Bigmouth Strikes Again: Carrie Marshall's blog

Carrie’s books | Carrie’s band

Category: Health

Scare stories and newspaper nonsense

  • 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.

  • 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.

  • A tsunami of scaremongering

    There’s a good piece in Assigned Media: “A Shameful Chapter”: How Anti-Trans Disinformation Drowned Out Science and Gripped the Mainstream. It’s about the US but relevant to the UK too: our media is just as captured, and their reporting is helping the right-wing attacks on trans people’s human rights and healthcare.

    It takes one pseudoscience peddler and uses their activities to show:

    “the reach and coordination of right-wing lobbying groups, their determination to spread medical disinformation to promote political goals, and their success in getting that message adopted in mainstream media — not simply in friendly outlets like Fox but in emerging power centers like the Free Press, and even traditional media like The New York Times.

    This pipeline of disinformation, which has elevated extremist views and undercut medical science, has had devastating effects on hundreds of thousands of trans Americans, most acutely young people, and their families.”

  • Home is where the hate is

    One of the anti-trans groups favoured by health minister Wes Streeting is the Bayswater Support Group, some of whose members advocate child abuse in order to make children “accept biological reality”. And in a new, heartbreaking report by Trans Safety Network, some of those kids describe how the group radicalised their parents into increasingly cruel behavior and opened the door for far-right extremism.

    A very familiar pattern emerges: increasing alienation, paranoia, cruelty and conspiracism as people get drawn deeper into radicalisation and further from reality.

  • A public health crisis

    A new report in the International Journal for Equity in Health says that transphobia in the UK is causing a public health crisis.

    The paper identifies multiple issues: limited or non-existent access to appropriate healthcare; social exclusion; policy-driven discrimination; and “minority stress”, which leads to adverse health outcomes including cardiovascular disease and risk behaviours such as alcohol use.

    The authors say that the health disparities faced by trans and gender-diverse people in the UK constitutes “a real-time public health crisis that demands urgent and sustained intervention.”

  • Inconvenient truth

    One of the hallmarks of the genital-obsessed weirdo movement is to claim that there’s not enough research about trans healthcare, and to then ignore any research about trans healthcare because it doesn’t support their lurid claims. And there’s a great example of that in Utah where the Republicans commissioned a Cass-style report to justify their ban on trans healthcare but forgot to put a bigot in charge.

    The result? The evidence shows that trans healthcare is effective and safe and that bans cause great harm.

    It’s very detailed – much more so than the Cass Review – and as The Advocate reports:

    “The conventional wisdom among non-experts has long been that there are limited data on the use of [gender-affirming hormone therapy] in pediatric patients,” the researchers wrote. “However, results from our exhaustive literature searches have led us to the opposite conclusion.” The study found over 230 primary studies involving 28,056 trans youth — “far exceeding” the evidence that typically supports FDA approval for high-risk pediatric treatments, including gene therapy.

    “The body of evidence we have uncovered exceeds the amount of evidence that often serves as the basis of FDA approval for many high-risk, new drugs approved in pediatric populations in the U.S.,” the authors added.

    The report emphasized that such treatments are not given to prepubertal children, that puberty blockers and hormones are typically initiated only in early or mid-adolescence, and that surgeries — especially bottom surgeries — are not recommended for minors. The review also found no significant long-term safety concerns, and that “regret” associated with treatment is extremely rare. In fact, among the 32 studies examining regret, researchers found it was “virtually nonexistent” — and when present, it was “only a very minor proportion” of treatment discontinuation.

    The response, from politicians and national press alike, has been to ignore it.

    As I’ve written before, the problem isn’t that we don’t have evidence. It’s that the evidence doesn’t say what the genital-obsessed weirdos want it to say, so they discount it, distort it or ignore it. They’re not interested in the truth. They just want to hurt trans people.

  • Don’t get sick. Don’t get old

    One of the things that really scares me is getting old – not because I’m scared of ageing, but because unless I die first I’ll eventually need to enter the care system. The care system in the UK is horrific for most, and there are extra terrors for LGBTQ+ people – so much so that many UK care homes believe they have no LGBTQ+ residents, as those residents have chosen not to reveal their sexuality or gender history for fear of discrimination or worse.

    Writing in Yorkshire Bylines, Nell Stockton explains the additional fears caused by the anti-trans Supreme Court verdict and subsequent EHRC misinformation.

    The short version: it’s an absolute shitshow that could do serious damage to older trans people’s lives, their health and their safety.

    All of us will hopefully get to live to a ripe old age. Trans older adults deserve to enjoy their later years as much as anyone, without fear of being outed and shunned, and we should not be forced into becoming recluses.

  • Cass, peer reviewed

    A new peer review of the Cass report yet again shows that it was a political exercise designed to rubber-stamp the government’s war on trans people and our healthcare. The report’s conclusion is damning:

    Our critical analysis reveals significant methodological problems in the commissioned systematic reviews and primary research that undermine the validity of the Cass report’s recommendations. During our review of the report and supplementary primary research, we found insufficient statistical rigor, unreliable datasets, claims presented without evidence, and misrepresentation of quotes from primary research participants.

    Cass should have been struck off for this. Instead, she was given a peerage.