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Feminism: Sex and gender discussions

If only there was some way to know what treatment trans patients should get

55 replies

GrabbyGabby · 05/05/2023 06:54

https://www.theguardian.com/society/2023/may/05/nhs-treatment-algorithms-not-taking-transgender-patients-into-account

Entire article waffling on about how doctors dont know how to treat trans patients when treatments are adjusted according to 'gender'.

It is so idiotic i don't know where to start.

The question should be how damaging is replacing sex with gender for trans patients.

NHS treatment algorithms ‘not taking transgender patients into account’

GPs say trans people being put at risk by lack of evidence on how to assess them by gender-based metrics

https://www.theguardian.com/society/2023/may/05/nhs-treatment-algorithms-not-taking-transgender-patients-into-account

OP posts:
tellmewhentheLangshiplandscoz · 05/05/2023 11:31
  • rolling so much,
OldCrone · 05/05/2023 11:39

If we look past the wishy washy language used in the article, this is important work that needs doing.

There are two aspects:

1 - ensuring the NHS computer systems can cope with the idea of a sex and an optional different gender with regards to risking, dosages etc. If there is one agreed way of recording sex and trans status, it will be much easier for everyone. NHS systems are so fragmented this will be a big piece of work.

The system was set up to record both, but in practice apparently only records gender. This article is from a few years ago, but I doubt anything has changed.

https://medium.com/@anneharperwright/sex-gender-the-nhs-bb86b0c3ebb

Sex, Gender & the NHS

Part 2: Your Medical Record and your Ladybrain

https://medium.com/@anneharperwright/sex-gender-the-nhs-bb86b0c3ebb

lanadelgrey · 05/05/2023 12:04

As I always say, turn your posts here into letters to both the letters page and the Readers’ Editor.

jotunn · 05/05/2023 12:17

If only there was some way to know what treatment pregnant or breastfeeding women should get.

Or in many cases, women generally. Rather than being given "small man" treatment and being told to get on with it.

PriamFarrl · 05/05/2023 13:08

PortiasBiscuit · 05/05/2023 07:42

My friend is a nurse and despite her private views she has to deal with some very ill people. If “gender”makes people more likely to engage with medical services than “sex” on a form, she doesn’t have a problem with it. Most doctors/ nurses know how to behave once they are faced with a physical patient.
This is a practical issue, not just a political one.

The thing is that I have no problem with people asking for their gender to be recognised. People need to know they will be safe and respected etc.

But, if you are filling out a form for a sexual health clinic they need to know what kind of contraception you need and just filling out gender isn’t going to do that.

Pluvia · 05/05/2023 14:26

I used to be friends with a female lesbian doctor who is now clinical director of gender health services in her area. She talks openly about being autistic. She spent years pursuing the more heroic side of medicine — A&E trauma specialist, volunteering around the world for disasters, reviving half-drowned refugees, spells with MSF and similar.

Then she retrained as a GP and hated it, because it was dull. Really hated elderly patients (so much so that I'm now I'm over 60 I'm very nervous of medical professionals). And then an epiphany, a lightning bolt — she discovered GI and transpeople, those poor marginalised middle-class white people who desperately needed her help. It was like a religious conversion. Within weeks she was off to London to retrain as a gender specialist. When I questioned GI and pointed out that people can't change sex she ran out of the room keening and ran round the garden weeping and distraught until I left. That was the end of the friendship and many others. The people I know who've gone with her into Genderworld are all white, middle and upper middle class, all educated to at least MA level, many of them in the caring professions.

A few weeks ago I found myself in a room with GC psychiatrists and psychologists, all in distress at the trans takeover of their discipline, all living in fear, pointing to the doctors teaching medical students in universities that gender is more important than sex and sending clever but confused trainees out into the world. They mentioned my former friend's name with fear and loathing: they regard her as a dangerous fanatic.

That's a rather long-winded way of saying that some (in fact IME a surprising number) of very clever people who understand complex science and who we trust with our lives and wellbeing are totally batshit and can be persuaded that black is white and up is down by bad actors. Look back at the thousands of women lobotomised for not being quiet and compliant.

PenguinFlipper · 05/05/2023 15:17

I started another thread on this not realising someone already had.

The subject of the article is nonsense, agreed. A cursory look at the Trans Gap website https://transgapproject.wordpress.com/2022/04/08/alcohol-clearance and transgapproject.wordpress.com/2023/05/04/qrisk-cardiovascular-risk shows they are conflating sex and gender for systems that in their own screenshots clearly say "sex" and are binary male/female.

There isn't a gender gap. The treatment is on the basis of sex.

And I'm not a medic, but it would seem to be somewhat dangerous to suggest that people are treated medically as if they were the opposite sex on that person's say-so. Men and women are physiologically distinct. That's why these very things are scored differently for each of the two sexes. As per a pp, there are not enough eyerolls.

@OldCrone interesting screenshots, thanks. Looks pretty confusing to use "male", "female" etc as categories of gender.

What's also problematic is the totally uncritical "journalism". Does the fear of TRA backlash mean the science correspondent is now reduced to lightly recycling crappy press releases? ChatGPT could do a better job!

Alcohol clearance

Alcohol clearance is a set of mathematical expressions that determines the rate ethanol is removed from the body. Most widely used is the Widmark Formula, which has a gender component. It is often …

https://transgapproject.wordpress.com/2022/04/08/alcohol-clearance

2userspast3 · 05/05/2023 16:23

So the idea is to spend lots of time and money on doing research on trans patients. Are we allowed to guess that transwomen will turn out to have the same medical profiles as men and transmen as women? No generation as stupid as this one deserves to survive, surely?

Themaghag · 05/05/2023 16:49

Every time I read or hear the words "sex as assigned at birth" I can feel my blood pressure going through the roof. Maybe that ought to be a thing too - a special survey carried out amongst biological women to discover just how much the mere mention of anything trans-related adversely affects their health and well-being. I'd wager that that's far more of a widespread problem than the so-called trans-gap nonsense!

PriamFarrl · 05/05/2023 16:52

I did hear about an oncologist who got so fed up with it all that he talked about ‘people who get prostate cancer and people who get cervical cancer’.

Brefugee · 05/05/2023 19:22

That article is a mess - they write Gender when they mean Sex.

And what can i say? Boo fucking hoo. We know thanks to good research that FOR FUCKING YEARS women haven't been treated properly for a whole range of medical conditions, and have been given wrong, sometimes dangerous, doses of medications. Dying of strokes/heart attacks because medics only know the male presentation of them etc etc ad nauseum ad infinitum.

And now, the preciouses are finding it difficult and BAM! everyone's researching? fuck it. I give up

Dougalskeeper · 05/05/2023 22:27

Couldn't care less if transpeople develop conditions as a result of being treated as a gender rather than as their sex. Own it

Platinum78 · 06/05/2023 00:34

There has been quite a lot of comment on this thread about how preposterous this article is. There are a number of calculators used by medics to determine whether a particular test result is atypical and merits further investigation. One such is the eGFR calculation mentioned on the Trans gap website. This is often referenced in blood tests for Urea/creatinine i.e. kidney function. The eGFR calculation is based on the assumption that a male body has a greater proportion of muscle than a female body and uses different calculations to determine the estimated Glomeric Filtration Rate because of this. For a person taking cross-sex hormones, after a period of time, The proportion of muscle in their bodies will change. So for example if someone, that contributors to these pages would probably describe as female at birth, takes testosterone (i.e. a trans man) then the proportion of muscle in their body will adjust to the typical range for a male of a similar age and vice versa. So, applying the 'female' calculation to a trans man will give a misleading result for their eGFR and vice versa. Using an inappropriate calculation could possibly incorrectly suggest to a physician that a patient either is suffering from, or is not suffering from, Kidney Disease.

OldCrone · 06/05/2023 05:38

So for example if someone, that contributors to these pages would probably describe as female at birth, takes testosterone (i.e. a trans man) then the proportion of muscle in their body will adjust to the typical range for a male of a similar age and vice versa. So, applying the 'female' calculation to a trans man will give a misleading result for their eGFR and vice versa. Using an inappropriate calculation could possibly incorrectly suggest to a physician that a patient either is suffering from, or is not suffering from, Kidney Disease.

I would describe that person as female, not 'female at birth', since humans can’t change sex.

The only questions they need to be asked are 'what is your sex?' (Female) and 'are you on any medication?' (Yes: testosterone).

If this person simply identifies as a transman, but isn't taking testosterone, then they can be treated as a woman for the purposes of determining whether or not test results are normal. Medically, their 'gender identity' is irrelevant.

GrabbyGabby · 06/05/2023 10:03

Totally agree OldCrone. The challenges here are nothing to do with being trans, amd everything to do about potential consequences of taking large doses of cross sex hormones, and drug drug interactions.

The trans community have not exactly been champing at the bit to get solid data on the long term effects of puberty blockers amd cross sex hormones. This is a much more pressing issue than how the medical system should deal with people who have issues acknowledging their sex.

I have a friend who is an ER doc. She had a young man come in, in their 20s, but with an NHS number that could only have been created in the last few years. Second bone fracture in a year. She suspected this was a transman, but the patient didn't disclose this so she couldn't address it.

The break was bad, but the incident that caused it seemed relatively minor. The doc was left wondering whether there was bone weakening due to puberty blockers. Again she could not discuss this with her patient. All she could do was say it was worrying that there had been two fractures in a short period and to discuss with their GP.

Trans people need to be supported to deal with the scenarios where they have to, for reasons of safety, confront their sex. And we need our clinicians to deal with this sensitively.

OP posts:
BernardBlacksMolluscs · 06/05/2023 10:11

OldCrone · 06/05/2023 05:38

So for example if someone, that contributors to these pages would probably describe as female at birth, takes testosterone (i.e. a trans man) then the proportion of muscle in their body will adjust to the typical range for a male of a similar age and vice versa. So, applying the 'female' calculation to a trans man will give a misleading result for their eGFR and vice versa. Using an inappropriate calculation could possibly incorrectly suggest to a physician that a patient either is suffering from, or is not suffering from, Kidney Disease.

I would describe that person as female, not 'female at birth', since humans can’t change sex.

The only questions they need to be asked are 'what is your sex?' (Female) and 'are you on any medication?' (Yes: testosterone).

If this person simply identifies as a transman, but isn't taking testosterone, then they can be treated as a woman for the purposes of determining whether or not test results are normal. Medically, their 'gender identity' is irrelevant.

yep

all that is required is for patients to be honest about their sex and the drugs they're taking

of course if you can't be honest with yourself, you're going to struggle to be honest with others

PermanentTemporary · 07/05/2023 07:02

Also found this article infuriating and so ridiculously dumbed down. A project to get applause from those in the know, and not to advance knowledge.

Women are at greater risk of laryngeal injury during intubation for surgery or life support, because their larynxes are smaller. Any decent anaesthetist should take that into account when choosing tube size, but apparently not all have done so in the past. How can they, if they don't know a patient's sex? There may even be a greater risk for transmen on hormones as their vocal cords enlarge with testosterone. Knowing sex plus the drugs you take matters.

There were Covid projects assessing whether the greater risk of death in men was reduced by taking female hormones - the existence of the projects was trumpeted by some TRAs. I'm certain I read that the projects were stopped as they showed no impact on death rates; the hypothesis being that male bodies have little ability to utilise female hormones. Last time I looked for those results I couldn't find them.

NecessaryScene · 07/05/2023 10:19

The doc was left wondering whether there was bone weakening due to puberty blockers. Again she could not discuss this with her patient.

What!? Hang on, so you can ask "men" if they're pregnant (because they're might be really female), but you can't ask "men" if they've been taking puberty blockers?

That doesn't make any sense. I think your friend may have been over-reading a stupid rule to make it even more stupid. How can you be barred from asking someone about medication they're on?

If this something about "outing" them - the puberty blocker question is far less outing than the pregnancy question, because it's not sex-specific! (Even if the bone-weakening effect is possibly greater for women).

GrabbyGabby · 08/05/2023 16:29

This was a few years ago. She sought advice from her superior on the day. She was told she could ask the usual questions about medications, which the patient v likely didn't answer honestly. She could ask questions that all patients are asked, which would now include the pregnancy question. But she could not ask directly if the patient was trans, as it was clear they did not want to disclose.

OP posts:
OldCrone · 08/05/2023 16:38

GrabbyGabby · 08/05/2023 16:29

This was a few years ago. She sought advice from her superior on the day. She was told she could ask the usual questions about medications, which the patient v likely didn't answer honestly. She could ask questions that all patients are asked, which would now include the pregnancy question. But she could not ask directly if the patient was trans, as it was clear they did not want to disclose.

So doctors aren't allowed to ask a patient if they're transgender.

Now transgender patients are complaining that they aren't getting the healthcare they need because doctors don't know when a patient is transgender and they're not allowed to ask.

This isn't the doctors' fault, and there's an easy solution. The doctors should be allowed to ask the appropriate questions and transgender patients should declare their status to doctors without being asked so that they can receive adequate medical care.

The transgender patients seem to want a very odd version of having their cake and eating it. They want adequate healthcare (for which the medical professionals treating them need to know their sex and medical history), but at the same time they want to keep their transgender status secret from the doctors treating them. Someone needs to tell them they can't have both.

ArabeIIaScott · 09/05/2023 07:32

'The transgender patients seem to want a very odd version of having their cake and eating it'

I can't read this without thinking of the manifesto for trans health care, in all its glory.

The right to perform surgery on themselves, iirc? The right to demand drugs as desired. Etc.

ArabeIIaScott · 09/05/2023 07:36

Here it is, copied and pasted verbatim:

TRANS HEALTH MANIFESTO

INTRODUCTION

Following the centuries-long repression of trans lives at the hands of the state, the next stage in the UK government's war of bureaucratic attrition is the recent publication of an NHS consultation that fails in every possible capacity, and a survey that gathers less data than we've already presented them. We call upon everyone fighting for the health of trans people to boycott this consultation & the survey, and reject its procedures & results in full. We encourage hostile participation in the form of direct submissions of demands that don't react to the questions posed or restrict themselves to the scope imposed by the government.

We wholly reject the NHS's attempt to codify the abuse, torment & traumatisation of trans people under the guise of 'healthcare'. We demand accountability for the historic & present abuse of power that the NHS has encouraged glorified psychiatrists to carry out. You do not own our bodies, you cannot control our lives, and you will not prevent our needs being met. We will not tolerate compromise.

The following living document is our vision for trans futures. We do not consider that our work will ever be complete, there will always be greater things on the horizon. As such, this manifesto is not final, but an open draft which will evolve as we do. This is our call to action. We will fight anyone who stands in the way of universal liberation. This is war, and we will win.

TRANS HEALTH MANIFESTO

Trans health is bodily autonomy. We will express our needs, and they will be met. We will change our bodies however we want. We will have universally accessible and freely available hormones & blockers, surgical procedures, and any other relevant treatments and therapies. We will end the medical gatekeeping of our bodies. We will have full, historical accountability for the abuses perpetuated against us in the name of 'healthcare'. We will see reparations for these crimes, and the crimes committed against others in our names.

We are not too ill, too disabled, too anxious, too depressed, too psychotic, too Mad, too foreign, too young, too old, too fat, too thin, too poor, or too queer to make decisions about our bodies and our futures. We are all self-medicating. Our agency will be recognised. We each labour far harder for the health of ourselves and those around us than any doctor ever has, and we will continue build supportive communities on principles of mutual aid.

We deny the separation of bodies, minds, and selves - a violence against any part of us is a violence against all of us. We believe that the epidemic of chronic conditions in our communities is a consequence of the war of attrition waged against us over centuries. We do not exist in isolation, and it is essential to our healthcare that we are all healing together, healing each other, and healing our world. We will heal the damage of borders and states, government and authority, capitalism and imperialism.

We recognise that the history of trans medicine is a history of colonial and fascist abuse. We see the history of eugenicist experimentation from Nazi concentration camps, to the colonial implentation of the West's regime of the gender binary, to virginity tests for South Asian and other Women of Colour in the UK in the 1970s; from the sterilisation & birth control trials forced on the women of Puerto Rico, to the thousands of Black and brown people who have died on NHS psychiatric wards; from the denial of the reproductive rights of disabled people, to the denial of access to abortions to people in the North of Ireland and the Republic of Ireland, past and present. We see the continued manifestation of eugenicist medicine in the denial of our bodily autonomy as trans people today: from coercive surgeries on intersex infants, to forced sterilisation in parts of europe, policing of and misinformation regarding our sexual reproduction, to gatekeeping of surgeries and medicines.

Our fight for bodily autonomy cannot be separated from our fight for reproductive justice. The demand to do what we want with our bodies is necessarily a demand for free and accessible abortions, for the decriminalisation of sex work, and for universal self-determination. We fight for an end to borders, prisons and police. We recognise that we do not exist independently of our environment, and so our fight for self-determination and health is a fight for climate justice, too. We are not separate from our environment, health is unattainable while the water is poisoned and the land is scorched.

There will be no clinics, and no authorities. We will conduct our own research, and experiment with our own bodies. We will heal and grow together. We will accumulate knowledge and share it freely and accessibly. We demand nothing less than the total abolition of the clinic, of psychiatry, and of the medical-industrial complex. We demand an end to capitalist & colonialist "medicine".

We demand hormones & blockers are made available over-the-counter and by free prescription upon request. We need free, universal access to safe hormones & blockers at any age, the opportunity to decide our own doses, and universally accessible information on the safety & efficacy of different regimens. We are already taking hormones in this way, so this demand is simply that the danger of doing so is effectively mitigated.

We demand that all therapies that can be are made available at drop-ins, with self-referral for any therapy or procedure for which drop-in is unsuitable.

We demand anonymous blood tests, both postal & at drop-in endocrinology clinics, where we can seek the advice of a consultant if we wish.

We demand the freedom to alter our bodies without justification. We demand an end to all surgical prerequisites - nobody should have to prove life experience,health or have to be taking hormones in order to exercise bodily autonomy. We demand that these surgeries can be highly customised to meet our individual & unique needs. We demand the right to multiple surgeries, including reversal of previous surgeries if desired, so that we do not have to fear regret. We demand the free & timely provision of genital surgeries, additive & reductive chest surgeries, hysterectomies and orchiectomies, tracheal & vocal surgeries, facial surgeries, lipoplasty, contouring & microdermabrasion, surgical hair removal & transplantation, and any other possible procedure to meet our needs as we express them.

We demand resources for hair removal anywhere on our bodies, and the option of local anesthetic during these procedures.
We demand voice coaching that does not coerce us to alter our voices in ways we do not express a need for, but respects our accents and our right to express ourselves however we desire.

We demand access to counselling & and any other therapies we choose.
We demand the revocation of medical licenses from all gender clinic doctors & nurses, past and present.

We demand the power to hold abusers of medical & administrative power accountable for historical & present injustices.

We demand medical training to enable us to safely carry out medical procedures & research for each other, for anyone of us who wants to learn. We will enhance our collective knowledge, so that the means to understand our bodies is universally accessible. We demand to improve the quality of medications we take and procedures we undergo, to reduce negative side-effects in the long term, and to highlight our own experience and understanding of their effects on our bodies.

We demand research centres & libraries of knowledge, autonomously & horizontally organised by and for trans people, in which research subjects are equal participants in deciding the experiments conducted & the manner in which those experiments are carried out. We demand full funding for any research or projects undertaken by these collectives.

We demand mandatory education, written & taught entirely by trans people, at all educational stages, from nursery to adulthood. Trans kids have a need to understand themselves, in the context of their own bodies, lives & experiences. We must repair the damage done by section 28, the legacy of which is still causing harm to today's children.

We demand material reparations for historical abuses against trans people, and for all people hurt by eugenicist medical practices and policies.

We demand an end to birth certificates and to legal gender. Gender records should be anonymised, and only ever recorded as part of equalities monitoring. Neither government, nor any institution, has any justification for keeping a register of trans people. Birth certificates are not just a violence against trans people, they are a material to the state's oppression of "undocumented" immigrants and asylum seekers.

We demand good quality, accessible & safe homes for all; and demand adquate resources to trans and marginalised people to establish communes & housing co-operatives to schemes and projects.

We demand that trans people are immediately freed from police, military & government contracts without repercussions. We reject the system of blackmail that corporations and governments engage in, whereby trans people who can work are "rewarded" with slightly less mistreatment in exchange for the exploitation of our labour. We will not allow pinkwashing of the violence of capitalism, imperialism and the state.

We demand amnesty, recourse to public funds and indefinite right to remain for all trans, lesbian, gay and bisexual immigrants & asylum seekers. No one is illegal.

We demand immediate release & pardon for all trans prisoners.

Edinburgh Action for Trans Health

HootyMcBooby76 · 09/05/2023 11:26

That manifesto is a scary pile of pish.
"We demand medical training to enable us to safely carry out medical procedures & research for each other, for anyone of us who wants to learn"

WHAT the actual hell? Has this been written by a 15 year old with blue hair and oversized comedy glasses by any chance?

If it wasn't so deluded and unhinged it would actually be funny.

Good luck with all your "demands" when the average Joe can't even see a GP for weeks on end for a simple appointment and waiting lists for routine surgery like gallbladder removal is three YEARS in my area.

Oh I forgot, if you say the magic word, you will be fast-tracked and kowtowed to.
My bad.

ArabeIIaScott · 09/05/2023 13:57

Aw, Hooty. I LOVE that manifesto. It always cheers me up.

RedToothBrush · 09/05/2023 14:01

PortiasBiscuit · 05/05/2023 07:42

My friend is a nurse and despite her private views she has to deal with some very ill people. If “gender”makes people more likely to engage with medical services than “sex” on a form, she doesn’t have a problem with it. Most doctors/ nurses know how to behave once they are faced with a physical patient.
This is a practical issue, not just a political one.

So has your friend stopped to think about how many people it will also make disengage? Or be badly informed and thus come to avoidable harm?

Cos I bet that number is bigger...