Doctor said no.

[Devlyn]

Lip service. The GICs all signed on to the new protocol but some intend to honour it mostly in the breach.
In terms of a league table of enlightenment I would say (best to worst) Exeter, Sheffield, Nottingham, Northampton, Leeds, London (and I have no idea where Sunderland fits in).

Oh, and it seems I should not have posted a link, so if someone knows some other way to help you find out how to download the protocol document I will be happy to edit the posting it to use whatever method is OK under the terms of service to reach the pdf file at cliniq.

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[FTMDiaries]

Lip service. Lip service. The GICs all signed on to the new protocol but some intend to honour it mostly in the breach.

In the case of Exeter, this is actual clinic policy and actual patient experience. Corroborated by several patients... including myself.

[Jess42]

This may not be the popular consensus but in reply to an earlier post I really think that therapy needs to be done beforehand. With that said though the therapist should allow you to find yourself instead of the other way around. Yes, they can diagnose you but that usually comes about from what you tell them. I would rather know myself on an extremely intimate level and make sure that is what I want for my life before I make any decision which may become non reversable. I'll even go as far as hypnotherapy and pay out of pocket for it just to make for sure and to be sure for myself that there aren't any repressed feelings that are making me want what I want.

When it comes to therapist, a few really want to be the all deciding decision maker but most really want to help you to make your own inner discoveries. Its pretty much a toss of the dice when choosing one regardless of references. Most go by what you say unless they feel like the elite desicion maker so a client's attitude is important in seemingly wanting to work through the issues and doing what a therapist suggest on the journy. Sometimes it may take quite a few sessions to figure things out so be patient and eventually they'll probably see what you feel. For example, I go to therapy for social anxiety and have been for eight months with this one therapist I have now. A week ago my therapist point blank asked me if I had any gender identity issues and I told him, "maybe but that's not why I'm here because the social issues cause me more stress than gender issues." He picked up on that just from our talks and BS sessions before and after the sessions. This means that I may have a professional opinion under my belt in which the professional concluded on his own. Now I can use the gender issues as the underlying cause of the social anxiety and it's my move to bring it up when I'm ready. To him I am not impatient over the gender issues even though sometimes I am. When I do bring it up he will either refer me to a gender therapist in which I will sign a consent form for the new one to recieve his notes which will take a lot of pressure off of me to open up to a new therapist or stay with him and work it out.

In six sessions my therapist picked up on my gender issues by me letting little things out slowly and nonchalantly and he isn't even a gender specialist. Of course I went through five other therapist before I found this one that would talk and BS more on a person to person level instead of therapist to client. Have patience, be prepared to search for a good therapist and also be prepared to pay out of pocket. Aside from the other five in which the average was two seesions before I started looking for another one, with this one I have been out of pocket 450 dollars. In my opinion, a small price to pay in order to have it discovered instead of opening up. So really keep looking and get a second opinion, 'cause not all therapist are gate keepers and many over time can probably pick up on it just by little things you say that seem insignificant. One that will talk before and after session person to person is priceless 'cause with me that is where I could give bigger hints of who I am.

[HenryHall]

Just as a datapoint, I also went through psychotherapy. Perhaps ten different therapists (half of them only for one or two sessions before discovering the misfit), 100+ hours over two and a half years.
On reflection it was enormously valuable - for the therapists' bank accounts that is. For me, on reflection, it was a complete waste of a lot of time and even more money.

[spacerace]

I am disgusted by the fact this level of paternalism towards trans people exists in 2013

Good luck OP - tell them what they want to hear

[Yuki-jker86]

It has been very beneficial for me to have this time. I think it was foolish of him to make a decision after one meeting and also not giving me chance to prepare. I think he understands this anyhow and that is why he said he will reconsider his diagnosis. He did say in his notes that even if his diagnosis was not strong enough to send me to London, he felt that in a couple of years I may be ready for that. I believe that this is due to a misunderstanding.
I believe I was merely masking a lot and I have made so much progress recently that he can't possibly think that I do not need to be referred.
I never thought I would feel comfortable dressing, but here I am sitting in my chair, nicely tucked, and wearing nice underwear, and a nice red FEMALE top. I like it. I've also bought makeup. I am actually starting to think of myself as more woman than man... in a sense. I discovered that I had warped my own definition of man and hence why I probably didn't display what he wanted to see. so much stuff.
but hell, I have been feeling like I want to tell people. I want to tell my family and friends, everyone I meet. It's not a strong feeling and my mind tells me that I ought to still hold back for a bit. but I am feeling more comfortable with myself and uncovering more of the feelings I had buried.
uhm, I'm blabbering.  well I think If I show him this picture I am sure he will certainly understand that I need this.
https://www.dropbox.com/s/kn65khmhrb3im3d/2013-08-09%2000.13.48.jpg
being bold is good.

Jess you are right, I do need to know myself better. I think the doctor sensed my many doubts. I think if I was absolutely certain I wouldn't need to use so many excuses, I could just cut straight to the point. I need to find that certainty before I see him again.

[Joe.]

I'm really glad you're feeling more positive. If you ever need to talk or need advice don't hesitate to drop me a message. I think that's a really nice picture. You're face looks feminine to me, especially the bottom half inparticular. It can only go onwards and upwards! I really hope it works out for you the way you want it to.

[Jess42]

It has been very beneficial for me to have this time. I think it was foolish of him to make a decision after one meeting and also not giving me chance to prepare. I think he understands this anyhow and that is why he said he will reconsider his diagnosis. He did say in his notes that even if his diagnosis was not strong enough to send me to London, he felt that in a couple of years I may be ready for that. I believe that this is due to a misunderstanding.
I believe I was merely masking a lot and I have made so much progress recently that he can't possibly think that I do not need to be referred.
I never thought I would feel comfortable dressing, but here I am sitting in my chair, nicely tucked, and wearing nice underwear, and a nice red FEMALE top. I like it. I've also bought makeup. I am actually starting to think of myself as more woman than man... in a sense. I discovered that I had warped my own definition of man and hence why I probably didn't display what he wanted to see. so much stuff.
but hell, I have been feeling like I want to tell people. I want to tell my family and friends, everyone I meet. It's not a strong feeling and my mind tells me that I ought to still hold back for a bit. but I am feeling more comfortable with myself and uncovering more of the feelings I had buried.
uhm, I'm blabbering.  well I think If I show him this picture I am sure he will certainly understand that I need this.
https://www.dropbox.com/s/kn65khmhrb3im3d/2013-08-09%2000.13.48.jpg
being bold is good.

Jess you are right, I do need to know myself better. I think the doctor sensed my many doubts. I think if I was absolutely certain I wouldn't need to use so many excuses, I could just cut straight to the point. I need to find that certainty before I see him again.

I don't really believe that a Psychologist can make a certain diagnosis, especially when it comes to something as extremely complex as being transgendered, in one setting. It may very well be his professional opinion from first impressions that you may not be dysphoric enough for the referral. I know that I can't just open up and let everything loose in therapy, especially the first session. I still hide behind my alternate, face the world personality. Like I said earlier, my therapist asked me not because what I said in therapy but rather things that I say before and after the sessions talking face to face like two people instead of client to therapist. These before and after moments are probably better for me than the actual sessions.

Sometimes if we try to live a lie, those aspects, actions and appearances die hard. When we finally decide to live according to our true selves those lies hold on fast. This may be what your therapist picked up on. Like I said, its hard to let down old guards when you fist meet someone such as a therapist and it's hard to judge a person's true self just in one meeting. You'll get there though it sounds like.

Yes. Definately get to know yourself better. You may find things out about yourself that you never even realized. I know me and have for a long time but I rarely ever let anyone else face to face know me. I am happy that you're feeling better though.

[Jess42]

Dysphoria is not a requirement

No, but the way some of 'em act you would think that it is.

[Yuki-jker86]

I'd like to know what IS the requirements. ^_^;

I think it's those things I quoted from nhs wales website.
I can satisfy those criteria easily I reckon. I actually shaved my arm hair today. it crossed my mind, I thought maybe a bad idea, but as those thoughts were going through my head I realise the clippers were in my hand and half my arm was already shaved. ah well so much for caution. XD

Jess, you are right. making a decision in one session... that makes me a little angry. I will definitely express this to him in my next appointment.
I like what you said about living the lie. I twisted my own definitions of man to fit how i feel. I viewed other men as less than a man because they were stronger than me or more aggressive etc.  I think the ideal I held, is actually more like an ideal for a woman. but we construct these lies i order to cope with how we feel and live our lives without going mad. and yes, it is very difficult to start to take them apart.

[Jess42]

I'd like to know what IS the requirements. ^_^;

I think it's those things I quoted from nhs wales website.
I can satisfy those criteria easily I reckon. I actually shaved my arm hair today. it crossed my mind, I thought maybe a bad idea, but as those thoughts were going through my head I realise the clippers were in my hand and half my arm was already shaved. ah well so much for caution. XD

Jess, you are right. making a decision in one session... that makes me a little angry. I will definitely express this to him in my next appointment.
I like what you said about living the lie. I twisted my own definitions of man to fit how i feel. I viewed other men as less than a man because they were stronger than me or more aggressive etc.  I think the ideal I held, is actually more like an ideal for a woman. but we construct these lies i order to cope with how we feel and live our lives without going mad. and yes, it is very difficult to start to take them apart.

It' sad but when we lie to ourselves so much that we end up believing that lie and it does nothing more than make us worst off. My worst was the four years I was in the military. Before I joined I just sort of mixed and matched, pretty much "is that a guy or a girl" type gender fluidity. The four years I could in no way express myself really hurt so I tried the macho manly deal and hated everybit of it. It took me several years to get out of that attitude of machismo and I still have holdovers to this day and it's been 20 someodd years. Psychologial hoopla and such, ya' know? But at least I'm back to the "is that a boy or a girl" stage when I want to be with ease. Now though its "is that a man or a woman" but heavily , about 90%, leaning toward woman.

[Bardoux]

I'd like to know what IS the requirements. ^_^;

I think it's those things I quoted from nhs wales website.
I can satisfy those criteria easily I reckon. I actually shaved my arm hair today. it crossed my mind, I thought maybe a bad idea, but as those thoughts were going through my head I realise the clippers were in my hand and half my arm was already shaved. ah well so much for caution. XD

Jess, you are right. making a decision in one session... that makes me a little angry. I will definitely express this to him in my next appointment.
I like what you said about living the lie. I twisted my own definitions of man to fit how i feel. I viewed other men as less than a man because they were stronger than me or more aggressive etc.  I think the ideal I held, is actually more like an ideal for a woman. but we construct these lies i order to cope with how we feel and live our lives without going mad. and yes, it is very difficult to start to take them apart.

Hi Yuki,

To be honest, it's all about jumping through the hoops and doing as they ask. When i went to the London GIC and there are a lot of transwomen who have had the same experience, i was received by the comment that i wasn't dressed feminine enough. Really? I dress how i bloody well want thank you very much. I turned up in female clothing and yet as i wasn't in full makeup and in a flowing dress, i appeared androgynous as opposed to unequivocally presenting female - whereas i thought i looked like a man in womens clothing and half of the tube carriage let me know so as well! They don't seem to care about individuals, it's all about ticking the boxes and moving people along the line. And if you don't tick those boxes then they can stall seemingly indefinitely on prescribing hormones.

Try phoning the GIC directly, and tell them about the experience you have been having and what to do. The psychologist you have been seeing shouldn't be gate-keeping at all, unless he feels you have additional or conflicting mental issues that need to be looked into further. I don't feel he should consider himself best placed to diagnose GID (if it's even at all possible to tell someone who they are and may not be) and it might be worth mentioning that to him in polite terms.

[lucy aylett]

i find it disturbing that we cant just decide for ourselves what we are and want to do with our own lives, i mean any other life altering chage you want to make is fine why do ppl make it so difficult i don't think it should be up someone who has no idea what your feeling to make that kind of decision for sum1

[Dreams2014]

i find it disturbing that we cant just decide for ourselves what we are and want to do with our own lives, i mean any other life altering chage you want to make is fine why do ppl make it so difficult i don't think it should be up someone who has no idea what your feeling to make that kind of decision for sum1

I've said this before. People can sit in a tanning salon for hours risking skin cancer for a darker skin colour. People can bleach and re bleach their hair until it is brittle and dry for the sake of a different hair colour. People can permanently ink their skin. People can pierce their skin with metal. People can get plastic surgeries, breast implants, nose jobs, complete face reworks etc. We can get organ transplants. Heck, you can even get limb transplants now.

But despite all that. We have to be treated like we're mentally unstable if we want to change our gender? Irony abounds.

[Jamie D]

I have been feeling like I want to tell people. I want to tell my family and friends, everyone I meet. It's not a strong feeling and my mind tells me that I ought to still hold back for a bit. but I am feeling more comfortable with myself and uncovering more of the feelings I had buried.
uhm, I'm blabbering.

You're not blabbering.  You are growing. 

[spacerace]

i find it disturbing that we cant just decide for ourselves what we are and want to do with our own lives, i mean any other life altering chage you want to make is fine why do ppl make it so difficult i don't think it should be up someone who has no idea what your feeling to make that kind of decision for sum1

It completely depends on where you live. In many areas of the U.S., there are informed consent options available to at least start hormones - no therapy required. That does not mean therapy is not a good idea; it definitely is given the magnitude of the decision involved. But it doesn't even work as well when they are a gatekeeper instead of a therapist - people are probably hesitant to really explore themselves when they are basically trying to pass a test

It will probably take awhile for the approval and diagnosis requirements to go away in places like the UK under the NHS.  They have an economic incentive to delay medical procedures and keep long wait lists, which then trickles down into the medical policy that is enforced by doctors. My comment isn't a "universal health care is bad" necessarily - there are trade-offs.

[Yuki-jker86]

yes, I was considering this.
one thing we do need to consider is that the NHS operates in a way that we do not pay for our treatment, it comes from tax money. I personally feel it is correct that they make certain decisions, as it is part of their budgeting responsibility. This is not to say that if a person really needs the treatment that the doctors can decide not to, I believe they have more of an interest in making sure the patient is serious and not just going through a phase.
another thing to consider is that the funding for this will be obtained from the welsh assembly, so it is the responsibility of a welsh NHS hospital to be the gatekeeper in this case. of course, it would make more sense if the GIC were in wales and they were making the decisions, but I am sure my doctor has the appropriate qualifications to make appropriate judgement calls.  of course that doesn't mean he can't make mistakes. also doesn't mean that the time taken to make that decision was in any way appropriate.


Thanks Jamie

[Bardoux]

yes, I was considering this.
one thing we do need to consider is that the NHS operates in a way that we do not pay for our treatment, it comes from tax money. I personally feel it is correct that they make certain decisions, as it is part of their budgeting responsibility. This is not to say that if a person really needs the treatment that the doctors can decide not to, I believe they have more of an interest in making sure the patient is serious and not just going through a phase.
another thing to consider is that the funding for this will be obtained from the welsh assembly, so it is the responsibility of a welsh NHS hospital to be the gatekeeper in this case. of course, it would make more sense if the GIC were in wales and they were making the decisions, but I am sure my doctor has the appropriate qualifications to make appropriate judgement calls.  of course that doesn't mean he can't make mistakes. also doesn't mean that the time taken to make that decision was in any way appropriate.


Thanks Jamie

These same funding issues will mean they will mostly likely prescribe you finasteride (if any AA) and progynova/estrace. I'm not slating pills but there is research out there about effectiveness vs other delivery methods, toxity to the liver etc and certainly the increased risks to people over the age of 40. Regardless of all this being put to the endo at CX, my friend who happens to be over 40 was told that was all nonsense and it would pills for her. Yes it's being paid for by the healthcare system, but do you realise how absolutely dirt cheap these pills are? And the fact that many of us all pay taxes and are thus in effect paying for a service we have no control over.
On the matter of surgeries, SRS as an example, conducted by the healthcare system your looking at costs of UP TO 20k. It can be done cheaper privately in this country, closer to the 10k mark, and yet that isn't allowed under Healthcare guidelines. They won't provide funding for surgery with a healthcare surgeon to do the same work privately, even though it would cost less. And of course, getting to the point of surgery will or should take a number of years on HRT, at which point the actual cost of transition under the healthcare system isn't that great at all.

As for determining someone's eligibility to start HRT, it should really be down to the individual working closely with a psychologist specialised in gender therapy. Yes it may be the case that not everyone is fully in control of their mental faculties and may need additional help to resolve additional or underlying issues, but after a series of 4-5 sessions it should be safe to assume to a reasonable extent how determined someone is to transition (and that shouldn't be determined solely on someone's external presentation).

[Yuki-jker86]

Bardoux, everything you are saying sounds good. so what can a person do?
Does that mean you would recommend finding a private clinic and keeping away from the NHS?

[Dreams2014]

Bardoux, everything you are saying sounds good. so what can a person do?
Does that mean you would recommend finding a private clinic and keeping away from the NHS?

Whilst I'm not Bardoux, If there were an option to go private rather than through the NHS, I'd choose private.