Sunday, 8 May 2016

The Gender GP

I was browsing one day through Quora. It takes up far too much of my time, though I can’t seem to get away from it. As you might expect, one of the topics I follow on Quora (among plenty of others) is gender, and I was delighted to come across a doctor writing openly about gender issues, in particular trans-gender issues.

Helen Webberley: Gender GP
The doctor is Helen Webberley, a General Practitioner from the UK. Her website, www.gendergp.co.uk, offers amazing access to a sympathetic doctor: “advice on gender issues, counselling and diagnosis, blood tests and monitoring, prescription medication”. And it comes with a plethora of means to get in touch: an email address, a mobile phone number, and the option to do face-to-face video conferencing with Helen. There is also a series of short videos explaining her own views about transgenderism and its treatment, and explaining how Helen can help.

If you’ve read any of this blog at all, you will know how much I am looking for answers to my questions, not just about my own gender, but about the medical treatment of transgender people. You will also know how sceptical I am about the current state of the science behind gender treatment. I have (several times) approached doctors who treat transgender patients (including surgeons who perform sex reassignment surgery ) and also doctors who are themselves transgender, for their own perspectives. They have all quietly declined to be interviewed publicly.

So I wasn’t filled with confidence that Helen would agree, but I got in touch, and she replied immediately and very positively. Here she is, sitting on my virtual couch:

How did you first get interested in treatment of transgender people?

I have always been interested in equality and diversity – it has always appalled me that anyone should be bullied due to their size, colour, hair, gender, preferences, religion etc. I got very interested in Sexual Health in the 90s and did lots of specialist training in this area, and then taught widely on how the medical profession should not judge differing sexual behaviours.

When I became a GP in Wales, I had a transgender person asking me for help, and the nearest clinic was in London. I made it my business to find out more about gender issues and how to treat them, and how to help this person who couldn’t possibly travel to London. It was fascinating, and very rewarding.

What made you decide to pursue it as far as you have (the website, etc)? Why not just treat patients in your own region?

I love technology, and was intrigued as to why healthcare was so far behind the rest of business when providing services online. I made my own website www.mywebdoctor.co.uk offering free advice to those who couldn’t get in to see their GP. I thought it would sit at the bottom of the huge pile of websites in the sky, but I was surprised at how many people asked for help.

I had an idea to offer specific help for transgender people, so I made a special dedicated Transgender page. When I woke up the next morning, I realised just how big a need it was!! From here it has progressed to www.GenderGP.co.uk .

Do you still have a normal GP practice?

Doctor, doctor! Gimme the news!
Until April 2016 I was the senior partner in a GP practice in Wales. My interest and work with the transgender community has meant that I have had to let this go, as I no longer had time to do both. After a brief spell of ill health, I decided to pursue my current interest and now I am a freelance GP and a full-time gender specialist.

What opportunities exist for other doctors who want to specialise in the treatment of transgender people?

There isn't really any official training available in transgender care. But with access to the Internet, there is now endless opportunity for doctors to read policies, guidelines and research to help them to understand more about the needs of the trans community and how best to help them.

I really believe that gender care should be a routine part of General Practice, just as contraception and menopause treatment is. GPs are good at dealing with stress, family issues, workplace problems and hormones. These are the nuts and bolts of gender care and GPs should be offering this routinely.

I have found that a lot of the dysphoria that gender variant people suffer is not due to their variance, but the attitude and responses from society and, ashamedly, the medical profession. If we sort that out, we are a long, long way toward making gender care very simple and easy and less demanding on the doctor and the patient. Trans people are startlingly well-informed: listen to them about their diagnosis and management plans – they have done most of the work for us.

I am presenting a piece of work at the WPATH this year – "Gender dysphoria or medical dysphoria: what causes distress amongst trans patients?"

I find myself concerned about transgender children. How does one determine whether it's ethical to treat children for transgenderism, especially since no long-term studies have been done looking at the outcomes?

The children I have met have been amazing. The diagnosis is often so clear cut, and allowing them to go through a life-changing puberty, that so clearly doesn’t match their true gender, is bordering on inhumane.

By blocking puberty and giving them time to mature and understand what they want and need for their future, you are preventing them from having to have life-threatening surgery in the future, and a life of mismatch and potential humiliation.

I so totally agree with you about the lack of evidence, and that we are guessing and feeling our way, hoping it is right. But we need to prevent transgirls developing into big hairy men, and transboys developing into shapely, delicate females. There is a reason why the suicide rate is so high in this group, and we must stop their bodies developing wrongly.

If you could wave a magic wand, and change one thing about the treatment of transgender people, what would it be?

Allow them to help shape and dictate their care. If they want to try hormones, take hormones, have an operation, change their bodies – make it easy for them, not the huge struggle they seem to face at the moment.

It seems that transgender issues seem to have burst onto the public stage in the last couple of years. Do you have any thoughts about why this might be? And where it might all lead?

The true prevalence of transgenderism of any degree (remembering that gender is a spectrum on which we all lie, somewhere between 0 and 100%) is massively underestimated, I expect. In the 80s, people felt more confident to come out as gay, and the same is happening now for the trans community. We are about to see the true extent of exactly how common it is to have some variance with your gender. Is ‘male’ and ‘female’ a human generated idea – and have we got it all wrong?

Human X and Y chromosomes
The concept that there are two genders is wrong (in my view). There are two sex-determination systems – XX and XY – and our society has presumed that our gender identity matches those and has made this dictate everything from what you should wear, to what job you should have, to what role you should take in life, to what bathroom you should use, to what gender you should choose to marry.

In the olden days, we also presumed that our sex-determination system also matches our sexual identity (who we are attracted to), but look how wrong we were about that. Again, society dictated that there would only be one sexual identity and we made all the rules about marriage and commitment to fit that. Latterly we have had to re-write the rulebook.

I believe that everyone is on a spectrum of gender (identifying as male or female or somewhere in between) and identity (fancying men or women or anywhere in between) and preference (liking pink or blue or fairies or sport or animals or trains). Society shapes this and suppresses our liberty to express somewhere else along the spectrum. I would love to see what happened in a new society, born without rigid rules and constraints and expectations. Would I have been a very feminine heterosexual?

My video talks about the sphere of diversity, and in that sphere are lots of spectra, and where we lie on each spectrum gives us a unique point within the sphere, unique to you and to me, and excitingly different.

Do you ever refuse to treat someone for gender issues? How do you determine if a person is suitable to be treated or not?

I would be very concerned about someone whose gender issues seemed to stem from a bad experience in earlier life. For example a person who wanted to hide from their genitals and sexuality due to a previous history of sexual abuse.

As my service is a remote service, I do not treat anyone who is shown to have manipulated the system in order to get medication.

Most people are absolutely honest and genuine and so grateful to have the chance to get the care they need, but sometimes I have to signpost people back to their GP.

Have you ever come under criticism from colleagues or the public for what you do?

Oh yes. In one year I have been reported to the GMC twice (but they have found no concerns) and threatened to once – all by leading doctors in this field in the UK.

AMAB? I thought you said...
A transmale counsellor working in the field said I wasn’t qualified. A well-known psychiatrist said that I wasn’t qualified and did not do a comprehensive enough assessment. If the diagnosis of an AMAB who has been cross-dressing for years, and would now like to develop some soft skin, breasts and shapely thighs isn’t a clear enough self-diagnosis, what is? Gay people don’t need a psychiatric evaluation before they are allowed a same-sex marriage. Not all people with abdominal pain are excluded for delusions before taking out their appendix.

Some of these healthcare professionals are supposed to be caring and helping the trans community, but the stories I hear of people’s experiences in their GIC make my toes curl, so I am not surprised that I am not always treated with respect. I wonder whether they are just keeping the GIC waiting list so long to fuel their private practice. I can’t see any other reason that they would not welcome an experienced GP who is helping relieve the burden of their work.

One of them publically wrote about how gender care that is straightforward should be delivered by people’s GPs, and in the same month I received a letter of concern from him via the GMC for doing just that!

Gender care needs to be brought under the auspices of General Practice, and done by good old (modern) GPs who are used to dealing with everyday people, every day. If we don’t start encouraging GPs to embrace this field of medicine, then the waiting lists for the GICs will soon be 10 years, not 2!

The public have been great, I have received so many letters, cards, reviews, testimonials – and every one has been truly complimentary. I have changed many lives for the better, and I expect saved a few desperate lives of people who thought they had nowhere else to turn.

Do you have any thoughts about the autogynephilia model of Bailey and Blanchard?

I had never heard of it so I just looked it up. The majority of transgender patients I have had the pleasure of treating could no way fit into this model. I guess that these ideas could be made to fit some people, but to generalise and say this theory explains gender issues is outright wrong.

I have never really thought about the philosophical arguments so much. I have always concentrated on the physical, psychological and social needs of my patients, so the theory is interesting but a bit mind boggling!

Which famous person would you most like to meet, and why?

My family and friends laugh at me because I just have no interest in ‘famous’ people. I would like to be famous for really transforming gender care in the UK and the rest of the world. I would like to shake hands with my future self for helping trans people to access safe and easy healthcare without fear of humiliation, prejudice or judgement.

===

As always in my interviews, I like to reflect a little about the answers.

First, Helen seems to be extremely unusual: a doctor who treats trans people and is willing to talk about it openly and willingly. She seems so open, so inviting, in contrast to the attitude of many other (but not all) doctors, which seems to be to be with awkwardness and silence (a vestige, perhaps, of the “shame, secrecy and trauma” which Alice Dreger talked about with intersex children).

Accepting: Webberley
In addition, Helen offers a multitude of ways for people to get in touch with her, which leads me to wonder how she can possibly get any work done. I seem to be forever answering emails, and I don’t have people all over the world asking me about hormones!

I approached a surgeon who performs sex reassignment surgery, and he declined to be interviewed. In fact, he was barely polite with my request. He would not consent to be named publicly. When I offered him an anonymous interview, he was sure that he would be recognised by his answers.

So I guess my point is: so what? If you are a doctor, and you are performing perfectly legal operations, believing in good faith that you are acting for the benefit of your patients, why should you hide? Surely you either believe in what you do, or you don’t. And if you don’t, why are you doing it?

Helen comes across as completely the opposite. Open, friendly, non-judgmental. Willing to discuss some very sensitive issues very freely. I see her very much as a step in the right direction: the direction which says that you don’t need to hide if your gender doesn’t quite fit the slot, but are deserving of sympathy and acceptance and respect. She isn’t hiding; instead she is out there trying to be noticed.

I found myself surprised (read: astonished) that she had never come across the autogynephilia model. I thought everybody knew about that one! But again I find this refreshing: that someone can come to a field (you might say a minefield) like gender, and just apply their own take on it, and be so positive, without being subject to what other people want you to think about it.

I couldn’t help challenging Helen on some of her practices. I believe medicine should be guided by science, and yet the science is lacking in a lot of areas. Again I found her answer refreshing: “guessing, feeling our way, hoping it is right”. How humble, and how different from the dogmatic certainty of people like Paul McHugh.

I am impressed (in case you couldn’t have guessed) with Helen. I find myself hoping that she is in the vanguard of a new wave of doctors: open, receptive, non-judgmental, willing to listen to trans people instead of dictating to them . I wish there were a hundred like her—and perhaps soon there will be.

My thanks, as always, to Helen for her patience, not just with my questions, but with my flurry of emails requesting clarifications on several points. My thanks, too, to her husband Mike for reviewing the final draft.

Form an orderly queue, please. The doctor will see you now.

Tuesday, 3 May 2016

Top of the Pops

I've got quite a numerical mind, and I am always interested in my statistics. I check my hit counter most days, and I enjoy watching what happens as the posts rise and fall in popularity.

Best chart show ever: TOTP
Sometimes a post from a while ago will experience a curious surge in popularity over a few days. Sometimes my blog will appear to suddenly become popular in a new country (Hello, Ukraine!). Why does this happen? I have no idea, but it's fascinating to watch.

What's very interesting to me is that I seem to have no ability to predict in advance which posts will be the most successful or popular. There are certainly some surprises in the Top 10, posts which are much more popular than I ever expected them to be.

Conversely, some of my favourite posts (in a personal sense) don't seem to have done all that well, and again I wonder why this is: am I completely missing my intended audience? While the blog is all about me, the hit counter is all about you, the reader, and shows me where your interests lie.

If this were a glittering award ceremony, I would be announcing the winners from a golden envelope, in no particular order. However, it isn't, and I am not. Instead, I here are my top 10 blog posts by number of hits (as I write, the total hit counter is 373,416).

(1) Jan Hamilton. The winner, with 10,047 hits. No real surprises here: the former soldier turned reporter has attracted considerable public interest over the last few years, and appears again at number 10 in this countdown.

(2) Jaye Davidson. A close second with 9,635. Again, not a surprise. The ephemeral Jaye Davidson sprang to celebrity in The Crying Game in 1992, playing a beautiful transwoman. After a brief appearance in Stargate, in 1994, he retired completely from acting. Ever since, or so it seems, everyone has been asking: what happened to Jaye Davidson?

(3) Female Bodybuilding comes third with 9,051. This is my first real surprise. I can't really account for why this article has been so popular. I suppose the subject matter must be especially compelling.

(4) Women who Crossdress comes next with 6,008 hits. A fair way behind the top 3, this is another surprise to me. Again, I suppose the subject matter must be interesting. While (1), (2) and (3) are quite close numerically, so are the next four entries.

(5) Leah True, with 5,774. This one doesn't surprise me. Like Jaye Davidson, Leah is beautiful, fascinating, and gone from public gaze. A lot of people looking, and I guess they end up here. I've tried to contact Leah and never managed it.

(6) Men With Long Nails, with 5,457. Again a surprise. Why should this subject be so compelling?

(7) Emma Ballantyne, with 5,423 hits. Scottish Emma has the famous YouTube channel, starrynowhere, which has over a million hits. She also allowed herself to be interviewed by me here, though this post (curiously) has only had 3,288 hits.

(8) Helen Boyd Interview, with 4,741. Helen Boyd needs no introduction at all to anyone even remotely trans. Here she answers my questions. Although she is so famous, she has her own very successful and popular website, which means people don't need to come here to find out her latest.

(9) Gender Variants on Facebook brings in 4,021 hits. This topic was very popular a couple of years ago-- though I notice that they still haven't introduced gender variants in my country. Come on, Facebook! Get with the program!

(10) Abigail Austen has rushed into the top 10, despite being one of my more recent posts. Not a surprise, since her latest documentary, and book launch, have brought her once more into the public eye.

Writing is better with nice nails
When I look at this top 10, I can see two clear patterns. First, celebrities (Abigail, Jaye, Leah, Emma). Between them these four are responsible for a lot of internet traffic; no surprises at all that some of it should find its way here (though my article about Caitlyn Jenner has scored only 408 hits). The second group seems to be articles about the boundary (the sometimes uncomfortable boundary) between male and female: female bodybuilders, female crossdressers, men with long nails. In this theme, I've also written about women with beards, and men in skirts. My article about That Whole Bathroom Thing, another ongoing issue, can be found here.

While we wait for the applause to die down and the speeches to finish, I would like to point your attention to some of my posts from the archives, which I think are deserving of a little more attention than they received at the time. These are in temporal order, starting with the oldest. These are some of my favourite posts. Why not take a look, and maybe even leave a comment?

(1) Lyn Tornabene and the Red Queen was one of my better early posts. Written back in 2012, it has gathered in only 574 hits. In it, I discuss the theme of pretending to be something other than your natural self, and how this relates to my own feelings about crossdressing.

(2) The More Things Change... was also one of my favourite posts from 2012, and has managed only 480 hits. It discusses one of history's most famous crossdressers, Lord Cornbury.

(3) Subfuscation! has scored only 427 hits. It's a whimsical discussion of the clothing restrictions facing students at Oxford University.

(4) My article about Japanese artist Yasumasa Morimura has managed only 738 hits, despite featuring Morimura's homages to Audrey Hepburn and Marilyn Monroe.

(5) My article about Alex Reid, a transvestite cage fighter who married a topless model, managed only 861 hits. Are you seriously telling me you don't want to read that one?

The final very interesting hit count is the About Me page, which has scored 9,471 hits, making this page the third most popular overall on the blog. That's very satisfying for me personally. I am always delighted when people email me to say they came across the blog and found it interesting or thought-provoking.

So please keep coming, keep reading, and tell your friends!