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.

My father's relationship wasn't very good with either me or my brother as children. He was never very kind or warm with us when we were young. I had a lot of resentment towards him when I was younger, but I have seen him change an awful lot over the years. He was raised by emotionally distant parents and I don't think he knew anything else. My mum has been a very positive influence on him over time though.

I was very fortunate that neither of my parents were sexist or limited myself or my brother in terms of gender stereotypes. My mum normally bought us educational things like K'NEX or books, or outdoor things like my treasured bike and scooter, obviously depending on our interests too. She always felt pigeon holed growing up and so she always wanted us to develop our own passions. I am really grateful for that.

My dad did used to be a little backward. The main thing I remember is he would make homophobic jokes about gay men, and he was also derogatory about trans women (trans men were not really known of much when I was young). However, those memories mainly go back to when I was very young, and he has grown a lot over the years.

I don't think he ever truly hated me for being a trans person, but he wasn't able to accept it for many years and felt that it was a shameful thing. He wouldn't really acknowledge it, for example a close friend of his that I knew as a child didn't know I had transitioned until I bumped into him last year.

However, when I faced some issues and discrimination, he was really angry about how I had been treated and tried in practical ways to help me challenge it. We have never explicitly talked about his change in attitude, but from then on he began to treat me different and today it really isn't an issue at all.

In an ideal and perfect world would it it have been more ideal if you had been able to receive intensive and advanced psychological therapies from a very young age say 7 years, with an intended outcome of healing your dysphoria?

I can really feel from your description that your transition felt absolutely necessary to you, but of course it isn’t without cost to you and those around you. Would you agree that a really rigorous effort by adolescent mental health professionals to actually heal dysphoria has the potential to serve genuine sufferers better than physical transitions?

I guess I’m asking that if you could have been healed by psychological interventions, would this have been preferable? (I believe it would).

If yes, do you see any way in which we can square this with the present trend to not treat dysphoria except medically? The current problem that society seems to have with treating dysphoria seems to me to do a huge disservice to sufferers.

Honestly, I don't really know. On one hand I think it could be due to the severe distress it causes. On the other hand, I wonder if its some kind of developmental abnormality instead. I have always wondered why, and I would like to know. However, I don't think it would have changed the choices that I made, because neither the therapy I had nor my attempts to find a way to be content as a women provided me any relief.

This question may be more uncomfortable. Since you dont believe that you are male, may I ask why are you choosing to give others the impression that you are, instead of the honesty of allowing people to know that you are a female presenting as male?

You will certainly be aware that males behave differently amongst other males as compared with females and vice versa. So by not disclosing there’s huge dishonestly in every relationship you have. So much so that I imagine friends would be extremely upset to discover the transition/deception. Whereas if friends knew the actual true situation from the outset they would then be true friends? Not sure if I’ve been able to explain my thinking.

Yes I have always felt any potential romantic partner should be aware. It never sat right with me not to disclose it. Obviously my sex dysphoria is a big factor in my decision not to pursue relationships. Equally though my feelings on disclosure combined with an experience of being outed as a result of that have also been key influences.

No I wouldn't be upset, nor would I be if I had chosen to inform them and they decided not to as a result. I really just would not feel comfortable knowingly going against a male patient's preference for same sex care.

However, I can't agree with the assertion that trans people should be forced to disclose to their colleagues or patients. Being outed was a very traumatic and resulted in some very bad things being done to me. As a result I have a lot of fear of it ever happening again.

I am really glad you have managed to maintain a good relationship with everyone involved. I really wish the best for you all. I know from my mother's experience how distressing it can be for a parent of a child who chooses to transition, and I hope you have been able to receive the support you need. I also know that your love for your child and efforts to maintain a close relationship is an incredibly powerful thing.

@MAW1993

Completely get that. I think I agree with you re forced disclosure because it is very intrusive, though I think that in the healthcare field it should be possible for a patient to request another practitioner if they have concerns due to someone not actually passing as the relevant sex without being stigmatised as the patient.

I don't know to be honest, but I do remember feeling that something was very wrong in relation to my genitals before I can recall being aware of the specific physical differences between boys and girls*

It's interesting isn't it. That answer strikes me as not liking your body rather than wanting to be the opposite sex as such.

Would you agree that not liking your own, female, body doesn't necessarily correlate to wanting to be male/a man?

You don't seem happy being a man without a penis, so is it the penis you crave rather than being a man?

And to repeat PPs, thank you for your honesty and openness here. It's so good to have a rational discussion and to be able to ask questions without being accused of being a bigot/TERF etc.

Just copying in your other questions:

'Why did you think you are trans and not a lesbian OP? If that's not a stupid question.'

'How can girls elect not to be intimately examined by a man if they are mislead into thinking they are female. Or if they can see they are a man, but are being required to pretend they can't see this because it's "mean"?'

If you mean in terms of conditions like autism, I do not have any neurodivergent conditions as far as I am aware. If you mean in the sense that I believe there is some kind of difference in how my brain developed, I think that is a possibility. However there is no definitive proof either way and it could just as likely be another factor, or could be multifactorial in nature.

I didn't think I was 'trans' to begin with, because I didn't know that was a thing. I just knew I was very unhappy and desperately wished I had been male. I began to be attracted to girls from the age of around 12/13 and I did think I was a lesbian and that might be why I felt the way I had throughout my life. However, when I found out about the existence of trans people that seemed to fit more. That was reinforced to me when I did attempt to live openly as a lesbian without feeling any relief regarding my sex.

I think that there is a responsibility on all trans people to be sensitive to the reality of their sex, and how that might make some things unsuitable. For example, whilst both male and female doctors need to be capable and competent in performing intimate examinations on men and women, men should be sensitive to the fact that some female patient will only wish to see female doctors. In the same sense, so should a trans woman (and the same for women and trans men in relation to male patients).

I don't think it is acceptable for a woman who do not feel comfortable receiving this kind of care from someone who is biologically male to be castigated as a bigot or have her wishes disregarded, regardless of how the health care professional identifies themselves. If a trans healthcare worker knows that that this is what a patient has chosen, I think they should recuse themselves and find a colleague who can perform the examination. Whether the patient would be able to tell they were trans really has no baring on the situation, in my opinion.

Thank you that is very kind of you. No I never saw a male looking back, I saw a female body, and what was what made me so unhappy.

When I look at my face in the mirror today I do see a man. Obviously people may have had thoughts I was unaware of, but as far as I know I have never had anyone assume I was anything other than that since my early 20s.

Obviously when I look at my whole body in the mirror, it is obvious to me that I am not a man though.

My mum is wonderful and I don't think I will ever be able to fully express how grateful I am to have had her. I am also very proud of how my dad has grown over the years.

I understand what you are saying, and telling my boss could be a good solution to the issue. I hadn't really considered it before, but I will be beginning my clinical placements next year and the matter of patient privacy is something that has been on my mind.

I think I have just always been very reluctant to tell anybody, because of what has resulted from that in the past, and I know for a fact that something like that would result in widespread gossip through my work place. However, I imagine that a manager would not be able to disclose this kind of information to my colleagues on a legal basis, though I'll need to look into that.

Thank you for the suggestion.

@MAW1993 Aww thank you for your answer, you're awesome! 🤗

I completely understand you concerns. My mum desperately wanted me to remain as I was, and was desperately upset about it all.

I definitely think there is value in exploring the option of alternative ways to cope with sex dysphoria. It doesn't prevent you from going through with a medical transition later. That said, you may find that child has already tried things that you are unaware of, and I can't begin to tell you the degree of urgency I personally felt once I had finally made that decision, after many years of unhappiness. Ultimately I think what is critical, is that in any discussion you make it clear that your love for your child will not change, regardless of the path they take.

If you do choose to breach the topic, I would begin with that, and then ask if your child if they would be willing to have a discussion with you about some worries you have. Whilst I know it's a very emotive topic, and one that is very politically charged at the moment, it's really important to try and remain calm and compassionate.

It may be that your child has considered a lot of the things you are worrying about, and that may make you feel more reassured that they are not making rash decisions. It is also possible they have not, and may be very defensive and assume you are trying to choose a path for them. As such, I understand that it's not an easy conversation to have, and if things become too heated, I would always try and go back to the first point - that you love them and will support them no matter what.

I hope that can be of some help for you and wish you the best with it all.

I would ask a colleague to provide the care, without going into my reason.

Yes absolutely, one of the things I think they should have done differently is this. I understand that in many scenarios, doctors will feel vulnerable to allegations of inappropriate behaviour. However, I can't understand why an independent chaperone was not an option instead.

That said, I still think the entire way they spoke to me was unempathetic and lacked sensitivity. I am absolutely in favour of exploring the feelings and identifying if there are any reasons underlying sex dysphoria, and I think the social worker I saw through CAMHS did so masterfully.

I want phalloplasty as I am still very unhappy with my genitalia. In terms of techniques, there is a lot of misunderstanding. For example, many of the images floating around on the internet are of procedures that are incomplete. There are still things that are far from ideal, but the completed procedures I have seen are aesthetically acceptable to me and sexually sensate (though this is dependent upon the technique chosen by the patient).

That said, it is a major, major surgery and there are many complications. Some are extremely unpleasant and can be serious. As such, I hadn't really decided definitively that I wanted to have the surgery until about 5 years ago (though it was then delayed by unrelated health issues).

That decision wasn't a straightforward one, however I don't believe that my unhappiness is likely to improve at this point, and it has a big impact on my life. That is why I am willing to take the risks that are involved, and the imperfections that exist with the surgery.

Surely if you believe that

a) someone should be able to choose single sex healthcare
b) you don't feel comfortable revealing your trans status to anyone

the only answer that satisfies both of these is to either not work in a job where it is an issue (ie the vast majority of jobs), or to choose a specialism where it is less relevant. You could specialise in neonatal care, ENT, pathlogy etc. Obviously you've got to get there first, but choose an area where patients tend to stay dressed, or where mixed sex care really doesn't affect anyone's dignity or privacy.

Knowing that it might make some patients uncomfortable, and treating them regardless, send disrespectful to me.

Basically, no you shouldn't have to reveal your private information, but they your shouldn't make the decision to work in an area where that beaches others boundaries IMO.

Thanks for responding OP. I know you don’t want to make discussions like this a part of your everyday life, but I think it will be very important that development of new services is informed by considered nuanced opinions from people with lived experience, and I hope there will be a way that you can feel comfortable with contributing.

No I don't know any more today why I feel the way I do than I did as a child. I want to clarify though, that I don't have hatred of female genitalia in general, only the fact that I possess them myself.

The therapy I had at the Tavistock aimed to explore that, but due to the way in which it was implemented I was not able to engage with it. I have talked about that in more detail in previous posts so will keep it brief here.

I also explored it with a social worker who provided me support via CAMHS. She wasn't a specialist, but she was very caring and as an adult I am in awe of her skill in working with troubled adolescents. I found those discussions far more beneficial than those I had with the Tavistock.

I then explored it with the private doctor I saw (plus a second opinion from an psychiatrist) from the age of 17 across 3 sessions, before he prescribed me testosterone about a year after I first saw him.

I then saved for and underwent a private mastectomy. I think I was 19 or 20. Before that was approved I was interviewed by two psychiatrists who had to be in agreement that this was the correct option for me.

I did not enter adult services at the age of 20, as there was a 2 year waiting list. Although I had already undertaken irreversible steps, as a new patient with a new clinical team I did have further discussions about my dysphoria and why I had chosen to transition. After a year they agreed to take over supervision for my testosterone prescription. I saw them once to twice a year until I was 26.

I asked for a phalloplasty referral at the age of 25, and again two psychiatrists performed an evaluation before clearing my referral. I had a consultation for phalloplasty and received a date for my surgery. Unfortunately, I developed an unrelated health condition that required treatment before I could ever contemplate such a major surgery.

I had largely recovered by around 3 years ago, however I had been discharged from the gender clinic I attended (my GP took over the monitoring and management of my testosterone prescription). As such, I am on a waiting list to be seen again, and re-referred to the phalloplasty team. The waiting list for the surgical team has now increased to many years though, so I don't think it is likely that I will have completed the surgical stages before my 40s.

I haven't yet got to the end of all the replies, but I want to say how articulate and thoughtful you are, and how deeply important I think this thread is.

I personally do not feel comfortable with such phrasing. There are a couple of reasons for that. Firstly, I find a lot of the adapted language to be demeaning, and to be frank, pretty cringey.

More importantly though, I fear that the use of vague language like this could be a barrier to people understanding their health and bodies. For example, if such language was used on patient information leaflets, I feel there are many people who would not understand what was meant.

Finally, I think it is important that all people (particularly in the context of young people and children) are taught the anatomically correct language for their body parts. That kind of education facilitates their ability to communicate issues or worries they have. That is key not only to treat health conditions, but also for safeguarding issues such as sexual abuse.

For me, I don't think that kind of language provides any benefit at all. Whether it is called a vagina / clitoris / uterus or whatever else makes no actual difference to the way that I feel about my biological sex. Were it that easy to resolve, I would never have transitioned. Obviously I can only speak for myself, however.

Yes with some provisions - I think any such therapy must be performed sensitively and at an appropriate level for the maturity of the child. I also think that it should be performed without judgement, and that an open and caring environment should be established. IMO it is essential that child feels able to be open and honest about their feelings, without fearing judgement.

I also think clinicians should consider the potential distress that can be induced by the topics they raise, and be sensitive in the way they do so. You cannot talk about sex dysphoria without talking about sexual characteristics, but the way in which I was treated at the Tavistock as an adolescent lacked compassion. The clinicians didn't seem to care about the distress they caused both me and my mother, and it times it felt like an exercise in humiliation.

I do think that options other than medical transition should be explored, and that if these can sufficiently relieve the distress then that is ultimately a better option. But I also think that if these techniques fail and the child remains in distress, it should not be framed as a failure if they do go on to medically transition.

Finally, I also think that the aim should always be to relieve distress and improve the child's quality of life, in the least invasive way possible. I do not think the aim should be to simply prevent transition at all costs. Rather, the very real and significant costs that exist should be balanced against the potential costs of preventing medical transition for that specific young person.

How effective these kind of interventions would have been for me, I really cannot say. But I do think if they were performed in the way I outlined, they would not have increased my distress, nor prevented me from transitioning should they have failed.

I have read reports from people saying they were cleared for medical interventions very early in their journey, and without a proper investigation of their feelings. I find that very concerning, because I know how distressing it is to feel your sexual characteristics are alien to you, not to mention the side effects and complications that can occur with treatment. How representative these accounts are of the way in which the Tavistock was run in recent years I really cannot say though, as I attended it over a decade ago.

Do you believe there are two only sexes?
Male and female?