Scotland

The first quantitative research to calculate transgender prevalence specifically in Scotland was The Prevalence of Gender Dysphoria in Scotland: A Primary Care Study (Wilson et al, 1999). After establishing that ‘there were no adequate data on the prevalence of gender dysphoria or transsexuality in the United Kingdom’, the researchers distributed a paper survey questionnaire to be completed by all GP (General

Constructing identities, reclaiming subjectivities, reconstructing selves: an interpretative study of transgender practices Scotland

42 Practitioner) practices in Scotland: ‘the number of patients registered with the responders’ practices was 4 105 872, representing 80% of the Scottish population’

(Wilson et al, 1999:991). Excellent response rates of 73% to the questionnaire were received, identifying a total of 273 patients registered at GP surgeries who had identified with gender dysphoria - defined in the Wilson study as: ‘a subjective experience of incongruity between genital anatomy and gender identity’ …. ‘excluding transvestism’ (Wilson et al, 1999:991). From this data the researchers extrapolated the following figures:

The prevalence of gender dysphoria among patients aged over 15 years was calculated as 8.18 per 100 000, with an approximate sex ratio of 4:1 in favour of male-to-female patients…Among these patients, 65 (24%) [1.9 per 100,000] were undergoing hormonal treatment without surgery, and 95 (35%) [2.85 per 100.000]

had undergone gender reassignment surgery [therefore 4.75 out of 100,000 undergoing hormonal and surgery in Scotland] (Wilson et al, 1999: 991).

Therefore the findings of the Wilson (1999) study indicated a prevalence of 0.008%

transgender people (‘excluding transvestitism’) living in Scotland who had presented for medical treatment, with a gender ratio of 4:1 MtF:FtM. The findings of this study suggested the increasing likelihood of ‘gender dysphoric’ patients presenting for medical care and the opinion that: ‘The apparently increasingly frequent presentation of gender dysphoria may reflect increasing social acceptance of the condition’ (Wilson et al, 1999:992). The Wilson (1999) study is regarded by the current research as the most reliable baseline data concerning transgender prevalence in Scotland to date.

The second study of transgender people living in Scotland was also led by Wilson: the NHS & University of Glasgow Scottish Transgender Survey (2005), based on 52 responses received from 39 transwomen and 13 transmen, 75% to 25% or a ratio of 4:1. For this second Wilson led study, paper-based questionnaires were distributed to transgender people throughout Scotland via GPs, self-help groups, and online sites, the aim of the study being: ‘to ascertain the needs and experiences of transsexuals in relation to lifestyle and services in Glasgow’ (Wilson et al, 2005:4). The emphasis on

‘services in Glasgow’ is not explained in the report, but could be inferred as referring to the main gender identity clinic in Scotland being located in Glasgow Sandyford Clinic The report concludes that ‘The current picture of transsexualism in Scotland is one of overall satisfaction for those who are post transition…82% of the respondents were post-operative’ (Wilson et al, 2005:2).

Constructing identities, reclaiming subjectivities, reconstructing selves: an interpretative study of transgender practices Scotland

43 Of interest is that the target population of the 1999 study by Wilson et al was individuals with ‘gender dysphoria’, whereas the target population of the 2005 Wilson et al study was: ‘Adult Scottish people who were identified by their general practitioners as having gender identity disorder (GID), and people with GID not known to NHS medical services’ (2005:2). This seems retrogressive given that GID was by this time being replaced by the term gender dysphoria in transgender discourse, was recognised as such by the Gender Recognition Act (UK Gov, 2004), and subsequently became the acceptable term in DSM-5 (APA, 2013). However it is possible that the Wilson et al (2005) study chose to use GID given that it was the term of use at the Gender Identity Clinics at the time of their study.

The Wilson et al (2005) study report questions why the responses were disappointingly low, coming in at only 52 compared to the 273 people with gender dysphoria having been identified by GPs in the Wilson et al (1999) study. It is possible to speculate (as the Wilson et al, 2005 report does not) that the difference in the number of responses between the two Wilson studies was due to the fact that the 1999 study relied on responses from GPs themselves about their patients with gender dysphoria, whereas the 2005 study relied, together with ‘transgender self-help groups and internet sites’, on GPs to distribute the questionnaires for their patients with ‘Gender Identity Disorder’

(GID). Individuals had to complete and return questionnaires themselves, and the report admits that these may have been over-lengthy and complicated (2005:5. Also self-report surveysare notoriously unreliable and have validity problems. It is also possible to speculate that some of the questions in the Wilson 2005 study were regarded as offensive by trans people, including those about sexuality using the controversial term

‘autogynephilia’ as well as the outdated categorisation of GID rather than gender dysphoria.

The third important survey of transgender people conducted in Scotland was Transgender Experiences in Scotland (2008), conducted by the Scottish Transgender Alliance (STA) the year after its inception in 2007. The objective was to gather both quantitative and qualitative evidence from transgender people living in Scotland, in order to inform the STA’s equality development work concerning the following areas:

Constructing identities, reclaiming subjectivities, reconstructing selves: an interpretative study of transgender practices Scotland

44 demographics and varieties of gender identities and expression; experiences of public services; discrimination or harassment within local communities (Morton, 2008:5).

The STA (2008) survey report cites the Wilson et al (2005) study as ‘the most directly comparable previous survey’, claiming that the two surveys were ‘distributed across Scotland in a very similar manner’, and that ‘the 71 responses of the Scottish Transgender Alliance survey is a 36.5% larger sample size (19 more respondents)’ than the Wilson et al (2005) with its 52 respondents, thus also claiming that the STA study was: ‘the largest survey of transgender people in any published Scottish research to date’ (Morton, 2008:5). The STA report compares the number of its research responses favourably with the Engendered Penalties (2007) report, the other relevant UK wide study (discussed below), which with 872 survey responses, ‘had the largest number of survey respondents of any international transgender research’ (Morton, 2008:5) including 73 responses from Scotland. The findingsthe STA Transgender Experiences in Scotland 2008 survey has provided baseline data for other reports. The main findings indicated that the experience of transgender people pertaining to social attitudes in Scotland has been predominantly one of social prejudice and transphobia, subsequently included in the submission from the STA for their Report to the Justice Committee Offences Aggravation by Prejudice Scotland Bill (Morton, 2009) .

Broader social attitude surveys not limited to transgender participants, but sampled from the total Scottish population, are pertinent to the current research in their revelation of prevailing prejudices towards transgender people in Scotland. The Attitudes to Discrimination in Scotland 2006: Scottish Social Attitudes Survey indicated negative attitudes towards two groups - Gypsy/ Travellers and transsexual people: ‘a significant proportion of people in Scotland still held discriminatory views, especially about transsexual people’ (Bromley et al, 2007:21). The 2006 survey found that 50% of respondents would be ‘unhappy if a close relative entered a long-term relationship with a transsexual person’, and 30% said ‘a transsexual person would be unsuitable as a primary school teacher’ (Bromley et al, 2007:120). Four years later the Scottish Social Attitudes Survey 2010: Attitudes to Discrimination and Positive Action, examined attitudes towards groups protected by the recently passed UK equality legislation (UK Gov, 2010) and concluded that in Scotland: ‘for the most part, only a minority of

Constructing identities, reclaiming subjectivities, reconstructing selves: an interpretative study of transgender practices Scotland

45 people hold views that could be described as discriminatory’. Despite this assertion, this report also found that certain groups - once again Gypsy/Travellers and transgender people – ‘appear to be the subjects of fairly widespread discriminatory attitudes’

(Ormston et al, 2011:v). Thus social prejudices in Scotland towards transgender people appear to have remained fairly consistent.

The final research listed here specific to Scotland concerning gender variance and social attitudes was Challenging Prejudice: Changing Attitudes towards Lesbian, Gay, Bisexual and Transgender People in Scotland (2008). This was in response to a call from the Scottish Executive [precursor to the current devolved Scottish Parliament] for LGBT community representatives in Scotland 2006 to establish a working group that would examine ways of confronting negative and discriminatory social attitudes towards their constituencies. The result was a report which defines the following statement of LGBT diversity: ‘LGBT people are estimated to make up around 5% of the population of Scotland, around 250,000 people across all parts of society’

(Donnelley, 2008: 14). The relevance to the current study is in the figures for the prevalence of sexual and gender variance in Scotland. Although caution needs to be exercised when extrapolating conclusions about transgender prevalence due to the difficulty of defining and counting transgender populations.