Gender Dysphoria Guidelines 2013 – UK.

The new guidelines for the treatment of gender dysphoria have been published by the Royal College of Psychiatrists. And they make for an interesting read.

Part of the problem immediately is that the state care or the National Heath Service and the Private practice many of the contributors to this document also run come into conflict.

Many of the negative experiences with the NHS from patients some of which I will document below fall far short of this what can only be described of as some Amazon ‘Wish List’ that falls apart really quite quickly when we examine it more closely.

So let’s begin I have taken part of this document out for scrutiny and augment, and they will be in quotes. This will then be followed by a critique of what was said and how it is in the ‘real world’ beyond their central heated offices and pot plants.

CR181 – good practice guidelines for the assessment and treatment of adults with gender dysphoria

The document reviewed below is this one and you can read it here, or open it along side this blog to cross reference if you wish. If you would like to comment on this at the very end there will be a link to the forums where this is possible as a guest poster (without registration).

cr181gpgatgdrcp2013

http://library.transgenderzone.com/?page_id=3036

 

REVIEW

Lets begin at the beginning. Reading through this almost ever paragraph rings alarm bells.

Transfer between services and across the lifespan without undue delay is essential.
Persons with gender dysphoria have a right to counselling and psychotherapeutic practice as part of the overall package of care.

Counselling is a rather wooly issue, as anyone can set themselves up as one. I have lost count of the amount of people who have visited TransgenderZone.com and said their counsellor was useless or at worse creepy! So most opt for their GP (family doctor). However research has shown for almost a decade that the average visit with a GP is 7 mins, and what they describe as a ‘counselling session’ is 11mins. What can be gleaned in 11 mins is open to question(?) other than passing you on to someone else, who is probably equally in the dark about all this. Even Mental health teams struggle with gender dysphoria as its pretty low on the agenda of a work-a-day local hospital shrink.

A good example of just how poorly understood transpeople are in the ‘parishes’ we need to look no further than a recent episode of ‘Unsafe Sex in the City‘ BBC3 that featured at least two transwomen. Bear in mind this is a busy University town (Exeter, Devon) with many young people, and many transpeople coming through the doors for treatment. One was asked the upsetting question about her periods despite having a penis the nurse saw before hand – cos the paperwork said she was female and she was on the woman’s floor which then resulted with a team debrief about this issue – the nurse was embarrassed – some may say that’s flattering, as she treated her as a woman (job done!) nevertheless, what came next was surprising’. One asked, “what is a transsexual?” one practitioner said, “Paul O Grady?” They agreed in the end a woman said. “lets just say trans to be on the safe side?” – this is the NHS right now! Just how long before the cameras exposed this has this been going on, and in how many other clinics? It demonstrates the mountain to climb with simple facts let alone adequate trans-centric care.

This paper is very gender clinic specific, in other words if you are in the GIC consulting room then much of this can apply, but getting any of this to function in the real world is difficult to say the least.

The following case studies are from our many conversations over the last few years on TZ. They stem from patients who have complained about their treatment by many of these very same practitioners who wrote this document and their clinics. Remember the practitioners listed often have NHS and private practices running in tandem. This can always create a conflict of interests despite what they may say.

Case Study 1

Correspondence with Gender Clinics especially London. Is poor. Serious medical issues are reported and it can be many months before a reply is forthcoming if ever. Lost letters (despite being signed for) go missing and sometimes the issues are time dependent, funding or commissioning issues where they want a response concerning a referral yesterday. For them to have a letter drop on their mat 3 months later is useless as by then the funds have been channeled elsewhere and have run out of funds for that financial year for example.

10. “There remains a paucity of research in the field. Research should been encouraged and funding set aside to offer specific grants looking at outcome and satisfaction with interventions and transition.”

I speak to a LOT of transpeople and by far the most disappointment is based around their ability to respond to issues in a timely way and in a satisfactory way. It is easier to lose your paperwork and forget you than to write back, again wishful thinking that is not delivered. I have always sent everything recorded delivery but even then its sometimes MONTHS before you get a response and that often requires a response from the patient which takes even more time. Its a merry-go-round and embarrassing and very damaging to their patients. Research starts at your front desk in this instance I am afraid.

11 “Service provision and clinical best practice for persons with gender dysphoria is underwritten by promoting patient autonomy and patient choice embedded in the NHS Constitution (Department of Health, 2013), and by ensuring that patients’ human rights and right to equality, protected under legislation, are complied with by both decision makers and practitioners concerned with service provision and treatment.”

Autonomy, yeah by that they mean you are on your own mate see you in 4 months! And ‘choice’ only applies if there is more than one option, for most the option is ‘Hobson’s Choice’ (only one choice /no choice), the overwhelmed and struggling Charing Cross Gender Clinic in Fulham, London, that should be at least 4 times bigger with 4 times the staff, with a decent electrologist on tap as part of the visit – not a separately funded concept is the way to g here, Transgender Zone and The Beaumont Society have suggested that there are in excess of 3 million transpeople in the UK – and recent reports suggest children coming forward is doubling – where are they all going to go? So your choice is applied regionally. In other words you attend the clinic nearest to where you are – usually – sure you could spend £200 pounds on a train and go somewhere else? But this is not like swapping GPs locally or asking for a male nurse instead of a female one for example. Choice is a non-starter for most.

“Any general practitioner (GP) involved in the overall care of transgender patients should usually be on the GP register of the General Medical Council (GMC) (or non-UK equivalent). General practitioners may have, or may gain, specialist interest through experience of working in the field, continuing professional development and specialist courses.5 All doctors registering with the GMC should follow guidance on standards of professional conduct (General Medical Council, 2013a): multidisciplinary working (paras. 35–38; see also General Medical Council, 2012) continuity of care (paras. 44–45) working in partnership with patients and treating them as individuals (paras. 46–52) treating patients fairly and without discrimination (paras. 56–64) being honest and trustworthy in communication with patients (para. 68). Similarly, a specialist nurse practitioner is a registered nurse who gains experience working as part of a gender identity team either in a gender identity clinic or other gender-specialist clinical network.”

Seriously? Most GP’s (Family Doctors) unless they have a high trans populous (Manchester. Brighton. central London etc) know almost nothing of trans issues other than what they ma have picked up by accident or watching ‘Big Brother’ on Channel 5, they know less than their patients (patients often do considerable research before approaching medicine, the patients are ‘expert’ in the fact that they also know what it feels like, and non-trans practitioners are left guessing), patients are then left to self-med and self-refer to some extent, when I say self-medicate I mean through ‘official channels’ being via the GP themselves, as often hormone replacement therapy is negotiated with the patient like some sweet shop –

GP – “What do you want me to do?”
Patient – “Um I don’t know you are the GP!” “I hear Estraderm is good?”
GP – “OK then I will put you on that!”

If the writers of this document believe that those GP’s, who have any number of other documents to read, will stop and absorb transgender issues to this extent, then the writers of this are sadly deluded.

I would like to raise this comment from my degree in social care and I have never forgotten it! It goes like this…

“Over 5500 potentially relevant journal articles are read every year.
To accomplish this him or herself, a clinician would have to read 15 articles each and every day every year …
If the clinician only managed to read two articles every day, after two years, the clinician would have to have a 10-year backlog. After 20 years, the backlog would take over 100 years to read!!

I think that is about as clear as I can make it, a GP has a choice to read two documents, one is on prescribing for older people and the other is trans guidelines, he has a large population of older people through his doors (society is getting older), then the choice to be made is obvious. This was reinforced by someone who told me that they went to a local endocrinologist and they had no idea what was for the best, as all his patients were diabetic type 2 (elderly). So winged-it.

Again this document remains a ‘wishlist mentality’ that will not have any real  impact. Other than to those involved, or for those who have an interest already.

“Patients are presumed, unless proven otherwise, capable of consenting to treatment.”

If we are ‘competent’ why do we have to play dress-up games for 2 years then?

If I want a nose-job’ I don’t have to do much more than ask for one, pay and lie down! I am competent.

Transgender people are treated as not competent by default, especially if they have to be assessed by a gender clinic first. They are automatically assumed to be unable to decide their own care pathway. Yet ironically it is the patient who has to fight to get to the GIC in the first place, many have lived in their acquired gender role for years before referral, it is they who have to deal with the red tape and disappointments conjured up by these services. It is they that actually have to TELL their GPs what they need, as the GICs are very lack lustre in guidance, and of course if the GP cannot get funding for the referral to the GIC because it is full then its all stops anyway despite the clinical need!

“Where people have successfully completed a verifiable long-term change of gender role and later decide to undergo surgery,”

Seriously how offensive is this paragraph? Just look at it – who the hell do these people think they are – as the mafia would say “VERIFY THIS!”

“Verifiable” is a joke in the transcommunity, as the moment they leave the clinic no one knows what happens to them, they could go and get changed in the car before driving home, Its all so easily faked it is laughable. The clinic would need an army of private eyes working to trace their charges, and what does a Gender Doc know about fashion anyway? I mean this season the ‘androgynous look’ is in and all the rage for women – go figure! Doris Day seems to be the benchmark by which the mostly male psychiatrists judge their patients transition.

Vogue.com

Modern, edgy, masculine spot the male? Um middle? Difficult to decide? Is this transition or not. Doctors! Best call Gok Wan!

(Doris Day) rarasuperstar.com

Traditional Gender Clinic View, Pretty, uber-femme, sweet and innocent. Easy to decide if living ‘en role’.

Someone who is camp and a show-off may dress in a ‘verifiable way’ and not be trans at all.

The COMMISSIONING Section is really quite interesting, and it is more interesting based on the terminology used to write it, I remember reading all this in the ‘NHS and Community Care Act 1990’ when these new management words came into common practice. That was when patients became ‘partners’ and ‘Stakeholders’ although everyone knows this is actually nonsense, as if you do not do as you are told you are thrown out of most services or ‘discharged’ politely.

Goodness, all the buzz words that rear their heads again, they have a full house…’multidisciplinary’, ‘Stakeholders’, ‘supervision networks’, ‘facilitate’, ‘specialist’, ‘choice’…

Seriously I cannot even get a prescription for HRT from these ‘specialists’ (and I am still a patient at CX) or a blood test under their management that they assess and advise, I have been attending there since 98 – had one blood-test before surgery in 2010 and that was not for the HRT. I think that was to check I had any :), I have not had any endocrine assessment from this cathedral of knowledge…in a decade. So from my perspective alone, this is all nonsense, maybe I am Karl Popper’s Black Swan? But truth is I hear it again and again. Another friend of mine wrote to them a few times about a serious issue they never got a reply. I have a list of similar efforts.

“Facial hair removal for women contributes to successful transition. Hair removal from donor sites that are relevant to genital surgery should also be funded to promote successful outcomes.”

I have been waiting a YEAR for genital hair removal despite a request from a Charing Cross Surgeon to my GP and funding body… the outcome? Still waiting! And there it is!

So Here I am waiting for Godot…what is a life in pain worth these days?

“Steps must be taken to eliminate discrimination (direct or indirect), harassment or victimisation within service provision against those with ‘protected characteristics’, including ‘gender  reassignment’, and also those who are perceived as being or are associated with such patients, such as partners, spouses, significant others and family members.”

Again this is great – but it has the same dream as a Chief of Police saying we want to eliminate crime. Then what would he do for a living? Its an impossible task, and saying this is just playing to the gallery as it does not stop it happening, physical effort touring the country working with institutions and practitioners is what is required, but I don’t see this happening. Writing it down is far easier.

Maybe the GIC could all buy super hero suits and accompany their charges to their garden gates to make sure they are safe, and tag along to their GP as a side-kick to help educate them?

“Collaborative working
Primary care continues to be central to the delivery of medical and psychological care to the majority of patients. It is desirable for a single practitioner to adopt the lead role to facilitate coordinated care. General practitioners are likely to undertake this role. Under new commissioning arrangements it is particularly important that treatments provided locally are coordinated with those provided by tertiary services. All information should be shared with the GP, and patients should be copied in to all letters between clinicians. Treatment in this field is particularly holistic in the degree to which different specialties may be involved. There is no necessity for specialists to work together under the same roof. Indeed, patients may not experience the full benefits of choice and emergent expertise if their options are constrained in such a fashion. Nevertheless, it is desirable that practitioners should establish protocols for working together. In whatever way the multidisciplinary approach is organised, whether at a gender identity clinic or by a group of health professionals locally, the patient’s choice of service provider should not be unreasonably limited, and delivery must not be unreasonably delayed.”

Some may say all lies, I have heard endless tales of patients being messed about for years,and more so since they have had surgery. Delays? 1 year for a few hairs to be removed and still waiting? Holistic? Its actually upsetting reading this. “General practitioners are likely to undertake this role.” This is truly a lottery. Most are very passive ignorant practitioners.

They message each other in a more pathetic way than Facebook. Maybe that is the answer a NHS Facebook?

Mary has had a prolapse – LIKE!
Like!Charing Cross Likes this…

I wish I lived in this world above they are speaking about, someone clearly does but it ain’t me!

What actually happens is the GIC write a letter that arrives about 6 weeks after your appointment with them, and then the GP puts it in their filing cabinet…that’s the holistic care part taken care of…

WAITING TIMES
“Liability for ‘undue delay’ arising from non-clinical circumstances may fall on the commissioners. In such circumstances, private treatment undergone by the patient may also become the responsibility of the NHS (Watts v. Bedford Primary Care Trust & Secretary of State for Health [2006]).”

Again this is nonsense, if they don’t want to pay they don’t want to pay, the solution is legal action and who do we go to for that?

19

Who pays for any legal challenge? Will the GIC cough up for a lawyer? Or put pressure on these commissioning bodies on our behalf? No they have no leverage at all. Other than write another letter that will be filed away. Patients are not partners they are vulnerable and helpless, left looking for ambulance-chasing lawyers to get even with a service that is struggling to provide the most basic care. They enter the ‘SICK ROLE‘ and do not escape it until 4 years have passed.

“[..]people self-medicating. Hormones and hormone-blockers are readily available via the internet. The medical practitioner or specialist must consider the risks of harm to the patient by not prescribing hormones in these circumstances. The WPATH standards of care (World Professional Association for Transgender Health, 2011) suggest the prescribing of a ‘bridging’ prescription on an interim basis for a few months while the patient is referred to a gender specialist and an endocrinologist.”

What they overlook is those who are actually self-medding via repeat prescription, I am now at the point where I am asking what other people take and copying that as they clearly have had an endocrinologist see them at some stage, I am a patient at Charing Cross, and have had no guidance whatsoever from them in what I should take, and it is not for the want of trying, and that is now since 1998 and counting. So what is going on there? I have never had the CX Endocrinologist give me a check up and tell me what I should take. So this is in actual fact lucky dip care at the clinic. If you are lucky you will get a prescription otherwise go enjoy your menopause in pain and sweat!

I slipped through their ever-so tight holistic net maybe?

“A verifiable period of time, usually at least 12 months, living in a gender role that is congruent with the gender identity is a requirement for those who seek genital surgery.”

WHY?

Surgery applicable to women only “and/or labiaplasty”

Labiaplasty after vaginoplasty is not something applicable to the guidelines (it is rarely funded as an extra on the NHS) as any woman can have a ‘designer vagina’ without all this nonsense once you have one Gender Clinics are out of the picture. Funny, ‘bio females’ don’t have to attend a gender clinic to get a labiaplasty? So unless you already have a vagina in this instance some may say you are being discriminated against.

Truth is since the Nuremberg Code (after WWII) and the later Declaration of Helsinki, outlawing the sterilizing the ‘mentally ill’ (Eugenics), has meant that when a transperson wants to effectively be sterilized in this way, and because they are under mental health services transpeople have to dance to the fiddle of the practitioner (sterilization happens in cancer care, and family planning all the time, but they are not mentally ill – some must be. This is ALL about protecting practitioners. Why should they need protecting? Unless they are unsure of their diagnosis? If they are unsure of their diagnosis to this extent then they clearly are just playing out the situation and crossing their fingers. In other words, the longer you wait the better, as those who are not ‘serious’ may drop out. But what they forget is the times involved can cause the drop-outs. They are still Gender Dysphoric, still unwell, but the costs of traveling down to Gender Clinics on trains or private care is so high they just end up self-medding and making the best of it. This is not success this is massive failure!

“Hair treatments
Facial and body hair removal, hair transplantation and provision of hairpieces where appropriate will prevent risk of harm and help a woman live more successfully (see Appendix 6).”

CLOUD-CUCKOO-LAND ON THE NHS…

“Facial feminisation surgery
Facial feminisation surgery is considered by some to be an essential part of the transition process by women. This procedure involves cranial surgery and, depending on the amount of work undertaken, can take anything from 5 to 12 hours. Surgery can encompass scalp advancement, brow  repositioning, removal of brow bossing on the forehead, re-contouring the orbital rim, cheek surgery, rhinoplasty, upper lip lift and the re-shaping of the jaw and chin.”

NOT ON THE NHS MATE!

“Hormone support should be carried out as part of the care from a team or network that includes a clinical endocrinologist or using clearly developed protocols (see Appendices 2–4), with access to an endocrinologist if necessary.”

I know of a number who have a problem here, some are actually talking about this right now in our forums, that they have given up trying to get advice here and are just taking estrogen and crossing their fingers! A huge number have just given up asking NHS GIC ‘specialist’ Endo nurses on Email – they never answer… You would have thought the ‘Super Hero multidisciplinary team’ would have slid down their poles and sorted out an emergency referral for all these people struggling and before their bones turn to dust – nah just forgot about it. I myself am now trying for a local endo – wish me luck. What are the chances he knows nothing about transpeople though? Pretty high I reckon! One person suggest I save up and pay the same doctor privately I should be seeing at the GIC on the NHS – seriously? What a mess.

“Full discussion of fertility issues should precede endocrine treatment.
There should be no differentiation between gamete storage in patients and the general population (see Appendix 8).”

I could cry here, I asked about this on the NHS and nothing came of it… Cruelty!

“Aftercare
Long-term monitoring should be offered once the patient is stabilised at the agreed end stage of the gender transition. Monitoring of the endocrine treatment should be directly available to the patient, without psychiatric or psychological involvement unless requested. A summary of commonly used preparations is listed in Appendix 4.”

I think after ‘Care’ is a bit rich here, maybe ‘after surgery’ would be better worded… A dilator covered in blood, and agony dilating post op, for 8 months of tears, others wanting to end their lives as they simply have no energy left from the trauma of it all, no fight left in them – they want to be rescued not on Microsoft Office! They finally can sort it out…but usually down to begging, no dignity in that!

Some care! Again monitoring of endocrine for me (see above) – ZILCH!

In my case, this ‘care’ has led to me feeling so ill I am now sticking two hormone patches on at a time hoping it may help? Or hunting through my old tablets wondering what is going on, I don’t know, I need to maybe buy my own blood test lab? and team? Bloating, and menopausal symptoms are causing me pain just sitting in a chair.

“It is important that the nurse has knowledge of the needs of patients with gender dysphoria and of the surgery that is involved. It is desirable for the nurse to be able to liaise with the other disciplines. It is essential that the hospital-based nursing team makes appropriate referral to the community team prior to discharge.”

Again my ‘liaison’ didn’t exist (Dec 2010) – it was go home see yah later! And this is the norm for almost everyone I know. I was then left to dilate and deal with it. When I was in Hospital for surgery, I had 3 other people in with me.

The bed to my left had a girl who had her rectum perforated, and bit of a panic there. She had to be held over. OK these things happen… But the girl opposite me, she was in pain for months after to the point where she wanted to take her own life and this is searchable in the forums. And me, well not exactly a shining example either… that’s just one day on one ward! That said I know of a few transwomen that are happy with their results. But they too have other disappointments that apply here in other ways, mainly important correspondence failures which have lead to mental health breakdowns..

Despite my obvious post-op suffering to all concerned, I had no visits, no nurse, nothing, I attended, the 4 month follow up (that was a struggle, people in pain having to take train tips? Seriously? Should be an ambulance service available… and was so much in pain the surgeon could not even touch the area, he then prescribed pain killers and told me to go home (helpful!) 4 months after that I was begging them to examine me under anesthetic! 3 months of pain, blood and tears later they finally did, I don’t think I have ever recovered emotionally from that actually. During that time I had no health visits at all. Now this is crazy! Deluded practitioners who probably if paid privately do all this but not on the NHS they didn’t! Practitioners seemed to even feel annoyed at me bleeding and being unwell. Like it was some irritation they could do without. Sorry about that.

“Chest surgery for women10
Surgery is usually undertaken as a day case, under general anaesthetic. The incision is either placed submammary or in the axilla and a saline or silicone gel prosthesis is inserted into a submuscular pocket, or sometimes subglandularly if there has been a good response to hormone therapy. Implants are designed for a female chest and therefore tend to be rather narrow for the broad male chest. Also, males tend to have their nipples rather lateral in position compared with females. The principal complication is encapsulation or hardening around the prosthesis which occurs in one in ten cases.”

NOT ON THE NHS MATE unless you want to appear in the national newspapers as a ‘scumbag’ NHS resource hogger. Truth is
I know a number of NHS patients who have failed in this. And have either bankrupted themselves paying private, or had to live with a flat chest or asymmetric breasts. Of course they do not mention breast reduction, people who are gynecomastic and take hormones can develop large chests I know, I am one of them! The weight hurts my back and chest (ribs). No provision for that in this though. And again very weighted (no pun intended) to private practice. People reading this will assume this is a global concept, it is not. The NHS will not deliver probably 80% of what is recommended here. This is ironic especially when they focus so much on ‘commissioning’ and GP’s and this is NHS speek, yet much of this list is private practice delivery only.

“Patients should continue to be seen by psychological and surgical specialists for as long as necessary. The opportunity should be provided for direct referral back to specialist clinicians or clinics at any time in the future if requested.”

If you can get an appointment that is! The desire to support you post-op is a shock and for most dries up after 6 months,  even if you are not discharged, no more letters, no more how are you feelings? Just, “see yah!” “All ‘CURED’ now!” When in actuality this has been the worse part of my entire experience at the clinic, but with the least support! This demonstrates a huge hole in their thinking, the idea that you are ‘cured’ suggests that you were ill before surgery, surgery has nothing to do with my GD, surgery is just ‘the icing on the cake’. So it is arrogant to assume that you are any less ill after surgery than you were before, I feel exactly the same albeit with untreated menopause. And I am still a patient.

“Monitoring for osteoporosis, breast and prostate carcinoma required. Medication and tests needed for life on 6-monthly basis for 3 years, then yearly if well (see p. 39).”

NOTHING OFFERED TO ME IN THIS INSTANCE just forgotten about.

Electroepilation
Laser hair removal

Both almost impossible to get on the NHS!

Storage of sperm

Not in my case, never offered.

 

CONCLUSION

I read with interest these guidelines and at first glance they sound Tony the Tiger G-R-E-A-T! Yeah bring it on!!! But there are far too many shortcomings that are not being addressed, which are at the most basic care levels. Mainly communications!

I am but one example of how there is a total and utter disconnect between what they think they are providing and what they are actually delivering.

It is to my eyes a fantasy, as previously said a practitioner’s ‘Amazon Wish List’, a “one day when I make it I will get all these things!”  In truth they are an unenforceable mish-mash of suggestions that are unable to be met or at least very poorly so. I sit here poorly medicated and in pain. Post op and a prime example of this brave new world of buzzwords and ‘specialists’.

Maybe it is time to start over with the most basic of NHS services and get that right first? And to a standard to be proud of. One person slipping through the net is a very serious issue. In social care it can be catastrophic. A child may die for example and make national news. But this fear seems to be missing from adult gender clinics. And children’s ones too if you read below later.

To me transgender people need to be detached from mental health services, as I know many many 1000s of transpeople, and none of them are mentally ill, unless it is some other comorbidity, in other words they are trans and being treated for something else. That’s like saying a transperson who has a broken leg should be treated by Orthopaedic Specialists rather than gender clinics. It is irrelevant! Too many docs are making a good wage from all this to let this cash cow drop out and back into general medicine, but GM is where I am, reliant on local healthcare and endos in the hope of treatment, the ‘specialists’ are nowhere to be seen. What makes transpeople ill is being treated with contempt, by their GPs, socially, and medically being second-class citizens, as I have become, transpeople get more ill with neglect! A stitch in time etc… or ‘proactive Care’. And I am sad to say many transpeople I know have suffered neglect at the hands of specialists, it is left to groups like Transgender Zone and Facebook groups to talk people down from the rooftops – where are the specialists at 2am when someone is on their last legs? I am depressed, and this could have been so easily avoided. If they’d only follow their own guidelines and advice rather than pontificating others do so. One blood-test, locally, results sent to GIC their expert reads them and makes recommendations GP carries that out – could be done in 24 hrs! But months of ill health is storing up other problems! If I can see this why can’t they?

In a perfect world – one they do not mention strangely (wonder why?) It should play out like this:

  1. Go to GP say I want to transition to female (or male).
  2. Local mental health check for any other mental health problems… trans not being one of them of course. They say fine prescribe.
  3. GP prescribes with local expert endo support, transition….
  4. At the time of the patient’s choosing they have their surgery paid for by the local funding, this means that they can choose anyone they like (in the EU) and the surgeons have to tout for their business. This should be an alternative private route to the others listed. No need to have any 1 or 2 years of X-FACTOR for girls in front of some psychiatrist who doesn’t know if those are girl’s jeans you are wearing or not. and as more men wear guy-liner foundation, bronzer, mascara and nail varnish its only going to get tougher for them 🙂
  5. GIC remain a smaller service for those that choose to visit them or may have complex comorbidity.

TransgenderZonedotComSatireOct2013thetfactor

I would love to believe this is a ‘brave new world’, but its just is so hit and miss (pun intended) that none of this actually works well in practice – its just down to luck and a postcode lottery.

I would just like to end on this guy.

 itv

 itv

Leo (ftm) can’t get his blockers prescribed and the clock is ticking, so has had to resort to going on national television and begging only last month!

This is the true face of this situation! And why the basics need to be addressed first.

As it stands these practitioners are building up an avalanche of misery, osteoporosis and other mental health problems by not taking their own advice!

Sort out the issues you already have before building up more problems for yourselves. To ignore it is folly, I can see some class-action law-suit on the horizon that may destroy everything.

Back to basics. Funding pressure, communication, correspondence speed, verifiable treatment locally (the gender clinic actively calls the GP and talks them through any issues and remain a phone call away for GP support), dignity and outcomes.

And electrolysis!

In this country we have the NHS that is the envy of the world (well that’s slipping), we have gender clinics, so that’s great too, imagine being born 200 years ago and feeling this way? But the fact is this is not 200 years ago, it is today, we have these great guidelines which demonstrate that there is a will to deliver this. But until they do, it is all smoke and mirrors. If you are a millionaire then chances are you would not even choose to be treated in the UK at all. There are better places – but that’s another story.

I just feel this is like some big private advertisement listing, promoting all the things you can have privately with the authors, just pay-up!

Ice Maiden

Sam Johnson

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