A joint blog by MRN and Gendered Intelligence for LGBTQ+ History Month.
Content warning: this article contains content pertaining to the asylum process and the process of receiving gender-affirming care.
An invasive and dehumanising culture of disbelief, and a reliance on stereotypes by decision makers, contributes to the increased marginalisation of people seeking asylum, trans people, and trans people seeking asylum. A comparison of the asylum system and the medicalisation of transness shows us the interdependence of different struggles, and how the presumption of deceit harms us all.
Policing of trans bodies: the medicalisation of transness
The medicalisation of transness (also called pathologisation) refers to the idea that trans identities can only be comprehensible or understood through a medical diagnosis, which results in access to medical treatment being gatekept. This often leads trans people to have to “prove” their transness through a heightened performance of stereotypical gender roles in order to access treatment and respect. Underlying this medicalised model is a presumption of deceit: that trans people are “liars” until they can prove otherwise.
In the UK, trans healthcare is largely specialist: individuals that wish to access healthcare related to their trans identity must go through the Gender Identity Clinic (GIC) system instead of via general healthcare routes. This system is difficult to access. Trans people must be referred into the specialist system by a GP or other medical professional (or self-refer in very rare cases), where they are put on a waitlist. Current wait times are estimated in excess of ten years.
At the GIC initial appointment stage, a doctor, usually a psychiatrist, psychologist, or psychotherapist, diagnoses the individual with ‘gender dysphoria’. Following this initial appointment, trans people must pass the ‘real life test’ – a waiting period to receive gender affirming care. Trans people can experience gatekeeping at all stages of this process: from their GPs, their doctors and their psychiatrists.
In 2017, the Government was looking to review existing gender recognition legislation, even potentially moving towards self-ID: the ability to self-identify one’s gender and having gender markers changed on all official documents (including birth and marriage certificates) without needing a medical diagnosis. As it stands, these plans have been dropped and the UK is backsliding on trans rights.
Policing of people seeking asylum: the immigration system
The UK asylum system holds those seeking protection to high burdens of proof, of their protected characteristic (including religion, disability, gender or sexuality), and that their fear of persecution on account of their protected characteristic is ‘valid’.
In both the trans healthcare system and the asylum system, stereotypical performances and rigid conceptions of identity are relied upon by decision makers. People are often treated with assumed distrust that their identity is as they say it is, and so during asylum interviews, they are held to cruel standards to ‘prove’ it. This can include being pushed to disclose traumatising private and intimate information. There is often the underlying assumption that queer people should already be out/socially transitioned, which can negatively impact queer people’s asylum claims.
This burden of proof, coupled with the presumption that people seeking asylum are “deceitful” and “not genuine”, often forces people to “perform” their protected characteristic in accordance with stereotypes, so that they can be recognised as their identity and gain asylum.
The invasive and lengthy process to access trans healthcare mirrors the systematic disbelief and gatekeeping of protection for (queer) people seeking asylum.
Trans people seeking asylum: unique barriers
While cis and/or queer people navigating the asylum system in the UK face significant hurdles at having their sexuality recognised by Home Office officials, trans people face additional barriers because of the medicalisation of transness. The barriers to be recognised as a trans person when seeking asylum reflect the state of trans rights in this country.
Outdated gender recognition legislation and outdated Home Office guidance for assessing trans people’s asylum claims elevate the judgement of a medical professional as the final say over someone’s identity. In guidance for people claiming asylum due to their sexuality, caseworkers are rightfully informed that psychiatric, psychological and other medical ‘testing’ of sexuality is banned, as being queer is not a mental disorder. These kinds of tests have been banned following European Court judgements. However, the guidance for trans asylum seekers – not updated in over a decade – establishes that medical and psychological reports are relevant material and should be considered in assessors’ decisions over whether someone is ‘really’ trans. The approach in the guidance is not backed up by any research that values the lives of trans people. As a result, inaccurate language and clear misunderstandings of trans people’s lives and experiences are present.
The experiences of trans migrants in asylum accommodation and detention are also marked by difficulties with accessing Hormone Replacement Therapy (HRT) or other transition-related care. After achieving status, trans migrants are less likely to be able to afford private transition care, and they may be more at risk when accessing medication without a prescription. This is especially the case for trans people on testosterone, as it is a controlled substance – a risk that is intensified for Black trans people and other racialised trans people.
The UK Government has begun to remove countries with self-recognition for trans people from the list of recognised Gender Recognition Certificates (GRCs). This means that trans people from those countries will have to provide medical reports, which they may not have, in order to receive a UK GRC.
The medicalisation of transness, combined with the cruelty of the UK’s immigration systems, poses unique barriers for trans migrants, particularly people seeking asylum, and for their dignity and wellbeing. Both the medical industrial complex and the border regimes immigration detention systems exert surveillance, power and control over trans people seeking asylum by holding them to harmful burdens of proof, invasive administrative processes and disbelieving their truth.
It is imperative that we build solidarity amongst different struggles to better support all those affected by oppressive systems, especially trans people seeking asylum, who are situated at the sharp end of both pathologisation and bordering.
Check out our Who is Welcome: Gender, Queerness and Migration campaign.