Last week, we published a short programmatic piece on our website, The Road to Transgender Liberation. We shared the article with our friends and comrades, and received some helpful feedback. In this short article, we would like to discuss some of the feedback concerning trans healthcare and provide a response. Our hope is that this significantly improves the first article and helps us achieve greater programmatic unity.
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In the original article, we pointed to the importance of raising the transgender movement to a greater level by demanding unity on the basis of class. Although trans workers have their own specific needs and face a very particular type of oppression, they can find great strength by uniting with non-trans workers and fighting the bourgeoisie together. Our attitude to the existing trans movement is to defend trans organisations, but raise this class demand in order to place their struggle on a more advanced level.
One of our comrades noted that the first article did not include anything about gender affirming care, which is demanded by most trans organisations. Gender affirming care expresses the demand of transgender people to have access to social, psychological and medical support during every phase of a transition. In most countries, there is significant gatekeeping around trans care, long wait lists, and a hostile environment. In both the Netherlands and the UK, a trans person wishing to undergo a medical transition must first receive a diagnosis of gender dysphoria from a specialised psychologist. Just the waiting period between the visit to the GP and the gender clinic can range from 4 months to two years.
The barriers to accessing hormones have led some transgender people to independently acquire hormones. Sometimes, this involves going through an intermediary who has a large stock of estrogen or testosterone from a legitimate pharmaceutical company. Most of the time this is safe, but sometimes there is a real danger that the trans person receives something with harmful substances. It is similar to acquiring illegal substances, which can sometimes be laced with dangerous chemicals that are not good for one's health. By barring access to hormones, some transgender desperate to transition do so independently. Although this is often done within a collective space with other trans people, the necessary supervision of hormone levels through regular blood tests and checkups is absent and the continual supply of hormones to ensure a continual transition is not guaranteed. Furthermore, because some people can have an adverse reaction to hormone replacement therapy, trans people transitioning this way lack the medical expertise to ensure the safety of their health. It is similar to the attack on reproductive rights in many countries, in which those in need of an abortion have to resort to dangerous methods instead of visiting an abortion clinic. It is a real evil of capitalist society that it has put up so many barriers to medical transitioning that the only way is through doing so independently, without medical supervision.
Additionally, trans people fear hostility from their GP, making the initial visit itself a source of major anxiety. Although there are many GPs that are friendly to trans people and will happily refer them to a gender clinic, a significant number of GPs are anti-trans and will make it harder for trans people to get a referral. As a result, it is difficult for trans people to have a sincere conversation with a medical professional–a GP, a psychologist, a school counsellor–about their gender identity. The perpetual threat of being denied care results in a toxic climate where the goal is to convince the psychologist or GP that one is trans. A normal conversation, in which one discusses one's feelings, doubts, desires and needs is often difficult. It should be noted that this is not the case for every trans person, as some get lucky to gain access to decent medical professionals who are supportive and empathetic. However, for many trans people a climate of fear and distrust characterises the entire process of transitioning.
Gender affirming care is the demand that transgender people receive support during every stage of their transition and access to medical care to live in their preferred gender. Trans people want to have supportive therapists while they begin living as their desired gender. They wish to be able to speak about their feelings, their challenges and what they want out of life without hostility. Trans people wish to gain access to gender affirming care without having to wait months, if not years, on a waiting list for an intake at a gender clinic. Instead of having to prove they are trans in order to get a gender dysphoria diagnosis, a person questioning their gender should be able to have such a conversation without fearing denial of care. The demand for gender affirming care seeks to remove barriers to transgender healthcare by structurally reorganising the entire process of medical transition.
How should communists raise the legitimate demand for gender affirming care to a programmatic level? We should first point out that we defend whatever trans healthcare currently exists and commend those who are campaigning for reforms. Our intervention concerns the question of how the working class should relate to this debate. The difficulties that trans people face in acquiring access to care for medical transition is part of the larger issue of healthcare under capitalism. Working people, both trans and non-trans, must struggle to gain access to quality healthcare under capitalism. In some countries, such as the United States, healthcare costs are extremely high and many working people end up in debt trying to pay medical costs. In other countries, such as the Netherlands and the UK, working people often have to exaggerate symptoms and even beg just to get the care that they need. Many of us who have been to an NHS clinic will have experienced anxiety when visiting a GP because of the fear that the doctor will dismiss our complaints. Even though healthcare is free in Scotland, the quality of the care is not always great and the waitlists can be extremely long. This is because it is underfunded, privatised, and still subjected to the capitalist market. The same is true in the Netherlands, in which healthcare costs are partially paid by the state through income-dependent health benefits. Those in need of an operation, a psychologist, or other forms of care not deemed 'necessary' can wait months (and sometimes even years) on a waiting list. Often, GPs will immediately prescribe antidepressants to those waiting for a psychologist, as it will take a long time to receive therapy and this is the only way they can get immediate relief from depression.
The only people who can actually receive high-quality care without a long waiting list are the petty-bourgeoisie and the capitalist class. By visiting a private doctor or psychologist, people from these classes can use their wealth to go private and pay their own healthcare costs. A working class person might be able to go private, but it will usually result in spending their savings and sometimes accumulating debt. Since most working people are not in a position to use their savings for a doctor, a psychologist, or a medical transition, they will be dependent on the capitalist healthcare system and sometimes suffer great anxiety in the process. The challenges that transgender working people face in accessing gender affirming care are no different from the struggle of non-trans workers to receive quality healthcare under capitalism. Although trans people face the added burden of stigmatisation, the working class as a whole struggles to gain access to psychologists and doctors in a capitalist society.
While some capitalist countries, famously Norway and Iceland, have a higher quality of healthcare, no capitalist country will ever be fully capable of meeting the medical needs of working people. Trans and non-trans workers need to unite and fight to bring the entire medical system under the control of the working class and reorganise it to meet its needs. For this to happen, a socialist revolution led by the working class and the popular masses is necessary. Only when working people take state-power into their hands will they be in a position to entirely transform the health sector and remove the profit-motive. The socialist reorganisation of healthcare can only be carried out by committees of patients, community leaders, doctors, psychologists, and other health professionals under the dictatorship of the proletariat. A proletarian dictatorship would make it possible for trans workers to create entirely new gender affirming institutions that fully meet the needs of trans people. Until a socialist revolution occurs, every attempt to improve the lives of trans people under capitalism will be highly limited and face the perpetual threat of being taken away.
What might the lives of trans people look like under the dictatorship of the proletariat? First, a mass campaign of against transphobia and anti-trans bigotry will be waged by the working class. Those who have committed historic crimes against trans people will be brought before a tribunal and face revolutionary justice. They will be given the opportunity to change their ways and live a normal life by serving trans organisations. A form of retributive justice will be applied to those who have done great harm to the trans community. Trans workers will meet with them, show them the pain they have caused, and give them the opportunity to change by performing necessary tasks for the trans community. As history has shown, some will continue their bigotry illegally, but many will change and become productive members of socialist society. A socialist society believes in the power of people to change, and uses the revolutionary state of the proletariat to transform people's ways.
Under the dictatorship of the proletariat, it will no longer be possible to use social media to spread anti-trans hatred (and every other form of bigotry). Instead, the new transitional society will use proletarian power to promote a gender affirming narrative that empowers trans workers and allows them to live a normal life. Committees of revolutionary workers will confront harmful stereotypes about trans people by creating new propaganda that presents trans workers as contributors to socialist construction and revolutionary transformation. Through a campaign of socialist education, trans workers will lead society in overcoming transphobia, struggle with transphobic ideas present within the working class, and use socialist media to popularise their new lives within socialist society.
Trans healthcare under the dictatorship of the proletariat will be drastically transformed. In schools, there will be a clinic where anyone questioning their gender will find a supportive group of patients, psychologists and doctors to talk to. They will be brought into contact with other young trans people, where they can openly discuss their feelings and think together about what they want to do to live as their gender. Those who wish to transition will receive full support from the revolutionary government. The socialist state will create transition centres run by committees of trans workers where they can try out new clothing, learn make up, and participate in activities with other trans people. These will be based on current transgender support networks, but receive a massive subsidy from the state in order to ensure maximum care. No longer will many trans people only find support online and face isolation, but have a supportive community in their neighbourhood where they can meet with other trans people. Since the dictatorship of the proletariat will remove the stigma from trans people's existence, visiting the transition centre will be a friendly, welcoming experience.
Those who want to transition medically with hormones will be able to acquire them in a supportive environment. All pharmaceutical companies under the dictatorship of the proletariat will be made state property through nationalisation. They will be reorganised on the basis of socialist planning in order to ensure that all working people have access to medicine. Trans people therefore will no longer struggle to get hormones, but have them when they need them and be fully informed at each stage of the process. Since the socialist state will massively invest in research related to trans healthcare, it will be possible to make transitioning easier and with better results than is possible under capitalism.
The United Communists of Europe calls upon trans workers to unite with non-trans workers and fight for a revolutionary communist programme. The entire welfare of trans workers is bound with the fight of the working class for socialist revolution. Together, we can overthrow the bourgeoisie and embark on the long process of socialist construction. Using our revolutionary state, we can enable all working people to gain full access to the highest quality healthcare imaginable. Trans people will receive the best medical and social care only in a society that is one the socialist road. Until that happens, we defend trans organisations and stand with those who are putting out the demand of gender affirming care. We hope that through a shared struggle, we can win trans workers to our perspective in order to raise them ideologically to the revolutionary struggle for socialism.
–For the dictatorship of the proletariat as the key to removing the evil of transphobia from society!
--For the socialist reorganisation of healthcare in order to meet all of societies medical needs!
–For a socialist society that provides gender affirming care to trans people and universal healthcare to all working people!
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