Even their marriage certificate was confiscated. The proposed marriage equality legislation will not allow people such as Brown to have her original marriage recognized again.
This is a source of personal heartache, but Brown is convinced that trans people’s biggest single problem is access to decent healthcare. Within 24 hours of her creating the hashtag #transdocfail, she had been inundated with 2,000 tweets of trans people’s negative experiences at the hands of medical professionals.
“It revealed a massive level of abuse. If it was happening to any other minority it would be on the national news,” Brown says.
Another ongoing battle for trans people is to revise the WHO’s International Classification of Diseases (ICD) so that transsexuality is not listed as a mental illness. Ironically, this was added to the ICD around the time homosexuality was removed; campaigners such as Burns say it is useful to be in the ICD to help trans people access healthcare, but it should be “less stigmatizing.”
When they finally gain access to transition procedures, most trans people are positive about their hormone treatment or surgery. More of their complaints, however, concern everyday health problems and ordinary care from doctors.
Many trans people feel “absolute terror” when faced with revealing their medical history for an orthodox operation or treatment, says Brown, and believe doctors then treat them differently.
“It’s not just the [National Health Service] NHS that is institutionally transphobic, it’s the whole medical establishment,” Brown says. “This attitude that you’re not treating the person, you’re treating a condition. The moment people realize you’re trans, it seems they can’t see anything else.”
James Barrett is the lead clinician at the Charing Cross Gender Identity Clinic, the largest and oldest in the world, which receives 1,400 NHS patients a year, a figure that is doubling every five years. About one in five referrals end up having genital surgery. The media is obsessed with stories of regret; in fact, post-operative trans people wanting to return to their original sex are “vanishingly rare,” Barrett says. Of the 6,000 or so NHS patients he has seen over 25 years, just two have permanently reverted to their original gender role. Barrett understands some trans people’s frustration with the glacial pace of gaining access to surgery, but says if it was made easier — or the selection processes less stringent — there might be proportionally many more regrets.
Barrett admits his work is not well regarded among many health professionals and is critical of some doctors who treat trans people.
“It’s not a majority, but it’s an extremely substantial minority,” he says of general practioners (GPs) who are reluctant to refer patients on to identity clinics, or are unwilling to prescribe hormones when guided by consultants at a specialist NHS clinic.
“We have persistent problems with GPs who won’t prescribe for patients even though to do so is safe,” he says.
A Dutch study found mortality rates among treated trans people no higher than anyone else; Barrett’s clinic’s oldest former patient is 92.
In fact, says Barrett, it seems that some GPs are prejudiced or ill-informed: one stated it was against her Christian beliefs to prescribe hormones; another recently insisted no such treatment was available on the NHS.