Living in perpetual gender transition
Feature article by Oscar Sharples
Gender transition is a complex, painful, and beautiful process. On top of facing transphobia from friends and family, trans people’s access to healthcare is relentlessly attacked, and we are increasingly used as topics for public ‘debate’. Even the luckiest of us face unthinkable violence, spend years on waiting lists — our mental health suffering as a result. Transition is also the way that we find ourselves, become comfortable in our bodies, and build a family with one another. In this way, gender transition can be seen as a never-ending process of growth and discovery.
My transition didn’t begin when I came out, when I started taking hormones, or when I had surgery. It began when I realised that my gender was mine. When I asked my primary school friends to call me George. When I forced myself into ‘boys-only’ football games. When I got called ‘he’ for the first time. It continued when I gave girlhood a try, finding it painful. It continued when I became a boy, a son, and a brother.
A big part of my transition was medical. Years of gruelling and dehumanising referrals, waiting lists, and assessments. Having to act to gender services as a mature, stable, resilient person who knows exactly who they want to be — when, in reality, I was 14, had lost friends and family due to my gender, my mental illness was untreated, and all I wanted was for my body to feel safe.
Many people don’t want to medically transition, and those that do all take their own paths. For some it’s puberty blockers, oestrogen pills, laser hair removal, facial feminisation surgery. For others, its peri-areola chest reconstruction, hysterectomy, phalloplasty. There is a long list of ways we try to make our lives that little bit easier to live.
But although these treatments exist, we spend every day fighting systems that stand in our way of reaching them. Puberty blockers have been the focus of recent discussion. Even though the GIDS (Gender Identity Development Service) states that puberty blockers are a reversible treatment, they do come with risk: according to the NHS, it is not known whether hormone blockers affect the development of the teenage brain or children’s bones. On the other hand, studies such as that by Turban et al. in 2020 evidence that puberty blockers drastically reduce young people’s risk of suicide. The NHS Gender Identity Clinic (GIC) states that as of March 2022, they have 10,648 people on their waiting list, and are receiving an average of 350 referrals a month. They are so far behind with these referrals, that they are currently offering first appointments to people referred in December 2017. People are waiting over 4 years without a single appointment, even though the NHS Constitution of 2021 sets out that patients should not wait longer than 18 weeks from GP referral to treatment. There are only 7 gender identity clinics across the whole of England, only one of which accepts referrals from under 17’s. Mixed with increasing demand and funding cuts, these waiting lists only continue to grow. Trans people are put at immense risk of self-harm and suicide during this time, and we are not strangers to losing loved ones to these waiting lists.
Waiting time statistics are simply the structural expression of a disregard for trans lives that runs deep. We are misgendered, mocked, attacked, and shunned. We’re excluded from bathrooms, sports teams, and even our own families. Those that survive the waiting lists face NHS staff scrutinising their gender identities, family and friends. At every gender clinic and GP appointment, trans people’s identities are called into question. The length of time they’ve been out, their clothing, hairstyles, and mannerisms are totalled up, and if they don’t reach the clinic’s expectation of what a trans person should look like, they risk being denied treatment. This effects nonbinary and genderfluid people most harshly. We all wake up every day to news of people campaigning to abolish the medical transition facilities we do have. Trans youth face the brunt of this, as their capacity to consent to medical treatment is constantly called into question. This is despite the fact that the only treatment youth can access are hormone blockers, which essentially pause puberty, to give the child more time to explore their gender identity. If the young person eventually decides to transition, they are saved from experiencing gruelling teenage years going through a puberty that causes gender dysphoria, depression, and often, risk of suicide. Furthermore, the NHS’s Gender Identity Development Service (GIDS) advises that if, upon further thought, the young person decides not to transition, they can go off puberty blockers, and puberty will resume as normal. The risks that are associated with puberty blockers are therefore remarkably fewer than the risks attached to denying a young person the right to comfort in their own body.
I was incredibly lucky that I only had to wait nine months for my first appointment at the Tavistock and Portman, the only clinic that provides healthcare for trans youth in the UK. Despite this amazing head start, the fight didn’t end with my first appointment. I was under the care of the Tavistock clinic for two years. This involved travelling to London every few months, where the staff would question my mum and myself about my gender presentation as a child, my sexuality, my relationship with my father, whether I wanted to have biological children, my mental health, my friendships, the list goes on. Although the Gender Identity Development Service (GIDS) acknowledges that untreated gender dysphoria causes anxiety and depression and thus many trans people struggle with their mental health, I was forced to put on a carefully calculated act of ‘unhappy with my body’ but ‘totally stable enough to receive treatment’.
When I turned 17, I transferred to the Laurels adult gender identity clinic in Exeter. Just after I turned 18, I started hormone replacement therapy — my first treatment after four years of being under gender services. I received top surgery the year after.
Medically transitioning was like finally having a migraine end and truly realising just how painful it had been. After six years of binding my chest — pulled muscles, torn skin, and bruised ribs — it was over. I got to watch a stranger’s face fade away in the mirror and be replaced with my own. It’s been nine months since I had top surgery and I can say with absolute certainty that I have lived more in these months than I did the previous nine years combined.
I am so grateful for all the past versions of myself. There’s the boy, messy unbrushed hair down to his chin, sweaty from playing football all day. There’s the girl who tamed her hair in tight plaits and hid behind a band T-shirt. There’s the boy pained by the fact his body isn’t what he wants it to be. I wouldn’t exist without them. I’m grateful for the people who fought for me no matter what. For the healthcare I received. Because I am a success story. I am the culmination of new medical treatments and privilege and luck. My story is one of ease and security compared to the vast majority of trans people. I’ve had an accepting mother who has fought for me, and I live in a country that allows me to have hormone replacement therapy and surgery for free on the NHS, even though the wait is excruciating. If I had undergone the same process a few years later, at that four-year mark when I started Testosterone, I would only just be having my first appointment. I would encourage everyone to learn about the transitions of those who don’t have the advantages I have had. The people who lost their lives to these waiting lists. The people who have experienced unimaginable violence from strangers and loved ones. The people who can’t medically transition due to health conditions, and those who can’t access treatment in their own countries.
My transition also didn’t end when I came out, when I started taking hormones, or when I had surgery. It continues in the way I wear too many necklaces, and in my ridiculous Doctor Who earrings. In the monobrow I refuse to hide. In the way I make myself heard, in the way I proudly wear these scars on my chest, and in the man that I continue to become. My transition continues in the way I surround myself with those who are in a transition of their own, so that we may create the most beautiful people, together.
All illustrations are created by Oscar Sharples