Questions & Issues for NHS/United Kingdom Members

This thread is for members who have to deal with the NHS for their transition and surgeries, UK members can post their questions and discussions here and get feedback from those who have experience or knowledge regarding the NHS.

I'm making this separate because we get too many "I don't know, but this is how we do it here" type answers to NHS questions, the intentions are good but are of no help. If you can't answer the question, do not reply, it will be deleted. UK members are still free to use any part of the forum to discuss this if they choose.

Karen

A big thanks to Elizabeth 66 for suggesting this, it's member participation that makes this place work..

Here is a useful link which the department of health issued for guidance for our GP's, it is a good place to start.

Guidance for GPs, other clinicians and health professionals on the care of gender variant people

Thanks for including this thread Karen I'm sure it will soon become very popular.

Great link Elizabeth. Here's another that might be helpful:

A guide to hormone therapy for trans people

I have just started to take my first steps towards getting help under the NHS. It helps that my diabetes nurse, Hazel, is a friend, so I wore nail varnish when "he" went to see her for a regular clinic appointment.

Hazel complimented him on my nail varnish and he asked about the best doctor to approach for a gender consultation.

I have made an appointment with the recommended doctor in 10 days time. Hopefully, that will be my first full step towards being able to transition. I will be happy to share how it goes.

At the moment, I am planning to go as "him" but perhaps with a blouse instead of a shirt, since the doctor won't definitely know why I am going to see her. Does that sound like the right thing to do?

Hi Rianna,

For my first appointment to see the doctor, I went totally dressed as I am very comfortable with how I look, and therefore confident in public.

I guess whether you go dressed or not, depends how you feel in yourself, but make the decision on how you feel about it, not what you think the Doctor might feel or think. It is his or her job to help you and set you on the right path, to a psychiatrist, and then a gender clinic. Just decide how you will feel more comfortable at the appointment. I saw a male doctor.

Good luck and I hope it all goes well, whatever you decide.

Take care,

Maryanne

Rianna, you don't have to see your GP dressed, the first time I spoke to my doctor about it I was dressed as male. I was then advised to see a counsellor and I was not dressed for the first few visits with her, I was only dressed for the last 2 visits, then when I saw my GP again, I went dressed. You don't need to go dressed, just dress in what makes you feel comfortable until you are ready to go dressed. I don't even think it is necessary to go dressed for your first GIC appointment, although most people do.

Rianna, when we first approached our GP re Debs he was dressed as him, when we were referred to the psychiatrist for further help, Debs saw her twice and neither times was dressed as Debs, we did take some pictures of Debs on her phone that we showed her, on our second visit we did take some printed pictures of her dressed, both indoors and out and about.After the second session, she was referred to Charing Cross GIC, and we are now awaiting our first appointment

Debs had previously been to see a clinical psychologist some years previously for different issues, her gender identity was touched on in those sessions, but no further action was deemed required at that time ..........


Hope this helps :)

Elizabeth great idea for the thread :)

Rianna

Nigella first went fully dressed as in trousers and top, with forms as well, as she was already presenting female full time.

The main thing is for you to go in whatever clothing you feel the most comfy in.

Do you have to see a psychiatrist before you can go to a GIC, because my GP has referred me and i haven't seen a psychiatrist yet.

Elizabeth it was done that way with Debs because she had already attended there for other issues previously and had seen her then, so a follow up for the gender issues was seen as a logical way to go, as she was seen by the clinics psychiatrist who saw her a few years ago ........... I don't think it is normal to be seen by a psychiatrist in that order

Quote:

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Originally Posted by Elizabeth 66

Do you have to see a psychiatrist before you can go to a GIC, because my GP has referred me and i haven't seen a psychiatrist yet.

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Yes the GP should refer you to a local psych first who then will in turn refer you to the GIC that your PCT has a contract with...most probably charing cross, charing cross i know will NOT take direct referrals from the GP

The GIC that he has referred me to is actually in Manchester... i would have thought that he would have told me if they refused the referral, maybe different pct have different procedures..

Elizabeth, how long since you had your referral ?

only about two weeks ago when they said...

Debs got told the physc would refer her when we saw her at the end OCT ......... by the time we got round to checking up with Charring, they told us the referral did not get to them till Feb, and they just got out to sending us the first set of paperwork on 22nd April ............. which will now have to be resent out to us as we have just got round to telling them about our move and we had to write to them with the address change, they would not take it over the phone :sad:

Quote:

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Originally Posted by Elizabeth 66

The GIC that he has referred me to is actually in Manchester... i would have thought that he would have told me if they refused the referral, maybe different pct have different procedures..

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i know of a few FtMs in Manchester there actually isn't a GIC in Manchester the one that is advertised is run and owned by the owner of the infamous transformation shops and they are a rip off scheme...what your dr has probably done is referred you to a psych in manchester who will in turn refer you to charing cross

It will all depend upon your PCTs referral process. I had to see a general psychiatrist to confirm that I fitted the Transgender spectrum. I think it is a way of weeding out the game players.

The psychiatrist wrote to my GP to confirm that I was in the TG spectrum and confirmed that he would support a referral to a GIC.

My GP contacted the PCT to ask for a referral, who then wrote back agreeding to fund the process and asked for me to choose which GIC I wanted to go to, a choice of 3 for me.

I choose to go to Leeds and waited for the referral to be made and then for the appointment.

In all from seeing my GP in Sep/Oct 2009 to getting a date in May 2010 to have my first appointment at Leeds was almost 8 months.

here is a list of gender clinics in the UK, unfortunately most primary care trusts seem to have a contract with charing cross which means travelling for most of us

Glasgow GIC, Sandyford, Glasgow
Leeds Gender Identity Services, Leeds
Charing Cross Hospital Hammersmith, London
Nottingham GIC, Nottingham
Porterbrook GIC, Sheffield
The Laurels Community Mental Health Team, Newton Abbot (soon to be moving to Exeter)

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Originally Posted by Nigella

In all from seeing my GP in Sep/Oct 2009 to getting a date in May 2010 to have my first appointment at Leeds was almost 8 months.

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8 months is brilliant Nigella, i hear horror stories about girls within northern PCTs that say they have waited over 2 years and more...i waited 6 months myself to go to charing cross

i will have to wait and see what happens then.. i will have to be patient, no pun intended...

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

I will check with him, but he said it was in Manchester, so i think it could be saint marys also..

With me I will be referred by my doctor to the sandy-ford clinic as they have a psychologist in house. Some clinics may not have an in-house service it just depends on the level of need in each area. I know that for srs it will be done in London unless I can save the money and go private for that part.

I will be studying in Glasgow for a minimum of 4 years and the clinic is there. Will also be living in private student halls not owned by the college. But the college is very anti-discrimination and is the first that I have seen that states gender reassignment on their equality and diversity statement.

Quote:

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Originally Posted by Kieron Andrew

here is a list of gender clinics in the UK, unfortunately most primary care trusts seem to have a contract with charing cross which means travelling for most of us

Glasgow GIC, Sandyford, Glasgow
Leeds Gender Identity Services, Leeds
Charing Cross Hospital Hammersmith, London
Nottingham GIC, Nottingham
Porterbrook GIC, Sheffield
The Laurels Community Mental Health Team, Newton Abbot (soon to be moving to Exeter)

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Also; Cherry Knowle Hospital, Sunderland for those in the North East of England. Beware, the waiting list is stupidly long and so too is Porterbrook clinic [I got told to wait three years LOL no].

Quote:

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Originally Posted by Kieron Andrew

8 months is brilliant Nigella, i hear horror stories about girls within northern PCTs that say they have waited over 2 years and more...i waited 6 months myself to go to charing cross

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8 months is good for the North-Midlands area of England; however, I waited only one month at the Sandyford in Glasgow which was refreshing since I’d been waiting several years for Sunderland and Porterbrook to see me…ended up going private it’s that daft! Then again, the resources for trans treatment is scarce and in high demand.

As far as I know the referral can only be by a psychiatrist. My Gp tried to get a refferal for me,as the pscychiatrist said he did not need to see me, and was told that the pschiatrist has to me to give a refferal. You cannot get a referral without a local psychiatric evaluation.

It would seem that some GPs and psychiatrists are still unaware of the correct procedures for GIC refferal. My refferal was delayed by two months because of this.

I have spoken to my doctor and confirmed i have been referred to Dr Webster a psychiatrist at St Mary's in Manchester.

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Originally Posted by Rianna Humble

I have made an appointment with the recommended doctor in 10 days time. Hopefully, that will be my first full step towards being able to transition. I will be happy to share how it goes.

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In the end, I wore men's trousers & jacket over my clothes with my new heels, so a sort of compromise on the dress aspect.

I wasn't quite sure how to begin, so I gave her a very abridged overview but stressed that this is a situation that has now become intolerable for me.

I mentioned that, thanks to colleagues, I am now able to dress at work on three days of the week, but that every time I have to switch back, I get this gut-wrenching feeling. I also told her that I feel that I am living a sham whenever I have to put on male clothing.

Dr Hill listened very sympathetically to what I told her then admitted that she hasn't much experience with Gender Dysphoria but said she was willing to undertake the journey with me. She also said that she realised it "took a lot of guts to talk to someone you don't know about this".

She asked what I wanted to get out of my visit to her today. I told her that I probably needed to start with counselling but my aim was referral to a Gender Identity Clinic such as Charing Cross and ultimately to become the woman that I know I really am.

Dr Hill is going to contact someone in Brighton (which happens to be where I work) who has more specialist knowledge of the sort of counselling I might need than the local mental health hospital a few miles from my home. The
colleague is also specialised in PsychoSexual problems, so I took the opportunity to stress that this is not a sexual thing in my case.

She will call me when she hears back from the colleague in Brighton and we will meet up again in about 3 weeks to discuss the next steps. I am more sure than ever that I am doing the right thing and that Dr Hill is the right person to help me.

Thank you all for your advice, I'm sure I will need more in the coming weeks and months.

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?

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Originally Posted by 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?

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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?

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

Quote:

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Originally Posted by Maryanne_sa

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

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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

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

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 :love:

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Originally Posted by Nigella

please note this does not affect TRANSVESTITES.

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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 :)

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.

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

Quote:

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Originally Posted by EQUALITY ACT 2010 EXPLANATORY NOTES

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.

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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.

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.

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. :hugs:

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. :eek: The fact they would knowingly let you self medicate hormones, and still not refer you seems horrendous.

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.

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 :sad:

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.

Quote:

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Originally Posted by Nigella

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.

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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?

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Originally Posted by RachelDee

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?

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

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.

Quote:

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Originally Posted by RachelDee

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?

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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.

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

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.

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.

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.

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...
:doh:

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.