Trans healthcare, then, is part of a wider political struggle for bodily autonomy that women, LGBTQ+ people, disabled people and ethnic minorities have all been fighting – a struggle that intensified during the decade of austerity that was the 2010s. This political struggle has primarily focused on trans adults, growing societal awareness of whom has allowed for more robust advocacy and rebuttal of the myths about medical transition. Even transphobes and reactionaries in the media and in politics, uneasy and disapproving though they remain, have come to begrudgingly tolerate adult medical transition as a matter of personal autonomy. After all, as trans people have successfully argued, adults are entitled to do whatever they want with their own bodies.

By the end of the 2010s, trans people weren’t the occasional freak show in the pages of a red-top tabloid. Rather, we were in the headlines of almost every major newspaper every single day. We were no longer portrayed as the ridiculous but unthreatening provincial mechanic who was having a ‘sex swap’; now, we were depicted as the proponents of a powerful new ‘ideology’ that was capturing institutions and dominating public life. No longer something to be jeered at, we were instead something to be feared. Soon after the Lucy Meadows inquest, that fleeting opportunity to shed light on the bullying of trans people evaporated. In the intervening years, the press flipped the narrative: it was trans people who were the bullies.

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Trans people may have relationships with cisgender people or other trans people, and date men, women or non-binary people. This reality is not often represented in mainstream media, with the result that lots of trans people are led to believe that transitioning may mean the end of their love life. At one point, I was one of the many trans people who believed, incorrectly, that I would be fundamentally unlovable to anyone who knew I was assigned a different gender at birth. While I soon learned that this wasn’t the case, I also realized – as a trans woman who onlydated men – that there were men out there who could simultaneously be attracted to me and also be abusive. This was particularly apparent on dating apps, where I was always open about being trans. If men initiated messaging and I declined their advances, it was not uncommon to receive a torrent of misogynist and transphobic abuse. Online, you can simply block a stranger who exhibits such malicious behaviour. Real-life domestic abuse, however, is often insidious and incremental, with the abuser creating a sense of dependence in the abused while eroding their self-esteem. The negative messages trans people receive from society about their bodies, their desirability as partners, and their worth as individuals can make them especially susceptible to emotional, sexual and physical abuse by partners.

It is important to realize that the framing of trans people as ‘parodies’ who reinforce stereotypes cruelly disregards the ways in which those same British trans people – whose gender expression, dress, hairstyles, makeup preferences and so on have, it clearly needs to be said, always varied as much as their cisgender counterparts’ – have spent the past fifty years being coerced into narrow gender conformity by their doctors, then mocked and derided as too stereotypical and regressive by cis onlookers. If it sounds like a catch-22, it’s because it is.

The media agenda with respect to ‘the transgender issue’ is often cynical and unhelpful to the cause of trans justice and liberation. Media coverage of the trans community rarely seems to be driven by a desire to inform and educate the public about the actual issues and challenges facing a group who – as all evidence indicates – are likely to experience severe discrimination throughout their lives. Today, the typical news item on trans people features a debate between a trans advocate on one side and a person with ‘concerns’ on the other – as if both parties were equally affected by the discussion. As trans people face a broken – which in turn leaves them with a desperate lack of support both with their gender and the mental health impacts of the all-too-commonly associated problems of family rejection, bullying, homelessness and unemployment – trans people with any kind of platform or access have tried to focus media reporting on these issues, to no avail. Instead, we are invited on television to debate whether trans people should be allowed to use public toilets. Trans people have been dehumanized, reduced to a talking point or conceptual problem: an ‘issue’ to be discussed and debated endlessly. It turns out that when the media want to talk about trans issues, it means they want to talk about their issues with us, not the challenges facing us.

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In the media, much of the focus on ‘trans rights’ in recent years has been on legislative rights (such as streamlining the process for legal gender recognition or having a gender-neutral passport), and on social conduct, such as checking a person’s pronouns. This emphasis stems in part from a media agenda set by cisgender people, often – as we’ve seen – for the purposes of creating controversy and fuelling a culture war. As a result, like many movements formed around an aspect of personal identity, class politics and a broader critique of capitalism have become sidelined in the trans movement. Besides the time and energy trans people have to spend defending civil rights and social courtesies, there’s a pretty straightforward reason for this. In any minority group, those who have the time, resources and political access to lead the charge for recognition and better treatment tend to be the middle-class members, who don’t appreciate the urgent issues of poverty and homelessness that for many can impede participation in activist movements. This representational imbalance leads to ‘single issue’ priorities, which emphasize the personal freedoms of the individual over the economic liberation of the entire minority group. Trans politics is no different. Poverty and homelessness are rarely framed as ‘trans issues’ in the media – or even by large LGBTQ+ lobby groups.

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Patriarchy is based on three key ideas: that ‘male’ and ‘female’ are a natural, immutable and exhaustive binary; that all males should be masculine, and all females should be feminine; that masculinity is incompatible with and superior to femininity.

Trans lesbians have as much of a right as any other lesbian to pursue sexual and romantic connections in an appropriate and consensual way, without being misrepresented as predatory men. Some lesbians are attracted to trans women and are open to dating them, and such couples risk total erasure of their sexuality by their peers and the media. These disputes often begin with the right of a trans woman to call herself a lesbian at all.

Trans feminists seek to interrogate society’s ingrained assumptions about the social and cultural meanings we ascribe to biology. They also generally incorporate an analysis of intersex people, who do not fit this reductive model, and who have suffered historical and ongoing mistreatment at the hands of a medical establishment obsessed with imposing binary biological sex on to bodies that don’t ‘fit’. The experiences of trans and intersex people show us that not all humans fit perfectly into two clear-cut categories of biological sex; indeed, the belief there are two separate sex categories is itself an erasure of sex variations that occur either naturally or through medical modification. The global dominance of men over women can never be dismantled while simultaneously maintaining, preserving and reinforcing the binary model of sex and gender.

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The existence of trans people ought to make everyone take a long hard look at their own dearly held ideas about gender, and wonder whether these ideas are quite as stable and certain as they once thought. This would be healthy. The distinction between men and women is often arbitrary. The distinction between ‘binary’ trans men and women and non-binary trans people is equally arbitrary and, in reality, the precise distinction between people we call cis and people we call trans isn’t rigid either. The fact that definitions can be so unstable is clearly deeply troubling to many – which is why it is easier to belittle challenges to binaries than to take on their contradictions, complications and exceptions. ‘We are all non-binary’ is potentially a radical new analysis for how we might reorder society, but conventionally it is used by gender critical feminists to mock those people making political demands to dismantle the binary’s imprint on our culture. Yet those critics provide no alternative for how we would otherwise emancipate society from binary gender stereotypes and roles. Once more, feminist hostility to non-binary people reasserts the notion of an inescapable biological sex that should be given more social and legal credence than a variant gender identity, a notion that merely replicates patriarchy’s own logic.

The experience of being trans is shaped by social class. While there are trans people, the vast majority are working class – just as the vast majority of the total population is working class. Trans workers are often employed in lower paid and more precarious jobs, with a high risk of discrimination and bullying in the workplace. As a result, trans political struggle is part of a wider class struggle. Despite this, trans politics is commonly misrepresented as coddled, bourgeois and anti-working class.

Both trans and cis patients alike have good reason to fear the increasing NHS reliance on the private sector, which drives up costs and introduces a profit motive to healthcare, including gender identity services and surgeries. There is an irony here: it is generally conservatives who make specious claims about money-making schemes preying on trans people, but, in fact, it is conservatives’ own policies of cuts and privatization that actually allow the private sector to behave vampirically.

The majority of trans people are working class, and the oppression of trans people is specifically rooted in capitalism. In short, capitalism across the world still relies heavily on the idea of different categories of men’s work and women’s work, in which ‘women’s work’ (such as housework, child-rearing and emotional labour) is either poorly paid or not paid at all. In order for this categorization to function, it needs to rest on a clear idea of how to divide men and women. Capitalism also requires a certain level of unemployment to function. If there were enough work to go round, no worker would worry about losing their job, and all workers could demand higher wages and better conditions. The ever-present spectre of unemployment, on the other hand, enables employers to dictate conditions. Equally, in times of severe crisis this ‘reserve army’ of unemployed people can be called into employment as and when the economy requires it. This system of deliberate unemployment needs ways to mark who will work and who will be left unemployed. In our society this is principally achieved through race, class, gender and disability. and revulsion at the existence of trans people usefully provides another class of people more likely to be left in the ranks of the unemployed (even more so if they are trans and poor, black or disabled – which is why unemployment is highest among these trans people).