Nonbinary healthcare (UK): Difference between revisions

Medical assistance with the [[transition]] process in the UK has historically only been endorsed under strict conditions, the most consistent condition being that the transitioning individual identifies as either male or female. Though the medical establishment lack recognised treatment protocols for [[nonbinary]] individuals seeking assistance with their transition, health professionals are beginning to recognise the need for the provision of relevant services.

Historically, eligibility criteria for medical treatment have presented a barrier for nonbinary individuals, specifically the 'real life test' (RLT) component which was later renamed the 'real life experience' (RLE). On the NHS London Gender Identity Clinic website there is a section regarding the RLE; ''"There is a two year Real Life Experience (RLE) of living in the reassigned gender role at the GIC for people who want to have genital reconstruction surgery (GRS). This is dated from the start of full-time gender role transition after which they can be assessed for referral for GRS. The RLE includes at least a year in some form of agreed occupational activities... The RLE sometimes called the Real Life Test is the period of time when a person lives 100% in their preferred gender. This means that they are known to their friends and family as well as at work (paid or voluntary) or at their place of study or daily occupation as their preferred gender. The literature and our own clinical experience, as well as the national and international guidelines,  are very clear that people have fewer regrets after surgery and hormones if they have had experience living all the time in their preferred gender. Consequently, before referring for surgery we do ask people to have completed the RLE"'' [http://www.wlmht.nhs.uk/gi/gender-identity-clinic/frequently-asked-questions/]. Nonbinary individuals requesting genital reconstruction surgery (GRS) may not be able to meet the RLE criteria for treatment as there is little social or legal recognition of the nonbinary demographic.

An article in the Independent newspaper published in 1995, includes a short interview with Dr Russell Reid in which he references people who have a 'desire to live between genders; ''“...many British psychiatrists regard the desire to live between genders with scepticism. Dr Russell Reid, a consultant psychiatrist who worked at the United States' first gender identity clinic, at John Hopkins University, Maryland, and now practices privately in London, believes that most androgynes suffer from a personality disorder, or are rebelling against society. “Unlike transsexuals,” he says, “their gender disorder stems from socialised behaviour and their own personality, rather than what some hormone has done to their brain”''. ''He adds, however, that they are often “very unusual, very bright, very alienated, very individualistic and feel strongly that they are who they are”... Dr Reid says his androgynous patients “have a terribly hard time in society – to be sitting on the fence just isn't acceptable””''. Dr Richard Green, former research director and consultant psychiatrist of the Gender Identity Clinic, London, was also included in the article as saying, ''“It's easier for us to put everything into pigeon-holes. We don't want to think about anything that’s in the middle. There are people, he says, who simply don't easily fit into our existing categories and their ambiguity can be threatening”''. The article begins by interviewing a small number of individuals from the UK who have undergone some form of 'gender'-related transition. One of these individuals, Zoltar Kattse, has had surgery privately to remove identifiable aspects of their 'sex' physicality as they felt from early childhood that they were neither male or female. Prior to medically assisted transition, Zoltar attempted suicide several times due to the intensity of the symptoms of gender dysphoria they were experiencing and was 'committed to a psychiatric hospital' where treatment consisted, says Zoltar, of ''“trying to force me to be female”'' [http://www.independent.co.uk/life-style/im-just-a-sweet-transgenderist-1613010.html].

* Excerpt from October 2010 meeting: ''“...Glasgow currently has a patient who has highly intellectualised the gender issues, he is biologically male and in between somewhere... Equality bill only mentions the male to female or female to male.”'' [http://www.sarahlizzy.com/blog/?p=61]

On 1 December 2010, the University of Cambridge Centre for Gender Studies hosted the final public forum in its series on gender and radical biomedical advances, ''“Transitioning gender: the challenges of radical technologies”'', in association with the Guardian and supported by Cambridge University Press [http://www.guardian.co.uk/commentisfree/audio/2010/dec/07/transitioning-gender-radical-technologies-debate]. One of the speakers was the aforementioned Dr Richard Green, who referenced ''“third gender or no-gender person(s)”'' seeking surgery to ''“remove breasts or male genitalia”'' and calls this a ''“medical dilemma for physicians because there’s no real life experience. Its either surgery or not”''. In the audio recording of the event, Dr Green ponders how NHS physicians decide whether to assist these persons and suggests there are three factors to consider; ''how persuasive is the patient's argument? Does the patient have enough money for private care instead? Is there a surgeon willing to perform the requested operation?''

At the Public Panel Discussion of Gender Reassignment Services in London (2007), Dr Stuart Lorimer confirmed that ''“the [London NHS] GIC follows a modified version of the Harry Benjamin Standards of Care... this was judged on a case by case basis”'' [http://www.translondon.org.uk/resources/LondonGRS.pdf]. The Harry Benjamin International Gender Dysphoria Association (HBIGDA) is now known as the World Professional Association for Transgender Healthcare (WPATH) [http://www.wpath.org/], they released version 7 of their Standards of Care in September 2011 which includes the following excerpt;

''"'''The SOC is intended to be flexible''' in order to meet the diverse health care needs of transsexual, transgender, and gender nonconforming people. While flexible, they offer standards for promoting optimal health care and guiding the treatment of people experiencing gender dysphoria – broadly defined as discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics) (Fisk, 1974; Knudson, De Cuypere, & Bockting, 2010b). As for all previous versions of the SOC, the criteria put forth in this document for hormone therapy and surgical treatments for gender dysphoria are clinical guidelines; '''individual health professionals and programs may modify them'''. Clinical departures from the SOC may come about because of a patient’s unique anatomic, social, or psychological situation; an experienced health professional’s evolving method of handling a common situation; a research protocol; lack of resources in various parts of the world; or the need for specific harm reduction strategies. These departures should be recognized as such, explained to the patient, and documented through informed consent for quality patient care and legal protection. This documentation is also valuable for the accumulation of new data, which can be retrospectively examined to allow for health care – and the SOC – to evolve."''

''“Many PCTs have limited budgets so some may defer funding, perhaps until the next financial year. If they refuse to fund outright, or you feel they are delaying unnecessarily, you can make a complaint to them or contact the Health Services Ombudsman”'' [http://www.wlmht.nhs.uk/gi/gender-identity-clinic/frequently-asked-questions/].