Bigmouth Strikes Again: Carrie Marshall's blog

Carrie’s books | Carrie’s band

Author: Carrie

  • “Queer Sounds, Small Town Souls”

    Bella Caledonia have published a lovely, thoughtful review of my book, Small Town Joy. I love reviews like this where I get to know a bit about the reviewer, as well as about the thing being reviewed.

    Some books you take in with your head. Others you absorb through your skin. Carrie Marshall’s Small Town Joy is one of those rare, resonant ones you feel in your chest. It hums, it vibrates, it stirs old ghosts. For those of us who grew up queer in Scotland’s small towns, feeling like off-key notes in someone else’s tune, this book lands like recognition.

  • Butterflies are not caterpillars

    One of the little joys of technology is that whenever I need to re-order my prescriptions, I can use the Patient Access app. It lists all my prescriptions and I simply tap the ones I need, and a few days later the pharmacy texts me to let me know they’re ready.

    If I weren’t trans, I’d be able to use the same app to renew my seven-years-running prescription for HRT patches. But I can’t, because my GP refuses to prescribe trans women’s healthcare. Signing off on the same patches, and the same strength of patches, that my GP routinely prescribes and monitors for women who are not trans is suddenly too complicated and risky and beyond their competence.

    So instead of tapping two or three buttons in Patient Access, every four months or so I have to get up, walk past my GP surgery, get on a train to the city, walk through the city centre, meet a pharmacist, walk back, get the train, walk past my GP surgery, wait a few days for the prescription to come through, walk down to the pharmacy just round the corner from my GP and get my perfectly ordinary medication.

    This is a pain in the arse, and discriminatory, and degrading. But at least it’s not a potentially fatal problem.

    A trans woman posted this on Bluesky while I was travelling back from my pharmacist meeting.

    Just got a call from a lovely but very nervous Dr, who advised I wouldn’t be routinely screened for breast cancer because I’m not indicated as being “biologically female” on the central NHS database and my biology wouldn’t indicate I’m at risk. My records have been altered, which is upsetting.

    Apparently they had discussions in the NHS recently and now I’m classified as biologically male. She didn’t even understand that I have been on HRT for 20 years and am biologically female in all important ways – I had to explain that to her.

    She’s based in England, so it’s a different part of the NHS. But it’s the same issue: parts of the NHS treating trans women differently from women who aren’t trans. And in this case, that’s very dangerous.

    I don’t want to dazzle you with my incredible in-depth medical knowledge here, but the thing that most increases your risk of breast cancer is… having breasts.

    Men can get breast cancer too, of course – hence why it’s sometimes referred to as chest cancer, so men won’t be too embarrassed to check themselves and seek help if they find anything concerning – but it’s comparatively very rare. Whereas if you have breasts rather than just a chest, your risk is much higher. Trans women’s risk isn’t as high as the risk for women who aren’t trans. But it’s still much higher than for men.

    And this is the problem when anti-trans rhetoric meets medical reality. “Biologically male” is a bullshit term pushed by anti-trans weirdos to yet again separate trans women, a term rejected by doctors because they know that what matters medically is the biology you have now, not the biology you were born with.

    But thanks to anti-trans activists’ billionaire-backed insistence that butterflies must always be classified as caterpillars, we’ve got this ludicrous situation where women with the two most important risk factors for breast cancer – breasts and estrogen – are being excluded from screening.

    Trans women’s bodies are not identical to the bodies of women who aren’t trans (which is why I opted out of cervical cancer screening invitations, as I don’t have a cervix). But they’re not identical to men’s bodies either, so in the case of my body I have zero risk of testicular cancer and an elevated risk of breast cancer. So by insisting that we ignore people’s bodily reality, the anti-trans idiocy genuinely puts trans women in danger – danger we had already addressed, danger that is clearly understood, danger that we have (or had) systems in place to minimise.

    Removing trans women from important health screening won’t do anything to improve a single woman or girl’s healthcare. But what it will do is put trans women’s lives at risk. For many in the anti-trans movement, I think that’s considered a bonus.

  • They’re no longer pretending

    The anti-trans mob never had “reasonable concerns”; they’re a hate movement. And they’re now so emboldened that they’re not trying to hide that any more. Speaking at yesterday’s Conservative party conference, both Sex Matters and the LGB Alliance made it very clear what they believed, with the latter’s CEO saying that supporting any form of transition is “evil” and that the goal must be “to strip out the poisonous homophobia of gender identity ideology from public life wherever we can.” The only way to eradicate “gender identity ideology” from public life is to eradicate trans and non-binary people.

  • The Cass Review: still a scandal

    A new peer-reviewed study of the Cass Review, the UK project that was used to stop trans teens’ healthcare, has been published. And like all the other peer-reviewed studies of the Cass Review, it’s absolutely damning. It once again demonstrates that the review was skewed to deliver a pre-determined outcome that flies in the face of the evidence.

    The study describes the review’s “disregard of international expert consensus, methodological problems and conceptual errors” and says that its internal contradictions are striking:

    It acknowledged that some trans young people benefit from puberty suppression, but its recommendations have made this currently inaccessible to all.

    It found no evidence that psychological treatments improve gender dysphoria, yet recommended expanding their provision.

    It found that NHS provision of GAMT [Gender Affirming Medical Treatment] (GnRHa, oestrogen or testosterone) was already very restricted, and that young people were distressed by lack of access to treatment, yet it recommended increased barriers to oestrogen and testosterone for any trans adolescents aged under 18 years.

    It dismissed the evidence of benefit from GAMT as “weak”, but emphasised speculative harms based on weaker evidence.

    The harms of withholding GAMT were not evaluated.

    The Review disregarded studies observing that adolescents who requested but were unable to access GAMT had poorer mental health compared with those who could access GAMT.

    Despite finding that detransition and regret appear uncommon, the Review’s recommendations appear to have the goal of preventing regret at any cost.

    The Review, and the UK Government, have taken the position that GAMT, an established treatment with observational evidence of early and medium term benefits and acceptable safety, should be actively withheld from trans adolescents due to lack of high certainty evidence of very long term efficacy and safety. Few treatments for any condition meet this criterion, and it is difficult to name another field in which regulators impose such a benchmark.

    …The Cass Review, lacking expertise and compromised by implicit stigma and misinformation, does not give credible evidence-based guidance. We are gravely concerned about its impact on the wellbeing of trans and gender-diverse people.

  • Death before healthcare

    When I self-referred to Glasgow’s gender clinic in 2016, the waiting list for a first appointment was 11 months. Now, it’s 224 years.

    That’s not a typo. The Sandyford gender clinic is so hopelessly understaffed that it’s barely seeing any people, so the backlog is ever growing. The national average is bad enough – 25 years – but in Scotland, the majority of people waiting for an appointment will die without ever being seen. The average wait time in England is 12 years; in Scotland it’s 58 years.

    And that’s not the waiting list for treatment. That’s just for the first assessment. Getting the same HRT that other women can get the same day from their GP can take months more.

    This shouldn’t be a surprise, because the NHS has long been told that the gender clinic model – created not to provide basic healthcare for trans people, but to gatekeep it – is hopelessly broken. The 224-year waiting list is the inevitable result of years of underfunding, understaffing and deliberate neglect.

    QueerAF:

    Trans+ people do not need to be assessed by gender clinics or diagnosed by psychiatrists to tell us what we already know: we are trans. The healthcare we need, especially when it comes to hormones, is already available to cis people through making an appointment with their GP. 

    Gender clinics are unnecessary and exist to segregate healthcare for Trans+ people. Abolishing this system and providing Trans+ healthcare in primary care, at the GP through an informed consent model, would solve many of the issues this data reveals. GPs already prescribe hormones to cis adults. Trans+ adults simply need the same access to this healthcare.

    The purpose of a system is what it does, not what it claims it does. And the gender clinic system is to all intents and purposes a ban on trans people’s healthcare. For much of the UK, if you cannot afford to go private your healthcare is denied.

  • Corruption and collusion

    Freedom of Information requests have revealed collusion between the Department of Health and Social Care and anti-trans groups:

    The correspondence shows Sex Matters, LGB Alliance and Transgender Trend manoeuvring their way into government as so-called “stakeholders” on trans policy, despite lacking any medical expertise and spreading narratives that misrepresent science, misuse human rights law, and dismiss the lived realities of trans people.

    It’s not just emails or letters. The documents show meetings arranged, consultations granted, suicide statistics disputed, and legal rulings twisted into tools to attack trans healthcare. While trans people themselves were left out of the room, ministers were treating hostile lobby groups as if they spoke for the public.

    There’s much more but the DHSC is trying to hide it behind freedom of information exemptions.

    This is not neutral “stakeholder engagement”. It is collusion with groups intent on dismantling the rights of others. And it is happening in secret — behind FOI exemptions, closed consultations, and redactions — while trans communities are left paying the price with their lives.

  • It’s never enough

    The Scottish Government has published new guidance about segregating school toilets, which means trans kids will be prevented from using the toilets appropriate to their gender. Is that enough for the transphobes? Of course it isn’t. The Scotsman quotes Maya Forstater of anti-trans hate group Sex Matters, for whom segregating trans children doesn’t go far enough.

    The policy “still suggests that a pupil might be able to go through their school career pretending to be the opposite sex without ever being ‘outed’ – that is, recognised as the sex they actually are.” Allowing trans kids to use other toilets, or at different times from other children, “will only worsen the child’s dissociation from the unchangeable physical reality of their sex.”

    They’re not even trying to hide it any more: it was never about protecting women and girls. They want trans people eliminated from society, and intend to do so by making trans people’s lives unliveable.

  • Gender and power

    There’s a good piece in Doing Feminist Legal Work about the connections between gender and tyranny going back hundreds of years, and the way they’re connected on both sides of the Atlantic today.

    The article makes the point that the US state-by-state attack on women’s reproductive freedoms, Donald Trump’s assertion that domestic violence by husbands shouldn’t be considered crimes, the growing calls on the US right to disenfranchise women and the war on LGBTQ+ people are all part of the same movement.

    Protecting women, in this context, isn’t about giving women freedom or autonomy. Quite the opposite. It’s about concentrating power in the hands of (mostly; every repressive movement has its Ernst Röhms) straight white men and removing it from everybody else. And to concentrate that power, in a playbook as old as time, you create an out-group who the laws bind but do not protect. That out-group usually includes queer people and in this current moment, trans people in particular.

    Trans people are being removed from the public sphere. And this is how you start. You are “protecting” women. But you do this by reducing women to a set of biological facts. We all know where that leads. In the US they are already there. The weaponisation of women’s rights or protecting women to marginalise and hurt another group, be they Trans people, immigrants or anyone else, is never feminist. Rather, it’s one of the first steps to tyranny.

  • The bathroom ban

    This, by Toby Buckle, is very good: Britain’s Bathroom Ban.

    The UK is in the process of implementing a prohibition on any trans person accessing any single-sex space. Trans people will be barred from using facilities that match their gender (i.e., a trans woman will not be able to use the women’s toilets), but also, it seems, may be barred from using those that match their sex at birth (nor may the same trans woman use the men’s toilets). Effectively, this policy will bar trans people from leaving their homes, and as such it is radically oppressive. 

    The ban is sweeping: it applies to workplaces, hospitals, schools, shops, restaurants, gyms, pubs, clubs, sporting bodies, schools, services like counseling or a women’s support group, and even voluntary clubs and associations. And it is mandatory: it’s not that these institutions can exclude trans people but they must exclude trans people. 

    And this is being done without a vote in parliament, by a Labour government elected on a manifesto pledge to make trans people’s lives easier. 

  • The only Kirk piece you need to read

    I’ve been saddened but not surprised by the rush to canonise Charlie Kirk, the murdered bigot, in so much of the UK press: reading pieces like yesterday’s utterly deranged column by Kevin McKenna in The Herald would leave you with the impression that Kirk was some kind of Debate Jesus crucified by trans women rather than what he was: a man who pushed hatred, advocated violence and profited handsomely from defaming marginalised people, a man who was murdered not by “the tolerant left” or the “trans lobby” but by a white man from a Republican family.

    Part of it, of course, is that many of the people writing about him share many of his views – maybe not all of them, but enough of them that admitting Kirk was a bigot would mean admitting that they’re bigoted towards certain groups too. Hence the whitewash.

    In that context, Ta-Nehisi Coates’s piece on the Kirk coverage is a must-read. It’s damning in part because it simply shows you what Kirk believed in and how he expressed it. But it’s also a pretty savage indictment of the people writing about him.

    Before he was killed last week, Charlie Kirk left a helpful compendium of words—ones that would greatly aid those who sought to understand his legacy and import. It is somewhat difficult to match these words with the manner in which Kirk is presently being memorialized in mainstream discourse… Kirk subscribed to some of the most disreputable and harmful beliefs that this country has ever known.