Nature abhors a vacuum, and it is no different in trans healthcare. Our investigation uncovers how a persecuted minority not only navigate oppression but also how vibrant social systems emerge in a community known for their compassion and sensitivity to the suffering of others.
For the last 50 years, hormonal transition had been tightly and exclusively regulated by the medical and psychiatric establishment. The balance of power was that they were the "experts" and got to gatekeep care, and that trans people were an illness to be treated. However, things have changed over the decades - although the control and oppression have taken a different form. Nowadays, transgender people, those with gender incongruence, are no longer a "mental health condition" to be treated by psychiatrists. The internet has revolutionised access to medication, information, and specialist knowledge concerning hormonal transition.
Historically, trans people were only "allowed" to transition if they met certain criteria: if they were pretty enough, if the psychiatrist thought they would assimilate, liked them, or those with enough money to fund their transition independently. The psychiatric system invented categories and labels that trans people were then forced to comply with in order to get treatment. As a result of these invented "taxonomies", communities became divided and fractured on spurious grounds. Sexuality and age of transition created an artificial divide, for example. "HSTS" and "AGP", these labels were invented by conservative Christian psychiatrist, Ray Blanchard. From this, certain communities felt they were the "real" trans people and others who weren't were derided and rejected. Tensions later escalated with community-assigned labels: between the "tu-cutes" (those who reject medical transition), and the "tru-trans" - those with physical dysphoria who choose to medically transition with lower surgery. And non-binary people, who may or may not be transgender, eventually sought recognition for a partial, or non-binary transition and gender recognition - something they are still trying to achieve today. Later, the concept of Blanchard's "AGP" was used by feminist groups to paint transitioned women as "perverts".
A natural result of HRT denial (as a result of an inability or reluctance to meet arbitrary conditions set by the phsychiatric community, amplified by oppressive healthcare regimes, governments, and states), was that numerous websites emerged helping trans people transition without medical intervention. Increasingly, people took control of their bodies, and chose to medically transition outside of the restrictive cis-supremacist structures that oppressed them. The result of this has been an increasing global unification within a community that has been historically fractured by psychiatric, medical and cis-supremacist control.
It was natural that trans people were initially worried about achieving the best transition and leaned heavily towards the medico-psychiatric model. Highly dysphoric trans people were told by their community that they would regret it, or they would make themselves unwell trying to achieve medical transition themselves. However, guidelines by established endocrinologists were now available, making dosing and treatment pathways easier. The medical grey market was well known to the trans community, and those with severe dysphoria often used online pharmacies to quicken medical transition before feeding into the established routes available on the NHS. Even 15 years ago, a wait to see a GIC was around about 2 years, necessitating prior generalist psychiatric evaluation, and an expectation to live "in role" without the help of HRT, voice therapy, or hair removal!
Increasing interference from, again, right-wing religious groups in the USA including "Alliance Defending Freedom" injected funding and misinformation to prevent hormonal, surgical and social transition. In combination and as a result of this, various tactics were propagated by feminist groups to dehumanise and "other" transitioned women. Access to HRT and surgery has been subjected to a concerted decade-long attack. Misinformation and disinformation quickly overwhelmed both established academic science and public opinion by means of the UK press, and slowly eroded trans people's human rights. The culmination of this in the UK was the Cass scandal, where the medical establishment was leveraged by the influence of these highly religious groups and feminists whose sole purpose was to deny trans people healthcare. Zinna Jones recently produced another commentary about this process. Quickly afterwards, a misinformed and overstepping Labour government, under the Christian evangelist Wes Streeting, enacted a total ban on medical care for those under 18 years.
As a result, parents of trans children are starting the difficult process of taking their children out of school to transition, or to pause puberty without suspicion. Some have found support in doing so amid existing structures, saying that it's often the case that autistic children or those with ADHD find school too difficult anyway. Following the ban, they and their children realise that there is no point in putting them through waiting games and conversion therapy of the proposed GIC's when they know deep down, that what their children need are puberty suppression or HRT and blockers. GIC's now offer effectively nothing to these families.
They are increasingly making the difficult decision to take the risk of separation, imprisonment, or having their children taken into care, against the risk of continuing harm, emotional turmoil, or the risk of losing them to suicide. We have heard from grieving parents who warn against the silent suffering of children and young people who stop asking for help from their parents, become hopeless and later suicidal with no apparent sign that anything was wrong.
Doctors who are aware of the scandal of Cass, and its conservative Christian roots, are caught between supporting the Hippocratic oath to "do no harm", realising that inaction is actively harmful, or to face prosecution. We talked with some who were informed, and would keenly turn a blind eye, although finding them is a lottery.
Trans people are creating tight-knit secret groups and buying HRT in bulk, in order to maintain their supply. Doctors hostile to trans people have already begun the process of denying transitioned women medical care with HRT even before an outright ban. HRT is essential in promoting health and maintaining healthy bodies, with no endogenous hormones, such medication is essential in maintaining healthy bones and preventing osteopenia. Activists in London, Aberdeen and Brighton have already established secure ways of ensuring their communities are not denied medication they rely on. We spoke to one of those groups, known only in secret under a codename, who were very positive about the direction they have found themselves in:
"We always wanted a system of informed consent, where trans people were given free access to medical transition on their terms. Perversely, the ban on puberty blockers is helping to achieve this. The fear of not transitioning without medical support and blood tests is now outweighed by the fact that it is increasingly difficult to do so. It's empowering for people to take matters into their own hands. We've even been approached by parents and families now, and we're happy to share our knowledge and expertise. We're developing guides and resources and even getting legal advice about what to do if they try to prosecute. Very few trans people we know these days are choosing to wait indefinitely for care, they just want to transition and get on with life, and we're finding people turn from despondent and depressed to happy and hopeful. We're giving people hope."
These underground groups are highly secretive, they rely on word of mouth alone, and trans people have been well versed in anti-oppression tactics. Antifascist groups who have been historically supportive, have been involved in advising them. People are assessed over time, smartphones are banned, and building trust and confidence is a key part of the process before anything is offered. As a well-known fully transitioned woman, I managed to accelerate the process, but I was still treated with caution. We all know what is at stake, and I was reassured that everyone took their role so seriously. The upcoming Levy review is poised to ban transition-related care for adults by using the same methods. Trans people are currently warning each other not to get involved with it. Transitioning "off-grid" now provides a reliable and sustainable alternative to state intervention.
Comments