Yes, It was really Dr Timmings. I was at work when my desk phone rang and the caller asked for Holly. He paused for a second and said 'Holly Fox'. I work in a IT company with 20,000+ employees in the UK and only 2 transwomen in the company know my new name in full so to hear a male voice asking for Holly completely caught me off-guard. My office has about 200 people in it, none of whom knows that I am transitioning, so it made our conversation a little awkward to start with so he eventually called me back on my personal mobile.

I did think the information on not needing T blockers was a bit strange, especially when he then seemed to contradict himself later on by telling me about some patients receiving T blocking injections costing thousands, which would be beyond most people's finances. He said that if I ended up having to get a private prescription then my order of priority would be Estradiol, Finasteride and then Spironolactone and also told me to finish the medication that I had and not simply stop. Reading between the lines I think he's just trying to reduce my health risks until the clinic takes over my medication because he said that they have had 3 near fatalities in the past 20 years due to the side-effects of the T blockers. People of my age are many more times at risk of heart attacks, heart failure, liver and kidney disease, or complete failure, blood clots, DVT and other nasties.

All the way through talking to me he was asking questions about my bloodwork, saying that he was unable to open the pdf attachment in my email. I think that he was really just testing me to see if I knew what I was talking about and I was able to answer all but one of his questions, which was what was my GFR level. This apparently is an artificial 'guess' at the efficiency of the kidney function. I do have slight kidney problems so it does make sense given my creatinine level. Maybe it was large amount of detail in my email to him that caught his attention and prompted him to call me.

Another area he covered was my appearance. He said that by now I would now have quite obvious facial changes, which were not so obvious to adults but would cause a reaction with toddlers and very young children. I haven't really notice much difference myself and neither has my 6-year-old granddaughter but I do seem to get toddlers looking at me and smiling, and this did happen in the doctor's waiting room on Monday morning. At work some people have said that I appear to be looking younger and at home my partner told me that I'm acting more like a 15-year-old girl! She's being sarcastic because she says that I don't act my age. She'll do some gardening and I'll be watching Glastonbury. She'll watch Jeremy Kyle and I'll be at the gym. She'll watch the grandkids at the park and I'll be on the rides with them!

My triathlon suit should be arriving today so I'll finally be able to go swimming again after 15 years.

See you soon.

Thanks so much for the update Holly :-) I'm noticing some very subtle changes in my face (although it's only been a month and a bit) and my Mum said I look different.

It is scary going through the risks of self medication because GPs are unwilling/untrained to help, and GICs are so back logged. Luckily I'm young and in good shape, although I did smoke for a long time. I still need to be very careful.

It will be over a year from sending my referral letter to getting through my second opinion appointment, and it will likely take 3-6 months after that to get my prescription. I do t blame GICs but it is frustrating.

It's really lovely to be seeing changes in how I look and feel. I could never go back to having testosterone in my system now!


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Holly

Is your GP a lost cause or just lost? 

The GMC guidelines for GP's tells them to contact the GIC's for help with bridging HRT rather than just rely on others in their trust who have no better idea.

http://www.gmc-uk.org/guidance/ethical_guidance/28851.asp

The guide also has a link to GP online training for gender variance.

http://elearning.rcgp.org.uk/course/info.php?popup=0&id=169

So if he is willing to learn and try then there are resources out there he can use,  not so useful if he's an ostrich with his head in the sand though! 

Glad your both getting on well with the meds,  some changes here too, boobies are defiantly a bit tender and subtle changes in the face, not sure how much of that is laser or HRT but i see her more in the mirror without extreme thicknesses of make-up.  My make-up remover wipe use is now down to only one and even that isn't saturated orange when done!!

I'm having a bit of a full time trial at the moment as I'm on vacation and have been Lisa full time for three weeks while here and its a massive confidence boost, even been going to the beach in my tankini and cute swim skirt, got to loose that weight though for the real bikini experience.  I'll admit make-up three times a day is a bit of a chore but getting it down to manageable time spent now and not really having any problems out and about, everyone has been real nice and keep calling us ladies and we get weird questions about splitting the restaurant check which we never did as a hetro couple or even when we have travelled with my dad.  I joke with her that they probably think I'm paying her to take me out lol

Anyway i hear the beach calling....

Slightly off-topic, but I was wondering whether anyone will be going to Pride in London next Saturday?

Got a call from the clinic at 9:45 this morning on my work desk phone. "We've had a cancellation. Can you come and see us at 11:30?" A frantic rush from Birmingham to Daventry and I'm now sat in the waiting room ready to meet Dr Timings. Absolutely incredible!

Hope it goes well Holly!

Did you just call the gender clinic and ask to be on a cancellation list or something?


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Emily, My exact wording on the email was "I will take any cancelled, short notice or same day appointment, just give me about 90 minutes to get to you".

Like everyone else has said he is a very nice man and calls you by your new name like you've always had it.

We started off by going through my blood work, which he was happy about and I pressed him further about his comments about not needing T blockers. How he described it was that they would initially prescribe Androgen blockers to get the T level down to a low value. Mine is at 0.3 nome/L, which in his own works is pretty non-existent. He said that now I have been at that level for a while the Estradiol would effectively continue to suppress T and that I would now only need a monthly injection, of androgen blocker which would later become every 3 months. This is also something my GP can administer so no need for a clinic appointment.

Next came the family history and the details of my referral. We didn't dwell on that long because there was not much to question me about since I had written my own referral.

Then came the part he could see I was apprehensive about, the physical examination. As he put on his rubber gloves he asked me why I was nervous. I told him that I was worried where he was going to stick his finger! He said that he didn't need to do a prostate examination but I would have to strip off to underwear. He then examined my feet and pushed and prodded all over. Before he got his stethoscope out. He found a hear beat, which is always a reassuring sign, but it was in the wrong place (on my right). I asked him if I was actually a time-Lord with 2 hearts but disappointingly it was just the body cavities throwing the sound. He wasn't able to hear some heart valve momement, which completely dumbfounded him and said that this had only ever happened to him once in 20 years. I now need to have angiogram and spirometers tests because of a family history of heart disease. Despite my health crashing down in December to a point where I couldn't walk more than a few steps, he says that I'm now in very good shape and that I have very strong legs, and would make a goody rugby player. What he giveth he taketh away! Now the really embarrassing bits. Checked my breast development and was quite surprised how advanced they were and told me that I really needed to tell all my work colleagues now because it was only the excess fat that was hiding both my facial and body changes and as that as disappears it will be impossible to hide. Then he asked me how large my testicles were. I didn't really have an answer to that, except 'not as big as they used to be'. I was then expecting the worst but instead he handed me what looked like a necklace with elongated beads. "Top end of the scale or bottom end?". At least all I had to do was point. Apparently my hips have also grown quite a bit, but I haven't noticed that myself.

He weighed me and measured my height saying that it was just a myth that you can shrink when taking hormones and doesn't actually happen. He then calculated the probability of death by taking hormones as you are then 20x more at risk. Fortunately as I have good blood and my health is improving all the time the risk for me is very small, so he will start me 'officially' on hormone treatment. At this point he handed me a few sheets of A4 for me to read through and send back. These are consent forms with an explanation of the treatment and asking you not to blame the clinic if you die. I wasn't able to sign there because they enforce a 4 week 'cooling-off' period, so in less than 6 weeks I should getting my first legal prescription and my first injection of Androgen blockers. At the same time I should be able to book my first laser hair removal - the NHS gives you 800 pounds of credit for this so I'll be off to SKN in Birmingham ASAP.

Hope this helps anyone wanting to know what's in store for them.

Thanks for the write up Holly, some good info about what happens in the physical. I still have that to come as he didn't have a chaperone on the day I saw him so I get a double appointment in Aug for Dr T to look at my bod and Dr K to look at my head!

Sounds like your skipping along on fast track now!  Congratulation for getting one foot on the step to HRT.  Do you mind if I ask if you have done your name change yet,  Are they letting you on HRT without it?

On the subject of T blockers, it sounds as if he is being a bit accurate and we are all a bit layman's in our wording.   From what he described he is putting you on is the standard NHS GnRHa implant to kill the T which is a monthly or three monthly injection.  Its effect is to over stimulate the pituitary gland which controls hormone levels.  Doing this ultimately causes the production of testosterone to stop.   

On the other hand Spiro and Cypro act to block the receptors and Fin stops the conversion to DHT, so are blockers whereas the GnRHa is more of a stopper so there is nothing to block.

Something to be aware of is that when starting GnRHa it causes a spike in testosterone during the over stimulation phase so you need to be on a blocker for the first couple of weeks or hold on for a wild ride, so make sure your GP prescribes a couple of weeks of Cypro at the same time.

The GnRHa implants are quite expensive and need a nurse to do them which is why no one self meds with them, they are also pretty much only really used by the NHS.

Lisa, thank you for the information about the injection. I hadn't really looked into that side because I thought that you were offered a choice and I would choose tablets, so that was never part of my research. Thanks to you I now know better and can start to understand them.

I am still living under my old name and still present myself as male. Unlike you and Emily I do not look remotely female yet, despite what Dr Timmings says, so my body transition is likely to take 2 years before I'm happy that I have changed enough to present as female. I say 2 years but at the rate Dr Timmings says that I'm changing it could be much sooner. I'm not one of those people who can just dress up, go out and not care about what anyone else thinks. I will be running with a duel identity for a year or two and will receive my prescription under my old name.

I got my official letter from Dr Timmings to my GP this morning and it basically tells my GP to provide a bridging description of Estradiol and Finasteride. Spironolactone is being dropped. As this letter was based on a 30 minute phone conversation with Dr Timmings on Thursday I expect that a second letter wil arrive shortly now that I have now had my appointment. This is the first official document that I have received addresses to: old name (Holly Fox) and the first time that anyone has written about me using 'she' and 'her'. I have to admit that part of me is a bit scared and very excited at the same time. Seeing it all in black & white has really brought home that everything I have ever known is changing for real and nothing will ever be the same again. It's like the film 'When World Collide'. You leave behind everything you have ever known and embrace the unknown. Just like the end of the film, the future is bright and exciting and I just can't wait to get there.

Mode Edit:Dosage

Just a few little odds and ends that I've remembered about the physical examination. Let's start with the knees. First they will get tapped by a rubber hammer with and without clenched teeth to test your reactions, the soles of your feet will be quickly brushed by the pole size of the hammer for your reaction (I nearly jumped off the couch!). Next part is with a tuning fork. This will be tapped and placed on each knee to see if you can feel the vibration. One side of the fork I then warmed and you will be asked to close your eyes and say whether your legs are being touched by the warm of cold side. Then you will be asked to hold out your arms and he will then gently pull at your fingers and ask you to close your eyes before getting you to touch your nose with a pointed finger from each hand. Your eyes will also be examined with a lit magnifying tool (can't remember the actual name) so that he can look at the blood vessels in the back of your eye. Another eye test was spacial awareness. Look at a cross on the wall while he puts his fingers in each corner of your field of view and you tell him when he is waggling his fingers. You will do this separately for each eye. Finally came the cough test where he puts his fingers on the edge of the pubic area and gets you to cough. I understand that this is to check for hernias but I believe that an addition test of coughing while pressing below the sack and possible a scan is done in the lead up to SRS, a few years down the line. You will also get your blood pressure measured.

If I remember any really significant I'll make another post but I think that's about it. NOT looking forward to the psychiatric interview whenever that's going to happen. I had enough trouble with voices in my head for years before taking Estradiol and I don't need someone rattling the cage to see if anything is going to happen. My other self also agrees. DAMN! Who said that? 

I could really do with trying to get myself on this fast track! With my current rate of progress I can't see myself getting on prescribed HRT until next year!

Thank you Lisa and Holly for all the information, it's all very useful to have! I've got myself booked in for my first blood tests now so that's something!


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Emily,
Just keep pushing hard. I pretty much bombarded the clinic with every detail I had; drugs, dosage, blood results, my interpretation, what levels I was working to, how I arrived at that conclusion and why I had varied the dosage of some drugs based historical data, some of which went back 3 years before I started my medication. Example, my Potassium level has been increasing over the past 3 years without any drugs, well before I started medicating. I did not have this fact until 2 weeks ago until went through the historical data with my GP. Knowing this now allowed me to make a judgement call and reduce the level of one drug to lessen the overall risk. My potassium has never been outside the normal range, but it was appraching the top end of normal. Dr Timmings confirmed that this is exactly what he would have done in both approach and action. I think this just shows that specialist love detail!

How are you contacting them? Via email?


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Emily

Everything was done via email to the standard email address (genderclinic@nhft.nhs.uk) and replied to by Gian (pronounced Jan) Seamark, Gender Clinic Nurse Manager. He passed on my 2 page email, plus updates to Dr Timmings once he was back from paternity leave. That's what prompted the initial phone call. Don't attach anything to any emails you send as this gets stripped out automatically by their email system

Thank you so much Holly :-)


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Looking back through my posts I don't seem to have properly acknowledged Lisa's help so I want to make a point now of saying thank you Lisa for everything that you've done to help me.

I've now scanned the forms that I got from the clinic on Friday, one is the consent for Oestragen treatment and the other is about registering for laser hair removal and a list of approved places. If anyone reading this thread would like a pdf copy please send me a personal message.

Dr Timmings also reccomended a support website, which has never come up on any of my Google searches and said that the section 'Knowledge is Power' is particularly useful: http://genderedintelligence.co.uk

Holly x

FRUSTRATION!

I finally got round to calling SKN this morning for a consultation about laser hair removal. They told me that they wouldn't even see me without confirmation from the NHS that my treatment would be paid for. The guidelines I got from Dr Timmings basically say that you have a consultation first, then the provider comes up with a treatment cost and emails the quote to NHS England, where they wait for funding confirmation before treament starts.

Why persist with SKN? Reccomendations from two of my trans friends about how your treated, looked after during treatment and after care support. The fact that SKN run promotions of up to 40% off (when they had extra stuff done under private bookings) had nothing to do with their judgement!

Emailed Dr Timmings and just waiting for a reply. Let you know when I hear back.

Holly x

That sounds rather frustrating Holly, a bit of a catch 22.  I need to go through the same process to start electrolysis but i think i will probably self fund a session or two the be sure i am happy with the practitioner before asking the NHS for funding, My theory being its going to be hard enough to set up so I don't want to change it if I don't get on with the person doing it.  Now thinking it may also help if i am already a patient, it may make them more interested in keeping me by doing the NHS bit.   But then at the rate I am moving on setting something up I may be at the end of my enforced laser hiatus anyway and may just get another round or two of light beams.

Glad you got the HRT without the name change, i'm in the same boat as you, i need some of their effects before i can go full time.  Yeah i just did three weeks but the make-up was still more than i hope to need in the long run and the stewardess on our flight home made it clear i haven't reached male fail from the front yet as she quickly backtracked from hello ladies when she saw me from the front!  Was super nice the rest of the flight though even if she did keep reinforcing Sir and MR ....If only i had just a tiny bit more courage to fly pretty, maybe next time!

Oh and sorry for not posting sooner in response to your special acknowledgement, can I claim jet lag?  But don't worry about it, we're all in this together and all sharing valuable info.  What to expect in the physical and that you didn't need name change for HRT has been super reassuring to me, thanks

Hi everyone,

Another milestone reached today. Had my appointment with my GP this morning to discuss my meds. He printed out a letter from the clinic where Dr Timmings discusses my medication. It shows very clearly that my GP got very confused quoting my dosage with what effect it had on my horemone levels, again not understanding. Dr Timmings politely pointed out to the GP that in order to get those results from my blood I couldn't posibly have been taking that particular dosage. Anyway, it came down to my GP asking me what he should prescribe for me, at what dosage and for how long. I told him that funding for my injections had to be secured from NHS England and that the clinic estimated around 6 weeks. He then printed out a 3 month prescription. He asked me if I needed anything else and I told him that I would need a 10 band ECG every 6 months starting this month and the rseults sent to the clinic, so back to the surgery on Monday morning for this.

I then went to visit a friend of mine in Coventry I hadn't seen for a long time, but had been keeping up to date with me on Facebook and told face to face that I am transitioning. She didn't flinch and told me that one of her dance students, who is now 11, is also transgender. Fortunately her birth name is Charlie so that'll make things a bit easier. Big hugs then followed, which I seem to be getting everywhere now and I'm enjoying every one of them!

On the way home I when to the chemist with my prescription. The GP told me to speak directly to the pharmacist in a private room away from the other staff, so when I arrived I asked for the pharmacist and spoke to her in front of  the staff and showed her the letter my GP had given me earlier, which she read every word. I told her that I didn't care if the staff knew but she told me that 'they don't need to know' and dealt with me personally.

As you've probably guessed I'm done with hiding who I am.

Holly x