Trans Day of Remembrance 2022/my last day at the Tavi

(TW: transphobia, ableism)

Edit: I’ve been asked to update the image

Last year for TDOV I posted a thirst pic, this year I’d like to take a different route. I’ve been working in the Tavistock and Portman Gender Clinic since September, and TDOV happens to fall on my last day of work there (they’re letting go of all bank staff due to an audit). I’ve been working with the speech and language therapy team as a voice coach, helping trans folks modify their voices in a healthy way to be better aligned with their identity. There are some great folks working in the SLT team, and I’ve *really* loved the work with patients. Seeing how quickly somebody’s relationship to their voice and expressing themselves can start to change, and how profound that change can be over time, is fantastically rewarding. I particularly like my NHS patients, because they’re almost always folks who couldn’t or wouldn’t see me privately*. The SLT practitioners who I’ve worked with, though all cis**, have been really affirming of all identities and flexible in approach to folks with different learning styles.

The wider clinic has been a very challenging environment for me as a trans person, for lots of reasons. Firstly the waiting list is about four years long for an initial appointment, plus another year or two until your second/third appointments to actually start treatment. If you’re friends with me then you’re probably aware of the very damning statistics about delayed medical treatment and its direct link to depression, suicidal ideation, and other mh issues. This wasn’t surprising though, because it’s a widely known fact and I personally know loads of trans folks who are languishing on the list.

Something that has surprised me, though maybe it shouldn’t have, is how many things have been said that in my personal opinion are incredibly ableist. I can’t repeat specifics, of course, but on multiple occasions during whole team meetings I’ve internally questioned whether some of the people working at the GIC think disabled lives have any value at all. Given how much it costs to pursue private healthcare, how many disabled folks are on benefits, and that the GIC is the only gender clinic serving London and the surrounding area***, this means a lot of disabled trans folks are stuck with only one option for their care.

As a side note that isn’t really a side note, the head of the GIC has ‘etc’ in his zoom name pronouns. I asked him about it on my first day and he said he couldn’t be bothered to type out all of the masculine pronouns- others have also said they’ve tried to explain to him that it comes across as flippant and dismissive. This would be a mild irritation at most from an average person, but as somebody who has run the clinic for years he’s certainly aware of how earnest folks are and need to be about pronouns, and how harmful treating that dismissively can be.

With the rise of ‘gender critical feminists’**** in the UK in particular, it’s a scary time to be trans. It’s even more scary if you’re disabled, low income, BMPOC, or otherwise historically marginalised, but I promise you we feel each other’s pain. It’s been incredibly hard to see the most vulnerable members of my community have a tough time with the only NHS service they have the option of using and to be unable to do very much about it. I’ve felt good about my time at the Tavi because all trans folks deserve affirmative and patient-centred care, and because identity based work like voice is (IMHO) best delivered by folks with community alignment/knowledge/lived experience. Lots of patients I’ve worked with have very directly expressed how pleasantly surprised they were to have a clinician who was trans, affirming, and pleasant to deal with. Lots of folks who work at the Tavi are none of these (with some exceptions).

The fact that trans folks in the UK have to wait many (often quite agonising) years for treatment, and then navigate a service where they have to jump through hoops to get the care they deserve*****, and put up with treatment that is often out dated and sub par, is maddening. I often have the impression that the patients are being punished for the length of the wait list (again, personal opinion/impression). The staggeringly poor provision of care for trans health needs and the rising transphobia in the UK are linked; the government is putting its funding where its moral compass is pointing.

If you’re in the gender critical feminist camp, or have friends/family who are, I’d love to invite some reflection and research into the trans community and experience. We’re not scary, or trying to invade your toilets, we’re just people. If you’d like to talk/be informed/be guided to resources, LMK- no judgement here, it’s a strange world and we’re all learning in our own time.

*I charge on a sliding scale for trans folks, but even the bottom end of the scale is a lot if you’re on benefits or otherwise have a tight budget

**The team is also entirely white, which is a red flag considering it’s our job to teach folks to speak/communicate. We had a short but meaningful anti-racism workshop with the fantastic Arianne Barnes soon after I joined the team, but the lack of diversity is inherently problematic no matter how nice or well trained we are.

***As far as I know, though pilot projects like Dean Street are very encouraging

**** Being transphobic in the name of feminism is spectacularly ridiculous; we know first hand how much better men are treated, and what it’s like to be harassed based on gender. Of course the majority of us are feminists.

***** For example patients are often asked to legally change their name or fully out themselves at work and in public before they’re seen as ‘taking their transition seriously’, but allowance for poor english skills, disability, neurodiversity, legal papers from other countries etc is not something I have seen.

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