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Sarah, The Bringer of Tea - Charing Cross Myths
10th November, 2010
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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untrue – some stem from the way the GIC operated in the past, or the approaches of previous clinicians – but all are outdated, and unreflective of current treatment protocol.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)

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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)
[User Picture]
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:auntysarah
Date:11th November, 2010 12:17 pm (UTC)

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

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I will be ensuring that such feedback is heard.
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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:http://www.google.com/profiles/saffy.walton
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.
[User Picture]
From:auntysarah
Date:11th November, 2010 09:35 am (UTC)
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Do you have more details?
From:http://www.google.com/profiles/saffy.walton
Date:13th November, 2010 11:30 am (UTC)
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Yes, but do not want to make them public as it may risk treatment.
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From:oatc
Date:4th December, 2010 08:06 am (UTC)
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And there is another unmentioned, but persistent issue: patients in fear rather than feeling supported or empowered. And they are quite right in their perceptions of the risk.
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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.
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From:oatc
Date:4th December, 2010 08:19 am (UTC)
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The ones who are only involved because CX won't accept referrals otherwise (as compared to at least one other clinic that accepts self-referrals, and others who accept GP referrals), and have massive workloads that are prioritised according to need, so trans patients, who are only being screened for "no obvious signs of mental illness other than GID" (which isn't a mental disorder anyway), rightly get low priorority compared to those currently in danger, or causing danger. The ones who have no training to spot trans conditions, resent their time being wasted, and quite often handled trans people in a harmful and disrespectful manner.

I know people who were lectured at their referral assessment that altering ones sex was a sin for which they would rot in hell, or were told to find Jesus, or were prayed over.

You haven't spotted the main method CX uses to delay, discourage and eliminated referrals?
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From:sarahs_muse
Date:20th March, 2011 05:08 pm (UTC)
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>You haven't spotted the main method CX uses to delay, discourage and eliminated referrals?

Losing the referral?
(Deleted comment)
[User Picture]
From:auntysarah
Date:11th November, 2010 02:10 pm (UTC)
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This feedback will be duely relayed.
(Deleted comment)
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From:oatc
Date:4th December, 2010 09:03 am (UTC)
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No, you are not paranoid. CX rapidly ends referrals, requiring a fresh visit to the local psych and a new first appointment, even if any RLE might now continue. In his book, Barrett says how important it is to ensure patients know that only the truly committed progress at a gender clinic. Even appointments missed due to transport disruption can lead to that. Despite CX having contracts with NHS areas hundreds of miles away.

When you think of the substantial fees CX charges for those strange sessions, filled with irrelevant and sometimes misleading chat, doesn't it look rather like the NHS is being truly scammed, and the patient being put through hoops for the sake of it? And for two years or more, when the SOC says 12 months, and the inventor of the protocol meant even 12 months to be very flexible, cutting it to three months in several obvious cases.

I went through Randall, when he was head of CX, but privately (on student's BUPA). He approved me for SRS 12 months after my name change, 15 after starting to live in role. But his NHS patients were required to perform a two year RLE, followed by five years more on the NHS surgery waiting list.

CX maintained that time period, claiming it clinically beneficial, right up to Labour requiring standard maximum waiting lists for surgery, which CX argued to be excepted from, but the minister insisted.

I was well ready for surgery after six months of RLE. We know doctors and other elevated professionals often get totally excused RLE, so why does the NHS have to pay useless psychiatric sessions over two years of RLE? It is the psychiatrists who demand it. The same ones who still only ask 12 months of their private (and non-professional) patients.

Perhaps it preferable work to dealing with the mentally ill.
(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:auntysarah
Date:11th November, 2010 04:06 pm (UTC)
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I have it on pretty good authority (I can't reveal my sources though) that it's Imperial College doing this. I haven't been able to find out why they're doing it.

As someone who sits on a statutory health scrutiny committee, that sounds right to me too - I don't think WLMHT would be able to do this, even if they wanted to.

Specialist Commissioning Groups can come into the frame here too - a lot of what is attributed to PCTs is actually their fault (although the level to which PCTs have to follow their instructions is debatable). East of England SCG, for example, mandates that all referrals to Imperial College for surgery, which will be funded by the NHS, must come from WLMHT.

No, I have no idea why they do that either. I'm currently trying to find that out, and believe me, I will. I don't know if you were reading this blog a couple of years ago, but I had a battle with Cambridgeshire PCT over funding. I lost my own particular case, but don't think for one minute that I've given up over the principle. Round 2 is just getting going, and this time I'm considerably better connected and better organised.
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From:oatc
Date:4th December, 2010 08:25 am (UTC)
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You seem to be really into reinventing wheels. Why don't you go to expert groups that already know the problems?
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From:kasumi_astra
Date:11th November, 2010 08:36 pm (UTC)
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I have an appointment scheduled with CX in March relating to a second opinion for surgery. My primary GIC is Porterbrook in Sheffield, with Professor Kevan Wylie.

I'm unsure which party would be the "second" opinion in this case, although I do know that Porterbrook and Professor Wylie had to do some negotiation for his opinion to stand. Charing Cross had demanded that they refer to their own preferred candidate for second opinion. It is my understanding that this has since been resolved, and that I am the first patient to go to CX from Porterbrook under this arrangement.

This process was set in motion for my stated minor preference for London for surgery, both in terms of location and surgeon (the alternative was Leicester). Despite stating this was a relatively minor preference, it appears Porterbrook have worked hard to achieve this.
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From:oatc
Date:4th December, 2010 08:27 am (UTC)
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I don't understand why your preference for surgery at CX was only "minor". You certainly will not regret it.
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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)?
[User Picture]
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)
[User Picture]
From:oatc
Date:4th December, 2010 08:28 am (UTC)
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ROFL
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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:nitoda
Date:16th November, 2010 08:58 am (UTC)
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OK, thanks!
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From:Rachel Lawson
Date:1st December, 2010 06:01 pm (UTC)

Also heard this...

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Hi,

I also heard Stuart Lorimer go through these same points at the Transgender conference at the UEA in Norwich in September. To be fair, he did say that many of the things listed either had happened in the past or were said to have happened, in a kind of legend way.

There's a report at http://www.transgender-advice.com/ that may be of interest. Unless you were there? I'm not sure? (if you were, it was me that reduced everyone to tears, including myself at one point!! lol)

Rachel
[User Picture]
From:oatc
Date:4th December, 2010 08:36 am (UTC)

Re: Also heard this...

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Mr Lorimer was circulating something similar three years ago. It seems to be his job to front.

In the meantime abuses have continued to be recorded.

Why is it given any credence? Because the community doesn't believe its own members? Because they like to think those bought it on themselves and deserving cases would be treated as the clinic claims? Because they crave the clinics approval? Because they think they have no alternative?
[User Picture]
From:auntysarah
Date:4th December, 2010 09:20 am (UTC)

Re: Also heard this...

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Not entirely sure what the point of suddenly replying to loads of old comments all at once is, both here and on the small amount of stuff I've written at QT, but people will talk! (or rather they would, if anyone other than the one getting the resulting comment spam in her inbox, i.e. me, noticed).
[User Picture]
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.
[User Picture]
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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