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.

There are several reasons why. The first is that I feel a lot of shame about the way that I am. Whether that is right or wrong, I cannot say, but telling people feels like exposing the parts of myself I hate the most.

Secondly, although I am running this AMA, in my 'real life' I am a private person and like to have a quiet and mundane life. I have never felt that I was treated as a normal person by people who knew that I was trans.

I had some wonderful friends in sixth form college, and there was never any malice intended from any of them. However, it was very clear that I was seen as an oddity by my peers. It's exhausting to always be seen that way and I wanted desperately to just be seen as 'normal', after feeling so isolated and different throughout my childhood.

Finally, when I was younger, I went to work a job where all the staff lived on site. It was a move away from where I had been brought up and the first time that no one know about my past. I became close with a girl who worked there, and it was clear we both were attracted to one another. She attempted to kiss me at a work party, and I realised I had to tell her about my past, as it was unfair for her to be intimate with someone she didn't know to be female.

Whilst she promised not to tell others, it ended up being known by all and sundry. Because I lived on site there was no escape from it, and there wasn't anywhere I could go to escape the whispers and sniggers. There was one member of staff who took it much further than that, which resulted in events I'm not sure I will ever fully recover from. I have had an extreme fear of telling others since then.

I do think about how my friends would feel if they found out, and whether they would feel betrayed or would no longer want to be friends with me. It's something I worry about a lot and wrestle with to this day. I have never found an answer to the issue though.

I think that is a matter of interpretation. To me the hatred of the female aspects of my body, and desperate desire to have male sexual organs, speaks to dysphoria related to my sex rather than a more generalised unhappiness with my body.

There are things I dislike about my body in the same way we all do. It would be nice to be better looking, in better shape etc. but that has never consumed my life, or made me feel worthless or without value, in the way that my feelings on my sex did.

Yes it is the male body that I have always wanted, rather than the wider cultural and social concept of being a man. Whilst it is not possible for me to have an actually male body, the changes to my body that have closer aligned me to that state have resolved a lot of my unhappiness.

Obviously though, on a practical level it isn't really possible to separate having a body perceived as male from being treated as if you were male. However, I think because of how my mother always encouraged me and my brother to follow our passions, I never felt limited by being a girl/woman in and of itself. I actually miss some aspects of it in terms of the social role, such as the closeness and sense of understanding I found in friendships between girls.

I am still in the academic phases of my medical education, and I haven't decided on a speciality yet. However, I don't intend to be involved in specialities that require intimate examinations, such as sexual health, gynaecology etc. for those reasons.

That said, I still have to consider the possibility of patient requesting same sex care for an intimate procedure. This is because I will have clinical rotations in different departments, both as part of my medical degree and within the foundation training programme. That is why I have already given thought to these kind of issues, and tried to find an approach that respects the dignify of patients without compromising my own.

Another commenter suggested a confidential disclosure to my boss. That's something I think could be a good solution, because I would have thought there were legal or institutional policies preventing them from disclosing it to others without my consent. I'm going to look into that to see exactly where I stand though, because I really can't face the prospect of a repeat of what happened to me in the past when I was outed.

I agree that it is disrespectful and unethical to perform an exam on a patient of the opposite sex, who has requested same sex care. I have spoken in other posts about how I feel trans healthcare workers have a responsibility to respect patients and not disregard their wishes, regardless of whether the patient would be able to tell.

Yes (excluding a few very weird and wonderful lifeforms😂)

Of course I do recognise that intersex people exist, and some people are born with a mixture of sexual characteristics. However, humans cannot produce a gamete other than a sperm or an egg.

OP do you think it's possible that people can tell you're female but are just being polite and no mentioning it?

i do think this is slightly naive , if this happens enough they will begin to wonder, by their nature medics are clever and curious people. It might be better to be honest with them. Also being a junior doctor is not like other jobs it involves spending long, long hours together, it's very emotionally challenging you may find harder to stay in the closet ( sorry don't have a better expression) than you think. Good luck anyway .

Thanks for answering all these questions so eloquently OP.

I'm having trouble focusing on text just now so I will RTFT later. Please disregard any questions that have already been answered, or any that are too personal for you to want to answer.

1. Would you ever consider a prosthetic penis, either as an in-between or as an alternative to phalloplasty?
2. Has the rise in people identifying as transgender affected your trust in surgeons and the quality of their work?
3. For you personally, is aesthetic or function more important for a phalloplasty result?
4. Do you feel able to go shirtless at the beach or pool?
5. How is your relationship with medical professionals and do you ever have reservations about going to the doctor?

And a couple that aren't body-related:

1. Have you travelled overseas while trans? If so, where have you been and what has been your experience?
2. How do you think your life would look if you'd been born later, say in 2005? Do you think your attitude and that of your family would be different? Do you think you'd be openly trans? Do you think you'd be caught up in activism?

Did you access your hysterectomy/oophorectomy on the NHS and if so, on what grounds were you able to persuade them it was necessary? I ask as a woman who tried to have a hysterectomy for years for health reasons (chronic pain) but was always refused on grounds of age. Have you experienced any health problems as a result of this surgery at the age you were?

Thank you for your further advice OP, I really appreciate it ❤️
We do manage to talk about it - though she struggles to talk about feelings. But I have tried to be open that I can find it difficult, whilst also reinforcing my love and support for her as you say. It’s interesting to think there are things she hasn’t told me, I’m sure that’s likely.

i am so sorry to hear about your experience of being badly treated when you divulged. That was one of my fears for my child - amazingly her peers so far have been completely supportive, but that’s in uni not the ‘real world’ I guess. You sound great and I hope you can find a comfortable way to approach this in your career. I have also worked in a medical career and the sensitivity and understanding of other’s perspectives that you show will go a long way, believe me. In my experience people in medical job are pretty open to trans issues because they are working with people who have them - so hopefully you would be met with understanding by managers.

Have you had psychological counselling for the mental toll having such a major secret that you need to keep the truth hidden at all times?

Thanks for your reply to my earlier question @MAW1993.

You mentioned in a previous response that you don't feel safe in men's toilets.

Given that you live "stealth" and pass as a biological man, are you able to say why you don't feel safe using men's toilets?

These days I don't really think so. I have always been quite masculine in appearance, and was still regular confused for a boy before I had undergone medical transition. These days I have a very masculinised face and body shape, and I am 5'11, so I don't think it is something people would be likely to suspect.

Of course I can never really know for sure, but I have never noticed doubts for many years, and to be honest people are not normally very good at being tactful if they do have them.

To be honest, whilst it is a possibility, I don't think it is a situation that is going to crop up as often as has been suggested here.

Also, in my experience most people either have suspicions based upon your appearance, or the possibility you are trans doesn't even occur to them. If there is something they think is odd, there are a lot of reasons they can assume first. I have been regularly surprised by how little people have interrogated things I thought would be problematic and could put me at risk of others finding out.

In contrast, I have seen other people who were suspected already to be trans, and if there is something that appears to be in keeping with that then it does tend to heighten their pre-existing suspicions.

I have worked other jobs that were very challenging both in terms of hours and emotional strain, so I personally feel confident in my ability to cope. It is possible I am naïve, and I should begin to get a better idea as my education becomes increasingly clinical. Thank you for your best wishes.

1. Yes I tried one, but I found it both uncomfortable and impractical and it didn't really help very much.
2. I have always approached any surgery with caution and looked into the individual surgeon and their record. I can't say that I feel any different in that regard now compared to earlier. There were people known to be butchers back when I first transitioned, and I am sure there are others today.
3. Function is more important. I hope I will not end up with urinary problems or a loss of sexual sensation, though I am prepared to go ahead knowing these could occur. Appearance wise, the more the results appear like normal male genitalia the better, but I think it would be naïve to assume it will be indistinguishable.
4. No, I don't go to the pool and at the beach I will put a rash guard on. I feel confident enough to change from a t-shirt to a rash guard, but I know others could notice the scars from my mastectomy if they were given the chance to inspect more closely.
5. It used to be very strained in the past, and I often was not treated with dignity or respect. I have also been refused care before, which was justified by doctors saying they didn't know how to treat a trans person. I don't mean in relation to areas where that may be relevant, such as gynaecological care.

I also would often have to field invasive and inappropriate questions, such as asking about the specifics of my sex life, when it was not relevant. When inquiring about the relevance the response would normally just be 'oh I'm just curious'. Whilst I appreciate that people are curious about things, I don't think its acceptable to use a patient, who may be feeling vulnerable, to satisfy that.

1. I have been to Germany to see family a few times as an adult. However, I don't think I was identifiable as a trans person at those times, so I don't think I could comment on how that experience might be.
2. I think I may have been able to speak to my parents and health care professionals about my issues at an earlier age. I think also the schools may have been more understanding and there could have been less bullying. As to whether I would be openly trans, I'm not sure because I have always felt a lot of shame about it and I don't know if that would be different. I don't think I would be caught up in activism because I've never really been that kind of person.

Yes I did. I was always told that I would need one within a number of years of being on testosterone. This was because they didn't know whether testosterone could increase the risk of a gynaecological cancer, but worried that might be the case.

However, I ultimately did not end up having one through my gender clinic. I suffered with repeated gynaecological problems after a surgery to repair injuries that occurred via a sexual assault. It left me with ongoing pain and issues, and so I was eligible on those grounds.

I'm really sorry to hear about your chronic pain, and their refusal to treat due to your age.

I'm so sorry to hear about your sexual assault.

Please do not answer the following question if you don't feel comfortable doing so.

Did you already suffer from sex dysphoria before you were assaulted, and if so, did this experience exacerbate your dysphoria?

Thank you for your responses. I've been curious for a while about why prostheses are often rejected, so this has been insightful (as have your other answers - - insightful in a good way)

@MAW1993 If ever you find yourself up North, you'd be welcome at mine for a cuppa any time! This has been a fantastic thread, thank you so much for answering all the questions without missing a beat. I've learnt such a lot, even though I thought I was quite well informed! 🤗

I'm so glad you've managed to maintain open communication. I think it is really difficult for most teenagers to speak honestly about their feelings on sensitive matters like their sex or sexuality with their parents.

Communication with my mother was always an ongoing thing. To begin with, I couldn't even tell her alone, and needed the help of my social worker supporter to breach it. By the end I felt able to talk to her about many things, such as my intentions to undergo phalloplasty. I think it became easier due to my increased maturity and understanding of myself, combined with the constant support and love I felt from my mother.

Although it's natural to worry about how your child could be treated, I would say that things have changed massively in recent years. I have noticed that many people are becoming more open and kind in relation to these kinds of issues, even if they do not fully understand them. I hope that when your child is my age, the world will look brighter still for trans people.

Thank you for your advice with regards to my career. Within the curriculum of my medical school there are compulsory sessions that sensitively explore the inequalities and vulnerabilities faced by certain patient groups (such as issues of racism, sexism etc). I have also noticed a gradual but positive change in attitude when accessing healthcare in more recent years.

Yes, mainly I fear the possibility of sexual assault. Although I think the risk of others being able to tell that I am trans is low, it's not a risk I want to take after previous experiences I have had.

No I haven't, I have always just focused on my career and keeping busy in life. It helps to keep me going and happy when I have goals to focus on.

OP - I'm interested in how often the follow up from the Tavistock is, and whether you declared your 'non-related' medical issue to them? What sort of questions do they require input from you about and how often do they do follow ups?

Thanks for sharing. One thing I picked up from Time to Think, the book about the Tavistock, was that there are people for whom transitioning is absolutely the right thing and greatly lessens their distress and lets them get on with their lives. It wasn't really covered enough in the book, if anything it strengthens the overall argument that Tavistock was so dysfunctional by the end. Really interesting to hear your story.

Thank you for this thread. I am the mother of a trans young man and it is extremely moving and helpful to read your story. I am really in awe of your emotional maturity and thoughtfulness. Thank you.