transness and disability panel discussion / group discussion ABBREVIATIONS USED: GIC: gender identity clinic CX: Charing Cross (gender identity clinic) DRC: disability resource centre MH: mental health AFAB/AMAB: assigned female/male at birth
Medical gatekeeping - intersection of transphobia and disablism in the medical profession. Personal experience: being on antidepressants can be used to invalidate access to GICs/surgery The transitioning process can highlight misogynistic medical bias - e.g. being offered an autism diagnosis as a trans man, when had previously been given a BPD diagnosis. There is currently a big problem with GICs rearranging appointments at short notice which is v disruptive for people with a variety of needs. A new system is coming in at CX hopefully which will ‘red flag’ people with disabilities to make sure appointments are not moved at short notice Hypochondria diagnosis can make it hard to get diagnosed with anything else - and get a GIC referral. Difficulty of convincing gatekeepers of difference between hypochondria/obsession with body and dysphoria. AB: Massive need for self-advocacy: doctors don’t really know what to do with trans patients and also don’t really know what to do with disabilities - idea of having to ‘grit your teeth’ through a lot of mental gaslighting - problems with self-doubt. Problem that being trans is classed as a mental health problem itself. Story about GP writing a letter detailing disabilities for DRC and including trans status. Also problem that other MH practitioners don’t understand what happens inside a GIC: assume that counselling etc is provided. Question: how do people approach pursuing medical pathways for gender and a mental health problem at the same time? ‘Overlap’ is a problem - very easy for doctors to look at separate issues and conflate. Conversely, what about when there is actually an overlap, & dysphoria and other MH conditions actually do interact? This is also an issue with physical disabilities - depersonalisation resulting from physical disability can interact with dysphoria. Panellists relate with this idea - several personal experiences not being able to disentangle these things/feeling they are deeply related.
Can be difficult to get this across to cis people who then use it to trivialise transness as a ‘by-product’ of stress/life changes. Sometimes mental health flareups and dysphoria can feel like separate things but be experienced simultaneously - reinforce each other or coincide.
There is an overlap between the problem of having to conform to ‘acceptable’ standards for being trans AND having to do the same thing for being disabled - have to be a ‘good crip’ and a ‘good trans person’ at the same time. These are difficult by themselves, and doing both of them together is even more difficult.
Physical issues with e.g. binding: MJB reports good treatment in having top surgery accelerated because of specific physical difficulties with binding. AB: there is progress happening slowly! It can be a lottery depending on who you see at Charing Cross - discussion of various practitioners & experience varying widely. Question: how important are diagnoses (of disability, of gender dysphoria)? MJB: disability diagnosis was v important to sense of self-perception, gender dysphoria less so - more of a practical help. AB: diagnoses useful in practical terms, reluctant to stake too much identity on them TK: tangible medical diagnosis is very important because self-diagnosis is anxiety-inducing (related to health anxiety). MJB: BPD diagnosis really helpful for coming to terms with self. Parallels in narratives Parallels in visibility debates - visible vs. invisible disabilities, visibility debates in trans communities eg. between afab and amab trans people. MJB: having to engage with more people in public as a disabled person (eg making complaints, requesting adjustments) means greater exposure to/potential for misgendering. AB: worrying about using up “awkward points” by disclosing disability - have I used up “credit” for disclosing transness/asking for pronoun accommodation? Which should I choose to make visible? TK agrees.
Panel agrees that afab trans people have more choice about this - much harder for amab to be ‘invisibly’ trans, esp. in formal/workplace context. ‘Visibility’ not a reachable/easily attainable concept.
Who are we trying to be visible to? General advice: if you want a diagnosis for practical reasons, don’t be afraid to ask your doctor directly. MJB: When you can name a physical diagnosis, you can be taken more seriously. Give doctors clear solutions - clear treatment pathways that you want.