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Gender Identity Clinic Appointment: what to expect?

Started by Richenda, January 05, 2016, 04:01:31 PM

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Squircle

Quote from: Debstar on January 13, 2016, 02:55:27 PM
The guidelines do state that. Although I am still unclear about the interum protocol. It seems like because it is interum and not an adopted standard of care the individual clinics may adopt any position? Correct me if I am wrong please.

If that happened to be I would be self medicating or going private soon after.

Debs.

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The guidelines came into play before I started transition, and yet they wanted evidence of how long I'd been full time before they'd discuss referring me to the hormone clinic.

If you want to transition quickly, go full time before your first appointment. If you don't they won't  necessarily stop you going onto the care pathway but there will be more assessment appointments, and it will generally take longer. The view that I've heard is that the guidelines are all well and good, but ultimately they have to put their names on documents supporting your access to irreversible treatments, so they prefer to take their time for both their sake and the patients. That's the same reason my GP wouldn't prescribe bridging hormones; he basically said it was too big a risk for him as it was something he considered specialist knowledge.

I don't know the ins and outs of the law regarding informed consent. It's my view that if you sign something saying you understand the risks and the prescribing doctor is absolved of any liability, you should be able to proceed with only yourself to be held accountable. However, I do think that sometimes the time buffers the NHS put in place can be useful. I don't know the exact numbers but there are people who, once they've been full time for a while, decide it's not for them anymore. I have a friend in a different country who has never spent two concurrent days as a woman and yet is looking to proceed with an orchiectomy in few months time, which I think is frankly a little crazy. Plus there was the whole furore with Richard Curtis a while back, when he was accused of malpractice despite following WPATH guidelines.

Anyway, best of luck to anyone going through the NHS. It's been good to me, I wouldn't have been able to have had surgery without it, so I'm grateful and the doctors and professionals I met were all lovely people doing their best for their patients, working to difficult budgets with lots of different pressures on them.
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Richenda

Oh Cheska I'm so sorry. Now I'm slightly scared to hear that re. the Nottingham clinic. Am I allowed to ask which consultant you saw? I have an interest in asking.

It's really sad in my view that these guidelines can be interpreted so strictly by some clinicians. I understand that others read them slightly more flexibly. Some places apparently won't even speak about your blood results if you are self-medicating.

Insisting that someone lives as a woman before they are given any medical support for their physical attributes is like saying you must go to war first in order to train as a soldier.
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byanyothername

Thanks Squircle :-) lots of useful information there.

Unfortunately I can't go full time straightaway but have started hair removal and other aspects of transition in order to get myself to the point where I can go full time asap. My main problem lies in the fact that I've built a very successful career which will prevent me from presenting at work until I am seeing the effects of my hair removal, and HRT.

I don't feel like I should have to sacrifice my career for my transition and I just have to hope that my GIC agrees with me, as long as I am showing that progress is being made. The doctors obviously need to be sure that they have a stable individual on their hands who is serious about the changes they are making, so I do see where they are coming from (up to a point, anyway!)

Thanks again x


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Richenda

Well here you go: http://news.sky.com/video/1622159/transgender-models-experience

http://news.sky.com/story/1622257/nhs-failing-transgender-people-report-says


I wonder if things will change with this kind of criticism of the NHS system. The whole RLE requirement is quite peculiar. As I suggested earlier, it's like saying you must go to war first in order to train as a soldier
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Richenda

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Squircle

Quote from: Richenda on January 13, 2016, 11:32:18 PM
Well here you go: http://news.sky.com/video/1622159/transgender-models-experience

http://news.sky.com/story/1622257/nhs-failing-transgender-people-report-says


I wonder if things will change with this kind of criticism of the NHS system. The whole RLE requirement is quite peculiar. As I suggested earlier, it's like saying you must go to war first in order to train as a soldier

I do agree with a requirement for RLE before surgery, although not hormones.

My biggest issue with the NHS, besides the tales of GPs discrimination, is the waiting time for a first appointment, and the lack of support during that wait. That's where the damage is done in my opinion; it's what drives people to self prescribe, and puts people at risk of depression and suicide. It should be no more than 3 months really. I also wonder about some of the arbitrary allotment of treatment; why only eight sessions of hair removal for instance?

Going back to your analogy for a second, I agree, but I would say that a soldier only discovers the full reality of being in the military once they go to war, and I'd say the same is true of RLE.
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Squircle

Quote from: byanyothername on January 13, 2016, 05:37:55 PM
Thanks Squircle :-) lots of useful information there.

Unfortunately I can't go full time straightaway but have started hair removal and other aspects of transition in order to get myself to the point where I can go full time asap. My main problem lies in the fact that I've built a very successful career which will prevent me from presenting at work until I am seeing the effects of my hair removal, and HRT.

I don't feel like I should have to sacrifice my career for my transition and I just have to hope that my GIC agrees with me, as long as I am showing that progress is being made. The doctors obviously need to be sure that they have a stable individual on their hands who is serious about the changes they are making, so I do see where they are coming from (up to a point, anyway!)

Thanks again x


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Just to play devils advocate, the problem in your case actually lies with your employer, as it's illegal for them to discriminate against you for being trans. But thats ideal world/blue sky thinking.

Do you mind me asking what general sector you work in? Hopefully now they will relax some of their previous protocols and work with you to keep you moving forwards.
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byanyothername

I work for an IT consultancy, so my value to the company is being sold to businesses as an expert in my field.

My day rate is quite high and although I think my company will be supportive towards me, if I'm not in front of customers then I'm not earning them any money. My hope is that they will allow me to have a 4-6 week period when I go full time in order to adjust, but for my own sake I'd rather be approaching male fail when I get to that point. I have to run meetings and be in front of different people almost every day. 

To be honest I'm more worried about the customers than my own company. I'm scared that they will refuse me because I'm obviously trans...probably just being a scaredy cat really!


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Debstar

Not at all. I am also in IT and hold a managerial position in our relatively small company. Comming out at work is a big deal and somthing I am planning on leaving till the last moment before hormones make it impossible to hide.

I am dedicated to my job and am concerned as to how this will effect the interrelationships with members of staff. It's not as simple to say 'I am the boss of you like it or leave it' because at heart I am primary concerned with my staffs welfare on the job.

Sorry I realise this topic is going way off point.

As far as the gender clinics ate concerned I'm going to give them a shot but if I get no joy I'm going private.


Debs.


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Squircle

Well I wish you both the best of luck, but be prepared for having to go private at least for hormones.

If you do go private both Dr Curtis and Dr Lorimer are lovely people. They have more flexibility than the GICs and you can always go back to the NHS afterwards when you are full time if you are looking to have surgery. But then the GICs may have altered the way they do things in the last year or so, I don't know.
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Richenda

FWIW I don't have any issue with the evolution of the thread topic. RLE is such a constituent part of the GIC experience that it seems a really important discussion, so please feel free to continue it. I'm finding this fascinating, saddening and informing in equal measure.

I take the point about RLE prior to surgery, but bloody hell it's hard sometimes, as seen above. There's still a huge amount of transphobia in Britain. I'm mostly self-employed so it's intrinsically much easier for me than Debstar and Anyothername. A lot of friends have got in touch with me to say I'm 'brave' to have stepped out. I'm not a runway model but can look fair enough according to them (they're a bit nicer than that) but that's half the trouble to me: RLE can also play into a looks-obsessed view of gender. I'm not stating that it does, just that it can.
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Debstar

Quote from: Richenda on January 15, 2016, 12:59:08 AM
FWIW I don't have any issue with the evolution of the thread topic. RLE is such a constituent part of the GIC experience that it seems a really important discussion, so please feel free to continue it. I'm finding this fascinating, saddening and informing in equal measure.

I take the point about RLE prior to surgery, but bloody hell it's hard sometimes, as seen above. There's still a huge amount of transphobia in Britain. I'm mostly self-employed so it's intrinsically much easier for me than Debstar and Anyothername. A lot of friends have got in touch with me to say I'm 'brave' to have stepped out. I'm not a runway model but can look fair enough according to them (they're a bit nicer than that) but that's half the trouble to me: RLE can also play into a looks-obsessed view of gender. I'm not stating that it does, just that it can.
Yes, also that the NHS still to this day persists somthing of a binary view of GD. At this point and my age I really honestly can not say where I fit on the spectrum but everything I have read about the NHS is that they look at GD in males as only about becoming fully the most womanly woman one can become.
I want to proceed with caution while I figure out how far I want to go. In my mind now I want IT ALL. But that is coming from a dysphoric perspective and I may find that hormones are enough for me.

Does that mean I must don a mini skirt and hot pink lipstick for 365 days of the year to prove that to a phycologist. :) I will if I have to but it's not really me.

I am a product of my upbringing (male) and a part of me does not 100% hate who I am because that is not a positive way to view the past me. I want the body of a woman but also don't want to let go of sone of the steriotypes of a man in a have cultivated (I mean hobbies).

This view of the system perpetuates typical gender roles and I wish the feminists could get on board and we could be friends but I'll leave that topic as it is a little too hot at the moment.

This is not me but let's say a man just wants boobs and nothing else to change. Why should that be a problem? Clearly that hypothetical person would be doing so under the scrutiny of societal presure so could not be accused of doing it for a lark.

Edit: and I guess that is the test from the NHS perspective. How much social ridicule is this person prepared to withstand?

Also reading today that for hormones one must present clear, "documented" history of GD. How the hell would I go about getting documentary proof of that?

Debs


[Edit: Apologies that was heading towards rant teritory but if I get denied by the NHS I really do not know what I will do. This supposed 12 month wait is agony as it is now that I have had a breakthrough with my identity it seems so cruel that I can not proceed sooner rather than later]

[Edit : I mean if you presented to a GP with depresion they would not say 'oh let's wait a few years till your sure about it' ... yes I have been diagnosed with anxiety/depresion but all it took was informed concent to get an imidiate prescription for SSRI's, blow the side effects I needed them]
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Kayla88

Quote from: Richenda on January 15, 2016, 12:59:08 AM
FWIW I don't have any issue with the evolution of the thread topic. RLE is such a constituent part of the GIC experience that it seems a really important discussion, so please feel free to continue it. I'm finding this fascinating, saddening and informing in equal measure.

I take the point about RLE prior to surgery, but bloody hell it's hard sometimes, as seen above. There's still a huge amount of transphobia in Britain. I'm mostly self-employed so it's intrinsically much easier for me than Debstar and Anyothername. A lot of friends have got in touch with me to say I'm 'brave' to have stepped out. I'm not a runway model but can look fair enough according to them (they're a bit nicer than that) but that's half the trouble to me: RLE can also play into a looks-obsessed view of gender. I'm not stating that it does, just that it can.

I have only met 1 person who has been a bit transphobic during my 7 months so far which decided that what I was doing is a life style choice, lol. I don't know about other areas since mine seems relatively fine.

Quote from: Debstar on January 15, 2016, 02:05:15 PM
Yes, also that the NHS still to this day persists somthing of a binary view of GD. At this point and my age I really honestly can not say where I fit on the spectrum but everything I have read about the NHS is that they look at GD in males as only about becoming fully the most womanly woman one can become.
I want to proceed with caution while I figure out how far I want to go. In my mind now I want IT ALL. But that is coming from a dysphoric perspective and I may find that hormones are enough for me.

Does that mean I must don a mini skirt and hot pink lipstick for 365 days of the year to prove that to a phycologist. :) I will if I have to but it's not really me.

I am a product of my upbringing (male) and a part of me does not 100% hate who I am because that is not a positive way to view the past me. I want the body of a woman but also don't want to let go of sone of the steriotypes of a man in a have cultivated (I mean hobbies).

This view of the system perpetuates typical gender roles and I wish the feminists could get on board and we could be friends but I'll leave that topic as it is a little too hot at the moment.

This is not me but let's say a man just wants boobs and nothing else to change. Why should that be a problem? Clearly that hypothetical person would be doing so under the scrutiny of societal presure so could not be accused of doing it for a lark.

Edit: and I guess that is the test from the NHS perspective. How much social ridicule is this person prepared to withstand?

Also reading today that for hormones one must present clear, "documented" history of GD. How the hell would I go about getting documentary proof of that?

Debs


[Edit: Apologies that was heading towards rant teritory but if I get denied by the NHS I really do not know what I will do. This supposed 12 month wait is agony as it is now that I have had a breakthrough with my identity it seems so cruel that I can not proceed sooner rather than later]


No one is forced to have GRS. They made that fairly clear when I went to a seminar, you go as far as you want to go. If you are fine with your lower parts then that's that. The NHS would be more than fine with that I imagine as it saves them money since the operation is expensive, lol.

No you wont need to dress in a miniskirt and pink lipstick, lol, I saw people in jeans and things when I went there. In the olden days I can imagine you would have to though but these days therapists aren't that strict. Just wear whatever your comfortable with.

The fact that you have been referred there from GP or Therapist shows you already have documented history of GD, however you will require to have at least 2 visits to a Gender Clinic before you obtain hormones normally. That however varies. You see the therapist then he would when he feels your ready for them, they send you to the endocrinologist to get them.

It is very very unlikely that you will be denied through the NHS.





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Debstar



Quote from: Kayla88 on January 15, 2016, 02:37:53 PM
No one is forced to have GRS. They made that fairly clear when I went to a seminar, you go as far as you want to go.

Hi Kayla,

Sorry if my wording suggested that I was being forced to have GRS. I just meant in terms of this abstract concept of RLE. That's why I raised the hypothetical of a man that wanted boobs because 'his' RLE would be as a man being a man.

Thanks for your other comments based on your experience. I hope you can detect a degree of hopefully unwarranted fair in the tone of my posts.


Debs.

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Kayla88

Quote from: Debstar on January 15, 2016, 02:48:09 PM
Hi Kayla,

Sorry if my wording suggested that I was being forced to have GRS. I just meant in terms of this abstract concept of RLE. That's why I raised the hypothetical of a man that wanted boobs because 'his' RLE would be as a man being a man.

Thanks for your other comments based on your experience. I hope you can detect a degree of hopefully unwarranted fair in the tone of my posts.


Debs.

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That's my fault I sometimes don't think much, I am close to the stereotypical blonde though I'm not blonde, my bad.





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Debstar



Quote from: Kayla88 on January 15, 2016, 03:16:50 PM
That's my fault I sometimes don't think much, I am close to the stereotypical blonde though I'm not blonde, my bad.

No fault on your part. I'm as confused here as anyone else.

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Richenda

Such a great discussion! I love what you've both posted above and can see both being 'right,' not that you were arguing with each other. One of the questions I was asked yesterday was how often I look the way I did. Actually I'll pop up a picture. That was a selfie the day before and I did my makeup much better yesterday than this pic. I'm only putting this because it was something I was asked: do you always dress female?

The discussion was a good one. I came away wishing I had said more about hating my male-ness. For me though that's not the penis as such (I like cocks  :D) but everything about being male. As I've mentioned, I'd happily lop off my testicles tomorrow if I could.

I was questioned a lot about this whole area of social transitioning as per the above discussion. Although I had a fair amount of documentary proof, I didn't have a complete set of it so will need to tidy up some loose areas for my GIC#2 in about 2 months. That's me realising that, not what they said. I'm a non-medical doctor (PhD) and so my prefix hasn't changed. I was questioned on that, which I can understand, but I said I worked bloody hard for my doctorate and wasn't keen to drop it. I'd love to be called Ms though. There was also some discussion about places where I might feel less comfortable about female role and I suggested that both teaching in a school (which I do rarely) and taking my eight year old son to a football match are the two. I just felt it was better to be honest, but I also said that the teaching thing is because I've not yet had voice coaching. There was discussion about my passport which I haven't changed because it's so damned expensive and the guidelines do state clearly that you don't have to. This was queried but hey ho. I will change it just as soon as I get back from Thailand in March.

I was questioned about my name change which is Richard to Richenda. This is where I also agree with you Debstar. For me, and this is just my own view, I still see those years as part of my journey. The inner me, who has screamed out for a gender identity that's true, sees the old as part of that journey: not something I'm going to pretend never happened. Having said all that, I have always loved the name Richenda and about 25 years ago said to friends it's the name I'd take if I transition. The other thing is that all my friends call me Chen (which I asked), which I love love love and Chen is my Facebook profile. I had a print out of that which seemed to go down well, I guess because 'Chen' is worlds away from Richard. (There's a slight complication in that I have a published bestseller in my old name but that's something for another time.)

I was asked what I wanted from the NHS so, Kayla, I think you're spot on about that: they won't tell you what's on offer or push you to have something. It needs to come from us. Fortunately I'd done my prep on this, thanks largely to this forum and reading online, so said what I would like to have. I've effectively asked for the full works. That's because, the more this rather fast referral has happened, the more happy I feel about going through with the whole shebang.

I do agree with you, though, Debstar too very much about this. There's still a heavy binary mentality over gender in my view, which sits at odds with some other countries: Thailand being the obvious example. It's soooooooo much easier to 'RLE' there. Actually you can wear and be whatever you want so long as you don't harm anyone else.

Just occasionally in the UK you also encounter transitioners who are more evangelical than society at large: 'you're not a true this or that unless you have such and such.' I like the fact that this forum clearly states that there's no 'one size fits all' attitude. I really do understand the need for some MtF's and FtM's to be very clearcut about their new gender identity (and perhaps I will be same when it has finally happened), but the current setup does not, in my view, cater for a continuum between two polar extremes, nor for those on a journey.

I had lots of positives from yesterday. Some things I wish I'd said more on but never mind, I can do so next time. Other things went way better than I expected e.g. the hormones discussion. There were some very funny moments sharing stories from my past and I enjoyed flicking back my cardigan to show my natural boobs: I decided not to wear a bra for that reason.

I guess this discussion has made me realise that if you're to get through the recommendations under the NHS you have to step out and demonstrate you're stepping out. I've taken the plunge on this and am doing it. I'll tidy up some loose grey areas before the next appointment. So, in theory, it should be fine unless there's something else I'm not being told. But, and it's a big but, I'm far from convinced that the way the current guidelines exist are right for everyone. I suppose the problem is that if you offer transition as part of a personal experiment the system might be swamped by people trying it. I guess I understand that they have to avoid that. In my view though it would be neither difficult nor costly to offer hormone treatment before so-called full RLE. Waiting times for first referral are so long and the system so difficult that many people self-med, self harm or take their lives. It's an avoidable tragedy and one that must be stopped.

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Debstar

Quote from: Richenda on January 16, 2016, 03:33:26 AM
I was asked what I wanted from the NHS so, Kayla, I think you're spot on about that: they won't tell you what's on offer or push you to have something. It needs to come from us. Fortunately I'd done my prep on this, thanks largely to this forum and reading online, so said what I would like to have. I've effectively asked for the full works. That's because, the more this rather fast referral has happened, the more happy I feel about going through with the whole shebang.

Thanks Richenda so much for you detailed post, it give a real insight in to the process.

When I get my time I'm just going to be 100% honest and let the cards fall where they may, if I do not like the outcome I private is still an option for me.

Thanks again..

Debs.
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Squircle

Quote from: Richenda on January 16, 2016, 03:33:26 AM


I was asked what I wanted from the NHS so, Kayla, I think you're spot on about that: they won't tell you what's on offer or push you to have something. It needs to come from us. Fortunately I'd done my prep on this, thanks largely to this forum and reading online, so said what I would like to have. I've effectively asked for the full works. That's because, the more this rather fast referral has happened, the more happy I feel about going through with the whole shebang.

They will go through all of the options on the first appointment after you are properly admitted onto the care pathway. They will create a plan for you by going through a form that has all of the available treatments/support listed on it, and at the end they'll put that plan into action by making the relevant referrals.

I agree about the wait, it's the major downfall of the entire system. Once I got there though, I found the people at the GIC really helpful, and not even remotely like the evil gatekeepers some people make them out to be. And my coordinator at least had no interest in forcing people into any particular treatment or gender binary.

At the end of the day though they are hopelessly over subscribed and can only offer so many places on the care pathway at a time. Plus, as a publicly funded organisation they are held hugely accountable for everything they do.
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