NHS - 2 years before hormones??

[Drawcansir]

Hey guys, gonna be a really short thread.

But I'm deferring from University atm in the hope to start transition and be in a comfortable position before 2 years are up. However, after ringing the university about the deferral which was fine. We rang the mental health nurse I saw a month ago to ask how long it could be before treatment starts. He said according to the website he gets all his information from (NHS Choices), treatment apparently doesn't start until two years have passed.

I've now read through the gender dysphoria/treatment page on that website and I cannot find anything related to treatment beginning after two years. The two things I found was a three month assessment period and then a 1 year period of RLE before gender re-assignment surgery.

If there is a two year period before any treatment, that like really screws up everything with my University placement, so I'm just super worried right now and wondering if anyone else using the NHS pathway has been told the same thing about a two year period before treatment?

[foreversarah]

I'm unsure about the 2 years thing but I'm in the same boat regarding education. I have just finished my undergraduate course having decided to delay anything until I have finished. For me, getting the education sorted is very important. I intend to do a postgraduate course of some sort but for now I'm taking, at the very least, a year out to start things off.

I have just started things off, I am currently waiting for a referral to go through which, surprise surprise, has been delayed having initially been told it would take 5-7 weeks.

[RachelH]

It really depends on your location.  The different clinics are subscribed and have different capacities. There is a significant increase in the number of referrals to the clinics, as such the time taken to access the care path way and receive HRT has increased substantially. 

However 2 years is a long time, and a year to get on a pathway is more probable, following referrals and the assessment period.  There is always the option of starting through a private clinic, and waiting to transfer onto the NHS pathway once you've jumped through their hoops. Although that will be expensive, but does give the option of starting sooner on the HRT.

When you have GID confirmed by the NHS, the time until you go on HRT is when you can prove you have started your real life experience (normally proved through ID and other essential documents).
It took me about 8 months to get onto the care pathway, and officially start HRT and the RLE counter for surgery.  Oh, and the surgery referral is after 2 years RLE, and with the back log the surgery date following referral is another year.  The NHS is struggling   I'm paying for my SRS privately, and will hopefully be in May 2014, so will remove 2 years of waiting on the NHS.

Hope this helps.

[FTMDiaries]

Nope! He's talking out his backside. I'm stunned that a nurse consulted NHS Choices: that's a patient information site that is rarely kept up-to-date, not a database for healthcare professionals! In fact, most of their info on GD is 2 years out of date.

Here's the current NHS Protocol for England: http://www.cliniq.org.uk/sitebuildercontent/sitebuilderfiles/nhsenglandinterimgenderprotocolcpag12072013.pdf

Have a good read of that, and you'll see that whilst they normally want you to undergo a minimum of three months' assessments, your GP or the GIC may prescribe hormones for you before you've completed your assessments if they believe it is in your best interests.

You also no longer need to go through Mental Health to gain access to a GIC; your GP can now refer you there directly. Just be aware that some GICs have ridiculously long waiting lists (such as London) whereas some (such as Sheffield and Exeter) have much shorter waiting lists. You can pick any of the GICs in the UK; you don't need to go to your nearest one.

The one thing for which they'd still like you to complete at least one year's RLE is surgery. So that matches up with what you found out for yourself.

If it helps you to know this, my GIC counted the start of my RLE as being the date on which I changed my name by Deed Poll, which was four months before my first appointment. There are no guarantees that you'd experience the same because it depends on the clinic, but it certainly moved things forward for me.

[RachelH]

The one thing for which they'd still like you to complete at least one year's RLE is surgery. So that matches up with what you found out for yourself.

If it helps you to know this, my GIC counted the start of my RLE as being the date on which I changed my name by Deed Poll, which was four months before my first appointment. There are no guarantees that you'd experience the same because it depends on the clinic, but it certainly moved things forward for me.

It's not they would like you to complete 1 year for SRS, but no surgeon will operate before 1 year.  The other surgeries you may wish for (Breast Augmentation, FFS etc) depends on the surgeon and can be done earlier if they are convinced of your conviction.

Also my clinic, would only count the RLE after they had seen me during my 3 monthly checks, and "proved" with evidence of my identity been changed and me living in my acquired female gender.  So as FTM says, it varies a lot between the different clinics.

[FTMDiaries]

There are also, very regrettably, different standards between genders.

In many clinics, MtFs are put under pressure to conform to higher standards of gender-appropriate presentation than FtMs. Heck, they're also held to higher standards than ciswomen. I've yet to meet a ciswoman who doesn't occasionally go out in jeans or scruffy clothes with no make-up on... but if a transwoman were to do the same, many GICs would consider that a failure to complete her RLE and she could find her treatment delayed.

[RachelH]

Sadly that is true I've always hated the way the NHS clinics seem intent on making m2f's life's much harder then needed.  It's a point I always argue with my specialist, he must look forward to seeing me 

However, the though of going out without makeup on is like a nightmare for me lol! I can just about answer the door, but that is after several months of passing convincingly whatever I wear, or lack of makeup.  But if someone was to revert to presenting to their birth gender, I've been told they will reset the RLE time to the beginning as it shows a lack of consolidation of your acquired gender.

[RachelH]

Oh, F2M are you starting T tomorrow, if so congratulations, and enjoy!

[foreversarah]

This, it's harder for MtF's is an interesting point. Thanks for bringing it up. For me, I'm not a huge fans of skirts, the same applies with shorts, because it shows off my right leg which is slightly disfigured as it was broken and healed in utero.

t's kind of (obviously not exactly) like the application of the standard of of proof in law. In criminal law, it is required for crime to be proven beyond reasonable doubt. Eg if 99 facts proved the defendant was guilty and only one proved he was innocent then that's beyond reasonable doubt and the defendant is guilty.

In Tort Law (Civil), it is on the balance of probabilities. If there is a slight bit of doubt to the defendant's wrongdoing (guilt isn't the right word to use in Tort law really) then the defendant will win and not have to pay compensation etc. eg if 51 facts prove the defendant was not 'guilty' and 49 'not guilty' then the defendant is innocent.

But obviously it's not always down to quantity, some facts carry more weight than others.



I seem to have rambled, and slightly off topic, sorry.

[FTMDiaries]

Sadly that is true I've always hated the way the NHS clinics seem intent on making m2f's life's much harder then needed.  It's a point I always argue with my specialist, he must look forward to seeing me 

However, the though of going out without makeup on is like a nightmare for me lol! I can just about answer the door, but that is after several months of passing convincingly whatever I wear, or lack of makeup.  But if someone was to revert to presenting to their birth gender, I've been told they will reset the RLE time to the beginning as it shows a lack of consolidation of your acquired gender.

The difference is: 'reverting to your birth gender' has different standards for MtFs than it does for FtMs. For us guys, we would have to do something extra, like wearing make-up or dresses, to be considered as reverting as our birth gender. So I'd have to actively do something above & beyond what I normally would do. For you ladies, the bar is much higher: simply not wearing make-up, or turning up in a pair of jeans (even if paired with a blouse) would be enough. You could simply be having a bad day like any other woman does: it might be the wrong weather for a skirt or perhaps you haven't had time to shave your legs... and bam! you've failed your RLE.

I've even been able to confess to my GIC that I sometimes buy my shoes in the women's section. I have size 4 feet - where can I get size 4 men's shoes? - and there are plenty of androgynous styles available in my size in women's shoe shops. My GIC was perfectly fine with this. But my MtF friend who suffers from severe eczema kept getting her RLE reset by her GIC because there are days that her skin is so bad that she can't wear full make-up. How much make-up do they imagine a ciswoman would be able to wear if she had a severe eczema flare-up?

Oh, F2M are you starting T tomorrow, if so congratulations, and enjoy!

Thanks Rachel! I doubt I'll be getting much sleep tonight!

[Bardoux]

If your based in or are able to get to London, look up Gendercare. You will be able to privately see the resident GIC psychologist and endocrinologist on the same day and get fast tracked into the system. A friend of mine was able to avoid most of the wait times this way.

And a huge congratulations to you FTMDiaries! very happy for you!

[FTMDiaries]

And a huge congratulations to you FTMDiaries! very happy for you!

Thanks! I'm getting very nervous, like the night before going away on holiday.

[Jayne]

my MtF friend who suffers from severe eczema kept getting her RLE reset by her GIC because there are days that her skin is so bad that she can't wear full make-up. How much make-up do they imagine a ciswoman would be able to wear if she had a severe eczema flare-up?

Hiya FTMDiaries, for those who haven't read my old posts I can confirm that i'm the MTF that FTM is talking about.
Charing Cross had very strict standards under the old rules but they have eased up now, when I had my second session I was told that in spite of the fact that I changed my name a year ago, have been wearing nail varnish every day for almost 3 years, always wear a bra with padding but keep my clothes gender neutral they wanted me to be full time before they started HRT!!
Up until then I thought I was as full time as possible but i'd been advised not to start electrolysis until i'd started HRT to reduce the amount needed & therefore do less damage to my skin. My second psychiatrist seemed to think that because I hadn't hidden my 5 O'clock shadow that I failed in being full time, if I had used make-up to hide it every day i'd have probably been hospitalised several times in the last 3 years due to severe eczema flare ups, even without make-up the skin on my face is red & weeps constantly (with make-up i'd look like an extra in a zombie film within days, lol)

I went to the GIC a few weeks ago & they are now writing to my GP to start my HRT & electrolysis ASAP.

Under the new rules things should move alot quicker for every trans person in the UK, even better news about the new rules mean that MTF's get 8 sessions of electrolysis & MTF's get masectomies done on the NHS without question.

At this point in time I would however advise people to try to avoid Charing Cross clinic as they are under strain from the amount of patients they have, they are working hard to train new staff to meet the pressure but it will take time before things improve.

[Drawcansir]

Heyy, thanks for all the info guys! 

Especially for that link FTMDiaries, eased my worries a lot. Now I can get back to stalking the forums and waiting for the next letter to arrive.

And congratulations FTM!   

[MaryXYX]

As someone already said, it depends which catchment area you are in.  I'm in the area for Charing Cross.  I got to see my GP fairly quickly.  Then a month or two to see the local gender psych - this will vary by area.  Then the gender psych told my GP to refer me to Charing Cross - there is a possible hole here because there are GPs who will tell you they have referred you but will actually do nothing at all.  CX's initial waiting list was six months for a first assessment, then five months for the second assessment.  Then they told my GP to prescribe hormones - it only took 13 weeks to type the letter.  So, the guideline is a three month delay before prescribing hormones, the reality is 13 months.

[kira21 ♡♡♡]

In am quite scared about my transfer to the care of Notts gender clinic.  My current psych said I should sail through as I am already socially transitioned, but these stories scare me, partly because my job isn't suited to wearing a skirt.  None of the other women do,  none,  and I would stick out like a sore thumb and also probably shred my knees and, well, embarrass myself by accidentally exposing myself, if I were to wear one. If these things are still true then they will never support me it would seem,  unless I chuck it in and get a job as something else,  which would have wasted all my study and time up until now,  and lose me so many other things. Not happy!! :-(

[kira21 ♡♡♡]

Oh and GPs are often awful.  On my first contact with a GP, she told me that the nhs don't support gender change and I would have to do everything myself privately.  I had to give them the guidance and still they didn't follow it.

[LordKAT]

Dressing female does not mean you have to wear a skirt.

[RachelH]

Dressing female does not mean you have to wear a skirt.

Definitely this.

I'm with Nottingham, and they are reasonably tolerant as far as I have seen.  I've wore jeans and tops occassionly to my meetings, and have never had any problems.  It's the whole package that is assessed.  I could wear male clothes there, but my hair, voice and everything else still screams female.. so don't worry too much Akira, you don't have to dress totally femme, as long as you are still clearly female, or presenting female.

[Shannon1979]

The whole system is up in the air at the moment, what with the new protocol and such. Bearing in mind different clinics work a little different, Nottingham currently takes 6 months from first appointment to prescribe HRT. However this is based on your assesment. If the clinic feels that you are not yet ready to be given HRT it could be longer. I am currently 3 months in and have just had my second appointment. so if all goes well i should have HRT by december.