Part II: 1983-now
1983 Stephanie Anne Lloyd, marketing manager, was referred by a Manchester doctor to Russell Reid at Charing Cross GIC. Afterwards she created Transformation retail shops for trans persons in Manchester and later London.
Ashley Robin, who had stepped in as the head of the GIC appointed Donald Montgomery as clinical physician in 1984, and retired in 1985.
1985 Christine Goodwin, bus driver, became a patient. She would later win recognition as legally female at the ECHR in 2002.
Two studies were carried out at the GIC by Charles Mate-Kole, Maurizio Freschi & Ashley Robin.
a) “We presented the results of a retrospective study of 150 patients and a second, randomised controlled study of 40 patients. We studied 150 male transsexuals at different stages of treatment: assessment stage (n= 50); waiting list stage (n= 50); and postoperative stage (n=50). The results indicated a significant reduction in neurotic symptoms and improved social state in transsexuals postoperatively compared with patients at the waiting list stage, who fulfilled the criteria for surgery but were awaiting operation, and assignment to an assessment group.”
b) We “compared two groups of male transsexuals who had been assessed and carefully selected for surgery. They were randomly assigned to one of two groups; the experimental group had their waiting time for surgery brought forward so that they were operated on within three months of fulfilling the criteria, and the control group had to wait for the routine two years before undergoing surgery. All the patients were equally matched for age, social class, number of years of clinic attendance, and several other variables that might affect outcome. The results suggested that after two years of follow up there were significant differences between the two groups on a number of psychiatric and social, variables, showing a significant advantage for the experimental group over the controls.”11-12 December 1986. International Conference on Gender Identity was held in London. This was really a British conference, but the Clarke Institute, Toronto was represented, and thus the name. It was organised by Charles Mate-Kole, research psychologist at the GIC. “Addresses covered a broad range of themes from the literary style of transsexual autobiographies to the hepatotoxic effect of methyltestosterone, and from the work of the speech therapist in the team to the latest surgical development in phalloplasty which uses a radial artery flap to create the urethra. The present legal disabilities of transsexuals were discussed and an interesting paper on classification clarified the distinction between transsexualism and homosexuality yet noted the curious variants in the relationship of gender identity to sexual orientation.” The Mate-Kole-Freschi-Robin studies were presented.
In 1987 J Bryan Tully completed his PhD thesis, Accounting for transsexualism, based on 204 trans patients, most of whom were seen at Charing Cross GIC, and concluded that “here is a fundamental weakness in the imposition of psychiatric 'syndromes' on gender dysphoric phenomena. Rather, 'gender dysphoric careers' are proposed as fluctuating enterprises in the construction of meanings, some meanings being more fateful and workable than others”.
Grant Williams, consultant urologist at Charing Cross Hospital, wrote to the British Medical Journal in November 1987. “One gender reassignment operation takes the whole of one afternoon in the operating theatre. During that time, I could perform 10 cystoscopies or resect four prostates or do three vasovasostomies. Most people would feel that to pursue gender reassignment surgery in the current climate must be bottom of the list of medical importance. The hospital continues with this, although it is totally against the wishes of the division of surgery." Charing Cross GIC doctors Charles Mate-Kole, Donald Montgomery, James Dalrymple & Steven Hirsch wrote to the BMJ in reply: “He is unaware of studies done in our department, the results of which were presented at a conference in December 1986 at this hospital”. RP Snaith from St James University Hospital, Leeds, pointed out that while surgeons at Charing Cross oppose gender operations, “and this is understandable since this one hospital has undertaken the major proportion of this work for the whole of Britain. This unfair burden should be corrected, as I pointed out, by the establishment of regional services.” Williams resigned from Charing Cross the next year.
1988, James Barrett, joined the GIC
1989 Luiza Moreira/Roberta Close, the Brazilian model, had gender surgery at Charing Cross Hospital.
1990. 20-year old Jackie McAuliffe had a first appointment.
1993 psychiatrist Alfred Hohburger died.
1994 Richard Green, ex-colleague of Harry Benjamin, became Director of Clinical Research, and saw trans persons two days a week.
Donald Montgomery gave a presentation at the Gendys ’94 Conference in Manchester discussing the GIC from the doctors’ point of view. At that time the clinic was getting over 300 referrals a year, 80% mtf, of whom 20% had “some form of gender reassignment surgery within five years”. He presented a typology: “primary core transsexualism, secondary transsexualism, the heterosexual transvestite, the asexual cross-dresser, the female transsexual, the small - the very small - number of patients with a biological component”. He discussed other GICs: “We are by far the biggest in the UK if not Europe, if not the world, I think, in terms of patient referrals. There is a small clinic just for the Leeds/Yorkshire catchment area. Professors Goldberg and Linton used to have a clinic here in Manchester but I think all the Manchester patients are probably being referred to us at the moment. There are occasional psychiatrists scattered around the UK that have an interest in gender identity disorders, without professional back up on the whole. Dr. Christie Brown still has his clinic at Maudsley Hospital but I think it's probably running down rather than increasing. Dr. Dunleavy in Newcastle and his colleagues have a small clinic there. There is also the child and adolescent clinic at St. George's”
Jackie McAuliffe had surgery in 1995. Later she would work as a prostitute in Paddington Green and be featured in a docu-drama based in the area.
++The GIC was moved out of the Charing Cross Hospital and into a smaller building, the Claybrook centre.
2000 The GIC approached James Bellringer to replace Mike Royal as the GIC’s surgeon. Royal provided on-the-job training,
Kelly Denise Richards, serving time at HMP Parkhurst for assault and robbery, was a patient. While still incarcerated, she had surgery and was transferred to a women’s prison.
In December that year it was announced that the number of NHS sex-change operations was set to triple, and that Charing Cross GIC would increase such operations from one to three a week at an extra £1 million per annum. Liam Fox, the Conservative shadow health secretary denounced the Labour Government of pandering to lobby groups.
2001 James Barrett became head of the GIC.
++Stuart Lorimer joined the GIC, first as an intern, but soon had his own weekly clinic.
In 2003 the GIC moved into its new premises at 179-183 Fulham Palace Road. It was now part of the West London Mental Health NHS Trust.
2004 Charles Kane, businessman, in detransition, was, unlike his transition, a client of the GIC.
2004 In 2004 as the Gender Recognition Bill was proceeding through parliament, psychiatrist Russell Reid faced a complaint to the General Medical Council that he too easily accepted patients for hormone therapy and surgery. The complaint was brought by four of his colleagues at the Charing Cross Hospital Gender Identity Clinic, psychiatrists James Barrett, Richard Green, Donald Montgomery and senior registrar Stuart Lorimer on behalf of four of his former patients. Reid retired his NHS post the next year. In 2007 Reid was found guilty of Serious Professional Misconduct, mostly for failing to communicate fully with patients’ family doctor (a rule that many doctors are unaware of) and not documenting his reasons for departing from the HBIGDA Standards of Care guidelines sufficiently.
The same year David Batty of The Guardian interviewed the GIC surgeon James Bellringer and was told “The number who express immense gratitude is overwhelming”. However Persia West who researched a report on the needs of trans persons in Brighton and Hove (many of whom had been referred to the Charing Cross GIC) and found “The level of dissatisfaction with the Charing Cross GIC was very high, in essence concerning the time the treatment took and the manner in which it was given.”
++Christina Richards, herself trans, became part of the staff at the GIC.
2006 The GIC saw 498 referrals.
++2007 Stuart Lorimer represented the GIC at a panel on trans health care as part of London's LGBT History Month, and then at the 2007 LGBT Haelth Summit in Manchester.
2011 A proposed conference, Transgender: Time to Change sponsored by the Royal College of Psychiatrists and led by Az Hakeem of the Portman Clinic, and featuring Julie Bindel, but with no input from any trans persons, was cancelled after the Charing Cross team criticized the emphasis of the meeting: “It now appears that the conference comes at trans issues from a very specific agenda, namely, to explore the validity or otherwise of gender diagnoses as medical and psychiatric phenomena. So long as this is the case, we feel we can’t support it.”
US physician Ted Eyton visited the GIC in 2013, and reported that it gets 1500 referrals per year from GPs. This rate has been doubling every five years. Charing Cross GIC gets about 50% of referrals in the UK. This was the same year as the Conservative-Liberal coalition proposed to demolish the main Charing Cross building, and to sell off 60% of the site to private developers.
2014 James Bellringer, who had been doing the majority of vaginoplasty work for Charing Cross Hospital resigned.
2016 The GIC saw 1892 referrals in 12 months.
The West London Mental Health Trust (WLMHT) announced:
“However, as WLMHT moves forward it is necessary to refocus the services that we provide. The Board has made a decision that the medium-term strategic focus for the Trust will be to develop mental health services, physical care and integration between the two.
“As a result, the Trust has come to the conclusion that patients requiring gender identity services would be better served in the long term by another provider, and has therefore served notice on our contract to NHS England.”++However it was becoming increasingly obvious that as trans persons were no longer regarded under a mental health rubric, the connection with WLMHT became more strained. In 2017 the GIC was repositioned within the Tavistock and Portman NHS Foundation Trust.
1933-1965 Lennox Broster, surgeon
193?-194? Clifford Allen, psychiatrist
1950-1982 John Randell, Physician for Psychological Medicine
196? – 198? Peter Philip, surgeon
1982-1985 Ashley Robin, head of GIC
1982-1993 Alfred Hohburger, psychiatrist
1982-2005 Russell Reid, psychiatrist
198?-200? James Dalrymple, Surgeon
1984- ? Donald Montgomery, clinical physician
1985-1990 Charles Mate-Kole, research psychologist
1994- ? Richard Green, Director of Clinical Research
? -2000 Mike Royal, surgeon
2000-2014 James Bellringer, surgeon
2002-now Stuart Lorimer, psychiatrist
1988- now James Barrett, head of GIC from 2001.
- Philip Snaith. “Conference Report: International Conference on Gender Identity”. Bulletin of the Royal College of Psychiatrists, 11, March 1987: 81. PDF
- Grant Williams. Letter to BMJ, 12 September 1987.
- Charles Mate-Kole, Donald Montgomery, James Dalrymple & Steven Hirsch. “Gender Reassignment Today”. Letter to BMJ, 17 October 1978. PDF
- R.P Snaith. Letter to BMJ, 12 December 1987. PDF
- Charles Mate-Kole (ed). The state of transsexualism-proceedings of the International conference on gender identity. Schering Health Care, 1987.
- Charles Mate-Kole, Maurizio Freschi, Ashley Robin. “Aspects of psychiatric symptomatology at different stages in the treatment of transsexualism”. British Journal of Psychiatry, 152, Apr 1988: 550-3. Abstract
- Charles Mate-Kole, Maurizio Freschi. “Psychiatric aspects of sex reassignment surgery”. British Journal of Hospital Medicine, 39,2, Feb 1988: 153-5. Abstract
- J. Bryan Tully. Accounting for Transsexualism. PhD Thesis, University of Brunel, 1987. Published as Accounting for Transsexualism and Transhomosexuality: The Gender Identity Careers of Over 200 Men and Women Who Have Petitioned for Surgical Reassignment of Their Sexual Identity. London: Whiting & Birch, 1992.
- Charles Mate-Kole, Maurizio Freschi, Ashley Robin. “A controlled study of psychological and social change after surgical gender reassignment in selected male transsexuals”. The British Journal of Psychiatry, 157, 2, Aug 1990: 261-4. Abstract
- Dave King. The Transvestite and the Transsexual: Public categories and private identities. Avebury, 1993: 39, 60.
- Donald Montgomery. “The Charing Cross Gender Identity Unit”. Gendys ’94 Conference, Manchester. www.gender.org.uk/conf/1994/montg.htm.
- D. Di de Cegli, James O. Dalrymple., L. Gooren, Richard Green, John Money, & Russell Reid. Transsexualism: The Current Medical Viewpoint. London: Press For Change. 1996.
- Nicholas Rufford. “Sex changes on NHS to triple”. The Times, 3 December 2000.
- David Batty interviews James Bellringer. “The number who express immense gratitude is overwhelming”. The Guardian, 2 August 2004. www.theguardian.com/society/2004/aug/02/socialcare.mentalhealth.
- Persia West. Report into the Medical and Related Needs of Transgender People in Brighton and Hove. Spectrum, 2004. PDF
- James Barrett. Transsexual and Other Disorders of Gender Identity: A practical guide to management. Radcliffe, 2007.
- Deborah Blaustein. The Gatekeepers of Gender: A History of Transsexuality in the National Health Service (including a Case Study of the Gender Identity Clinic at Charing Cross Hospital). University of London, 2012.
- Thomas Sissons. “Charing Cross Hospital has hardly been 'saved' - and the decision to cut its services will have a terrible effect on public health and medical training”. Independent, 18 February 2013. www.independent.co.uk/voices/comment/charing-cross-hospital-has-hardly-been-saved-and-the-decision-to-cut-its-services-will-have-a-8493715.html
- Ted Eyton. “Visiting the oldest Gender Identity Clinic in the World: NHS’ Charing Cross, London England”. Ted Eyton, MD, September 26, 2013. www.tedeytan.com/2013/09/26/16645
- Joseph McCormick. “NHS trust confirms plan to replace surgeon responsible for majority of UK gender reassignment work”. Pink News, 1st February 2014. http://www.pinknews.co.uk/2014/02/01/nhs-trust-confirms-plan-to-replace-surgeon-responsible-for-majority-of-uk-gender-reassignment-work.
- “The 'Biggest Hospital Closure In NHS History'”. LBC, 29th July 2014. www.lbc.co.uk/biggest-hospital-closure-in-nhs-history-to-be-confirmed-94553.
- Kate Lyons. “Gender identity clinic services under strain as referral rates soar”. The Guardian, 10 July 2016. www.theguardian.com/society/2016/jul/10/transgender-clinic-waiting-times-patient-numbers-soar-gender-identity-services.
- Joseph Curtis. “Transgender treatment clinics overwhelmed as number of referrals has soared by up to 28 times in a decade”. Daily Mail, 11 July 2016. www.dailymail.co.uk/news/article-3684173/Transgender-treatment-clinics-overwhelmed-number-referrals-soared-28-times-decade.html.
- Nick Duffy. “NHS trust terminates Gender Identity Service contract amid trans health turmoil”. Pink News, 25th August 2016. www.pinknews.co.uk/2016/08/25/nhs-trust-terminates-gender-identity-service-contract-amid-trans-health-turmoil
Deborah Blaustein’s University of London thesis sounds quite interesting. Unfortunately I was not able to find a copy.
Re the two Mate-Kole-Freschi-Robin studies: obviously transsexuals who have been granted what they need are less neurotic than those who are frustrated by being kept waiting year after year for no good reason.
For several of the doctors, eg. Richard Green, I was not able to find out when they came and left.
The Wikipedia page on the West London Mental Health NHS Trust does not even mention the Gender Identity Clinic, nor does the Wikipedia page on the Hospital mention recent attempts to close it and sell off the land.
Obviously the attitude of the staff is much better than it was in the 1960s under John Randell who insisted on using birth pronouns and telling trans women that they would always be men. However Persia West’s report shows that there is further to go. The proposal that Charing Cross GIC be discontinued and replaced by local GICs is possibly a good thing, if it is done right. However the track record of the Conservative government since 2010 does not bode well.