British Association of Gender Identity Specialists (BAGIS)

Annual Scientific Symposium

4th – 5th October

Riddell Hall at Queen’s University Belfast

Some Observations by Michael Steven 

Opening

The Lord Mayor Deirdre Hargey, opened this Symposium, by talking about her plan, as Belfast Lord Mayor, of having a “Belfast for All” and how the transgender community has lots of resources in Belfast.

Funding

James Barrett, President of BAGIS, then spoke about the gender identity services getting more funding than other health services and that the structures within gender identity services are starting to be developed. 

The Media

Dr. Barrett’s talk was very entertaining, it looked at recent media horror stories like “Social contagion causes rapid onset gender dysphoria”.  Dr. Barrett did not believe rapid onset gender dysphoria existed,  the people concerned had always probably been trans, they had just had the opportunity to come out now. He drew an analogy of someone saying Elton John had suddenly become gay, as Elton John had been previously married to a woman. Dr. Barrett then reminded us all that key facts where needed rather than opinion, especially concerning toilet laws, the problem being that some people like Germaine Greer, still see trans women as being men.

Comparison to Gay Rights

Dr. Barrett then compared gay rights to trans rights, in the civil rights movement, noting that mainly teenagers are saying they are trans now.

However, one of the differences between the gay rights movement and the trans rights movement is that people have only relatively recently been able to get information from the internet, trans people can now talk to people in the same situation as they are online, from anywhere in the world.

Another parallel Dr. Barrett found with the gay rights movement, was that people are ticking the non binary and trans box on forms to say they are non binary and trans out of solidarity, even if they are not, which people used to do to support the lesbian and gay community. 

Psychotherapy

Dr. Barrett then examined psychotherapy and its use in diagnosing gender dysphoria, a problem with psychotherapy being that everyone can say they are disturbed about something and you do not need to be disturbed to have gender dysphoria, in fact gender dysphoria will not go away, even if you are disturbed. 

Fertility Preservation

Very excitingly for me, Dr. Barrett thought that the battle to conserve fertility is the new human rights battle for trans people, BAGIS is actually funding a court case right now, to ensure that all trans people can conserve their fertility and receive NHS fertility treatments, not depending on where they live, as trans people currently face a postcode lottery to get this funding.

Gender Recognition Panel

Then Paula Gray, an Upper Tribunal Judge from the Gender Recognition Panel, gave a talk on the history of the Gender Recognition Act in the UK and the fact that the Gender Recognition Panel still has to enact the law, even if it is out of date.

Judge Gray said that the Gender Recognition Panel very rarely refuse applications, they generally only refuse an application if the person themselves refuses to collaborate with the panel. Judge Gray also reminded us that these decisions can be appealed to the High Court and she gave the example of the recent non binary case, where the appellant could not get an x put on their passport for their gender marker.

Judge Gray also informed us that if a person is terminally ill and their gender recognition certificate application is time critical, the Gender Recognition Panel can expedite their application.

TENI

Sara Phillips, Chair of Transgender Equality Network Ireland (TENI), then talked about the Gender Recognition Act in the Republic of Ireland, enacted in September 2015. People in the Republic of Ireland (ROI) can now change their gender  by self-declaration, if over 16, unfortunately this Act does not include non binary people yet. To change your gender in the ROI, a Statutory Declaration of Gender is required for people over 18, which takes about 4 days. For 16 and 17 year, olds it is a lot more difficult to change gender.

Sara Phillips told us that the ROI uses the legal model and not the medical model of gender identity and TENI used a lot of LGBT and trans groups to get the Gender Recognition Act legislation through,  a crucial moment in this campaign was the Irish Marriage Equality vote, which greatly helped their gender recognition campaign.

Cancer Care

Dr Alison Berne, a part-time registrar at the Charing Cross Gender Identity Clinic, then told us about her research in “Addressing Inequalities in Cancer Care for the Trans population”. Dr. Berne told us that very little research has been done on transgender people and cancer care. However, she had found that unfortunately trans women who start hormone therapy after the age of 40, are more likely to get prostrate cancer.

Sexual Health

Dr. Kate Nambiar, from the Brighton Sexual Health and Contraception Service then gave a talk on her research in “Sexual Health for Trans People”. One of the shocking facts from her talk was that Trans women are 30 times more likely to die of HIV, because many of them are sex workers.

Academic Qualifications

Professor Della Freeth from the Royal College of Physicians of London, then gave a talk on the “New Academic Qualifications in Gender Identity Healthcare: PG Cert and PGDip for all Health Professionals and Disciplines.” She said there was a clear need for credentialising in this area.

ASD and ID

Professor Freeth’s talk was then followed by parallel workshops, I chose to attend Dr. Paul Wither, who works in a Specialist support team that covers Greater Manchester’s workshop on “Supporting Trans People with ASD and / or ID in their care pathway”. Dr. Wither started his workshop by asking us if we could “Name 10 people with an intellectual disability?” None of the workshop’s participants could, which highlighted the fact that for many people with an intellectual disability (ID), there are no role models they can look up to and they can have low self-esteem.

During the workshop, the question of why quite a lot of people with autistic spectrum disorders (ASD) seemed to have gender dysphoria came up. Dr. Wither thought this was because people with an ASD were more honest and less likely to have a social theory of mind, so their gender dysphoria is not masked, as it can be in the rest of the population. Dr Wither thought that people with ASD may not know or care what societal gender norms are.

Dr. Wither also noted that some people with an ASD have difficulty distinguishing between the online versus off line worlds, for example, some people seem to think online is their real life, for their real life experience purposes.

Dr. Wither noted that for people with an ID, simple communication is important, you need to check their understanding of what you are saying, their ability to focus may also be low.

Dr. Wither commented that people with an ASD, might not be able to concentrate on what you are saying to them, you need to consider if the person is anxious or experiencing sensory overload. People with an ASD may be good communicating verbally but they may have information processing difficulties.

Trans Pregnancy

The next workshop that I attended, I thought was the most exciting of them all. 

It was entitled “Trans Pregnancy: Conception of a Change”. A trans person, who recently became a dad, told us about his experience of trans pregnancy. 

He said that the only information currently available on trans pregnancy, appears to be the trans community. The speaker had been told that he would be infertile after taking testosterone. However, the speaker pointed out, that we actually don’t know the long term effects of testosterone on fertility. The speaker had been on testosterone and had come off it in order to become pregnant. During his pregnancy, the speaker continued to pass as male, his large belly being the only sign that he was pregnant.

The speaker said that research in the trans community suggests that it takes about 4 months for periods to come back for trans men, no matter how long they have been on testosterone.

The speaker was never misgendered directly during his pregnancy, however he did suffer from indirect misgendering, for example at pregnant mum groups etc.

The speaker had felt male throughout his pregnancy and gender dysphoria was not a big problem for him. However, he wanted to have a male chest and to feed his baby at the same time. The speaker had owned his body during his pregnancy and he felt like a superhuman growing a baby.

The speaker had had a home birth and the home birth team had always got his pronouns right. A nurse wondered why he had a uterus at his 12 week scan but apart from that, he had had no other problems. 

The speaker reminded us that there are so many more trans guys out there who want to have babies and there are no actual studies to show that testosterone use will cause infertility.

The speaker reminded us that some trans men get dysphoria and cancel their pregnancy. Transmen also have to be careful that they are not taking testosterone when they want to become pregnant, as the testosterone may affect their baby, there has already been “A critical incident” in which a mental health trust worker said a transman had become pregnant whilst on testosterone.

The speaker reminded us that both parties are responsible for raising a child, it should not matter what gender(s) they identify as, they just need to be caring and nurturing to raise a child. 

Fertility Preservation 

Prof. Neil McClure from the Queen’s University of Belfast, reminded us that we all start life as female, during the first talk of the Symposium on the Friday morning. He told us that menopause occurs when a female runs out of eggs and the corpus luteum is the most active gland in the human body.

Prof. McClure said that when trans men take testosterone, the testosterone exerts a negative feedback loop on the hormones produced by their ovaries, this negative feedback loop continues as long as a trans man continues to take testosterone. However, the effects of testosterone treatment are reversible. 

Prof. McClure then told us about fertility preservation in trans men. He said that up until 8 years, ago egg storage did not work very well, as ice crystals used to form in them, now that doesn’t happen because a different technique is now being used to store eggs. Prof. McClure said that now frozen eggs that have been stored, are as good as fresh eggs in fertility treatment. He said that success in IVF is now largely dependent on eggs being collected from a biological woman, when they are under 35. 

The next speaker was Dr. Pippa Sangster, from the University College London Hospital, also speaking on fertility preservation. She reminded us that biological boys only start to produce sperm at puberty. Hormone blockers delay puberty, so trans girls, need to go through puberty to have sperm to preserve. She also said that sperm quality is also quite important and the most common regret in trans people, is fertility damage due to taking hormones. She also urged us not to forget, it is really hard to adopt and people want their own biological child. 

Dr. Sangster said that trans girls may change their mind about fertility preservation when they get older, the good news is that trans women do not need to masturbate to preserve their sperm now.

Dr. Sangster also noted that fertility clinics need to be more inviting for trans women and asked how can these clinics be more appealing to trans women for fertility preservation? 

Dr. Sangster said that the HFEA has made some advances to accommodate trans people, there is now a sperm or egg form instead of the gendered form that trans people can use to preserve their eggs or sperm.

A Postcode Lottery

Dr. Barrett then told us that fertility preservation for trans people is currently funded in Scotland and Wales, however there is no government in Northern Ireland (NI) to fund it, there is some funding in some parts of England. He said that trans people are expected to accept sterility in some areas of England.

However, Dr. Barrett pointed out that fertility preservation for people with sickle cell anaemia and arthritis is not free either, therefore we can fight the government’s fertility preservation decisions together. This is going to hit the news soon, as fertility preservation for trans people is currently a postcode lottery, BAGIS is currently fighting a legal case for government funded fertility preservation for trans people.

In the question and answer session after the fertility preservation talks, I discovered that young people need to be off blockers for at least 6 months to produce enough sperm to preserve. Fertility preservation in young trans children was also discussed, how do you consent to a child’s fertility preservation? I also learnt that it can take 2 years for an adult male’s testosterone levels to return to normal, after taking oestrogen and there is a need to have an adult and child friendly leaflet on fertility preservation for trans people, fertility consent forms tend to be overly long.

I also learnt that unfortunately, in trans men, It is difficult to see follicle development abdominally, it is much easier to see this vaginally, this is the same for egg collection.

People Outside Gender Services

Then Katrin Lehman from the Ulster University gave a talk on the research I am currently helping her with, entitled “GIFTS: Qualitative Study of the Lived Experience of Trans, Non-binary and Questioning People Outside Specialist Gender Services” One of the findings from her study, was that Northern Ireland needed a Commissioned Gender Identity Clinic for Adults, with more staff. 

Social Interaction

Anna Nobili from the University of Nottingham, gave a talk on her research “A Qualitative Study on the Perception of Factors Influencing Interpersonal Events in Young Transgender People Attending A Transgender Health Clinic”. This study showed that trans youth, had more social interaction problems than their peers and that trans people can sometimes come out first as co play characters.

Non Binary Voice

Matthew Mills from the Charing Cross Gender Identity Clinic, in London then gave a very entertaining talk called “Non binary voice”. Matthew reminded us that we all want to be seen and heard and he enabled his clients to find a voice. As an actor in the past, he wanted to de gender the larynx as in reality, the world was not binary.

Matthew wanted us to look at music and consider the fact that on testosterone vocal chords grow. He wanted to ensure that his clients achieved a pitch of voice that they were happy with. He pointed out that unfortunately, If you have a pitch over 155 hertz, it is considered to be a low feminine range and that is a bias that concerns trans people.

Matthew also reminded us that in reality, we cannot hear what our voice sounds like to other people, however we are each the authority on our own voices. By listening to people’s voices, you can hear wether their vocal fold and tract has had exposure to testosterone or not, due to a different pitch and resonance. Matthew also said that binding can also cause a problem with the resonance of your voice.

Matthew’s clients worked in groups to get community support and learnt how to use their voice, as the musical instrument they had and to find out what voice people would like to have.

Eimear McCrory, from the Belfast Trust, then did a talk about Speech and Language Therapy for Trans people in Belfast. I personally thought that this presentation could have been better because Eimear just appeared to be telling the audience about one woman of Transgender History and the Transgender support group that they lead. There are at least 3 other Transgender support groups in Belfast alone, that I cannot remember her mentioning in her talk, although I know that people from these other groups, also attend her service.

Uterine Cancer

Dr. Ahmed Ali then gave a talk about “Uterine Cancer and Long-Term Testosterone Therapy” this was a very important talk, as his research appeared to have found that there was no link between uterine cancer and long-term testosterone therapy and therefore trans men no longer probably need to have ultrasound uterine scans every two years.

Prisoners

The last talk of the day was a fascinating talk by Dr. Christina Richards from Charing Cross, Gender Identity Clinic, in London on the “Assessment of People with Forensic Histories For Gender Dysphoria and Associated Treatments”.

She reminded us that prisons are split into binary identity places, which is a big problem for non binary people. She also said it is difficult for prisoners to apply for gender identity certificates, very often prisoners are defaulted to their birth gender.

Dr. Richards noted that unlike everyone else, prisoners may have criminal or sexual reasons to change gender. Therefore prisoners mental health needs to be checked first, of course prisoners are more likely to have poor mental health.

Dr. Richards reminded us that prisoners need to be able to show they have had a strong desire to change their gender for more than 6 months, to be diagnosed with gender dysphoria. She also said that consideration needs to be taken on wether a prisoner can take hormones or have surgeries, as these can destabilise anyone, including prisoners.

Conclusion

This Symposium was amazing. It was wonderful to hear from Gender Identity Specialists, who are helping in the fight for trans fertility preservation rights, working with trans and non binary people to look at their cancer and sexual health care, helping trans and non binary people with ASDs or IDs, trying to make it easier for people’s gender identity to be recognised, working with trans and non binary prisoners and helping trans and non binary people to find their voice.