How medicine mistreats disabled trans people

Trans people exist within a quirky population cluster that also contains a number of disabling conditions, says therapist Sam Hope. We need society to accommodate us with all our differences.
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'Autogenic' by Ludo Foster, a rectangular abstract painting with vibrant splashes of purple, yellow, pink, blue and fuchsia watercolour paint. There are glimpses of white paper amid the colour and expressive black ink lines drawn on top.

[Image: ‘Autogenic’ by Ludo Foster]

Content note: abuse, misdiagnosis, trauma, oppression.

The COVID-19 pandemic is highlighting the overlap between the trans and disabled communities. Many trans people are self-isolating due to health conditions, and those contracting the virus are often having a particularly tough time with it.

One of the reasons for this is that trans people experience health inequality, because they are a marginalised group. And everyone knows that stress (including ‘minority stress’) is bad for the immune system and can exacerbate and even cause health problems.

What is less known, however, is that trans people exist within a quirky population cluster that also contains a number of disabling conditions. As I say in my book“A number of divergent traits cluster together in the population – non-heterosexuality, left-handedness, joint hypermobility, genius, synaesthesia, ME/CFS, fibromyalgia, physical conditions like EDS and POTS, gender variance, certain facial features, dyslexia, ADHD, high sensitivity, autism, dyslexia, dyspraxia and other body and brain quirks.”

These differences can complicate trans people’s experiences

Having one of these traits increases the odds of having another. So not all trans people are left-handed, but they are more likely to be left-handed than cis (non-trans) people. Some traits in the cluster are seen as positive – perfect pitch and genius, for instance. Some, like left-handedness or synaesthesia (e.g. the ability to ‘smell’ colours), are generally treated with neutral curiosity. Some are marginalised identities, and some disabling conditions.

When I run trans awareness training, I invite attendees to reflect on how they think about each of these differences and consider how they might complicate trans people’s experiences.

For example, the link between transness and autism is widely discussed. While nobody speculates as to how left-handedness could cause somebody to be trans, considerable research is devoted to speculating on what it is about autistic people that causes trans traits. Sometimes ‘gender confusion’ is listed as an autistic trait. Anti-trans campaigners cite the high incidence of autism in trans youngsters as a reason to block their transition, which is patronising towards trans and autistic people.

The social model of disability helps untangle these attitudes

A social model approach helps here – an approach that looks at disability in terms of how society accommodates it rather than the individual’s medical needs. A beautiful illustration of this can be found in research published in The Lancet. In a nutshell, it finds that trans people’s mental health problems are related to how they are treated – assault, bullying, isolation and discrimination take their toll on our emotional wellbeing.

In response, the World Health Organisation finally took ‘Gender Identity Disorder’ out of their list of mental illnesses in 2019, something they did with homosexuality in 1990. The clear message is: not accommodating trans people creates mental health disability.

Add in the cluster phenomenon, and trans people’s lives become increasingly complicated, our social environments more and more disabling. If society shrugged its shoulders and said, “oh, some people are just quirky in multiple ways – that’s how some folks are,” these differences would not be such a burden. As it is, holding multiple differences can complicate our interactions with the world in far-reaching ways.

Complications, including ‘medically unexplained symptoms’

Autism can make us stand out more than society wants us to. For example, a trans woman who cannot cope with the texture of make-up or feminine clothes due to sensory difficulties might be seen as ‘not making an effort’ with transition. A non-binary person who cannot cope with ticking clocks and fluorescent lights might be labelled fussy and over-demanding, which might be used to undermine their non-binary identity. A trans guy who struggles with voice loudness or conversation turn-taking might be perceived as domineering or aggressive.

Physical disability can also complicate matters. A young trans person who needs to use a cane or wheelchair to walk due to hypermobile joints or Ehlers Danlos syndrome (EDS) – which is common in our community – might be seen as attention-seeking. Postural Orthostatic Tachycardia Syndrome (POTS) is also common in this population, and the symptoms – dizziness, chest pains, fatigue – can be put down to anxiety or depression. These emerging conditions often go undiagnosed, frequently interpreted as ‘Medically Unexplained Symptoms’ (MUS), a term used to imply an illness is psychologically based.

It is not unusual for someone to have a combination of neurodivergent traits (like autism, ADHD and dyspraxia), which often go undiagnosed within marginalised groups, and also some unexplained physical symptoms, plus an LGBT+ identity. Someone who is this different is also more likely to have a trauma history: unfortunately, both disabled and LGBT+ people have a much higher risk of being abused by others due to vulnerability, stigma and isolation.

The medical profession favours lazy models

All too frequently, I see people with this cluster of differences labelled with ‘personality disorder’, and every trait is seen through that lens. Transness is interpreted as impulsive or attention seeking, neurodiversity goes undiagnosed and labelled ‘problem behaviour’, a worsening physical condition is assumed to be all in the mind. Despite the research emerging that it is reasonable to assume trans people will have other unconnected conditions, the medical profession favours lazy models that causally link all of a patient’s differences.

Therapists are also guilty of this. The tendency is to roll all those traits up into ‘trauma response’, which does us no favours when it prevents us getting diagnosis and treatment we badly need for unrelated issues. Sadly, there are still many therapists who believe LGBT+ identity is caused by childhood trauma, that we’re not part of natural diversity but something that ‘went wrong’. It is very telling what is treated as a natural part of human variety, and what is treated as a problem that we need to find the cause for.

LGBT+ identities, neurodivergences and physical differences all become ‘symptoms’ instead of being understood as unique and discrete patterns in a naturally quirky population group. Such unsophisticated approaches to therapy or diagnosis can do real violence to sensitive, divergent people in desperate need of understanding and acceptance.

We don’t need studies finding out what causes us to be us, we need a society that accommodates us in all our differences and gives us the healthcare we need. More than that, we need a society that fully accepts us as who we are.

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Sam Hope is an author, therapist and trainer specialising in gender diversity, trauma, anti-oppression and working with difference. Person Centred Counselling for Trans and Gender Diverse People: A practical guide is out now with Jessica Kingsley Publishers.

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