Gender identity clinics

So the waiting list for the NHS was essentially that there was no, no contact between the point of getting the letter to say your referral has been received, to the point of receiving a letter to say your first appointment will be on this day. In those two and a, two years and a bit there was, there was no contact whatsoever. And I guess it kind of left me at moments sort of sitting there, sometimes I’d be like, okay, it’s, I knew it was going to take over two years, the process is slow, the letter will come eventually. As soon as it hit the two-year mark that was when I started to panic. Every sort of day that passed, or maybe my, maybe my names slipped off the list somehow, and how do I know if I’m still, how do I know that I’m still moving towards it? Should I ring them? Can I ring them? You know and I, it may just be me but the, the outward sense I get from the clinics is that they, you know, they, they’re short on resources, they’re short on time, they don’t want people ringing up all the time to say, When’s my appointment going to be? Do you know yet So, I was very shy in thinking okay maybe I should, you know just ring and just check that I’m still on the list somewhere, that it’s still moving. So I never actually did that.

But in, yeah in the first two years, I didn’t really think much about that at all, it was only once it got over that, past that two year mark, because my initial letter had said, In excess of two years so I thought well it could be any day now. So it was, it was in that period that I was sort of worrying like, oh you know, cos I think it was probably about two years and three or four months before I got the letter, so in those three or four months I was, that was when the panic sort of set in. But I, yeah I guess, I guess for me it’s, the, my thoughts around that are just that there is nothing you know even if it’s just a letter to say that halfway through or something, to say you are still on the list, don’t worry. Or something like that, and you know even before you start to think about the, that there’s no real other support offered in the meantime while you’re waiting. I think that’s a, you know obviously a, an even bigger thing. But yeah, just something simple as a letter just to reassure us that you know things are still moving in some sense, but for me anyway there was absolutely nothing from, from the point of referral to being offered the first appointment.

It’s quite demoralising to know I’m so far away and, because, I mean, so Coronavirus and all that has put everything completely on hold so… But even without factoring that in you know, it’s kind of knowing that I’m still about 2 years away at least from getting my first appointment where the they kind of talk to me and do the interview and decide that ‘Yes’ – I really am trans – which I’ve already been through once and that I’m already on hormones and they kind of go ‘Yes that’s fine’ and then with [GIC] particularly then have another waiting list you go on once you’ve had your first appointment besides whether they say ‘Yeah you’re trans enough’ you then go on another waiting list to see someone who will then either refer you for hormones or for in my case it would be top surgery because I will not be able to afford top surgery privately, it’s about £7/8000 which is not money I have unfortunately. So I now have to wait, have to wait 2 years at least plus another 1 year or more, it’s getting longer by the day obviously to then speak to the person who can give me my referral for top surgery and then I’d have to wait again for another referral, I believe they want two referrals so another years’ wait in theory for the next appointment so that’s 4 years and then by the time I’ve got my two referrals for top surgery I need a I need to wait for the top surgeon and all the top surgeons in the UK have like, I think at least 8-month-long waiting lists. So it’s kind of the knowledge that it’s gonna be another 5 years at least until I’m able to access surgery.

So, it’s at the moment it’s about the same as Charing Cross, which is about twenty, twenty-six months I want to say, something like round about two years. The hope is that it will ramp up, the issue was obviously Covid happened, so they were going to start ramping it up before the lockdown and stuff happened, obviously they had to kind of put a pause on things to get, because figuring out what’s gonna happen, so they’ve kind of figured out to, like they’d, things have started to get opened up and get rolling again, but also they were still trying to do appointments they could, so those were through Zoom, like Zoom appointments and stuff like that, so they were still trying to see people.

I’m, like I’m happy to say like the people who are working in the Gender Service do really care about their patients, and do really want to see, like I, are actively trying to make it better for their patients, their care and stuff so like they feel like there’s trans people working in the service too, and stuff like that. So it’s, like it’s lovely to see and like having seen it, so like yeah, the hope is that eventually it’ll ramp up and the waiting list will get smaller. Because like this was, there was like, this is, this service has been in the talks for like years, like, and I mean years. Like I’ve not been, like I’m like I’ve been involved but nowhere near the one of the people, like it’s been two decades at least, and talking to the, some, some of the trans people involved in the fighting of this, for this, it’s like, it was a slow process and the hope is that like now that we’ve shown to an extent that this is working, and it’s benefitting trans people, that we can get more things moving essentially.

I did three appointments. The first one I was mainly talking about my childhood again, like really fabricating this narrative that I was very focused on having a trans identity from the beginning. I think the second one was more focused on my relationship with my parents. It had very little to do about gender identity in general. It was about my personal relationship with my family and friends and predominantly with my parents. That one was cut short because I was stuck in traffic. At the end of it, she told me she didn’t feel comfortable basically allowing me hormones yet, even though what I’d said was sufficient because she didn’t personally feel comfortable giving anyone hormones after just two meetings. I don’t really think is a good excuse. We waited another month and the last one was the one where she asked me about my general mental health and we talked a little bit about it.

I ended up lying about how I felt and then that conversation was mostly because we knew that I was probably gonna get green lit for hormones so that conversation was supposed to be about [coughs] life after hormones and how my family and friends would react and what expectations I had about my life and then she was very stuck on the fact that I had not come out to my parents yet and insisted that I give her some sort of verbal promise that I come out to them before starting hormones because she, even though I was financially independent of them and lived in a different country and had been identifying and living as trans for more than a year at this point, she didn’t feel comfortable signing the papers until I guaranteed her that I would come out to them that following month because I was going home for Christmas [coughs] because she was essentially convinced that if someone’s parents have a very, someone’s close relatives or friends have a very bad reaction to them coming out as trans then that can put them off transitioning essentially or getting hormone treatment for it. So, she didn’t want to put me in a position where I no longer wanted to transition, but was on hormones even though I assured her several times that that would not be the case. But those were the three.

My first appointment was great. My first appointment was with Doctor [name], on, and he was, he was very understanding, for essentially one of the most invasive areas of my life, when you go to the clinic they want to know everything from jump, and that involves talking about your childhood in incredible detail, talking about everything from, from how you felt as a child to how frequently do you masturbate. It was, it was the levels of, of information to give a stranger in a room while also worrying that somehow you were going to give the wrong answer. And I found that really difficult. I thought he did great, I thought that the situation, it was one of those difficult bits of, I didn’t judge him for it, I understood what he had to do, and he was very open and frank about how uncomfortable it was going to be, and he understood that and apologised for it. So, there was a very sort of human interaction there, which was really great, but in general, no. I mean I’d rather have a root canal than go through any of that again.

So, after the first appointment, I then had to wait for my second appointment, and my second appointment was horrendous from start to finish. My second appointment was horrendous from start to finish. I cannot remember the name of the doctor, I feel like I’ve actually blocked out the name of the doctor, he was an older gentleman and it started going wrong when I realised that I’d been in the room for about twenty five minutes and I hadn’t said anything, but he had talked a lot about his theories of genders and names and expressions and how people do things, and it, I remember there being, a, I’m one of those people where I’ll make a lazy joke to make someone laugh in a situation because it’s easier for to me to get through it, that’s just who I am as a person. I am a walking Dad jok in most cases. And I remember him asking me why I didn’t use men’s rest rooms. And I said because they smell worse. And he told me that I wasn’t taking it seriously. And there was a minute where I was like, I don’t think I understand what’s happening here

He also had very strong opinions on what trans people should or shouldn’t name themselves, and the names that they should pick and whether or not it outs you as being trans. And I think in a lot of ways, I suspect what he was trying to do was do that like, the notion of passing for a trans person, the idea of being in society and instantly being seen as cisgender, for some people is the absolute aim. I have always been another or some variety, and I’m very comfortable in that way. So, if someone wants to ask questions and, again I’m, I’m, these are not things I have not considered. He was very certain that, you know, calling myself [name] would be inappropriate, I should pick a different version of a name. Here are the names that I should and shouldn’t do. And it just got very, his opinions that I didn’t agree with, and also, I felt like that had very little bearing on me.

The end result, I mean the, the bit that, and of course at this point he is the, the person between me and testosterone, so he is the person between me, and as far as I understood it as well, it was I wasn’t sure if medical transition was going to be the right thing for me. But I knew that I needed to give it a go because nothing else had worked. If it didn’t work, it was then going to have to be further exploring about like what’s going on with me. I never really had the trans identity that the, my trans, knowing about my transness has fixed things. I think partly because I was just so much older when it really occurred to me, and doubt is one of my natural sort of states of being. I doubt everything. So, this is, he was also this person that’s standing between me and testosterone, I mean and being able to work out if this is going to help or not. And so I found it incredibly challenging but at the end he was like, You can go on testosterone, but I want you to change your name And a stipulation for me going on testosterone was the legal name change. Which I refused to do. And I still refuse to do because I’m a grown-up. But also, it’s my name, it’s my, and nobody has the right to tell me where I should feel dysphoric or where I should feel bad about something.

With the gender clinic they like to start from the very beginning. So when you first get seen they just basically get to know you and then you’ve got to wait for your next appointment, so they tried to say to me, Well cos you have been on the hormones, we’ll give you your first signature today, and then your next appointment you’ll be getting the second signature So the next appointment came about say three months later, two or three months later, and I was under the impression that you know I had told them in the beginning that the most important thing for me now is my top surgery, because I’ve been on these hormones for a long period of time, I’ve had changes, my body has changed, so now I’m feeling more distressed because my body is, my body is masculinised however I have these feminine features. So, this is something that’s urgent for me. So, I was under the impression that you know I’m travelling, I’m doing a ten-hour round trip because at this point I was no longer driving, and I’d moved to [city]. So, I was under the impression you know I’m going to go there, I’m going to get the second signature for hormones, and they’ll talk to me about the top surgery. Why wouldn’t you? But that wasn’t the case. Then they basically said we can’t do that in the same appointment, you’re gonna have to wait and so the doctor even lied to get me out of the room, because I was obviously I was like, No, tell me why you can’t do it And he said cos I had to have a full body examination, he said, with like some nurses, he basically said to me, They will sort out your referral for you So, if So obviously when I spoke to the nurses they were like, Well no, obviously you can’t do that with just nurses, we can’t do that for you So I was really, so I left them very disappointed, not knowing, the thing is they don’t give you your next appointment date in that appointment, so you don’t know when your next appointment is going to be. They always say around four months, so yeah so, I had to wait, and I wasn’t happy with the service that I received so I put in a complaint to PALS.

And I said they haven’t justified why I’ve got to wait and they’ve obviously put my case across, and they spoke to the people, you know the doctors who were in charge of me, and they basically lied and said that well, I, they need to make sure that I’m steady on the hormones before they do the, any referrals and I didn’t know the dosage that I was taking, I wasn’t sure of what I was, what I was taking so therefore they couldn’t, they didn’t have an accurate description of what was going on so they couldn’t do, so they were not able to do a referral at this point. But if you look at my notes that they done, which, you know get sent to me after, it said, it said all the doses that I, all the information that I told them was on there. And it isn’t even highlighted that I’d expressed a need for top surgery etcetera etcetera, so they were trying to say that you know I didn’t give them enough information for them to make that that call. Which obviously it wasn’t true. So I wrote back to them, to the complaints service again, and I said, I’m not happy about that, and I’ve done all this research saying that your hormone treatment does not affect your top surgery, whether you can have top surgery or not There’s a couple of things in the guidelines which you need to qualify for, which I’ve qualified for, which they say it in my notes, it’s says that and so there’s no reason for them to delay my surgery, so, in the end I didn’t get another appointment until I think maybe four or five months later, and when I got there they didn’t apologise to me or nothing, they just basically spoke, talked to, spoke to me about the top surgery and said, Yep, happy to do the referral today And I said, What? Are you going to do that today So, this was August of 2019, and they said, Yep, we’ll do it today So, I left there feeling very hopeful that this was going to happen, cos I’d already contacted the hospital of like so this is in [city], near me. I’d already contacted them to find out the waiting times, so I, I roughly could estimate when it was going to happen to me. But as usual I was let down again, because five weeks later when I contacted the hospital to find out about the referral, kind of how long it would be, they said they hadn’t received it. So obviously I’ve contacted the gender clinic, and they basically said ah they’ve got a backlog haven’t got round to doing it, and I said, This is quite unacceptable and I just said to them, Do you know what, I’m going be seeking legal action, because I feel like there’s obviously something dodgy going on here and I said, You need to do this referral or else I’m going to actually turn up, I’m going to turn up to the clinic again, and I will not leave until I know it’s sent off, because this is very important to me Anyway, somehow, by some sort of miracle they was able to do it that day. Cos then they tried to say to me, Oh we need a second signature So, I thought, don’t you dare, don’t you dare tell me I’ve got to have another appointment. Because this was not disclosed to me in that last appointment I had So they said, No don’t worry, we can get that done electronically today, and it will be sent off today And they done it. That same day. So yeah, called up to the hospital a few days later and they said they received it, gave me a guideline of the time, and so I think they received it in September and then I had my consultation at the start of March, this year, and my surgery was supposed to be last Friday, but obviously because of Covid, [laughs] so after all [laughs] after all of that fighting, all of those years of just being let down and I finally got a date, finally got that date, I’m like Yes Like doing this big announcement on Facebook, finally getting my tits off on this date, it’s happening 15th, Friday 15th May, this is happening. Obviously, it was at this point it was only a ten week wait from when I got told, so like Yes, I can’t believe this is happening And then April time when they told me it’s cancelled. I can’t believe it. I was like, Of course this would happen, to me, this would happen. I’ve finally get that one thing, that, that one, that one, the thing is the hospital is a ten minute drive from me, it’s a two hour procedure, something that could have just been done years ago if people had hurried up, and then now it’s been caught up in Covid. And I’ve just, I really truly believe that if that second appointment that I had, where they, they, you know they can’t, they authorised my, technically it was for the hormones, if they had just done the referral then, I would have had my surgery by now. So, it’s a very frustrating position to be in, it’s the waiting that is the massive barrier for me.

Once I actually got there to the appointment it was, you know, there were instructions to get there and it was fine. It was pleasant. The clinician who spoke to me was very pleasant and respectful on the surface of it. The thing is, I know how this works and I know that you have to tick a certain number of their boxes and you have to get through a certain amount of stuff and so I was giving the longest answers to the shortest questions where the guy would ask me something about, what’s your gender history and I realised 5 minutes later, I’m already talking about my penis, you know. Because I know that we have to cover that, don’t we, you know? I kind of… Oh, it came up very naturally in conversation that he asked me, ‘Do you use your penis in sex?’ But, I think he was always gonna ask that, you know? And it’s really none of their business.

And so that, so the experience was actually was pleasant and he was a pleasant guy and we had a nice conversation. But there were these questions that shouldn’t have been there and, you know, and there were things like where he didn’t know what ‘non-binary’ was. Like he kind of you know, he said, ‘Oh, well, so your partner…’ – so you, you know, I’d mentioned about some of my sexual history about fancying men or women or whatever – so, ‘And your partner…’ – kind of as way of conversation – and he was like, ‘Oh and your partner at the moment is a woman?’ I’m like, ‘No, I told you earlier they’re non-binary’. But and you know and he was like, ‘Ah, but born female.’ I’m like, ‘Assigned female at birth, yes, but that’s not important because they’re non-binary’. There’s like, clinicians could do with a bit more a bit more education like the actual bedside manner, not bedside manner, but the manner, great for this particular clinician. And I had a good time and he made me feel relaxed, but, but they need to really separate out the sexuality stuff and realise that’s none of their business. And, and yeah, just learn what non-binary is, really and [laughs] like yeah.

For what they are, and for my in light of, you know of my expectations of the gender clinic and what they are, my experiences with them directly, when I’ve been in the room have been pretty good. So the clinicians I’ve seen, I think I’ve seen an array, and they have all been I think in contrast to the GP’s that I’ve had, I’ve never had to fight for anything when I’ve got in the room, I never, never had to explain anything beyond what I’d been expected to explain, I’ve always been made to feel comfortable, and I’ve always felt listened to.

And that’s been really important. I think outside of that, it’s been more challenging, so where, I guess when, when you’re in the room with them they give you their full attention, they give you and they give you support and they give you exactly what I felt I needed. But then outside of that room trying to coordinate things with them has been really challenging. And that’s something that I think potentially, not that I want to point out their flaws ‘cos I’m just forever grateful that they exist, but that needs work.

So I know at the moment it’s a struggle to even speak to somebody on the phone, over the past kind of year, so I’ve, again trying to get on, get away from Sustanon, ‘cos the last, the last appointment I had last October with a clinician at the gender clinic they said, ‘I can’t believe you’ve been on Sustanon for two years, you shouldn’t have been on this for two years’. So, I’m like, ‘Oh my goodness, okay, I need to sort this out.’

So I they, they kind of gave me a list of things to do and I went away and did them, I got my blood test sorted which I obviously had to send to them, ‘cos my GP didn’t want to. And I had to sort all of, all of this out and, but then actually getting hold of someone at the gender clinic has been really, really difficult, and time has gone by now, where so I needed an ultrasound scan for them to sign off on me switching, and various different things like that, and because that’s all taking time, obviously the current situation and COVID-19, taking that into account as well, I’m now at a point where I’ve done everything they’ve asked me to do, but my blood tests are out of date, so they’ve now come back to me and said I need to do my blood tests again.

So then that, that’s why I’ve been for one this morning, so that’s shifted back again and it’s, I feel like I’m going to be at my next appointment in, you know maybe, I dunno, it would have been 6 months but probably a year’s time, and in terms of my hormones, nothing will have changed, well I’m hoping something will have changed but potentially nothing will have changed and the fact that they then, so I think they tried to get in touch with me a couple of weeks ago to discuss, to tell me that I needed to get more blood tests and they rang me twice in the space of 5 minutes while I was at work, I didn’t have a number I could call back, and they basically left a message and said ‘We’ll write to you’. So I then had to wait for a letter, thankfully they’ve sent me an e-mail, which is good, and I think ‘About time’ – they’ve just shifted onto e-mail – so I had to, I had to wait for the, for the email for then for them to basically tell me that I need to go and do my blood tests. And I’ve got no way of then getting back to them, and even though I can I can leave the voicemail messages saying please can somebody get back to me, I’m sure there are thousands, millions of voice mails like that, and I appreciate the stress that they’re under, but yeah, that communication again is missing, and it feels like there’s a lot of onus on, on you as a person to sort things out. Which is exhausting.

So, the gender clinic, generally, when I’ve been with them face to face, they’re great. Outside of that not so much. And I think as well, you know the space between the times when I see the gender clinic, often things have happened and they’ve, they’ve got no idea what’s happened in between, and a couple of times as well, so you know I’ve, I’ve had to try and communicate with them that for example I’m looking into getting a gender recognition certificate now and I know that I need a psychiatrist from that team to provide some evidence. I’m in the phase now of contemplating trying to contact them to ask them for that piece of information, because to be honest trying to get that before I see them face to face again, I think it’s just going to be such a mission I might as well just wait until I see them again. So that’s, that’s my frustration really with the gender clinic, and I get there are rational reasons for all of those things, but it doesn’t make it any less frustrating, I guess, so.

I’ve found my experience quite positive there I guess at the moment. They, you know there was definitely both, both the people I’ve seen there have been quite open in saying, Okay this is, you know non-binary people and, and their experiences are something we’re, you know we’re quite quickly adapting our systems to now. And so there was, you know certainly, I guess my worry, my only anxiety going into that first GIC appointment was that I was still reading things online that said that GIC’s weren’t geared up for non-binary people, that I’d face a lot of barriers, and stuff like that. So actually, so to hear those two people both say you know we acknowledge that there are limitations to the way we do things and we are actively changing things at the moment, made me feel a lot more comfortable about that. Cos, I thought this, okay this, in for me, in this clinic, it doesn’t feel like this is going to be a barrier to, to me moving forward in any way. So from that perspective I haven’t perhaps faced any of the barriers that I thought I might, going into that.

So, this first appointment was half of my assessment. So, I have [Laughs] the second appointment in a year and that’s when I get the diagnosis and that is when the GIC write my prescription. That is when they take over my hormone care. Even though I turned up to them and I was like so yeah, I’ve been living full time as a women for two years now. I’ve been on hormones for a year. Here’s my gender history. Oh okay, we’ll take over your hormone treatment at the next appointment in a year Like, I mean in my case, at least it’s like well, I’m not gonna die. I do actually have a supply, you know, of the—but no, because in that meantime I’m now gonna have to pay another £250 for another appointment at the private clinic and so they’ll keep treating me. You know, it’s just rubbish. Like, one a year, yeah, it’s usually and that’s what the guy said to me, it’s probably like a year’s waiting time and it was, until very recently, I think six months or nine months was standard in between appointments. So, should be a year plus inflation, right, [Laughs] for my second appointment and then also there’ll be some speech and language therapy session I think maybe a year after that, the consultation for surgery, which will probably be the orchidectomy, but who knows.

Yeah I think that there is like a major power imbalance especially given the power imbalance is with people that don’t know anything about trans people or about transition yet they’re allowed to hold the keys and for the most part they’re cis. So yeah I think there is a major power imbalance and I think that that power imbalance forces a lot of trans people into a position where you just have to like, just live on the like, how can I, which one is it the – I can’t remember if it’s defensive or offensive – I don’t know, but it just makes you, it just makes you live in a place where you’re always having to legitimise yourself to a healthcare professional but in their frame of what trans people are, as opposed to like your truth or your understanding of what trans people are or of your experience, and it just creates like this like self-perpetuating cycle where you’re holding trans people in a place that is like immovable and you’re not allowing like, for fuller understandings of trans experiences because we all have to adhere to this one narrative if we’re going to get access to the things that we need access to. And so I think it’s just so harmful on like, so many levels.

As a trans person who has to come into contact with healthcare professionals a lot, just because of the nature of the journey, some, I think you get, I think on one hand you almost get used to speaking to professionals, so on one level you kind of get used to walking into a room, having already educated yourself a little bit, and knowing that you might be questioned a bit so, not that you go into a room in a defensive way but you kind of almost go into a room knowing that you’re going to have to assert your own power in order to I guess get the support that you need sometimes.

So, and I don’t think that’s something that’s obviously you know, it’s, it’s not just an experience that trans people have, but I think that it’s, it’s something that as trans people you just get used to doing every time you walk into a room with a healthcare professional in one. I think that being said though, it can be very easy then to go into a room with this sense of power, and this purpose, and to then be disempowered very quickly when that professional for whatever reason, it’s not, you know if the professional has a reason, I think, for not supporting you for whatever reason, then sometimes that’s valid, and sometimes I think there is room for challenge, because as a patient you’re the expert in terms of yourself, but you’re not an expert when it comes to that, you know medication, and diagnoses all the time.

So that being said, you know I think it can be, yeah you can be disempowered quite quickly and sometimes it happens, like I say sometimes it happens for a reason and sometimes that’s okay, sometimes it happens and it’s not okay. So sometimes you can be challenged by a professional, like I was on illegitimate grounds, and in a way that then invalidates not only what you went in there to say, but also you as a person, and that can stay with you for quite a while. So, going into a room with a healthcare professional and having a conversation with, with a professional can be a very scary thing.

And I guess what terrifies me I think is that, for me, having a Mum that’s a healthcare professional, and being a healthcare professional myself, you know I’m going into these spaces and I’m coming away exhausted, having had that experience on the other side and, and being in a position where I’m, you know relatively I guess in a good place mentally, to manage those power relations. When you’re a young person or somebody who is not in that place then it’s an even scarier thing.