I went to the Tavistock as a young person - AMA

[MAW1993]

I attended the Tavistock from 2008 to 2011, beginning when I was about 15. I made this post because I saw the many questions people asked on a previous AMA. Unfortunately, the OP was uncomfortable answering some of them, and I felt there may be a need for an AMA with someone who can be more open.

Clearly the emergence of distress related to my genitalia did not precede a developmental capacity to be aware of their existence. My feelings first emerged around the age of 2 to 3, obviously it is hard to remember the precise age, but I know it was already existent before I began nursery, a stage of my life from which I have many memories.

How would you like me to expand? Is there an answer I can provide that will be satisfactory, other than one that speaks to abuse, misogyny or brainwashing? I was never taught that my body should be a source of shame, that woman or girls were less than, or that it was unacceptable to be myself within a female body, and yet when I first became aware of my genitalia an uncontrollable sense of shock and discomfort arose. The kind of feeling that hits you when you find out a loved one has died, and it's as if your heart has fallen into your stomach.

Oh my goodness. I can’t think of anything to say other than what my daughter would - ‘mic drop’!

Seriously OP, how are you not a famous writer? Not only do you consider the human condition with a clarity, insight and sensitivity beyond what I have ever encountered … you can also compose a forensic rebuttal of unjustified and ill-informed attacks on your motives.

I have 15 years of life experience over you, and have always been proud of my writing and ability to express myself, but you blow me out of the water. I can’t begin to imagine how proud your parents are of you. The world is a much more wonderful place for your presence and I could not be more glad that the treatment you needed to find a way to live in it exists.

Sorry I’m blathering on like a fool now, but I can’t deny that this thread has changed me and the way I see others. I have been guilty in the past of regarding transgender people with suspicion and disdain, without properly attempting to look beyond that to the person inside. I will never, ever do that again. It is also safe to say that will have absolutely no bearing on the attitude I hold towards predatory males who not only hurt women and children, but hurt you and people like you in the efforts they make to conflate the two in the minds of the public.

Also a potentially more accurate comparison -

Gynecomastia is extremely distressing and embarrassing to many men, and the same is true of hirsutism in women. I know there will always be societal pressure against people for their perceived defects. However, the upset posed by appearing other than your sex is far more deeply personal and distressing for most people than a comparably stigmatised body difference such as being fat or having a big nose.

I have plenty of hang ups about my body but they don’t stop me living my life. If a disease caused my testosterone to rise and left me with a beard, a deep voice and male pattern baldness I don’t know that I’d be able to leave the house without feeling constant shame, deep hurt and the eyes of every member of the public inspecting my body with suspicion.

Surely the experience of a transgender person, who perceives or feels their sex should be different than what their body is, is more comparable to these kinds of scenarios? And while of course the judgement of others makes everything harder, even if there were no stigma at all surrounding being a woman with a beard, or a man with breasts, I still would feel upset and lost because it wouldn’t be me and I would feel like my sense of self was shattered.

How would you like me to expand? Is there an answer I can provide that will be satisfactory, other than one that speaks to abuse, misogyny or brainwashing?

I asked because I find it curious. Not because I was.expecting any particular answer.

I'm a mother, I'm trying to imagine how I'd approach it if my 2 or 3 year old child was distressed by their genitals.

I'd certainly want to know the cause of it.

Morning op. Really pleased this thread still live.

Just listening to the BBC News and new clinical practice expectations that patients can request same sex clinical treatment. I remembered your experience and need to keep your personal life personal.

It’s such early days in the public emergence of the trans community. The political response oscillates from one extreme to another whilst losing that the issues are about safeguarding and safeguarding is concerned with protecting people from opportunistic criminal activity.

The position I have is issue has nothing to do with the trans community but with the community who seek a loophole and seek to exploit it to the detriment of others.

It is unacceptable that a person’s personal information is intentionally outed.

OP, I wonder if you see a clear difference that should be apparent to clinicians, between gender-incongruent people for whom medical and surgical transition is the right thing, and gender-dysphoric people for whom, ultimately, it isn't?

I'm thinking of the difference between your post-surgery experience and that of people like Keira Bell and Ritchie Herron. In your view, is there a differential diagnosis that should be capable of distinguishing between those two groups?

Honestly, you're too kind, but thank you so much. My mother is a far better wordsmith than I, but I have no doubt that my exposure to complex language and debate from a young age has influenced the way in which I express myself.

Thank you, this is a much better comparison. It is very hard to explain such an alien feeling towards your body to someone who has not experienced that.

I would agree that the distress felt by a man suffering gynaecomastia does not indicate that he views female characteristics to be shameful or of less value. I also agree it's very hard to separate the distress people feel from the influence of societal stigma surrounding bodies that do not fully fit with the two expected manifestations of biological sex.

I would like to see the complete acceptance and understanding of intersex people, and others who possess traits untypical of their sex. However, I am not convinced that this would alleviate the distress felt by a boy who develops breasts, or a girl who begins to grow a beard. Similarly, I believe that sex dysphoria would still occur in a society without sex / gender stereotypes and misogyny.

I would like to know the cause of it, as would my family. However, that desire does not justify an attempt to deny the genuine uncertainty surrounding it, or supplant it with an unevidenced theory that best aligns to our worldview and expectations. That is how it came across to me, when you repeatedly requested that I acknowledge that sex dysphoria is a mental illness, despite a prior response that reflected on the research that is available and acknowledged the profound limitations of that evidence base.

I would argue that it is fairer to characterise your approach as one that seeks a specific cause, considering a lack of engagement with the exploration of currently available research, alongside the insistence upon a position that you have yet to link to an evidence base. Again, I would genuinely welcome the provision of research that indicates that this causal relationship exists. I appreciate that I did not specifically cite the research that I spoke about for the sake of brevity, but am more than happy to provide the full details of every study I have used in that response if people feel that would be valuable.

As to how to approach a child presenting with sex dysphoria - I would avoid making assumptions about the motivations or reasons responsible for their presentation. At present, we do not have enough information to establish a definitive cause, nor do we know whether potential factors, treatment indications, or prognosis can be applied to the entirety of what is a heterogeneous cohort. These factors underlie the importance of thorough psychological assessment and support for all children.

The false ascribing of a cause based on what is most comfortable for us is demonstrably harmful. This includes the insistence that the only possible cause is organic, which resulted in the increased provision of an inadequately researched medical intervention to subjects in which we lacked any evidence of benefit or clinical knowledge of the likely course of their distress. It also includes the insistence that the sole cause is mental illness, as well as the non-sequitur that that means the only acceptable treatment is talking therapy.

Thank you so much. I think that is a really positive development that has the potential to decrease distress in relation to intimate examination or care, and increase engagement with essential screening services, such as mammography and prostate examination. As discussed earlier, I am still considering how I will logistically navigate the maintenance of both same sex care and my privacy. I have written to the GMC as was recommended, both for practical guidance and for their policy regarding the disclosure of confidential staff information to other colleagues or patients.

In my experience, members of the public who have never had contact with trans people are strongly influenced by the tone and nature of media and governmental discourse surrounding these issues. In contrast, the acceptance and support of a known individual is often displayed, sometimes from the most unlikely of sources. I hope these two realities can be aligned to promote the development of nuanced and sensitive discussions of the issues and people at stake, without abdication of the responsibility to use evidence to inform policy and medical guidelines, and the need to safeguard vulnerable groups.

In my experience, members of the public who have never had contact with trans people are strongly influenced by the tone and nature of media and governmental discourse surrounding these issues. In contrast, the acceptance and support of a known individual is often displayed, sometimes from the most unlikely of sources. I hope these two realities can be aligned to promote the development of nuanced and sensitive discussions of the issues and people at stake, without abdication of the responsibility to use evidence to inform policy and medical guidelines, and the need to safeguard vulnerable groups.

Sorry, forgot to add the 👏👏👏

I agree that it ought to be apparent that medical and surgical transition will be suitable for some and not for others. That said, I empathise with the difficulty inherent to attempts to differentiate between those two groups, as well as in predicting prognosis and determining optimal management of the rapidly changing cohort seen in recent years.

I am aware that there exists evidence of young people being coached to provide a false account of longstanding childhood dysphoria to clinicians, in order to obtain medical intervention. IMO a key factor that promotes this behaviour is the widespread fear that clinical assessment exists only as a tool to justify the refusal of care, as was often the case in the past. Regardless of the cause, the effect of this is that clinicians are left unable to differentiate between the two groups.

I am also aware of accounts of clinicians treating medical transition as the only correct treatment for all young people, and a failure to explore the nature and course of a patient's presentation. I must be honest that this was not the case for me, and the whole process was so protracted that despite attending the Tavistock for 3 years, I do not feel I received support of any type (including psychological). However, the initial trial of puberty blockers within a clearly defined group of patients did not begin until 2011, at which point I was on the verge of being transferred to adult services anyway. It appears that the procedures and policies changed significantly after my experience there.

Unquestioning affirmation has been particularly alleged about private practise, the setting in which Ritchie Herron was first assessed. In his case, that was then compounded by a complete failure to perform any kind of holistic assessment upon his transfer to NHS services. Instead his private diagnosis was readily accepted and he was encouraged to pursue medical transition. Keira Bell has also spoken of unquestioning affirmation, and being granted access to puberty blockers after just 3 meetings over the course of a year. Similarly to Ritchie Herron, trauma and mental health issues were defining features of her childhood. In both cases there appears to be a disregard for the evidence and a failure to safeguard two very vulnerable people.

IMO, in order to facilitate the adoption of the Cass review recommendations that would prevent such practise, we also need action at a societal level. The stigmatisation of people who suffer from gender or sex dysphoria must be addressed, to facilitate an environment in which young people feel able to openly and honestly discuss their sex-related distress.

Many people who have suffered dysphoria from childhood do not present until adolescence or even adulthood. In my experience, the message that there was something shameful about my feelings was clear from a young age. This was a key factor that led to my inability to be open with my family, resulting in presentation being delayed until early puberty. Significantly, the delayed presentation of children with sex dysphoria cannot be readily distinguished from a false account of early distress. The creation of an environment where children feel they can be honest and access support from the commencement of distress would make the determination of the most appropriate treatment much more achievable.

Sadly, with most discourse being polarised, I think decreased stigma is unlikely be achieved at present. The way that these children are being spoken about in the media, and the policies that NHS England have recently enacted, will only further foster fear. On this matter, Keira Bell has recently spoken out about the ways she has been repeatedly failed. That includes the extreme ideology that suggests children should receive medical intervention without any degree of assessment, but also her treatment from the organisations that spearheaded her as a poster child for detransition. I'd highly recommend reading her interview to gain a better understanding of the continued harm inflicted by the lack of nuance in current debate. It is titled 'We Need to Complexify Our Understanding of Transition and Detransition'.

👏 👏

On this matter OP, I do have a question. Considering your clear capability, why is it that you are only early into your studies at university? I remember you saying you worked as a house removals man for a while. No offence intended to the occupation or to you, but I really am curious as to what prevented to you utilising your intellectual capacities at an earlier stage of your life.

I'm not the OP, but I personally find that unsurprising. I am also a smart person, although nowhere near the OP's level. It took me quite a time to find my feet. Intelligence can be as much of a hindrance as a help if you are a person of conscience. So many institiutions manage their internal processes in an inhumane, illogical and allegedly profit maximising way, that people who come out fresh from university, often with first class degrees, are disillusioned and don't know where to turn.

Thank you both, I can assure you that I don't come across as anywhere near as put together in real life though 😂

I intended to go to university after school (though not to study medicine). However transfer from child to adult gender services results in being placed on another long waiting list, which I knew would be followed by having to begin the entire assessment process again. As such I took time out to work and save money for a private mastectomy. Unfortunately, it was whilst working that job that I was assaulted, and suffered injuries in need of surgical repair. That repair broke down and resulted in ongoing infections that were not resolved until my mid 20s.

At that point, I had only been able to work part time for a while which makes it hard to get an interview. A close friend worked at the removals company and got me one there. I loved the job and the people I worked with so stayed with it for a while. I then developed an autoimmune disease and needed more time out of work. I had largely recovered and had just begun looking for work again when COVID hit, but I managed to find a haulage job as that was considered an essential service.

However, I found that I was no longer sufficiently stimulated by the work, and had had aspirations to study medicine for a while. As such, I quit a few years ago, before doing an access course and then starting my degree.

I don't regret the work experience I have had though. I had a lot of fun with the people I worked with, and I think there is a lot to be said for working a manual job and seeing the way that people stereotype and treat you.

Thanks, OP. For anyone else who's interested, here's the interview that he's referring to: https://genspect.org/we-need-to-complexify-our-understanding-of-transition-and-detransition/

Yes this is it. I would like to make clear that I think genspect are another harmful organisation, pushing ideology rather than evidence. However, the interview itself shows a lot of nuance and deep thought.

I have found your thread very thought provoking OP, and have very much appreciated the respectful discussion.
More conversations like this, early on, would have been helpful I feel.

Please can I ask you to elaborate on your take on Genspect?

I just wanted to say as another trans person, it is nice to see someone speak so much common sense. I have also seen the massive change in the make up of the trans community, and how we are allowed to talk about things. How things are for people like you and me has been completely overruled with talk about how feeling like a woman is about liking pink nail polish or playing with Barbie’s which is just insulting to everybody.

I am a trans woman and have been transitioned for 16 years and my husband is a trans man who transitioned 21 years ago. We also have very little contact with the ‘trans community’ of today, as we feel completely unwelcome and like we have nothing in common. The amount of abuse you get for not agreeing with all the ideology is so overwhelming. We just want to lead a quiet, normal life - hang out with our friends, go to work, buy a house and hopefully one day start a family. I hate people thinking I am some kind of exhibitionist or political extremist.

People fighting to get people like Adam Bryson in women’s prisons don’t speak for me or my husband! Every year they release that list of murdered trans people and then use their names to fight for the ‘rights’ rapists and murderers like the people that killed them. It makes me sick.

I also wanted to say how sorry I am to read about your terrible time after being outed at work. I have been so lucky to never experience anything that bad but it is the kind of thing we all worry about and reading your experience made me well up.

I see you have explained why you wish to get genital reconstruction, but I was wondering if you could go through why you decided on phalloplasty rather than metoidioplasty, which I understand has less complications?

@MAW1993 and @LunaJessica do you feel emboldened by recent events to say ' trans activists don't speak for all of us'? I know it must be incredibly difficult and you and people like you would have to ' out' yourselves presumably but it's such a shame that your support system has been hijacked by these people, and you are amongst the long list of victims of this, alongside women and gay/bisexual people. Do you have an organisation that speaks on your behalf?

It's so nice to hear from trans people who don't buy into gender ideology. Thank you for sharing.

I honestly have conflicted feelings about potentially gatekeeping who is genuine trans, and from my perspective the GC movement makes it more difficult to have those conversations. I like the OP’s approach of allowing people to explore their gender identity without judgement, as in the case of his younger relative.

Do you feel that the politicising of the debate has been unhelpful from both sides, op? Or am I getting that wrong?

Can I also just echo what others have said about how incredibly articulate and knowledgeable you are. And how well you handle difficult issues even when they are very personal to you. You will be an asset to medicine.

Edited by MNHQ on the poster's behalf to replace a potentially offensive term