Questions & Issues for NHS/United Kingdom Members

[Nigella]

Same with me Deborah, my PCT offered Sheffield, Nottingham or Leeds. I think that down south CX is more than likely the preferred choice for PCTs.

[Rianna Humble]

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.

Problem is, there are only a small number of NHS Gender Clinics and if the PCT refers you to a private facility, they will use a greater proportion of the budget that they have reserved for this condition

Charing Cross was never ever mentioned to me, I was referred routinely to Nottingham - perhaps the PCTs in the East Midlands are more aware?

East Midlands will be in the Nottingham Gender Clinic's catchment area/ Just as well since Charing Cross seems to be the only one in the South

[Rianna Humble]

All of a sudden, 48 weeks has come down to just over 3 and the time for my first appointment at Charing Cross GIC is nearly upon me. At the moment, I'm swinging between elation at the thought that the waiting is nearly over and dread of what is going to happen.

Although I am now 10 month into my RLE, I still haven't made any real progress with my voice.

I really don't know what to expect from this first appointment, can anyone put my mind at rest or at least give me some pointers for what to expect?

What sort of preparation shoud I do for this first appointment?

[Carole Cross]

You don't need any preparation for the appointment, just arrive there on time and have any paperwork you may need such as deed poll, NHS number and letter from your employer as to when you went full time at work as a female employee. Don't worry about your voice or any mannerisms, they are not there to judge you on those just be honest to any questions they ask. You will be fine.

[Natasha_C]

Hi… Please may I ask for help. I have my appointment with my GP on Monday and just wondered will he ask any questions I need to be prepared for ? It’s quite a large practice of doctors so he doesn’t know me very well and I just want to make sure I get the appointment with a psychiatrist for the C Cross referral without any problems.

[Rianna Humble]

Hi Natasha, I know how you feel about the first appointment to discuss this with your GP - when I went along I was dirt scared and excited at the same time and had absolutely no idea how to explain it. In the end it all just sort of came out.

The main thing that my GP wanted to know was what sort of help I would like her to give me. You already know the answer to that one - you want a referral to a psy who can write a report for your referral to Charing Cross. They do need to "assess" whether you might have any psychiatric complications, but there is nothing to worry about with that.

The other thing you can ask your GP to do is to check on how your local PCT handles funding requests for GID - my local one does tghings in a non standard way and that delayed my appointment at Charing Cross

Best of luck with your GP, please let us know how you get on.

[Carole Cross]

Hi natasha, when I saw my GP I told him 'I think I was born the wrong gender' and took it from there. I was very nervous but I knew I had to do it rather than continue to live a lie. Once you initially get the message across it should be easier to talk about it as you can express your inner feelings. It can be frustrating at times getting treatment on the NHS as there are long waiting times and sometimes you have to chase things up yourself but you will get there in the end.

[Natasha_C]

Thank you for all your help. I was just honest and am now on my way to a local psychiatrist. My doctor surprisingly asked me lots of questions and whilst he tried I dont think really understood this condition but it doesnt matter as I'm on my way. Not sure how long I have to wait now but am so pleased to be on the road & thank you again for all your help.

[RachelDee]

My GP asked me where I wanted her to refer me to (originally it would be at Nottingham) but I told her Charing Cross because the doctor I see currently is in London so its probably going to be easier if its in the same place. Though it will likley be some time before I get any kind of appointment.

Would any of your happen to know if an orchiectomy would be funded by NHS gender clinics at all?

[Nigella]

I don't believe that this would be funded. Any procedure that is considered to be "cosmetic" is not normally funded as part of the funding available for GI. If there is a requirement, I would believe that they would recommend a full SRS procedure.

[RachelDee]

I believe so, although if you're intending full GRS then surely by having an orchidectomy the surgeons would have less material to work with when the time came?

Well they don't remove anything but the testicles right. Through an opening just above your, umm you know. Just below the belly button.

I dont imagine it would make any difference to GRS that hormones/anti-androgens wouldnt do already?

Any procedure that is considered to be "cosmetic" is not normally funded as part of the funding available for GI.

Not sure I would call it cosmetic though? It does not really change how anything looks (and I dont go round showing people lol....). But I would say has a significant health benifit by reducing the amount of Estrogen you need to take, and removing the need for anti-androgens? I think thats pretty win-win. Especially if the NHS is paying for the medication (over time that would all add up right).

It's a lot cheaper than SRS too. I can have SRS at any time as its not something that will be apparent to other people, or really chance much - but for the immediate future I think an orchidectomy would be helpful to transition. Perhaps I have this wrong?

[Nigella]

Cosmetic may have been the wrong choice of words, but that is what the NHS consider any surgery, apart from SRS, to be.

The NHS will not, IMHO, pay for two operations. The orchidectomy would be more costly than the medication even though you will be on estrogen for the rest of your life. Anti-androgens are only needed till the point that either the hanging bits go, or your body naturally reduces the T.

Having said that, I have found that PCTs work differently so one size does not fit all. A simple answer is to ask when you start on the care pathway.

[Carole Cross]

Thank you for all your help. I was just honest and am now on my way to a local psychiatrist. My doctor surprisingly asked me lots of questions and whilst he tried I dont think really understood this condition but it doesnt matter as I'm on my way. Not sure how long I have to wait now but am so pleased to be on the road & thank you again for all your help.

This is one of the main problems when going to see your GP, most of them probalby have no experience in dealing with patients with GD and do not know the correct procedures. There are NHS guidelines but many will not have seen them prior to seeing thre patient. I was lucky in that my GP seemed to know some of the procedure and I also did some research myself beforehand. The government has produced a couple of surveys for the trans community, to help them improve the process of treatment for GD across the NHS. The first one is now closed but the second can be found here: http://www.equalities.gov.uk/pdf/2nd...e-bulletin.pdf

[Carvery Carly]

Just came back from doctors and told them about my GD. Luckily, the doctor I saw already has patients who are GD, so that was a bit easier for me explaining things as I'm sure she knew how to deal with it better.
She asked the usual questions - "how long I've felt like this" etc. She also asked me "What do you want me (doctor) to do to help".
She explained it's a long process as they want to make sure it's what I want to do. Got to talk to different people as it will affect others (SO and kids) as well.
After I explained myself and my feelings, she said she was going to get in touch with a therapist. I asked if that would be Nottingham or CX. She said no, it would be someone local first then I'd have to go back to her and then get referred onto CX.
She asked me if I was ok to have letter for therapists appointment come to my home address, I said no and gave her my works address. I'm more than likely be a work than at home. So it would be easier to pick up letter.
I asked her about time scale to see therapist, she said 6 to 8 weeks.
I hate waiting.

Sorry to waffle but I just wanted to share my news, as I'm excited and nervous of how things at last (after nearly 40 yrs of feeling like this) are progressing, albeit at a snails pace.

Much love,
Carly.

PS when I eventually see therapist, what's the usual procedure. Do I have to explain myself and my feelings to them, except more in depth than what I did to the doctors?
Please could someone let me know what to expected as I'm a nervous/shy person at the best of times.

[Rianna Humble]

That's a great start, Carly! I'm so glad that your doctor is being supportive

You do have to see a local therapist first so that they can help screen you for other possible problems that could get in the way of helping you to deal with your Gender Dysphoria, but don't get too nervous about it, (s)he will be there to help you. When I had my appointment last year, the Mental Health doctor asked me if I preferred to tell her about myself or answer direct questions. I opted for a bit of each starting with me telling her how this had affected me over the years. She had some standard questions to ask to screen out other mental health complications, but I felt very relaxed with her and able to say what was on my mind.

I had told her that I felt violentlysick every time I had to put on men's clothing, but I didn't understand why it was not so bad when I dressed as a man in the office. She suggested that it might be because the others knew I was only pretending to be a man. That made a lot of sense to me.

BTW, if at the end of the appointment, the therapist says she will make her recommendation "right away" you need to know that this does not mean the same thing inNHS terms as it does in English so be prepared to be patient.

[Carvery Carly]

Happy news.
Got my appointment letter through yesterday (11th July) to go and see the therapist on the 11th August at 11am at the local hospital's Mental Health Unit.
When I see the words Mental Health, it makes me sound like I'm a nutter, which is miles from it.
Or is it just me reading between the lines?

All I have to do is confirm that the date is convenient then it's ok.

Another bloody month to wait. Why does Time go so slow when you don't want it to?

I'm nervous and excited at the same time. Is that a rational feeling to have?

How should I prepare myself for the appointment, i.e mentally and physically?
Should I write down some questions/feelings?

Much love,
Carly.

[Rianna Humble]

Hi Carly, that's great news about your appointment!

Don't worry about it being with the Mental Health trust, this is normal procedure to screen against other problems that could either mimic the effects of GID or complicate the treatment.

Yes it is perfectly normal to be nervous and excited at the same time - I was before my appointment at the local Mental Health trust and before my first appointment at the Gender Clinic.

The best way you can prepare is just to relax and take it easy, but one thing to be very clear about at the start of the appointment is to let them know your purpose is to get a recommendation to a Gender Clinic.

The doctor I saw asked me if I wanted to tell her about myself or answer questions. In the end I did both. There will be some standard screening questions, just answer them simply and I am sure it will all go well.

[Carvery Carly]

Happy news.
All I have to do is confirm that the date is convenient then it's ok.

Phoned to confirm that date for appointment is ok.
Only 3 weeks and 6 days to go. &

Much love,
Carly.

[Nigella]

For those UK girls who are unsure of the way forward, here is my experience of the route I followed to get to the [size="2"]LEEDS GENDER IDENTITY CLINIC [/size] and their requirements:

Please note that a specific time frame has not been included as they will differ for each person

Visit my GP to discuss my transgenderism

GP refers me to a psychiatrist at the local Mental Health Unit, this is to ascertain there are no other issues affecting the way I was feeling.

Return to GP to discuss the results of the visit to psychiatrist.

GP applies to Primary Care Trust for funding. Funding may come from other sources due to changes to NHS funding going on within the NHS at present.

PCT approve funding and offer choice of 3 GICs LEEDS, Sheffield and Nottingham.

Appointment at LEEDS GIC for assessment.

Requirement by GIC - Initial meeting with Gender Specialist and Clinical Nurse Specialist to discuss GIC requirements and my expectations. Up to 5 further meetings with Clinical Nurse Specialist, with a minimum of 3 meetings. Final meeting with Gender Specialist and Clinical Nurse Specialist to discuss diagnosis.
PLEASE NOTE it is only at this point that an official diagnosis of GID is made. Up to this point LEEDS GIC are only assessing you.

After diagnosis the care pathway you will follow will depend upon your own circumstances.

My own experience, provided evidence of living in "role" and further meetings with Clinical Nurse Specialist while waiting for appointment with Endocrinologist. This was a quick route because I had been living as Nigella for 5 years before seeking any "medical" assistance.



Other UK based members, please add your understanding of the process for the GIC you have used. It is hopefull to build a picture of the basic requirements for each PCT/GIC within the UK. If there are sufficient replies, it may be possible to create a sticky with all the information to help those who come after us.

[Shelly Preston]

NHS Scotland

There are basically 4 main consultants in Scotland, who handle anyone with Gender Dysphoria.

The clinics are based in :-
( NHS Highlands), (NHS Grampian), (NHS Lothian) and (NHS Greater Glasgow & Clyde (Sandyford Clinic))



Only the Sandyford Clinic will take self referrals, whilst the others work through the General Practitioners.

This is not ideal for some who only need advice. but have no wish to alert their G.P.’s, however that is the current system. Should anyone be taken into any programme under the control of the above,

Then they will advise the person’s G.P. as the G.P. is the person responsible for the patients welfare. Hormones are issued by the G.P. under approval from the consultant, so at some point the person needs their G.P.’s assistance.

There are currently new Gender Reassignment protocols being compiled by the NHS / Scottish Government, and self referral to all clinics is part of the review.

Anyone in Scotland can refer to the Sandyford clinic, and distance is no longer a barrier.
I believe Sandyford are now allowed to take self referrals from some areas in Northern England, which is a recent policy change

If any one needs the name of a particular consultant for an area, please send me a pm.

[Natasha_C]

It is my NHS psychiatrist appointment tomorrow so I am pleased to be making steady progress. The letter says the appointment is 1 hour which is quite long. I wondered does anyone know what type of questions they are going to ask ? I am just going to be honest, but if anyone can help a little what I can expect I would be so grateful.

[Rianna Humble]

When I went to my appointment, I was dressed and the psy didn't bat an eyelid. She asked me whether I preferred to tell her about myself or answer formal questions, so I replied "we could do a little of each - I'll tell you about myslef then you can ask me anything I haven't covered".

She was a very good listener, at the end she asked me to clarify a couple of points and then introduced the screening questions:

* Have I ever suffered from mental health problems?
* Has anyone else in my immediate family?

and things like that.

At the end she explained that she would send a report to my GP "straight away" (which in English translates to about 4 weeks later) recommending that I be referred to the Gender Identity Clinic and that this would then be forwarded with my GP's referral.

I hope your appointment goes as smoothly

[Rianna Humble]

Sorry to post 2 on the trot. My 2nd appointment at the GIC ended with the doctor saying he will be writing to my GP to recommend I start Oestrogen and explaining that he wants me to start on a low dose for 6 to 8 weeks then double it if there are no adverse signs.

My question is what possible side effects should I be mentioning to the people I work with most closely? Not so much physical but mental and/or emotional? I realise I shouldn't notice too much for the first couple of weeks, but I want to be as pro-active as possible since I am the first person they have had in my office from day 1.

[Sharon]

You could warn people that you will be unusually happy and likely to be smiling a lot more often.

Some people barely notice emotional changes (other than that happiness thing) while others get walloped by sudden mood swings that seem to come out of nowhere. Personally, I don't see a need for you to warn anybody about possible emotional changes -- just wait and see how you react and then decide if you need to give an explanation.

[Carole Cross]

I have been on estradiol valerate for 8 weeks now and my breast growth started after 4 weeks and I have noticed a slight reduction in body hair growth and a softening of the skin. I have to be on a low dose for 12 weeks because of complications with my blood test results but should be on a higher dose after that. I have noticed that I can become tearful at times but no real mood swings yet. I was told to not expect many changes in the first few months so I am happy with the progress so far