As part of our newly-launched BAEB campaign, Gendered Intelligence CEO, Dr Jay Stewart has written on the idea of bodily autonomy for trans people.
Who has the right to bodily autonomy?
In a film called Gendernauts by Monika Treut, (1999), trans historian Susan Stryker said:
It’s been a really powerful way of feeling that I’m in control of my own body, that it’s like saying: my body belongs to me and I’m going to do with it as I choose… I have the right or the ability to exercise complete control over this flesh. I live here. I don’t rent, I’m not borrowing it from someone. I didn’t have to pay a damage deposit. It’s mine. To do with it as I see fit. … [it’s] my responsibility. (Monika Treut 1999– interview with Susan Stryker)
This was the single most important utterance that I had heard when I was developing an understanding of my own gender, and emerging trans identity at the turn of the millennium. The principle of bodily autonomy as a human right is stated clearly. I am in my own body. It is mine. And it is ultimately my responsibility. There is a sense of graveness but also freedom in this revelation.
Bodies are also routinely regulated by the state and societal norms pervade our thinking in relation to our own bodies and indeed in the way that we judge and police other bodies. So, I recognise the tensions between freedom and constraint. Nonetheless in contemporary discourse when it comes to trans adults’ lives the sentiment of bodily autonomy is appreciated widely. But what about people who are under 18 years old? Do they have a right to bodily autonomy?
On 22nd April, Minister for Women and Equalities Liz Truss, gave evidence to the Women and Equalities Select Committee. Here she set out her priorities for the Government Equalities Office. In response to the reform to the Gender Recognition Act, she stated:
“…not a direct issue concerning the Gender Recognition Act, but [one which] is relevant, [is] making sure that the under 18s are protected from decisions that they could make, that are irreversible in the future. I believe strongly that adults should have the freedom to lead their lives as they see fit, but I think it’s very important that while people are still developing their decision-making capabilities that we protect them from making those irreversible decisions.”
What is an irreversible decision?
Being a legal adult means something in society. It means the ability to take responsibility for your actions. Children are granted differing levels of responsibility which builds throughout childhood and teenage life before developing into an independent adulthood. With this comes degrees of freedom and opportunity to take decisions which is generated from demonstrating an ability to take ownership of responsibilities. It’s an iterative process.
For instance, I have ten year old twins and for Christmas last year one of my children wanted an iPhone 11 pro, whilst the other wanted a snake. Having your own smartphone (we settled on an iPhone 7) is a key moment in a child’s and indeed their carer’s/parent’s life. As they step into their own digital social world, I worry. It’s important that I learn about what’s involved – what are the risks? Of course, my constant thought is that I want to protect my child. Allowing my child to have a smartphone involves ongoing conversations about trust. We agree some basic rules. We equip ourselves and educate ourselves about how to keep safe and my child must embrace the responsibility that is involved in having a smart phone.
Now, what about the snake – well that’s another dilemma. Will the child look after it, feed, clean out its vivarium? Will the child take responsibility? In addition to this, did you know corn snakes live ‘til they’re 20 and that potentially would make my child will be 30 by the time it dies? That’s quite a commitment for a 10-year-old. However, giving a child an opportunity to be responsible is part of watching them grow. And of course, as responsible adults we are the back-up plan; we are there to catch our young people if they need us.
Entering teenage years the journey continues towards independence. Choosing GCSEs, A or T Levels, who to be friends with, who to break friends with, ear and other piercings, emerging sexualities and life experimentation. Decisions are happening all of the time. Which ones can be categorised as ‘irreversible’ is hard to say.
Okay, so let’s talk about gender
So, how does this relate to gender? Currently when we are born we are given a gender – an emphatic ‘it’s a boy’ or ‘it’s a girl’. That decision is based on genitalia. Each of us has no say in the gender that we are given. One could argue that it’s the first non-consensual act. We think of ‘being a boy’ or ‘being a girl’ as a very normal part of human existence, natural even. However we don’t have to dig too deep to know that gender is a fundamental aspect of social life and there are deeply embedded social expectations to behave in particular ways based on the gender that we have been given.
What if you don’t behave in these particular ways? Or can’t? What can a person do?
At Gendered Intelligence we run groups for young people who feel that the gender that was given to them (the gender that they didn’t choose), doesn’t feel right to them. Being trans is an identity category or label that some individuals— including young people— take on for themselves. It is a word that we use to explain something about our gender where we are saying ‘hang on folks! The gender that you’re putting on me – it’s not right. It doesn’t feel right.’
Some individuals will use this term about themselves and feel empowered. Finally we are able to communicate something about our sense of self, about our inner feelings to the world around us, including our loved ones and family members.
Some will try on the label and take it off again – it’s not for them after all. Young people are welcome to come to GI to explore their gender and if they find that actually they come to the conclusion that they’re not trans, then of course that’s okay too. No judgement on the proverbial journey!
It’s not for anyone else to tell another person that they’re trans, or indeed that they’re not.
Being trans or becoming trans involves a process of self-determination. Not all identity categories work this way. I think sexual orientation also involves a process of self-determination in the sense that an individual might say, “I’m a lesbian. That description helps me to organise and communicate my principle desires for other women”. Not that people actually talk like that!
The problem with society is that being trans, like being lesbian, gay or bisexual, involves us saying ‘hey, I’m not the thing others have put on me and assumed me to be. I am different to that’. Despite strides made by the LGBT rights movement over the past decades, society continues to assume a person is heterosexual until they tell us otherwise. Likewise, we assume that a person, a baby born and a child growing up, is okay with the gender that they’ve been given or at least that they don’t have any intentions to change it (we often call this cisgender). In short, LGBT people go against the ‘norm’.
So, here we are at the crunch point – let’s imagine there is a person under the age of 18, who is telling the people around them that they do not feel themselves to be the gender that they have been given – what actual decisions are ahead of them? And who is making them?
What is an irreversible decision? Or where may the harm lie?
Truss’s concern around individuals making ‘irreversible’ decisions is a hangover from a medically framed model of being trans. When a trans person chooses to have medical intervention, they do this in dialogue with a health practitioner who is a specialist in gender care. The doctors’ code of ‘do no harm’ provides an ethical dilemma around balancing the rights of an individual to bodily autonomy and the ability to take responsibility for themselves, with that of the duty of care a statutory funded health practitioner has to their patient.
One way doctors have dealt with this is to differentiate the treatments between that which is ‘reversible’ from that which is considered to be ‘irreversible’. Before a person undergoes any kind of medical treatment via a Gender Identity Clinic or a Gender Identity Development Service (GIDS), they will carry out social actions that are changeable, moveable and if wanted also reversible. They are not fixed acts. For instance, to start using a different name, to try it out and seeing how it feels As a person goes about their daily life, they might try to experiment with their gender expression – clothes, haircuts, make up, or with their mannerisms, walk, voice etc. There is a lot in social life that a person can change if they wish to – all of which are not harmful and are, if you choose to think of it this way, ‘irreversible’.
This is about experimenting with the ways in which our expression feels authentic to us as individuals, where we feel that we are being most real, where we feel settled in our self (as much as possible anyhow – I’m being cautious here if we are to recognise the complexities of a world that highly regulates body image, as indeed, we regulate those of others).
Trans people, including those under 18, should be – and indeed are – free to change any of these social aspects of what we would call ‘gender’. This is because we have the right to be able to autonomously express ourselves and that should be respected.
It is in the refusal to respect a trans person’s wishes where harm is caused. And yet, to use a trans person’s name and pronoun can be such a small act on the part of those around us and the difference can be so very validating for us. And if a person changes their name and pronoun again, or returns to a previous one, or goes onto wear a totally different style of clothes again, or in anyway reflects a different gender expression again, then that’s all perfectly acceptable. It all forms part of the rich tapestry of diverse life. The more openness to explore the better for everyone.
Likewise if a person feels confident with their name and they want to change important documents they can do that – there are processes to change names on passports, getting a deedpoll, changing names on exam certificates and if the person needs to change their name again and again, going back to their previous gender marker, then it is entirely possible – it is reversible, if you choose to think about it like that.
So what about body changes?
Families and young people who attend the Gender Identity Development Service (GIDS) will discuss options around the treatment that will change their bodies. Some children (usually around 10-12 years old) might explore puberty blocking treatment. For anyone younger than this, there is no hormone treatment or medical intervention of any kind. Puberty blocking treatment is reversible in the sense that when administered it stops puberty progressing and, if treatment stops, puberty kicks back in (like pressing the pause button – this is how it is currently understood).
For 16 year olds who want their bodies to masculinise through testosterone or feminise through oestrogen (sometimes called cross sex hormones) they will need to have been on puberty blockers for at least a year. Remember -sixteen is the age that a person can access health services and administer medicines without consent from their legal guardian; they can also get married, pregnant and join the army – all pretty responsible stuff.
So here we have a picture – a young person and their legal guardians have been in GIDS services for some time, they will have attended several appointments, talked about their relationship to gender and what they would like to happen; they will have had the opportunity to explore and express their gender in everyday life and be continuing to do that; they may have made some changes to their identity documentation, been put on puberty blockers and, at the age of 16, go on cross sex hormones. At 18, they may consider surgery – as Liz Truss MP says, they would “have the freedom to lead their lives as they see fit”.
GIDS is there to provide a space to discuss and explore – what does the young person want, what do the family members think, what are some of the concerns everyone has, what do we know about the choices that are available? It’s important that there is space for discussion, exploration and to get the right information in order to support decision making. Parents and carers are involved. Staff in schools are involved. Sometimes Children and Adolescent Mental Health Services (CAMHS) are involved. Therapists and counsellors are involved. Gendered Intelligence, along with a whole number of LGBT charitable and voluntary sector organisations, may be involved. We make up a collective of professionals around the child – thinking about what is in the child’s best interests, safeguarding them, holding them at the centre, listening to their wishes, supporting them in the respective roles that we have, asking ourselves ‘where may the harm lie?’ We each bear our own responsibilities here, and recognise that the young person has responsibilities too. No one is rushing (in fact waiting lists are long!) There are no quick decisions made out of nowhere.
There is always a context – an iterative process of decision making.
We need to do away with the false dichotomy of ‘reversible’ and ‘irreversible’ when talking about young trans people and decision making. It’s not useful. What is useful is for adults to process their fears of gifting children their right to autonomy. We all know that young people thrive when given responsibility. We also know that, as adults, we should be supporting and reassuring young people, providing a safety net beneath them, working with them.
Trans, gender questioning and gender diverse people, especially those under 18 years of age, need more support not less. We need less judgement, not more.