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The Gender Recognition Act Consultation – What You Need To Know

A lot has happened this week in relation to LGBT activism. On Tuesday 3rd July, the Government Equalities Office (GEO) released the results of the LGBT survey conducted last year. That same day, the government also launched its LGBT Action Plan to try and address many of the inequalities that the survey results revealed. This includes a commitment to provide £4.5 million in funds by March 2020, and an intention for more after that date. A big part of the action plan includes a consultation on the Gender Recognition Act 2004 (GRA), which was the first piece of UK legislation to allow trans people to legally change their gender, by gaining a Gender Recognition Certificate (GRC). In this post I’m going to focus on the GRA, try and explain what the current Act means, and go through the consultation which is available to complete here until 11pm on 19th October 2018.

What do you currently need to do to access a change of gender in the UK?

The current requirements to access a GRC depend upon the application route taken, of which there are currently three – the ‘standard’ route, the ‘alternative’ route, and the ‘overseas’ route. For the standard route you need:

  • To be 18+ years old;
  • To have, or have had, gender dysphoria (the wording of the act doesn’t specify diagnosis, but the government guidance website does);
  • To have lived in the ‘acquired’ gender for at least two years;
  • To make a statutory declaration to live in the ‘acquired’ gender for the rest of your life.

It’s also important to note that the 2004 act is entirely binary – saying that a person of ‘either’ gender, living or changing to ‘the other’ gender, etc. Non-binary legal recognition is currently not possible in the UK.

The alternative route is very similar, and is mainly there for people in (protected – i.e. legally recognised) marriages and civil partnerships. You still need to be 18+, make a statutory declaration to live in your gender until death, and have or have had gender dysphoria (or had surgery to change your sexual characteristics – this is one difference between the routes, as this isn’t an alternative stated in the standard route). However, you must also have lived as your gender for at least six years prior to 10th December 2014 in England, or 16th December 2014 in Scotland. The overseas route is if your gender has been legally recognised by an ‘approved country or territory’ (though this document hasn’t updated changes in the legislation of other countries since 2011).

The alternative route is easily the most complicated aspect of the GRA because of its interaction with marriage law, which has change since the GRA’s introduction. People who are married can (now) stay married when getting a GRC, but both the person and their spouse must both fill in a statutory declaration saying they intend to stay married. If the spouse refuses to do this, it creates a seriously problematic situation because their is no ‘timer’ on their refusal. An ‘interim’ certificate can be granted (which can be used as grounds to end the marriage) if this statutory declaration is not completed. This has been termed the spousal veto, which I touched upon back when writing about The Marriage (Same Sex Couples) Act 2013. This is also one of the areas where devolution impacts the GRA – an interim certificate can only become a full certificate in England and Wales once the marriage is ended. If the marriage was registered in Scotland, the interim GRC can be used to apply to the sheriff court for a full certificate without ending the marriage first. Because same-sex civil partnerships still don’t exist under UK law (though this might change, after a Supreme Court victory on this issue on 27th June 2018), civilly partnered couples have to convert their civil partnership to a marriage before applying to the Gender Recognition Panel.

So yes. If you fulfil the criteria for one of the routes, you have to download the appropriate form, and post this with ‘supporting documents’ and a £140 fee to the Gender Recognition Panel. The supporting documents currently needed are:

  • An original or certified copy of your birth certificate;
  • Copies of deed polls/other official documents of name change;
  • Proof of living in one’s ‘acquired gender’ for the necessary amount of time (2 years for standard, 6 years for alternative) – original copies of your passport, driving licence, payslips, utility bills, etc.;
  • ‘Any medical reports’. This has to include either ‘a report made by a registered medical practitioner practising in the field of gender dysphoria’ (who are listed here) or ‘a report made by a registered psychologist practising in that field’. In both cases, a second report is also needed by a registered medical practitioner (who can be anyone, gender specialist or not). This is expected to be either your GP, or surgeon.

There is no interview with the Gender Recognition Panel.

Some of the problems that have been pointed out with this system are (non-exhaustive list!):

  • No possibility of legal recognition for people under 18, non-binary people, or intersex people;
  • pathologises gender identity by requiring extensive medical documentation;
  • The possibility for a spouse to block access;
  • The offensive notion that other people can adjudicate on whether a person’s gender is deemed ‘real’ or not, in the eyes of the law;
  • The cost;
  • The stress and labour of the accompanying bureaucracy.

What is the current consultation?

The consultation is 25 pages long. You have to provide contact details, including an address. This will hopefully discourage individuals who you would otherwise provide insincere or abusive answers.

It is important that responses to the consultation do not conflate or confuse the Act’s provision with the remit of The Equality Act 2010.

Following the contact information questions, the consultation asks for:

  • Experiences of Trans Respondents;
  • Whether you think there should be a requirement for a diagnosis of gender dysphoria, a report detailing treatment received, evidence of living in the acquired gender for a period of time, respectively;
  • Whether you agree with the current provisions for spousal consent for married persons;
  • Whether the fee should be removed, and what other financial costs trans people face when applying and their impact;
  • Whether privacy and disclosure of information provisions in section 22 of the GRA are adequate;
  • If there’s anything you want to say about how the current process affects people with one or more protected characteristic under The Equality Act 2010;
  • Whether you think changing the GRA will affect the participation of trans people in sport;
  • Whether you think the operations of:
    • the single-sex and separate-sex service exceptions
    • the occupational requirement exception
    • the communal accommodation exception
    • the armed forces exception
    • the marriage exception
    • the insurance exception in relation to gender reassignment in the Equality Act 2010 will be affected by changing the GRA;
  • Whether you think the act needs to accommodate non-binary people;
  • Any further comments.

All questions have open text fields for full answers, to accompany mostly yes/no tick boxes.

 

Category:

LGBT, News, The gender binary, Transgender

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On ‘Straight Acting’ and Stonewall.

Yesterday, I came across an article written by Noah Michelson provocatively titled ‘If You Think ‘Straight Acting’ Is An Acceptable Term, You’re An A**hole’. I would say the article is well worth reading, as it evocatively considers some of the concerns with Roland Emmerich’s new film ‘Stonewall’ – namely the accusations of historical inaccuracy, whitewashing, and homonormativity¹ in order to try and bring the film to a wider audience.

Michelson makes the point that:

Being “straight-acting,” for a gay man at least, is directly related to how convincingly he is able to present traditionally masculine mannerisms. The term is so markedly offensive because its very existence insists that there is a particular, instantly identifiable manner of being gay (defined by effeminacy). And what’s more, those qualities are seen as patently unattractive, undesirable and wildly dangerous.

He discusses his own experiences of policing his forms of self expression to articulate a more normative masculinity, in order to protect himself from queer bashing. He remarks how he regrets this, but poignantly asks whether he’d even be here to regret it if he hadn’t – emphasising increasingly how ‘same-sex’ attraction in and of itself doesn’t render one a victim, but the expression of transgressive masculinities and femininities amongst women and men respectively (and those who cross over or identify as neither in particular) puts one at risk. Now, there are those queers who, in the interests of their own safety, or their own ability to socially navigate the world they’re in with the least possible hassle will engaging in ‘straight acting’ actively. Then there are those who simply find that their default state of being is to articulate themselves in an unremarkable, normative manner. There is of course nothing wrong with that. I would however encourage those who have identified or do identify with the term ‘straight acting’ to ask – why do you? How is this identification situated within a larger social narrative and context which shapes who each of us are and how we feel? If you are concerned with how others perceive your masculinity in relation to your sexuality, why is that? Given that masculinity and femininity have large, complex narratives, can you see that when you say you’re ‘straight acting’, what people take from this will never be as simple as pure, value-neutral description (whether they realise it or not)? This can be articulated by different people in different ways to serve very similar ends. A common example being dating app profiles with caveats such as ‘not as camp as I look’, pre-empting judgement from a gay audience which has a clear hierarchy of value.

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Emmerich inserts the fictional protagonist Danny into the narrative of the film in order to “provide a very easy in” for a straight audience. One can understand the desire to want your film about an incredibly important civil rights event to reach and educate as many people as possible. There’s two important problems with this however. 1 – It didn’t remotely happen that way, and 2 – It throws the non-normative queers who were there doing what they did under the bus in order to pander to those potential viewers whose acceptance comes with terms and conditions of palatability. It also raises the very important question – have queer people moved so far away from the scary, dangerous activism of the past that is now spoken of reverently, these brave heroes, that we daren’t tell the story how it was for fear of making less headway with creating queer acceptance than we could?

I would say that if LGBTQ support is *dependent* on whiteness, normative masculinity, middle-class status, conventionally attractive embodiment – all the checkboxes of Danny that make him the least marginalised of the marginalised – then it is worth very little. Further, it’s 2015. Shows and films with casts not centred on whiteness, cisness, etc. have demonstrated their ability to be both commercially and critically successful – one needs look no further than Orange is the New Black. I believe that the film would actually have had a better impact on queer rights and empathy for oppressions faced in terms of sexuality and gender if Emmerich had dared to be more accurate, rather than worrying about the most socially conservative end of the spectrum. The comparatively slow limp of transgender rights and protections demonstrates exactly what happens when we try to gain acceptance by sweeping the more difficult queers under the rug. The irony that the charity ‘Stonewall’ only added trans to its remit this year is ridiculously long overdue, but not surprising due to this homonormative precedent. The very fact that Emmerich has been so heavily criticised is evidence that a mainstream audience could handle the more complex intersections of marginality the real historical figures experienced.

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It’s a fair question to ask what the problem with Danny’s role in the narrative is. Stonewall is famous for being a turning point, the explosive tipping point for LGBT (but let’s be honest, mainly G) rights. Therefore it’s easy to assume that the ‘mainstream gays’ who are visible and in many Western contexts doing relatively okay were also there. Not so. Those men and women with same-sex attraction in the 1960s who could hide it, often did. The straight actors were only to peer out of their closets after the radical queers had fought for some space for them. Emmerich would’ve done well to realise this, and recognise that his film had a duty to the queers still most marginalised today who fought *because* they had no other choice. Stonewall is a story for all queers, for all people to be inspired by, but not at the expense of de-centring the real, brave people who fought.

It’s very important then, to recognise the difference between what being ‘straight acting’ can mean in the world, and what it means when it’s inserted into this film which will be taken by many people as a representation of what happened. This may explain then, why when a historian of Stonewall, the only surviving member of the Stonewall  Street Youth, and other queer writers and experts were asked what they thought of the premier – the results were overwhelmingly damning. Emmerich has also said “as a director you have to put yourself in your movies, and I’m white and gay”. Maybe, just maybe, this film wasn’t about you, Roland. Maybe it also wasn’t about potential audience members who would deem The Stonewall Riots unacceptable if they saw them led by (as Michelson says) “non-white transgender people, genderqueer individuals, drag queens, butch dykes and sissy men”. Maybe that’s why Miss Major Griffen-Gracy, one of the few survivors of the Riot itself, said “How dare they do this again” of the film.

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Miss Major – Photograph credit to Annalese Ophelian.

It’s ironic that the historian David Carter explains that whilst he liked the characterisation of Ray, in reality Raymond Castro was “a very masculine guy, a generous guy – and very conservative-looking. He wasn’t effeminate – he never went in drag. He didn’t prostitute himself, either”. Emmerich had an opportunity to include a character who embodied a normative masculinity, whilst retaining historical accuracy – a bit of a godsend given that was important to him in this historical sea of queers that were more difficult to market. Why that wasn’t done is open to speculation. But if telling the story of Stonewall was important to Emmerich, as he says it was, but positioning the trans women of colour who were absolutely central to the events (Marsha P. Johnson, Sylvia Riviera, Stormé DeLarverie, and the aforementioned Miss Major) as the *main* characters, the central narrative, was too difficult… then maybe he shouldn’t have been the person to make this film.

1 – Whilst this term has been used in different ways in different contexts, the most common, and how I use it here, was popularised by Lisa Duggan in unpacking how heteronormativity can be assimilated into LGBT culture, practices, and identities. Heteronormativity is (often insidious or unconsciously manifested) practice that positions straightness, cisness, and normative gender and sexual roles as ‘normal’. That isn’t to say there is necessarily an explicit articulation of homophobia etc., but that in positioning particular qualities as normal (rather than common, or relatively frequent) one includes a moral dimension to the description – that positions particular others as ‘not normal’. Heteronormativity can manifest in such simple interactions many non-straight people will have experienced – an acquaintance say, asking a guy ‘do you have a girlfriend?’ or a girl ‘do you have a boyfriend?’ – the assumption of heterosexuality. In a sense then, homonormativity is exemplified by, for example, gay white men who have a distaste for campness, drag, gender-bending, and other aspects of queer culture that are distinctly un-normative. Plus of course, it’s never as simple as saying that a person *is* or *is not* hetero/homonormative – people articulate multiple and complex views, and may comfortably celebrate radical queerness in some contexts whilst wishing to distance themselves or tactically ‘tone it down’ in others. What this means for how queerness is considered by the wider population is an interesting point to consider.

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Film, LGBT, News, Popular Culture, Sexuality, The gender binary, Transgender

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Non-binary gender identity negotiation – My PhD explained!

I gave this talk at the 2015 ESSL (Education, Social Sciences, and Law) conference at the University of Leeds. Enjoy!

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LGBT, The gender binary, Theory Literature, Transgender

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On Caitlyn Jenner’s Coming Out as Transgender

(Note – at the time of writing, Jenner explicitly stated in the interview that she was still using male pronouns, however this has since been updated to reflect a respect for her name and identity).

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On 24th April, Caitlyn Jenner ended media speculation by giving an interview to Diane Sawyer with ABC, announcing to the world that she is a transgender woman. As of 6.00 am Saturday 25th April GMT 2015 the full interview is still elusive (in the UK), with this 15 minute poor quality excerpt the longest I could find. Some high quality, short clips are found here. However I’ll be commenting on and synthesising the various reports and clips on and from the interview available so far.

We still identify as female. And that’s very hard for Bruce Jenner to say. ‘Cause why? I don’t want to disappoint people.

 Caitlyn Jenner

There’s a range of different things we can learn from this interview. The first thing is that a lot of people don’t appreciate what a big deal medical transitions are for trans people – emotionally, physically, and in most of the world, financially. Jenner literally laughs off the fact that some ‘sceptics’ suggest that this coming out could be a bid for attention, related to her part in the reality TV series Keeping Up With the Kardashians.

Are you telling me I’m going to go through a complete gender change, okay, and go through everything you need to *do* that, for the show? Sorry Diane, it ain’t happening!

Caitlyn Jenner

In addition to this, Jenner revealed she accessed hormones and facial surgery in the 1980s – being trans is not something new to Jenner herself, putting such ignorant cynicism to rest immediately. Her transition was ceased in 1990, after meeting her later wife of 23 years, Kris Kardashian. And in terms of ‘why now?’, she states unequivocally how she couldn’t hide this any longer. Jenner also made the points that fears over hurting her children meant she lost her nerve with her first attempts with medical and social transition, and that she and Kris might’ve still been together (they divorced in December 2014) if she had been ‘able to deal with it better’.

Which brings us to another important point that Jenner clarifies – how her sexuality has nothing to do with her gender identity. That identifying as a woman does not mean that she is attracted to men. Sawyer slowly walks through the logic of this – ‘if you are assigned male… and you become female… but you like women… are you a lesbian? are you a heterosexual… who…?’ Brenner cuts her off brilliantly, saying ‘you’re going back to the sex thing and it’s apples and oranges!’.

Whilst not discussed, it raised the question – how does a person’s gender identity relate to the sexuality of their partner? The answer is that it doesn’t, because whilst sexuality labels are most often used to signpost who a person sleeps with, these *labels* are also about identity. For instance, not all men who have sex with men identify as gay, and this is very important to recognise, in terms of both respect, and when conducting studies on sexual health. As a further example, if a person assigned male at birth comes out to her wife as a transgender woman, this doesn’t retroactively ‘turn’ the wife into a lesbian (assuming she was straight in the first place, and not bisexual for example…!). Also if the wife is still attracted to her transgender partner, still in love with her, that doesn’t mean she’s attracted to other women. It is an example of a straight-identified cisgender woman in what could be viewed as a lesbian, or same sex relationship… even if neither person, given their histories, identifies as a lesbian. But as long as one grasps the initial point that sexuality and gender identity are independent, and that labels aren’t gospel and depend on the person and situation rather than being a ‘neutral’ expression of ‘fact’, the rest can be negotiated from there.

For brevity’s sake, I don’t want to focus on the reactions of Jenner’s family, or the story of Jenner’s youth and athletic successes. The negotiation of significant personal issues is never easy, and the horrific marginalisation and ‘joke’ status that transgender people can still be relegated to isn’t up for debate. Jenner’s wealth and celebrity privileges don’t negate that coming out was a very brave thing to do, and she also makes it clear that she wants to do some good and help people by being open about her transition. She makes the point that her foothold in the reality television world gives her a powerful tool with which to raise awareness, even if not becoming an expert activist overnight.

The Twitter responses to the interview using the hashtag #BruceJennerABC have been overwhelmingly positive, though as S. Bear Bergman poignantly put it, “wondering who else should get 2 hrs on prime time TV?” whilst linking the list of unlawfully killed transgender people on Wikipedia, undoubtedly a list that under-represents. It was also pointed out by Kate Bornstein how the interview didn’t mention non-binary identities at all. Whilst not necessarily part of Jenner’s experience of gender, such a powerful opportunity for visibility and education could have benefited from greater breadth of reflection on the multi-facetedness of transgender lives. Jenner’s fame, wealth, and success position her as amongst the least vulnerable of transgender people, who collectively are still in dire need of protection, representation, access to services, and understanding. Let’s hope that Caitlyn Jenner inspires increased and better quality allyship.

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News, Popular Culture, Socialisation, The gender binary, Transgender, Women

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Review: Louis Theroux Documentary – Transgender Kids

The Documentary Transgender Kids is available to watch on BBC iPlayer until 30th April 2015 – which can be found here. Apologies if you are outside of the UK and this link doesn’t work.

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On the 5th April, Louis Theroux’s latest documentary aired on BBC 2. To quote the BBC’s description of the programme: “Louis travels to San Francisco where medical professionals are helping children with gender dysphoria transition from boy to girl or girl to boy”. Whilst even this is an oversimplification (structuring transgender narratives as always having a binary ‘end result’, and also trans narratives or realities being dependent on gender dysphoric feelings, non-intuitive though this might be for some), the content of the program has been well received.

I agree with Paris Lees when she says that Louis excels at asking questions designed to aid the average viewer’s train of thought in understanding the subject matter. Whilst maintaining his position as ‘guy who doesn’t know much but wants to learn’, he also avoided tired issues of etiquette such as referring to people by the names and pronouns they identify with – as this is easily Google-able, but they moved through this in such a way so that viewers who didn’t already know this kept with the program.

The start of the documentary is strategically important and intelligent. We meet the parents of the little girl Camille, who iterate that their chief concern is doing right by their child, and learning how to best ensure their welfare – a position anyone can get behind. We are also introduced to Diane Ehrensaft who for me, was a highlight of the programme in demonstrating exceptional warmth, sensitivity, and wisdom. One would hope to see Diane’s approach in any professional working to support transgender and gender variant people, but which the voices of the transgender community tell us is sadly not the case.

People with little to no knowledge of transgender often ask the question ‘but how do you know’, and more so in the case of children. The anxiety surrounding the notion of supporting a ‘mistaken’ transition, of the risk of ‘getting it wrong’ is at the front of many people’s minds. It’s a big problem that many people (including medical professionals) can assume that it is ‘safer’ to prevent any kind of gender expression or transition that runs contrary to assignation at birth, because of potential risk. Louis raises this question (at 14.17 in, to be exact). Diane Ehrensaft is worth quoting directly in her response:

Is it a risk? Let’s call it a possibility. So with that possibility then we think, the most important thing is the same exact idea – to find out who you are and make sure you get help, facilitating being that person *then*. We have one risk we know about. The risk to youth when we hold them back, and hold back those interventions – depression, anxiety, suicide attempts, even successes – and if we can facilitate a better life by offering those interventions, I weigh that against there might a possibility that they’ll change later, but they will be alive to change. So that’s how I weigh it on the scales.

Bravo.

It’s also worth mentioning that whilst stopping or reversing transitions does happen, it is comparably rare. These examples shouldn’t need to be ‘hushed up’ because of the fear that they will be used to de-legitimise transgender people’s access to gender affirming services. Indeed one can see that being able to access such things and then stop can also be highly beneficial for an individual, to help work out who they are, and what they want.

The program didn’t make the mistake of trying to make a fictional debate about whether kids should or shouldn’t be given access – it was clearly sympathetic. I felt the show helped lead its audience to accept the importance of this point. It skillfully managed to do this without reducing the transgender voices on the program to one ‘line’ – there were definite differences between the children appearing on the show.

This was perhaps illustrated most clearly by Crystal/Cole, who exhibited a non-binary gender (although the show didn’t name it as such), sometimes expressing herself as Crystal and sometimes as Cole. They broached the fact that for some children (and indeed, plenty of adults as well) gender expression and pronouns could depend upon environment (‘he at school but she at home’) or on time (‘some days I’m Crystal but some days I’m Cole). There are also some conflicts within this particular narrative – Crystal’s mother (at 24.56) says that:

She has said in private with her therapist that she is a girl. Almost 100%. When I’ve sat down and had private conversations with her and said would you ever be interested in [transitioning medically], how do *you* feel about it? And her answer is ‘I can’t do that mommy, I have to be a boy’, and I enquire further as to why and she says ‘because I’m poppy’s only son, and it would destroy poppy’.

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This hints heavily at a father who isn’t supportive/understanding/accepting of his child’s gender expression, though we also hear Crystal herself say that she doesn’t prefer one name over the other, and later in the program says she wants to be male when she grows up (though for the very normative reasons of liking the thought of a wife and children, as if one must be male to have this). The show deals with this complexity well, and reflection upon Dr. Ehrensaft’s words are fitting. Crystal/Cole may be a transgender woman who, as a child, is navigating her father socially. They may be a non-binary person, with male and female identities, or some further understanding of themselves may manifest over time. I felt we were invited as an audience to recognise that ‘searching for truth’ is not the point of engaging with transgender people, but the most important factors are respect within the moment, and facilitation of what is needed for happiness and health. Which is not as complicated as critics might make it.

The mainstream media has responded positively to the documentary, although not all the conversations to have come out of it have been positive. For example, BBC Women’s Hour disappointingly attempted to create a very artificial ‘for vs. against’ debate’. Quite rightly, this inspired anger from transgender activist CN Lester, fed up of trans voices and narratives legitimacy being framed as a debate, as if each ‘position’ had equal evidence and importance.

Bottom line – this is a strong and sensitive documentary which I would recommend. Whilst obviously positioned within an American context (and the differences with the healthcare systems are important to consider), many people could learn from the compassion of some of the parents who recognise how important it is to become an advocate for their child. By challenging cisnormativity (the idea that identifying with the gender one is assigned at birth is ‘normal’ or ‘correct’), society is slowly dragged towards being safer and easier for those under the trans umbrella.

 

Category:

Children, LGBT, Popular Culture, Science, Socialisation, The gender binary, Transgender, TV

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SuperQueers! LGBT+ in comic books

There’s been a fair bit going on recently. Transgender Day of Visibility was on 31st March, and the UK has seen the leader’s debates in the fretful warm-up to the general election. Therefore I wanted to write about something a little less serious, whilst still shedding some light on something not touched on much in mainstream outlets – LGBTQ comic book characters, which for me, shouts capes and spandex first and foremost. There’s been quite a few lists of favourite GSM (gender and sexuality minority) lists compiled by more expert comic book fans – but I’ll try and mix some slightly obscure and interesting examples with some well known classic heroes (and villains) who you might now see in a new light. So in no particular order then…

1. Mystique

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And pretty genderfluid too, but not in the way that normally means.

If (like me) your main familiarity with the X men was the film adaptations, or possibly the animated series of early ’90s morning kids TV – you’ve missed out on some seriously different character development. Amongst the most critical being the erasure of Mystique’s bisexuality. Besides originally being mother to the mutant Nightcrawler (that blue skin wasn’t coincidence) but also foster mother to Rogue (whaaat?), she was also over 80 years old by the millennium, with her shape-changing powers meaning her ageing is atypical also. As this article details, “Mystique’s character was not revealed as bisexual until The Uncanny X-Men #265, almost thirteen years after she originally debuted. This was due largely to the mandate by then Marvel Comics’ editor-in-chief that there would be no GLBT characters in the Marvel Universe.” Mystique’s début was in 1978 by the way, so not exactly the pre-legal days of Batman and Superman. Progress is slow though, and slower for letters other than G and L.

2. Batwoman

Delicious irony, in that she was originally introduced as a ‘no homo!’ love interest device, because it didn’t look very hetero when Batman and Robin shared a bedroom, even in the 1950s.

Batbed

Whilst like many of the big names there have been various incarnations, parallel universes, and all-round confusing re-inventions, Batwoman was rejuvenated as a Jewish lesbian in a slightly obvious move of clunky tokenism in 2006.

3. Northstar

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Important due to being the first openly gay Marvel superhero – though again, due to the policy of the then editor-in-chief Jim Shooter preventing any openly gay characters (along with the Comic Code Authority), despite debuting in 1979, he was only allowed to be explicitly stated as gay in 1992. With the ability to travel at near light-speed (and the associated resilience and strength), Northstar also got married in Astonishing X-Men in 2012.

4. Extraño

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An early DC queer example premièring in 1988, Extraño, meaning ‘strange’ in Spanish, was painfully stereotypical, though more explicitly ‘out’ before Northstar. Referring to himself often as ‘auntie’, he was confirmed to be HIV positive – possibly from doing battle with an adversary called Hemo-Goblin, who, I kid you not, was “a vampire created by a white supremacist group to eliminate anyone who was not white by infecting them with HIV”. In their own way, the comic book industry tried to engage with important political issues new to the world in the 1980s.

 

5. Wiccan

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A powerful member of the young avengers, Wiccan predictably has powerful magical abilities. With a backdrop that involved standing up to homophobic bullying, and a romance with fellow hero Hulking, this meant the character was particularly well received.

6. Alysia Yeoh

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Although not a superhero per se, Alysia is important as the first major transgender character in a mainstream comic (in 2013), as the roommate of Batgirl. Whilst there has been a few aliens who can morph gender around, psychics inhabiting bodies of different genders, and shapeshifters, this is the first time a transgender person (of colour no less, she’s Singaporean) had been naturalised and involved realistically.

7. Loki

Another huge character in no small part because of film franchises, and also with a complex, multi-incarnate history, Loki has a history of bisexuality and gender fluidity that has been promised to be explored more.

8. Sailor Uranus

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Although more well recognised from anime than from manga (comic book style serialisation in Japan), the Sailor Moon franchise was chock full of lesbianism, with Sailor Uranus having a relationship with Sailor Neptune. This was quite obvious in the originals through their flirtations – but in typical LGBT erasure/censorship, when translated for a US audience, the characters were positioned as cousins. Due to failing to remove all of the flirting however (either through sloppiness or a wish to actually be somewhat faithful to the original), it was accidentally implied not only that they were lesbians, but incestuous lesbians. Great job, conservative America.

9. Xavin

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Whilst we’ve already looked at Alysia as a sensitive and important example of transgender in comics, Xavin is something else. Quite literally, being a non-human known as a skrull who don’t experience gender in the same way. Xavin assumes male, female, and skrull forms. The character raised interesting interpretations of gender as for Xavin, this could be changed as easily and with no more personal significance than an outfit choice.

BONUS: The Young Protectors

Click to read the comic in full, for free!

Now this is something special. With an interesting, diverse cast of characters and a compelling plot, this young-superhero based comic has a gay-driven storyline, without reading like any kind of seedy knock-off. There’s a great balance between character development and action, and I only find it a shame there isn’t a more extensive serialisation to get one’s teeth into. And I’m not alone either. The creator’s Patreon backing is pretty huge. Well deserved, given the entire story is free to access.

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Fictional Literature, Film, LGBT, Popular Culture, Sexuality, The gender binary, Transgender, TV

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Insider/Outsider – The Politics of Who to Listen to

As someone who works on non-binary gender identities without unequivocally being an in-group member (though as previously discussed, it’s a little bit complicated), this is an important issue for me. There’s a long and unpleasant history, and not just relating to gender, of people speaking over the voices of groups they are not members of. Of speaking for or about people in ways those people did (or do) not like. This article is not a debate about whether this is a problem or not: it is. Recognition of privilege is something that everyone has a moral imperative to engage with – in part to simply avoid being an ignorant arse who doesn’t recognise hardships others face that they don’t, but also because oppressions are intersectional, which is best illustrated by the comic below – originally posted by Miriam Dobson here.

bobslide2 bobslide3 bobslide4 bobslide5 bobslide6

 

However, whilst it’s a good rule of thumb to listen to in-group members telling you things about their group, especially when you’re not a member of that group, there are additional complexities that are worth recognising.

People within marginalised groups disagree.

This should be pretty obvious. Any population big enough to be associated with a social oppression (be that people of colour, queer people, trans people, women, etc.) is going to contain vast swathes of differing opinion. This raises two important points, that may seem a bit contradictory. Firstly, marginalised people can be wrong about things that pertain to the group they’re a member of. Secondly, issues can easily become complex enough that claiming there is a ‘right’ and a ‘wrong’ becomes simplistic or troubling all on its own. It’s important to add that the *possibility* of error on the part of a marginalised person doesn’t mean it’s okay for someone to use this to conveniently dismiss claims they don’t like. Especially those claims that come from direct experience. Experiences of different people can contradict, and don’t respectively erase each other. It’s a complex world we live in.

People new to marginalised groups don’t magically become experts immediately. Some never do.

I heard one transgender activist put it this way: ‘coming out is like saying you want to do a GCSE in maths, but then people start asking you advanced calculus all the time and expecting you to know the answer’. Each person is the authority of their own life. But that’s different to being equipped with an arsenal of political, academic, or activist language and nuanced understandings of what things can mean to different people. It’s different to an awareness of historical or cultural contexts, politics, precedents, or social structures. In some cases, it’s vital to remember that a marginalised person doesn’t need any of those things for their voice to still carry a weight and value that a non-marginalised person’s cannot – such as voicing experience. It’s also a problem to expect everyone to be an expert, as not everyone is or wants to be a scholar or an activist.

Whilst I would suggest most people don’t believe you need to be a member of a demographic to study a particular demographic, it’s a good rule of thumb that lived experiences trump theoretical awareness. Experiencing something doesn’t make someone an expert, but there’s a reason why many people who do experience an oppression do become experts – because they have a particularly powerful motivation to do so. We could of course ‘what does ‘expert’ even mean anyway?’ but that’s a different discussion.

Marginalised people can’t speak for all members of the group they occupy, because no-one can. But…

If a marginalised person says ‘we want this’ or ‘we experience that’, it is more likely to be a slight simplification, or a political statement with a particular purpose rather than something hugely problematic. Their social positioning to the political meaning of the statement is changed and charged by their in-group status.

Experiencing one oppression doesn’t mean someone is sensitive to other forms of oppression, necessarily.

You find racist gay people. You find homophobic disabled people. You find transphobic women. This can often have troubling implications, as if they’re highly politically motivated to fight for the rights and well being of their group, they’re almost certainly leaving someone out in the cold.

11014942_795019177258091_2714052417708962523_n

 

Often, if a scholar does work on a particular group of people, and many members of that group take issue with what they’re saying, it’s extremely pertinent to listen to the actual people, rather than the theorist. This is illustrated rather perfectly not just by history (it was the highly qualified, expert doctors who decided that homosexuality and transgender were mental illnesses, no?) but also by the continued work hate speech of scholars polemicists such as Janice Raymond and Sheila Jeffreys.

Ultimately, knowing who to listen to can sometimes be a complex ethical process, dependent on collecting and processing lots of information. But if in doubt (or even if not, in fact), listening to voices of experience is your best bet. The devil can be in the detail where contradiction comes up, but this only heightens the importance of education.

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Feminism, LGBT, Popular Culture, Socialisation, The gender binary, Theory Literature

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Non-binary genders have Thousands of Years of Precedent

The enormous extent to which the binary gender system has been enforced – which claims everyone can only be male or female –  has left many people unaware of the existence of anything (or anyone) else. A lot of this has to do with a phenomenon that sociologists understand as the ‘medicalisation’ of sex. Differences in gendered behaviour (whether that be a man doing ‘women’s things’ or vice versa), sexual attraction, or clothing choice became understood as sicknesses, best left to the expertise of a doctor -when before you would’ve called for a priest, or even more likely, not actually been all that bothered. Anthropologists in the 19th century gave fantastical reports of ‘exotic’, ‘alien’ cultures. These social models regarding gender and sexuality were unintelligible to people bound by the western model: that you could be a man (who was attracted to women), or a woman (who was attracted to men). And that’s that. Such ancient and enduring social systems which involve a third gender (or more!) and other ways for understanding sexuality that aren’t readily analogous to ‘gay’, ‘lesbian’, or ‘bisexual’ can be found all over the world, but it isn’t even these that I’m referring to in the title of this article. One doesn’t need to travel far to find hugely mainstream historical precedent for the concept of a third gender. How about one of the most important and influential civilisations in the western world? Ancient Greece.

I want to talk about a particular text, written by Plato. Student of Socrates, teacher of Aristotle, it’s fair to regard him as a founding father of philosophy. The text is a collection of speeches by different important Greek thinkers, written to reflect  each man delivering his speech to the others at a drinking party. This is Plato’s Symposium.

One of the speeches was given by Aristophanes, who was a comic playwright. He asks why is it that when in love, many people report feeling ‘whole’, as if previously incomplete? The explanation, he says, is due to how mankind used to be.

Humans were, according to Aristophanes, originally beings with two heads, four arms and legs, and two hearts, who were very powerful. Each head (and corresponding genitals) could be male or female – so there were three possible sexes! Male, where both were men, female, where both were women, and ‘androgynous’, where you had one male and one female. These powerful double-people decided to storm Mount Olympus, so to stop them Zeus smote them, tearing everyone in half. Each person then desperately tried to find their original pairing – which positions the male and female double-people as gay men and lesbian women, with the third gender representing what we would now label heterosexuality. This comic illustrates perfectly.

aristophanes

This importantly demonstrates how a two gender system hasn’t always had the total monopoly one might assume it has. Whilst this doesn’t say anything about the thoughts had about gender by the everyday ancient Greek, it simply shows there was recognition of a third gender through stories, and there wasn’t any strangeness or moral failure or sickness associated with it. The same culture gave us Hermaphroditus, the neither-male-nor-female divine child, and root of the word hermaphrodite, often historically used to describe intersex people.

SONY DSC

 

Whilst the identity labels are new (the word ‘homosexual’ only being created in the late 1860s for example), all evidence shows that the rich human variation of gender identity and sexuality have been around for as long as people have  thought about themselves and who they are.

 

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Fictional Literature, Intersex, LGBT, Sexuality, Socialisation, The gender binary, Transgender

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Facebook Gender Categories Explained

In case you didn’t know, Facebook allows for a user to fill in their own gender identity, rather than be forced to select ‘male’ or ‘female’. This is great news for everyone, including many people who ARE male or female. But what is meant by many genders can leave some people puzzled.

gender options

Oliver Haimson et al. has gathered some data which shows what people who use the custom gender option actually define themselves as:

facebook gender options

 

Whilst the numbers total over 100%, that’s due to there being no restriction on how many gender identity labels a person can hold. It’s a good graph to get a rough sense of the identity categories that people are using. There’s also many categories where the differences may not be clear. What’s the difference between transgender and transsexual? What’s the difference between ‘trans’ and ‘trans*’?

Of course, the meaning of a label can differ depending upon who you’re talking to – different terms resonate differently with different people, and two people’s understandings may easily contradict, so there is never going to be an easy ‘factual’ list that can be referred to. Identity is a highly personal thing, and can only be defined by an individual. This post simply acts as a guide to give some basic explanation of these categories. Some labels may seem to overlap completely in one person’s eyes (say, trans man and trans male) whilst highlighting an important difference to someone else. I’ll be grouping some identities together due to similarity, but it’s important to bear this in mind and that of course, much variation can exist between people who may identify with the same gender identity. I’ll also explain some of the differences between some of the labels.

It is important to remember – gender identity is not sexuality! A person of any gender identity may associate themselves with any sexuality (though of course some may be more common than others. Whilst a cisgender man would not identify as a lesbian, a transmasculine person may have a more complex relationship with this identity for example).

This list is not intended to be authoritative or exhaustive. No-one knows your gender identity better than you yourself! If anyone wishes to expand or add in the comments section, please feel welcome.
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 Genderqueer/Non-binary

Often used as umbrella categories, these terms both refer to gender identities other than simply ‘man’ and ‘woman’ – people who exist outside of the gender binary. Neither tells you much about a person’s gender besides that they’re not (exclusively) male and not (exclusively) female. Some genderqueer or non-binary people may embrace or express masculinity, femininity, both, neither, a mix, or vary depending on time, place, or people – regardless of the gender that person was assigned at birth. The possibilities are practically endless.

Gender fluid/Bigender

Being gender fluid can mean that a person sometimes identifies as male/man, sometimes as female/woman, or sometimes as androgynous other non-binary identities. Similarly, people identifying as bigender may experience two differently gendered personas, typically ‘masculine’ and ‘feminine’ which may change. Whilst not frequent enough to come up on the Facebook chart, the identity of trigender may be used by people who can change between male, female, and non-binary identites too. Note that someone may potentially have more than two gender identities and still identify as bigender – a person cannot ‘identify wrongly’. It is simply what a person feels fits with their sense of themselves.

Agender/Neutrois

Sometimes also described or understood as ‘neutral’ or ‘null’, some people may experience these identities as an absence of any gender, or, subtly different, as a neutral gender identity that isn’t male or female. This doesn’t tell you anything else, such as whether a person identifies as transgender, or has any wish to engage with a transition.

Gender nonconforming/Gender variant

These gender identities are quite self-explanatory, and broad. These labels don’t share information about the person’s relationship with maleness, femaleness, masculinity or femininity – but that their gender expression may not fit with cultural expectations of their gender assignation. Someone identifying as gender nonconforming or gender variant may identify as trans, or may not.

Two spirit

A non-western gender identity, two spirit is an umbrella term for gender identities associated with the cultures of some indigenous North Americans, such as the Oglala Lakota (note: I say ‘cultures’ rather than culture to avoid conflating different tribes and groups, which are distinct). There isn’t a simple way to generalise, though historically two spirit people often engaged in work or cultural practices not associated with their assigned birth sex. Called ‘Berdaches’ (a problematic term no longer used, and considered a slur) by western anthropologists, two spirit people may identify with both male and female gender roles and thus be recognised as a third gender within indigenous American cultural contexts.

Transmasculine/Transfeminine

A transmasculine person identifies more with maleness than with femaleness, but may not necessarily identify entirely as ‘a man’ (some however, might – and use this label as an indicator of their position regarding masculinity). Likewise a transfeminine person vice-versa – identifies more with femaleness but not entirely as ‘woman’. In accordance with the ‘trans’ aspect of this identity, transfeminine people are assigned male at birth and transmasculine people are assigned female at birth.

Androgynous/Androgyne

This is an identification with the mixture of masculine and feminine presentation so as to be a mixture of the two, and ambiguous in gender presentation. The terms can be used quite broadly, however.

Other

What can be said here? Other. Something else. Gender unknown space unicorn. Being deliberately vague is often a deliberate political decision.

Neither

Not male or female. If you know the person well you may know more detail (though you probably shouldn’t ask out of idle curiousity). The individual themselves may not have a clearer definition than this – sometimes it’s easier to know what you aren’t than exactly what you are, and that’s completely fine.

Intersex

Intersex people, by arbitrary medical definitions, may not physiologically fit into the gender binary in one way or another (most commonly, through having what are termed ‘ambiguous genitalia’ at birth). Intersex infants may be surgically altered without their consent, in order to assuage the  gendered anxieties of parents and doctors. Some people who may be ‘diagnosed’ as intersex may identify as men, women, or other gender identities, whilst some may feel their intersex status is something they identify with.

Pangender

Whilst pangender may imply an identification with all genders, more usefully it can be understood as fluidly experiencing a multiplicity of genders. A FAQ can be found here – where it is also clarified that appropriation of gender identities from other cultures (such as two spirit, or hijra) isn’t okay.

Gender questioning 

This is the process of questioning or working out one’s own gender, and may not be a permanent identity – though there’s no set amount of time someone might do this for! A questioning person may not be sure of what they identify with, and might not come to an answer – which is absolutely fine.

Transgender/Trans/Trans Person/Transgender person/Trans woman/Trans female/Transgender female/Transgender woman/Trans man/Trans male/Transgender male/Transgender man

Transgender people are people who do not identify with the gender they were assigned at birth. Trans is a shortening of transgender. The differences between ‘man’ and ‘male’, and ‘woman’ and ‘female’ may be something an individual has a solid opinion on, or they may feel unconcerned about the implied difference, or not see one. By specifying ‘person’ in a Facebook gender identity, someone may be iterating that whether they identify as male or female or otherwise isn’t something they want to share there.

Trans*/Trans* Person/Trans* man/Trans* male/Trans* woman/Trans* female

Some people use the asterisk to specifically highlight they are using ‘trans’ as an umbrella term, rather than to refer specifically to (binary identified) transgender people. There have been discussions both for and against the use of the asterisk, further indicating how personal comforts are a big part of identity label choice.

FTM/Female to male/MTF/Male to female

Often used by binary identified transgender people, these identity labels are used as a shorthand way of indicating the gender the individual was assigned at birth, and what they currently identify as. The terms don’t necessarily imply ‘I was a man and I am now a woman’ for example, as many MTFs would also say that they were always women, simply assigned incorrectly at birth based on their genitals. Thus the implication of having changed from one thing to another is something some trans people have a problem with, whilst others still find the identity label useful.

Transsexual/Transsexual person/Transsexual female/Transsexual woman/Transsexual male/Transsexual man

Transsexual is now quite an old-fashioned term, most associated with medical language and discourses of the mid-20th century. Many trans people don’t like the term or may find it offensive, but others may embrace it, particularly older trans people. The term is also typically used in a binary fashion.  Transsexual females/women are women who were assigned male at birth. Transsexual men/males are men who were assigned female at birth. Some people make a distinction between transsexual and transgender based on whether gender affirming surgeries have been undertaken, but this isn’t very common and can problematically create some artificial distinction between men and women who have certain medical procedures and those who don’t.

Cis/Cisgender/Cis female/Cis woman/Cisgender female/Cisgender woman/Cis male/Cis man/Cisgender male/Cisgender man

Cis is simply short for cisgender. Cisgender is the ‘opposite’ of transgender, and is used to indicate that a person identifies with the gender they were assigned at birth. So if at birth the doctor exclaimed ‘it’s a girl!’ and that person grew up to say ‘yes, I identify as female’ – that person is cisgender. Some individuals have claimed this is a slur, which is nonsense – the term exists as a neutral way to talk about people who are not trans, without positioning cisness as ‘the normal’ gender identity, or that ‘man/woman = cis man/cis woman’, which is the product of cissexism.

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Intersex, LGBT, The gender binary, Transgender

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The 32 Problems I Found with this Gender Identity Service FAQ Guide.

Transgender people have, as a group, an enormous amount of awareness of the problems with accessing gender related support through the NHS. This post will highlight some of these problems. Below is a letter received in February 2015 from the Leeds Gender Identity Clinic, copied verbatim (including all errors, down to mis-spacings and grocer’s apostrophes). The quality of this letter is pretty dreadful, and prompted my critique and questions, to be found below the letter.

The numbers in square brackets are references for my points. Some numbers will repeat, indicating the same response to a repeat of a problem.

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Leeds Gender Identity Service

Frequently asked questions August 2013 [1]

Leeds Gender Identity Service is well established, around 20 years old and has evolved over the years. It is a dynamic process. Below are some frequently asked questions and our answers as they stand in 2013.[1]

1) What are the team’s views and commitment to the client group?

The service has a very committed multi disciplinary team. Fortunately all members of the team (Consultant Psychiatrists, Medical Practitioner[2], Endocrinlogist, Clinical Nurse Specialist’s[3], Occupational Therapist, Prescribing Pharmacist, Clinical Team Manager, Clinical Service Manager and the Team Administrators) Share the belief in the bio psycho social model[4] and its application within physical, mental, social and general health and Gender Dysphoria in particular. All members of the team believe in the recognition of Gender Dysphoria[5] and the need to facilitate and co ordinate gender reassignment in the safest and most effective manner.[6]

The service believe in mutual respect between service provider and service user, informed consent, capacity ,[3] guidelines and a flexible application accordingly[3] to individual needs are paramount to the success of an agreed outcome.

2) What standards of care are followed by the service?

The Harry Benjamin International Standards of Care have a well established and historical influence on standards of care which are considered worldwide, over recent times these have evolved into the WPATH, version 7, and standards of care for the health of transsexual, transgender, and gender nonconforming people. As a team we are mindful[7] of this guidance. The team are guided by the National Royal College of Psychiatrist standards; however these have not been ratified[8] are recognised by NHS England. The Gender Act, ICD10, DSM IV, Nice guidelines, Act of parliament 2004 and the policies of the trust including First Do No Harm all guide our practice.

The service has an active involvement in the development of the National standards of care professionals group. This includes other leading, NHS, Gender Identity Services in the UK. The purpose of the group is to define agreed, UK, baseline standards of care.

A proposed DSM V is due for publication; however this is still in draft format.[9]

The DOH[10] published guidance for G.P.’s[3] and other health care staff in May 2013. Leeds Gender Identity Service along with other NHS teams[11] were involved in the preparation of this document.

3) What is included within the care pathway?

The care pathway is guided by the standards of care which are stated above however has the ability to be flexible to meet individual needs. It includes all the stages of Gender reassignment, assessment, hormone treatment, social gender transition and surgery[12]. The service initiates the 2nd opinion and surgical referral but these are completed outside of the Leeds Gender Identity Service[13] therefore any waiting times associated with these are outside of our control.

4) What is the assessment?

The assessment stage takes up to 4 sessions (4 months) however a minimum of 2-3 sessions completed over a 2-3 month period could be agreed according to individual needs.

The criteria of the assessment is confirmation of the diagnosis of gender Dysphoria and exploring aspects of physical, mental and social health. Issues of eligibility and readiness to move into the next stage would be evidence based.

5) What is the social gender transition (SGT)?

Social gender transition is in its entirety approximately 2 years[14]. In order to complete an assessment of social gender transition the information gathered during this stage of social gender transition needs to be evidence based, this would include:

Living in role full time[15]

Change of name[16]

Some form of occupational activity[17] this could include voluntary work, paid employment, further studies or evidence of engagement/ daily living in the new role[18]. The service looks at occupational activity in the most flexible way and will agree with each service user how they will meet this requirement depending on their individual circumstances. If extra support is required by the service user a referral to the occupational therapist is available.

It is the service user[3] responsibility to collect this evidence. The team’s responsibility is to document it [19].

The hormone stage describe3d in question 6 would also fit into the SGT and will last 12months this would include a surgical referral once a positive 2nd opinion has been received.

Leeds Gender Identity Service is keen to learn from our experiences, working safely and flexibly within the care pathway to meet the changing needs of the client group.

For those clients who feel they are unable to live in full time SGT or do not wish to live in role at all in a specified area of their life e.g. employment ‘special circumstances’  this can be discussed with the clinician. If ‘special circumstances’ is agreed the following criteria must be met:

The client will be assessed as fitting the diagnostic criteria of Gender Dysphoria with a high level of confidence[20]. (In accordance with ICD 10)[3]

Psychotherapy opinion / treatment will be accessed and a detailed report provided to the Gender Identity Service supporting a referral for hormone treatment.

A 12 month plan will be agreed if appropriate to identify additional objective evidence for all other aspects of SGT can be ‘agreed between client and clinician.

6) What is involved in the hormone stage?

The service has an appointed Medical Practitioner, Consultant Endocrinologist and a prescribing pharmacist they are responsible for this stage of the pathway. The lead professional remains involved throughout the stages including the hormone stage. Close liaison with General Practitioner[3]/other professionals are a must. This stage could last for 12-18 months or significantly shorter in individual cases. While attending the hormone clinic Clients[3] will receive regular blood test[3] from their GP and blood test monitoring by the gender service, until such a time that it is safe to transfer all hormone treatment care to the GP including appropriate prescriptions.

7) What is the surgical stage?

Surgery stage:  2nd opinion is a prerequisite to a surgical referral. Once we receive a positive 2nd opinion a referral to the appropriate surgeon is initiated.  Any delays within this stage would be due to delays in variables[21] totally outside the control of the team.

The service will be responsible for referring clients to an NHS Gender Specialist for a 2nd opinion appointment however if individual clients wish to access private 2nd opinion appointments to speed up waiting times it will be the responsibility of the client to self refer or negotiate[22] this with their GP.

Leeds Gender Identity Service is happy to receive and act upon a positive, private 2nd opinion from a reputable[23] Gender Specialist at the appropriate time within the care pathway.

The service usually refers clients to specific identified surgeons however will consider referral to other areas if a client has a specific request and the CCG[24] are willing to fund surgery in the requested area.

Clients will need to have completed 12months,[3] full time, SGT before receiving a mastectomy and have received 6 months hormone treatment[25].

Breast Augmentation is not currently a core treatment[26] commissioned through Leeds Gender Identity Service; however clients can apply for this following completion of 18 months on hormone treatment[27] if there is clear failure[28] of breast growth. This treatment can be applied for through individual CCG’s via individual funding requests.

On occasions clients have requested orchidectomy surgery without a penectomy, the service will work collaboratively with clients to ensure the treatment provided is in line with supporting client choice and within the safety of clear clinical boundaries.

This would include:

Confirmation from the endocrine clinic that current hormone levels are safe, stable and within range.

And

A ‘one off’ appointment from an independent NHS gender Specialist is obtained.

8) How long will it take me to move through the care pathway?

The service follows a care pathways which can be adapted to individual circumstances taking into account transition which has already taken place before attending the service and specifically for those clients holding a Gender Recognition Certificate. An illustration of the pathway could be represented as follow:

The full process from start to finish around 3-4 years[29]

The shortest flexible process depending on individual needs could be condensed to 18-24 months; this has to be realistic taking into account waiting times for second opinions and surgery which are outside of the services[3] control[30].

9) How do the team keep abreast of new developments and ensure client safety and satisfaction?

The service is part of a wider governance group which include most other UK, NHS Gender Identity Service’s[3]. This group meets on a 6 monthly basis and shares views, takes learning’s[3] and discusses standards and guidelines within the area of Gender Identity.

The team are also part of the Specialist Services Clinical governance group within Leeds and York Partnership NHS Foundation Trust who meet on a quarterly basis and also have a team monthly Clinical Governance meeting where issues can be discussed in more detail. Clinical audits, rigorous clinical supervision, evidence based practice are all essential parts of our practice.

Service user feedback is an area which we have worked particularly hard on over recent years. We always provide clients with feedback forms following any new developments and we also ask service users to complete satisfaction questionnaires. Information taken from these forms is used to develop and inform practice in the service[31].

10) Will I get funding to access the service?

The service is commissioned by NHS England therefore potentially we could accept referrals from around the country. Individuals are funded for assessment and if appropriate core treatments which are funded by NHS England.

11) How will I know what is happening in the service?

The team have a specified lead in service user involvement she works alongside service user volunteers to produce a six monthly newsletter. The Newsletter will update all readers on any new developments within the service, will provide feedback on any completed service user feedback form and how this has informed practice and provide service users with an opportunity to display thoughts, feelings, poems or information to others!

The newsletter is posted out to all service users and is available in the waiting area.

You can also access the News letter via Leeds and York Partnership NHS Foundation Trust website.

12) What if I am discharged from the service but am experiencing a Gender related problem?

The service offers “one off” appointments to clients experiencing an issue they need to explore within the specialist service. To access this you will need support from your GP[22] so they can write to the team and ask us to see you. Again this will be funded by NHS England. The “one off” appointments may cover issues which are stated below:

“One off” assessment lasting for an hour n order to advise GP about outstanding problems and submit a medical (psychiatric) opinion.

A “one off” assessment lasting for an hour carried out by our Medical practitioner who is able to advise GP’s on endocrinology issues.

GP’s can also request “one off” extended full day assessment in complex referrals where specialist advice / recommendations are required.

13) How long will I need to wait to be seen once I have been referred?

The service is commissioned to see a specified number of new clients each year by NHS England[32]. Once we have seen these clients a waiting list will start to form for the next financial year. NHS England are kept informed on the waiting list on a monthly basis and will use this information to help identify new assessments to be funded on each rolling year.

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trans_symbol

…And now my bit.

[1] – Well, at least this makes it easy to identify as out of date. Major changes have occurred in the provision of gender based care (such as the release of the DSM V – an important diagnostic tool which actually redefined gender related diagnoses). An update is essential.

[2] – Wait. Only one medical practitioner? For the whole practice? This is alarming not only because of how understaffed it makes the practice appear, but also if any service user has a bad experience with that doctor, there is no-one else. The implication is that access to services all go through this one person.

[3] Grammar is hardly the most important issue here, but when I read an official document providing medical guidance, and it reads as if it was thrown together and not given a second glance, that translates into an uncertainty about the meticulousness and professionalism of the institute being represented. Such primary-school-level errors simply give an unprofessional air, and are easily avoided.

[4] Even with a biology degree I needed Google here, so they could really rephrase to be more user-friendly. How about ‘we understand that personal, social, and psychological factors play a vital part in experiences of gender, and do not seek to reduce service user’s needs to something purely biological’?

[5] – Um. Whilst this is clearly meant to be reassuring, it’s so basic as essential as to come off as alarming at the idea that anyone possibly might not recognise Gender Dysphoria in a Gender Identity Service. If I went to the GP for a vaccination and they said ‘don’t worry, I believe in these!’ I really wouldn’t feel better. There is a history of medical practitioners failing to respect transgender people’s agency, but this statement is hardly an effective way to gain trust.

[6] – I’m so relieved they clarified they wouldn’t do things an unsafe and ineffective manner. Pointless waffle.

[7] – ‘Mindful’ – this is so vague as to be useless. It implies they don’t actually have any external code they’re bound to follow, and can choose to ignore any guidance as and when they see fit. I’m not an alarmist, and I don’t for one minute think guidance would be actively rejected. But not referred to, in preference of one’s own considerations? I can see that happening. Especially as they go on to blanket name six other sets of policies, as if trying to universally appease without actually committing to anything.

 [8] – If not ratified, why chosen/used? I couldn’t easily verify whether this has changed since 2013, but practising with unratified standards seems like it requires explanation, at best.

[9] – This is simply out of date. The DSM V has been published, and this is a really important point. The service is potentially then misinforming service users who may not have much knowledge on the topic.

[10] – Explaining what an acronym is when you use it is widely regarded as a good idea – Department of Health. Should also get a [3] tag for not being ‘DoH’.

[11] – If they’re going to say this, they might as well say who.

[12] – This demonstrates how practice is still quite focused on a model of transgender care that emphasises the gender binary, heavily implying ‘one state of being to another’. It of course is fine for individuals who do feel this way about their gender, but is an approach that fails some of those trans people who are most invisible and marginalised within society.

[13] – Why?

[14] – It doesn’t ‘take’ any time at all, because this is an arbitrary and artificial measure created by the medical establishment. This functions as a method of restriction and control, again policing gender identity along arbitrary and binary boundaries. See here, here. and here for some further considerations, though it’s fair to say it’s a point of contention and much discussion, but lacking much research, especially that which emphasises trans voices.

[15] – Further absolutist, binary conception of gender. The very existence of bigender people blows this out of the water.

[16] – If a person is happy with their name, why should they have to change it? Once again ignoring non-binary people, this also ignores unisex names even amongst binary trans people (Alex, Charlie, etc.)!

[17] – The argument for this is to essentially force trans people into being exposed to the world, again to demonstrate a performance of seriousness and sincerity for medical gatekeepers. Whilst this is argued to provide time within which to learn about oneself and gendered practices, it is highly problematic. Not only the danger this puts people in who wish to and may not pass (before being given access to hormones and procedures that can significantly aid in this) but also for those trans people who may experience mental or physical conditions which makes these demands difficult or impossible. The validity of an individual’s gender identity is not dependent upon how that individual is viewed by others in society.

[18] – ‘new vs. old role’ – a dated, binary based requirement and phrasing that doesn’t work for many trans realities.

[19] – And judge what can or can’t count as ‘acceptable’ evidence, which is coloured by binary and cissexist positionality.

[20] – I went into the ICD (International Classification of Diseases) 10. As it was endorsed in 1990, it was no surprise that it still included ‘transsexualism’ and ‘duel-role transvestism’, and used wince-inducing terms like ‘the opposite sex’. There was no obvious mention of ‘confidence levels’ in relation to diagnoses. Therefore what this actually means, I have no idea and I don’t see how anyone else could readily be expected to either.

[21] – ‘Variables’. Nice and vague there. Such as?!

[22] – The expectation to do this is problematic if someone has a GP who is cissexist or transphobic. Which isn’t as rare as one would hope or expect.

[23] – What defines reputable? Obviously this isn’t easy, but such vagueness only serves to emphasise the position of power which the Gender Identity Service occupies. Obviously it’s vital that standards of care are maintained in private practice as well as state funded, but this wording doesn’t help anyone.

[24] – Clinical Commissioning Group. But everyone knows that, apparently.

[25] – No explanation as to why this is. Further relates to problems with the Real Life Test/Social Gender Transition (SGT) as it stands. Fails to account for those trans people who are very knowledgeable, secure, and stable in relation to their needs.

[26] – More unanswered questions. Why? Estrogen does stimulate breast development yes, but frequently produces small or even unnoticeable development. To create a hierarchy of gendered traits/procedures seems inherently nonsensical as what different trans people value and need for their well-being is obviously variable.

[27] – An excessive, arbitrary, and under-justified restriction. Whilst one can appreciate that with change being stimulated by estrogen, an immediate surgery around that time may risk complications, this absolutism runs contrary to the pledge to individual service user needs and desires.

[28] – And a further restriction. Who decides what, and at what size, ‘failed’ breast development is?

[29] – In true cissexist fashion, prioritising the intensely small minority of individuals for whom gender affirmation procedures are not appropriate, to the disproportionate suffering of a very large number of trans people.

[30] – It’s not the first time, but the service has very clearly distanced itself from responsibility for delays. Obviously this is a recurring problem which has invoked complaints and righteous demands for explanations. Are all of these interactions outside of the service strictly necessary? Could the system be made more transparent so that service users can see what aspects of the pathway causes delays? These are questions that trans people deserve answers to.

[31] – Might it be prudent for the service to also engage with transgender groups, so as to get informed guidance from members of the transgender population who aren’t in the (often stressful) process of accessing these services? Of course the feedback from service users is essential, but by no means the only resource available to them for the optimisation of their services.

[32] – This is of particular note. The idea that only a certain number can be seen, in a way that isn’t dictated entirely by resources (as different individuals require different amounts and types of time and care) but is decided upon in advance doesn’t make sense. It also emphasises one of the biggest problems at the heart of the insufficiencies of NHS Gender Identity Services – lack of funding. The number of individuals seeking aid is growing exponentially, and this remains unrecognised by funding bodies. This isn’t a criticism of the document per se, but highlights one of the more important frustrations with the larger system.

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LGBT, Science, The gender binary, Transgender

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