Experiences of trans and gender diverse young people

It was quite negative at first. So, at my surgery in [area of city] like there are four GPs, I think. I made an appointment with one and she was very sort of, so I said, “I’ve been thinking, I’ve been questioning my gender. I’ve looked online. I’ve found there’s this gender identity clinic, can you refer me to it”. She was like, ‘Well yes, I can refer you to it, but you know, there’s very long waiting times and this and this.’ And I said, ‘Okay, would you be amenable to shared care if I go to a private clinician and they write the prescription or I go there and pay for the appointment, but then they write to you and you prescribe the medication.’ She basically said, ‘No.’ She wouldn’t do that because she had this power complex that some GPs have where they don’t like to be told what to prescribe and they just are afraid of having their arse bitten if they get sued if they prescribe the wrong thing and then and they’re just really caught up in this abstract notion of risk and things like to the point where they just don’t prescribe what people need.

And so, I didn’t see her again. Instead, I went to see a different doctor at the same practice who was great. And she was like, yes, you know, I would do shared care if they write you the first prescription I will take it on. Tell me a bit about yourself and what’s going on. You know, she actually was interested in hearing, rather than with this first GP it was like an uphill battle even to because I felt she wasn’t listening from the start. This second GP, she was going do the shared care for the whole time I’ve been on hormones and she is, yeah, she is one of the good ones. And, but the first GP did at least refer me to the GIC and didn’t like say she wouldn’t then not. Yes, that’s been my experience with the GP.

I remember coming back from my second appointment with the gender clinic, with a full green light on starting hormones, you know a number of years after, after waiting for it, and I, things were almost flowing a bit too smoothly, and I remember going into the GP the GP office and speaking to them about this, and about the consultation I’d had and them saying, “Well we can’t prescribe you hormones, we, we’re not going to do that.”

And I, yeah I can remember just being floored, because at that point I’d, I feel like I’d ticked all the boxes, I’d gone at a slow enough pace in my own mind to think I’m not going to regret this, and I’d, you know I’d jumped through the hoops with the gender clinic and not that they were hoops, I think they were necessary, but you know all the psychological assessments and to then kind of hear a GP say that, I remember them saying, “You know well we, how can I just take your word for it that this is something that you want and you’re not going to regret,” and I just thought hang on a minute, I’ve just had two psychological assessments from gender specialists who have kind of assessed me and said, and kind of validated why I’m accessing, why I want to access this treatment, and to have them just turn round and say that, I just was not expecting.

And it then took, I think I then saw three GP’s two in the same practice and then one in another practice, all of whom said no, for various different reasons. So one was, one was funding related and yeah, I remember having conversations with the CCG about funding but not really getting anywhere. So I remember, so the GP that I’d spoke to, I’d spoke to at the time said, “Well you know I don’t know if I can if I can license that. I don’t know if I can use if I can prescribe testosterone,” this is with me sharing all the shared care prescribing guidance that the clinic had given me, which I then had to call up the clinic and ask them to send to me, because whichever copy went to the GP disappeared.

So I was having all these conversations, I remember one GP just outrightly just saying, “No.” And I was about to, I have to admit I’m a little bit ashamed to admit this, but I’m not, I spoke with my Mum again, being the healthcare professional that I know and trust the most probably in the world, that, and speaking to her about what I actually could and could not challenge with the GP, because I always walked in and still walk into a GP’s surgery and feel quite disempowered. I think probably because of that experience as well, because I just didn’t, I almost didn’t feel like I had a leg to stand on, to then challenge what they were saying.

So when I got to the third or fourth GP I think it was, and they said, “Yes, why on earth has nobody not done this for you yet?” It was, I, if that was, again I reacted with shock and could not say anything because it was such a total, you know, it was a total contradiction to everything I’d been hearing. And I think that, that took around six months to rectify, and I remember having to, at one point I had to write to the gender clinic to ask for some specific guidance about what to say to my GP, cos at that point I think I was like, “No I’m going to stick with this GP, and if I don’t speak to them about this then the next trans person that walks in the door, is going to have the same experience.”

I think it was in September that I first went to see the GP and to be honest she was very supportive and understanding. Straight away she filled out the referral form for me to go to the gender clinic. Didn’t really ask many questions or anything. It was me that said to her, I know how long the wait is there anything we can do about bridging hormones and she actually said, yeah, let’s do that. She sent me away for tests. I had a blood test and I had an ultrasound and then later my next appointment with her was when she told me about their new policy and everything that they’d made. So, she just said, there’s nothing really that I can do. And I’m not in the position to see a private doctor or anything. Basically, I knew that I would just have to do it myself, I guess because of the way that it was affecting my mental health, I just couldn’t really face it, the wait. It’s a long time. It’s a really long time, especially when it effects, for me I felt like it was affecting every aspect of my life. But after I got the hormones, I went back to the GP and I told her that I was self-medicating and she was really good about that. She had a look at what I was taking and I’m now getting blood tests every six months with them so they can keep an eye on it.

So with shared care that's basically where if you have a private agreement then they can, they basically prescribe you with the hormones and then you're NHS GP will then, will then administer it for you. So yeah so basically I signed up to a private healthcare service. This service has received quite a lot of criticism within the media but my personal experience with them have been fantastic. I mean when I first joined with them, I wasn't in a really good financial situation so what happened there was they agreed to you know lower the price a little bit. But the issue that I was getting was getting the shared care agreement. So my original GP was like no, because he doesn't have experience with it and he's heard of that private healthcare service and obviously seen stuff in the media. So he wasn’t willing to work with them. But luckily one of the nurses she basically sort of stepped in and said that she was happy to sign that agreement. So yeah my personal experience with that private healthcare service was really good. They basically assessed me and obviously spoke to a psychiatrist etc. and then got signed off on the hormones. So basically everything that they pretty much do on the NHS, they done that but in a much shorter time period. So obviously the only issue with doing it like that is that you have to have the money to front first and then obviously you've got to continually like continuously pay for the service and for your hormones. So when I did get into financial crisis I wasn't able to afford my hormones which caused a lot of problems for me. But in terms of in terms of the service that I personally received from this particular private healthcare clinician it was fantastic. Obviously with the NHS it’s just, back then when I started, it was a case of my GP didn't have a clue what to do or you know where to even refer me to so it just shows how much, how little the NHS invests into the gender sector.

Kind of further on had issues and so had a shared care agreement with Gender Care to get my testosterone prescriptions on the NHS so that I can get like just pay the NHS rate instead of having to pay £40 out of pocket otherwise I wouldn’t be able to afford it which was good and that was fine, they agreed to that they were happy with that for a few months. And then after about four or five months one of my friends who is Trans, a Trans guy one of my friends went through the same pathway with Gender Care, you know, had a shared care agreement had it sent back to the GP and the GP refused him and then he said why have you refused this and he said we don’t do shared care agreements, so he said, with my permission I know for a fact you do you’ve got one of my friends gets testosterone through you this is exactly the same script I don’t, you know, my friend doesn’t have any, you know, I don’t have any issues, my friends doesn’t have any issues that would mean I can’t take testosterone why are you refusing and they said we don’t do shared care. And then they refused to do his shared care agreement, they refused to do anything with that, they had loads of meetings and they started trying to take, they tried to take my shared care agreement away they said they didn’t wanna do it anymore my endocrinologist [name] bless her she is an angel got on the phone with them and had a right, no you’ve agreed to this you can’t take this away this is really harmful to take it away and they kind of begrudgingly agreed to continue prescribing and have continued prescribing. But yeah that was definitely kind of a, for a month or so I was really worried like I’m not going to be able to get my script anymore they’ve just arbitrarily decided no. And my friend was not able to access it my friend had to go to another GP, they tried about five GP’s before they found one to prescribe and I’m kind of whilst I’m still with my current GP for ease of access I am kind of looking around for a more Trans friendly one that I’m not gonna have to worry every month that oh what if they take away my script now.

Well we talked with the, there’s this one private doctor, I think they’re up in like [country] or something like that, where we, who we reached out to get blockers early whilst we were on the waiting list for Tavistock. We had to have this phone call conversation with a person, we, it was basically like everything the Tavi was wanting us to know, but in an hour, you know instead of like five months. And then after that they were prepared to give us blockers and we could get them cheaper if we did this shared care agreement with the GP, but the GP’s and the like clinics said no, they’re not going to do the shared care agreement with us, so then we had to scrap everything really because it’s really expensive for all the blockers and things like that, if you don’t have the shared care agreement. And then the Tavistock tried to dissuade us from taking them as well, they were like, “If you go with the shared care agreement, you’re not going to be able to get blockers from us,” so basically it was like, almost like blackmail or bribery, or something like that, like you can have this but you’re not going to get the help that you need if you get the help you need basically.

So, there are GPs around here. Ok, so they are actually as it goes very good. Everyone knows in like out the people that I know, the trans community at least within the university everyone knows the good GPs and GP practices and good GPs within those practices. You know, word gets around. Have I ever heard of anyone getting a prescription, don’t be ridiculous, of course not. You know, no GP around here will prescribe a bridging prescription. I’ve never heard of anyone get a bridging prescription, in fact. I can explain what a bridging prescription is. So, a bridging prescription is HRT prescribed on the NHS whilst you are waiting for a GIC appointment, they won’t do it. They won’t do [clears throat] they won’t do bloods so they won’t do sex hormones. I was very lucky in that because I have a good relationship with my GP, he basically said, look, you haven’t had any bloods done for a year, I can effectively wrangle that will include a sex hormone you know, in with your other baseline blood stuff that we’ll do, but beyond that you are on your own. I’m sorry but we can’t do surveillance. The LGBT centre can’t do surveillance either, but they will, at least do liver function tests and sexual health screening. I would be really, really useful if they could, but again they need an endocrinologist.

So one of my friends, they managed to get a bridging prescription. Because they was in, they were having sort of a mental health crisis. And obviously their GP, because it literally depends on your GP, whether they’re clued up or not about it. They basically allowed them to do a bridging, the bridging process which is where they, while you are waiting to be seen, they basically prescribe you the hormones on the NHS. So my friend was lucky in that case. But when I brought that case to my GP, he literally was having none of it basically. So yeah it was it was tough but yeah hopefully things have changed by this point because we talking like, how many years ago now, we're talking about 6 years back, 5/6 years back. So hopefully things have changed for the better and you know more bridging prescriptions are happening because it’s obviously a really long wait for the gender clinic, especially since Covid.

It’s worked well for me. I would not recommend it unless it’s, like literally the last, last option, because there is not, I’m, I’ve made the effort to try and research and do all this kind of stuff, but it’s not something that’s, I think it’s also kind of something to acknowledge that most people who do self-med that I know of, so far, and this is, there’s not really much data on it because obviously people feel tricky about self-medding in general. So those people who do self-med do seem to be a bit knowledgeable about what they’re doing.

And so that’s been pretty good. What I do think is like it’s definitely easier for AMAB people to self-med, due to test, due to oestrogen not being a controlled substance. I’ve, I know a lot of AFAB people who want to take testosterone to you know transition, struggle and wanting to self-med, and it’s just like it’s just, I can’t recommend it in any way, like even as a last option because I, well I wouldn’t be like, obviously they’d have to do the research because I wouldn’t, like and one other thing I tell people when they self-med or if they are thinking of self-medding is you are on your own, you can’t rely on your doctor, or me, or anyone else. You are, that’s what it means, self-medding, you are taking care, an agency of your own care, and that comes with risks, and so full well understand that like you are like largely on your own.

And one thing I do to say about people who are self-medding, do tell your GP regardless, the, they, one thing your GP will say, what your GP will probably say is please try and stop. And if you’re lucky they might bridge you, but don’t expect it. Don’t expect bridging to happen, or anything like, or if you’re lucky the monitoring may happen, might not. But why I’m saying like to tell the GP is because it’s like similar with drug use or anything like that like recreational drug use, telling your GP is important because they’re not cops, they’re not going to take it away from you, or call anyone on you. They’re there to take care of you, and so if something does go wrong, in the event like something does go wrong and that you end up in hospital, they at least have an idea of what’s happened to you, so they can help. Cos that’s the first thing the doctors will ask for is your GP records, if they can get it, and then if that’s on somewhere on record, it could help you in the end. And so don’t, always tell your GP.

Another thing, like self-medding is like there is resources out there and it is it definitely much more reliable and easier for as I said AMAB people, due to the availability of oestrogen, the availability of anti-androgens which is the drugs that block testosterone, so it is so yeah, and like there’s always the, one thing I’d say is like I guess, if you see something marketed on Amazon, or like eBay, or anything like, like that seems sket, like seems somewhat sketchy, and doesn’t have the relevant drug in the title, and you can’t find it on like BNF or Drugs.com or something like that, that is most definitely not HRT. That is most definitely some, something that’s probably just herbal crap or something, at worst it’s something that’s vitamins or something at best, even. At worst it’s something like St. John’s Wort or some herbal remedy which can seriously interact with medication you’re already taking, which is scary.

So yeah like yeah self-medding, it’s something like I’ve had people approach me about in the sense of like they are considering it, and I’ll be like, I can’t tell you what to get or do, I can tell you what I’ve done, I will provide you resources so that you can do it safely as possible, but at the end of the day you’re on your own. And like I, it’s, it seems cruel to like wash my hands of that kind of responsibility, but at the end of the day I’m not a doctor, I’m not an endocrinologist, I’m just someone who’s done it themselves, and it’s something I always tell like people like, you, this isn’t something that’s, you can do on a whim. Or expect any help for, really.