Down the Reddit Hole: on informal trans [health]care networks
Mizy Judah Clifton discusses the difficulties in accessing trans healthcare in the UK and the popular practice amongst the trans community of using Reddit for informal health advice.
Reddit: hardly considered a bastion of good politics, let alone sound healthcare advice. Given the platform’s not undeserved reputation as the breeding ground of incel-ish men, I didn’t expect to become a frequenter of Reddit. But such is the state of trans healthcare in the UK right now.
The average patient, having either self-referred or been referred by their GP to the ominous-sounding Charing Cross Gender Identity Clinic (GIC), will join a waiting list of 12,286 people and look (very, very much) forward to being contacted for their first appointment scheduled for five years time—given that, as of January 2023, the GIC was offering appointments to those who were referred back in June 2018. It is little wonder, then, that GoFundMe pages are springing up all over social media—making my own Instagram feed a densely populated zone of trans desperation—to fund the increasingly extortionate costs required to bypass the NHS via private healthcare providers. It is an unfortunate reality that due to various socio-economic barriers, as Vic Parsons put it in a recent article for Novara Media, trans people aren’t exactly “a demographic naturally destined for private healthcare”.
Even if money can buy happiness, it certainly doesn’t buy you a diagnosis of “gender dysphoria”. Doctors are usually consulted in the hope that their expertise will render patients’ symptoms less mysterious. However, in a curious inversion of this, trans people present their theory and desired outcomes to the doctor (“I’m trans, and would like some hormones, please”) and request to be believed. It comes as a nasty shock when a bank transfer of £500 to your gender-specialist clinical psychologist of choice still does not provide a sufficient guarantee of a gender dysphoria diagnosis. This is where Reddit comes in.
See, for instance, this thread on the subReddit r/transgenderUK. Compiled by a generous Reddit user, it contains a list of the major psychologists, psychiatrists, and endocrinologists—the whole (rather unholy) alliance—that offer private assessments and referrals for trans adults seeking to access hormone replacement therapy in the UK. They are part of a bewildering system that is comparable to a relay race for the patients (clients?) trying to navigate the UK’s trans healthcare—except the patient is the baton, being passed very, very slowly between people who are either disinclined to run any faster or simply incapable of doing so. Even my clinical psychologist, who was kind enough to diagnose me with “gender dysphoria” ten months ago, recognises Reddit as a site of informal trans healthcare networks. Indeed, she has the anonymous reviewers of Reddit to thank for recommending her (I’ve since put in a further good review). Permit my flippancy over a situation that is utterly dire, but it seems to me that Reddit should be charging a commission for having indirectly supplied much of the clientele to all of our surgeons and “gender-specialist” psy-disciples.
But Reddit does more than simply help with the general shopping around that characterises private healthcare more broadly. It equips trans people with a better understanding of which private providers are gatekeepers of the “austere, lab-coated, sleep with the 5th edition of the Diagnostic and Statistical Manual (DSM-5) under their pillows at night” variety and which are receptive to a more informed consent style model. I am, of course, being somewhat reductive here, but my point is that if the people I affectionately call “my Reddit boys” are to be believed, then many of us have had bad experiences with our providers: refused that prerequisite diagnosis; told we must lose weight to be eligible for surgery (when a different surgeon would be happy to proceed); and interrogated to no end about our life histories. Shiny biographies on providers’ websites tell you very little about how they treat the trans people who are so often dependent on them. My Reddit boys are people that I’ve never met in person, and yet they often seem to have my best interests at heart, much more than doctors do, providing a space of solidarity. Our parents told us never to trust strangers on the Internet, but when you can’t trust your own parents—at best, they’re well-meaning but clueless, and at worst, they’re actively transphobic—it makes sense that we turn to each other, albeit virtually, because we have little place else to turn. In the words of Oscar, a trans man I spoke to about the reasons why he consulted Reddit: “when you feel like your doctor isn’t being honest with you, you’re more willing to listen to anecdotal stuff”.
But even as an avid Reddit user—or perhaps, especially as an avid Reddit user—I’m rather wary. Philosopher and trans activist Amy Marvin warns against the temptation to romanticise trans for trans (t4t) care networks, arguing that for all their radical potential, t4t practices can also be spaces of “abuse, expulsion, and assumptive care”. Whilst none of these words capture my personal experience of trailing through Reddit threads, they gesture towards the way in which such spaces can be problematic and easy to get lost in. I can’t count the number of hours I’ve spent on Reddit, my eyebrows furrowed in intrigue (and jealousy) at other people’s top surgery pictures or asking users if the rather obscure symptom I’m experiencing is a sign that my voice is about to drop. It is risky to say so in the current trans-antagonistic climate, but I conjecture that as much as it is a site of useful and wholly necessary information sharing, Reddit can also be a site of trans madness. It can fuel, rather than mitigate against, what trans scholars such as Hil Malatino and Cameron Awkward-Rich have called “bad trans feelings”.
What happens on Reddit tells us something about the inadequacies of formal healthcare networks and their failure to reliably give trans people the care that we deserve—in this sense, it is a canary in a coal mine. I’m certainly not advocating a top-down, heavily institutionalised trans healthcare system, though. If I could design a system, it would be a minimal one, the kind wherein you can just rock up to Boots and grab some Testogel for the road, Paul Preciado style. But this is a long way off, in the meantime, it goes without saying that I’m rather attached to my canary.
