Trans Health

On Friday 13 September 2019 the first in the list of Trans News items on the Google News page is from the BBC: Transgender waiting lists 'putting people at risk'.
The article discusses how long people that identify as being Transgender sometimes have to wait before receiving any specialist medical help.
It begins with the words:

Transgender people are being put at greater risk of suicide and self-harm because of "unacceptably" long waits for specialist medical clinics in Scotland, according to campaigners.

The Scottish Trans Alliance (STA) (which has been funded by the Scottish Government Equality Unit since 2007) is mentioned in several places in the article.
The article also mentions that:

At the start of 2019, almost 300 people had been waiting more than a year for a first appointment with a specialist.
NHS guidelines say gender dysphoria is a condition where a person experiences discomfort or distress because there is a mismatch between their biological sex and gender identity.
The condition is not covered by the NHS's 18-weeks referral-to-treatment target but the STA thinks the first appointment with a specialist should be within that timescale, because delays can take a "real toll" in terms of depression and anxiety.

The article also includes an analysis by BBC Scotland Health Correspondent Lisa Summers.
The analysis includes some of the story of some of the experiences of a trans man named Alex McIntosh. And also Dr Jo Gardiner, a GP who has seen a growing number of transgender patients.
James Morton of the STA mentions:

The long waits to begin hormone therapy in particular can put people at greater risk of hate crime.
If you're trying to live in your gender identity in society, but you haven't been able to access hormones or surgery, then your physical appearance is more likely to indicate you are trans.
So it can create a high level of risk in social situations and take a real toll in terms of depression and anxiety.

And my thoughts?
The National Health Service (NHS) in the UK is under pressure from many sides. It's has a difficult job to do in balancing funding with meeting the needs of people. Over recent years there has been quite a lot written and said about failings in the provision of mental health care. For example there's an article in the Guardian here, and from the Parliamentary and Health Service Ombudsman here.
There's an article in the Lancet entitled Trans* health: “diversity, not pathology which mentions:

“Being transsexual, transgender, or gender non-conforming is a matter of diversity, not pathology”. This statement is from The World Professional Association for Transgender Health (WPATH) Standards of Care, 2011 guidelines, which provide clinical guidance for health professionals and challenge medical classification that has long considered gender identity disorder, a term that has largely been replaced by gender dysphoria, to be a mental health problem.
As WPATH point out, “some people experience gender dysphoria at such a level that the distress meets criteria for a formal diagnosis that might be classified as a mental disorder.” However, gender dysphoria is not caused by psychopathology or mental illness, but is mainly an issue with identity. Misdiagnosis, or simply overlooking gender dysphoria is misleading, unhelpful, and harmful. Not only does it compound social stigma but it also misinforms the medical profession. Gender dysphoria is not a mental illness; however, internal biological conflicts—a yearning to live in the gender role dictated by the brain, not the genital sex, or phenotype—might lead to a mental health diagnosis.

The NHS says:

Gender dysphoria is a condition where a person experiences discomfort or distress because there's a mismatch between their biological sex and gender identity. It's sometimes known as gender incongruence.
Biological sex is assigned at birth, depending on the appearance of the genitals. Gender identity is the gender that a person "identifies" with or feels themselves to be.
While biological sex and gender identity are the same for most people, this isn't the case for everyone. For example, some people may have the anatomy of a man, but identify themselves as a woman, while others may not feel they're definitively either male or female.
This mismatch between sex and gender identity can lead to distressing and uncomfortable feelings that are called gender dysphoria. Gender dysphoria is a recognised medical condition, for which treatment is sometimes appropriate. It's not a mental illness.
Some people with gender dysphoria have a strong and persistent desire to live according to their gender identity, rather than their biological sex. These people are sometimes called transsexual or trans people. Some trans people have treatment to make their physical appearance more consistent with their gender identity.

According to this article in The Independent

The World Health Organisation (WHO) no longer categorises being transgender as a "mental disorder".
On Saturday 25 May [2019], the health agency approved an update to its International Statistical Classification of Diseases and Related Health Problems (ICD-11), a manual used globally to diagnose diseases.
The decision to remove transgender identities from the ICD-11's classification of mental disorders was announced by WHO in June last year.
The update has now been approved via a vote held by the World Health Assembly, the WHO's governing body which represents the organisation's 194 member states.
The changes to the health manual will come into effect on 1 January 2022.

The view is that to be transgender is not to have a mental illness.
Having said that, to be trans and to have to  hide the fact can cause distress. And sometimes that distress can be so great that it can lead to mental health issues.
It's vital that the NHS either invests more in making specialist help available to people that identify and being trans much sooner than seems to be the case at the moment, or changes the way that services are provided so that GPs are able to offer better support.
To be honest, though, probably both of these are needed.

Girls, Guys, Shades of Gender, Suspender Belts and Pay Cuts

A little while ago I was involved in conversation with a transvestite that raised some thought provoking ideas.

She seemed to feel that all transvestites are on a path that leads to a need for more and more time to be spent as a girl. Less and less as a guy.

That as time passes there’s a need to be more and more girl-like and less and less guy-like.

And that there’s an inevitability in all of this for all concerned.

As we talked I expressed my disagreement.

For myself I feel at peace with where I am at. My life is a mix of guy and girl, masculine and feminine. I don’t feel a need for the balance that there is at the moment to change.

I know that different people have different feelings and experiences. But I also know what my own are.

Actually at times all these kind of terms can get surprisingly confusing.

Girl, guy. Man, woman.Male, female.Masculine, feminine.Gender, sex. And I think that we (including myself) sometimes use some of these words interchangeably when they aren’t always quite so interchangeable.

However, having spent a little time looking around the WEB at definitions of some of these terms, there seems to be some confusion there as well.

There’s an interesting article here: Sex Difference vs. Gender Difference? Oh, I'm So Confused! – but it isn’t easy reading.

There’s an article on the UK National Health Service WEB site entitled : Gender dysphoria which also seems a little odd. It says:

Biological sex is assigned at birth, depending on the appearance of the infant. Gender identity is the gender that a person “identifies” with, or feels themselves to be.

and also says:

Gender can be defined using very narrow medical terms such as what types of chromosomes you have, or what types of genitals you were born with. However, many transsexuals (and also many experts in the treatment of gender dysphoria) find this type of narrow definition both unhelpful and offensive.

Whilst the World Health Organisation says:

"Sex" refers to the biological and physiological characteristics that define men and women.

"Gender" refers to the socially constructed roles, behaviours, activities, and attributes that a given society considers appropriate for men and women

My own feeling is that there is more to gender than the World Health Organisation gives credit to. And they definitely have a different understanding of the word sex than do most of the people that I know.

I have a feeling that somewhere in all of this the word psychology should also appear.

I’ve heard it said, and I think that I’ve mentioned it previously in other blog posts, that there’s a view that gender is a line that joins masculine to feminine and that different people are at different places along the line.

There are times when people feel compelled to live their lives as though they were at a position on this line that they don’t really feel that they are really at.

Sometimes even at entirely the wrong end of the line.

Also, for many, the pressure to conform to a role that is either purely masculine or purely feminine has been intense and damaging.

The good news is that the pressure is, in some places at least, lessening. People are being allowed to be themselves. There’s still a long, long way to go, but at least things are moving.

I have this feeling that there are many more than 50 shades of gender, and that they aren’t all grey.

Over the years I’ve grown to accept and, in a way, celebrate, my own gender and have been fortunate enough to have family and friends that are able to accept it as well.

I feel that my position isn’t at either end of the gender line and I’m OK with that. The makeup and feminine clothing that I wear at times is an expression of this.

Actually it’s not just about gender in the sense of socially constructed roles. Nor is it just about sex or genital surgery. It’s more about who I feel that I am. It’s an expression of myself.

I think that different people are in different places when it comes to gender.

That there are lots of people that are in the process of still discovering who they are and where they are.

In a way, perhaps we all are still learning and still making discoveries about ourselves. And if we’re not then maybe we should be?

And I’m sure that the world is always a nicer place when people are allowed to be themselves when the way that  they are and the things that they do are of no harm to anyone.

And then … here’s a list of a few gender characteristics taken from the World Health Organisation:

• In the United States (and most other countries), women earn significantly less money than men for similar work
• In Viet Nam, many more men than women smoke, as female smoking has not traditionally been considered appropriate
• In Saudi Arabia men are allowed to drive cars while women are not
• In most of the world, women do more housework than men

There’s no mention of makeup, nylon stockings, suspender belts, skirts, blouses, dresses or high-heeled shoes.

Instead it’s a list of things that seem to be a result of men exercising unfair and unreasonable control over women. Although, I guess the smoking in Viet Nam represents something of an own-goal scored by the men.

And, ok, to be honest, I’ve heard is said that the history of high heeled shoes fall into that category as well. And there are perhaps people that would say the same of stockings and suspender belts.

As I said earlier. It’s a complex business.

But, for myself, I’d definitely rather have the suspender belt and stockings than a pay cut. Though immeasurably better would be the suspender belt, stockings and equal pay for equal work.