a complaint to the northampton gender clinic

The below text is a copy of my complaint to the Northampton Gender Clinic, over their website stating that oestrogen causes 'breasts to become lumpy and increase in size slightly'. If they respond, I'll give an update in a new post.

Dear Northamptonshire Healthcare Foundation Trust,

I am writing this email as means of a formal complaint regarding some of the information on your Gender Dysphoria Clinic website. My complaint is in specific reference to the information section on changes due to hormonal replacement therapy. Under the "effects of taking oestrogen", the website states that one effect is "breasts becoming lumpy and increasing in size slightly". This is what shall form the basis of my complaint, for reasons that I outline below.

The website currently states that effects of taking estrogen include "breasts becoming lumpy and increasing in size slightly". This is a misrepresentation of feminising HRT, and poor medical communication.

I firstly wish to highlight how the GDC's phrasing of breast growth is not in line with other NHS organisations. Whilst I appreciate that GDCs have discretion over their communication to patients, the phrasing that NHFT GDC has chosen is inappropriate. For example, if we look at the Transcend service in Merseyside, their feminising hormone guide simply states "breast growth", a phrase corroborated by the Northern Region Gender Dysphoria Service consent information sheet, and online information from the Nottingham Centre for Transgender Health. On the national NHS website's treatment section for gender dysphoria, it describes "breast development".

Breast growth is a well-documented, and highly-expected part of feminising hormonal therapy. It is a major part of why transfeminine individuals seek out such therapy, and as such it is important to accurately report how oestrogen promotes breast growth. Whilst it is true that the extent to which breasts grow on oestrogen is variable, with some people describing their growth as "slight", it is misinformation to describe this process as "breasts becoming lumpy". The usage of "lumpy" has connotations to tumours, implying that breast growth on oestrogen is to be seen as unnatural, or an undesirable side-effect. Furthermore, it implies that breasts that are developed as a result of HRT are somehow different to breasts developed during initial puberty. This is not true, and echoes harmful misconceptions many people have about transfeminine breasts being 'unnatural'.

Furthermore, I believe this phrasing results in being a deterrent. If we tell someone wanting to medically transition that oestrogen will merely result in their breasts becoming "lumpy", and increasing in size "slightly", this may incorrectly put that individual off from pursuing HRT, due to misinformed beliefs regarding its efficacy. This is particularly poor practice given the wider political situation that transition healthcare is embroiled within.

As explained above, I believe your phrasing to be extremely harmful, both toward trans individuals considering HRT, and cis individuals wanting to learn about HRT. Due to this, I formally request that this phrase be removed from the website as a matter of urgency, being replaced with a phrase that is more in line with other NHS patient-facing communication, such as breast growth.

Yours sincerely,

Jamie Jewkes