On Wednesday morning, Profesor Robert Winston made some wild claims regarding trans people on BBC Radio 4’s “Today” programme. He talked about “horrific” surgeries, extremely high surgical complication rates and linked this to a high level of regret. For those not familiar with the topic this might sound like solid science from a respected personality.

It’s not science.

One possibility is that he’s just clueless about the topic. After all, he’s a fertility rather than gender specialist. Another option is that he’s dishonestly using statistics to engage in scaremongering based on a political, not scientific, viewpoint.

Winston made equally wild claims about cycle lanes causing pollution last year. He didn’t say what paper he was referring to so he couldn’t be fack checked. This time, he sourced his claims the following day via Twitter and the article is available online for a fee.

One of Winston’s statements on Radio 4 was that there are complications in about 40% of trans surgeries. That figure does not appear in the paper. It actually says the complication rate is 32.5%, but we also get into confusion over terminology.

You see the same confusion with “elective” vs “emergency” surgery. These are medical terms with specific meanings not apparent to the layperson, and elective just means it was scheduled in advance, but it can still be life-saving surgery. And if you worry about such things, don’t ever read the patient information leaflet for Ibuprofen. Apparently, it causes heart attacks.

Someone as senior as Winston is no doubt aware of the possibility of confusion when using technical terms. But he wants us to believe trans surgery is terrible, so he abuses this confusion and talks about complications then moves on to “horrific” surgeries. He leads the listener to believe that all complications are “horrific” and many surgeries have unwelcome results.

They don’t.

Most complications are minor, and might not even register with the patient as a complication. For example, nearly half (44%) of the complications in the study are “Meatal Stenosis”. These form the bulk of the 21.7% “reoperation” rate, largely from one German study (The paper is available for free, but contains graphic genital surgery images not suitable for an office environment) It might sounds serious and make it seem like SRS is Germany is very dangerous. However, in lay terms, it means “you probably piss in a funny direction, or dribble a bit”. The fix is minor in most cases and might not even need an operation. The Germans seem to use a two-stage technique, so appear to be unfussed by needing “re-operation” – they have already scheduled a second-stage operation.

Some things can go wrong of course, as with any surgery, but most of the “complications” are in this vein or even more minor.  A bit more bleeding than was expected or some tissue granulation.

Now we get into issues of individual agency. If the patient understands the possible consequences of a treatment and has given informed consent, isn’t that OK? Even with the scary prognosis Winston paints, it’s better than the alternative of a lifetime on Spironolactone or Zoladex. And that’s before we worry about the mental health issues involved.

I am a liberal, and I believe firmly in individual agency. It is entirely possible Winston has a more authoritarian view on this. But without knowing his views on similar issues such as abortion and the right-to-die, I don’t know what his outlook is.

Having planted the scary 40% figure in people’s minds, Winston then goes on to conflates regret with surgical complications. Signal boosting stories of regret and framing the debate to exaggerate regret rates is sadly a common anti-trans media tactic right now. However, trans surgeries have one of the lowest regret rates of any surgery – recent studies report it as being around 1-2%, with a meta-study looking at papers all the way back to 1960 when surgical techniques were less developed still only places the figure at 2.2%. For comparison, surgical regret rates for prostate surgery was a whopping 47% in one study. Another paper found that breast cancer surgery had a 24% regret rate.

Finally, the programme was nominally about trans children.

Children can’t get surgery.

Longtime readers of this blog will recall that I have previously written about the census in some detail. And if you’ve been about the last day or so, you’ll have seen the fuss over the news that the Office of National Statistics might make declaring your sex optional in the 2021 census.

The full details are not known as the Sunday Times story is from a leaked report and contains few details. This did not stop the Times breathlessly rushing to get quotes from two well-known anti-trans “feminists”. It seemed no trans people were asked for quotes.

The misreporting around this issue is even more widespread than usual for trans-related stories. Misreporting caused by concerns that facts will get in the way of a good headline that further demonises trans people. So here are some myths already doing the rounds, debunked.

Myth: Gender will no longer be recorded in the census, or we will have inaccurate data on gender
There are many forms in existence in which make gender optional, and most people still tick the appropriate option. Religion is a far more sensitive issue and even when the question was made optional in the 2011 census, only 7% of people chose not to provide an answer.

And the Office for National Statistics are likely to use “imputation” to fill in the gaps – a system they routinely use and causes problems analysing statistics for minority communities, such as trans people and poly households. In a nutshell, if you put your name as Mary and don’t tick “Female”, the ONS may still record you as female in statistics.

Myth: This will erase women’s identity
Tick the box, or don’t tick the box. Your choice, nobody else’s. Established religion has not disappeared since the question was made optional in 2011.

Myth: Trans people and only trans people will not answer the question, which is why it’s optional
Most trans people identify more strongly with one gender than the other, and are likely to simply tick the box they most closely identify with. The groups most likely to skip this question are, roughly in order of likelihood:

  1. Those who think it is “none of your damn business”. (A view that’s been held by some feminists quite separate from trans concerns for some time)
  2. Respondents who didn’t understand the question, perhaps because of language issues
  3. People who simply couldn’t be bothered.
  4. Non-binary people

I predict that we will see some attempts to extrapolate the non-binary population of the UK based on 2021 data. I doubt such extrapolations will be valid.

Did the Office for National Statistics get this right?
In a word, no. At least, it doesn’t look like they have but it is hard to say until the final report is published – it may be that there has been selective quoting from the report in the original article (£) and the ONS considered other factors more important. In particular, I find it a little over the top for a government report to state that asking about sex rather than gender is reallys “unacceptable”. But that may have been one side point in a longer article, or reporting the views of a focus group.

And “Other” was rejected because it was “thought to homogenise trans people and differentiate them from the rest of society“. That statement suggests that whoever wrote the ONS report has a tentative grasp of trans issues at best, as it is only true if you start from the assumption that all or most trans people will tick “other”. Liberal Democrat Conference speakers cards have an “Other/Prefer Not To Say” option on them for gender for over a year, and we have not had any complaints about that. If we were going to get complaints about getting an equality issue wrong, that’s precisely the environment in which I would expect them to surface.

And finally, there seems to be some conflation in the quotes between non-binary and intersex issues. It is unclear why the ONS has lumped intersex people in with non-binary people in this way, as they are overlapping but still distinct groups in much the same way as being Irish and having red hair are.

Last Saturday, The Times published an opinion piece by Janice Turner in which she tells a version of events that took place at Speakers’ Corner last week during a protest by trans activists. By the time of publication, Janice’s narrative of an elderly woman being beaten up had already been proven false by video circulating on YouTube. This is my letter to the editor in response to that piece, sent on Saturday afternoon – The Times have chosen not to publish it.

Dear Editor,

I am writing in response to Janice Turner’s article “The battle over gender has turned bloody”.

Janice seems to be unaware that the incident which occurred during a protest last week was videoed and that it was posted on YouTube. The video tells a very different story to the one she presents, in which she claims a trans activist committed an unprovoked assault on a 60 year old woman. Or perhaps she has taken a leaf out of Donald Trump’s campaign playbook, and wants to try to establish her view as the pure and unadulterated truth regardless of the evidence to the contrary.

What the video shows is Janice’s “60-year-old in specs and sensible shoes called Maria”, who she clearly want to portray as someone defenceless, holding a trans activist in a headlock and trying to kick them repeatedly. I understand the police were called, viewed the video and concluded no action was needed because Maria’s injuries had been sustained as a result of her being pulled off by one of the activist’s friends.

Although stills are available, the video has since been taken offline. Presumably because the person who posted it realised that crying foul when you sustain injuries in the process of assaulting someone else is not a good PR tactic.

I condemn all violence. If Janice wants to condemn violence, she too should condemn all violence. Not just those incidents that help prop up her narrative of hate.

Yours,

Councillor Zoe O’Connell

Companies House advice on dead names
A topic that comes up frequently in Trans circles is the problem of “Dead” (I.e. pre-transition) names, something that many trans people are reluctant to make public for a whole variety of reasons. Unfortunately, many forms ask for this information with the assumption that most people who have changed names have only done so because they have married.

I ran into this problem myself just over a year ago, in the context of a charity I became trustee of as a result of my role as a councillor. Neither Companies House nor the Charities Commission actually require this information but that is not made clear, and when holding public office it is often necessary to dot the i’s and cross the t’s on paperwork to avoid unforeseen repercussions later on. I asked both organisations for confirmation, and I reproduce both their responses complete with reference number in the hope that it helps others in future.

Charity Commission advice on Dead Names Click the images for full size versions, and plain text versions of the respones from Charity Commission and Companies House are also available if anyone needs them.

I have not been keeping a particularly close eye on online pharmacy services for a while, but an interesting email from InHouse Pharmacy sent to their customers has come my way – and it suggests that the ongoing pressure on online pharmacies has not let up recently, with international payment provider OrbitRemit now refusing to serve online pharmacies.

I could not find any further information about this change on either InHouse Pharmacy or OrbitRemit’s web sites, although I did run across an FAQ on IHP’s web site that’s now specifically blaming “BigPhama” – something that’s long been assumed to be the root cause of their problems, but had not previously been confirmed: “Unfortunately we no longer accept Visa Debit and Credit Cards or MasterCard due to lobbyist pressure from BigPharma interests.

The good news for IHP and those using their services is that Bitcoin is becoming increasingly mainstream and now list this as their preferred payment option. Although it offers no buyer protection compared to other services, it is hard to see any way that pressure can be brought to bear on IHP via this route.

State Opening of ParliamentI noticed a couple of the usual outlets today reporting that the Queen’s speech included measures to protect LGBT+ people. So I went to check the text – and that’s not quite what it says:

My government will make further progress to tackle the gender pay gap and discrimination against people on the basis of their race, faith, gender, disability or sexual orientation.

That is a half-complete list of the protected characteristics from the Equality Act 2010. The complete list is race, faith, gender, disability, sexual orientation, age, marriage/civil partnership, pregnancy/maternity and gender reassignment.

I can understand why some of these might not be included if the topic is employment protections – but the exclusion of gender reassignment given the track record of both the DUP and some (not all, thankfully) of the Conservative Party on these issues is worrying. I hope this is merely an oversight, but it seems worthwhile keeping a close eye on any legislation that comes forward during this parliament, to make sure it is fully inclusive.

It would be very easy for someone to slip through legislation that misses or even penalises trans people while parliament is busy dealing with Brexit.

 

Update: I have now received a copy of the briefing notes for the Queen’s Speech, and whilst they do include trans-related provisions they are all in the past tense. There does not appear to be anything in here for LGB people, let alone T+!

LGB&T Equality

• We have established a £3 million programme from 2016 to 2019 to prevent and address homophobic, biphobic and transphobic bullying in schools.

• To support transgender equality we have increased investment in Gender Identity Services and issued new guidance to prisons on the treatment and management of transgender offenders.

 

Parliamentary copyright images are reproduced with the permission of Parliament – yes, I know it’s a photo from the wrong year but free-to-use ones aren’t up yet

It will come as no surprise to anyone following the results that no trans members of parliament were elected yesterday, as despite the shock over the overall result relatively few seats actually changed hands. However, a record number of people standing (9) also means some record results – yesterday saw three trans candidates gaining second place. The last time a trans candidate at a parliamentary level reached second place was also the first known trans parliamentary candidate, Alexandra “Sandra” MacRae, who stood for the SNP in 1992.

General elections are predominantly national rather than local campaigns, and the fates of trans candidates have followed those of their party colleagues standing elsewhere – Labour up but with limited gains, Liberal Democrats slipping slightly in non-target seats and the Greens struggling to make an impact.

Liberal Democrats Helen Belcher
Chippenham
2nd place, 25.6% (-3.8%)
Majority: 29.1%
Green Party Aimee Challenor
Coventry South
5th place: 1.3% (-2.6%)
Labour Sophie Cook
East Worthing & Shoreham
2nd place, 39.3% (+19.8%)
Majority: 9.3%
Green Party Andrew Creak
Caerphilly
(Non-Binary)
6th place, 1.1% (-1.2%)
Liberal Democrats Charley Hasted
Swansea East
(Non-Binary)
5th place, 1.8% (-2.4%)
Green Party Dom Horsman
North West Durham
5th place, 1.1% (-2.6%)
Green Party Lee-Anne Lawrance
Runnymede and Weybridge
(Non-Binary)
5th place, 2.6% (-1.5%)
Zoe OConnell Liberal Democrats Zoe O’Connell
Maldon
3rd place, 4.3% (-0.1%)
Labour Heather Peto
Rutland & Melton
2nd place, 22.7% (+7.3%)
Majority: 40.1%

 

Photo sources – not all Creative Commons. Please check before reuse:
Helen Belcher, Charley Hasted: Liberal Democrat candidate promotional literature.
Aimee Challenor: CC BY-SA 3.0, credit Green Party of England and Wales.
Sophie Cook: Labour party candidate promotional literature.
Dom Horsman, Lee-Anne Lawrance: Provided by the candidates for use on this blog.
Zoe O’Connell: CC BY-SA 3.0, credit Zoe O’Connell.

And so, with polls closing in the last set of elections less than a week ago it is time for another election – 4pm today was the deadline for candidates in the upcoming General Election to get their nomination papers in.

This year’s local elections saw relatively few openly trans candidates with only three people putting their names forward, and no winners. That might seem relatively few, but county elections often produce a different crop of candidates to district councils and three was at least an improvement on the last set of council elections, 2013, in which no known trans people stood.

Against that background, and given this was a snap election in which parties would have less time to ensure a diverse slate of candidates, it would not have been surprising to find fewer openly trans candidates standing than in 2015.

But politics at the moment is defying expectations, and trans candidates are no exception with a record of six eight nine trans and non-binary people nominated – four Green, three Liberal Democrats and two Labour. This compares well to four in 2015 and none in 2010.

As ever, if you know of anyone I have missed (and you are certain they are out!) please do let me know.

Liberal Democrats Helen Belcher
Chippenham
Swing required:
9.1% (2015)
-3.9% (2010 – held seat)
Green Party Aimee Challenor
Coventry South
Swing required:
19.2% (2015)
20.2% (2010)
Labour Sophie Cook
East Worthing & Shoreham
Swing required:
15.0% (2015)
15.9% (2010)
Green Party Andrew Creak
Caerphilly
(Non-Binary)
Swing required:
21.0% (2015)
No Green candidate in 2010
Liberal Democrats Charley Hasted
Swansea East
(Non-Binary)
Swing required:
24.5% (2015)
16.6% (2010)
Green Party Dom Horsman
North West Durham
Swing required:
21.6% (2015)
No Green candidate in 2010
Green Party Lee-Anne Lawrance
Runnymede and Weybridge
(Non-Binary)
Swing required:
27.8% (2015)
27.3% (2010)
Zoe OConnell Liberal Democrats Zoe O’Connell
Maldon
Swing required:
28.1% (2015)
20.3% (2010)
Labour Heather Peto
Rutland & Melton
Swing required:
20.1% (2015)
18.5% (2010)

 

Photo sources – not all Creative Commons. Please check before reuse:
Helen Belcher, Charley Hasted: Liberal Democrat candidate promotional literature.
Aimee Challenor: CC BY-SA 3.0, credit Green Party of England and Wales.
Sophie Cook: Labour party candidate promotional literature.
Dom Horsman, Lee-Anne Lawrance: Provided by the candidates for use on this blog.
Zoe O’Connell: CC BY-SA 3.0, credit Zoe O’Connell.

Unsurprisingly – given there were only three candidates standing versus ten last year – none of the openly trans candidates were successfully elected on Thursday.

I will be posting my list of General Election candidates after the nominations close on 11th May, and the notices of poll have been published.

Labour Sam Feeney
Cambridgeshire, St Ives North & Wyton
3rd place: 17.3% (New boundaries, so no %age change)
Mridul Wadhwa
Edinburgh, Craigentinny/Duddingston
6th in a 4-member division, 6.3% of first preference votes
Alex Bear
Derbyshire, Ripley East and Codnor
4th place: 2.2% (+2.2%)

There was hand-wringing piece in the Independent yesterday about an Essex pharmacy that provided a journalist with HRT. It’s so bad and on so many levels that I felt it worthy of mentioning here specifically. However, this is hardly an isolated incident – the media have a very long history of trying to scupper trans healthcare, including David Batty’s persecution of doctors practicing trans medicine and past efforts by the BBC, similar to this one, to shut down entirely legal sources of medicine.

Turning back to the Indy piece, sources such as the pharmacy they mention are often a lifeline for people who can’t get medication in any other way. Even having had to wait, sometiems years, to get help many people subsequently find their GPs refuse to prescribe drugs because it goes against their religion, even when recommended by a specialist. Or they live somewhere where they can’t access specialist care without long journeys – there is no Gender Identity Clinic anywhere in Wales, for example. (Fortunately, there are moves afoot to remedy that particular problem)

This isn’t due to a lack of evidence of the effectiveness of health care – research has shown that blocking health care for those seeing transition is extremely dangerous, with the suicide attempt rate for those unable to access services at around 50%.

The Indy also plays up the risks of HRT, which if you believe the tone of the article must be incredibly dangerous, and state that it shouldn’t be “used unmonitored”. However, amongst the long-term-transitioned trans women I know of who have been able to find a stable supply via cooperative and responsible GPs, none are being monitored – because the real world risk for most people is not high enough to make it worth the GP’s time. Progynova is even an over-the-counter medicine in some countries, such as Spain.

In case you’re wondering, the side effects list of an over-the-counter drug in the UK such as Ibuprofen includes difficulty breathing, vomiting blood, stroke, liver failure, heart failure and heart attacks. If there’s a lesson here, it’s “don’t read the side effects list on the leaflets”.

Finally, the headline cites “Fears of ‘DIY transitioning’“. DIY transitioning is exactly what people have been doing for decades because the press and medical establishments have a long history of making it as hard as possible to access treatment.

To be clear, having to defend grey market medication is a far from ideal situation to be in. But it is disingenuous to harp on about the “dangers” of these sources, while ignoring the effects of cutting off that supply. And trawling forums for “exclusives” like this is terribly dangerous and will just force desperate people further and further underground, where they’ll end up being taken advantage of or finding sources of supply that are really dangerous. I imagine many people will be wary of asking for help on that particular Reddit forum after it was cited by the paper.