Pretending That Trans Men Aren’t Really Women Serves No One

A protocol is a set of measurable, objective standards to determine a course of action, not a manifesto to cater to individual beliefs and feelings

Royal Sussex Hospital

A few months ago in social media, there was a flurry of outrage around a document entitled: Perinatal Care for Trans and Non-Binary People from the Brighton and Sussex University Trust of the UK National Health Service.

I was a bit surprised at the timing of the publicly expressed angst at a document that has been in circulation since December 2020. But no matter, it’s still worth a bit of a dissection. And it sure offers up plenty for a robust discussion.

What is a mother and are all mothers women?

We don’t get off to a very good start. Clause 1.1.3 declares that: Maternity services have typically been designed as a cisgender (cis) women-only service, which may not serve the needs of trans and nonbinary individuals. When providing perinatal care to trans or nonbinary people, the Trust and its employees should treat service users according to their self-identified gender, not the sex they were assigned at birth.

The word “maternity” goes back to Medieval Latin maternitatem (nominative maternitas) "motherhood," from Latin māternus "of a mother," from māter "mother", which of course makes this a word that is totally fit for purpose as only women can become mothers. Fortunately for those of us who pay the mortgage by providing maternity services mammalian biology and physiology are not dependent on ideology, feelings or beliefs so we will never be confronted by a body with a penis trying to push out a baby. The only service needed is a woman only service. This does not make it impossible for us to treat everyone with respect and the dignity of using individualized terminology when needed.

I am not a “cis” woman, because I don’t have a gender identity. I am a woman who is not buying what the trans lobby is selling. There are not two categories of women, but only one because trans women are men.

And for shame that a health service is spouting the “assigned at birth” nonsense. There is nothing in the training of obstetricians or midwives about ‘how to assign sex or gender to neonates’. Not a single class, lecture or training session is devoted to this. In fact, it’s considered so blindingly obvious that no one will have a problem with observing and recording a baby’s sex at birth, that it isn’t mentioned at all. The 0.018% of the population born with a Difference of Sexual Development (DSD) is not a reason to change the current system of recording sex at birth. Intersex is nothing of the sort because there are only two sexes and neither of them are somehow “in between” or proof of any sex “spectrum”.

If health professionals working outside of the maternity setting follow the instructions given here to “treat service users according to their self-identified gender, not the sex they were assigned at birth”, then both women and men are going to die of preventable illnesses that they weren’t screened for. This is a dangerous practice that can also lead to the death of babies who are conceived by “men”.

Clause 1.1.4 states:  Pregnant people and new parents are entitled to safe and respectful perinatal care regardless of gender identity, or history of medical and/or social transition.

No one is arguing that all people don’t deserve safe and respectful care in all medical settings, for whatever reason. I’m a bit concerned though, that some men (who are also “new parents”) may think that they deserve to have all their needs met too. I won’t forget a night shift where I had to have hospital security remove a drunk man who turned up at 3 am to visit his partner and their new baby. His mother (!) called the ward to complain that we had prevented him from seeing his baby and we “couldn’t do that to him”. Um, yes we could and we did. He was intoxicated; the woman and her baby were both sleeping and this was a ward; there were other women and babies that he was disturbing.

This clause continues: Respectful care recognises and affirms the gender identity of the pregnant person, and normalises the experience of carrying a pregnancy whilst trans or non-binary. Professionals should recognise that the desire to conceive, birth and feed a baby can be shared by people of any gender identity.

This is the first bit of obfuscation designed to lead us down the path of fantasy and delusions. Along with many others, I don’t have a problem affirming any bit of nonsense that makes a person requiring care from a health service feel comfortable. But we are dealing with embodied reality here and the reality is that every “pregnant person”walking in the door needing midwifery services is a biological woman. Every single one. None of these people will ever have prostate problems. And I struggle to get my head around a definition of “nonbinary” that includes pregnancy. Surely pregnancy is proof of the nonsense status of this designation? Only female “nonbinary” people can get pregnant; if you are male you can have as much unprotected sex as you desire and never worry for a moment about becoming pregnant.   

Of course, I recognize that every adult may have the desire to birth and feed a baby, while at the same time I recognize that not all people will have the capacity to do so and pretending otherwise changes no one’s biology or underlying physiology.

Clause 1.4.11 reads, When talking to groups of people, such as during Parentcraft Classes, always use gender inclusive language. For example say, “Pregnant women and people can choose to birth at hospital or at home”, rather than, “Pregnant women can choose to birth at hospital or at home”. Using gender inclusive language is important, regardless of whether trans or non-binary people are known to be in the space. In this way, we validate and normalise the diverse gender identities of all those who give birth.

Wouldn’t it be better to rephrase “gender inclusive” language so that it doesn’t exclude anyone? For example, the over 99% of women who are happy to attain the status of mothers. What about “You can choose to birth at hospital or at home”. I mean, if this is supposed to be a class preparing people for birth (both doing it and supporting doing it), you are presumably in a room where everyone knows what they are there for? It’s not like you need to spell this out, surely?

If you want to learn of the many harms caused to women by using “gender inclusive” or de-sexed language, then this paper outlines this very clearly.

And you can torture me before I will go along with “normalising” women who have made a deliberate choice to harm their bodies (and possibly their babies) along with the faux male look you get when you choose to amputate your healthy breasts. If ever there was an argument against normalizing a pathology into what is supposed to be a celebration of welcoming new life on our planet, this is surely it.

However many gender identities you choose to believe in, they are irrelevant to figuring out who can have a baby.

Pronouns: secret agents abound!

Section 1.6 is about documentation. Documentation is a vital tool in all patient care, especially in the hospital setting. It serves as background information for the variety of health professionals who will be dealing with a large number of patients over the course of every year. According to this document “pronoun stickers” are available for use by clinicians to help them to know how to address those requiring their care.

Clause1.6.4 tells readers that, Stickers should only be applied to patient notes with informed consent. They can be applied to the front or inside of the Pregnancy Care, Labour and Birth Care, and Postnatal Care Records. The intended benefits of using pronoun stickers are to reduce the burden on service users to disclose their pronouns to each new professional they encounter. These stickers may not be appropriate for individuals who prefer to disclose their gender identity and pronouns to only a select few professionals. These stickers will be most beneficial if they are just used for trans and non-binary people, and may go unnoticed if used for everyone.

From this it would appear that pronouns are quite tricky. I’m not sure why they are important in face-to-face consultations; surely if there is any doubt, they can be replaced simply by referring to the patient/client by using their name? Ditto in the notes.

Wouldn’t it be distressing for anyone to decide who knows and who doesn’t know (about a gender identity)? Will people have to remember who they’ve given permission to, to use not obvious pronouns and who isn’t supposed to know? This is all too reminiscent of the thicket of words that form queer theory ideas, which are deliberately designed to be confusing, leaving the knowledge to those elevated in academia the arbiters of who is more correct.

Clearly the rules are relaxed once you declare “I’m trans”

Section 3 is about antenatal (AKA prenatal or prepartum) care.

Clause 3.1.4 contains some disturbing content: The current clinical consensus is that individuals who conceived whilst taking testosterone should be advised to stop taking it, if they plan to continue with the pregnancy. Testosterone is considered a teratogen, with potential implications for reproductive development of the fetus. If a pregnant person reports taking testosterone at any point during pregnancy please refer immediately to the Gender Inclusion Midwives who will co-ordinate advice and support. Referral to the Gender Inclusion Team’s named Consultant Neonatologist (see Appendix 1) Prescribed Medicines Clinic is recommended in order to discuss potential implications and liaise with obstetric services for additional surveillance if required (See Appendix 8- Prescribed Medication Referral Form)

Proof that others are happy to go along with harming babies to prioritize “paternal” (sic) mental health is this study written not by medical professionals, but sociologists who try very hard to make the case that pregnant “men” (or wanna be pregnant “men”) are so fragile and vulnerable if they don’t sacrifice their testosterone regimen during pregnancy that the risk of permanent harms to their fetuses is worth taking. And that all the medical professionals they may see over the perinatal period should really be supporting this. Because focusing on the wellbeing of babies could be construed as well, transphobic don’tcha know. I have already written about this study here.

Over the course of recorded history, there have been a few utter and total disasters for children who are affected by substances their mothers have taken during pregnancy, some for pleasure and others prescribed to fix something. The two most obvious are any form of alcohol and smoking. A quick Google search will suffice on the lifelong debilitations that can accrue for a new human from a woman who has a few wines after work at a critical phase of fetal development and no one reading this can claim that smoking is health enhancing for anyone. Basically, anything that can cause harm to adult bodies and minds has the same effects on fetuses, but this can manifest more negatively, simply due to the intricacies of mammalian development.

Thalidomide was prescribed to women for morning sickness, but it caused catastrophic birth defects. I believe that women would rather have felt continuous nausea, if the alternative resulted in this:

Diethylstilbestrol (DES) was used between the 1940s and 1978 to prevent miscarriages in women. It didn’t really work for this purpose, but was still used for other reasons, sometimes in pregnancy. DES is now known to be an endocrine-disrupting chemical, one of a number of substances that interfere with the endocrine system to potentially cause cancer, birth defects, and other developmental abnormalities. 

Why did it take so long to stop prescribing this harmful drug to pregnant women? Because the high rates of cancer associated with DES are not in the women who consumed this, they are in the baby girls who get specific cancers in their own lives: clear cell adenocarcinoma, breast cancer, pancreatic cancer and precancerous cervical lesions are all much more common in women born to mothers who exposed them in utero to DES. And these women have vastly inflated rates of fertility, pregnancy and reproductive disorders, meaning that even the grandchildren of women who had DES in pregnancy have adverse effects.

So, readers, I ask you; who is monitoring the children and grandchildren of women taking excessive doses of testosterone before and sometimes during pregnancy? Yoo hoo, anyone out there? Or would this be considered to be transphobic or bigoted towards “men” who have babies?

Because it is up to women to report that they have taken testosterone, what happens if they don’t tell a care provider or refuse to stop? If they were using illegal drugs in some countries, they could be jailed for child endangerment while still pregnant. In some countries pregnancy helps to prioritize placement on scarce treatment services for addicted women as it is recognized that this is a uniquely vulnerable time for babies and their mothers.

Are emotions only valid if you have an “identity”?

Section 3.6 is about emotional health, which of course is a concern for all pregnant “people”, but I think it is supporting a fundamental error:

3.6.1 Identifying as trans or non-binary is not classified as a mental illness, but some individuals will have experienced gender dysphoria. Gender dysphoria may be exacerbated, remain the same or be improved during pregnancy, depending on the individual.

3.6.2 Gender dysphoria during pregnancy may be separated into two sources, which health care providers should understand. Dysphoria can be rooted in an individual’s feelings about their body, and the physical changes that are associated with pregnancy. Dysphoria may also be triggered by social interactions, both with individual practitioners, and through engaging with a gendered system.

3.6.3 Professionals should be alert to the potential for worsening dysphoria, and encourage pregnant people to seek the support of a gender aware therapist or counsellor if required (see Appendix 9: Resources)

Identifying as something you are not may no longer be considered a mental illness, but this is clearly not universal.  Anorexia is still considered a mental illness as is body dysmorphic disorder. It must be a microscopically small line between this and gender dysphoria in its manifestation. In fact, from my vantage point I think a case can be made to support an argument that any biological woman claiming to really be a man who deliberately creates in “himself” a pregnant body is exhibiting signs of a dangerous self-sabotaging.

Once the baby is born, the nonsense continues

Section 5 is about postnatal care and 5.5 is about infant feeding.

5.5.7 Non-gestational parents may wish to participate in feeding their infants using their own bodies. Cis women who have previously breastfed may have the most success in relactating. Trans women and cis women who have not been pregnant may also be able to induce lactation to some extent. Methods for inducing lactation include using galactagogues and physical stimulation. Alternatively, some families choose to use supplemental nursing systems with expressed milk or formula.

Yes, I agree that some “non-gestational parents may wish to participate in feeding their infants using their own bodies.” But does this mean they should? The concept of the mother/baby dyad is very specific as it references only one combination, that of a birth mother and her baby. “Other” mothers and parental substitutes are not party to this unique duo. Only a mother and her baby can manage the complex, intimate dance that breastfeeding is; theirs are the only bodies primed and equipped to successfully nurture a brand-new baby into a thriving toddler and beyond. The UK has some of the lowest breastfeeding rates in the world, which means that most women are already being failed by the health system and wider society to reach their own breastfeeding goals, but encouraging “non-birthing people” “to participate in feeding their infants using their own bodies” is totally counterproductive.

I may wish to be identified as a global supermodel, with a matching bank balance, but I don’t see anyone out there facilitating that for me.

Whether or not men are an appropriate group to be encouraging to breastfeed is covered in the next section.

Under the Definitions Appendix, this is part of the entry for Hormone Therapy:

Hormone therapy for trans women and non-binary AMAB [assigned male at birth] people may include suppression of endogenous testosterone and supplementation of oestrogen:

o Testosterone suppression can be achieved pharmacologically with blockers such as decapeptyl, or surgically through removal of the testicles

o Oestrogen supplementation can be given through oral pills or topical gels

o Trans feminine hormone therapy redistributes muscle and body fat and stimulates breast development, with maximal breast development at about 2- 3 years. Hormone therapy also suppresses sperm production, but not completely for every individual so should not be relied on as a form of contraception. Stopping oestrogen can result in the return of spermatogenesis.

Where is the justification for medical experimentation on babies? Where is the mother of any baby who is being put to the breast of the body of a natal male? What happened to “first do no harm”?

Since when is the paramount goal of a clinical treatment protocol to meet the wants, beliefs and feelings of patients over providing appropriate care that gives people the best possible outcomes?

And why in the present era of globally overstretched health services are taxpayer funded services such as the NHS overspending disproportionately on less than 1% of their population when so many people cannot access primary health care?