7

The magic S word …

It is testimony to how long the process of transition on the NHS is that I have posted nothing on trans matters for months now, even though that is ostensibly the whole purpose of this blog: certainly the reason I was encouraged to begin it, though I was afraid it would make a very stop-start narrative with massive gaps from the beginning.

While such has been the case, both the hubby and I have been lucky in not having faced much in the way of unexpected delays, with every appointment at the GIC entailing meaningful progress (Not all are so fortunate). Yesterday I had my third and final appointment at the GIC, after which I was discharged and referred to the surgical team at Charing Cross Hospital, from whom I shall hopefully be hearing in the near future.

Excited? Most definitely. Apprehensive? Somewhat. This will be my first major surgery, and the extended convalescence (about ten weeks) afterwards will present its own challenges, but finally knowing the end is in sight is tremendously fulfilling, and of course I can turn for support to the many people I now know who have taken this route successfully (and with the same surgical team). I also know I will not be impeded from getting the sick leave I need.

Here I am with two wonderful friends – Helena and Amanda – standing outside the hospital which I shall be visiting more formally in due course.

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And thank you to everyone here who has encouraged me through this surreal but ultimately positive story. Hopefully its closing chapters should come at a slightly faster rate from now on …

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8

T-minus 24 Hours

This is just a quick but significant news update to report that as of this time tomorrow, my husband Cal – who has been waiting since early 2015 to receive treatment for his gender dysphoria – will finally be getting his first dose of testosterone. This has been long delayed by a combination of NHS bureaucracy and actual malpractice (some Welsh GPs – unfortunately including one we were involved with – having seemingly ganged up to stymie trans care in Wales) but all the hurdles are finally crossed. We are both excited, if a little nervous – we are not sure what the effects will be, and the intramuscular injection is bound to be painful – but this is most definitely a time for celebration. I am so proud of him for having come this far, and more grateful than I can ever express for the support he has given me on the same journey (which was somewhat easier from my perspective, since I finally got official treatment last November).

Nothing much else going on in our world. I am still writing, programming, have taken up Tarot and Wicca, and am considering taking up ballet post-op, if I can find (or start) any trans-friendly groups. Hoping to have more creative news soon – I have made a new C64 game recently for a competition, and had a novel accepted for publication – but actually releasing them to the public now depends on how quickly others can move (The competition organisers and the publisher). I am also planning another fanfic to conclude the Movellan War trilogy, since the new season of Doctor Who actually did not close off that promising plot hole the way I was expecting it might (Any feedback on the other two, incidentally, would be massively appreciated, up to and and including “I got bored on the first page.” It helps to know).

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12

Transition Update – Second GIC Appointment

Yesterday I went up to London for my second Gender Identity Clinic appointment. It had been intended that I should be referred for surgery at this stage. Unfortunately, there was a snag …

After my first appointment last year, my GP was instructed to put me on a certain regime of feminising HRT, with a view to getting my hormone baselines to a level equivalent to post-surgery. They refused, citing amongst other things lack of experience, the fact that gender transition is still technically an unlicensed (albeit routine) use of these drugs, and their belief that the GIC recommendations had no authority in NHS Wales. I argued, I took them to advocates and the Assembly Member, but they refused to budge.

I eventually (November 2016) found a new GP who agreed to prescribe me somewhat of a compromise (using a cheaper but less effective anti-androgen), but the damage was done and I have lost 8 months. I return to the GIC in October for a follow-up session, but unless I am on the right prescription by then I will be no closer to being referred for surgery.

It is clear now the NHS in Wales, at least at the primary care level, is substantially opposed to providing gender reassignment, but since there is certainly no Welsh GIC in the works (for many reasons, both cost-based and owing to Wales’ weird geography) unfortunately their cooperation is essential. With the support of the GIC, I now intend to report my old GP to the General Medical Council and hopefully this will set a small fire under the collective posteriors of GPs who are refusing this care (and of their union the BMA, who are it seems not our friends in this political tussle). Since my husband is also meant to be starting his HRT very soon, and we see no likelihood of leaving Wales any time soon, this is doubly personal.

On a lighter note, some snaps I took while I was there …

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Horsenden Hill, Perivale. Its claim to fame is that it is the main location in the last ever episode of “Doctor Who” (1963-89 version). Well, I felt awed, anyway, and tired (It is a fair bit steeper than it looks in this shot).

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Shipping cranes at West India Quay, near Canary Wharf. Seen in the movie “Hellraiser,” in spite of that film being superficially set in some weird Anglophile American locale (The clear shot of a British Rail Intercity 125 train hardly helps, also).

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Smiling through the chaos, until next time …

22

Jumping Hoops – A Rant on the Welsh NHS

Today, as I learn that my legal caseworker is leaving her job and my MP can’t be of any help in local health issues, I am far from being in the best frame of mind…

Let’s quickly recap… Early last year, my husband and I went to our GP to finally pursue gender reassignment, as is our right under NHS protocols. However, the NHS in Wales is more restrictive than its English counterpart, as the GP correctly informed us, and accordingly set up the various hoops that we would need to jump through to receive treatment. These were…

Referral to the community mental health team for assessment.

Referral from the CMHT back to the GP.

Application to the “gatekeepers” (nothing to do with Ghostbusters) for funding.

Once funding obtained, referral to the West London Mental Health Gender Identity Clinic – the only one available to Welsh NHS patients.

A year’s waiting from said referral to our appointment times.

First GIC appointment.

…and that is as far as we have got, at present. However, our first appointments did go very well, and as far as London goes we have no complaints. The clinicians we saw were sympathetic and eager to help, and in my case even provided me with a prescription for HRT to be handed to my GP. Hormone therapy is, of course, an essential first stage of transition, and one that patients in England (and even some Welsh health boards) can obtain even before their first appointments, to dissuade them from self-medicating on internet-bought hormones… which I have been doing for over a year now. My GP, unfortunately, said that they could only help with authorisation from London, so you can imagine how pleased I was to finally obtain some.

Having imagined that, you can now imagine how displeased and shocked I was when my GP practice – a Cardiff Bay-based clinic that had been recommended to me as trans-friendly – still refused treatment. Their latest justification is that there are proposed changes to the Welsh gender identity care pathway, and they want those implemented before taking the responsibility. They assured me it would not take long.

About a week ago I went to a trans information meeting hosted by a local NHS official, who spoke on these proposals and told me they may take up to three years to implement… though she did also tell me – as one might expect – that my GP is making pathetic excuses, and has a responsibility to treat their current patients according to the existing gender care provisions. Also, much to my surprise, she informed me that our GP had lied when they claimed there was no provision for speech therapy under the Welsh system – though both Cal and I had expressed a great interest in it.

She even told me she would be in touch to help me challenge this state of affairs… but unfortunately was not. I have since told my caseworker and my MP – to the sad lack of effect stated above – and contacted my Welsh Assembly Member, but have heard nothing back. That leaves me, at present, at a bit of an impasse, where all I can think to do for now is express my dismay and disgust that things have had to come to this. Unless the local health authorities will support Cal and I in our transition, there is nothing much London can do all by itself (monitored HRT being, as far as I know, still being a prerequisite for surgery, and Cal not being able to self-medicate in any case – testosterone being far too dangerous to take without professional help).

Our worst fear, though, is that they are playing for time, hoping that if they can stall us for long enough then inevitable NHS cuts will impact on the whole gender care service and they will simply be able to deny us care and get us off their monthly budget for good. Paranoid of us? Possibly, but that practice hasn’t exactly been enthusiastic or sensitive in helping us. I recall asking them if they could prescribe Vaniqa hair reduction cream just after my GIC referral… only to be answered with a blunt “we can’t give that to men.”

Though, to be fair, one doctor down that practice has been sympathetic to us both, though the last thing he said to me was “the squeaky wheel is the one that gets oiled.” Cryptic at the time, but in retrospect we both think he was giving us broad hints that the system is not our friend, and we will have to fight tooth and nail if we want to see this through. Not something I excel in, but I guess it can’t hurt to learn.

If anyone has any suggestions for our next manoeuvre in this battle, please pass them along. I could use some fresh perspectives after today’s disillusionments.

22

Year of Politics and Procrastination…

I always suspected this blog would tail off rather than go out with a bang, alas, but although I must take part of the blame for that in a sense it has been unavoidable: in the early stages of transition one’s mood was of constant panic, and it was a matter of priority to keep very busy and pro-active to have some sense of control over it all. Additionally, things seemed to move more quickly. Now, nineteen months down the line, things seem a lot slower-paced, although by no means resolved. Cal and I are both now officially patients at the London GIC (Charing Cross) and technically on the gender care pathway, although our GP practice continues to refuse us any interim care and I am still self-medicating HRT based on rough figures which have so far not killed me, touch wood (As ever, this practice does not come recommended). However, a trans social meeting I attended recently gave me to understand that we should be receiving care from our GP by now, so a complaints procedure is looking increasingly like our best option. It’s stress we could live without, of course, but we knew this would be a struggle.

It might help, of course, if we were transitioning at a less volatile time, but it seems whenever we glance at social media these days there is a new reason to fear the course of global events and what this may mean for us as LGBT+ people, as well as NHS patients: the Orlando massacre, the rise of the right and hatecrime, Brexit, the apparent disintegration of the Labour Party, Donald Trump, etc. Being introverts never made so much sense… Unfortunately, I now find myself as an introvert at a loose end, having finished the novel I was working on and lacking inspiration for a project to follow it. I am hoping to start some voluntary work later this month with a Cardiff LGBT charity, and Pride Cymru is coming around again (13th of August), while Cal is hoping to upgrade his working hours to full time. Modelling, alas, has fallen off considerably – not that I ever expected it to go huge – though I do have a few shots from a training shoot I did a couple of weeks ago at Mark Cleghorn Studios (Barry, Vale of Glamorgan), based around the “Little Black Dress” theme:

Not that I would say I am remotely satisfied with how I look, nor ever likely to be, but it was nice to be asked. Validation has been in short supply of late, for us both.

Thus, we continue to support each other, and I really can’t imagine how I would have got through this without Cal, but the motivation and stamina to be “out and proud” is difficult for us both to maintain, even on mere social media, so my apologies for my very inconsistent presence this year. I hope I will feel more in the mood for visibility in the future. I know invisibility does not serve my community very well. It can feel awfully stress-relieving, though, but I will seek a healthy balance.

15

Fighting Back

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Cal returned from the GIC last Tuesday, and the news was all good: like me, he has been granted a second appointment in February, at which point all going well he will be approved for HRT. The clinician seemed absolutely charmed with him (only naturally), and they had a good conversation. The fact that we both have had such positive experiences with the London side of things is certainly something to be very grateful for. It touched upon a subject of grave concern to us both right now, though: the UK’s impending referendum on whether to remain within or leave the European Union. The clinician was pessimistic, and when we consider the implications of leaving (which now seems the likely outcome) it is hard to feel too blithe about our future. For one thing, if it throws the UK back into recession, the NHS will suffer more cutbacks, so our transitions could be stopped by simple market forces. For another, it is liable to make the UK more isolated and right-wing, which rarely goes well for LGBT+ people (no more than one might expect of a Trump presidency…). Even if neither of those scenarios develop, we are bound to be affected as Cal is French, and will thus have to change nationality (at high expense) or risk losing his job, his right to stay without a visa, and his rights to NHS treatment. If Cal has to leave the UK to transition, I will of course leave with him, which will thus stop or at least hugely delay my own transition. Thus, if you are one of my Brexit-supporting work colleagues and you wonder why I am less than friendly with you these days, you can probably work out why now…

Furthermore, though, it has been next to impossible for anyone in the LGBT+ community to be particularly happy and easygoing this week, in the wake of the Orlando massacre. Cal and I attended a memorial vigil in Cardiff Bay (image above) and were moved to see so many of us and so many allies come out in support and recognition. The priest at my very LGBT-friendly church also gave a sermon and prayers on the shooting (acknowledging that it was an anti-LGBT hate crime, unlike a certain prelate). Still, it is hard to get away from the sense that the world is still not exactly on our side, whatever the mansplaining, cisplaining voices at work would have me believe: “Of course it won’t make any difference to you if we leave the EU. You people have full rights now. We’re a tolerant society.” And so forth, while I bite my tongue.

Cal thinks we may have spent too long biting our tongues, and now is the time to speak out, fight back, and be uncompromisingly courageous and visible. He has determined to make this year his first Pride appearance, and thus our first Pride as a couple. We have also initiated complaints proceedings against our GP, whose non-response to our progress at the GIC continues to infuriate us. Such combative behaviour does not come naturally to either of us, but it helps to remember that we have, in such a short time, gained many friends within our community who are also affected by these issues. God willing, this will be the year when we cease to be the timid little trans couple living almost like recluses for fear of offending, and not before time. Perhaps the world could use a little offending…

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14

GIC – First Assessment

Apologies for the delay, but things haven’t stopped moving since I returned from London last Friday. As for the reason I was there at all… well, it certainly took a long time (albeit 11 months rather than the dreaded 13) and there were plenty of times I dreaded it wouldn’t happen at all, or would be cancelled and rescheduled time and time again, but in the end it all went to plan.

The Gender Identity Clinic was well hidden away in an unassuming part of west London, and I shall respect their secrecy and be no more specific. Suffice it to say it was over a shop, the purpose of the building was unstated, and that one had to be rung in via a door intercom. It may well be that they fear the potential of harassment to their patients, although as I had lunch nearby and saw various transpeople exit and enter the building, it occurred to me that some locals had surely noticed over the years. Nevertheless, I had no trouble in the area. I never tend to experience transphobia in London, would that it was not so expensive to live there.

I made sure to travel very early, just in case there were any transport delays and also in case I had not correctly estimated the time to reach the clinic, but in the end had about a two-hour wait. I had a meal, a quick walk, and pestered the hubby on the phone, which whiled the time away and kept my morale up until I actually pressed that door buzzer. Then, I had another 45-minute wait within the clinic itself, along with various other nervous-looking transwomen, as they were running late. I began to have a paranoid fear that someone would only come at me with an apology that the clinician was for some reason unavailable and I would need to reschedule, when thankfully the gentleman himself emerged from an office and invited me in. I smiled, took a deep breath, and followed.

The meeting lasted a further 45 minutes and covered all expected bases, repeating much of what I had been asked during the community mental health assessment in Cardiff last year: how long had I known, was I inclined to suicide or self-harm, how was puberty for me, medical history, work and social circumstances, etc. The clinician acknowledged that much of this would be repetition, owing to that extra hurdle one is expected to pass within the Welsh NHS. I was rather pleased he did not seem to consider this fair.

His final assessment, at any rate, was the most morale-building experience I have had in ages: I seemed, evidently, to be a totally straightforward case, and he had no issues in referring me onwards to discuss surgery, and also in writing to my GP to, at last, authorise HRT and get me off my self-medication. This latter habit of mine, which I had been warned could stand in my way, thankfully did not become an issue. He acknowledged it was not the best thing one could do, but also one that many people and especially those in the Welsh NHS turned to for lack of GP support, and I had at least attempted to do so in an informed way (A general hint I might give, to anyone considering that option, is always to seek as much information within one’s community and support groups as possible).

He also said, to my immense gratitude, that in his opinion I had successfully completed my social transition. While I can imagine a few gender-critical feminists balking at the notion of a male clinician supplying that seal of approval, at all events hearing it from him was reassuring, as it always is when I meet someone who only sees me as Eleanor. There are days when feel I could happily enact my transition 1970s-style, tear up all roots, move among strangers, and start life afresh… only the hubby still loves Cardiff. Well, I could probably do most of that that here. It’s a big city, though a new job will still be essential, hopefully sooner rather than later.

So, my next step is to visit my GP today bearing the clinician’s written authorisation, which will hopefully soon have me started on the first true stage of my medical transition (Anti-androgen injections, and continuation of my regular estradiol doses, but medically supervised). As for surgery… my second assessment will be in February. Another test of patience, but at least now I know I am on track, I no longer have anything to prove, and I can, in a way I did not quite feel free to before, finally embrace the fact of being a woman, being myself, instead of being cursed with that nagging sense of anxiety, that fear of being disbelieved, deemed as delusional or perverted, and told for my own sake I should backtrack and reconsider my options.

There is no going back now, and I could not be more delighted.


P.S. Thank you to all my followers here who have supported me through this. Your encouragement has done a great deal to keep me on track, and I only hope I have managed to be a little entertaining for my part. xxx