I’ve taken a long time to get to where I am, and I’m still not where I want to be. I suppose that’s what makes life worth living: if any of us had got to where we wanted to be (really and truly), what would there be left for us to do? Now, I know that the life-as-a-journey metaphor is a tired one, and the transition-as-a-journey one equally so, so I won’t labour the point. In fact, I’m not even even going to talk about the decades I spent living-as-though-male, which in real terms is (and probably always will be) the longest part of my life journey. No, just now, I want to rant about waiting times for trans health care.
When I told my GP that I was trans (or, to be precise, that I thought I was trans), I was so relieved to be taken seriously. Indeed, she was absolutely fantastic, referring me straight away to my local gender identity clinic (GIC). Having done my research, I knew there was a long waiting list, but I also knew that it was a lot shorter than in other parts of the UK, so I was relatively thankful to have to wait only five months for my first appointment. And I was confident that things would move faster once I was in the system. In particular, my research led me to believe that trans patients typically began hormone replacement therapy (HRT) within three to six months of their initial appointment. Exciting!
My first appointment was in January 2017, and it did eventually come. (Actually, those five months gave me time to convince myself that I really did want to go through with this – and also to come out to a number of people, not least my wife and son – but that’s for another post.) So I expected to start HRT some time between April and July. My second appointment (really a continuation of the first) was in March, so not such a long wait. At the end of this appointment, I had several syringefuls of blood extracted and was given HRT consent forms to look at before my next appointment, which was in June. So I presumed I would start HRT then. Everything seemed to be on course, even if April would have been better from my perspective!
June came (and by this time I’d started having laser hair removal – again, I’ll save that for another post). I found out about my blood tests. Apparently, my cholesterol levels were slightly higher than the threshold for the nurse practitioner to prescribe HRT, so I’d have to make an appointment with a doctor at the GIC. Why couldn’t I have been told about this back in March? Anyway, that meant a delay, as I couldn’t get an appointment till the end of July, nearly two months later. At least I had a date for starting HRT now!
The final countdown?
My appointment with the doctor was really little more than a rubber-stamping exercise. She was perfectly happy to prescribe HRT despite my slightly elevated cholesterol levels. Except that she doesn’t actually do the prescription – that’s down to my GP (now they tell me!). A letter (yes, a letter – in 2017!) would be sent to my GP, who would take it from there. I was advised to leave it a couple of weeks before making an appointment. To be on the safe side, I arranged to see my GP three weeks later. Finally, things were starting to fall into place, and I began counting down the days publicly on Twitter:
Alas, ten days later:
The next few weeks were very frustrating, to say the least. I just couldn’t understand how medical bureaucracy could be quite so horrendously inefficient in the era of instant communication. It didn’t help that I was in the middle of a 12-month interruption to my PhD, during which I had hoped to have got a lot of this kind of stuff out of the way. Anyway, the letter eventually came through, only to find my GP on holiday. Still, I was at least able to restart my countdown:
‘E-day’ came on 2 October, and I went to see my GP. Unfortunately, the letter that had taken so long to prepare was not quite clear enough for her to be sure what to prescribe. Aargh!
Luckily, it only took a few days more (I thought it could have been weeks) before I finally got my prescription. On 6 October, I stuck on my first estradiol patch, and on 9 October, I got my first triptorelin injection (and began a two-week course of cyproterone). Today I will be getting my fourth injection. How’s it going? Well, you guessed it, that’s a story for another post!
I had a GIC appointment last month (December), which included a blood test to check my testosterone and estradiol levels. I also mentioned that the patches were irritating my skin (I’m fast running out of places to put them), so hopefully my next prescription will be for estradiol gel instead. But for now I’m waiting for a letter from the GIC …
I hope E M Forster would forgive me for borrowing the title of his novel for something as banal as this blog post (and that he wouldn’t be too affronted by the modernity of it all).