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.

I’m a doctor. Obviously I treat the patient in front of me with sensitivity and take account of their health beliefs. But I really think it’s not helping anyone when HCPs and NHS leaflets use language like ‘assigned female at birth’ which appears to support the idea that sex is anything but an unchangeable fact.

One reason why the trans ideology has grown so quickly is because many people believe ‘Being born in the wrong body’ is a genuine medical condition. There are multiple reasons why people may come to believe themselves to be transgender. For many, particularly the adolescent girls whom I see as most at risk of damage from this ideology, the trans identity is something constructed as a response to, and an explanation of, their psychological pain. They are not ‘truly trans’ because no one is truly ‘born in the wrong body’, but they live in a culture where it is being presented to them as a valid narrative. Every time a doctor or nurse uses language like ‘assigned female at birth’ that legitimises the idea of ‘transness’ as a real thing, that supports the idea that people may, in some intangible way, not be their actual sex, it gives credence to this narrative.
We can be sensitive to people with dysphoria without ever pretending that we believe they have changed their sex.

You could use a woman's name as examples of people with this problem

Unfortunately to cynics like me I would assume that the race/sex/other characteristic of any person in a leaflet from a potentially-Wokified environment would have been chosen due to political factors, rather than being a reflection of incidence in reality.

I would almost assume that if they used a women as an example it would be to illustrate "women get/do this too" despite it being primarily male...

But maybe I'm too cynical.

and b) there is literally no harm having a leaflet that says "If you have a prostate you are at risk" because it's more important that prostate cancer is identified early, than to risk alienating a vulnerable patient

But there is a risk because not all men know they have a prostate. If you start talking in terms of prostate havers a large number of men will think 'never heard of that, don't think it applies to me.'

@terfinginthevoid thank you. Covid 19 has highlighted that diseases/illnesses can have very different outcomes for women and men.

@MiddlesexGirl

and b) there is literally no harm having a leaflet that says "If you have a prostate you are at risk" because it's more important that prostate cancer is identified early, than to risk alienating a vulnerable patient

But there is a risk because not all men know they have a prostate. If you start talking in terms of prostate havers a large number of men will think 'never heard of that, don't think it applies to me.'

In the prostate cancer guidance for transwomen that was linked to earlier in this thread, there's a quote from a transwoman saying 'I didn't know I had a prostate' and that many tw who do know they have one assume it is removed during gender reassignment surgery. So that wouldn't help, would it, ffs? Who is meant to benefit from this programme of increasing the opacity of language????

I remember a while ago a TW saying that when they underwent surgery they first had to sign a form acknowledging that this surgery would not change their sex. I guess it would be necessary as part of informed consent. This should be emphasised to all people who are transitioning - that transitioning is cosmetic and social but does NOT change sex. It is failing everyone to suggest it does.

You’re a professional, I imagine with training in medicine. So deal with facts not fairy stories.

Oh FFS, as a health professional just say “as a trans man, you still can be at risk of ....therefore in order to see if you are at risk/your symptoms we can screen/test to check for this.

I'd love to ask the trans pressure groups, the ones that assert twaw no questions no distinction, if they are happy for a large proportion of the people they represent to die from preventable disease.

And if not, what do they propose to resolve this?
Why is all the pressure placed on HCPs to resolve what, to me, seems illogival and extremely difficult to resolve while saving lives and using terminology that ticks the right boxes.

what do we do if the patient has a mistaken belief, that they have ACTUALLY changed sex? There is a lot of misinformation out on the net

And in the messages some are picking up in school. DD was astonished to hear (from me) that no, there isn’t any medical technology that actually makes people change sex. They’d had PHSE lessons on transitioning, biology lessons about gene technology, information about hormone therapy and plenty of people shushing anyone who asked questions. She really thought that there was ‘medicine’ that did the whole job and transformed someone’s sex, genes, inner and outer organs, the lot.

I hope that any child actually planning transition is better informed, but are they all? Does someone still lay it out straight and do they understand it?

The world is turning bonkers.

She really thought that there was ‘medicine’ that did the whole job and transformed someone’s sex, genes, inner and outer organs, the lot.

I remember first reading about a "sex change" when I was a (very literal-minded) 11(?)-year-old back in the 80s. I was baffled because it didn't seem to fit my understanding of the level of medical technology we were capable of. My best guess was that there was something you could do to trigger some latent ability in the human body, but it still didn't seem to make much sense.

I later figured out that we were just talking about cosmetic procedures, but I was certainly confused for a while.

Can't imagine how confused a child might get today with people actually trying to maintain a lie, rather than just being a bit metaphorical with the term "sex change".

@vivariumvivariumsvivaria

Thanks, *ChristinaXYZ* I hadn't seen them, will have a look.

And, yes, I know how to talk to patients - but the nuance here is what do we do if the patient has a mistaken belief, that they have ACTUALLY changed sex? There is a lot of misinformation out on the net, and some people believe that if their passport, driving license etc says "female" that they are actually female. This is added to by the news reporting political parties saying that acknowledging someone's biological sex is transphobic.

Dysphoria is not well understood, and I do not work in a gender clinic, but people who happen to be transitioning still get other illnesses and will need to attend other departments. I have no qualms dealing with someone's delusions if they have dementia or a mental illness, but, as we all know, a transgender person is not mentally ill and so there is no support or guidance because the really tricky nitty gritty of "what if" has been ignored.

That is awful about the transman who was so poorly because they measured his bloods against male sex, and the transman who's baby died because they didn't know he was female. I'm sorry to say that I can see exactly how that came about. if the NHS paperwork says they are of the opposite sex then mistakes are going to happen.

one of the crazy features of this whole discussion is that the original group of people the trans lobbyist purport to support, the transsexuals, know and fully acknowledge the sex that they were born.

Miranda Yardley, Fionne Orlander and several others I follow on twitter are very clear that they have put male on the census and know that they are male. They also use the male single sex facilities (and Fionne is quite a pretty delicate person but has no issue in the men's toilets)

The ideology and activists have long moved away from the people it claims to support (and in many cases is quite abusive to transsexuals for stating biological reality). We now have a new group with emotional issues that cause them to put their lives at risk. Doctors are selling them a lie and completely going against all medical ethics and standards.

OP is it possible for you to put together a few facts and have a meeting with a senior manager that you trust. Focusing on the legal liability side of treatment - I'm sure that if someone died because no one wanted to tell them the truth and that was allowed to affect any treatment or decision making, the medical practice involved wouldn't have a leg to stand on.

If you can get management to think about it from a medical negligence angle I think many of the issues will become clearer. In any other medical situation, not being absolutely clear and factual with the patient could result in a medical negligence claim in the event of a problem.

If a trans person died because they were allowed to erroneously believe that they were actually the opposite sex and that was allowed to dictate treatment, the family of that trans person would be well within their rights to sue.

In order to be transman you have to have been born female and vice versa. It is not possible for me to be a transwoman because I was born female and that fact cannot be transphobic.

If you need any resources to put something together let us know - the cases of the transmen that actually put their own lives at serious risk and resulted in the death of a baby would be a start.

The life of that baby was put second to the ideology - that can't be right.

She really thought that there was ‘medicine’ that did the whole job and transformed someone’s sex, genes, inner and outer organs, the lot.

a person I know who has had quite a few children and wanted to be midwife said that she thought that too.

@MiddlesexGirl

and b) there is literally no harm having a leaflet that says "If you have a prostate you are at risk" because it's more important that prostate cancer is identified early, than to risk alienating a vulnerable patient

But there is a risk because not all men know they have a prostate. If you start talking in terms of prostate havers a large number of men will think 'never heard of that, don't think it applies to me.'

I worry about immigrants and others with english as a second/third/nth language who might not know what the word "cervix" refers to. And all the women whose children act as day-to-day translators because the kids won't know how to translate those medical words but will be able to translate "woman aged 25-50".

She really thought that there was ‘medicine’ that did the whole job and transformed someone’s sex, genes, inner and outer organs, the lot.

If such medicine existed, I'd take it in a heartbeat. Not exaggerating, not kidding. But it doesn't, so I live with the hand I am dealt. I decided 20 years ago that I'd rather have an intact female body, even though I really resent having breasts and a vulva, than be on lifelong hormones and covered in (even more) scars.

@bd67thSaysReinstateLangCleg

She really thought that there was ‘medicine’ that did the whole job and transformed someone’s sex, genes, inner and outer organs, the lot.

If such medicine existed, I'd take it in a heartbeat. Not exaggerating, not kidding. But it doesn't, so I live with the hand I am dealt. I decided 20 years ago that I'd rather have an intact female body, even though I really resent having breasts and a vulva, than be on lifelong hormones and covered in (even more) scars.

This, by the way, being something I considered to be a specific form of body dysmorphia related to the sexed aspects of my body. I still remain unclear what a "gender identity" is.

All government communications to the public are designed to be understood at Key Stage 2 level. Whilst they may be perceived as patronising to the majority of the population they have to be inclusive to those with a lower reading ability. Which is fine, I have absolutely no problem with that.

However, I do have a problem with certain medical conditions being bluntly referred to as either a male or female condition only in the terms of whether you might develop disorders or cancers based on the reproductive organs you were born with, which you might have had removed as part of transition. But that isn't the end of it. My fabulous colleague and friend has a horrible condition which almost exclusively affects women of child bearing age and which has decimated her lung functionality to less than 20%. It is called Lymphangioleiomyomatosis or LAM for short. She is 35 years old and is looking at a lung transplant within the next few years.

Do any TransMen think about these things or are they aware of them? Has anyone made them aware of conditions like this? You can't leave your biology behind and pretend it doesn't exist. I know they are still included for cervical screenings and mammograms, as they should be, but it really just doesn't come down to conditions related to your reproductive organs. Your original, biological sex can have a huge impact on the illnesses you might develop.

Thank you, all, this has been really helpful.

I do agree, and this thread has helped me clarify in my head that it's the medico-legal side of things that is making me very anxious. That and the Scottish Hate Crime Bill, which appears to be so nebulous that if a patient complained that they felt I was transphobic then I'd be in a lot of trouble. Members of royal colleges have to be of upstanding character, I expect that being accused of a hate crime would be an issue.

What it all boils down to for me is that the NICE guidelines say that if a woman is

Also, a post of mine has been deleted. I'm not sure why.

No matter how careful I am with language, no matter how much I try to stick within the rules, I didn't get it right and I upset someone.

Kind of makes my point, though, doesn't it?

OP are you in Scotland? It might change advice if you are but also, unless you are the CEO or similar, shouldn’t there be a board meeting or something so you can come to an agreement on wording, possibly seeking expert legal advice, if you feel this is a precarious position?

Natal females of any gender identity?

I mean, I guess in an individual face to face discussion with a transman who believes they are literally now male, I could choose to say 'This condition affects people who, like you, were born with a uterus/ovaries/other relevant part of the female reproductive system''. But who knows whether anything short of the outright falsehood that female-specific conditions are also male-specific conditions will do.

I mean, seriously, you can't not mention sex when dealing with sex specific conditions. It's already a concession (and a confusion) not to use the words 'women and girls'.

In any public health or general messaging the words 'women and girls' should be retained. Plain English increases understanding, engagement and lives.

*saves lives