Normal UK Situation?

[Leo.]

Ok so I had my first GIC appointment a few days ago. Its all happening via the NHS. I need to stay with this clinic, only other option is the specialist clinic which has a 10 month waiting list just for the initial appointment.. Anyway I wanted to check if what I was told is normal for the NHS situation or if this is done with a different protocol here. Im in Scotland so I dont know if the English NHS situation is different to here either

Firstly I thought the RLE stuff might be a bit flexible if you've already been doing it your whole life as opposed to someone who might never have gone out in public dressed that way before. No, it has to be an entire year regardless of your situation. Doesnt make sense to me. Im at the point where I am because I've reached the stage of not being able to deal with this anymore, forcing me to wait another year before I can do anything is not helping me. All he said was no surgery until RLE is complete. Im not sure if that was strictly bottom surgery or if it included top or not. I didnt ask at the time because I was kind of annoyed by that point. Bottom I can wait a year for and not mind that much, its top I really need done. I will go private if thats what it takes to get it done before then. I need to find out about this though so I know one way or another

Besides how long its all going to take, what got me the most was HRT. I was glad to hear that I could start on T once RLE commences. I have to see someone else first with a 2-3 month waiting list, then back to him again for endo referral before I can even start anything. I asked about what form I would get, how often etc. He said injection as I expected and it would be a low dose. I then asked how often, thinking maybe every 2 weeks to start off. He says once a month.. A low dose once a month, what good is that going to do at all? Even every 2 weeks typically isnt enough to see any decent changes so what monthly is going to do I have no idea. I know the dose can be increased over time, I mean I expected to start out on a low dose then build it up, but the once a month got me. I read about people here just starting T who instantly go on weekly injections. I dont know how long monthly would last but it just seems more time wasting to me. He didnt say it would just be for a few times then increased or anything so it just came across like it would last for ages. Looking back theres alot I should have asked at the time but I find it hard to think when its in the moment

I know the NHS is a slow process but its like they deliberately try to make things take even longer for us, those who are already at the end of their teather with it being forced to wait and wait, clearly not a priority to them at all. I was just wondering if starting on monthly injections is normal here or if its just this clinic. I now have to wait another 2-3 months before I can talk to anyone else about it, here is my only other source of information. I will be asking everything I think of at my next appointment but in the long meantime I just want to know if this sounds normal or not. My GP is great but he doesnt know specifics about this process. He has had 2 MTF patients but I get the impression they didnt pass any information onto him so he didnt know much to tell me. Unlike them I will be helping him and passing on all information to him so he can help other future patients

[Nygeel]

I know that nebido or sustanon are the two forms of injection that are usually taken in the UK and probably Australia. They are slower in how they're released than what most people in the US take. The doses are also way different. Like in the US you take  X amount every other week, in the UK it's something like 4X amount once every other month.

[AdamMLP]

I'm pretty sure Scotland is a little different from the rest of the UK, but not by much once you get your referals.

Ask if they're going to be putting you on Nebido or Sustanon because they're very different, but I don't think I've ever heard of either of them being given once a month.

I don't now how helpful this is because I've not got time to look through it becuase I've got to be up early, but I found some stuff on real life experience in a document a while ago, I can't remember if it was WPATH though.  I do remember 12 months coming up somewhere in regards to surgery though. http://www.wpath.org/documents/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf  Page 49 mentions the administration of testosterone.

[Leo.]

I will need to find that out thanks, when I asked all I got was 'injection'. He wasnt very forthcoming with giving information (opposite to my GP who will talk on and on for ages about anything) so he wasnt that easy to get anything from. Maybe the next person will be. Just ages to wait now. Hopefully it'll be a bit quicker than he said but doesnt seem likely

It is probably one of them then, I dont know any specifics on them to how often they should be given or anything so once a month on low sounded off to me in terms of I couldnt see it doing anything at all. Hmm completely different system to the US then, in many ways they seem to be better off as long as you can afford it. In terms of this anyway, SRS and others Im glad are covered. I didnt expect it to be given so infrequently. I need to find out more if/when it would be increased or become more frequent. Sounds like you'd get very slow changes on this system

Thanks Alexander, I'll read through that. Seen alot of different NHS documents, they all seem to vary a bit. Read somewhere RLE was a minimum of 3 months, others its a year. I think it should come down to the individual situation to determine that but clearly they dont and apply one rule to everyone. I think 12 months is fine regarding bottom surgery but I think you should be allowed top before then, especially when Im bad with it and unable to pass like this even with 2 binders on.. I want to go back in the next few days and ask him if hes available for a minute. It'll annoy me til I know if I can or not. Few changes on low T and no top surgery will not be a great year purposefully trying to be seen correctly in the eyes of others

[tgchar21]

Hmm completely different system to the US then, in many ways they seem to be better off as long as you can afford it.

That's the way it is in general when comparing healthcare between the two countries (and why so many Americans think "Obamacare" will lead to a lower quality of care).

[Make_It_Good]

Hey Leo,

I completely empathize with your frustrations.
  Ive been going through the NHS in the UK (England though, not Scotland) for 7 years now.

What youre describing is pretty typical for the NHS, but ofcourse it does vary from clinic to clinic.

I also assumed that once I was at the GIC all my time living how I was beforehand, would contribute to the RLE, but no. My clinic said that none of it counted (even though I had several years of it, and 2 of those years were under the supervision of teen mental health), and my RLE only started once under their care. Worst of all, they were telling me NO surgery at all until Ive completed 2 years RLE, and no hormones until 1 yr has been done.

If I had had the money, I would have gone private, but there were times when I didn't have more than £5 to my name, so I had to stick it out. And honestly, its worth the wait and frustration.
I know things seem to happen quicker in the US etc, but I personally would rather go through things via the NHS if I had to choose to (unfortunately) do things all over again.

I was extremely persistent in my insisting that they move my RLE forward. Every session I was hounding them and I wrote letters and did things outside, finding legit people to back me up etc. I think I got very annoying to them :p but, in my case, the woman Id see at the clinic saw that I was more than ready, and I was referred for hormones after 9months (those 3 months made a difference to me). I was referred for top surgery after about 15months, rather than 2yrs and lower surgery 5months later. Once things get going, things feel easier and quicker and it is worth the wait. You KNOW that things will start happening, even if it isn't tomorrow, like we all hope.

As for the hormones, I was on a lower dose too. Sustanon every 4 weeks. And it will be sustanon, theres no way they would put anyone on Nebido once a month. But atleast the injections will be smaller :p

[Tay]

It sounds pretty normal to me.

The GIC I went to believe that the RLE starts after your first appointment there AND when your name is changed by deed poll.

From that point they will not even refer you to the endocrinologist who recommends you for hormones until you have had a minimum of 3 months counselling and RLE. (The reality of this is that with waiting lists and time between counselling appointments, the first appointment to discuss hormones is generally after 9 months - 1 year of RLE under the supervision of the clinic.)

Referral for a second opinion for top surgery happens between 6-12 months after that. They also won't refer you until you have completed a minimum of 1 year GIC-supervised RLE, if somehow you miraculously managed to make it to this point before one year.

Referral for lower surgery (hysto included) generally wouldn't happen until you have completed 2 years GIC-supervised RLE and have been on supervised cross-gender hormone therapy for a minimum of one year.

It does take a long time and it does feel that it is longer than necessary, however the GIC clinics (from my experience) are massively under-funded and under-staffed. They also must operate within guidelines and be strict to the letter to prevent any possibility of accused negligence. You have to remember that the NHS is a publicly funded entity and that the general public, and often those influencing the funding decisions, don't think that transgender treatment should be a priority. It's hugely upsetting but from what I've seen and what I've been told by my GIC, that is the case.

Most of all, remember that it will be worthwhile. My transition took five years from when I was first referred to the GIC but now I have my life back and I couldn't have otherwise afforded the medical transition if I had to pay out-of-pocket. The NHS system is slow but it serves a purpose.

Also, I know a guy who has sustanon injection every four weeks and his testosterone levels are fine. You'll have to figure out, along with the doctors and blood tests, how frequently your dose should be as everyone is different.

[Mr.X]

Worst of all, they were telling me NO surgery at all until Ive completed 2 years RLE, and no hormones until 1 yr has been done.

Wow, really? How does that even work out? I mean, you can dress like a man, walk like a man, talk like a man. Basically do everything you can do without hormones and surgery...But if you are not shaped like a man nor sound like a man you just will not pass. And can they force you to live through all of that? They call it the real life experience in which you are supposed to live as the gender you are on the inside, but how can you do that if the outside world just sees a woman? It sounds very counterproductive to me.

Sorry for butting in here. I am afraid I have no information for the OP. My apologies!

[Natkat]

Wow, really? How does that even work out? I mean, you can dress like a man, walk like a man, talk like a man. Basically do everything you can do without hormones and surgery...But if you are not shaped like a man nor sound like a man you just will not pass. And can they force you to live through all of that? They call it the real life experience in which you are supposed to live as the gender you are on the inside, but how can you do that if the outside world just sees a woman? It sounds very counterproductive to me.

it's pretty typical  many European countrys require that.
basically you must live in a male/female genderole as much as posible by your look, using male name pronousing and so on, it is hardcore specially when your not allowed homones, gendermarked changed or anything, who your pretty much outed all the time.

[FTMDiaries]

I think he just meant you'd have to wait at least one year for bottom surgery, because according to NHS Scotland you can be referred for top surgery sooner. Here is the Scottish Government's protocol for Gender Reassignment: http://www.sehd.scot.nhs.uk/mels/CEL2012_26.pdf

As you can see on page 3, you need to have 1 year's RLE before bottom surgery, but you can be referred for hormones or top surgery after only one assessment.

There's more of the same on pages 7 & 15. So if you need top surgery ASAP, press him for an early referral as per this protocol.

[Leo.]

Its just frustrating how long it all takes. I wouldnt necessarily mind as much but Im having to put my life on hold to try sort all this out. Im considering going back to uni next year (I will finish my Masters degree in Clinical Pharmacology next month but I feel I want to change direction a bit and go back to the start where I originally wanted to apply for medicine) and wanted to at least be passing by that stage than changing around everyone and have to explain everything. I could be on T for some time by then but I want to have top surgery done before next September. The main drawback for me right now is with my gf. We want to get married as soon as possible and cant til my legal gender is changed with birth certificate which I know is after 2 years of RLE. Thats not too bad but if this whole thing is going to take 5+ years to sort out its just putting alot in our way. With her being in the US and me having to stay here to get this done its changing our plans as well for the future. Just hoped I could rush things through a bit with RLE and top referral but it seems slower than I'd imagined

Im hoping they might count the date of my name change as start of RLE. I had planned to have changed it before my first appointment legally but had a setback with the surname so wasnt able to. If it goes well tomorrow and it becomes set I will get new documents sent out and have it changed within the next few weeks hopefully. Not sure if they'd take it as that or what they dictate to me. From what he said it seemed RLE cant start til after I see him again, so 2-3 months wait on seeing this next person if its like a 2nd opinion or whatever then however long wait before I can see him again.. I cant even get to start it now. If it was counted from now it wouldnt even be as bad

Though sounds it could be worse. 2 years RLE with 1 without HRT? wow. Its really not fair to force us to do it with nothing to help us. The fact to prove RLE we have to have some kind of employment or something is forcing us to constantly correct people with pronouns and everything else in the workplace. Fine if you're lucky and pass already but those who dont it can be quite traumatic. Im pretty sure its my awful body that stops me from passing. My voice isnt that bad, i have the lowish monotone going on. They seem to have already taken me as the wrong gender before I open my mouth so I cant win right now

Wish he had clarified that but if its just a year for bottom surgery Im fine with it. If I can be put on the waiting list for top soon I will be happy. Thanks FTM. That diagram is the same that he gave me. Actually on the last page is where I am, I am with Dr. Callender's clinic. Though it was a psychiatric evaluation type thing it is all classed as a GIC in itself with him running it. On mine it has top coming off the RLE box as opposed to after completion which I hadnt noticed at the time or I would have asked but it can be hard to tell timescales with this. I will print this out too. I definately need to get back to him about this if it can be done after the first assessment. He might want me to wait til after I see the next person first but can only ask anyway. I'll still need to wait awhile anyway on a waiting list so dont see why it needs to be prolonged any further. I'll try see him tomorrow if I can, would have been nice if he'd given me his email address. I'll do what I can to try get this referral as soon as possible. I cant be happy til Im rid of this. I can have markers and stuff changed but he wants to deal with that a bit further down the line. So changing my name very soon I'll just leave my passport for now, no point paying for a new one then having to get another one later to change the gender marker on it.

Mr. X - Thats the problem I've had my whole life. I've done everything I possibly can to come across right to people but seem to fail. Can only assume its because of how my body looks. Even with 3 binders on I cant hide it all that well. I dont understand they expect us to 'live as a man' for a year when we arent seen as one how can we? Theres nothing else I can do without intervention to help me

I am glad to be allowed T when I start but I was confused over dose frequency. If this is normal though maybe it'll be fine, I just hadnt heard it being given so far apart. Top seems to only require one referral letter so if he would do that for me soon it would help. He might not though he seems to be fine with making me wait forever from the way he put things across. Will try though. As I said they dont seem to personalise things to the patient here its just follow procedure and thats it so if I have to do so long of RLE before Im allowed it I cant see that changing. If I have to wait til its complete then I want to go private with this part

If Sustanon every month is normal and still gives results I wont worry so much then. I will ask what form it will be but from whats said here it sounds like it should be this. It might vary depending on my blood tests that might just be a general thing, hard to tell really when he doesnt explain much


Thanks for all the replies. Helps just hearing from others that its not just me etc and what else I can do. I think it will be a long road ahead

[FTMDiaries]

Yes, it is incredibly annoying how long they make us wait.

This is the downside of socialised medicine: the patient becomes a supplicant expected to gratefully accept whatever crumbs the State deigns to allow them; rather than a customer with purchasing power and choice.

It's exceptionally cruel to expect us to spend a year passing in all areas of our lives before we're physically able to do so. The only silver lining is that we don't have to go into massive debt in the process.

[geek]

It's exceptionally cruel to expect us to spend a year passing in all areas of our lives before we're physically able to do so.

I agree with this 100% and it was actually a big fear of mine before starting HRT (when i was still learning how it works here in AUS)

Yes, it is incredibly annoying how long they make us wait.
The only silver lining is that we don't have to go into massive debt in the process.[/b]

THIS

i dont mean to be an ass to your party, and i certainly hope i dont offend you OP, it isn't my intent, but from someone who lives somewhere that surgeries for this need to be funded yourself, which in itself for most of us is a much worse waiting list the fact that youre complaining about having to wait for this amazing FREE surgery, just leaves me speechless - but apparently not speechless enough to make this post :p

[Arch]

Both types of systems have advantages and disadvantages, I guess. But a lot of guys in the U.S. go years and years without even top surgery, let alone hysto, because they have no insurance that will cover the procedures. So the waiting game happens here as well. On average, we might even wait a bit longer because some guys spend years living on the edge (common if you're trans and people are reluctant to hire you) and saving up.

But we do seem to be a bit faster in getting the ball rolling and getting T, I'll admit. Find out as much as you can, and push as hard as you can. I hope you get lucky.

[Leo.]

i dont mean to be an ass to your party, and i certainly hope i dont offend you OP, it isn't my intent, but from someone who lives somewhere that surgeries for this need to be funded yourself, which in itself for most of us is a much worse waiting list the fact that youre complaining about having to wait for this amazing FREE surgery, just leaves me speechless - but apparently not speechless enough to make this post :p

Im not even complaining about the surgery, its the system on the whole. Not even just for here, everywhere. The fact they think its ok to let us wait years on end when major depression and suicide is rather high amongst this group. I know its lucky we can get all this stuff at all, just wish they gave us a little priority over those who put themselves in the situation they're in (drinking, smoking etc) while we certainly didnt choose this. Just realising how seriously it affects our lives would be nice. The NHS is extremely busy and I expect a long waiting list, its just getting on it in the first place. I'll be fine if I dont have to wait years to get top done, thats all Im mainly concerned about. I am greatful for the surgery, I didnt actually expect it would all be covered. I thought I was going to have to pay anyway

The main point of this was just to ask if the once a month injection was normal or not as I thought weekly or biweekly was the norm. And when top would be possible if I could do it during RLE or had to wait til after it. As much as I want bottom done I dont really mind having to wait a few years for it. I just want top done as its my major problem. The last thing Im doing here is complaining about the surgery. I would pay for it if I had to. I couldnt afford the entire bottom procedures but I could some of it. The fact we dont have to pay for it is obviously a great thing, we're lucky to not have all that insurance bs here I dont understand why any country would operate a healthcare system based on money its so wrong. I just dont think this should be a privatised industry


Anyway I dont post much, I just wanted to ask about HRT mainly and what was typically normal here

[FTMDiaries]

The fact we dont have to pay for it is obviously a great thing, we're lucky to not have all that insurance bs here I dont understand why any country would operate a healthcare system based on money its so wrong. I just dont think this should be a privatised industry

I've lived under both systems in different countries (socialised medicine & private insurance) and I far prefer the private system. I cannot overemphasise how vital it is for patients to have the power of choice over their own healthcare; this is something that has been lost in this country and it is one of the reasons why we have to wait so long for what you accurately describe as something that should be a priority. YMMV, other opinions are available.

Anyway I dont post much, I just wanted to ask about HRT mainly and what was typically normal here

That link I posted to NHS Scotland's protocols actually goes into detail about how T is typically prescribed in Scotland (under 'Hormone Management for Trans Man').

[Leo.]

I've lived under both systems in different countries (socialised medicine & private insurance) and I far prefer the private system. I cannot overemphasise how vital it is for patients to have the power of choice over their own healthcare; this is something that has been lost in this country and it is one of the reasons why we have to wait so long for what you accurately describe as something that should be a priority. YMMV, other opinions are available

I do agree the system is better over there if you can afford it, and thats the problem with it. What about all those people who cant afford to pay $200 just for a visit to their doctor regardless of whether they actually get anything or not. This gets to me on a personal issue when my gf has to pay $200 to see her doctor when money is a problem as it is. Here we dont need to think twice about going to the doctor and dont pay for prescriptions either. Yes its still paid for indirectly through taxes but the fact its not a direct payment in the way it is there still makes it alot easier. Of course its important but here they dont force you into anything you're not comfortable with. We dont have to have HRT or surgery if we dont want it, we have that choice. If we dont agree with what our doctor or something says we can choose to go see someone else for another opinion. Ok to be honest all my old GPs were incredibly useless and for years I didnt bother going to the doctors. I now have a really good GP and wouldnt hesitate to go see him about anything. He prioritises the needs of his patients above everything else. I do understand the length of time this can take in ensuring how sure we are about undergoing the biggest thing in your life you can change but I cant help but wonder if alot of that is for their sake rather than ours. Them living with the 'mistake' of giving someone surgery who later realises it wasnt right for them, rather than someone in my position there isnt a single bit of doubt I need all of this yet I have to play by the same rulebook as someone who might not really have a clue what they want. Also the thing there is perhaps it is a higher standard of care because everyone is so paranoid about getting sued they will do the best they can. Not that we dont get good work done here, they just seem more driven by the money angle than we are here

Theres pros and cons to each system. Here we get it all covered but play the waiting game. There, as long as you can afford it, it can all happen potentially faster than it does here. Just depends how you weigh things up, time against money

That link I posted to NHS Scotland's protocols actually goes into detail about how T is typically prescribed in Scotland (under 'Hormone Management for Trans Man').

I read through that and gave a copy to my GP this morning at my appointment so he can find out more about the process, so thanks for that information. He said it is very useful. I'll find out more about everything at my next assessment appointment whenever that will be. If its pretty normal to get a once a month injection then its not a big deal as long as the levels are ok and changes still happen. I had just expected it to be more frequent but of course the US system is different in that sense too. When people post about this stuff I dont know what country they're in so I couldnt really differentiate it