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.
In the US so haven't a clue with the NHS , but good luck.
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.
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.
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)
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.
Quote from: Richenda on January 06, 2016, 04:16:45 AM
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.
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 :)
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.
Quote from: Richenda on January 07, 2016, 10:37:31 AM
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?".
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?
Quote from: Richenda on January 09, 2016, 07:03:43 AM
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
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.
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.
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.
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.
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."
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.
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.
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.
The only condition for getting into the pathway is a diagnosis, and you don't need to have any RLE under your belt for that.
Hormones, they generally prefer 6 months from my experience. They won't take proof that you've been self medding as proof of RLE. My GIC wanted proof from a place of work or study, or something similar.
At the end of the day guidelines are just guidelines and not protocol. Each GIC is slightly different in the way they go about things. I've got a few friends who have self medded and none of them were asked to stop, just made aware of the risks.
Hello everyone,
Well I had a fabulous consultation. First the bloods:
About 2 weeks ago I had a full suite taken: everything imaginable just to make sure I hadn't damaged myself by self-medication. All the results are 'excellent' to quote the consultant. I do run every day, so consider myself fairly fit (sub 3hour marathon runner) but that doesn't mean you can't damage, or even kill yourself, so I repeat what I'd said previously: I wouldn't recommend self-medication to anyone. Aldactone (Spiro) in particular gave me big trouble a year ago.
On the two key indicators:
Estrogen: 305 pg/mL
Testosterone: 14.5 nmoL
The estrogen is okay I think, and probably higher now as my dosage has risen by 40% since the bloods. The T level is a little high for MtF but that's not surprising given I'm only taken a low(ish) dosage of finasteride. What I would say is that my breasts are growing noticeably at the moment, including the last fortnight. It's also worth saying that I've only been back on regular meds for 2.5 months, and started with very low dose. I'm very pleased about the estrogen all things considered and he said the bloods do show my medication is working.
Anyway, the consultation was super duper. He has recommended me for transition, saying I fulfil all the criteria. Even better my second consultation is going to be later this week when I will meet with the prescribing consultant. I'm absolutely over the moon about this as that should have been another 1 year waiting list for the clinician in question. It's partly because of another cancellation which just came in. So, fingers crossed, there's a chance I might get prescribed this week. Even if I don't I'm well in the system for the NHS, including blood screening, and that can only be a good thing.
In terms of the consultation, I found it to be thoroughly professional as you would expect, non judgemental, accepting: but not in a rubber stamping way. The questions were good and appropriate. My responses fulfilled clinical criteria and hence the recommendation for full transition. Whoop :) Thank you so much for all the valuable advice. It helped me go back over paper trails and prepare myself for the sorts of things which might be asked. I was totally open and honest: 100% so, telling him everything about my past and I would certainly recommend this to anyone else in this position.
Congrats
Make sure you ask for decapeptyl or prostap. They are liquids. The other option (Zoladex) is a pellet and is more painful to get
Ok this has me worried, I have my my first GIC appointment coming up but curently I am not full time, nor out at work, nor had my name changed.
I thought the GIC might be able to help me getting on HRT and then I would come out after that and then go full time.
Don't get me wrong I know others may see this as backward but for me it is how I have planned to manage my transition.
How is this going to effect me with the NHS... I have this constant worry that they will rubber stamp me as NOT TRANS and kick me to the kurb.
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Quote from: Debstar on January 12, 2016, 01:53:23 AM
How is this going to effect me with the NHS... I have this constant worry that they will rubber stamp me as NOT TRANS and kick me to the kurb.
They will not "... kick you to the kerb" but your path through the system may be longer than Richenda's. The more you do for yourself the quicker you get through the system.
Quote from: Debstar on January 12, 2016, 01:53:23 AM
Ok this has me worried, I have my my first GIC appointment coming up but curently I am not full time, nor out at work, nor had my name changed.
I thought the GIC might be able to help me getting on HRT and then I would come out after that and then go full time.
Don't get me wrong I know others may see this as backward but for me it is how I have planned to manage my transition.
How is this going to effect me with the NHS... I have this constant worry that they will rubber stamp me as NOT TRANS and kick me to the kurb.
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Well depending on who you see or what GIC your going too will depend on how quick things can be, Charring cross is very slow as an example, it took me a long time to get there and had an appointment in November, my 2nd appointment is in May. Wherever you go your looking at 2 appointments for HRT.
What you are doing is not backwards, many people prefer HRT prior RLE, it makes sense really.
Tbh the way I think about it for if they have a solid reason as to class you as not trans because its not something they can really prove either way. Best way would explain the situation, thats all you can do really.
Hi Debstar,
First up, from one near-newbie to a new poster: welcome.
Second, I don't think you should feel at all discouraged, I really don't. So please please don't take that knock. From my experience yesterday, which picks up on something pyhxbp told me earlier in the thread, no-one is going to tell you you're not trans, at least I don't think that's the case. All that may happen is that the process may be slightly longer, but heck it's long under the NHS for all of us. I've lived for 47 years in the wrong physical body ;) (I knew when I was 4 when I used to put on my sister's underwear.)
Others on here, third, know far more than me about this, which is why I began the thread so I'm only just learning. FWIW, which may not be much, I agree with you in theory. I can definitely see a place for hormone treatment occurring as a precursor to so-called RLE. After all, stepping out as a woman in the UK before any treatment has begun is a brave thing to do. One of the reasons I didn't answer the question about where I was referred is that I didn't want to misquote any clinician but let's just say that your view is also shared amongst some professionals. The current guidelines can be perceived as rigid, so it probably depends on who you see and how they interpret them. My understanding is that there's a move to make them more flexible and, interestingly, the Gov't have this last week said they may look at whether gender binary thinking i.e. just male and female categories are appropriate or whether there needs to be recognition for transgender people who are either on a journey from one to the other or who wish to stick somewhere in the middle. Don't be discouraged: you're on the path and they will recognise that. Hugs xx
Thanks, yes I'm booked in to Nottingham. The advice was only that current wait times are 1 year for the first appointment.
I'm trying to be patient but it's getting hard.
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I've heard good things about Nottingham. You probably know the waiting list used to be about 6-7 months and is now, as you say, a year. So that's great if yours is coming up soon? Am I allowed to ask who you are seeing there?
I really think you will be fine. And at the end of the day only you know your true self and the dysphoria with which you live. The fact that you are taking this step and seeking treatment should be proof enough for an outsider. x
Quote from: Richenda on January 12, 2016, 10:23:16 AM
The current guidelines can be perceived as rigid, so it probably depends on who you see and how they interpret them. My understanding is that there's a move to make them more flexible and, interestingly, the Gov't have this last week said they may look at whether gender binary thinking i.e. just male and female categories are appropriate or whether there needs to be recognition for transgender people who are either on a journey from one to the other or who wish to stick somewhere in the middle. Don't be discouraged: you're on the path and they will recognise that. Hugs xx
Hi,
Yes I have read a story of another who transitioned in the 80's who said that ridged thinking was why many felt regret post SRS.
For me at this point while I want to fully transition, I suppose I can not know how I might feel after HRT and that may be enough.
An introduction to myself, I am a 39 year old genetic male who after some therapy has decided to stop avoiding the main reason I have been so unhappy my whole life.
Debs.
Debs.
Quote from: Debstar on January 12, 2016, 11:32:46 AM
Hi,
Yes I have read a story of another who transitioned in the 80's who said that ridged thinking was why many felt regret post SRS.
The 1980s were totally different. You cannot draw any conclusions about today based on the 1980s other than things are a lot better now than they were then.
I guess that's the problem. People responding to this thread may have transitioned in the 80's 90's. Sorry I am new here so do not know you or all your stories yet. None of the current guidelines I have read say turn up in a dress or else ;)
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Hi Debs,
That sounds really great about your transition and that's such a wise approach too. I think they will like that kind of honesty. Anyone who goes into it claiming 100% confidence is probably more likely to ring alarm bells. Actually, the current guidelines make that point.
I'm sure you're right about that rigid thinking in the 1980's. It was so interesting reading reviews of David Bowie yesterday. Although not someone who transitioned, he certainly helped pioneer re-thinking about gender stereotyping. What a pioneer.
Good luck with it all. Please keep me (us) posted on progress. I really wish you the very very best. You will be fine. Have confidence. Hugs x
Quote from: Debstar on January 12, 2016, 01:53:23 AM
Ok this has me worried, I have my my first GIC appointment coming up but curently I am not full time, nor out at work, nor had my name changed.
I thought the GIC might be able to help me getting on HRT and then I would come out after that and then go full time.
Don't get me wrong I know others may see this as backward but for me it is how I have planned to manage my transition.
How is this going to effect me with the NHS... I have this constant worry that they will rubber stamp me as NOT TRANS and kick me to the kurb.
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I had planned to manage my transition in the same as well, it didn't work out that way. They supported the diagnosis of gender dysphoria and acknowledged that I was progressing in my transition in other ways and that I was moving towards going full-time but felt that I wasn't ready to enter into the treatment programme, specifically because I hadn't legally changed my name or transitioned at work.
That's not good news Cheska! What did you do in the end? I thought the NHS guidelines specifically state that you don't need RLE to get onto HRT?!
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Quote from: Cheska on January 13, 2016, 02:33:35 PM
I had planned to manage my transition in the same as well, it didn't work out that way. They supported the diagnosis of gender dysphoria and acknowledged that I was progressing in my transition in other ways and that I was moving towards going full-time but felt that I wasn't ready to enter into the treatment programme, specifically because I hadn't legally changed my name or transitioned at work.
That does not sound good. What year did you do this?
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Quote from: byanyothername on January 13, 2016, 02:41:10 PM
That's not good news Cheska! What did you do in the end? I thought the NHS guidelines specifically state that you don't need RLE to get onto HRT?!
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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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Quote from: byanyothername on January 13, 2016, 02:41:10 PM
That's not good news Cheska! What did you do in the end? I thought the NHS guidelines specifically state that you don't need RLE to get onto HRT?!
It has been pretty demoralising. I've just continued how I was though, I'm in the process of changing my name already and everything else between now and my next appointment.
Quote from: Debstar on January 13, 2016, 02:52:21 PM
That does not sound good. What year did you do this?
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That was just a couple of months ago.
Quote from: Cheska on January 13, 2016, 03:27:42 PM
It has been pretty demoralising. I've just continued how I was though, I'm in the process of changing my name already and everything else between now and my next appointment.
That was just a couple of months ago.
Wow yes I bet. I really feel for you. But wonder also if they gave you any insight with respect to the protocols as to why they came to that conclusion? What clinic did you go to ? Also if it is not to personal me asking your age?
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Quote from: Debstar on January 13, 2016, 03:32:14 PM
Wow yes I bet. I really feel for you. But wonder also if they gave you any insight with respect to the protocols as to why they came to that conclusion? What clinic did you go to ? Also if it is not to personal me asking your age?
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Nottingham, 26. They didn't really say anything beyond that. They sent the same thing went back to my GP as well.
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.
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.
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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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
MPs are recommending a Root & Branch review.
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.
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.
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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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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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.
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.
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]
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.
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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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.
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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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? (https://picasaweb.google.com/115176379929031232329/January162016)
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.
Doesn't look as if the picture has loaded. I'll try a hyperlink:
https://picasaweb.google.com/115176379929031232329/January162016 (https://picasaweb.google.com/115176379929031232329/January162016)
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.
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.