A new study reported in Crikey has examined the overwhelmingly negative way trans and gender-diverse people (for readability simply referred to as trans people) are reported on in the news media. This article intends to be a palate cleanser for such media reporting — by bringing some facts to the trans debate.
So you think you can trans
A 2018 survey of Australians in years 10 to 12 found that 2.3% identified as trans and gender-diverse. That’s roughly 35,000 trans Australians in that age group alone.
Exploring and establishing one’s identity is often difficult enough, without the added burden of working out something as fundamental as where one sits on the gender spectrum. Accordingly, trans people experience a disproportionate prevalence of mental health disorders such as depression and anxiety.
Fortunately healthcare for trans people is evolving rapidly. In the past five years there has been a dramatic shift away from framing gender diversity as a mental health disorder towards a model that acknowledges that normal is a big spectrum and we should get on with the business of affirming that. Hence the development of gender-affirming healthcare.
Gender and sex
Gender is how someone identifies and presents themselves; sex refers to biology. To avoid conflation, we refer to whether someone was assigned male at birth (AMAB) or assigned female at birth (AFAB), not forgetting those who are born intersex.
Not all trans people choose to have medical or surgical affirmation, and it is not a prerequisite of being trans to have either. But for those who do choose medical affirmation, hormone therapy is now as simple as a visit to the GP instead of the old model that necessitated engaging with a psychiatrist and endocrinologist.
A thorough mental health assessment is still required before gender-affirming surgery, according to the World Professional Association for Transgender Health guidelines.
If an AMAB’s gender lies in a feminine direction, they can be prescribed feminising hormone therapy. Similarly, a masculine AFAB can be prescribed masculinising hormone therapy. There are risks and potentially undesirable permanent effects associated with both these interventions and there will be a proportion of people who regret their therapy (estimated to be up to 0.6%).
But consider a “typical” medical intervention. Someone has a problem; a treatment is available. You weigh up the risks and benefits of the treatment and decide together how to proceed. For a trans person, the benefits are wholly subjective and unquantifiable; the risks are very quantifiable. So the usual arithmetic does not apply and all the doctor can do is fully inform the person of the risk. If the person accepts that risk then we proceed under the informed consent model of care.
Change
The individual success of gender-affirming hormone therapy, the inward and outward changes to the self, is determined subjectively. Blood tests monitor physiological changes for safety and medication dosage adjustment. After a brief learning curve, it’s really not that difficult for medical generalists to add gender-affirming healthcare to their skill set.
Hundreds of GPs across Australia are offering gender-affirming care to adults. People under 18 still require the written consent of both parents to proceed and people under 16 often work with specialist multidisciplinary units such as the one featured on Australian Story’s profile of the wonderful Michelle Telfer last month.
Relentless negative coverage of trans people is unhelpful and the tired reiteration of the same one joke over and over again (“omg millennials have as many genders as they do avocados”) is exceedingly tedious.
While there’s always room for progress, the reality is that it has never been easier for trans people to have their gender affirmed medically if they choose.
So if you are trans and reading this, I want you to know that there are healthcare workers out there who would love to meet you. And News Corp can fuck right off.
Responsible medical advice to trans folk would include that for many medical conditions, sex is significant to the diagnosis and the treatment, and that gender is irrelevant
So spot on.
Close to heresy of the current dogma.
❤
Yeah, Newscorpse.
Dear Mitchell,
While I completely agree with you about what News Corp can do with itself, I don’t agree with your assertion “For a trans person, the benefits are wholly subjective and unquantifiable; the risks are very quantifiable. So the usual arithmetic does not apply and all the doctor can do is fully inform the person of the risk”.
I disagree with you about the benefits being unquantifiable. I can offer you a bucket load of quantifiable data that *could* be collected and reported, should any one care to do a study on the GOOD things happening with trans healthcare. I shall use my own experience as one example: prior to my transitioning to thrive as James, I was a long-term, chronic patient in my local hospital following multiple and repeated self-harming episodes, including one continuous stay of 20 weeks. In the year before I legally became James, I was seeing a clinical psychiatrist at least fortnightly, sometimes more frequently, and was navigating my way through my miserable existence on five different prescriptions to treat my depression and suicidation. Although I enjoyed a full-time career working in a meaningful and productive job, my monthly post-rebate medical bill was typically in excess of $1000 per month, including medications. Three years later I am only taking testosterone and I see a counsellor once a fortnight – necessary because I need to deal with the trans-antagonism I experience from the fans of Mark Latham, Lyle Shelton, Andrew Bolt etc who behave as if my happiness is a threat to their masculinity. My tax agent has calculated that I spent $38,000 less on healthcare in 2019-2020 than the previous financial year. How’s that for something that is neither subjective nor unquantifable? The biggest quantifiable risk I face now is that I’m going to live long enough to have to experience aged care services.
Allowed to comment?