Questions & Issues for NHS/United Kingdom Members

[Rianna Humble]

I've just received an appointment at the outpatients of my local NHS Mental Health trust and don't know what to expect. I'm excited and apprehensive at the same time.

Can anyone enlighten me?

[Kieron Andrew]

I've just received an appointment at the outpatients of my local NHS Mental Health trust and don't know what to expect. I'm excited and apprehensive at the same time.

Can anyone enlighten me?

you'll just get asked very basic family history, also things like when did you realise you were different?, what clues made you realise you were different....it will be fine, just questions to see if you need more counselling or whether they feel they can refer you directly to a GIC, i had one appt with the local NHS psych and was referred straight away by him to charing cross, best of luck..when is your appointment?

[Rianna Humble]

Thanks for the information, Kieron. My appointment is 1 week from today - 10th June at 10:30 a.m.

[kay_jessica]

My Doctor, who obviously did not know the proceedure, referred me directly to Charing Cross, who after months, wrote back to him to tell him that I had to see a Pychiatrist first.

I was then referred to Queen Mary's hospital and saw a psychiatrist and a psychologist (at the same time). After which they were happy to refer me to Charing Cross.

So yes, you will need to see a Psychiatrist first, otherwise, months are wasted.

Take Care,

Maryanne

My GP tried to do the same. Fortunately, I was able to correct him without having to wait months for an abrupt letter from CX. On the subject of "Do you go dressed or not?". Well I didn't on my initial GP visits, but did on my psychiatrists visits (I had 2, because he was late for the first and was unable to spend as much time as he needed). Going dressed was quite rewarding, for me anyway. I am very comfortable being Kay so actually going dressed was not a problem. What was rewarding was that the psychiatrist openly admitted that he was not expecting me dressed and did not even realise that I was his patient waiting in his reception as he rather embarrassingly assumed that the male patient sat opposite me was me. Hmm. But no, you don't have to go dressed to either. But if you are comfortable presenting in public, why not? He/She and the clerical staff will already knows you are trans so its no big deal. Just go and have fun.

Hugs

Kay

[Katiegirl]

I have not posted for sometime but on reading some of the posts I think the the following information might be useful:-

I transitioned at work on the 29th Feb 2008 and my first visit to the Gender Clinic at Charring Cross Hospital was in May 2008 to see psychiatrist Dr Lorimer for an hour. My second was in September 2008 to see Dr Davies which resulted in me being prescribed Hormone therapy treatment.
I then went to see Lorimer and Davies about every 4 months in turn until November 2009 and which point Davies recommented me for surgery and subsequently received an appointment to see Mr Bellringer on the 1st March 2010 (2 years after transitioning).
The appointment went well and a surgery date was fixed for 15th April 2010. Unfortunately for unknown reasons the surgery was cancelled on that day and I had to return home. I now have an appointment to see Mr Bellringer on the 28th June for another surgery date most likely in August.
At the beginning of March 2010 I applied and was granted my Gender Recognition Certificate and I am now legally a woman.
Note
GR Surgery will only be considered by the NHS until after 2 years from your proven transition date

Hope the information is useful enen though it has been considerably condensed.

Katie

[Nigella]

This may not be the right thread for this, but as it is only relevant to the UK, I think it is the best place.

A new UK law will come into effect in October 2010 which makes a lot of major changes for TRANSEXUALS, please note this does not affect TRANSVESTITES.

This link from ACAS, gives a breakdown of the major changes.

The biggest change that I have seen is that there is no longer a requirement for a person who is living in the gender that is opposite to their birth gender, to be under medical supervision to be classed as Transgender by definintion.

Anyway have a look, hope it helps some of you

[Kieron Andrew]

please note this does not affect TRANSVESTITES.

Actually in a way it does, i sat in on the talk Stephen Whittle gave about the new law at Sparkle, and it protects TS, TV and partners from harrassment, because the new law says that for TRANSGENDER people (covering ALL) if someone verbally says they INTEND to transition in the FUTURE (whether they actually do or not)...they are instantly covered by the law both at home or at work...they don't even have to follow through with that transition straightway...it is the INTENT to transition that covers ALL Transgender people in this law as long as they say it to someone that they INTEND to transition....also partners and family members of trans people are also covered by the harrassment laws for home, work, goods and services by 'association' of being a partner/friend of a trans person

*note i have bolded words because this is to show the wording of the law as it is now*

Stephen did state that Press For Change is working on changing the law even more so that words Gender Ressignment and Transsexual are scrapped completely to cover all Trans People transitioning or not regardless, but im sure this is some time away, but for now it is a huge step for all trans people in the UK

[Nigella]

Unfortunately Kieron, the UK law does not specifically cover transvestites. Some aspects of the new laws can cover transvestites, but only in the same way it would cover a number of other groups.

Our politicians consider transvestism to be a lifestyle choice, which means they will not legislate specifically for them.

The link I put up was from the ACAS site which advises employers. As a last point, until the new law is challenged in the courts it is nothing more than a piece of legislation. The courts make rulings on individual cases which can and sometimes do change the specific wording/meaning of the original legislation, this is called case law.

[Rianna Humble]

HM Government has published guidance that helps to interpret the intent of the act, in there we can read:

Section 7: Gender reassignment
Effect
41. This section defines the protected characteristic of gender reassignment for the purposes of the Act as where a person has proposed, started or completed a process to change his or her sex. A transsexual person has the protected characteristic of gender reassignment.

42. The section also explains that a reference to people who have or share the common characteristic of gender reassignment is a reference to all transsexual people. A woman making the transition to being a man and a man making the transition to being a woman both share the characteristic of gender reassignment, as does a person who has only just started out on the process of changing his or her sex and a person who has completed the process.

The examples imply that a person has to have started to live their life in the opposite gender to come under the protection of this Act, but no longer needs to have sought medical help.

From this guidance, I think it is clear that a Cross-dresser or Transvestite does not have (in the words of the Act) "the protected characteristic of gender reassignment" since they have not begun living their life in a new gender.

[Sarah Ellis]

I've not posted here in a while. But some of you may know my story in full. But basically to summarize, that after years of depression and courses of counseling by a psychologist, I eventually told my GP of my gender issues. She then referred me to another psychologist whom I told exactly what I had told my GP. I was then referred to the Cherry Knowles Hospital where I still await a reply from them for a date to see someone. Although they did confirm earlier this year that I am on their list.

They did say it could take around 4-6 months though. But the likelihood is that it may well be longer. I will be trying to chase it up though by the end of next month if I still hear nothing.

[Rianna Humble]

Hi Sarah, I'm glad to see you at least got on their waiting list. I know how frustrating the NHS waits can be - it looks like Charing Cross will have to make a second approach to my local PCT for funding - that's if the government doesn't break up the PCT before they can make a decision. If they do, the cost of my treatment will form a very significant proportion of the funding available to my GP and I won't want to hold my breath waiting for them to decide that I am a priority case.

I hope you hear soon about your appointment, and good luck chasing it.

[RachelDee]

Hi all,

I hope this is the right thread to post this (I thought a new thread would be pointless with this one here) but ive been trying to find as much information on the process of gender issues with the NHS as i can over the past few days. Just so i know what to expect in terms of counselling & referals (and waiting times). I have seen many videos on YouTube of people who have transitioned who live in the US etc, but i was trying specifically to find one in the UK. The following video (from June 2010) mentions the NHS process.

Starts at around 2:25
http://www.youtube.com/watch?v=IL676iFlsvs

There are a number of videos by the same person describing their journey too (if you wish to look) but this one deals with the NHS issues specifically.

On a personal note; I must admit that after i heard this i felt a bit angry, and uncertain. Seeing the avatars here im not sure this will be an issue for a lot of people, however the idea of living full time as a women before any assistance is given is one that i cannot really get my head around. The fact they would knowingly let you self medicate hormones, and still not refer you seems horrendous.

[Melody Moore]

Hi Rachel.... what a load of BS that is?.... I would immigrate - screw being forced to tolerate that type of Bigotry in Britain.

Holland or Australia sounds like your best bet.

[Rianna Humble]

The YouTube video person's experience is not necessarily typical. The NHS standards of care say that she should have been seen by a psychiatrist before being referred to a Gender Identity Clinic. This step seems to have been omitted. In at least one of the GIC's you are discouraged from beginning your RLE before you have been fully assessed by the clinic staff.

My own problem with the way the NHS does this is around the funding process. In particular the fact that each Primary Care Trust is free to set its own process for determining who should be allowed to be treated at a GIC. It seems that my local PCT has got its own system but hadn't informed the doctors what that system is. My doctor followed the national guidelines and referred me to the GIC after psychiatric evaluation, but the PCT seems to be ignoring the request for funding because it didn't follow their unusual practice

[Nigella]

Funding etc within the UK is very much down to local PCTs, (Primary Care Trusts), that is those who hold the purse strings. Originally my PCT had no funding available for TGs, then in the new financial year, funding became available. The first step taken was referral to a general psychiatrist. He determined that I was a suitable for referral to the GIC.

I was not referred by my GP until the PCT had agreed to fund my progress through them. Once funding was agreed I was referred to Leeds GIC and had 3 assessment meetings after which I was seen by the Consultant Psychiatrist and my Clinical Nurse Specialist. These meeting were to determine my suitability for entering the care pathway. Fortunately for me, I was classed as a Primary Transexual with Gender Dysphoria.

It is only at this point did the GIC provide the necessary medical support to begin transition. The first stage is for the TS to begin living the life of a female full time, this includes an official name change, working or volunteering in the choosen gender and provide evidence of this action being taken. This can take a period of time and as much help as possible is given to overcome any difficulties that the TS has. A TS will not be referred to an endocrinologist by the GIC until such satisfactory evidence is produced.

I cannot comment on the disparity others are having on their journey through the NHS, but I have been fortunate that my journey has been a smooth one and because I have lived as Nigella for five + years, my journey started in the NHS system in May and I am just waiting for an appointment to see the Endo. That is quick compared to others.

[RachelDee]

The first stage is for the TS to begin living the life of a female full time, this includes an official name change, working or volunteering in the choosen gender and provide evidence of this action being taken. This can take a period of time and as much help as possible is given to overcome any difficulties that the TS has. A TS will not be referred to an endocrinologist by the GIC until such satisfactory evidence is produced.

When you say help is given to overcome any difficulties, do you mean that they will assist with things like hair removal/voice training and such?

[Rianna Humble]

When you say help is given to overcome any difficulties, do you mean that they will assist with things like hair removal/voice training and such?

Although I haven't yet been able to attend, I know that voice coaching is available, but I don't think hair removal is

[RachelDee]

Really? That's sad to hear. I wish you luck with it though, and would be interested to hear your updates if you wish to share them in future

http://www.nhs.uk/Conditions/Gender-...roduction.aspx

I find it confusing how the NHS website's guideline of care is seemingly totally different to what the actual care is for this condition.

[Nigella]

When you say help is given to overcome any difficulties, do you mean that they will assist with things like hair removal/voice training and such?

Voice training is available within my GIC, however, I don't think any GIC offer any assistance with "cosmetic" changes, that is hair removal, trachea shave etc. By difficulties, I mean that if you find it difficult to go 24/7, initially, they will work with you to get to that point.

[Steph Butterfield]

For anyone in the North East of England reading this who wants referral to the local gender indentity service, the service will take referrals direct from a GP. When I requested referral to gender identity clinic in 2005 I wasn't presenting as female as I was still living as a male. I was still attending the psychology dept locally when I did my deed, and at this point i presented as female.

The Sunderland Gender Clinic is very patient centred


Stephanie

[Carole Cross]

If you are lucky, your PCT funding may include one or more of hair removal, trachea shave and breast augmentation. Many do not offer funding for these it is really down to the infamous 'postcode lottery', I will only get funding for my grs. Your GP should be able to tell you what is covered in your funding.

I decided to go full time before my first visit to Charing Cross and they seem to have no issue with this, I haven't heard before of any GIC discouraging patients from doing this, it is down to the patient to decide.

[Nigella]

Carole, PCTs are funded via the NHS and whilst they are able to be autonimous about where they spend their funding, the NHS do set some rules. The procedures you have described are considered to be cosmetic and as such the NHS have said they are not to be funded as part of transition. Having said that, the PCT can decided to fund such procedures.

This is very much based on an individual basis, primarily the lead medical professional in each case will have to decide if such procedures are essential to the well being of the TS.

You are right about being full time prior to going to a GIC. The main aspect of the transition is that it is at the pace of the individual who is going through the process, as such people are accepted on to a program at any stage of their transition.

[Sarah Ellis]

This one needs an update in my case.

You know the rest of my story this week. But basically, I have to now start the first stage, getting to know others, letting others (that I already know) be aware of who I am and my intentions and to get myself comfortable in that role. I have already been referred to the voice coach clinic and a another therapist. As with most of us in the UK, only when this is done and I have made progress will I then be referred to the endo. It's bloody hard work though.

I did mention to the psychiatrist at the clinic the other day of things like t- blockers (anti androgens) and she discouraged me from trying anything like that.

On the subject of surgery (NOT SRS), my PCT may or may not provide this as it's all down to funding again. Hell, they wouldn't even fix my eyelid last year and that was before I'd took this step.

[Kittie]

A few months ago a took the first step to try and get on the transition bus. I went to my GP and explained that I believe I am TS and want to be put on hormones, which resulted in me being referred to a consultant at an outpatient clinic. Here I tried to explain my feelings in more depth and I was diagnosed with gender dysphoria. I was then told she will apply for funding for me to have an assessment at Charing Cross. I recieved a letter this morning and I now have another appointment at the same outpatient clinic, can anyone give me any ideas what this will be for? I didn't think I would need to go back. Because I'm so insecure I'm worried that there is going to be bad news or something...

[Carole Cross]

Unfortunately it seems that most PCTs are still referring patients to Charing Cross and not using clinics that are nearer to them. I think the only way to change this is for patients to ask the PCT themselves although there is no guarantee that the PCT will agree to this.