Trans Healthcare and my Experience at Nottingham Gender Identity Clinic

Content Note: medical abuse; sexual assault; cissexism; transmisogyny

Any trans person who knows anything about their history will tell you that we haven’t exactly got along with the medical establishment (to say the very least). As hopelessly naïve as I was, I thought things would be at least a little different now, in 2013, after the huge strides in trans activism and awareness in recent years. I thought that even if the care I received turned out to be not so much care, and more “care”, I could still reason with them, that they might just change their mind if I only explained things to them. Everyone is, deep down, a reasonable person, right? How wrong I was.

I’ve been continually misgendered by one of the so-called “gender specialists”. I’ve been told off for wearing a t-shirt, jeans, and a hoodie, told that I’m not “feminine enough”, that I’m not straight enough, that I’m not emotionally stable enough, that I should be dressing and acting “like a woman” (whatever that is supposed to mean), that I need to find my gender role. I’ve been told that self medicating hormones for more than year and a half isn’t sufficient proof that hormones are right for me, told that I have no right to make decisions for my self, that I’m too contrarian. I’ve been told, I’ve been told, I’ve been told…

He. Him. His. Boy. Man. Male. Your right to self definition matters not to us. You’re not pleasing to the male gaze. You’re not submissive enough. You haven’t fully learnt and internalised your patriarchal socialisation yet.

I’ve been told that I need to socialise more, that I don’t have enough friends, that I need to get a job (I did work, but that wasn’t a “proper” job in their eyes), that I just need to “get out more”. Easier said that done when I’m autistic, living with crippling depression, anxiety, and am dancing on the knife edge of suicide. When was the last time you saw “getting a job and friends” a prerequisite to medically necessary treatment? I can just imagine the national outrage if such requirements were in place for heart surgery.

It would be a grave mistake, of course, to let someone become a woman before they’ve been taken down a notch. We can’t have anyone with any sense of self worth or agency belonging to the under class.

To make matters worse, the Nottingham Gender Identity Clinic requires that (lifted straight out of the WPATH Standards of Care, the main guideline used in the “treatment of transsexuals”):

“Prior to the commencement of hormone therapy […] the General Practitioner will be requested to carry out the following assessment: Full physical examination, including secondary sexual characteristics […]”1

I’m forced to choose between no access to hormones, surgery (if I’m able to pass through yet more asinine requirements), and correct identity documents (getting your gender officially recognised by the state can be difficult if your “new” gender isn’t a “legitimate” one, as authorised by a clinic), or nothing less than sexual assault.2 There is absolutely no reason given, nor any possible reason in existence, for a routine full physical examination before hormone therapy, none.3 Baseless, groundless, useless, pointless. Not only do they seek to control what I do with my body, but they seek to pester, poke, prod and pry into my body. Talk about doctor/patient power imbalance…

To make matters even worse, the trans people going to Nottingham Gender Identity Clinic are roughly the subset of trans people who experience body dysphoria, given that Nottingham Gender Clinic is supposed to provide a fix for said dysphoria. For many, including myself, the idea of being “fully physically examined, including secondary sexual characteristics” is horrific in any context, by anyone, in any situation. Unnecessarily forcing someone to go through a hugely embarrassing and emotionally excruciating examination as a requirement to fix the very discomfort the examination aggravates is nothing but cruel. For all their professions of wanting to help, their taking of the Hippocratic oath was an astoundingly hypocritical act.

I don’t think I’d be overstating if I said that the Nottingham GIC has blood on their hands. One Belgium study found that the suicide rate dropped from 29.3% to 5.1% after surgery,4 and given that hormones are required for surgery the suicide rate in people who are both pre-surgery and pre-hormones is probably even higher.

The Nottingham Gender Clinic, and trans healthcare at large, not only serve as the gatekeepers of hormones, surgery, and to some extent correct identity documents, but as the defenders of the patriarchal status-quo. Going through their process is a crash-course in the socialisation we didn’t receive from birth. The medical establishment would rather trans people didn’t exist, but since they have to grudgingly accept that we do, the establishment goes to the next “best” thing – making sure that the trans people they let be “legally trans” conform to cisnormative patriarchy and its gender roles as much as humanly possible.

The clinic and its laws and regulations are yet another leaf born from the same tree as the legislation that requires people with uteri to undergo transvaginal ultrasound scans or psychological evaluations before they’re allowed access to abortion. It’s the same patriarchal tools at work that attempt to destroy any sense of agency and humanity left in someone, the very same policing of minds, bodies and beings that’s revelled in by the abortion moralisers.

It’s a truly sad state of affairs. I don’t know where I’d be, or if I’d be here at all, if I couldn’t purchase hormones online.


Update: I finally got a prescription, and it only took 873 days, self-medicating for over two years, and having surgery on my own, to get it!

  1. Nottingham Gender Clinic Protocol (PDF): Role of the General Practitioners, Page 3

  2. I understand that, as a sad artefact of the privatised insurance industry, full physical examinations are a yearly affair in the United States (and maybe other countries), so this statement may seem a little bewildering to some readers. In the UK, however, full physical examinations or even general check-ups don’t happen at all unless a good reason presents itself, of which being trans certainly is not one.

  3. WPATH Standards of Care v7 (PDF): Appendix B, Overview of the Medical Risks of Hormone Therapy, Page 97. No contraindication that would require a full physical examination is listed in the WPATH Standards of Care v6 either.

  4. Long-term Follow-up: Psychosocial Outcome of Belgian Transsexuals After Sex Reassignment Surgery, Sexologies, Volume 15, Issue 2, April–June 2006, Pages 126–133