'Social Contagion' by HJ Giles
EDITORIAL NOTE: This was written in August 2020, and originally published February 2021 in the print edition of Gutter #23. Much of the information regarding coronavirus and the first lockdown will therefore be out-of-date, and the piece is to be considered as a personal account of that period of time. The details regarding trans healthcare in the UK, meanwhile, remain just as relevant as they were last year.
Early in the pandemic, when the truth of what was about to happen became clear, when people in the UK began to understand that they were going to spend the next six months at home, isolated, seeing few if any people, a joke began circulating on trans social media: what a perfect time to transition! ‘Everyone is talking about how they’ll come out of quarantine with new hair... and all the closeted trans folks on HRT are just nervously/excitedly giggling in the background’, said one viral tweet. It was not a joke.
I wake up, read, stretch and shower. I take three pills: iron supplements, to avoid anaemia; Vitamin D, because trans people don’t get enough sun; and finasteride, to stop my hairline receding. I squirt estrogen on each of my shoulders and thighs, and massage it in, waiting for it to dry, to sink into my body. I wash my hands so that I don’t leave smears of estrogen around the house: my boifriend doesn’t want any more than she has already. I look in the mirror.
Some days I wear a full face of make-up, because what better time to enjoy myself than when I don’t have to worry about other people’s judgement? Besides, it helps me feel myself when the world has become so small. Some days I don’t wear any at all, because if no-one’s going to see it then what’s the point? Besides, it’s hard enough just to keep going without adding another task to the to do list. All the women I know are making the same decision. We’re split down the middle.
My routine is the same as it was before the pandemic, and wholly different. Before, I was just getting ready; now, I’m holding myself together. I wake up full of impossible questions: Am I going to have enough work to survive? Are my friends and family going to die? Will I ever get to perform again? I just cleared my throat: was that the disease? How is my trans community going to cope with this isolation? How long can this go on? How long can I go on? Doing the same thing each morning quiets my anxiety. Doing the same thing every day is crushing me.
I walk the same circuit around my local park, half a mile from my front door, two or three times a week. Lockdown prevents me from travelling further, but I need the air and the exercise, and this is the best nearby bit of green space: a small loch and woodland in the grounds of an old castle. The castle is tiny and ruined, the track is muddy, the water is full of dead trees, and all this is perfect for bird life.
I take my binoculars and walk slowly around the pond. Some other walkers are wearing face masks; we all keep a careful distance from each other, wait for each other when the path is narrow. Near the fence, a coot is nesting. She shifts around on her nest. Further in, I see two moorhens squabbling and flapping at each other, and maybe the white of a swan. The song in the trees is rich, layered, territorial. I watch the little birds carefully and open an app on my phone, looking up markings and song patterns. Chaffinch, wren, dunnock, chiff chaff. I never took the time to learn these birds before this year.
In the year leading up the pandemic I was part of three different support teams for neighbours recovering from vaginoplasty. This trans surgery has a three month recovery period, with very little mobility for the first month, which means that my friends needed support with cooking, cleaning, cat litter, dog walks, laundry, shopping—all the daily work of staying safe and alive. Flats had to be kept hygienic to prevent infection, store cupboards had to be kept full of easy and nutritious meals. And recovering from surgery is hard on mental health, can leave you feeling isolated and depressed. All the pressure of relating to your trans body makes things harder still, so emotional support and good friendship were also part of the care responsibilities.
And so when the pandemic hit, in the middle of the recovery period for my third friend, after a year of spending many hours each week running errands, wiping surfaces and managing calendars, my first thought was, It’s OK. I know how to do this. The Facebook chat that organised care for one person started to deliver support to a whole community; the spreadsheet template I copied from one care team to organise the other became the model for a city-wide mutual aid project.
I work with other locals to set up a support line for any queer and trans people to ask for help. We receive messages from strangers who need someone to collect their groceries and prescriptions, who need information on what the Gender Identity Clinic is doing, who want someone to talk to. More than that, we learn that we need to help each other. We give benefits advice to one another. One of us gives another their bike. When one of the team falls very ill, a group organises a support pod. Sometimes we are too tired, sometimes the meetings are too long. Sometimes we don’t know what to do. We’re always worrying that we’re not doing enough. We are daily social and emotional support for each other.
At the same time, we begin to learn about how the pandemic is affecting trans healthcare. All trans-related surgeries are cancelled. Many GICs reassign some or all of their staff, freezing services. Those that stay open cancel all face-to-face appointments, and some refuse to set up video consultations in their place. GP surgeries shut down or reduce services, cutting off some trans people from the blood tests and hormone injections that maintain our bodily integrity. Vanuatu shuts down flights, cutting off a major hormone import route, and other suppliers see a run on stocks. The listings on the grey market websites we send to each other in encrypted chats are updated: out of stock, out of stock, out of stock.
Before COVID-19, trans healthcare in the UK was already at breaking point. The wait from GP referral to GIC appointment, to receiving any public healthcare at all, was already a 2 year minimum, and 5 years in some parts of the UK. Thanks to strong national health insurance, we don’t need to rely on work-based coverage, but when the public health service fails we’re left with no option but to fund our own healthcare. For the course of my wait, I spent £25 a month on a subscription to a private provider, £40 a month on hormones, £70 a month on hair removal and £100 a month on therapy. I paid for the medical aspects of my transition with the scholarship for my poetry PhD. Half on rent, a quarter on transition, and a quarter left to live on.
As the news of lockdown spread, trans people saw something else: we were going to be waiting longer, making do with less, and paying more. The only people we could rely on for care were each other.
I take up running. I need to do something with my body. I need to feel a different sensation. I download the Couch-to-5k app and set myself a target. Three times a week I put on rainbow shorts and a workout tank, clip my hair back, and run. The same circuit each day: along the bike path, round the loch, through the near-empty links. I like the sense of strength. I like how weird my body looks now and how I can outrun the stares. In the walking segments between the runs, I spot the birds: blue tit, goldfinch. Eventually I’m running the full half hour and there’s no time to watch them, but by then I recognise them by their flight and their song.
On the fifth of May, two months into the pandemic, twenty three months after I was first referred by my doctor, the local GIC calls me and offers me an online appointment. I stammer through the three minute phone call. Oh? Oh? Yes. Yes. Yes. That’s me. Me. Fri fri fri friday? In two days? Yes. Yes. Yes. Yes. That’s fine fine fine. When they hang up, I realise I have been pacing my room so hard I was running on the spot. I stagger, fall, sob. Holding on to the wall, I make my way through our little flat to where my boifriend is working, her desk across the room from mine. What the fuck? I say. What the fuck?
I was not expecting a phone call. I didn’t know that my GIC was one of the only clinics in the UK that was still open, or that it was one of even fewer that were still recommending hormone prescriptions. I had been waiting for nearly two years. I had given up hope that they would ever call.
Once I stop crying, I text my trans friends for advice. What would be asked at my first appointment? What should I prepare? I write four pages of answers to questions I might be asked. I wait. I try to work, to sleep. I run.
Two days later, I lay those pages next to my laptop, at the same big wooden table I’ve sat at for every day of lockdown. My boifriend sits next to me and holds my hand. I talk to the clinician for an hour. I want to beg. I want to look at him and say, Please. I can’t afford to pay for this any more. I have no work. I think I could fall apart at any moment. I’ve been hoping so hard for so long. Please.
Instead, I brush my hair, smile, and speak carefully. I explain my case history and ask intelligent questions. I make sure to be clear and certain and to show I know what I am doing, but also not to show too much certainty or too much knowledge. At one point he references a scientific study. ‘Oh yes,’ I say, ‘I read that one. And have you heard of—?’ I look at his face and see that I have slipped up. His resistance is growing. I am starting to look like a difficult patient. I laugh and blush and look down.
He gives me the prescription I need. The fight I was frightened of never comes. I don’t even have to use most of my pre-prepared answers. The video call ends. I cry again. I’ve rarely felt so lucky, or so tired.
It is common advice for employees undergoing gender transition to take a period of leave, a month or so, before returning, ‘changed’, to be reintroduced to staff. A clean break, leaving as one gender and returning as the next. The authors of employee handbooks perhaps imagine that a week or two is enough time to learn everything you need to learn, enough time to grow into yourself.
In the middle of the 20th century, standard practice for gender clinicians in the Anglosphere was to insist that their transitioning clients, if they wanted to undergo hormone treatments and then surgery, cut off all contact with their families and friends, all ties to their previous life, and begin a whole new life in their whole new gender. Many trans people have written about how they were also coerced into separating themselves from their trans friends, their community. Early gender clinicians believed that they were reintegrating trans people into gender with as little disruption as possible, with no public hint that anything transgressive had happened. Trans community—trans people sharing their experiences, supporting each other, and building their lives—has always been a risk to the institutions of gender.
Did you know that, in the chrysalis, most of the larva melts into goop? The caterpillar doesn’t really grow wings: it breaks down and then forms a new body. Structures like wings grow from the ‘imaginal discs’ in a larva. No wonder one of the most important Anglophone trans publications in the 1990s was called Chrysalis Quarterly. (You can read it all at www.digitaltransgenderarchive.com) We hide, we break down, we rebuild. No wonder many of us began to imagine the pandemic as a chrysalis. When people see me again, my voice will have shifted its pitch. My hair will have grown. My wardrobe will have changed.
But gender is messy, I paint myself with goop every morning, and trans people are always creating each other. The model of a complete transition in one concentrated spell, though still important and necessary for some, is for many shifting towards something more social and more exploratory. It’s now more common to know people at multiple stages of transition, by different names in different years. We hide less: we let our messiness out.
This coming out means that more trans people can find and support each other through these stages than ever before. We teach each other about hormones, make-up, clothes, attitudes, politics, body modifications. We fetch each other’s prescriptions, do each other’s dishes, cook each other’s meals. We fight, we break up, we schism, we learn. Some people call this outbreak of community support, this infectious idea that trans people make trans lives possible and worthwhile, a ‘psychic epidemic’, a virus of transgenderism corrupting the youth. We call it mutual aid. In a true pandemic, cut off from state healthcare, mutual aid is all we have.
By the start of May, things are starting to change in Lochend Park. Watching carefully, I can see two gigantic puffy grey balls underneath the moorhen by the fence. Inside the doocot, it’s a riot of pigeons, and it stinks. In the darkness, shapes move: is that a pigeon feeding a chick? Is that a broken shell? Each time my boifriend and I visit, we’re hoping for the best prize of all: ducklings. On the days we see them, we have to suppress a screech, have to not frighten them off: a little flotilla of yellow fluff with a duck at each end.
Some young men are playing a noisy football match over beyond the trees. I feel a burst of rage. Don’t they know there’s a pandemic on? I have only touched one other person since lockdown began, have only had three in person conversations, through masks, at a two metre distance. What are these boys thinking?
I’m in a WhatsApp group of queer and trans birdwatchers. We send each other pictures of the best birdlife and a lot of emojis. We tell each other where best to spot the cygnets on the Water of Leith, and how the (huge, fat, delightful) eider ducklings are doing. Eiders, a seafaring bird, look after their ducklings in a crèche, the females grouping together to share the work. There’s probably a political metaphor here, but I’m most excited by how many balls of fluff it brings together at once. The group is my biggest joy during the pandemic. It keeps me going.
On the 11th of May, four days after my GIC appointment, a sociologist published an article in the Spectator arguing that ‘coronavirus shows why it’s vital to distinguish sex and gender’. Rightly, she pointed out that in England and Wales men were twice as likely to die from COVID-19 as women. Wrongly, she implied that this meant that trans women were also twice as likely to die from the disease, and so that medical scientists must always prioritise recording sex assigned at birth. The scientific truth is that we have no idea what trans people’s vulnerability to coronavirus is, because we don’t know which aspects of sex decrease women’s death rate (hormones, organs, social factors, or something else?), and because trans populations are too poorly studied, with only very low quality data. Misleading arguments like this, which prevent recording good medical information about trans people, make that situation worse. But then, the Spectator article wasn’t about making a scientific argument: it was another salvo in a culture war.
On Twitter, the comments were worse. A mild example: ‘Biological sex matters. If a transwoman [sic] disagrees, well then they can ask corona virus [sic] to go easy on them because they identify as a woman.’ There were plenty of jokes about exposing trans women to the pandemic to see if their gender identity was real. There were plenty of jokes about trans women dying. Enough people I know have died to poverty, disease and suicide that I never want to see another joke.
In times when trans rights are, bizarrely, a central issue in Anglosphere culture wars, a symbol for young-vs-old, postmodernism-vs-liberalism, radicals-vs-centrists, self-vs-nation, or any of the other tired binaries, I understand again why many trans people want to hide, to cocoon. It is extraordinary to find that one’s life is reduced to a symbol in vast and complicated social conflicts. It is impossible to relate to other people as human, let alone to yourself, when the facts of your life have become inhumanly abstract.
But I made a decision to transition in public, to show my changing body and changing identity to the world, to shift and grow over time, to ask the world to keep up. I’ve let my uncertainty show. I’ve asked my friends and my work to help. It’s cost me more than I ever expected.
Transitioning in public, with a public-facing career as a writer, means that at every stage I’ve endured comments from strangers, colleagues and former friends about every aspect of my transition. My clothes, my body, my make-up, my behaviour have all been fuel for criticism both personal and political. If I talk about trans issues, or fight for trans rights, the targeting is more severe, the comments harsher, the triggers more absurd. Once, a colleague commented that me referring to authors and politicians by surname was ‘male behaviour’. Once, a colleague publicly condemned a poem I wrote on the grounds that ‘the speaker is male’.
I’ve become painfully conscious that any gesture I make, any word I speak, any poem I write might be evidence of my violence, my masculinity, my danger. Keeping faith with the past versions of my work and name, my public history, makes it all the harder. Sometimes I wonder if what these people want is for me to cut all ties with the past and just go somewhere else, wholly different, causing no one trouble.
On April 27th, eight days before the GIC called me, the New York Times reported that scientists were, to test for increased immune response to coronavirus, treating an experimental group of men with estrogen, the same hormone I cover myself with each morning.
My left breast is growing and my right one isn’t. My left nipple is painful and sensitive all day, yelling at every touch, and my right nipple is silent. The longer this goes on the more worried I get. Has my non-standard hormone regime, interrupted by not being able to afford GnRH-agonists and by my own uncertainty, permanently confused my breast growth? Will I grow a single large breast and be even more of a monster than the world already thinks I am? I ask internet forums, my boifriend, a trusted trans woman mentor. They all tell me that this is perfectly normal. Everyone goes through this, whenever it is they start growing breasts, whether their body produces plenty of estrogen by itself or not.
My phone buzzes. It’s a WhatsApp message from a trans guy I’ve been put in touch with. He’s not sure about the effects of hormones on his body. He likes some things, but not others. He doesn’t trust his doctors and he’s cut off from trans community. He needs someone to talk to about it. He has me.
Half an hour each evening, I answer questions on Reddit forums about trans healthcare in the UK. I have to limit myself to half an hour, because I could keep going all night, and the next day. Dozens of other people are doing the same thing. Collectively, in our hundreds, we produce some kind of knowledge.
I work with a small team of people to build a website detailing pandemic interruptions to trans healthcare and offering guidance to different options. We make a chart naming and shaming the clinics who have stopped services, who haven’t even given their patients pandemic information. Often, right after we release a new infographic with precious little green and a lot of red, a clinic will finally release a service update.
The country’s most influential GIC published a coronavirus factsheet stating that pausing hormone treatment, if the pandemic makes it necessary, won’t cause any lasting harm. My trans friends and I know that this is not true. We know intimately the physical pain and mental horror caused by hormone interruptions. We know we’re being treated as disposable. We organise a letter-writing campaign to push the clinic to change its information. They change it. We’re astonished, because we don’t really know what victory feels like. We’ve gotten used to losing.
A trans guy I know texts on an encrypted service asking if anyone knows someone who can safely administer a testosterone injection, because his GP won’t do it right now. I do know someone. I have a friend who’s offered to do this before, so I text to check that he’s happy for his number to be passed on. I act as a tiny matchmaker for this small, intimate service.
I think about these connections, these social webs, the transness that binds us to each other. I imagine us as a revolutionary underground, taking clandestine action in a world beneath our public selves. I imagine us as an invasion of body-snatchers, taking over your entire town before you’ve noticed. I imagine us as a mycelial network, a political rhizome, a song you can’t get out of your head. I imagine us spreading, spreading.
Around me, people are losing their jobs, their friends. Around me, people are dying. Some people I know are staffing free food distribution points. I read an article about people signing on as hospital cleaners, supermarket cashiers: key workers. I think about the work that is key to my life. I think about explaining what I did in the pandemic to future generations. I don’t know if I’ll be able to make sense of it. I keep telling myself that what I am doing is enough.
By July, the birds in Lochend Park have changed again. The humans no longer keep such a distance, but I’m still nervous. There’s less song, and more hard work: awkward early flights, learning to feed, to dabble. Most of the water birds are growing into their adult plumage. The male mallards have messy brown feathers, a flash of down here and there, and the sleek green head starting to appear. I watch the juvenile geese, no longer gangly and yellow, but bright white three-quarter size models of their parents. I’ve known you since you were an egg! I think, many times every walk. The cygnets stay grey and fluffy for the longest, but have adult poise, sailing along gracefully, eager to be queens of the pond. I miss the riot of when they were all young. I’m ready for it all to happen next year. I hope that, even if I’m able to travel further then, I’ll still visit this park and follow the birds from egg to adult. I try not to think about what it would mean if this is still the only place I can walk.
A friend with whom I have had an awful break—because of trans politics—sends me an email at three in the morning. ‘I know you think the world should bend to your will,’ the email begins. I know what she means. She means that my behaviour is aggressive, dominating, that my political work is characteristically male. I think about these words as I do my work, wash the dishes, walk to the park.
Lying awake one night, I decide to make these words a compliment. With my friends, I am bending the world. With my friends, I am bending my body. I am not bending to anything as clear as my will—if only I knew what that was!—but towards something in which we can live, I can live.
The first thing I do, when lockdown eases, is walk up a mountain. The mountains are where I feel some sense of peace; on a mountaintop, I can see across the country. For months I’ve been legally and ethically prevented from travelling more than five miles from my house. But now I can finally drive off into the Highlands.
I take with me a six square foot flag, cheaply printed from a design-your-own website. The flag has a background of pink, white and blue stripes, and in black, front and centre, a multi-gender symbol with a closed fist. I’ve been taking it up each mountain I climb, claiming the Munros, the Scottish mountains higher than three thousand feet, for trans liberation. At a time when trans issues are so fraught in my country, it’s a way of asking the land for strength.
At each summit, I fly the flag and take a photograph. I try to do this when there aren’t other people around. I don’t want to have to explain myself. I spend far too much time doing that. Leaving the summit of Meall Buidhe along its wide ridge, a handful of pipits flying below, I pass a man I’ve seen approaching from half a mile away. ‘What’s the flag?’ he asks.
‘Just a little liberation flag,’ I say. ‘Just a little liberation.’