Susan's Place Transgender Resources

Newbie here! Five minutes in and I'm asking my first question ....

To all those going through the snail's pace of pre-transition within the NHS, I would love to know if its just me or does the frequency of Gatekeeping within gender clinics becoming more of a dire situation?

I have been through three clinical interviews over the past three years, eight sessions of psychotherapy which I must confess was great and very useful and attended every appointment asked of me ..... and still, no closer to starting my hormone therapy.

I'm at a loss.
Please help!

Jenny

Hi, IndigoSkye!

Welcome to Susan's Place.

I can't comment on GICs in the UK, since I live in Canada.  However, I do sympathize with frustrating wait times!  I hope you are able to move forward with HRT soon.

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eugh the wait times are obscene. The whole system seems to be utterly broken.

I'm still waiting to even speak to my gp and get a referral to the GIC, then I get the "fun" of this. *sigh*

Sadly, I think like a lot on the NHS, funding at least part of it privately might be helpful, if you can scrape the money together. Gendercare will do bridging hormones but it's an expensive proposition.

You have my sympathies, and a fellow Brit sitting here going "COME ON! I just want my sweet hormones already!"

Keep in mind the informed consent route is an option. It is affordable and HRT can work its magic until the public system catches up for you.

Kirsten.

Sent from my SM-G930F using Tapatalk

Quote from: IndigoSkye on April 22, 2019, 01:40:09 PM
Newbie here! Five minutes in and I'm asking my first question ....

To all those going through the snail's pace of pre-transition within the NHS, I would love to know if its just me or does the frequency of Gatekeeping within gender clinics becoming more of a dire situation?

I have been through three clinical interviews over the past three years, eight sessions of psychotherapy which I must confess was great and very useful and attended every appointment asked of me ..... and still, no closer to starting my hormone therapy.

I'm at a loss.
Please help!

Jenny

Hi Jenny,

Your GP should be able to refer you as soon as you see them. Or you can self-refer.  The waiting list where I am is currently at 2 years. I was referred in September last year, and I contacted the GIC last week about bridging hormones. They are going to discuss my case tomorrow, so I will let you know what the outcome is as soon as I hear something.

love
Alice

There are not enough facilities and specialists to cope with demand it seems. By now referrals are probably up 600 to 1000% in the UK to what they were in 2014.

Hello Jenny

I have great admiration for our NHS but it is simply not adequately funded for transgender care and as Kylo points out, the demand has increased dramatically over the last 5 years and anyone going on a GIC waiting list would likely not be seen till 2021. You may consider pursuing both the private and the NHS route simultaneously.

I am very happy with GenderGP who provided both therapy followed by HRT. After 3 months GenderGP arranged a "Shared Care Agreement" with my NHSGP such that my medication and Blood Tests are obtained free under the NHS. There has been no pressure to dress en femme but I have voluntarily decided (and definitely only because I wish to) to publicly transition in Summer.

There are many GenderGP threads here on Transgender Talk Board and HRT Board.

I wish you happiness and success whichever options you choose to employ.

Hugs

Pamela

Quote from: Kylo on April 22, 2019, 03:33:36 PM
There are not enough facilities and specialists to cope with demand it seems. By now referrals are probably up 600 to 1000% in the UK to what they were in 2014.

Hate to say and i may not be necessarily right, just merely making an assumption but..
Seems to be a trend where others have to follow others first rather than make their own decision in progression.
And many have married, had kids, done the male role, but only now choosing this path. The change in today's
society, becoming more tolerant and accepting has obviously helped however.  x
     

Clearly we are a rapidly increasing sector of the population. More of us are coming out of hiding; sadly some feel they must remain in hiding.

Hugs

Pamela

I feel like we're seeing more trans people because there's more information out there. Previously a great many of us never realised there was another path, a potential solution to the burden we'd carried and the confusing feelings we had. The internet is a wonderful thing in that it allows you to seek out information we 10 or 20 years ago simply did NOT have access to and suddenly people are seeing their own experiences reflected in others and realising "oh... oh THAT'S what it is!"

Sort of like the increase in cases of Austism is a direct result in society getting better at recognising it. It's unlikely there's actually that many more cases, it's just those cases that were previously overlooked at now getting actually diagnosed. I mean when I was a kid unless you were seriously disabled you were just "dumb" or "disruptive" and I spent most of my childhood actively being punished for my tics and meltdowns with zero understanding or compassion.
If I was born 20 years later, well, i'd have a diagnosis of ASD and support.

So i look at the increase in Transgender and gender related issues and I see a real similarity there with likely very similar reasons. Unstead of just shoving it down deep inside and living in that fog, people are seeking out a way to live as their true authentic self.
and the fact we're seeing so many suggests that this binary narrowly defined box of "male/female" simply isn't a realistic depiction of the human experience.

Of course I don't know the numbers but it'd be interesting to see how many referred to the GIC go on to actually have hormones or surgery and how many feel better after just speaking to someone who gets it and can help them understand themselves better.

What we're seeing is an NHS service that's woefully underfunded even by NHS standards. And it's underfunded because it's not seen as "important" (mental health care is one of the most ignored and dismissed aspects of health care in general).It hasn't been invested in as demand has grown and as a result it's struggling.
we don't have enough professionals able to speak to people and help them because no funding has been given to them as the years have gone by.

thing is, it's not JUST gender services suffering this. Mental health care hasn't had any money for decades either.
I remember when I had my youngest I was ASSURED i would get councilling to deal with the PTSD I suffered from with my previous birth (yes, actual genuine ptsd, nice). for months and months I kept asking because I was terrified and they kept saying "yes we've referred you, yes you'll speak to someone before the birth, it'll be fine!" but 6 months came, then 7, then 8... still no councilling. They had ONE person who specialised in birth trauma and she was overworked with too many referrals.
at 37 weeks my health had taken a dive and I was induced, without ever seeing anyone to speak about my fears, without any consideration of what i'd been through and how scared I was.
I was taken to the same hospital room, same bed as last time, same procedure and well, suffice to say, I ended up locked in a bathroom beating my head against a wall repeatedly.
Psych team were brought in and were all "well ffs, it's PTSD! Why did nobody speak to this person!?"

But that's sadly how the NHS IS with things that aren't specifically "medical". Gender care comes under mental health and as a result, no funding.

I'm not at all surprised the GIC is overworked, it sucks and it's dangerous for sure, but it's not surprising given how little attention certain areas of the NHS get and how ignored the NHS in general is.

I take exception to this narrative in some circles that the increase in trans cases is "because it's trendy" because lemme tell ya, there's nothing "cool" about losing friends and family, about potentially destroying your marriage, about being denied basic human rights like being able to pee in a damn bathroom without being attacked or screamed at. Who wants that?

In a way, it would be SO MUCH easier to have done all this early, before you had all that baggage. Before you had so much to lose. But sadly a great many of us didn't realise, explained things away with other things, lied to ourselves and kept up the act thinking we had no other choice and it was just "how life was".

Gendercare definitely needs a big shakeup. Maybe more therapists to discuss that intial thing, more support for the social transition side or just unravelling what your feeling. Make it a bit easier to access hormones (why can't the GP do that? they do other hormones. I mean my gp could give me feminising hrt so why can't she give me masculinising hrt? What's the difference? There's risks with both but for whatever reason it's AOK to give me estrogen with my consent but not testosterone? Even though my body naturally produces both and Estrogen nearly killed me? COME ON. I've seen the side effects of birth control on some people, like hair falling out, seisures, blood clots. But the GP is aok giving you that and not even monitoring it!)


The system no longer works for the demand. That's not the fault of the people accessing the GIC, anyone accessing the GIC is doing so because they feel they NEED to. The fault lies squarely with a system that's had no investment put into it and not evolved with a changing culture that's increasingly pushing against this outdated notion that humanity falls neatly into two narrow boxes and that chromosomes or genitalia somehow magically determine which box you fit into (which we're increasingly understanding simply isn't the case)

We'll always be a minority, but hopefully one day we won't be seen as abberations but rather just a natural variation.

I mean it wasn't that long ago people were trying to claim that homosexuality was a choice and a "trend" and people were only "becoming gay" because of peer pressure or for attention.

Having worked my way through the CX GIC process up to the point of getting my GRS referral, I'll raise these points:

- The initial wait for the first appointment is illegal and inexcusable, this isn't gatekeeping, just a reflection of both a lack of funding and poor management. A few private routes do exist,  and in reality aren't that expensive if you can find the money.

- Once in the process, it's built to most happily accommodate the more binary among us, and without other conflicting health issues, it simply follows the WPATH guidelines fairly well, and just flows through without much fuss. Yes it takes time, but that's for very good and justified reasons.

- If you're non-binary/queer it can get more complex, but I can't comment directly.

- Once you've done 12 months HRT and RLE, GRS referral (if you want it) is actually simple, and with very low (2-3 months) wait times, unless you need hair removal.

- The letter/summary from each appointment takes 8-10 weeks to be sent out. I have no idea why; may be they're waiting for the papermill to fell the tress, most frustrating!

The key to the entire process is to own it. Their role is to ensure that things like HRT or GRS are in the best interests of your overall health,  your role is not to assume either they or your GP are all-knowing on the subject, so be informed.

Megan. X

Sent from my MI 5s using Tapatalk

If you go private for the hormones you need to then get your doctor to perscribe right? can they do the monitoring or does gendercare INSIST you have to go back to them to have it assessed because the gp doesn't really know what they're looking at?

How often do you need that done?

If you go private, that doesn't influence your referral to the GIC right? so when you go in for that first appointment 2 years after getting on the dang waiting list, having been taking hormones all that time, does it change the pathways? I mean presumably you no longer need that second appointment to "okay you for hormones" because you're already on them right? So does it speed up the process at all?

I mean personally i'm hoping an IUS will help with the worst of my issues at least short term BUT if it doesn't, I really do need access to the HRT. And after 2 years that usually means a hysterectomy and such. Which presumably would be NHS funded (though i wonder if I can get it done outside the GIC because I have cystic ovaries which kinda should be taken out at some point anyway.. hmmmm... I might chat with my doctor about whether some of this can be done via a route that actually HAS funding)

I want top surgery too but I can wait on that, that isn't so urgant as it doesn't make me want to hurl myself off the roof on a regular basis like my hormones do. Eugh, they are just horrible.

I'm trying to figure out a breakdown of the costs involved in a private route while waiting for the GIC which would be those two initial appointments then the regular upkeep appointments IF my gp agreed to the shared care (I get blood hormone tests run pretty regularly anyway so that shouldn't be a problem, theoretically)
for 24 months... or longer, depending on what the GIC decided to do.

Has anyone actually gone via something like Gendercare and then into the GIC? What then happens? do the GIC just take over from there? Do they get funny about it? Are you kinda stuck doing the private endo things or will they switch over to their endo for your liver function and hormone tests?

Of course in my case I don't even know what my gp will say when I go in to speak to her next week. I'm hoping she'll be sympathetic to the issues i'm facing here. I cannot continue to live with estrogen poisoning me. I just can't.

But I need to carefully budget those funds for private.

Quote from: F_P_M on April 24, 2019, 10:01:39 AM
If you go private for the hormones you need to then get your doctor to perscribe right? can they do the monitoring or does gendercare INSIST you have to go back to them to have it assessed because the gp doesn't really know what they're looking at?

How often do you need that done?

If you go private, that doesn't influence your referral to the GIC right? so when you go in for that first appointment 2 years after getting on the dang waiting list, having been taking hormones all that time, does it change the pathways? I mean presumably you no longer need that second appointment to "okay you for hormones" because you're already on them right? So does it speed up the process at all?

I mean personally i'm hoping an IUS will help with the worst of my issues at least short term BUT if it doesn't, I really do need access to the HRT. And after 2 years that usually means a hysterectomy and such. Which presumably would be NHS funded (though i wonder if I can get it done outside the GIC because I have cystic ovaries which kinda should be taken out at some point anyway.. hmmmm... I might chat with my doctor about whether some of this can be done via a route that actually HAS funding)

I want top surgery too but I can wait on that, that isn't so urgant as it doesn't make me want to hurl myself off the roof on a regular basis like my hormones do. Eugh, they are just horrible.

I'm trying to figure out a breakdown of the costs involved in a private route while waiting for the GIC which would be those two initial appointments then the regular upkeep appointments IF my gp agreed to the shared care (I get blood hormone tests run pretty regularly anyway so that shouldn't be a problem, theoretically)
for 24 months... or longer, depending on what the GIC decided to do.

Has anyone actually gone via something like Gendercare and then into the GIC? What then happens? do the GIC just take over from there? Do they get funny about it? Are you kinda stuck doing the private endo things or will they switch over to their endo for your liver function and hormone tests?

Of course in my case I don't even know what my gp will say when I go in to speak to her next week. I'm hoping she'll be sympathetic to the issues i'm facing here. I cannot continue to live with estrogen poisoning me. I just can't.

But I need to carefully budget those funds for private.

-If you go private with a service like GenderGP, they will raise the prescriptions, and usually get them shipped to you direct via an online pharmacy. They can do the monitoring (at cost), but it's best to get your GP on board - mine was happy to to get the regular tests done for me, and I was fully open with them about what I was doing. Your GPs understanding will vary, unless you're in a tiny village, they may already have other trans clients.

-Going private has NO effect on NHS referrals to the GIC, it is illegal for them to treat you any different, and many people start HRT with a private service while they wait for the NHS to catch up. They can then swap over when practical. This saves time down the road as you've already met the 12-month HRT criteria required for GRS. i expect they will still run their own 2-stage assessment to get you on NHS funded HRT, that is their process....

-I'm not too up-to-speed on FTM HRT, but my understanding is that blockers aren't required(?), so only T is needed, I'm unsure on the cost of this though; Oral E is certainly cheap.

-I don't think the 12-month HRT rule is required for top surgery, but I may be wrong.

-The GIC does have one Endo, but they generally expect your doctor to monitor stuff, though will act as a source of assistance to the GP if needed. Monitoring should be run at 3-monthly intervals while any ramping up/down of HRT is happening, then 6/12 monthly when levels are stable.

I hope this helps, and if your GP is not helpful, then ask for another! They don't have to be experts but happy to learn and support you is important. Good luck. X

thanks for the help!

I've had a fair few endos in my life as I already have a hormonal disorder which makes HRT a little.. interesting (lowest dose possible by the sounds, and taking it from there)

Blockers aren't usually required with T no, it's just lovely pure T but in my case I produce VERY little estrogen anyway (yet it runs absolute chaos in my body, go figure) so it shouldn't theoretically take much to stop it and turn me into a wolfman hahah. (I'm actually serious, given how hairy I am as a woman, i'm totally gonna be a wolf man and it's gonna be SO funny)

I'm hoping my GP will be cool with it. I mean I like my GP, she's nice, which is why I waited longer to see HER and not the old stuffy man who seems to be scared of vaginas and won't discuss anything with me without looking half terrified and disgusted (Seriously wth man? Why are you scared of body parts you freaking wierdo? He almost lost it when I asked him to check on my scarring down there because it was hurting me and felt odd. No joke, he insisted I have a chaperone and then peeked out the corner of his eye and scurried away! Like dude, I know it's a mess down there but sheesh, it can't be THAT horrible!)

I dunno where my regular lady gp stands with trans stuff though. I mean I know my legal rights in that respect, but I don't know where SHE personally stands. I hope she's supportive and understanding, after all, she knows my history and she's done internals on me, she KNOWS how traumatic I find the whole thing. She also knows full well my body is broken and stupid and doesn't know how to do anything right. so hopefully she'll understand but i'm nervous.

I've researched till i'm sure i'm actually going mad.

But yeah, private looks like the only way to get hormones without a very long and very difficult wait.

The NHS is under pressure. No small amount of pressure is being put on it from cutbacks and that we have a large number of native elderly, and EU nationals and other immigrants that make use of the system. I cannot see things improving much under the current mode, something will have to give. I was informed last time I was at the GIC (for my final appt. before discharge) that more funding is being allocated to transgender care but how and when and whether that will make a dent if patient numbers keep climbing remains to be seen. I suspect that given the enormous waiting lists and number of patients waiting they will try to streamline the gatekeeping/diagnosis system in some shape or form. 

giving some power back to the gp might be a start to be fair...
Allow them to perscribe hormones. After all, gps USUALLY know their own patients.

But yeah, it's a mess and it's quite sad. I mean I love the NHS, they've saved my life on several occassions (quite literally, back in August I nearly died of sepsis) so I have a lot of time for it as a system but that doesn't mean I do't get quite angry at how inefficient it is and how poorly funded it is.
we deserve better, the staff deserve better, everyone deserves better.

Maybe if big companies and rich people paid their dang taxes we'd have the money. -_-

buuuut politics man... it's always a sore point.