Medical services for trans people

The parliamentary committee are not our friends, and have recommended keeping trans medical bottlenecks at the moment when trans medical care could open up. They recommend more gender clinics, when gender clinics should be shut down.

Trans is easy to recognise. Trans men are people assigned female at birth who are convinced that they are men, want to be treated as men, or want to express themselves as men. They may want bodily alteration to appear more clearly to be men, to themselves and to others. Trans women go the other way. We know who we are.

That settled conviction is in some way different from those mental illnesses which divorce one from reality. I don’t understand how, particularly, but my understanding of myself as a woman is different from my friend’s schizophrenic daughter’s belief that there is an electronic device in her head which enables the Government to know what she was thinking. My desire to express myself female is more like a gay man’s desire for a particular male partner- incomprehensible to some straight men, but not “insane” or “psychotic”.

The committee say there are huge waiting lists. 13,500 trans people were waiting as of January 2020, before covid. Their evidence was a BBC report. The report’s figure came from Freedom of Information requests to each gender clinic, but some figures date back to July 2019 and the committee heard evidence that lists have increased since then. One clinic’s waiting time was increasing by five months each year, even before covid.

A trans person should be able to go to their GP and say that they are trans, and get a prescription for hormones. If the trans person understand that hormones may reduce their fertility and sexual response, that should be enough. The GP might want a psychiatrist to make absolutely sure that the patient was not psychotic, but should be able to check that themself. They might not like the idea of a healthy testicle being amputated, but they should accept that orchiectomy is beneficial, just as they should accept that abortions are necessary.

The trans person needs hormones, hair removal and speech therapy for women, and psychological support for the transition, which can be the most stressful experience in a person’s life. They may not need medical treatment at all- if a trans person wants to transition without threatening their fertility they should be able to do so.

So NHS England funding the Royal College of Physicians to develop education in gender dysphoria medicine is a backward step (report, para 194). Physicians, medicine, not surgery. These physicians would have the boring task of giving hormone prescriptions to patients who asked for them.

In Wales, there is the germ of a new path. There are around 70 GP “clusters”, and any GP who wants can train to be the lead on gender identity within the cluster. Cat Burton from GIRES gave evidence that most people approaching their GP just want to talk to someone about dysphoria arising from presenting in their assigned gender. They might not transition socially. They might just take hormones. Whether the “tiny minority” who have surgery is a small proportion of those who transition, or of those who approach their GP whether or not they transition, is unclear from the report. How Cat knows and who she asked, whether there was a survey and how systematic it was, is not clear from the report. I had thought trans men needed chest masculinisation to transition socially.

I would love to know how many more people talk to their GP about dysphoria, than transition. That would show how terrifying transition is, because of all the prejudice.

However, the Committee recommends more “trained and specialist clinicians”, para 197. They would keep the bottlenecks, even though they admit the new pilot clinics cannot make surgery referrals (para 191) and cannot reduce the waiting lists.

If there was the political will, the NHS could cut the surgery backlog by temporarily reporting private surgeons who perform the operation across the EU.

The committee found trans people have difficulties accessing primary health care. Some GP practices make difficulties over recording correct name and gender. A trans man with a cervix still needs smear tests. Getting them is a computer problem, but the NHS should be able to sort that.

Michael Brady, national adviser for LGBT health, said GPs needed training in order to be “more comfortable” using correct pronouns and managing trans patients (para 204). In other words, GP practice is filled with prejudice.

The committee found that LGBT people are more likely to be mentally ill, but there is insufficient mental health care and GPs might seek mental health support from GICs, though they do not give it. Psychiatrists treating for other conditions challenge trans people’s gender identity.

After the LGBT consultation in 2017, the government committed to an LGBT action plan rectifying the problems it identified. The committee found the Johnson government has gone back on this. Liz Truss confirmed that, para 218. She said she was working on banning conversion therapy instead, as if doing both were impossible.

The committee considered nonbinary recognition. The government and EHRC said it was too difficult. There were complex practical consequences for public life. The LGBT action plan had committed to seeking evidence on nonbinary recognition, but even that had not been done (para 225). The committee was reduced to demanding the government explain what difficulties might prevent nonbinary recognition, but since ministers refused to appear to give evidence, that recommendation is unlikely to be followed. The committee called on the EHRC to research the area, but with Lady Falkner, Akua Reindorf and others on its board this is unlikely.

While there was a majority on the committee for all these restrictions on trans rights, anti-trans campaigner Jackie Doyle–Price voted for them to be even more restrictive. Her constant ally was Phillip Davies, men’s rights activist and anti-feminist MP.