Saturday, 4 March 2023

Seriously not helping 2

In a previous post I talked about some people whose behaviour is seriously not helping the cause of trans people. These are people whose antics and conduct are so unreasonable that they are creating a backlash of resentment which is making things worse for the rest of us.

Aaaaaand I've come across some others. The first person I've heard about lately is Jessica Yaniv, a 35-year old Canadian transwoman, described on her Wikipedia page as a "transgender activist". Yaniv has been causing all sorts of trouble in British Columbia.

Jessica: seriously??
The issue I first came across was hearing that Yaniv had brought a series of lawsuits against beauty salons in her district who had refused to perform waxing of her genitals.

The salons were all small businesses run by a single beautician, most of whom were immigrants to Canada. Yaniv sought damages of up to $15,000, alleging transphobic discrimination.

Yaniv hasn't had genital surgery, which is pertinent to this article in that the beauticians stated (very reasonably) that they didn't advertise waxing for male genitalia, that they hadn't been trained to perform it safely, and that they objected to working on male genitalia for personal or religious reasons. They all said they didn't refuse on account of Jessica's transgenderism.

So here's the thing. It's quite possible to find salons who will wax any part of you, no matter who you are. For a hilarious example from Scotland, you can read about Miss Twist's experiences here. It's just a matter of phoning around first, and asking politely. Speaking for myself, I get my legs and chest waxed regularly by a lovely woman called Lynne, and I've never had any trouble (mind you, I don't go for genital waxing).

Jessica Yaniv deliberately targeted small businesses (rather than the large beauty chains), run by women whom she knew would be uncomfortable with the request, and who would be unlikely to be in a strong position to mount a defence against legal action. In other words, her behaviour was predatory. The lawsuits were all dismissed, but the associated costs and inconvenience caused two of the beauticians to go out of business as a result, even though she was ordered to pay damages to them.

You might think that such a resounding legal defeat would deter Yaniv from further similar antics--but she's no quitter! The next thing which came to my attention was that she was protesting that a gynaecologist had refused to see her. Yaniv posts frequently on Twitter, and she wrote:

Yaniv: So a gynaecologist office that I got referred to literally told me today that 'we don't serve transgender patients', And me, being me, I'm shocked.. and confused... and hurt.

Gervais: twittering
But the thing is, any reasonable doctor looking after Yaniv would know not to refer her to a gynaecologist. A gynaecologist just isn't the right sort of specialist to be dealing with any potential problem with her equipment. She might as well complain that her electrician refused to fix her plumbing. The right doctor would have been a urologist, or maybe an endocrinologist. Although as I have written before, the Australian and New Zealand College of Obstetricians and Gynaecologists is demonstrating willingness to treat transwomen.

And my second comment is that she, being her, isn't shocked... or confused... or hurt, but delighted that she now has another excuse to play the despised victim, and kick up another ruckus.

But this time her comments came to the attention of comedian Ricky Gervais. I have never really enjoyed his comedy, although I came to view him in a new light as an actor. Like many comedians he can be quite vitriolic in his material, and lately he's been disappointingly transphobic very openly. In exactly the same vein, he lays into Jessica Yaniv via his Twitter account. Here's one example, but there are others.

It doesn't bother me if Jessica Yaniv annoys Ricky Gervais--but it does bother me when her antics are causing harm to the wider trans community, and they undoubtedly are. Canadian media say trans people have reported a sharp upturn in online hate toward them as a result of the publicity around Jessica Yaniv.

I find myself wondering what Jessica Yaniv gets out of all this controversy. I sense that she is using transgender rights as a shield, behind which she hides while lobbing rocks at everyone within reach. She craves attention, she craves publicity, and she enjoys exchanging Twitter insults with adversaries. I wonder what her next stunt will be--I'm sure we shall all hear about it in due course. But I'm prepared to predict that it seriously won't be helping.

Lemieux: seriously??
Still in Canada (!) we turn to the case of teacher Kayla Lemieux, who has been teaching woodwork in the Oakville Trafalgar High School near Toronto. The problem is Lemieux wears colossal prosthetic breasts (unfailingly reported as "Z-cup", although I don't know what that actually means), complete with very prominent artificial nipples, while teaching students. Understandably, this has provoked "months of debate" about her appearance.

Things seemed to develop when the New York Post reported it had followed Lemieux and discovered that she doesn't wear them all the time, and in fact usually presents as a man. Naturally, there is photographic evidence, and the testimony of a neighbour in further support.

I don't really think the New York Post represents the pinnacle of investigative reportage. Nonetheless, it seems pretty clear that Lemieux has been well and truly busted (geddit?). Lemieux has finally been suspended from her job (though without being sacked), and the New York Post is taking the credit.

"Oh, that's not me!"--seriously??
When you're discovered doing something you've been trying to keep secret, you have two options: you can come clean, or you can double down. With a weary sigh, I note that Lemieux has doubled down. She insists that the man in the New York Post's photos isn't her. You can judge for yourself here.

She insists those boobs aren't fake; that she is intersex, and has gigantomastia, although she admits she is "in transition" and has been on hormones. She also insists there's nothing wrong with the way she dresses, although there have been other complaints about her clothing, not just her boobs.

Lemieux: I don’t think there’s any problem with how I have dressed. It’s the personal opinion of other people. I don’t think I have dressed unprofessionally.

There's so much to discuss about Lemieux that I'm not quite sure where to begin!

First, let me state quite clearly that Lemieux's ginormous bazooms are plainly fake. Oversized breasts just don't have those prominent nipples. Second, large boobs are heavy, and women with very large boobs struggle with neck pain and back pain, and often have surgery to reduce their size. Only people who can take off their boobs at the end of a hard day can cope with boobs like those. (I'm also sure the man in the picture is Lemieux).

Oh wait--that's an airship!
You would wonder why a teacher in a woodworking class would be wearing huge boobs, which must surely get in the way and present a genuine hazard when using tools and other equipment.

Second, nobody (not even the New York Post) has reported that any of the complaints about Lemieux were because people objected to a transgender teacher; in the middle of all this, I think that's a positive thing to remark upon. If Lemieux just wanted to be a woman, and work as a teacher, she already had that: all she needed was to just wear what ordinary teachers wear, and buy a reasonable pair of boobs.

The fact that all that wasn't enough makes me think that there is something else going on with Kayla Lemieux. If she only presents as a woman when working at a high school, then there must be something about that which tickles her pickle, so to speak. And the parents (and staff, and school board) of the Oakville Trafalgar High School must really think so too. How did she get the job in the first place? If she was already employed, and then transitioned, it would be obvious that the boobs didn't grow gradually. If she wasn't already employed, whose idea was it to give her a job?

And if Kayla Lemieux is the only trans teacher in her locale, how much harder is she making it for the next trans teacher who comes along? If Lemieux is the only example of a trans teacher they have come across, who is going to want another?

Like Lemieux, I only present as a woman sometimes. But the difference between me and Kayla Lemieux is that I'm always very conscious of the scrutiny that I receive from other people, and I'm aware that I may be the first trans person they've encountered close up, which makes me a sort of ambassador for trans people in the cis world. And my goals are to look fabulous, feel wonderful, and enjoy the company of friends. It definitely seems that Lemieux has some other goals. I don't know what they are, but they are seriously not helping.

It will be interesting to see how things unfold with Kayla Lemieux, although I don't see those colossal melons appearing in a woodworking classroom again any time soon.

If you come across any other people out there whose antics are seriously not helping, please drop me a comment below!

Sunday, 5 February 2023

What a year!

While it's still my intention with this blog to write articles exploring aspects of gender, I still want to write about my personal experiences in 2022, which seems to have been a watershed in my life as Vivienne.

Let me take us back to 2012, when I posted this article, which was about trying to evaluate the place of crossdressing in my life. At that time I was married, closeted, and dreadfully miserable. The article contains this paragraph:
Another symptom of need is that crossdressing haunts my dreams. These are frequent; at least once per week, and for the Freudians among you they are simple, straightforward, wish-fulfilment dreams. I am in some situation where crossdressing is OK: out with my friends, speaking in public, in a job interview, meeting new people. In each case, I am lavishly and wonderfully dressed: I draw compliments and warmth and enthusiasm. People find it interesting and cool. And then I wake up, and that lovely warm rosy glow fades pretty sharply in the face of the alarm.
Fast-forward a few years, and things got a lot better. I started to go out dressed; to interact with people in shops and restaurants, and to express my gender more openly. I started to tell people I'm a doctor rather than hide behind the term "academic", and to blog about medical issues.

Selfie Queen

But things were still a bit slow on the Vivienne front. Dressing was unusual. I know exactly how many times I've dressed, because I take a million selfies every time I do. I'm a complete selfie queen--and now I've become quite the expert on the various photo edits I can do on my phone, my tablet and my laptop, to make the images as flattering as possible.

About 0.00001% of my selfie collection
Part of the selfie thing is to try out various looks and see what works: and there's a lot to think about if you're trying to take a male chassis and turn it into a womanly body! Part of the selfie thing is a long-standing habit: I would use my selfies during those long periods of dressing drought, to soothe my yearnings and remind myself that lovely fem times would reappear. And part of the selfie thing is that I really, really like to look pretty, and seeing nice pictures of myself gives me a real burst of euphoria. (And for the record, while I do adjust the colour balance for the most flattering look, none of my pictures have been enhanced with any image filters, such as FaceApp).

So I know that the number of times I actually dressed enough to take selfies over the last few years is about 4 or 5 times--a year. Part of the problem was that I never quite felt like I had the look together properly. I had to have a huge lead-up to getting dressed: just getting the body hair under control was a mission. And then I didn't feel like my wardrobe was up to much, so I never quite felt the outfit worked. I had one or two go-to outfits, and a whole lot of other garments which just weren't quite right.

Another part of the problem was (and is) that we have busy lives. We both work long hours, including night shifts, and we have a cartload of kids and animals to take care of. So opportunities were quite few.

And what I wanted, most of all, was a social life. I tried to make contact with some trans people, but for various reasons I didn't really get any momentum. The turning point was making contact with the local Pride network.

Out for Coffee

I'd already had the experience of experience of going to a party at a friend's house as Vivienne, and meeting people there. But everyone there was a friend of a friend--this was a bunch of complete strangers I would be meeting.

A car selfie!
The event was called Out for Coffee, and it was a simple enough idea: turn up to a local coffee shop, meet a bunch of Pride people, and make new friends. Although I have been Vivienne my whole adult life, it's a very unusual experience to introduce yourself to someone by your fem name. At first, it felt really powerful and meaningful--I knew this was something new. Vivienne's identity was becoming more real.

On this first occasion, I brought not just Missy but my stepkids, one of whom is quite rainbow themself. It was a family-friendly event (as many Pride events are). At first I was quite nervous and we all just sat and ate together. But after we'd had breakfast, I started to mingle--and everyone was fantastically lovely.

One woman said I should join the local Queer Women group. I was delighted by the invitation--but also cautious. Would they be OK with members like me? I asked. I know that not all women's groups are welcoming to trans people, and I would hate to make anyone else feel uncomfortable--or even encounter hostility.

So I messaged one of the moderators of the Queer Women group expressing my concerns, and this is her response:
Thanks so much for reaching out with your concerns. You will be most definitely welcome in our group and if anyone makes you feel otherwise please let myself or (other moderator) know, we would hate for you to feel unwelcome or uncomfortable. Our group is about diversity and acceptance for all queer women whether you express this full time or not, it doesn't matter to us. If it makes you feel more at ease, we do have other M2F people in the group who regularly come to our events too. I hope we get to meet you at an event soon šŸ˜€ PS: that's a great photo! 
Vivienne becomes a Person

And so I started going along to social events with the Queer Women. The moderator was right: everyone is absolutely lovely, and totally welcoming and inclusive. Vivienne's identity has become completely real: I've been to so many events that I get recognised by the regulars, and I now have friends who have literally never seen me dressed as a man. That is an extraordinarily powerful feeling.
I need all the help I can get!

There have been coffee meetups, board game meetups, meals out, drinks out, social events at people's homes, book club, you name it. There have also been some outdoor things I haven't gone along to: walking trips and boating trips and cycling trips. For me, it's unbearably hot just wearing my wig and shapewear, even before there's any exercise involved!

There is a fantastic mix of women in the group--including a few M2F transwomen. There are women of all ages and backgrounds. The thing they (and I) have in common is an enjoyment of good company, and having fun. To be accepted without question and treated just like one of them is extremely affirming. Some of them even work at my hospital!

Meanwhile, as my wardrobe has expanded, and my makeup skills have improved (practice, practice!), getting dressed has become a lot easier. It still takes an hour from a standing start--but it used to take half a day! And having makeup and clothing just there on the shelf or in the drawer makes the access much easier.

I've also come out to lots of other people, including my hairdresser (who has helped with hair) and my lovely beautician. I get a full leg wax every few weeks, and of course I have been telling my beautician about Vivienne from the first day. She's always wanted to meet Vivienne, and this week we finally made it happen! She introduced me to the other staff members as Vivienne, and of course it was lovely to get pampered in a beauty salon. Another bucket list item ticked off!

Up on the Stage

One of the Queer Women events involved an open-mike evening in a local rainbow-friendly venue, where audience members would get up on stage and read some of their own writing. I decided that I had to get up and give that a go.
Is this thing on?

This time, the audience wasn't just Queer Women, but members of the public, although clearly everyone knew what the themes were going to be. I was struck by the material from the other writers. There were agonising coming-out stories. There were unrequited love stories. There was poetry, and prose. It was raw; it was real. And then there was me!

I've written quite a lot of medical stuff under my male name, and this includes a few anecdotes about inspiring patients I've met on the journey. I chose three: an inspiring one, a moral dilemma, and a funny one. They seemed to go down really well, and afterwards lots of people came up to talk to me.

So let's come back to the wording of that first paragraph:

I am in some situation where crossdressing is OK...: check.
...out with my friends...: check.
...speaking in public...: check. a job interview...: we'll let that one slide!
...meeting new people: check.
In each case, I am lavishly and wonderfully dressed: I draw compliments and warmth and enthusiasm. People find it interesting and cool. Check check CHECK!

It was astonishing when I reviewed that article to discover that so many things, which were once completely unthinkable, have not only happened, but have happened joyfully, triumphantly, and there's every likelihood they will continue to happen! It goes without saying that I could never have achieved that without the love and support of the wonderful Missy.

I've already started off this year with more of the same: four outings so far, including the waxing. Who knows what will happen next?!

Wednesday, 3 August 2022

Prohibition Party!

It’s one of my favourite things to get an invitation where the person says “Vivienne is welcome too”. A few weeks ago I got an invitation to a friend’s birthday party. It was to be fancy dress, with a Prohibition theme. While I could use this article as an opportunity to show more pictures of myself (and I will!), there are actually other aspects to it which I’ve been reflecting on since.

How do I look?
As I’ve mentioned before, I don’t normally enjoy “dressing up”. It feels like pretending to be something I’m not, while dressing as Vivienne feels like doing something that I am. But this was an opportunity to do the latter while pretending to do the former—I don’t know if that makes any sense at all!

There were several obvious problems. I don’t possess the elegant willowy figure of the 1920’s flapper—or the gangster’s moll. But secondly I had no idea where I would come up with any sort of costume to wear.

Missy’s mum came to the rescue and had very nearly everything. She’s extremely fond of rummaging in flea markets, op shops and charity shops, and has a huge collection of all sorts of amazing stuff. She provided the dress, the wig, the fascinator, the feather boa, the pearls and rings and necklace. Even a vintage black clutch bag (foreground).

The white gloves and choker came from a dress-up shop, and the tights and shoes (which you can’t see) were model’s own. I had to take the gloves off for the mirror selfie because my phone screen wouldn’t register my touch when I had them on!

I spent ages getting ready. Among other things, I had never worn stick-on false eyelashes before. I took an hour to put them on in any sort of reasonable position, and I had to take them off and reposition them several times!

Meanwhile Missy decided to go as the gangster: the fedora, the black shirt and white tie, and a plastic gun from the dress-up shop. It was a great outfit and she looked fantastic. In fact, everyone did; it was like walking around in a scene from Bugsy Malone.

Flapper girl in a Gatsby world.
As we walked in, I realised, for the first time, that aside from a few people that we know, most people would be strangers--and not necessarily expecting to see me turn up in a frock. There were a couple of dozen people there, including teenagers, and everyone seemed to react positively. One or two of the men looked slightly taken aback when I introduced myself, but after that nobody showed the slightest discomfort. One of the women asked me where I got my tights, and I asked her where she got her corset. (Interestingly, two of the women were also dressed in male gangster gear, and looked fantastic).

The house had been done up beautifully as a speakeasy with darkened windows, decorations and soft lighting. There was a very well-stocked drinks table, and plenty of nibbles. There was even someone "on the door" and we had to pretend to give the password. But the most impressive feature was a full-on gambling den, with a full-sized roulette wheel, a blackjack table, and a professional croupier to run the whole thing. No money was won or lost--we played only for chips, though there were prizes for the biggest winners.

The croupier kept referring to me as "the gentleman with the green chips". I wasn't in the least bothered about this; I really just found it funny. In fact I joked with him: "What have I got to do here to get treated like a lady?!"

The chat and the company were outstanding. We mingled and met some lovely new people. We played roulette and blackjack. We enjoyed the nibbles and drinks. I felt wonderful. From time to time, I was suddenly struck by the realisation--all over again!--that I was out, dressed, and feeling fabulous.

Baby needs a new pair of shoes!
Looking back on this splendid evening, my first impression is how far I have come. An evening like this one--glamorously dressed and having a wonderful time with a group of lovely people--would have been pie in the sky only a few short years ago. Every time I've looked back on it, it's given me a little emotional boost.

My second reflection is that, perhaps in some sense I was also being an ambassador for trans people in company. Perhaps the people at the party hadn't come across someone like me before, and perhaps having a laugh and a chat with me might make them feel more comfortable encountering other trans people in their lives.

But the third boost it gave me is that I had told quite a lot of people, including people at work, that I was going to be going to a party "in drag". And naturally they wanted to see the photos afterward. And so I've had the experience of showing people who don't know about Vivienne some photos of Vivienne! I've had nothing but positive comments from them; many of them said they thought they were looking at a woman in the photos, although they obviously recognised it was me.

All of this makes me feel just that little more confident in myself, a little more confident about coming out to more people (slowly does it!), and a little less nervous of future encounters. How can any of this be a bad thing?

Now, let's blouse. I gotta go iron my shoelaces. Don't take any wooden nickels!

Tuesday, 31 May 2022

Opening the Closet

In the last couple of weeks I've finally come out to all my children.

This was a surprisingly difficult thing to do. Not because I didn't want to, but because there were significant obstacles in the way. Those of you who know me (and followers of this blog) will already know how much my ex-wife loathes cross-dressing, and how manipulative and obstructive she can be.

Without going through all the exhausting and tedious details (and there are many!) I managed to navigate the worst of her obstacles and finally do the Big Reveal.

Having been very careful in making this move has allowed several things to happen. It has allowed me to contemplate seriously, and for the first time, what my life might look like if I didn't have to hide who I am. For many years, I had to deal with a wife who told me how disgusting, how shameful, how unacceptable it is to enjoy wearing feminine clothing. This was very corrosive to my self-esteem.

During this time, hiding and pretending felt normal. It felt safe. It felt like a boat I didn't want to rock, because I was still very fearful of further negative consequences, and I didn't think I had the strength to weather them.

But the idea of no longer having to hide was beginning to take hold. Looking ahead, I could see light for the very first time--a light which I didn't dare to dream would ever shine on me. When my ex-wife's protests began to mount, the thought of moving backward was intolerable.

The Big Reveal

I've always found it amusingly ironic that a common metaphor for facing up to something difficult is to "put your big girl panties on". This was definitely one of those moments!

The star of the show was the eldest boy, in his late teens. He accepted it immediately and completely, and was so mature. He was the one I was most worried about, as he’s grown up believing his dad was an ordinary guy (albeit a geeky, scholarly one), and I wasn’t sure how he would take the news.

The one I expected would be no trouble was the eldest girl, in her middle teens. She’s very “woke”, very pro rainbow people, and has often made statements in support of minority causes. Although she also wasn’t expecting this announcement, I thought she was the one “primed” to be accepting. Instead she was quite upset, and took herself off to her mother’s place immediately.

The younger two have been fine, especially the one who is already a bit rainbow.

What I told them all is: this isn’t a secret any more. I didn’t want to pull them into the closet with me, but instead to open the door a lot wider. What that means (for me) is no more hiding. While I’m not going to wave Vivienne in people’s faces, nor am I going to be hiding away and hoping I don’t meet anyone who might recognise me.


I’m still processing all this. My daughter’s reaction hit me especially hard. Instead of feeling relief, or satisfaction, or triumph, I felt deflated and disheartened for a couple of weeks. It made me wonder whether I had done the right thing at all: did I push it too hard? Should I have waited longer?

I’m gradually feeling slightly better, and early indications are that she is coming around a bit more. But I still feel it’s too soon to be celebrating.

The person who has made all this possible has been my amazing partner, Missy, who has unfailingly supported me, gently coaxed me away from my tendency to catastrophise everything, and used wisdom and gentleness to help me reframe my feelings more positively. I still wonder how I’ve ended up being so fortunate.

Out, and Proud?

The word Pride is often used by rainbow people. We have Pride parades in many cities every year. They have gone from being protest marches against oppression to being (in the main) colourful parades suitable for the whole family, which is a wonderful thing. The struggle isn’t over, of course, and in some countries things seem to be actually going backwards.
It's nice to finally meet you!

But the notion of Pride is a powerful one. It’s retaliation against the sense of shame and exclusion that many of us have felt. (I know that what I’ve experienced is a drop in the bucket compared to what others have experienced!). The concept of Pride is for rainbow people to be able to say: here I am; I am a worthy person; and I am proud of who I am.

As of today, I’m not feeling proud of myself--yet. Perhaps this moment will come. And, as one person after another learns about Vivienne and responds with warmth and acceptance and curiosity, rather than revulsion or scorn, my self-image is gradually changing. And my wardrobe is improving and my makeup is looking better and I’m feeling more comfortable and natural when I go out. The overall trend is upward.

When I started talking to my trans friends and acquaintances and Facebook groups about coming out, several of them clearly saw it in very different terms from me. They saw it as a thing to celebrate. Have a party, they said (a gender-reveal party!). Make it a special day! Enjoy it!

This had never once occurred to me. Until recently, coming out has been something I dreaded, and was not looking forward to it at all. (Missy spoke of “ripping the plaster off”). Having a party to celebrate? It’s definitely something I’m thinking about, and it might make a turning point.

So what is the future going to look like? That light in the distance is beginning to look a whole lot closer. And the face that I'm going to show to the world is going to look like this one a whole lot more often.

Monday, 16 May 2022

Bits and Bobs

I've been collecting a few items of news, which aren't really worthy of a blog post all by themselves, but I have decided to put them together here.


Obviously, as much of the rest of the world is, I am appalled by Russia's invasion of Ukraine.

Zi FaƔmelu
Before this invasion, I knew very little of Ukraine. On the other hand, I was surprised to find that if you rank my blog hits by country, Ukraine comes in 10th. This is almost three times higher than my own country, New Zealand! It won't come as a surprise that hits from Ukraine have all but disappeared since the start of the invasion.

The number of hits from Ukraine made me realise that there is a trans population in Ukraine which is trying to reach out across international boundaries. I took comfort from this--until I started reading. Until recently, being trans in Ukraine could result in you being institutionalised. Ukraine ranks 39th among the 49 countries in Europe for LGBT+ freedoms and rights. Gay marriage, for example, is still illegal.

Then I read stories like this one, which describe how transwomen attempting to flee Ukraine have been detained and turned back at borders. One transwoman, Zi FaĆ”melu, describes in Rolling Stone magazine how she was repeatedly turned back at the border, because in Ukraine, military service is now mandatory for all males, and her passport still states she is male. Eventually she escaped by swimming across the Danube river into Romania. She is now living safely in Germany.

I can understand how the presence of war, plus a country just beginning to experience a little awareness and acceptance of rainbow people, is making life extremely difficult for trans and other rainbow people. But if Ukraine isn't friendly to trans people, Russia would undoubtedly be a lot worse. Russia ranks 46th on that list, and Vladimir Putin has described gender fluidity as "a crime against humanity".

One thing is for sure: the Ukrainians are showing that they are not willing to give up their freedoms and submit to the oppression and restrictions of Mother Russia. Hopefully once they send Mr Putin back to Moscow with a bloody nose, they can get on and grow in freedom and tolerance, as they have been over the last few years.

Ukraine has also won the Eurovision Song Contest for this year. As I've written before, the contest isn't so much a competition of musical talent as a sort of political popularity contest. This victory is definitely a message of support and encouragement from the rest of Europe to the people of Ukraine.

Meanwhile, to any Ukrainian people reading this blog, I salute your courage, and I hope that the war ends soon and you can rebuild your country.


As a doctor, I'd known that the World Professional Association for Transgender Health was a thing. However, because I was still being very stealth, I didn't really want to put my hand up, because I thought I might be traced, and that might be a "bad thing".

However, that's changed now. New Zealand has an affiliated branch of WPATH, called the Professional Association for Transgender Health Aotearoa, PATHA. I got in touch with them, and they were delightful. I've paid my membership fee, and Dr Vivienne Marcus is now a full member of PATHA.

I'm not sure what this will mean for my future. At the moment I'm just trying to cautiously reach out to the other members. It's that equivalent of slipping in at the back of the lecture theatre and hoping nobody notices you. But I'm confident of full acceptance from them.

What's not so clear is how I can contribute to the cause. I don't particularly look after trans people in my daily work. I don't think being a PATHA member is going to really change anything about how I do my job. What I am good at is writing and teaching, and I've explained that to the executive on my application. It remains to be seen what (if any) contribution I can make. I will certainly notify you of anything momentous I end up doing.

Lofi Girl

I can't remember where I first saw an animation of Lofi Girl, but it struck me immediately as being both pleasing and familiar.

Lofi Girl is the name of a French YouTube channel and music label, which, which provides an endless stream of what Wikipedia calls lo-fi hip-hop, accompanied by an endless animation of a young woman sitting writing in a diary. The music is intended to be relaxing, background music, which can be used to accompany study, relaxing or other activity; in essence, audible wallpaper.

I like lots of things about this. First, I like the animation, which is clearly inspired by the sort of Japanese anime typical of the wonderful Studio Ghibli, whose work I adore. In fact, Wikipedia says they originally used a short segment from the film Whisper of the Heart, before being legally required to take it down. Since then, they have commissioned an artist to recreate an anime-like character (whose official name is Jade) to feature.

Vivienne as Lofi Girl
The Lofi Girl sits, looking thoughtfully at her book and writing by hand. She's listening through headphones (presumably to what we hear), deep in thought. From time to time, she pauses and looks up at the cat, which sits on the windowsill looking out of the window. Then she carries on. This provides just enough action for me to sit and watch it for hours. From time to time, the weather changes outside the window, and day turns to night and vice versa.

What I love about this is that she sits exactly the way I do. I love to write in my journal; I use a gorgeous fountain pen, and delicious inks from Jacques Herbin in Paris. And while Lofi Girl is a leftie and I'm not, I do sit with my chin in my hand while I write. And from time to time I pause and look up into the middle distance. Journal writing is my happy place; both an intellectual and a sensual pleasure.

Surprisingly, the part about Lofi Girl which attracts me least is the music. There's nothing particularly wrong with it, but I find it quite samey after a few hours.

Amazingly, the Lofi Girl website allows you to customise the appearance of the Lofi Girl and create a still image. So this is what she would look like if she were Vivienne--complete with dog!

Saturday, 15 January 2022

Doctors as Gatekeepers

Let me open this first post of 2022 by wishing all of you a very happy and productive New Year, and let me also hope that COVID-19, in whichever variant, doesn't interfere too much with your plans and your lifestyle.

I came across a cartoon this week on my Facebook feed*. It was drawn by Sophie Labelle at Serious Trans Vibes. She also has a Facebook feed called Assigned Male Comics. Some of her comics have been anthologised into printed volumes which are available from her website store in both English and French.

According to the Wikipedia page, the comics have been produced since 2014, and have received positive reviews from critics. Certainly she seems to attract very positive and supportive comments on Facebook, although she has also occasionally been the target of hate. From my perspective, the medium of comics is a very effective way of communicating transgender topics, and I've written about this before, here and here.

Here's the cartoon which caught my eye*. I hadn't come across any of Labelle's work before. I did not recognise the character depicted (it turns out to be one of Labelle's main characters, a young trans-girl called Stephie).

As of today, 15th January 2022, this cartoon has had over 6,700 likes, 172 comments, and 1,700 shares, although these numbers seem to be par for the course for Labelle's cartoons on Facebook.

But what troubled me about it was the implication that that doctors are deliberately obstructive to trans people; deliberately causing them to experience "unbearable pain or intense suffering"; and deliberately inflicting "torture" upon them. This view struck me as unfair and I wanted to explore it further.

Being both a trans person myself, and a doctor, I'm aware of the tension that exists between the two groups. I'm aware (of course) of the frustration that exists from trans people who cannot get doctors to listen to them, believe them, or treat them. And I'm aware (of course) of the antics which some trans people sometimes resort to, such as lying or manipulation, to try to get their way. Others resort to hormones they buy online, or travel overseas to get surgery.

And I want to explain why I think "gatekeeper" is very much the wrong metaphor for what doctors are doing.

There is definitely a problem

Before I go further, I want to state that there is definitely a problem in the medical treatment of transgender people. I am, in my professional and online lives, trying to help to put it right, and I have discussed this matter before on this blog, for example here.

I wrote a long comment on Labelle's page, attempting to explain a more balanced view. She deleted it, and posted this:
Labelle: got a few truscums who wrote 10 pages long comments on how gatekeeping is essential to be truly trans, I got to delete their comments before anyone saw them, as a morning treat! I hope they didn't save their essays anywhere and they're lost forever.
I had no idea what a truscum is, although it's obviously intended to be an insult. You can find a discussion of its meaning here on Wikipedia. From what I have read, that description doesn't apply to me.

This exchange was not the most heartening opening to a discussion I've ever had. I contacted Sophie Labelle again for her comments, and she blocked me. But I nonetheless thought it was worth exploring the two aspects of it: why do (some) trans people feel that they are being tortured by doctors, and what could actually be going on from the doctors' point of view? And, most pertinently, can anything be done to fix it?

Why is it so hard to get good transgender medical care?

I want to begin this section by pointing out that I believe most doctors genuinely want to help transgender people, and that good gender treatment is fully in accordance with good medical practice. But there are several obstacles to achieving this, some larger than others.

Road ahead closed
First, most doctors have very little or no training in gender treatment. That means that few doctors have personal experience to draw upon. In addition, guidance from professional bodies is extremely sparse. When I was a medical student, in the last century, gender identity problems were not taught at all, though we did learn about intersex conditions in paediatrics. In endocrinology, we learned about people with hormone disorders: too much of this, or too little of that, and how to help, but none of this was in the context of people who want hormones to help with their gender.

Second, many (but not all) doctors are commonly faced with patients asking for (even demanding) treatments which could be potentially harmful. Strong painkillers are a great example, and I've seen patients who have resorted to ingenious methods to circumvent the system to obtain them. We've all been bitten, sometimes very hard, by such patients, and therefore many of us are understandably suspicious of people who don't seem genuine.

Put another way, if you are lying to your doctor, there is a very good chance that your doctor knows or suspects that, and this is likely to erode their sympathy and work against getting their cooperation. There is often a distrustful undertone to the relationship between the doctor and the transgender patient, where neither of them feels that the other is being completely open or completely helpful. The whole purpose of this post is to try to improve that situation.

Third, there is a very good rule of medicine: first, do no harm. This advice is so old and venerable that people think it was written by Hippocrates. (It wasn’t). But the meaning of the statement is clear: before you give a treatment you hope will help, you need to really make sure it isn’t going to make things worse. It encapsulates a theme of being cautious in the practice of medicine, which in general is a good thing (I believe). And its core is the patient’s wellbeing, which is paramount. If you are asking for a treatment which your doctor thinks may harm you, they are very unlikely to comply.

No doctor wants headlines like this.
Fourth, there is little good science in the field of gender treatment. What good science there is is drowned amid flag-waving, virtue-signalling, politics and wishful thinking. See my post here for a detailed discussion of these issues. This is especially true for gender treatment in children.

Fifth, those few doctors who have courageously taken on the treatment of transgender people sometimes run into serious professional trouble, threatening their career or livelihood.
Dr Helen Webberley (whom I interviewed here) has been treating thousands of transgender patients (including children) for some years, but has got into some serious hot water with medical authorities in the UK. (As I write, Webberley is still under suspension from practising as a doctor, and her tribunal is ongoing).

This sort of thing acts as a powerful disincentive to doctors to advocate for transgender people or treat them. Those doctors who are interested in training in gender issues will be looking at Webberley's case, and some will decide that the risk of getting into trouble is just too great. 

All of these things make it very difficult for doctors to effectively treat transgender patients.

The fictional case of "Bob"

I've created this fictional scenario to illustrate how an ordinary family doctor, without any training in gender treatments, might approach a consultation with a late-transitioning person. I'm not trying to suggest every transgender patient presents like this. I'm not trying to suggest every doctor would feel the same (and in particular, I would not). But hopefully this scenario will illustrate some potential ways of medical thinking.

Imagine you are that ordinary family doctor, and a patient comes to see you. You have known Bob and his family for 10 years. He is 52. He likes golf and fishing. He was a bank manager until last year, when he lost his job. Since then he has put on a lot of weight and begun to drink more heavily.

Bob tells you he is transgender. He is actually a woman inside, something he has felt for his whole life, but kept hidden from everyone, including his wife. He has been cross-dressing in secret for many years. But now he feels he cannot remain hidden any more, and wants to transition. He wants hormones. He wants surgery. He wants a legal name change.

Burdened: Bob
How do you react? You’ve been Bob’s doctor for years, but he has never mentioned this before. Nothing about him seems remotely feminine.

From one perspective, the story is true. Bobbie could have kept her feelings and behaviour hidden successfully for years, but could carry the burden no longer. This is her chance to be true to herself; to finally become a woman. You look up the referral pathway to the nearest gender clinic, which has a waiting list of two years. Bobbie says she can’t wait that long and wants to travel to Thailand for surgery. She asks you to prescribe female hormones for her, but you are not familiar with these treatments, their doses, or their side-effects. You really want to help Bobbie, and you tell her you will try talking to some colleagues for advice, and you will do what you can, but from Bobbie’s perspective, what you are offering is not enough, and far too slow.

Are you acting as a “gatekeeper” here? I argue not, though Bobbie might feel that you are. Who is right?

From another perspective, Bob’s story doesn’t ring true for you. Bob has always looked and acted like a man’s man: coaching the football team, golf, fishing, powerful cars. Losing his job hit him really hard. He is probably clinically depressed. He is certainly drinking too much, and you suspect his marriage is in trouble. He certainly isn’t the first middle-class, middle-aged guy who has had an unexpected mid-life crisis, even if most of them buy a motorbike or get a tattoo. You think that it would be better for Bob to sort himself out: cut down the drinking, get another job, lose a bit of weight, take more care of himself. You offer him antidepressants and recommend exercise. You tell him that if he still feels the same once those other things are sorted out, you will help him with his request to change sex, but you think in a year or so Bob’s feelings could well have changed and he might feel very differently.

Are you acting as a “gatekeeper” here? Maybe yes (Bob would certainly think so), but are you a bad doctor for doing so? For listening to your patient, making the very best, compassionate, objective assessment of what you think is really wrong, and trying to put it right? I would certainly argue no.

Aye, there's the rub!

And that's where the scissor-point is. Bob's story is fictional, of course, but there is enough truth to it that many elements are recognisable. A doctor, with either perspective of dealing with Bob, is practising good medicine. They are not being a bastard. They are not being cruel. They are not, in any way, deliberately attempting to hurt Bob or cause him distress. They are not torturing Bob! And they are not acting from a perspective that "gatekeeping is essential to be truly trans".

No way, sucka!
The image of the doctor as gatekeeper requires that there is this wondrous place, filled with bountiful hormones and surgery and unlimited gender treatments, but there's a huge steel door, and like a big mean bouncer, your doctor is looking you up and down and saying in a gravelly voice: Yer name's not down, yer not coming in.

But no such bounty exists! From a doctor's perspective, the official pathways are swamped and waiting lists are long. Some transgender people have other issues: depression, drug and alcohol use, self-harm, which can complicate the picture. (If you treat Bob’s depression, will his desire to transition go away?) Some transgender people point to gender as their one biggest problem, and play down other concerns, even though they seem important from the doctor's viewpoint. Some transgender people seem to have unrealistic expectations of how rosy their lives will be after treatment, even though this isn’t necessarily what happens. And some people change their minds about what’s best for them, as their lives unfold.

I'm not saying that trans people who are trying to get treatment are not suffering. I am not trying to suggest they should just suck it up and forget the whole thing. Instead I am trying to point out that what doctors do is not deliberate cruelty. The situation involving children is even more fraught. Gender services for children are even fewer than for adults, and a child who is growing rapidly creates even more pressure in an already pressured situation.

So what's the solution?

The solutions are clear, but none of them is easy. First we need good science to inform medical practice. That, in itself, is difficult, slow and expensive. As I've written here, if your science produces conclusions which some transgender people find unpalatable, you are likely to face powerful negative repercussions. That in turn provides powerful disincentives to scholars to pursue the science around transgenderism.

Second, we need better training for doctors in the treatment of gender conditions. The good news is that there is some evidence that this is starting to happen, although obviously it will take a while to work through the system.

Third, we need clear professional guidance from professional bodies to existing doctors, about treatment regimes, referral pathways, and so on. Again, this is happening, with organisations such as WPATH setting out standards of care (currently brewing up their 8th edition) for transgender people worldwide.

Fourth, we need better investment and funding for those systems which currently exist, to match the increasing demand for their services, cut waiting lists, and improve access to treatment. For these outcomes, you need to lobby your politicians, not your doctors.

Meanwhile, transgender people, and the doctors looking after them, will struggle to make anything successful happen with what already exists out there.

How can I get the best out of my doctor?

The first thing to say is that doctors are people, which means there are some who are brilliant, some who are dreadful (sadly I've met some of them), and most of the rest are perfectly OK in the middle somewhere. Most of us went into medicine because we actually want to help people, after all. We are also aware that the power-balance in the doctor-patient relationship very much favours the doctor. While medical paternalism is still (unfortunately) a thing, the old notion that "doctor knows best" is obsolete, and practised only by a few, aging doctors.

But if you understand how your doctor is thinking, it is likely to result in a better outcome all round. You will be able to reassure them and defuse some of their reluctance. You will be able to put forward your goals in a way which seem to be in accordance with good medical practice, not against it.

It doesn't have to be a conflict.
If you happen to run into a dreadful doctor, get another doctor! If your doctor is uncaring, brusque, unsympathetic, or otherwise unsuitable, vote with your feet. Change to another doctor in the practice, or change to another practice entirely. There is likely to be a social media page for trans people in your area. Ask around for recommendations about a supportive doctor near you.

If your doctor seems willing to help, but unsure what to do, point them to the WPATH website, which is positively bursting with resources to help: medical guidance, standards of care, a comprehensive reading list, a search facility for colleagues and experts around the world. If they really want to talk to an actual transgender doctor, I'm happy for them to contact me by email.

Try to work with your doctor, not against them. Try not to take it as a personal attack if they don't fall over themselves to do whatever you ask. It's fine to negotiate, with statements like "I know that if I start with the higher dose, I might have more side-effects, but I'm willing to accept that risk for myself, and I will cut down the dose if I start to run into problems". Most doctors will respond very well to this approach, and many doctors like it if you've done your homework first: "I know I will have to keep an eye on my blood pressure and my blood sugar too, but I've been losing weight and keeping fit".

Plain honesty is likely to work very positively. "Look, I know it wasn't very smart, but I'm desperate, and I've been taking these hormones I got from the Internet. I brought you the box so you can take a look at them. They don't seem to be working very well. I really want to be on something safer and more effective".

Manipulation, lies ("Oh no, doctor, I would never take anything that I bought online") and subtle threats ("If you don't prescribe these for me, I'm going to start getting them online anyway, so you might as well") are likely to make things very rocky.

The hardest part (understandably) is to be patient with your doctor if they seem too slow. You may well be that doctor's first ever transgender patient. Your interaction with them will likely colour all future interactions with trans patients. Most doctors (as I've said before) will be willing to work together with you toward you meeting your goals, which will be rewarding for you both, and will likely make things easier for the next trans person that doctor has to treat.

The situation is changing. I know it's too slow for many people, but it's going to be better. Meanwhile, let's all try to understand one another a little better.


* I believe that my sharing of this image on this page consitutes Fair Use. The original cartoon was published on a public forum (Facebook), where it has been viewed many thousands of times. I have not changed or altered the image in any way. I have attributed the artist, and added links to her Facebook stream, her website, and her Wikipedia page. I have not attacked the artist or the image, but used it to illustrate a discussion point which is very strongly in the interests of the trans community--in other words, my use is in alignment with the implied original purpose of the image. I do not earn money or other reward for this blog. The image has already been shared over 1800 times without apparent objection from the artist, which indicates implied permission for its being shared online.

Friday, 24 December 2021

The Red-Nosed Reindeer

Since Christmas is fast approaching, every shop and radio station is playing Christmas songs all the time, and one which has always stood out for me is Rudolph, the Red-Nosed Reindeer.

I'd always thought Rudolph had started life as a song, but Wikipedia says the story was originally written in verse for the Montgomery Ward chain of department stores in the US in 1939, and only became a song in 1949, popularised by Gene Autry.
Rudolph leading the other eight

Before Rudolph came along, the names of Santa's other reindeer had come from the familiar poem A Visit From St. Nicholas by Clement C. Moore, first published in 1823. It's the one that begins 'Twas the night before Christmas. The poem gives the names as Dasher, Dancer, Prancer, Vixen, Comet, Cupid, Donder and Blitzen. (Not Donner, although he did name the last two reindeer after thunder and lightning).

In any case, Donder has now become Donner, and the list of reindeer that every scholarly child (such as I was) commits to memory is the eight names above, plus Rudolph, who is of course the youngest.

From the famous song, here's the bit which troubled me then, and still does today, enough to want to write about it here. Everybody knows that Rudolph isn't like the other reindeer. His shiny red nose marks him out as different:
All of the other reindeer used to laugh and call him names.
They wouldn't let poor Rudolph join in any reindeer games

When I was a child, I didn't have a shiny red nose, but there was definitely something palpably different about me. I didn't fit in with the boys, no matter how I tried, and therefore I was always an outsider, yearning to be accepted. I remember being lonely and perplexed, wishing I could like football, wishing I could like rough-and-tumble play, and wondering what it was that was so intangible, and yet at the same time so inescapable. Not only were the boys unwilling to play with an atypical boy, so were the girls.

For Rudolph, the story ends happily. One foggy Christmas Eve, Santa realises that Rudolph's shiny red nose is just the thing to light the way for the sleigh. Hurrah.

All of the reindeer loved him, and they shouted out with glee
"Rudolph the red-nosed reindeer, you'll go down in history!"

As a child, I thought the other reindeer were a bunch of two-faced bastards. Santa decides Rudolph is cool, so suddenly they all change their tune? Partly I wanted Rudolph to tell the other reindeer to bugger off: partly I was pleased for Rudolph that he found the acceptance he had craved.

Happy Christmas to all, and to all a good night!
You may say (and you could be right) that I'm completely overthinking all of this. It's just a children's Christmas story, after all, and therefore it requires a happy ending with a perfect resolution.

But there is, I think a deeper interpretation, which is that those people who seem to not fit in--the one that other people laugh at, and call names--not only have something valuable to contribute, but can actually lead, and become popular, and become famous. Can, in fact, "go down in history".

So if I have one Christmas wish for us all, it is this. I wish that we get recognised as being special, and wonderful, and that we are loved, not just by Santa but by everyone.

Wherever you are, I wish you a glorious, sparkly, magical Christmas.