"New patients have to wait four years for their first appointment"

July 11, 2016 2:17 AM

The number of Britons taking steps to change their gender has shot up dramatically in recent years, leaving vulnerable people waiting years for treatment, reports the Guardian.

Referrals to NHS clinics in various parts of England have shot up - with 28 times as many patients at a clinic in Nottingham compared to 2008 and waiting lists in Leeds reaching four years.

The paper has published a set of related stories today:
Gender identity and the big questions that have yet to be answered
Transgender stories: 'People think we wake up and decide to be trans'
Meet the gender reassignment surgeons: 'Demand is going through the roof'

posted by winterhill (7 comments total)

I'm frustrated that th Guardian didn't put more effort into making clear were not talking about people being trans as a fad. (And we had everyones favorite gender non-conforming children don't turn out to be trans stat. That's true, but gender non-conforming children is a different population than kids who you'd think of as clearly trans.) It's significantly easier to get a referral to a GIC now than in 2008 (let alone 1998) because GPs are more likely to not just laugh you out of the office. Combine that with better access to information from the Internet and boom, there's your increase. (Plus someone like the older woman interviewed quite possibly wouldn't have sought a referral.)
posted by hoyland at 2:59 AM on July 11, 2016 [5 favorites]

Is Gender identity and the big questions that have yet to be answered correct when it says "When a person is born intersex and has treatment at an early stage to make them female, they tend to grow up feeling female, and vice versa?"

The word "tend" is a bit weaselly, but even I'm aware of a very famous case where someone who had SRS as a child was utterly miserable at being assigned female, and didn't know why.
posted by Joe in Australia at 3:03 AM on July 11, 2016 [2 favorites]

Maybe people feel safer asking for help now. Isn't that a good thing? The NHS just needs to catch up.
posted by adept256 at 3:12 AM on July 11, 2016 [5 favorites]

Is Gender identity and the big questions that have yet to be answered correct when it says "When a person is born intersex and has treatment at an early stage to make them female, they tend to grow up feeling female, and vice versa?"

This is not my area of expertise, but my understanding is that there's a lot wrong with this sentence. There was a preference dating back to the work of John Money for assigning female in a lot of cases (which had to do with notions of what a penis should look like, as I understand it). Current best practice is to acknowledge that a child will (generally) make their gender identity known and an initial assignment may well be wrong. (There's some research tracking the gender identities of people with particular disorders of sexual development* that can be used to guide an initial assignment.) Additionally, "has treatment at an early stage to make them female" is talking about genital surgery on infants to create normative genitals, which is at best going out of fashion and at worst highly unethical.

*At least in North America there's been a move towards using "disorders of sexual development" (DSDs) rather than "intersex" on the grounds that it's clearer that we're talking about a variety of things (and no one could quite agree on what intersex meant).
posted by hoyland at 3:38 AM on July 11, 2016 [6 favorites]

Waiting times for GICs in this country are ridiculous (just over three years from GP to GIC for me, starting over five years ago) and the ever-growing waiting list for GRS for trans women is very rapidly becoming a big problem as well. Lack of funding is obviously a huge problem, but lack of planning and poor admin is also contributing. No plans were made for the senior surgeon leaving a few years ago (representing exactly half of their staff), despite his having threatened to for a long time - because he wasn't given any students. His replacement is currently on maternity leave, as she has been since March at least - cover for her clinics (but not any actual surgery) was only commenced a few weeks ago. Nobody had done the work of securing a competent replacement in advance. This leads to situations like the current nine month waiting list I'm on for corrective surgery (a simple same day procedure that means the difference between being able to sleep and sit or not) which would normally be on a wait measured in weeks, at least. The fires and crises are as predictable as they are depressing, arriving irregularly, but each time upsetting the whole system far worse than if it were properly managed.

And yet, apparently they've been ignored continuously amidst hand-wringing, which renewed my frustration at the continued effort of cis groups (e.g. WPATH and its cousins, various councils and committees, boards, etc) to position themselves as authorities on trans people and their lives all the while preventing us from living fully and justly.

This is a thing that is slowly changing. My trans activist housemate attended their annual conference recently as a member, and while she reported a lot of epic fail, there was a lot of very progressive awesome as well, and a growing presence of actual trans people(!) involved in various capacities. Long long way to go yet, of course.
posted by Dysk at 12:36 PM on July 11, 2016 [1 favorite]

There's at least one three trans person people whose names are on the SOC. (Though I think of two of the three as at least a little out of touch (one more so than the other) and I think the third has actively toxic ideas.)

I think WPATH is limited because it is fundamentally an academic organisation. It claims to be a professional organisation, but, at the end of the day, most of the people writing the SOC are academics. This makes things tricky both because they're in a small field and have to play politics and because a lot of the progress doesn't seem to come out of academia anyway. (I mean, Tom Waddle and Mazzoni and so on were doing informed consent for like 10 years before v7 of the SOC came out, which has tortured language that was clearly a compromise to get the SOC to sanction those models while still allowing room for university clinics to not change much of anything. And yet the NHS pathway is stilll stuck behind where the SOC is, IIRC.)
posted by hoyland at 3:17 PM on July 11, 2016

Is Gender identity and the big questions that have yet to be answered correct when it says "When a person is born intersex and has treatment at an early stage to make them female, they tend to grow up feeling female, and vice versa?"

I think that sentence sort of skims over a lot of complexities. There are all different kinds of intersex conditions. I've been reading recently about people who are born with complete androgen insensitivity (CAIS), which means that a baby with XY chromosomes develops a body that looks female from the outside, but they develop male gonads rather than a uterus and ovaries. They are raised as girls and they usually only discover their condition when they're teenagers and don't get their period. From what I've read, despite their male DNA, most people with CAIS feel like women and they tend to live out the rest of their lives as women after finding out.
posted by colfax at 5:31 AM on July 12, 2016