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Charing Cross Myths - Sarah, The Bringer of Tea
10th November, 2010
11:26 pm

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Charing Cross Myths
The following document has come to my attention. It is something that has been produced by clinicians at the West London Mental Health Trust (i.e. Charing Cross Gender Identity Clinic), I guess as part of a patient/community relations exercise, and aims to detail some commonly held beliefs about the clinic and contrast them with their view. I am told that all the clinicians have signed up to it. Here's the document - feel free to pass it around, and I hope it proves helpful!
WLMHT GENDER IDENTITY CLINIC (GIC) MYTHS

The WLMHT (“Charing Cross”) Gender Identity Clinic has existed in one form or another since the early 1960s, and clinical practice is constantly evolving. It is perhaps inevitable that, in that time, a number of false beliefs and misconceptions have arisen.

Not all these beliefs are “myths” in the sense of having always been untrue – some stem from the way the GIC operated in the past, or the approaches of previous clinicians – but all are outdated, and unreflective of current treatment protocol.

The following, then, are examples of commonly held beliefs about the WLMHT GIC which are untrue:

You have to wear a skirt to the GIC
Perhaps the most widely cited misconception, this is not the case. As part of the Real Life Experience (RLE), male-to-female transitioners are expected to present themselves in female role 100% of the time, and sometimes it is relevant to discuss this in clinic appointments. However, the range of feminine apparel is, obviously, wide and varied, and cannot simply be reduced to “wear a skirt”.

A less common variant holds that female-to-male transitioners must wear a suit and tie to be taken seriously at the GIC. This too is without basis.


You have to be living "in role"
Not the case. We see people who experience gender related distress; some are pre- transition, some do not undergo transition at all. All are valid referrals to our service.

You have to want surgery
Not at all. Not everyone needs or wants gender related surgery.

You have to be suicidal
On the contrary, it is important that those undergoing transition be stable, physically and psychologically. It is not unusual for us to see people who have, as a result of their gender distress, been depressed – sometimes to the point of suicidality – but we would hope that, as transition progresses, this gradually improves.

You have to be heterosexual
We have heard health professionals say this of the clinic, but it is patently ridiculous. It would be grossly unethical of us to insist on heterosexuality in our patients.

You can't admit to doubt
Transition is, for many, a major life change and it would be unusual to have no doubts whatsoever. You should feel comfortable discussing feelings of doubt with your clinicians.

You have to give a standard trans narrative
As the UK’ s largest gender clinic, we see a huge diversity of people, and neither wish nor expect you to tailor your own experiences to a set of clichés. Just be honest.

The GIC will start you at the beginning again
This was our practice in decades past. In the last decade or so, it has been standard practice to acknowledge previous time spent in the preferred gender role. Typically, we “back date” the start of transition to the start of living in role full time as well as making an official name change or equivalent.

The GIC will stop your hormones
No. Our concern is that you take hormones safely. We routinely carry out blood tests at the first appointment, and may advise accordingly, but we generally do not ask people to stop hormones on which they are established.

The GIC will penalise you for having gone private/self-medicated
Obviously, we cannot approve of self-medication as it can be dangerous and often leads to a poorer result than that gained under medical supervision. However, we recognise that it is a modern reality, though, and do not penalise you for it. The same is true of previous contact with private practitioners.

It will take forever
Within the limits of available NHS resources, we aim to provide a timely and efficient service.

They deliberately play Good Cop/Bad Cop
Different clinicians have different approaches, and will form different therapeutic relationships with their patients. Choice of clinician is determined by availability of appointment slots, not by any sort of organised Good/Bad Clinician policy.

November 2010


Also posted at http://auntysarah.dreamwidth.org/249079.html - you can comment here or there.

(34 comments | Leave a comment)

Comments
 
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From:plumsbitch
Date:10th November, 2010 11:44 pm (UTC)
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small proofing/formatting spot: you've run pars headed 'you can't admit to doubt' and 'you have to give a standars trans narrative' together!
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From:auntysarah
Date:10th November, 2010 11:46 pm (UTC)
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Fixed! Ta.
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From:cyberspice
Date:10th November, 2010 11:46 pm (UTC)
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Interesting.

All of the complaints they defend against are well known to me. Also over many years I've heard of real examples of each complaint. Back in the days of Randall and then Green such practices were common.

Its good to see them addressing these issues and if they genuinely have turned over a new leaf that is excellent news.
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From:darkwaterfairy
Date:11th November, 2010 02:20 am (UTC)

Have you ever heard of a Diabetes Clinic whose patients fear it?

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I don't know whether to laugh or cry.

Personally, in this very last few months, they've effected '...Good Cop/Bad Cop' (whether or not it was 'deliberate'), i quote "it's all down to Dr __, I can advocate to him on your behalf, but in the end, it's his decision", threatened '...penalise you for having gone private/self-medicated', and I have also witnessed such "myths" occur to others in the last year, and known friends subjected to them, including the arbitrary withdrawl (by ordering GP) of hormones.

It's good i guess to have them admit, even if it is begrudingly and vaguely, that they have been abusive in the past, but a begrudging and vague admission is not the outright and unreserved public apology that shows honour and respect.

One also noted the lack of a stated cut off point for past malpractice, or should we take it that they continued doing so right up until October 31st?

Similarly there is no mention of their unreasonable, discriminatory, and (in these times) stupendously unrealistic, demand that one has been in work or study at the very time of seeing them, nor the excessively multiply negative response to trans females who wish for genital surgery daring to continue to use their genitals for sex in the meantime. Should one take the omission of these from the list of myths as implicit admission they do practice these?


Yes, I know that they are better than in the past, and yes, i know that most of the problems, or at least the most severe ones, stem from one particular individual who remains, with the others having a semblance of ethics and wishing to do a better job, but if this is an attempt to obtain a clean slate its a failed move.

I'd rather they rooted out the infection and any flesh that has been supporting it's continuing ravages, than merely change the dressing.

Edited at 2010-11-11 02:21 (UTC)
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From:whisperkit
Date:11th November, 2010 03:37 am (UTC)

Re: Have you ever heard of a Diabetes Clinic whose patients fear it?

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I very much agree with this. Also, in most of those they [i]don't[/i] admit to past abuse, just that patients may have the 'mistaken' belief that these things have ever occurred.

Patronising bullshit, really.
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From:cmcmck
Date:11th November, 2010 08:26 am (UTC)
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Having seen many people face up to CX over many years, all I can say is patronising bullshit, but then I wouldn't expect anything more really.

At least it's no longer John Randall- now there WAS a complete arsehole!

CX maybe need to remind themselves of a few things by re watching the BBC documentary 'a change of sex' from a couple of decades back. I love it when people re write history backwards- I'm very familiar with that trick, for obvious reasons!

Also, notice how FtM guys don't exist?

From:ext_317431
Date:11th November, 2010 08:28 am (UTC)
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The GIC will penalise you for having gone private.
Well that was true earlier this year.
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From:auntysarah
Date:11th November, 2010 09:35 am (UTC)
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Do you have more details?
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From:numberland
Date:11th November, 2010 10:14 am (UTC)
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My worry here is what happens when someone sees this statement, follows it's advice (to not worry about such things) and then can't get treatment. If it's true that's great but I wonder if it is someone trying to make it true by writing this which might be bad in the short term for people caught out by this.
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From:auntysarah
Date:11th November, 2010 10:18 am (UTC)
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I think it's also intended for local psychs, the ones supposedly doing the referrals, but who sometimes take it upon themselves to try and "diagnose" the patient themselves, and who often think much of the above tropes are true.
(Deleted comment)
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From:auntysarah
Date:11th November, 2010 02:10 pm (UTC)
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This feedback will be duely relayed.
(Deleted comment)
(Deleted comment)
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From:auntysarah
Date:11th November, 2010 03:19 pm (UTC)
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West London Mental Health Trust don't perform surgery - that's a different trust, specifically Imperial College.

Commissioning arrangements is something I am doing some fairly intense activism on at the moment, but I'm not quite ready to go fully public with it yet. Watch this space.
(Deleted comment)
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From:darkwaterfairy
Date:11th November, 2010 04:35 pm (UTC)
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Sarah, the body you intend to relay feedback to, is that to the violent child themself (CX), or to the hands off irresponsible parent (the MHT)?
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From:auntysarah
Date:11th November, 2010 04:45 pm (UTC)
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Feedback will be reaching the GIC direct.

Edited at 2010-11-11 16:45 (UTC)
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From:nitoda
Date:15th November, 2010 07:11 pm (UTC)
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Do you have a source URL for this document at all? I'd like to post it on, but need something more reliable for source authentication than just trusting your judgment, much as I generally do, sorry!
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From:auntysarah
Date:15th November, 2010 08:11 pm (UTC)
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I don't have a source URL. I was mailed it by Dr Stuart Lorimer, who I understand has presented it at FTM London.
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From:sarahs_muse
Date:20th March, 2011 05:03 pm (UTC)
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I was surprised when I read:



The GIC will start you at the beginning again
This was our practice in decades past. In the last decade or so, it has been standard practice to acknowledge previous time spent in the preferred gender role. Typically, we “back date” the start of transition to the start of living in role full time as well as making an official name change or equivalent.

The GIC will stop your hormones
No. Our concern is that you take hormones safely. We routinely carry out blood tests at the first appointment, and may advise accordingly, but we generally do not ask people to stop hormones on which they are established.

I thought that was still standard.
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From:sarahs_muse
Date:20th March, 2011 05:13 pm (UTC)
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I'm too scared to approach CX yet... maybe a few more years.
From:joolyelan
Date:26th January, 2012 08:43 am (UTC)
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All points are good, every one can accept it.
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