Quick note on the scheduling; I’m going to change the day this posts to a Saturday and see how that impacts my views. Anyway….
It’s been a bit of an eventful week. Both life-wise and transition progress. I’m only going to talk about my transitioning progress in this post as that’s enough for now. There’s been a lot of change in my work/private life as well I’ll get into in the next post, mainly because I’m waiting on some updates next week that will hopefully feed into it and answer some ongoing worries.
So with that, let’s get into it…
What’s my Deal with GPs?
The part I started the whole blog for really. So what’s been happening?
I finally plucked up the courage while I had a day off to book an appointment with me GP. Yikes.
Bit of backstory, I’ve had really bad experiences with GPs. Generally I’ve found them to be unlikable people who are far to arrogant for the literal power they hold over people’s lives. I’ve had GPs prescribe my grandmother morphine at 1000x the potency she needed (well above what would have been fatal if a pharmacist hadn’t caught it). I’ve had one try to stop my brother’s epilepsy medication prescribed by a national expert because she didn’t think it was necessary any more (without formally reviewing). I’ve had one tell me I don’t need to see anyone about my dislocating knee because it’ll sort itself out, and lastly I’ve had one tell me to just stop taking antidepressants because I’m not on a high dose leading to a week of real hell. I might talk about that one day.
That being said I’m not a fan.
We moved surgery recently to another in the area. To be honest we didn’t have much choice, I phoned around all the surgeries we’re in the catchment area for and only a couple were accepting new patients. I asked each time if they had any doctors who either were specialised or had a special interest in womens or LGBT+ health, but nobody knew. One tried to convince me their doctors could treat all patients and were fine, what a nice world that would be.
Making the Call
So I joined the surgery and I knew eventually I would have to phone them and book to talk about this gender stuff. I had a few days off that my wife didn’t so on the first day I resolved to phone in and at least get something booked.
Goddamn that was scary.
Like, seriously. I was shaking when I dialed the number, when it said I was in a queue I was just about ready to hang up. I felt sick, my stomach was tying itself in knots, I was an unhappy girl.
I got through to reception. Always the hardest part. If you’re not from the UK you won’t understand the reputation GP surgeries have, but to put it in perspective when a spoof news site ran this article about how every appointment booked is a personal defeat, nobody really found it unbelievable.
You see in the NHS we have a shortage of GPs. Rather than try to fix that problem we’ve stuck a load of barely trained and certainly unqualified “Care Navigators” (read: secretaries) who will direct you to the most appropriate care pathway. Usually that care pathway is not seeing a GP, and if at all possible it’s “fuck off home and get better”.
In this instance she informed me I would need to see an Advanced Nurse Practitioner. I mentioned it was a referral for a gender identity referral and discussion about private care and she let me know it was fine, ANPs could do all of that. I said I didn’t think their 10 minute appointments would be long enough, she said the system wouldn’t let her book anything else. When I informed her it certainly would as I work with that system as well and all she had to do was right click on a second slot and merge-book she admitted the system would let her but she wouldn’t do it.
Didn’t really fill me with confidence.
I get a slot booked for 08:10 about a week later. I hang up and just about curl up into a ball, I’m sweating, shaking, out of breath, fuck.
While I’m waiting for the appointment I get everything in order. Generally I’ve learnt online from my trans-sistors (lul) that medical professionals know nothing about trans care and at best they’re just dumb, at worst actively discriminatory. I was going to make sure I went in prepared.
Going from the management training I’ve been doing (real life application, sadly cannot use as reflective practice) I set out my goals for the meeting, framing the outcomes I would like. I had 3 priorities, in order:
- Get a referral to the NHS Gender Clinic
- Get agreement from my GP to support private treatment via blood tests
- Get agreement from my GP to prescribe medication at private clinic instructions
I printed off a few things, and I’ve copied them here in case anyone else finds them useful to bring:
- The Gender Identity Clinic Referral Form (Tavistock and Portman Trust)
- An NHS circulation on how GPs have to support private gender care
- Of note, the general gist is that the NHS must support private care as appropriate, for GPs this means if they would do something when an NHS service requested it (blood test, prescribe, etc.), then they must do it is a private provider requests it.
- A copy of the Tavistock page on their waiting list, at time of publication this doesn’t have a length of waiting list of wait to be seen (also the page is hidden)
- A copy of a BBC article highlighting that at the beginning of 2018 the wait was over 2 years
- A leaflet sent to me by GenderGP outlining MtF hormone treatment, going through what is offered, effects and timelines, side effects, dosing etc.
- A copy of an email from GenderGP outlining what blood tests they would need, email not included but tests were:
- For the initial pre-treatment tests: FBC, U&E, LFT, Lipids, HbA1C and Blood Pressure
- For the ongoing monitoring (3 monthly until stable): Estradiol, Testosterone and Blood Pressure
- For the annual monitoring (12 monthly): FBC, U&E, LFT, Lipids, HbA1C, Estradiol, Testosterone and Blood Pressure
With this all done I was prepared, nothing to do but wait.
Heck was I worried. I couldn’t sleep properly the night before, and the temperature didn’t help. We had the window open, and as we live on a main road there were a lot of turds in loud cars going past. This was, at time of writing, yesterday.
I was fully awake at 05:30 (normally I’ll drag myself out of bed anywhere from 07:45 to 08:15) but determined to try and sleep some more. At 06:30 I had a serious case of terror-stomach-problems and spent a little while on a toilet regretting everything. By 07:00 I had a shower, got ready, and left the house at 07:30 ready to head to the surgery.
I got there about 07:50 and checked in, trying to keep myself distracted with cute pictures on reddit (r/eyebleach) and failed, luckily I was the only one in the waiting room to notice myself twitching.
I got called in pretty quick, maybe 07:55? 15 minutes ahead, a good sign, maybe?
The ANP I was was an older gentleman, mid fifties. He was quietly spoken but seemed nervous. When I explained what I was looking for and asked if he had any experience with trans healthcare he admitted he did not, but that he had spoken to their senior practitioner the day before to check what he should do. The senior practitioner agreed that they also didn’t know what to do, but knew enough to point out trans people knew more about their healthcare than professionals often did, so see what happened.
He listened to my goals, agreed to write the referral, and we spent a little time working through it.
Annoyingly he kept misgendering me. I don’t think there was any malicious intent, his hand did keep shaking as he was writing so I think he was as nervous as I was (big scary babby-tran that I am). He kept writing “he” on the history section, and didn’t ever think to ask wht pronouns I’d like to use, but I think that’s down to lack of understanding or training. I am considering offering myself to do a training session with them, we’ll see if I pluck up the courage.
Why didn’t I stop him though? Why didn’t I speak out and say “oi, it’s ‘she’, thank you!”? Because I was scared. I was already nervous, didn’t want to speak out too much, and was worried that he might decide to stop being helpful if I criticised him.
Once the referral form was done I moved onto talking about the private care. I outlined my needs (I’m really bad with blood tests so I need them done professionally, I can’t do them myself privately), and provided the NHS support document and hormone leaflets, and asked if the surgery would support me. He didn’t know and said he’d need to talk to the practice manager the next day.
That was it, out I went. It was now 08:25, meaning I’d spent half an hour in there. There were people in the waiting room at this point, but it was okay; I was only 5 minutes over my slot. Lucky thing I was early and the ANP could call me in, or the receptionists unwillingness to trust me would have caused a massive delay to the first appointment of the day.
I had to spend a little time thinking things through and letting them settle in. I went directly to work, got through the pleasantries with the people who started at 08:00, and locked myself in my office for a little bit. I did some emails, checked some reports, and let it all sink in.
This was it.
I’d come out to my GP surgery, I’d requested a referral for gender services which was now on its way, I’d started the process to begin transitioning.
Lastly; the next day
Dateline: today. I got a call at about 12:00. I stupidly told the ANP he could phone me any time in the morning because I didn’t have any appointments, forgetting I had a literally full day booked doing group training with senior managers. I wasn’t leading the sessions, just supporting, so I let the lead know I would need to step out some time in the morning for a personal call. No problems there, but I was then spending all my time with one eye on my phone, just waiting for the call.
Eventually it came, I darted out of the room, and just about sprinted to the other side of the building to look for a spare room to hide in, stealing a clinical room briefly (privileges of having a manager’s card to open all the doors).
He said they’d support it.
HE SAID THEY’D SUPPORT IT.
They’d do all the blood tests as long as I took responsibility for passing that information to the private team. They’d do the prescribing as long as the private team were clear in taking responsibility for what was prescribed and agreed their responsibility for monitoring ongoing care.
Holy shit y’all.
I expected to have to fight! To persuade my case! To at the very least meet with the senior practitioner, have them sit there and judge me, reject the idea, me have to threaten to escalate to the CCG, NHS England, whoever the fuck I had to in order to get my right to timely care.
None of that.
I’m not quite there yet. I’m still processing. I’m so happy.
I can’t quite decide if I want to grin and tapdance or bust into tears, and it’s a bit of a tricky balance between the two. It’s my birthday tomorrow (At time of writing) and I’m with my parents to celebrate. It’s going to be tricky, emotionally, as I’m not sure where my head is.
I need to just bawl my eyes out.
My next steps are to make a plan. The surgery may support it but I need to get myself in order and organise what I’m going to do. There’s a lot to do. I need to come out to a bunch more people, I need to make sure work are prepared, I need to start looking at hair removal (I’m so goddamned hairy), I need to organise getting started with GenderGP and paying their fees. I need to get ready to start living as me, and that’s a scary thought. The closet is nice and warm, and dark, and safe. Outside is loud, and scary, and dangerous.
But I’mma do it.