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Back Dating RLE Start Date and HRT Pre GIC? (UK Trans peeps halp!)

Started by Danniella, June 20, 2014, 03:52:38 AM

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Danniella

Hey all.

An uncharacteristically short post for me today >.>

But I was talking to one of the receptionists at the NHS Gender Identity Clinic I am on the waiting list for (Still got another 4-5months to wait -.-;), and I was asking her if it was possible to back date the official start date of my RLE when I do finally get there.

In addition, I was asking her what their policy was on trans people who come to them having already been on HRT for some time. (Self medding baaaaaaaaaaaaaaad and stuff)

Unfortunately...she said that she couldn't comment on either of these issues...and that I would have to wait until I was seen at the GIC before they could talk to me about things like that...which has me very concerned :S

I started full time last month...and I really don't want to lose 6 months worth of potential RLE time, which would in turn delay my applications for a Gender Recognition Certificate and recommendations for SRS etc.

In addition I'm now also worried that they won't want to touch me with a 10 foot pole since I started self medding >.>

It's strange to think that I could be punished, or have my progress denied, because I couldn't wait 13 months to begin my transition in earnest :(

So has anybody here  experienced what happens when you are full time and self medding when you arrive at an NHS GIC? How did things pan out for you? I can't find any official documentation or policies on this subject, but surely it can't be that uncommon can it?

Looking for some reassurance that I haven't screwed up the process >.>
You say "Using humor as a defence mechanism" like it's a BAD thing!



  •  

kira21 ♡♡♡

It depends on your situation and who you get to talk to.

I would evidence as much as possible (staff badges, passes, pay slips, change of passport including gender marker, driving licence again with gender marker, a few photos).

They will say "you shouldn't self med" but I would be suprised if it affected their decision to accept RLE or to take you under their endo provision.  In fact it can speed things up as you will already have established a few things that they will be interested in.

They will want to take you off the spiro and do a blood test with no spiro in your system for at least two to three weeks to get a baseline as they don't use spiro, they use gozerelin typically as its better and they use cyproterone to control the initial T spike that it causes, but not spiro. I managed to get my GP to prescribe pre-GIC and with me, having stopped spiro some months ago, which I had been slowly reducing for the months previous, due to the links to breast bud fusing and limited/irregular breast growth, I have found that my T level is at nearly zero (0.1 ng/ml) with no blocker anyway, so... win. Three less tablets in my daily pot and no dehydration.

You should try and get your GP to prescribe as the guidance says they are allowed to prescribe 'bridging endocrine treatment' until the GIC take over. (I think its page 15 or 16 of the guidance).

I hope that you are still getting regular blood tests from your GP, regardless of how you are procuring your medication.

Danniella

Quote from: kira21 ♡♡♡ on June 20, 2014, 04:19:24 AM
It depends on your situation and who you get to talk to.

I would evidence as much as possible (staff badges, passes, pay slips, change of passport including gender marker, driving licence again with gender marker, a few photos).

They will say "you shouldn't self med" but I would be suprised if it affected their decision to accept RLE or to take you under their endo provision.  In fact it can speed things up as you will already have established a few things that they will be interested in.

They will want to take you off the spiro and do a blood test with no spiro in your system for at least two to three weeks to get a baseline as they don't use spiro, they use gozerelin typically as its better and they use cyproterone to control the initial T spike that it causes, but not spiro. I managed to get my GP to prescribe pre-GIC and with me, having stopped spiro some months ago, which I had been slowly reducing for the months previous, due to the links to breast bud fusing and limited breast growth, I have found that my T level is at nearly zero (0.1 ng/ml) with no blocker anyway, so... win. Three less tablets in my daily pot and no dehydration.

You should try and get your GP to prescribe as the guidance says they are allowed to prescribe 'bridging endocrine treatment' until the GIC take over. (I think its page 15 or 16 of the guidance).

I hope that you are still getting regular blood tests from your GP, regardless of how you are procuring your medication.

Thanks! That's a lot of useful info :D

I have been taking evidence of full time as I go, documents with name changes, e-mails to and from my work explaining the process and confirming start dates etc, so hopefully that will be adequate to back date my RLE then :)

I will question my GP over the bridging endocrine procedures, and if they would be willing to help in that regard. I was unaware that was an option! (Can you link me to a copy of these guidelines so I can investigate properly? I think all the info I have is taken from a patients perspective...) But my GP has been less than helpful so far, I have had to kick and scream just to get the basics taken care of >.>....so I am not particularly confident about it, but nothing ventured nothing gained :S

But yeah, I have been having to pay to get regular blood tests from a private specialist clinic in Edinburgh etc (Since my GP won't even do my blood tests -.-) It's annoying...but I have no desire to keel over from HRT failure ;)
You say "Using humor as a defence mechanism" like it's a BAD thing!



  •  

kira21 ♡♡♡

Your GP should at least pay for the blood tests, even if they are not prescribing :-/ its their job to look after your health. Have you asked a different GP at the surgery?

If they steadfastly refuse, ask for a referral to see the local hospitals endo. They should be able to do them for you and may also be another route into bridging endocrine treatment.

Have you looked into changing gender markers on documents already and changing name legally and then bills etc. Its all useful when establishing RLE. Plus I was so happy when all my new bank cards and passport came through.   I was sooooo happy and excited to collect  my new passport. I pass very well so I think the passport office people thought I was nuts when I went to collect it as I could hardly contain myself.

kira21 ♡♡♡

The document is here:
http://www.england.nhs.uk/wp-content/uploads/2013/10/int-gend-proto.pdf

Extract from page 16:
In most circumstances, the patient will have completed their GIC assessment prior to the
GIC physician making a recommendation for hormone therapy. Typically, this will be
around six months, but no less than 3 months, after the patient's first consultation.
However, the GIC physician, the patient's GP or another medical practitioner involved in
the patient's care may prescribe "bridging" endocrine treatments as part of a holding and
harm reduction strategy while the patient awaits specialised endocrinology or other gender
identity treatment and/or confirmation of hormone prescription elsewhere or from patient
records.

I said to my GP, that self medding could be harmful and it would be better for my health if I were on NHS prescriptions with regular blood tests. He agreed and boom.... done.


Danniella

Quote from: kira21 ♡♡♡ on June 20, 2014, 04:46:55 AM
Your GP should at least pay for the blood tests, even if they are not prescribing :-/ its their job to look after your health. Have you asked a different GP at the surgery?

If they steadfastly refuse, ask for a referral to see the local hospitals endo. They should be able to do them for you and may also be another route into bridging endocrine treatment.
They seemed steadfast that they would not do the tests if I was on any medication not prescribed by the NHS...very strange in my opinions...And since they would not prescribe me anything I was stuck between a rock and a hard place of paying £170-£200 every few months for private ones. :(

Quote from: kira21 ♡♡♡ on June 20, 2014, 04:46:55 AM
Have you looked into changing gender markers on documents already and changing name legally and then bills etc. Its all useful when establishing RLE. Plus I was so happy when all my new bank cards and passport came through.   I was sooooo happy and excited to collect  my new passport. I pass very well so I think the passport office people thought I was nuts when I went to collect it as I could hardly contain myself.
I'm in the process of this at the moment, I got my name change documentation through the post recently, so am now working to amend all my document. One of the few nice things my GP has done, is offer to take care of all my NHS records and switch the name and gender markers etc on them. It was a nice surprise :)

Although they did warn me that I would as a result get the odd automated letter asking me to arrange smear tests etc as a result x'D

Quote from: kira21 ♡♡♡ on June 20, 2014, 04:52:22 AM
The document is here:
http://www.england.nhs.uk/wp-content/uploads/2013/10/int-gend-proto.pdf

Extract from page 16:
In most circumstances, the patient will have completed their GIC assessment prior to the
GIC physician making a recommendation for hormone therapy. Typically, this will be
around six months, but no less than 3 months, after the patient's first consultation.
However, the GIC physician, the patient's GP or another medical practitioner involved in
the patient's care may prescribe "bridging" endocrine treatments as part of a holding and
harm reduction strategy while the patient awaits specialised endocrinology or other gender
identity treatment and/or confirmation of hormone prescription elsewhere or from patient
records.

I said to my GP, that self medding could be harmful and it would be better for my health if I were on NHS prescriptions with regular blood tests. He agreed and boom.... done.


Ah...I'm in Scotland...not sure if it is different here or not (I know the English system is pretty close to the Scottish one now though)
You say "Using humor as a defence mechanism" like it's a BAD thing!



  •  

kira21 ♡♡♡

Quote from: Danniella on June 20, 2014, 05:05:31 AM
They seemed steadfast that they would not do the tests if I was on any medication not prescribed by the NHS...very strange in my opinions...And since they would not prescribe me anything I was stuck between a rock and a hard place of paying £170-£200 every few months for private ones. :(

Get a referral to an endo. Perhaps you should ask him if he would like to be sued for not picking up on problems with your heath that have developed, whether they were caused by your previous actions or not. It's not like a person with complications caused by illicit drug use would be sent away with 'well you did it to yourself'.

Quote from: Danniella on June 20, 2014, 05:05:31 AM
I'm in the process of this at the moment, I got my name change documentation through the post recently, so am now working to amend all my document. One of the few nice things my GP has done, is offer to take care of all my NHS records and switch the name and gender markers etc on them. It was a nice surprise :)

Yes, that is a basic legal requirement, so don't think they were doing you any favours.  He should also write a letter to support your gender marker change in the passport and driving licence offices. Get that before you get pushy about the endo appointment and blood tests.

Quote from: Danniella on June 20, 2014, 05:05:31 AM
Although they did warn me that I would as a result get the odd automated letter asking me to arrange smear tests etc as a result x'D
Ah...I'm in Scotland...not sure if it is different here or not (I know the English system is pretty close to the Scottish one now though)

I get those letters. I have to admit I like it. :-) Maybe one day I will go along. lol.

The Scottish guidance was used as the basis for the english one. You will need to check it out:
http://www.sehd.scot.nhs.uk/mels/CEL2012_26.pdf


from what I see at a cursory glance it says:

"Criteria for the prescription of hormone therapy

The GIC must first ensure patients meet the following eligibility and readiness criteria as adapted
from the WPATH Standards of Care6
before taking the decision to refer the appropriate clinician
prescription of hormones.

The criteria for hormone therapy are as follows:
1. Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Aged at least 16 (see Appendix 5 for protocol details for children and adolescents aged
under 16)
4. If significant medical or mental health concerns are present, they must be reasonably well
controlled.

5
Ibid (page 26) 6
The World Professional Association for Transgender Health (WPATH) Standards of Care for the Health of
Transsexual, Transgender and Gender Nonconforming People, 7th Version, September 2011 (P 34-50),
http://www.wpath.org

The presence of co-existing mental health concerns does not necessarily preclude access to
feminising/masculinising hormones; rather, these concerns need to be managed prior to or
concurrent with treatment of gender dysphoria.

In selected circumstances, it can be acceptable practice to provide hormones to patients who have
not fulfilled these criteria. Examples include facilitating the provision of monitored therapy using
hormones of known quality as an alternative to illicit or unsupervised hormone use or to patients
who have already established themselves in their affirmed gender and who have a history of prior
hormone use.
"

Danniella

Quote from: kira21 ♡♡♡ on June 20, 2014, 05:19:06 AM
Get a referral to an endo. Perhaps you should ask him if he would like to be sued for not picking up on problems with your heath that have developed, whether they were caused by your previous actions or not. It's not like a person with complications caused by illicit drug use would be sent away with 'well you did it to yourself'.
That was the stance I took at the time...but still no dice -.-; They called a "Crisis meeting" and everything, got the head of the practice in and everything. I didn't know where I stood in my rights etc at the time so I just folded :S

Quote from: kira21 ♡♡♡ on June 20, 2014, 05:19:06 AM
Yes, that is a basic legal requirement, so don't think they were doing you any favours.  He should also write a letter to support your gender marker change in the passport and driving licence offices. Get that before you get pushy about the endo appointment and blood tests.
I though tI needed a Gender Recognition Certificate (thus 2 years RLE) before I could get them changed? o.O

Quote from: kira21 ♡♡♡ on June 20, 2014, 05:19:06 AM
I get those letters. I have to admit I like it. :-) Maybe one day I will go along. lol.
I think I will like them too xD

Quote from: kira21 ♡♡♡ on June 20, 2014, 05:19:06 AM
The Scottish guidance was used as the basis for the english one. You will need to check it out:

from what I see at a cursory glance it says: (Lots of good things that I totally copy and pasted into a document to ensure I don't lose it!: Danniella)
"
Yay! ammunition! Gearing up for another blazing GP assault now! :D
You say "Using humor as a defence mechanism" like it's a BAD thing!



  •  

kira21 ♡♡♡

I would go back and get more pushy if it were me.  In fact, I did and it worked.

I would ask them about the illicit drug question as they would treat an illicit drug user and would face the penalty if they sent *them* away and they developed problems, so perhaps ask them 'are you discriminating against me because I am trans', because they are. They should offer you a blood test.

Personally I would tell them you are talking to your solicitor about both issues, then ask for a copy of their complaints procedure . For the price of a blood test, they will probably fold I would guess.


Danniella

Quote from: kira21 ♡♡♡ on June 20, 2014, 05:37:23 AM
I would go back and get more pushy if it were me.  In fact, I did and it worked.

I would ask them about the illicit drug question as they would treat an illicit drug user and would face the penalty if they sent *them* away and they developed problems, so perhaps ask them 'are you discriminating against me because I am trans', because they are. They should offer you a blood test.

Personally I would tell them you are talking to your solicitor about both issues, then ask for a copy of their complaints procedure . For the price of a blood test, they will probably fold I would guess.
Mmhmm, I have next Thursday off anyway, so I shall charge forth into the GPs office in the morning and attempt to fight my corner more :D

I'm a damned sight more confident in myself since going full time, so I should hopefully get better results than past me who sat meekly in the GP's office unsure of anything and everything ^^

My question re:gender markers on the passports and drivers licence etc though still stands...they are next on my to-do-list...so if it IS possible to get the gender markers changed before like 2 years I would be over the moon! :D

Thank you so much, you have been so helpful! ^^
You say "Using humor as a defence mechanism" like it's a BAD thing!



  •  

kira21 ♡♡♡

Yes, letter from GP to say that your gender change is expected to be permanent... trip to the passport office and its done in a day if you plan it well and pay for passport on the day.

Same for DVLA but that needs posting.

Again, not completely sure about Scotland but I can't imagine it being much if at all different.

Danniella

Quote from: kira21 ♡♡♡ on June 20, 2014, 05:50:01 AM
Yes, letter from GP to say that your gender change is expected to be permanent... trip to the passport office and its done in a day if you plan it well and pay for passport on the day.

Same for DVLA but that needs posting.

Again, not completely sure about Scotland but I can't imagine it being much if at all different.
Wow :D

I will have quite the strange looks when I go to the passport office I imagine...

"Hello!, I'd like to change the name...address...photograph..oh yeah...and gender on my passport...why are you calling the fraud department?"
You say "Using humor as a defence mechanism" like it's a BAD thing!



  •  

kira21 ♡♡♡

You might think, but they didn't bat an eyelid when I did it. Seriously. I even said, I bet this is strange for you and she said, no not at all, and complimented me. I left feeling like I had won the lottery. Plus I had a trip booked so I got on a plane to Amsterdam the day after and used it for that. It was a good trip.

Danniella

Quote from: kira21 ♡♡♡ on June 20, 2014, 06:47:08 AM
You might think, but they didn't bat an eyelid when I did it. Seriously. I even said, I bet this is strange for you and she said, no not at all, and complimented me. I left feeling like I had won the lottery. Plus I had a trip booked so I got on a plane to Amsterdam the day after and used it for that. It was a good trip.
-squeeeeee- Okay so now I know what I am doing on my time off! I want a new passport so badly! :D

Thank you so much ^^'
You say "Using humor as a defence mechanism" like it's a BAD thing!



  •  

kira21 ♡♡♡