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Trans Healthcare And Legal Protection: Changes In UK Law

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There are currently quite a few changes happening for transgender (or trans) people in the UK which directly affect trans healthcare and legal aspects of transitioning (making changes to live as your true gender, such as changing your name and undergoing medical treatment). Some, such as changes to the Gender Recognition Certificate (GRA; a document legally stating a trans person has transitioned from the gender they were assigned at birth to their true gender), are only proposed and not yet happening. Others, however, have had more immediate impacts. For example, the High Court Ruling around hormone blockers has a direct impact on trans youth receiving medical intervention. While the current situation in the UK is a little confusing and could be startling or distressing, it is important to be aware of what is going on and how it may affect you and the people around you.

Precedence

Historically, there have been several positive changes made for trans people in the UK. The introduction of both the Gender Recognition Act (2004) and the Equality Act (2010) allowed trans people to have their true genders legally recognised and, subsequently, protected them from targeted discrimination. The NHS (National Health Service), in cooperation with the Gender Identity Development Service (GIDS), previously provided hormone blockers to trans minors who wished to begin a medical transition. They would be given for at least a year, after which cross-sex hormones (testosterone and oestrogen) could be offered. Beyond GIDS, the NHS Gender Identity Clinic (GIC) handles trans people seeking their support over the age of eighteen. While there are still issues with these advancements, such as the use of outdated language like 'preferred gender' in the Equality Act and the long waiting lists of up to 33-36 months for a GIC appointment, the UK has previously seemed to be moving forwards in terms of accommodating and actively helping trans people.

Proposed Changes To The GRC

In an attempt to make the often lengthy and difficult process of obtaining a GRC, as worded by the government,  'kinder and more straight forward', the UK government reached out to LGBT+ members of the public, groups and charities to provide ‘evidence’. This evidence will inform changes around the GRC. The government's already-proposed changes would include transferring the process to an online medium, opening three new NHS gender clinics and reducing the £140 fee for a GRC.

Questions asked by the appeal for evidence included whether the proposed changes went far enough, if the spousal consent provision (requiring a trans person's spouse to agree with them getting a GRC and, if they don't, requiring that the marriage or civil partnership is annulled) should be removed and if the current age requirement for a GRC (eighteen and over) should be lowered.

While responses varied, some organisations such as The Proud Trust and the LGBT Foundation agreed on lowering the age requirement, recognising non-binary people (who are not currently legally recognised in the UK) and completely removing the spousal consent provision, sometimes called a 'spousal veto'. Many evidence providers seemed frustrated or confused by the proposed changes, considering them limited or barely indicative of any change at all. Miss Kali-Ann Gills, a trans woman who gave evidence for the appeal, said ‘having recently been made aware of the refusal to make any meaningful reforms to the Gender recognition act I have been left in a state of complete shock and bewilderment’ and that she is ‘left in a perpetual state of limbo neither one gender or the other, physically female yet, legally male’ by being unable to go through the process of obtaining a GRC.

Although the appeal for evidence is a positive sign of upcoming change, it's important to realise that the responses to the appeal do not dictate the exact changes which will happen. It is, however, an encouraging step forward from the government highlighting their acceptance towards positively changing trans legislation and improving quality of life for trans people in the UK.

High Court Ruling On Hormone Blockers

Despite the potential positivity of the GRC's proposed changes, there has been a development in trans medical treatment in the UK which is being seen by many as profoundly negative, especially for transgender youth. The  GIDS was successfully sued on December 1st, 2020 regarding their dispensing of hormone blockers which led a claimant, Keira Bell, to go down ‘the wrong path’ in transitioning from female to male. Hormone blockers are a common and reversible medical intervention for younger trans people which can pause the process of them living through the often distressing puberty of their assigned gender.

The claimants alleged that GIDS did not consider other options and pushed trans youth towards hormone blockers, while some feared for their children's future experiences at GIDS and the potential for them mistakenly transitioning. The High Court's decision makes it unlikely that trans people under the age of sixteen will be able to access hormone blockers without a court order of some sort, although the exact stipulations have not yet been made clear. The reasoning behind this that people under sixteen are being seen by the High Court as largely unable to give informed consent for this particular medical treatment.

As a result of this, GIDS has paused any new referrals to endocrinology (hormone-related medical services). Trans people receiving treatment currently remain unaffected, however they will be contacted by their endocrinology providers with more information. An important aspect of the ruling is that it applies to private healthcare providers as well as GIDS, so it is not an option to simply switch from the NHS to private healthcare to avoid it.

GIDS does plan to appeal the ruling, but the timeline currently not available to the public.  A larger concern is the mental health of trans young people who may have been one appointment away from being prescribed hormone blockers, as well as the repercussions of any potential further decisions to stop treatment for those currently undergoing it. LGBT+ people often already face tough mental health issues, with one in eight LGBT+ people in the UK attempting to take their own lives in 2018 (Stonewall, LGBT in Britain - Health). Above all, there is much uncertainty around the ruling and what it may mean for individuals at different stages of their transitions.

Disoriented and Confused

This is a time of confusion and change for trans people in the UK, as well as those close to them. Trans legal protection is being potentially improved, while healthcare for trans youth has faced what is being seen by many as a major setback. However, there is always hope to be found amidst of chaos. The government has actively chosen to listen to public opinion on the proposed GRC changes, meaning individual voices still matter. The GIDS plan to appeal the High Court Ruling can also give some hope to young trans people that this difficult medical situation around hormone blockers won't last forever.

The Aftermath

For trans youth, it may feel as if control has been taken away from their ability to transition. Luckily, there are still many aspects of transitioning which they can control. One accessible example is obtaining a deed poll, which is a completely free, legal change of name that can be used to for bank accounts, at schools/colleges and on official documents. Under sixteen, they require parental consent. However, if one is over the age of sixteen, it only requires either one or two witnesses to sign the document.

If you are currently on the waiting list for GIDS, undergoing assessment with GIDS or receiving treatment from GIDS, make sure that you check in with them to see what's going on with your individual case. Some patients will have already been contacted.

If you're distressed and experiencing a mental health crisis due to the changes, you can search the name of your local area and 'CAMHS mental health crisis number' to find a local resource which can help you. CAMHS is the NHS Children and Adolescent Mental Health Services. Regardless of emotional severity, talking to someone like a friend or family member, or even a teacher or GP, about personal troubles could help you understand how you're feeling and avoid bottling up your emotions.

As a cisgender person, you can still help out your trans friends, family and acquaintances. Reach out to them and make sure that they're okay, especially if the changes directly affect them. Be wary that mental health crises may be more likely and try to be open to talk about what's going on if they need you to lend a comforting ear, but remember that you can point them towards the aforementioned resources - don’t forget to take care of yourself as well!