Bigmouth Strikes Again: Carrie Marshall's blog

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Category: Health

Scare stories and newspaper nonsense

  • Years and years

    Various newspapers report that Glasgow councillor Chris Cunningham has disputed the terrifying 200-years-plus predicted waiting times for Glasgow’s Sandyford clinic, claiming that the waiting time is six to seven years. And that means he’s either ignorant or deliberately misleading people, and so are the newspapers – because the evidence shows that if you’re referred to Sandyford today and the clinic’s desperate, years-long understaffing isn’t addressed, you’ll wait your whole life for an appointment that will never happen.

    Cunningham is quoting the text published on the Sandyford’s website, which says:

    We are currently allocating appointments to those referred during the following periods:
    Adult Gender Service Waiting list: November 2018
    Young Person Gender Service Waiting list: November 2019

    But the report that he’s disputing isn’t about the wait time for people who joined the waiting list six or seven years ago, some of whom – but not all of whom – are finally getting first appointments. It’s about the wait time for the people being added to the waiting list today.

    Thanks to freedom of information requests we know that the Sandyford clinic is barely seeing anybody. It saw fewer than 24 new patients in a year while over 500 new patients were added to a waiting list that now exceeds 4,000 people.

    What happens to waiting lists when more people are added than you’re seeing? They get longer.

    The core problem here, as with other gender clinics, is desperate understaffing, and that’s something we’ve known about since at least 2016: as The Guardian reported over nine years ago, gender clinics were already struggling to provide healthcare for what everybody knew was only a tiny but fast-growing proportion of the trans population because of a lack of capacity, and of suitably trained and qualified staff.

    The charity GIRES said at the time that the most conservative estimate of the trans population would mean around 130,000 people seeking medical assistance from a system already struggling to cater for just 15,000 people; the actual numbers could be much higher, with figures from other countries indicating that roughly 1% of people are trans.

    We could have fixed the roof when the sun was shining, but of course we didn’t. So what everybody said was going to happen happened.

    I referred myself to Sandyford in 2016 and had my first appointment in 2017, a wait of eleven months.

    Had I referred two years later, in 2018, the waiting time had grown from 11 months to seven years – so if I were one of the lucky few, I’d be getting a first appointment round about now.

    And if you’re being referred to the same service today?

    The 2016 Guardian report cites concerns that some trans people might have to wait 4 years for a first appointment. Today, the average UK wait time based on current clearance rates is 25 years. If you’re referred to Sandyford today and nothing changes, you can expect a first appointment in 224 years.

    The NHS waiting list target from referral to first appointment is 18 weeks.

    We know the solution to this, because it’s in effect in many other countries: basic healthcare like HRT is prescribed and monitored by ordinary GPs through an informed consent model, not through the bottleneck of overloaded and understaffed clinics. GPs have capacity issues too, I know, but not remotely on the same scale as the gender clinics.

    The only difference between the prescription and monitoring of my HRT and that of any other women is that my GP refuses to do it.

  • Recovery

    There’s a good piece by Doc Impossible on Stained Glass Woman about the other kind of surgical recovery: your mental recovery, and how to try and help yourself handle the aftermath of what is a very big deal. Surgical recovery isn’t just physically difficult and debilitating; it’s very tough on your mental resources too, and post-surgical depression is very common (after all kinds of surgery, although this piece is talking about gender-affirming surgeries). Many trans people are already quite isolated in their everyday lives, and that makes being housebound for a few weeks and unable to go far for a while afterwards very, very hard.

    I had major surgery in February and I’m still recovering from it: physically, because it takes a very long time to heal; mentally, for many of the reasons outlined in the Doc’s post, and financially, because I couldn’t work for 1/12th of the year; we freelances don’t get sick pay or holiday pay, so time not working is time not earning. And as ever, I think I’ve had it easier than many people.

  • Fill the page with rage

    I came out as trans nine years ago this week, and I think it’s interesting to look at the transition – not mine, but the transition in the Scots press’s reporting on LGBTQ+ issues and trans people during that time.

    Here’s a fairly typical piece from The Herald in the summer of 2016, which covers “culture war” issues but makes it very clear that the anti-LGBTQ+ voices are an unrepresentative minority; it gives more space to the people trying to make the world better than to the ones determined to make it worse.

    Today, The Herald (and The Scotsman, and most of the wider media) is editorially anti-LGBTQ+, its columnists rabid and its online comments cesspools.

    What’s changed? I’d argue that a big part of it is because the ad money and profit that used to keep newspapers publishing now goes almost entirely to Google and to Facebook’s parent, Meta. Online ad revenues are in freefall, with more and more outlets competing for less and less money. And many newspapers are now owned by companies that care little for journalism, companies that consolidate and cut until all that remains of once-great publications is their masthead.

    That has left newspapers, already experiencing plummeting circulations as print media dies, desperately trying to attract online page views by any means necessary.

    The Herald doesn’t publish ABC circulation numbers any more, but in 2023 its circulation was just 12,928 – down from 28,900 in 2016. The Scotsman is similarly reticent, but in 2022 its average circulation was under 9,000 people – only half of which were over-the-counter sales; many copies are given away for free in hotels and airports.

    Many newspapers have pivoted to a digital-first strategy based on turning journalists into “content providers” and “more closely mirroring social media” (in the words of the chairman of The Scotsman’s parent company) rather than traditional journalism.

    This is something I wrote about in Small Town Joy in the context of local papers not covering local music any more (with some exceptions): local newspapers in Scotland will barely or rarely cover local artists but will publish online articles about US pop star Taylor Swift in the hope of attracting rogue Google traffic.

    There was a particularly ghoulish example of that this week when the Ardrossan & Saltcoats Herald, a very small circulation newspaper only covering the north west coast of Ayrshire in Scotland, was publishing agency stories online about the terrifying hurricane in the Caribbean, which is quite some distance away from readers in Kilbirnie.

    As the gutter press has long demonstrated, one of the most reliable ways to make money from journalism is to make people angry and confirm people’s prejudices. That’s particularly true online. A nice article won’t have people battling in the comments section all day long and won’t be shared in furious Facebook posts or excerpts on X, but one demonising asylum seekers or trans people or the “woke” will. The newspapers know this, which is why they have embraced a business model I call The Three Cs: clicks and comments from… you can guess the third c-word.

    It’s an evolution of the old mantra, “if it bleeds it leads”: fill the page with rage.

    This is doing terrible damage.

    Those papers may not be bought by many people, but they are read religiously by the researchers and producers at the BBC, who scan them for stories to fuel that day’s phone-ins and magazine shows and who have their writers in the “usual suspect” database of rent-a-gobs (a database I was also on for over two decades: once you’re on it your phone rings regularly). And they are read religiously by politicians, and by the people who want to influence those politicians, and shared by the people on social media who want to make you furious and hateful. So they’re a central part of the outrage industry that gives disproportionate attention to some of the very worst people and helps push their agendas.

    The outrage industry is most damaging to the people being demonised, of course. But it also damages wider society.

    We are becoming an angrier, less tolerant, more selfish country. And our newspapers and broadcasters are playing a huge part in driving that change.

    If you want to worry about transitions, worry about that one.

  • 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.”