Trans children and adolescents in Australia

Australian doctors affirm trans children, and show why affirmation works: Trans or gender diverse children with good health and wellbeing who are supported and affirmed by their family, community, and educational environments may not require any additional psychological support beyond occasional and intermittent contact with relevant professionals in the child’s life, such as the family’s general practitioner or school supports. Others need a skilled clinician working with the family, to help them support their child. Where there are other mental health problems, they should be treated together with GD.

Parents who do not support their child’s transition may make their mental health worse. “Do no harm” does not mean refusing gender-affirming treatment:

Withholding of gender affirming treatment is not considered a neutral option, and may exacerbate distress in a number of ways including increasing depression, anxiety and suicidality, social withdrawal, as well as possibly increasing chances of young people illegally accessing medications.

Social transition improves emotional functioning. It should be the child’s decision, and may be just at particular times or particular places. Social transition brings trans children’s depression, anxiety and self-worth to the same level as cis children’s. Doctors may need to be advocates, telling schools this is what the child needs. An endocrinologist should see the child before puberty starts.

Children referred in adolescence need different treatment. The child may have spent a long time coming to understand their gender dysphoria, and considering how to explain it to parents, so will want immediate support and medical help, but a parent might see this as sudden, and have difficulty adjusting. The child needs a comprehensive exploration of the adolescent’s early developmental history, history of gender identity development and expression, emotional functioning, intellectual and educational functioning, peer and other social relationships, family functioning as well as immediate and extended family support.

Once there is significant breast growth and menstruation in a trans boy, puberty suppression is not recommended. Gender dysphoria around menstruation can be reduced with norethisterone. Testosterone in trans boys may produce irreversible facial and body hair growth and scalp hair loss. Deepening of the voice is irreversible. Clitoral enlargement and vaginal atrophy may be reversible, but this is unknown.

Oestrogen in trans girls will reduce muscle mass and strength, soften skin, and decrease libido and spontaneous erections. These effects are probably reversible. Breast growth is irreversible. The testicles will shrink, and sperm production decrease: it is unknown if these effects are reversible.

Teenagers vary in their maturity, and ability to make decisions with complex risks and benefits. However delaying hormone treatment in trans girls means increased masculinisation of face and body, and suppressing puberty without starting stage 2 treatment (gender-affirming hormones) can weaken bones. Refusing treatment reduces an adolescent’s sense of their own autonomy and agency.

GPs should give an initial assessment, including of the family support and functioning, and advise on the effect of treatment on sexuality, sexual pleasure, and fertility.

A trans boy may have chest masculinisation surgery as young as 16. There should be a joint decision with child, parents and clinicians coming to consensus, taking account of the child’s maturity. However the guidelines advise delaying genital surgery until adulthood, because it will make the patient sterile, and may reduce sexual pleasure and interest.

The New Zealand Adolescent Health Survey suggested that 1.2% of adolescents identify as transgender. The guidelines suggest that this means referrals will continue to rise. Only an atmosphere of support and acceptance will enable a child to make a proper decision.

Guidelines pdf.

Is Quakerism a religion?

A religion gives shape to lives, and binds communities together. It helps us understand and live well. A religion is not merely a “belief system” but a way of life. Ninian Smart analysed the phenomenon of religion in seven dimensions, some of which fit Quakerism in Britain particularly well:

The practical, ritual dimension

Quakers worship together weekly. Our ritual is simple, so that I have denied it was ritual at all, but it gives shape to our worship. We go together to a particular room, where we sit in silence, in a circle or square. There is a table in the centre, with a Bible and Quaker Faith and Practice on it. The meeting starts when the first person sits down, so others joining may nod a greeting, but not speak one. People may speak during worship, and there are complex rules governing who speaks and how, designed to foster speaking in a mystical sense of being moved to “minister” for the benefit of all the people there and discourage other speech.

We learn to sit in silence, listening for that motivation to speak, then act in the same way when we make decisions together. We hold marriages and funerals. When the family arranges the funeral elsewhere we hold a memorial meeting. We have no formal ritual for welcoming a new-born into the meeting, but procedures for making an adult a full member: usually there is a “visit” where the applicant gives an account of their spiritual journey and calling into Quakerism.

The experiential, emotional dimension

We highly prize experience. Even when we affirmed and taught Christian doctrine, it was a framework for the experience of worship, being moved to speak, and living out our lives as led by the Spirit. People may come to our society by Convincement, a period of felt spiritual hunger and seeking then seeing that our way fits their spiritual needs, even their spiritual selves. We experience Leadings, where a person will come to understand a particular form of service to the Quaker and wider community is required of them. Living well is doing what feels right, rather than following a system of rules.

We do not seek a heightened state of emotion but a quiet integration of it. “Take heed, dear Friends, of the promptings of love and truth in your hearts”- this is a felt sense guiding action not an emotional state for its own sake. We teach our faith to new attenders, but also provide libraries so that people may explore it as they feel the need.

The narrative, mythic dimension

In the Enlightenment humans came to understand the world rationally, and to make truthful statements about it. This has confused Christians, some of whom take Genesis as literal history. Some Quakers react against that by rejecting the Bible. So we and they lose stories which should have power for us. We can reclaim the Bible by finding value in its stories, of men and women created together in the image of God, of Jesus speaking as moved by the Spirit and following God’s leadings to a non-violent resistance ending in his death. Too literal and rational, we may reject “conjuring tricks with bones”, or accept Christ as a real presence among us.

We might use them better, but the myths and stories are there in the Bible to teach and inspire us if we are open to it. These stories are true, even though Adam is not a historical figure: they tell us about God and humanity. We are more comfortable with stories of our own history and heroes, of Elizabeth Fry working with prisoners and their children, of 17th century Quakers speaking out in the King’s churches and claiming equality with the King’s judges.

The doctrinal, philosophical dimension

Our doctrine is in the service of our experience.  We have several easy mnemonics for profound truths: “There is that of God in every one,” we say, and what that means, for me and for my relationships with others, works out through my life. I can begin to understand on first hearing the phrase, grow in understanding as I apply it, and read what Quakers have said about it. Quakers sit in silence for an hour on Sundays and talk incessantly the rest of the time. We think and teach what is the experience of the meeting for worship. We learn to communicate our spiritual experiences.

The ethical, legal dimension

Stating we have testimonies to Truth and integrity, Justice and equality, simplicity, and peace, we begin to learn what Quakers consider is the good life. We retain Christian ethics including the Golden rule. I am a Quaker insofar as I am part of a Quaker community and leading a good life according to Quaker values and psychology. Advices and Queries explain what we have found to be Good.

We would like to think our ethics are practical. We take sexual morality seriously, but do not have a uniform set of rules for everyone: different kinds of relationships are accepted. Some Christian ethics has the effect of creating an out-group, but we reject that as unethical.

The social, institutional dimension

Every Quaker is part of a local meeting, their own worshipping group, then the area meeting, a group of local meetings. We know each other in the things which are eternal. There are gatherings of Quakers doing work for Quakers in Britain as a whole, with links to local meetings, coming together in different groups to knit together the whole community of the yearly meeting. We support paid workers to undertake particular tasks, overseen by committees of Quakers meeting in worship.

The material dimension

Many of us would say that the material dimension is irrelevant, that we can meet in any space large enough for the gathering, but we often have special meeting houses for our worship. We want these to be practical buildings, let out to others for meetings, and yet we come to love them as spaces hallowed by worship. We rarely produce Quaker art, but make vast quantities of records of our decisions, and libraries of our writings.

Seeing a religion as a belief system drives Enlightened people away. Genesis as an account of how the Earth came into being is worthless, long superseded by scientific knowledge. Religion as the ties that bind a community and teach the good life nurtures people and enable us to live well together. Christians with the Creed at the heart of their worship might first ask a religion new to them, what its adherents believe, but denial of reality and assertion of falsehood is no necessary part of good religion. These seven dimensions of religion show how it can have practical value for everyone. I read of them in Buddhism: a very short introduction by Damien Keown.

cracks in the concrete

All those silent Quaker meetings! What am I doing there? They can seem long and painful. I am groping in the dark. Thoughts run through my mind, of what I need in the supermarket.

Saturday was difficult. I thought my friend’s union was handling his redundancy procedure, but when we met for lunch I found they weren’t, and he was meeting with management on Tuesday. I worked with him to make a statement of his case, to try to get the union involved, and looked up the law on an argument I had never put in a claim, when I did tribunals eight years ago. It is more restrictive than I had hoped, but I found another thing I could say. It felt far too crude to me. I was saying “This is harassment” rather than arguing why. He gave a long involved account of an issue at work which I struggled to understand. Would it really save the employer time and effort, as he claimed? What would they say to such a claim? I felt my efforts and abilities were so meagre compared to the difficulty of the task.

There are personal relationship issues within the meeting which I cannot discuss here, and they weighed on my mind. It seems to me that in the succession of silent meetings we stew in our own woes and self-castigation, not hearing each other- though of course I may be projecting. I sit with people unable to hash things out. I see misunderstanding growing to hurt.

It seems to me I learn better to see things from another’s point of view. He’s wrong, but this is why he sees it this way. We explain he is wrong. Oops, is he abashed and hurt? What he says next shows he is not, but resentful and protesting he is right. Mmm. Maybe that is his way of dealing with it, maybe he will work it out later, or maybe he is incapable of empathy in this case. People are different. Empathy is difficult, unless you can make an analogy to your own experience.

No, I can’t resolve the issue- but I can possibly move it forward.

In Meeting, one ministers on gratitude, for family and worthwhile work among other things. I just feel my pain, shaking, twisting my body, clenching my teeth trying not to gasp. The pain’s intensity is surprising: my surprise and resistance make it manifest in movement. After, I stood and spoke, of the injustice I see in my friend’s “redundancy” dismissal, and my powerlessness: what I can do seems so little! Then I stand, uncertain- are there any more words?

and I feel a sense of love, blessing and acceptance from above.

I hope this was ministry for other people. It may have been just for me- and I need to know that pain! How else can I heal it?

After, I discuss the redundancy with an employer. “It’s very difficult to prove redundancy”, he says, and I observe that I always acted from the claimant’s point of view- it is very difficult to prove it is Unfair or discriminatory. They do need to save money, and why not on salaries- and why not on his? Then he makes useful suggestions- there are organisations which do pro bono work- as if I would not have thought of that. He explains why my friend’s face might not fit, and his manager find him threatening, which is interesting, but mainly it is useful when I am speaking. I lost that job because I got emotionally involved, I say, then start to squeak and gasp out the words. NOT because I felt with the claimant, who was having such a difficult time, but because

I should be able to accomplish more!

The rage against my powerlessness! I see it more clearly. I hold it in awareness, with less distraction. I am not suppressing it so much.

Doing benefit tribunals, the image came to me of facing a brick wall. Sometimes there was nothing I could do; but sometimes I would see a crack in it, and launch at the crack. Here is the same image in a song, which I found here:

This world is for the lovers and the fighters
The bold hearts and the dream-igniters
The bold hearts and the decolonizers
The bold hearts and dream igniters

You better believe there’s cracks in the cement,
Transphobia just came and went…

Trans medicine and storytelling

Transition is a process of self-discovery, self acceptance and self-expression. How should society react to that? By celebrating and facilitating it.

Doctors should consider gender dysphoria, the discomfort arising from not fitting the assigned gender. They should treat any underlying psychological conditions, any resultant anxiety and depression, and help the patient consider all options for gender expression. Gender dysphoria- that feeling of extreme discomfort and alienation- exists.

Medicine proceeds, perhaps especially in this case, on stories. Until 1912 doctors did more harm than good to their patients: natural healing processes and placebo accounted for most of the cures. The doctor sees a distressed patient who wants a solution to their problems, which has sufficient scientific rigour to convince them. Once a solution is proposed, other patients are aware of it, and consider whether it might apply to them. A cold can be cured, by waiting, but epilepsy or arthritis can only be managed. Perhaps no-one has good mental health, but most people can function reasonably well.

People have been expressing themselves as the opposite sex for centuries, part time and full time. The chance of getting that accepted by society through medical confirmation was blissful, and scientific stories of brain difference grew up with mythic stories of being a “woman trapped in a man’s body”. Stories grew to counter the narrative, which people share to enjoy a communal sense of disgust against the Other: stories of mutilation and falsehood- yet still we transition.

David Brooks writes of two kinds of stories- myths, from Athens, of solitary heroes overcoming challenges, showing competitive virtues of strength, toughness and prowess; parables, from Jerusalem, of ordinary people together, showing co-operative virtues of charity, faithfulness, forgiveness and commitment. The two cultures are not so rigorously divided, but the point stands. To some feminists those co-operative virtues can seem too much to fit the “feminine” stereotype used by the Patriarchy to hold women down. Then trans women are the enemy, enforcing feminine subjugation. No group of people can exist without co-operative virtues, not a city, company or family. All human beings have co-operative and competitive virtues, and in maturity learn to balance both. More competitive societies, failing to value co-operation, increase stress and depression.

The story of the “true transsexual”, who transitioned gender roles with hormones and surgery, enabled me to accept being myself. I could shed the poisonous male act. But that male act was also a story, about how men should be, not fitting real people in the real world, and the “true transsexual” story was too restrictive, demanding too high a cost. Now we have stories of “non-binary” people, who do not fit either gender stereotype and play between.

Trans men are confronted with the story of the butch lesbian, fearlessly being herself without the need to pretend to be a man. And some women present as butch lesbians, but carry regret and a sense of incompleteness: does that arise because they are really trans, or because men are treated with greater respect than butch lesbians?

The way we present to other people is a story we tell about ourselves to others. We judge others constantly, and try to be seen in particular ways. Do you dress casually, fashionably, stylishly, scruffily? How do you hold yourself? Do you look others in the eye? Jewellery sends signals.

Transition is hard to stop once you start. I went to work presenting male, but went out at the weekend expressing myself female. I found I could do that in straight spaces as well as queer spaces, in the concert hall then the supermarket as well as the gay village, and the male act at work seemed more and more stifling and unbearable. Transition was a story, a solution which took hard work and determination but would complete my liberation. It would take time, but I knew the solution, I was clear about where I was going. How could I resist? The doctors I chose went along with that story. Protests from outside, particularly cries of disgust and derision, only strengthened my resolve- of course, when seeking to realise my true self, there would be carpers and mockers: think the chromatic woodwind “critics” in Strauss, Ein Heldenleben.

After transition, I embarked on a yet more perilous quest, to find who I am, as a human being. From a point of not knowing, I find what motivates me, what repulses me, what gives me joy. I come to trust my humanity, my gifts and qualities, as good in themselves. Why would I be so hard on myself? I am still escaping that oppression.

The story of transition, the person liberating their true self, is not countered by attempts to undermine it. The carpers and critics may attack its scientific rigour, but it retains enough to convince us. It has too much staying power to be blown away. It works. It liberates us, and insofar as more work of liberation remains to be done after, we only see that after completing transition.

A woman told of years with the psychiatrists demanding whether she was sure she wanted a vaginoplasty. Are you sure you will not regret losing your penis? Of course she was. It was not the right question. I want to produce, here on my blog, a more satisfying story which will supersede the other, the difference between solid gold and gilded lead clear to all, and now I am groping. Unknowing has something to do with it, the way the person is crushed into the male box. Who are you, really? What stops you knowing yourself?

Transition works. Give us something better, and we will choose it. Non-binary identity works for people who identify as non-binary. Making transition easier, stopping the carping, might reduce our desperation to prove ourselves. Transition would be less of a big deal. It would be recognised as one way people can be. That would reduce its emotional heat.

Gender Recognition Act reform

What might the government do to change gender recognition in England and Wales? We don’t know, but can guess. We don’t even have the consultation yet but do have the Scottish consultation, the report of the Women and Equalities Committee, and Justine Greening’s announcement of the English consultation, made on 23 July 2017.

The announcement promised New measures to deliver greater equality for the LGBT community… ahead of the 50th anniversary of the partial decriminalisation of homosexuality. That’s accurate. The criminal offences were not completely expunged from the statute book until this century. Initially, there was a narrow defence to a charge of gross indecency or sodomy, which applied in restricted circumstances. Homophobia was still everywhere, and “normal”.

The new rights for gay men were underwhelming. Men who have had sex with men, even once, could not ever give blood, and that humiliates people who want to do a good thing for society. You can’t because you’re gay. Then a time limit was put in- they could give blood if they had not had sex with a man for a year, which is quite an intrusive question. The proposal was to reduce this to three months, but many people would find that an unbearable sex famine. Stonewall’s response was that there should be individualised risk assessment. Of course- what about faithful couples? The three month limit has now been implemented. These rules are in place to keep blood donors and the patients who receive their blood safe, said the press release.

Given the Women and Equalities Committee report, the new rights for trans people are underwhelming too. They are first described as Proposals to streamline and demedicalise the process for changing gender. It is not a consultation on trans rights, but on the Gender Recognition Act alone.

Proposals will include:

Removing the need for a medical diagnosis of gender dysphoria before being able to apply for gender recognition. The current need to be assessed and diagnosed by clinicians is seen as an intrusive requirement by the trans community; and

Proposing options for reducing the length and intrusiveness of the gender recognition system.

The gender recognition system is intrusive because it requires documentary evidence of expressing our true selves for two years, as well as that medical evidence. And our promise to live in the acquired gender life long is not enough: the statutory declaration which we swear to that effect must be assessed by the gender recognition panel.

However while in Scotland the consultation proposed a simple statutory declaration, the English announcement is considerably more guarded. Many options would “reduce the length and intrusiveness” other than a simple stat dec, and we might even still have to wait two years before starting the process.

While the Committee proposed reforming the Equality Act, to restrict the circumstances in which we could be excluded from women’s spaces, the announcement refers specifically to the Gender Recognition Act and procedure under it. The Equality Act was never on the table.

Suzanna Hopwood of the Stonewall Trans Advisory Group said “I am really pleased… the current system is demeaning and broken.” Indeed it is, and no nearer being fixed now than nearly a year ago.

So it is false for A Woman’s Place to claim that self-ID would mean becoming a woman simply because you sign a form. It is false for them to claim that anyone’s rights would be affected, apart from trans people’s. They are fear-mongering. Making such statements as they do, they have an obligation to establish the truth: if they are ignorant of it, that does not excuse their circulating falsehoods. People should ignore them.

Unfortunately, the Sunday Times is spreading the misrepresentations, fear and lies: “Men identifying as women [they mean trans women] were permitted to swim in the ladies’ pond on Hampstead Heath in North London and a woman with a fear of men was locked in an NHS women’s psychiatric ward with a burly 6ft-tall transgender patient.” They also wrote, “Ministers have vowed to defend women’s rights to exclude transgender people from female-only spaces such as changing rooms, lavatories and swimming sessions. In a significant victory for campaigners, the government has promised not to put the rights of those who identify as women ahead of those who are biologically female.” But there was never any intention of changing the Equality Act. The campaigners have been wasting their time, and won nothing.

That Sunday Times article quotes the government’s response to a petition from gender critical feminists. It adds nothing. “That does not necessarily mean we are proposing self-declaration of gender,” says the response, but they are having a consultation: why consult, if you have decided the outcome beforehand? The Guardian was initially cozened into publishing the same non-story, including an insulting comment from A Woman’s Place, but later added a comment from Stonewall putting the record straight. “The exemptions to this rule only apply to sensitive and complex services, for example refuges, where services can exclude trans people if they can demonstrate that is absolutely necessary, for example if inclusion would put that trans person at risk. However, these exemptions are rarely used and in almost all situations trans people are treated equally as is required by our equality laws.”

That Sunday Times article is a propaganda coup for the transphobes. There was no victory. There was no change proposed to the Equality Act. But they have spun this as them winning concessions pledging to retain the Equality Act exemptions, and their staunch press allies have gone along with it. Further, they have spun those exemptions as a right to exclude, which only applies in restricted circumstances. We need to point out how narrow the exemptions are.

The Equality Act and trans people

These are the provisions of the Equality Act 2010 referring to trans people. There is extensive guidance and notes.

What trans people are protected? Anyone who intends to transition to the other gender as a binary trans person. Non-binary people are not protected. The Act refers to “gender reassignment” but “transsexual persons”, so gender and sex are confused.

7 Gender reassignment

(1)A person has the protected characteristic of gender reassignment if the person is proposing to undergo, is undergoing or has undergone a process (or part of a process) for the purpose of reassigning the person’s sex by changing physiological or other attributes of sex.

(2)A reference to a transsexual person is a reference to a person who has the protected characteristic of gender reassignment.

(3)In relation to the protected characteristic of gender reassignment—

(a)a reference to a person who has a particular protected characteristic is a reference to a transsexual person;

(b)a reference to persons who share a protected characteristic is a reference to transsexual persons.

Note cis people are not protected. It is lawful to discriminate in favour of trans people. The guidance says the protected characteristic includes people who have completed the process- “has undergone a process” was completely clear, but the notes put it differently. Anyway, a GRC does not mean I am no longer protected, or that the provisions allowing discrimination against trans folk no longer apply to me.

What are we protected from? Direct discrimination, being treated worse than a cis person because we are trans, s13; discrimination because we are off work for medical appointments, treatment or convalescence because we are trans, compared to someone taking time off for appointments for any other medical condition, s16; indirect discrimination, where there is a requirement that cis and trans people equally have to satisfy, but trans people have a particular difficulty satisfying- unless that is a “proportionate means of achieving a legitimate aim”, s19.

We are also protected from harassment, that is bullying because we are trans, s26, and victimisation, bad treatment because we have raised a grievance or made a claim under the Equality Act, s27.

Like the other protected characteristics, we are protected in matters of work, which includes employment but is wider, services provided by companies or public bodies, schools, further and higher education, clubs and associations.

Sporting bodies can impose rules on transsexual people to secure fair competition or the safety of competitors, s195.

All-women shortlists for political candidates can include trans women, s104.

The bits I want to pay particular attention to are the exclusions of trans women from women’s spaces. Schedule 3 applies to the provision of services and public functions.

The armed forces can discriminate against us if that has the purpose of ensuring combat effectiveness. Here, the statute looks at “purpose”- it is a matter of intention, not how effective the discrimination would be in increasing combat effectiveness, or how disproportionate to the aim. Para 4.

Churches can refuse to marry couples where one party has a reassigned gender, para 24. Or when the pastor falsely but “reasonably” believes s/he has.

Single sex services can exclude us. Here is para 28:

28(1)A person does not contravene section 29, so far as relating to gender reassignment discrimination, only because of anything done in relation to a matter within sub-paragraph (2) if the conduct in question is a proportionate means of achieving a legitimate aim.

(2)The matters are—

(a)the provision of separate services for persons of each sex;

(b)the provision of separate services differently for persons of each sex;

(c)the provision of a service only to persons of one sex.

All services are affected, from toilets to rape crisis centres and women’s refuges. It means we can be excluded or treated differently because we have undergone a process of gender reassignment, even if we have a gender recognition certificate.

Note the test of “proportionate means of achieving a legitimate aim”. The Equality and Human Rights Commission says this is only in exceptional circumstances.

Para 27 regulates when single-sex services may be provided: an establishment for persons requiring special care, supervision or attention, or where “a person of one sex might reasonably object to the presence of a person of the opposite sex”.

Schedule 9 relates to employment. Para 1: An employer can require an employee to have a particular protected characteristic, if it is a genuine occupational requirement. An employer can also require an employee not to be a transsexual person. This has also to be a “proportionate means of achieving a legitimate aim”.

Here are the explanatory notes on exclusion from services of gender-reassigned people. A group counselling session is provided for female victims of sexual assault. The organisers do not allow transsexual people to attend as they judge that the clients who attend the group session are unlikely to do so if a male-to-female transsexual person was also there. This would be lawful. I disagree: would you exclude a trans woman if one cis woman would not attend? But the guidance notes are broad.

And on employment: This paragraph provides a general exception to what would otherwise be unlawful direct discrimination in relation to work. The exception applies where being of a particular sex, race, disability, religion or belief, sexual orientation or age – or not being a transsexual person, married or a civil partner – is a requirement for the work, and the person whom it is applied to does not meet it (or, except in the case of sex, does not meet it to the reasonable satisfaction of the person who applied it). The requirement must be crucial to the post, and not merely one of several important factors. It also must not be a sham or pretext. In addition, applying the requirement must be proportionate so as to achieve a legitimate aim

Unemployed Muslim women might not take advantage of the services of an outreach worker to help them find employment if they were provided by a man.

A counsellor working with victims of rape might have to be a woman and not a transsexual person, even if she has a Gender Recognition Certificate, in order to avoid causing them further distress.

Well, a service specifically for unemployed Muslim women at a Muslim community centre might not use a trans worker, but a service for women could not refuse to employ a trans worker on the off-chance that Muslims might use it. The rule has to be “proportionate”. Possibly, a service could refer Muslim women to another worker; but as that would discriminate, that should not cause problems for the trans worker.

The guidance notes were written quickly at the time of the Act, and since then the Equality and Human Rights Commission has had time to consider the matter more fully, and issue codes of practice. They say, The basic presumption under the Act is that discrimination because of the protected characteristics is unlawful unless any exception applies and any exception to the prohibition of discrimination should generally be interpreted restrictively.

The exceptions are permitted if they are a proportionate means of achieving a legitimate aim. This is the “objective justification” test. It is a defence for the discriminator, so the discriminator must prove it is justified.

The aim must be legitimate- legal and non-discriminatory, representing a real, objective consideration. Ensuring the wellbeing or dignity of those using the service, preventing fraud or abuse, ensuring health and safety, and ensuring services go to those most in need, are legitimate aims.

Proportionate requires a balancing exercise. Could the aim be achieved by less discriminatory means? Cost can only be taken into account if there are other good reasons for the discrimination.

The more serious the disadvantage caused by the discriminatory provision, the more convincing the objective justification must be.

Any public body discriminating must comply with their public sector equality duty. This is in s149 of the Equality Act: in everything it does, the public authority must have regard to its duties to eliminate discrimination, advance equality of opportunity, foster good relations between trans people and others, remove or minimise disadvantages suffered by trans people, take steps to meet their different needs, and encourage trans people to participate in public life. They should tackle prejudice against us, and promote understanding.

A transvestite

Hope Lye dresses in low cut short dresses and tweets selfies from men’s loos. He likes male pronouns, calls himself a “gender critical trans identified male” and says trans women should also go to the gents.

He is balding, and does not wear a wig. His problem is that he does not understand Britishness, any more than trans. My friend from Tasmania said that when he was young, in Australia there were no eccentrics, just “bloody nutters”. Here we tolerate eccentricity, and do not make personal remarks. If he wants to go round looking like a weirdo, people will ignore him, for that is the culturally-accepted way of showing self-respect. He might get beaten up in the very roughest pubs, but drinkers in most places just won’t care.

Someone suggested that trans women try to look like women, and give off ambiguous signals to straight males. Transphobic attacks arise because men find us attractive then find that disturbing. Hope, however, wears no wig despite his short, receding hair. His copiously tattooed arms and legs are not feminine.

He whined about being suspended from Twitter, he said “for saying I’m male”, probably for being abusive to trans women, but Mumsnet had a long thread of adulation: “He truly is an ally to women, and it’s appreciated”. A trans woman produced a photo allegedly of him, when younger, doing a Nazi salute, and Mumsnetters appeared to confirm his nastiness- “he has an (allegedly) very shady and fucked up past”; “Hope was indeed involved with some dubious stuff in his youth.” But she doesn’t hold that against him: “Spot on on this, though”. Well, I suppose they have to take any allies they get. They were sweet, really, sympathising with him: femininity is so hard to escape!

Hope may be an exhibitionist rather than a transvestite. He blogs, with several photos of himself outdoors, or in toilets- who wants a picture of himself with a loo? Yuck- and is desperate for people to “ask me about my identity”. Sometimes, people do. He is not short on self-regard: when they ask him, “I normally end up educating other men”. He calls on “gender critical trans identified males” to follow him into the gents, show it’s safe, and put pressure on the trans community to do the same. “I have been challenging the media to feature how I go about life… They aren’t listening… No one’s listening!” Not even to his one-man crusade to get trans women into men’s loos.

However, we’re different. Most people who go out cross-dressed are testing the waters before transition. We want to fit in: the thing about being ignored as an eccentric is that it deprives you of ordinary human company. I don’t want to talk to strangers in the pub, especially not people who might be laughing at me, but to friends.

He claims to be perfectly safe in men’s loos, but told a different story in the past. In 2015 he complained of men putting their hands under his skirt and touching his “bum” (so, some understanding of Britishness). “Slut shaming right through to transphobia was the order of the day.” Also, though he is now a transvestite, formerly he wanted to transition: he came out as transgender in December 2014, and realised “many trans people fear being ridiculed or even murdered”. “I want to change now but alas the NHS is very slow. I hate being a man. I tried to conform to my birth gender for 47 years but can no longer do it. It just isn’t me!” He stopped wearing men’s clothes or using his male name, wanted hormones and “fully transitioning”. He was sickened by the misogynist abuse that [cis] women receive. He started campaigning for trans rights, and tried to get British Sky Broadcasting to add “Mx” to its list of possible titles. He dressed in micro-skirts and stockings with the tops showing, not a good look for a man of 47.

Then in April, he decided to identify as a “biological male” rather than trans or gender non-conforming, which are “ridiculous identities anyway”.

His “shady and fucked up past” reveals something of his current character. He shows no sign of repentance, and now he is involved in a hate campaign against trans people.

How would people behave, without internalised transphobia? It is a matter of self-respect, for me as a trans woman, to use women’s facilities. I try to look good when I go out, not ridiculous.

We need to talk?

How is the debate on Trans issues in the UK, and does it matter at all?

There are a variety of views amongst those left wing feminists who would ban all trans women from women’s spaces. Some are disgusted with us, and want to spread that disgust to others. Some want us excluded, and to stop calling ourselves “women”, but would otherwise be our allies, supporting us in getting separate services. Some want to divide us up- there are “genuine” trans women, who might be treated as women, but a lot of men. Which are men is unclear. Some seem to think men would pretend to be trans women in order to enter women’s spaces. Some seem to think some trans people are genuine trans women, some not- alleged autogynephiliacs, perhaps, though I have seen “homosexual transsexuals” grouped there, who the woman claimed transitioned in order to seduce straight men.

To me, genuine trans women are those of us who transition or who intend to transition, which means adopting women’s presentation in clothes and hair. It is problematic, though- need they seek hormones or surgery? Keeping a beard excludes you from this definition, I think, but what I think does not really matter. What matters is the everyday encounters a person has. And the motive for transitioning is often used as a scare factor- shock horror, someone is deluded, transitioning is obviously wrong- but people still transition comfortably.

There are also the hard-right, who want to demonise us because they like to create out-groups. That is the motivation of The Spectator. Meanwhile, it is reported that employers would be less likely to recruit a trans person. There is a low level of prejudice against us, which the Right would inflame if it can.

We have faithful allies. Most of the Labour Party say “Trans women are women”, though there is the tiny minority which think we are a more important issue than any other, and would leave the party because of it.

There are some very nasty people frothing about and some odd alliances. A man, apparently a former Nazi, has feminists praising him loudly. There has been a public bomb threat from an idiot troll. There might be some interesting ideas brewing, so many people are thinking about this, but it might be better to see what has become a trend in a year’s time rather than to try to sift them out from the cacophony now.

And really, none of it matters. Can I enjoy time with friends, am I in danger walking down the street, can I do something I find worthwhile, all these things matter. One of the most exercised transphobes is not likely to recognise a trans woman in a loo, and I am unlikely to have anyone cause a scene when I use one. There is an ugly, feverish argument on social media with a tiny number of people spending a lot of time on it, and probably very little will come of it. I would be better to find something beautiful to contemplate. Here’s a Kandinsky.

Gender incongruence

Is the ICD-11 (International Classification of Diseases) redefinition of “Gender incongruence” a progressive change to the medical treatment of trans people? No. It claims not to be a mental illness- good- but then makes desire for physical alteration the diagnostic criterion. To be diagnosed with gender incongruence, you need to want rid of your primary and secondary sexual characteristics, or to want those of the opposite sex to your birth gender.

This is the definition: Gender incongruence is characterized by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex. Gender variant behaviour and preferences alone are not a basis for assigning the diagnoses in this group. Gender incongruence of adolescence and adulthood is characterized by a marked and persistent incongruence between an individual´s experienced gender and the assigned sex, as manifested by at least two of the following: 1) a strong dislike or discomfort with the one’s primary or secondary sex characteristics (in adolescents, anticipated secondary sex characteristics) due to their incongruity with the experienced gender; 2) a strong desire to be rid of some or all of one’s primary and/or secondary sex characteristics (in adolescents, anticipated secondary sex characteristics) due to their incongruity with the experienced gender; 3) a strong desire to have the primary and/or secondary sex characteristics of the experienced gender. The individual experiences a strong desire to be treated (to live and be accepted) as a person of the experienced gender. The experienced gender incongruence must have been continuously present for at least several months. The diagnosis cannot be assigned prior the onset of puberty. Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis.

So thinking you are a woman, though you have a penis, would not fit this definition. The desire to be accepted socially as a woman is not enough, even though most people only show off their genitals to sex partners. There is a separate diagnosis for childhood, but it too requires dislike of ones own sex characteristics and desire for the target gender’s.

Gender Incongruence comes under ICD-11 17, conditions related to sexual health, which includes physical illnesses but also paraphilic disorders. It uses “desire” as a diagnostic criterion. So how might that desire be assessed, except by a psychiatrist? Might there be a similar desire which was a mental illness, such as a psychotic delusion? I can’t find the appropriate treatment in ICD 11: it does not exclude an attempt to reconcile the person to their physical characteristics.

For me, the role, expressing myself as a woman, was more important than the physical changes. It liberated me to be myself. I now believe my passionate desire for the physical changes came from social pressure, the idea that the “true transsexual” wanted these changes, and only “true transsexuals” should transition. I regret my physical alterations, probably in part because the operation was not as successful as it was in others I have talked to. I have had a significant loss of sensitivity.

The Guardian correctly reported that GI no longer comes under “mental, behavioural and neurodevelopmental disorders”, and quoted Lale Say, co-ordinator of the WHO department of reproductive health and research, who said, “We think it will reduce stigma so it may help better social acceptance for these individuals”. I am glad not to be called mentally ill. That is a relief. I am concerned that there might be greater pressure to have surgery and hormones. I am not convinced they are necessary, or that they would improve our happiness if we were not told they were necessary.

There should be two rigorously separated approaches to gender incongruence. One is the medical approach: really, those of us who want to present in the other sex without surgery or hormones should not need to see a doctor, so that reasonably concerns itself with medical treatment, but some might like reassurance from a psychiatrist without any assumption that they will have hormones. The other is the legal/social approach: those of us who transition, intending to live life long in the acquired gender, should be treated like others of that gender. Those who intend to transition or manifest as non-binary should not suffer discrimination because of it. As long as the legal definition does not require medical diagnosis, people may not be pressured into unnecessary medical treatment.

It is necessary to define a medical condition to say what a health service or health insurance should pay for, and what doctors should do. The desire to alter your body in this way is not a mental illness. The health problem, for those who desire the changes, is that the changes are necessary.

The desire to transition may involve mental distress- can I manage it? How will work, family, community react? Am I deluded in wanting this? Psychotherapists could be part of helping a trans person resolve these issues. Gender dysphoria- that distress- exists and is mentally debilitating. Mental health services have a role in helping with it. The mental illness is not a deluded belief that you are part of the true gender. The mental illness is the difficulty you feel realising that, given the social pressure you suffer to conform to the assigned gender. Gender dysphoria, discomfort with gender role, exists and is debilitating, and one cure is transition.

The document will be sent to WHO member states, and will take effect from 1 January 2022 if adopted.

Weird London

It is always lovely to go into London. With time to kill, I wandered down south of Euston Road towards the British Museum. First to St Pancras Church, which has two huge sculptures temporarily displayed in the narrow patch of grass between the church and the pavement. One appears to be two men wrestling, with Rodinesque muscly bodies, until you see they share the same head. Inside, the church was dim, like a hall, but has two organs, one against the West wall and one, moveable, near the Sanctuary. There is a notice, do not touch the organ without express permission. In a chapel in the north-east corner, there was a Madonna icon in which the child was off to her left, and low down, and tiny, and seemed odd, but it was the only thing in the church I found beautiful. Some men passed through the chapel, glancing briefly at me. In the nave, a man stood, then ran suddenly a few yards west, then stood again, then ran back. He was still there as I left.

South through the University. I wandered into The English Chapel. It was built by the Catholic Apostolic Church in the neo-Gothic style in 1851-4. I like fan vaulting, but find it pointless- church architecture should have moved on by then. They believed Christ had appointed twelve further apostles, and were a worshipping group until around 1905, when they did not appoint a successor apostle. So now it is a trust owning property, and part of the church, the West chapel, is let out to Forward in Faith for daily services. There are no pews. A man knelt near the west-facing altar. The priest came in from his office and spoke to me, though I said I was half-touristing, half-praying: using the beauty as an aid to contemplation. The stained glass windows, replaced after being destroyed in the Blitz, are lovely. He explained that around the stalls carved into the walls are the heads of English monarchs. One wears a wimple. They were out of fashion when Mary became Queen, and I asked him who she was. Matilda, possibly? He did not know. I spent some time contemplating the carvings, then walked on.

At Friends House I met someone about Outreach, then had lunch downstairs, where I recognised several people. Should I say hello? Someone I know, to my shame, only as “X’s partner” said hello, so I joined her. She has been researching in the Friends House library, and came across a 19th century classification of beauty in three classes: active sublime, passive sublime and “sprightly”. “Your necklace would be ‘sprightly’,” she told me. Well, it is irregular blobs of blue/green glass, so yes. A certain kind of tree is “active sublime”, a certain kind of owl “passive sublime”. Possibly “active” in the kinds of feelings aroused in the beholder. I don’t want to know the classification, it would just be another way I judged myself- I must spend more time with Active Sublime, even if I preferred Sprightly.

A paid worker was kindly eating with a volunteer.

A man talked at me for half an hour about something which stressed him, which was not really why I had wanted to see him, though I had wanted to get to know him a bit. Because I was trying to get a word in, I was much blunter than I would otherwise have been: “Why did I not get an interview for that job?” He gave what would have been an off-the-peg defence to a discrimination claim- because I did not fit a particular essential criterion. Because of discrimination, the selection has to be completely objective and it was, he told me. But, I was not making a claim, just asking.

Signs on the railings said “Please do not smoke in this area or sit on these steps.” Guess what someone was doing. And I saw this sign, which looks official but is a stencil, a graffito stating hope not reality. Those metal gates did not look welcoming. The area is beautiful, but not welcoming.