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.

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

15

Little Miss Morbid

Owing to the recent extreme quietness of news on the transition front, which tends to test the morale, I dug out an old vampire novel Wolves of Dacia (nothing to do with cars) that I wrote around 2008, hoping to keep myself busy for awhile with editing and maybe see if I could make something of it. That has somehow now turned into a near-total rewrite of the thing. On the plus side, I am feeling very motivated and excited about this new project, but on the negative side this means everything else is going to slide for probably months on end (me being the obsessive type), so I beg all of your pardons in advance for being a very unreliable blogger and reader for the foreseeable.

Having said that, this week turned up a couple of bits of trans news. Natasha Hinde of Huffington Post contacted me to canvass an opinion for an article she was writing, “Uterus Transplant Surgery Could Help Trans Women To Become Pregnant.” I gave what I thought at the time was a careful and balanced answer (partially quoted in the article), which I subsequently feared might have been a boring and non-committal one, and which I now discover to have been an offensively controversial one to judge from the drubbing it has received in radfem / gender-critical quarters. Politically, I do seem unable to please any of the people any of the time… I suspect it is long past time I took my husband’s oft-repeated advice and forced myself to stop even visiting trans-political type sites. Since my diplomatic skills are conspicuous by their absence, I don’t expect to achieve much on that battlefield other than flirting with depression, unless regular practice in morbid thinking makes me a better Gothic novelist in the future and thus saves on further rewrites.

Also, today I have just returned from my first day-long course on the Royal Mail women’s development program “Springboard” (on which, I think it might be as well to state, I was specifically invited by female RM executives in full knowledge of my trans status). I cannot say much on that as participants are sworn to confidentiality, but as tends to be the case in real life, the day passed completely positively and courteously, I was made to feel welcome, encouraged to participate, and not once judged or cross-questioned.

Sometimes, I do wonder what if any good the Internet actually is.

springboard

0

In the Tunnel, Needing Hugs…

Ok… Yesterday’s optimism and philosophical attitude seems to have packed up and left, and I am currently just doing my best not to catch my reflection, as the sight of it disgusts me. There will always be days like this with gender dysphoria, and all political correctness aside, I have no problems with calling it a disease, as it is certainly not conducive to ease. I will try to see a GP on Monday, if I can get into the walk-in surgery, but even that seems an age away, and all time not spent trying to escape from my prison cell, so to speak, becomes a test in staving off frustration and depression. Finding things to be grateful for in my appearance has, unfortunately, been a dismal failure as a strategy. The more feminine I try to appear, the more jarringly masculine I look, to the extent that I am close to giving up even trying to ever “pass”. Sometimes I would just love to move somewhere with no people at all other than myself and my spouse, who is the the only person who relates to my true self, then I can at least call myself what I like and not cringe inwardly every time somone addresses me as “mate”, “sir”, “young man”, and “Anthony” (who, incidentally, does not even exist. Sorry to everyone who thought that was a real person).

Tomorrow will hopefully bring better news. I will be attending The Gathering LGBT meeting at the United Reformed Church (Windsor Place, Cardiff City Centre). I am hoping that will at least help me find a place within the local trans community, and through that some emotional support to help me through this. At present, I have only my spouse to truly understand my situation, and without them I might well have gone mad… I only hope I do not drive them mad with my melancholic obsession.

Incidentally, if you have a trans friend in this situation, do be very wary of the following piece of reassurance…

“But you’re a great looking [insert birth-assigned gender here]. Loads of people would be grateful to look the way you do.”

This may be well meant, but is just adding guilt to the mix of emotions. One might as well tell a person who has lost their legs to buck up and be grateful because some people have lost their arms as well. It is also the basis of the widely-reviled “reparative therapy”, such as Leelah Alcorn endured, based upon techniques for making the patient feel so bad about themselves that they (sometimes) strive to police their “aberrant” behaviour, (often) commit suicide, or (hopefully) punch out the so-called therapist.

The next one is a lot better, but don’t be surprised if it fails to completely elicit a cheerful frame of mind…

“It doesn’t matter how you look. You are a [insert innate gender here] whatever people think.”

Somewhat akin to telling a life-term prisoner that they are indeed innocent and unjustly convicted (always good to hear), but without actually being able to promise them a release date from their cell… Still, knowing for sure that I have gender dysphoria is better than wondering if I am just screwed up in the head or suffering an extreme manifestation of a fetish (Unlikely, as I would expect a fetish to be fun, and being “cross-dressed” just makes me more painfully aware of my masculinity).

Not that it is easy to reassure someone in this situation. To anyone reading this who is facing it, the most vital thing I still have to suggest is not to face it alone. If no-one in your close circle will see or acknowledge you as you true self, locate your nearest local LGBT group quickly. There are people out there who will help, and if they can’t always bring the light at the end of the tunnel any closer, they can at least hug you for the duration of the journey, and that counts for a great deal.

3

Magic Buttons

So, I have registered at last with a new GP, and will hopefully be able to arrange an appointment next week. I’ve no idea what the outcome of that will be, but resolved to work with them in whatever we decide will be my best interests. In the meantime, I have various LGBT social gatherings and the regular chore of tweezing my facial hair out to keep me amused…

And how am I feeling as things develop? Frankly, if there was a button in front of me that would immediately turn me into fully-realised female form, I would be sorely tempted to press it. On the other hand, if its only outcome was to put an end to my obsession and my dissatisfaction with my birth-assigned gender, I would be almost as tempted to press that too. Though positives are emerging, still this is not a fun thing to live with, it consumes much time and thought, and I am sceptical of a truly satisfactory outcome, never mind a quick one. Part of me would just like this to be over, one way or another. I do not allude to suicide, however. One thing the Leelah Alcorn case has starkly reminded us of is that too much death has already haunted the trans community, and I have no wish to add my mark to that body count.

On that note, I have to wonder at the number of triggers that worked to break my repression cycle on this occasion, and which put Eleanor firmly in the driving seat of “Anthony” … Each day seems to furnish a new example of discrimination and hate-crime, whether internationally or locally. The trans community in which I have, for so long, denied my place, is by no means a safe or comfortable place to reside, but I can no longer take any comfort in self-denial, and perhaps there is something for me to think on in this. Perhaps I may never be the 100% passable woman of my dreams, but if my acceptance of my place within this community and my subsequent involvement in it can bring any benefit, something more meaningful may have been achieved than if I could just magic myself into a new body here and now (or had been born in my ideal one to begin with).

“God doesn’t make mistakes,” as Leelah Alcorn’s mother (in)famously told her, and she was right. But God does issue challenges, and – while not wishing to exacerbate their grief – I believe Leelah’s parents did not rise particularly well to their challenge (probably because they misinterpreted it).

I hope and pray that I shall rise better to mine.

3

First LGBT Social: A Liberating Feeling

Today, after several recommendations and much screwing my courage to the sticking-post, I finally attended my first ever LGBT social event: a coffee morning in Barry (of “Gavin and Stacey” fame), organised by Race Equality First. Evidently, they deal with all manner of hate crimes, not just race-related. Not knowing the lay of the land, I came very discreetly dressed, with just a long top in lieu of a dress, slightly see-through so layered over a short-sleeved bodysuit that would have just looked like a tight t-shirt to a layman’s eye. My only obviously feminine concessions were a black chiffon scarf and a woman’s leather coat. Most other attendees, in fact, came in full feminine attire, but I am in early stages still and would struggle to “pass” (i.e. To look convincingly feminine whatever I was wearing, save for full orthodox Islamic garb, or possibly Samus Aran’s power suit…).

Still, a very encouraging and productive meeting, where I got a lot of very helpful information, a lot of support, and a couple of free cups of tea (The event is publicly funded, it seems. Nice to know several years of Tory rule have not completely decimated charitable and diversity activities in South Wales). I also got advised to pluck rather than shave my beard, and by hell does it hurt and bleed at first… Still, I can see the distinct advantage in it. Not having to layer on concealer as if I was plastering a wall would be a handy thing.

For anyone in the South Wales area who thinks this would be helpful for them, the group is…

https://www.facebook.com/groups/683965685032284/?fref=nf

They meet alternately in Barry and Cardiff, and seem to be very keen to help and advise.

Next stop: registering with a new GP tomorrow morning. The steps I need to take from thereon are, as far as I understand, to book an appointment and request a psychiatric referral. Though I have been advised to be very adamant in telling them what I need, my initial approach will be rather more nuanced. Since full transititoning is one heck of a drastic step to take, especially when I am only really coming out for the first time, I am hoping to work with the psychiatrist to carefully determine what will truly be best for me. I have a friend who believed and was even advised that a body modification surgery would greatly enhance their life, only for it to have exactly the opposite effect…

Having said that, given the current depth of my obsession, I am likely to keep on self-medicating with the herbal “phytoestrogens” until some kind soul either shoves me in a strait-jacket or puts me on a safer and guided alternative… I’ll keen an open mind (though on the whole, I’d rather avoid the strait-jacket). Wish me luck… x

0

Uncertain Entity

Today I finally contacted the local NHS branch to ask if they could put me in touch with any transgender-friendly GPs, or preferably one who had some experience in the field. The bad news is that they were unable to find any (at least with experience), but I was very impressed how quickly they responded to my email and how helpful they were otherwise. My correspondent found me a local group to contact and passed the details onto a colleague closely involved with LGBT issues, who will hopefully be able to supply more detailed information. They were very respectful and sympathetic throughout, and have made me feel very positive about this whole thing for the first time in ages.

So in case anyone reading this is still holding back on that element of coming out, I would encourage you to proceed, though perhaps contact the local NHS authority rather than simply take the matter to any GP, who may or may not be understanding. One would hate to have to re-register with another GP in the event that they proved anything but…

As far as consequences go, all I am currently attached to is the hope of meeting people who can help me find the right advice I need, leaving the matter of treatment aside for now. Whilst I certainly believe myself to be a female operating system installed upon a male platform, to put it elegantly, for all I know about medicine and psychology I may just be a corrupted male operating system with peculiar ideas about itself… but I have a feeling that finally knowing for certain, however long that takes, will be a liberating step in and of itself, whatever treatments (or none) may follow. Being an uncertain entity is a bewildering sort of life…