Welcome to Inclusion Bites, your sanctuary for bold conversations that spark change. I'm Joanne Lockwood, your guide on this journey of exploration into the heart of inclusion, belonging, and societal transformation. Ever wondered what it truly takes to create a world where everyone not only belongs but thrives? You're not alone. Join me as we uncover the unseen, challenge the status quo, and share stories that resonate deep within. Ready to dive in. Whether you're sipping your morning coffee or winding down after a long day, let's connect, reflect, and inspire action together. Don't forget, you can be part of the conversation too. Reach out to jo.Lockwood@seechangehappen.co.uk to share your insights or to join me on the show.

So adjust your earbuds and settle in. It's time to ignite the spark of inclusion with Inclusion Bites. And today is episode 113 with the title, Healthcare without Barriers. And I have the absolute honor and privilege to welcome Doctor Helen Webberley. Helen is the founder of GenderGP, an online health and well-being clinic which proudly serves transgender people of all ages across the world. When I asked Helen to describe her superpower, she said it is her ability to drive change, challenge the status quo, and amplify the voices of those who often face discrimination within the health care system whilst also demonstrating resilience. Hello, Helen. Welcome to the show.

Hi, Jo. Thanks so much for having me. It's an absolute pleasure to be here. Thank you.

I feel very honored. I I used your services through GenderGP back in 2016, and I've followed your trials and tribulations over the last couple of years, which no doubt you will expand on. But yeah. But it's, it's a real honor to have you here, and thank you for sharing your time and giving us your voice. So, Helen, health care without barriers. Tell us more.

Yeah. That's, well, it's kind of like as we say that, it's it should be everybody's privilege. It should be everyone's daily bread and butter, you know, health care without barriers, that's what we all need. And, you know, everywhere in the news you read about health, you need health positivity, health promotion. It's all about being healthy, being fit, being healthy, being happy, being well. But then actually when some people want to be fit and healthy and happy and well, it doesn't always go to plan. And that's as I as a in my career as a doctor, I've seen it several times within several community groups but none so big as the trans and non binary. From here on I will simply just say trans but for the trans, non binary, gender diverse, gender incongruent people, I spotted back in 2015 Safety things were not good and that there were boundaries and there were barriers and there was gatekeeping.

And even worse, there was bias and prejudice and harm from within my own profession. And I was just shocked. And it's interesting you say that you you used my service back in 2016. I can't believe it's been such a long time since this all started. It sometimes feels like yesterday. And then at other times, it feels like a whole lifetime. Sometimes good, sometimes bad, which you kind of allude alluded to in your trials and tribulations. And we've still got a long way to go to cut down and break down those barriers and make healthcare inclusive to all minority groups.

And while I have the privilege to be a doctor, to have medical training, to have the experience of the trans community, and while I've still got kind of life and blood in my veins, I really, really hope to make a really big difference, to trans health care. And I guess, like I say, we've still got quite a long way to go.

Yeah. You talked about bias and prejudice, and and I guess also there's and I speak from my own experience see. There's my own internalization of those biases, prejudices, and the and the and the narratives you hear in the media and online and other places. And I know that I in my early stages of exploring my identity, I didn't know where to turn. And, you know, it's we talk about 2015, 2016. It's quite a while ago, and the world has moved a long way in trans awareness, and I certainly see a difference. So back then, I I went to see my GP, and he had really no idea. There was no there was no knowledge at GP level, and we I think we still find that postcode lottery around primary care support, where to go, differences of of of service or of of delivery.

How I I appreciate you're not necessarily speaking for the NHS at all see, but where what can the NHS learn about supporting trans non binary people more effective?

Well, it's interesting you talk about the internalisation and I I think what people don't realise is, Wellbeing healthcare professionals and the public who who can speak so foully sometimes, what they don't realize is that people who are about to pick up the phone or go online to make an appointment to see their GP, to take that brave step to say, okay, you may not know this, but I am actually transgender, and I would like to do X Y Z, and I would like you to help me with that. That is a huge step. The people that I've spoken to, that doesn't that doesn't come quickly or easily. It may be a spur of the moment second when you're like, I'm gonna do this right now. I'm gonna do it. I'm gonna be brave enough. And that that instant gives you the bravery to do it. But it's been planning and plotting for a long time.

And I've heard people tell me that they pick the phone up and to put the phone down, they pick the phone up, they get through and it's like, how can I help? And it's like, okay, can I have my flu vaccine? You know, it's such a brave thing to do. And then when you do it, there's the the canceled appointments, see okay, I can't do this. I'm gonna cancel and then I'm gonna rebook and then I'm gonna cancel. It's such a journey to make that, to make that first appointment. That's what I've heard. And then when you get to that employment appointment, oh my goodness, are you brave enough to say the words or do bottle and just say you've got a bad ear or your knees hurting again? You know, but just such a journey. And it's so important that that first that the the look on that doctor's face when you say the words for the first time, their response, that look that, are they hiding it? Are they are they visibly shocked? Are they petrified? Are they are they disgusted? And these are all experiences and emotions that I've heard, you know, reflected back to me from people who've who've been through this. And then that internalized, as you say, feeling or shame or emotion that goes back into you as a response to your experience with that doctor does untold harm.

Can you imagine going to the doctor? No problem at all. I'm trans and I've just decided in my life that now is the right time to take those steps and do something about it. And I'm going to phone up and I'm going to make an appointment and I know I'm going to go in and I'm going to have the best experience. And the doctor's going to say to me, oh, that's great. I'm so glad you're, you were brave enough to tell me that. Thank you so much for sharing it with me. Right. Let's get on this journey together.

How should we do this? What should we do? What are the first steps? How can I help? It would be such a different experience. And I have heard that never, maybe, never, which is really, really, really sad. And you talk about the postcode lottery, Jo, and that's just not fair. That's just not fair. You should feel, you should be confident that you're going to get the same experience wherever you go, whichever doctor that you see, whichever nurse, whichever hospital, whichever clinic, whichever outpatient department, whichever GP surgery, whichever flu vaccination clinic. But we again know that that's not, that doesn't happen. And even worse than that, we talk online and look in the community and speak at forums and you're like, oh I wonder what my GP is going to be like and you look it up and you're like, oh jo. Have you seen what they're saying about that surgery? Oh, my God.

But that's where I'm registered. What am I going to do? So it's just it's just a travesty. And if ever we talk about non inclusion or barriers or inadequate health care, I mean, that that's just epitomizes it really.

It I'm just I'm smiling and grinning as you're talking there because I'm probably the first person you're gonna meet that had an extremely positive interaction with my GP on first contact. And I I tell I briefly tell you the story. It it was I was going through some real mental health crisis. So I so I come out publicly, Facebook and all those sort of things, and then I was going through this real crash. And my wife at the time said, right, I'm gonna book an appointment to go and see your your GP. He'll sort you out. I think she expected the GP to sort of to give you some tablets, fix me, and tell me I was being silly and getting on with life. But instead, I he he said, what's the matter? And I said, I just went it came out my mouth.

I I'm trans. I don't wanna transition sort of thing. It came out my mouth. And immediately, he he he he focused on me. He can metaphorically, he he cleared his diary. So this 10 minute appointment, I was in there for an hour and a half to 2 hours. He just cleared it. He just carried on.

There was no there was it see. He referred me to the GIC. He asked me a couple of questions around, if I had a magic machine that could change your gender immediately, would you want it to be one way or reversible? And I said, give see the machine. I'll smash it to pieces with a hammer. I never wanna go back through it. So, like, so I think at that point there, he really engaged, talked about my mental health, and he even gave me his NHS personal email address. So he said, if any if you wanna talk to me, email me. You don't need to go through the system.

You just email me anytime if you have any issues about this. And so he's been amazing. He he signed the share care agreement straight away. We got that sorted. So it it can happen. But as you as you say, most of the apprehension is that well, I think there's this belief within the the trans community that medical professionals Inclusion and the realization that medical professionals are just human. They focus on their specialism. Anything out out of their blinkers, they just don't know.

And I think trans people are kind of on that periphery of understanding still.

Yeah. But that's, but that shouldn't be allowed. And, you know, I'm I'm I'm you can't see me, but I'm clapping and applauding and patting your GP on the back here because that is exactly what we need. But the next step that we need is for your GP not to have to refer you to the GIC. So the next step we need is for doctors to be able to empower themselves to learn about trans healthcare. Now when I first join, started doing this, I was like, oh my goodness. Do you know what people are asking me to do? They're asking me to switch their hormones. So this person who's got an estrogen profile is asking me to switch off their estrogen and give them testosterone.

And that testosterone is going to make their voice deep. It's going to make their their skeleton, their muscles bigger. It's going to develop facial hair, make their head hair probably thin, if that's what's in their genes. It's going to reduce their lifespan because men have a shorter lifespan than women. This is all the things that were going through my head. And then I looked at the other way around, and I was like, okay. This person is asking me to switch off their natural testosterone and give them estrogen instead. And that's gonna make their bodies develop in a way that, you know, an ovarian puberty would happen.

It just felt so unnatural to me as a learning doctor. But then but then I had the fortune of the peep the person opposite me saying, yes. Exactly. That is exactly what I want. I want that. Please, as quickly as possible, can I have it now? Can can you do it? Can you do it? And the problem that we have at the moment is, well now I don't know how to do it and I'll refer you to this open hole. What I and I can't guarantee your experience when you get there and I don't know how long it will be to get there. But it's just that fear of doing something apparently so unnatural.

And so when I was wondering about how unnatural it is in my in my youth, if you like, I looked at the kind of the chemical composition of the hormones. And there's just, if you can picture those kind of hexagons and lines that make up chemical compounds, it was just like 1 or 2 bars difference. And then I looked to, like, cholesterol and they're like, these are these 3 the estrogen, the the testosterone, cholesterol, all the same kind of compound. You've just taken a little arm off or added a little hexagon on. And I'm like, this is they're actually so similar. And the hormones are just natural. They're just natural things that our body needs. And does it really matter which one you have? We know it's really important to have 1 and to make sure you've got enough hormones, we know that really clearly.

And make sure that you don't get them too early, and make sure you don't get them too late. We know all of that about hormones. But it doesn't actually matter which one you have as long as you have it. And if you've got someone saying, well, do you know what? I don't want the testosterone Joanne. I want the estrogen hormone. That's gonna suit me much better. Why are we not listening to these people and saying, yeah. No problem.

And then, you know, again Belonging about I'm talking to your GP if he's listening here. It's okay. So how do you do that then? How do we switch off someone's natural hormones? And I'm like, well, we do it. We do that. We do that in in kids who've got precocious puberty is when they start puberty too early, like age 5 or 6. And that's just way too early to start puberty. Their their ovary or testicle woke up way too early, and we just stop it. We give them this medicine, and there is a natural hormone that stops it.

And we do it with people with prostate cancer, for example. We give them that medicine because we know that prostate cancer feeds off hormones, off testosterone usually. And we'd and, we don't want it to. So we switch off the testosterone. So I'm like, so it's really easy to switch off someone's hormones because we and we're already doing it in general practice. And then how do you replace someone's hormones? And And I was like, we do that already too. We we manipulate hormones with oral contraception, we give hormones for menopause, whether that's estrogen or testosterone. You know, when someone's not making enough of their own.

Some people are born when their ovaries or their testicles don't work properly and they don't produce enough hormones, so we give them the the hormone by medicine. When you put 2 and 2 together, we already switch off people's hormones in general practice very easily, every day. And we already replace those hormones with the hormone that they need, the body needs, every day, all day every day. It's all bread and butter. But then if you're Joanne, it's not quite the same. We don't do that because we don't know how to do it, and we're scared of it, and it feels too new, and we must refer you. But what we've got to do is move towards a place where we're not scared to do it, and we already know how to do it, we already know how to do it. The other question actually which is, well how much do you give? How much hormone do you give? And it's like, well see know, we know what the right level is.

We do a blood test and we know, for example, that someone with ovaries, we kinda wanna see the the estrogen between 308100. So that's what we wanna see in a trans woman or a transfeminine person as well. So we know all these things and that but yet GPs kind of have this feeling that they don't know how to do it, when actually it's the simplest thing in the world, and we're already doing it every day. So it's actually just down to the bravery. It's should I do it? Am I allowed to do it? What might happen to me or the person that I'm helping, my patient, if I do do it? And those are the those are the the political Safety regulatory bits that that we need to to definitely sort out, and that's the problem. And the other problem at the moment is that GPs are not being supported to make these decisions. And if they ask the question, am I allowed? But not really saying you are. There's nothing out there saying you help, you do, you help your patient, make sure you do the best by them.

And, you know, the Royal College of General Practitioners fairly recently have kind of said, we support doctors well, they haven't they haven't said that in these words, but this is the interpretation. We support doctors who don't feel able to do this. We recommend that doctors refer to gender specialist gender identity clinics. We don't think that our GPs should be asked to provide this specialist care. And if you think about specialist care, when you you mentioned a little a minute or 2 ago Jo, that back in there's been a big rise in awareness of trans people. Kind of you know 2015, Safety, we had a celebrity or 2 that came out as trans and there was this big awareness rising of awareness the people that have had to be hidden for so long suddenly became visible and as as the braver ones became visible first, the shyer ones became visible after them. And so we've had a big rise and so what that means is that it's this is not a small specialist subject And and the NHS have kind of cutoffs. You know, if if there's a condition that has less than 500 cases a year, then that's considered to be highly specialised, and that should only be dealt with in super specialist clinics because you can't have just one doctor in the whole of that area that knows how to do it.

You so you you put those those very rare conditions in super specialized clinics where there's lots of support. But but we have way more than 500 cases a year, way, way more. And so we we can't we have to move away from that super specialized model, and that means we have to bring it back into primary care, which is GP surgeries, and secondary care, which is your local hospital. But at the moment, doctors are kind of scared to do it. They don't know if they're allowed to do it. They don't know what will happen to them if they do do it. And they feel that they don't have the skills and knowledge. And if you but if you look at the the duties of a doctor, which is the which is good medical practice, which is the kind of the medical law if you like, The first rule is make your patient your first concern, and the second rule is make sure your skills and knowledge are up to date.

And so those doctors out there that say, I don't know how to do this, and I accept that I don't know how to do this, and I'm not going to increase my skills or knowledge in this area acting against the duties of a doctor. And I sometimes feel we all need to get our flag out and walk march up and down the street and go in front of the the doors that are currently closed. And behind those doors, we're having very negative Joanne negative conversations, and we need to knock on the door and say, actually, your duty as a doctor is to increase your skills and knowledge in this area of health care and make your patient your first concern, even if they're trans.

Is some of the fear based on, well, fear of litigation, fear of see transitioning, fear of being caught up in front of the GMC for getting it wrong? Is it a genuine lack of lack of awareness? Is it bias? You know? Trans people have gone from being a bit weird to being a threat somehow in the the last 5 or 6 years. We've we've turned the tables. Now now we're taking over the world. We're now political football. Whereas before, we were kinda like this, this this dirty little secret that used to somehow leak onto the front page of the tabloids every so often, and that was it. Now everyone everyone's worried about us. We don't know our own mind. We we're I I don't know.

I I I'm I'm really confused as to what the root of it is. Is it just bias and fear? Fear of being hold up themselves and prescribing off license or whatever the phrase physiology is there. These these medicines and hormones aren't designed for people like see. Therefore, it's risky to without the trials. Is that is that the situation?

Wellbeing very interesting, isn't it? So the litigation, litigation really means that see, a trans person's going to come to you, as a doctor in 10 years time and say, you gave me hormones, and you made my breasts grow or my voice drop, or my, you know, my beard grow, and I now regret it, And it's your fault. You acted negligently, and therefore I'm going to sue you. So that's that's litigation. And unfortunately, of course, the media like to show those stories. And but what we do know is, if we talk about regret rates, with every single medical intervention, there is a regret rate. And when when you look at the regret rate for transitioning, the regret rate is tiny. Now I'm we may talk about why people might regret it in later on in the show if we have time, but but let's just accept for now that we know that the regret rate for transitioning is minuscule. Compared with, for example, knee surgery or breast augmentation or some plastic surgeries, hip surgery, a penectomy, all lots and lots of things that we do, people people regret.

And those regret rates are much higher but they're they're not, they haven't got that kind of emotion attached to them and doctors doctors still do them. So that's litigation. We're, you know, people are scared of being sued in the future in case somebody regrets it. but, but actually what you need to do is just make sure that that person, at the time that they're making that decision with you, are giving informed consent. And that means, do they know, they're saying to you, please Joanne you switch my hormones? And they're saying, I know what this means. I know what this will do to me. I'm fully aware of the pros and cons. I know what this can and can't achieve.

I know that this is what I want to do. And I really, really believe that at this time, and I've been thinking about it for a long time, this is the right thing to do. And so the doctor's job is to say, okay, well, you know, these are the pros and cons, these are the risks and benefits, what do you reckon? Are you sure you're aware? Absolutely, I'm aware. Fine. And you can't, that's never going to be medical negligence. That is not medical negligence. That is not that that might be someone may Change their mind down the road and we know that's very rare. But it's not medical negligence, it was a good informed consent process.

So we don't so in many ways, if people are if doctors are worried about that, I don't think we should. Make sure that your consent processes are good and we're fine kind of thing. The GMC, the GMC guidance. So GMC are the regulator of doctors and the guidance has changed a lot over my time. I watched it change as I was going through my own process with the GMC. And the GMC actually have become much more trans aware recently and they're quite positive. They're saying you must help your patient and you you mustn't just say no. You must if you're gonna say no, you have to have a really good reason for saying no.

And, you know, they they do see, if you don't know what you're doing, then then talk to a gender specialist, which is a bit tricky because they're not enough around. And actually, if if the gender specialists who are working in the NHS at the moment spend all day on the phone to the GPs to give them reassurance, then the waiting list Wellbeing even longer. So that's a bit of a that's a bit of a problem. But I don't think there will be a doctor in the land who who's trying to think about helping their trans patient who won't have heard of my case. And, you know, that's why it was so important that I won that case. And I hope that the lasting message is that doctor went through a lot, but the final message is, it was absolutely fine. She she she managed to prove to the tribunal that those 3 young patients that were quite stark examples, if you like, it was it was right and it was fine for her to treat them the way that she did. And I hope that that gives other doctors out there confidence.

But we could do with the GMC giving a bit more confidence. And actually maybe even saying, you know, if you if you deny care, what are going to be what are the consequences going to be? It's all right, it's all very well for you saying, well, if I give care, will I be will I be, you know, hold up in front of the GMC, let's say. But what if I deny care, will I see, will will I have action taken against see? You know, am I fit to practice as a doctor if I can't help this transgender patient in front of me? And And that's what we need to switch that narrative to. You may you mentioned the off label. We use off label drugs all the time in medicine every day. And, you know, we, we explain to people that sometimes the drug that we're recommending for that condition is, hasn't got a license. And there's loads of reasons why it might not have a license. It's just that some people use that as an excuse.

Oh my goodness. But it's like, okay, if you're gonna use that as an excuse, you have to use that as an excuse for all of the things that we prescribe off label medication to. You can't just say I'm not gonna give it for trans people, but I am gonna give it for arthritis or for cancer or for diabetes, etcetera. You you know what I mean? And jo therefore, what is it? Is it the fear? The fear of not knowing. If you don't know, if you're not educated, if you don't if you haven't had the education and knowledge, it makes you scared, for sure. And there isn't enough education and knowledge. If you have a look at medical school curricula, postgraduate training, undergraduate training, later in life graduate training, where do you go and learn how to be a transgender doctor? There just aren't any places, there's no education. And even the very small amount of education that we have, we used to have the GIRES, module with the e-learning module with the RCGP, and they took it down because it was perhaps too affirmative and replaced it with a basic one which says see people are transgender and you must use the right pronouns and see if you can get the name right.

And I'm like, come on. We we need the training that says how do I turn off the hormones and how do I switch the hormones and what hormones should I give and what's the safest way of doing it and how often should I do a blood test. That's the knowledge and education that we need out there and that see haven't got, unfortunately. And then there's bias. You know? And what what what happens to those doctors who actively won't help? So not the ones that are just, oh my goodness. I don't know and I'm not even going to work bother finding out how to do it. I'm just going to refer you. What about the ones that say, well I don't believe in this, I'm not going to refer you.

Go away. Don't be such a silly girl. Don't go away such a silly boy. Look what you're doing to your wife. Look what you're doing to your family. How can you possibly think like this? Everyone's gonna laugh at you. And this is what people have experienced in the GP surgery. God is against you.

Now that's just not right. You're just not allowed to do that as a doctor. And it's about time that the doctors who are behaving in that way faced the difficulties that the doctors who want to help are a bit scared of, if you know what I mean.

It's a generational thing. Does it tend to be more established senior GP, or is it across the board? Is it I I mean, am I well, being age biased here?

I don't know actually. I mean, it'd be interesting survey to do, wouldn't it, of trans people. How old was your doctor? What have you? I mean, we know that the younger generations are much more fluid in and much more understanding. But then also, we know that that there are some young people out there who can be very, very bitter and twisted and Safety. And, you know, our younger generations are unfortunately experiencing some difficulties in their in parenting and what have you, and can be very vicious and, and, and antagonistic. So it's tricky, isn't it? Is it an age thing? I don't know. You get it's interesting. If you listen to people talk about their grandmother, for example, you know, when I told my grandma I was Joanne, and you listen to the different experiences, some have a great experience, you know, oh my goodness that's so amazing, well done topic kind of thing.

And then some are just awful. And so I guess, it's across all age groups, the, the bias and the prejudice. But the simple answer is it's not allowed and it shouldn't be allowed, but it is still being allowed. And that's the problem. It's

funny you say that about age. And I I met some Chelsea Pensioners in a jazz bar in Chelsea, a pizza express in Chelsea, the the pheasantry, I think it's called. And I had a great evening with these Chelsea Pensioners. They were just chatting away. I thought they'd be biased and prejudiced, but Mhmm. I suddenly realized that they've had so many lived experiences around the world and lived a full life. And while I thought I was gonna struggle, I had I had I was celebrated and, other story, my my my wife's father, my father-in-law. He tells a story about a member of the family you shouldn't speak of.

They were cross dressing or trans or something like this, a dark part of the family. So this is not a modern phenomenon. This is this is something that's been going on since the beginning of time. Trans people aren't new. It's just again, we've moved from this from from being hidden to being aware, and I think that is that scaring people, isn't it? We're disrupting society.

Yeah. You yeah. You talked about that a little a couple of times, you know, that fear. And, you know, back in the back in the day, see were Joanne people just sexual perverts or were trans people those kind of people that were just in that house down the street that nobody ever saw and it was full of amazement and wonderment and what have you? Or are trans people in some in some ways dangerous to people in bathrooms or in hospital wards or or in on school trips in in the wrong dormitory kind of thing. You know, there's this fear of of the unknown. And it's no different from people who used to be scared of colored people, you know, were they going to be dangerous in some way? Or people who gay people, you know, were they were they going to just attack you and have sex with you kind of thing, you know. So that that kind of fear and awareness and and knowledge and education and and actually bringing voices to life, which is what you're doing through your podcast, is how we educate. So as well as the kind of the medical knowledge that we need to hurry up and get out there, which is some of the work that GenderGP is doing, It's also about hearing those voices.

And you, you mentioned voices at the beginning and, you know, the trans voices are being hushed and they're not loud enough. And if they do speak loudly, they get attacked with the nastiest, most vicious comments that people are allowed to to do and even to in court some people, you know, this debate about Joanne, trans whatever Joanne inclusion or trans awareness or being Joanne. You know, the debate about whether it's a it's a real thing or whether you're putting it on or what have you. With the debate about how we're allowed to to treat trans people online or in the street and and the the the kind of the debate about the things we're allowed to say about or to trans people Wellbeing allowed. And it's being allowed in courts, it's being allowed in in tribunals, it's being allowed in workplaces, in schools, the debate, I mean. And by allowing the debate, we're allowing that uncertainty, that fear, that bias, that discrimination, that prejudice. If we say right, actually, on 14th March 2024, that debate is no longer allowed. Trans people exist, trans people are a portion of our society and actually they're just as boring or as or exciting or as ordinary or as unordinary as you or I are.

Nothing to see here. Right. Equality and Diversity respect and embrace Diversity, equality for all, no more debating. The only debating we will now do is how best can society hurry up and be inclusive to trans people everywhere. And that's the debate that we should be allowed to be having. Instead of and it it just drives me mad. I can't even read it in the newspapers. You know, the politicians are allowing debate in their own commons or whatever it is.

I don't know. I just I just, you know, that that and that is why we're facing this uphill struggle at the moment. That's because the people in power are still allowed to debate, and they're even allowed to say it publicly. I can't believe it.

Well, they're getting a microphone shoved in their face and ask the question, can a woman have a penis? that's what's happening. And they're they're running scared because that's that's a that's a no win answer, whatever you say. You're gonna get berated if you agree, berated if you don't agree. Or if you pause for 3 seconds, why do you have to pause for 3 seconds to think about your answer? So people are being bullied into a response.

But the answer is so clearly yes. There is an answer to that, and the answer is yes. And that's we've already established this in the Equality Act and, you know, there are the protected characteristics and gender reassignment is a protected characteristic. So we've done all that. Can a woman have a penis? Yes. Can a man have a vagina? Yes. Can you possibly be not a man or a woman? Yes. What genitals would a man or someone who is not a man or a woman have either? Then we've done it.

We've discussed it. It's there. And that's what the the politicians should be saying right at the beginning. Right. Actually, let's just have some ground rules here. You know? Some people that you might may think of as a man may have a vagina, and some people who who may think of as a woman may have a penis. Like, let's just get that out of the way. And now we need to start making some rules and some societies and poll political policies that makes all of these people included.

I know many women and I know many men. I've never actually really got into the depths of do they have a penis or do they have a vagina. It's not something that really enters my mind at that point when I'm having a conversation with them. But for some people, it becomes, like, I happen to transfix on these body parts. Yeah. And and it's it's it's, yeah, it it's becoming kind of, that seems to be the big issue. You know, do you have a penis or not? Is that part of the problem where, 20, 30, 40, 50 years ago with all the gatekeeping, if you were a trans woman, you were expected to behave in a certain way. You know, we saw the the film the BBC One documentary.

Was it Judith or Julie Grant or something, whoever it was, the, the trans woman in the in the seventies who was on telly? They they filmed her going to the gender specialist, and she had to perform and be taken seriously. And I've even heard some a a doctor even say, well, I I'm I'm attracted to you, therefore, you pass. You must be a woman. That kind of thing in order but now now trans women can have beards. They can have hair chest hair. They can they can have cropped hair, they can they can they they break the boundaries of the of the social construct of gender. Is that what's is that what's causing this confusion where trans people aren't behaving like women, they aren't behaving like men, they're they're they're blurring everything. It's really confusing.

I mean, I think, Jo, what we what we need to move to the next see, isn't it? And then just like you don't say, look at that black man walking down the road. We would not be allowed allowed to say that. What you say is, look at that man walking down the road. And if, you know, and we've all been there where, you know, you you you're recounting a story that someone you met in town and you say they're black and someone will challenge you and say, why did you say they're black? Is it was it is it relevant that they're black? And it's like, well, no, that was just kind of, you you you know, we've all been there. We need to lose that. There's a man on the street I met today, end of. And I think if we lose that trans woman trans man bit, there are you a woman or a man or doesn't matter? Do you know what I mean? But I think by holding on to that, sometimes that label, sometimes we we I think we're we're still continuing that divide. Now I know that there are some trans people who are very very proud of that trans identity and they want to be that, in the same way that some black people are very proud of their heritage and they want to keep that.

And this is not about stripping that away, but this is about not making it a part of every single label. You are allowed to be a woman, even if you have a penis, even if you underwent some kind of gender reassignment, what whatever. Whether that was just a name change or a person, you know, the way I way I want to talk to you or a medical change or surgical change, it doesn't matter. But some kind of gender reassignment. So let people let people choose whether they keep their trans label or not. And but from society's point of view, stop Wellbeing people. I have a problem with people being labels homosexual and bisexual and heterosexual as well. Just leave this leave it out.

It doesn't matter. They're just people who like having sex because that's a good thing to do if you want to, You know?

Yeah. And, I mean, there was there was a stage in my life in the last 5 or 6 years where that label was important to me. But I I don't get up in the morning and go, yay. I'm a woman. Yay. I'm a woman. I I get up and I I I make breakfast. I fill my car with petrol.

I I do some work. But my my my sense of identity of who I am doesn't fit into my brain at all. I just am these days, and I think I always said the ultimate aim of my gender transition was for life to be ordinary and boring again.

Yeah.

And that that was the outcome. It wasn't a continual forever party and celebration of anything. It was just I just am. I've got a I've got a wardrobe full of clothes. I've got a couple of shoes, and I've got a coat. And I I get I look at the weather and go, I'm gonna wear this today. And that's who I am. And it's I think so, certainly, I agree with you about trying to drop that primary identity

Mhmm.

Of trans or nonbinary or being black or being white. If it means something to you, brilliant, celebrate it. But it doesn't have to.

And that's, I think, probably the definition of true inclusivity, when it doesn't matter what you are or what who you are, you're just a person in Safety, see as everybody else. And that's true inclusion, I think.

Yeah. It's your contribution and your your value your personal values and the impact you have on others that's more important than the packaging, for want of a better way of describing it. So you mentioned earlier about we've been prescribing hormones and and tweaking this and tweaking that for a long time. And let me just touch on, if you don't mind, the menopause. You know, my my wife is is is, you know, late fifties. She's, like many women in her late fifties, is is on this cusp of menopause, perimenopause, trying to figure out what's going on. And her GP, and she's had a number of them recently, are really struggling with hormones and and the balance and engaging with her. So even from her perspective, there's a lack of understanding around estrogen, testosterone.

I've had more blood tests before my hormone profile than she's ever had. They won't give her one. They just said, there's no point in giving you a blood test. So they've got no idea whether she's between 300 and 800 or whatever it may be. So does does that reinforce the fact there's a lack of understanding about sex based hormones, if I would have a better way of describing it?

Definitely. Definitely. And, you know, I can't remember when it was, what year it was. I'm rubbish with years, but there was, you know, they did a big study on hormone replacement therapy and they stopped the study early because they thought there was a harm and that HRT hormone replacement therapy would cause cardiovascular disease, heart disease, strokes, etcetera. And it caused a major panic. And I think it I think it was the one of the worst things that's happened to women and men actually. Well, estrogen people and testosterone people over the years because, it's it's really put a damper on on the the the importance of hormones. And in the olden days, we're only supposed to live till about 60.

You know, we were done. Do you know what I mean? And but these days, we live till a 100. And and the hormones are really important. They're really important for your mental well-being and your cognitive function, which is, you know, your your ability to think and and work work stuff out if you like. And they're really important for your bones, bone strength. We know that, for example, people with ovaries who've been through the menopause and no longer have their estrogen, we know by the time they're about 70, if they fall over, they break their hip. Or if they fall over, they they get a fracture in their wrist because their bones have gone thin. And when, you know, if you sometimes if you think about that little old lady in the street who's humped over, that's because she's got her bones have gone thin in her spine and and they've crumped over.

We know how important hormones are, and yet we're so bad at doing it. And it's just like, come along now. Let's stop being bad at it. Go and read the books. There's plenty of information out there. We don't need Davina McCall to go and to be the one that educates us. That's kinda we need to do this medically and understand that sex hormones are really, really important for very many reasons. And let's let's start making people's lives better by giving them hormones with informed consent.

These are the risks. These are the benefits. This this is what will happen if you do take extra hormones. This is what will happen if you don't take extra hormones. What would you like to do? And we have to give that in a balanced way, not listening to the media, not listening to the the negative medical press. We have to do a proper evaluation and help people, but we're not doing it well at all.

Do you feel willing and able to comment on the NHS England guidelines that came out yesterday? It was very timely. It came out yesterday around, puberty blockers, the cash report, the closing of Tavistock, gender identity services, and what's gonna happen now to youth services around gender. Do you have a perspective on any of that?

Well, I mean, people will die as a result of this. The NHS, Wellbeing people who have signed that those recommendations will be responsible for child deaths in the United Kingdom. That is for sure. Absolutely see, Which is horrific to think. And what I am amazed at, and again it comes down to people with prejudice Wellbeing having holding positions in high places and having power, to to to enforce and to make policy. But we've done this. Right? We have something called the World Professional Association of Transgender Health. We have the European Professional Association of Transgender Health, and we have one in the US, see Australia.

Like, look, we have lots of PATHS, Professional Association of Transgender Health. Now they are panels of absolute experts. They are medically qualified, psychologically qualified, and they're lay people. There's a there's big panels. And what the panels have done over the years is analyze all the research, research, all the evidence, the small trials, the big trials, the they've looked at clinics who've been providing this care for many years, and they pull everything together and they make guidelines, international accepted clinical guidelines on how to treat adults and how to treat young people, and they publish them. And the most recent one that the WPATH published was back in 2000 I thought it was last year, wasn't it? And it's very clear. Puberty blockers save lives. Puberty blockers given at an given at the right time will prevent life changing, life altering effects on the body, which reduce stigmatization and bullying and harassment and prejudice and bias, all those things that we've talked about.

They save lives in from suicide, mental, poor mental health, etcetera. And they give trans young people the opportunity to live their life in the gender that they truly are. Now I just absolutely cannot understand why people in the NHS who are making these new policies for the care of UK trans people are not reading it. I've never seen it once referred to in the CAS report or what have you. Or in NHS England's, you know, they say, oh, we follow the WPATH guidelines. And I'm like, well, you clearly you don't because you're just now saying that that these young people shouldn't see have this care. And this care has been probably been more evaluated than any other care I know because of its highly political and contentious profile. You know, certainly when other treatments that I've see given to patients definitely haven't undergone this scrutiny.

But this treatment has been undergone so much scrutiny and they've all come together and the Endocrine Society and said, absolutely. Puberty blockers and hormones should be given to transgender youth at the time that is right for them, which is when they're ready for them, not when we're ready for them, when they are ready for them. And so if you have a trans young person who is ready for them at the start of puberty and they can give informed consent, they should absolutely have them. And if you've got a trans young person who's ready to undergo puberty that matches their gender identity, and they can they have the capacity to give informed consent, or they have a parent who's able to give informed consent for them, they should absolutely be able to have the hormones that give them the puberty that matches their gender identity. And the rest of the world is listening to WPATH, and the United Kingdom is saying that we don't have enough evidence. I don't really know what they're reading that the rest of the world is not read. The trouble is It's really just wanna say one more thing. Sorry.

And the trouble is that the UK have been on a pedestal for so long that other countries are following us. And so Sweden, Finland, and Denmark, they're like, oh my goodness. If the United Kingdom is stopping it, we must stop it too. And then we use that as a backlog. Oh, goodness. Well, if Denmark is stopping it, we were right to stop it. And I'm like, no. They just followed us.

So it's I'm I'm appalled at the people who've made those decisions. And as I said, and I'm gonna say it again very loudly, deaths will occur as a direct result of the people who have signed those papers. Yeah.

I was gonna ask you that because I've when I checked through the, the reports and documents yesterday, I did notice that the countries you mentioned were backing off. So what you're saying is almost like its this chicken and egg. You know? Are they backing off? Or we've been talking about backing off. And they also meant that w path are almost backtracking on their guidance as well, which I guess because we're calling into question, everyone's having a conversation now. But one thing I did note significant in the Inclusion the documents was they they didn't base any of the evidence on lived experience. They completely ignored people with lived experience. It's all about clinical evidence, and we all know that there's not enough clinical trials that are qualitative and quantitative enough because the the the sample size is is too small often because people don't wanna put themselves forward or don't wanna help themselves, whatever. So it's really hard to to judge the the truth.

And that's what that's what I I my my outcome of reading what I read yesterday was you were trying to hit a deadline of the middle of March for when the the current services close on 31st March and the new services open on the 1st April. You wanna make sure they've got the guidance you want them to have, not the guidance they're following at the moment in in almost like that. They were trying to engineer the outcome to support the well, engineer the report to support the outcome they wanted.

Yeah. I mean, you say and then WPATH when, when the the NHS England published their their interim recommendations, WPATH and EPATH put out a statement, a very a joint statement, and basically said that they find the NHS interim recommendations harmful, harmful, dangerous. Those are big words, you know, for another kind of body to to criticize the NHS and say that the work you're doing, the thing you're about to publish is harmful and dangerous. I mean, that's, that's, those are pretty big words. And you talk about the fact that there's not enough research, there's plenty of research. It's just that people don't wanna read it. You know, they don't wanna listen to it. And they say, oh, the sample size is small.

see we make medical decisions on smaller sample sizes than that all the time. And also there are plenty of big studies, plenty big enough studies. What they're saying is that we don't have enough studies where you've got a 100 people young people who say they are trans. You split them into 2 groups. You give one of them puberty blockers and one of them one you don't give puberty blockers and you see what happens. And you've got to make it blind so that you don't know what happen. But of course you do know what happens because it's quite obvious because puberty goes carries on. Jo.

Of course you can't do that. You can't, of course you can't do that kind of study because it's just not ethical. So we'll never have that kind of study but we do have plenty of evidence to show that puberty blockers and gender affirming hormones improve physical health, emotional health, psychological health, and social health. We have plenty of evidence. It's just that the people don't who are making decisions, they don't wanna read it.

But how's the world gonna change? It it seems to me that we're we're getting further and further down this this rabbit hole of of of political and people making decisions, people with gender critical views making decisions, rewriting the rules. Are we are we are we gonna see stuck in this this place for for generations? I mean, is there a way out of this?

But it's those people that we've got to make sure that the people in high places are inclusive and that they understand the equality act and that they understand about gender identity and gender reassignment, and they understand that the debate is not allowed anymore. And those people in high places, those are the ones that we've really, really, really got to make sure that you're not gonna be allowed to be in that high place making those decisions if you're not totally and utterly gender aware. The, the, you know, it's really it's just so important to eradicate those people in those positions, and not allow them to to have that platform. And the people that are fueling that in the, in the media and and, you know, the well known celebrities, I'm definitely not gonna name them because it just gives them a bigger platform. They shouldn't, you know, we need to start saying that you will be in trouble if you start saying stuff like that. We don't accept that in our society. And play in the, you know, in the medic in the within the NHS, within the, the Royal Colleges, within the Diversity, and within the politics, we need to make sure that those people are not allowed to have a voice. And if they are in any way non Inclusion, and if they are any way prejudiced or biased or discriminatory, then they need to then they need to be penalized for it.

But while they're there with power, we we stop we we face a big struggle. And the other thing I feel terribly strongly about is that they their voices are so loud and their voices see amplified and actually some of them are very nasty because because only people who allow that prejudice and biases, and discrimination to to persist in their lives, they are by virtue got Safety streak in them. And so they have nasty loud voices, which they use. Whereas people who are more equal and diverse and inclusive and better better people in society, we're more we don't like to shout quite so loudly. And if we get shouted at, we go into a little shell sometimes and don't allow our voices to be to be so loud. That's not helpful. We need we and if our voices are small, we need to get together and shout together to make sure that our voice is allowed. And the other thing that happen, as you well know, you know, we talked about it earlier, the person who has to hide in their house because they're Joanne, the people are having to hide away again because if they come out, they might get stones thrown at them, and therefore they hide away again.

And we've got to just see, come on. Come out. Come stand next to see. And if they throw stones at us, we will divert you divert them and we will push them away together because I am a trans ally and I will help you. So we need trans allies. We need trans people to be given their voices back again, and we need that to be louder than those, those people who have the heart the position at the moment. And also, do you know what, Jo? If there are deaths and if there are suicides and if there is harm that comes to these people because of policies that people have signed and put their name to, then they need to be held to account for those deaths.

Yeah. I concur. You you mentioned one of your superpowers is demonstrating resilience. But its not easy standing up and having an opinion. Even as a a cis woman yourself, you must get a lot of abuse, a lot of threats thrown at you. How do you how do you cleanse yourself in self care?

Mhmm. I do have very broad shoulders. And and when I know something is right, I will stand up forever until other people will listen with me to to believe that it's right. And I totally believe that this is right. I don't have a single shadow of a doubt that transgender identities exist and that we should include transgender identities amongst all of our other gender identities And that people who are transgender should have the same rights to health and wellness and the most amazing life as anybody else does. And sometimes people want to access medical and surgical care in order to help them to live their best life. I have no doubt at all that all of those things are right, and therefore I will keep shouting. And sometimes people do hurt me and sometimes, you know, sticks and stones may break my bones.

Sometimes, you know, people have threatened me, but but I believe so strongly in in what I feel is right. And I do feel that I have the privilege to have an education and a, an eloquent voice. I can counter almost any argument that someone puts to me against what I've just said because I've learned so much about it. And I want to be able to use that, to use that experience, intelligence, eloquence, to help a community that might stutter and stumble when they're asked something so awkward. So it's really important for me to do that. And I do have, I do have a very strong resilience, you know, where many people would chuck their phone or laptop or teddies out of the cot and go, I can't do this anymore. I I will take a deep breath and go, I can do this because it's really important. There are a lot of people that I can personally help and not just by making health care accessible, which I've done to thousands of people, but also by being a voice, being by being ally an ally, and by sharing the experiences and knowledge that I have.

see it off of Twitter. That's brilliant.

Well, there you go.

Helen, that's been an amazing conversation. I mean, thank you from my own personal story, but, also, thank you for sharing your your thoughts, your resilience, and your your your perspectives. And we need to hear more thoughts, perspectives from people who are. Have the resilience to stand up and be counted. Because as you say, there's a huge bow wave of of negativity who which is well funded, very vocal, has Inclusion that we hear those all the time. But we know we know we know that those aren't the majority voices. They're just amplified disproportionately, and that there is a lot of love and lots of poor hell. And, if any trans people listen to this, you have to believe that as well.

But the world is not terrible. Feels like it sometimes, but, Joanne trans people get on with their lives and have a fantastic experience. It doesn't have to be that. So, Helen, how can people get hold of you if this is they wanna support you? Obviously, the people who wanna troll you know where you are already, but people wanna support you.

I I am on social media if people want to, reach out to me on Twitter or or LinkedIn. I'm, you know, doctor Helen Webberly, and I'm always listen, always there to listen to friendly people who who want to share experiences or who want to, ask questions. I'm not there for any negative people. And if you wanna if you wanna say anything negative to me about about trans people, believe me, I will not respond. But if you want to to learn, to join, to become an ally, to understand help others understand if you want to understand yourself, reach out. And I think I want to be part of that human wave of people that have an most enormous voice that gets because I want to see this in my lifetime. I'm 54 now. I've got, you know, think I'm I'm past the fifties.

So let's, we've got we've got to do this in my lifetime. So come on, let's get our voices together, and start waving those flags and making a and telling those people in power that we are right.

Well, I'm 60 next year, and I want to see this in my lifetime. So I I'm with you on that. And let's anybody who is wants to have their voice amplified, get in contact. That's fantastic. Helen, thank you so much.

Thank you very much, Jo. Thanks for inviting me.

As we bring this conversation to a close, I want to express my deepest gratitude to you, our listener, for lending your ear and heart to the cause of inclusion. Today's discussion struck a chord. Consider subscribing to Inclusion Bites and become part of our ever growing community, driving real change. Share this journey with friends, family, and colleagues. Let's amplify the voices that matter. Got thoughts, stories, or a vision to share? I'm all ears. Reach out to jo.Lockwood@seechangehappen.co.uk and let's make your voice heard.

Until next time. This is Joanne Lockwood signing off for the promise to return with more enriching narratives that challenge, inspire, and unite us all. Here's to fostering a more inclusive world, one episode at a time. Catch you on the next bite.