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.

It doesn't sound conscious of the feelings of others, though, if you are willing to disguise what is a salient and material fact - that you are female - to patients, whose needs are surely paramount. Requesting a same sex clinician is not the same as preferring a clinician of the same sexality, at all.
Do you honestly feel that because you apparently 'pass' as a man, that should mean that your patients who want a male doctor should be fooled into accepting you? Does that really fit with the ethics that you've learned at medical school? Is it fair that a clinician who doesn't 'pass' doesn't have the same ability to gaslight the patients - and should the rules around doing so really depend on how well someone passes? Can you imagine how upset a patient would be if they had a need for a clinician of a particular sex, and found out that they had had someone of the opposite sex and hadn't been told? (whether or not they could tell, or had an inkling, or not). This seems like a fundamental breach of trust to me, and I find it hard to imagine that you could square that with your ethics of being a doctor. Do you not see a problem in fooling people to whom it might really matter, even if it doesn't matter to you - doesn't that erode their basic trust in you as a doctor?

Did the psychological help and counselling at the clinic not delve into why your female organs caused you so much distress? Ie. What might have caused this in the first place?

But the OP is aware of that and is sensitive of the needs of others. If people ask for a male clinician and they are abused or lied to or rape victims told they need to examine their prejudice, that is a different matter, but the OP seems aware that they are biologically female and of the female sex, and is not imposing their choice on others.

Do you think transwomen should equally be allowed to treat female patients, without disclosing anything, or do you think there should be rules set by the GMC about honesty? Do you agree that there is a difference between a fundamental characteristic like sex where it is already established that the patients have a right to ask for a particular sex clinician, and something like sexuality or other characteristic that they do not? Do you feel that your desire to be seen as a main outweights the patients' needs in these circumstances, or do the patients' needs come first? Would you not tell your boss or your colleagues your status? Do you think other trans doctors who may not pass as well as you do should be obliged to do this?

If you were to become a parent, how would you tell your children about your trans status ?

This is a great thread OP and it’s generous of you to share your experience with us. Imo the OP is describing true gender dysphoria - intense, debilitating distress caused by the sexed body. It normally starts very young and does sometimes resolve in adolescence. The experience described makes it clear that this condition is completely different from the whole concept of ‘gender identity’.

What do you think of other types of being trans, such as transracial or transabled? These people can also feel a lot of distress, to the point of getting legs amputated. Should they also have a clinic where they can go to have their bodies surgically changed?

What? Is that actually a thing??

How much effort was put into helping align your thoughts and feelings with physical reality, rather than manipulating the physical reality? With most types of dysmorphia, such as those who believe they need healthy limbs amputated, the therapy focuses on helping you come to terms with your body and working out why you feel alienated from it. With gender dysmorphia, it seems the opposite was done. Or were there attempts in counselling to help you accept your body and understand what triggered these feelings?

OP, no question for you but want to thank you for sharing your very personal story, answering questions so insightfully and honestly, and, importantly, for taking on board opposing views.

This is truly the first time I've read anything so respectful and measured to BOTH sides of the debate.

Wish you well.

Do you have male and female friends at the moment, and is there anything you now know/ understand about men from being accepted as one, that you would not have before?

Hard to say I expect as some of that stuff comes with age/ life experience anyway.

I appreciate that this is a really hypothetical question, as it couldn't really happen, but if you'd never seen a man, or perhaps (easier) just never seen a penis, do you think you would have had the feelings of not wanting to be a woman?

Also, which toilets do you use, if you don't mind me asking.

Do you think that exploring a relationship before further surgery might help you?

You sound lovely. Do you think you are shutting yourself off for physical or mental reasons and have you tried to explore these with anyone?

Do you have fears about incontinence or complications afterwards? As an older woman than you, these sadly come with their own barriers to intimacy.

I agree that this distress seems unlikely (?) to just appear without any cause, to the extent that having female parts contributed to believing life wasn't worth living. Obviously I'm not an expert and perhaps whatever prompted it was completely benign but took hold. I wonder if your mother, as an observer of you as a child, has any suggestions?

I wonder what the parallels are with other types of dysmorphia.

As you say though OP probably doesn't hugely matter to your life now.

I hope you don't mind my musing "out loud" when you've been so open OP - I'm interested but I'll be quiet now!

Thank you op for sharing your story. I have read some of your answers more than once. It has been very interesting.

I hope your future gives you all you hope for.

What was your father's relationship like with your brother?

Was/is your father homophobic and/or sexist in any way when you were a child?

Was your mother aware of your deep distress at your body when you were a small child - how did the distress manifest?

This is really interesting OP, lovely how you talk so openly, honestly and intelligently. I hope you find love in the future.

Do you think gender dysphoria is a mental health issue? And why/why not?

It is. A surgeon in Scotland did two amputations before being told not to do it anymore. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1127127/

I’m interested in the link between this and sex dysphoria and why the latter gets treated with hormones and surgery, but the transabled one doesn’t.

Also, look up Oli London who spent £100,000s on surgery to look Korean. He’s now de-transitioned but has had lots of surgery so doesn’t look like he used to look.

If I'm not made aware of the request, whether that is because it is not voiced by a patient who assumes me to be male, or because I am allocated by a colleague without being told why, then I cannot fulfil it.

As such, I recognise that some will not agree with my position, but I don't think it's ethical to enforce disclosure of personal information from medical staff to either the people they must work with or to patients.

From a purely selfish point of view, harder. But only because the raised awareness of trans people made me worried that others would recognise it in me. However, it hasn't been a concern for me for quite a long time.

@MAW1993

I get the point on not disclosing your trans status if you pass, tbh (though not all women on here do and I understand that).

Two questions, though:

1. if you were dating, when would you disclose your status?

2. if you didn't pass, would you be upset if your colleagues or friends didn't put you forward for single sex care etc? This is where, to be honest, most trans women who transition after puberty are.

Hi OP. I have a 19 year old trans child. They are assigned female at birth, but have socially transitioned and ‘pass’ confidently using a male name and pronouns. We have, I think and hope, a close and open relationship and his dad and other family members are supportive. I really found it helpful and moving to read your thoughts on how you would approach this as a parent to a trans child. Thank you so much. I wish you well in your career.

I don't agree that forcing staff to disclose highly personal and sensitive information is a balanced response to the possibility of a trans medic unknowingly providing treatment to a patient who wished for same sex care.

I don't think that sex is the same as sexuality, the point I am making is that it is equally unacceptable to remove the right for privacy from trans people, as it is for any other group.

I mentioned that I passed, because I was asked as part of the question whether I did. I don't think the degree that someone passes is a measure of anything other than luck.

I've made it clear that I have no intention of fooling anyone or disrespecting someone's desire to same sex care. I also explained that it does matter to me, and the ways in I try to be thoughtful and careful when balancing the needs of others with my own right to privacy.

Ultimately, if you think the only ethical way to exist as a trans person is to walk around with it tattooed on your head, then we are not going to agree. You're entitled to your opinion, but it isn't one I share, so I don't think I will be able to provide you an answer you deem satisfactory.

I was asked, and I did try to provide them with an answer. However, the truth of the matter is that I don't know why I feel the way I do, even today.