Advice on Chatting to GP (UK based, or any)

[Peacebone]

So I've come out to my support worker at university about my gender. I currently ID as genderqueer/non binary/agender, though I'm increasingly wondering if I would feel better if I could access top surgery and maybe hormones (though the idea of hormones does kinda scare me). I find it really hard to explain... I'm not very good at articulating myself due to communication style.

I don't really know how to approach my Dr. I don't have a fixed GP, as I use my university surgery. Some GPs I've been to for mental health related stuff have been really dismissive (before I was diagnosed with bipolar, I went to a GP saying I thought I had it and he told me it was "fashionable"). Also, I'm 30 and wonder if I'll be considered too old...

I'm also not overly masculine in my presentation. I don't have issues with my body which make me feel suicidal (they did in the past though, or I'd drown my feelings with drink and drugs, but I'm currently not so bad), but I do have issues due to intimacy and relationships which I'm coming to realise are due to gender. 

So any advice on approaching a GP and getting them to refer me to a gender clinic would be awesome. How did you go about it? Have I left it too late at 30?

[Tysilio]

30 is definitely not too late -- I started transitioning about a year ago, at 61, I've been on T for 5-6 months, and it's going just fine. Slower than I'd like, of course, but... changes are happening faster now.

I can't really advise you about talking with a GP, as I began with therapy and went from there, but I think the main thing is just to be honest about your feelings, and to be clear that you're looking for a referral; anyone who'd deny you that would be acting irresponsibly. Are you able to make a one-time appointment with a specific person? If so, perhaps you could see someone you've seen before (for any reason), who treated you respectfully.

[FTMDiaries]

Hi, and welcome!

I'm in England too, and am currently transitioning on the NHS having started with my GP. I'm 42 and started transitioning at 40 after a lifetime of dysphoria, so you're definitely not too old to get started if it's something you want to do.

You're right that the correct place to start is with your GP. I recommend simply telling them that you're having trouble with your gender - and have done for many years - and that you want the GP to refer you to a Gender Clinic (GIC). There's one in Leeds and another in Sheffield if you're looking for somewhere close to home. Ask them to refer you direct: you don't need to go through the local CMHT for a psychiatric assessment any more.

Your doctor may ask you some general questions about why you think you have gender issues; they may even ask some impertinent questions about your love life and family. But they should refer you. And if they don't refer you, just book another appointment with a different GP until you get what you need.

The good news is: GICs don't push you to have any treatment you don't want. If you're unsure whether you want testosterone or surgery, they won't force you to have them. They'll work with you to help you figure out what you need to do to resolve your gender issues.

But the bad news is: waiting times are ridiculously long. You're looking at a wait of at least several months - or possibly more than a year - before you'll be seen. If you're desperate, there are private clinics in London that can help you, for around £200 per session.

Good luck!

[billiejane]

i saw my GP recently just to get a therapist or something to help me understand it, that was a couple months ago, and it looks like it will be a long wait. when i went in i just sorta blurted out that i have issues with my gender, and the guy just asked a couple questions and then said he would refer me to a specialist, which is the gic in exeter. when you go i suggest saying where you want to be referred as when i went, they didnt really know the protocol and you dont want to be sent somewhere else by mistake.

btw im 21 and really you cant find a more masculine guy if you had a million guys to pick from, which sucks, but didnt really change how he treated me, at least i didnt think so. in the end i went with a friend and was incredibly nervous, dont really think i could have stayed there without their support.


good luck with your appointment though

[Peacebone]

What questions do GPs typically ask?

I did go through a phase of trying to perform femininity (mostly to hide my sexuality and try to fit in) and it always felt wrong... I've only just started binding and yeah, gender totally has affected my love life, as I'm 30 and have only ever had one short relationship.

I guess I'm worried because of having a non-binary gender (I guess I refer to myself as a "boi"/genderqueer), I won't get taken seriously, so maybe I should say I'm a binary man? I'm also neurodiverse and going through autism services as well, so worried they may be dismissive due to that.

Yeah, referral wait in Leeds tends to be 1-2 years!

I'll book an appointment next week.

[FTMDiaries]

What questions do GPs typically ask?

Depends on the GP and their familiarity with trans* issues... but questions could include "What makes you think you have issues with your gender?"; "How long have you felt this way?"; "Are you sexually active?" and so on.

I did go through a phase of trying to perform femininity (mostly to hide my sexuality and try to fit in) and it always felt wrong... I've only just started binding and yeah, gender totally has affected my love life, as I'm 30 and have only ever had one short relationship.

Many of us go through 'girly' phases of trying to figure out how to live as a female. The clinics are used to hearing this and it won't invalidate you. It's also understandable if we haven't had the 'usual' amount of relationships, under the circumstances.

I guess I'm worried because of having a non-binary gender (I guess I refer to myself as a "boi"/genderqueer), I won't get taken seriously, so maybe I should say I'm a binary man? I'm also neurodiverse and going through autism services as well, so worried they may be dismissive due to that.

Don't worry too much about being non-binary at this stage. Your GP probably isn't an expert on gender dysphoria and doesn't need your entire life history, so the GIC will help you through this. They do treat non-binary patients. So perhaps your initial discussion with your GP might focus more on how you don't feel like a woman, and that you want the GIC to help you figure out what you do feel like? Then you can be more specific when you get to the GIC.

Oh, and I have Asperger's (as do quite a few people here at Susan's), so don't worry about them being dismissive. There is a strong correlation between ASDs and gender dysphoria so they shouldn't be surprised.

Yeah, referral wait in Leeds tends to be 1-2 years!

Yup. Awful, isn't it? There are other clinics where the wait is shorter, but I doubt you'd want to travel all the way to e.g. Exeter for your appointments. Here's a tip: it wouldn't hurt to ring both Leeds and Sheffield and ask them what their current waiting times are for new referrals. That way, you can make an informed decision when your GP asks where you want to be referred.

I'll book an appointment next week.

Best of luck! If it helps, I have a link somewhere to an NHS document informing GPs of what they need to do when a patient presents with gender dysphoria. I'll see if I can post a link over the weekend. It might help you to read through it and perhaps print it out for your GP, just in case they don't know what to do.

[Felix]

I'm not in England, but I just kept telling my doctor that I'm transgender, point blank and matter of fact, until he got uncomfortable and transferred me to someone with more experience with transgender healthcare. I had the benefit of not being in a hurry, so I was able to document my gender identity with my clinic for a year or so before I started transition. When I did ask for hormones, my physician asked me to get a letter from a mental health professional so we could follow WPATH guidelines, but she didn't go over the letter with a critical eye and she never had any questions about how masculine I am or who I sleep with. I was never asked by anyone to do my gender any differently than I'm comfortable with, and my age (29 when I started) was never mentioned. This is in Oregon. I was uninsured for some of it and had state insurance for some of it.

I think having an autism-spectrum diagnosis is very common for transmen and shouldn't hurt your credibility.

Good luck. I hope things in the UK are at least as good as my experience was.

[crowcrow223]

But the bad news is: waiting times are ridiculously long. You're looking at a wait of at least several months - or possibly more than a year - before you'll be seen. If you're desperate, there are private clinics in London that can help you, for around £200 per session.

I haven't waited that long to be honest, I know it differs but in my case, they first referred me to a local mental help centre, I think I've waited about 2-3 months for it, and then from then on, I've waited 3 months for my first appointment at GIC, and my next one is in four months' time since the first one. Not too bad.

Best of luck! If it helps, I have a link somewhere to an NHS document informing GPs of what they need to do when a patient presents with gender dysphoria. I'll see if I can post a link over the weekend. It might help you to read through it and perhaps print it out for your GP, just in case they don't know what to do.

Dunno if it's the one but there you go: http://www.england.nhs.uk/wp-content/uploads/2013/10/int-gend-proto.pdf

Don't feel pressured to say anything to your GP, they won't dismiss you because you're not "trans enough", they can only refer you somewhere, and can't do anything else

[FTMDiaries]

I haven't waited that long to be honest, I know it differs but in my case, they first referred me to a local mental help centre, I think I've waited about 2-3 months for it, and then from then on, I've waited 3 months for my first appointment at GIC, and my next one is in four months' time since the first one. Not too bad.

You were lucky, as was I (once I finally found the right clinic). However, all of the GICs have seen a huge surge in referrals over the past few years and this year has been particularly busy.

Dunno if it's the one but there you go: http://www.england.nhs.uk/wp-content/uploads/2013/10/int-gend-proto.pdf

Thanks crowcrow, that's very helpful and definitely worth a read. But the document I had in mind was this one, which is an internal document for GPs telling them how they're supposed to treat us. It's a good idea to read this so that you know what to ask for - and to take it with for the doctor because they might not have had a trans* patient before: http://www.nhs.uk/Livewell/Transhealth/Documents/gender-dysphoria-guide-for-gps-and-other-health-care-staff.pdf

There's also a link on the first page of that document that you might find useful: it goes to the NHS's resource page for trans* people, and has a lot of info on it.

Don't feel pressured to say anything to your GP, they won't dismiss you because you're not "trans enough", they can only refer you somewhere, and can't do anything else

^This. And also, please bear in mind that they can't refuse to refer you due to personal, cultural or religious beliefs (this is stated in that document I've linked).

[AdamMLP]

There's also a GIC in Nottingham. I don't know how close that is to you, just thinking of one's up north.

Everyone else pretty much covered it all. I just went and asked to be referred to a GIC, and said that I was trans. It was the first time I'd met him, so don't worry about not having a regular GP. You may have to push for them to get the protocol right, as some still believe you need a local mental health assessment first - you DON'T. If necessary suggest they call the GIC for clarification, that's what I had to do.

Good luck.

[crowcrow223]

You may have to push for them to get the protocol right, as some still believe you need a local mental health assessment first - you DON'T. If necessary suggest they call the GIC for clarification, that's what I had to do.

Oh really? Good to know I've just wasted few months of my life XD No, but seriously, it's important for others, so they wouldn't waste their time

[AdamMLP]

Oh really? Good to know I've just wasted few months of my life XD No, but seriously, it's important for others, so they wouldn't waste their time

I believe that hasn't been needed since August 2013 when the interim gender protocol was brought out.  My GP tried to sent me to CAMHS (I was under 18 at the time), and they pretty much told me to get lost because it wasn't needed, and by the time they found an appointment for me I'd be over 18 anyway.  I hope you're moving on now though.

[crowcrow223]

Thanks for your input!
Yeah, I'm moving on quite well, thank you got a proper HRT regime that's not as harmful as the previous one, looking to get couple of services funded by the NHS, my main objective would be to get tracheal shave on NHS, do you reckon it's gonna be a hassle? You seem to know a lot lol
Thanks boo!! xx

[AdamMLP]

Thanks for your input!
Yeah, I'm moving on quite well, thank you got a proper HRT regime that's not as harmful as the previous one, looking to get couple of services funded by the NHS, my main objective would be to get tracheal shave on NHS, do you reckon it's gonna be a hassle? You seem to know a lot lol
Thanks boo!! xx

That's great news.

I'm not so knowledgeable on services for female patients, but I think I remember watching a woman have one on the TV program "24 hours in A&E", so it seems possible. A quick read if the gender protocol http://issuu.com/bethseymour/docs/nhs_england_interim_gender_protocol/1 (page 12) but it seems like you need to discuss it with your GIC and it has to be put to the CCG (clinical commissioning group who replaced PCTs) for funding.

Perhaps someone on the girls side will know someone who has got it.