Alice Litman was a transgender woman from Brighton, England, a notably LGBT-friendly city. She took her own life in May 2022, aged 20, after spending 1,023 days waiting for her first appointment with the Gender Identity Development Service (GIDS). Her case received criticism due to the duration of her wait to receive gender-affirming care and insufficient mental healthcare. Litman's death led to an inquest and a prevention of future deaths report.
Litman came out as transgender and first sought medical support with her gender transition from her General Practitioner (GP) in September 2018, when she was 16. [1] [2] Litman's GP vastly overestimated the proportion of people who regret gender transitions, told her the extended delay before receiving gender-affirming care was a good thing, and suggested a "watch and wait" approach. [3] [4] Litman was not referred to GIDS, which works with transgender patients under 18, until nearly a year later in August 2019. [3] [4] This referral came after her first suicide attempt in June 2019, [2] the first of two that year. [5] In March 2020, after turning 18, Litman was discharged from mental health services because she did not meet the threshold for adult intervention, despite having previously attempted to end her life on two occasions at that time. [6] [7] As a result of the GIDS waiting list being too long, Litman's parents contacted Michael Webberley, a co-founder of GenderGP, who then met Litman in September 2019. GenderGP later prescribed cross-sex hormones to Litman in April 2020. [7] [8]
Litman was never prescribed testosterone blockers and became increasingly distressed by this fact over time. [9] [10] Her sister, Katie Litman, said receiving them from the age of 16 when she first went to her GP to ask for trans healthcare "would have stopped transformations in her body which she did not want." [4] On 26 April 2022, 4 weeks and 2 days before she died, Litman contacted her GP in Brighton via an online form. In her message, she said she had been on the GIDS waiting list for too long, that she needed an appointment, and that she felt hopeless and that her life was not worth living. [8] [11] [12] On 26 May 2022, Litman's body was found on the Undercliff Walk in Roedean, Brighton, [5] after she took her own life. [13] She was 20 years old, had been on the waiting list for GIDS for 1,023 days, and had not had her first appointment at GIDS at the time of her death. [13]
A pre-inquest review was held at Woodvale Coroner's Court in Brighton on 27 January 2023. The court heard Litman was on the waiting list to be seen at GIDS and had received support from the CAMHS (Child and Adolescent Mental Health Services) at the Surrey and Borders Partnership NHS Foundation Trust before being transferred to adult services when she turned 18. Assistant coroner Sarah Clarke said she would examine the availability of trans health and mental health services and the transition to adult mental health services, and recognised that long waiting lists for such services were a national problem. A three-day inquest was scheduled for 18 September 2023. [14] [15] [16]
The inquest was heard over three days from 18 September 2023 by Brighton and Hove Coroner's Court at County Cricket Ground, Hove and was led by the coroner, Sarah Clarke. [17] [18] [11] The inquest was adjourned for two weeks while Mrs Clarke formed her conclusion and the prevention of future deaths report. When it reconvened, Clarke released her conclusions, including that transgender healthcare services have insufficient funding and resources, [17] that Litman's transfer from mental health services for children to those for adults was "non-existent", and that the support she received generally was "half-hearted". [19] The prevention of future deaths report found several matters of concern, including delays to accessing trans healthcare, insufficient mental healthcare for those waiting for trans healthcare, and insufficient training and procedural clarity for those supporting young transgender people. [20]
On 13 July 2022, Kate Litman, Alice Litman's sister, wrote an article in PinkNews in which she criticised the absence of gender-affirming healthcare her sister had received and the lack of knowledge in those caring for her. [4] She also gave a speech at the Transgender Day of Remembrance vigil in Soho, London on 14 November 2022. [21] The Litman family ran fundraisers for the charities Allsorts Youth Project and Gendered Intelligence. [4] Litman has been mourned in numerous vigils on Transgender Day of Remembrance. [21] [22]
Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identity—their personal sense of their own gender—and their sex assigned at birth. The term replaced the previous diagnostic label of gender identity disorder (GID) in 2013 with the release of the diagnostic manual DSM-5. The condition was renamed to remove the stigma associated with the term disorder.
The Standards of Care for the Health of Transgender and Gender Diverse People (SOC) is an international clinical protocol by the World Professional Association for Transgender Health (WPATH) outlining the recommended assessment and treatment for transgender and gender-diverse individuals across the lifespan including social, hormonal, or surgical transition. It often influences clinicians' decisions regarding patients' treatment. While other standards, protocols, and guidelines exist – especially outside the United States – the WPATH SOC is the most widespread protocol used by professionals working with transgender or gender-variant people.
Lesbian, gay, bisexual, transgender and queer (LGBTQ) people face difficulties in prison such as increased vulnerability to sexual assault, other kinds of violence, and trouble accessing necessary medical care. While much of the available data on LGBTQ inmates comes from the United States, Amnesty International maintains records of known incidents internationally in which LGBTQ prisoners and those perceived to be lesbian, gay, bisexual or transgender have suffered torture, ill-treatment and violence at the hands of fellow inmates as well as prison officials.
In the United States, the rights of transgender people vary considerably by jurisdiction. In recent decades, there has been an expansion of federal, state, and local laws and rulings to protect transgender Americans; however, many rights remain unprotected, and some rights are being eroded. Since 2020, there has been a national movement by conservative/right-wing politicians and organizations to target transgender rights. There has been a steady increase in the number of anti-transgender bills introduced each year, especially in Republican-led states.
Puberty blockers are medicines used to postpone puberty in children. The most commonly used puberty blockers are gonadotropin-releasing hormone (GnRH) agonists, which suppress the natural production of sex hormones, such as androgens and estrogens. Puberty blockers are used to delay the development of unwanted secondary sex characteristics in transgender children, so as to allow transgender youth more time to explore their gender identity. The same drugs are also used to treat other conditions, such as precocious puberty in young children and some hormone-sensitive cancers in adults.
Eli Erlick is an American activist, writer, academic, trans woman and founder of the organization Trans Student Educational Resources.
Transgender health care includes the prevention, diagnosis and treatment of physical and mental health conditions for transgender individuals. A major component of transgender health care is gender-affirming care, the medical aspect of gender transition. Questions implicated in transgender health care include gender variance, sex reassignment therapy, health risks, and access to healthcare for trans people in different countries around the world.
Transgender rights in the United Kingdom have varied significantly over time, with transgender Britons facing many issues not experienced by non-trans individuals. These include various laws and public attitudes in regards to identity documents, as well as anti-discrimination measures used by or pertaining to transgender people, in the areas of employment, education, housing and social services, amongst others.
Detransition is the cessation or reversal of a transgender identification or of gender transition, temporarily or permanently, through social, legal, and/or medical means. The term is distinct from the concept of 'regret', and the decision may be based on a shift in gender identity, or other reasons, such as health concerns, social or economic pressure, discrimination, stigma, political beliefs, or religious beliefs.
Mermaids is a British charity and advocacy organisation that supports gender variant and transgender youth. It also provides inclusion and diversity training. Mermaids was founded in 1995 by a group of parents of gender nonconforming children and became a charitable incorporated organisation in 2015.
A gender identity clinic is a type of specialist clinic providing services relating to transgender health care.
The Gender Identity Development Service (GIDS) was a nationally operated health clinic in the United Kingdom that specialised in working with children with gender identity issues, including gender dysphoria.The service closed on 28 March 2024 after serious concerns were repeatedly raised over a number of years by several independent NHS whistleblowers.
Arkansas House Bill 1570, also known as the Save Adolescents From Experimentation (SAFE) Act or Act 626, is a 2021 law in the state of Arkansas that bans gender-affirming medical procedures for transgender people under 18, including puberty blockers, hormone therapy, and sex reassignment surgery. The law also bans the use of public funds for and prohibits insurance from covering gender transition procedures, while doctors who provide treatment in violation of the ban can be sued for damages or professionally sanctioned. The measure makes Arkansas the first U.S. state to make gender-affirming medical care illegal.
Stella O'Malley is an Irish psychotherapist and author, with three books on parenting and mental health. She is a regular contributor to Irish national newspapers, podcasts, and TV. She made a documentary about gender dysphoria in children for Channel 4, and is the founder of Genspect, a self-described gender critical organisation opposed to gender affirming care.
Genspect is an international group founded in June 2021 by psychotherapist Stella O'Malley that has been described as gender-critical. Genspect opposes gender-affirming care, as well as social and medical transition for transgender people. Genspect opposes allowing transgender people under 25 years old to transition, and opposes laws that would ban conversion therapy on the basis of gender identity. Genspect also endorses the unproven concept of rapid-onset gender dysphoria (ROGD), which proposes a subclass of gender dysphoria caused by peer influence and social contagion. ROGD has been rejected by major medical organisations due to its lack of evidence and likelihood to cause harm by stigmatizing gender-affirming care.
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