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.

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