"Long before it's in the papers"
March 30, 2016


Not “freaks”: doc charges colleagues with mistreating sex-change patients

March 30, 2016
Courtesy of The BMJ
and World Science staff

Many doc­tors are still dis­cour­ag­ing peo­ple from get­ting sex changes they want and need, and be­ing rude to trans­gen­der peo­ple, a prom­i­nent U.K. doc­tor charges in a ma­jor med­i­cal jour­nal.

James Bar­rett, a con­sult­ant psy­chi­a­trist at Char­ing Cross Gen­der Ident­ity Clin­ic in Lon­don and pres­ident of the Brit­ish As­socia­t­ion of Gen­der Ident­ity Spe­cial­ists, launched the broad­side in an ed­i­to­ri­al in The BMJ, form­erly the Brit­ish Med­i­cal Jour­nal.

The ar­ti­cle this week charged that many doc­tors are still un­ac­ceptably draw­ing on on Chris­tian or sup­posedly eth­i­cal be­liefs to dis­cour­age sex changes, some­times by cre­at­ing im­prop­er ad­min­is­tra­tive road­blocks.

Peo­ple with gen­der dys­pho­ri­a—that is, who feel their true gen­der ident­ity is the op­po­site of their bi­o­log­i­cal sex—“aren’t freaks,” Bar­rett said. “They are teach­ers and ac­coun­tants, po­lice of­fi­cers and doc­tors, par­ents and tax­pay­ers, and—im­por­tant­ly as de­serv­ing of re­spect and de­cent, rou­tine” care.

The need for treat­ment for gen­der dys­pho­ria world­wide has nev­er been higher, Bar­rett claimed, cit­ing fig­ures from the U.K.’s Na­t­ional Health Serv­ice that the com­bined wait­ing list for its 11 gen­der ident­ity clin­ics is at least 5,000 peo­ple. 

Some peo­ple end up re­gret­ting sex changes, but stud­ies have found that this af­fects only around two per­cent of trans­gen­der peo­ple.

Early and prompt treat­ment at a gen­der ident­ity clin­ic leads to huge and sus­tain­a­ble im­prove­ment in qual­ity of life, Bar­rett said. So it seems odd “that such ef­fec­tive treat­ment was ev­er con­sid­ered a low pri­or­ity—or that ac­cess to it should have been de­layed.”

Yet in the ex­pe­ri­ence of those who work at gen­der ident­ity clin­ics, he added, “as many as one in five [gen­er­al prac­ti­tion­ers] won’t pre­scribe for peo­ple with gen­der dys­pho­ria, even af­ter ex­pert ad­vice” from a qual­ified clin­ic.

Rea­sons that doc­tors have giv­en for this re­fus­al, he said, in­clude con­cerns about treat­ment be­ing dan­ger­ous or dif­fi­cult (both wrong), or ex­pen­sive (it’s not, par­tic­u­lar­ly). He has al­so heard what he calls dis­turb­ingly frank ad­mis­sions that it was against “deeply held Chris­tian be­liefs” or that “we are trained to treat ill­nesses, not to change na­ture.”

Bar­rett said that doc­tors who lack ex­pe­ri­ence in the field should care for pa­tients with coop­era­t­ion and ad­vice from gen­der ident­ity clin­ics.

Bar­rett al­so sav­aged the disre­spectful treat­ment that he said some doc­tors give trans­gen­der peo­ple, treat­ing them as though they’re sick and re­fer­ring to them by their form­er sex even years af­ter a change­o­ver. Pa­tients, he wrote, of­ten find their trans­gen­der sta­tus “can fea­ture in ev­ery med­i­cal con­sulta­t­ion and re­fer­ral even if not rel­e­vant to the ail­ment in ques­tion, in a man­ner that would be un­ac­ceptable if the is­sue was that they were gay or black.”

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Many doctors are still discouraging people from getting sex changes they want and need, and being rude to transgender people, a prominent U.K. doctor charges in a major medical journal. James Barrett, a consultant psychiatrist at Charing Cross Gender Identity Clinic in London and president of the British Association of Gender Identity Specialists, launched the broadside in an editorial in the BMJ, formerly the British Medical Journal. The article this week charged that many doctors are still unacceptably drawing on on Christian or supposedly ethical beliefs to discourage sex changes, sometimes by creating improper administrative roadblocks. People with gender dysphoria—that is, who feel their true gender identity is the opposite of their biological sex—”aren’t freaks,” Barrett said. “They are teachers and accountants, police officers and doctors, parents and taxpayers, and—importantly—patients as deserving of respect and decent, routine” care. The need for treatment for gender dysphoria worldwide has never been higher, Barrett claimed, citing figures from the U.K.’s National Health Service, or NHS, that the combined waiting list for its 11 gender identity clinics is at least 5,000 people. Some people end up regretting sex changes, but studies have found that this affects only around two percent of transgender people. Early and prompt treatment at a gender identity clinic leads to huge and sustainable improvement in quality of life, Barrett said. So it seems odd “that such effective treatment was ever considered a low priority—or that access to it should have been delayed.” Yet in the experience of those who work at gender identity clinics, he added, “as many as one in five [general practitioners] won’t prescribe for people with gender dysphoria, even after expert advice” from a National Health Service clinic. Reasons that doctors have given for this refusal, he said, include concerns about treatment being dangerous or difficult (both wrong), or expensive (it’s not, particularly). He has also heard what he called disturbingly frank admissions that it was against “deeply held Christian beliefs” or that “we are trained to treat illnesses, not to change nature.” Barrett said that doctors who lack experience in the field should care for patients with cooperation and advice from gender identity clinics. Barrett also savaged the disrespectful treatment that he said some doctors give transgender people, treating them as though they’re sick and referring to them by their former sex even years after a changeover. Patients, he wrote, often find their transgender status “can feature in every medical consultation and referral even if not relevant to the ailment in question, in a manner that would be unacceptable if the issue was that they were gay or black.” doc charges