Scottish MtF transgender help

[Cat]

Hi all,

Hope you don't mind me posting here, but since this thread is active, about Scotland, and the OP (Sandra) is, or was, in a similar position to me, it seems like the best place to ask for help and advice.  I am right at the beginning of this process.  I visited my GP in early May and obtained a referral to local psychiatric services which is scheduled for the very end of July.  It feels so far away!  I'm struggling a lot with my feelings of dysphoria and am desperate to begin receiving treatment so I can move forward with my transition, but I'm a bit confused as to what my best options are for making this happen as soon as possible.

My naive first assumption was that I would see the psychiatrist and -- assuming I was diagnosed with gender dysphoria -- I'd be able to access whichever treatments and therapies were available after that.  As I understand it now, this first appointment is only an initial screening prior to my being referred to a GIC, and from what I've read here, that could take a further year or more.  I don't feel like I can cope with waiting over a year before I can even begin HRT.  I've read that I can self-refer to Sandyford, and I'm thinking that maybe I should do this without waiting for my local psych appointment?  Because I live in Tayside, I don't think I can self-refer to Chalmers, since it's only for the NHS Lothian region.  But I'm also worried that the same problem Danniella had may complicate things if I try to self-refer to Sandyford from Tayside... I'm not sure if there's anything I can do about that.

I've read so much, but some of it is contradictory, and I'm not sure how much applies here.  My friend told me today that, in Scotland, it ought to be possible to begin HRT prior to starting the RLE and after only one psychiatric assessment.  But elsewhere I've read that this almost never happens in practice.  Someone in another thread here posted that GPs should now be referring straight to the GIC, but since this hasn't happened, perhaps the local psychiatrist would count instead?  I wonder if there is there any chance at all that I could successfully request hormones from my GP (or at least a referral to endocrinology) following this first assessment? 

The other thought I've had is about going private.  While I could probably afford a couple of consultations, I don't know if I'd be able to take any prescription I received back into the NHS system (again, the literature says I should be able to, I think, but I'm not sure if the NHS would be obstructive in practice).  I wondered if I might be able to skip the initial waiting times by paying what I could afford, but then continue on the NHS pathway after that (there's no way I could fund the whole process myself).  But I'd be concerned about the effect doing that might have on my NHS treatment.  Maybe it can't work that way...?

Anyway, sorry for the long first post.  I hope it's not too much of an imposition.  While my partner and a few friends have been great about this, and my family are supportive, even if they don't understand it yet, I don't know any other women in my situation, and there are no local support groups I can find.  Thanks so much for reading, and all the best with your own journeys. ^^ xx

~Cat

[Sandra_Dickinson]

Cat: Hay you! I went to uni in Dundee

I know it's hard to hear right now but the best option is really to wait and let things run their course. In my initial posts I forwarded the idea that it would take up to a year and a half to get seen, when it turned out to be less than 6 months. I'm really glad to hear you have a supportive family, its the best thing right now.

I think you should stay with Sandyford (They have an open day soon that I was invited to), They are prompt, caring and understanding - not that Chalmer's street aren't - but this journey is yours alone, and I think they will help you best.

You seem young, but maybe that's just me and the wine reading too much into backstory. I know it feels like an age and it hurts everyday, but the wait will make it all worth it. You are sure of what you want, but every step closer will become it's own victory.

PS: There's not really much chance of receiving HRT from a GP -they're trained for female HRT treatments, not people like us - heartbreaking I know, but it's better to not get your hopes up. At least until you have seen a gender therapist and endocrinologist separately.

PPS: Private healthcare is only a option if you can stay with it, most practices don't like the idea of you switching between and can put you on a longer waiting list if you've received private and returned to NHS. It is slow and I know it hurts, but it's the best option if you can't afford to keep up private costs (Which are extortionate)

PPPS: (I know, taking the piss) Have you received any correspondence from Sandyford yet?

[Danniella]

Hey Cat! And welcome to the growing list of Tayside transitioners! xD

I'm probably what I would reckon to be around 7-8 months ahead of you in the process.

Unfortunately if you life in Tayside you cannot self refer to ANY NHS Gender Identity Clinic, Sandyford or Chalmers. If you try to do so (like I did) it can take them up to 4+months before they actually get back to you and tell you that you need to go through the tayside mental health pathway first.

I was very lucky in that they kept my original referral date after the clerical error...but I know of others who have not been so lucky.

Things in Tayside are just a bit different than the rest of the country (for some indeterminable reason). So allow me to lay down the process in as clear a manner as I can (MY FAVOURITE! BULLET POINTS!)

• Step 1: See GP and arrange to enter the Tayside mental health pathway. Make sure to properly express to both the GP and the psychologists that you have a clear goal of receiving a referral to the GIC as soon as possible, so everybody is on the same page. (The new pathway has not been in place for long, and my second psychologist didn't even know why I was there, you need to be firm and sure of what you want to keep making progress)


• Step 2+3: See your first and second psychologists for a number of sessions. It can take a month or two to get your first appointment, but after that you should have 3-4 sessions in quick succession (approximately a week apart). The number of appointments you need per psych varies depending on what previous information is on your file, how you express yourself, if you have any other mental health issues, and of course the psychologist's view on the whole thing. (For reference, my first psych needed 4 seperate hour long appointments over the course of a month before she was satisfied to pass me on down the line, but the second psych only needed 1 30min appointment to come to the conclusion that I needed to get specialist help from the GIC)


• Step 4: Confirm that you have completed the pathway, and that you are going to be referred to your clinic of choice. (Be sure to call the clinic themselves approximately a week after the referral is sent out to make damn well sure you are on their waiting list)


• Step 5: Wait...for 12-14 months. This is the hardest part, and it's during this time you may have the desire to seek private healthcare or begin the RLE (see optional steps at the end)


• Step 6: You will be contacted with your first appointment at the GIC when you are near the end of the list, congratulations! The hard part is over...


• Step 7: You will require ANOTHER psychological evaluation at the GIC before they will give you access to their services. On the plus side, this time the psychologists will at least know what the hell you are talking about xD


• Step 8: Once you have been fully diagnosed as having Gender Dysphoria, you will be signed off by the specialists, the doors are thrown opened and you gain access to all the services they can provide...or at least access to their individual waiting lists that is

Below are some optional steps that you may or may not undertake during this process.

• Optional Step 1: Go private and get an appointment or two with a gender specialist. While expensive (the clinic I recommend cost me £300 per session) I can't recommend it highly enough. During your early transitioning phase, you will be surrounded by people asking you questions, but you will not be able to ask them any back. I cannot express just how comforting and liberating being able to sit in a room with a specialist and ask questions face to face can be during this time.


• Optional Step 2: Self Medicating...a touchy subject. I do not condone it. Having gone through it myself I can tell you that it is neither an easy nor cheap thing to do. You must research meticulously, find reliable suppliers, experiment to find the correct dosage for yourself, and pay for regular and expensive blood tests to monitor it (Your GP will not cover these if you are self medding). But the temptation will always be there. Just be careful and think of the dangers, and the alternatives. Remember that passing and transition is 80% confidence, fashion and voice, and only 20% HRT, you can, and should, do ALLOT before you resort to it.


• Optional Step 3: Start your RLE early: There is nothing anywhere that prevents you from getting the jump on the que by starting your Real Life Experience (Going Fulltime) ahead of schedule. In fact I highly recommend it! All of the services that the NHS can provide, from HRT to surgeries, have a pre-determined period of time that you need to have spent in RLE before you can gain access to them. For Example you need to have been living fulltime for 4 months before you gain access to HRT. 12 Months before access to SRS and so on. You could wait until you are seen by the GIC before starting full time, but why waste the 12-14 months on the waiting list? So long as you keep evidence of your start date and continuation of the RLE (Letters to work, name change documentation, photos, anything that proves you were living fulltime) the GIC can back-date your RLE start date. If you start it early enough, you can potentially walk into the GIC having been fulltime for months, and be granted access to services almost immediately. (The specialist psychs also love this, as it shows you are committed, driven and know what you want)

This is the official Scottish Government Gender Reassignment Protocols, read and memorise the process, know what your GPs/Psychs can and can't do for you. Always push for your next step. http://www.sehd.scot.nhs.uk/mels/CEL2012_26.pdf

If you need any further advice, or just want to chat with a fellow trans Dundonian, feel free to drop me a message.

Good Luck! <3

[chrissydr]

They did change a few things. You don't need the RLE before getting hormones anymore, so you don't have to do that if you feel that you can't do it just yet.

Saying that, its propbably going to be alot more comfortable to start doing things that make you more towards the gender you really are. For instance I wouldn't pass to save my life, but I am taking steps to express myself more femininely to alter the perceptions of people in small ways to make the transition easier.

[Danniella]

They did change a few things. You don't need the RLE before getting hormones anymore, so you don't have to do that if you feel that you can't do it just yet.

Really? That's the first I have heard of it!

It's good news if so. I understand the standpoint of ensuring that people are committed to the process before allowing permanent changes to take place, but it can be quite brutal to those who really struggle with passing early on.

[Beverly]

They did change a few things. You don't need the RLE before getting hormones anymore, so you don't have to do that if you feel that you can't do it just yet.

I see a lot of people clinging to this particular hope. It is a guideline, not a rule. GICs set their own rules. I have never known anyone to get away without some RLE.

As an example, Daniella's post above points out that the guidelines say you can self-refer. The reality is that you cannot.

[chrissydr]

I see a lot of people clinging to this particular hope. It is a guideline, not a rule. GICs set their own rules. I have never known anyone to get away without some RLE.

As an example, Daniella's post above points out that the guidelines say you can self-refer. The reality is that you cannot.

But as you said it is based on the GIC. And as far as Sandyford goes. You can. And they give you hormones before RLE. The rules were changed for Scotland, to allow hormones before RLE. Wether you realized it or not, it does happen. All the time now. I was self-referred and will be going on hormones without RLE.

I don't know why you would say you can't when I am proof you can do both.

http://transactivist.wordpress.com/2012/07/17/scotland-hands-unprecedented-power-to-trans-patients/

You don't need RLE before hormones, and if they don't give them to you then they are not doing what they should be doing.

[Beverly]

I don't know why you would say you can't when I am proof you can do both.

Because I am not you. I do not know your history.

Reread my post. I said that "I have never known anyone to get away without some RLE". Note the "I have..." bit.

I was relating my experience just as you were and pointing that Daniella's experience also differed from the guidelines.

[Danniella]

But as you said it is based on the GIC. And as far as Sandyford goes. You can. And they give you hormones before RLE. The rules were changed for Scotland, to allow hormones before RLE. Wether you realized it or not, it does happen. All the time now. I was self-referred and will be going on hormones without RLE.

I don't know why you would say you can't when I am proof you can do both.

http://transactivist.wordpress.com/2012/07/17/scotland-hands-unprecedented-power-to-trans-patients/

You don't need RLE before hormones, and if they don't give them to you then they are not doing what they should be doing.

Actually you are totally right re-the HRT

Looking closer at the official guidelines I linked above, HRT can on a case by case basis be gained before the 12 month RLE ^^

As far as I know the self referral issue is a recent tayside specific one though. I spoke to the people at Sandyford multiple times and they explicitly stated that I couldn't self refer if I lived in Tayside :S

(I would also still recommend starting your RLE as soon as possible, HRT or no HRT, you still need 12 months under you belt before you can get a referral for your SRS, if you want that ofc)

[Sandra_Dickinson]

Personally I've never seen a psychiatrist and have had only one appointment with a GP that took about twenty minutes. After that I was referred to Chalmer's street and on my way to HRT. Things do sure seem complex up there in Tayside for some reason!

You can self-refer to Scottish GIC, and the rules state that they don't require RLE, but - as I think has been stated - that entirely depends on your situation and what the Doctor thinks is best. I'm not out to my family, only my close friends (Dad is a bit of homophobe, terrified of telling him really) and I suppose you could call me part-time. I know I wasn't asked for RLE, but I regularly go out in full girl mode and showed up to my appointment as feminine as I could get.

I agree with Daniella though, the best way forward is to take control of this yourself - it's the best advice I was given (Nikkit*Mwah*). Go out in girl mode, buy make-up and put it on daily. Learn all those little things that make a woman. Discover your style and how you like to dress. Do it all at your speed - it took me 5 months of going out as a girl before I worked up the guts to go out alone and ask the barista for my own coffee, and that was so liberating. I got laughed at by some construction workers the same day -_-

I'm on my way, but I don't pass. I think it's important to remember that even if you pass flawlessly and stealth into a new life, you will always be trans. It's part of us and it can't be escaped. RLE with that attitude helps your confidence.

There are going to be little victories and defeats that you will learn to deal with, and problems you don't expect. Who else has stood like a moron staring while a gent held a door open?

[chrissydr]

Because I am not you. I do not know your history.

Reread my post. I said that "I have never known anyone to get away without some RLE". Note the "I have..." bit.

I was relating my experience just as you were and pointing that Daniella's experience also differed from the guidelines.

Read what you said. You said it was clinging to a particular hope, and that you said in reality you cannot. Taking out any phrase you meant to say on a case to case basis ( ie. the 'I have seen') and the thought was that you can't even though the guidelines said you could. To be honest, i didn't take that into account with anything about what you have seen, as its pointless to argue about what you have seen, because I don't know what you have seen. I said what said, because you seemed to debate the thought that you could get it without RLE based on the guidelines that are in place.

Hope is all we have sometimes. If I had read that without knowing what I do know. I might have sunk further into my depression. But the reason I said what I did. Is because its not just a particular hope, that I am clinging to. It is the truth because, there are people out there that are getting the help. And getting the extra step to make it a little less of a horror story.

[chrissydr]

RLE is a bit not possible for me. My mother knows and is supporting me. My wife is supporting me, but she said she would leave once I have the surgery. The rest of my family doesn't know, so its a bit impossible for me at the moment.

The thought of doing it without HRT or having some more planning time with certain things are out of the question. I would be looking at years before I could do anything such as HRT or RLE. This just helps as well to deal with the suicidal tendencies that I have had and they help quell the demons inside.

I try to look at it from the perspective of planning as much as possible. Need to make sure I do as much as humanly possible, while I can. Its going to be a long and difficult road to go down, enough as it is.

[Beverly]

I'm on my way, but I don't pass. I think it's important to remember that even if you pass flawlessly and stealth into a new life, you will always be trans. It's part of us and it can't be escaped. RLE with that attitude helps your confidence.

I agree 100%

Hope is all we have sometimes. If I had read that without knowing what I do know. I might have sunk further into my depression. But the reason I said what I did. Is because its not just a particular hope, that I am clinging to.

It can be (at present) a false hope. That is why some of my friends have had to go private for their HRT.  I see this being trotted out on a regular basis and I see the blow-back some weeks later when people found out it just wasn't so at their GIC. I spent my Saturday night in an A&E ward with a new girl who is self-medding - and collapsed - because she could not get HRT without RLE.

It is the truth because, there are people out there that are getting the help. And getting the extra step to make it a little less of a horror story.

I am glad you are getting the help you want, but not everyone is. In spite of the guidelines....

[chrissydr]

I agree 100%


It can be (at present) a false hope. That is why some of my friends have had to go private for their HRT.  I see this being trotted out on a regular basis and I see the blow-back some weeks later when people found out it just wasn't so at their GIC. I spent my Saturday night in an A&E ward with a new girl who is self-medding - and collapsed - because she could not get HRT without RLE.


I am glad you are getting the help you want, but not everyone is. In spite of the guidelines....

Knowledge is power . Researching into the little problems that can come up are part of everything that we do. No not everyone is getting the help the way that they want. people jump into things without realizing what may happen. Self-medding is a choice but a choice people do make. I almost took my own life due to the thought that I could never be the woman, i know I am. I almost went the route of medding myself when I thought that I couldn't got the proper route.  People do that because they are told that they can't get help because, although they have not read the guidelines, that they won't be able to get the help, they do need.

What I have been trying to express is that there is the possibility to get the help, and there the light at the end of the tunnel might be closer than you think. I think maybe I am a bit more optimistic about things than I should be. But at the end of the day, i have done the research and found its not as depeessing as some would have me believe it to be

[Sandra_Dickinson]

I agree 100%

You agree I don't pass? You tactless bitch!
<THIS IS A JOKE. PLEASE DO NOT TAKE THIS SERIOUSLY>

Chrissydr: I agree research is the key here. We all have different journeys towards a similar goal, and what makes this place great is the ability to share those journeys. My wife also stated that full time is the end of our marriage, and won't kiss me or even entertain closeness if I'm in girl mode. She's my best friend then, not my wife. Still hurts though, as I do still love her.

[Danniella]

I can relate with the wife issues

Unfortunately after receiving my diagnosis, she decided that getting involved in online swinging circles and having orgies in our marriage bed behind my back was an appropriate method of communicating her displeasure with me and the situation. (I discovered this when one of my friends alerted me when photographs and videos of the offending events surfaced on the internet...)

I can only hope that your own relationships continue, or end, in a slightly less gruesome manner.

[Cat]

Thanks so much for the replies! <3  Obviously not everything is exactly what I wanted to hear (even if I expected that, it's still hard...), but it really helps a lot.  I'm so grateful for your support.


Sandra:  Hihi! ^^ I'm at uni here right now (I lived here anyway, though).  I guess I'm older than I come across, and definitely older than I look irl (or so I'm told).  I'm actually 34. It's a big part of why I feel so impatient... other than the whole hating what I look and feel like in this body so much that it's hard to get through each day.  At least this is one place where I don't need to explain that! 

I haven't received anything from Sandyford yet.  This thread was the best source of info I could find, and I wanted to ask you all about it first, especially given the problems that seem to arise from living in Tayside.  Anyway, you're right, it's terribly hard to hear that I may have to wait as long as I thought, but it won't help me to have false hope.  I will try everything I can.  I couldn't fund the whole private thing.  I've made another GP appointment so that I can ask her opinion on going private initially and how it would affect me, and also ask whether she'd refer me to an endo after my local psych appointments.  But I will work on the assumption that she'll say no to both of those things, which stops me from getting my hopes up.

I've been really lucky with my family, but my dad is struggling a lot.  He hasn't been able to face me or talk about it yet, but sent me a message of support, despite not understanding.  I got the best possible reaction from them, considering I was worried that they might never speak to me again.  They are going to lag behind for a long time in how they process it, I think, but I've told them I have to move forward at my own pace.  My partner has been amazing through all of this, and says she's sticking with me no matter what.  I realise there are no guarantees, but she accepts me completely as a woman and is working on adjusting herself to the idea that she'll be with a woman in future, so... fingers crossed.  I know exactly how fortunate I am at present in that regard, especially reading some of your replies here.

I do have clothes and makeup, I've been discovering my style (actually feeling good and taking pride in my appearance for the first time in my life is a great feeling), and I suppose I'm going out in 'half girl mode' atm.  Subtle makeup, more feminine hair, bootcut jeans and ankle boots (I love those boots).  I'm going to start trying to wear women's tops now, but keeping it subtle until I feel more comfortable.  As Danniella says, confidence is so important, and I'm sort of lacking it right now, so I need to build it up slowly. 

But hey, I've been laughed at by construction workers even when presenting as a guy in the past, so I'd take that as them being them, and not a reflection on you.

I take your point about learning to embrace my trans status.  It's something I found very difficult at first, but which is already getting easier now.  Thanks for the advice! ^^


Danniella:  Hey! xD  Thanks so much for the comprehensive summary of the process in Tayside (with bullets! \o/).  I will be sure to affirm that I'm seeking a referral to the GIC.  I wasn't so clear on this when I visited my GP the first time, mainly because I was a complete mess and could hardly talk to her, and I also didn't know about the new protocol at that point.  I wonder if I should contact Sandyford anyway, just in case I get lucky with them backdating my referral, but perhaps it's unlikely....

In terms of having private appointments with a gender specialist... you would recommend this purely for the opportunity to talk and ask questions, but it isn't likely to speed up my access to treatment, is that right?  It still sounds like a worthwhile thing if I could afford it, but I might be more reluctant to spend so much money 'just' to talk, however useful that would be.  It's worth thinking about, though.

I will admit to considering self-medding, and in my darker moments deciding that I must do it, but most of the time it scares me and I have no desire to if I can avoid it.  I have been considering whether I should start my RLE regardless.  Concerns over how well I will pass in the shorter term (I suspect not very o.O) and social anxiety over things like having to return to uni in September as an openly trans woman to people know already know me as something else are the main things holding me back.  I'm debating whether I should change my name and start this process by the end of the month.  I am just starting on my voice.  Other than my obvious lack of breasts (lol), my face and voice are the major areas of concern.  I want to get started, so I'm gonna have to reconcile myself to the fact that those things are not going to be perfect, or even passable, and that I need to be strong enough to deal with that until I improve those areas.  I don't want to get to my appointment when it finally happens only to be made to wait further.  -_-

And thanks, I appreciate the offer of advice or a chat.  We should totally do that.  You're way further on than I am, and I imagine you know lots of people you can talk to already, but if you ever want to talk to someone else local, the same applies in reverse, k?


And sorry, I do have a tendency to type too much once I get started. :3

~Cat

xx

[Sandra_Dickinson]

Daniella: my word that's horrible, I hope you're doing well. It must be awful to have that from someone you trusted so much.

Cat: You certainly do come across as younger <3 pretty much the same age as me though so I can relate. It's a pity uni is over or I'd meet up for a coffee and a chat

Keep us updated on anything that happens, and don't worry about long replies!

I'm really glad I made this thread, as it's helped me incredibly and its good to see it helping others - also I've met some amazing people!

[Danniella]

I wonder if I should contact Sandyford anyway, just in case I get lucky with them backdating my referral, but perhaps it's unlikely....

It might happen, always worth a shot since getting through the Tayside pathway can potentially ad 4-6 weeks to the time it takes to get in the door at sandyford -.-'

In terms of having private appointments with a gender specialist... you would recommend this purely for the opportunity to talk and ask questions, but it isn't likely to speed up my access to treatment, is that right?  It still sounds like a worthwhile thing if I could afford it, but I might be more reluctant to spend so much money 'just' to talk, however useful that would be.  It's worth thinking about, though.

I found that it actually did help me get through the tayside pathway in some ways. You can request that whatever specialist you see shares your information with your GP + Psych team, which can help them diagnose you quicker.

I'm yet to see if this will help matters in Sandyford, but it's always nice to have another specialist report in your back pocket anyway (Even if just to read at night during the dark early times to convince yourself you are not crazy)

I have been considering whether I should start my RLE regardless.  Concerns over how well I will pass in the shorter term (I suspect not very o.O) and social anxiety over things like having to return to uni in September as an openly trans woman to people know already know me as something else are the main things holding me back.

I actually wish I had come out in University. From what I hear, it's a good environment for it. Lots of bright minds experimenting with new ways of thinking, meeting new people and no massive pressures makes for a good environment to experiment with one's self in.

I'm debating whether I should change my name and start this process by the end of the month.  I am just starting on my voice.  Other than my obvious lack of breasts (lol), my face and voice are the major areas of concern.  I want to get started, so I'm gonna have to reconcile myself to the fact that those things are not going to be perfect, or even passable, and that I need to be strong enough to deal with that until I improve those areas.  I don't want to get to my appointment when it finally happens only to be made to wait further.  -_-

Finding that strength to step out your door even on the days when you know you don't pass is the hardest part imo. But once you get used to it, you become stronger than you could ever imagine.

And thanks, I appreciate the offer of advice or a chat.  We should totally do that.  You're way further on than I am, and I imagine you know lots of people you can talk to already, but if you ever want to talk to someone else local, the same applies in reverse, k?

Yup yup, I'm actually meeting up with another dundonian trans girl from the forums this weekend! I'm always happy to meet up with questioning peeps or those in transition for a coffee and a chat (We are in the shadows...but we do exist )

And sorry, I do have a tendency to type too much once I get started. :3

Don't worry...that happens to most of us when you find somewhere safe to express yourself after a long time of keeping it all inside...you should see the length of some of my posts linked in my bio >.> (I have a habit of writing about my experiences like they were short stories...makes for some looooong posts x'D )

[Danniella]

Daniella: my word that's horrible, I hope you're doing well. It must be awful to have that from someone you trusted so much.

Well I had a complete and utter mental breakdown (Pro tip...seeing pictures of your wife and partner of 10 years being spit-roasted by two overweight 40 somethings while entwined in another woman is NOT a good way to discover they are cheating on you, it has somewhat negative side effects to one's sanity).

Buuuuuuuut after trying to throw myself off the Tay bridge, spending a month in a mental hospital, another two months heavily medicated and under suicide watch, countless hours of therapy, a divorce and one gender transition...I think I'm pretty much over it...mostly x'D

AT LEAST I CAN LAUGH ABOUT IT NOW RIGHT!? RIGHT!/ -maniacal laughter-

...

Okay I'm done venting now...CARRY ON ABOUT YOUR BUSINESS!!!