Stock photo of hormonal pills. (Photo by BSIP / UIG via Getty Images)
Gender-affirming healthcare for trans and non-binary people is under attack, legally and politically, in the UK.
We saw this with Keira Bell’s well-funded trial, which almost succeeded in making transgender children need court approval to get puberty blockers; we see it with the fact that the trans healthcare crisis means that a trans person in London who goes to their GP today for a referral to such a clinic can wait up to 26 years for a first. appointment, through the current admission rate; and we see it every time a politician bleats about “only women with a cervix” a lie that stems from the fact that many trans and non-binary men have difficulty accessing testing cervix and timely reproductive health care.
Transphobic rhetoric of how gender-affirming surgeries are “mutilationAnd lies about how hormone replacement therapy leads to “infertility 100% of the time” are widespread, shared by “gender critical” activists, heterosexual newspaper columnists and regularly slipping into debates parliamentarians.
But why are cis people so concerned about gender-affirming healthcare for trans people, when they themselves receive gender-affirming healthcare all the time?
Let me explain it to you with a story. A few years ago, one of my roommates was prescribed by his GP a testosterone blocking drug called spironolactone. She suffers from PCOS and the doctor said the spironolactone would help treat some of the symptoms she was experiencing, such as increased hair growth on her body and face.
She left the appointment, the prescription literally in hand, and picked up the medication from the pharmacist a few minutes later. After trying spironolactone she found that she liked the side effects even less so she stopped taking it. And then she asked me if I knew of any trans women who might want the drugs she left behind – because trans women, too, are prescribed spironolactone to block their testosterone.
But the vast majority of trans women in the UK cannot get spironolactone from their GP. If they wanted to block their testosterone, which many trans women do, they would start with a GP appointment, which would lead to a referral to such a clinic, then a wait of several years before a psychiatric evaluation and a referral. clinical gender diagnosis. dysphoria. Then they could be prescribed a testosterone blocker – and, most likely, the hormone estrogen as well.
This inequality of access to hormones is not limited to spironolactone. When I wanted to try taking testosterone, I first had to go to my GP for a referral, which allowed me to spend several years on a waiting list at a clinic. kind of the NHS. Finally, I had two two-hour appointments, one with a social worker and one with a clinical psychologist, to discuss everything from my childhood to my sex life to my mental health. I have received the valuable diagnosis of Gender Dysphoria, which enables me to obtain gender affirming hormones and surgery. Then, finally, I was prescribed a testosterone gel.
If I had been a cis man, say in my forties, struggling with low libido, depressed, and a bit of a bad mood, then maybe I would have seen my GP as a first stopover as well. But there the similarity ends. As a cis male, my GP could order a blood test and, if my testosterone was low, send me to a specialist (after waiting several weeks rather than years) who could prescribe a gel. of testosterone. Note: no waiting for several years, and no need to obtain a clinical diagnosis to prove myself.
In either case, testosterone gel is used as a gender affirming treatment. But the way the same medicine is prescribed is very different.
Gender-affirming healthcare: not just for trans people!
It’s not just the hormones that cis and trans people use to assert their gender.
Breast jobs? Gender affirming surgery. Hormone replacement therapy for postmenopausal cis women? Gender affirming healthcare. Hair transplants for bald men? Gender affirming treatment. Viagra? Gender-affirming healthcare, definitely.
I would say, and gladly do, that in many cases a cis person who goes to the gym, gets a tattoo, shaves their legs, wears a bra, colors their hair, or puts on makeup acts in a way who, for her, affirms their gender – as unlikely as it is to recognize that this is what they do.
But there is no £ 250,000 participatory lawsuit claiming cis men should not have access to Viagra. It might have been money better spent.
And that’s because when cis people assert their gender – whether it’s through the clothes they wear, their hairstyles, their jewelry or, yes, the surgeries they undergo to better assert their gender – it does not matter. It’s ordinary. So commonplace, in fact, that we don’t even see it that way.
However, when trans people assert our gender through the way we dress, our hairstyles, our jewelry or, sometimes, through medical interventions like taking hormones or surgery, it is very important for them. cis people. It is seen not only as health care, like what they have, but trans health care. And as such, they feel the need to not only control it tightly, but also oppose it and make it harder for us to have it.
And for those of us who speak publicly about aspects of our own personal medical transitions, they think there is nothing wrong with telling us exactly why they think what we have chosen to do with our bodies. is disgusting – in language that would be rightly blasted if it were aimed at cis people. Trans people are expected to accept some level of abuse if we speak publicly about the gender-affirming health care that we have access to, in a way that a cis woman taking hormonal contraception or a man who dying her hair graying might be surprised to find out.
The answer is not to restrict access for cis people to gender-affirming health care, but to facilitate access for transgender people. Hormones should, as trans civil rights activists have long argued, be available in GPs and sexual health clinics on an informed consent model – in other words, in the same way that the same hormones are already available for cis people. And why are some drugs available in large supermarkets, while others are not? Codeine and antihistamines at Tesco, but not testosterone? Why?
The previous examples of testosterone and spironolactone aren’t the only hormones where we’re seeing this health inequality between trans and cis people play out. We see the same with estrogen: readily available to cis women as a hormonal contraceptive from their GP, but extremely difficult to obtain for trans women, who must go through a gender clinic and psychiatric assessment to access the same. medication.
In fact, most trans healthcare is actually cis healthcare, if you think about it – very few speech-language pathologists, laser hair removal specialists, or penis-building surgeons for trans men who are trained. originally to offer their services to trans people. Their services were first aimed at cis people, then adapted to trans people.
And the fact that cis people are happy to have these different forms of health care to themselves, but vehemently oppose them when trans people want, brings us back to the question: why do cis people care. gender-affirming healthcare for trans people and not binary people? Health care may not be their problem after all.