Break the Gates Open

The following was sent as part of a response to a NHS survey on the Prioritisation of Specialised Services Research. Contains mentions of medical and sexual abuse:

The current model of Gender Identity Services, Gender Identity Clinics, obstructs trans people from living full and healthy lives. Waiting lists are astronomical, with patients forced to wait months to years for a basic consultation, with no guarantee of treatment.

Clinicians stigmatise, disbelieve and fetishise patients. Invasive and irrelevant questioning of patients is standard. Requiring patients to recount our childhood and sexual history in detail in order to receive basic medical care is coercive and frequently traumatic. Unnecessary breast and genital examinations are also disturbingly common. Overall, Gender Identity Clinics treat trans patients as curiosities to be mentally and physically probed with no respect for personal boundaries.

Gender Identity Clinics are majority staffed by cisgender people (people who are not trans), creating a power dynamic where cis clinicians set the mark on what “correct” examples of gender are, based on patriarchal ideals. This is not solved when trans clinicians are introduced, however, since trans clinicians are subject to the same pressures and the gatekeeping element remains. Non-binary, gender non-conforming, lesbian, gay and bisexual trans people are all disproportionately impacted by the expectation to fit these gender norms. Clinicians are also predominantly white and regularly discriminate against patients who do not fit white, eurocentric standards. Patients are picked apart and denied treatment based on anything from our clothing, to our mental health, to our employment status, to our immigration status.

GPs can already offer bridging prescriptions to patients who are self-medicating with hormones. Given that this is widely acknowledged as an important harm reduction measure, the continued existence of GICs amounts to wilful abuse of trans people.

Hormone prescriptions, surgeries, hair removal and other procedures must be made available to anyone who requests them on an informed consent basis. Knowledge of available treatments must be made widely available to the public. Education is needed for all healthcare workers in order to end transphobic discrimination in all sectors of the NHS, so that trans people can safely access the healthcare we need.

Nobody should be able to decide another person’s gender for them. A diagnostic model of transition healthcare will always produce transphobic conditions because it relies upon the idea that trans people do not understand our own identities.

Priorities for Gender Identity Services (E10):

- End transition gatekeeping, make hormones and procedures available free for all on an informed consent basis
- Fund trans-inclusivity education for all healthcare workers, written and taught entirely by trans people
- Fund medical training for trans people
- Fund research by trans people
- Remove the healthcare charges for migrants and cease sharing patient information with the Home Office