The author is a UK academic and mother of a son who experienced sudden onset gender dysphoria. She has attended the Gendered Intelligence parents support group, and her son consulted Stuart Lorimer at GenderCare. She can be found on Twitter as SunMum@Mum3Sun
The business model of a private gender clinic in the UK looks a dead cert. To start with, you need demand, and the rising demand for gender reassignment services offers that in abundance. The NHS offers a gender reassignment pathway, but demand in recent years has outstripped the resources of a publicly funded health service. Waiting lists at the main adult provider, the Charing Cross Gender Identity Clinic, the UK’s ‘oldest and largest adult clinic’ founded in 1966, are currently about 12 months from the first referral. Referrals have ‘almost quadrupled in 10 years, from 498 in 2006-07 to 1,892 in 2015-16’ according to the Guardian in July 2016.
At the Tavistock and Portman, the only NHS service for children and adolescents with gender dysphoria, referrals have increased ‘about 50% a year since 2010-11.’ In the year leading up to this Guardian report, the rate of change in child referrals showed ‘an unexpected and unprecedented increase of 100%, up from 697 to 1,398 referrals’.
In the same 2016 Guardian article, Charing Cross GIC lead clinician James Barrett comments jocularly on this sudden increase in demand:
‘It obviously can’t continue like that forever because we’d be treating everyone in the country, but there isn’t any sign of that levelling off.’
Now this is a rather strange comment, given that only five years before, in 2011, Barrett stated that rates of gender dysphoria were stable and unchanging. Citing a 1996 study, he presented the condition as vanishingly rare: ‘It seems that the incidence of transsexualism is very roughly 1 in 60000 males and 1 in 100000 females, and it seems to have remained constant’. Given that ‘treatment is drastic and irreversible’, Barrett insisted that diagnosis must be entrusted to the experts of the gender identity clinic:
The least certain diagnosis is that made by the patient, made as it is without any training or objectivity. This uncertainty is not lessened by the patient’s frequently high degree of conviction. Neither does the support of others with gender dysphoria help, since conviction leads people to associate with the likeminded and to discount or fail to seek out disharmonious views. [ James Barrett, Advances in psychiatric treatment (2011), vol. 17, 381–388 doi: 10.1192/apt.bp.109.007484)
Pitching the service: Respect and Authority
GenderCare, headed by Stuart Lorimer, is a private London gender clinic mostly staffed by clinicians employed at Charing Cross GIC: endocrinologist Leighton Seal, psychologist Christina Richards and speech therapist Christella Antoni. These are professionals who have reputations at stake.
And while GenderCare does offer some Skype and email consultations, prospective patients or parents of gender confused young adults can be reassured that this is not an online clinic like that run by Helen Webberley, a Welsh GP whose Online Transgender Medical Clinic displays no more relevant qualifications than a one hour e-course in ‘Gender Variance’ designed by a transactivist organisation for GPs.
Twitter contains some negative reports of Webberley’s outfit: ‘A guy I know was rushed into hospital with liver failure because of Dr W’s incompetence, not having his bloods reviewed meant he was on too high a dosage of testosterone & literally nearly died.’ According to one young person, Webberley ‘has this weird online ‘grooming’ thing going on, contacting young people via social media’. Of course, Twitter testimonials do not constitute actual evidence and should be viewed with caution. Yet it’s clear to anyone who spends time investigating that young people are discerning as they sift through their choices and look for medical help they trust.
The GenderCare website by contrast is reassuringly respectable: these are ‘Specialists in Gender Care’, genuinely experts in their field. The site and FAQ frequently remind us that patients will be seen by a team of medical experts The FAQ emphasises hormonal treatment, with assurances that the letter needed for medical transition will be prepared as quickly as possible.
What would be the hurry? It appears that, since 2011 when Lorimer’s Charing Cross colleague James Barrett insisted on the ‘drastic and irreversible’ nature of medical transition and the caution that the ‘least certain diagnosis is that made by the patient’, there has been a sea change in the field. Now Barrett presents gender dysphoria as a condition with no parallel. It simply is what it is, and gender specialists are sui generis: neither psychiatrists, nor endocrinologists, but what it says on the can: ‘gender specialists’. Barrett compares gender dysphoria in a 2016 blog post for the BMJ, to ‘the Australasian Platypus’[full article behind paywall]:
The first specimens were dismissed as a joke of some sort.
But then more came, and alive and kicking at that. There followed a mighty taxonomological struggle. They were reptiles or perhaps some sort of bird, surely, as they were warm blooded, laid eggs and were venomous. On the other hand, the fur argued for mammals, but they didn’t have proper breasts, the defining feature of the mammals, and that business of being venomous is more of a reptile-like thing, is it not? And they do lay eggs…but warm blooded…perhaps a bird of some sort…?
In the end, it was all solved by everyone admitting that the Platypus was real, important, couldn’t be dismissed and didn’t fit any existing category very well. It got its own, special category where it has paddled, very happily, ever since, albeit joined by echidnas and some long-extinct fossilised forebears.
The comparison is witty and memorable, but leaves us no wiser. Lorimer also subscribes to what we might call the Platypus model of gender theory (‘a variety of clinical specialisms might lay reasonable claim to ownership of gender care but, like the platypus, it’s its own creature, distinct and different’. Although trained as a ‘Liaison psych’ he believes that ‘ultimately, it’s about pragmatism – who has the appropriate skill-set to do the work.’
For gender identity, there is no well-founded theoretical model, no objective test: we simply have to believe in the authority of the expert. Believe me because I say so. For the young people who visit GenderCare, diagnosis by a gender specialist offers confirmation and validation of their internal sense of self. YouTube videos about ‘my first visit’ to GenderCare form a genre of their own, revealing the overwhelming power of this validation. One young person reports
‘It were a really positive experience. He were very validating and he shouldn’t have been because I obviously know that someone validating your experience isn’t necessary. But hearing him saying the words saying he’s diagnosed me, he’s signing me off…It’s like all my Christmases come at once.’
There are many transition YouTubes made by young clients of Dr. Lorimer; they are moving videos, in which these young people freely admit they suffer with self harm and sometimes suicidality. A single visit to GenderCare can apparently provide a rapid remedy. The process is quick and simple: when blood tests are in and the letter comes through, a young woman who desires to transition FTM can start testosterone. One has already got ‘syringes through the post’, the ‘sharps bin’ and the needles:
‘I don’t know if you’ll be able to see this. Look at the fucking size of that needle. Look at it compared to the size of my finger. Well clearly I’m not needle-phobic. But fuck, it’s huge. I’d hit myself in the face with a brick if it meant starting on testosterone.’
Pushing at the boundaries
In taking on private work, Lorimer would need to protect his professional reputation and adhere to legal and medical regulations. This may at times present complications. In 2014, according to a post on ‘The Angels’ (a trans support forum), the UK’s Care Quality Commission (CQC) raised questions about the ‘grey area’ of his private practice, prompting Dr Lorimer to temporarily stop seeing clients.
Leaving aside the question of what may or may not have happened in 2014, the key regulatory boundaries with gender reassignment are to do with time (how quickly hormones are dispensed) and age (those under 18 are treated in a different way from adults). For much of 2016, the GenderCare website warned that hormones are not normally prescribed on a first visit. That is certainly not the belief expressed on Twitter today:
The burgeoning youth market
GenderCare’s FAQ tells us they primarily treat over-18s, although some exceptions are made. Lorimer confirms this on Twitter:
Earlier in this post, we saw that some young people on Twitter were freaked out by what one calls ‘this weird online grooming thing going on’ by Helen Webberley’s outfit. The respectable GenderCare would surely do no such thing. But Lorimer too has a social media presence through which he touts for business, a Twitter voice seemingly designed to speak to the young – especially trans men. Here we find him mythologizing the joys of testosterone:
Parents know that when young people want something, they want it Now! And for some young women the thing that is needed, and needed quickly, is testosterone, seen by dysphoric adolescent females as a panacea for all ills.
About ‘two thirds’ of his patients, Lorimer explains are ‘trans men’:
Like the proverbial high court judge, I need to make my way over to the Urban Dictionary . But Lorimer is the doc who talks to young people, who plays knowingly with the idea of ‘A girl’s body and the way she carries it.’ Looking at YouTube or at Twitter, you would think that Stuart Lorimer was an expert on adolescent gender dysphoria. But this apparently is not the case:
Lorimer may have ‘extremely limited experience of children/adolescents’. But it takes a very limited dip into the sea of adolescent angst freely available on Twitter and YouTube to realise that GenderCare clients are in the throes of the kinds of relationship and body issues that many adults remember. These are not strange young people, but people suffering from a horribly familiar set of feelings. Of course, we don’t know the age of all those who tweet of vlog about their GenderCare appointments. They might simply be youthful in spirit, but young they certainly appear to be. These don’t sound like people who are approaching ‘drastic and irreversible’ bodily alterations with maturity, discretion or objectivity:
Perhaps most troubling is that in 2016 Lorimer arrived on Tumblr, overwhelmingly a place for young people (very popular with ages 13-18), with a GenderCare Tumblr site. Lorimer seems anxious. Why? Is it because he knows he’s rather old to be on Tumblr?
Tumblr is full of accolades for GenderCare. And whilst one might think a need for hormones and surgery would be necessary only for those who strongly believe themselves to be the opposite sex, evidently even ‘nonbinaries’ are supported in their quest for medical intervention via GenderCare:
Lest readers think this nonbinary stuff is hyperbole, Dr Lorimer (aka The MXMaster) confirmed the Tumblrite’s observation on Twitter last August.
The market potential for ‘nonbinaries’ must be unlimited. Who amongst us fully conforms to gender stereotypes? And GenderCare isn’t the only UK gender clinic cashing in on the ‘enbie’ market:
Let’s see: Can you spot the difference between ‘non-binary’ and ‘binary’ mastectomy?
But returning to GenderCare, one of the more ironic aspects of all this is that Lorimer himself is certainly old enough and wise enough to see beyond the teenage rush for bodily alteration. A highly flattering image of Lorimer appears on the website of photographer James M. Barrett (not the gender clinician this time but a photographer who specialises in beautiful images of gay men). The photographer’s Facebook page comments sagely on the contemporary rush for bodily alteration:
‘In popular culture, there is an extraordinary urgency to take charge of our bodies and minds, and to “become the person that we were always meant to be”! It is as if we can rewrite our lives and give birth to new selves, simply through the power of positive self-belief, and some bloody good cosmetic work on our physical appearance! It is not just a practical idea that looking more attractive might increase our pulling power or lift our spirits. It is the fantasy that if we could just become achingly beautiful, then we will also be unbearably desirable, and our whole lives will be transformed from ordinary to unique. And of course, digital photography plays right into this fantasy, allowing us to perform virtual nick-and-tuck manipulations, and to airbrush a veneer of youthfulness onto our imagined selves. The images in this portrait series have also been heavily worked in post-production, but the effect is meant to suggest something very different: a harsh beauty that resonates with uncertainty, doubt, restlessness, world-weariness, perhaps mid-life crisis…but which also carries a tender intimacy, resilience, ruggedness, and a new-found robustness that comes from surviving a crisis.’
Wise words. And we know that Lorimer subscribes to this aesthetic. Not only has Barrett photographed him but under another image a ‘Stuart Lorimer’ comments: ‘Fantastic portrait!’. In his own photograph, Lorimer looks great: retouched, digitally improved, there is no necessity for cosmetic surgery, drugs, or scalpels.
For professional purposes, simpler photographic techniques suffice:
Now Lorimer knows, for certain, that Tumblr is for young people:
‘Tumblr, like lycra is probably not for anyone over 30 –yet here I am. Every fibre in my fortysomething being is screaming at me “GO! THIS IS FOR YOUNG PEOPLE!” but I’m resisting that because I think it may be useful for me to tout for lucrative business, as head of GenderCare, to have a presence here.’
Why? Maybe because young people use Tumblr to explore sub cultures of body hatred and body alteration. Lorimer is careful to add a disclaimer that he does not represent his ‘NHS employers or my GenderCare colleagues’.
But there is no escaping the fact that this is the official GenderCare Tumblr. There is no doubt that he is advertising transition services. In this location, Lorimer does not share his wise appreciation of the power of digital photographic enhancement to act out our fantasies. Instead he offers age-appropriate ‘links to things I find diverting that are not especially relevant (cute animals)’:
Don’t worry, young person about your first trip to get T. You will meet a cuddly gender doc wearing a pink suit.
After all, this is all a game, a joke. Fun. Isn’t it?
Well I for one don’t think it is. My son, you see, became seriously depressed in his second year at university and developed sudden onset gender dysphoria. No earlier signs, easily the most ‘boyish’ of my boys. But after a romantic rejection and drug experimentation he developed depersonalization, googled his symptoms, found they were a symptom of trans, stopped washing, seeing his friends, his handwriting changed, he made odd repetitive hand movements, he became angry and he stayed up all night. I thought he was having a breakdown. His GP thinks it is depression or maybe schizophrenia. But, urged on by a counsellor, I in my naivete paid out for an assessment at GenderCare. After all, the clinicians were the real thing, weren’t they? They all worked at Charing Cross GIC in the NHS. They couldn’t be just cynical or stupid, could they?
I was astounded when my son came back telling me that he would be starting hormones in a few weeks. I emailed GenderCare and asked whether I could supply some contextual information. Lorimer contacted my son to ask permission (since he was 22 at the time). Son said yes, so I sent off a timeline of events, including details that I thought might be relevant to a diagnosis, including a series of recent traumatic events. Lorimer duly wrote a report saying he was a bit worried and wanted a second opinion. The second opinion was with his colleague at Charing Cross GIC, James Barrett (not the photographer, who could only have beautified my beautiful son digitally acting out his fantasies). As Barrett had no access to context (this time son said No), he had an avuncular chat with son (cost £200) and advised on choosing a new name and the right to access female toilets. My son, who a family therapy team thought was ‘struggling with his decision to transition’, now repeatedly refers to the fact that he has been ‘diagnosed by two gender experts’. But in this matter, there is no diagnosis: doctors simply echo back to patients their own self-diagnosis. And the first doctor to offer him that external recognition was Stuart Lorimer.
GenderCare combines accessibility to the young through its active presence on social media, with a show of clinical expertise. The recent news that the Charing Cross GIC would be run within the Tavistock and Portman NHS trust led Lorimer to comment on ‘that potentially big plus. Possibilities for great cross-fertilisation between child and adult services.’ He wouldn’t notice the crassness of the metaphor, because what Lorimer is breeding is a business model; the fertility of confused young people is neither here nor there.