Gender Identity Clinic Appointment: what to expect?

[Richenda]

Hi everyone,

I have my Gender Identity Clinic appointment next week following GP referral and I'm not really sure what to expect or what to look for / ask? How much can I seek under the NHS?

My transition is going happily at the moment. I seem to have settled on a workable pattern of meds.

Any advice will be gratefully received.

[stephaniec]

In the US so haven't a clue with the NHS , but good luck.

[Kayla88]

When I attended they asked about my past, how I felt back then, parents, when did I start wanting to be a girl.

If you have changed your name you could always ask for a letter from them so you can change your gender on your passport.

If you want surgery, you could ask how long is the queue, how much time they expect for you to be doing RLE before giving the letter.

You could ask about Hair removal options and voice training.

[Richenda]

Brilliant! Thank you.

I hadn't even thought of hair removal option under the NHS.

I've been considering an orchiectomy too so I'll ask about that and other surgery options.

[pyhxbp]

The things that you can request on the NHS are:

- HRT including GnRH analogues to block testosterone
- GRS. They will put it off until after you are settled on HRT but indicate your intentions
- Facial hair removal. They will funded a limited number of sessions. If your hair is dark go for laser
- Speech therapy. This can depend on your GIC

More difficult stuff is:

- Breast Augmentation is only funded if, after years of HRT, you have negligible boobage
- Counselling, this seems to vary depending on GIC
- Facial Feminisation Surgery is not funded

Generally speaking they like to see you being active in your transition usually via paper trails. So if you have changed your name by Deed Poll or Statutory Declaration then bring it with you and tell them. That will put a line in the sand that says "My transition started on this date" and they will then measure everything from that date. I changed my name a year before I went to the GIC and it made my life so much easier because I was deemed to have completed a year's RLE before I turned up.

If you go on GnRH analogues it will effectively be an orchiemtomy as these drugs basically chemically castrate you. Ask for Decapeptyl (Triptorelin), Prostap or Zoladex (Gosrelin)

[Richenda]

Wow that's fantastically helpful pyhxbp.

On the meds side I've been taking hormones and T-blockers on and off for 18 months. The 'off' is because I self med (I know, I know very very stupid) and had a few spin outs, mostly I think due to spiro. That's what propelled me to get seen properly. Having said that, I've had a very good few months (touch wood) on low dose progynova (estradiol validate) and finasteride. Breast growth is very obvious despite the sporadic nature of my treatment. It will be fantastic to have all this properly done though and your drug info is brilliant: thank you!!!!

By the way, yes I've had the full suite of bloods taken in advance although I believe there's one they couldn't do (DHT?).

The other info is also brilliant. Transition publicly has been made harder by having a public profile but there's a moment when I'm going to step out completely.

By the way, a surgical orchiectomy is something I'd love to have.

[pyhxbp]

By the way, a surgical orchiectomy is something I'd love to have.

I have never known anyone who got one of these on the NHS because everyone I know wanted full GRS.

[Richenda]

Hiya, rather than head into a different area I've posted up a separate topic on full GRS vs Orchiectomy here:
https://www.susans.org/forums/index.php/topic,202093.new.html#new

I'm going to compile a list with two columns of things I'm going to seek with some push, and others that I will just enquire about.

Yay. Can't wait

[Richenda]

Back on this thread rather than the orchiectomy one I began, I don't have the same kind of paper trail as you pyhxbp but I do have some paper trail e.g. visit to my Surgery a year ago. I've also got all the internet orders going back 18 months of my self med orders, which I repeat to anyone reading this is inadvisable.

[pyhxbp]

Back on this thread rather than the orchiectomy one I began, I don't have the same kind of paper trail as you pyhxbp but I do have some paper trail e.g. visit to my Surgery a year ago. I've also got all the internet orders going back 18 months of my self med orders, which I repeat to anyone reading this is inadvisable.

What they like to see is paper indicating that you are managing socially. To a GIC the RLE is all about paper. Have you changed your name? (Deed poll/Stat Dec). Have you bank statements in your new name? Payroll slips in your new name? Letters from the NHS in your new name, etc etc.

They like to see a continuous series of these. This is what RLE means in UK GICs because if you change all your "life paperwork" to a female identity then you are probably living as female, but no-one will pop round to check. How you live as female is more or less your concern. What they do with people who possess a gender neutral name like Alex or Chris I have no idea.

Take all your paper anyway and show it to them.

Having said all that, I always turned up in a skirt because I do not mind wearing one and I thought "Why not press all the buttons just to be sure?".

[Richenda]

Yeah I'm planning on arriving looking fem

That's interesting about the RLE aspect. I thought there's a bit of a backlash against that requirement in the latest guidelines? Aren't they more or less ditching RLE?

I've got proof of name change and documentary evidence of hormone treatment going back 16 months so hopefully that will enable the process to be ongoing?

[pyhxbp]

Yeah I'm planning on arriving looking fem

That's interesting about the RLE aspect. I thought there's a bit of a backlash against that requirement in the latest guidelines? Aren't they more or less ditching RLE?

I've got proof of name change and documentary evidence of hormone treatment going back 16 months so hopefully that will enable the process to be ongoing?

That should be fine. Insist that they peg the start of RLE to the name change date, that may shorten other things in the timetable. You might as well have a head start if you can.

Everybody jumps up and down about RLE. It is really an admin thing these days. I never cared about it since I was living as female before I went to the GIC. No hormones, nothing. Just an ugly woman ...

I have no idea what the current requirements are for RLE

[emma5410]

I am not sure what you have in terms of name change. There are two parts to it. A deed poll/statutory declaration is the first step but it is not proof in itself.  They will want to see some proof that you are using the name and living full time e.g. utility bills, official letters etc.
I do not think they will prescribe you hormones until they are convinced you are living full time but that may have changed with the new protocols. They probably will not on your first appointment anyway. They normally need two opinions before they assess you as trans.
The following are the new protocols.
https://www.engage.england.nhs.uk/consultation/specialised-services-consultation/user_uploads/gendr-ident-serv-spec.pdf

It does seem to allow orchidectomy.

[Richenda]

The name change issue is curious, as is the whole RLE thing (which is a bit of a nonsense in my view). You can legally change your name by writing it on a piece of loo paper as long as it's witnessed. To make it statutory requires a solicitor's signature but isn't any more legal than the aforementioned name change, it's just that some bodies require it although I'm not convinced they can legally insist on that. The one document you have to change is the Driving Licence but in my case that didn't apply because my new name happened to have the same initial and I'm a Doctor

I've got plenty of proofs re. use of name going back over a year anyway so that should be fine. There's a slight complication about having a writer's pseudonym but that's a long and boring discussion (for here).

Meds will be an interesting discussion. I'll let you know what happens because the reason I have been sped through this process is that my GP is very concerned about me continuing to self med, which I've been doing for c. 15 months: again there's a paper trail on that including a visit to my GP 9 months ago. If they're not prescribed tomorrow, or recommended to my GP to prescribe tomorrow, it will make no difference to me taking them: I'd rather kill myself than not transition. I won't quite put it like that but they will probably want to know

The funny thing about this whole process is that I don't need anyone else to tell me who I am. That's not meant to be arrogant: it's just a fact of the long life I lived inside a prison. Now I've been released I'm not going back inside.

[Kayla88]

If your GP is concerned about you self medding is he doing the blood tests to ensure your safety?
I know my GP was concerned to some degree but never bothered with doing blood tests as I already have tests for kidney and liver from my illness. I would have liked them doing hormone level checks though so I could adjust accordingly.

The name change and title change is important for them as it shows how far your willing to go, unfortunately these things are a requirement these days due to various issues.
I went full time prior to me self medding, which went down well actually with the therapist I saw, though he still wouldn't prescribe me pills as the rules require 2 people to sign off on it basically. I hate rules.

[Richenda]

Yes she took a full suite which is great because although I self-med I don't recommend doing that to anyone. What's also good is that two separate doctors and my GP have in the last six weeks approved my current level of medication and told me not to stop taking it. I'm on oestrogen and one T-blocker.

[Richenda]

Oh by the way the current guidelines do seem to include recommendation for ongoing hormone treatment in my case and various permutations: http://wlmht.nhs.uk/wp-content/uploads/2013/05/Gender-dysphoria-guide-for-GPs-and-other-healthcare-staff.pdf

It'll be interesting to see if that's the Dr's view

"Hormones
As a general rule, the prescription of exogenous hormones (oestrogens, androgens) is not endorsed until initial assessment is completed. This will take more than one appointment unless the individual is transferring from an appropriate child and adolescent or other gender service. In these cases, hormone treatment decisions may be managed in a shared care arrangement with the other gender service until the second appointment.
If the individual is already taking hormones (having been started by a private gender specialist or through self-medication), it is generally not stipulated that they stop altogether, although there is emerging evidence that self-medication can lead to a poorer outcome. The focus is rather on safe use of hormones, and blood investigations inform this. If someone is taking doses or combinations which represent a risk, they will be advised of this and appropriate guidance given.
Dependent on whether an individual has socially transitioned in the sense of living full time in their preferred gender role (or is felt by the specialist gender clinician to be likely to do so imminently), it may be reasonable to recommend that the GP prescribe exogenous hormones - oestrogen for trans women (Male-to-Female) and testosterone for trans men (Female-to-Male) - possibly in combination with a GnRH analogue. It is important to note that there is every indication that these are safe and effective treatments.
Before starting either, however, it is important to explore implications for fertility. This might include discussion of gamete storage. The GP is usually best placed to advise on local availability of gamete storage services."

[Squircle]

Which GIC are you going to?

As far as I know, most GICs will still insist on some RLE. A name change document won't be enough evidence of this on its own. You need more proof that you have been living full time. I took my deed poll, bank statements, bills, and a letter from my employer stating I'd been working as a woman from a certain date. I didn't need all of that in the end, they were happy with the deed poll, one bank statement and the letter from my employer. I had been full time for a total of seven months by the time of my first appointment.

My first session was basically a getting to know you. My coordinator asked about my background, both gender and family related. He also did a risk assessment to find out if I had any history of substance abuse, crime or violence, and to ascertain the likelihood of me hurting myself or anyone else. There is basically zero chance of you being prescribed hormones on your first visit, or even your second.

My second appointment was with both the coordinator and a psychiatrist. This was to get the diagnosis. I was then admitted onto the 'care pathway', and put on a waiting list for the hormone clinic (it took about three months).

My experience was that they didn't want to hold me up, and were keen to move me through the whole process as quickly as they could within the rules.

[Richenda]

Thanks for this. It'll be interesting to see what happens. RLE shouldn't be too much of an issue though. As I've said before above, there's a big paper trail going back 15 months incl the things you mention. It sounds as if the actual referrals will be more of an issue. Ho hum.

I think RLE is mainly stipulated for GRS not many of the other aspects of referral? I'm interested in you saying that about hormones because that's not what the guidelines actually say (see above). But you may very well be right: I shall continue to self-med if that's the case, but not from toys out the pram. Just reality.

[emma5410]

It used to be that they would not prescribe hormones until you have been full time for three months. I was self-medding for about a year when I saw a NHS endo privately in 2012. He was happy to prescribe but said he could not until I was full time. That is before the new protocols came in but I am not sure how widely they have been adopted.

I would definitely get regular blood tests if you are self medding. My GP was reluctant but I pushed the point and he agreed (or the other GPs in the practice persuaded him).

I went to CHX and the pysch, on my second appointment, prescribed hormones.  I was also discharged as I had been full time for almost two years and had my surgery booked privately. They said there was nothing further they could do then I had already done.