GRS Wales Blog

This guide relates to the United Kingdom. Apologies, but I don’t know enough about the rest of the world to write accurately. This guide relates only to those who are sure that they are transsexual. If you are not sure then try to wait a while before you get sucked into something that may take control before you are ready.

So you’ve decide that you are definitely transsexual….where do you go from there?

The only way to remain sane is seek medical treatment. But How?

First Steps

The National Health Service isn’t, in general, the best provider of treatment for any transgender conditions. There are still too many providers of Health Services who genuinely believe that Transsexuality is a life choice rather than a condition that we are born with. They are not allowed by law to refuse us treatment so instead they try to put obstacles in our way. They might refuse to prescribe hormones on the NHS or refer you to a psychiatrist hundreds of miles from your home. The waiting lists are often over 18 months but they tell you that they are 18 months or less because they don’t start counting until you hear from them and that can take months.

However, if you are unemployed or low paid you probably have no other option than to use the National Health Service for all your treatment. In that case, you must see your family doctor (GP). Your GP is the only person who can refer you to a National Health Psychiatrist. Try to have a talk with your GP. It is extremely likely that they will have never come into contact with a transsexual before and may have very little idea about the condition, or worse, may have pre-conceived ideas. If they seem interested or sympathetic to your condition then you are ready to begin your long journey. In those cases where a doctor has no interest or seems unwilling to help then see if there is another doctor within the practice who would be willing to help. If you still have no luck then consider finding a new GP. You can get a list of GP’s from your local Family Health Services Authority (address in phone book). It is important to have the right doctor involved in your treatment because the journey will take a long time using the NHS.

If you have a little more money then the private way is usually better and much quicker. However, you must do your research. A Psychiatrist who has no knowledge of any of the transgender conditions isn’t much use because the journey will be a lot slower and psychiatrists sometimes know as much as the general public. They just don’t like to admit that they sometimes know less than their patient. There job is to make sure that you are a transsexual and you can cope as a member of your correct gender for the rest of your life. A Psychiatrist with no knowledge of transsexualism could make mistakes that could affect your whole life. There is a Psychiatrist that many people use. I am not going to tell you who he is because this site receives 2,000 visits a week and if all 2,000 people made appointments, his waiting list would be longer than the NHS. He is listed on this site but you’ll have to find him yourself.

If you are a child who is transgendered then your options are reduced. If you are under 16 then you are only allowed to visit the only Gender Identity Clinic in the UK for Children and Adolescents if you are accompanied by a parent, school teacher, social worker or other responsible adult. Further details are available from the Mermaids web site. You can refer yourself to the same hospital if you are 16-18 years old.

In the NHS, when you have found a GP who is willing to treat you, you need to ask him to refer you to a psychiatrist, or better still a Gender Identity Clinic (GIC). But as in the private sector try to find out as much as you can on the issue. If you live in Newcastle, Belfast or are referred to Charing Cross Hospital in Fulham, London then you may be in trouble. Most areas that don’t have their own GIC will refer you to Charing Cross Hospital. If you can avoid it then do so. There is a problem though.

Many Health Authorities will have contracts with only one hospital so how do you get around that?

When you’ve found a psychiatrist or Gender Identity Clinic that you have heard good reports about then approach your GP. Your GP may say that they can’t refer you because the Health Authority does not have a contract with them. That may be true but you can ask your doctor for Out of Area Treatment (OAT). This means that your Health Authority may buy in the services of a Psychiatrist or GIC from an area that they don’t have a contract with. This is a perfect way of avoiding the Charing Cross Nightmare.

Where Next?

When you have got your appointment with a psychiatrist you will have a wait. If you go private you will have a wait of anything up to six weeks. If you go the National Health Service Route it can be up to two years or even longer.

At your first visit you will be assessed by a psychiatrist. It is important that you answer all their questions completely honestly. There are people who read other people’s tales of how they got treatment, and then proceed to use exactly the same story. The psychiatrists can see right through this. If you genuinely felt as if you were born in the wrong body then say so but if you had other thoughts and feelings then be completely honest. Not every transsexual is the same and an experience psychiatrist will know much of the spectrum of Gender Identity issues. You won’t get thrown out of treatment if you tell the truth, even if your tale is different to everybody else’s. However, the course of treatment may be different if the psychiatrist suspects that you are trying to conceal the truth and it may take you longer to complete. The only thing I would suggest for many NHS hospitals is to wear a dress or skirt, at least for your first visit. Many NHS psychiatrists have pre-conceived ideas of the way they think women should look and behave. They also seem to confuse transvestism and transsexuality at times. Do not say you have transitioned if you haven’t. To an experienced psychiatrist you will usually give yourself away.

In the private sector, if you have told the truth then hormones will usually be prescribed on the first or second visit. It is always a good idea to have had a blood test before your first hormones in order to have a base for future testing and to make sure that you don’t have any liver or blood problems. Hormones are dangerous and you MUST be monitored on a regular basis. Your GP will normally arrange for this to be done. If traveling the private route then ask your GP if they will convert your private prescription to an NHS one. Some will and it can make the journey much cheaper.

In the NHS, expect a longer wait for hormones. This appears to be another obstacle that is often put in your way. At Charing Cross Hospital, for example, I have heard of patients being told that they must live in role for one year before you can receive hormones. This is relatively new. When I visited Charing Cross Hospital in the late 1980’s I was prescribed hormones on the second visit despite being a long way from transition. It has also been reported that patients who have been referred to Charing Cross after they have started hormones have been asked to stop. Although you may have to wait, do not, under any circumstances, attempt to buy hormones illegally. They are dangerous. My Blood Pressure went so high that had I not been changed to another oestrogen I could have had a stroke. If you buy them illegally you risk dying or seriously injuring yourself which could delay, or stop altogether, any further treatment. Herbal hormones too are not safe unless monitored. I used to work at Customs and Excise so don’t try importing hormones either. Each Region has a Letter Office of Exchange with Customs Officers. They have a computer Program called Tic-Tac which lists all drugs and if it’s a prescription only drug, they will know about it. You might get away with it once but you’ll eventually be caught.

In the private sector you will normally have interviews for 1-2 years before you are referred to a second psychiatrist to confirm the diagnosis of the first. In the NHS it can take up to six years, which appears to be another obstacle. If your second referral is positive then you will be referred to a surgeon.

Almost There

After you have been through all the hurdles you finally get to the pre-surgery stage. In the NHS you will usually have one appointed for you but there are ways round this. Again you need to do some research. Different surgeons have different methods. If you find a surgeon that you like but that the hospital doesn’t use then you can ask your Health Authority for an OAT to the surgeon of your choice. If you are going the private way then you still need to do your research but cost may come into your decision too. Again, I am not going to mention surgeons but whilst many are good at the surgery, some have more experience which is reflected in the price.

You will initially be interviewed by the surgeon and must answer all their questions honestly. As in the case of your psychiatrist, they will want to know everything. They will also tell you a few things that you must do. If you don’t you won’t get the surgery. This includes stopping oral hormones. If you don’t you risk dying. Some surgeons will test your blood to make sure that you have stopped.

The day will approach for your surgery and you do need to prepare. In the case of MTF’s, you will need to buy your first sanitary towels for after the operation and you need loose nightclothes to keep good circulation. Something to read would be an advantage because you will be confined to bed for a while and your stay in hospital is usually about 10 days.

Things don’t end with the hospital and surgery. You need to prepare for your journey home. A long journey might be very uncomfortable and you may need to ask your surgeon for an exemption certificate to avoid wearing a seat-belt if traveling by car (you will not be able to drive anyway). A long journey may also mean that you need to plan for several stops to stretch your legs. You won’t have had much exercise for days and your circulation will not be at its best. Try to avoid traveling by plane unless you can afford to travel first class as the confined space will not be very comfortable in economy and if you can afford it try to spend a few days renting somewhere or staying in a hotel until you feel a little fitter.

After your operation you will still need to visit your surgeon from time to time to check that everything is healing correctly. Some psychiatrists may also ask you to return post-operatively. It’s a good idea to take these visits. Not only do they want to ensure that you are adjusting properly but for the research value of treating future patients. Some people believe that surgery will make everything better and that’s not always the case. Sometimes there are other underlying problems that the doctor would like to help with. GOOD LUCK in your journey.

Copyright of Pamela Sexton, 2005.

Reproduced with the kind permission of Pamela Sexton

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