Experiences of trans and gender diverse young people

So I’ve had limited interactions with it so far, mostly just the research I’ve done and the stuff I know from other people and enquiries. I haven’t had any private appointments yet. I am very much aware of the fact that it is a lot faster, than NHS healthcare. But there seems to be pretty much the same level of gate keeping essentially what you’re paying for is just the expedited process from what I’ve seen of the various expectations that doctors tend to have for you.

So an appointment with someone at a place like Gender Care or the London Transgender Clinic, which I think are two main private trans healthcare providers in the UK at the moment is about £250 to £300, £350. And you tend to have two appointments before you can get anything, if that makes sense. So you would essentially pay roughly £600 before you can be prescribed hormones.

Yeah so in late, late 2016, I guess I kind of, I knew from what I’d read on line that from the point of referral it would be a long while before I actually saw someone so I went to my GP and, and asked for that referral a lot earlier than I’d actually made the decision that testosterone was something that I wanted. Cos I thought well I might as well get the ball rolling while I’m, while I’m playing out this process. I was, I was sure enough by, by the point of going to the GP that there was something going on with my gender identity, I wasn’t quite sure what words fit best to me in terms of how to describe myself at that point, but there’s definitely something and may, you know even if I don’t decide to access any medical treatments, whether the gender clinic can offer me anything in that.

So late 2016 I went to the GP’s and asked for a referral, and I think it was February 2017 I got a letter back from, to say, you know, “Your referral has been received, the waiting list at this point is in excess of two years. We’ll write to you a month before your appointment.” And I guess still at that point I was, I was like, “Oh, oh that’s a long time,” but at, I’d also not I didn’t feel like I was at a point where I was ready to, to get going with anything anyway. I was still thinking things through, I was still trying to work out exactly what path would, would be right for me, so I wasn’t too, initially at that point I wasn’t too worried about the fact that there was still at least a two year wait ahead of me. But things then started to escalate quite a lot over the next few months at that point, my thinking was, I, I guess my, my thinking all of the time was consumed by it, you know it was something I was thinking about at every available moment every day. And once, once I’d become much more sure that, that testosterone was something I at least wanted to, to look into some more it soon got to a point where I thought, ah, I can’t wait two years. If this is something I want to look to pursue, I can’t wait that long.

So, so yeah that, so in the, I think I decided to, to look into it through a private clinic and I had my first appointment with them in the June of that year, in June 2017. Still when I went to that first appointment I wasn’t a hundred percent sure, I was still going back and forth as to well I know, you know I know I’d quite like this impact of testosterone, but not that one. And that, that, but again I guess I was trying to get ahead of things, I was trying to, to get into the system before I’d actually got to my decision. And thought well maybe, you know maybe they’ll, they’ll talk about things in that appointment or, or give me more information that I haven’t thought about that might help me with that decision. Which ultimately I, in the end I don’t feel like I really got any added information in terms of what, you know experiences and testosterone might be from that. It was my interaction with the private clinic was two assessments, you know which was kind of like the whole life history, asking all the different questions that they need to ask being passed on for a second opinion, and then an appointment with the nurse prescriber and that was it really.

So I thought, I guess, my expectation of that process might be that there might be some more guidance, that it wasn’t just an assessment process, there might be some more information to be gleaned from that and it might help me come to the decisions that I needed to come to, and work out what the best path for me was, but ultimately that process, there wasn’t really anything there you know there was the usual sort of list of these are all the impacts of testosterone, go away and read them. But yeah, I thought the process might offer more support, and not just assess, in that sense.

I personally believe that not being able to access hormones through [Private provider] would have, well I know, it would have absolutely crushed me. And with the fact that I do have some mental health problems and I've struggled with them, I believe that I would, you know, I was born into a hole of depression for one, thinking that I've got another two years of this, this hell. I'd have to put sort of my life, my sort of my public eye life on hold. I'd have to wait until I've had the physical transition that I want and need to be out as a guy. You have to put that all on hold. All the things I enjoy, I'd have to just stop it and then go and you know, and wait, you know, put my personal life on hold just for this. I'd be very upset. I know that I'd start feeling anxious a bit, especially if I was passed my 18th birthday. I'm an adult and yet I still don't look like an adult male cause I’ve haven’t had interventions. There's only so much you can do to pass before you have testosterone. I know I'd start struggling with anxiety again. Because the problem with, you know, you look, you're actually 18 but you look like you're 14 sort of thing.

It does bring issues and it does bring anxiety with it. And so I believe I'd be feeling anxious. I generally believe that if they'd said, oh, but it's a two years wait and there was no other option, I believe that I would be feeling suicidal as a thing and I know a lot of people express these feelings as well as me and it's the sort of thing if you are being forced to sit and wait and wait and wait for this. It's, you know, you just don't wanna do it any more. When it's already been what I've been experiencing dysphoria for six maybe seven years I've got the dysphoria, I've been feeling discomfort in my body since I was four. And it's the sort of thing, you know, once you've been experiencing that for so long, another two years of your adult life, it just crushes you and you don't wanna do it anymore. So I genuinely believe it would be giving me suicidal feelings. I would be turning to any other option I could possibly find sort of self-medicating or whatever. You know, finding friends who are on testosterone and paying them to get extra doses so I could take some, sort of thing. Because I'd be so desperate to just get on with it. It's the sort of thing. I've been patient for two years and I've been feeling this for a long time. I've been trying my best to wait and understand and it's just gone too far to the point where look, I'm done now. I need to get some treatment, which is why I ended up going privately, because I can't wait for another two years. I couldn't wait another two years and then have them do long assessments and all of that. You know, I just can't wait that long.

First of all I had to get a diagnosis of gender dysphoria so for that I had to contact one of their clinicians so I just sent that person an e-mail saying ‘Hey I’m [name]’, you know, answered, they have like a list of questions on information they need from you on the website like age job all kind of stuff where, you know, any health info, any relevant stuff. To get in contact with them is I just sent an e-mail using that guideline, I got an e-mail back really quickly they said you know, that’s fine they can do that appointment, I think it was £250 at the time, I think that might have gone up now so do check, not necessarily current I had to travel to London to see the doctor and I kind of had, it was a short kind of hour talk where we talked about, you know, me, my identity, why I felt I was Trans you know, my experiences kind of health issues, you know, health like background so like if there’s any reasons why you shouldn’t be given, you know, the go ahead for going on testosterone hormone therapy you know, really nice it was really lovely actually really relaxed, you know, it wasn’t judgemental they aren’t trying to gate keep in my experience.

They just wanna, you know, know who you are and check that, you know, you haven’t got any underlying health issues that may mean that you can’t go on hormone therapy so for me that was easy. I then had to, they said, you know, yeah I’m happy that you’re Trans I believe that you’re Trans here’s your little letter of Transness which is again the person I spoke to said, you know, they didn’t, they hated that they had to do this they felt that, you know, should be able, someone should be able to say I’m Trans and be believed but because this is the process, that was the process. you know, that we would, sorry we then went on to they said, you know, here’s your letter, here’s your referral if you book an appointment with the endocrinologist after six weeks or whatever you can book it for I think six weeks was how long I had to wait, I think it’s longer now but again it’s been a couple of years so yeah I did that. I had to get blood tests results first, they gave me a list of all the bloods I had to be taken they just went to me use your GP and have them take the bloods and check it and then take those blood test results to the endocrinologist we spoke about, you know what I wanted from testosterone you know, what my current like blood result levels were and what was relevant, that everything was fine there, you know, all normal, all good. They took my height and weight there at the time and just kind of generally talked about what I should expect make sure that I was happy with that and understood you know, what I was kind of getting myself in for as it were, you know, I understood what the side effects would be and that you can’t pick and choose it’s just what your body would naturally do so it was all cool, I said yeah, you know, happy with that and the endocrinologist said, you know, my levels were fine they believed I, you know, understood everything and that they were happy to prescribe me and I got testosterone or my testo gel that I take that day and I’ve been taking it since. I then had a six monthly, they had six monthly check ups at first, I had my first check up in the six months after that so I think it was the September or October of that year and they kind of just looked again took my blood test levels a few weeks before, went back to kind of the endo they looked at it said yeah that’s good, you know, everything’s normal you haven’t had any like issues with cholesterol stuff, your weight’s fine, your height, you know, this is what’s changed kind of checked I was still okay with everything.

And then, you know, everything was fine and they tell me again to come back in another six months which I did, again took my weight, checked everything, checked if I was like feeling fine, checked my levels everything was fine again and now I’m on they said, you know, come back in a year’s time. So from now on it should be yearly check-ups, so it’s kind of pretty simple getting one and monitoring again and they’re really good at replying to e-mails of like, you know, if you’re worrying about stuff or are unsure about something or, you know, like is this okay, is this the normal change and they’ll be like yeah that is the normal change. Really, so yeah my kind of experience was positive, I think cost wise the initial appointment I believe was £250, I think the first appointment with the Endo was £300 off the top of my head, again I think the prices might have changed and then the six monthly or yearly appointments are a £100 each so yeah obviously it’s financially quite a big investment and I’m fortunate in having been able to afford that but yeah because of the shared care agreement with my GP I get all my prescriptions through that sort of £9 a month or £9 every script just the standard NHS charge. So yeah, that’s kind of my experience.

They've been brilliant. I did some looking online at different private places. And I was shocked that nearly all of the places were huge amounts of money to go to have a single session was £900 at one place. And they, and I saw that as very visibly they are profiting off trans people. But the specific place I went to [Private provider] were very supportive, I think very reasonably priced. They even offered financial help for people who were on low income and I believe, you know, they genuinely wanted to look out. They have free advice 24/7. You know, you can ask any question and you send them an email. They'll respond. They'll tell you they have advice on their website. And they were genuinely out to support people not profit off them. So, they were very helpful, very understanding. You know, I first contacted them I didn't think my mum was going to support me with private. And my friend said that she would actually help me get some money together and pay, she would actually contribute and help me, cause she saw just how much it meant to me.

And I explained to them, you know, I'm currently no income or shall be low income soon I’ve got a friend will help me scrape together some money and some savings. But I really don't have much. And they were like, ''Okay, we'll see what we can do. We can sort it out.'' And then later I was like, ''Oh wait I've convinced my mum and she said that she can help with this.'' They were, they've been very affordable and they offer a shared care plan with the GP which means that if I can get my GP to agree to doing the blood test or getting my GP to agree to prescribing the testosterone, it means that I get it on the NHS and not have to pay for it. So the costs I've had to pay, you have £195 one time start up fee. That's just your starting up one time. And then it's £30 every 28 days for membership. That's just that you’re a patient. Other and then everything costs some but it's not ridiculous. I saw this one place that was like, ''Okay, it costs £240 for a half an hour session.'' [Private provider] it was £60 for an hour booking of an assessment, which was very affordable and understandable, you can pick which person you want to be with or you can select that you want them to pick for you if you don't have a preference for who you wanna talk to. And and then when it gets to testosterone or whatever hormone it's, you know, £20 plus depending on what dosage you're getting, what you're getting, where you're buying it from and it's £20 plus a month.

My first contact with them was summer and this didn’t go anywhere, ‘cos I hadn’t talked to my mum yet. But I was like, hi, could you give me some resources and information about if I were to do this, how I would do it so I can talk to my mum? They gave me all that and that was a really interesting read through and I kind of understood it a lot more then. And then starting in like September as I said, we started contacting them properly in starting this pathway and throughout they’ve been great. Like there’s been, I asked for the stuff and like they gave me here’s the pathway and here’s what you need to do straight away and so I understood like, yes, this is step one. Having that kind of next goal or insight was the motivation to keep going, ‘cos even though it’s like a long wait or a long process, it was always like yes, not long until this bit and that was always a great kind of great resource. So, in order to get hormones under [Private Provider] you eventually have to do an interview, not too dissimilar to this one, which is part of like my comfort in signing up because they ask you about the history of trans issues and like how have you always felt about this. They can kind of get a full portrait of your background. And it’s done over a video call like this, ‘cos they run an entirely online service.

I’ve people I’ve always spoken to on there have been great and supportive and very nice. Even going forward they’ve kept great communication with me like in the next three months I need a blood test, just to ensure my vitals are all okay and stuff and that’s been, the communication on that’s been great and it’s just been a great experience overall. And, ‘cos you pay like a subscription and that means that you can always contact them for advice and stuff and whilst I’ve not had to use that service yet, whenever I have, in the past, whilst I’ve been on the pathway not that kind of post care almost. They’ve always responded quickly and effectively and been precise and accurate with their terminology and stuff.

It’s not like wherever I’ve seen the kind of the reaction to them in the media since they like they’re giving hormones to people that, age groups that some people perceive to be like too young to know or whatever, myself included. I am that age group. But it’s not like a, do you want hormones, yes, here you go, they have this very, very kind of strict process for it. As I said, they kept me well informed on what those processes were. But like it’s never felt I guess unnecessary. It’s always felt like, yes, this is like, I understand why they’re doing this and the reasons for it. And like I’m okay with that. So, it’s like I contacted them first and then I had to have a first like appointment, over video chat where they asked me questions and like give me information and I think it was like an information session. They gave me information about what it is to my parents and to me and say like these are the changes that [name] will undergo, this is the costing and this is how long the timeline should be. Here is what I do every few months and all the rest and that was very clear and precise. And then there was another session afterwards, after doing some paperwork and stuff and then before they finally gave me my hormones, after I’d done everything I could have done, freezing the sperm, I’d done getting blood tests and I’d done everything. They gave me another thing that was like an informed consent sheet and it was like, here is everything that could possibly happen to you if you’re on HRT like everything that’s been like, must’ve been like 20 pages long and I read through the whole thing that was really informative and like even though some of it’s like a zero point zero one percent she might get run over by a car. It’s like it was informative to kind of know that and to say, yes, I give my full consent to this. That was a really informative process and also one that I felt secure in and never like, this is going a little too fast. It always felt like, like I’m getting these on time, but also whilst maintaining these important checks and balances.

I was very anxious going into that appointment, partly because I didn’t really feel like I knew what to expect, but also because I think the research and reading I had done around trying to work out what to expect from that appointment had, had led me into hearing things about, you know, how well non-binary people are understood in those settings. I’d certainly developed by that point a sense that there might be some game playing that needed to happen for me to access what I needed to access. And I was very aware of that going into that appointment. And in the build up to it I was very aware of trying to make a decision of how much of that game I wanted to play. What, what was I prepared to compromise on, and what wasn’t I prepared to compromise on. And ultimately I decided to go into that appointment, you know, cos all of these thoughts had crossed my mind that should I, should I wear make-up, should I do this, should I do that? Should I not wear it so that it looks more convincing? And ultimately, I just decided no, I’m going to go in as I would, as I would present, would choose to present on this day if I wasn’t going to this appointment. I’m going to do exactly the same thing. I wear make up on a daily basis always have done, still do, so I thought ultimately, I thought, “No I’m not going to change that.” And I guess… to some extent I felt like I did have to play the game a little bit, but I did stand my ground on a few things which ultimately delayed me getting access to testosterone.

It costs £50 every time you call them. I try not to call them, which means that I email them. They never reply to their emails. And so, [sighs] I need a face to face discussion with the doctor. I don’t have the money to just keep paying them for half an hour discussions with. Yeah, it’s difficult. They are doing a great job and they’re treating loads and loads of people, but I don’t think they quite appreciate how expensive it is. You know like I get that they’ve got like a medical practice business like medical industrial complex thing to navigate and run. It still feels there’s only so much money you can give to someone before you began to feel like you’re like pissing it away kind of a bit. It’s not even that I’ve spent so much. I’ve probably spent like £350 over the course of two years. And I stopped paying the subscription fee because I don’t know if they’re going to like, just ‘cos I’m so unsure in myself as to whether I wanna be taking them at a specific dose. I’m like trying to negotiate that with them and talk about like what would work. Which means that they’re not, because I’m not paying them the money and they’re not replying to me emails as fast because they’re not replying to my emails as fast, I can’t make any decisions about what I want to take, because I can’t make any decisions about what I want to take, I can’t pay them and so they won’t email me fast. It’s this whole, it’s this whole thing, where like yeah, where like I still haven’t had any advice, really. Not, not like a sit down talk. I think there’s a difference between signing a consent form and having informed consent. Like signing a consent form is a legal process, having informed consent is the thing where you have come to terms with the knowledge that someone else has given you about whether you want to make a decision for yourself. There’s like a fundamental difference. And I think they sort of amalgamated that into just like a consent form. They’ve gotten rid of the informed consent component. It’s kind of stressful to navigate that. And I’m still waiting for the GIC. I’ve been on the GIC waiting list for two years and I’ve heard nothing.