WEBVTT 1 00:00:07.600 --> 00:00:10.975 Welcome to Inclusion Bites, your 2 00:00:10.975 --> 00:00:14.495 sanctuary for bold conversations that spark change. I'm 3 00:00:14.495 --> 00:00:18.170 Joanne Lockwood, your guide on this journey of exploration into 4 00:00:18.170 --> 00:00:21.870 the heart of inclusion, belonging, and societal 5 00:00:22.170 --> 00:00:25.935 transformation. Ever wondered what it truly takes to create a 6 00:00:25.935 --> 00:00:29.715 world where everyone not only belongs but thrives? 7 00:00:30.015 --> 00:00:33.855 You're not alone. Join me as we uncover the 8 00:00:33.855 --> 00:00:37.470 unseen, challenge the status quo, and share 9 00:00:37.470 --> 00:00:41.230 stories that resonate deep within. Ready to dive 10 00:00:41.230 --> 00:00:44.844 in. Whether you're sipping your morning coffee or winding 11 00:00:44.844 --> 00:00:48.144 down after a long day, let's connect, reflect, 12 00:00:48.524 --> 00:00:52.030 and inspire action together. Don't forget, 13 00:00:52.570 --> 00:00:55.530 you can be part of the conversation too. Reach out to 14 00:00:55.621 --> 00:00:57.315 jo.Lockwood@seechangehappen.co.uk 15 00:00:59.375 --> 00:01:02.995 to share your insights or to join me on the show. 16 00:01:03.695 --> 00:01:07.450 So adjust your earbuds and settle in. It's time to 17 00:01:07.450 --> 00:01:10.990 ignite the spark of inclusion with Inclusion Bites. 18 00:01:14.765 --> 00:01:18.604 And today is episode 113 with 19 00:01:18.604 --> 00:01:22.430 the title, Healthcare without Barriers. And 20 00:01:22.430 --> 00:01:25.950 I have the absolute honor and privilege to welcome Doctor Helen 21 00:01:26.010 --> 00:01:28.910 Webberley. Helen is the founder of 22 00:01:28.910 --> 00:01:32.285 GenderGP, an online health and 23 00:01:32.285 --> 00:01:35.905 well-being clinic which proudly serves transgender 24 00:01:36.045 --> 00:01:39.265 people of all ages across the world. 25 00:01:39.829 --> 00:01:43.670 When I asked Helen to describe her superpower, she said it is 26 00:01:43.670 --> 00:01:47.204 her ability to drive change, challenge 27 00:01:47.204 --> 00:01:50.965 the status quo, and amplify the voices of 28 00:01:50.965 --> 00:01:54.645 those who often face discrimination within the health 29 00:01:54.645 --> 00:01:57.960 care system whilst also demonstrating 30 00:01:58.180 --> 00:02:01.479 resilience. Hello, Helen. Welcome to the show. 31 00:02:01.939 --> 00:02:05.299 Hi, Jo. Thanks so much for having me. It's an absolute pleasure to be here. 32 00:02:05.299 --> 00:02:08.724 Thank you. I feel very honored. I I used your 33 00:02:08.724 --> 00:02:12.265 services through GenderGP back in 2016, and I've 34 00:02:12.860 --> 00:02:16.400 followed your trials and tribulations over the last couple of years, 35 00:02:16.780 --> 00:02:20.060 which no doubt you will expand on. But yeah. But it's, it's a real honor 36 00:02:20.060 --> 00:02:23.895 to have you here, and thank you for sharing your time and giving us 37 00:02:23.895 --> 00:02:27.655 your voice. So, Helen, health care without barriers. Tell us 38 00:02:27.655 --> 00:02:31.230 more. Yeah. That's, well, it's kind of 39 00:02:31.230 --> 00:02:35.070 like as we say that, it's it should be everybody's privilege. It should be 40 00:02:35.070 --> 00:02:38.705 everyone's daily bread and butter, you know, health care without 41 00:02:38.705 --> 00:02:42.224 barriers, that's what we all need. And, you know, everywhere in the news you read 42 00:02:42.224 --> 00:02:46.040 about health, you need health positivity, health promotion. It's all about 43 00:02:46.040 --> 00:02:49.659 being healthy, being fit, being healthy, being happy, being well. 44 00:02:49.799 --> 00:02:53.455 But then actually when some people want to be fit and healthy and happy and 45 00:02:53.455 --> 00:02:57.175 well, it doesn't always go to plan. And that's as I 46 00:02:57.215 --> 00:03:00.910 as a in my career as a doctor, I've seen it several 47 00:03:00.910 --> 00:03:04.590 times within several community groups but none so 48 00:03:04.590 --> 00:03:08.270 big as the trans and non binary. From here on I will simply just say 49 00:03:08.270 --> 00:03:11.455 trans but for the trans, non binary, gender diverse, gender incongruent 50 00:03:11.915 --> 00:03:15.675 people, I spotted back in 2015 Safety things 51 00:03:15.675 --> 00:03:19.470 were not good and that there were boundaries and there were barriers and 52 00:03:19.470 --> 00:03:23.010 there was gatekeeping. And even worse, there was bias and prejudice 53 00:03:23.069 --> 00:03:26.715 and harm from within my own profession. And 54 00:03:27.015 --> 00:03:30.855 I was just shocked. And it's interesting you say that you you used my service 55 00:03:30.855 --> 00:03:34.290 back in 2016. I can't believe it's been 56 00:03:34.830 --> 00:03:38.510 such a long time since this all started. It sometimes feels like 57 00:03:38.510 --> 00:03:41.970 yesterday. And then at other times, it feels like a whole lifetime. 58 00:03:42.735 --> 00:03:46.495 Sometimes good, sometimes bad, which you kind of allude alluded to 59 00:03:46.495 --> 00:03:50.034 in your trials and tribulations. And we've still got a long way to go 60 00:03:50.080 --> 00:03:53.760 to cut down and break down those barriers and 61 00:03:53.760 --> 00:03:57.460 make healthcare inclusive to all minority groups. 62 00:03:57.975 --> 00:04:01.815 And while I have the privilege to be a doctor, to 63 00:04:01.815 --> 00:04:05.355 have medical training, to have the experience of the trans community, 64 00:04:05.575 --> 00:04:08.780 and while I've still got kind of life and blood in my veins, I 65 00:04:09.320 --> 00:04:12.760 really, really hope to make a really big difference, to 66 00:04:12.760 --> 00:04:16.495 trans health care. And I guess, like I say, we've still got 67 00:04:16.574 --> 00:04:19.875 quite a long way to go. Yeah. You talked about 68 00:04:20.415 --> 00:04:24.110 bias and prejudice, and and I guess also there's and 69 00:04:24.110 --> 00:04:27.010 I speak from my own experience see. There's my own internalization 70 00:04:28.350 --> 00:04:31.970 of those biases, prejudices, and the and the and the narratives you hear 71 00:04:32.375 --> 00:04:36.135 in the media and online and other places. And I know that 72 00:04:36.135 --> 00:04:39.655 I in my early stages of exploring my 73 00:04:39.655 --> 00:04:43.270 identity, I didn't know where to turn. And, you 74 00:04:43.270 --> 00:04:47.110 know, it's we talk about 2015, 2016. It's quite a while 75 00:04:47.110 --> 00:04:50.710 ago, and the world has moved a long way in trans 76 00:04:50.710 --> 00:04:54.105 awareness, and I certainly see a difference. So back 77 00:04:54.105 --> 00:04:57.785 then, I I went to see my GP, and he had really no 78 00:04:57.785 --> 00:05:01.569 idea. There was no there was no knowledge at GP level, and we I think 79 00:05:01.569 --> 00:05:05.250 we still find that postcode lottery around primary care 80 00:05:05.250 --> 00:05:08.615 support, where to go, differences of of 81 00:05:08.835 --> 00:05:12.595 of service or of of delivery. How I I 82 00:05:12.595 --> 00:05:16.080 appreciate you're not necessarily speaking for the NHS at all see, 83 00:05:16.780 --> 00:05:20.620 but where what can the NHS learn about supporting 84 00:05:20.620 --> 00:05:24.414 trans non binary people more effective? Well, it's interesting you talk about the internalisation 85 00:05:24.715 --> 00:05:28.555 and I I think what people don't realise is, Wellbeing healthcare professionals and the 86 00:05:28.555 --> 00:05:32.300 public who who can speak so foully sometimes, what they don't 87 00:05:32.300 --> 00:05:36.060 realize is that people who are about to pick up the phone 88 00:05:36.060 --> 00:05:39.785 or go online to make an appointment to see their GP, to take 89 00:05:39.785 --> 00:05:43.465 that brave step to say, okay, you may not know 90 00:05:43.465 --> 00:05:47.145 this, but I am actually transgender, and I would like to 91 00:05:47.145 --> 00:05:50.680 do X Y Z, and I would like you to help me with that. 92 00:05:50.820 --> 00:05:54.580 That is a huge step. The people that I've spoken to, that 93 00:05:54.580 --> 00:05:58.264 doesn't that doesn't come quickly or easily. It 94 00:05:58.264 --> 00:06:02.025 may be a spur of the moment second when you're like, I'm gonna do this 95 00:06:02.025 --> 00:06:04.664 right now. I'm gonna do it. I'm gonna be brave enough. And that that instant 96 00:06:04.664 --> 00:06:08.159 gives you the bravery to do it. But it's been planning and plotting for a 97 00:06:08.159 --> 00:06:11.439 long time. And I've heard people tell me that they pick the phone up and 98 00:06:11.439 --> 00:06:14.319 to put the phone down, they pick the phone up, they get through and it's 99 00:06:14.319 --> 00:06:17.705 like, how can I help? And it's like, okay, can I have my flu 100 00:06:17.705 --> 00:06:21.465 vaccine? You know, it's such a brave thing to do. And then 101 00:06:21.465 --> 00:06:25.065 when you do it, there's the the canceled appointments, see okay, I can't do this. 102 00:06:25.065 --> 00:06:28.190 I'm gonna cancel and then I'm gonna rebook and then I'm gonna cancel. It's such 103 00:06:28.190 --> 00:06:31.889 a journey to make that, to make that first appointment. That's what I've heard. 104 00:06:31.949 --> 00:06:35.485 And then when you get to that employment appointment, oh my goodness, are you 105 00:06:35.485 --> 00:06:39.245 brave enough to say the words or do bottle and just say you've got a 106 00:06:39.245 --> 00:06:42.900 bad ear or your knees hurting again? You know, but 107 00:06:42.900 --> 00:06:46.580 just such a journey. And it's so important that that 108 00:06:46.580 --> 00:06:50.275 first that the the look on that doctor's face 109 00:06:50.354 --> 00:06:53.955 when you say the words for the first time, their response, that 110 00:06:53.955 --> 00:06:57.315 look that, are they hiding it? Are they are they 111 00:06:57.315 --> 00:07:01.120 visibly shocked? Are they petrified? Are they are they 112 00:07:01.120 --> 00:07:04.800 disgusted? And these are all experiences and emotions that I've 113 00:07:04.800 --> 00:07:08.479 heard, you know, reflected back to me from people who've who've been through 114 00:07:08.479 --> 00:07:11.205 this. And then that internalized, 115 00:07:12.545 --> 00:07:16.225 as you say, feeling or shame or emotion that goes back into you as a 116 00:07:16.225 --> 00:07:19.710 response to your experience with that doctor does 117 00:07:19.710 --> 00:07:23.470 untold harm. Can you imagine going to the doctor? No problem at 118 00:07:23.470 --> 00:07:26.910 all. I'm trans and I've just decided in my life that now is the right 119 00:07:26.910 --> 00:07:29.835 time to take those steps and do something about it. And I'm going to phone 120 00:07:29.835 --> 00:07:32.075 up and I'm going to make an appointment and I know I'm going to go 121 00:07:32.075 --> 00:07:35.355 in and I'm going to have the best experience. And the doctor's going to say 122 00:07:35.355 --> 00:07:38.460 to me, oh, that's great. I'm so glad you're, you were brave enough to tell 123 00:07:38.460 --> 00:07:41.740 me that. Thank you so much for sharing it with me. Right. Let's get on 124 00:07:41.740 --> 00:07:44.860 this journey together. How should we do this? What should we do? What are the 125 00:07:44.860 --> 00:07:48.575 first steps? How can I help? It would be such a different experience. 126 00:07:49.035 --> 00:07:52.735 And I have heard that never, maybe, never, 127 00:07:53.115 --> 00:07:56.940 which is really, really, really sad. And you talk about the postcode lottery, 128 00:07:56.940 --> 00:08:00.640 Jo, and that's just not fair. That's just not fair. 129 00:08:00.780 --> 00:08:04.480 You should feel, you should be confident that you're going to get the same experience 130 00:08:04.785 --> 00:08:08.385 wherever you go, whichever doctor that you see, whichever nurse, whichever 131 00:08:08.385 --> 00:08:12.065 hospital, whichever clinic, whichever outpatient department, whichever GP surgery, 132 00:08:12.065 --> 00:08:15.639 whichever flu vaccination clinic. But we 133 00:08:15.639 --> 00:08:19.479 again know that that's not, that doesn't happen. And even worse than that, we talk 134 00:08:19.479 --> 00:08:23.245 online and look in the community and speak at forums and you're like, 135 00:08:23.245 --> 00:08:25.565 oh I wonder what my GP is going to be like and you look it 136 00:08:25.565 --> 00:08:28.865 up and you're like, oh jo. Have you seen what they're saying about that surgery? 137 00:08:29.030 --> 00:08:32.790 Oh, my God. But that's where I'm registered. What am I going to do? 138 00:08:32.790 --> 00:08:36.630 So it's just it's just a travesty. And if ever we talk about non 139 00:08:36.630 --> 00:08:40.135 inclusion or barriers or 140 00:08:40.135 --> 00:08:43.895 inadequate health care, I mean, that that's just epitomizes it 141 00:08:43.895 --> 00:08:47.595 really. It I'm just I'm smiling and grinning as you're talking there because 142 00:08:47.910 --> 00:08:51.370 I'm probably the first person you're gonna meet that had an extremely positive 143 00:08:51.990 --> 00:08:55.695 interaction with my GP on first contact. And I I tell 144 00:08:55.855 --> 00:08:59.215 I briefly tell you the story. It it was I was going through some real 145 00:08:59.215 --> 00:09:02.970 mental health crisis. So I so I come out publicly, Facebook 146 00:09:03.029 --> 00:09:05.850 and all those sort of things, and then I was going through this real crash. 147 00:09:06.790 --> 00:09:09.910 And my wife at the time said, right, I'm gonna book an appointment to go 148 00:09:09.910 --> 00:09:13.404 and see your your GP. He'll sort you out. I think she expected 149 00:09:13.545 --> 00:09:17.105 the GP to sort of to give you some tablets, fix me, and tell me 150 00:09:17.105 --> 00:09:20.740 I was being silly and getting on with life. But instead, I he he said, 151 00:09:20.740 --> 00:09:24.120 what's the matter? And I said, I just went it came out my mouth. 152 00:09:24.500 --> 00:09:28.340 I I'm trans. I don't wanna transition sort of thing. It came out my mouth. 153 00:09:28.340 --> 00:09:31.885 And immediately, he he he he focused on 154 00:09:31.885 --> 00:09:35.585 me. He can metaphorically, he he cleared his diary. 155 00:09:35.860 --> 00:09:38.580 So this 10 minute appointment, I was in there for an hour and a half 156 00:09:38.580 --> 00:09:42.100 to 2 hours. He just cleared it. He just carried on. There was no there 157 00:09:42.100 --> 00:09:45.855 was it see. He referred me to the GIC. He asked 158 00:09:45.855 --> 00:09:49.215 me a couple of questions around, if I had a magic 159 00:09:49.215 --> 00:09:52.975 machine that could change your gender immediately, would you want it to be 160 00:09:52.975 --> 00:09:56.600 one way or reversible? And I said, give see the 161 00:09:56.600 --> 00:09:59.800 machine. I'll smash it to pieces with a hammer. I never wanna go back through 162 00:09:59.800 --> 00:10:03.240 it. So, like, so I think at that point there, he really engaged, talked about 163 00:10:03.240 --> 00:10:06.904 my mental health, and he even gave me his NHS personal email 164 00:10:06.904 --> 00:10:10.584 address. So he said, if any if you wanna talk to me, 165 00:10:10.584 --> 00:10:13.545 email me. You don't need to go through the system. You just email me anytime 166 00:10:13.545 --> 00:10:17.250 if you have any issues about this. And so he's been amazing. He 167 00:10:17.250 --> 00:10:20.470 he signed the share care agreement straight away. We got that sorted. 168 00:10:20.930 --> 00:10:24.755 So it it can happen. But as you as you say, most 169 00:10:24.755 --> 00:10:28.514 of the apprehension is that well, I think there's this belief within 170 00:10:28.514 --> 00:10:31.520 the the trans community that medical professionals 171 00:10:36.380 --> 00:10:39.700 Inclusion and the realization that medical professionals are just human. 172 00:10:40.295 --> 00:10:43.834 They focus on their specialism. Anything out out of their blinkers, 173 00:10:44.134 --> 00:10:47.815 they just don't know. And I think trans people are kind of on that 174 00:10:47.815 --> 00:10:51.250 periphery of understanding still. Yeah. But that's, 175 00:10:51.690 --> 00:10:55.529 but that shouldn't be allowed. And, you know, I'm I'm I'm you can't see me, 176 00:10:55.529 --> 00:10:58.565 but I'm clapping and applauding and patting your GP on the back here because that 177 00:10:58.565 --> 00:11:02.265 is exactly what we need. But the next step that we need 178 00:11:02.485 --> 00:11:05.705 is for your GP not to have to refer you to the GIC. 179 00:11:06.270 --> 00:11:09.630 So the next step we need is for doctors to be able to empower 180 00:11:09.630 --> 00:11:13.390 themselves to learn about trans healthcare. Now when 181 00:11:13.390 --> 00:11:17.214 I first join, started doing this, I was like, oh my goodness. Do 182 00:11:17.214 --> 00:11:20.654 you know what people are asking me to do? They're asking me to switch their 183 00:11:20.654 --> 00:11:24.029 hormones. So this person who's got an estrogen profile 184 00:11:24.730 --> 00:11:28.269 is asking me to switch off their estrogen and give them testosterone. 185 00:11:28.865 --> 00:11:32.545 And that testosterone is going to make their voice deep. It's going to 186 00:11:32.545 --> 00:11:36.384 make their their skeleton, their muscles bigger. It's going to develop facial 187 00:11:36.384 --> 00:11:40.200 hair, make their head hair probably thin, if that's what's in 188 00:11:40.200 --> 00:11:44.040 their genes. It's going to reduce their lifespan because men have a shorter 189 00:11:44.040 --> 00:11:47.295 lifespan than women. This is all the things that were going through my head. And 190 00:11:47.295 --> 00:11:50.115 then I looked at the other way around, and I was like, okay. This person 191 00:11:50.335 --> 00:11:54.015 is asking me to switch off their natural testosterone and give 192 00:11:54.015 --> 00:11:57.839 them estrogen instead. And that's gonna make their bodies develop in 193 00:11:57.839 --> 00:12:01.600 a way that, you know, an ovarian puberty would happen. It 194 00:12:01.600 --> 00:12:05.105 just felt so unnatural to me as a 195 00:12:05.105 --> 00:12:08.945 learning doctor. But then but then I had the fortune of the peep the 196 00:12:08.945 --> 00:12:12.785 person opposite me saying, yes. Exactly. That is exactly what I want. I 197 00:12:12.785 --> 00:12:16.210 want that. Please, as quickly as possible, can I have it now? Can can you 198 00:12:16.210 --> 00:12:18.850 do it? Can you do it? And the problem that we have at the moment 199 00:12:18.850 --> 00:12:22.450 is, well now I don't know how to do it and I'll refer you to 200 00:12:22.450 --> 00:12:26.274 this open hole. What I and I can't guarantee your experience when you 201 00:12:26.274 --> 00:12:28.995 get there and I don't know how long it will be to get there. But 202 00:12:28.995 --> 00:12:32.840 it's just that fear of doing something apparently so unnatural. And so 203 00:12:32.840 --> 00:12:36.440 when I was wondering about how unnatural it is in my in my 204 00:12:36.440 --> 00:12:40.280 youth, if you like, I looked at the kind of the chemical composition of 205 00:12:40.280 --> 00:12:44.125 the hormones. And there's just, if you can picture those kind of hexagons and 206 00:12:44.125 --> 00:12:47.645 lines that make up chemical compounds, it was just like 1 or 2 207 00:12:47.645 --> 00:12:51.100 bars difference. And then I looked to, like, cholesterol and they're like, these are these 208 00:12:51.100 --> 00:12:54.699 3 the estrogen, the the testosterone, cholesterol, all the same kind of 209 00:12:54.699 --> 00:12:58.435 compound. You've just taken a little arm off or added a little hexagon on. 210 00:12:58.515 --> 00:13:02.275 And I'm like, this is they're actually so similar. And the hormones 211 00:13:02.275 --> 00:13:05.955 are just natural. They're just natural things that our body needs. And does it 212 00:13:05.955 --> 00:13:09.450 really matter which one you have? We know it's really important to have 213 00:13:09.450 --> 00:13:13.130 1 and to make sure you've got enough hormones, we know that really clearly. And 214 00:13:13.130 --> 00:13:15.505 make sure that you don't get them too early, and make sure you don't get 215 00:13:15.505 --> 00:13:19.025 them too late. We know all of that about hormones. But it doesn't actually matter 216 00:13:19.025 --> 00:13:21.985 which one you have as long as you have it. And if you've got someone 217 00:13:21.985 --> 00:13:24.930 saying, well, do you know what? I don't want the testosterone Joanne. I want the 218 00:13:24.930 --> 00:13:28.770 estrogen hormone. That's gonna suit me much better. Why are we not listening 219 00:13:28.770 --> 00:13:32.455 to these people and saying, yeah. No problem. And 220 00:13:32.455 --> 00:13:36.055 then, you know, again Belonging about I'm talking to your GP if he's listening 221 00:13:36.055 --> 00:13:39.495 here. It's okay. So how do you do that then? How do we 222 00:13:39.495 --> 00:13:43.269 switch off someone's natural hormones? And I'm 223 00:13:43.269 --> 00:13:46.470 like, well, we do it. We do that. We do that in in kids who've 224 00:13:46.470 --> 00:13:49.975 got precocious puberty is when they start puberty too early, 225 00:13:49.975 --> 00:13:53.335 like age 5 or 6. And that's just way too early to start 226 00:13:53.335 --> 00:13:57.180 puberty. Their their ovary or testicle woke up way too early, and 227 00:13:57.180 --> 00:14:00.960 we just stop it. We give them this medicine, and there is a natural 228 00:14:01.020 --> 00:14:04.620 hormone that stops it. And we do it with people with prostate cancer, for 229 00:14:04.620 --> 00:14:08.375 example. We give them that medicine because we know that prostate cancer feeds 230 00:14:08.755 --> 00:14:12.515 off hormones, off testosterone usually. And we'd and, we don't want it to. 231 00:14:12.515 --> 00:14:16.020 So we switch off the testosterone. So I'm like, so it's really easy to 232 00:14:16.020 --> 00:14:19.540 switch off someone's hormones because we and we're already doing it in 233 00:14:19.540 --> 00:14:23.345 general practice. And then how do you replace someone's hormones? And 234 00:14:23.425 --> 00:14:27.264 And I was like, we do that already too. We we manipulate hormones with 235 00:14:27.264 --> 00:14:30.564 oral contraception, we give hormones for menopause, 236 00:14:31.210 --> 00:14:34.890 whether that's estrogen or testosterone. You know, when someone's not 237 00:14:34.890 --> 00:14:38.705 making enough of their own. Some people are born when their ovaries or their 238 00:14:38.705 --> 00:14:42.385 testicles don't work properly and they don't produce enough hormones, so we give 239 00:14:42.385 --> 00:14:46.080 them the the hormone by medicine. When you put 2 and 240 00:14:46.080 --> 00:14:49.700 2 together, we already switch off people's hormones 241 00:14:49.760 --> 00:14:53.465 in general practice very easily, every day. 242 00:14:53.685 --> 00:14:57.465 And we already replace those hormones with the hormone 243 00:14:57.525 --> 00:15:01.205 that they need, the body needs, every day, all day every day. It's all bread 244 00:15:01.205 --> 00:15:05.050 and butter. But then if you're Joanne, it's not quite the 245 00:15:05.050 --> 00:15:08.250 same. We don't do that because we don't know how to do it, and we're 246 00:15:08.250 --> 00:15:12.035 scared of it, and it feels too new, and we must refer you. 247 00:15:12.175 --> 00:15:16.015 But what we've got to do is move towards a place where we're not 248 00:15:16.015 --> 00:15:19.290 scared to do it, and we already know how to do it, we already know 249 00:15:19.290 --> 00:15:22.570 how to do it. The other question actually which is, well how much do you 250 00:15:22.570 --> 00:15:25.610 give? How much hormone do you give? And it's like, well see know, we know 251 00:15:25.610 --> 00:15:29.045 what the right level is. We do a blood test and we know, for 252 00:15:29.045 --> 00:15:32.805 example, that someone with ovaries, we kinda wanna see the the estrogen 253 00:15:32.805 --> 00:15:36.620 between 308100. So that's what we wanna see in a trans woman or a 254 00:15:36.620 --> 00:15:40.140 transfeminine person as well. So we know all these things and that but yet 255 00:15:40.140 --> 00:15:43.845 GPs kind of have this feeling that they don't know how to do it, when 256 00:15:43.845 --> 00:15:47.365 actually it's the simplest thing in the world, and we're already doing it every 257 00:15:47.365 --> 00:15:50.740 day. So it's actually just down to the bravery. It's 258 00:15:51.060 --> 00:15:54.440 should I do it? Am I allowed to do it? What 259 00:15:54.660 --> 00:15:58.440 might happen to me or the person that I'm helping, my patient, 260 00:15:58.740 --> 00:16:02.185 if I do do it? And those are the those are the the political 261 00:16:03.017 --> 00:16:06.725 Safety regulatory bits that that we need to to definitely sort 262 00:16:06.725 --> 00:16:10.440 out, and that's the problem. And the other problem at the moment is that 263 00:16:10.440 --> 00:16:14.220 GPs are not being supported to make these decisions. And if they ask the question, 264 00:16:14.280 --> 00:16:18.105 am I allowed? But not really saying you are. 265 00:16:18.325 --> 00:16:22.165 There's nothing out there saying you help, you do, you help your patient, 266 00:16:22.165 --> 00:16:25.120 make sure you do the best by them. And, you know, the Royal College of 267 00:16:25.120 --> 00:16:28.720 General Practitioners fairly recently have kind of said, we support 268 00:16:28.720 --> 00:16:31.280 doctors well, they haven't they haven't said that in these words, but this is the 269 00:16:31.280 --> 00:16:34.995 interpretation. We support doctors who don't feel able to do this. 270 00:16:35.135 --> 00:16:38.815 We recommend that doctors refer to gender specialist gender identity 271 00:16:38.815 --> 00:16:42.470 clinics. We don't think that our GPs should be asked 272 00:16:42.470 --> 00:16:46.230 to provide this specialist care. And if you think about 273 00:16:46.230 --> 00:16:49.955 specialist care, when you you mentioned a little a minute or 2 274 00:16:49.955 --> 00:16:53.715 ago Jo, that back in there's been a big rise in awareness 275 00:16:53.715 --> 00:16:57.290 of trans people. Kind of you know 2015, Safety, we had a 276 00:16:57.290 --> 00:17:01.050 celebrity or 2 that came out as trans and there was this big awareness rising 277 00:17:01.050 --> 00:17:04.349 of awareness the people that have had to be hidden for so long 278 00:17:04.675 --> 00:17:08.435 suddenly became visible and as as the braver ones became visible 279 00:17:08.435 --> 00:17:12.140 first, the shyer ones became visible after them. And so we've 280 00:17:12.140 --> 00:17:15.920 had a big rise and so what that means is that it's this is not 281 00:17:16.300 --> 00:17:19.875 a small specialist subject And and the 282 00:17:19.875 --> 00:17:23.715 NHS have kind of cutoffs. You know, if if there's a condition that has less 283 00:17:23.715 --> 00:17:27.555 than 500 cases a year, then that's considered to be highly 284 00:17:27.555 --> 00:17:31.260 specialised, and that should only be dealt with in super specialist 285 00:17:31.260 --> 00:17:35.020 clinics because you can't have just one doctor in the whole of that area 286 00:17:35.020 --> 00:17:38.715 that knows how to do it. You so you you put those those very rare 287 00:17:38.715 --> 00:17:42.155 conditions in super specialized clinics where there's lots of 288 00:17:42.155 --> 00:17:45.980 support. But but we have way more than 500 cases a year, 289 00:17:45.980 --> 00:17:49.180 way, way more. And so we we can't we have to move away from that 290 00:17:49.180 --> 00:17:52.645 super specialized model, and that means we have to bring it back 291 00:17:52.725 --> 00:17:56.485 into primary care, which is GP surgeries, and secondary care, which is 292 00:17:56.485 --> 00:18:00.250 your local hospital. But at the moment, doctors are kind of scared to do 293 00:18:00.250 --> 00:18:02.330 it. They don't know if they're allowed to do it. They don't know what will 294 00:18:02.330 --> 00:18:06.009 happen to them if they do do it. And they feel that they don't 295 00:18:06.009 --> 00:18:09.155 have the skills and knowledge. And if you but if you look at the the 296 00:18:09.155 --> 00:18:12.915 duties of a doctor, which is the which is good medical practice, 297 00:18:12.915 --> 00:18:16.640 which is the kind of the medical law if you like, The first 298 00:18:16.640 --> 00:18:20.480 rule is make your patient your first concern, and 299 00:18:20.480 --> 00:18:23.920 the second rule is make sure your skills and knowledge are up to 300 00:18:23.920 --> 00:18:27.705 date. And so those doctors out there that say, I don't know how to do 301 00:18:27.705 --> 00:18:31.225 this, and I accept that I don't know how to do this, and I'm not 302 00:18:31.225 --> 00:18:34.540 going to increase my skills or knowledge in this area 303 00:18:35.240 --> 00:18:38.920 acting against the duties of a doctor. And I sometimes 304 00:18:38.920 --> 00:18:41.934 feel we all need to get our flag out and walk march up and down 305 00:18:41.934 --> 00:18:45.295 the street and go in front of the the doors that are 306 00:18:45.295 --> 00:18:48.895 currently closed. And behind those doors, we're having very 307 00:18:48.895 --> 00:18:52.570 negative Joanne negative conversations, and we need 308 00:18:52.570 --> 00:18:56.090 to knock on the door and say, actually, your duty as a 309 00:18:56.090 --> 00:18:59.929 doctor is to increase your skills and knowledge in this area of health 310 00:18:59.929 --> 00:19:03.655 care and make your patient your first concern, even if they're 311 00:19:03.655 --> 00:19:07.495 trans. Is some of the fear based on, well, fear of 312 00:19:07.495 --> 00:19:10.559 litigation, fear of see transitioning, fear of being 313 00:19:11.100 --> 00:19:14.620 caught up in front of the GMC for getting it wrong? Is 314 00:19:14.620 --> 00:19:18.305 it a genuine lack of lack of awareness? Is it 315 00:19:18.625 --> 00:19:22.005 bias? You know? Trans people have gone from being a bit weird 316 00:19:22.385 --> 00:19:26.040 to being a threat somehow in the the last 5 or 6 years. We've 317 00:19:26.200 --> 00:19:29.880 we've turned the tables. Now now we're taking over the world. We're now political football. 318 00:19:29.880 --> 00:19:33.560 Whereas before, we were kinda like this, this this dirty little 319 00:19:33.560 --> 00:19:37.264 secret that used to somehow leak onto the front page of the tabloids every 320 00:19:37.264 --> 00:19:41.105 so often, and that was it. Now everyone everyone's worried about 321 00:19:41.105 --> 00:19:44.800 us. We don't know our own mind. We we're I I 322 00:19:44.800 --> 00:19:48.320 don't know. I I I'm I'm really confused as to what the root of it 323 00:19:48.320 --> 00:19:52.080 is. Is it just bias and fear? Fear of being hold 324 00:19:52.080 --> 00:19:55.905 up themselves and prescribing off license or whatever the 325 00:19:55.905 --> 00:19:59.445 phrase physiology is there. These these medicines and hormones 326 00:19:59.665 --> 00:20:03.370 aren't designed for people like see. Therefore, it's risky to without 327 00:20:03.370 --> 00:20:05.710 the trials. Is that is that the situation? 328 00:20:06.790 --> 00:20:10.330 Wellbeing very interesting, isn't it? So the 329 00:20:10.330 --> 00:20:14.145 litigation, litigation really means that see, a trans person's 330 00:20:14.145 --> 00:20:17.665 going to come to you, as a doctor in 10 years time and 331 00:20:17.665 --> 00:20:21.190 say, you gave me hormones, and you 332 00:20:21.190 --> 00:20:24.570 made my breasts grow or my voice drop, 333 00:20:25.910 --> 00:20:29.590 or my, you know, my beard grow, and I now 334 00:20:29.590 --> 00:20:32.825 regret it, And it's your fault. You acted 335 00:20:33.365 --> 00:20:37.125 negligently, and therefore I'm going to sue you. So that's 336 00:20:37.125 --> 00:20:40.540 that's litigation. And unfortunately, of course, the media 337 00:20:40.920 --> 00:20:44.679 like to show those stories. And but what we do know is, if 338 00:20:44.679 --> 00:20:48.365 we talk about regret rates, with every single medical 339 00:20:48.365 --> 00:20:52.125 intervention, there is a regret rate. And when when you 340 00:20:52.125 --> 00:20:55.725 look at the regret rate for transitioning, the regret rate is 341 00:20:55.725 --> 00:20:59.540 tiny. Now I'm we may talk about why people 342 00:20:59.540 --> 00:21:02.660 might regret it in later on in the show if we have time, but but 343 00:21:02.660 --> 00:21:06.215 let's just accept for now that we know that the regret rate for 344 00:21:06.215 --> 00:21:09.735 transitioning is minuscule. Compared with, for 345 00:21:09.735 --> 00:21:13.415 example, knee surgery or breast augmentation or some plastic 346 00:21:13.415 --> 00:21:17.240 surgeries, hip surgery, a penectomy, all lots 347 00:21:17.240 --> 00:21:21.080 and lots of things that we do, people people regret. And those 348 00:21:21.080 --> 00:21:24.815 regret rates are much higher but they're they're not, they haven't got that kind of 349 00:21:24.815 --> 00:21:28.415 emotion attached to them and doctors doctors still do them. So 350 00:21:28.415 --> 00:21:32.170 that's litigation. We're, you know, people are scared of 351 00:21:32.170 --> 00:21:35.930 being sued in the future in case somebody regrets it. but, but actually what you 352 00:21:35.930 --> 00:21:38.490 need to do is just make sure that that person, at the time that they're 353 00:21:38.490 --> 00:21:41.985 making that decision with you, are giving informed consent. And that 354 00:21:41.985 --> 00:21:45.825 means, do they know, they're saying to you, please Joanne you switch my hormones? And 355 00:21:45.825 --> 00:21:49.470 they're saying, I know what this means. I know what this will do to me. 356 00:21:49.470 --> 00:21:53.309 I'm fully aware of the pros and cons. I know what this can 357 00:21:53.309 --> 00:21:56.590 and can't achieve. I know that this is what I want to do. And I 358 00:21:56.590 --> 00:22:00.414 really, really believe that at this time, and I've been thinking about it 359 00:22:00.414 --> 00:22:04.095 for a long time, this is the right thing to do. And 360 00:22:04.095 --> 00:22:07.059 so the doctor's job is to say, okay, well, you know, these are the pros 361 00:22:07.059 --> 00:22:09.700 and cons, these are the risks and benefits, what do you reckon? Are you sure 362 00:22:09.700 --> 00:22:13.299 you're aware? Absolutely, I'm aware. Fine. And you can't, 363 00:22:13.299 --> 00:22:16.835 that's never going to be medical negligence. That is not medical 364 00:22:16.835 --> 00:22:19.955 negligence. That is not that that might be someone may Change their mind down the 365 00:22:19.955 --> 00:22:23.794 road and we know that's very rare. But it's not medical negligence, it was 366 00:22:23.794 --> 00:22:27.380 a good informed consent process. So we don't 367 00:22:27.460 --> 00:22:30.980 so in many ways, if people are if doctors are worried about that, I don't 368 00:22:30.980 --> 00:22:34.645 think we should. Make sure that your consent processes are good and we're 369 00:22:34.645 --> 00:22:38.405 fine kind of thing. The GMC, the GMC guidance. 370 00:22:38.405 --> 00:22:41.845 So GMC are the regulator of doctors and the guidance has changed a lot over 371 00:22:41.845 --> 00:22:44.940 my time. I watched it change as I was going through my own process with 372 00:22:44.940 --> 00:22:48.700 the GMC. And the GMC actually have become much more 373 00:22:48.700 --> 00:22:51.760 trans aware recently and they're quite positive. 374 00:22:52.284 --> 00:22:55.885 They're saying you must help your patient and you you mustn't just say no. You 375 00:22:55.885 --> 00:22:59.245 must if you're gonna say no, you have to have a really good reason for 376 00:22:59.245 --> 00:23:02.300 saying no. And, you know, they they do see, if you don't know what you're 377 00:23:02.300 --> 00:23:05.660 doing, then then talk to a gender specialist, which is a bit tricky because they're 378 00:23:05.660 --> 00:23:09.505 not enough around. And actually, if if the gender specialists who are 379 00:23:09.505 --> 00:23:12.544 working in the NHS at the moment spend all day on the phone to the 380 00:23:12.544 --> 00:23:16.304 GPs to give them reassurance, then the waiting list Wellbeing even 381 00:23:16.304 --> 00:23:19.660 longer. So that's a bit of a that's a bit of a problem. But I 382 00:23:19.660 --> 00:23:22.700 don't think there will be a doctor in the land who who's trying to think 383 00:23:22.700 --> 00:23:26.525 about helping their trans patient who won't have heard of my case. And, you know, 384 00:23:26.525 --> 00:23:29.965 that's why it was so important that I won that case. And I hope that 385 00:23:29.965 --> 00:23:33.700 the lasting message is that doctor went through a lot, but 386 00:23:33.700 --> 00:23:37.419 the final message is, it was absolutely fine. She she she 387 00:23:37.419 --> 00:23:41.179 managed to prove to the tribunal that those 3 young patients that were 388 00:23:41.179 --> 00:23:44.995 quite stark examples, if you like, it was it was right and 389 00:23:44.995 --> 00:23:47.955 it was fine for her to treat them the way that she did. And I 390 00:23:47.955 --> 00:23:51.760 hope that that gives other doctors out there confidence. But we could do with the 391 00:23:51.760 --> 00:23:55.600 GMC giving a bit more confidence. And actually maybe even saying, you know, if 392 00:23:55.600 --> 00:23:59.200 you if you deny care, what are going to be what are the consequences going 393 00:23:59.200 --> 00:24:01.835 to be? It's all right, it's all very well for you saying, well, if I 394 00:24:01.835 --> 00:24:05.515 give care, will I be will I be, you know, hold up in 395 00:24:05.515 --> 00:24:08.898 front of the GMC, let's say. But what if I deny care, will I see, 396 00:24:09.160 --> 00:24:12.840 will will I have action taken against see? You know, am I fit to 397 00:24:12.840 --> 00:24:16.680 practice as a doctor if I can't help this transgender patient in front of 398 00:24:16.680 --> 00:24:20.445 me? And And that's what we need to switch that narrative to. You may you 399 00:24:20.445 --> 00:24:23.965 mentioned the off label. We use off label drugs all the time 400 00:24:23.965 --> 00:24:27.600 in medicine every day. And, you know, we, we explain 401 00:24:27.600 --> 00:24:31.220