Whimsical, queer exploration of all things gender.

Posts tagged ‘LGBTQ’

Why We Should Stand Up For Trans Rights and Recognition at the University of Toronto

My good friend and colleague S.W. Underwood and myself wrote a piece in response to Dr. Jordan Peterson’s recent comments at the University of Toronto, regarding his refusal to use the pronouns individuals identify with. Please see here for the article!

http://torontoist.com/2016/10/u-of-t-trans-rights/

Slurs – What they are not

If you look it up, a common-sense definition of a slur is simply an insulting remark, that might also harm someone’s reputation. This is over-simplistic, in that it doesn’t consider power dynamics. Often when we talk of slurs we’re talking about language used by those with power (which can mean being socially normalised, not demographically vulnerable to systemic forms of discrimination) to bash those without, in a hateful way associated with some kind of disenfranchised group. I would say minority group, though importantly women of course  experience all kinds of misogynistic language despite the size of the demographic (spoiler: because patriarchy). Most people can recognise and be suitably disgusted by a wide range of slurs, particularly racial ones. There’s also the conversations constantly happening within marginalised groups around the politics of reclaiming previously weaponised words as a form of empowerment – slutwalks, self-defining fags and dykes, and the now quite longstanding world of queer. But due to the (sometimes faltering, and certainly incomplete) progress that has been made through decades of social processes whereby more and more people get switched on to how language is used being something that matters, legitimate processes of challenging oppressive language have been levied as a rhetorical shield against being criticised, or even described.

I would argue there are two particular terms in relation to transgender people in particular that ignorant or prejudiced individuals like to claim are slurs or pejorative – cisgender, and TERF. Cisgender, or cis for short, comes from the latin meaning ‘on this side’ (whilst ‘trans’ means ‘on the other side’). It is a value-neutral descriptor for individuals whose gender identities align with how their gender was assigned at birth. TERF stands for trans-exclusionary radical feminism, and describes people (usually women) who profess a feminist identity but do not consider transgender women to be ‘real’ women.

Cisgender exists in order to de-position the words ‘man’ and ‘woman’ as always being about people who are not trans (notice how trans men and trans women are always indicated by the prefix, but most of the time cis men and cis women are ‘just’ men and women?). When we say man, or woman, we don’t have any information about whether an individual is cis or trans, but for as long as cisness is positioned as the ‘default’, trans status is positioned as ‘not normal’, rather than minority. Transness is implicitly excluded from being ‘real’ men or women for as long as those words on their own don’t include a universal appreciation of the possibility and reality of transness.  This isn’t to say that cis people can’t and don’t experience tensions, discrimination, or negative feelings because of enforced gender roles. But they do benefit from being viewed as real, constant, stable, and never having to convince or confess to others what their gender is, because it’s taken at face value. Cis people broadly benefit from being ‘the default’, and from cultural practices of ascribing gender to people based on what we see, and this often being taken as ‘more real’ than what an individual has to say about themselves.

People who don’t like these words existing often try to claim that they’re slurs in order to delegitimise their usage. Because of the fact that oppressed individuals may sometimes, in understandable frustration at experiences of inequality express their anger through disparaging the oppressive groups. Compare TERF to say, racist, or homophobe. These are words that are used to describe people with a particular set of (discriminatory) beliefs, or who engage in discriminatory practices. In those cases, people called homophobes and racists tend to respond by going ‘no I’m not! (I have a friend who is gay!)’ – yet fascinatingly TERFs don’t say that they don’t think that trans women aren’t women, but that… it’s offensive to say they are? In more extremely hateful individuals one does see people defiantly, proudly proclaiming themselves as racist, homophobic, transphobic – because they believe it is right to be so. Those who don’t believe it is right to be so but don’t recognise the problems with their actions are now the bigger problem.

People can try to shut down descriptors which shake their ignorant worldviews. TERFs see themselves as ‘feminists’, men and women critical of ‘cis’ see themselves as ‘just men and women’ (I’ve never seen a trans person have a problem or make a critique of the word cisgender, which probably has a lot to do with experiences of having their genders systematically delegitimised).

It is a Machiavellian, political move to utilise narratives of oppression resistance in order to reject descriptive labels that function to make a minority less Othered (in the case of cis) or to describe a set of beliefs unambiguously, making it easier to see their failings (such as TERF). One can see it in other domains – take the descriptor of ‘Blairite’ – because support for the political ideology of Tony Blair has been criticised heavily, proponents try to silence their critics through tone policing and claiming those labeling them are being offensive.

The bottom line – it’s important not to confuse people being pissed off with a group of people described by a word, and the word itself having a disparaging meaning.

 

 

Why I don’t want to talk about Caitlyn Jenner

The irony of this piece of writing isn’t lost on me. But as possibly the most visible and discussed transgender person ever, it’s practically impossible to be engaged with transgender scholarship and activism without acknowledging that she has influenced the conversations that are being had.

When I wrote about Caitlyn’s coming out last year, there were two points about the future I was keen to see pan out. The first was that her reality TV foothold gave her a valuable platform despite not becoming a well-informed activist overnight. The second was hoping that she inspired more and better quality allyship. The latter point is unquantifiable, and I remain hopeful that this is the case (although this is the direct the world is slowly moving in anyway). The former… well, it’s time to review.

It’s timely, as the premier of the second season of I am Cait, and it’s fair to say that Jenner is clearly willing to engage with members of the trans community beyond her political position as a conservative Republican. The inclusion of Kate Bornstein is a delight for many, as her books Gender Outlaw and Gender Outlaws: The Next Generation among others have embraced and supported a diverse cross-section of the trans community.

cait

As Jenny Boylan put it “The Ingenious, Subversive thing is, @IAmCait is not actually about her”. Productive dialogue between left and right wing people is incredibly hard to foster, because no-one wants to change their mind. Everyone holds their views because they feel they are right, or better, or most useful. Stepping out of the echo chamber is hard. I can definitely imagine commenting more on this show, because there seems to be an emphasis on growth through conversation.

Jenner’s own position however – she’s quite recently declared extremist right wing presidential candidate Ted Cruz as “very nice”, and wants to be his ‘trans ambassador’. This is despite the fact that Ted Cruz views the support of trans students as “lunacy”, and that a trans student using a space “inflicts” them on others using that space. Cruz also has associations with Kevin Swanson, an extremist pastor advocating that gay people be put to death, and has associated himself with the support of extremist anti-abortionists who are associated with murder and attempted bombing.

Brynne Tannehill has given an excellent reasoning for Jenner’s seeming ability to doublethink away Cruz’s bigotry. She articulates how conservative trans people such as Jenner:

don’t have skin in the game. They were ultra-conservative before transition, and remained so after transition because a Cruz presidency doesn’t endanger them personally. They live in safe places, with a safe income.

escape cognitive dissonance in a lot of ways. They don’t believe that Ted Cruz would do all the horrible things he and the FRC have promised to do. They believe that the most important thing to transgender people is “a good economy” that gives us more job opportunities. They claim to be “looking at the bigger picture,” or say that “I’m not a single issue voter,” with an implication of moral and intellectual superiority.

Tannehill explains how polemical anti-left understandings of Democrat policy lead them to the conclusion that they would be better off under Cruz. For those who are literal millionaires, in terms of taxation, they may well be right. But even if we ignore the tired discussion that illustrates how right wing economic policies favour businesses and the wealthy, Jenner fails to recognise how:

Ted Cruz has promised to force the world’s largest employer of transgender people (the DoD) to hunt down and fire all of its transgender employees. Never mind that if the FRC’s plan is implemented, transgender people would not have access to correct government ID. Nor would they have legal recourse when discriminated against in employment. Nor when refused service, nor when tormented by religiously motivated co-workers, nor when school administrators can legally refuse to provide an education to transgender students.

This would obviously hit poorer trans people, trans people of colour, disabled trans people the hardest. Caitlyn has wealth, glamour, and a platform – but her lived experience doesn’t bring much to the table. She doesn’t have experiences of marginalisation that have sharpened her consideration of social issues, nor is she a scholar. She has said how she would have “all my girls to advise him” – she might be able to wield the social capital to protect those near and dear to her, but what about everyone else? In my article last year, I quoted S. Bear Bergman postulating “wondering who else should get 2 hrs on prime time TV?” Innumerable trans people with a spectacular range of stories and expertise to share come to mind, some have appeared on TV, some have not. I would find it alarming if anyone with the platform of Jenner were to normalise a radical, hateful extremist such as Cruz, despite the potential laudability of what she might be trying to do through her show.

To be clear, I applaud attempts by Jenner to engage outside of a conservative echo chamber. So why don’t I want to talk about her anymore? Because she’s not who we should be listening to. Some of her friends, and her critics, and the community she wants to represent, are.

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).

CDaVDFsVEAArXaI

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.

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

mystique-destiny-death

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

weddin glarge

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

Extraño

 

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

Wiccan-Hulkling_kiss

 

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

bg19yeoh

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

Sailoruranus

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

250px-Xavincover

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.

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.

 

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.

————————————————————————————————————————————————————

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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…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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