Transgender people, workplace health, and the EHRC consultation

Workplaces: Shops (and offices?) in Gloucester

Introduction and context

At the time of writing, transgender people in the UK are holding our collective breath. Our Supreme Court has ruled that the word ‘woman,’ means ‘biological woman’ in the context of the Equalities Act (2010) and the Equality and Human Rights Commission have issued interim guidance which expands this ruling into dictating that transgender people should use the toilets of our birth sex, be treated on hospital wards of our birth sex and be excluded from sport as members of our affirmed sex.  Consultation about the clarity of their code of practice is due to end at the end of June; it will then be laid before Parliament to give it statutory force.

If you are reading this, you probably know already but: Being transgender is the reality of the sex you know you are not matching your sex as recorded at birth. The term includes not only binary (fully male or fully female) transgender people; some non-binary (neither fully male nor fully female) people also describe themselves as transgender, as do some people born with intersex variations. I am writing from the perspective of a binary transgender woman, because that is my lived experience; there are non-binary and intersex writers who can tell their truths in a way that I cannot.  I am writing in a personal capacity, and my views are purely my own.

You probably wouldn’t draw this conclusion from traditional media (especially print media), and you certainly wouldn’t do so from social media, but transgender people actually have full lives and, unless circumstances (health, caring responsibilities) dictate otherwise and preclude us doing so, we earn our livings in exactly the same way that cisgender people do. There are scientists who are transgender, there are artists, there are writers, there are mathematicians, cartographers and philosophers; there are transgender people in every career under the sun. Unsurprisingly, we are therefore in all sorts of workplaces from farmyards to offices to tech clean rooms.

Gender dysphoria — the sense of unhappiness that someone’s birth sex does not match their knowledge of who they are — can cause profound distress. Imagine being in a horror film where every time you look in a mirror, the wrong person is looking back at you.  Imagine that every time you hear your own voice, it is the voice of someone you are not.  Imagine that you have the wrong body parts, with puberty bringing the associated (and definitely unwanted) bodily functions. Other people cannot tell who you are ‘on the inside.’  You are misgendered at work every day and unless you have a name that is gender-neutral, that goes for every time someone refers to you.  Imagine going through childhood and adolescence knowing that you are a girl, but with your parents, relatives, and teachers being adamant that you are a boy.

It should go without saying but:

Being transgender is not a mental illness. Full. Stop. 

That is scientifically accepted, but the medical, scientific and sociological literature notes that gender dysphoria is a recipe for depression and anxiety.  Sooner or later there may come the time when someone can no longer carry on in their birth sex and they seek medical help, subsequently transitioning to live in their affirmed sex.  The waiting lists for a first NHS appointment at a Gender Identity Clinic (the relevant specialist unit, often abbreviated to GIC) in the UK are measured in years rather than months. Unsurprisingly, this can lead to further stress and misery unless the patient, as they have become, can afford private medical care.

Some people transition with the support of their Gender Specialist, but some transition before their first visit to a GIC. Some people are able to start HRT to start transitioning medically before that visit, with the HRT either privately prescribed or bought online. 

 

Social Transition

So, what does a ‘transition’ involve?  Social transition involves a change in name, telling not only family, friends, and bank, but also your managers and HR, utility providers, Govt departments, and so forth. It also involves a change in clothing and being in public in your affirmed gender on an everyday basis.  That is not easy, especially to start with!  Transitioning is horrendously stressful with worries about how and whether people at work will accept you in your affirmed role, and how your friends and family will react as well as how you will fare in public, especially in the early days of your transition.  Some people transition under the supervision of their doctors/specialists; others – especially those faced with a horribly long wait for NHS treatment - transition before they have even managed to see a gender identity specialist.  It can take a year after that first appointment before medical transition even starts.  The specialist will observe/assess how you fare in your affirmed gender in a ‘real life test’ and refer you for surgery when that test is complete.

 

Medical Transition

Medical transition is complex.  For someone transition physically to female, as I did, this involves hormone treatment to feminise the body and cause breast growth, electrolysis or laser treatment to remove facial hair, possibly speech therapy (a lot of trans women learn from peer tutorials online nowadays, but that wasn’t a thing in the 1980s), and gender reassignment surgery – which was called a sex change operation (or just ‘the operation’) in my day – to create female genitals.  It may also involve fertility preservation - not an option when I was transitioning!  Some trans women may undergo facial feminisation surgery and surgery to reduce the size of their Adam’s apple, depending on what features are causing distress.  All of this, and the ongoing assessment of the Real Life Test, takes time and multiple medical appointments over several years, often requiring a full day to travel to the appointment and back afterwards each time, and of course a longer period for recovery from surgery/surgeries.

Treatment for transgender men or transmasc people follows a similar pattern, save that testosterone therapy masculinises the body and face, and that the surgery may involve a bilateral mastectomy (‘top surgery’), a radical hysterectomy, and phalloplasty (the creation of a penis). 

Incidentally, the regret rate for gender reassignment surgery is less than 1%.  For comparison, the regret rate for breast enhancement surgery in cisgender women is 31%; 27% of people who undergo rhinoplasty (nose jobs) regret it.

The current situation

I mentioned at the start of this post that the Equality and Human Rights Commission (EHRC), the UK human rights body, have very recently said that transgender people must not use the public conveniences of their affirmed sex and that that we should use conveniences of our birth sex. They have also said that that we can be barred from the latter if we pass successfully in our affirmed sex. Fear of problems caused by using the toilet of someone’s affirmed gender can cause transgender people to dehydrate themselves during the working day, leading to urinary infections.  Sadly, this pressure not to use the ‘wrong’ toilets is also leading to cisgender women being challenged or attacked because someone wrongly believes they are transgender.  We are being urged to ‘use our advocacy’ to campaign for third spaces, and to use accessible facilities - ‘disabled toilets’ - but being trans is not a disability and suddenly starting to use the accessible facilities may out people against their will.  Additionally, in some workplaces, the accessible toilets may be in gendered facilities…

Unless a workplace has gender-neutral toilets, this makes a working day rather difficult!  This is also a factor to be borne in mind when planning travel for work or when booking venues for meetings and conferences.  For fieldwork, and relieving oneself in remote places, please remember that maybe not everyone will have the ‘plumbing’ you might think they have, and please be aware that transgender and non-binary staff may be worrying to the extent that they may try to miss fieldwork.

Some transgender men and non-binary colleagues may menstruate and can of course be caught by surprise.  For fieldwork, it is a good idea to add period products to first aid kits and to make everyone aware that they are there with no questions asked if they are needed.  Even in the workplace, transgender men and non-binary colleagues may try doubly hard not to admit to menstrual pain.

Sadly, some of the major things that affect transgender people are caused by colleagues who do not understand what gender dysphoria is and who - accidentally or deliberately – deadname trans colleagues (call them by their birth names) or misgender them.  Misgendering hurts as much as a physical slap.

Let me repeat that – misgendering hurts as much as a physical slap.  When deliberate, it is bullying.  It is a rejection of a transgender person’s entire identity and life.  Fear of being misgendered and deadnamed can be a major stressor in the run-up to transition.

This is probably a good place to say that the word ‘tranny’ is a particularly offensive and degrading slur.  It is the direct equivalent of calling a person of African origin the ‘N’ word.

I also need to say that there has been a major increase in bullying, harassment and discrimination against transgender people in recent years.  Coupled with gender dysphoria and the inhuman length of waiting lists, 41% of transgender people either commit suicide or make a serious attempt.  A full 84% of transgender people seriously consider suicide at one point or another.  Given the current political and social situation in the UK, I fear that those figures will rise.  In my personal social group (and I don’t know that many trans people well enough to be aware of issues affecting them personally), I have seen people signed off work because of stress and anxiety brought about by our current working and social environment.  I know of people who are in despair but carrying on, worrying about whether they will be able to go to the toilet during their working day. I know of people pondering whether their marriages, entered into in their affirmed gender, who are unsure whether those marriages are still legal and valid.  I know people who are afraid of being policed in relation to their toilet use, and people who actually have been policed for it in their workplace.  [Incidentally, my friend’s 6-year-old child was very recently thrown out of the Ladies and told to go in Gents at soft play by someone in the Ladies who reckoned the child was a boy, and then thrown out of the Gents by someone who decided the child was a girl. The child is 6, and very small for their age. My friend found her child crying on the floor between the two sets of toilets}.  I know people who are worried sick about transgender friends and family members, with these stresses affecting their working lives. 

Until the Supreme Court judgement, I would have said that in contrast to the issues I’ve outlined, transition and gender reassignment have tremendously positive effects on people with gender dysphoria.  Statistics and the medical literature demonstrate that transition brings higher self-esteem, greater resiliency, greater relationship satisfaction, more confidence, and a marked reduction in depression.  I would add that were we facing a less hostile environment, it brings a sense of wholeness, and the ability to live a live as the person you have always known that you are. My life and my career would not have been what they are if I had not transitioned.  Thigs have been better than I could ever have dreamed.  I can only hope that in the very near future, the ‘legs are knocked out’ from under transphobia, that common sense and compassion will apply, and that transgender people will continue to be able to play a full and fulfilled role in society and in our professional lives in our affirmed gender without worrying about where to wee.