Over the past year, trans rights have been in the spotlight in a way we’ve never seen before, in many cases, not for positive reasons. In December of 2020, actor Elliot Page came out trans, making him arguably the most well-known transmasculine person in popular culture. In the four months since then more than 115 bills in the US have been proposed to limit health care and rights for trans people.
In an interview for Vanity fair, Page described how coming out made him feel and its positive effects on his mental health, giving him energy to feel creative, “I think all of the energy and time that was going towards feeling uncomfortable, constantly checking my body, just feeling unwell.”
This interview and the subsequent filmed interview with Oprah Winfrey comes at the same time as a study by peer reviewed journal, JAMA Surgery, that found a 42% reduction in psychological distress in transgender people accessing gender re-affirming surgery. The same study also found a 44% reduction in suicidal thoughts.
On the flipside of this, those who were unable to access surgery or procedures were twice as likely to experience mental health problems.
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On the decision to share his transition, top surgery and to be interviewed by Oprah, Page said “I wanted to share with people just how much it has changed my life. And I want people to know that not only has it been life-changing for me, I do believe it is life-saving and it’s the case for so many people.”
Here in the UK, one of the main legal debates around gender affirming interventions is whether or not those who are under the age of 16 can give consent to receive hormone therapy or ‘puberty blockers’.
Those opposed to this cite cases of young people accessing puberty blockers, then going on to access cross-sex hormones and possibly surgical treatment only to regret it later.
The two latter mentioned interventions are not reversable and therefore to access them you do currently have to be 16 or over and 18 or over respectively. Cases such as these are likely in the minority but often garner a lot of publicity.
Last year, the High Court ruled that it is “highly unlikely” that a child under 13 could ever give valid consent to treatment, “very doubtful” that a 14- or 15-year-old could give consent and even suggested that in some cases 16- to 17-year-olds may not be capable of giving consent and should therefore seek a court order.
On this ruling, Stonewall UK released a statement, “For decades, hormone blockers have been used to pause puberty for children experiencing precocious puberty. They also play a vital role in helping to alleviate the distress many trans people experience and offer much-needed time to questioning young people to explore their identity. Denying this vital support is not a neutral act and can be deeply harmful to young trans people.”
In the statement, Stonewall UK also outlined how this ruling directly contrasts the Gillick competence medical law, that states people under the age of 16 can be capable of sufficiently understanding and consenting to medical treatments such as abortion and contraception and states that they have the ability to understand their long-term physical and psychological consequences.
The hypocrisy present in allowing for this law to stand for those accessing treatments such as contraceptive pills/interventions and abortions but not for young people who desperately need more time to understand their relationship with their bodies and their gender, brings into question whether there is some systematic transphobic thinking at play here.
After receiving a lot of criticism for the ruling, as of April 2021, the High Court has now introduced a work-around where parents can give informed consent to puberty blockers on behalf of their child who is under the age of 16. The NHS is also launching an independent review group into the prescription of puberty blockers for under 16s.
Although a slight improvement on the initial ruling, the Family Division of the High Court’s decision to allow parental consent raises other issues. Many LGBTQ+ youth have strained relationships with their parents/guardians, and this could be seen as excluding those who are not close with their parents.
Another way trans people can affirm their gender in the UK is by legally applying to change their gender.
Under the Gender Recognition Act 2004, adults over the age of 18 can change their gender recorded on their birth and marriage certificates. In order to do this they must meet a list of requirements:
- A declaration that they will live permanently in their acquired gender
- A medical report of gender dysphoria diagnosis
- A medical report of any hormone treatment or surgery, or any planned treatments
- Evidence they have lived full time in their acquired gender for at least two years, such as copies of their passport and driving licence
- A fee of up to £140
Recently, the decision was made to reduce the fee to £5.
Although on the surface this seems like progress in the right direction for trans people, who’s mental health will undoubtedly improve as a result of having their identity fully affirmed, there are still many elements to this process that those from within the community believe are invasive, costly, humiliating and bureaucratic.
Many feel there should not be a requirement to have a diagnosis of gender dysphoria, which in of itself can be an upsetting and intrusive experience and instead believe trans people should be able to simply self-identify.
Particularly for young trans people, who in the world of 2020 and 2021 have had more accessibility into understanding their gender and representations of people like them in tv and film are more prevalent than for any generation before, being forced into understanding their identity as something that is a ‘dysphoria’ and a medical issue can be psychologically distressing.
As of September last year, the Scottish government drafted a bill that removes any requirement for a medical diagnosis.
Lee Clatworthy from the national transgender charity, Sparkle said that despite the reduction in fee, the process is still “overly long-winded” and that they believe it “won’t compel more to apply”.
This reduction in fee is also contrasted by the fact that you still must provide a passport or driving licence with the gender you identify as, both of which costs money to change from your biological sex. Changing your passport can cost up to £152.
It is evident this process puts off many thousands of people, every year from applying to legally change their gender. By 2018, fewer than 5,000 people had legally changed their gender, a public consultation found. It isn’t known exactly how many trans people there are in the UK, though the government estimated between 200,000 and 500,00 but is likely an underestimate.
As well as the JAMA Surgery study, a 2020 report from the US, published in Pediatrics found that out of over 20,000 transgender individuals over 15% attempted to access puberty-blocking hormones but only 2.5% were given access. Of the participants who were denied access, 90% reported suicidal ideation as a result and considered ending their lives.
These important findings from last year and early this year evoke the thinking on having one’s gender affirmed that Elliot Page emphasised in his Vanity Fair interview, “I do believe it is life-saving”.
A sense of self and ability to just ‘be’ in one’s own body is something every human should have the right to.
In his Oprah Winfrey interview, Page is asked about what has brought him the most joy since coming out and receiving top surgery, he replies, through a wavering voice and tears in his eyes "getting out of the shower and the towel is around your waist and you’re looking at yourself in the mirror and you’re just like, ‘There I am,’”
Discussions around whether we are making it harder through laws, legislation, and bureaucracy for people to be mentally healthy in who they are and who they are recognised as by the society around them are important.
Those brave enough to share their own stories, such as Elliot Page not only shine a light on just how important these discussions are but also encourages those of us who are cisgendered, and very well may never meet a trans person, to reflect on our beliefs, to empathise and to listen to someone speaking from experience on just how life saving living as your authentic self can be.
If you are looking for guidance, either for yourself or someone you know on any of the issues raised in this article visit Mindline Trans+ website or call their helpline on 0300 330 5468, visit Mermaids website or call their helpline on 0808 801 0400 , visit Gendered Intelligence website or call their helpline on 07511614834.