Waiting lists for Gender Identity Clinics (GIC) on the NHS are long. Waiting months is normal, waiting years is certainly not uncommon. It can take a while, and there aren’t that many GICs around the UK. On top of that they’re dealing with both the funding cuts and the extra pressure the government is piling on the NHS and an increase in patients as more people are getting the courage up to get help for gender dysphoria. My transition timeline is not atypical. My own transition timeline went like this.
2008, September
At the age of 29, I went to my GP to request a referral to a GIC. She did this no problem, and was (and still is) very supportive.
2008, December
I was referred to a psychiatrist for an initial diagnosis of ‘not crazy’ (it happens, and they like to weed these people out before they get to a GIC so they can be referred onto the people who can help them) so GIC appointment can go ahead. Saw the psychiatrist’s underling. Based on being nearly 30, a short appointment and her dismissing all I said, she declared I was just having a crisis because turning 30 was a big deal (it actually was, but not in the way she thought – I honestly believed all through my 20s, until I made the decision to see the GP about transitioning, that I wasn’t going to be alive for my 30s. Hitting 30 was an achievement). I wrote a stinking (but polite) letter to the actual psychiatrist, detailing absolutely everything about my gender experiences though my life in the letter. I was then given an appointment with him.
2009, January
Saw the psychiatrist, who was lovely. He chatted with me briefly, then asked a few extra questions. He then apologised for his underling and said that without a doubt I had gender dysphoria and he would be giving the go ahead for the GIC. This is why I always recommend to write an essay so you can get everything down and give it to the professionals. It reduces time and confusion and gives them something solid to refer to.
2010, October
I was still on the waiting list. By this time I knew there was no need to mess around with what-ifs, and so legally changed my name. My GP obligingly wrote a letter for anything needing a gender marker change (ie, DVLA). Having my name changed so I’d done the ‘real life test’ (which was supposed to not be a thing by then but totally was) helped to speed things up when I eventually got to the GIC. The annoying part was that there is no option to change gender on my GP’s system, so they had to create a new record with my new name and gender and painstakingly copy everything across. Bless their heroic efforts.
2011, October
I got my first appointment at the GIC. They had no problems diagnosing me, and the process for transition began. There were a couple of appointments with their team psychiatrist, blood tests, and general checkups as the process ground slowly on.
2012, early
I received an appointment to see the psychiatrist from 2008/9 in order to start the process of transitioning. This confused me. It confused the GIC. As they had no clue what that was about, it was safe to cancel the appointment. The psychiatrist’s office only had info to say I needed an assessment. From the GP. I called them to find out what was going on. It was cleared up quickly and hilariously.
Our GPs have three surgeries over the area. For whatever reason, official GPs for patients are juggled around on a regular basis. So you can have a couple of different GPs a year, and end up with a GP you’ve never met or heard of. This is usually not a problem, and you just see the GP you get on with – it’s mainly to have someone to shunt things off to that need peering at and signing, like routine blood test results and repeat prescriptions. So, what had happened was my current listed GP had gotten an update letter from the GIC, and he took a look at my file, saw I was male, and assumed I was a guy wanting to transition into a gal, and just started the paperwork for the referral from scratch. No harm done, it was pretty funny.
2012, October
Finally I was given the go ahead to go on testosterone. Handy gel to slather on daily as it means my hormone levels will be more stable. Given my diabetes, my thyroid, and whatever else is causing my fatigue, being stable without the ups and downs that you get with injections is just sensible. I was also told my request for top surgery would go to their ‘gender panel’ for approval, and then everything would be set in motion for that, pending the obligatory second opinion.
2013, February
Due to the vast amount of patients that need to be reviewed, my case was delayed. It was finally approved. Now I needed to wait for local healthcare funding to be approved.
2013, June
Funding delayed because the local authority fucked it up. I was unsurprised, given the area I live in. The GIC hit them with sticks, the funding got sorted, I went on the waiting list for a second opinion at another clinic.
2013, November
I was given the go ahead by the second GIC, the paperwork got sent back to my primary GIC, and I go into waiting mode for another appointment to discuss everything.
2014, February
The GIC referred me on to my surgeon of choice at the end of the month. Things now moved relatively speedily, because it was a private clinic. The NHS funds the private treatment of specialist surgeries they don’t do, and chest reconstruction is one of them. Because this is a niche surgery, and the surgeon also had other patients in the queue (trans and non-trans), it was a few weeks wait for a consult. A few weeks? After the speed of everything so far, that frankly sounded almost too fast. As I had my surgery down in Brighton, I also needed to arrange sensible dates with family, who I’d be staying with for the two week recovery period.
2014, April
Mid-month I get my consult. Two weeks later, I’ve had the surgery. It went very well, I was (still am) ecstatic. Because I am a jammy git when it comes to anaesthetic and surgery, I was fine and perky to be discharged the next day. I also suffered very little pain and had full range of arm motion, and could sleep on my side without pain. I am jammy. And very grateful.
2014, November
I had a followup with the GIC about how I was doing and if I wanted any further surgery. I didn’t. I’m not interested in a phalloplasty for various reasons, and didn’t see the point of putting myself through a hysterectomy unless it was medically necessary, because it was just sitting there doing nothing much to worry about.
2015, early
Funnily enough, I don’t remember the month, but I was discharged from the GIC back into GP care for monitoring hormones, etc etc.
2016, the year from hell
As we all know, 2016 was the year that shall not be named, because it was a shitfest on so many levels. It was the year of celebrity deaths, natural disasters, awful politics, and also the year I lost my mum to cancer. She was diagnosed at the beginning of February with surprise liver cancer, and died at the end of March. So that was 2 months of emotional and physical hell. It all had an impact on me, my body rebelled, and for whatever hormone-related reason, my period came back with a vengeance.
2017, February
Having accepted that I was stuck with the periods from hell, I went to the GP. If I wasn’t trans, I would have been looking for treatment of some kind anyway. Because I am transgender, I had to be referred back to the GIC as they need to do assessment and prescriptions for hormone blockers or a referral for a hysterectomy, even though it would be for medical reasons, not gender.
2017, October
Went to GIC, blood results indicated that my testosterone levels were in the male range, but my oestrogen levels were high and that’s why my period came back. First option was hormone blockers, but the side effects would probably muck around with my blood sugar levels. They’re annoying enough anyway, they don’t need extra help to do their glucosey worst. As I’d been 5 years on testosterone by this point, they generally recommend hysterectomy anyway because of possible cancer risks. Of course, because I am transgender this is classed as gender affirmation surgery. It needed yet another second opinion from another GIC to ensure I understand the implications and that I’m not crazy blah blah. The GIC finds this frustrating as well, because at this point patients have transitioned, are living as male, and the reason for a hysterectomy is medical. But this is just one more hoop we’re all forced to jump through. They referred me on to another GIC for the second opinion.
2018, May
Appointment for second opinion finally came through for the end of May – it should have been months earlier. That’s NHS cuts and an overstretched, underfunded and understaffed speciality service for you, not their fault. Appointment went fine, was told the second referral letter would be sent out in the following few weeks.
2018, July
Phone appointment with usual GIC, who had heard nothing about the second referral and were concerned that it shouldn’t take two whole months to get that letter out. They said they’d chase it.
2018, August
Letter from the other GIC. The doctor I’d seen was ‘off for the foreseeable future’ and letters would be dealt with upon their return. No other information. Contacting my usual GIC next week when the person I need to speak to is back from holiday.
2019, January
Letter from Leeds finally arrived giving the go-ahead for surgery. Around 6 months to sort another doctor to sign a letter on behalf of the one off work. This is less a criticism, more an observation that the NHS, especially gender services, are chronically underfunded. The fact the letter was printed on really cheap paper probably adds to this conclusion. Anyhow, as a hysterectomy is a routine surgery, the wait shouldn’t be too much longer.
2019, March 8th
Surgery consult from Sheffield arrives. 22nd March, 2019, so pretty speedy. It also clashes with my diabetic eye screening on that day. Eye screening is rearranged because that’s routine, and postponing the surgery stuff further for a routine check that was only done 6 months before anyway seems idiotic.
2019, October 24th
Since the surgery consult I’d had panic attacks, insomnia and depression, and realised a hysto really was not for me and that I was going to regret it. Needed another GIC appointment to discuss this. Nurse was uppity and disapproving but referred me to the doctor anyway. The doctor was great and agreed with me about not wanting to have an invasive procedure without trying non-invasive stuff first. She suggested Depo Provera, which I would have jumped at two years ago had it been on the table, because I know I get on with it fine having been on it a couple of times since I was a teenager for several years. Have now been discharged back to the GP, and will book an appointment for a Depo shot when the letter comes through. I hope this is the last I have to see of the GIC now.
2019, December
As there’s been no contact from the GP, I book an appointment with the nurse to get the ball rolling to get the shot. First hurdle is that the forms for it aren’t accessible on male records, nurse does it manually. Sent to the doctor for approval. This gets delayed because despite having a letter giving the okay from the GIC, the GP (I’m not sure which one) insists on a back and forth for several weeks with the GIC. The Christmas period is delayed until the new year, but an appointment is made of the 17th of January (later switched to the 30th due to the nurse being off sick).
2020, January 30th
Secretary calls in the morning to say the nurse has cancelled due to needing GP approval. Given this was granted already I was understandably confused, but I was told she didn’t have any more info and the nurse would be in touch to arrange a new date.
2020, end of February
Contacted by the nurse with a date for the Depo shot.
2020, March 17th
FINALLY I’m given the Depo shot (along with a smear test, which came back normal). This nurse was brilliant. She explained what had actually happened was the the system wouldn’t let her log any of the necessary paperwork in order to administer the shot because the forms aren’t available on the male records. Legally she couldn’t do it. They literally had to get an NHS IT project going in order for them to be able to get the form working on my file so they could give me the shot, which took a month to get done. She’s put forward a strongly worded message about not disabling sex-specific forms to management because this is going to be a pain for any other trans patients of any flavour, and costs them money to bodge it (suspect if anything moves them, it’ll be money saving). I have no idea if that will do any good, but I appreciate it anyway.
2020, July 5th
Next Depo shot was due mid-June, but no one can get it because of COVID-19. This is sensible and understandable, and I’m not going to complain, and my regular blood test for diabetes etc is still going ahead, so that’s good. Cis women are supposed to be shunted onto progesterone contraceptive tablets, which I possibly could be too. I’ve had no contact from the GP about this, and I didn’t bother trying to contact them because I just know it will involve another round of emailing the GIC to find out if it’s okay to put me on tablets. However, I’m going to see what happens with the Epic 4th of July Pub Crawl, because if we get another surge in cases and go back on lockdown, it may be worth attempting it.