I previously talked about Gate-Keeping in regards to mental health care, and today I will talk about a closely linked subject. Medical Gate-Keeping for Trans* people is a very prevalent issue, even in self-described more tolerant countries such as my own. I’m going to use obtaining Hormone Therapy in the UK as an example as it tends to get the most controversy, however suffice to say these things apply to other treatments and other countries.



A Short Introduction to Medical Philosophy

Often people confuse the regulations and guidelines that restrict healthcare to Trans people as simply being an extension of how medical treatments are dealt with. However this is far from the case, here are the points that medical professionals generally go by outside of stigmatized areas.

The Evaluation on whether or not a treatment is a good idea to perform should be based on the potential benefits weighed against risks.

In any very grey areas of the course of treatment, patients are given the power to decide for themselves, once they have been advised as to the risks and potential benefits of each treatment.

An 100% diagnosis is not always required for treatment to be administered. Even if there is reasonable doubt, situationally it can sometimes be considered beneficial to treat without confirmation. This is usually the case when a diagnosis is either too time consuming or too complicated to confirm.

Severity is only a factor in deciding whether or not someone should receive treatment if there are high risks associated with it or there are issues with administering this treatment to mild cases. (e.g. Antibiotic administration.

The Situation as it Stands

Many of the Trans* activist community live in areas for which the concept of “Informed Consent” is seen as applicable to Trans* people, and they are able to circumvent many unnecessary restrictions. Unfortunately as of now in the UK, this is not the case. Even those suspected of deviating from the NHS’s guidelines are brought before the General Medical Council and accused of malpractice. For many then there are no other options but to go through the system. And this system is not forgiving.

NHS Limitations

Before you can even see an NHS professional, you must jump through an enormous amount of hoops. Firstly, providing your GP is at least Trans* tolerant. (Most aren’t informed of the protocol), you hopefully will obtain a referral to one of the few GICs in the UK. Even if this happens, there is a waiting list in excess of a year for these clinics. (That’s a year waiting without treatment for one of the highest suicide risk-groups there are)

I mentioned there that most GPs don’t know how the system works, well this is very rarely overlooked. I challenge anyone here to find any Physical Condition which requires patients to put their own research into what the GP needs to do to do their job. I am willing to bet £20 over PayPal to anyone who can find me a significant number reports that show this happening. This acceptability for lack of knowledge, but more so the expectation of the obtaining of information being the patient’s responsibility isn’t found anywhere outside the numerous stigmatized health issues.

So let’s say your GP knows what to do, they send off a referral the next day. Now what? Well it’ll take about a month for the GIC to even get back to you, which they will send you a form that needs to be completed, sent off and received before you are then put on to the long waiting lists. Now take this over a year down the line and provided you haven’t killed yourself you will be given an appointment with about 3-4 weeks notice. If you cannot attend this appointment, you must give 2 weeks notice, if not you are removed from the system, and back to square one. Provided the obvious extremely small window of opportunity for the Royal Mail to deliver your letter and for you to make arrangements to see if you can attend. (Keep in mind many people make journies across the entire country to attend these)

I’m now going to say something which might surprise a few members of the higher up parts of the NHS. Lots of Trans people don’t have stable housing, let alone transport. It can cost money to get to these appointments, and one tiny problem in that 2 week window before the appointment that prevents someone from attending because say, they have parents who are intent on stopping them can throw all progress away. If by some miracle you make it through the wait, and find some way to attend. Now do you get treatment?

The NHS decides: No

NHS Policy dictates that 3 months of gender specific counseling is required for the administration of Hormones. So okay? Why not see a gender specific counselor during the long wait period? Well, obviously the only way to obtain the counseling you need to qualify is you guessed it. Through the GIC. The NHS’s justification to this is to reference some false idea of “Regret Rates”, which are remarkably low. What regret rates are primarily composed of statistically (at least the part they are attempting to remove) is that which comes from misdiagnosis. Essentially someone who thinks they’re Trans* but decide that they are not later on. While it can be argued quite well that there are very few cases of this actually happening, a much easier reason undermines that rationale.

That’s not how medicine is practiced. It simply isn’t. What’s happening here is an inflation of supposed risk, not only the concept of regret but the actual idea that regret from going on HRT is somehow comparable to the significant risks posed by other health treatments. Regrets for going on HRT certainly are not as statistically life threatening as going without treatment. (See 40% attempted suicide risk, for example). If this were any other condition and they used the actual same philosophical backbone rather than trying to mask it in a transphobic concept of “regretting”. It would be fine. We don’t call statistically unsuccessful treatments to conditions as being “regret rates”, we don’t refer to people who have suffered rare and life threatening side effects as a result of treatment as “regretting it”.

It’s downright childish to approach someone who took risky medication to treat a life threatening condition and suffered for it, and to say “Bet you regret taking that medication!”. And it’s simply moronic to then take that example and start to apply restrictions on offering this treatment. If you dig down the rationales and the specific terms they like to apply to Trans* people, the reality is very clear. It’s simply undermining people who need help, it’s treating is unlike any other similarly threatening condition. The risks are far less, the treatments are far more effective when compared to similarly threatening conditions which are offered treatment without question. And it comes down to the same ignorant baseline which is “Well Gender Dysphoria isn’t really a medical condition.” just as with mental illnesses where people say “well they aren’t real illnesses”. The constant attempt to dismiss and undermine the validity of conditions is toxic.

I wish there was another side to this, I really did. But everything about this approach of restrictive treatment is wrong. It doesn’t line up with the rest of the medical approach, which means that either it’s not being treated properly, or that somehow Gender Dysphoria shouldn’t be treated like a real medical condition. And I’ll give you a hint. It’s the former. This system needs to change, and it needs to change now.

Final Word

I wanted to say as a final word to voice my admiration of the bravery and strength of those who go through the system in the UK. It’s horrible and forces people to do things they shouldn’t need to do for basic care. If you’re someone who’s been through the system first hand please contact me with your stories, I’d love to hear them.