Doesn't self-ID only benefit non-genuine cases?

[UpfieldHatesWomen]

I'm trying to figure out if there are actually any benefits to self-ID at all for people with gender dysphoria. The arguments for self-ID are that it costs money, and it's 'humiliating' to have to present your case to a panel of experts. First of all, a GRC only costs £140. Doesn't seem like a staggering amount of money, if you follow the narrative that people will kill themselves in their masses without it. Are there other costs that I'm missing here? The NHS covers hormones and medical procedures in the UK. I also fail to see what's humiliating about a psychological/medical assessment, to see if you actually have gender dysphoria or whether you have a sissification/autogynephelia fetish. Unless, of course, you're never going to get a diagnosis of gender dysphoria, because you don't have it and simply get off on invading women's privacy/have a fetish etc. Self-ID benefits those who want to keep their penis - but if you have gender dysphoria, why would you want to keep your penis? TV propaganda such as the ITV series 'Butterfly' would have us believe that those with gender dysphoria hate their genitals so much they'll try to cut them off with pieces of broken glass. It seems like self-ID only benefits fetishists and misogynists, so why are politicians never challenged on how exactly self-ID is supposed to benefit transgender people, why are they so insistent on self-ID as the only possible route to trans rights? Are they just woefully ignorant about autogynephelia/transvestism/sissification etc? These fetishes are as old as the hills, why is everyone pretending they suddenly don't exist? Or for that matter, pretending that predatory men don't exist? Female politicians are subjected to the very worst kinds of misogyny on social media, so how can they be so incredibly naive about how misogynistic men and opportunists will use self-ID as a vendetta against women? It doesn't seem that self-ID actually help genuine cases, only those who would normally be refused a GRC because they have shown they're insincere/have other mental health problems/trolling etc.

Have you ever talked a patient out of something else that was harmful to them? Even if they thought it was going to help?

No.

I’m directing you towards a bigger picture than a single patient because I expect doctors to have curious minds.

Gender stereotypes are causing current day youth to be distressed OR gender confusion is manifesting as a symptom of other types of distress. Perhaps both simultaneously.

I have no idea if this is relevant to your particular patient or not. Do you?

No need to answer, better to respect their privacy and speak generally.

Thepurported

I think Claudia's story is a harrowing one although its interesting that Reid has much support amongst trans people too. If JB told the story accurately there were clear points that should have raised questions. However, I would be wary of suggesting that story is one that is a common narrative of the current treatment and timescales on the NHS today. Of course it is tempting to push that from a GC perspective but, anyone referred to the NHS pathway today is highly unlikely be seeing a surgeons tools this side of 2025 or quite likely longer for many.

I dont think it is relevant to any trans patient I've seen personally.

As a (shit) GP, if someone approaches me requesting referral to specialised services, I err on the side of giving it to them. I might stall it by suggesting the trial of the first line of treatment the specialist is likely to recommend. Patients generally know when there is a problem. Sometimes they are unaware of how much a GP can do which deem a specialist unnecessary.

Patients generally know when there is a problem
Does this apply to patients with mental health problems too? Do they know WHAT their problem is?

It’s a travesty that mental healfh services are so underfunded. In an ideal world a gender distressed patient presenting to a GP could be referred to both MH and GIC services so they can properly unpack everything and deal with any comorbid conditions (such as undiagnosed autism and eating disorders, both commonly reported by detransitioners) before transitioning. Gender Clinics are so stretched that there is little time to spend with each patient and appointments are widely spaced and infrequent.

My patient wants it so he wouldn't have to put on a mask for assessments.

Can you explain what you mean here? Getting a GRC is a legal process. Are you suggesting that if someone becomes legally recognised as the opposite sex the medical professionals treating them will treat them differently from someone who doesn't have that legal recognition?

This seems to be turning the whole process on its head. Currently, the legal recognition can only be obtained once someone has gone through the medical process (diagnosis of gender dysphoria, usually followed by medication and/or surgery).

statsgeek

I'm not suggesting that Claudia's story is typical today or even of its time (Reid's case involved five patients), but you must have heard about the more recent detransitioners' stories?

I'm aware that Reid had support from trans people, but tbh I don't understand how anyone could support that man and his practices. There seems to be this blind faith in the affirmative approach, and regretters are treated as an unfortunate by-product of the process.

That's because the people assessing would expect him to conform to typical gender stereotypes and he doesn't want any hiccups.

This is in a gender identity clinic? We are constantly being told that being trans is nothing to do with stereotypes, and yet the doctors assessing patients in GICs are assessing them on the basis of stereotypes.

I would think an example could be a particular DV shelter could be trans exclusionary as long as there were others in the area that weren't and it therefore didn't impact on vulnerable victims leaving them without support.

But if they all accept transwomen, that could exclude some actual women who need a male-free space, leaving those vulnerable women without support.

Old crone

That's why i am not against proportionate trans exclusion as long there is a safe service in the area that they can use.

Thepurported -

I do hear the de-transitioners and their stories are important and very useful for the medical professionals to learn from. Sadly they are often drowned out by the 'desisters' or some who just had a bit of a GNC childhood who are a different thing. Sadly it seems that to some blurring the lines between the two is useful. Whilst their stories are also valid it kind of seems a bit off when the particularly loud desistors shout to stop or remove treatments that they themselves were never treated with as they were never diagnosed.

That's why i am not against proportionate trans exclusion as long there is a safe service in the area that they can use.

You don't seem to have understood my post.

I am not against proportionate trans inclusion as long there is also a safe service in the area for women which is female only. Support for women must prioritise women, not male people who want to be women.

Whilst their stories are also valid it kind of seems a bit off when the particularly loud desistors shout to stop or remove treatments that they themselves were never treated with as they were never diagnosed.

Are you saying that people are only trans if they are medically diagnosed? (With a condition that isn't a medical condition, so why it needs to be diagnosed at all is a mystery.) Isn't that a bit transphobic? When we keep being told that people are trans if they say they are. Or is that all a bit inconvenient when it comes to desisters?

Patients usually know when something isn't right with their health. They dont always know what but if someone comes and says something is wrong, I believe them..if tests show nothing is wrong, I usually think we haven't done the right test or cant do the right test rather than assuming there isn't anything wrong at all. If someone came to me with struggles about gender identity, that is too far outside of my remit to assess. Therefore, I'd make the appropriate referrals to people who are better situated to help. I'd never decide that a person doesn't require referral. Usually they'd approach the mental health professional or therapist they are already seeing for referral though sometimes this might need the GP to complete under instruction of the therapist. Again, I don't need to make any call about whether or not the person could benefit from transitioning.

From my understanding from trans patients, the people who stand between them and validity as the other gender sometimes hold problematic views of their own. Some, again, from my understanding, have intentions to not allow harm by encouraging someone who isn't "true" to make permanent changes and harm themselves (because therapy or something would be more appropriate) or others (opportunistic predatory men) and for this reason, they have a bias about how a trans person should behave and look. This person could even be trans, LGBT+ or a fierce ally. You could have someone like Caitlyn Jenner (who I understand all women and LGBT+ advocates and allies pretty much find universally problematic) deciding whether you're "truly" living as a female based on their subjective values womanhood. My wife who has conceived and carried our two babes probably wouldn't meet Caitlyn's standards.

You know fine well that:
Patients with gender dysphoria are distressed.
Patients who are distressed often don't know WHAT is making them distressed.
The current model of treatment will only allow transition as a treatment for gender dysphoria. It won't allow exploration of any other reasons for distress.
Underfunding of mental health services compounds this; there's not only no exploration of other reasons for distress within gender identity services, there's no way to get a referral to help a patient with other sources of distress to explore in parallel.

Stop being so disingenuous. You know these things and you know not everyone who is distressed knows why (or is right if they think they know why).
Would you refer an anorexic patient to a slimming group? Even if they said "I know I'm distressed because I'm fat"?

To be diagnosed with gender dysphoria, you'd have to be seeing a qualified specialist of some description in that field. That's not a diagnosis a GP would make.

I think it is rubbish to think that a qualified therapist will only explore some degree of transitioning to deal with issues around gender dysphoria. I think they will work with the patient and take each case individually. Medication is appropriate for many if not most of my patients who report anxiety and/or depression but it isn't always the best treatment for some individuals. Even if most of my patients who report such symptoms do leave with a prescription,it doesn't mean I do not or have not considered or recommended other treatments too.

"Would you refer an anorexic patient to a slimming group? Even if they said "I know I'm distressed because I'm fat"?"

The only thing sort of like a slimming group that we can refer to requires you to meet BMI criteria which an anorexic would not meet. That would be a good starting point for our conversation about where I can refer someone with their BMI in terms of support with weight management. So yes, when a patient tells me something is wrong with them, I listen. That patient might not get the referral they expected but I can help with a referral to someone who might be able to reduce the problem in some way.

You really need to spend some time with Detransitioners stories GeePee

There is no diagnostic test for being transgender. Young transmen are having hysterectomies (yes, even on the NHS) in their early 20s, yet women in their 30s who already have families struggle to convince doctors to agree to tubal ligation.

In your opinion, is total hysterectomy a good idea for a female person in their early 20s?

The word ‘trans’ makes otherwise sensible people act like they are sniffing glue.

I have no issue referring women in their 20s for hysterectomy regardless of whether it is about gender conformation or because they want to lose the ability to conceive. Especially since I've had kids... I recommend it to people who haven't even asked.

You recommend hysterectomies as contraception?

Well, I guess it’s good that you just refer on then.

Hopefully the clinicians that make decisions are better informed.

@noblegiraffe

Sometimes I might, yes. Lots of women who have no interest in having (more) children suffer crippling endometriosis or other conditions that could be alleviated by a hysterectomy.

Others don't like the idea of having their tubes tied or cauterised and so would like a more extensive form of sterilisation. I'm not saying the specialist always agrees to do it by any means but I dont stand in their way. Adult women are unlikely to ask for something like that without researching their options.

There was one Asian lady who thought that was her only surgical option to not conceive so requested that but accepted a tubal ligature.

And yes, specialists are specialised so they are more informed about their field than I am.

Lots of women who have no interest in having (more) children suffer crippling endometriosis or other conditions that could be alleviated by a hysterectomy.

Not at 21 though?

Gee
I’m glad you refer on to specialists tbh. There are many treatments for endometriosis that don’t involve hysterectomy but if you don’t know that then at least they will see someone who does. I do think you are being disengeneous about a lot of this though.
Investigations and referrals can be detrimental to patients where there are other factors at play eg in functional illness which is estimated to account for 25% of GP consultations. These patients will benefit from a therapeutic approach looking at other factors such as mental health, lifestyle, reducing unnecessary medication and generally demedicalising the condition to allow the patient to take back control of their own life, instead of expecting a ‘pill’ to fix everything. I’m sure as a GP you will accept this?
I hope in time the approach to patients with gender dysphoria will change and focusing on improving mental health and accceptance of a healthy body will become more widely used (though clearly this will not be correct for everyone). This is certainly something that could start with a supportive and knowledgeable GP.