My Transgender Thoughts – For Patients

What is Gender Variance?

The fact that you are reading this means it has some meaning for you, whether it is you or someone you know who has feelings relating to their gender. Perhaps you or they just wonder what it would be like to be the opposite sex?

Maybe sometimes you or your partner feel like dressing in the clothing designed for the opposite gender to the one that you were born into, and maybe it gives you or them comfort. Or maybe every day is complete anguish for you that your body on the outside is completely mismatched to how you feel on the inside.

Sometimes these feelings can be very strong, and at others they can be pushed away. Sometimes they stay away for some time and other times they just won’t go away, and they can seem totally overwhelming.

Perhaps someone very close to you has these feelings and it is hard to understand. Maybe your husband or your wife, your son or your daughter, your beloved grandchild, has shocked the world by being brave enough to voice the way they are feeling.

When I was growing up, being ‘gay’ was just becoming more accepted. People were ‘coming out’ at school, work, in society. ‘Out of the closet’ – what a shame they had to hide in the closet in the first place. I just wish that there had been the same ‘outing’ for the transgender community at this time, so it would be easier now.

However, we are half way through a decade that is seeing great emergence of trans acceptance. And I am very proud to be a doctor in the midst of it. I am very proud to do what I can for the community and when I am old I will be proud of what I have achieved. It may not have been easy for me all the way, the same as it hasn’t been easy for my patients, but I am glad to be a part of this wonderfully stoical community.

 

Stories

I have heard some amazing personal accounts from my patients, some have had me in floods of tears and some have made me wonder at just how brave and accepting some families and individuals can be.

Of course, children always have a special meaning to everyone, and their stories are often very poignant. Some are very lucky to have staunchly supportive parents who will fight their corner with verve and passion, and take them to the other side of the world (literally) to get the care they need.

Some children are not so lucky and have to keep their secret hidden away, they have to suppress their feelings and join in with the ‘wrong’ group of children in the playground, and wear the ‘wrong’ clothes to the parties.

And of course I hear the stories from the grown-ups later in life, of the shame of being ‘caught’ dressing in the wrong (or right) clothes, the humiliation of inadvertently putting their hand up to try on the beautiful dress in school, to realise with horror the jeering and teasing that was now to follow.

Funnily enough, the later end of the age spectrum is extraordinarily touching too. People nearing the end of their life, staunchly refusing to live the lie any more, and die at peace and in the shoes they should really have walked in all their lives.

I imagine people bravely walking down the street, dressed correctly, feeling complete and right at last, stepping into the workplace ‘different’ to how they used to be, but finally ‘normal’ – but all the time wondering and knowing that people behind may be staring, sniggering, judging.

We, as society, have got very good at not staring and not judging, and not pointing – I am looking forward to a time when trans people are fully accepted as normal, just born with a variance, born different to other people in the same way that all of us are different, and just as beautiful and amazing none-the-less.

My children think nothing to their Mum being a Transgender Doctor, to them it is no different to their dad being a Bowel Doctor – in fact they laugh more at their Dad’s horrible job of putting telescopes in people’s bowels, than their Mum’s job of helping people be who they should be but just need a bit of medical help to get there.

 

Gender Health

Transgender Health has historically been considered to be a very specialised area. There has been no formal specialist training and many transgender people have struggled to get timely and fair care.

NHS Gender Clinics are in short supply, with long waiting lists and old-fashioned rules. The doctors are usually either psychiatrists hailing back from when it was felt necessary to exclude severe mental illness in someone who felt born into the wrong gender, or endocrinologists because they deal with hormones.

Actually, the basic needs of trans people are, in my view, best looked after by GPs. GPs are excellent all-rounders, and every day we deal with hormones, psychological anguish, stress, feelings, emotions, families, sexual issues and workplace problems.

There seems to be a great enigma around a ‘man’ taking female hormones, or a ‘woman’ taking steps to increase her testosterone levels, but in fact testosterone and oestrogen occur naturally in both sexes, and at varying levels in different people.

I am excited about the next few decades as more and more transgender care is delivered safely and compassionately by the person’s GP, a doctor best placed to understand the full physical and psychological needs of their patients.

Undoubtedly, more research needs to be done on feminisation and masculinisation and whatever term we would use to mean ‘in the middle of both’. We need to understand the best regimes to suit individual needs, to minimise the risks and maximise the outcomes.

 

Unfairness

Under-16s can legally go to the clinic and ask for an abortion, and have one without their parents knowing. Yet imagine how much struggle a trans 15 year old has to go through to get a drug prescribed to halt puberty so that their bodies don’t go through life-changing and irreversible changes that will haunt them for the rest of their lives.

My son is 16, he has just gone through puberty, you can imagine the comments: “My gosh, look how he’s shot up.” “His voice has changed so much!!” “Look how athletic and muscly he has become.” “You can see his Adam’s apple growing, his jaw so angular.” “Amazing changes in his hair on his face, chin, body.” I am so glad he wants these changes and welcomes them and loves them, because if those changes were going to change him from a fairly asexual child, into a man when he should have been a woman, how tragic it would have been.

Imagine wanting soft hairless skin, budding firm breasts, long slender legs, widening hips that look great in jeans, long soft hair to be styled any way you want – but instead developing into a man – WHEN IT CAN BE STOPPED – easily and safely, but just nobody will listen.

You can have tattoos, nose-jobs, breast enlargement or reduction liposuction, face-lifts seemingly at the drop of a hat, UNLESS you are transgender – then you need a certificate to prove you won’t regret it.

You can keep your job that you are very good at, UNLESS you are transgender, and then you may be asked to leave as it may not be good for the company’s reputation.

You can have access to your children who live with their mother, UNLESS you are transgender, and then you may be denied access, for fear of poisoning their minds and making them the object of ridicule.

Your GP isn’t allowed to deny you treatment on the grounds of age, race, religion – but they are allowed to say ‘I don’t know enough about this to help you, perhaps you need a psychiatrist.’

We look at someone wearing a scarf around their head where their hair used to be and feel sorrow and wonder what awful cancer treatment they may have had to endure. Yet we look at a transwoman wearing a wig because their male genetics have caused hair loss which is unbecoming for a woman, and many will smirk and laugh and mock and judge.

And sadly, in some pockets of the world, you may just get beaten up or locked away, just for being you.

 

Hormones

If you are a woman going through the menopause, you can easily choose to have HRT to stop the hot flushes, and to halt premature aging. BUT – If you are a man wanting to take HRT you have to plead and wait and justify your case, and maybe even go the clinic in a dress to prove to them that you are for real.

If you have a thyroid gland that doesn’t work properly, you will be given thyroid hormones to supplement it and stop the bad effects of low thyroid. BUT – If your sex organs produce the wrong hormones to fit your body, you have to face prejudice and go through extremely thorough assessments in order to get what you need.

If you are struggling to conceive, you are given strong drugs to damp down the glands in the brain which drive your sex-organs. BUT – If you are wanting these for other reason, you have to go to the ends of the earth to get them.

If you are male and approaching 50 and your testosterone production is low, then two quick blood tests and you can get treatment on the NHS. BUT – if you are genetically female and your testosterone levels are too low, then guess what – not quite so easy.

If you have a medical condition that requires specialist treatment in a hospital then you are entitled to see a consultant within 18 weeks and to start treatment soon after. BUT – if you are requiring specialist help with gender issues then you may have to wait four years, and your appointments may be cancelled at very short notice without explanation, and to actually start on the treatment you need is a long way off.

These are reports I hear very often, every day, all the time.

 

Regrets?

People often ask me how I can be sure that someone is transgender before I treat them. What if they will regret ‘turning into’ a man or woman? How do I know they aren’t lying to me to get hormones?

I have met men who would look at me with incredulity if I told them that they would get comfort out of wearing fine silk pants and a matching lacy bra. I have met women who freak at the sight of the emergence of another black chin-hair in the make-up mirror. I wouldn’t advise or recommend that they took cross-sex hormones, and they certainly wouldn’t ask me for them.

I have met people who feel so strongly that they shouldn’t have a penis that they have even tried to cut it off themselves, or tie a band around it like a lamb’s tail. They wear a bra and stuff it with socks. They spend vast sums on the Internet for potentially dangerous, false medication because their GP feels unable to help them.

I hear women who tell me that they bind their breasts so tightly that it hurts and stuff their jeans with padding to make it look like a manly bulge. And men that tuck their penis away and make sure they sit down to pee – no urinals for them, they are for the opposite sex.

Don’t ask me if they will regret it, it is insulting.

Then of course there are all the people in the middle of the two extremes, those who have confusing thoughts and feelings, those who need some psychological support from experienced professionals in the field, and lots of support from their families, friends, co-workers and the general public.

 

Mental Illness

Gender Variance is no more a mental illness than Diabetes is. The difference is that we can treat diabetes, we can’t sure it but we can treat it – we can use drugs to keep it at bay, to keep the blood sugar levels right so they don’t cause damage to the body.

We can’t cure gender issues either, we can’t stop someone from feeling that their assigned gender is wrong. And we can give them drugs and operations to change that, to make their gender right for them – it’s just that Diabetics get treatment easily and quickly where trans people have to fight and wait for it.

Gender Variance is no more a mental illness that being gay is. Ask a gay person if they would like treatment to stop them being gay and they will laugh at you and say no thank you. They just want the space and freedom to live the way that they want to live it, funny that isn’t it……?

Do gay people committing to a same-sex marriage have to have a formal psychological assessment to make sure they are not mentally ill? If you want a nose-job and you admit you are transgender, you do!

However, Diabetes and Gender Variance both do cause mental distress. People with diabetes are scared that their lives may be shortened, that their organs may fail them, they may have to have a leg amputated or a kidney replaced. People with gender issues suffer extreme distress because they struggle with what is ‘normal ‘ for them and what is ‘normal’ for society.

How many trans people are on anti-depressants, anti-psychotics, sleeping tablets and anxiolytics? How many have attempted self-harm or suicide because they can’t get the peace that they need? Far too many, and many more than we know.

Is it being transgender that causes this mental anguish or is it the actions and reactions of society and the medical profession that cause the distress?

Gender ‘Dysphoria’ describes the discomfort and anguish that gender issues cause some people. Unfortunately, I mostly see cases of ‘Medical Dysphoria’ – where it is not the gender issues that cause the anguish, but the failings of the UK Medical Profession.