Hey everyone,

I've recently come out to my parents about wanting to transition from FTM after experiencing gender dysphoria my whole life.
I'm unsure whether this is a rumour or not, but does taking T earlier in life result in quicker changes? I am 19.
I went to my doctor and she said she would refer me to the GIC in London, which is great.

My only concern is the waiting time before appointment comes through. Ideally I'd like to start T asap, but I know waiting times for GIC's can be long.
As this was done through my doctor, would making an appointment privately be any quicker/better in the long run with regards to prescription costs and starting the process quicker?

Primarily, I'd like to know whether I'm likely to go to the GIC before 2015 and start transitioning for a good few months before university - I want to postpone university until I can pass as male so I can be stealth.
I'm also curious as to the waiting time between appointments and the average amount of appointments before prescriptions for hormones can be made. After researching, I found sometimes people are prescribed hormones upon their second appointment; how common is this?

I'm interested to hear how other people coped with their RLE; I'm extremely introverted and I think without hormones to change my physical appearance and voice, transitioning pre-T will be difficult.

Sorry if this is long, I'm new to all of this and after accepting myself, this waiting game is excruciating. Any help with the transitioning process in the UK in general would be great, researching can only give you so much information, and personal experiences are always more helpful!

Thanks guys.

Charing Cross (CHX) GIC in London has a long waiting list.  We're talking about 8-9 months minimum here.  I don't know where you are in the country, but if there's anyway that you can get to another GIC (such as the Laurels (4 months wait) or Nottingham) I'd strongly advise going there over CHX if you wanted to stick to the NHS.  Your GP can refer you to any GIC in the country, not just CHX.

If you wanted to go private there's Gendercare and Transhealth, both in London.  They charge around £200+ for an initial appointment and £150ish after that.  If you agree to do shared care with your GP beforehand you will be able to get T on prescription (and pay the £7ish prescription fee for it) though.  The wait will be a lot shorter, but it depends on what your funds allow.

I'm waiting for my first appointment with the Laurels in Exeter, they normally do 3 appointments with a psychiatrist 6 weeks apart, and then around 2 appointments with the doctor before prescribing T.  I would think that it's very uncommon to be given hormones after just two appointments, they like to have 6 months RLE and know you before giving the go-ahead.

I can't really give much info on RLE as I'm going to be starting that on the 30th of this month, but if you've got any more questions feel free to ask!

My first visit to a gender specialist was in March 2010. I was then referred to the GIC in Nottingham and I began T in July of 2011. As I'd already changed my name in January of 2010 and had documentary proof of time being lived as male they accepted that as part of my RLE. My top surgery was in August 2012 and I'm now about to have my first stage phalloplasty all through the NHS

MY GP stalled for time a bit as i began my transition pre-18. Now I'm over that age, it seems to have gone VERY quickly. The initial consultation at CHX took about 4 months for me to come through so it wasn't as long as the 8-9 months you have been told. It is different for everyone i guess.
In terms of waiting times in between appointments, they aren't too bad and you will find that you achieve quite a lot at them (after your first one!)

Quote from: CJ on April 20, 2014, 04:14:48 AM
MY GP stalled for time a bit as i began my transition pre-18. Now I'm over that age, it seems to have gone VERY quickly. The initial consultation at CHX took about 4 months for me to come through so it wasn't as long as the 8-9 months you have been told. It is different for everyone i guess.
In terms of waiting times in between appointments, they aren't too bad and you will find that you achieve quite a lot at them (after your first one!)

How long ago was this? CHX ran out of funding last year and there's a massive backlog that they only started clearing when the new financial year began in April. It seems wrong to give false hope.

All these waiting times seem to me, I went to my GP in May last year and have only just found out I won't be seen at the Leeds GIC until DECEMBER!!!  I would kill to have waiting lists as short as you seem to have down south - 18 months to initial appointment

Luckily my GP has been quite understanding and has referred me to an endo at St James, so my next batch of hormones should be an actual prescription

Quote from: lxndr on April 19, 2014, 05:48:41 PM
They charge around £200+ for an initial appointment and £150ish after that.  If you agree to do shared care with your GP beforehand you will be able to get T on prescription (and pay the £7ish prescription fee for it) though.  The wait will be a lot shorter, but it depends on what your funds allow.

With regards to shared care how does this work? Would I have to have my first appointment at the GIC before discussing funding for hormones or is it something that can be agreed prior to starting everything?

Funding isn't an issue, but as other people have said the waiting times can vary which encouraged me to try things out with the NHS first, also seeing a local doctor first was more reassuring to me. I'm seeing my proper GP May 2nd and will ask him about any changes with my referral. If not, I think my parents want me to go privately to save time; does anybody know an average waiting list for appointments privately?

I'm in the Midlands but travel is something I can do - privately/on NHS are there particular clinics that are faster than others?
Do clinics talk you through surgery after starting T also or is that something you have to schedule yourself (i.e. appointments for top surgery).

Thanks for all of the informative responses everyone.

Quote from: qwlmp on April 20, 2014, 03:28:50 PM
With regards to shared care how does this work? Would I have to have my first appointment at the GIC before discussing funding for hormones or is it something that can be agreed prior to starting everything?

Shared care is something that you'll need to agree with your GP if you're going to go down the private route.  It isn't needed if you're going to a GIC via the NHS.  I'm not that knowledgeable about private stuff because it isn't really an option for me (I'm an apprentice and moving out on my own in a few months so don't have that much money to put down), but most people suggest setting that up with your GP before going to a private clinic.  It's basically an agreement with your GP that they'll listen to what your private doctor is saying and will work with them to prescribe hormones on their recommendation.  The private clinics can prescribe hormones themselves but that means that you'll have to pay the cost of them rather than just the NHS prescription charge, which is only about £7.

QuoteFunding isn't an issue, but as other people have said the waiting times can vary which encouraged me to try things out with the NHS first, also seeing a local doctor first was more reassuring to me. I'm seeing my proper GP May 2nd and will ask him about any changes with my referral. If not, I think my parents want me to go privately to save time; does anybody know an average waiting list for appointments privately?

Funding isn't an issue this year yet, but was last financial year with CHX, meaning that they couldn't take on anymore patients until April, so they've got 9+ months of backlog to clear first, which is why they've got a pretty long wait at the moment.  Waiting times on the NHS vary between GICs, I don't think they vary for different people between clinics (I have heard of one case where someone got seen by the Laurels quicker than everyone else, but I think that was due to them already being on T and not needing the psychotherapists appointments like the rest of us).

Privately there's only Gendercare and Transhealth that I know of, both of which are in London.  Gendercare is having some issues at the moment to do with his premises and whether they need to be licensed in a certain way or something.  That should be sorted reasonably quickly as far as I'm aware, but it means that they can't see any patients at the moment.  Transhealth quotes about 2 weeks on their website I think, but I don't know how accurate that is.  I'd have thought that you'd have been able to see them within a month though, but don't quote me on that.

Quote
I'm in the Midlands but travel is something I can do - privately/on NHS are there particular clinics that are faster than others?
Do clinics talk you through surgery after starting T also or is that something you have to schedule yourself (i.e. appointments for top surgery).

Would getting to Nottingham be feasible for you?  Apparently the waiting time there is around 6/7 months at the moment, but that's still shorter than CHX is currently.  I think the shortest one at the moment is the Laurels, but that's down in Exeter and is about a 4 month wait (I was referred 29th January and my initial appointment will be with 4th June).  If you're wanting anything to happen quickly and have the cash for it then private is the way to go.

GICs will talk to you about surgery around 6 months after starting T, arrange for funding to be put in place for the surgeon that you want to go to, and then it's either up to you to arrange the appointment or they do that as well, I'm not sure.  I only ever really hear about people going to Yelland, and he's a little different as he's a private surgeon who the NHS will send patients to or something similar.

Quote from: lxndr on April 20, 2014, 06:52:03 AM
How long ago was this? CHX ran out of funding last year and there's a massive backlog that they only started clearing when the new financial year began in April. It seems wrong to give false hope.

My first appointment was just under a year ago and had 2 more since then

I happened to come across the Nottinghamshire clinic website. From a brief glance, it looks quite informative.

http://www.nottinghamshirehealthcare.nhs.uk/our-services/local-services/specialist-services/prescribed-services/gender-clinic/what-we-do/

I think clinics vary widely, and even an individual clinic will change over time. The clinic that I go to (North East) was very quick when I first started, then had a time where it was over stretched, but now seems to be back on track.

Quote from: MaximmusFlavius on April 21, 2014, 08:14:56 AM
I happened to come across the Nottinghamshire clinic website. From a brief glance, it looks quite informative.

http://www.nottinghamshirehealthcare.nhs.uk/our-services/local-services/specialist-services/prescribed-services/gender-clinic/what-we-do/

I think clinics vary widely, and even an individual clinic will change over time. The clinic that I go to (North East) was very quick when I first started, then had a time where it was over stretched, but now seems to be back on track.

The timescales I've been mentioning are what others have said within the last month or so, and are likely to be right.

I was on the waiting list to see the Leeds GIC, and was told 6 weeks till my first appoinment. I continualy chased them up and was told the waiting list across the country was vast and I simply had to wait. After 18 months I gave up and went to the London Gender Clinic and was on hormones within 6 weeks.
The NHS is awesome but for in this particular section it sucks tbh.

So consensus from the Brits would be that it's probably better (easier?) to transition in the United States?

[Before I post this, if qwlmp is still looking at private stuff, Dr Lorimer has started practicing again, which means that GenderCare is back to normal.]
In my opinion there are pros and cons for both countries.]

Quote from: __________ on April 22, 2014, 09:01:10 PM
So consensus from the Brits would be that it's probably better (easier?) to transition in the United States?

In the States it seems that people have more control over when and how they transition.  You can go to a therapist in your own time, or even get T on an informed consent basis (which I love the idea of).  It's in your hands, but it does mean that you need the money for it, although from the sounds of it there are places which use a sliding scale and make T more accessible for people.  Here we have little control over the timescales, depending on where you are in the country and how far you can afford to travel it could take months or a year just to see someone at a GIC, unless you have the money to go private.

There is also the issue here, which is more of a problem for some people who can't pass without hormones, that they require you to do 6 months of RLE before considering you for T.  Even at the private clinics they prefer you to have done something towards socially transitioning, like changing your name.  If you don't pass that means being outed to almost everyone that you meet, which isn't something I'd be comfortable doing, but fortunately I seem to pass, even if it is as a thirteen year old boy.  Basically, you have to play their game and do things in the way that they want you to do it and there's not much you can do about that.  I'm jealous of Americans seemingly having more control over how and when they do things.

Going private here is something that I think a lot of the demographic would really struggle to do, and personally I wouldn't be able to lay that amount of money down on a regular basis.  It's good that it's there for the people who can afford it, but it's unfair that so many people are forced to paying for a service that they should be able to get free just because the NHS services are so over stretched in this area of healthcare.  We've already paid for it through our taxes, yet people are paying again to go privately.

But it is free - or as free as it can be while paying taxes - and that's something that you can't complain about.  Sure, the surgeons aren't always perfect, there's one or maybe two that I'd consider going to right now, and one of those isn't fully NHS, but it's something that I would have to be saving up for a lot longer than the year the NHS requires you to have been doing RLE for to afford it.  Bottom surgery is covered as well, and that's something that is seriously expensive, especially in the States where almost everything to do with healthcare seems ridiculously overinflated.
The NHS isn't perfect, but it does get you there in the end.  I'm happy that there's a service that's as good as free, but I just wish that it didn't take so long, they're so rigid, and that how it worked was better understood within the medical community.  Just today I heard about three cases of people struggling to get their GPs to write their referrals, and that's something that shouldn't happen, but unfortunately it does.  The right hand doesn't know what the left's doing and all that.

If you can afford it America seems great.  If you can't the UK will get you there... eventually.  A mixture of the two would be perfect.  I have to say that we do have the monopoly on socially transitioning though, I feel for all you guys every time someone mentions going to court to get their name changed, or putting out a newspaper ad.

Sorry for the essay, I'm procrastinating on sleeping.

Thanks for the detailed reply, lxndr.  Sounds like in the UK it's slow and steady, while here in the US it's far quicker but expensive (I pay for everything out of pocket because insurance companies generally don't cover transgender care - the religious nuts lobby the Republican party pretty hard to ensure that any treatments not in line with their narrow beliefs are excluded from insurance coverage; abortions, contraception, trans stuff etc.)

Sounds like the UK practitioners are still in the "gatekeeper" mindset, what with your regular family doctors unwilling to refer patients to clinics, then clinics requiring real life experiences (which are insane in my mind - why put someone in that situation before they can even have a chance at passing?).  Do you see this loosening up at all?  I remember reading that the UK guidelines have changed to the real life experience is not required anymore before hormones are prescribed, but it sounds like word hasn't reached the practitioners yet.

Quote from: __________ on April 23, 2014, 07:48:19 AM
Sounds like the UK practitioners are still in the "gatekeeper" mindset, what with your regular family doctors unwilling to refer patients to clinics, then clinics requiring real life experiences (which are insane in my mind - why put someone in that situation before they can even have a chance at passing?).  Do you see this loosening up at all?  I remember reading that the UK guidelines have changed to the real life experience is not required anymore before hormones are prescribed, but it sounds like word hasn't reached the practitioners yet.

I think it's less of our GPs being unwilling to refer us because we're trans, and more of them not knowing how to refer us and not having the time or impetus to go and find out, but that's not really a help knowing that when you're on the receiving end of it.  I say that because my GP willingly referred me to the local mental health services because in the old protocol you needed to be cleared by them first for any other issues which might present similar to gender dysphoria, but he was less willing to learn that he no longer needed to do that.  In his mind he was happy to leave me with the local mental health team not wanting me and not referring me on further, even though I showed him paperwork informing him that all he needed to do was write a letter.  Luckily my GIC was willing to talk to him on the phone and explain it all so he eventually referred me.

I've read the documents that say that RLE is no longer needed (or that "bridging endocrine treatment" can be provided), but I've never heard of it being put into practice.  I've got a feeling that it's more trans women who ask for it, I think I heard a woman on here talk about it once, but I'm not sure if she managed to get it or not.  I think it would be a struggle getting any of them to prescribe it, maybe more so with T as irreversible changes can start to happen very quickly.  By the time a guy got to see the GIC they could have a beard and male voice, the last thing they'd want to do would then be to say that they didn't feel they had gender dysphoria and force them to detransition.  I can imagine that's why it doesn't happen very often yet, even though it technically can.

Quote from: lxndr on April 23, 2014, 08:10:10 AM
I've read the documents that say that RLE is no longer needed (or that "bridging endocrine treatment" can be provided), but I've never heard of it being put into practice.

I took a copy of the new guidelines in to show my GP but the practice was unwilling to help, she was however willing to arrange a prescription with an endo at St James hospital.  I recently had this appointment and the endo is quite happy to arrange a hrt prescription for me as bridging treatment as I won't be seen by the GIC until December. 

It's taken quite a bit on fang-dangling to get to this point though, I've already been self medicating for a while and been full time since August.  I'm not sure what they would say to someone just at the beginning of their transition.

Quote from: lxndr on April 23, 2014, 08:10:10 AM
By the time a guy got to see the GIC they could have a beard and male voice, the last thing they'd want to do would then be to say that they didn't feel they had gender dysphoria and force them to detransition.  I can imagine that's why it doesn't happen very often yet, even though it technically can.

It wouldn't really be possible for a GIC to force someone to detransition, yes they are the  gatekeepers for physical transition on the NHS, but they can't tell you how to live your life and there are other private options for transition in the UK (which I would quite happily of used, if the UK wasn't so London-centric and there were private specialists here in the North)

Kaylee has hit the nail on the head, with the recent rule changes it is often best to print out the rules to show to GP's.
My surgery had no idea about transitioning before they met me, within a month or so the staff seemed quite well versed in the rules for transitioning & one particular GP has made it her mission to learn as much as possible to aid my transition.

There is still a serious kink in the sytem that needs to be ironed out but that is the fault of those deciding who gets funding & for what but it's not a problem with GP's or GIC's. I feel that within another year transitioning on the NHS will be much easier once the new rules are better understood but it may take the threat of a lawsuit to make the funding team pull their fingers out of their behinds.

Persistence pays off, it seems, with the NHS!  And I guess some thanks are in order too: because of all of your efforts to educate your own doctors, it'll be so much easier for any subsequent patients who walk through those same doors.

Quote from: __________ on April 22, 2014, 09:01:10 PM
So consensus from the Brits would be that it's probably better (easier?) to transition in the United States?

It can be. There are some informed consent clinics in the US (major cities) that can provide you all of your care at a fairly low cost. The wait lists aren't always that bad, and the way you're treated tends to be better than GIC. On the other side, when it comes to surgery, if you're in the US insurance rarely covers it (but some people are "in the know" and can find ways to get around it). In the UK I think there's only a certain number of surgeries performed per year regardless of demand. You also have stricter "rules" about who gets priority in those situations.

So...it all depends on your resources, and what you want/need.