Disciplinary proceedings against a leading sex-change doctor bring shame to the medical profession.
London – 6 October 2006
This week saw the opening shots in a mighty battle between the conservative medical establishment and a radical pioneering doctor who has bought fulfillment to dozens of previously troubled patients.
Dr Russell Reid is an internationally-renowned consultant psychiatrist, specialising in gender reassignment treatment for people who want to change sex. These individuals have been diagnosed with gender dysphoria; a condition where they feel they were born in the wrong body – that their physical gender does not match their psychological and emotional gender.
Dr Reid’s prescription of hormone treatment and genital surgery has enabled many of these people to secure happiness as transgender men and women who have successfully harmonised the physical, psychological and emotional aspects of their being.
Despite this positive record of achievement, the General Medical Council (GMC) has begun fitness-to-practice hearings against Dr Reid, which are expected to last five weeks.
The charge is that between 1984 and 2003 he was over-hasty in prescribing sex-change treatments for some patients; not giving them a sufficient cooling off period in case they wanted to change their minds.
It is claimed that he failed to follow the guidelines devised by the US-based Harry Benjamin International Gender Dysphoria Association (HBIGDA). Although not legally binding, these guidelines advise doctors on how soon to start hormone treatment and how soon to undertake surgery. They are followed by most specialists in sex-change treatment.
The HBIGDA acknowledges that the guidelines can be flexible, with adaptations to meet the needs of individual patients. Nevertheless, some conservative medical practitioners regard the guidelines as ethically binding and inviolable.
While I do not necessarily agree with, or condone, every single clinical judgement made by Dr Reid, one thing is clear: he made decisions about treatment based on what he thought was best for his patients. As a world-acclaimed pioneer in gender identity issues, he has the respect and appreciation of many transgender people.
Long ago, when many of his professional colleagues still saw gender dysphoria as a disorder, Dr Reid developed a patient-centred approach that listened to the feelings and choices of transgender people. He respected as valid their desire to change sex.
The problem for Dr Reid is that the Harry Benjamin International Gender Dysphoria Association guidelines state that patients should have been living in their new gender role for at least three months before being prescribed hormones, or have had at least three months of psychotherapy.
Patients should also undergo a minimum of 12 months hormone therapy and live in their new gender role for at least 12 months before referral for gender change surgery.
Conservative, cautious sections of the medical establishment have elevated these sensible guidelines into an inflexible dogma; insisting that doctors should not depart from them – regardless of the expressed needs and wishes of their patients.
Dr Reid challenged this view. He began treating some patients earlier than the guidelines stipulated. This is why he has now been hauled before the GMC.
Dr Reid denies the charge of professional misconduct. He says he gave full and careful consideration to the guidelines as part of a thorough assessment of each patient’s needs, but that sticking to the guidelines was, in some cases, not in the best interest of his patients. In other words, he did not adhere to the guidelines where this would not have been, in his judgement, beneficial to his patients.
The complaint against Dr Reid originated with doctors at Charing Cross Hospital’s gender identity clinic.
They claim he failed to follow the minimum eligibility requirements stipulated in the guidelines for the prescription of hormones and surgery.
Dr Reid rejected the inflexibility of the approach taken by the Charing Cross gender identity clinic. He treated patients who had thought carefully about their gender and sexuality, who discussed rationally the pros and cons of gender reassignment treatment, and who concluded very clearly that they needed and wanted treatment.
Dr Reid’s GMC disciplinary hearing is not really about whether some of his patients were given treatment that they may have later regretted. Even patients of more cautious, orthodox gender reassignment specialists, who followed rigorously the HBIGDA guidelines, have in some cases subsequently wished they had not had a sex-change.
The issue at stake in the GMC hearing is who decides whether and when a person has gender reassignment treatment: the doctor or the patient? Should a doctor have a right of veto over the wishes of a mature, rational, informed patient who has decided to opt to change gender?
In the words of transgender activist, Dr Heather Peto of Cambridge University, a male-to-female transsexual and campaigner with the LGBTI human rights group OutRage!:
“Gender dysphoria, like sexual orientation, is not a decision a doctor makes for us; it is an objective fact that affects an individual. Unlike sexuality, some medical intervention is necessary: I needed hormone treatment to give me breasts and feminise my appearance, for example. This treatment needs to be medically supervised, but it is the patient who should decide if and when they have the treatment. Yes, some cooling off period is sensible, but at the end of the day if a rational individual convinces a doctor that they have thought long and hard about the matter, if they know the risks and want to proceed, why should a doctor and an arbitrary time-limit stand in their way?, queried Dr Peto.
“Being transgender in the 1980s and 90s was frankly horrible; not only did you have to deal with the transphobia, homophobia and sexism of society at large, but also the transphobia, homophobia and sexism of the medical and psychiatric professions.
“In 1991, when I first reported my gender dysphoria (the feeling that my physical gender did not match my mental gender), my doctor and consultant psychiatrist did not believe me. I presented the classic symptoms of gender dysphoria: I was physically male but had always believed that I was female and there had been some cruel biological mistake.
“While growing up I identified with other girls, fancied men and, embarrassingly, during my early teens I identified with the extreme feminine stereotypes that women were decorations and home-makers. To the gender psychiatrists of the 1980’s this was classic gender dysphoria, so why was I disbelieved when I went to my doctor for help?
“The reason was that like all teenagers I was developing my personality and identity by trying out roles. I soon realised that being female did not mean being subservient to men and suppressing one’s intellect. To the psychiatrist who saw me, I was a bolshy feminist. My sexuality developed too: I was attracted to women as well as men. The psychiatrist could not understand why I would want to alter my physical gender when I could have sex with women as a man. The fact was that when I fantasised about sex I fantasised that I had female genitalia and was making love with those physical assets. My penis, while functional, had no appeal for me and the thought of using it was abhorrent.
“Screwed up? The medical profession certainly thought so. How could a man want to be a women, yet be a feminist and want lesbian sex? But let us just pretend for a moment that I had been born physically female, would this have been a physiological disorder? Feminism and being a lesbian might have been threatening to some men but that was their problem. Later research has shown that a transgender person’s brain structure is more similar to the gender that they identify with than with their physical gender, and that this is likely to have occurred because of hormone imbalance during pregnancy.
“So, if a person has been unlucky enough that their brain has developed a different gender to their body, what should they do about it? Some people hide it for the rest of their lives; others acknowledge it but come to terms with the difference; while others want to correct the biological mistake and alter their body to fit their brain. However in the 1980s and early 90s the only people most gender reassignment psychiatrists would treat were those people ‘who could not live in their present gender,’ which was defined as people who wanted to adopt an extreme gender stereotype and desired to be ‘straight’ in their reassigned gender.
“This was a foolhardy psychological position. It meant that transgender people who wanted treatment would often need to lie about their thoughts and feelings to their psychiatrists in order to get treatment. Transgender support groups would exchange information about what a given psychiatrist would want to see in order to give treatment e.g. only wear floral dresses in front of Dr so-and-so and claim you want to be a home-maker. The result was that psychiatric treatment for gender dysphoria was a joke. If you are making up a life to get hormones and surgery, then the psychiatrist’s advice to you is based upon a false premise. Far more patients have been harmed in this way than patients receiving treatment too readily.
“By 1994 I was being treated by the mainstream psychiatrists. I was hugely frustrated that my intellectual analytical approach to my treatment was simply pooh-poohed as someone who should never progress beyond hormone treatment.
“As a result, I rebelled by being interviewed on a BBC Radio 4 program ‘All in the Mind’ in the mid-1990s, in which I tried to raise the level of debate about what gender dysphoria means and how it should be treated.
“I was punished by my psychiatrist, by having my hormone treatment of three years duration withdrawn. It has never been reinstated, even though no-one doubts that I have been living as a woman over the last 12 years. It is far harder to live as a women while looking physically male, than it is if I were ‘able to pass’ as a women. However the GMC have never shown the slightest interest in this type of abuse of medical authority. It is a great shame that I did not go to Dr Russell Reid instead of the mainstream psychiatrists.
“In the last 15 years attitudes have changed. Being lesbian, gay or bisexual no longer has the same stigma as before. The possibility of a gay gene and of gender differences in peoples brains has led to a general realisation that perhaps LGBT individuals cannot change who they are; that a person should be taken as who they are, and that differences in sexuality, race or religion help contribute to diversity and enrich society.
“Much to the relief of transgender activists, mainstream psychiatry has moved with the times and even the Charing Cross gender identity clinic now adopts many, if not all, of the approaches that Dr Russell Reid has long espoused. He was and is a pioneer. The disciplinary case against him should be dropped,” said Dr Peto.