Content note: mention of transphobia, fatphobia, gender dysphoria, ableism, brief mention of sexual abuse
I had my first appointment with the Gender Identity Development Service (the UK’s gender clinic for children and adolescents) in March 2017. I was fifteen, I’d been struggling with depression and gender dysphoria for as long as I could remember, and couldn’t wait for my appointment with the ‘experts’ — the people supposed to know how to help me. I had absolutely no idea what was in store for me.
Being referred back in 2016, I had a privilege that trans people today don’t have: a waiting time of ‘only’ eight months. Today, one recent investigation suggests you’re looking at an average waiting time of 25 years. I can say without a doubt that if I had been faced with this, I would not have survived. And trans people today simply aren’t surviving: many trans community members have died by suicide whilst left on these waiting lists, and NHS England have been accused of attempting to cover up the extent of these deaths. Understandably, then, the trans community spends a lot of time talking about waiting lists. For most of us, the main issue with NHS gender-affirming care is its absence. But after spending almost ten years under gender services, my concerns extend far beyond the issue of access.
I feel a deep responsibility to recognise the privileged position I am in, having been able to access gender-affirming care at all, and so I’ve only recently come to recognise my experience with gender services for what it is: trauma. For far too long I thought I was simply experiencing the reality of the UK healthcare system. Particularly as a child, I had no reason to doubt the motivations of the people and the systems that I was told were there to help me. So when the clinicians led me and my mum into separate rooms, I did my best to push down my anxiety. My mum had already been warned (off the record) that autistic kids had a very hard time accessing gender-affirming care at all. So seeing as it said “suspected autism” on my file, I knew it was my job to prove that this wasn’t true at all (spoiler: it was).
The questions began as I expected:
When did you start to feel different? When did you first learn about trans people? When did you tell your mum? How have your friends and family reacted?
They were hard questions, of course, but I understood why they were being asked.
The clinician then asked, very bluntly, if I had ever been sexually abused. I said no, and she kept pushing. Was I 100% sure? Really?
She asked me relentlessly about my dad, who I have never met.
How do you feel about never having met him? Do you wish you had a dad? Do you feel you have to fill that role in your family yourself? Do you think that if you were born a boy, he’d have decided to be in your life?
It got more invasive as it went on.
Who do you have crushes on in school? Boys or girls? Are you sexually attracted to them? Have you dated anyone? Have you had sex with anyone?
Which parts of your body do you like and not like? Which parts of your genitals are you uncomfortable with? How often do you masturbate? How do you masturbate? What do you fantasise about when you masturbate?
Sadly, I did not come out of that appointment feeling violated, understanding that those are disgusting questions to ask a child, and knowing that I didn’t deserve to be treated that way. Instead, I came out deeply terrified that I had answered the questions wrong, and that they would refuse to help me.
I’ve spent the last ten years memorising the correct answers to these horrific questions, and slowly worked my way through our antiquated and frankly abusive system. Whilst I’d really like to think that things have improved since 2017, I’m struggling to find much evidence of that. Ten years later and I’m still faced with coercive practice at every turn, both from the gender clinic and the specialists that work with them. The few trans people I know that have worked this system report similar experiences.
I eventually got top surgery in 2021, with a surgeon that pinched me so hard in my consultations that I would cry in pain, that made offensive comments about my body, and did not listen to what I wanted my results to be. But I had no other choice but to put up with it, or I wouldn’t get the lifesaving surgery I needed. This year I was denied access to lower surgery, because of my weight. The surgeon made it clear that he didn’t want me to lose weight because of medical reasons, but because the results would “look better”, if I was thinner. He’s the only surgeon available, so I have to do as he asks.
And yet despite all of this, in terms of gender-affirming care, I am one of the most privileged out of every trans person I know. I made it into a system that seems impenetrable. I got hormones and top surgery under the NHS; I’m close to getting bottom surgery. There will come a day soon where I come out of the other side of a system that my friends and family can’t even enter. Yet this privilege comes with the knowledge that waiting lists are only one part of our problem.
What are we supposed to do when the people who are supposedly there to help us abuse their power? Going through coercion and trauma shouldn’t be a condition of accessing lifesaving healthcare.