Archive for September, 2015

Developments in the NHS

Posted: September 27, 2015 in Uncategorized

So before you read any further, please click here and read this blog post.

It’s by Will Huxter, and it purports to be a step in improving communication and services of the gender clinics in the NHS (National Health Service, for the non-Brits among us).

For those who don’t know, transitioning in the UK on the NHS goes the same way whether you are MtF, FtM, or non-binary: you ask your doctor (GP) to refer you to a gender identity clinic for treatment. In some places, you are first referred to a mental health teams (known as CAMHS), before being referred on to the gender clinic. One at the GIC, you undergo a number of psychiatrist appointments before discussing treatment and then, if you’re lucky, starting on those treatments. Usually in the exact order that the NHS prefer.

If you read down the comments on that blog post, there are a lot of problems with the NHS system. I’ve heard of people who have literally taken a decade to transition. Common complaints about GICs, both directly to them and quietly amongst transgender circles, include dismissive behaviour, rudeness, punitive language and measures against patients, inexplicable obstacles put in the way of transitioning, lack of communication with the patient, lack of communication with each other, and so on and so forth.

And these problems are being placed on a group of people with a ridiculously high rate of self-harm and suicide, and a disproportionate tendency to be victims of violent crimes and sexual assaults.

The impression that the entire state of play gives it this: it’s okay, they’re only transgender.

No, I’m serious. If I could list that about a single hospital, there’d have been a Sun pun and special measures by now. Would it have done anything — well, likely not, given that there’s no teeth behind these inspections nine times out of ten. But it would have happened. Hospital and care home scandals have been all over the news in the last five years, as we get steadily more disgusted and fed up with appalling hospital treatment.

But this? This isn’t known about. If you’re not transgender, or a close loved one to a transgender person, you won’t have heard of this. It’s only now being raised, because people finally mobilised and started petitioning the government about other transgender issues.

And the problem is, it’s been raised before. Problems with dismissive GPs, disinterested mental health services, and long waiting times were raised years ago, and nothing was done.

So honestly, I’m a sceptic. I’m sure Mr. Huxter has his heart in the right place, but I’m also sure he won’t change anything. There needs to be real effort and power behind changing the sorry state of play in the NHS gender transition system, and there isn’t. The powers that be just don’t care enough, and neither do the wider population.

But this attitude is what gender transitioning in the UK can do to you, folks. So beware.




(Apologies for the grumpiness, I’ll try and blog something a bit more cheerful next time!)

Yesterday was exactly two months to the day before my top surgery, so I figured it was good timing to talk about top surgery in a bit more detail.

FtM top surgery is similar to a mastectomy, with the exception that after removal of the breast tissue, there is a lot of contouring that goes on as well, and usually a fair amount of fiddling about with your nipples. (Yeah, real technical terminology going on here.) There’s various techniques depending on how big your breasts are and, basically, the bigger the boobs, the more your chest is going to feel like you got hit by a 4×4 afterwards.

I will be blogging and vlogging in real detail when the time comes as to exactly what the experience is like, but right now, I’m experiencing the preparation stage.

And that’s a pretty long-ass stage.

Very basically, top surgery is a cosmetic procedure. Physically speaking. I’m not saying it’s just like people who want a nose job; what I’m saying is that top surgery is not something that your medical team goes ‘oh fuck you need this now!’ and rush you into theatre. This shit takes ages.

In my case, I have a straightforward referral and I have no medical history that would be of any concern to a surgeon operating on my upper body. (If the poor bastard was operating on my right knee, that would be a whole other story, but thankfully boobs don’t grow out of your knees.) So I get ‘turn up on the tenth for your pre-operative assessment, then if all goes well for that, turn up on the nineteenth for surgery.’

Referral comes from your psychiatrist. Yes, despite transgenderism no longer being viewed in the West by the medical community as a mental illness, it’s a psychiatrist (or similar) who gets to yay or nay your medical transition. Some surgeons in the US use a waiver model, where you sign a waiver not to sue them if you change your mind later, but most don’t. No psychiatrist’s letter, no surgery.

Some surgeons need two referrals, some need one. In my case, only one was needed. The surgeon accepted the referral, I made arrangements with his staff, and got booked in for surgery on 19th November. Job done!


Sort of.

The #boobwar is over, in the sense that now the only thing that can betray me is my own body, and if it does that, I’ll be shut out of surgery anyway. But that doesn’t mean that I’m just sitting and waiting for surgery day.

Because the surgeon has to do a significant amount of contouring and sculpting work on your just-decimated chest in order to make it look masculine as opposed to just flat, his or her job is made easier if there’s a bit of muscle definition already there to work with. And looking as masculine as possible is my goal, so I’m working out a heckuva lot at the minute.

Then there’s the medical instructions. I’ve been sent a doorstep of a booklet asking all sorts of questions, and telling me to take various vitamin supplements and herbal whathaveyous prior to and after the surgery in order to help healing. Now I’m not the homeopathic remedy kind of guy, so that took a bit of shopping around to freakin’ find, but whatever. He’s the expert.

Then there’s the general improvement to diet and fitness so the surgery doesn’t knock me flat on my arse too badly. Because I work two jobs, I don’t eat as well as I should. No more — and boy, am I not enjoying it. Seriously, after this surgery, I am never eating oranges again.

And, of course, there’s post-surgery preparation. I’ll need to sleep sitting up for a few days after. I may have drains. I won’t be able to reach above my head easily, and anything on a high shelf becomes impossible. I will contort my face like I’ve had a medieval pike driven through my thigh if I try and lift anything heavier than a piece of cotton wool. Working out is out, pun not intended. And I’m going to have to pack a special hospital bag, including pillows for the car on the way home, and a shirt I can put on without moving my shoulders.

But all of that is nothing compared to the psychological preparation.

I am not a very feelsy person. What bothers other people doesn’t seem to bother me, whereas what other people can do without thinking twice, I’m freaking out about. I get stressed about having to drive between two offices at my day job, because what if my universal access card doesn’t work. Turn up as a key witness for a three-week trial? No problem, bring me a magazine so I’m not bored.

Surgery is the same. Actually getting a major surgical procedure isn’t bothering me in the slightest. It’s not even on my radar yet. But what if I get lost on my way to the pre-op assessment?! What if I can’t sleep in their hospital beds? Holy shit, what if they serve some fucking awful weird-ass breakfast and won’t let me go until I eat the damn stuff??

Seriously, that’s bothering me. And on other forums where I’ve discussed this with other FtM guys, the reaction has actually been ‘wtf are you for real?’

Well, yeah. Actually I am. What I feel is unusual, sure, but it’s fine to feel the way I do. Just like it’s fine for other trans guys to not want to get top surgery, or have hormones, or whatever else. As long as I understand the enormity of what I’m doing, and the fact there is no turning back after the anaesthetist turns up on the nineteenth, then whether or not it’s making me nervous is irrelevant.

And weirdly, that’s taken me longer to settle down with than any of the rest of it. That it’s fine to feel the way I do about this upcoming event.

And after surgery?






(If anyone wants to send me chocolate to tide me over with happiness and e-numbers after I’ve been chopped up, I will love you forever. Just saying.)

So what’s involved in female-to-male transitioning?


Generally speaking, transition can be split into two pieces: social transition, and medical transition. In some countries, legal transition could be considered its own unit but in many countries legally becoming your chosen gender is very patchy and complex, and is completely bound up in social transition, so for the purposes of clarity, I’m sticking with these two lumps.


Social transition is what it says on the tin: it’s transitioning as far as society and your social life are concerned. That basically encompasses going about your life like you’re already your preferred gender, as much as possible. For me, this was largely about changing my name, coming out to everyone who knew me, wearing men’s clothes, and adopting a male position in life as much as I could without medical transition.


Sometimes, social transition is enough. Sometimes it’s not, and people choose to also medically transition. That is, they undergo medical procedures to bring their physical body far more into line with their gender than it originally was.


Key point: some transgender people do not medically transition. It doesn’t make them any less transgender, and anyone who says that it does is a dick.


Medical transition is very different for MtF and FtM people, and my experience wholly lies with FtM transition, so that’s what this post will focus on.


Basically, there’s three main steps: hormone treatment, top surgery, bottom surgery. Typically, they’re in that order too.


Hormone treatment is basically being prescribed testosterone by a doctor. It’s known as T generally within the trans community, because it’s a long and clumsy word, and T more or less puts you through puberty. Over time, your voice drops, you grow body hair in places you didn’t before, your sex drive sometimes changes, and in the short and mid term, some people have felt very aggressive.


Top surgery is removal of the breasts and re-contouring of the leftover tissue and skin to create a masculine chest. It’s not quite the same as a mastectomy, but it’s very similar to us laypeeps. The procedure is a major surgery, conks you out for a while, and leaves scars. But hopefully over time the scars fade to the point you can’t see them. Google ‘topless transman’ to see some results.


Bottom surgery is kind of two things: one version is removal of everything feminine between your ribs and your knees, i.e your uterus, vagina, etc. The other version is lengthening of the urethra (can’t spell…) to create effectively a micropenis. Bottom surgery is actually pretty unusual and the majority of transmen don’t do it. Moreover, removal all the ladybits can have major health complications and surgeons can be pretty reluctant to do it unless your dysphoria is exceptionally bad relating to it.


Those are the extreme basics. Each ‘step’ is very complex and individual, can be done out of order, and is wholly dependent on the individual undergoing transition. So here’s a case study: me.


Generally, I can pass okay at the minute. Except in the summer. This is a photo taken in June by the North Sea, so it was cold enough to wear a jacket. Because the problem is that I have a massive rack. Seriously, 30F. And when it came to medical transition, I knew what had to happen.


I was not brought up in a trans-friendly area. I don’t currently live in one. So for me, I needed to be able to switch very fast between ‘looks female’ and ‘looks male.’ In the winter, I already look male, but in the summer, there’s not a hope thanks to my chest. So I opted to have top surgery first. See this post for a rant about how difficult that was!


In November, I will have my top surgery. Some time after that, I will start hormone treatment. And I won’t have bottom surgery. That’s what medical transition is for me. Other guys have had bottom surgery. Some guys haven’t had top surgery. One guy I know isn’t going on hormones because it’ll wreck his singing voice and that’s more important to him than the funny looks he gets now when he speaks.


Medical transition is formed on the basic steps — but the journey through those steps, which ones to take and which ones to skirt around, is entirely individual.






(Major apologies for skipping a week — I went camping, and had no access to the online world. My bad.)