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.

Have you ever been assessed for any mental health problems, ASD, or similar by anyone who wasn't primarily investigating your gender issues?

If you are in medical school and expect to have to do intimate examinations on people, do you accept that there are some men that would not feel comfortable having a biological female treating/examining them and deserve to be able to ask for a same-sex clinician? Equally, do you accept that some female patients might be traumatised by someone who presents as male examining them? (In fact, these things could be the case even for non-intimate care). Do you think it's fair to them and ethical for none of your patients to be informed of your sex, or do you think it's obvious to them already (which I would guess is less common for a transman than a transwoman)? How do you intend to deal with this going forward if you are not going to inform patients of your status? I can understand that you might not want to, but presumably in a profession such a medicine, your wants would have to take second place to the needs and requests of your patients?

In terms of formal treatment, not really. The reason for that I went through a bit above, but I really wasn't able to engage with the therapy sessions at the Tavistock and didn't speak very much at them.

Informally, I tried to live as a gender confirming female whilst in high school, though that was really motivated by bullying and not a good experience. I tried to live as a butch lesbian in my final years of high school, and I was definitely happier than when I was trying to be stereotypically female. However, the distress at my breasts and genitals was as powerful as ever, and never alleviated.

Transition was something I really didn't want to do, as the climate at the time was very different. I remember trans people being something to laugh at, and I was very ashamed to be associated with that. I worried people would think I was some kind of pervert, and didn't know how I would ever get over the embarrassment or be able to say that I wanted to be male. But equally I was feeling increasingly suicidal.

I did think about suicide a lot, but I knew how awfully my first attempt impacted on my mother, and I decided that I would never try it again, at the very least whilst she was still alive. I also am not religious, and believe we only get one chance at life. I thought that it would be a disservice to myself and to others to not give it every chance to try and find a way to live happily. That was what ultimately motivated me to say, to hell with it, and transition and see if I could make a successful life out of it. It was incredibly difficult, and still is in some ways, but finally in my 30s I'm starting to feel like there is a light at the end of the tunnel for really the first time in my life.

In terms of would I consider another treatment to make myself happy with my female body - absolutely. If there was a therapy or a medication or whatever else that could have gotten rid of my feelings I'd have jumped on it. But do I think that such a thing existed for me - no, unfortunately.

I don't really know whether the way I am is a mental illness, a neurological difference, some development thing or any of the other theories. Although I would like to know why, in terms of how I deal with it the cause is not very important, only the ability to relieve the constant misery I felt.

I honestly don't believe there was anything that could have allowed me to come to terms with being female. I know it sounds like quite an extreme thing to say, considering what may appear externally as a very young age at which I started to make movements towards transition. But whilst my childhood and adolescence may not have been a long time in years, it felt like many life times of misery.

I don't think it can have done. I was born in 1993, and social media wasn't really a thing in my life, until I was in high school. The feelings that I have had about my sex have been around a very long time. The first memory I can think of is from when I was in nursery.

I have never really believed I was the opposite sex, rather I desperately wished that I were and that I had male genitals. I really have no idea why I feel this way, only that I do, and have for as far back as I still have memories.

What do you think that taking testosterone and having surgeries has given you, in benefits to your life?

There are a few things I can think of:
(1) Being seen in a more timely fashion.
(2) The provision of space to speak about my feelings to the team without my mother there, which really exacerbated my feelings of shame and humiliation. Even outside of sex dysphoria, I find it much easier to speak to clinical staff about private health matters, as I do not know them on a personal level.
(3) More empathy in general. I never found the staff to be warm or kind, they didn't seem to understand why I was upset and would continually ask very invasive questions that I had said I didn't want to talk about in front of my mother e.g. masturbation habits, whether I had had vaginal sex, why I didn't want to have such sex etc.
(4) They also always treated everything I said with a sense of incredulity. I vividly remember the woman I spoke to rolling her eyes at almost everything I said. In the end I didn't engage with the process at all and so couldn't access support of any form.

I do think it is important for a children presenting with sex dysphoria to have a proper psychological assessment. I also understand the relevance of emerging sexuality in adolescence, the need to explore and challenge gender stereotypes, and the need to promote open thinking. I just think it must be done with sensitivity and kindness.

Thank you that is very kind to say, I am much happier today and my life is very different. Yes that is a good summary of my feelings and what prompted my decision after a lot of wrestling with it.

Other parts of my body have caused distressed, really in the same way as most people. I was spotty as a teenager and hated that, and I was a bit overweight for a period as a young adult and that affected my self esteem. However, those concerns were honestly like minutiae compared to the pervasive, distressing and all consuming horror I constantly felt about my sex.

I'm not 100% sure what you mean by men as males? If you mean do I think that trans men are male, then the answer is no (however much we wish that were the case). However, socially I think its a bit more complex. Many trans people are treated as their adopted 'sex' day in and day out without anyone otherwise aware.

For example, I don't think it's dishonest to refer to myself as a man, even if I am not male. I have lived and been known as nothing other than that for 13 years. To call myself a woman doesn't seem accurate in that sense, though I appreciate others will disagree.

I am really not involved with trans activism. However, I joined some support groups when I was younger, and found people very supportive and kind. It was nice to not feel such a sense of isolation. That said, I found the spaces changed very much within a short space of time.

By the time I went to university, the trans support group consisted of around 20 regular attendees. None had sex dysphoria, had undergone any kind of medical transition, and at most had undergone some kind of limited social transition by changing pronouns for example. I don't say that to demean or interrogate their experiences, rather I just didn't feel I had any real connection to that. It didn't feel like we had anything in common, or that they could understand the kind of things I discussed with other people who medically transitioned, and so I stopped attending.

I have personally never fully identified with, or understood, the concept of gender identity. Obviously none of us can know how others think of and perceive themselves, but I don't personally feel like I have any sort of internal 'gender identity'. I just feel like me. My decision to transition really was motivated by my desire to have a biologically male body. Whilst I have always known that is not a real biologically possible, this was as close as I could get to that.

None had sex dysphoria, had undergone any kind of medical transition, and at most had undergone some kind of limited social transition by changing pronouns for example. I don't say that to demean or interrogate their experiences, rather I just didn't feel I had any real connection to that. It didn't feel like we had anything in common, or that they could understand the kind of things I discussed with other people who medically transitioned, and so I stopped attending.

My decision to transition really was motivated by my desire to have a biologically male body.

Really good to get your thoughts. I've long found it bizarre really that these fairly different things are lumped under the same term and personally that's where my understanding sort of breaks down.

I would guess that the vast majority of people think "trans" is the desire to have the opposite sex body yet the gender identity and self-id stuff has really muddied the waters and, in my opinion, turned a lot of the discussion into academic-leaning or political-leaning linguistic games. Meanwhile your average person assumes that man=male and woman=female, or at least as far as anyone knows .

Yes, after my suicide attempt as a teenager I was referred to CAMHS and had a course of CBT with a psychologist. Unfortunately, I still felt a lot of shame about my feelings at the time so I never discussed them with her. I didn't find it very helpful.

When I was older I went to my GP when I was, again, feeling suicidal. I was referred back to CAMHs, but this time for regular one to one support with a social worker. She was truly wonderful, and I think is responsible for me still being here today.

She could definitely tell there was something deeper underlying everything, and would gently pry a little, but not push too far. She addressed a lot of my other issues in terms of being bullied and having a distant relationship with my father, and built up a trusting relationship with me. I did ultimately tell her about how I felt in terms of sex dysphoria, and she encouraged me to speak to my mother. I still didn't feel able to tell my mother, and so she offered to organised a session with the three of us together, which I agreed to.

My mother had long suspected there was something wrong, but I now know that at the time she suspected I was a lesbian and struggling with bullying and self-acceptance. It was a terrible shock for her, and whilst she didn't love me any less, she told me later that it she felt a form of grief for the first few years.

The social worker referred me to the Tavistock as it wasn't her area of expertise, but continued with her overall life support until I was 18.

I have never been diagnose with ASD. I was diagnosed with depression by CAMHs the first time I saw them, hence the CBT. I had recurrence of that, prompting the second CAMHs referral, and then again as a young adult. My GP handled it when I was an adult, and I had a course of SSRIs, which were very beneficial for me.

The Tavistock itself never actually diagnosed me with anything due to my inability to really engage with the team in the way that they conducted things.

What advice would you give the parent of a young person (say, late teens) who has come out as transgender, has "socially transitioned" and is firmly entrenched in online transgender spaces and wants to pursue a medical transition? Particularly with regard to the absolute parental terror about things that are irreversible and - to someone who has never experienced dysphoria - objectively harmful. Things like binders which can damage healthy breast tissue, phallo/vaginoplasty which can permanently remove fertility or cause chronic pain, puberty blockers and hormones which parents may feel are inadequately tested and their effects poorly understood - can you as a trans person understand why many parents are so frightened of these measures, which feel so drastic to them, and why they might grieve/cry/suffer mental health problems because they want to support their child but don't want to be a party to physical harm that may be regretted when it's too late?

Sorry that's garbled, but I see many young transgender people refusing to engage with parents' fears and worries, dismissing them as toxic and unloving if they do anything other than enthusiastically affirming all of the choices their child makes. It's an excruciating position for a loving parent to be in, and very difficult to know how to negotiate it without destroying the relationship .

I always try and walk the fine line between not outing myself, whilst still respecting others.

I have male Muslim friends who don't believe in shaking hands with members of the opposite sex. It's not a view I share, or personally agree with, but I avoid shaking their hands as I think they are entitled to their beliefs and don't want to undermine them without their knowledge.

I don't believe other people are entitled to know about my genitals, biological sex, or trans status. I think that medical professionals are entitled to privacy the same as anyone else, and that it would be overly invasive to demand that they expose personal details to every patient they meet.

In the same way, some LGB people may be more comfortable seeing LGB medical professionals, and I think that should be facilitated where it is possible. But I would not support any attempt to do so by forcing medical staff to disclose their sexual orientation to patients. Any approach should uphold the privacy, values and integrity of both parties.

My biological sex is not obvious to anyone after many years on testosterone and I have never had anyone assume me to be anything other than male since I was around 20. It is an issue I have thought about, and I have decided an approach. I have no intention of telling any patient my trans status; no one other than my family knows, and I don't tell people in my day to day life (other than if I were to find a romantic partner).

However, where a male clinician has been specifically requested for any reason, I will leave that to a another colleague to perform. I have no intention of ever wilfully going against another's wishes.

I appreciate that answer will not satisfy everyone, as some patients may feel that way, whilst not explicitly stating it due their assumption that I am male. But I feel it is the way I can best respect the wishes of others, whilst not exposing and putting myself at risk.

I have two questions if it’s ok?

Do you have any regrets?
Have you lost any family or friends by transitioning?

Sorry and another!

What would be your advice to others that feel similar to how you felt?

With the exception of my privates, which I intend to have surgery on now I have recovered from ill health, I now feel ok with my body.

I am no Adonis, I have plenty of flaws just like any other. But I don't feel abject horror and misery every time I see myself. It's hard to explain what it is to feel ok in your own skin for the first time in your life, but the sense of relief is palpable even now.

A couple of things worry me about this:
'Today the only people who do know that I was not born a man are my family.'

Does that mean you've lost touch with those you describe as a loving set of friends from school? And do your medical records show you as male, which might lead to problems with correct treatment?

I just wanted to say thank you for your honesty here in answering questions. You are clearly intelligent and articulate and I wish you happiness in your life.

How will that work though? How will you avoid working with someone who has requested a male practitioner if you're not going to share your status with your colleagues?

Thank you for saying this. You sound very conscious of the feelings of others, and realise that although you are a trans man, other people have a right to their own feelings and deserve respect. Do you think your life has been made easier or harder through trans activism?

Oh I can absolutely understand why parents have a sense of grief. My mother could not have been more accepting of me, but even she went through a grief process for years. Even if one has no doubt that their child would benefit from transition, no one wants to see them suffer terrible distress, complications, or to become a target for discrimination or mistreatment.

When it comes to the possible side effects of treatments, for me it was a matter of balancing them. I had tried to live a happy life without undergoing anything physical, and hadn't been able to. I was desperate and suicidal, even to the point that the presence of a loving and supportive parent felt like a trap - I couldn't live but I couldn't die, and inflict that trauma on her. I know now what a perverse way of looking at things that was, but when you are so desperate for your unhappiness to end your thinking can become very warped.

So to me, the risk of hormones, surgery etc. were dwarfed by the reality of my existence and the unhappiness I felt, and had felt all of my life, and the need to keep going and live my life to the fullest, for the sake of those who loved me.

I can't speak for every trans person, or person suffering sex dysphoria. It may be that the young person you talk about has the same experiences as me, and has simply grown up in a different era. Had I been born more recently, I am sure I would be involved in online trans spaces and potentially viewed by my family as simply being influenced by my peers. Equally, perhaps the increased exposure to trans people that young people have today, has helped to develop an idea that would not have otherwise existed. It is impossible not to be shaped by the environment in which we are surrounded, and so difficult to determine the degree to which these factors have influenced us.

I fully understand the very real worry that people will make these decisions and live to regret it. How are we to distinguish between those for whom it will ultimately be harmful, and those for whom it can be life saving? That's not an easy question, and something I don't think anyone has gotten a handle on.

If it were my child I would allow myself to grieve, to cry, and to struggle with what they were going through and what could come to pass. I would also tell them that there was nothing they could do or be that would stop me from loving them. I think you can provide unconditional love, without agreeing with the course of action that your child takes.

I would try to establish an environment where the young person could talk to me, without fear of judgement or lecturing, in the hopes they would explore their feelings with me. By that, I don't mean blindly agreeing with everything someone says, but rather addressing their thoughts and feelings with empathy, genuine curiosity, and without judgement.

If I had specific concerns about things I thought indicated this wasn't the right path for them, I would try and talk to them about that. I'd explain what I feared could happen, and why I had these concerns. I would emphasise that my attempts to explore these concerns were motivated only by my desires for what was best for them, and not by a desire to control them or dictate their life choices.

Some young people will still be angry and feel deeply defensive. That's not easy for any parent to navigate, but I don't believe that a genuine, kind and empathetic discussion is likely to lead to the irreparable break down of a relationship. However, I do think that approaching it in a dictatorial, angry or controlling way could alienate a young person, even if that anger came from a place of love and concern.

When engaging with people I love on a matter upon which we deeply disagree, I try to remind myself that each of us has unique experiences and ways of seeing the world. It is easy to see a behaviour, and assume that the underlying motivation is one that would cause us to behave in such a manner ourselves. I don't think that is helpful though, and it leads to assumptions and the breaking down of good communication.

I hope this helps, I'm sorry it might not be as concrete as you were hoping for, but it is hard to speak in specifics without knowing the people involved.

Thank you for that brilliant and measured response. You are quite right, there is a specific young person behind my questions, and you have given me a lot to think about.

The other question:
'Sorry and another!

What would be your advice to others that feel similar to how you felt?'

I have no regrets about the choices I've made. However, I do miss a few things that were unique to being read as female. One is the friendships I used to have with other girls/women. There is a closeness there, that is not replicated in friendships between men and women, or between men, at least in my experience. That said, I have many wonderful friendships still today, and I would not trade them.

I also miss the understanding that it is normal to have emotions, and to cry. Society often does not provide space for this for men and I think that's a terrible shame

That said, as I've gotten older, uglier, and perhaps wiser, I've realised I don't need to exist as a stereotype and can simply be me. However, there is no denying that there is societal pressure for people to behave in specific ways depending on their sex, or in my case, the sex I am perceived to be.

I am very fortunate in that the overwhelming majority of my family were very accepting, even if they struggled to understand it. I did have a very strained relationship with my father for years, but we have both mellowed over the years and it is very different today. There were a small number of people in my extended family who made unpleasant and derogatory comments, and still do not accept me now. I choose not to interact with them as a result.

My main advice to others who feel as I felt is that your life doesn't have to be over. You get one shot at life, and you owe it to yourself to find happiness however you can. Transition is not easy, and nor is waiting for it if you have decided it is right for you. But it is possible to find a place in the world for yourself, and to be content and fulfilled. Don't rush into anything, and think deeply about what the right choice is for you, but also don't deny yourself happiness because you fear the reactions of others.

Sorry if I was unclear, I have not cut anyone out of my life due to them knowing me before I transitioned, though some chose to end their friendship with me when I came out.

However, I was bullied very badly in high school, and throughout my years there I did not have a friend. The main friends I had past my young childhood years were in sixth form college.

I still have some of them on Facebook, and it is nice to see them get married, have children, live their lives etc. However, as is the case for many of us, we have all moved on with our lives and simply drifted apart. It was no conscious effort on either of our part, and there is no ill will, we just haven't been a part of each other's worlds for 15 years.

As I transitioned young, I was already living as a man when I met all the friends I made as an adult. I did not disclose my past to them, because I felt like I had spent enough of my life as an oddity, and I find my trans nature inherently humiliating and undignified.

My medical records do show me as male. This can cause problems for some people. For example, it will prevent routine invitations to sex specific screening. I chose to have a hysterectomy not only due to my sex dysphoria, but also not being able to handle the ordeal of cervical screening.

People are still entitled to screening and healthcare appropriate for their biological sex, but they will not be reminded and must book it themselves. I always disclose my biological sex to health care professionals, as it would do us both a disservice for them not to consider it when managing my health.

I know there are a few questions that I have not yet gotten to. I need to make dinner, but will be back later to address them.

Thank you all for an engaging and interesting discussion so far.

Just popping in to say thank you for doing this AMA, it’s really interesting and I wish you well for the future.

Don't have a question but just want to say a big thanks and well done for this thread OP. If I'm being honest I would normally consider myself gender critical...but really that's only because I feel forced to stand on one side of the debate.

You're clearly a a very emotionally intelligent person who's willing to answer with a lot of careful thought - you've reminded me of the human side of the debate and how nuanced it is

It would be really helpful to have perspectives like yours being platformed more, but...I suppose it wouldn't sell many newspapers or social media ad space