The WLMHT (‘Charing Cross’) Gender Identity• One’s innermost concept of self as male or female or both or neither – how individuals perceive themselves and what they call themselves. One’s gender identity can be the same or different than the sex assigned at birth. Individuals are conscious of this between the ages 18 months and 3 years. Most people develop a gender identity that matches their biological sex. For some, however, their gender identity is different from their biological or assigned sex. Some of these individuals choose to socially, hormonally and/or surgically change their sex to more fully match their gender identity.
• The gender to which one feels one belongs.
• Internal and psychological sense of oneself as a woman, a man, both, in between, or neither.
Clinic has existed in one form or another since the early 1960s, and clinical practice is constantly evolving. It is perhaps inevitable that, in that time, a number of false beliefs and misconceptions have arisen.
Not all these beliefs are ‘myths’ in the sense of having always been untrue – some stem from the way the GIC operated in the past, or the approaches of previous clinicians – but all are outdated, and unreflective of current treatment protocol.
The following, then, are examples of commonly held beliefs about the WLMHT GIC which are untrue:-
You have to wear a skirt to the GIC
Perhaps the most widely cited misconception, this is not the case. As part of the Real Life Experience (RLE)A former requirement for medical transition, during which one was required to live full-time in their self-determined gender role; this requirement has been removed in the current WPATH Standards of Care (Version 7)., male-to-female transitioners are expected to present themselves in femaleA sex, usually assigned at birth, and based on chromosomes (e.g. XX), gene expression, hormone levels and function, and reproductive/sexual anatomy (e.g. vagina, uterus). role 100% of the time, and sometimes it is relevant to discuss this in clinic appointments. However, the range of feminineDescribes socially and culturally constructed aspects of gender (e.g. roles, behaviour, expression, identity) typically associated with girls and women. apparel is, obviously, wide and varied, and cannot simply be reduced to ‘wear a skirt’.
A less common variant holds that female-to-male transitioners must wear a suit and tie to be taken seriously at the GIC. This too is without basis.
You have to be living ‘in role’
Not the case. We see people who experience gender• However gender is far more complicated. It is the complex interrelationship between an individual’s sex (gender biology), one’s internal sense of self as male, female, both or neither (gender identity) as well as one’s outward presentations and behaviours (gender expression) related to that perception, including their gender role. Together, the intersection of these three dimensions produces one’s authentic sense of gender, both in how people experience their own gender as well as how others perceive it.
• Gender is expressed in terms of masculinity and femininity. It is largely culturally determined and is assigned at birth based on the sex of the individual. It affects how people perceive themselves and how they expect others to behave.
• Socially and culturally constructed roles, behaviours, expressions and identities of girls, women, boys, men, and trans people.
related distress; some are pre- transition• The social, psychological, emotional and economic processes that a trans person undergoes to move from their assigned gender role into their chosen or acquired gender. The time this takes is variable and depends on the individual’s ability to embrace significant change in their life. If requiring genital surgery the individual will have to undergo a so called Real Life Test, i.e. living in their acquired gender role for a minimum of 1 year.
• Refers to the process during which trans people may change their gender expression and/or bodies to reflect their gender, including changes in physical appearance (hairstyle, clothing), behaviour (mannerisms, voice, gender roles), identification (name, pronoun, legal details), and/or medical interventions (hormone therapy, gender-affirming surgery).
, some do not undergo transition• The social, psychological, emotional and economic processes that a trans person undergoes to move from their assigned gender role into their chosen or acquired gender. The time this takes is variable and depends on the individual’s ability to embrace significant change in their life. If requiring genital surgery the individual will have to undergo a so called Real Life Test, i.e. living in their acquired gender role for a minimum of 1 year.
• Refers to the process during which trans people may change their gender expression and/or bodies to reflect their gender, including changes in physical appearance (hairstyle, clothing), behaviour (mannerisms, voice, gender roles), identification (name, pronoun, legal details), and/or medical interventions (hormone therapy, gender-affirming surgery).
at all. All are valid referrals to our service.
You have to want surgery
Not at all. Not everyone needs or wants gender• However gender is far more complicated. It is the complex interrelationship between an individual’s sex (gender biology), one’s internal sense of self as male, female, both or neither (gender identity) as well as one’s outward presentations and behaviours (gender expression) related to that perception, including their gender role. Together, the intersection of these three dimensions produces one’s authentic sense of gender, both in how people experience their own gender as well as how others perceive it.
• Gender is expressed in terms of masculinity and femininity. It is largely culturally determined and is assigned at birth based on the sex of the individual. It affects how people perceive themselves and how they expect others to behave.
• Socially and culturally constructed roles, behaviours, expressions and identities of girls, women, boys, men, and trans people.
related surgery.
You have to be suicidal
On the contrary, it is important that those undergoing transition• The social, psychological, emotional and economic processes that a trans person undergoes to move from their assigned gender role into their chosen or acquired gender. The time this takes is variable and depends on the individual’s ability to embrace significant change in their life. If requiring genital surgery the individual will have to undergo a so called Real Life Test, i.e. living in their acquired gender role for a minimum of 1 year.
• Refers to the process during which trans people may change their gender expression and/or bodies to reflect their gender, including changes in physical appearance (hairstyle, clothing), behaviour (mannerisms, voice, gender roles), identification (name, pronoun, legal details), and/or medical interventions (hormone therapy, gender-affirming surgery).
be stable, physically and psychologically. It is not unusual for us to see people who have, as a result of their gender• However gender is far more complicated. It is the complex interrelationship between an individual’s sex (gender biology), one’s internal sense of self as male, female, both or neither (gender identity) as well as one’s outward presentations and behaviours (gender expression) related to that perception, including their gender role. Together, the intersection of these three dimensions produces one’s authentic sense of gender, both in how people experience their own gender as well as how others perceive it.
• Gender is expressed in terms of masculinity and femininity. It is largely culturally determined and is assigned at birth based on the sex of the individual. It affects how people perceive themselves and how they expect others to behave.
• Socially and culturally constructed roles, behaviours, expressions and identities of girls, women, boys, men, and trans people.
distress, been depressed – sometimes to the point of suicidality – but we would hope that, as transition• The social, psychological, emotional and economic processes that a trans person undergoes to move from their assigned gender role into their chosen or acquired gender. The time this takes is variable and depends on the individual’s ability to embrace significant change in their life. If requiring genital surgery the individual will have to undergo a so called Real Life Test, i.e. living in their acquired gender role for a minimum of 1 year.
• Refers to the process during which trans people may change their gender expression and/or bodies to reflect their gender, including changes in physical appearance (hairstyle, clothing), behaviour (mannerisms, voice, gender roles), identification (name, pronoun, legal details), and/or medical interventions (hormone therapy, gender-affirming surgery).
progresses, this gradually improves.
You have to be heterosexual
We have heard health professionals say this of the clinic, but it is patently ridiculous. It would be grossly unethical of us to insist on heterosexuality in our patients.
You can’t admit to doubt
Transition• The social, psychological, emotional and economic processes that a trans person undergoes to move from their assigned gender role into their chosen or acquired gender. The time this takes is variable and depends on the individual’s ability to embrace significant change in their life. If requiring genital surgery the individual will have to undergo a so called Real Life Test, i.e. living in their acquired gender role for a minimum of 1 year.
• Refers to the process during which trans people may change their gender expression and/or bodies to reflect their gender, including changes in physical appearance (hairstyle, clothing), behaviour (mannerisms, voice, gender roles), identification (name, pronoun, legal details), and/or medical interventions (hormone therapy, gender-affirming surgery).
is, for many, a major life change and it would be unusual to have no doubts whatsoever. You should feel comfortable discussing feelings of doubt with your clinicians.
You have to give a standard trans narrative
As the UK’s largest gender• However gender is far more complicated. It is the complex interrelationship between an individual’s sex (gender biology), one’s internal sense of self as male, female, both or neither (gender identity) as well as one’s outward presentations and behaviours (gender expression) related to that perception, including their gender role. Together, the intersection of these three dimensions produces one’s authentic sense of gender, both in how people experience their own gender as well as how others perceive it.
• Gender is expressed in terms of masculinity and femininity. It is largely culturally determined and is assigned at birth based on the sex of the individual. It affects how people perceive themselves and how they expect others to behave.
• Socially and culturally constructed roles, behaviours, expressions and identities of girls, women, boys, men, and trans people.
clinic, we see a huge diversity of people, and neither wish nor expect you to tailor your own experiences to a set of cliches. Just be honest.
The GIC will start you at the beginning again
This was our practice in decades past. In the last decade or so, it has been standard practice to acknowledge previous time spent in the preferred gender role• This is the set of roles, activities, expectations and behaviors assigned to females and males by society. Our culture recognises two basic gender roles: Masculine (having the qualities attributed to males) and feminine (having the qualities attributed to females). People who step out of their socially assigned gender roles are sometimes referred to as transgender. Other cultures have three or more gender roles.
• Socially constructed and culturally behavioural norms, such as communication styles, careers and family roles, that are often expected of people based on their assigned sex.
. Typically, we ‘back date’ the start of transition• The social, psychological, emotional and economic processes that a trans person undergoes to move from their assigned gender role into their chosen or acquired gender. The time this takes is variable and depends on the individual’s ability to embrace significant change in their life. If requiring genital surgery the individual will have to undergo a so called Real Life Test, i.e. living in their acquired gender role for a minimum of 1 year.
• Refers to the process during which trans people may change their gender expression and/or bodies to reflect their gender, including changes in physical appearance (hairstyle, clothing), behaviour (mannerisms, voice, gender roles), identification (name, pronoun, legal details), and/or medical interventions (hormone therapy, gender-affirming surgery).
to the start of living in role full time as well as making an official name change or equivalent.
The GIC will stop your hormones
No. Our concern is that you take hormonesChemical substances that control and regulate the activity of certain cells or organs; see also: sex hormones. safely. We routinely carry out blood tests at the first appointment, and may advise accordingly, but we generally do not ask people to stop hormonesChemical substances that control and regulate the activity of certain cells or organs; see also: sex hormones. on which they are established.
The GIC will penalise you for having gone private/self-medicated
Obviously, we cannot approve of self-medication as it can be dangerous and often leads to a poorer result than that gained under medical supervision. However, we recognise that it is a modern reality, though, and do not penalise you for it. The same is true of previous contact with private practitioners.
It will take forever
Within the limits of available NHS resources, we aim to provide a timely and efficient service.
They deliberately play Good Cop/Bad Cop
Different clinicians have different approaches, and will form different therapeutic relationships with their patients. Choice of clinician is determined by availability of appointment slots, not by any sort of organised Good/Bad Clinician policy.
Source
West London Mental Health Trust [Charing Cross GIC] – November 2010