This is the second blog post in a series on personal experiences of the Newcastle GIC (Northern Region Gender Dysphoria Service – NRGDS). If you have had an experience with Newcastle GIC and would like to share it so that other trans people know what to expect, please get in touch! You can also report your experiences with individual healthcare practitioners (including social workers, reception staff, etc!) in our Durham Trans Healthcare Survey.
This post is about the second appointment at the Newcastle GIC of Eliza, a 29 year old binary trans woman. She had her first GIC appointment in May 2017 and the second one in February 2018. She began taking oestrogen privately in January 2017 and had a shared-care agreement with her GP in place. She is slim, white and bisexual and attended the appointment with a femme-presenting partner. You can read about her first appointment here.
The appointment was with Dr Deborah Beere. First, they spoke briefly about Eliza’s current situation with her hormone prescription. Dr Beere said that it had been “helpful” of Eliza’s GP to give her a bridging prescription and that they would take it on, with 4-monthly blood tests. Eliza was asked to forward her latest blood test results to the GIC.
The interview was a lot less structured than last time and there was less of an indication of gatekeeping. Eliza was not asked directly about her gender at any time, it was assumed by her presentation, existing hormone therapy and answers in the previous appointment.
The main topics discussed were:
- Her job and how transition had gone at work, with her friends and family
- Her mental health and whether she was on any antidepressants
- Her medical history, including all medication she was taking and any genetic risk factors, whether she had been in trouble with the police, and drug and alcohol use
- Her parent’s jobs
- Her school and university life
- Her gender identity development (in a clichéd fashion, which was acknowledged when challenged)
- How much she knew about being trans, whether she was in touch with any trans people
- Her sexuality, relationship history and current relationships
Dr Beere also discussed various therapies that Eliza could choose.
Eliza had already had a significant amount of private laser treatment, Dr Beere agreed to write to the NHS-contracted sk:n clinic in Newcastle to tell them that Eliza was entitled to NHS care. This would cover the remainder of her laser treatments and some electrolysis. There is a limit to the number of sessions available under the NHS for hair removal, but Eliza was unlikely to reach that limit as her treatment was almost completed.
With regards to voice therapy, there was a waiting list of several months. A group session of an introduction to voice and communication therapy occurs every few months, after this session Eliza would be able to access one-on-one coaching.
As Eliza was already taking hormones, the discussion of medication was not as thorough as usual. Dr Beere still spoke about the negative side effects and risks. She mentioned that Eliza’s target oestrogen level should be between 400 and 600 [note: we assume the unit is pmol/l] and that testosterone is fully suppressed. She mentioned that there was no need to continue with finasteride once testosterone had been fully blocked, though some people choose to continue on it for psychological benefits. They would also continue to monitor her lipids and liver function.
Dr Beere told Eliza that for GRS she would need a second opinion from another clinic, the closest one to Newcastle being Edinburgh. In order to access this, she would need to demonstrate that she had lived “full-time” as a woman for at least a year and that her hormone levels were stable. If genital hair removal was required, the surgeon would advise this and it could take several months to a year for this process. After surgery, Eliza would need lifelong dilating and douching. Some women, particularly older ones, opt for a cosmetic vulvoplasty.
Eliza requested a letter for the passport office in order to get her gender marker changed on her passport, which was freely given.
When asked, Dr Beere said that they wouldn’t “freak out” about non-binary people attending the GIC, but we are particularly interested in hearing from you if you are a non-binary person who has accessed this service.