Trans rights

The World Professional Association for Transgender Health said the refusal or withdrawal of HRT for trans patients raised “ethical and clinical” concerns.

“Hormones should not be stopped for political reasons or in the absence of a recognised medical issue,” a spokesperson told TBIJ. “If GPs are withdrawing prescriptions despite recommendations, this could result in negative impacts on patients' mental and physical wellbeing.”

[…]

The issue appears to reflect a wider rollback of access to gender-affirming healthcare in the wake of April’s publication of the controversial Cass Review into health services for trans young people. This review claimed that the evidence base of using puberty blockers and gender-affirming hormones for young people was “weak”. Some of the same medicines are used in adult care.

The review did not recommend a ban on puberty blockers but resulted in one for young people experiencing gender dysphoria (they are still permitted for children experiencing early puberty). The ban was extended by the new Labour government in August. Adult gender services are now also under review.

The World Professional Association for Transgender Health said the refusal or withdrawal of HRT for trans patients raised “ethical and clinical” concerns.

“Hormones should not be stopped for political reasons or in the absence of a recognised medical issue,” a spokesperson told TBIJ. “If GPs are withdrawing prescriptions despite recommendations, this could result in negative impacts on patients' mental and physical wellbeing.”

Puberty blockers delay the onset of puberty, but don’t necessarily result in a measurable effect at the time they are taken. The main impact is seen when people are older. The physical effects of a puberty that does not match a person’s gender can have serious negative consequences for transgender adults.

In my role as a GP, I regularly hear from transgender adults (who have not had puberty blockers) struggling with distress related to bodily changes which occurred during puberty.

I have met people who don’t speak because their deep voice causes others to make incorrect assumptions about their gender. Some harm themselves or avoid leaving the house because of the distress caused by their breasts. Others seek costly surgical treatments.

This is when the benefits of maintaining equitable access to puberty blockers for those who need them become obvious. People are seeking hormones, surgery and mental health support for changes which could have been prevented by using puberty blockers when they were younger.

The ministry’s position statement recommends that puberty blockers are prescribed by health professionals who have expertise in this area, with input from interdisciplinary colleagues.

In my experience this describes how puberty blockers are currently being prescribed in New Zealand. Clinicians are already cautious in their prescribing. They work with multidisciplinary input to best support the young person and their family. They recognise the importance of mental health and family support for young people. 

Using chaos and fear to enforce conformity:

Some bathroom bills cover all K-12 schools, colleges, and government-owned buildings or spaces. Some cover just K-12 schools, while others cover some government buildings but not others, according to the Movement Advancement Project. Proposed drag bans are similarly haphazard: North Dakota’s proposed ban characterized all drag shows as “adult-oriented,” making them equivalent to strip clubs, while West Virginia lawmakers floated a ban that appeared to criminalize transgender people being around minors, period. The net effect is that it is impossible to know for sure what is permitted and what is prohibited.

This is a feature, not a bug. Just as the earlier “cross-dressing” laws were vague enough to make any non-conformity treacherous, modern-day analogs do the same. Anyone who falls outside the mainstream of traditional gender presentations, regardless of whether they happen to also be queer, now faces heightened scrutiny thanks to a patchwork of laws across the country.

All of these laws and proposals have one goal: making LGBTQ+ people—or anyone else not wedded to traditional gender roles—feel uncomfortable and unsafe. If people feel unsafe in this fashion, they will retreat from public life or radically change their self-presentation to conform better. Conservatives are likely thrilled with either result, as in both cases, they will have robbed queer people of their ability to fully and authentically participate in society. And that’s exactly the point.

A new poll from Gallup about Americans’ attitudes around transgender rights reveals a growing distaste for far-right efforts to ban gender-affirming care.

According to the poll, six in 10 U.S. adults oppose laws banning gender-affirming care for minors.

At the same time, a slim majority – 51% – of Americans think transitioning is morally wrong. Just forty-four percent call it “morally acceptable.”

The morality of transitioning – which the survey called “changing one’s gender” – falls along partisan and generational lines.

Those who consider it morally acceptable include political liberals (81%), Democrats (72%), those who don’t identify with a religion (67%), those who don’t attend religious services regularly (59%), young adults aged 18 to 29 (56%) and college graduates (53%).

It's intentionally the opposite of public safety. It's giving violent bigots carte blanche to assault any woman who doesn't meet their expectations of femininity. It's not designed to "work"; it's designed to sow chaos and fear.

These state bathroom bans provide few, if any details about how they would be enforced because they don’t need to — private citizens are often meant to be the enforcers, said Logan Casey, director of policy research at the Movement Advancement Project, a nonprofit that tracks LGBTQ+ legislation.

“The way that the laws are de facto enforced is often through the emboldening of private individuals to police other people’s bathroom use,” he said. “There’s no written enforcement because the proponents of these bills know that just by talking about this, let alone enacting these laws, that they are emboldening individual people themselves to enforce these bathroom bans.”

A recent example that takes this formula to an extreme can be seen in Odessa, Texas. A new expansion of the West Texas town’s ordinance allows individual citizens to sue transgender people caught using bathrooms that match their gender identity and seek “no less than $10,000 in damages,” per the Texas Tribune.

Deputizing private citizens to enforce this kind of law enables high rates of harassment and violence against transgender people as well as cisgender people, Casey said, particularly women who do not conform to traditional ideas of femininity. 

In a 2015 survey of more than 27,000 trans adults, nearly 1 in 7 said that a professional, such as a therapist, doctor, or religious adviser, had tried to make them not transgender; about half of respondents said they were minors at the time. By applying this rate to population estimates, the Williams Institute at UCLA projects that more than 135,000 trans adults nationwide have experienced some form of conversion therapy.

Despite the data, lawmakers frequently don’t believe that conversion therapy is still happening in their community, says Casey Pick, director of law and policy at the Trevor Project, the LGBTQ suicide prevention group. “We’re constantly running up against this misconception that this is an artifact of the past,” she says. So, five years ago, the Trevor Project began scouring psychologists’ websites and books, records of public testimony, and known conversion therapy referral services, looking for counselors who said they could alter someone’s gender identity or sexual orientation.

As the research stretched on, Pick noticed webpages being revised to reflect changing times. “We saw many folks who seemed to leave the industry entirely,” she says. “But others changed their website, changed their keywords, [from] talking about creating ex-gays to talking about ex-trans.”

[…]

And in Las Vegas, Cretella drew a direct connection between the old work of the Alliance and the new work of gender-exploratory therapists. “It truly is very similar to how the Alliance has always approached unwanted SSA [same-sex attraction],” she told the assembled therapists. “You approach it as ‘change therapy’—or, even less triggering, ‘exploratory therapy.’”

There is an increasing demand for trans and gender diverse (TGD) health services worldwide. Given the unique and diverse healthcare needs of the TGD community, best practice TGD health services should be community-led. We aimed to understand the healthcare needs of a broad group of TGD Australians, how health professionals could better support TGD people, and gain an understanding of TGD-related research priorities. An anonymous online survey received 928 eligible responses from TGD Australian adults. This paper focuses on three questions out of that survey that allowed for free-text responses. The data were qualitatively coded, and overarching themes were identified for each question. Better training for healthcare professionals and more accessible transgender healthcare were the most commonly reported healthcare needs of participants. Findings highlight a pressing need for better training for healthcare professionals in transgender healthcare. In order to meet the demand for TGD health services, more gender services are needed, and in time, mainstreaming health services in primary care will likely improve accessibility. Evaluation of training strategies and further research into optimal models of TGD care are needed; however, until further data is available, views of the TGD community should guide research priorities and the TGD health service delivery.

Informed consent means that a trans person could access gender-affirming care without any need for mental health  treatment or a lengthy assessment process. This model is routine in the vast majority of all non-transgender medical care. Cisgender people routinely access similar hormonal medications as trans people without a mental health diagnosis for conditions like polycystic ovarian syndrome, precocious puberty, menopause, loss of virility with age, and birth control.

Many doctors worldwide use a gatekeeping approach to gender-affirming care, but the informed consent model for transgender hormone replacement therapy is also widespread in the United States—a map of IC providers created by activist and journalist Erin Reed lists nearly 1,000 such providers in this country. This has been the result of decades of advocacy by the trans community to have our healthcare approached similarly to other comparable treatments. 

[…]

How do we know that informed consent works better? Well, to start, granting trans people significant levels of autonomy over their medical care is in line with the ethics of the medical profession, which directs doctors to engage in shared decision-making and uphold client autonomy whenever possible. As Bryan Murray puts it in a piece for the American Medical Association Journal of Ethics,  “Informed consent is at the heart of shared decision making—a recommended approach to medical treatment decision in which patients actively participate with their doctors.” Scholar Madeleine Lipshie-Williams points out that the gatekeeping mode for gender-affirming care is at odds with how the majority of medicine is practiced in the U.S.: “[the gatekeeping model], which requires medical professionals to provide official opinions on a trangender patient’s readiness to accept and undergo care, stands in contrast to the majority model of medical consent in the US.” Lipshie-Williams also argues that the informed consent framework is preferable because it is necessary for the normalization of trans identities: “there cannot be a depathologizing of transgender identity as long as transgender individuals are required to be seen by mental health specialists to confirm both the validity of their own self-proclaimed identity, as well as their mental fitness to consent to medical interventions that have been broadly accepted as necessary. There is an inherent contradiction in declaring medical care necessary whilst simultaneously maintaining that those for whom it is necessary continue to lack the capacity to consent to this care without assistance.”

A really good guide to being an activist in general:

One of the most important things that trans folks need to get before their arguments can work well is that we tend to get pushed pretty hard to the political left when we come out and transition. It’s not some brainwashing thing—we just tend to be poorer, better-educated, and get hit with the shitty side of our capitalistic social structure, all of which pushes voters toward more liberal or leftist political positions. Given that we tend to hang out in groups, particularly online, we get hit pretty hard with the echo chamber effect, which reinforces socially-common political biases through self-sorting.

In simple terms? It means that by hanging out with a bunch of other trans folks, we tend to get entrenched in political stances that are common in the trans community. It’s the Fox News Grandpa effect.

And I’m guessing that it makes you feel a little uncomfortable to hear that.

This is the first and most important thing you need to face if you want to persuade people outside of your social bubble effectively: you are not immune to persuasion or propaganda. You have absorbed a lot without noticing it over the years, both before and after your transition. And those things? People have noticed them, and noticing those things has colored their view of you as a person and a rhetor.

Put a different way: if they know you have a history of arguing for what they see as hard-left stuff, stuff they think is a bad idea, they’re going to treat other things you argue for with a degree of pretty understandable skepticism.

When you can relate…

But the truth is more complicated than any before-and-after story. Testosterone didn’t suddenly turn George from girl to boy. As a young child, he was different in ways that were undefinable but palpable enough to make him an outcast. Invitations to sleepovers and birthday parties were rare. Kids thought he was strange; he thought they were incomprehensible and cruel.

George was bookish, had odd interests and was utterly ignorant of the things that captivated the girls around him. He stood outside the worlds of either girls or boys in a state of loneliness I can still hardly bear to recall. And then puberty came along and took his suffering to new levels. It was like being buried alive in a body not his own, a body suggesting roles he could in no way fathom.