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Author: Sam Hall

Equalities Minister Liz Truss sets out her disturbing plan for reforms to the Gender Recognition Act

Posted on by Sam Hall

Minister for Women and Equalities, Liz Truss, gave evidence on 22 April 2020 to the cross party Women & Equalities Select Committee via a Zoom meeting, setting out her priorities for the Government Equalities Office. The final section of her speech was devoted to trans rights, specifically to the reform of the GRA (Gender Recognition Act) following a public consultation in 2018. Brexit and other shenanigans saw this issue shelved for a time, giving us all a breather, but here it is, rearing its ugly head again. (you can read the transcript of that speech here) 

 

You see in the beginning, those amongst us who live and think progressively, had great hopes that a consultation might result in the lifting of some of the frankly archaic and discriminatory processes embedded in the existing GRA. At the time (2004) of its original passing, this bill and this country were at the forefront of the international push for trans rights. One of the first countries in the world to enshrine the right to change gender and have it legally recognised, including protecting trans people against discrimination, we then saw trans people protected in their own special category under the Equalities Act 2010.

But it was also a time when trans visibility was minimal, and necessarily so; to be out as trans at the time of this bill passing was to attract harassment, violence, both sexual and otherwise, social isolation and rejection. In fact the GRA was intended to allow people to up sticks and start their lives over, so as to avoid this degree of persecution; secrecy was enshrined in the Act and in the medical processes that necessarily accompanied a ‘full’  transition across the gender divide. At the time, and still today, it is those who assigned male at birth who suffer the most. An adult body that has been through puberty on testosterone has features which cannot be undone. Many trans women are recognisably assigned male at birth, and cannot escape the biological effects of testosterone, even though this has been and continues to be the source of psychological distress of an untold magnitude, resulting in suicides, poor mental health, job and family loss, addiction and poverty.

GRA reform was meant to mean that people did not have to jump through so many hoops to demonstrate that distress; it has never been compulsory to have had any medical treatment in order to acquire a Gender Recognition Certificate (the outcome of a panel decision upon postal application), which in turn allows for the issuing of a new birth certificate with an altered gender marker, and yet people felt pressured to do so – to prove themselves if you like. It was meant to make it cheaper (only 6000 applications in 15 years suggests this was a privileged few who could afford the fee of just under £200) and it was meant to be an opportunity to allow recognition of non-binary identity. GRA reform was something that younger, less binary-constrained trans people wanted and were pushing for. The NUS got right behind it. It was not going to mean anything to anyone who wasn’t trans, apart from perhaps being pleased that we weren’t having our identities quite so heavy policed by the state. And then came the counter-attack.

 

The GRA reform consultation saw a rapid rise in interest, especially on line. It spawned a raft of interconnected hate groups, (Fairplay for Women, Woman’s Place UK, LGB Alliance) with spurious links to far-right evangelical hate groups in the US, and questionable sources of income. It gave birth to the widespread hate-filled rhetoric against trans women which still lurks beneath the Covid19 tarpaulin, and resulted in court cases both crown and civil, as hate crimes soared and libel ran amok. The past two years have been really tough for trans communities who have largely hunkered down and tried to weather the storm, taking a path of passive, or non-violent resistance as befits and dignifies an oppressed minority under siege. It has taken its toll on peoples individual and collective self esteem, and has predictably affected the most vulnerable amongst us.

Counter-counter action has often come in the form of misplaced protest from our cis-allies who are rightly angry on our behalf, but at the same time fuel the fury of the gender-critical by giving more ammunition to the idea that there is a well funded trans lobby with an agenda. There isn’t. What there is however, is a large and vulnerable group of people whose voices are absolutely not being heard. Trans men and non-binary people are not even getting a look in, and trans women are cherry-picked for their allegiance to the cause of misplaced feminism.

 

For the privileged, there is nothing but fear encountered when an oppressed minority starts to become more visible. Trans people and their lives challenge gender norms in a way that literally rock the foundations of our socially conservative society. A society where the nuclear family is upheld as a building block, despite it being a hotbed for abuse and violence, where men are masculine and women are feminine, and babies are born of a union between the two. I know that the rise of LGBT visibility, same sex union and now marriage and other rights that have been won over the past 50 years are hugely important, but somehow the trans rights movement is uncovering a deeply, deeply held belief that somehow this is wrong. And it must be stopped. It boils down to the weaponisation of the penis and vulnerability of those without one. We cannot allow this legitimate concern to be appropriated as a cosh to bash trans people with.

  

In Liz Truss’s speech, she goes on to mention three specific issues, none of which are actually anything to do with the GRA or the recent consultation held on its reform. All are thinly veiled attempts to begin to roll back the precious rights we have won this century, including the treatment of distressed children. There is clear malintent here, and I very much fear the direction of travel.

Sam Hall.

Dr Sam Hall is a regular Gscene columnist and is also a practising  GP and the Chair of the Clare Project, Brighton & Hove’s long established self-supporting transgender support and social group based in Brighton and Hove open to anyone wishing to explore issues around gender identity.

The virus does not discriminate, but WE do.

Posted on by Sam Hall

GScene is publishing this commentary from our regular columnist Dr Hall, a GP working in Brighton & Hove.

A damning piece in the Sunday Times hangs BoJo out to dry and rightly so. But it isn’t just him. People who object are saying he was listening to the scientists, who are saying they were warning the government much earlier than when action was finally taken. There is mud slinging everywhere with necessary politicization of this pandemic. Everyone desperately wants to find someone to blame, as long as it isn’t themselves.

The problem is we are all culpable here. Whatever your politics, regardless of who/what could have been done better and when, we are ALL collectively guilty of failure to protect the most vulnerable in our society. Elderly, people with dementia and learning disabilities, the socially isolated, homeless, mentally ill, undocumented, those who are BAME or differently abled, LGBT people, people of different religious persuasions, and many other minority groups are disadvantaged in these times.

The virus does not discriminate, but WE do. Society does. Our “free” healthcare system is set up to favour those who are white, wealthy and well. It works for those who can articulate and manipulate. Attempts to make the NHS more inclusive are largely ignored in the higher echelons so that boardrooms and decision making bodies do not represent the population they serve, and the same is largely true in other public sector organizations such as the civil service and parliament. Lip service is paid to diversity by ensuring quotas of women and people of different ethnicity but this is only scratching the surface.

In a country upheld for and proud of its welfare state, we are failing miserably to care for those who need care most. The poverty gap is widening and healthcare inequalities with it. Educational achievement follows the same trajectory. Only the wealthier can afford to move house in order to gain admission to a better school.

What this virus is showing us, and it really hurts, is how unfair we are to people who are deemed less useful, whose lives are not as valuable, or whose contribution is financially draining. We have ALL bought into a capitalist model that necessarily rewards the haves and continues to punish the have nots.

It was ever thus.

Until we are humble enough to accept our collective guilt and take collective action, blame will continue to do the rounds, taking people out one at a time, starting at the top.

If Boris doesn’t have some sort of metanoia along with his cabinet and those who have advised, them there is little hope for the rest of us…

Dr S. Hall MBBS, FRCA, MRCGP

 

OPINION: Sam Trans Man – Thinking beyond gender.

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Dr Samuel Hall on dismantling the false divide and achieving true equality.

JUST recovering from my second lot of genital surgery. The first operation, where they skinned my arm to make my penis and sliced both buttocks up to cover the deficit on said arm, left me deeply traumatised, both physically and mentally. It’s perhaps a good thing you can’t really know what this is going to be like until you do it (a bit like having a baby). I could only ever glimpse what was to come – ultimately the acquisition of a functioning penis, bodily integrity, improved mental health and wellbeing.

I could barely imagine the impact for those close to me, who cannot yet see how much happier I am, because there is a time lag as what is going on under the surface rises slowly to become visible to others. The fact is, this second (and not so long) operation, involving some very unpleasant rearrangement of my undercarriage, has meant I can now pee through the penis created at the first surgery. And that, my friends, has led to happiness I have rarely experienced, save perhaps following the births of my three children.

This has taken me totally by surprise. I didn’t expect to feel quite this degree of joy, peace, integrity and contentment. At huge expense, but totally worth it, and importantly for me as a clinician, proving that this is indeed the cure for gender dysphoria. I cannot see gender any more, it’s just… disappeared.

This element of transition isn’t something all trans people do, or need to do. There are more trans people who haven’t and never will have gender reassignment surgery, either through lack of funds or access to surgery, or through lack of need from a psychological perspective. This is a little known or understood fact outside trans circles, or perhaps even within them, where the binary persists despite the very deconstruction of it that we are doing with our bodies. There is no one way, no right way, to be trans. For some it’s as simple as needing to be acknowledged as sitting more comfortably outside of the binary; using gender neutral pronouns, seeing themselves as a person first and foremost. In fact this is increasingly common, and rightly so, since the gender binary is an arbitrary societal construct which has been increasingly reinforced throughout Western and much religious history.

More and more people are defining themselves as non-binary, including many people who don’t see themselves as trans at all, which is fair enough, since the very concept of non-binary is transcendent of gender altogether. To me the arrival point of this natural evolution of thinking is beyond gender. To a place where an understanding of what true equality means. In the same way that the breaking down of racial barriers or even the concept of race at all, results in an appreciation of the equal value of human beings of all skin colours.

Other trans people, myself included, have such a severe sense of mismatch, that the surgery becomes inevitable, a matter of time only. Especially if you live in a country where there is access to surgeons and/or funding for treatment, which is increasingly the case in first world countries.

I can’t help thinking though, that we are missing a trick here. You see if the issue of gender is a societal one, then surely the breakdown of gender in society can lead to the equality so many of us long for. I may have this wrong, but my understanding is that one of the fundamental aims of feminism is to achieve equality with men. If the abolition of gender as a restrictive binary choice is championed, surely this is one of the quickest ways to achieve equality?

This is why I struggle so much to see the logic behind the anti-trans lobby that is so very vocal and well-funded at the moment. We are natural allies with feminists. With the mothers who are distressed by their child’s gender variance, with the angry lesbians and loud voices protesting against the violation of women’s safe spaces. There is so little logic behind the constant assertion that trans women (assigned male at birth) are a threat to cis female people in any circumstance.

Of course it’s always possible to find the exception that proves the rule. So a sad case of a trans woman sexually assaulting female prisoners has been held up as the reason for initiating the exclusion of all trans women from all such safe or female-only spaces. This is akin to suggesting that all people of colour should be excluded from a certain place or space based on the infringements of one individual. Such action would never be condoned in our society today.

The breakdown of gender is both desirable and necessary for the advancement of human consciousness and our understanding of ourselves as species. It is equality that drives respect for all people, animals, plants and planet. It is equality that underpins political movements on the liberal left, seeking to iron out the grossly unfair distribution of wealth, food, education and opportunity. It is equality that should prompt us to move away from using ‘political correctness’ as a slur, or accusing people of being snowflakes because they call us out on things we hadn’t considered before.

Gender causes the oppression of half of the Earth’s population and, like race, affects us all. If we truly believe that all human beings are equal, we must continue to fight this battle against the increasing tendency to reinforce gender norms in both subtle and brutal ways. From the pink or blue nursery wares, to the rape of women and girls in war-torn countries, we are all steeped in, and deeply attached to this false divide. Modern feminists on the right side of history need to let go of their firmly held position in this binary to see the wood for the trees. Then we won’t need a debate. We are all the same.

OPINION: Sam Trans Man – A reason to live!

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Dr Samuel Hall on HIV/AIDS hitting home, and working not only to save lives, but souls.

I’VE been putting off writing this column for a while. Partly, I think, because I always feel like a bit of a fraud when it comes to writing about HIV, which this month’s issue is dedicated to. I feel like a fraud because in the 1980s and 90s I was a bystander, an outsider to the LGBT+ communities. I wasn’t out, I hadn’t transitioned, I saw the rise of HIV infection and deaths from HIV related diseases from the sidelines, as a young doctor working in intensive care, this wasn’t having an impact on my life in any way.

I wasn’t really affected by it, until one day one of my colleagues lay dying in an intensive care bed in front of me during a long hard night shift. Then it hit home. Felt a bit closer. It was a uniquely personal experience of the power of disease, pathology, overcoming medicine. We couldn’t help him, the world hadn’t caught up yet, there was no cure, no holding this at bay. So now, rather than a capable and resilient colleague with whom we had all shared tough shifts, we found ourselves crowded around another patient we couldn’t save, and felt helpless.

Yesterday I worked an out-of-hours GP shift. This is a very different way of working to my usual everyday GP clinic. The out-of-hours is telephone-based, and we try to sort things out over the phone if we can. If that’s not possible, we arrange for people to visit one of the bases that are open in the evenings and on weekends. And if that doesn’t work, we arrange a visit by a roving doctor in a car. Being a GP is hard, but working in the out-of-hours service is even worse. You don’t know the patients; NHS IT means you can’t see their history; you’re geographically miles apart and aren’t able to use facial expression and body language to aid your assessment on the phone. You have to rely on your knowledge, experience and intuition.

Many doctors don’t like working out-of-hours because it’s more risky from a medicolegal standpoint. And it’s the backstop for other healthcare practitioners out there. Nursing home staff, district nurses, carers, pharmacists and paramedics all use the GP service to refer the patients they can’t deal with. We mop up all the difficult and lonely, the forgetful and anxious, the hypochondriacs, the chancers, and the overtly suicidal.

Years ago I wouldn’t have coped with this kind of work. I hid behind the snazzy bling of intensive care and hi-tech anaesthetic equipment. I saved lives no doubt, but doing the kind of work I do now, as a GP, saves souls. There’s a connection to be made, and a doctor is in a privileged position. Patients will trust us and tell us things they can’t say to anyone else. This is never more evident than during an out-of-hours session when you have an interaction with a patient you’ve never met and probably never will. You’re so aware of the potential to say or do something detrimental, you learn to tread carefully and assess the risk of making a mistake, and spend a lot of time ensuring that both you and the patient are safe. Them, from further harm, and yourself from the torture of having got it wrong.

It was in this context then, that I picked up the phone and dialled the number of a young (well, younger than me) man who had earlier called an ambulance. On arrival the crew had assessed him, decided he didn’t need to go to hospital, and passed him on to us for a call later in the day. I woke him up. He wasn’t sober, and he didn’t want to live. This guy had run out of steam for life. As his story unfolded on the phone, I began to feel helpless. He was HIV positive, he’d been assaulted by an intimate partner, and he was addicted to several illegal drugs. He had tried his best to pull himself together, had done some detox, and sought appropriate help. But none of this was enough. Not in the face of such low self-worth. I wondered how much of his poor mental state was due to his HIV status. And what is the connection between this and intimate partner violence, depression, suicide and addictive substance misuse? I felt the pull of the darkness he was living in.

I just wanted this guy to have one thing he could live for. One little speck of hope, of light to focus on so that he could walk away from the temptation to end his life. It wasn’t the first time he’d felt like this, there has been a previous serious suicide attempt in the recent past. He hadn’t succeeded and in some way didn’t want to this time either. That’s why he’d dialled 999. He needed to be saved from himself. He couldn’t trust himself not to take his own life. Anyone who has ever felt this will know just how terrifying it is.

“I just wanted this guy to have one thing he could live for. One little speck of hope, of light to focus on”

Dr Sam Hall
Dr Sam Hall

Many of us do know what it feels like to want to leave the planet. To go to sleep and never wake up. Mercifully these feelings do pass, if we can only find a reason to hang on, we can ride the wave of emotional pain and move on with our lives. All I could hope to achieve on the phone yesterday morning was to give this patient enough hope to get though another day. I felt helpless and I was helpless, because nothing changes unless we want it to. Not a single word of mine was going to be enough if he couldn’t find a reason. But he did. We spoke for 20 minutes. I gave him numbers to call for help, he said he wanted to live. For today, anyway, that is enough.

OPINION: Sam Trans Man – On the road

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Dr Sam Hall
Dr Sam Hall

Dr Samuel Hall on how parenting is a privilege, and sending your kids out into the big wide world.

I’VE just lost a weekend. Setting off on Friday night with my eldest child on a road trip to deliver her to university, we stayed overnight with friends in the north, and then drove further north still, to Scotland, arriving in Edinburgh on Saturday afternoon. One carload, including bike, one food shop, one emergency bedding dash (who knew students got double beds these days?!) and several hundred pounds later, I left my progeny in Edinburgh and drove home again via another old friend’s place in Northumberland.

Arriving back in Brighton on Sunday night, I felt like a different person. Something had shifted within, snapped, and I felt lighter. But also bereft.

Going to university is a watershed moment in their life, in my life. This child of mine has an opportunity that remains the domain of the privileged. My child is white, English speaking, from a middle class, well educated family. They have had better life chances than so many of their peers already. I feel lucky to have this to give my children, but am also aware of their privilege, and believe that they are too. I wasn’t. At 18 I had no idea what it meant. We didn’t speak the language of equality in my narrow Catholic worldview. Especially not in relation to the gender divide. I was raised to believe that women should marry and bear children, and stay at home to raise them. That’s what the women in my family did. My mother gave up a nursing career before she qualified in order to get married. I found this extraordinary. I grew up knowing I wanted to become a doctor, and with that in mind I don’t suppose I ever entertained the idea of giving up my career for the sake of the family. It was out of the question.

And yet I still very much wanted to have children. I did it relatively young compared to many of my colleagues; I had my first child at 28, the second at 31, and the third at 34. I would have had more. I loved having children. I struggled to give birth and had to have C sections with each of them, something that always puzzled me as I never imagined that would be the case. I breastfed my children for as long as I could, and really enjoyed being the primary carer for a heady six months before returning to work each time.

When I returned to work as a junior doctor, it was hard to integrate the ‘me’ I was at home with my work ‘self’. Away from the hospital I was relaxed and totally immersed in caring for a small baby, later ones with older sibling(s), enjoying the miracle that had grown inside my body and was now present as a separate, whole and yet totally dependent person in my life. One who filled my every waking thought. Including my hours at work. As a new parent it’s undoubtedly harder to concentrate at work, or indeed anywhere away from your child, and I longed to bring the baby in to the workplace just to reconnect. With myself.

As children grow older you learn to integrate yourself a bit more, and I can see people around me at work who are also parents, doing the same thing. There’s something about being a parent that gives you a toolkit you can’t get another way. It doesn’t matter how you come to be a parent, or what route you took, nor does it matter how long you’re in the role for in a child’s life; parenting is a skill, and most of us don’t acquire it that easily. Of course you can learn good parenting skills whilst you’re still a child yourself, if you’re lucky, from your own caregivers. How many of us find ourselves behaving just like our own parents, in times of distress as well as joy, anger and sadness, laughing with the same sense of humour and folding our washing a particular way, or not at all.

Parenting, as I think I have said before, is a privilege. It helps you to be less selfish, and it means you’re obliged to share with other people who are parenting. There is a constant need to talk things through, compare notes, take advice and finesse our skills. Keeping up to date with teens is the worst bit yet as far as I’m concerned. I don’t want to be seen as too strict or old fashioned, but I do want my children to feel safe and to know where the boundaries are.

This last point is one that I’m forced to rethink as a result of this weekend just gone. I no longer have the right to parent my child. That stopped on their 18th birthday, and even though I did become aware of it at the time, that was a year and a half ago, and it’s this road trip that’s brought it home to roost. The fact is, as a parent you’re owed nothing, yet owe everything, you must give thanks and praise, but never expect it in return.

You need to be selfless and generous without expectation, and in the final analysis ‘let go’ of a new adult. Sending them out into the world with only hope. Hope that they are okay. Hope that you have taught them enough. Hope that they have sufficient ‘adulting’ skills, hope that they learn what it is to try and to fail; to try and to succeed; to laugh, cry and feel deeply whilst they are alive, and to consider that they too might one day be the right person to raise another one.

I’m nothing short of humbled by my experiences of parenting, and whilst I know I’m far from a perfect one, I also know that I’m good enough, and that’s all that matters. This is what I learned on my road trip.

OPINION: Sam Trans Man – What is gender?

Posted on by Sam Hall
Dr Samuel Hall
Dr Samuel Hall

Dr Samuel Hall on the differences between gender and its ‘concrete counterpart’ – sex.

ONCE A year in July the Gscene issue is given over to all things trans… I love it. This year even more so because the editor is encouraging us to talk about gender. And gender is my favourite subject.

Gender dysphoria has dominated my life thus far, and gender injustice has become my biggest passion. Gender is so poorly understood, so misused and so artificial, it’s extraordinary how much of an influence it actually has on each of us, and the societies and communities in which we live.

What is gender then? We all think we know, but in reality there’s a huge amount of confusion between gender, and its concrete biological counterpart, sex.

Let’s look at a dictionary definition; 
Gender (noun)
1. The state of being male or female (typically used with reference to social and cultural differences rather than biological ones).
2. (In languages like Latin, French and German) each of the classes (typically masculine, feminine, common, neuter) of nouns and pronouns. Grammatical gender is only very loosely associated with natural distinctions of sex.

Gender wasn’t really used to refer to males and females until the 1970s. Prior to this the use of the word was largely limited to grammar. The rise of feminist theory, embracing a conceptual difference between biological sex, and gender as a social construct, brought to the forefront the work of a sexologist, John Money, who first introduced this as a terminological distinction in his work in the 1950s. This distinction is still very much adhered to by social sciences, and by the World Health Organisation.

Unfortunately this semantic distinction becomes very blurred in other areas, including much of the public domain and mainstream media, where the words ‘gender’ and ‘sex’ are used interchangeably and without consideration for the true meaning of either word. It’s taken us well into the 21st century to even begin to establish agreement that sex is the correct term to use when referring to biological classification, and gender as a marker of self-identification and consequent representation to, and experience by the world as masculine, feminine, both or neither.

Of course there is, rightly, ongoing research to establish whether biological differences contribute to or influence the development of gender in humans. The jury is out on that one for the time being and will be for some time; it’s extremely difficult to do studies needed to settle the ‘nature’ vs ‘nurture’ debate.

Suffice it to say that as a trans person, especially if you’re very ‘binary’ (although I aspire to a non-binary identity, unfortunately I’m not yet big enough to surrender my male privilege), and most especially if you have undertaken significant surgeries and treatments to establish yourself as the opposite sex, you will inevitably have made the separation between ‘sex‘ and ‘gender’ with your actual body.

As a person transitions, their gender identity doesn’t change, but their sexual characteristics do. It’s possible, therefore, with the correct treatment, to align one’s body with the ‘felt’ sense of gender. The problem is, what if ‘gender’ is a construct? Then is the internal and innate sense of self (gender) that we trans folk pursue congruence with our bodies for, a figment of human imagination?

If, at the age of four years old when I refused consistently to wear a dress or a skirt and insisted that I be treated like a boy, instead of forcing the issue, my mother had said, “Don’t worry dear, lots of boys don’t have a penis…” how might things be different for me today? In truth I don’t believe there would be a great deal of difference. In fact I think it’s likely that had I been allowed to live as a boy, I’d have transitioned much sooner. Not because I’m a slave to gender, but because, for me, being trans is about biological sex. It’s about incorrect wiring.

My brain expected (as a young child), and still expects, to have male genitalia. I was born like this. With a neurodevelopmental variation; one where my body parts didn’t match up with the developing neurobiology in my brain and spinal cord. This is the only sensible explanation I can come up with as a scientist and a trans person. I need to have some understanding as to how this can happen, and why it appears increasingly prevalent.

Being trans isn’t a modern trend. There are stories and histories from across cultures and eras. There are clues in different cultures and there are examples of both reverence and of appalling treatment directed at trans people. We’ve almost certainly been with you since the beginning of consciousness. But there are definitely other factors at play. We cannot legitimately explain the explosion in waiting lists away, citing visibility and acceptance as reasons for large numbers of people coming forwards to identify as trans.

We need to look at brain development very early in life, and at gender role distinctions that are being reinforced in ever more toxic ways in very young children. We need to look at our language and how we all contribute to a continuation of a binary ‘split’ in the human race, which allows one half to be deeply oppressed and abused the world over, and the other half to access a world of privilege and dominance that gives them a misplaced sense of entitlement and ferments brutality against women. We all need to deconstruct gender.

A concerted effort by every human on the planet is what it will take to free both women and men to live outside of, or beyond, gender. In a world where biological sex and its characteristics are regarded as positive attributes, regardless of what they are or whom they belong to, and where people are respected for their single common attribute, that of being human.

OPINION: Sam Trans Man on drugs

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Dr Samuel Hall on the drugs he’s dependent on and how his brain is rewiring itself in his second puberty.

Dr Samuel Hall
Dr Samuel Hall

PLEASE forgive my indulgence, since I’ve little to say about chemsex as per last month’s theme, instead I’m exploring the influence of a drug that I’m totally dependent on for both my physical and mental health, and wellbeing. Testosterone.

As I write I’m on enforced convalescence. Who knew that I’d have to be dragged away on holiday? That I’d be reluctant to travel or seek the sun… I was initially reticent because we had to book this break prior to my surgery in February, and I was nervous that I wouldn’t be healed enough to travel, or that some complication would hold me back. But my beloved, who always knows best, persevered, riding roughshod over my protestations to drag me away from gloomy England to a tranquil spot in the mountains nestling above the Costa del Sol, eating local food and dipping my toes and still healing arm into the freezing Mediterranean. What bliss. I know that I’m both extremely lucky and singularly ungrateful – I really don’t deserve to have someone so very much on my side! I’m increasingly becoming a grumpy old man in the eyes of my family and the tide is seemingly unstoppable. And yet I’m blissfully happy.

I’m not sure what it is that makes this juxtaposition possible, but some insight has come over the past few months from my wife. She thinks I have Asperger syndrome. Somewhere on the spectrum of autistic disorders, people with Asperger’s are often very difficult to interact with, being lost in their own intellectual worlds and missing normal social cues, they can be frustratingly literal in speech and interpretation, and find it difficult to express or understand the nuances of relationships. The terminology around the autism spectrum is rapidly changing as neurodiversity is explored and increasingly understood. There is a long way to go, and I’m certainly no expert.

However, reading around the subject a little more, and thinking about my childhood behaviours, as well as questioning my parents, has helped both my long-suffering wife and I to understand why we often miscommunicate, sometimes with great detriment. Of note here is that there’s a well-documented association of autism with gender identity issues. There’s no hint or supposition of causation, but there’s an association which is suspicious. Way more people who identify as trans are on the autism spectrum than one might be led to expect given the prevalence of ASD in the cisgender (non-trans) population. This isn’t a medical journal, so I’m not going to expound theories or present you with statistical evidence here, this is merely an assertion of the little we already know.

What I will say is that this is revelatory to me on a personal level. It’s increasingly recognised that children assigned female at birth (ie, put in the pink box) are harder to diagnose than those assigned male (blue box). But we also know that girls and boys are socialised very differently, and that some of the social skills that girls learn allow them to hide their autistic traits more easily. Much in the same way that adults with autism have often learned to mitigate the impact of their differently-wired brains so that they can and do function effectively in society. Nevertheless, it’s a sad and little known fact that adults with ASD are less likely to be in long-term successful relationships (amongst other things) than those without (so-called ‘neurotypicals’).

Whilst I’m aware that some of the language and expressions I’m using may be outmoded or considered inappropriate to others, this is very much a personal journey, an exploration of my own internal wiring, and a search for answers about my experiences as I have transitioned.

You see all this has become far, far more obvious since I started medical treatment. I believe it’s the testosterone that’s changing my brain and the way I perceive and interact with others. Each stage of my transition (including surgeries to masculinise my body) has been accompanied by an alarming sense of ‘skills lost’, rendering me incapable of doing things I could previously accomplish easily, or even excel at. Over time I’ve been able to regain these lost skills, as I’ve adjusted to the new reality of seeing and being seen as male – but this doesn’t really make sense. Why would a change of fuel, a different hormonal milieu, have such a deleterious effect on my ability to function? The studies haven’t been done of course, but the gender clinicians did warn me that I would enter puberty (admittedly for the second time around, only this time the ‘right’ puberty for me).

Prior to transition I was seen as someone who had empathy, and was able to comfort those in need and provide emotional support to those around me. On testosterone I gradually found myself losing these skills, which, I think, must therefore have been learned, rather than innate. My brain is rewiring itself in this second puberty, and I’m having to relearn how to be with people.

This reinforces the idea that gender is a construct, adhered to by parents, teachers, peers and society in general. The acquisition of empathy and the capacity to relate emotionally is nurtured into us, it’s not ‘nature’. No wonder then, that boys and men are considered less emotionally intelligent (please note these are generalised statements and really not applicable to individuals). Those in the blue box simply don’t stand a chance and cannot compete with those in the pink box, who’ve been carefully tutored into emotional intelligence and care-giving since birth.

Again I generalise here – I appreciate fully that there are many men/boys who are sensitive and gentle with others’ emotions, and plenty of girls /women who are tougher by far. Broadly speaking, what I’m getting at is the notion that neither gender identity nor autism spectrum traits are innate. It’s entirely possible that we’re socialising these problems into our children by placing constraints on them that are both prohibitive and restrictive, and that only a massive change in outlook can alter this state of affairs…
Food for thought at least.

#MyPronounsAre – a city wide campaign celebrating Trans Visibility Day

Posted on by Sam Hall

This week sees the launch of #MyPronounsAre, a city-wide initiative from Brighton & Hove City Council.

Our local services have a well established history of engaging with and on behalf of the trans communities both at home and abroad, and this is a campaign in the spirit of inclusivity that really makes a difference.

When Rainbow Chorus heard of it, they were very keen to join this campaign which highlights the experiences of gender variant folks who may not feel comfortable with their assigned gender.

We are all, unfortunately, assigned a gender at birth. A set of rules and expectations that is both arbitrary and rigid at the same time governs each of our lives whether we like it or not. Whether we see it or not.

Gender, and its effects on society, is insidious. It creeps through all the layers and echelons of our culture and times, dividing us into warring camps. It is present throughout the world and breeds misogyny and misandry in turn. It results in violence towards those perceived as women, and awards privilege and toxic masculinity to those seen as men. None of us are safe from the effects of the gender binary.

Trans and non-binary people are bridging this chasm in challenging ways that are sometimes difficult to understand or tolerate, precisely because we are all so bound up in the binary. This campaign reminds us that the most important changes we can all make are those which promote inclusion, because with inclusion comes a desire to learn about the experiences of those with whom we have little in common.

It is very easy to be blind to the exclusion of others until or unless we have an interaction with a person who has hitherto been on the outside. We all love our tribes. Rainbow Chorus is still learning how to be fully inclusive, as are we all. Their commitment to trans-inclusivity has included handwritten pronoun badges at rehearsals for some time now, so it is a pleasure to share

#MyPronounsAre with them in time for Trans Day of Visibility on March 31 and reflect on how far this choir has come in the past few years. There is always more to do; but I am proud to stand and sing with a choir who welcomed me 5 years ago as the man I am today.

Dr Samuel Hall writes a regular column for Gscene and sings even more regularly with the Rainbow Chorus. They appear together in a documentary on Channel 5Star on April 5, @9pm called When Mum becomes Dad and Son becomes Daughter.

OPINION: Sam Trans Man on the internet

Posted on by Sam Hall
Dr Samuel Hall
Dr Samuel Hall

Dr Samuel Hall on the risky business of opening up online to change how people think.

I made it! When I last wrote my column I was on the brink of surgery that I’m now slowly mending from. And what an incredible month it’s been. I’ve had highs and lows, mishaps and setbacks, euphoria and dysphoria, felt elated and despairing in the same breath, and am finally beginning to settle into a more manageable pace emotionally and physically.
Phalloplasty surgery wasn’t lightly undertaken. This was the first and hopefully worst of three surgeries to get my working penis. A decision I neither undertook lightly, nor wanted to undertake at all for the most part. I mean – who would, right?
Being trans is a constant battle for me; since my mid-30s I’ve been fighting the urge to ‘change sex’. Of course, it all started long, long before that, in my earliest memories a missing penis was a constant reminder of the shame I felt about my body, betraying me the moment my genitals were revealed to me or anyone else. I managed to keep a lid on it for half a lifetime, but eventually gave up fighting about 10 years ago. Exhausted by my own shame, I came out. And now, well now, everything has changed.
For the past few months, even while I was planning a date and negotiating with the surgical team, and I was pretty certain I had to do this, I was still going round in circles asking myself the question, “Is this the right thing to do?” As a person with experience of gender dysphoria and the treatment thereof, I forged ahead, knowing from the previous steps I’d taken in transition that this too would catapult me into a better, more wholesome and functional life.
But as a clinician and a scientist, I have and do struggle with justification for these life-changing, expensive and sometimes dangerous treatments. Like most doctors, I’d rather not do anything to my body that isn’t essential for health and wellbeing. Despite my own first-hand experience of vast improvements in self-esteem, mental and emotional health, capacity to function and ability to concentrate on my family and career, still I hesitated to take this final step.
Some of my reluctance was related to my conservative Catholic upbringing and the deep-rooted beliefs I have had to grapple with these past 10 years. Further hesitancy stemmed from knowledge of the surgical risk, pain, failure of the graft, scarring and damage to my arm, which has become the donor site for my precious new penis. Still, more of my musings were about the morality of this kind of surgery and whether this would really make a difference to how I felt about myself – surely what was in my underpants wasn’t really going to change my life to any degree? No-one else knows or needs to know, right?
But I knew. I’m the one who felt like a fraud, masquerading as a man but not fully male. Who knew? This is a ridiculous way to think, I know. But I did think this and it crippled me. Now, after just the first operation, my shame has gone. The simple act of looking down at my genitals and seeing my penis, has healed this lifelong burden.
Dr Michael Dillon
Dr Michael Dillon

I’ve long been an admirer of Dr Michael Dillon, one of the earliest documented people to transition from female to male, also a physician, who pioneered genital surgery as a guinea pig in the 1950s. We’re still guinea pigs, with genital surgery for female-to-male people very much a poor cousin to male-to-female in terms of expertise and development, and difficulty of access. The techniques are crude and in need of further research and investment worldwide, although we are fortunate in this country to have a team of surgeons working in this field.

As a doctor, I know I have a more detailed and intimate understanding of what is involved than most, and I’m able to talk about the surgery I’m having in a dispassionate and medicalised way that facilitates the education of others and fosters a better understanding. I had flirted with the idea of speaking up in a public forum for a time, but right up until the morning of surgery, wasn’t sure I had the balls for it. Suddenly I was imbued with enough conviction to post on Facebook as I waited for, woke from, and wondered about the consequences of my decision. I would open myself up to the world in the interests of changing how people think. It was my time to step up.
Of course, this kind of vulnerability, the kind that the internet has afforded us, is risky. The worldwide web is a cruel place, we live in bubbles, it’s largely unpoliced, it’s easy to see it as more real than the ‘real’ world, and we can be badly hurt if we’re not prepared or emotionally robust enough to cope with the backlash when it comes.
Even if we are prepared, sometimes the price is just too high. I worry about all the trans people who are speaking up at the moment, in their homes, schools, towns, city halls, at regional and national government elections, in the media, in private and public sectors, in the NHS, the armed forces and in celebrity circles. I worry that a backlash is coming.
I worry that with the increased visibility we trans folk are enjoying, with the rising up of Trans Pride that corresponds with the loss of shame we feel as we step up to the plate, with the freedom that comes with being out, also comes the vitriol, the hatred, the discrimination, both overt and covert, the micro-aggressions, the unwarranted personal attacks and widespread vilification of whole communities of people just because they are ‘different’.
I worry that we haven’t even seen half of what is coming our way in this country. Dirt lifting to the surface. The political shift that we have seen these past 10 years is terrifying, and the internet is the place where the battle for what is right will happen.

OPINION: Sam Trans Man 

Posted on by Sam Hall

Dr Samuel Hall on the gender binary and how it’s the final hurdle in the battle for equality.

I recently glimpsed the potential to educate people about trans issues via this publication and its readership through a different lens. I’ve been writing for Gscene for almost five years, and although it often seems like an indulgence to me (I really enjoy writing so it’s great to have an outlet), I’m aware that by committing myself to paper, sometimes intimately, I’ve been educating others in the LGBT community in a way that I hadn’t foreseen. Reading Sugar’s column last month struck a chord – as a trans man and a trans woman, published side by side, I saw just how important it is that we (transpeople) have a voice, and I am so grateful to the proprietor and editors for that.

Despite historical and present day differences, a lack of understanding and perhaps education; despite the fact that many people in the LGBT community have forgotten, don’t know or don’t care about us, us trans folk are central to what it means and always has meant to be queer. Trans women of colour were at the heart of the Stonewall riots, and we’ve been at the vanguard of human rights-driven activism ever since.

If you’re a white gay male, the chances are you have been living a relatively ‘easy’ life for some time, compared to your forebears and the giants upon whose shoulders you stand. But don’t forget to look back down the human ladder you’ve climbed, to see where there is still persecution, loneliness, homelessness, desperation and fear of death from disease. And if you can’t see it on your doorstep, look further afield. Look at the ladyboys, the hijra in India, the sex workers in South America, the Latino and African-American trans women all over the States who are being singled out for transphobic hate and exploitation on a relentless loop which sometimes kills them.

Ever since I emerged from the horror show of my own coming out, I’ve become more and more passionate about changing how the world sees trans people. We need to be seen for who we are, with richness and diversity that is appropriate for a global community. We are, in international terms, a massive minority. We’re being increasingly heard, all over the planet, which is exciting, but also terrifying. Just as the world is beginning to see into the ‘gay community’ and realise that it’s anything but homogenous, so the LBG part of our community is beginning to see into ’T’ and experience the huge variation in language and expression around gender and identity. We’re men, trans men, transmasculine, non-binary, drag kings and queens, transvestites, transfeminine, trans women, women, and a whole lot more. We’re battering the binary with our language assault. Society at large cannot contain us. The #GendeRevolution will happen this century. More and more people will walk away from the construct we labour under. It’s so incredibly liberating to do so. My personal sense of freedom is particularly strong at the moment. I write on the eve of phalloplasty surgery, and I feel freer than I’ve ever felt in my life.

In fact, I can’t really believe how liberated I feel. It’s as though I’m on the brink of busting out of a cage that I’ve helped to make, but no longer want to live in. A safe place that we all know about and understand. A world rigid with rules about gender. A place I’ve run back to again and again since my early teens, each time I even came close to busting out I ran back. The light was too dazzling. I couldn’t have coped with the enormity of what it means to disprove the gender binary by crossing the uncrossable divide. This chasm that we’re all so sure of, live our lives by; it doesn’t exist. Trans people, by our very existence, are the bridge over the binary. We allow the imposed halves of humanity to unite in our bodies, and force a closer look at sex, gender and identity. Through our bodies, the rest of the humanity can see itself as it is. Unique, different, and yet the same. There’s nothing which connects us more strongly than this. No skin colour, biological attribute, disability, circumstance of birth, sexual orientation or gender identity is more important than the first and only significant denominator, our common humanity. We’re all one. For some reason, the gender binary and all the oppression it brings, seems to be the final hurdle in the battle for equality.

I shouldn’t be surprised. After all, the gender binary is common to all cultures, places and times. We need male and female forms of our species in order to reproduce, and we expect and respect the differences that biology confers, including the vast number of people who are intersex. But try to pick this apart from the gender roles and expectations that we apply in modern western society to children the minute they’re born, if not before. There’s no logic what so ever in assigning a set of rules to a child based on their genitalia.

It’s very important that we in the LGBT communities remain at the forefront of this discussion. However threatening it may feel, the thinking and language around the deconstruction of gender is essential if humanity is to survive. Once we separate biological sex from gender, we see that one is real, and the other isn’t. Trans people are victims of a societal construct that enslaves them, some cope with this by finding a way to express themselves that gives a sense of freedom, others are biologically ‘miswired’ and need to change their bodies to stop them feeling suicidal, and others still are rebelling against a binary construct that they can see is destructive to all of us. Until we break the hold that the gender binary has on society, women are trapped in oppression, men are trapped in perpetrator mode, and people who are neither are totally invisible.

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