Macmillan Cancer Support leaflet aimed at trans patients: "regressive, unscientific and generally very poor advice" says nurse

[IwantToRetire]

(Some may find this article distressing to read if they or friends or family have suffered from cancer.)

The leaflet, titled “LGBTQ+ people and cancer”, is produced by Macmillan Cancer Support in partnership with a group called “Outpatients”. It is quite possibly one of the most offensive pieces of healthcare literature, amended to include people who “identify as” the opposite sex, that I have seen thus far.

" ... Your team will talk to you about where you will stay. Hospital wards may be single sex or mixed. Where you stay should give you privacy and keep you safe. If the hospital has single-sex wards you will usually be able to stay in a ward which matches the gender you identify with.

" ... Some health conditions are still often treated in clinics that are gendered. For example, if you have a problem affecting the vagina or nearby pelvic areas, you may have an appointment at a women’s health clinic. A problem affecting the prostate, you may be given an appointment at a clinic for men. These clinics can be difficult to cope with if your gender identity does not reflect the sex you were assigned at birth.

" ... If you were assigned male at birth and have had genital reconstructive surgery. If you have had surgery to make a vagina, the risks of cancer in this area are thought to be low. You do not have a cervix and do not need to go for cervical screening (a smear test).

" ... Sometimes surgery to treat cancer is also gender-affirming. Surgery to remove the cancer may remove a body part that you prefer not to have anyway.

Extracts only - full article at https://thecritic.co.uk/gender-identity-ideology-is-undermining-healthcare/

sex, which is observed at birth and cannot be changed.

This is about health. You cant have health professionals playing along with a fantasy.

If people want to be trans whatever (70s gender benders) that's fine.

What isn't fine is the whole emporer's new clothes we are being told to adhere to. Be trans but dont fool yourself you have changed your sex, and absolutely dont expect other people to collude in the lie.

If this was the trans reality than hogwash leaflets like this wouldn't have to be written. The pressure to write these lets all play a game of pretend, is exactly what TRAs want.

For us all to dance to their tune.

As i said before, this leaflet is aimed at trans people not at MN GC posters. Why would you expect it to include the transphobic rhetoric you spout@Catsmere?!

I don't really see the problem with this leaflet. It's plain english and largely accurate.

It should state that many hospitals will try to accommodate trans people in separate rooms wherever possible, which is usually the case.

Ooh, "transphobic". Don't make me laugh.

Would you expect anorexia patients to be put with those in for bariatric surgery because they think they're fat?

Why should men ever be placed in women's wards?

I mean, I’d look back at your posts for some examples of the transphobic rhetoric, but that’s a bit hard on this thread….

Absolutely this. I don't often agree with ElleWoods15 in this particular forum, but here I definitely do.

Also, speaking as someone who's been treated for cancer and spent more time than I want to think about hanging around the Royal Marsden in various waiting rooms, Macmillan publishes approximately 32398793393275 different leaflets for different groups. It seems perfectly reasonable that there should be one for trans-identifying people.

Nobody is saying there shouldn't be a leaflet.

What is being said that NHS staff, or whoever, shouldn't have to collude with the fairy tale of changing sex.

ie the leaflet should be titled and stated throughout that those people who have a gender identity need to remember, as it is and can be a matter of life or death, that having a gender never changes your biological sex. Therefore in relation to health threatment and working with health professionals you HAVE to work with them on a basis of honesty and discuss your health issues from the basis of your sex.

Health professionals should NOT have to play the Emporer's New Clothes double speak.

Be trans, but dont expect people to collude with the lie in your head.

And most of all dont but an extra burden on an already over stretched NHS.

So the leaflet is doing trans people no favours because it again makes out they are these very special people who everyone else has to dance around and collude in their internal fantasy. Which implies that everyone else is not deemed to be as important.

This is a health isssue.

Health is about biological facts.

And biology says you are and always will be the sex you are born.

Health isn't just about biological facts though. It's generally considered good practice now to treat the whole patient and create space where they can be comfortable and aren't going through something that feels like a hazing ritual to access medical treatment.

That isn't just for trans patients. It's for lots of different groups - so, lots of NHS provide kosher or halal food on the wards for example, which isn't a hard-core scientific necessity either but is about supporting the whole person and treating them with dignity and respect.

So you think that a leaflet aimed at a religious group should say 'You may believe in your sky fairy, and that's your right, but you've got cancer, so you should focus on reality'
Or a leaflet aimed at women who'd never had kids and therefore had a higher rate of certain cancers 'Having kids would have reduced the risk of this, but suck it up because facts is facts'
Sure, you have no understanding or respect for someone who has a trans experience, but most healthcare professionals, and indeed compassionate people, understand that the point of these material illnesses affecting all humans, is that humans are coming from lots of different experiences.

As you've doubled and tripled down on your OP, I doubt it's worth saying to you specifically, but anyone who has a problem with this kind of information being available really needs to reflect on what is actually motivating them. You're not a warrior for the rights of women and girls when you do this. You just think so poorly of a group of people that you want them to be treated with blunt insensitivity when they have a potentially life threatening condition.

I'm as gender critical as they come, and I don't see a problem with that leaflet.

So you think that a leaflet aimed at a religious group should say 'You may believe in your sky fairy, and that's your right, but you've got cancer, so you should focus on reality'

Utterly irrelevant.

This is about health care.

Health care is about the functioning of the body.

And obviously over time health diagnosis and treatment change.

But what doesn't change is bodies.

So if you are treating an actual fact, ie people bodies, which are divided into 2 sexes.

As I said, if you want to be trans that's fine, but dont expect health professionals to effectively deny the reality of their training.

Which is that sex is a biological fact.

I keep repeating and will keep on repeating you cant ask for help from someone in relation to your body and then expect them to lie about the body they are treating.

The sooner we stop this complete nonsense that you can change sex, and just keep to facts. Then how you want to present yourself or modify your body is your personal business. You have no rights to tell someone they have to collude in your belief system.

I suspect I'm going to seriously regret posting here but here goes. I'm a trans man who has been treated for a gynaecological cancer. I found support during treatment from OUTPatients, the LGBTQ+ cancer charity that produced this leaflet with Macmillan. OUTpatients speaks to and supports trans cancer patients daily, and this leaflet was produced with input and feedback from this patient group, including myself actually - I was part of a focus group pulled together to contribute stories which informed the content. I mention this because I think it's important to understand this content wasn't pulled out of thin air, it was produced based on the real experiences, fears, concerns and challenges of real trans cancer patients. If the content of the leaflet doesn't speak to you, I can only echo what other posters have said here - it isn't about you.

The part about the removing body parts being ultimately affirming accurately describes the experience for some trans people. Of course a trans man is going to feel differently about having a mastectomy or hysterectomy than a cis woman might (though not all cis women are going to feel exactly the same about it either). It is not hurtful or offensive for someone to experience something differently to you.

Personally, I had a hysterectomy due to my cancer. My feelings about it are ambivalent - it certainly wasn't a walk in the park to go through the healing and hormonal upheaval. But actually it has made my transition onto testosterone smoother & it's very nice to never have to worry about periods or contraception ever again. It was my surgery and my experience and I'm entitled to feel about it the way that I feel. This takes nothing away from anyone else who had a different experience.

I don't know what "reality" OP thinks is being denied. Trans people really exist and we really get cancer, and it should be obvious to anyone with even the barest shred of empathy that while of course a cancer diagnosis is challenging for anyone, trans people might face some particular challenges in navigating treatment.

The leaflet at no point says anything false or misleading about who has what body parts or what the implications of that will be for treatment. And I can attest first hand that the vast majority of NHS staff proved perfectly capable of both talking to me about what was going on with my body in accurate medical terms AND respecting my trans identity. Nobody lied or denied reality, and to be honest I think the "denial of reality" here comes from posters who won't recognise trans cancer patients exist or think it's some kind of "fresh hell" to offer them tailored support. I am struggling to fathom the lack of empathy, to be honest. A cancer diagnosis is already terrifying and isolating enough, already strips so much from you, and you'd wish to make it even harder? I can't tell you how isolated I felt for so long before I discovered OUTPatients, or what a difference it made to me to speak to other trans cancer patients.

I want to say the NHS staff and particularly the nurses were wonderful - even though it was clear how busy and shortstaffed they perpetually were, they were so obviously absolutely committed to person-centred patient care that I'm honestly offended on their behalf at the suggestion that any of them would willingly do anything to any patient, trans or otherwise, that would make them feel uncomfortable or disrespected. It would be antithetical to them. I will never forget the chemo nurse who was so busy but still took a moment to sit quietly with me when I was overwhelmed with the pain from vein burn. Or another nurse on the chemo ward who was chatting to us about her evening plans but when no one came to replace her when her shift ended, she simply stayed without a word of complaint until everyone's treatment was done.

I only met one exception - when I was recovering on the ward post-surgery there was one nurse who was inexplicably horrible, she stormed into my room like I'd personally wronged her, wouldn't make eye contact with me at all, ignored me when I greeted her and tried to make small talk with her, and talked about me over my head to her colleague rather than speak to me. She then proceeded to make an error with my care that left me in pain for several hours. I would like to charitably assume she was just a shit nurse who was equally rude and careless with all her patients, but she was also the only nurse I encountered who was openly gender critical, so it's hard not to draw the conclusion that her hostile behaviour towards me was because I was trans. Whatever you think of trans people, I hope no one here thinks they deserve to be treated like shit while recovering from major surgery just because of who they are. And if that's what "reality based" care entails it only emphasises the need for trans-informed information and support from other sources.

@MissingLynks thank you for your thoughtful and personal post above. It is really helpful to hear what your experience was and how you may have felt differently about it. I too had a hysterectomy, to treat ovarian cancer in my case, and it's interesting to see what may have been different about it for you.

The nurse who was rude to you - that was plain wrong and unpleasant of her. I think GC is a spectrum. I would absolutely characterise her behaviour as trans-hostile (transphobia is overused and misapplied a lot but that's what it was). I hope and believe that you would be treated with respect in any setting by the vast majority of people with GC views.

(There was an AMA thread a while back started by a trans medical student. It was one of the best things I've ever read for helping me understand a transman's point of view. It had Tavistock in the title if anyone wants to look for it.)

Thank you for your insights, @MissingLynks

I don't understand why Jean/ The Critic's editors couldn't get the name of the leaflet linked to the article correct - it is clearly aimed very specificially at trans and non-binary folk, not the wider LGBTQ+ community (that's a different leaflet).

I think it's good that Macmillan make the effort to work with different groups of cancer patients to produce clear information about what to expect/ how to navigate their treatment and healing.

@MissingLynks
Since you quoted me ("fresh hell") I can tell you that you got what I was saying completely wrong. What I meant (and I was pretty clear, it's hard to see how you missed it) was that it would be crazy for somebody with an artificial vaginal to expect a gynecologist to treat any problems resulting from that. That's the domain of the surgeon who created the artificial vagina. People who are biologically male obviously would not be served well by seeing a gynecologist.
You, as a transman, would, because you are biologically female.
So I was actually saying trans people should get tailored support for medical problems specific to their biological sex.
Like all patients, you should be treated kindly and respectfully and get the appropriate treatments.
I hope that clears it up for you.

Thank you for the clarity. You'll be relieved to hear that nowhere in this leaflet does it suggest trans women should be treated by a gynaecologist, nor is this something trans women would usually expect. And even if they did have this expectation, it remains an odd choice of words to describe such a misunderstanding as "fresh hell".

You might also wish to consider that trans people who have been on gender affirming hormone treatment for any length of time are not always appropriately treated as their birth sex - rigidly insisting trans people must be always treated as their "biological" sex does not always acknowledge the reality of their biology. This is particularly relevant to cancer screenings and treatment as hormone treatment impacts your risk profiles. Trans people should be recognised and treated as trans, with the bodies and the body parts that they have, which is far more complex than rigidly insisting they are either male or female, end of story. I'm grateful the vast majority of health care professionals I encountered were capable of appreciating that.

@MissingLynks
This is what I was referring to;

For example, if you have a problem affecting the vagina or nearby pelvic areas, you may have an appointment at a women’s health clinic.

I was wondering if this included problems with artificial vaginas. If so, that would be a fresh hell, because it's bonkers.

If you're going to get pissy about the words "fresh hell" you're getting offended just for the sake of it. I'm not playing that game.

rigidly insisting trans people must be always treated as their "biological" sex

Nope. Be honest, please. This is my quote;

"So I was actually saying trans people should get tailored support for medical problems specific to their biological sex."

That would mean for example, not going to a gyno for an enlarged prostate, just because you have an artificial vagina and want the validation of being able to see a gyno. When problems are related to your biological sex, you need to see the appropriate medical professional.

Problems with the hormones you may be taking are another kettle of fish, but those aren't the purview of a gyno either. That's what endocrinologists do. A gyno does not have expertise in sex reassignment hormonal treatment.
Cancer, otoh, is treated by oncologists. So any of those conditions being treated by a gyno would not be appropriate treatment.

But hey, you obviously are looking for reasons to be offended, so I'm sure you'll invent something else that I didn't say in order to justify it.

Btw, please tag the poster you are responding to in your posts. Otherwise we don't get notification that there is a response and might not realize who you're talking to.
All you need to do is is put the @ sign and then the poster's username. Thanks.

I am not "looking for reasons to be offended", in fact I have been very gentle and reasonable and patient in explaining my experiences and perspectives.

Your insistence that a trans woman would go to see a gynaecologist for an enlarged prostate and would want to do so purely for the purposes of "validation" does not appear to be based in any scenario that has actually happened or been proposed outside your head.

Actually in many cases, it can be legitimately confusing as to who is the appropriate doctor to see if your body doesn't match the expected model - a urologist isn't necessarily an expert on post-surgical trans women either.

This is especially true with complex diseases such as cancer which might require the input of multiple different specialties. I certainly had some experience of being batted between departments when I was struggling with surgical menopause symptoms and, because of my transness, no one could seem to agree whose responsibility it was to help me, and I know other trans people have shared this experience - fair from insisting on seeing a certain doctor for "validation" it's more usually a case of one person doesn't know quite what to do with you, so they refer you to someone else who also doesn't know what to do with you, and you end up going round the houses. We could perhaps label this the "not my purview" approach to healthcare.

And speaking of purviews, you are of course correct to note that oncologists treat cancer, endos do hormones, etc - but you may be unaware that decisions about a patient's cancer care are usually made by multidisciplinary teams (MDTs), since cancer is a complex disease and treatments come with a high risk of complications. I variously had gynecologists, oncologists, endocrinologists, gastroenterologists, and even the gender clinic involved in my treatment at various times and I received the best treatment when they communicated and collaborated with each other. If the "not my purview" approach comes gender critical recommended, then again this only highlights the need for other perspectives.

I'll happily at you @XChrome but to be honest I'm not really getting the impression you're interested in actually talking to any of the people you're talking about.

Also, I'd like to thank you to those of you who've expressed interest and kind words.

@MissingLynks

Your insistence that a trans woman would go to see a gynaecologist for an enlarged prostate and would want to do so purely for the purposes of "validation"

Well there you go again, misrepresenting what I said. I was questioning whether or not that sort of thing was happening. I did not understand what the brochure was saying, if it was referring to biological males going to gynos or not. If the above scenario happened, given he knew a prostate is not found in biological females, of course it would be for validation that he is a woman. What other possible reason would there be for seeing a gyno about the medical problems specific to a biological male? Again, I do not know if this sort of thing has happened and neither do you. That's why I asked the question. I thought maybe somebody here knows of some case.

These misrepresentations are what I mean by looking for a reason to be offended. You are twisting the meaning to conform to a scenario you have created in your own mind, so you certainly have no call to lecture me about that. I was asking about a possible scenario, but you are actually claiming your scenario is fact.
So do such things happen? I don't know. That's why I phrased my initial post as a question. Quote;

They want gynecologists to treat problems with artificial vaginas?

As you can see, I was saying if such scenarios are happening or are going to happen, it's crazy.

If the "not my purview" approach comes gender critical recommended, then again this only highlights the need for other perspectives.

It doesn't, and I know about interdisciplinary medical teams. I used to work in health care administration. My point was that the initial specialist consultation for hormonal problems would be to an endocrinologist, who may then bring in other specialities if needed.
If you don't know exactly what somebody means, it's common courtesy to ask for clarification instead of making things up. You have not done this. You have made assumptions instead.

I don't disagree with anything you are saying about care for people with transgender needs at all. Why you seem intent to find something to argue about is something you'll have to work out yourself instead of putting it on me.

but to be honest I'm not really getting the impression you're interested in actually talking to any of the people you're talking about.

As I noted previously, your impressions seem to be skewed by a personal agenda and I can't help you with that. So this is getting exactly nowhere. You seem completely unaware of how peevishly accusatory you are coming across. I can see no benefit in further discussion if this continues to be the case, but thank you for sharing your perspective.
Best of luck to you in your health care experiences.

@XChrome, are you this rude to everyone, or do you just reserve it for trans identifying people?

Kindly point out where I was rude. Quotes, please.

As I noted previously, your impressions seem to be skewed by a personal agenda

My impressions are skewed by personal experience, as I've explained at length now, of being a trans person with cancer, ie one of the people you are discussing on this thread. I'm fully aware you'd rather be talking about me, not to me, but for anyone here who is actually interested in what that experience is like, rather than just entrenching their own prejudices and assumptions, I hope it's been informative. I won't be commenting here any more.