Selective Mutism, Stuck in my transition

[Paradox]

Hello. I'm male to female transgendered, I'm in the UK, and I have a really big problem.
I'll also apologise in advance for this wall of text I'm about to write, I never know how to keep things brief. I always have to explain everything as well as I'm able to.

I've suffered with mutism for pretty much my whole life.
In my early childhood it was quite minor, probably not even noticeable most of the time. As I grew older though it became increasingly worse. By the time I was around age 13-14 I was at a stage where I would be considered to have Selective Mutism, although the actual diagnosis only came some years later. I have some other problems, like an overall anxiety disorder, Schizoid Personality Disorder, and some psychosis. Also last year I saw a psychologist who's convinced I'm autistic, and I agree with that assessment 100%. I'm currently on the waiting list for an official diagnosis for that.

With all that, I feel I should point out that it isn't entirely certain wether my mutism is a result of Selective Mutism, the autism, or something else. But regardless, I'm 26 now and over the years living with this issue while constantly being under the care of mental health teams, my mutism has only ever gotten worse and worse. My mutism is worse now than it has ever been in my whole life. I'm only able to speak to four people, all members of my family, and even to them it's very limited. I only speak when I feel I have to and again, it's very limited. Because of the combination of autism and Schizoid PD I'm not even able to 'fake' conversations as practice. I don't know how to do small talk, I never have. It makes absolutely no sense to me.

Anyway, onto my transition. I came out to my family around 8 months ago. I've started HRT privately through Dr Webberley (MyWebDoctor, GenderGP) and I'm four months into that. I've changed my name, I'm undergoing facial hair removal (also privately). That's all going well. The problem comes from the NHS side of things. I got a referral from my GP to see a psychosexual.. er.. person. Therapist maybe? I can't remember the title. She's a very nice woman and I definitely feel like she could help me, however she is unable to do so unless I speak..

She is absolutely adamant that a Gender Identity Clinic won't even entertain the idea of accepting me if I don't audibly speak to them. They'll just turn me away outright. Also no surgeon will consider operating on me if I can't audibly talk to them. She herself can't help me either unless I talk, and she's told me to postpone our next appointment until I'm able to speak to her. Well that was around 5 months ago and I've postponed it by a month 5 times. So I'm stuck. I absolutely need to be accepted into a Gender Identity Clinic because I certainly cannot afford Gender Correction Surgery privately, and even if I could, they apparently won't operate on me if I can't talk to them. I'm pretty sure I'm going to need facial surgery as well, rhinoplasty at least, and maybe I could afford that in a few years if I'm really really strict with saving money, but again, will they operate on me if I don't speak? She says they won't.

So I'm stuck. My mutism is worse than ever, I have no idea what to do. I can and will keep trying to get better with the help of my mental health team but after 12 years of trying and failing it's hard to see this problem being fixed, certainly not anytime soon.

My only real option right now is other forms of communication, like writing. But that also has some complications. And these complications would apply to audible speaking as well, were I able to do that some day. You might think from reading this stupidly long post that I'm perfectly capable of writing in a way that get's my point across adequately. But the thing is, I'm under no pressure writing this. When I'm in a doctor's office being asked questions, I'm horribly nervous. Words and sentences don't form in my head and I have to think for 5 minutes just to write a simple sentence.

Interesting timing, I just got a phone call from my mental health team who were checking up on me, asking how I'm doing. I use a service in the UK called Next Generation Text, which uses a relay assistant to mediate between me and the caller. The caller speaks to the assistant and the assistant types what they're saying for me to read, and I type back my reply and the assistant tells the caller what I said. Just that simple question asking how I'm doing was really difficult to answer, I had to think about it for a couple of minutes while the caller was probably wondering why I'm not saying anything. And eventually I just came up with "Hello. I'm struggling". (My mental health isn't good right now.)

Part of the problem aside from being nervous, is that with questions and queries about being transgendered, they're often if not always about how I'm feeling about things. Me and feelings aren't good friends. This is the autism and Schizoid PD coming into play. I have no gosh darn clue how to express feelings. I don't even feel complex feelings, at least not that I can explain. To me things are just good or bad, or maybe right in the middle. Explaining why I feel that transitioning into a female is the best thing for me, or explaining my feelings towards my genitalia, or anything like that is so so difficult. With questions like that I have to spend hours trying to find the right words to explain it. If I just used my own way of understanding emotions it would just be something like this:
"I feel bad about being male because it makes me sad, being female would make me happy. I do not like my genitalia because it's gross. I would be happy if I had female genitalia".
That doesn't really cut it in the GIC process. I have to be very specific and convincing, and express things passionately. But I don't know how to do that. At all.

When I went to see Dr Webberley about starting HRT it was the worst appointment I've ever had. She asked really vague and difficult questions and I just didn't know how to answer. I was just sitting there with my phone in my hand, wanting to type something to her that would answer her questions. I probably spent about 5 to 8 minutes on each question. At the end of the appointment she said that from what she's observed and from the answers I'd given she didn't feel that I really wanted to transition, and she couldn't prescribe me anything based on that. It was so crushing, I felt so bad I pretty much started planning my suicide right there and then.

She suggested that I write down my feelings as best as I could and email them to her. So I spent two days writing this big essay on my life and how I've felt about myself and my gender from very young up until this point in life. It was probably one of the hardest things I've ever done. But I did it, and thankfully it was enough to convince her. And the HRT started soon after.


So that's the story. As long as it was I probably still managed to miss things out..
Has anyone else struggled with any of this? Any help or advice? I'm really stuck and I don't know what to do.
Help

[Kylo]

I was like this as a kid, but never taken to see a doctor or anything to get it diagnosed. I would have called myself a "mute kid" for sure, and it was selective.

The good news is, you can completely kick its ass. Nobody would ever know these days that I ever had a problem; I can speak to anyone about anything and can probably out-talk anyone in a room. That's not to say I became an extrovert, I still tend to say nothing in social situations unless strangers approach me first and I can get a read on them. The roots of the problem was social anxiety and lack of social experience, which fed each other in a vicious cycle back in the day. My parents did not socialize me as a young kid so I never learned the basics of interaction with anyone but them and spent my school years disconnected from the other kids and most other people. It took about 6 or 7 years after leaving school and being thrown into an environment in which I had to look after myself entirely to finally get over it and gain the experience needed.

I specifically remember kids asking me things in school and having no idea how to respond in time. That was because I lacked the social skills to process the question without becoming anxious, and also to have an answer - not easy to do when you don't share their interests or do the same things as most of the other kids were doing after school. They would ask about a TV show or something my parents would never have let me watch anyway, and not only would I freeze up but I would have to say I didn't know what they were talking about anyway.

So I guess you need to identify what the problems are, and rationalize that the doctors are only there to help you. If you have problems speaking to people you don't know or trust, you could start by stressing to them you have this problem and for them to talk slower, arrange their questions with your condition in mind. They are there to help so I figure they will try to accommodate you. The way to get over this condition is to talk to more people and to face the unpredictable - and yes, to make a few mistakes along the way, trust me I've made a lot, but in the end, you will get there. It is literally a matter of practice makes perfect, and just remaining plugged into what is going on enough to understand what people are talking about. Your processing time does speed up the more you do it. These days, I'll be the first one in a room to process a joke's been made and laugh while others are still in the middle of "getting the joke" or the emotional state of someone talking, which is a significant improvement. And you can do it without help all by yourself if you want to, like me, although I am sure there must be services available to help you with this if you ask, and speech therapy and therapy for anxiety does exist.