The great HRT shortage: a very British disaster

Hundreds of thousands of women in the UK have been affected by the ongoing shortage of many HRT products. The products aren’t made in the UK but the shortage is very much a UK thing. Emma Hartley discovers why.

The short version: the UK government messed up.

The slightly longer version: supply problems have been massively magnified by a change to the way the UK prices HRT medication, changes which have also been affected by the Brexit-related fall in the value of the pound.

Hence a supposedly global problem having disproportionate effects on women in the UK.

At the heart of a problem so ferociously complex that many in the pharmaceutical industry even have trouble understanding it, could this be a simple case of incompetence?

It certainly seems to be.

This hateful, murderous ignorance

The thing about bigots is that often, they have no idea what they’re talking about. Sometimes that’s because they’re stupid. But all too often it’s wilful stupidity, where the information is widely and easily available but they either don’t look for it or refuse to believe it.

Here’s an example from this morning. Over on Mumsnet, aka Prosecco Stormfront, the anti-trans lot are appalled at the idea of trans women being able to change the gender marker on their passports without having to present medical evidence, report to a panel and so on.

The thing they’re concerned about has been law for 49 years.

Not only that, but the law simply codified something that’s been happening since at least 1942.

If you weren’t wilfully stupid that might give you pause: after all, if self-ID were so dangerous and open to abuse we’d presumably have seen a flood of passport-changing predators over the last 77 years; the fact that there hasn’t been a single case demonstrates how ridiculous that argument is. But nobody’s going to change their mind here. All they’ll do is ignore the evidence and demand the law be changed to accommodate their bigotry.

They’re not interested in facts, or in evidence. They’re wilfully, maliciously, proudly ignorant.

Their far-right friends show just how dangerous wilful stupidity can be. In Ohio, right-wing forced-birthers have introduced a bill that would force doctors to carry out medical procedures that aren’t physically possible at significant risk to pregnant women’s health.

I’m not making this up. The bill, Ohio HB413, says that if a doctor doesn’t want to face charges of murder for letting an embryo die, they must try to reimplant an ectopic pregnancy – something that isn’t medically possible.

A doctor will face criminal charges unless they:

Takes all possible steps to preserve the life of the unborn child, while preserving the life of the woman. Such steps include, if applicable, attempting to re-implant an ectopic pregnancy into the woman’s uterus.”

There are no documented cases of this ever being done successfully. The likelihood of success is zero. The risk of killing the woman is significant.

But these so-called pro-lifers aren’t interested in the health of the woman. They already advocate “watchful waiting”, which means refusing treatment to a woman until she miscarries – despite the very real and significant risk that she may die of a haemorrhage if her ectopic pregnancy isn’t treated.

That’s where wilful stupidity leads you.

Women’s reproductive healthcare is not some dark art or some secret. The evidence around ectopic pregnancy, its dangers and how to minimise those dangers is solid and easy to access.

But these murderous yahoos don’t want evidence. They don’t want facts. They want doctors to do what they’re damn well told because they know better than so-called experts with their “facts” and their “science” and their “not killing women”.

As Grazia Daily put it:

This is what happens when people who know nothing about women’s bodies make laws about women’s bodies.

The Endocrine Society is getting really tired of this shit

“I’m getting pretty tired of this shit too” – estrogen, yesterday

Do you know what endocrinology is? It’s the branch of medical science that studies the endocrine system, the glands that secrete hormones. Hormones regulate our metabolism, our physical development, our reproductive function, our sleep, our mood… you get the idea.

The Endocrine Society is the international organisation for endocrinology experts, and it works in association with other groups such as the American Association of Clinical Endocrinologists, the American Society of Andrology, the European Society for Paediatric Endocrinology, the European Society of Endocrinology, the Pediatric Endocrine Society, and the World Professional Association for Transgender Health in the study of hormone therapy for adults and puberty blocking for young people.

These guys, gals and everyone in between are the world’s leading experts in hormones and hormone treatment. Which is probably why right-wing newspapers never talk to them, because they’d spoil their hateful fun.

In the US, right-wing media has politicised a sad custody case involving a young trans kid, with experts such as Donald Trump’s idiot, conspiracy-peddling son and probable Zodiac killer Ted Cruz sharing their ill-informed and uneducated thoughts on subjects they know fuck-all about.

The Endocrine Society has, frankly, had enough of this bullshit.

In a very strongly worded editorial in their members’ magazine Endocrine News, the Society urges policy makers to shut the fuck up with their anti-trans bullshit. It’s not quite as strongly worded as that, but it’s as close as you can get in a medical journal:

many of the claims being made about gender-affirming care for transgender and gender-incongruent individuals are inaccurate.

…Claims that a transgender child would receive surgical or irreversible hormonal treatment do not reflect the reality of medical practice.

…Considerable scientific evidence has emerged demonstrating a durable biological element underlying gender identity. There do not seem to be external forces that genuinely cause individuals to change gender identity.

Suppressing puberty is fully reversible, and it gives individuals experiencing gender incongruence more time to explore their options and to live out their gender identity before they undergo hormone or surgical treatment. Research has found puberty suppression in this population improves psychological functioning.

It is critical that transgender individuals have access to the appropriate treatment and care to ensure their health and well-being.

…Policies concerning the diagnosis and treatment of transgender individuals should be based on science, not politics.

You can understand their frustration. In the current climate, solid, peer-reviewed science by people who know this field inside out is being ignored in favour of the thinky thoughts of yummy mummies, religious fundamentalists and far-right trolls who claim “facts don’t care about your feelings” while yelling the latter over the former, who claim to be “silenced” by “extremists” while silencing the very people who know the subject inside out.

The problem is not a lack of data. The problem is the same as with the anti-vaccination movement. The media is platforming scaremongering over science, feelings over facts and extremists over experts.

We don’t need mental health awareness. We need action

Today is World Mental Health Day, and the theme is suicide prevention. Many politicians and commentators will say or write suitably concerned things about the importance of getting help, without acknowledging that they are part of the reason people need help in the first place.

Mental health is political.

The causes are often political. And the shocking lack of support and treatment for people is political too.

I’ve lost two friends  to suicide this year. One of them took his own life while on a too-long waiting list for treatment. His death was the result of political choices. The system might not have been able to save him. But the system never tried.

The grotesque underfunding of the NHS, underfunding that makes vulnerable people wait years for treatment if they live long enough to access it, is not accidental. It’s the result of many years of swingeing cuts, of ideologically driven changes to the way the NHS works, of a deliberate lack of funding for the training of health professionals, of a refusal to fairly tax corporations and the most affluent people in society to adequately fund health and social care.

I’m particularly aware of this because I’ve seen how desperately underfunded mental health services are. It’s even worse if you’re trans: people who are trans have to wait even longer for help, which is why the suicide, self-harm and substance abuse rates in our community are so frightening. In some cases the gap between initial referral and actual treatment can be four or even five years.

That’s political too. Trans healthcare is a grotesquely underfunded and overworked subset of mental health provision. Once again, that’s the result of political choices – choices affecting the wider NHS, and choices such as the UK governments’ persistent refusals over many years to heed warnings of growing demand for trans-related healthcare. The current crisis in the gender clinic system was predicted years ago by credible experts. Politicians chose not to listen, let alone provide any additional funding.

Commentators play their part too. My own mental health has been severely impacted by the daily demonisation of and scaremongering about trans people in mainstream media – Radio 4 was at it again this morning, platforming anti-trans bigots without any dissenting voices – and on social media, where I have to block thousands of people just to be able to use the apps normally.

It’s not just us. It’s the immigrants blamed for putting pressure on the NHS to distract from funding cuts and creeping privatisation. It’s the EU nationals forced to apply for settled status to continue living here, the non-white people demonised in the national press as criminals and terrorists, the so-called “snowflakes” laughed at for daring to talk about their mental health, the people from ethnic, sexual and romantic minorities whose very existence is questioned and whose rights are deemed less important than those of others.

And most of all, it’s poverty.

There’s a reason people in Glasgow’s affluent West End live longer than those in the deprived East, and that reason has existed since the West End came into being: it isn’t race, it isn’t religion and it isn’t sexual orientation or gender identity.

It’s money.

Money enables you to buy better living conditions, better food, a better education for your children, in many respects a better life.

That’s not to say affluent people don’t get mental health problems. Of course they do. But they don’t rot on the same waiting lists that poor people do. They aren’t bullied by the DWP like poor people are. They aren’t on zero-rights, zero-hour contracts like many poor people are. They aren’t reliant on desperately overstretched and underfunded community mental health services like poor people are.

Mental health problems are not a sudden plague caused by who knows what. They are the inevitable result of successive governments removing the safety net for society’s most vulnerable people, the consequences of creating a society where the most privileged are able to deny their responsibility to help the less fortunate and incite hatred of those who need help most. They are the result of inadequate housing, of slashed funding for mental health services, of inadequate protection against hate crimes and discrimination, of a low-wage, low-rights employment market.

They are the inevitable result of a society that works for the few and despises the many.

It’s not enough to say “if you’re sad, get help”. There needs to be help available. All too often there isn’t. And that’s no accident. That’s political.

We don’t need better mental health awareness. We need better mental health provision. We know we need help. For too many of us, the help isn’t there.

Don’t let the politicians away with it. Don’t let them post “it’s OK not to be OK” and consider their job done. Demand answers. Demand action.

Too many people aren’t OK. And that’s not okay.

Go and get the flu vaccine

I was given the flu vaccine the other day. I hadn’t really thought about it but since a lung cancer scare a few years ago there’s a flag on my medical records and I’m considered high risk for pulmonary infections and COPD, so I get invited to this stuff.

As you’d expect, the vaccine didn’t give me flu, make me grow horns or make me autistic, because vaccines don’t do that. What it did do was make me feel a bit crap for a few hours before protecting me from catching – and more importantly, spreading – a really horrible disease.

As Frances Ryan writes in The Guardian, the flu jab saves lives.

Flu is often thought of as nothing more than a week of feeling rotten, but it can be life-threatening, particularly for older people and anyone with an acute illness like cancer or underlying chronic health conditions, like me.

In 2018 I developed flu complications that left me unable to breathe or move and on a ventilator for months. It’s left me with life-changing fatigue and pain, but in many ways I was lucky. Last year 1,700 people died of the flu – despite the fact that this was a relatively mild strain – and further hospital admissions put even greater pressure on an already overstretched NHS.

The vaccine is free for at-risk groups and incredibly cheap for everybody else. You should get it, if only to prevent having to take time off work to feel like shit.

Unfortunately we have a problem persuading people to take vaccines. Ryan:

The UK, like much of the west, is battling an anti-vaxxing movement in which social media has become a gateway for scare stories and quackery. Diseases such as measles are on the rise in England, with the UK recently losing its measlesfree status with the World Health Organization because a growing number of people believe dangerous myths about vaccines.

Things are so serious that one newspaper is taking a stand. Here’s today’s Daily Mail.

The crusading, campaigning Mail is going to fight against the forces of idiocy and darkness that have persuaded parents that vaccines are dangerous.

Forces such as, er, the Daily Mail.

The Mail scaremongered about vaccines for years, and while other UK papers (including the Guardian for a while) did the same it was by far the most vocal. Its sustained, decade-long campaign against the safety of the MMR vaccine continues to inspire and be cited by the global anti-vaxx movement.

As late as 2005, the Mail continued to argue that debunking the MMR/autism scare was fake news and accused critics of disgraced doctor Andrew Wakefield as perpetrating a witch hunt.

The science editor of the Daily Mail argued that ‘the MMR scandal is getting worse. Urgent questions about the vaccine’s safety remain unanswered. The doctor who raised those questions is being subjected to what appears to be a witch-hunt. The parents’ recourse through the courts has been blocked. Now they have to put up with being told yet again that the evidence of their own eyes is fraudulent.’

The Daily Mail spent a decade scaremongering about vaccines: Google “Daily Mail MMR” and you’ll find tons of uncorrected “the truth about MMR” articles and articles that push the long-debunked claim that vaccination causes autism.

Its new campaign is laudable, but it won’t undo the damage it’s done to public safety not just here, but globally.

Little miracles

The Royal Hospital for Children in Glasgow, my son’s home for the last week

I mentioned in a previous post that my son has been in hospital. It’s been a very long couple of weeks: he was misdiagnosed twice before his atypical symptoms led to a correct diagnosis and treatment, which included surgery. He’s home with me now, recovering.

My head is a mess of thoughts just now, but I wanted to post one thing: I’m very grateful to the many NHS staff from surgeons to domestic staff who helped look after us over the last week or so. For all its flaws, the NHS is an extraordinary thing. The people who work for it ensure it performs little miracles every single day.

Why the search for an LGBT+ gene is dangerous

There’s been a lot of publicity over a new study into the so-called “gay gene”; the study reports that although there doesn’t appear to be a single genetic marker for gay people, there may be several. Similar studies have attempted to find a genetic marker for trans people.

Here’s why that’s scary.

This image was posted by Antony Tiernan, and in response the writer Huw Lemmey noted the context: “over a million British people still buy this paper every day.”

Let’s be optimistic and believe that nobody would choose to abort a baby whose genes suggested they might be gay or trans. That doesn’t mean genetic screening for LGBT+ people couldn’t happen, or couldn’t be misused.

The problem with any kind of genetic screening is that it’s a guide. For example, I’ve just had my genes analysed and I have a slightly raised risk of pulmonary disease. That doesn’t mean I will get it. It just means there’s a higher likelihood than perhaps you have.

One of the things I was screened for is abnormalities relating to the BRCA1 and BRCA2 genes, which we know are implicated in many cancers. I’m clear – but the screening only checked a small proportion of the thousands of potential variants. I could still have a difference in one of those genes that means I’m more likely to get cancer.

Now imagine I’d been screened for genes linked to being trans. The same thing could apply: you could check for 100 different anomalies, and that could come back negative – but there could be hundreds upon hundreds of other genetic variations that you don’t check for, and which have contributed to me being the fabulous trans woman you see today.

Why does that matter?

It matters because if we developed a genetic test for LGBT+ people we might decide to use it in asylum claims, because one reason people claim asylum is because they face persecution for being LGBT+ in intolerant countries. Imagine: we could easily differentiate between the real asylum seekers and the fakers!

Far-fetched? Last week a British judge rejected an asylum seeker’s application because he didn’t seem gay enough. He contrasted the man’s demeanour with that of another man who “wore lipstick” and had an “effeminate” manner.

In that case, the judgement was appealed and has been sent back for review. But what if the judge had rejected the applicant because his genes “proved” he wasn’t gay?

It could also be used to “prove” that people are lying about their sexuality or gender identity in other circumstances. There’s already fierce and often malicious debate over whether some trans people are “trans enough”, so for example anti-trans bigots are keen to differentiate between “true” trans people, who they pretend to care about, and “fake” trans people – people like me who haven’t had surgery – whose human rights they want to curtail and whose healthcare and support services they want to defund.

Could failing genetic testing mean I’d be denied NHS treatment such as hormone therapy?

Scaremongering? Here’s TIME magazine with a short history of how bullshit science has been variously used to justify discrimination against people of colour and against women.

In the early 20th Century, out of context IQ testing was used to justify the forced sterilisation of black and hispanic people.

the notion of feeble-mindedness, at least partly determined by IQ tests, was used as a justification for the Supreme Court’s notorious Buck v. Bell decision, which allowed forced sterilization for “insanity or imbecility,” mostly among the population of prisons or psychiatric hospitals.

One of the links in that article goes to a study of pseudoscience on women’s suffrage.

many scientists supported the antisuffrage argument of “physical force,” claiming that women lacked inherent energy needed to physically enforce laws and should be excluded from voting. A secondary argument claimed that such cyclic elements as menstruation and menopause made women too irrational to vote.

More recently, halfwits in Silicon Valley have been pushing the bullshit theory that men are better suited to tech jobs because of exposure to “prenatal testosterone”.

Sexuality and gender identity are complicated and multifactorial, and they are normal variations in human behaviour and biology. That means there can never be a reliable genetic test for being gay or being trans, and we should be scared of anyone who wants to create one.

As TIME’s Jeffrey Kluger writes:

…as long as there is science—which means forever—there will be people willing to misuse what it teaches.

The kindness of women and the sadness of men

Emily Todd VanDerWerff is a critic at large for Vox, and she’s reviewed an interesting video by PhilosophyTube that addresses the issue of men’s mental health.

I thought this bit of her review was particularly interesting.

Thorn suggests that one project worth undertaking, should you have a platform like his to do it, is to increase the number of emotional colors that men feel free to paint with, so they’re not forced to work with such a limited palette. By making a video like this one, he says, other men might be able to recognize themselves in his story and find sustenance and help with the process of navigating their own emotions.

(A personal sidebar: This is deeply true. Since coming out as a trans woman, I’ve found a staggering number of emotional support systems open to women compared to those for men, because women in our culture are expected to be emotional, whereas men are expected to be buttoned-down. If I’m having a hard day or quietly crying at a restaurant, I almost always receive a quick, “Are you okay?” from other women who might be around. This never happened to me when I lived my life as a man…

That’s been my experience too. The conversations I have with women are very different from the conversations I used to have, and still have, with men. It’s not just evident in conversations with close friends; it’s there with people I didn’t know an hour previously too. It’s hard to put into words, but I think the difference is what’s meant by the question “how are you?” from someone you know outside of a professional context.

Having played for both teams, I think there is a difference in the way men and women ask it and answer it. The women I know ask it with meaning and answer honestly. Whereas the men ask it and really hope they don’t get an honest answer – which is handy, because the man being asked has no intention of providing one. He’s fine. He’s always fine.

I think things are getting better – for example the stigma around talking about mental illness seems to be fading – but I think among men of my age and older there’s still that boys-don’t-cry, stiff-upper-lip thing going on. Which is perhaps partly why my friends and I have lost two men to suicide in the last three months: while women are more likely to suffer from mental health problems, men are more likely to kill themselves. In 2017 in the UK, 5,821 people killed themselves. 4,382 of them were men.

This is what we mean when we talk about tackling toxic masculinity. It’s not about tackling all masculinity, changing what it means to be a man or diminishing men in any way. It’s about increasing the number of emotional colours that men feel free to paint with.

Help is here

For the second time in just a few months, my friends and I are mourning another life lost to suicide.

Too many people are struggling with mental health and suicidal thoughts. If you’re one of them, please speak to somebody. The world is a better place with you in it, and can be a better place for you.

Put these numbers in your phone if you think you might need them.

0800 58 58 58 – The Campaign Against Living Miserably; online chat is available on the website.

116 123 – Samaritans. If you prefer you can email jo@samaritans.org.

0808 802 8008 – Music Minds Matter, for musicians and people in the music business. Also MMM@helpmusicians.org.uk

 

Inciting hatred of trans women in the name of feminism is “despicable”

There’s a great interview with the equally great Ruth Hunt, departing CEO of Stonewall, in Buzzfeed News. Ruth hasn’t just had a hard job. She’s had to deal with constant online abuse, some of it criminal, and has been the target of bigoted pundits in the media too.

“Mainstream newspapers running consistently transphobic articles, day in, day out, ostensibly expressing concern about the fate of butch lesbians?!” Hunt sniffs with contempt before finally letting go.

“It’s like, ‘You have not written a SINGLE positive piece about butch lesbians in my ENTIRE ADULT LIFE. Your style pages have not reflected me; your problem pages, your look, your discussion about lesbian identity, has never included me. Don’t you DARE pretend that you are now advocating for me as an excuse to attack trans people. THAT makes me angry.”

The increasingly unhinged scaremongering over trans women has led to Hunt being repeatedly questioned in the toilets because she doesn’t look stereotypically female. On Twitter last night, a Scottish journalist noted that exactly the same thing happened to her wife:

I want to say to “gender critical” people: 

You are damaging trans people, and that’s bad enough. 

BUT YOU ARE ALSO DAMAGING THE PEOPLE YOU CLAIM TO BE PROTECTING.

Back to the article. This, about the online noise over gender recognition reform, is really interesting.

when Hunt’s experience of Twitter was an endless shelling against trans rights, the charity sought external help — specifically, to investigate what exactly was happening on social media and what it meant. It looked as though those against trans inclusion and attempts to simplify gender recognition were a large proportion of the total.

The analysis found that the supposed majority was just a vocal minority.

A similar distortion played out in the media earlier this month. The Sunday Times published a letter from 30 academics urging universities to “sever their links” with Stonewall for “stifling academia” because it encourages universities to oppose transphobia. It appeared to represent, in its dozens of signatories from across British higher education, a predominant position within academia.

But just days later, a counterpetition of academics, supporting Stonewall and opposing transphobia, attracted 3,600 signatures. This was not reported in the Sunday Times.

I liked the bit in brackets here

The decision to embrace trans rights led to her and Stonewall being engulfed in hostility. Regular deluges on social media. Weekly, sometimes daily, criticism in the media. High-profile lesbians and gay men criticising her and her charity, withdrawing personal donations, signing petitions in protest — moves all eagerly published by right-wing newspapers. (It hasn’t worked overall, though: donations are up 11%.)