Sunday 16 February 2014

Do we need GICs?


The Norwich Gender Identity Clinic is under threat. This is undoubtedly bad news for UK trans people, but I'd like to offer a different perspective on the situation.

Do we actually need Gender Identity Clinics at all? I don't think we do.

I appreciate as someone who has long since gone through transition this might seem a rather privileged point of view, but hear me out. I am normally the voice of reason, the moderate, always toeing the trans party line, but this is something I feel quite strongly about.

I remember my visits to the GIC at Charing Cross 30 years ago; they terrified me. My life literally depended on the outcome of a series of interviews with psychiatrists. I had to get access to the medical treatment necessary for transition. I had to. There was no choice here. My future happiness would be determined by whether the GIC panel agreed with something I already knew.

The GICs acted as gatekeepers, arbitrarily deciding who was suitable for treatment. I was lucky: I ticked all the boxes and to my relief got access to the hormones I needed. If I'd been an inch taller though, things might have been different, as they didn't want women over 6 feet entering society. The point was to turn out trans people who could blend in. We were judged by male cis-sexist standards of beauty. We were in front of a jury.

That was 30 years ago, but things got worse. Whereas I had been given access to blockers and hormones for a year before I fully switched gender roles, recent practice has been to require transition before being considered for hormone therapy. This is an unnecessarily cruel practice that has only now been dropped with the latest clinical guidelines. In many cases though, people are still forced to transition without medical intervention, simply because of the time it takes to get an appointment at the GIC; many self medicate by ordering hormones online.

Other barriers still bar our access to treatment. Being unemployed appears to have been used to justify refusal for gender surgery, as the individual cannot demonstrate they are fully integrated into society, the cis-normative view of society that is. I can't imagine any other branch of medicine where you are required to demonstrate you are functioning 'normally' before being given access to treatment. Have the doctors ever considered someone might be unemployed because they are trans?

I remember the relief I felt when I was told I was trans. This wasn't some diagnosis I was fearing, as if I was about to be told I had some life threatening disease. There was an enormous sense of release that I was officially believed and I would be allowed access to treatment I knew all along I needed. I didn't need their diagnosis, I needed their drugs and their scalpels.

There is a complete lack of self determination. I've come across people who are questioning and exploring their gender identity, and therapy can be invaluable in that journey, but most trans people I've ever met know they are trans and don't need a panel of cisgender experts to tell them that. We operate within a system where the laws, rules, procedures and protocols are governed almost exclusively by cis people, who frankly can never fully appreciate what being trans is like. I only know of one doctor who is trans currently working in the UK.

GPs have for years prescribed HRT to cis women. They are happy to refer people to surgeons for all manner of elective surgeries, including mastectomies, breast augmentation, vasectomies and hysterectomies. When a trans person wants access to therapies though, they have to endure potentially years of assessment by psychiatrists.

The rare cases of trans regret that get held up as examples of why we should make it hard for trans people to get access to treatment seem a bit of a smokescreen to me. From my subjective view of the cases I've read about, the regret seems to come not from an incorrect decision of whether the person is trans, but from the reaction of others after they transitioned. The attitudes of others should not be a reason to withhold treatment. This is of course exactly what used to happen when I transitioned 30 years ago, where excessively masculine trans women would be refused treatment on the basis of how society would ultimately treat them.

Being trans is no longer considered a mental disorder. A very encouraging development, perhaps as a result of this depathologising, came last year when a non-psychiatrist was appointed head of a UK GIC. For the first time perhaps, being trans is seen as just a condition that means people need access to standard medical treatments, and don't need prodding and poking. Maybe the medical establishment is starting to work with us rather than against us.

The GICs are under-funded and being squeezed tighter and tighter. They are very limited in how many people they can see each year. We need to move away from a system that channels trans people down a single path and drip feeds them onto medical services. Maybe we need to move away from a system that starts out by questioning a person's gender identity and move to a system that exists to provide medical assistance to help trans people through transition and beyond. How about a 'Transgender Medicine Specialist' in each hospital?

Maybe one day we can see a system where we don't have to go on trial before a jury of cisgender experts sitting in judgement over the lives of people they can never truly understand.



Anne Cognito is the author of Sunlight in the Darkness: my life as a trans woman in the shadows, out now on Amazon and Apple iBooks. http://annecognito.moonfruit.com


Friday 7 February 2014

A call for LGBT unity

The London Pride parade this year will be held on Saturday 28th June 2014 - the 45th anniversary of the Stonewall riots. The contribution made by trans people to the Stonewall riots is usually overlooked, but this is a great opportunity to raise the profile of trans people, as we've not had the best representation over the years, both at Pride and in the wider LGBT community.

The Stonewall riots were led by two trans women, Sylvia Rivera and Marsha P Johnson, a fact that seems largely ignored when talking of the gay rights movement. When the New York police were raiding bars in the 60s and arresting gay people, trans people were often the target, being the most overtly 'gay' and easy to spot. Herein of course lies a problem we so often encounter: that of conflating sexuality and gender identity. Trans people are seen as 'super gay', when in fact our sexuality has nothing to do with us being trans. There are undoubted intersections with sexuality though: there are gay trans people, bisexual trans people and straight trans people. Sexuality is a spectrum for trans people just as it is for cis people.

As much as we educate society about sexuality and gender identity, the two continue to be conflated. Violence against trans people, and particularly trans women, is justified by portraying us as deceivers, there to entice men into having sex with us. We are seen through the lens of sexuality; we are seen as 'traps' (I still can't believe people use that word to describe us). We are just regular men and women living our lives, but as soon as our trans history is revealed then sexuality comes into the mix. We reflect a person's insecurities about their sexuality back at them.

When I was bullied at school for being trans, my gender identity was never considered. I was bullied for being gay. The slightest hint of effeminacy would be swiftly met with such eloquent rebukes as "You f**king poof". Again we see gender identity viewed through the lens of sexuality.

There is homophobia. There is transphobia. It is impossible to separate the two. Without homophobia, we are just men and women dating whomever we choose and not being judged for it. There are so-called academics who question the legitimacy of trans people's identities, judged separately from aspects of sexual orientation, but the violent transphobia that is sadly too common is I believe rooted in homophobia.

With such intersections between L,G,B and T it makes no sense to campaign on behalf of LGB people and purposefully ignore the needs of trans people. After years of neglecting the trans community there has never been a greater need for campaigning, such is the gulf in progress in the LGB arena compared to the overlooked T.

And so to Stonewall UK, the LGB campaigning group who name themselves after riots instigated by trans people, and who steadfastly refuse to even mention trans people in their advocacy. Would it have hurt them to have a poster which read "One of these women is trans, if that bothers you then we still have work to do", or how about "Some people are trans, get over it" as part of their recent poster campaigns? Stonewall is Europe's largest LGB campaigning group; there isn't a trans organisation even close to the size of Stonewall.

To see the effect lobbying can have, consider the equal marriage legislation passed in England and Wales compared to that in Scotland. In England we have the situation where a spouse can veto the application for gender recognition of their transitioning partner. Stonewall Scotland, unlike Stonewall UK, are trans-inclusive and campaigned alongside trans groups on the equal marriage bill. The result: in Scotland the Spousal Veto clause was thrown out.

With the departure from Stonewall of chief executive Ben Summerskill, now is the time to re-examine Stonewall's representation of trans people. Perhaps soon we can properly recognise the contribution trans people have made to human rights campaigning. Perhaps soon the name Stonewall can be used with a true sense of pride in what it represents.


Anne Cognito is the author of Sunlight in the Darkness: my life as a trans woman in the shadows, out now on Amazon and Apple iBooks. http://annecognito.moonfruit.com