Bigmouth Strikes Again: Carrie Marshall's blog

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Category: Health

Scare stories and newspaper nonsense

  • Unethical. Unscientific. Unsafe

    The ever-growing waiting times for adult trans healthcare have effectively privatised medicine for trans adults: good luck waiting 25 years or more for a first appointment if you can’t afford a private GP and a life of private prescriptions; shared care, where a private GP prescribes your medicine and your local GP oversees it, is largely banned (so for example it’s been stopped in my bit of Scotland). And now the NHS in England is turning its attention to teenagers. Its new policies are unethical, unscientific and unsafe, and have effectively banned best practice healthcare for trans teens.

    Healthcare will be withheld – a clear human rights violation – if patients don’t agree to be part of research studies – another human rights violation; patients have the right not to be forced into such studies – and private clinicians who provide the care the NHS denies may be investigated by regulators with the threat of withdrawing their licence to practice medicine. The proposed protocols enshrine dangerous and discredited conversion therapy as a preferred course of action instead of providing evidenced and effective treatment we know to be life-enhancing and in some cases life-saving.

    This article by Susie Green goes into the detail.

    What we’re seeing here is healthcare decisions made not by clinicians but by columnists; not by medical experts but by propagandists.

    Green:

    So where did these protocols come from? Who created them? We don’t know and they aren’t telling us. It seems ridiculous that they would ignore WPATH Standards of Care V8, especially when you consider the rigorous work done to ensure that it is based on extensive literature review and contributions, and scrutiny from over 4,000 clinicians worldwide who specialise in transgender healthcare. But with a government hellbent on damaging trans people as a way to distract from their failings, I don’t think it is difficult to work out that NHSE has become a politically manipulated service. And trans people are the ones who are suffering because of it… [the NHS] doesn’t want to improve trans healthcare for children. They want to stop it.

    These new protocols aren’t medical. They’re political.

  • HRT+DNA

    Over at Stained Glass Woman, Doc Impossible has written a fun piece about HRT and what it does regarding DNA.  As ever, the “basic biology” crowd are ignorant about actual biology: the super-short version is that DNA is an instruction book but hormones decide which specific instructions your body will actually follow. Change those hormones and the body changes too, and not just superficially.

    I love this stuff: as in other areas of science, the more we know the more we discover about the sheer complexity, variety and, if faith is your thing, miraculousness of it all. To paraphrase Hamlet: there are more things in heaven and Earth than are understood by social media science deniers.

  • “I no longer feel safe”

    Jane Fae writes in Metro about the UK government’s demonisation of trans women:

    “I no longer feel safe as a transgender woman. I no longer feel included.

    …Did I mention I was angry? Well, yes, that. But also scared; fearful for my future in a country that can contemplate this; and – having seen how vicious, how violent the anti-trans backlash has been in some parts of the world – wondering just where this one stops.”

  • Pain

    I really love Cat Valente’s writing, and her latest essay – Pain Is Not Penance – is a thoughtful piece about pain and our understanding of it. Some of it feels like an exorcism.

    Pain, Valente writes, is something many of us have learnt to believe is a punishment:

    For something you’ve done, something you’ve been, something you failed to do, something you wanted, chose, strove for, resisted, something you couldn’t stop, something you turned away from or turned toward or turned into, something you gave in to, something you saw or didn’t see, something you lost or took or abandoned or wouldn’t let go.

    And that can lead to one of the most dangerous beliefs in our society:

    Pain is payback. You earned this hurt. It didn’t happen to you, you collided with it. It isn’t random, it is your pain, for you, because of you, and if you’d only been better, if only you’d been stronger, if only you’d held on a little longer or let go a little sooner, if only you’d been more, if only you’d been less, if only you’d managed to be Goldilocks’ Own Brand Pristinely Precisely Perfect Fucking Porridge, you wouldn’t be doubled over in the dark right now, burning alive from the inside out.

    I don’t want to spoil the rest of the article. It’s well worth your time.

  • Now they’re closing clinics

    A US health clinic for trans people has closed its doors permanently after the introduction of a state-wide ban on healthcare for trans teens. As Xtra magazine reports, the ban was largely based on wild allegations by a single person, allegations that appear to be largely or completely baseless. But the national press, and the New York Times in particular, doesn’t let the facts get in the way of a good scare story – and those scare stories often end up being used as evidence by the bigots in support of their bans.

    From the article:

    While the bulk of the blame for the clinic’s shuttering lies with the state’s conservative legislature, its closure was also accelerated by a group of anti-trans journalists who presented Reed’s unsubstantiated allegations to a wide audience.

    …[despite the claims being debunked] Reed got a rosy portrayal from New York Times journalist Azeen Ghorayshi. Ghorayshi reported that she couldn’t substantiate most of Reed’s claims, and yet still went on to paint Reed as a brave truth teller in the pages of the paper of record.

    Evan Urquhart in Assigned Media has more, including interviews with the parents of trans teens.

    “We care about the clinic we take our children to. We care that it is providing ethical care. We care that it is following the standards of care. But using the words of this person [Reed] who has been shown to be unethical, to deny healthcare to all these people, just isn’t right. In Missouri, politicians are making health care decisions right now, none of whom are qualified to do so.”

    For too many journalists, this is a game. But for the people losing their healthcare – and the right-wingers have adults in their sights as well as teens – it’s a matter of life and death.

     

  • Fake science, real cash

    The Huffington Post has an interesting exposé of the people making good money from bad takes and pseudoscience: you can make tens of thousands of dollars presenting pseudoscience in the employ of anti-trans religious extremists. And while the article is mainly about the US, the UK gets a look-in too. You may recognise the names here from their very frequent appearances in the UK press.

    The spike in anti-trans legislation means states need even more experts to defend it. And in order to deepen the bench, states have started enlisting academics who aren’t in health care or don’t even primarily research humans. One is a Manchester University professor named Emma Hilton, who mainly studies a particular species of frog and how it offers an understanding of inherited human genetic disorders. Hilton is a founder of a British group, Sex Matters, that advocates for legally segregating spaces by sex. She earned $300 an hour last year defending bans on trans girls playing on girls’ sports teams in Utah and Indiana.

    By way of explaining why she was qualified to weigh in on school sports, she told one court, “I participate keenly in sports at an amateur level, playing netball recreationally.”

    “Our understanding of human biology is in part a result of the study of animal models,” Hilton said in an email. She declined to address the relevance of netball, which is like basketball without dribbling.

    Another is Michael Biggs, an Oxford sociology professor who admitted in court to writing transphobic tweets under the pseudonymous handle @MrHenryWimbush and described himself as a “teenage shitlord [turned] Oxford professor.” “Transphobia is a word created by fascists, and used by cowards, to manipulate morons,” reads one representative post.

    Florida paid Biggs $400 an hour to defend its Medicaid ban.

  • Where’s the rush?

    The London Gender Identity Clinic has just updated its waiting list information: as of July 2023 it was making first appointments for people first referred in July/August 2018, five years ago. With 324 new referrals each month and 55 first appointments offered per month, it’s clear that that five year figure is only going to increase.

    Maths isn’t my strong point. But a service that’s only seeing 20% of new referrals each month is a service that’s adding 80% of new referrals to a waiting list that’s already five years long. So if you’re referred today, your waiting time won’t be measured in months, weeks or even years; it’ll be decades.

    In Scotland, where the population is smaller and we have a different NHS, things are marginally better: the Edinburgh gender service is currently making first appointments for people referred two years ago. However in Glasgow, which covers a much bigger area (and oversees all surgery-related care for Lothian, Tayside and Grampian NHS areas too) and is the largest such clinic in Scotland, the waiting list for adults is around five years, up from four years in late 2022.

    Gender services are not bound by the same Referral To Treatment (RTT) and Treatment Time Guarantees (TTG), which mandate that patients should not have to wait more than 18 weeks between referral and the beginning of treatment. Rather, the care for trans people is best illustrated by a small but telling detail: if you believe that the wait for an appointment is affecting your mental health, NHS Scotland will direct you to a page of mental health resources on the Sandyford website. When you visit the page you’ll see a short, simple message: “The page you requested was removed.”

    One of the reasons that waiting lists are growing (other than the fact that trans healthcare is centralised when most of it could easily be handled by GPs) is because where there are vacancies, as there are in Sandyford, the current viciously anti-trans climate makes vacancies hard to fill: in the case of the Sandyford you don’t just have to brave online abuse but run a gauntlet of bodycam-wearing Christian extremists to get in the front door on some days. And while the wider faults in trans healthcare have been glaringly apparent for many years now, no politician is going to demand the improvements that are so desperately needed when you know exactly how the press and pressure groups would spin it.

    I’d love to live in the fantasy world the bigots describe, where you simply refer yourself to a clinic and have hormones and surgery the same day. It’s much nicer than the reality, in which our healthcare is little more than a link to a web page that doesn’t even exist.

  • Years and years

    One of the more irritating barks of the anti-trans sealions is “what rights don’t trans people have, exactly?” It’s irritating because it’s deliberately obtuse: many of the rights we have on paper are rights that are not enforced, which means they might as well not exist. And the sealions know that but pretend not to.

    A good example of that is the right to NHS treatment that most UK nationals take for granted. But Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust has just announced that for the foreseeable future, it will not be accepting any referrals to the Northern Region Gender Dysphoria Service (NRGDS). You cannot get trans-related treatment through the NHS via any other avenue, so the NHS has effectively just scrapped trans healthcare in the region. We know that this healthcare is life-saving for many people, and yet in that part of England it simply isn’t available to anybody who isn’t already on the years-long waiting list.

    This isn’t the first time this has happened. In 2021, it emerged that Northern Ireland’s only gender identity clinic hadn’t accepted a single new patient since 2018. The Sandyford in Glasgow stopped taking new patients for its youth services for a while last year too.

    Even where new patients are being accepted, the backlog isn’t being cleared quickly enough. According to a freedom of information request earlier this month, trans people in Yorkshire can expect to wait thirty-five years for a first appointment at current clearance rates.

    The reason for this awful state of affairs is because there aren’t enough staff or resources to cope with demand for healthcare that remains part of the desperately underfunded and short-staffed mental health division of the desperately underfunded and short-staffed NHS. Despite years of warnings – including in the Theresa May government’s own LGBT action plan – trans healthcare has been starved of resources; rather than follow its own committee’s advice on reforming our healthcare, the May government decided instead to go for the much cheaper and largely un-requested reform of the gender recognition act. Which as I’m sure you know has been a great success.

    And to make things worse, the online bullying and press demonisation of trans healthcare providers in a style very reminiscent of the Christian Right’s attacks on abortion providers has made it very hard to fill vacancies. Until recently the Sandyford Clinic in Glasgow had just two psychiatrists, each of whom only attended one day per week, to cover the whole of the catchment area.

    The problem with trans healthcare is very simple. Healthcare that could easily be provided by our GPs – the HRT I take is the same HRT cisgender women take; the occasional blood tests I need are the same blood tests cisgender women need; the process for referring trans people to surgery doesn’t need to be any different than the process for knee surgery or back surgery, and so on – is all forced through the gender clinics, where psychiatrists do exactly the same job as your local GP surgery does. But there are far fewer psychiatrists than there are general practitioners, so the waiting lists get longer and longer and longer until healthcare is stopped altogether because the service can no longer cope.

    There was outcry in the newspapers a few weeks ago over the news that some 7.6 million people in England were waiting for NHS treatment, and two out of five had been waiting for more than 18 weeks. But that 18-week target doesn’t apply to mental health services, so there’s no outcry when ADHD and autism waiting lists exceed two years (many trans people are neurodiverse) or when trans waiting lists run into the decades, or when all trans healthcare is simply stopped. Officially, we have the same right to NHS treatment as anybody else. But in reality, we really don’t.

  • The trick is to keep peeling

    It’s nearly six years since I started transitioning, and my relationship to my body has changed quite significantly since I began. As I wrote in my book, I never had the severe body dysphoria that many trans people experience, the discomfort, unhappiness or even horror that comes from your body and mind not matching up. But over time, I’ve found that those feelings have grown.

    On the face of it, that seems odd. After all, I’m six years further down the HRT road now so my biochemistry is better. I’ve had over 230 hours of facial electrolysis. So I’m closer to where I need to be than I was back then. But I don’t feel that way.

    It turns out that I’m not the only transitioning person who feels like that. Writing in Stained Glass Woman, Doc Impossible has some thoughts, and while I’m not sure I agree with all of them I think it’s an interesting piece.

    To summarise it: think of gender dysphoria as pain.

    Pain isn’t a constant. I’ve been getting facial electrolysis for four years now and last week’s session was one of the most painful ones I’ve ever had. It was the same technician, the same machine, the same needle size and strength. If anything it should be a walk in the park by now because the really thick hairs, the one that felt like they needed the entire National Grid to electro-shock, are long gone. But my pain threshold was different that day, possibly because I’ve been going through some things and not looking after myself as well as I should have been. So the needles really hurt – and things I normally would barely have noticed were very noticeable and very painful. It was absolutely excruciating.

    What if dysphoria works like that too? As I’ve written in my book, sometimes I ask myself: how strong do I feel today? Some days I’m stronger than others, and things bounce off that would normally hurt. And of course the reverse applies too. If your threshold for physical pain can vary, then surely the same applies to your threshold for psychic pain.

    What about the phenomenon I’ve experienced, of increasing dysphoria as I transition? In Doc Impossible’s piece they suggest that perhaps dysphoria is like an onion, with multiple layers – so if you address one of the issues that makes you dysphoric, you remove a layer. And that’s good, but what’s underneath it? Another layer, one that you might not have been aware of because you were focused on the layer now gone. And now you have a new, completely exposed layer to deal with.

    those sources of constant, moment-by-moment pain? They’re either gone or dramatically reduced.

    Which means that your brain can stop shutting off lesser, but still significant, sources of pain.

    When we start noticing “new” dysphorias, the truth is that they were always there.

    I think that’s a really interesting way to look at it, because I do think there’s more to it than just frustration: of course after 230 hours of electrolysis I’m pissed off with my weekly face stabbing, and the whingeing part of me thinks it’s very unfair that other trans women can achieve full clearance in a fraction of the time, and for a fraction of the money, than it’s taking me. But while there’s definitely an element of flagging after the halfway or three-quarters point, I think there’s also an element of onion peeling here. I’m unhappy about different things than I was six years ago, because there were bigger things I had to deal with first.

    The trick, it seems, is to keep peeling.

  • Women should beware of period apps

    Yesterday, a UK court jailed a woman for taking abortion pills shortly after the UK limit during lockdown, when normal medical care was unavailable. There’s a great deal to be angry about here, not least the complete absence of the “protect women” crowd when it comes to protecting women’s reproductive rights. But there’s also a warning: if there’s any possibility that you might need an abortion at some point in your life, be very wary of what data you share with apps and websites.

    One of the details of this particular case is that the English police, as the US police have also been known to do, used the woman’s digital footprint as evidence against her; in this case it was her search history and message history. In the US, social media and smartphone location histories have been used to target women travelling out of state for abortions. Women and non-binary people have been flagging up the potential dangers of cycle tracking apps for some time too.

    We like to think that we’re more enlightened than the US, but we’re not: abortion in the UK is not decriminalised. And people seeking abortions can be betrayed by their digital footprint just as easily here as across the Atlantic.