Bigmouth Strikes Again: Carrie Marshall's blog

Carrie’s books | Carrie’s band

Category: Health

Scare stories and newspaper nonsense

  • 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.

  • And now we wait

    My GP thinks it’s highly likely that I have ADHD, which I contracted by watching TikTok videos, having friends with blue hair and reading about Critical Race Theory. *sideways look*

    I’ll no doubt write more about it some other time, but the tl;dr version is that my winning personality may actually be a neurological condition. Fun times!

    I received confirmation of my referral today, along with a bunch of questionnaires and a letter explaining that the current waiting time for any assessment is “approximately 80+ weeks”.

    I know what you’re thinking. 80+ weeks? For an initial assessment?

    Me, I’m probably not thinking what you’re thinking, because I have experience of trans healthcare. I’m thinking:

    Woah! Slow down there, Speedy Gonzales! Round here we measure wait times in years!

  • The wedge

    It’s been obvious for many years that if you vote for an anti-trans politician you get an anti-abortion politician; the whole trans panic has been manufactured by an unholy alliance of political and religious conservatives who believe that they, not you, should decide what you can do with your body. But even by their low standards they’re not usually as blatant as the Republicans in Nebraska.

    As the Washington Post reports, Ben Hansen filed amendments to the anti-trans bill 574, already a dangerous and hateful piece of legislation designed to remove trans people’s healthcare, that would ban abortions after 12 weeks – effectively a ban on all abortions. Senator Merv Riepe blocked the amendments, for now at least. But the amendments, and the furious reaction to Rip’s blocking of them, should remove any doubt that the war on trans people’s bodily autonomy is part of a wider war against everybody’s bodily autonomy, or that the “gender critical” movement is at best a useful tool for the evangelical right.

  • If you believe nothing, you’ll believe anything

    This, from Vice, is very good: America’s Most Influential Conspiracy Theorists Are Going All-In On Transphobia. It’s about how people with various agendas, from Qanon conspiracists to self-promoters, are finding transphobia the perfect vehicle for making the world demonstrably worse. And this is not a US-only phenomenon.

    The fact that these once-fringe subcultures and the so-called mainstream have merged to such an extent means that when they all focus their attention on something, the effect is especially devastating. And right now, that shared focus is an all-pervading panic and hostility about drag queens, “groomers,” transgender identity as being somehow “contagious,” the supposed sexualization of children by LGBT people, and the false claim that gender-affirming care is a form of abuse or mutilation. 

    …The relationship between the anti-vaccine and anti-trans movements makes logical sense, in that they both farm a specific suspicion of science and mainstream medicine. More subtly, both the anti-vaccine and anti-trans worlds also try to weaponize regret, sowing fear that a medical choice might go irreparably wrong.

    …This sort of explicit instrumentalization of conspiratorial ideas is the direction, it would seem, in which things are heading. Demonizing trans people is proving popular because it has political and social utility for so many different people, from Substack to the hall of Congress, from increasingly popular podcasts and the guests they can’t seem to give enough time to to parents confused, as parents always are, by the way the world has changed since they were young.

  • Another smoking gun

    This, by Jude Doyle, is horrifying: more email evidence of how the Christian Right is pulling the strings of the anti-trans movement, this time in pushing the narrative of “detrans” people or “detransitioners”, people who undergo (or sometimes just propose to undergo) transition and then change their minds. The piece describes a huge and highly effective media machine that takes care of every detail, right down to writing the words it wants detransitioners to mime.

    At the beginning of her gender-critical career, Shupe’s public voice was more or less her own; that is, she actually gave the interviews and wrote the blog posts that appeared under her name. As Shupe entered the world of the Christian right, however, her voice was increasingly retooled or outright manufactured by her handlers.

    Sullivan quickly took over Shupe’s public image, instructing her to refer all requests for interviews or public appearances to him. In an email chain dated April 2019, he told her not to talk to a Washington Post reporter he deemed trans-friendly, and directed her to what he called “good Catholic media sources.” In another April 2019 email, Sullivan provided Shupe with what he called an “outline” for an op-ed, along with instructions for pitching: “You should shop it to the main liberal papers offering it to each one for 24 hours before offering it to a new one. After about four or five, you could then offer it to some more ‘conservative’ papers until you get one to bite.” The “outline” provided by Sullivan was a full essay of 1,609 words. One sentence was typed in red, indicating that Shupe should fill in the details herself. 

    This is clearly happening in the UK too.

    If you’re a reader of the (Glasgow) Herald, this bit might jump out at you:

    “ADF has some excellent writers familiar with the length and style that appeals to op-ed page editors, who could take even a very rough sketch or outline of thoughts from you—or just talk with you—and then create a draft that I think you will be very happy with.” 

    The ADF’s Lois McLatchie has popped up in The Herald’s pages several times recently as a columnist, and her columns are very good at what they do; unfortunately what they do is attempt to excuse the inexcusable and wage war on human rights. That The Herald publishes them without context is an indication not just of how effective the ADF’s machine is, but also how debased our journalistic institutions have become.

    The piece makes it clear, yet again, that none of this is about “protecting children” or “protecting women”. It’s a religious war.

    “I was gradually waking up to the fact that, you know, I was just a useful idiot, are the two words I would use,” Shupe tells me. “I got the vibe that they wanted me to help them, they wanted me to use them, but they wouldn’t trust somebody like me around their kids.” 

  • We don’t want to die

    I’m aware that I’ve written a few posts recently about the deaths of young trans women, largely from suicide. Let’s look into that a little bit.

    There’s a famous statistic that says 41% of trans people have attempted suicide at some point in their life. It’s from a US study of trans people, and the number is often used online by anti-trans bigots urging us to “join the 41%”. There’s quite a lot of literature on this subject now, and if you do a literature review you’ll find that the numbers are pretty consistent: globally, 32% to 50% of trans people say they’ve attempted suicide at least once. The number of people with ideation, which is when you make plans but don’t go through with them, is higher still.

    That’s much, much higher than in the wider population. Sticking with the US, the National Survey on Drug Use and Health found that 4.3% of Americans said they had had suicidal thoughts in the previous year.

    So. For the population as a whole, suicidal ideation affects 4.3%. For the trans population, more than 41%.

    What’s the difference? Here’s a clue. In the latest study of trans and non-binary youth in the US, the study found that people who underwent affirming healthcare – such as hormone therapy – had a lower rate of suicidal ideation than the wider population: just 3.5%.

    What’s the difference between 3.5% and 41%? Support. Many older trans people have encountered all kinds of issues around being trans: staying in the closet for years, difficulties in obtaining healthcare, societal disapproval, familial ostracism, loneliness, discrimination, hate speech, sexual assault… you know the kind of thing.

    But when trans people are supported, given the healthcare they need and the support they deserve, they get happier.

    From the study:

    During the study period, appearance congruence, positive affect, and life satisfaction increased, and depression and anxiety symptoms decreased. Increases in appearance congruence were associated with concurrent increases in positive affect and life satisfaction and decreases in depression and anxiety symptoms.

    Healthcare in “making people better” shocker.

    The problem isn’t who we are. It’s how so many of us are treated because of who we are. That isn’t an us problem. That’s a you problem (or if you’re one of the good people, a them problem). Trying to “eliminate transgenderism”, or just turning a blind eye to the destruction of our rights and healthcare by those who want to, has a body count.

  • A scandal at Sandyford

    The Sandyford clinic is where Glasgow’s gender clinic is based, alongside various sexual health and victim counselling services. I’ve been attending it since 2017, and I’ve been meaning to write a proper piece about it for some time: visiting in person, even before COVID, was like playing the abandoned-hospital level of a horror video game. Empty corridor after empty corridor, your footsteps echoing, sitting alone in a large waiting room wondering if the next person you see will be a psychiatrist or a serial killer.

    There were protests outside it yesterday by the loons and cowards of the Scottish Family Party, who said they were coming at 11am to brick up the entrance to protest its role in women’s reproductive freedom. In the end they arrived at 8am with cardboard boxes printed with bricks, took their photo and then hid at the Mitchell Library until the colourful and camp counter-protest – which attracted more than 100 people – was over, returning afterwards to take another photo at the wrong building.

    The moon howlers of the SFP weren’t there to protest its trans services, although I’m sure that was a bonus. But the Sandyford Clinic has been the subject of ridiculous scaremongering for years now, with anti-trans bigots and cynical Conservatives claiming yet again that the clinic is “experimenting on children” and fast-tracking them into surgery. The fact that children don’t get gender-affirming surgery and nobody is experimenting on anybody is an inconvenient truth they prefer not to address.

    This morning, The National newspaper printed a story about a scandal at the Sandyford. But it’s not the invented one of the bigots. It’s the real one anyone attending can tell you about.

    Just two psychiatrists, each working one day a week, cover adult services for the whole west of Scotland. The young person’s team is soon to consist of a single person, who will work half the week and cover all of the country

    I know both psychiatrists, and they appear to be good people. But they’re not magic people. They’re massively overworked in a department that’s desperately underfunded and understaffed. One position has been advertised for years now and nobody has applied, because who’d want to work in an environment like that?

    “There’s this massive waiting list and there’s going to be loads of scrutiny on you and people are going to be actively campaigning for your service to close down and there’s 1000 newspaper articles written about your client br every week. When you put it like that, nobody is going to want to do it.”

    When I self-referred to the Sandyford in 2016, it took 11 months before I was offered an initial assessment visit. Officially the adult waiting list is nearly five years long now. Anecdotally I’m hearing it’s even longer than that. And the lack of staff means the healthcare you do get is inadequate. Last May a really important appointment was made for me; nobody informed me about it and I didn’t discover it had been made until November. The earliest next appointment was in February.

    If this were any other branch of healthcare, the coverage would be deafening. But I think it’s a safe bet that the genuine scandal at the Sandyford, one that’s affecting the healthcare of a small but significant group of people, will get less coverage than any scaremongering. And that too should be a national scandal.