And twenty years after government officially declared that being trans is not a mental illness, why is trans healthcare still located in NHS mental health trusts instead of in ordinary district general hospitals?

Gender Identity Clinics: Genesis and Unoriginal Sin



I think I actually am really upset about (everything) the referral call with my doctor. I had created this fantasy world in my head where my NHS doctor would somehow have advanced knowledge of trans and gender theory and that I could tell him the truth. Bending the truth scares me because I took long enough to get to this point because my experience of dysphoria was not what I had read it should be. It would feel like I was lying to myself somehow. But yeah I fucked up. Because he didn't know anything, and the conversation got weird. It was stuff like: did you have any adverse childhood experiences? Why are you mentally ill? Alongside more normal things like how long have you felt like this. Bearing in mind, he inherited my mental health care from my previous GP and didn't prescribe me my antidepressants, made me wonder how that would have gone if he was my GP when I was going on them for the first time. (But let's face it, it's not hard to get antidepressants on the NHS because there is Nothing. Else. Available. I can't stress that enough. So I'm sure it would have been possible. I just hope he doesn't expect his other mental health patients to be able to explain why they are mentally ill.) Having adverse childhood experiences isn't something you can help and it should not be stigmatised, and on a super advanced gender theory level yes there are people whose A.C.E. contibuted to their gender identity! However I do not feel that health professionals should be asking these questions with regards to gender referrals. It's complicated because I don't consider myself to have had A.C.E. although I did go through a stage of my illness where I really was trying to figure out why I was mentally ill (yaaay!) and disclosed some things to a psych which she said would go on my record. I guess he either hadn't looked at it or they didn't end up putting it on. The thing in question might be counted as A.C.E. on paper, though I don't personally consider it as such as ultimately I grew up in a loving and relatively stable home, which mitigates a lot of things.

From my awkward answers to his weird questions, he is now supposed to put together a referral to the gender clinic. I remembered to tell him which one I wanted (you can choose the one with the shortest waiting list even if it's far away, I think they have to do that as some of the waiting lists are like 5 years and some people just aren't near any of them). He didn't ask if I preferred a different name (I do). By the end of the call I was so frazzled that I didn't push the issue. Told myself it would be ok. I have heard horror stories about people ringing the GP to check up on their referral after a number of months and being told it was never put through. I'm trying to ignore that possibility. You're meant to get a letter within a few months but I have no faith in the NHS's letters. I had a cervical smear this year and they are meant to send you a letter saying if you have normal result or abnormal cells but I never got one. Fortunately as it's a test you can ring your GP for the result (thankfully it was normal). But me doing that should not have cancelled the letter- as far as I know there is no way the receptionist can, like, tick a box to say I was told my result verbally so don't send it. So where's my fucking letter?! On it's own it's not a big deal but as things are it goes on the pile of 'ohhhh fuck the NHS will probably dissolve within my lifetime....' that a lot of people in the UK my age and younger just kind of live with. Anyway, I realised today that I'm really not ok about any of this. The conversation with the doctor fucked me up and I've been feeling shitty ever since. I'm having an identity crisis. I'm still using my old name at work and now I barely know what my name is any more.

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Reminder [UK]: your GP is REQUIRED to refer you onto a gender identity clinic if you ask them to. They may try to refuse a referral - but it is not up to them. They do not get to decide who is 'trans enough' to be referred. The system is broken enough as it is - do not let your GP refuse you at the first hurdle.

If your GP refuses a referral:

1) Ask them to officially note the refusal in your file so that they cannot deny that they refused a referral later.

2) Talk to the practice manager - point out that it is a requirement that they refer you.

3) Speak to PALS.

Finally, once they do agree to refer you - chase up on it. A reluctant GP may 'lose' or 'forget' your referral. Don't sit for 6 months thinking that a referral has gone through when your GP hasn't 'gotten around' to it yet. Chase weekly.Advocate for yourself. Sometimes being a (polite, but firm) nuisance is the only way to get things done.

I'd appreciate if you could share to make sure this gets seen by people who need to see it.

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In light of recent and ongoing UK fuckery, I am so sick and tired of the idea that extremely transphobic things “aren't really transphobic” because they are coming from people who “probably mean well” and “don't hate trans people”.

Yeah, because bigotry can only be perpetrated by people who are actively, consciously hateful, sitting in their villainous lairs and dreaming up new innovative ways to be evil. (Obvious sarcasm.)

Transphobia is not just “when you actively and knowingly hate trans people”. Transphobia is also

A paternalistic attitude that says that trans people can't really be trusted to know themselves or what they want and so need to be gatekept from healthcare by cis “experts”

A refusal to listen to and take into account trans expertise; hell, a denial that trans expertise even exists

The idea that while some trans people existing in society is fine, ideally we should be limiting that number as much as we can

The idea that transition - social or physical or both - should only ever be a last resort after all other “possible avenues” have been explored, because being trans is fundamentally an undesirable inferior state and ideally we should be protecting people from transition for their own good

An attempt to clamp down on the use of “dangerous unregulated private healthcare” and an insistence on “safety” and on “doing things the right way” that manifests in reality as a denial of care because no viable alternatives to such “dangerous” options are actually provided

A carving out of exceptions to the basic principle of bodily autonomy whenever a body happens to belong to a trans person

A total dismissal of the concept of harm reduction when it comes to trans people; the only harm reduction that really matters is making sure no cis person accidentally does anything trans, and that end should be doggedly pursued no matter how many trans people it will harm along the way

An expectation of ludicrously unattainable standards of evidence and success for any healthcare involving trans people, that you would never demand of “normal” healthcare - a >15% regret rate for some common surgery is fine; a <1% regret rate for something trans-related is a national scandal that calls for an immediate inquiry into care standards

The refusal to change policies and approaches that have been demonstrated time and time again to harm trans people, because you view the status quo of cis authority over trans bodies as more important than the survival of the people those bodies belong to

The demand that cis people as individuals, and cis society at large, deserve to have their opinions taken into account regarding how a trans person chooses to live and what they choose to do to their body, and that trans freedom should hinge on cis approval

An assumption that segregation between “normal healthcare” and “trans healthcare” is just natural and necessary, even when it is literally the same procedure or treatment

The welcoming of openly trans-hostile voices into conversations about trans issues to the exclusion of actual trans people, because “it's really important that all views are aired” (apart from the views of trans people, obviously)

The attitude that, no matter how ignorant of, detached from, irrelevant to, and unwilling to learn of trans people's lives you are, your personal consent and satisfaction must be obtained before any progress around trans equality can be made, and trans people must only move at the pace of your willingness to understand and get on board

An insistence on endlessly rehashing the same basic points again and again and preventing any forward movement by repeatedly dragging the conversation back to square one, forcing trans people and their allies to debunk the same nonsense again and again and defend the same well-proven, well-established truths again and again

The denial that transphobia even exists or is a significant problem that needs to be addressed - it's not bigotry, it's just conflicting views! After all, gender identity is a polarising issue!

and so much more besides. Transphobia is a social system, a way of thinking, a set of baked-in assumptions, an institutionalised bias. Conscious, active “hatred” is not a prerequisite for anything listed above, but they are all transphobia, and at the root of all of them is a casual indifference to trans survival, a prioritisation of cis comfort and cis interests over trans lives, and an instinctive valuing of cis existence over trans existence. A lot of cis people don't even recognise these things as transphobia because they themselves hold those casual prejudices and therefore see the extensions of them as natural.

And at this point, I don't care about “good intentions”. These things are all manifestations of the insidious and deeply evil web of transphobia that prevents trans people from living full lives as equal participants in society. People who keep holding these attitudes and doing these things aren't “basically well-intentioned”; they're just bigots who don't know or care that they're bigots.

Transphobia is not just “when some hateful fanatic says they want all trans people dead”. Transphobia is all around us. Start seeing it.

Great news for trans people in the UK and Ireland!!!

A surgeon who carried out the UK’s first womb transplant on a cisgender woman has said similar transplants for transgender women are probably about 10 to 20 years away.

In February, Imperial College London professor, James Smith, and his colleague, Isabel Quiroga, from the Oxford Transplant Centre, carried out the womb transplant on a married woman whose 40-year-old sister was willing to donate her own, having already given birth to two children.

The 34-year-old recipient, who lives in England and wishes not to be named, received the transplant during an operation lasting more than nine hours at the Churchill Hospital, in Oxford.

It is hoped that, in the future, womb transplants can be performed on trans women, giving them the chance to have a baby, but Smith said the reality of this is still decades away.

There is currently no “technical feasibility” to perform the operation on trans women due to a difference in the pelvic and vascular anatomy, the shape of the pelvis and issues with the microbiome – the network of micro-organisms that live in the human body, he explained...

Dr Narendra Kaushik, a surgeon in the Indian capital New Dehli, said in May 2022 that transplanting uteruses into trans women is “the future."

Uterine transplants are currently rare, costly and experimental surgeries that typically rely on donor organs. They are often done on people born without a uterus so they can become pregnant and give birth.

The first successful womb transplant took place at the University of Gothenburg in Sweden in 2014. Two years later, the operation was carried successfully once more in the US.

About 50 babies have now been born worldwide as a result of womb transplants.

Kaushik, who has 15 years of experience in gender-affirming surgeries, said: “We cannot predict exactly when this will happen but it will happen soon. We have our plans and we are very optimistic.”

-via PinkNews, August 23, 2023

Just listened to the new episode of Tortoise’s Slow Newscast about Gender GP and it’s sooooo bad. Maybe I should have known better than to bother with it, but I’ve enjoyed their non-gender related stuff. I also know at least one person who uses Gender GP, and I separately have been hearing from an FTM support group I’m in that a lot of NHS trusts are no longer willing to do shared care with Gender GP while still doing it with other similar services. I had hoped maybe it would shed some light on why that might be, because even though trans healthcare is vital it’s still important that it be done ethically and held to the same standards as other healthcare. But no, instead it was basically a referendum on whether medical transition is good/bad. Again. Fucks sake.

(For non-UK people, Gender GP are a private service for transition related healthcare but they can, or have in the past, worked with the NHS to provide shared care e.g. blood tests for HRT monitoring. It is needed because it’s a very, very, very long drawn out and difficult process to access NHS transition care.) The podcast’s thesis was that the founder of Gender GP (a cis GP named Helen Webberley) is not practicing ethical healthcare because there isn’t enough assessment before providing HRT. They do treat children but the majority of their customers are adults. However you can guess which demographic was focused on. No children or adults who had undergone treatment with Gender GP were interviewed. There was a suggestion from the interviewer that maybe Helen Webberley is y’know a little bit ditzy, naive as hell of course, but also isn’t she bad for making money out of this? In this way she is juxtaposed against the NHS, which is the Good and Right way to transition, because they don’t profit off trans kids I guess. This argument stops working in any country that doesn’t have free at point of use healthcare of any kind, but never mind that. Also the podcast to its credit acknowledges several times that there are no currently practicing NHS gender clinics in the UK, and that this is a problem. But that’s about all we get in that department. There’s a waiting list, but no clinics. That list gets longer and longer. It’s so fucked up.

I would argue that the podcast is sceptical about the entire concept of being transgender, and I wonder if they even realise this about themselves. Two mothers of trans sons are interviewed, one who used Gender GP and one who accessed black market hormones. The first mother says that Gender GP ruined her child. But she was still referring to her child as her daughter and using she/her. You would think that if medical transition was the only concern, the mother would have been fine with the social and 100% reversable changes in pronouns and name. I know it’s hard for someone who has known you their whole life as one name and set of pronouns to remember at first, but this was different, she just hadn’t done anything. Without saying it out loud she was clearly waiting for it all to blow over, and not even considering that it might not. Meanwhile the child’s father (they were divorced) is helping the child access Gender GP, which can’t have helped matters. The mother sadly laments how Gender GP tore her family apart. The 2nd mother was worried about her child accessing black market hormones and using home syringes. This is a valid worry. However she also referred to her child purely as daughter, she/her and actively aschewed his new name. I don’t even know why she was interviewed as her son wasn’t using Gender GP, and this wasn’t a perspective about what Gender GP was clearly designed to be- a safer option in between black market hormones and the endless wait for the NHS. It was very clear she was even more ‘wait for it to blow over’ than the first interviewee. She spoke with apparent disgust (though to be fair was voiced by an actor who may have been hamming it up a bit) that since socially transitioning at school her child was suddenly really popular and was liked by many people he wasn’t before, and they all loved using his new name....that part felt especially weird, like she was angry that her child was being called a name he preferred by his friends. It’s not the first time I’ve heard of parents alluding to children coming out as trans at school to become popular. I read an article where a parent was relaying what their child had said, where apparently their classmate came out as trans in assembly and everybody clapped. The idea that there might be other factors involved, such as novelty that will wear off for the classmates, the classroom social standing of the child in question, or even in the case of the 2nd podcast interviewee’s son, increased confidence post coming out making him more sociable, was ignored. I do understand that this is a relatively new area of medicine without much long term data to draw on. However all types of healthcare has to start somewhere, and I wouldn’t have thought that the fear of an army of angry and betrayed detransitioners one day (which the interviewer was clearly disappointed that Webberley had never seen) should hold back progress. There are older adults who transitioned as children out in the world. On tumblr almost a decade ago I remember young trans guys in parts of the US accessing hormones through informed consent clinics, to much hand wringing from certain reactionary internet circles-see if you can contact those people. How are they doing?

There is so much more I could talk about but I have to stop there or I’ll go on all night. Edited to add: this should not be interpreted as a defence of Helen Webberley, only as a condemnation of the podcast episode’s framing of the concept of gender services that don’t require stringent assessment as very dangerous and scary and automatically malpractice. There’s a reason why I listened in the first place- because I had heard not great things about Gender GP. Sadly I didn’t get a look at its problems and its founder’s problems, I got yet another highly biased condemnation of the entire concept of transness with way too much airtime for parents who don’t believe their teenage children have their own internal selves.

Edit again: I understand now what the podcast was saying about clinics- there are currently no gender clinics in England that treat children. There are a few in the country that treat adults over 18, and the waiting lists are really long but at least you can refer to one in any region. My referral was for Nottingham even though I’m in the south as it currently has the shortest waiting list on the tracker.

being trans in the UK right now is so very strange, you're able to go to a mainstream high-budget arts and/or science institution and find beautiful acknowledgements of your history and respectful inclusion of current lives and projects and politics that's based in well-researched community-minded testimony and statistics, but then the government and healthcare industry is all but openly admitting that they want you to disappear off the face of the earth, based largely on the ravings of one terminally online author, a few disgraced academics and comics, and their far-right antisemitic misogynist racist american evangelist friends on a site run by a billionaire megalomaniac. i go to some positive visibility celebrating bodily autonomy that makes it seem like we're moving forwards on the same day as the cass report is released and everything is on fire

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Can you tell I'm ready to ....??

Please remember that Dr. Hilary Cass was not qualified to make that report.

Remember that the report excluded any trans people or professionals in trans healthcare to “avoid bias”.

Remember that the basis for NHS England’s decision to ban puberty blockers (specifically for gender related care) was based on a NICE report and that reports primary reason for recommending against puberty blockers was because the studies lacked double blind tests, ignoring how unethical that it would be for a double blind test to be performed on a trans kid undergoing one of the most traumatic experiences of their lives. Ignoring that a double blind test isn’t even possible for something that has clear and visible physical characteristics.

Remember that Dr. Cass herself doesn’t support the banning of puberty blockers nor the idea of doing double blind tests with them as being ethical or even possible.

Most importantly remember that now more than ever we need to be a community, please don’t let them divide us. But also remember that this isn’t the end, Liberals frame this as a doomsday but it is par-for-the-coarse in capitalism for groups like us to be targeted, don’t be dragged into the Liberal narrative.

read the sisters of dorley (alyson greaves, 2021-ongoing), a story containing such highlights as:

a satire of the trans healthcare experience in the uk

a meta-commentary on how trans women engage with/reclaim an erotica genre that both helped and hurt us growing up

the full spectrum of the transfem experience (cute & happy vs. absolute horror) juxtaposed together at all times

a bunch of neurotic trans girls in denial about being a cult

the worst opsec you've ever seen saved only by the secret it's protecting being too ludicrous to think of

more codependent transbian relationships than you can shake a stick at

the weirdest sexy chaser lady you've ever met

and a bunch of novelty mugs with really terrible puns

it's an ongoing doorstopper with every content warning under the sun and it makes me feel every human emotion at once

outfit for the airport tomorrow is beige cargo shorts and a multicoloured bumbag. couldn't be anymore patrick butcher if I tried