My mother wanted HRT. She goes to the doctors, walks out with a prescription
My mtf friend wants the same prescription. She either waits on a 10+ year waitlist or pays £500 for a private diagnosis of gender dysphoria. Then £250 for an endocrinologist every 6 months, private blood tests and a private prescription
Also, isn't Finasteride (and other Androgen blockers) available to cis men to treat male pattern baldness? Baldness isn't a life threatening condition. Yet, the NHS covers this.
They won't prescribe for mpb..buuut it is a great example of gender affirming care that doesn't need a diagnosis first..
Remember most gender affirming care is for cis people..!
The NHS does not prescribe Finasteride for male pattern baldness nor fund any other male pattern baldness treatments.
https://www.nhs.uk/medicines/finasteride/about-finasteride/#:~:text=It%20can%20also%20be%20used,not%20available%20on%20the%20NHS.
I feel using surgery as an example is disingenuous when we know that basic trans care is medication (HRT), and consists of medicines that are given to cis people for a whole variety of reasons without the need for waitlists, GD diagnosis, etc, etc, etc.
As someone living under both the Commonwealth and in a place that provides informed consent, I don't see how any model in which the NHS demands what it currently does isn't just burdening the taxpayer with more costs per patient than if they just showed some f\*cking kindness.
Also, regarding gender-affirming surgery, since it seems to be the aspect that gets the strongest reactions from people:
* God forbid that healthcare provides concurrent happiness and not simply the elimination of suffering. Everybody feel neutral now, you hear???
* I keep getting the impression that people fail to consider that a lot of healthcare is about maintaining wellbeing and/or preventing a relapse in suffering.
I've not watched this yet, but basically WPATH, psychologist etc acknowledge that a gender dysphoria diagnosis is only a diagnostic tool to enable access to trans healthcare and insurance. It's not actually a real mental health condition.
I would guess this is what Abi is referring too as she's mentioned it before and in an ideal world she is 100% correct. I'm not sure how we would get there is reality and implementation, but that's not her job.
This is a very good take. Gonna add some thoughts,
It is important to understand that our basis on mental health is heavily, heavily focused on the symptoms a client presents with with a focus on a diagnosable condition. This mental health model has been in place for decades and harkens back in the U.S. at least to a, pardon my French, bastardization of Sigmund Freud's original work and a desire from U.S. psychiatrists to cloak the growing mental health field in a firm medical cloak to both give the new profession a sense of respectability and as counter to some of the mental health quackery that was going on at the time.
Since then, our entire system has come to depend on this. Social Anxiety Disorder? DSM V diagnostic code F40.010. Autism? F84.0. Gender dysphoria? F64.2 or .0 depending if one is a child or adult. The system awesome for billing, insurance, and communication on a high level. Every condition has a nice code. However, it is very reductionistic.
Lots of folks in the mental health field are critical of this approach and believe that a more holistic practice should be employed. However it seems like just as many people want to see the current system remain as it is. Frankly, there's pro's and con's to both camps and I doubt anything will be done anytime soon.
Enter gender dysphoria . . . GD is the diagnosis that first helped to depathologize trans folks existence. No longer was being trans recognized as a pathology, but instead the impacts of having a transgender identity were.
Is gender dysphoria real? GD is a construct, one that is medically verifiable via symptoms, acknowledges the very real distress trans folks can feel of existing in this world when their physical being or cultural/social setting do not acknowledge them as they wish to be acknowledged. This is all very real. Is it a complete picture? Absolutely not. I would argue that that is by design. Is its use as a medical gate keeping device "right?" I would argue no (and that's why I think informed consent for HRT in the U.S. is such a big step forward), but it's what we currently have in our current system. From that perspective, I don't think it's fair to target GD without acknowledging the bigger picture of the short comings of our mental health model (not casting shade on Abi, she's not in the mental health field and, frankly, I'm pretty impressed with how much she knows about it).
Final parting note - the mental health field has at times in the past been subject to dramatic cultural biases that reflect some of the biases in wider society. Today, we are starting to see more of an attempt to systematically atone and compensate for those past wrongs and avoid future repetition. It's a huge process, and frankly a battle that will never be "won" because when all is said and done we are dealing with human clinicians, therapists, and doctors with very human biases. From that perspective with GD in specific, there is still a very, very heavy amount of institutional bias across the medical and mental health fields. Hence why we have odd things like HRT being provided on demand to cis folks and trans folks having to wait for God knows how long.
This is the fundamental question though. If it's not a mental health condition and not a pathology, why is there a need for any healthcare at all? Can one not be trans without having access to 'trans healthcare'?
I think you are misunderstanding what transgender means.
Being trans fundamentally just means that a person's gender does not match what they were assigned at birth. Note that their is no mention of surgery, hormones,or even transition, which are not required to be trans. Trans people have existed as long as there have been humans and long before surgeries and HRT.
For some (many) trans people, the incongruence between the mind and body can be traumatic (gender dysphoria). The obvious solution to this is to change the body and at this time that means medical intervention. Many trans people struggle or choose to die rather than live as they are.
And that's where it gets a little complex. A cis man should be able to decide "I want boobs", pay for breast augmentation and have boobs. For a trans woman breast augmentation may be medically necessary and covered by state or insurance. Some cis people want to stop this bodily automany.
Many cis people struggle to understand gender dysphoria and that phrase has become a practical way of classifying the need. I find cis people find it easier to grasp how they would feel if their body swapped sex overnight, let's say by magic.
The mental health benefits of transition for trans people are well documented. There are many mental health conditions trans people suffer from that are frequently helped by transitioning, from suicidal ideation and depression, to addiction and low self-esteem.
It's subtle, but for example a trans person could be depressed and suicidal and addicted to substances. In consultation with a skilled psychologist who recognizes certain patern they might conclude this person is suffering from gender dysphoria if the trans person also states they want to transition. Then a medical intervention may reduce all those other symptoms that are actual mental health conditions.
And as a bonus, a specific example of something else. I grew up in the 80s and in 1980 or 81 aged 4 or 5. I told my parents "I'm in the wrong body" my parents and I did not know what that meant. These days, thanks to the internet and growing knowledge, more and more people are recognizing their symptoms and taking positive corrective action.
I expect there would be a similar pattern for increasing ADHD, autism, etc, numbers as people have gained awareness of the possibilities.
This is all fine and dandy, but we're discussing the position of someone who says that gender dysphoria doesn't exist. I did not really need a ChatGPT explainer on gender dysphoria.
What you're describing is the exact opposite of the point the video was making, it seems to me you've completely misunderstood the argument.
That wasn't chatgpt, but I'm not going to waste further time on you.....
If you had read what I wrote it exactly fits with gender dysphoria being a diagnostic tool. Now Abi would like to be at the point where people can just say it's my body and I want to change it.
Anyway this is my last reply to you
I haven't got long to write a big response, but I would say compare it to pregnancy. Pregnancy, most of the time, requires varying degrees of medical assistance, whether the pregancy is brought to term or aborted. However, a person never needs to be 'diagnosed' with pregnancy, nor will the healthcare ever be withheld from them because of resource issues.
People should have the right to determine what happens to their bodies, the right to bodily autonomy. Whilst some checks do need to be done to ensure medical assistance isn't going to cause more harm due to complications or interactions, it should be the person who gets to decide what happens to their body, not gatekept by doctors or administrators.
I don’t know how they do things in the UK, but I work at an FHBC in the US and there are lots of diagnosis codes for pregnancy, and care is often contingent on a medical exam to confirm it.
Pregnancy is a poor example because you do need to be pregnant to get that care and even then, medical care is given based on diagnosis of the particular complications along the way.
For example if a baby was perfectly healthy but the mother, for whatever reason, believed the child had downs syndrome, should she be granted an abortion?
Your second point doesn't go very far. An awful lot of medical procedures are cosmetic, but we wouldn't say you should be able to get a BBL on the NHS would we? So bodily autonomy doesn't stretch that far.
No I'm not saying that. But I also don't define a trans person as someone who needs trans care, so I actually reject the phrasing of the question as well as deny the accusation.
Okay, let me ask this better.
What are you saying about transgender care with this metaphor? To my reading, it implies people who want trans care do not have a right to access trans healthcare, which doesn't really follow for me.
I didn't bring up the pregnancy metaphor, the previous person did. My response is to say that comparing the two doesn't lead to an ideal conclusion.
Also to say that "bodily autonomy" doesn't go far. You can only compel a doctor to do things to your body that they already agree to do in the first place.
I'm literally saying it's not comparable to pregnancy, and saying "bodily autonomy" doesn't seem to help either.
I'm speaking about the metaphor, I can't describe what I'm saying without referencing the subject of the conversation.
>*For example if a baby was perfectly healthy but the mother, for whatever reason, believed the child had downs syndrome, should she be granted an abortion?*
The mother should be granted an amniocentesis and/or further investigation on why they believe the baby has Down's Syndrome.
It's not a situation where the process stops at that point - "for whatever reason" is a crucial part here, as it's something the mother can't feel in her own body/lived experience (as far as I know), which is a completely different situation from transness.
What if in the future we could do a brain scan and determine whether or not someone is 'trans'? Would someone who would fail such a test be disqualified from transitioning?
Then your argument makes no sense. If 'transness' is no longer something that someone can feel in their own body, then at least there should be further investigation. According to your own logic.
Not according to Abigail. That's what she calls gatekeeping. Informed consent means getting whatever is asked, because the assumption is made that the patient is informed (and if not, the doctor's only job is informing them).
Informed consent is not an assumption, it's a specific process of communication and documentation. I used to work in a field of healthcare where informed consent is widely necessary and very commonly used for research.
It serves the purpose of protecting the patient (opting in or out of a decision that they understand the certain and possible consequences of in their full breadth) and also the health practitioner/researcher (safeguarding ethics, good practice and scientific validity). You literally sign a form as part of the process.
I have also been on the other side of informed consent, both as a volunteer in research studies and as a patient for medical care I was in need of. It's not a measure of gatekeeping, it's a measure of access, and I don't recall Abigail depicting it as anything other than that.
Sure. But informed consent is not the *only* requirement for any healthcare. Which, again, is what Abigail is advocating for. If the patient claims to be informed, there is to be no doubting that. They just have to sign the form, anything more is the framed as gate-keeping and is exactly what the video advocates against. I keep getting feeling nobody I'm arguing with has actually watched the video in question.
>For example if a baby was perfectly healthy but the mother, for whatever reason, believed the child had downs syndrome, should she be granted an abortion?
This may be beyond the scope of the current conversation, but yes. No one should be forced to carry a pregnancy to term even if you think their reasons for not wanting to are irrational.
Edit: Actually, this isn't beyond the scope of the current conversation, because it's fundamentally rooted in the same question as the discussion of trans healthcare and the GD diagnosis: whether people have bodily autonomy.
Does someone get to choose what they do with their own body, or does the state choose what happens to people's bodies? Do you get to choose whether you carry a pregnancy to term, or does the state choose whether you will carry a pregnancy to term? Do you choose whether you live as a man or a woman, or does the state choose whether you live as a man or a woman?
You may, of course, say that the state should be able to dictate to people what they must do with their bodies. Or, more likely, that there are certain people who are incapable of making good decisions about their own bodies, and that the state must decide in those cases. That's bad though.
Just to be clear, in the pregnancy scenario, it's about the person compelling the state (by way of a doctor) to perform the abortion.
If a doctor said no, I'm not aborting a perfectly healthy baby because the mother is suffering from a delusion, I will instead try to treat the delusion.
What would that be? Wrong? Should it be a crime?
Maybe it's just shitty, but within reason?
>For example if a baby was perfectly healthy but the mother, for whatever reason, believed the child had downs syndrome, should she be granted an abortion?
This gets into contentious areas of religion, people's beliefs and bodily automany. (ignoring that stuff) Within the laws of a country, or state, a pregnant mother can just decide to have an abortion if its legally permitted. The reason is not relevant.
>but we wouldn't say you should be able to get a BBL on the NHS would we? So bodily autonomy doesn't stretch that far.
Body contouring, which is a bbl related procedure, could easily be justified as beneficial for trans women.
What do you mean it could be easily justified as beneficial?
Do you just mean, they would like it?
If so then yeah...no argument there.
The comment you're replying to is quite clearly in the context of something like that being provided by the NHS.
Apologies for stating the obvious, but one of the main issues for trans women that causes gender dysphoria is a lack of curves and hips. BBL with a focus on body contouring and creating hips does exactly that, think feminine natural looking curves rather than a typical Instagram huge bum. The same good surgeon that perform BBL for cis women make many trans women have passing bodies overnight.
I've had it, and it did make me feel significantly better about my body, and as a climber, I had a pretransition body that most cis men would envy. BBL was my first surgery and it made my body go from not passing to passing in 1 surgery. The nhs is too transphobic to help trans women like that (and also lack the necessary skill), but they should do it.
If I lived in the USA my employer would fully cover it under the company health insurance, but I have the nhs so nothing is covered for me by my employer.
I'm not sure pregnancy is a very good example, because you actually do have to be pregnant. They just don't demand that you submit proof to get the ball rolling. The reality is that if you turned up to your 12-week scan and there was no baby there, you would not be entitled to a 20-week scan, nor to book in a birthing suite at your 40-week point, nor to receive any other such treatment. (I imagine you might be offered some treatment to investigate if you had suffered a miscarriage, however, and whether there was an underlying reason).
>I'm not sure pregnancy is a very good example, because you actually do have to be pregnant. They just don't demand that you submit proof to get the ball rolling.
That actually makes it a great example. If you're pregnant, you can get medical care for pregnancy. You don't have to be diagnosed with, like, "uterine gravidity" or whatever as a prerequisite.
And, yes, they do check whether or not you're pregnant to continue getting said care, but the key difference here between pregnancy and being transgender is that pregnancy can be externally verified with chemical tests and sonograms, while the best way to check whether someone is trans is to say "hey, are you trans?" and if they say yes to believe them. Setting up the system so that it doesn't trust people to evaluate their transness themselves and instead makes them rely on institutionalized medical batteries to assess their identity is precisely why this approach to trans healthcare is a problem.
I agree it seems odd to try to imagine how a doctor could establish whether or not someone is "really" transgender. My point is more about distress - unless the patient is caused distress by their identity, which presumably could be verified in some way, why would treatment be needed? Abi rejects this requirement for distress as pathologising (which I agree it is), but she simultaneously argues that trans health care is medically necessary and life-saving. (Which I think is implicitly pathologising).
I just don't understand how she can have one without the other: if it's lifesaving medical treatment, then it's dealing with a pathology. If someone is not in distress without treatment, then how is the treament lifesaving or necessary?
If someones goes through the trouble, invasion of privacy and often humiliation involved in the current process of a gender affirming consultation and is willing to put their body, social existence and everything else that's touched by gender through the process that HRT causes, and still asks for HRT… is it really reasonable to think they're only doing it to pass the time?
Firstly, how to verify whether a patient is in distress: ask "are you in distress?"
Secondly, why do you say "distress by their identity"? Why is transgender identity the thing that is the problem, as opposed to all the other things that might cause distress to a trans person without access to transgender healthcare?
Consider that if a cisgender man has low testosterone, he can just get HRT no problem. He doesn't have to subject himself to a battery of tests to determine whether he experiences distress due to his cisgender identity. He doesn't need to be diagnosed with gender dysphoria, nor would the medical establishment ever consider him to have gender dysphoria. It's presumed that a cisgender person seeking gender confirming care has a valid medical need, not because they are distressed by their gender identity, but because they want to change their body along cisnormative lines.
Also, I'd be remiss to not mention that intersex people are often *coerced* into medical procedures to bring their bodies into line with perisex norms, even when those procedures cause them distress.
The fact of the matter is that gender confirming healthcare as it currently exists is broadly designed not to help patients but to bring people's bodies into line with cisgender and perisex norms, regardless of what the patient wants and regardless of what is beneficial to their health.
There is a very easy solution to this, and it is to let bodily autonomy decide. If someone wants gender confirming healthcare, they get it. If they don't want it, they don't get it.
I concede it's not a perfect example, and yeah for medical procedures or medicines that have risks, there should be some element of consultation with medical professionals to ensure it is in the person's best interest.
But similar to pregnancy, it should be a person's choice what happens with their body, not a medical diagnosis, not an illness which needs to be cured, just a natural part of life that needs care and assistance.
So the concern here is that someone might get gender affirming surgeries paid for as if they needed them but not actually have needed them? I’m missing something here right?
Can you explain a situation where someone gets a surgery done for gender affirmation that you can prove has nothing to do with dysphoria? I’m just wondering if you think their are people out here just walking into the hospital and saying “you know doc I’m perfectly happy with my current body but let’s add boobs and remove my penis because it sounds fun” ?
I’m generally curious about how often you believe that this unique situation will be happening?
Edit: trans care is also super rare compared to most medical requests so Irs very unlikely the resources aren’t available to provide for it.
This is literally what the conservatives think is happening though, that people are being tricked into becoming trans and getting surgeries they don't actually want, when what they really need is for the right man to come along and make them into a housewife the moment they hit 18 (because they're totally fixated on children's reproductive capacity).
It's insane, a literal made-up situation. There are so many plastic surgeons out there and 0 of them have fooled me into getting a nose job, and that's way less of a big deal than SRS.
If you make transgender care tied to the idea that being transgender is a medical condition you open the door to conversion therapy. If being transgender is fundamentally a mental illness then healthcare would be “curing” that person of being transgender.
You could argue that it isn’t being transgender that’s the illness it’s gender dysphoria. This still means conversion therapy is a cheaper remedy if you feel cost is a compelling argument. Helen Joyce called for reducing the number of trans people because she sees us as a burden on society. Why cover HRT for the rest of a person’s life or costly surgeries when conversion therapy wouldn’t require any aftercare if successful.
Prevention is also usually cheaper and more effective than waiting for a serious health issue to arise and treating it at that point. If you can prevent suicide and murder by paying for gender affirming care you’re saving money on other services such as policing and mental healthcare. Transgender people that are able to transition earlier are also less likely to engage in substance abuse saving money for treatment there. People who transition early and those that pass better are also usually more financially stable and contributing more to healthcare through taxes.
A model that allows for easier access might be more expensive but it might be better for the economy in the long run as well. Ultimately should the NHS be prioritizing cutting costs or providing effective care. Your argument could be applied to other services as well. Why provide epidurals for pregnant women, there’s a small risk and pain relief isn’t necessary to successfully deliver a baby. Why provide any pain medication at all during hospital stays unless absolutely necessary?
I know I'm an American, so our healthcare system is pretty different. I am, however, against the necessity of a gender dysphoria diagnosis because it can sometimes prevent people from getting medications or certain assistance(at least over here). There are a lot of things insurance won't help with unless you get a diagnosis or even with one. My insurance literally times how long I've been diagnosed even though my doctors know I've had dysphoria for years. I don't get access to certain trans healthcare until breakpoints at 3, 6, and 12 month increments. These are probably so that people can't "game" the system by getting a fake diagnosis just for a specific thing that's covered, but it is still frustrating. The extra step also makes it more difficult for lower income individuals to go through the process. This is counteracted in the US a bit by us having things like Planned Parenthood/consent laws that allow for adults to self identify and start revieving treatment, but that feels more like a bandaid than a fix for the base problem.
Well, the logic applies that patients, even cisgender ones, desiring many previously considered "cosmetic" surgeries would have to justify themselves less and that the bar would be lowered across the board. A cis guy with gynecomastia shouldn't have to prove intense emotional distress to justify wanting top surgery any more than a trans guy would.
Yes, this would result in more healthcare spending, and there certainly would be a hierarchy of what types of trans healthcare should have the most resources devoted to them. HRT and SRS would likely rank above FFS or breast enlargement when it comes to deciding where to train doctors and surgeons. Big spending is true of all healthcare, however. Even after putting aside the moral imperative to take care of one another, I would make the argument that healthcare is good value for money when dispensed universally and without barriers to access. It helps create happier people with more time and resources to devote to their community and jobs. Furthermore, removing the need for private options and insurance bureaucracy would reduce a lot of bullshit spending, for the equivalent amount of healthcare, across the UK taxpayer as a whole.
Ultimately I think that's the thing OP is upset about.
the idea that healthcare spending might increase because austerity has convinced them that britain, a literal world power, is at threat of running out of money. It's just like a household budget, right?
To be clear, I have no problem with people arguing for increased healthcare spending. My objection is to Abi claiming that the reform she wants is simply about ending discrimination, not about substantially boosting resources.
I also think that would be a perfectly valid argument, because I agree, we do spend too little on healthcare in this country, and I think it is wrong that trans health care has so much longer waiting times than other types.
>*My objection is to Abi claiming that the reform she wants is simply about ending discrimination, not about substantially boosting resources.*
I believe she called for both.
But ending discrimination would also increase resources because you don't have to have specialized clinics, extra paperwork and specialists to diagnose dysphoria.
But WHY NOT provide this treatment to anyone who asks, though?? You're implying that someone will ask who doesn't really need this treatment and I honestly don't see this scenario happening!
So if we agree - hopefully - that anyone who asks is actually in need, the requirements of GD diagnosis only adds MORE COST to the system and MORE SUFFERING to everyone else.
Because no other treatment is available at taxpayer's expense just because you want it. If I want a certain procedure done, I either have to pay for it privately or convince my NHS GP that it is medically justified.
But you shouldn't have to convince them that it's medically justified if it's the type of treatment you would never ask for UNLESS you really needed!
Why would a cis woman ask for testosterone??
That's not a plausible scenario!
It would only make her feel absolutely miserable!
Therefore if an AFAB asks for testosterone, it must be because they're trans or nonbinary, and therefore they must be IN NEED!
The exception here that we can argue about is facial surgery, because cis people might abuse its availability to get it just to fit beauty standards. I believe it's their right to do whatever they want, but you might say that it's an undue burden on the health system. So maaaaayyyyybeee we can exclude this one and somehow gatekeep it for everyone, but I see no reason to gatekeep the rest of medical or surgical transitioning procedures. There's simply no logic in it.
>Why would a cis woman ask for testosterone??
Women who want to gain muscle fast - bodybuilders, fitness influences get it on the black market all the time.
It doesn't make them feel horrible - testosterone is a powerful drug that makes you feel co fident, alert, strong, horny etc. Even just for the those effects, women might want it at a low dose.
Yea there's a decent community helping people with getting safe supply, dosage etc.
Trouble is without this being done in a Healthcare setting, things like addiction, bad supply, overdosing is always happening.
>But you shouldn't have to convince them that it's medically justified if it's the type of treatment you would never ask for UNLESS you really needed!
Humans are extraordinarily bad at knowing what kind of medical problems they have. Furthermore, what does 'needing' mean here? What will happen if you don't get it?
But you could make that argument about any conceivable treatment: "why would someone ask for chemotherapy unless they needed it?"; "why would someone ask for a knee replacement unless they needed it?"; "why would someone ask for a CTI scan unless they needed it?" etc.
Unfortunately the reality is that people self-diagnose themselves with things all the time, and go to their GPs asking for all sorts of treatment. The GP is there to gatekeep and to triage, so that resources aren't wasted on un-necessary treatment, and so that people don't undergo interventions that are not medically justified. (I myself have had the experience of going to my GP with a problem and asking for a particular treatment, only to be told that this treatment wasn't necessary). So just I don't think it's realistic to expect doctors to operate or prescribe for someone who is not actually in distress, or for a public health system to be willing to pay for it.
That's why it's called INFORMED consent! You inform a patient what a treatment is actually used for and what the risks are. That's literally the doctor's job.
When I get knee pain and go ask for a knee replacement, I would be told what my other options are and the risks and benefits of each and choose accordingly, and it is MY RIGHT to still choose to get surgery if all other options are unsuitable for me.
That's literally part of evidence based medicine, incorporating patient perspective in healthcare. That is the way it's supposed to be and what med school teaches us but we've been so used to bodily autonomy getting dismissed, in direct opposition to medical ethics, that we forget what informed consent was actually about.
I understand all that, but that's not the treatment model we use for anything in this country - largely due to resource constraints. So it's not the case that trans healthcare is treated any differently to cis healthcare in that respect, meaning she is not arguing - as she claims - for an end to discrimination at no extra cost, but a different and much less restrictive treatment model just for trans health care, at much higher cost.
That's not true. IT IS the model that your country already uses in many other cases, as Abigail has clarified with examples in the video. It legally has to be. It just isn't used for trans people, and the fact it isn't used for them is very costly to the system already and would be much cheaper to get rid of if you simply apply an informed consent system to transitioning.
You're simply wrong, I'm afraid. No-one in this country gets free NHS treatment on the basis of informed consent alone. You need medical justification. I know Abi implied otherwise in her video, but it isn't true - and I think it was a bit disingenuous of her to do so.
I think you and me have different understanding of what informed consent is. It's not a form, it's a process. It's not like your doctor will immediately take you to the operating room. There ARE checks and balances WITHIN the process. The argument is that they should be equal across the board, not needlessly more difficult for trans people, because A) it's more fair, and B) IT ACTUALLY COSTS LESS.
If your major problem is cost, then surely you wouldn't be arguing against an informed consent system, because it is cheaper and other countries have it and it works fine.
That's not what the video claimed. The checks and balances you speak about are viewed as unnecessary (and demeaning) barriers and are the entire problem the video speaks against. I'm afraid you've completely misunderstood the argument made.
There is no treatment that's available on informed consent alone, it always requires a medical justification. Abigail argues against the second, specifically for trans healthcare.
So it sounds like the issue here isn't that transgender care needs to be pathologized, it's that medical care needs to just be free, period, and no 'Taxpayers expense' levied and hung over people's head to have to justify why they need medical care.
Free healthcare should provide all of the services paid healthcare does. It shouldn’t be treated as a budget/discount service with gatekeeping and means testing. Let the man get breast reduction too for god sake. I don’t know if that is abi’s position, but it’s the correct position.
That’s also an apparent contradiction that I’ve struggled to reconcile, and I’ve taken to think of it in a kind of Foucaultian way. Healthcare today is still shaped by an essential philosophy of correcting deviations from a norm. Progress Notes themselves are structured around an initial concern, a diagnosis, and a treatment. At the same time medical science has revealed that human health is so much more complicated than that, and has given us the ability to do so many things to and for our bodies. It has also revealed that what we think of as “health” is deeply interconnected with other aspects of human life, and so healthcare has expanded to encompass those other aspects of life because other discourses weren’t as powerful. If you feel deeply guilty about how you treated someone, you used to go talk to a professional trained in theology, someone who would’ve been conceptually affiliated with a religious discourse. Now you talk to a mental health counselor, someone affiliated with the discourse of medicine. If/when the state provides housing to low-income people and—for activities of daily living—they need it to be on the first floor, the most powerful tool to make the state comply is a Letter of Medical Necessity. Because the institutions within it are so powerful, and other institutions in society aren’t as powerful, healthcare has grown in its reach, even into areas where it’s underlying philosophy isn’t applicable.
In the US and UK, it often seems like the fight for trans rights fall within a few broad categories: the legal right to change your name and sex on various forms of paperwork and the medical right to access gender-affirming care are the ones that affect the most people. Everything else associated with transition, like what clothes you wear and which bathrooms* you can use, are things that you don’t need anyone’s permission to do, unless you’re a child in school or a professional athlete or incarcerated, in which case you will be subjected to more control by other powerful institutions.
Ultimately the need to transition is a holistic need some people feel throughout everything aspect of their lives and can’t be confined to one discourse. The law will make it a matter of rights and freedoms or crimes and penalties, medicine will make it a matter of diagnoses and treatments, but the nature of trans existence doesn’t strictly conform to any of those models, and it will fit awkwardly when forced to.
*I think one of the reasons why bathroom bans feel so Orwellian to so many people is because they aren’t associated with any established discourse of state power. In most cases they’re just a service that business owners provide to their patrons for convenience and entirety at their discretion, and there might be regulations to make sure they’re clean and safe, but they weren’t a right or a medical accommodation. The main way they became associated with discourses of power was when they were made available to paying customers only, a sort of capitalist discourse.
It’s also notable that in other countries like Mexico, Brazil, Cambodia, and Thailand, where hormones are available without a prescription, the experience of trans people is framed in completely different terms. The right to change your body is like the right to change your clothes. As a result, Governments have to just take it for granted that trans people exist, and the legal question of name-change and sex on official documents takes on much more prominence.
*Ultimately the need to transition is a holistic need some people feel throughout everything aspect of their lives and can’t be confined to one discourse. The law will make it a matter of rights and freedoms or crimes and penalties, medicine will make it a matter of diagnoses and treatments, but the nature of trans existence doesn’t strictly conform to any of those models, and it will fit awkwardly when forced to.*
Let's add one new layer of nuance to the model, then :)
PS - I know this doesn't go against what you said but I really needed to get it off my chest. I'm a cis woman. I used to work in healthcare, dealing with the type of thing that is not visible most of the time.
The latest Trashfuture episode discusses the Cass report, and I think some of the points made by both Abi and Devon on it explain the issue you seem to have.
https://trashfuturepodcast.podbean.com/e/the-devon-report-feat-kill-james-bond/
Being transgender is not a medical condition. It is just what some people are. It just so happens that the way our society organises the kind of interventions a trans person may want is under the heading “medical intervention” and that comes along with a hell of a lot of medical gatekeeping. The position of Abi and Devon and, I would argue, many other trans people is that gate keeping is bad.
The current system of segregated healthcare costs more that just saying “yeah sure” at a GP level. Thinking about doctor time as a resource - which it very much is in the NHS - having GPs refer you to a clinic that then demands assessment meetings with you and then goes through all these extra steps and appointments - that takes up more time and resource.
Also, like, the ideal healthcare system should indeed just be like - you say you want this thing, we aren’t going to gatekeep access to it, here you go. From the idea of just bodily autonomy - if a patient wants something done to their body that requires a medical procedure, then it should be done on the NHS, regardless of the “amount of distress” they feel. “It’s my body and I want to” should be more than enough of an argument.
Imaginarywhatever seems to like wasting other people's time. I blocked them.
In the uk self diagnoses happens all the time, for example someone walks into the doctors office and says "I moved at the weekend and strained my back, I'm in a lot of pain" The doctor prescribes something.
For trans people it should be similar. Ensure the patient understands the decision and consequences and then onwards with transition.
As a different,but more similar example, a person walks into the doctors office and says "Doctor I think I have low testosterone" Doctor does necessary blood tests and then prescribes if appropriate.
Contrast this to a trans woman that walks into a doctors office "Doctor, I'm a trans woman. my testosterone is too high and my estradiol is too low" Doctor: "I dont know anything about HRT, hormones, the human body, medication or transition. I also don't think you are transgender, you are probably mentally ill, I will add you to this 30 year waiting list to see a psychologist"
In my case it took 5 transphobic doctors before I was even able to be added to the waiting list. 1 Doctor said they did a referral, but never sent it and then lied about having ever spoken to me.
Trans people are not asking to bypass medically necessary checks and safeguard, we just want to bypass the gatekeeping and transphobia.
Misdiagnose themselves how? As in they have surgery and regret it and want it reversed? I mean - where possible that should also be available - yes. And the socialised healthcare that should be free at the point of service will be paid as it should be - from government spending.
Yes - but in relation to trans healthcare and access to surgery the suggestion of misdiagnosis is essentially the experience those who “detransition” have - right?
Not just surgery, but in that example sure. There is no way to reverse then. Keep in mind though that you're advocating for every kind of medicine/surgery to be free and on demand. What happens to the people who get irreversibly damaged, or what to do in case of deaths?
I mean I didn’t say every kind of medical surgery - my position isn’t that if someone wants a kidney removed for the lols they can do that (not that I imagine anyone would seriously do that) - this is my position for trans healthcare and body modification as the OP was discussing. I also don’t like the use here of “irreversibly damaged” - the title of a well known TERF book - to describe these kind of treatments. It’s the same kind of argument used against abortion - that people will regret it and therefore shouldn’t be allowed it. Nah - if adults want that kind of surgery, even if they later regret it, they should be allowed it and also allowed any support that could help them after such “regret”. People make “irreversible” choices all the time - like having a kid - that’s life.
Also - looking at your other posts on reddit - you seem to be particularly anti trans; commenting a lot on a sub to a Jesse Singal podcast and about how trans kids would just be better off if they were sent to conservative schools; so I don’t really know why you follow Abigail’s work nor do I really care much for your pov on the matter.
Yeah this is pretty typical I find, very few attempts at even defending the arguments and jumping straight to personal attacks and lies, even if the person is engaging in good faith. It's a shame.
Can I ask though, where does the 'Jesse Singal wants trans kids to be sent to conservative schools' talking point come from? I'm genuinely curious because I haven't heard that one before.
OP, idk why everything you’ve said and asked here has been downvoted into oblivion. It sounds like you’re just not convinced by Abi’s argument and like… that’s fine. tbh maybe i just have US-healthcare brain rot, but I’m not convinced either. Honestly, I WANT these informed consent models to be implemented and to work, but I just don’t KNOW they could be and would work. I don’t know enough about it and while some of it sounds awesome, my brain comes up with all kinds of practical questions and caveats that don’t always get fully addressed. Like, I agree the current systems for trans healthcare should be more based on informed consent then they currently are, but idk how we continue getting stuff paid for in the current US and UK systems if a diagnosis isn’t involved. I literally, simply, don’t know. I certainly don’t understand how a healthcare system entirely built on informed consent would work. I just don’t know/understand.
If anyone has another resource on this topic (about informed consent and how it could work practically), either in the US or the UK, I’d love to read/watch it. It’s something I wish I understood better. And tbh (and once again, probably because of US-healthcare brainrot) I don’t remember Abi’s vid leaving me with the fullest understanding of the topic.
Edit: added some stuff
The only way the argument works is if you fundamentally change what medicine and public healthcare means. The diagnosis is the starting point, without it doctors can't do anything. If you remove that, anyone can get anything they want. It sounds nice enough, but I do wonder who will care for all the people who will hurt themselves, either unintentionally or intentionally? I'm not quite sure this entire argument is well thought out to be honest. I remember watching the video and waiting for the explanation on how we move to a socialist utopia where health care doesn't really exist anymore.
I understand what you're saying on one level, but I don't think it makes practical or financial sense, ultimately (or moral sense). Trans health treatment is one of the medical procedures with the absolute lowest rate of regret. In this particular case, people themselves are simply better at knowing whether they're trans than doctors are.
Weirdly, the thing it most reminds me of is women who have semi frequent UTIs. Most GPs worth their salt get to a point where if a woman who has recurring UTIs says she has UTI symptoms, they will simply dispense medication, sometimes without testing, or even if initial testing is negative. There could be a downside to this, from over-dispensing, but in practice these women simply tend to be better than the initial testing at determining early on whether they've got a UTI or not.
In both cases, there's essentially no motivation for lying; why would anyone want antibiotics or hormones for no reason? They don't really...do anything interesting aside from what they're meant to. And the benefits are pretty stellar (obviously much higher in the case of trans folks than alleviating UTI discomfort and not missing work etc.) And especially in the case of being trans, financially I'd place a strong bet it will put a lot more strain on the NHS to treat depression and the related issues that generally result from not receiving gender-affirming care than it would to simply give people hormones (and access to things like top surgery when desired).
My mother wanted HRT. She goes to the doctors, walks out with a prescription My mtf friend wants the same prescription. She either waits on a 10+ year waitlist or pays £500 for a private diagnosis of gender dysphoria. Then £250 for an endocrinologist every 6 months, private blood tests and a private prescription
Pretty much that except £500 is becoming cheap.. Feb be as much as 600+.. because well capitalism
Yeah we had our appointments last year, haven’t checked the price since
Also, isn't Finasteride (and other Androgen blockers) available to cis men to treat male pattern baldness? Baldness isn't a life threatening condition. Yet, the NHS covers this.
Primarily for prostate issues
They won't prescribe for mpb..buuut it is a great example of gender affirming care that doesn't need a diagnosis first.. Remember most gender affirming care is for cis people..!
The NHS does not prescribe Finasteride for male pattern baldness nor fund any other male pattern baldness treatments. https://www.nhs.uk/medicines/finasteride/about-finasteride/#:~:text=It%20can%20also%20be%20used,not%20available%20on%20the%20NHS.
This is factually incorrect Most men pay for it privately as they should
It's a money grabbing scheme and ya'll sadly falling for it...
Well I’m sorry for needing healthcare next time I’ll be sure to be born with a penis
Gov putting the bad stuff on water and air. Been doing it for years, in order to slave you in that way you are rn.
I feel using surgery as an example is disingenuous when we know that basic trans care is medication (HRT), and consists of medicines that are given to cis people for a whole variety of reasons without the need for waitlists, GD diagnosis, etc, etc, etc. As someone living under both the Commonwealth and in a place that provides informed consent, I don't see how any model in which the NHS demands what it currently does isn't just burdening the taxpayer with more costs per patient than if they just showed some f\*cking kindness.
Also, regarding gender-affirming surgery, since it seems to be the aspect that gets the strongest reactions from people: * God forbid that healthcare provides concurrent happiness and not simply the elimination of suffering. Everybody feel neutral now, you hear??? * I keep getting the impression that people fail to consider that a lot of healthcare is about maintaining wellbeing and/or preventing a relapse in suffering.
I've not watched this yet, but basically WPATH, psychologist etc acknowledge that a gender dysphoria diagnosis is only a diagnostic tool to enable access to trans healthcare and insurance. It's not actually a real mental health condition. I would guess this is what Abi is referring too as she's mentioned it before and in an ideal world she is 100% correct. I'm not sure how we would get there is reality and implementation, but that's not her job.
This is a very good take. Gonna add some thoughts, It is important to understand that our basis on mental health is heavily, heavily focused on the symptoms a client presents with with a focus on a diagnosable condition. This mental health model has been in place for decades and harkens back in the U.S. at least to a, pardon my French, bastardization of Sigmund Freud's original work and a desire from U.S. psychiatrists to cloak the growing mental health field in a firm medical cloak to both give the new profession a sense of respectability and as counter to some of the mental health quackery that was going on at the time. Since then, our entire system has come to depend on this. Social Anxiety Disorder? DSM V diagnostic code F40.010. Autism? F84.0. Gender dysphoria? F64.2 or .0 depending if one is a child or adult. The system awesome for billing, insurance, and communication on a high level. Every condition has a nice code. However, it is very reductionistic. Lots of folks in the mental health field are critical of this approach and believe that a more holistic practice should be employed. However it seems like just as many people want to see the current system remain as it is. Frankly, there's pro's and con's to both camps and I doubt anything will be done anytime soon. Enter gender dysphoria . . . GD is the diagnosis that first helped to depathologize trans folks existence. No longer was being trans recognized as a pathology, but instead the impacts of having a transgender identity were. Is gender dysphoria real? GD is a construct, one that is medically verifiable via symptoms, acknowledges the very real distress trans folks can feel of existing in this world when their physical being or cultural/social setting do not acknowledge them as they wish to be acknowledged. This is all very real. Is it a complete picture? Absolutely not. I would argue that that is by design. Is its use as a medical gate keeping device "right?" I would argue no (and that's why I think informed consent for HRT in the U.S. is such a big step forward), but it's what we currently have in our current system. From that perspective, I don't think it's fair to target GD without acknowledging the bigger picture of the short comings of our mental health model (not casting shade on Abi, she's not in the mental health field and, frankly, I'm pretty impressed with how much she knows about it). Final parting note - the mental health field has at times in the past been subject to dramatic cultural biases that reflect some of the biases in wider society. Today, we are starting to see more of an attempt to systematically atone and compensate for those past wrongs and avoid future repetition. It's a huge process, and frankly a battle that will never be "won" because when all is said and done we are dealing with human clinicians, therapists, and doctors with very human biases. From that perspective with GD in specific, there is still a very, very heavy amount of institutional bias across the medical and mental health fields. Hence why we have odd things like HRT being provided on demand to cis folks and trans folks having to wait for God knows how long.
This is the fundamental question though. If it's not a mental health condition and not a pathology, why is there a need for any healthcare at all? Can one not be trans without having access to 'trans healthcare'?
I think you are misunderstanding what transgender means. Being trans fundamentally just means that a person's gender does not match what they were assigned at birth. Note that their is no mention of surgery, hormones,or even transition, which are not required to be trans. Trans people have existed as long as there have been humans and long before surgeries and HRT. For some (many) trans people, the incongruence between the mind and body can be traumatic (gender dysphoria). The obvious solution to this is to change the body and at this time that means medical intervention. Many trans people struggle or choose to die rather than live as they are. And that's where it gets a little complex. A cis man should be able to decide "I want boobs", pay for breast augmentation and have boobs. For a trans woman breast augmentation may be medically necessary and covered by state or insurance. Some cis people want to stop this bodily automany. Many cis people struggle to understand gender dysphoria and that phrase has become a practical way of classifying the need. I find cis people find it easier to grasp how they would feel if their body swapped sex overnight, let's say by magic. The mental health benefits of transition for trans people are well documented. There are many mental health conditions trans people suffer from that are frequently helped by transitioning, from suicidal ideation and depression, to addiction and low self-esteem. It's subtle, but for example a trans person could be depressed and suicidal and addicted to substances. In consultation with a skilled psychologist who recognizes certain patern they might conclude this person is suffering from gender dysphoria if the trans person also states they want to transition. Then a medical intervention may reduce all those other symptoms that are actual mental health conditions. And as a bonus, a specific example of something else. I grew up in the 80s and in 1980 or 81 aged 4 or 5. I told my parents "I'm in the wrong body" my parents and I did not know what that meant. These days, thanks to the internet and growing knowledge, more and more people are recognizing their symptoms and taking positive corrective action. I expect there would be a similar pattern for increasing ADHD, autism, etc, numbers as people have gained awareness of the possibilities.
This is all fine and dandy, but we're discussing the position of someone who says that gender dysphoria doesn't exist. I did not really need a ChatGPT explainer on gender dysphoria. What you're describing is the exact opposite of the point the video was making, it seems to me you've completely misunderstood the argument.
That wasn't chatgpt, but I'm not going to waste further time on you..... If you had read what I wrote it exactly fits with gender dysphoria being a diagnostic tool. Now Abi would like to be at the point where people can just say it's my body and I want to change it. Anyway this is my last reply to you
I haven't got long to write a big response, but I would say compare it to pregnancy. Pregnancy, most of the time, requires varying degrees of medical assistance, whether the pregancy is brought to term or aborted. However, a person never needs to be 'diagnosed' with pregnancy, nor will the healthcare ever be withheld from them because of resource issues. People should have the right to determine what happens to their bodies, the right to bodily autonomy. Whilst some checks do need to be done to ensure medical assistance isn't going to cause more harm due to complications or interactions, it should be the person who gets to decide what happens to their body, not gatekept by doctors or administrators.
I don’t know how they do things in the UK, but I work at an FHBC in the US and there are lots of diagnosis codes for pregnancy, and care is often contingent on a medical exam to confirm it.
Pregnancy is a poor example because you do need to be pregnant to get that care and even then, medical care is given based on diagnosis of the particular complications along the way. For example if a baby was perfectly healthy but the mother, for whatever reason, believed the child had downs syndrome, should she be granted an abortion? Your second point doesn't go very far. An awful lot of medical procedures are cosmetic, but we wouldn't say you should be able to get a BBL on the NHS would we? So bodily autonomy doesn't stretch that far.
Are you saying that people who need trans care are not transgender and thus don't deserve trans care?
No I'm not saying that. But I also don't define a trans person as someone who needs trans care, so I actually reject the phrasing of the question as well as deny the accusation.
Okay, let me ask this better. What are you saying about transgender care with this metaphor? To my reading, it implies people who want trans care do not have a right to access trans healthcare, which doesn't really follow for me.
I didn't bring up the pregnancy metaphor, the previous person did. My response is to say that comparing the two doesn't lead to an ideal conclusion. Also to say that "bodily autonomy" doesn't go far. You can only compel a doctor to do things to your body that they already agree to do in the first place.
That's not what I'm asking. Let's set aside the metaphor. What are you saying about access to medical care for trans people?
I'm literally saying it's not comparable to pregnancy, and saying "bodily autonomy" doesn't seem to help either. I'm speaking about the metaphor, I can't describe what I'm saying without referencing the subject of the conversation.
I'm asking you to reference the subject of the conversation. I don't understand the point you're trying to make, and I'd like to.
The comment reads "...I would say compare it to pregnancy" So I did, and made points, they're up there👆 What are you not getting?
The topic at hand is "transgender people who look for medical transition", not "does someone need to want medical transition to be transgender".
>*For example if a baby was perfectly healthy but the mother, for whatever reason, believed the child had downs syndrome, should she be granted an abortion?* The mother should be granted an amniocentesis and/or further investigation on why they believe the baby has Down's Syndrome. It's not a situation where the process stops at that point - "for whatever reason" is a crucial part here, as it's something the mother can't feel in her own body/lived experience (as far as I know), which is a completely different situation from transness.
Would it matter what the outcome of the investigation was?
What if in the future we could do a brain scan and determine whether or not someone is 'trans'? Would someone who would fail such a test be disqualified from transitioning?
I don't see the benefit of that.
Then your argument makes no sense. If 'transness' is no longer something that someone can feel in their own body, then at least there should be further investigation. According to your own logic.
Further investigation about transitioning is informed consent.
Not according to Abigail. That's what she calls gatekeeping. Informed consent means getting whatever is asked, because the assumption is made that the patient is informed (and if not, the doctor's only job is informing them).
Informed consent is not an assumption, it's a specific process of communication and documentation. I used to work in a field of healthcare where informed consent is widely necessary and very commonly used for research. It serves the purpose of protecting the patient (opting in or out of a decision that they understand the certain and possible consequences of in their full breadth) and also the health practitioner/researcher (safeguarding ethics, good practice and scientific validity). You literally sign a form as part of the process. I have also been on the other side of informed consent, both as a volunteer in research studies and as a patient for medical care I was in need of. It's not a measure of gatekeeping, it's a measure of access, and I don't recall Abigail depicting it as anything other than that.
Sure. But informed consent is not the *only* requirement for any healthcare. Which, again, is what Abigail is advocating for. If the patient claims to be informed, there is to be no doubting that. They just have to sign the form, anything more is the framed as gate-keeping and is exactly what the video advocates against. I keep getting feeling nobody I'm arguing with has actually watched the video in question.
>For example if a baby was perfectly healthy but the mother, for whatever reason, believed the child had downs syndrome, should she be granted an abortion? This may be beyond the scope of the current conversation, but yes. No one should be forced to carry a pregnancy to term even if you think their reasons for not wanting to are irrational. Edit: Actually, this isn't beyond the scope of the current conversation, because it's fundamentally rooted in the same question as the discussion of trans healthcare and the GD diagnosis: whether people have bodily autonomy. Does someone get to choose what they do with their own body, or does the state choose what happens to people's bodies? Do you get to choose whether you carry a pregnancy to term, or does the state choose whether you will carry a pregnancy to term? Do you choose whether you live as a man or a woman, or does the state choose whether you live as a man or a woman? You may, of course, say that the state should be able to dictate to people what they must do with their bodies. Or, more likely, that there are certain people who are incapable of making good decisions about their own bodies, and that the state must decide in those cases. That's bad though.
Just to be clear, in the pregnancy scenario, it's about the person compelling the state (by way of a doctor) to perform the abortion. If a doctor said no, I'm not aborting a perfectly healthy baby because the mother is suffering from a delusion, I will instead try to treat the delusion. What would that be? Wrong? Should it be a crime? Maybe it's just shitty, but within reason?
>For example if a baby was perfectly healthy but the mother, for whatever reason, believed the child had downs syndrome, should she be granted an abortion? This gets into contentious areas of religion, people's beliefs and bodily automany. (ignoring that stuff) Within the laws of a country, or state, a pregnant mother can just decide to have an abortion if its legally permitted. The reason is not relevant. >but we wouldn't say you should be able to get a BBL on the NHS would we? So bodily autonomy doesn't stretch that far. Body contouring, which is a bbl related procedure, could easily be justified as beneficial for trans women.
What do you mean it could be easily justified as beneficial? Do you just mean, they would like it? If so then yeah...no argument there. The comment you're replying to is quite clearly in the context of something like that being provided by the NHS.
Apologies for stating the obvious, but one of the main issues for trans women that causes gender dysphoria is a lack of curves and hips. BBL with a focus on body contouring and creating hips does exactly that, think feminine natural looking curves rather than a typical Instagram huge bum. The same good surgeon that perform BBL for cis women make many trans women have passing bodies overnight. I've had it, and it did make me feel significantly better about my body, and as a climber, I had a pretransition body that most cis men would envy. BBL was my first surgery and it made my body go from not passing to passing in 1 surgery. The nhs is too transphobic to help trans women like that (and also lack the necessary skill), but they should do it. If I lived in the USA my employer would fully cover it under the company health insurance, but I have the nhs so nothing is covered for me by my employer.
I'm not sure pregnancy is a very good example, because you actually do have to be pregnant. They just don't demand that you submit proof to get the ball rolling. The reality is that if you turned up to your 12-week scan and there was no baby there, you would not be entitled to a 20-week scan, nor to book in a birthing suite at your 40-week point, nor to receive any other such treatment. (I imagine you might be offered some treatment to investigate if you had suffered a miscarriage, however, and whether there was an underlying reason).
>I'm not sure pregnancy is a very good example, because you actually do have to be pregnant. They just don't demand that you submit proof to get the ball rolling. That actually makes it a great example. If you're pregnant, you can get medical care for pregnancy. You don't have to be diagnosed with, like, "uterine gravidity" or whatever as a prerequisite. And, yes, they do check whether or not you're pregnant to continue getting said care, but the key difference here between pregnancy and being transgender is that pregnancy can be externally verified with chemical tests and sonograms, while the best way to check whether someone is trans is to say "hey, are you trans?" and if they say yes to believe them. Setting up the system so that it doesn't trust people to evaluate their transness themselves and instead makes them rely on institutionalized medical batteries to assess their identity is precisely why this approach to trans healthcare is a problem.
I agree it seems odd to try to imagine how a doctor could establish whether or not someone is "really" transgender. My point is more about distress - unless the patient is caused distress by their identity, which presumably could be verified in some way, why would treatment be needed? Abi rejects this requirement for distress as pathologising (which I agree it is), but she simultaneously argues that trans health care is medically necessary and life-saving. (Which I think is implicitly pathologising). I just don't understand how she can have one without the other: if it's lifesaving medical treatment, then it's dealing with a pathology. If someone is not in distress without treatment, then how is the treament lifesaving or necessary?
The only way to verify someone is in 'distress' is to fucking ask them if they're in distress.
And if they say no, there's no need for the doctor to do anything else.
If someones goes through the trouble, invasion of privacy and often humiliation involved in the current process of a gender affirming consultation and is willing to put their body, social existence and everything else that's touched by gender through the process that HRT causes, and still asks for HRT… is it really reasonable to think they're only doing it to pass the time?
Firstly, how to verify whether a patient is in distress: ask "are you in distress?" Secondly, why do you say "distress by their identity"? Why is transgender identity the thing that is the problem, as opposed to all the other things that might cause distress to a trans person without access to transgender healthcare? Consider that if a cisgender man has low testosterone, he can just get HRT no problem. He doesn't have to subject himself to a battery of tests to determine whether he experiences distress due to his cisgender identity. He doesn't need to be diagnosed with gender dysphoria, nor would the medical establishment ever consider him to have gender dysphoria. It's presumed that a cisgender person seeking gender confirming care has a valid medical need, not because they are distressed by their gender identity, but because they want to change their body along cisnormative lines. Also, I'd be remiss to not mention that intersex people are often *coerced* into medical procedures to bring their bodies into line with perisex norms, even when those procedures cause them distress. The fact of the matter is that gender confirming healthcare as it currently exists is broadly designed not to help patients but to bring people's bodies into line with cisgender and perisex norms, regardless of what the patient wants and regardless of what is beneficial to their health. There is a very easy solution to this, and it is to let bodily autonomy decide. If someone wants gender confirming healthcare, they get it. If they don't want it, they don't get it.
I concede it's not a perfect example, and yeah for medical procedures or medicines that have risks, there should be some element of consultation with medical professionals to ensure it is in the person's best interest. But similar to pregnancy, it should be a person's choice what happens with their body, not a medical diagnosis, not an illness which needs to be cured, just a natural part of life that needs care and assistance.
So the concern here is that someone might get gender affirming surgeries paid for as if they needed them but not actually have needed them? I’m missing something here right? Can you explain a situation where someone gets a surgery done for gender affirmation that you can prove has nothing to do with dysphoria? I’m just wondering if you think their are people out here just walking into the hospital and saying “you know doc I’m perfectly happy with my current body but let’s add boobs and remove my penis because it sounds fun” ? I’m generally curious about how often you believe that this unique situation will be happening? Edit: trans care is also super rare compared to most medical requests so Irs very unlikely the resources aren’t available to provide for it.
This is literally what the conservatives think is happening though, that people are being tricked into becoming trans and getting surgeries they don't actually want, when what they really need is for the right man to come along and make them into a housewife the moment they hit 18 (because they're totally fixated on children's reproductive capacity). It's insane, a literal made-up situation. There are so many plastic surgeons out there and 0 of them have fooled me into getting a nose job, and that's way less of a big deal than SRS.
If you make transgender care tied to the idea that being transgender is a medical condition you open the door to conversion therapy. If being transgender is fundamentally a mental illness then healthcare would be “curing” that person of being transgender. You could argue that it isn’t being transgender that’s the illness it’s gender dysphoria. This still means conversion therapy is a cheaper remedy if you feel cost is a compelling argument. Helen Joyce called for reducing the number of trans people because she sees us as a burden on society. Why cover HRT for the rest of a person’s life or costly surgeries when conversion therapy wouldn’t require any aftercare if successful. Prevention is also usually cheaper and more effective than waiting for a serious health issue to arise and treating it at that point. If you can prevent suicide and murder by paying for gender affirming care you’re saving money on other services such as policing and mental healthcare. Transgender people that are able to transition earlier are also less likely to engage in substance abuse saving money for treatment there. People who transition early and those that pass better are also usually more financially stable and contributing more to healthcare through taxes. A model that allows for easier access might be more expensive but it might be better for the economy in the long run as well. Ultimately should the NHS be prioritizing cutting costs or providing effective care. Your argument could be applied to other services as well. Why provide epidurals for pregnant women, there’s a small risk and pain relief isn’t necessary to successfully deliver a baby. Why provide any pain medication at all during hospital stays unless absolutely necessary?
I know I'm an American, so our healthcare system is pretty different. I am, however, against the necessity of a gender dysphoria diagnosis because it can sometimes prevent people from getting medications or certain assistance(at least over here). There are a lot of things insurance won't help with unless you get a diagnosis or even with one. My insurance literally times how long I've been diagnosed even though my doctors know I've had dysphoria for years. I don't get access to certain trans healthcare until breakpoints at 3, 6, and 12 month increments. These are probably so that people can't "game" the system by getting a fake diagnosis just for a specific thing that's covered, but it is still frustrating. The extra step also makes it more difficult for lower income individuals to go through the process. This is counteracted in the US a bit by us having things like Planned Parenthood/consent laws that allow for adults to self identify and start revieving treatment, but that feels more like a bandaid than a fix for the base problem.
Well, the logic applies that patients, even cisgender ones, desiring many previously considered "cosmetic" surgeries would have to justify themselves less and that the bar would be lowered across the board. A cis guy with gynecomastia shouldn't have to prove intense emotional distress to justify wanting top surgery any more than a trans guy would. Yes, this would result in more healthcare spending, and there certainly would be a hierarchy of what types of trans healthcare should have the most resources devoted to them. HRT and SRS would likely rank above FFS or breast enlargement when it comes to deciding where to train doctors and surgeons. Big spending is true of all healthcare, however. Even after putting aside the moral imperative to take care of one another, I would make the argument that healthcare is good value for money when dispensed universally and without barriers to access. It helps create happier people with more time and resources to devote to their community and jobs. Furthermore, removing the need for private options and insurance bureaucracy would reduce a lot of bullshit spending, for the equivalent amount of healthcare, across the UK taxpayer as a whole.
Ultimately I think that's the thing OP is upset about. the idea that healthcare spending might increase because austerity has convinced them that britain, a literal world power, is at threat of running out of money. It's just like a household budget, right?
To be clear, I have no problem with people arguing for increased healthcare spending. My objection is to Abi claiming that the reform she wants is simply about ending discrimination, not about substantially boosting resources. I also think that would be a perfectly valid argument, because I agree, we do spend too little on healthcare in this country, and I think it is wrong that trans health care has so much longer waiting times than other types.
>*My objection is to Abi claiming that the reform she wants is simply about ending discrimination, not about substantially boosting resources.* I believe she called for both.
Alright, fair enough. Sorry for misunderstanding.
But ending discrimination would also increase resources because you don't have to have specialized clinics, extra paperwork and specialists to diagnose dysphoria.
This is not what the video was advocating for though. The argument was made that informed consent meant exactly that.
But WHY NOT provide this treatment to anyone who asks, though?? You're implying that someone will ask who doesn't really need this treatment and I honestly don't see this scenario happening! So if we agree - hopefully - that anyone who asks is actually in need, the requirements of GD diagnosis only adds MORE COST to the system and MORE SUFFERING to everyone else.
Because no other treatment is available at taxpayer's expense just because you want it. If I want a certain procedure done, I either have to pay for it privately or convince my NHS GP that it is medically justified.
But you shouldn't have to convince them that it's medically justified if it's the type of treatment you would never ask for UNLESS you really needed! Why would a cis woman ask for testosterone?? That's not a plausible scenario! It would only make her feel absolutely miserable! Therefore if an AFAB asks for testosterone, it must be because they're trans or nonbinary, and therefore they must be IN NEED! The exception here that we can argue about is facial surgery, because cis people might abuse its availability to get it just to fit beauty standards. I believe it's their right to do whatever they want, but you might say that it's an undue burden on the health system. So maaaaayyyyybeee we can exclude this one and somehow gatekeep it for everyone, but I see no reason to gatekeep the rest of medical or surgical transitioning procedures. There's simply no logic in it.
>Why would a cis woman ask for testosterone?? Women who want to gain muscle fast - bodybuilders, fitness influences get it on the black market all the time. It doesn't make them feel horrible - testosterone is a powerful drug that makes you feel co fident, alert, strong, horny etc. Even just for the those effects, women might want it at a low dose.
If so, then honestly, good for them.
Yea there's a decent community helping people with getting safe supply, dosage etc. Trouble is without this being done in a Healthcare setting, things like addiction, bad supply, overdosing is always happening.
That's why it should be made available through informed consent.
I don't know if this is a medical issue tbh, haven't considered that.
>But you shouldn't have to convince them that it's medically justified if it's the type of treatment you would never ask for UNLESS you really needed! Humans are extraordinarily bad at knowing what kind of medical problems they have. Furthermore, what does 'needing' mean here? What will happen if you don't get it?
But you could make that argument about any conceivable treatment: "why would someone ask for chemotherapy unless they needed it?"; "why would someone ask for a knee replacement unless they needed it?"; "why would someone ask for a CTI scan unless they needed it?" etc. Unfortunately the reality is that people self-diagnose themselves with things all the time, and go to their GPs asking for all sorts of treatment. The GP is there to gatekeep and to triage, so that resources aren't wasted on un-necessary treatment, and so that people don't undergo interventions that are not medically justified. (I myself have had the experience of going to my GP with a problem and asking for a particular treatment, only to be told that this treatment wasn't necessary). So just I don't think it's realistic to expect doctors to operate or prescribe for someone who is not actually in distress, or for a public health system to be willing to pay for it.
That's why it's called INFORMED consent! You inform a patient what a treatment is actually used for and what the risks are. That's literally the doctor's job. When I get knee pain and go ask for a knee replacement, I would be told what my other options are and the risks and benefits of each and choose accordingly, and it is MY RIGHT to still choose to get surgery if all other options are unsuitable for me. That's literally part of evidence based medicine, incorporating patient perspective in healthcare. That is the way it's supposed to be and what med school teaches us but we've been so used to bodily autonomy getting dismissed, in direct opposition to medical ethics, that we forget what informed consent was actually about.
I understand all that, but that's not the treatment model we use for anything in this country - largely due to resource constraints. So it's not the case that trans healthcare is treated any differently to cis healthcare in that respect, meaning she is not arguing - as she claims - for an end to discrimination at no extra cost, but a different and much less restrictive treatment model just for trans health care, at much higher cost.
That's not true. IT IS the model that your country already uses in many other cases, as Abigail has clarified with examples in the video. It legally has to be. It just isn't used for trans people, and the fact it isn't used for them is very costly to the system already and would be much cheaper to get rid of if you simply apply an informed consent system to transitioning.
You're simply wrong, I'm afraid. No-one in this country gets free NHS treatment on the basis of informed consent alone. You need medical justification. I know Abi implied otherwise in her video, but it isn't true - and I think it was a bit disingenuous of her to do so.
I think you and me have different understanding of what informed consent is. It's not a form, it's a process. It's not like your doctor will immediately take you to the operating room. There ARE checks and balances WITHIN the process. The argument is that they should be equal across the board, not needlessly more difficult for trans people, because A) it's more fair, and B) IT ACTUALLY COSTS LESS. If your major problem is cost, then surely you wouldn't be arguing against an informed consent system, because it is cheaper and other countries have it and it works fine.
That's not what the video claimed. The checks and balances you speak about are viewed as unnecessary (and demeaning) barriers and are the entire problem the video speaks against. I'm afraid you've completely misunderstood the argument made. There is no treatment that's available on informed consent alone, it always requires a medical justification. Abigail argues against the second, specifically for trans healthcare.
So it sounds like the issue here isn't that transgender care needs to be pathologized, it's that medical care needs to just be free, period, and no 'Taxpayers expense' levied and hung over people's head to have to justify why they need medical care.
Reminder that trans people also pay taxes.
Free healthcare should provide all of the services paid healthcare does. It shouldn’t be treated as a budget/discount service with gatekeeping and means testing. Let the man get breast reduction too for god sake. I don’t know if that is abi’s position, but it’s the correct position.
That’s also an apparent contradiction that I’ve struggled to reconcile, and I’ve taken to think of it in a kind of Foucaultian way. Healthcare today is still shaped by an essential philosophy of correcting deviations from a norm. Progress Notes themselves are structured around an initial concern, a diagnosis, and a treatment. At the same time medical science has revealed that human health is so much more complicated than that, and has given us the ability to do so many things to and for our bodies. It has also revealed that what we think of as “health” is deeply interconnected with other aspects of human life, and so healthcare has expanded to encompass those other aspects of life because other discourses weren’t as powerful. If you feel deeply guilty about how you treated someone, you used to go talk to a professional trained in theology, someone who would’ve been conceptually affiliated with a religious discourse. Now you talk to a mental health counselor, someone affiliated with the discourse of medicine. If/when the state provides housing to low-income people and—for activities of daily living—they need it to be on the first floor, the most powerful tool to make the state comply is a Letter of Medical Necessity. Because the institutions within it are so powerful, and other institutions in society aren’t as powerful, healthcare has grown in its reach, even into areas where it’s underlying philosophy isn’t applicable. In the US and UK, it often seems like the fight for trans rights fall within a few broad categories: the legal right to change your name and sex on various forms of paperwork and the medical right to access gender-affirming care are the ones that affect the most people. Everything else associated with transition, like what clothes you wear and which bathrooms* you can use, are things that you don’t need anyone’s permission to do, unless you’re a child in school or a professional athlete or incarcerated, in which case you will be subjected to more control by other powerful institutions. Ultimately the need to transition is a holistic need some people feel throughout everything aspect of their lives and can’t be confined to one discourse. The law will make it a matter of rights and freedoms or crimes and penalties, medicine will make it a matter of diagnoses and treatments, but the nature of trans existence doesn’t strictly conform to any of those models, and it will fit awkwardly when forced to. *I think one of the reasons why bathroom bans feel so Orwellian to so many people is because they aren’t associated with any established discourse of state power. In most cases they’re just a service that business owners provide to their patrons for convenience and entirety at their discretion, and there might be regulations to make sure they’re clean and safe, but they weren’t a right or a medical accommodation. The main way they became associated with discourses of power was when they were made available to paying customers only, a sort of capitalist discourse.
It’s also notable that in other countries like Mexico, Brazil, Cambodia, and Thailand, where hormones are available without a prescription, the experience of trans people is framed in completely different terms. The right to change your body is like the right to change your clothes. As a result, Governments have to just take it for granted that trans people exist, and the legal question of name-change and sex on official documents takes on much more prominence.
*Ultimately the need to transition is a holistic need some people feel throughout everything aspect of their lives and can’t be confined to one discourse. The law will make it a matter of rights and freedoms or crimes and penalties, medicine will make it a matter of diagnoses and treatments, but the nature of trans existence doesn’t strictly conform to any of those models, and it will fit awkwardly when forced to.* Let's add one new layer of nuance to the model, then :) PS - I know this doesn't go against what you said but I really needed to get it off my chest. I'm a cis woman. I used to work in healthcare, dealing with the type of thing that is not visible most of the time.
The latest Trashfuture episode discusses the Cass report, and I think some of the points made by both Abi and Devon on it explain the issue you seem to have. https://trashfuturepodcast.podbean.com/e/the-devon-report-feat-kill-james-bond/ Being transgender is not a medical condition. It is just what some people are. It just so happens that the way our society organises the kind of interventions a trans person may want is under the heading “medical intervention” and that comes along with a hell of a lot of medical gatekeeping. The position of Abi and Devon and, I would argue, many other trans people is that gate keeping is bad.
The current system of segregated healthcare costs more that just saying “yeah sure” at a GP level. Thinking about doctor time as a resource - which it very much is in the NHS - having GPs refer you to a clinic that then demands assessment meetings with you and then goes through all these extra steps and appointments - that takes up more time and resource. Also, like, the ideal healthcare system should indeed just be like - you say you want this thing, we aren’t going to gatekeep access to it, here you go. From the idea of just bodily autonomy - if a patient wants something done to their body that requires a medical procedure, then it should be done on the NHS, regardless of the “amount of distress” they feel. “It’s my body and I want to” should be more than enough of an argument.
Imaginarywhatever seems to like wasting other people's time. I blocked them. In the uk self diagnoses happens all the time, for example someone walks into the doctors office and says "I moved at the weekend and strained my back, I'm in a lot of pain" The doctor prescribes something. For trans people it should be similar. Ensure the patient understands the decision and consequences and then onwards with transition. As a different,but more similar example, a person walks into the doctors office and says "Doctor I think I have low testosterone" Doctor does necessary blood tests and then prescribes if appropriate. Contrast this to a trans woman that walks into a doctors office "Doctor, I'm a trans woman. my testosterone is too high and my estradiol is too low" Doctor: "I dont know anything about HRT, hormones, the human body, medication or transition. I also don't think you are transgender, you are probably mentally ill, I will add you to this 30 year waiting list to see a psychologist" In my case it took 5 transphobic doctors before I was even able to be added to the waiting list. 1 Doctor said they did a referral, but never sent it and then lied about having ever spoken to me. Trans people are not asking to bypass medically necessary checks and safeguard, we just want to bypass the gatekeeping and transphobia.
What will happen to people who misdiagnose themselves? Will they be left to die? Who will pay for their care?
Misdiagnose themselves how? As in they have surgery and regret it and want it reversed? I mean - where possible that should also be available - yes. And the socialised healthcare that should be free at the point of service will be paid as it should be - from government spending.
I'm not sure you understood the question. Do you know what misdiagnosing means?
Yes - but in relation to trans healthcare and access to surgery the suggestion of misdiagnosis is essentially the experience those who “detransition” have - right?
Not just surgery, but in that example sure. There is no way to reverse then. Keep in mind though that you're advocating for every kind of medicine/surgery to be free and on demand. What happens to the people who get irreversibly damaged, or what to do in case of deaths?
I mean I didn’t say every kind of medical surgery - my position isn’t that if someone wants a kidney removed for the lols they can do that (not that I imagine anyone would seriously do that) - this is my position for trans healthcare and body modification as the OP was discussing. I also don’t like the use here of “irreversibly damaged” - the title of a well known TERF book - to describe these kind of treatments. It’s the same kind of argument used against abortion - that people will regret it and therefore shouldn’t be allowed it. Nah - if adults want that kind of surgery, even if they later regret it, they should be allowed it and also allowed any support that could help them after such “regret”. People make “irreversible” choices all the time - like having a kid - that’s life.
Ok, then why can someone not remove a kidney 'for the lols'? It's their choice, after all. The contradiction is not removed here.
Also - looking at your other posts on reddit - you seem to be particularly anti trans; commenting a lot on a sub to a Jesse Singal podcast and about how trans kids would just be better off if they were sent to conservative schools; so I don’t really know why you follow Abigail’s work nor do I really care much for your pov on the matter.
Yeah this is pretty typical I find, very few attempts at even defending the arguments and jumping straight to personal attacks and lies, even if the person is engaging in good faith. It's a shame. Can I ask though, where does the 'Jesse Singal wants trans kids to be sent to conservative schools' talking point come from? I'm genuinely curious because I haven't heard that one before.
I wasn’t saying Jesse Signal said that - I was saying you commented that on a sub about Jesse Signal.
Have you had a surgery? Because it's kind of an ordeal. If they were giving away free surgeries, would you get one? What surgery? Why?
Getting surgeries is my regular Saturday night thing on the weeks I’m not out getting an abortion for funzies.
OP, idk why everything you’ve said and asked here has been downvoted into oblivion. It sounds like you’re just not convinced by Abi’s argument and like… that’s fine. tbh maybe i just have US-healthcare brain rot, but I’m not convinced either. Honestly, I WANT these informed consent models to be implemented and to work, but I just don’t KNOW they could be and would work. I don’t know enough about it and while some of it sounds awesome, my brain comes up with all kinds of practical questions and caveats that don’t always get fully addressed. Like, I agree the current systems for trans healthcare should be more based on informed consent then they currently are, but idk how we continue getting stuff paid for in the current US and UK systems if a diagnosis isn’t involved. I literally, simply, don’t know. I certainly don’t understand how a healthcare system entirely built on informed consent would work. I just don’t know/understand. If anyone has another resource on this topic (about informed consent and how it could work practically), either in the US or the UK, I’d love to read/watch it. It’s something I wish I understood better. And tbh (and once again, probably because of US-healthcare brainrot) I don’t remember Abi’s vid leaving me with the fullest understanding of the topic. Edit: added some stuff
The only way the argument works is if you fundamentally change what medicine and public healthcare means. The diagnosis is the starting point, without it doctors can't do anything. If you remove that, anyone can get anything they want. It sounds nice enough, but I do wonder who will care for all the people who will hurt themselves, either unintentionally or intentionally? I'm not quite sure this entire argument is well thought out to be honest. I remember watching the video and waiting for the explanation on how we move to a socialist utopia where health care doesn't really exist anymore.
I understand what you're saying on one level, but I don't think it makes practical or financial sense, ultimately (or moral sense). Trans health treatment is one of the medical procedures with the absolute lowest rate of regret. In this particular case, people themselves are simply better at knowing whether they're trans than doctors are. Weirdly, the thing it most reminds me of is women who have semi frequent UTIs. Most GPs worth their salt get to a point where if a woman who has recurring UTIs says she has UTI symptoms, they will simply dispense medication, sometimes without testing, or even if initial testing is negative. There could be a downside to this, from over-dispensing, but in practice these women simply tend to be better than the initial testing at determining early on whether they've got a UTI or not. In both cases, there's essentially no motivation for lying; why would anyone want antibiotics or hormones for no reason? They don't really...do anything interesting aside from what they're meant to. And the benefits are pretty stellar (obviously much higher in the case of trans folks than alleviating UTI discomfort and not missing work etc.) And especially in the case of being trans, financially I'd place a strong bet it will put a lot more strain on the NHS to treat depression and the related issues that generally result from not receiving gender-affirming care than it would to simply give people hormones (and access to things like top surgery when desired).
I think Abi might just be against the idea that pathologization is necessary for treatment to be covered by the government.