Shon Faye: “No one has been thinking about the future of trans healthcare”

By Paul Ray

The British establishment has become rather obsessed with trans people. In 2020, one national broadsheet newspaper and its sister Sunday paper between them ran over 300 articles (almost one per day) about transgender people. Debates and arguments around trans identity have become staples of talk shows like Good Morning Britain and political programmes such as Question Time. The journalist and author Shon Faye, a transgender woman, is sick of going onto TV sets to debate the legitimacy of her identity.

“The trouble with TV and radio in particular is if you actually think about how long these debates are given – because I’ve done them – it never lasts. It’s over in a flash. You get maximum nine minutes, I’d say, probably even less. And lots of these ideas are more complex than that, and more nuanced, and more unfamiliar to the public.”

“It’s much easier to reassert prejudices that have been built up in the media, that people are familiar with over the decades, in nine minutes than it is to challenge them, and to introduce a whole new way of thinking. So I don’t think that format suits trans people, or people advocating for them. It creates a spectacle out of it. But one that very rarely improves understanding from a trans positive perspective.”

Faye recently published her debut book, The Transgender Issue: An Argument for Justice. Across seven chapters, Faye methodically and calmly sets about introducing these nuanced and perhaps unfamiliar arguments in favour of trans liberation. It certainly strikes a different tone from those frenzied and vitriolic ‘debates’ you see clipped on social media. The book is packed with hard data and statistics that dispel many of the myths around transgender identity, such as the pernicious image of trans people as pampered middle-class elites (in fact, trans people are much more likely to have lower incomes and to experience poverty than the wider population). I found these facts and statistics useful for future reference when discussing this topic, but I already considered myself a trans ally. I asked Faye whether these facts and methodical arguments were aimed at people like me, or whether they’re actually intended to convert those with a more hostile attitude.

“That was one of the challenges in writing it, to think about who the reader is, and that’s quite difficult. The two main groups would be people like you, maybe, who were broadly supportive anyway, but to arm them with further information and to make them feel more confident in advancing these arguments, in whatever scenario – the dinner party, whatever.”

“The other is… there are some people who you’re just never going to convince, so I’m not trying to convince them. Especially the most extreme ones, they’re probably too far gone. But there are so many people in the middle who either are silent on it, or don’t know what to think […] and in some ways they’re the most important group, because they’re probably the largest in Britain in terms of potential readership, and they’re the people you can convince, and they’re actually the people who you need to convince.”

“Trans men cannot access lower surgery on the NHS right now.”

It often seems that the trans ‘debate’ as an emotive media spectacle is a peculiarly British phenomenon. I ask Faye why the topic of transgender people dominates newspaper headlines and TV schedules in a way that it doesn’t, for example, in the US.

“I think here there’s been a cultivation, for a long time, of keeping it alive as a ‘debate’. We have a very small media class in this country that’s mostly drawn from the same sort of backgrounds, the editors and the commissioners and stuff like that, and I think that that very small group of people have agreed amongst themselves, perhaps unconsciously, to keep this as a live issue over the past decade, to keep it as a debate. And all that happens is that’s self-perpetuating. You wouldn’t have a debate on Newsnight now, for example, about whether or not gay marriage is real marriage. Like, you just wouldn’t. But there probably was a time where you would have. And so there is a choice to keep this thing as a live issue.”

Faye also makes the point that in the UK, opinions about the trans community cut across the political divide in a way that they don’t in the more neatly tribal US. “In the US, because of polarisation, people associate transphobia with Trump and the Christian right, and anti LGBTQ+ right-wing movements and anti-abortionists and things like that, whereas here it’s got a much more respectable face, including under the guise of certain strands of feminism. So here it’s not seen as automatically a right-wing position to be anti-trans, even though I’d argue that it is.”

The Transgender Issue is essentially Faye’s attempt to sidestep the ‘debate’ in its current media form. Rather than engaging in the perennial arguments about Olympic athletes and gender neutral toilets, Faye uses the book to detail the real, most pressing issues facing ordinary trans people in Britain today: workplace discrimination, the bloated and Kafkaesque trans healthcare system, poverty and homelessness. I ask Faye why I found out about those issues in her book, rather than in the constant media attention devoted to the trans community.

“The reason, I would say, is because we don’t have trans people in any significant positions of power. Despite this ‘trans lobby’ myth, we don’t have trans MPs or trans MSPs or trans members of the Senedd or trans members of Stormont. And we don’t have trans judges, or senior journalists. There’s just a complete dearth of trans people in public life.”

From consuming British media coverage of trans issues, you could be forgiven for thinking it’s easy for trans people to get on hormones and change their sex at will. But, as Faye tells me, this image couldn’t be further from the reality of life as a trans person using the NHS, especially for trans children and teenagers seeking appropriate healthcare.

“GIDS, the Gender Identity Development Service, is not fit for purpose and hasn’t been for a while. And it has a monopoly on access to care for young people on the NHS in the UK. And unfortunately, for trans children and young people to get the healthcare they need, the waiting lists there are also crazy.”

“What we have now is a two tier system, where if you’re middle class and your parents are supportive, they will likely pay for you to go private. But of course if you don’t have supportive parents, or you do but they’re not wealthy or clued up enough or whatever, then there’s institutional barriers to them accessing private care, and there isn’t anything in place. What we would need for a really equal standard of care is ending the monopoly that GIDS has on access to care, and finding a more flexible model of care for young people in community-led services.”

“Here it’s not seen as automatically a right-wing position to be anti-trans.”

Faye makes the point that the need for healthcare reform for trans people goes way beyond simply pumping more money into the NHS, although that wouldn’t go amiss. In the UK, there are only six NHS surgeons capable of performing vaginoplasties (bottom surgery for trans women), two of whom are set to retire in the next few years. I ask Faye if there are any measures being put in place to address this threadbare situation.

“Yeah, and that’s only for male to female genital reassignment. For phalloplasty, which is trans men’s lower surgery, there is actually no access to phalloplasty at the moment in the NHS, because the team that was doing it has been decommissioned, and they haven’t been recommissioned yet on an NHS contract. So actually trans men can’t access lower surgery on the NHS in Britain right now.”

“So there is no… there is no plan for that, because it’s deprioritised, and no one has been thinking about the future of trans healthcare. You have to hope that there will just be enough people who qualify as surgeons who decide that that’s their area of interest, but that’s a big if. It speaks to the broader crisis in trans healthcare— basically it’s the whole approach. It drastically needs reform, but there’s this bottleneck, because of the gender identity clinic system, and the still old-fashioned form of psychiatric control over who can transition. So unfortunately we’re just going to see those lists continuing to grow and grow, and unfortunately that system will come to its knees in the end, but it’s whether or not there’s going to be anything to replace it. And that’s rather bleak.”

Is the political will there to reform the dysfunctional gender identity clinic system? Or is the situation really as bleak as Faye makes it sound?

“The devolved government in Wales is a bit less hostile than the UK government. They’ve got a more reformed, modern system in the last couple of years, and that’s largely because of a lot of work and time invested by trans campaigners at local level, and it’s really slow and incremental and quite unglamorous work. So that is the sort of work that potentially has benefit to trans people. And I do think there’s will at local level and grassroots level for that, and within some parts of the NHS some clinicians are very willing, but I don’t think there’s enough political will for it to be rolled out in the timely way it needs to be.”

Image: Paul Samuel White