Is my job transphobic?

[vivariumvivariumsvivaria]

I am a health care professional. I work in sexual health. Most of my patients are female, an increasing number of whom also have a gender difference, which is why they land up in my clinic.

Is it transphobic to say to a person who has a condition which only affects female people that this is because of their sex? I have re-written patient information leaflets so that trans men and NB identified females have the correct language in the info, but the fact remains that it is a condition linked to their sex.

I'm a little worried because the Lib Dems and Greens have said that it is transphobic to refer too someone's biological sex if they have transitioned. I think their definitions leave me vulnerable to being accused of bigotry because sex is immutable.

I want to talk to HR about this, but, can't quite think about how to frame it without sounding like I'm, well, a bigot.

The prostate cancer example upthread: in fact, here's an example of nice, clear, simple phrasing from Prostatecanceruk:
'Am I at risk of prostate cancer?
In the UK, about 1 in 8 men will be diagnosed with prostate cancer in their lifetime. We don't know exactly what causes prostate cancer but there are some things that may mean you are more likely to get it – these are called risk factors.

There are three main risk factors for getting prostate cancer, which are things you can't change. These are:

getting older – it mainly affects men aged 50 or over...'

I see no reason that women couldn't have equally clear, simple language directed to them about cervical cancer.

Note that this equally works when including transwomen and excluding transmen: they use 'mainly', and 'about'.

And (promise I'll go back to work in a moment!) they have a separate section called 'trans women and prostate cancer'

Its because you have some vulnerable anatomy" would be much kinder

All anatomy is vulnerable..some sex specific some not. Cancer/disease does not care about identity and consent depends on the patient being fully informed. Its not not time to start being vague /misleading

@DodoPatrol

And (promise I'll go back to work in a moment!) they have a separate section called 'trans women and prostate cancer'

That's really clear and helpful isn't it DodoPatrol ? Both for men and for transwomen. No reason why information for women and transmen can't be equally clear and helpful, I don't think...?

Again - while leaflets are a concern, I have updated ours so we have leaflets with plain language (women and girls) for women, and gender neutral terms in line with our Stonewall training for those who need that. I don't have a problem with that, we also have leaflets specifically for lesbians, people with learning disabilities - we are pretty good at leaflets.

If a person is being seen F2F in a consultation and they BELIEVE themselves to have actually changed sex, though, well, someone has to explain to them that they haven't.

It does seem to me that it is the job of the gender clinic to make sure people understand the limitations of their treatments. You can't change sex, yes, that makes you upset, here is some counselling.

The person who attended a different department from mine had not ever attended a gender clinic. They were self medicating from private, possibly illegal sources. They had changed some paperwork but possibly didn't have a GRC. They weren't well and they needed care which they refused to engage with because they believed they had changed sex and that "women's health" didn't apply to them.

I want to speak to HR because I gather that insisting that someone's biological sex is real is now transphobic.

I don't think the Greens and the Lib Dems have thought this through, people are going to either not engage in health care or avoid working with transgender patients for fear of getting things wrong - which WOULD be transphobic.

It makes me feel dizzy.

@Flapjak

It really should be part of whatever therapy people with gender dysphoria recieve, that whatever interventions they go on to have, that the world is made up of two sexes, neither which can change, and that their bioligical sex is relevant when it comes to healthcare. I still dont understand how trans men can be suicidal over the word 'female' yet go on to have babies. 9 months of being pregnant vs occassionally needing to acknowledge biological sex !

According to latest theories, gender identity such as 'trans' doesn't necessarily involve dysphoria and isn't an illness or disorder. Advice is to 'affirm' only - which is to say, don't ask questions.

So they are not necessarily going to be receiving any therapy whatsoever.

@MolyHolyGuacamole

There's no reason why you can't have a pile of leaflets clearly identify sex with matching gender, and another pile that is gender neutral using parts of anatomy.

There's no reason why you can't have a pile of leaflets clearly identify sex with matching gender, and another pile that is gender neutral using parts of anatomy.

Apparently there's hundreds of genders so good luck. And how much is that going to cost the NHS? For what - because someone's feelings might be hurt? Such nonsense.

"It's because you have some vulnerable anatomy" would be much kinder.

The average adult literacy level in the UK is that of a 12year-old.
The average adult numeracy level in the UK is that of a 9year-old.
Health literacy tends to be pegged to the numeracy level. And this is before considering matters such as second languages or SLD.

I wonder what level of health literacy is necessary to understand "It's because you have some vulnerable anatomy." Likewise, is this phrasing "much kinder" or actively harmful if it were to lead to people avoiding appropriate healthcare?

I'd have some level of disquiet about terming a part of the anatomy as 'vulnerable' in a patient public health education setting.

Related: healthliteracy.geodata.uk/

www.e-lfh.org.uk/programmes/health-literacy/

www.reading.ac.uk/web/files/simplification/tech_paper_1.pdf

The person who attended a different department from mine had not ever attended a gender clinic. They were self medicating from private, possibly illegal sources. They had changed some paperwork but possibly didn't have a GRC. They weren't well and they needed care which they refused to engage with because they believed they had changed sex and that "women's health" didn't apply to them.

Well, I suppose it comes down to consent, really. If a patient refuses treatment there's not much you can reasonably do, is there? I suppose there may be parallels with some religious groups refusing medical treatment?

Plus, those of you who are advocating "just say AFAB" -you are assuming that the individual themselves is capable of understanding that sort of shorthand.

Transgender nd NB people are as varied as any other population, not everyone has good literacy or comprehension skills.

Language, especially medical language, needs to be clear, for everyone.

Embarrassing thank you, those links are very helpful.

Arabella yes, as long as it is informed consent. If the person does not understand because I cannot explain it properly, then the fault is mine.

Language, especially medical language, needs to be clear, for everyone.

That's so crucial.

The average adult literacy level in the UK is that of a 12year-old.
The average adult numeracy level in the UK is that of a 9year-old.

Wow, really? This explains quite a lot, tbh.

vivarium, surely the NHS has guidance on this? I agree entirely you should be providing the opportunity for informed consent. I would say the use of clear, factual language is essential for that.

Another point that I think isn't grasped is that normal women have to avoid using the language that these transmen prefer to use themselves.

If normal women were to accept the non-women-associated terms transmen like, then they'd start associating them with women - the concept they're trying to reject - and they'd become dysphoric about them and need new terms.

For the system to be stable, the dysphoric individuals have to have terms that they do not associate with the other people of their actual sex.

So breastfeeding is out, and chestfeeding is in, but if in 5 years the word "chestfeeding" is associated with women in general, then that will be a new problem for them.

Can you not simply use a fairly neutral phrase such as 'this condition affects those recorded female at birth'?

'Those recorded female at birth'? So..... Females? 😂

I agree that when talking about medical stuff, it's really not the time for vague, woolly statements that could be open to interpretation. It needs to be clear and factual. It's so important!

Another point that I think isn't grasped is that normal women have to avoid using the language that these transmen prefer to use themselves.

If normal women were to accept the non-women-associated terms transmen like, then they'd start associating them with women - the concept they're trying to reject - and they'd become dysphoric about them and need new terms.

This is an excellent point.

No it’s not.
I’m a female GP with extra training in gynae/contraception etc. I therefore see a lot of women with conditions that only women have. None of them have them because they identify as women or girls but because of their sexed bodies. And I still see far too many of them who have put up with horrendous, debilitating symptoms because they are women and they’ve been brought up to think that suffering is normal.
I’m also trying to keep a close eye on a teenager with significant MH difficulties who has recently told CAMHS she thinks she may want to identify as male in future and has been encouraged to look at GIDs, Mermaids etc and I’m really concerned about that. If recognising women’s healthcare problems, women’s biology and the way healthcare as a whole treats women and their bodies makes me transphobic then so be it. I will continue to advocate for my patients and that means understanding biology.

surely you could refer to their body part
If their issue is with their uterus, then you can say that.

Check with hr and management what the guidelines are. It's a potential minefield.
I've heard of some absolutely bonkers things going on with regard to this type of thing so I think you're right to be cautious on this.

The term 'assigned female at birth' is very problematic to me - it implies that the doctor or midwife made the decision about what to 'assign' the baby as, had a say in that decision, like they could have chosen male or female and just decided to plump for one or the other?

What about ‘females’ or ‘female bodied’