trans* NHS experiences

there's more than one path, actually

Following on from the discussion on Shout Out last week about NHS services for trans youth, I thought it might be interesting to look at people’s personal experiences of NHS help, particularly at the early stage where the individual identifies as being gender variant, or uncomfortable with their assigned gender, and decides they want to do something about it and need help.

Quickly throwing in a caveat here; not everyone wants or needs help or intervention from the NHS. And the NHS does not, and does not pretend to, offer everything on a plate. Far from it. You do not need permission to be who you want to be.

But some people will want help from the NHS. Advice, counselling, hormonal and/or surgical intervention. And the first port of call is your GP. Who should refer you to a local psychiatrist for assessment, if you are seeking referral to a Gender Identity Clinic. And then if that psychiatrist thinks your needs can be helped by the GIC, you will be referred on to one. In the case of Bristol, either the one at Exeter or the Claybrooke Centre at Charing Cross.

We’re interested in hearing your first-hand experience of the early stage of this process. What help were you looking for? How did your GP respond? What happened? If you’d like to contribute your experience, you can add it as a comment below, or have it as a separate blog entry (just ask!) -under your name or anonymised. Would you be willing to record your experience for Shout Out? Or have it read out on there?Please say.

To start the ball rolling, here’s my own experience:


By the summer of 2001, I had come to see transitioning as the only viable way forward for me. But there seemed to be a big gulf between where I was, and where I wanted to be. I wanted help, and hormones. So I saw my GP, and explained as best I could.

I was lucky; he was fairly knowledgeable, and very supportive. He started things moving.

Though things do move slowly in the NHS…. a few months later the PCT responded that they could provide nothing, and recommended I see Prof Richard Green at Charing Cross, as a private patient.

I saw Prof Green in December 2001. He told me to go away, start living full-time, and come back in six months, after which time he would maybe possibly consider prescribing hormones.

It was a bit of a disappointment. In fact, it was a serious blow. Though this response was very much in line with standard GIC policy at that time.

He also advised that I should be referred to the GIC as an NHS patient. But at that time, the PCT was broke- they’d recently paid out a huge wodge of compensation over the children’s hospital scandal. My GP said they couldn’t even afford the plastic hip joints for hip replacements, at that time. So I didn’t try to push it.

In March 2002 I saw Dr Russell Reed, again as a private patient. He offered a diagnosis of gender dysphoria, and a prescription for hormones. As he said, “She has been tempted to obtain hormones through the Internet and under the Harry Benjamin Guidelines it is more appropriate for these to be medically monitored.”

Two months later I formally changed my name and began living full-time in female gender role.

Russell Reed was later found guilty of ‘serious professional misconduct’, by the GMC, after a case brought by some of the senior clinicians at Charing Cross. Which I thought a shame.

My GP has continued to be supportive.

I re-entered the NHS care pathway in 2005.

What I know now, that I wish I knew then: how the system works; what is the care pathway; how much your transition is really very much up to you; the NHS can help, but support will most likely come from people in a similar position to you. And family if you’re lucky.




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8 Responses to trans* NHS experiences

  1. Mani says:

    Hi Dru

    I’ll share my experience of NHS “Help” so far

    I went to my GP last Oct10 to disclose my transgender nature and request help from the NHS. He was useless and fobbed me off! I had to change GP. I saw my new GP in Feb11, he was a bit crap too but at least researched what he should do. He referred me to a local psychiatrist who I saw in May11. He in-turn confirmed that I wasn’t bonkers and referred me to a Gender Identity Clinic in Aug11. I am currently being “grilled” by a team at a Gender Identity Clinic.

    Since “coming out” I have met lots of transgender people from all parts of the spectrum. The various local support groups and National online forums have been a Godsend. What a varied bunch of people we are! I’ve made lots of new, like-minded, friends – love em all!

    I have had my face lasered for six Months and I’m now finishing off with electrolysis – a very expensive any privately paid for process. I’ve also had 40 years worth of testosterone damage chiselled from my head (FFS). Since Sept 5th 2011 I have been living full-time female. It’s early days yet, but, so far, so good and I’m enjoying the experience.

    This is my own version of RLE and not a, NHS rules, countdown to GRS. I’m happy to “back pedal” if living fulltime as a girly is not for me. My friends have been told that this is an experimental phase, an essential part of self-discovery. GRS/SRS is a procedure that I do not anticipate having done – I like my bits the way they are. I don’t fancy guys and whose gonna see my dangly bits anyway? Apart from my intimate partner, I can’t see the point – I suppose wearing a bikini would be easier – but I’m in my fifties – not many fifty year olds would want to show off their “camel toes” would they 😀

    I haven’t changed my legal name and I still have a male passport – I’m looking forward to the transgender passport option being available soon. I’ve come to realise that I will always be transgender however I present. Personally, I’m not a believer in the gender binary, it’s a continuum – I might get booted off the NHS pathway for having such a notion.

    My GIC therapist at the clinic, who I have now seen three times, has informed me that the NHS does not support shemales – bloody cheek! It’s just as well I continue to self medicate my own feminising hormone regime cos it looks as though the NHS doesn’t want to help “Inbetweenies” like me.

    The current NHS way of treating transgender people supports the outdated notion that gender is bipolar. It’s an all or nothing approach that allows for a one way flip from one gender to the other and nothing else. Whereas, I truly sit on the gender fence and just I’m trying to get comfortable.

    Trans and Proud!

  2. I don’t have much to say on the NHS transition process because, for various reasons, including living in Australia for part of the time, I didn’t use them much. However, it is important to note that trans people’s interactions with the NHS do not stop after transition. You’ll probably need hormones for the rest of your life, and you’ll still get sick. Importantly you may get sick in atypical ways. Trans women don’t need cervical smears, but they can get prostate cancer. You and your doctor need to be aware of this.

    I have had a few problems with NHS staff, and these fall broadly into two areas. The first is that, because I didn’t go through an NHS Gender Clinic, I have been seen as someone who as “self-medicated” and therefore someone who is undeserving of help. Secondly I have had a couple of GPs claim that they “do not know enough” about my situation to treat me. That included not only refusal to supply a prescription for hormones, but even refusing to sign my GRC request despite the fact that I had all of the necessary paperwork and just needed someone to attest that the surgery had been done.

    I think it would be very useful for this group to keep a list of local GPs who are happy to take trans people as patients.

  3. Kim says:

    I spent many years, on and off, in the NHS circus, including four consultations at Charing Cross – two in 1998 and two in 2010, before eventually deciding physical transitioning wasn’t for me. After more than thirty years (since my teens) of identifying – but most of the time not presenting – as female, I eventually decided – with the help of two helpful transpeople – that I’m closer to gender neutral than female.

    I was lucky that my GP was sympathetic when I told him what I wanted – I got the impression I wasn’t the first transperson he’d seen. The first psychiatrist I saw took a very positive approach, but at Charing Cross they said they wouldn’t help me until I started ‘presenting as female’ – in other words, dressing up as a woman. I refused to do that – I’m not prepared to present as a female stereotype any more than I’d present as a male stereotype. Women have spent years of campaigning against being forced into stereotype roles – why should it be any different for transwomen?

    Unfortunately, I’ve found that a lot of transwomen I’ve talked to have taken that same reactionary approach, refusing to accept me as trans because I don’t cross-dress and appear to be male. However, more recently I’ve talked to other transpeople (male. female and queer like me) who have taken a much more progressive approach: we all have the right to determine our own gender identity, and others aren’t entitled to contradict it. That is the stance we should all take.

    Actually, I did try living as a female for a while, but it felt uncomfortable, and I soon decided it was more trouble than it was worth.

    So my experience has been a bit like Mani’s, and I agree that the NHS insists on the all-or-nothing approach. But I wouldn’t describe their attitude towards gender as ‘bipolar’ – that means something completely different! What Mani and I (and a lot of other people) are doing is challenging the ‘gender binary’ – the insistance that you have to be either male or female and refusing to recognise anything in between. Luckily my natural appearance is fairly androgenous anyway, and occasionally people ‘mistake’ me for a woman even when I’m making no attempt to present as one. But most of the time I’m taken as male.

    I had some electrolysis and IPL to remove my facial hair until I ran out of money, but at least I now have less facial hair than before. I’m not sure what to think about them refusing me the hormone treatment I wanted now that I’ve decided I don’t need it, tho’ ideally I would like to be given something to reduce my testosterone production and perhaps slightly increase the oestrogen, but not enough to make me sprout boobs – I don’t need them. But I’ve resigned myself to the fact that this isn’t possible, and nor is going private. If anyone knows any evidence to the contrary, please let me know! Actually, I did hear about a genderqueer person getting some partial hormone treatment – and surgery as well – on the NHS, but I don’t know the details.

    Incidentally, I don’t like the way doctors talk about “diagnosing” people as gender dysphoric. Gender dysphoria isn’t a diagnosis, it’s a symptom. I don’t need a doctor to tell me I’m gender dysphoric, any more than anyone
    needs a dentist to tell them they’ve got a toothache.

    So that’s my story – not the run-of-the-mill gender transition story that the media are so fond of, but something a bit more subtle.
    So that’s as far as I’ve got, and after years of experimenting with various male and female names I’ve finally started the process of formally adapting this unisex one and banishing for good my given male name.

  4. Carole Cross says:

    Mani and KIm I think your GICs are going against current NHS guidelines for refusing to treat you. I know of several transwomen who are not opting for surgery and are still continuing their hormone thereapy treatment. I do know that CXH GIC are more sympathetic now than in the past and are willing to continue treating those who do not want gender surgery. Gender surgery is not a requirement for obtaining a GRC so you can become legally female without gender surgery if that’s what you want to do.

    Any GIC clinician who tells you the NHS do not support shemales are wrong and they are also being discriminating towards you which they can be reported for. It is against current NHS guidelines to refuse to treat you if you do not want gender surgery.

    For the record I have been going the treatment at CXH for the past 2 years but I am hoping for surgery and have my first surgical referral in two weeks. Carole x

  5. Gary lloyd says:

    I’ve been to my doctor who was very good and understanding,he has sent me to a psychiatrist who has agreed i should go to a gender identity clinic and has sent a letter to my doctor telling him this,that was just over a month ago,I’m still waiting for my appointment,don’t know what’s happening or how long it will take,hope I hear something soon, don’t know if I should go to this appointment dressed as a lady or not, I think I should,but don’t have any information about what’s going to happen or what’s expected of me,I’m prepared to do whatever it takes to become the woman I should of always been, it’s been a hard experience for me,I’m doing this on my own and don’t know where to go to get help, I live in the bristol area and would love to meet people like me,but I don’t know where to go, I want to go out dressed but have nowhere to go,it’s quite frustrating and I want to find somewhere I can get help with my hair and makeup,buying clothes etc ,can anyone help me, don’t know where to go for help, with love Gary (britney silk) ps any help would be gratefully received

    • Dru says:

      Hi Gary …. sorry for the slow reply. Appointments at gender clinics can take ages to come through; which one are you being referred to? …admin at Charing Cross has been v poor but is apparently improved now (this is not a reflection on the clinicians there, by the way) -you should go to the appointment however you feel comfortable going.
      A big thing about transitioning, which you’ll definitely have taken on board by the time you get any distance along that path if and when you tread it, is that you have to give yourself permission to do it, not seek it from anyone else. You will get support from the trans community if you look for it, and help from medical professionals if you choose; but ultimately, you’ve just got to get on and do it, in your own time, at your own pace.
      May I recommend you join the Transbristol Facebook group? there is a proposal to get a social group (Transcafe) up and running; that may be a good thing for you? -there are also other support groups ibn the Bristol area (see links above)

      • britney silk says:

        Gary lloyd ( britney silk) I don’t know which gender identity clinic I’m being referred to, I’m a woman at night and a man in the day at the moment, I’ve been self medicating hormones for over 3 months now,and have been feeling much better since I’ve been doing this, my problem at the moment is I could do with some help to dress and look good enough to pass i think I look pretty good,but I’m very nervous about going out dressed, I’d like to meet people like me and learn more on how to pass in public, but I live in a small village and don’t know anyone who could help me,I want to start living 24/7 as a woman but I’m just not confident enough to do this, I don’t live far from bristol,and wonderd if there was anywhere i can go for help, I’m doing this on my own,and feel very alone, I want to find friends, I want to go out and meet people, I need to build up my confidence,I can’t go anywhere hear I’m worried people won’t like what I’m doing, I live in portishead,and don’t think I can go out here but wondered if there was somewhere in bristol I could go, I’ve already started my transition,just need a bit of help,I tried joining face book but just had problems, I don’t think they like people using there feminine name and closed it down, I’d rather meet people in person, thanks for your reply, I don’t know what I’m going to do now, feel like my life is on hold waiting for a appointment that I might never get, I can’t carry on waiting like this,I feel i should carry on and do everything myself for myself, but need a little bit of help, thank you for trying to help but I don’t think this is really doing anything for me, yours Gary lloyd ( britney silk)

  6. Susannah says:

    Hi Britney. You can have a look at my website
    There are lots of useful links there. I’m happy to chat and point you at useful places.

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