Thursday, 21 June 2018

The WHO removes Trans identities from the ICD 11 Mental Health Disorders section


July 18, 2018: In what is a historic announcement for activists, the World Health Organization (WHO) has acknowledged the rights of trans people[1] to have their gender identities without prejudice, persecution or stigma. 

A new online version of the International Classification of Diseases version 11 (ICD11) has removed gender identity related diagnoses from the chapter on mental health disorders. Instead, the WHO has created a new set of trans-related diagnostic categories for adults, young people and children. These have been placed alongside physical illnesses, disorders and syndromes in the chapter “Conditions related to sexual health”.[2] 

Patients will now receive the diagnosis of ‘Gender Incongruence’, which has three subsections:
·        HA60 Gender incongruence of adolescence or adulthood
·        HA61 Gender incongruence of childhood 
·        HA6Z Gender incongruence, unspecified 

Effectively ICD11 acknowledges the reality of the experiences of people with trans- gender identities and gender incongruence, and that these are normal human variations. With ICD11, the WHO is signposting a requirement for trans health care to be provided without the added stigma of a mental health diagnosis.

Activists from the global trans community have been demanding these changes for well over twenty years. The medical psychopathologizing of gender incongruence, often based on nothing more than moral and religious indignation, allowed the systematic, institutional and personal abuse of trans people. Research has demonstrated a global, universal experience by trans people of transphobic prejudice, discrimination, harassment, violence, and criminalisation of trans people’s core identities.
The announcement and publication of ICD11 should signal the end for any vestiges of historical, abusive transgender ‘mental health’ practices such as aversion therapy, compulsory sterilisation and enforced hospitalisation.
Julia Ehrt, Executive Director of Transgender Europe, on hearing the announcement said
 “This is the result of tremendous effort by trans and gender diverse activists from around the world to insist on our humanity, and I am elated that the WHO agrees that gender identity is not a mental illness.”[3]
Trans people in North America[4] will continue to experience the stigma associated with a mental health diagnosis. In the rest of the world, though, these new diagnostic codes should mean significant, positive changes for all trans people pursuing any health care, including gender-affirming and reassignment treatments.

Details of the WHO ICD11 categorisation of Gender Incongruence can be found here  



[1] Trans refers to those people who experience their gender identity as different from that assigned at birth.
[2] World Health Organisation (2018) 11th Revision of the International Classification of Diseases (ICD-11) for Mortality and Morbidity Statistics, Chapter 17 Conditions related to sexual health: Gender Incongruence (Foundation Id : http://id.who.int/icd/entity/411470068) at https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f411470068 , acc. 19/06/2018
[3] Transgender Europe (2018) World Health Organisation moves to end classifying trans identities as mental illness, 18 June, at https://tgeu.org/world-health-organisation-moves-to-end-classifying-trans-identities-as-mental-illness/ acc. 19 June 2018
[4] American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.) (DSM-5). Arlington, VA: American Psychiatric Publishing is used, primarily, to code mental health conditions in North America. DSM-5 replaced the previous categories contained under Gender Identity Disorder, to an overarching diagnosis of gender status of a mental health condition




Monday, 14 May 2018

GenderQuake: The Diversity Debate Briefing

Channel 4 Gender Quake                  

Diversity Debate Briefing        

© Stephen Whittle for Press for Change 7th May 2018

Prior to the Channel 4 Gender quake debate, my friend Kate Bornstein, asked if I would brief Caitlyn Jenner on some of the key issues here in the UK.

As such I prepared this briefing for Caitlyn.  

After speaking to Caitlyn, Channel 4 contacted me and asked me to go to London and take part, as they wanted me to answer a question on the history of the Gender Recognition Act 2004 and how attitudes had changed in the UK. I find travel increasingly painful and tiring, and now problems with muscle tone in my oesophageal flap are such that I need to sleep in a sitting position, or choke as the flap falls over my trachea.  London hotel’s rarely have a decent armchair in the bedroom, nowadays never mind an adjustable bed. However the armchair was promised, and though I really did not want to take up Channel 4’s offer, our kids were not going to let the opportunity for at least one of them to meet Caitlyn Jenner pass by, and my daughter who lives in London really wanted to go with me.

I offered this briefing to the other panellists I was able to find contact details for. This was all very last minute, so the only other panellist able to take up the offer was the journalist Ash Sarkar, who on the night did a sterling job along with Munroe Bergdorf and Caitlyn Jenner of maintaining personal dignity, whilst doing an excellent job of arguing the case for trans inclusivity.

It was obvious from the minute they seated us that they had no intention of asking me a question, but we got to meet some heroes; trans man and male model Kenny Jones and his girl friend who we chatted with over drinks, and of course Ash Sarkar the journalist I have admired for some time, who has now jumped to the top of my list.

The trip down to London was OK, but the hotel was not great – it was roasting hot, the armchair was a saggy mini sofa without a back, so useless. Consequently I barely slept, which has affected the remainder of the week, with my MS related fatigue levels knocking me out for Friday and Saturday, which has meant working all Sunday. I tell you, Channel 4 already owes me a lot, but now they are arguing that it never agreed they would pay for me to have an evening meal before the show!

Was it worth it? No, not really. We know the debate was pretty grim – too little time, and consequently shallow. As we know it descended into heckling with a group of women shouting ‘penis’ every time Munroe Bergdorf spoke. We also realised Germaine Greer at 80 is developing memory problems. I love the way she complains about having been the tallest girl in school, she should have tried being one of the shortest – not a great starting point for a trans guy.

 Monroe was fantastic, and she stood her ground. Ash and Caitlyn provided her with as much back up as they could get in, including Caitlyn also asking, along with Munroe, for the hecklers to be removed. I suspect Channel 4 did not remove them because that was the show they wanted all along.


But, what was good was
  • managing to touch base with Caitlyn Jenner, who one cannot
    deny was a poor choice to represent anything about the lives of ordinary working and middle class trans people here in the UK. However, she was very keen to show that she understood our concerns about her role, and she was very willing to learn. We couldn’t have asked for more from her.
  • getting the picture that my daughter really wanted (there was a time when trans women and trans men never travelled anywhere together, one can see why we were fearful of being 'clocked'). 


Below is the briefing I prepared. Part A gives guidance on how to answer 4 key questions:
1. Are you a woman (or a man)?
2. Can the law make someone into a woman or a man?
3. Should the Gender Recognition Act be updated? 1
4.Would updating the Gender Recognition Act allow men into women-only spaces?

Part B (1) addresses the proposals for updating of Gender Recognition and Equality Legislation, and Part B (2) some current concerns regularly raised to PFC's free legal advice service by members of the UK's trans community, in particular these cover
1. Trans Prisoners
2. Trans Children and Adolescents
3. Trans Asylum Seekers
Finally Part C gives a short history of PFC and some background to our community’s activism.

I hope that at least one decent thing came from this ghastly pseudo debate; a decent briefing which you find useful.

© Stephen Whittle 14 May 2018

Part A: Key Questions and Answers                                                           

1.    Are you a woman (or a man)?

Primary Answer: We don’t know the answer to that, but neither does science or anyone else. A man is a social construction. However, male and female are biological categories which were defined when science was not properly aware of the complexities of the ‘natural’ body.

Secondary Answer: The Gender Recognition Act provides a legal not a scientific status. The Act is not about secrecy, it is about privacy; a right to have a reasonable level of privacy about one’s medical history, which is only the concern of a person’s doctors, and their life partners.  

Stephen’s Additional Answer: I was born female, I grew into manhood. I was a deeply unhappy child, then a suicidal teenager. At 19, I became ‘a Stephen’, and being ‘a Stephen’ has turned out to be the best decision I ever made. But what ‘a Stephen’ is, requires a very complex and considered answer. However, my wife, who says she knows exactly who I am; and it is definitely a man.

2.    Can the law make someone into a woman or a man?

Primary answer: The Gender Recognition Act provides a legal, not a scientific status. The Act recognises how someone is living, not what they were labelled at birth. It was about improving personal safety for trans people and providing some protection from the hard knocks of prejudice and discrimination we so often experience.

Secondary Answer: Should a quick glance by the midwife determine a person’s life chances and opportunities? Biology is very reductive and limiting; gender is a complex social construction. The Act acknowledges the complexities of gender, within a framework of improving Civil rights and Personal Safety.
PFC’s campaigning for the Gender Recognition Act 2004 was clear that;
·        nothing PFC would do, would remove the rights of others, and
·        no one was to be left behind.
The major beneficiaries of the Act have not been trans people (the prejudice still exists), rather it has been for the people who love trans people, who have been able to have their status also recognised in law; as wives and husbands, parents and children.

Stephen’s Additional Answer:  Thank god I am a lawyer, and don’t have to concern myself with anyone’s aetiology. My concerns are with the human rights of each and every one, and trans people fought a very long and hard battle for their human rights. What the Act meant for me and my family was that 13 years ago my wife was able to have a wedding ceremony in which friends and family celebrated the already 26 years of commitment she had made to me (and me to her). Our children were able to have a father, not just over the breakfast table, but also on their birth certificates.

3.    Should the Gender Recognition Act be updated?

Primary Answer: Yes. The Act was state of the art at the time of its making, but new science and new knowledge now means we should amend the Act to acknowledge the reality of trans lives. Obtaining a diagnosis of Gender dysphoria on the NHS can take 3 to 6 years – that is 3 to 6 years in which the life you lead is effectively not recognised.
‘Self-identification’ doesn’t mean anyone can get legal gender recognition, but it would mean trans people no longer have to be diagnosed as having a mental illness.

Secondary Answer: A change to ‘self identification’ in the law, will simply unify the current system we use to be recognised as ourselves by others. Before the Gender Recognition Act 2004, self-identification was all that trans people could do; we changed our names, applied for a new driving licence and started living as ourselves. That system was all we had for over 50 years – and it was without reports of men getting new passports, so they could enter the ladies loos and commit crimes.

Stephen’s Additional Answer:  Does anyone really imagine a criminal man pretending to be a woman going through the motions of obtaining a Gender Recognition certificate?  This would mean altering his legal status throughout his life; getting a new passport as a woman, changing his gender on his driving licence, his employment record, his pay slips, his bank card, his medical records, and having his educational and professional certificates altered so he can commit a crime in the ladies’ loos. Of course not; the system will be no different from how it is today, except that trans people will not have to wait as long to have their status – the daily life they are living and working in – recognised by the law.

4.    Would updating the Gender Recognition Act allow men into women-only spaces?

Primary Answer: Currently, any man can dress up as to enter a women’s loos (for example) to commit a criminal offence. That has always been possible. If that man had obtained gender recognition so as to commit those crimes, that would have been a fraudulent application, and have no legal validity. He would find himself in double trouble.

Secondary Answer: A man who did that would get called out, be arrested and go to jail for some time. Amending the law would not change that.
The alternative proposed, is to ban all people from changing their legal gender, unless they have full genital reconstruction surgery, and then enforcing that rigorously by having physical examinations of applicants. This would Lead to many untimely deaths of bright, funny and clever people who have something to teach us all about what it means to be human.  

Stephen’s Additional Answer: It would mean I would be obliged to use the ladies loos (and I am not shaving the beard off).  

Part B: Current concerns of the UK trans  community.                       

(1)  Updating of Gender Recognition and Equality Legislation

In 2017, the European Court of Human Rights confirmed the position that the UK Government took in 2004, when it held that requirements for sterilisation and genital reconstruction surgery before legal gender recognition, were a clear contravention of the Art 8 human rights of France’s trans community.
In 2017 The UK Government announced a proposal to review the Gender Recognition Act 2004, and  to update it, allow self-identification rather than medical diagnosis to be the basis for legal gender recognition. Ireland, Argentina, California, Columbia, Portugal, Denmark, Norway and Malta all currently allow self-identification for legal gender recognition.   

After a campaign by some Feminists earlier this year the proposed consultation was put on hold. The Feminists suggest that men will use the legislation to demand access to women’s only spaces such as changing rooms, and toilets in order to commit sexual assaults.

A recent review by PFC of those states, found that there had been no recorded complaints raised by women’s organisations (or any other groups or individuals) that men were using the legislation to gain access to women only spaces.

If a man did use the Act to pretend he was really a woman in order to commit a crime, the criminal law exists to deal with them.

In 2016, the House of Commons Women’s and Equalities Committee inquiry into Transgender Equality found the Gender Recognition Act and the Equality Act are not sufficiently cognisant of the many different lives trans people live.

People with a non-binary gender identity don’t fall into the remit of either, as currently written.

The Inquiry recommended updating the Gender Recognition Act.The Inquiry also recommended following the advice of PFC and many other organisations, and instead of basing qualification for protection on the process of gender reassignment, (which on the face of the Act is non-medical, merely a social process of transitioning) it should be clearly stated that protection is based upon the essential characteristic of gender identity.
The government of the day said it would consider the issues but has failed to do anything so far.

(2)  Current Concerns raised to PFC’s legal advice service

PFC volunteers continue to provide a free legal advice service to trans people, their family, friends and those who work with them. The people we currently mostly advise are:

1.    Prisoners,
2.    Adolescents, and children’s parents and schools, and
3.    Asylum seekers

1. Trans Prisoners 

In 2016, the Government held an inquiry after several suicides of trans prisoners. As a consequence, new, improved, Prison Rules were agreed.

The UK doesn’t have many transitioned, trans prisoners at any one time; current numbers are between 40 and 50.

Unfortunately, the Rules don’t allow trans prisoners to be placed in a prison of their preferred gender role until they have obtained legal gender recognition.

Very few trans prisoners will have obtained legal gender recognition; they rarely know it is available, and if they do they often believe (erroneously) that gender recognition will be too difficult or too expensive.

The new Prison Rules require a prompt cases conference on the incarceration of a trans person. The conference must include and listen to the concerns of the trans prisoner.

Unfortunately, the rather macho-prison service isn’t noted for its trans friendly attitudes. Few prison staff have the time or interest to make sure a case conference happens, never mind help a prisoner to change their legal name and gender.

We regularly are in touch with prisoners who are struggling to have their hormone treatment promptly prescribed, frequently leaving them distressed, and angry – a guaranteed way of ensuring they lose the plot and break the core prison rules, getting further into trouble and being further isolated.

Consequently trans prisoners:

  • end up in the ‘wrong prison’,
  • spend weeks without their correct hormone therapies,
  • are terrified of assault (and it is a real threat, with compensation often paid for the physical injuries received),
  • are isolated, without friends, and frequently placed into effective solitary (for their own protection),
Many become mentally unwell, and become obsessed with suicidal ideation.

PFC volunteers write to many prisoners and arrange to send in copies of the Prison rules, to send in clothing and shoes purchased from charity shops, and to provide a pen-pal friendship.  Mostly though PFC Volunteers spend their time writing to prison governors requesting (begging) that the PSI rules are abided by.

The problem is not the Prison Rules, it is the failure of Prisons and Prison staff to use the rules to help the trans prisoners in their establishments.

A lack of training in the Rules hasn’t helped, and even offers of free training for Prison staff are turned down, because of staff shortages, they cannot consider releasing staff to attend for the hour it would take to train them.

2. Children and Adolescents                            

The UK has an excellent child and adolescent Gender Identity Clinic as part of a larger mental health trust – but it is only one for the entire nation of 66 million people.

Whilst the Clinic provides an excellent service,
·        it cannot cope with the numbers seeking help, and
·        there is no doubt that it has increasingly drawn flak from some feminist women  who object to the idea of affording children any support in their preferred gender identity.
PFC REPEATEDLY states that

  • children do not receive cross-gender hormones and
  • no child has ever been given gender reassignment surgery,
but the Feminist attacks have been sufficiently vocal to make clinicians very nervous about the provision of the service.

Most adolescents gain their information off their phones. Many are not aware that treatment is free under the NHS.  The most vulnerable; those who are living in the care of the state, end up buying expensive and ineffective hormone therapies from pharmacies in the Far east, with no awareness of the dangers they can bring.

PFC would like Public Health England (which is part of the National Health Service) to promote the services that are available, and to ensure that schools and colleges have ‘easy to access’ simple information for adolescents and young adults..

FACTS and FIGURES on the NHS England Gender Identity Clinical Services  

The 2000s have seen a huge growth in the numbers of children and adults seeking Gender Identity Clinical services, but there hasn’t been a proportional increase in clinical services
  • The London Adult Gender Identity Clinic, the biggest and oldest in the UK,  has seen a 5 fold increase in numbers attending for assessment between 2007 and 2017.
  • Nottingham, a regional Gender Identity Clinic has seen a 28 fold increase in number over the same period.
  • The Laurels, Devon’s regional Gender Identity Clinic, has seen a rise from 31 new patients in 2005-06 to 636 in 2015-2016. 
  • Sheffield’s clinic went up from 8 new patients in 1998 to 301 in 2015.
For those who as adults want gender reassignment surgery, it is technically available free from the NHS. However, a failure to invest means we have a real shortage of trained surgeons; just 2 surgeons for trans women, and 2 surgeons for trans men. 

3. Asylum Seekers                                                  

The government claims the UK is facing a refugee crisis. We do have refugees, though not as many as people think. 
Some of these refugees are trans people seeking asylum from the persecution and violence they will face in their home country.

In the past, PFC had a very good relationship with the UK Immigration service, and we regularly were asked for, and provided country reports which facilitated the provision of asylum status to the most vulnerable trans people.

Since 2010, that relationship has fallen by the wayside. We now see trans trans men and women who are seeking asylum being detained, and then made destitute whilst they fight to prevent their deportation to a certain, early, death.

PFC now provides the country reports, mostly for free, through solicitors who are supporting trans people through the Immigration Tribunal system. 

Whenever these people win asylum – and they mostly do at the first tribunal - the Government appeals . They appeal using grounds such as they cannot see the judges’ reason for the decision, which is invariably rubbish and my students can always find the judges’ reasoning. This means the process can take up to 6 years of a person’s life during which they can receive no benefits, are not allowed to work, and their only means of survival are food vouchers worth £30 (US$40) a week.

It is inhumane, and unreasonable to be relying upon a team of unpaid volunteers to provide the only support these people can have.

Part C: A Short History of Press for Change  

1992 Press for Change (PFC), the UK trans lobby group is founded to create change, and win Respect and Equality for All trans people

In 1997, A PFC activist wins a case at the Court of Justice of the European Union, which provides employment protection for trans people throughout Europe.

In 2002, two PFC Activists, win a case at the European Court of Human Rights which provides a right to legal recognition in the preferred gender role for all trans people who transition.

What people often forget is that PFC lost far more cases than we won, but what is important is that we won the key cases.

2002-04: PFC workswith the UK government on the Gender Recognition Act 2004.  At the time, this was state of the art legislation; the first gender recognition system which did not require trans people to be sterilised or undergo genital reconstruction surgery.

During the drafting of the Act, it was argued that trans people should be permanently sterilised (being unfit to raise children) and they should then risk lives and livelihood by undergoing major invasive, genital reconstruction surgery, the results of which are rarely satisfactory.

Fifteen years ago, the UK Government recognised this as not only grossly intrusive, but also cruel.

It would mean many disabled or older trans people risking their lives on the operating table, and most trans men having to forgo a career and family, whilst undergoing six to twelve surgeries over as many years, simply to qualify for their human rights.

2006-2010 PFC works with the UK government in the inclusion of trans people in the Equality Act 2010; again state of the art, model, legislation.

Since 2010, the Equality Act has been a huge success, and has greatly improved job security and access to housing, goods and services for trans people.  We have seen the number of claims of employment discrimination, or discrimination when accessing goods, services, housing and facilities drop to almost zero. However, numbers of claims don’t necessarily reflect what is happening on the ground.

The End © Stephen Whittle for Press For Change, May 2018



Monday, 7 May 2018

The Guardian fails to Stand up in the Battle over Transgender Rights





On Friday 4th May 2018, the Guardian newspaper published this The title above the letter says: 

"Standing up for transsexual rights"

And yet, the letter does anything but that. 
The Guardian letter 'Standing up for Trans Rights'Ever since I left home, aged 18 in 1973 I have read the Guardian.  I have come to expect  the Guardian newspaper to show a modicum of intelligence, some historical awareness and to do basic fact checking.  
Why on earth then would the Guardian choose to publish a reactionary and inflammatory letter, under this heading, when in fact the letter's authors want to take away core human rights that the trans community won in 2002 at the European Court of Human Rights.  
The proposal suggested in the letter, which was written by a a tiny group of 'transsexual' women (their word, not mine) who support an even tinier minority of feminist women, would roll back key elements of the Gender Recognition Act 2004. 
Whatever these 'transsexual' women think - and we all accept the Act, being a product of its time, is by no means perfect - it was, and still is, the champion of our existence as a community of people seeking our place and right to participate in the civil and political world. 
As a campaigner, I worked with the UK Government's Department for Constitutional Affairs on the Gender Recognition Act 2004. As a consequence of that Act, in 2005 I was able to marry my partner of 26 years (now 40 years) and I became the legal father to our four children.  Both had previously been impossible.

‘Drop your Knickers’ Test. 

If the legislation was to recognise the prurient and voyeuristic division of the trans community that these women propose; a difference between “US and [those]transgender people who remain physically intact” it would, effectively, mean creating a ‘drop your knickers’ test. 
During the drafting of the Act, it was argued that for trans people to have legal recognition of the gender role in which they permanently live, they should be permanently sterilised - being unfit to raise children -  and then have to undergo major invasive, genital reconstruction surgery, the results of which are rarely satisfactory. Sadly, many countries do still subject trans people to legally prescribed, state-enforced sterilisation and surgery. 
Fifteen years ago, the UK Government recognised such a requirement as not only grossly intrusive, but also cruel, as it would mean many disabled or older trans people risking their lives on the operating table, and most trans men having to forgo a career and family, whilst undergoing six to twelve surgeries over as many years, simply to qualify for their human rights.
In 2017, the European Court of Human Rights confirmed the position that the UK Government took in 2004, when it held that a requirement for these procedures (compulsory sterilisation surgery for legal gender recognition violates Article 8 of the Convention) was a clear contravention of the human rights of France’s trans community.

Gender is to Sex, as Race is to Skin Colour

Most people now understand that gender is to sex, as race is to skin colour; merely a social construction primarily used to  oppress others. 
Along with the UN, numerous governments including Ireland, Denmark, Portugal, Malta, Columbia, Pakistan and Argentina have also acknowledged that as social constructions, gender diversities can take many myriad forms, none of which are of lesser value than any other.
Thankfully, the days when trans people were divided into primary/secondary; post-op/pre-op, passing/non-passing are history.

It is a history these ‘transsexual’ women would do well to read up on.