trans Masculinidades (the Transmasculine Front) and other activists based in Buenos Aires hosted a meeting with TPATH members from the Bahamas, Aotearoa/New Zealand, Norway, South Africa, the UK and the USA. We shared information on our various areas of work, and the local activists talked at length about the history, implementation and practical impact of the Gender Recognition Law.

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Argentinian activists host TPATH members at Casa Jáuregui.

While it is important not to deny the significant challenges faced by trans people in Argentina, which include harassment by authorities, economic marginalisation and many forms of violence and discrimination, many of us were struck by how much has been achieved by activists in Argentina and (consequently) how advanced trans rights are in this country. The Gender Identity Law has been carefully written to enable flexibility; this has meant, for example, that it was interpreted to enable non-binary recognition by a judge as recently as last week. It also guarantees access to healthcare, which has meant that every possible medical intervention is available to trans people, either for free or through relatively inexpensive health insurance (in theory, that is: in practice, various legal battles have been necessary). This has been of benefit to cis women and queer people as well as trans people: for instance, through enabling easier access to hysterectomies or breast reductions.

During the meeting, the local activists described gender-affirming medical interventions that most of us had never even considered, such as beard hair implants for transmasculine individuals who cannot or would prefer not to use testosterone. Moreover, while long waiting lists exist for some procedures such as surgeries, those of us attending from European countries and (especially) Aotearoa/New Zealand were astonished by how much shorter they were than equivalent waiting times in our own countries, in part due to the absence of unnecessary gatekeeping procedures and treatment bottlenecks.

I was profoundly moved by the opportunity to attend this meeting, and regretted that so much of my time in Buenos Aires was spent in the sterile environment of the Hilton. However, I was also glad to have the opportunity to work with others to challenge the hierarchies and cisgenderist assumptions inherent in WPATH. We undertook many small interventions: asking questions about ethics, consent and power dynamics in the sessions we attended, raising concerns in private conversations, reporting blatant contraventions of the WPATH code of conduct. I was also pleased to hear many of my colleagues openly critiquing problematic issues identified during an update on the progress of the forthcoming Version 8 WPATH Standards of Care, and take part in attempts to hold our professional body to account during a member’s meeting on the final day.

Overall, I found WPATH 2018 to be a very tiring, draining and frequently unpleasant experience. However, I do not regret attending. I am grateful to have had the opportunity to learn so much from so many. I am also glad to have played a small role in supporting my intersex and trans colleagues and my colleagues from the Global South in attempting to help transform WPATH so it is more transparent, more accountable, and less colonial in attitude and in action.


Session summaries

The following links are to Twitter threads in which I summarise plenaries, talks and mini-symposia I attended at WPATH 2018.

Saturday 3rd November

Opening session and President’s Plenary

Keynote: Employment discrimination against trans people (Sam Winter)

Keynote: Trans legal history in Latin America (Tamara Adrian)


Sunday 4th November

Mini-Symposium: The Argentinian experience of public transgender health after the implantation of the Gender Identity Law

Oral presentations: Services in different parts of the world (Australia, Southern Africa, Scotland)

Mini-Symposium: Trans refugees: escape into invisibility

Mini-Symposium: Latin American perspectives on depathologization of trans and travesti identities

Plenary: Show hospitality to strangers: intersex issues in the time of gender identity laws (Mauro Cabral and respondents)
Note: this was listed as a plenary session in the programme, but actually took place alongside multiple parallel sessions. Consequently, this talk was under-attended by Western healthcare practitioners in much the same way as the Latin American sessions.


Monday 5th November

Oral presentations: Suicidal and non-suicidal behavior

Mini-Symposium: Ethical considerations in transgender health research

Oral presentations: Fertility

Oral presentations: Reproduction


Tuesday 6th November

Mini-Symposium: Child and adolescent medicine Mini-Symposium: Child and adolescent medicine

Plenary: SOC 8 update

Plenary: SOC 8 Q&A

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GRA consultation: A guide for feminist and LGBTQ+ academics and allies

The UK’s Government Equality Office is consulting on possible changes to the Gender Recognition Act 2004 (GRA). Anyone can respond. The consultation link is here: https://www.gov.uk/government/consultations/reform-of-the-gender-recognition-act-2004.

The consultation ends at 11pm on 19 October 2018.

There has been a large backlash from people hostile to trans rights. It is important that academics who support trans rights respond to the consultation, ideally with reference to relevant evidence from scholarly research. This guide provides advice on doing so.

(Note: post updated 15/10/18 to include additional links and my full consultation response)


Background

At present, the GRA enables adults to obtain a Gender Recognition Certificate (GRC) and change the gender on their birth certificate from female to male, or vice-versa.

  • This has consequences for the registration of sex/gender upon marriage or civil partnership and affects some insurance and pensions.
  • It is of symbolic importance for many trans people.
  • Non-binary genders and trans people under the age of 18 are not recognised.

The GRA is not relevant to legal changes of name or sex/gender marker in any other arena.

  • Trans people are already able to change their name and sex/gender marker with organisations such as banks, schools, universities, social services, the DVLA and NHS. No medical evidence is required for this process.
  • Trans people are already able to change the sex/gender marker on their passport with a letter from a doctor.

Trans people have criticised the GRA for being unnecessarily bureaucratic and intrusive.

  • Applicants submit evidence – including medical records, letters from mental health specialists, and proof that they have lived in their ‘acquired’ gender for at least two years – to the Gender Recognition Panel.
  • The process costs £140 (plus additional costs) and there is no right to appeal.
  • An official list of people who have changed their sex/gender in this way is kept on a ‘gender recognition register’.

Note: I use the term ‘sex/gender’ as current UK law does not distinguish between ‘sex’ and ‘gender’: the two are used interchangeably.

 

Backlash

Since the GRA consultation was announced, numerous single-issue anti-trans groups have emerged to oppose amendments to the GRA and argue for a wider push back against the social recognition of trans people’s genders and access to sexed/gendered spaces.

Anti-trans groups have spread misinformation about the GRA.

  • e.g. the purpose and function of the GRA has been conflated with the Equality Act 2010, which governs trans people’s access to sexed/gendered public spaces.

These groups have a powerful voice in the mainstream media.

These groups have access to significant funding that trans groups do not.

  • Tens of thousands of pounds have been spent on billboards and newspaper adverts opposing trans rights.
  • Anti-abortion American fundamentalist groups such as ‘Hands Across the Aisle’ and far-right publications such as Breitbart and The Federalist have extensively promoted the work of ‘feminist’ anti-trans groups and shared crowdfunding pages.

These groups claim to represent feminism.

  • They wrongly argue that gender recognition poses a threat to women’s rights.
  • Trans women are often represented as potential or actual sexual predators.
  • Trans men and non-binary people often are represented as tragic or deluded.
  • By contrast, numerous groups who work with vulnerable women (e.g. Scottish Women’s Aid) have supported trans affirming reforms to gender recognition.

These groups are encouraging their supporters to respond to the GRA consultation.

  • This happened in response to a similar consultation by the Scottish government. While in that instance most respondents supported extending trans rights, thousands of anti-trans responses were also submitted.


Responding to the consultation as academics

As academics, it is important that we support good governance grounded in empirical evidence and the principles of equality and equity for all. As feminists and/or LGBTQ+ people, it is important that we recognise that current attacks on trans rights echo and are linked to similar attacks on women’s and LGBTQ+ rights.

In responding to the consultation:

Concisely reference scholarly evidence where possible.

  • Assert your own expertise where relevant.
  • In the linked PDF below, I have used in-text citations for brevity. However, Government bodies tend to prefer links or full-reference footnotes, so please bear this in mind.

Ensure your response to each question makes sense as a stand-alone comment.

  • Don’t build an argument across the entirety of your consultation response or cross-reference your previous answers.
  • Consultation responses will be analysed on a question-by-question basis.

Responses from organisations are given more weight by the government.

  • If it is possible to submit a response on behalf of your department, school, centre, professional organisation or academic special interest group, please do so in addition to your personal response.

If you have limited time and energy just responding to the tick-box questions will make a difference.

Please share this information with your colleagues to ensure a large, evidence-based trans-positive response to the consultation.


Resources

Here are two documents I have produced to help you and your colleagues in responding to the consultation.

GRA consultation – suggested starting points for responding to consultation questions
This document includes information on each consultation question, including relevant evidence and citations that you might want to use in your submission.

GRA consultation – a guide for feminist and LGBT+ academics
This document includes the full content of this blog post plus the suggested starting points for responding to consultation questions.

For guides to the consultation from non-academic organisations, see:
Amnesty International
LGBT Foundation
Mermaids
Stonewall
National Union of Students
GIRES and TELI (focuses on recognition for trans youth)

You can see my complete personal response to the consultation here: GRA response.

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Family Planning workshop at Trans Health Matters (23 October)

In a couple of weeks I will be attending the Trans Health Matters conference, which is held at Resource for London on Tuesday 23 October.

You can read about and book tickets for Trans Health Matters 2018 here.

Co-hosted by holistic sexual health centres cliniQ (London) and Clinic T (Brighton), this event offers an insight into cutting edge practice and research, particularly with regards to sexual and mental health.

I will be speaking at a workshop entitled Trans Family Planning: Contraception, Fertility, Pregnancy and Childbirth, alongside Kate Nambiar, Michael Toze and Francis Ray White.

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Resource for London, Holloway Road

Trans people often find there is a lack of information available on their own fertility, or that they have been misinformed about the reproductive capacity of their own bodies. Similarly, trans people wishing to form families continue to face social, legal and medical barriers to parenthood. The workshop will comprise three short interventions, reflecting on current challenges and opportunities for trans reproductive autonomy, and an opportunity for attendees to reflect on how this might relate to their own work.

Kate Nambiar is a medical doctor and researcher who works at Clinic T. She will be discussing issues around contraception for trans people.

Michael Toze is a Research Fellow in the School of Health and Social Care at the University of Lincoln. He will talk about UK medical practice and law with regards to trans fertility, parenthood, and sterilisation procedures.

Francis Ray White is a Senior Lecturer in Sociology at the University of Westminster, and I am a Research Fellow in the School of Sociology and Social Policy at the University of Leeds. We will be discussing intial findings from the Trans Pregnancy Project.

 

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Forthcoming talk: Hysterical Bodies

event posterWednesday 28 February
7pm – 9pm
Birmingham LGBT Centre
Free entry and food provided.

Bread and Roses for All, and Hormones Too!
A panel discussion with Aquila Edwards and Luke Dukinfield, facilitated by Robin Lynch and hosted by Birmingham Women’s Strike Assembly.

I will be giving a short talk about intersections between trans health and women’s health, focusing on how our bodies have historically been pathologised and disciplined in medical settings.

There will then be a facilitated discussion. I’m honoured to be sharing the panel with some fantastic speakers so it’s sure to be a really interesting event.

Register to attend for free on Eventbrite.

Facebook event page.

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Trans Genealogies: special issue articles now online!

trans symbol

Trans symbol by Chris Hubley

[Edit 14/02/19 – the special issue has now formally been published, and is available here.]

I’m delighted to announce that the articles written for the Sexualities special issue ‘Trans Genealogies’ – edited by myself, Deborah Lynn Steinberg and Igi Moon – have now been pre-published on OnlineFirst.

While the creation of this special issue has been a particularly long and difficult affair, it was really fantastic to work with such interesting and thought-provoking articles. I’m really excited that we can now finally share them with the world.

—

The articles will be formally collated and published in a single issue of Sexualities in a few months’ time. This will be available both online and in print format, and I’ll no doubt be using that as an opportunity to once again encourage people to read them.

However, for now you can read the special issue articles here:


Introduction: The Emergence of ‘Trans’
Ruth Pearce, Deborah Lynn Steinberg and Igi Moon
[OnlineFirst] [open access]

Axiomatic: Constituting ‘transexuality’ and trans sexualities in medicine
JR Latham
[OnlineFirst]

Response and responsibility: Mainstream media and Lucy Meadows in a post-Leveson context
Kat Gupta
[OnlineFirst]

Rethinking queer failure: Trans youth embodiments of distress
Katrina Roen
[OnlineFirst]

‘Boying’ the boy and ‘girling’ the girl: From affective interpellation to trans-emotionality
Igi Moon
[OnlineFirst]

Genderqueer(ing): ‘On this side of the world against which it protests’
Zowie Davy
[OnlineFirst]

De/constructing DIY identities in a trans music scene
Ruth Pearce and Kirsty Lohman
[OnlineFirst] [open access]

Mak nyahs and the dismantling of dehumanisation: Framing empowerment strategies of Malaysian male-to-female transsexuals in the 2000s
Joseph N Goh and Thaatchaayini Kananatu
[OnlineFirst]

—

Here’s what we have to say about the special issue content in the editorial introduction:

We open with JR Latham’s ‘Axiomatic: Constituting ‘‘transexuality’’ and trans
sexualities in medicine’. Latham provides a genealogy of medical becoming, draw-
ing the reader’s attention to the manner by which trans identities may be consti-
tuted in and through a pathologising discourse that retains the influence of
pioneering mid-20th century clinician Harry Benjamin. Through his elucidation
of four axioms of transsexualism, Latham also unpacks the role of sexuality in
the becoming/emergence of trans in medical settings, and explores the manner by
which we might arrive into entirely contingent spaces of gender subjectivity and
enactment that we nevertheless take for granted.

A second example of the disciplinary impact of categorical thinking is explored
in Kat Gupta’s article, ‘Response and responsibility: Mainstream media and Lucy
Meadows in a post-Leveson context’. Like Latham, Gupta describes how trans
might ‘emerge’ and ‘become’ through the interventions of non-trans actors: in this context, journalists writing about trans teacher Lucy Meadows after she came out
in the workplace. Meadows’ dreadfully sad fate is only compounded by the con-
tinued construction of an unwanted male identity for her in British newspaper
reporting. However, as Gupta carefully demonstrates, this was not entirely the
outcome of intentional prejudice: rather, the misgendering of Meadows emerges
through the subtle contingencies of repetitious reproduction and metacommentary.

The four articles that follow critique binary thinking from a range of perspec-
tives, and question both cis-normative and trans-normative approaches to categor-
isation. These articles ask how we might think about bodies and psyches in a more
open and ethical manner, informed by ‘trans’ discourse but with wider conse-
quences for understandings of gender and sexuality. They look at how we might
move beyond the axioms described by Latham and the cultural forces analysed by
Gupta, inviting us to consider how we might re-think our approaches to bodies and
identities, avoiding binaries in inhabiting these ideas while building new solidarities
and allowing new possibilities to emerge.

In ‘Rethinking queer failure: Trans youth embodiments of distress’, Katrina
Roen explores how we could seek to break from normative thinking, including
the transnormativities that have emerged with ‘trans’. Noting that trans youth
are frequently associated with narratives of distress and self-harm, Roen draws
upon Jack Halberstam’s concept of queer failure and Sara Ahmed’s feminist cri-
tique of happiness in order to ‘unsettle’ these narratives and imagine new trans
possibilities ‘that do not involve straightening or alignment’.

Igi Moon also looks predominantly at the experiences and narratives of trans youth in ‘‘‘Boying’’ the boy and ‘‘girling’’ the girl: From affective interpellation to trans-emotionality’. In their article, Moon argues that emergent trans discourses offer an important alternative to binary notions of emotionality. Moon describes ‘trans-emotionality’ as a pluralistic approach to understanding gendered feeling that has been made possible through non-binary and genderqueer peoples’ responses to experiences of sexual liminality and dis-orientation.

In ‘Genderqueer(ing): ‘‘On this side of the world against which it protests’’’,
Zowie Davy questions the categorical lines that are frequently drawn between
‘transsexual’ and ‘genderqueer’ trans identities, desires and bodies. Revisiting a
series of interviews from the early 2000s, Davy employs the Deleuzian notion of
‘assemblage’ to question frequently taken-for-granted assumptions around trans
difference. She asks us to be reflexive in our understanding of the terminologies of
trans, transsexualism, transgenderism, genderqueer and non-binary; terminologies
that can be used to help us understand specificity but which can also be used to
close down analyses of connection and similarity. In this way we are effectively
encouraged to be attentive to the limitations of a ‘non-binary’/‘binary’ binary in
our accounts of trans possibility.

An optimistic account of such possibilities is provided by Ruth Pearce and Kirsty Lohman. In ‘De/constructing DIY identities in a trans music scene’, the authors draw upon a case study of an ‘underground’ scene in the UK to explore how trans discourses and everyday political approaches can feed into processes of cultural production. This offers an insight into what possibilities might emerge and flow from ‘trans’ as a pluralistic approach to gender and identification.

The issue closes with an account of Malaysian legal and media advocacy, ‘Mak
nyahs and the dismantling of dehumanisation: Framing empowerment strategies of
Malaysian male-to-female transsexuals in the 2000s’. In this article, Joseph N Goh
and Thaatchaayini Kananatu effectively revisit a range of themes from across the
special issue: processes of becoming and definition (including self-definition
as well as being defined by others) and the manner in which activism intersects with the media and law as well as the medical and political establishments. Like the UK case studies, this account is one of both specific importance and broader relevance. It is vital to acknowledge the particular context of the struggles for gender liberation by mak nyahs in Malaysia: a context shaped both by local law and religion, and the
complex post-colonial impact of Western discourses and political interventions.
The emergent language of mak nyah identity effectively stands in opposition not
only to the cis and binary gender norms of conservative politics and religious
fundamentalism, but also to a homogenised white, Western, Anglophone discourse
of ‘trans’. At the same time, Goh and Kananatu highlight how high the stakes are
and how difficult the battles for liberation can be for gender diverse peoples around
the world, in an important account of the dangers and possibilities that come with
‘trans’ visibility.

I hope readers find the special issue articles as fascinating, challenging, and useful as we did. Enjoy!

 

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Forthcoming talk: The Transgender Moral Panic

I’ve been invited to give a guest lecture at the University of Warwick next week, on Thursday 8th February.

This will be part of the “Hidden Histories” alternative lecture series, organised by Warwick Students’ Union with support from a number of academic departments.

The talk will take place from 7pm in S0.21 (Social Science Building), and is open to all. I will speak for around an hour and there will be time for questions and discussions.

Here’s the blurb from the Facebook event page:

The Transgender Moral Panic: A Brief Social History

Over the last few months, 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, with psychologist Meg-John Barker describing 2017 as “the year of the transgender moral panic”.

For the 2nd lecture in our Hidden Histories series, Ruth Pearce will explore the background to the recent wave of media interest, taking in radical feminist theories, scientific racism and proposed changes to UK law. She will show how the transgender moral panic has been shaped by deep-seated cultural anxieties around sex and gender, brought to the fore by the precarious successes of the trans liberation movement.

Ruth Pearce is a trans feminist scholar. Her research primarily examines discourses, practices and experiences of trans health. Her PhD was awarded by the University of Warwick in 2016. Her thesis looked at how trans health is differently understood within trans communities, activist groups and professional literatures, with a range of meanings and practices contested within and between these spaces.

Come along for what is set to be a fascinating event exploring a topic which is generally erased from mainstream curricula. Refreshments will be provided!

Hidden Histories banner

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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.

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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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CPATH: diversity, inclusion and decolonisation in trans health

I’m currently attending the CPATH (Canadian Professional Association for Transgender Health) conference in Vancouver. It’s a fascinating event which I’m hoping to write about more in the coming days. I’ll also be livetweeting whenever possible.

The first two days of the event are a “pre-conference” training session aimed largely at healthcare professionals, followed by a more standard three-day conference over the weekend. I’m fortunate enough to be attending the whole thing, funded through the ESRC-sponsored Trans Pregnancy project. I’m here to learn about how gender-affirming care is being practiced in North America, and to connect with people working in reproductive health and in supporting transition.

What’s really struck me so far is how much more intersectional and inclusive of actual trans people this event is when compared to professional events in Western Europe, particularly last year’s WPATH conference.

I was struck at the how the first pre-conference session I attended – billed as an introduction to gender-affirming care – had questions of diversity, power, and consent absolutely embedded into the presentations. Attendees were encouraged to reflect critically on their own privilege and social position, and that of key writers and trend-setters in the field. We discussed how social determinants of health (such as wealth, education, citizenship etc) play a huge role in determining inequalities within trans populations as well as between trans people and the cis majority.

These are pretty standard topics within sociology, but even so I felt the session was very well-presented and I learned a lot from the informative but open and deeply self-aware approach taken by the two presenters, Gwen Haworth and Jenn Matsui De Roo. It was immensely refreshing to see this kind of conversation take place in an event attended largely by healthcare providers. Too often, I feel clinical providers and researchers in the UK find themselves at loggerheads with trans patients. Often this may be because they haven’t thought to take a step back and consider the cultural context of their patient’s life and the systemic issues that this person might have encountered, let alone the deeply unequal power dynamic of the clinical encounter.

It was also really important for me as a non-clinician to take the time to listen to the stories and experiences of healthcare professionals, and learn more about the energy and care they put into the vital work that they do. I fear too many sociologists looking into issues around healthcare don’t actually attend medical conferences, and as such miss out from directly hearing about professional views and experiences.

I was also delighted to see that the space is pretty trans-friendly. People are generally sensitive around language, there are gender-neutral toilet blocks, pronoun stickers, and there’s also a “safer space” quiet room. At the WPATH conference last year, a number of trans attendees were attempting to make all of these things happen through forms of quiet guerilla disruption, for instance through putting holographic stickers on the toilets that switched between “male” and “female” images. At CPATH, trans language, trans culture and trans needs feel like part of the fabric of the event.

IMAG0167

My CPATH 2017 Conference name badge.
Under my name is a sticker reading “preferred pronoun: she/her”.

Finally, it’s good to see that there’s a serious decolonial agenda at CPATH. The conference booklet acknowledges that Vancouver is built on unceded lands; there are numerous sessions led by indigenous practitioners, researchers and activists; indigenous perspectives and issues are regularly discussed by non-indigenous attendees; and the introductory plenary for the conference proper on Friday will feature an opening speech and talks from indigenous activists and healthcare providers.

Of course, while all of this looks good for CPATH, the progressive appearance of the conference can hide the struggles that make real inclusion and recognition possible. I’ve heard that the opening plenary was the outcome of a struggle over indigenous representation after a number of papers were rejected. So, however good CPATH looks to me as a (white, British) outsider, it’s important to acknowledge the ongoing, silent (silenced) work that so often takes place behind the scenes to make this happen.

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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.