Names marked with an asterisk* have been changed to protect identities.
London, United Kingdom – As debates about gender identities rage in the UK, several medical professionals have told Al Jazeera they are afraid to speak up about the issue, fearing it could lead them to harassment, harassment and threats of disciplinary action for alleged discrimination .
They also warned that health services could be changed in ways that ultimately harm patients and wider society, if sex-based medical terminology and practices are eroded while gender identities are favored.
The three experts Al Jazeera spoke to for this article requested anonymity for fear of personal and career retaliation.
From a medical perspective, humans come in two forms: male or female.
But in recent years, gender identities have become more prominent, posing challenges for key sectors such as education and healthcare.
Gender is characterized as one’s internal idea of the qualities of being male or female or otherwise. It is seen as an identity and is not qualified by biological markers.
It is often fluid but always self-declared.
And to further complicate matters, gender has often been used as a polite synonym for sex, especially in the United States.
In February 2020, Edith*, a forensic psychiatrist, became increasingly concerned about the mixing of sex with gender after the Association for LGBTQ+ Doctors and Dentists (GLADD) announced that the UK’s General Medical Council (GMC), the regulatory body that educates and trains doctors , would remove gender markers — which GLADD referred to as “gender” — as a protected characteristic from its online public registry.
This meant that doctors could strike their gender off the register, which is divisive.
Some argue that patients, for example victims of sexual assault whose abusers were of the opposite sex, should have the right to know their doctor’s biological sex.
Others say doctors should have the right to dictate how they want.
In November 2022, the British Medical Association (BMA) published a report entitled “LGBTQ+ Equality in Medicine” which stated: “Physicians come from a broad cross-section of backgrounds, experiences, sexual orientations and gender identities.
“Discrimination, both from patients and colleagues, adversely affects the lives of doctors. The BMA is clear that discrimination based on sexual orientation and/or gender identity has no place in the medical profession.”
But according to Edith, there is pressure to push an affirmative approach to all issues of gender identity over evidence-based methods.
“It’s not a psychiatrist’s job to promote positive stories; you’re supposed to be neutral and objective,” Edith said.
At an educational event, Edith posed questions to a panel about trans women in mental health facilities who change gender while awaiting criminal trial.
“They found it [the question] ‘transphobic’, ‘discriminatory’ and ‘biased’. I’m a forensic psychiatrist, this is what you see. Just because you state a fact and you don’t like it doesn’t mean it doesn’t exist… People play the system sometimes.”
Earlier this year, the case of Isla Bryson, who now identifies as a trans woman, was a cause for concern. The Scottish Prison Service initially placed Bryson, who was convicted of raping women in 2016 and 2019 while known as Adam Graham, in Scotland’s only prison for women.
But after criticism from politicians and women’s rights groups, Bryson was transferred to a men’s prison.
At the time of publication, GLADD had not yet responded to Al Jazeera’s request for comment.
When contacted for comment, a BMA spokesperson pointed to an online rack from the organization’s point of view, saying it was behind the signing of the GLADD charter, which calls for the banning of so-called conversion therapy – another controversial topic.
Some are concerned that such a move could cause clinicians who offer meaningful therapy to be prosecuted.
‘People don’t dare to talk’
Ashley*, who has years of experience teaching medical education at colleges and hospitals, said a culture of fear is emerging.
“People don’t dare talk,” Ashley said. “Not even doctors, because it’s just not worth it.”
Ashley said a group of students and health professionals affiliated with GLADD routinely sift through tweets from clinicians who refuse to use gender identity terms, such as “cis,” instead of gender-based medical terminology.
Ashley shared screenshots of a presentation given last November by a GLADD-focused diversity director that said hospitals should house trans women in women’s wards.
“It is in the public interest not to have a queer theory, gender identity in the NHS [National Health Service]’” Ashley said, “I worry about the elderly being placed in mixed wards. It’s protecting things that aren’t being looked at and I feel like it’s a government failure at the moment because they’re not protecting the public from this.”
For his part, as gender squabbles continue, UK Health Secretary Steve Barclay has asked leaders of NHS bodies to review memberships of LGBTQ+ charities and assess the need for diversity officers.
A spokesman for the Department of Health and Social Care said in a statement to Al Jazeera: “Taxpayers rightly expect value for money from every penny spent in our NHS. That’s why the Minister for Health and Social Care has asked the NHS and all the department’s arm’s length bodies to assess whether their diversity and inclusion memberships are good value for money, and to consider ways to improve.
In its first-ever census to include gender identity, the Office for National Statistics this year stated that 262,000, or 0.5 per cent of the UK’s population aged 16 and over, identify with a gender identity other than their birth sex.
Under British law, one does not need medical treatment to change from female to male on documents such as passports and driver’s licenses.
But adjusting birth, marriage and death certificates requires a five-pound ($6) Gender Recognition Certificate, and that requires a medical diagnosis of gender dysphoria and at least two years of living in the “confirmed gender”.
“There are clinicians I’ve talked to who have had men [patients] who identify as female and have had all information about their biological sex completely erased,” said Isadora Sanger, a retired psychiatrist who is still registered as a physician.
“She [trans patients] presenting with complaints that may be related to hormone treatment, and doctors are not even able to openly discuss this with them – and so it’s a very tense interaction, not being able to say or ask… It’s just muzzled doctors from being able to do their responsible work.”