UK ?

[Zoe Louise Taylor]

Based on what they've said to me at Leeds, they do put a pretty big emphasis on living your 'preferred role' in full time education or work. I know that definitely applies to the criteria for RLE, so there's a chance they may say no, but I don't know for sure, I think every gic is slightly different in how they interpret guidelines.

I wouldnt mind coming out at my current job if I really needed to, I just feel I wouldnt be accepted at my current place :/ I feel I would maybe need alot of support from a councillor who is experienced in this sort of thing if I were to come out!! Xwould a gic help me with this? Xx

[Beverly]

I got reffered to porter brook clinic in sheffield in february,  and have my firat appointment on the 15th of December
....
I do have a quick question, will a gic in the uk prescribe hormones if im not currently out at work? I live the rest of my time as female,  but dont currently work as female, as Im afraid of losing my job :/ ive been frantically applying for new jobs, but I really feel id be bullied if I were to come out at my current place :/

I do not know anyone at Sheffield. I was initially referred there but the waiting list was beyond a joke at that point (3 to 5 YEARS) so I want to Charing from which I have now been discharged. I know about a dozen people at Leeds and what they have gone through.

Both Leeds and Charing put a big emphasis on RLE as do most GICs because they reckon that you need to be committed to transition to make a success of it and RLE is seen as commitment. As for getting bullied at work, you are not in the USA - here in the UK there are laws about discrimination and gender related violence. Your employer will come down hard on anyone who violates that. Also we seem to lack the bible-thumping crazies who make the life of american trans folk such a misery.

I've heard about clinics refusing to give treatment based on RLE and living in a preferred role however I also recall reading somewhere about this being classed as something like 'non-clinical delay' as the guidelines state it is not needed and can be challenged.

Look hun - if you are basing your hopes on that document then you are in for disappointment. Maybe they will do it differently for minors, but for adults that document and its "guidelines" mean very little. Maybe one day the medical establishment will change but right now they follow their own guidelines and the official ones are just sparkles and moonbeams. Nonetheless I come across trans people clinging to the "official guidelines" like a  magic talisman that will produce results for them and they all get so frustrated.

--

More people need to understand that hormones are not magic bullets - the changes they make are mostly internal, inside your head and no one can see those. That is why so many people on trans websites spend so much time under surgeon's knives for GRS and FFS, or getting hair restoration or having bristles killed off or having voice coaching, voice surgery, learning makeup, wardrobe, deportment and so on. Most of a transition is not hormone dependent, most of it is hard work and determination and sheer bl**dymindedness.

Hormones will produce some boobage and softer skin and a bit of fat redistribution and it will help but it maybe 15% - 20% of what will help. Just remember that in the UK your employer will not stand in your way and the police  take gender related crime seriously.

Compared to many places worldwide the UK is a good place to transition, but the real key to a good transition is to take control of it yourself and make sure that all the admin happens on time, that appointments are made on realistic timescales and that you have clear objectives about what you want and be prepared to work with the gender clinics whatever their requirements are. Being politley pushy is OK but being demanding or unreasonable  will just slow things down.

Before you go, get your name change sorted (takes less than an hour in any Magistrates' Court - cost £20) and get it changed on some utility bills or anything official and then take it with you because it shows you are willing to push forward. If you can (and I will get roasted for this) go in a skirt. I know it is not supposed to matter and maybe you will never want to wear one again but are you seriously telling me that you cannot do it for less than an hour to tick whatever silly boxes exist? Yes I know it is dumb, yes I know we should not have to do it, yes I know women wear trousers (heck - I wear them all the time) but if it cuts down the length of time you have to deal with GICs then surely it has to be worth it. I know people who took a "principled stand" over many of the points I have mentioned and their transitions are so slow and take years - mine took less than 18 months.

You can drive a lot of this forward by simply finding out what the GICs want you to do and then doing before they ask you to. It is amazing how much that speeds everything up.

[Squircle]

I wouldnt mind coming out at my current job if I really needed to, I just feel I wouldnt be accepted at my current place :/ I feel I would maybe need alot of support from a councillor who is experienced in this sort of thing if I were to come out!! Xwould a gic help me with this? Xx

Yes, they will give you support. I don't know what the provision is for actual counselling but the impression I got from Leeds is that they will help in any way they can. Because I was already working as a female they didn't elaborate on that area to me.

If you want to speed things up though, being full time at work will help a lot.

[speckyhailey]

Look hun - if you are basing your hopes on that document then you are in for disappointment. Maybe they will do it differently for minors, but for adults that document and its "guidelines" mean very little. Maybe one day the medical establishment will change but right now they follow their own guidelines and the official ones are just sparkles and moonbeams. Nonetheless I come across trans people clinging to the "official guidelines" like a  magic talisman that will produce results for them and they all get so frustrated.

Nevertheless, if they decide to go on their own guidelines, I will challenge it. The fact that a person has come to the point where they are seriously considering HRT and other treatment shows quite a commitment, especially for minors seen as they want you to go through a mental health service before they see you. If the NHS can make people wait for months, even years, just for an appointment, I'm not going to let them put me through further stress reorganising my life and trying to pass when I've not had any help towards it.

[Squircle]

If you can (and I will get roasted for this) go in a skirt. I know it is not supposed to matter and maybe you will never want to wear one again but are you seriously telling me that you cannot do it for less than an hour to tick whatever silly boxes exist? Yes I know it is dumb, yes I know we should not have to do it, yes I know women wear trousers (heck - I wear them all the time) but if it cuts down the length of time you have to deal with GICs then surely it has to be worth it. I know people who took a "principled stand" over many of the points I have mentioned and their transitions are so slow and take years - mine took less than 18 months.

The people at Leeds (the ones I've dealt with anyway) are young and open minded. I have never once gone in anything other than jeans and t shirt, but they put me straight through to the pathway and the hormone clinic, and I'm getting my first opinion for surgery in a few weeks. I see a lot of women in the waiting room who have taken the whole 'dress femininely' advice to heart and it doesn't do them any favours. I think you are better off wearing what makes you feel comfortable and being yourself.

[Squircle]

Nevertheless, if they decide to go on their own guidelines, I will challenge it. The fact that a person has come to the point where they are seriously considering HRT and other treatment shows quite a commitment, especially for minors seen as they want you to go through a mental health service before they see you. If the NHS can make people wait for months, even years, just for an appointment, I'm not going to let them put me through further stress reorganising my life and trying to pass when I've not had any help towards it.

My own experience of my gic is a long way from the torturous path full of old gatekeepers with old fashioned views of gender that I read about in forums. I think with you being young youll be fine. I think with some of the older patients they tend to be a lot more cautious.

Good luck anyway

[speckyhailey]

My own experience of my gic is a long way from the torturous path full of old gatekeepers with old fashioned views of gender that I read about in forums. I think with you being young youll be fine. I think with some of the older patients they tend to be a lot more cautious.

Good luck anyway

I don't know. I've had bad experiences with the NHS. They prevented me from playing sports for more than a year, and sports is a huge part of my life, basically due to their incompetence and long waiting times, as well as making me go halfway across the country to attend appointments that I didn't need to. Two years later I have only just received treatment for the injury and I've never received the physiotherapy I was promised at the start. I cannot bear to be forced into RLE before I am ready or to be forced to wait for treatment to take place because a GIC decides to do what it wants rather than follow the guidelines given by the NHS. I can't afford to go private so the NHS being decent about it is all I can hope for.

[Zoe Louise Taylor]

Yes, they will give you support. I don't know what the provision is for actual counselling but the impression I got from Leeds is that they will help in any way they can. Because I was already working as a female they didn't elaborate on that area to me.

If you want to speed things up though, being full time at work will help a lot.

Fab im willing to go along with whatever they require of me as long as I get help and support to do so having read through the document that the gic sent me, it does appear asthough there is a great deal of councilling and support groups! So thats good

Im just kinda hoping that I can find another job soonish, I think transitioning In such a masculine environment would be very tricky :/ I know there are laws against bullying in the workplace,  but I dont want to feel too alienated!! Xx

[Squircle]

I don't know. I've had bad experiences with the NHS. They prevented me from playing sports for more than a year, and sports is a huge part of my life, basically due to their incompetence and long waiting times, as well as making me go halfway across the country to attend appointments that I didn't need to. Two years later I have only just received treatment for the injury and I've never received the physiotherapy I was promised at the start. I cannot bear to be forced into RLE before I am ready or to be forced to wait for treatment to take place because a GIC decides to do what it wants rather than follow the guidelines given by the NHS. I can't afford to go private so the NHS being decent about it is all I can hope for.

Well that sounds bad, but treatment for injury isn't what I was referring to, I was talking about Leeds GIC. The guidelines you are talking about aren't the official opinion of the NHS, they are literally just guidelines and not many GICs follow them to the letter. I'd imagine a lot of this is to protect both themselves and the patient. I don't agree with everything they do but once I met some angry trans women I perhaps realised why they are less inclined to hand out hormones without any kind of commitment from the patient. There are some there I've spoken to who aren't full time, haven't come out to many people, and dress in the hyper feminine way I mentioned before, and they expect the Doctors to let them straight onto the books and hormones. My electrolysist works with the NHS and she says she's seen plenty of people who are demanding hormones with no commitment on their part, but when the hard work starts and the reality of how tough transition can be hits home, they drop out and go back to their male lives. I'm not saying that's you because I know nothing about you, but the GICs can only afford to treat so many people per year and so they like to make sure that those spots are going to the right people.

If you go along and say that you feel like you are making a commitment because you are 'seriously considering' hormones then they will want you to do just that - seriously consider it until you know that this is the right path for you. They will see you every month and there's a chance especially considering your age (I'm assuming you are 16ish?) that you might be able to get blockers or even bridging hormones, but they'll want to be convinced before they put you onto the care pathway because they only want people who are fully committed on that list. Again I'm not casting any aspersions on you or your situation because I don't know you. The guidelines are all well and good but then you get the actual funding levels that are available, then issues of liability etc.

The GICs are certainly not perfect and the NHS can be a nightmare at times but I still think it's better than the alternative, because there are people in other countries who can't transition because they can't afford to. My personal experience of the people working at Leeds is that they do genuinely care for their patients and are doing their best whilst dealing with meagre budgets and increasing demand.

[Squircle]

Fab im willing to go along with whatever they require of me as long as I get help and support to do so having read through the document that the gic sent me, it does appear asthough there is a great deal of councilling and support groups! So thats good

Im just kinda hoping that I can find another job soonish, I think transitioning In such a masculine environment would be very tricky :/ I know there are laws against bullying in the workplace,  but I dont want to feel too alienated!! Xx

Yeah I can't really preach because I work as an artist in a studio full of creative types, I would've found it much harder in a more masculine environment. You might be surprised by how people react though. And you look good which helps!

[Cat]

I think it's a fair point about the commitment.  I suspect my own case was helped enormously by the fact that I had unilaterally gone full-time prior to having my psych appointments, but it was easier for me to do that over the summer since I had time to adjust before going back to university this autumn.  If I'd been working instead, it might have been more difficult, depending on the work environment. 

The guidelines do take account of this, given their emphasis on being 'established in your acquired gender role' as one of the prerequisites for HRT. 

When I first came out, I was resentful of the idea of RLE full stop -- and especially prior to receiving any help in passing.  I was terrified of people seeing me as a 'man in women's clothes' and imagined all kinds of terrible situations arising from it.  Pretty soon I realised that I needed my transition to be as fast and as smooth as it could possibly be and I had to make a tough choice.  Did I stick to my guns on 'no attempting to pass until I get help' and risk not getting that help because I hadn't convinced them I was serious enough?  Or did I take the (incredibly tough) route of trying to live my life as the woman I knew I was inside, irrespective of anything else?  I'm glad I chose the latter.  Sure, it sucks going out and knowing you don't pass well, but it also makes you stronger (as a friend on here told me prior to my doing it).  And despite my fears, I didn't get any bad reactions from anyone.  Moreover, I felt empowered and in control of my situation (up to a point) and that helped ameliorate my dysphoria somewhat.  With the right clothes, hair & makeup, breastforms, etc., no one looked twice at me... although I found it impossible to talk at first (I'm only starting to get more confident with that now). 

Everyone feels differently, and everyone's circumstances are different.  I would never presume to say there's a right or wrong way of doing things.  There are all kinds of reasons why a person can't or won't come out, and in an ideal world, the assessments would take account of those factors and judge on a case-by-case basis whether those ought to slow progress toward HRT -- if it were truly felt that the person was unsure or unstable in their gender identity, for example -- or whether they represented an external block that ought not to stand in the way of treatment.  I do understand the resentment toward 'gatekeeping', but I guess I also understand why the NHS needs to be sure. 

The least I would hope for the future is that faster and wider access to HRT could be facilitated for those patients who clearly meet all the requisite criteria, however.  At present, it's too much of a lottery. 

[speckyhailey]

The NHS interim protocol states that there is no requirement for any social transition but that there must be persistent gender dysphoria. RLE is required for surgical procedures.

RLE is not very viable for me. I am heavily involved in the local rugby club, as player, referee and coach, and I am an instructor at a martial arts club. Being forced into RLE would greatly compromise these roles. Furthermore, despite there being many who would support me, there are also a large number of people at my school who wouldn't. As much as I want to start, there is too much at risk for RLE, in particular my A levels. I could start HRT and hide a years worth of physical changes quite easily and then begin full time when I start university. Surely it is better to allow someone to gradually ease into living as their preferred gender over a year's time rather than pushing them into an overnight change?

[Cat]

I agree with you.  I think it would be far better if the system were able to take such things into account. 

Sorry, the reference I made to being 'established in [one's] affirmed gender' is made specifically with regard to GPs prescribing bridging treatment; you're right to say it's not a blanket prerequisite for HRT according to the guidelines.  I can't comment on how the GICs are with that (i.e. how ready they are to prescribe when someone is unable to undertake RLE).  My anecdotal impression is that they're more reluctant than perhaps they ought to be, but I have no direct experience of that. 

As regards the GP situation, I feel that my GP would never have prescribed bridging treatment if I hadn't been full-time already.  Which, again, is not necessarily how it should be, but that's been my experience.

[Beverly]

The NHS interim protocol states that there is no requirement for any social transition but that there must be persistent gender dysphoria. RLE is required for surgical procedures.

It does not matter. The GICs have their own rules and that is what they will follow. If you yell and scream about it they will just say to go to some other GIC. It is their way or the highway.

RLE is not very viable for me. I am heavily involved in the local rugby club, as player, referee and coach, and I am an instructor at a martial arts club. Being forced into RLE would greatly compromise these roles.

So are you planning never to live as female? Or are you planning to give these activities up at some point anyway? Surely it is obvious that if you are going to keep doing these things and you are going to transition then at some point people will notice?

Once you go on hormones you will almost certainly lose physical strength, your metabolism will slow and you will tire more easily. Activities requiring physical strength will become much more difficult. There is no way round that.

Surely it is better to allow someone to gradually ease into living as their preferred gender over a year's time rather than pushing them into an overnight change?

Indeed. So why wait for doctors? Why not ease yourself into the change? Why not start making changes now? Start growing out your hair, start grooming yourself more, exfoliating, moisturising and so forth? Start practising your voice changes because voice is important. Start watching how women move and interact with each other. Transition is a long process because bodies change so slowly so you might as well get started now.

The doctors/GICs will not present you with a solution on a plate. We all have to figure out our own transitions. All the doctors do is watch for you going crazy or depressed and seeing that the medication is not killing you. Everything else is in your hands which is why they want to see that you are committed to the process.

[Seras]

Surely it is obvious that

there is too much at risk for RLE, in particular my A levels.

Which is a fair point.

[Zoe Louise Taylor]

I totally understand why they would want pepple to be full time before hormone treatment is prescribed, and as I said before I am willing and ready to take that step! Would the fact that I am actively seeking other employment in which I could attend work as female work in my favour in this regards? X

[speckyhailey]

As in ayhdrb, that I would enter RLE when I go to university. I will be giving up my roles in local places anyway and the benefit of them in terms of CV building are there. I will give up playing rugby next summer regardless as I cannot risk any injuries impacting my A levels but coaching and refereeing I will stick with. I will also have graded for 2nd Dan black belt by then, meaning I can go into a less physical, more instructing role at martial arts. The problem is I'm more than 1 1/2 years away from going to uni now and feeling like sh*t everyday. I am growing my hair out, I keep as clean shaven as possible, I'm gradually trying to act more feminine so as to ease everyone around me into it as well, I moisturize my skin anyway. The only stuff I'm not really doing is wearing make up and practicing my voice due to the fact that I have a largeish family that is often in the house, so anything I try to wear or speak like is noticed.

[Seras]

You not out to your family Hailey?

[speckyhailey]

You not out to your family Hailey?

I'm out to my parents. They are supportive but they just don't quite understand. My siblings are all younger than me and to be honest I don't want to come out to them until I need to.

[Seras]

Well that's really cool. You are already doing a lot better than me at that age, I was 22 before I didn't work up the courage and my mum made me tell her what was wrong! But you know in hindsight I wish I had come out at your age, and I wish more than anything I got HRT and all this stuff earlier. It has actually been really getting me down recently. You should think hard on what you think matters more to you. Playing rugby and all that or doing this.

If transitioning is something you really wanna do, the earlier the better, so long as you are ready.