Tag: NHS

The NHS said yes

On monday, I had my second appointment with the gender clinic at Charing Cross (which moved to Hammersmith in 1973). The doctor tried a bit too hard to be charming as he asked me all the same questions as I’ve been asked innumerable times.
He wanted to know my family tree. Do I have any LGBT family members? What’s my first memory of gender issues? At what age did I leave school? Do I have any friends? (Would they lend me £20 if I asked?) Do I take drugs? Etc etc etc
He also asked me the last time I wore a dress. “That includes weddings and funerals.” I can’t remember. I know I put one on occasionally as a joke at Mills. Nicole said it made me look like a footballer in drag for a comedy skit. As it happens, I’m not really into cross-dressing, and I’m not really genderqueer these days. But the question is troubling for transmen who do like to drag it up a bit. It’s even more alarming for those dealing with intense family pressures. Do we want to force people into being ostracized so they can get the treatment they need? I don’t know what would have happened if I’d said less than 2 years rather than guessing 15.
But, as it worked out, he said I will be having top surgery “rather quickly.”!!!!! As soon as my PCT approves the funding. I asked if being here on a student visa was going to be an issue and he pointed out that they were already paying for me to talk to him. He said that the primary concern of doctors is what’s best for their patients and described the NHS as a vast left-wing conspiracy.
This was one of those moments when I really love Britain. God bless the NHS! The good doctor also suggested that I become British. I’d love to.

Advice for Migrant Trans People in the UK

The doctor also gave me a very useful bit of advice, that I need to double-check with my university, but which sounds very good. He said that I could change my name in the UK and put off changing my name at home until it’s feasible. He says there is no problem having one legal name and gender in one country and a different name and gender in another. I need to verify that I can still get my uni to give me the right forms to extend my student visa, but I think their non-discrimination statement for trans people means they will be willing to deal with the two names problem.
Of course, it’s not ideal to carry around a US passport with name change documents. What I need is government-issued ID, ideally with the right name and gender. He told me that I can apply for a provisional drivers liscence. I do not need to learn to drive, it’s basically a permit to learn which doubles as a photo ID. He said he knew of a blind person who had one. It stays valid for years and counts as proof of legal residency and can be used as a travel document (instead of a passport) within the EU. He is going to post me a letter which I can use to get the correct gender markers.
I don’t know if I’m happiest for finding out I’m getting top surgery or for finding there’s an easy solution to my paperwork disaster. I’m also wondering if I can use British documents to bluster my way through getting stuff changed in the US. To change my name in Alameda County, California, I need to publish a notice in the newspaper and then get on a 4+ month waiting list to appear in person, in court. It would be a hassle if I wasn’t abroad. Changing my gender on my US passport is even more of a hassle, to the point whre I think becoming a British citizen might even be easier.

I promised more blogging

I haven’t written about gender stuff for a while. I finally had my appointment with the Charing Cross Gender Clinic, after months of waiting. Fortunately, the shrink had actually read the amusingly stupid report from the previous shrink, so I was not forced to recount my childhood yet again, just a few details of it. I don’t know why they care about it. Some trans people aren’t dysphoric at all before puberty. Heck, some aren’t really dysphoric until well after puberty. And I hate that my unwillingness to skip rope is considered a sign of being trans. It was mostly a sign of being a huge nerd, something that was not tied to gender at all. I was awkward and unathletic. I also was unable to protect my face during dodgeball and hated it too. Does that mean I’m really a girl after all?
They need two appointments before they will give me a referral and they’re understaffed, so appointment number 2 is in february. I might be able to call occasionally and see if something sooner has become available, but I don’t want to feel guilty about queue jumping, so I might not. The UK economy is kind of fucked, so maybe I should just pay privately, especially if I can get a part-time job.
All the gender stuff is still really vital to me, but I just don’t want to talk about it. Somebody on a website had a go at me a few weeks ago about my gender issues and history and it really sucked. So I quit posting anything of import there and I’ve quit posting here and I quit seeing my shrink when T died, but the not-talking-about-it school of dealing with life seems to work as well as the talking-endlessly-about-it approach. After a while, it all gets boring. My cousin had a book called “After Enlightenment, the Laundry.” Like, no matter how fascinating your current thing is, after a while, the mundanity of real life reclaims the center stage.

Speaking of which

In my real life, shortly after I gave my concert in May, my dad came to the UK for a month. He stayed down the street from my flat for a bit and traveled for a bit and then we went to Ireland together and then he went home. In July was gay pride and a bunch of other stuff that seemed to suck up all my energy and now I can’t even remember what it was. Helen and I cycled in a big loop around the Isle of Wight, which was nifty and very hilly. I love biking. August is going to slip quickly past.
I joined a bad called Helen’s Evil Twin. I’m the bassist, so I’m in the non-acoustic line up. My first gig with them is on August 13th. As it happens, this is a high profile gig and a large percentage of people I know in London will be there.
In other news, I’m trying to get caught up with where I should be in my PhD, but this is making the writers block thing worse instead of better. It seems like everything I write takes a long time and then comes out boring. I should write a whole huge amount of stupid crappy pieces, just to get going and then pick the good parts from all of them and combine them into one good piece. Or something. I’m worrying too much and I think I need to do a masterpiece or something. I keep reading about symphony composers from a hundred years ago, and they’re all geniuses who write masterpieces and spend years on them and say something really meaningful. Intellectually, I’m against that, but intellectually, I’m against a lot of things that I can’t actually seem to shake free.
And now, here’s a boring blog post to go with my boring attempts at music lately. I had a conversation with a guy a couple of years ago about how he would rather be crazy and write good music than happy and boring. I’m happier than I was when I had that conversation, but I think I would have ended up musically boring either way.

Further Adventures with the NHS

I went today for a psychiatric assessment. I spend a lot of time being evaluated, alas. This one was at a Tower Hamlets Primary Care Trust medical center. It seemed like most of the other people there were for more body-focused medical stuff. It didn’t have the kind of security that Dutch mental health centers have. Indeed, the doors opened automatically as I approached.
My appointment letter was for “Ms Celeste,” which is better than Miss, at least. The receptionist looked at the letter and looked at me and asked who the appointment was for. I said my name. She looked at me a long second and then said ok and told me to sit.
The shrink was youngish. He had a student sitting in, a man about my age. I said I was ok with that. “Just ignore him” said the shrink. Right.
He had me go on and on about my childhood. Which, frankly, is not that interesting. Any fascinating memoir of my life would start later. I mean, the first time a gender shrink asks you about your childhood, you get to construct a narrative of yourself in regards to gender. Did you always know something was different? Were you blissfully unaware? Did others point out locations of difference that you didn’t see for yourself? All of this tempered by the understanding that the receiver of said narrative is a hurdle between you and hormones/surgery/whatever you’ve come for.
So I banged out a narrative for an hour about how I’m a totally reasonable sane person. He wasn’t a gender specialist, so when I said FTM, he asked what that stood for. So gender issues weren’t even that present in the conversation. He did use the phrase “Gender Identity Disorder” though, and it got my hackles up a bit.
I don’t like being called disordered. At all. The catholic church calls homosexuality “intrinsically disordered,” which is a value judgment that I’m not keen on either. Why must every location of difference be called a disorder? Could it be a condition instead? Some other medical phrase? I’m proud of who I am. Indeed, to be different means that you have to be proud or be crushed. My identity is not a disorder, it’s just atypical.
Then funding came up. He asked me when my student visa expires and started talking about “planned elective surgery.” Which, I mean, Tower Hamlets is not awash in cash. It’s one of the poorest boroughs in London. Why should they allocate their tax money to a foreign student? I don’t know how NHS funding works, but it seems to be geographically divided. Are the residents of Tower Hamlets the main funding source for their primary care trust? Or does it come out of a large pot and then is distributed by population?
In order to change my documents in California, I need to get top surgery. Also, to be able to go swimming or wear a T shirt ever again in my life. So if the NHS won’t fund it, I can . . . wait or self-fund. I don’t think it’s reasonable to try to get it too far from where I’m actually living, so surgery in California is not a good plan unless I move back there. It’s possible for people in the UK to “go private” which means pay themselves for stuff rather than wait for the NHS to decide to pay for it. I have no idea how much this would cost here, nor if it would effect them covering my T prescriptions or anything else. Aside from whether or not I could afford it, there’s issues about recovery time. It’s long. I won’t be able to lift things for weeks. This sort of situation requires close friends and I’ve only lived here since August. So even if I got NHS funding, it still might not be a reasonable plan. So maybe I’m destined to wait years no matter what.
When I do get it, if I still have savings, the first thing I’m going to do is buy the bike jersey I’ve been wanting, which I so can’t wear right now.

NHS Mental Health Trust Shrink

In order to ration care treat trans patients, the NHS wants shrinks to be involved. Specifically, you can’t get a referral to an endocrinologist without a psychiatrist. Also, importantly, nobody wants to pay for anything unless you jump through all the proper hoops like a trained circus dog. So this morning I arose bright and early to go see a shrink.
The letter informing me of my appointment told me to go to the Queen Elizabeth Psychiatric Hospital (QEPH), which is right by school. It always struck me as highly convient, having the mental hospital right next to the Uni. I also often wonder how the queen feels about having a mental hospital named after her? There must be a great number of strange things named after her. The Queen Elizabeth Car Park. The Queen Elizabeth Strip Mall. The Queen Elizabeth Home for Rabid Puppies. Does she get any say in it? “Oh, thank you for the kind offer, but I was really holding out for a suspension bridge?” (Or can there be multiple Queen Elizabeth Bridges? Would that be too confusing? Could there be both the Queen Elizabeth Bridge and the Queen Elizabeth Suspension Bridge?) I mean, personally, I wouldn’t be picky, but I have many fewer people asking to use my name for their construction projects. Nevertheless, I think I would balk at a mental hospital. What are you trying to say?
Most Brits probably have odd ideas about America. I think they imagine the shootout at the OK Corral as being highly symbolic of the country as a whole, which is not an entirely unfair assessment. Similarly, I have various stereotypes floating around in my head about the UK, many of which come from Victorian novels. High school English classes typically spend one year on American Literature and then one year on British literature. The Victorian era seems to have been a golden age of writing in England. Or, at the very least, it’s the one most enshrined in American highschools. Costume dramas made by the BBC are also a major cultural import into the states. We all imagine a dark, smoky gray London with a polluted fog overhead, women in petticoats, Dickensonian beggars, murderers left and right (with Sherlock Holmes or Miss Marple on their tail) and hulking brick asylums, filled with suffering upperclass women who can’t accept their station in life. Women who want to read too much. Women who want to be men.
Fortunately, I have managed to avoid being committed. I woke at an extremely early hour and managed to spill every drop of my morning coffee on the floor before I left for my appointment, alas and woe. The QEPH is in a typical largish medical building. They have automatic doors, which, unlike mental health centers in the Netherlands, are actually automatic. The reception was separated only by a normal counter, again, unlike the Netherlands which was behind glass. Maybe they think I’m crazy, but at least they don’t think I’m dangerous. That was nice.
The doctor asked me when I first knew I might be trans. I should have a set answer for this by now. I should write out my official narrative and post it to my blog. Then, when somebody decides that I need to see a shrink, I can just give them the link. I don’t fucking know when I first had gender issues, ok? sheesh. I really don’t want to draw any kind of line anywhere. I don’t want to validate all the homophobic bullshit I used to be subjected to. I don’t don’t want invalidate decisions of other butch women not to transition. When did I cease just being a butch woman? When I started taking hormones and told people to call me he. Not before. It happened then.
Lack of coffee, up early in the morning, strident (formerly) lesbian feminist, so very very american. I must have seemed a bit like Hillary Clinton. But, you know, if she were a bloke. I was confused by the questions and gave confusing answers. I’m pretty sure I annoyed the doctor. Nevertheless, I have successfully jumped through this hoop.
He explained that there were evaluations and waiting lists and whatnot. We don’t just give out hormones on demand to people who ask for them, he explained. Why the hell not? What terrible harm would befall the commonwealth is trans people had easy access to transition? None!
Alas, this is just one hoop. This doctor is not a gender specialist. I’m to keep seeing him while I wait to see the one specialist for the region. Who is not in Birmingham. The second largest city in the UK has no gender clinic. The waiting list is apparently months long. In the mean time, I can keep taking T – and I can keep paying for it.
I am so very, very, very glad I started on hormones while I was back in the states. Sure, we’re all cowboys and it’s the wild west and all, but that’s not all bad. The social worker in San Francisco explained that the city had no vested interest in saying no to trans people. What purpose would it serve? The city pays for it’s residents to get this service if they want and need it, like the NHS pays for Brits (and foreign students). And San Francisco found it was coming out ahead when it got rid of all its hoops. People who come in for hormones also get the other health services that they need. Happier people tend to take better care of themselves and are healthier. Does it save tax money to say no to trans people? No, quite the opposite.
I left my heart in San Francisco. Sometimes, I think it’s the only place in the world where anything makes any sense.
I felt good about myself when I left QEPH. I got through this round. I was treated more or less like a normal person. When I got back outside to the bike parking, somebody had left a nice, new, red mountain bike leaning on my bike. With no lock on it at all. You’d have to be crazy to leave that bike out unlocked like that! . . . oh right . . . I wish my issues weren’t treated as mental health issues.

Sharp

If you’re wondering about that photo shoot magazine business, well, they haven’t paid me yet, so I’m going to wait to mock them. But I got my T shot finally on Monday (and I feel so much better).
On Monday, I showed up to my doctor’s surgery and after asking the receptionist if I could speak with a nurse, I asked her if, as a favor, she could please change me from “Miss Celeste” in the NHS system to “Mr.” They have to use my legal name, fine. But titles aren’t legal. And every time I got something addressed to “Miss Celeste” I felt like they had tied a pink bow around my neck. “Mr” would help. A lot.
The receptionist looked at her computer. “Is your real name ‘Celeste’?”
“uh. yeah.”
“Are you from the states? Are you American?”
“yes . . .”
“Oh! Well, over here ‘Celeste’ is usually a girls name! That’s probably what’s caused the confusion.”
I did not start laughing. I said, “My mom was a big Johnny Cash fan.” Which is true, but I wasn’t exactly a boy named Sue. I went to sit down and out of the corner of my eye, I saw the receptionist get more and more confused looking until she went into the back. And then my name came up.
The surgery has a sort of an announcement system. “Would so-and-so please go to room 15?” I couldn’t tell if they said “Miss Hutchins” or “Les Hutchins” or what. They pronounce “Les” like “Lez”, not like “less.” And “Liz” is also a name, which sounds very very much like Les. It’s confusing. But my last name was clear, so I went to the room.
The nurse showed me how to open the ampoules. They’re made entirely of glass. You have to snap them open and be careful not to cut yourself. But they snap cleanly. She told me not to worry about bits of glass getting into the T. I asked her if she could just do the shot for me, since she’d opened the container.
She agreed and I asked for it in my bum. It’s a good idea to rotate injection sites, because of scar tissue and whatnot. Since I use my legs, I thought I’d ask her to do someplace that I can’t reach. She was anxious that I not lower my trousers in front of the window, but then she just pushed the needle in. No gloves. No hand washing for her. No antiseptics for me. Not even a quick jab with the needle. It just went right through my unsterilized skin. I’m surprised the British aren’t ultra-cautious about this, like they are about everything else Is it just her? I guess I don’t need to be too paranoid about that part then.
I asked if I could just have a few needles instead of buying a hundred, so she gave me some (yay) and then asked me how I dispose of them after using them. I explained that I put the cover back over them and put them back in the little plastic pouch they came in, so nobody would get stabbed, and threw them away. “Oh no, you’ll go to hell for that!” she said.
My friend has a joke he loves: There are Jews in hell for eating bacon. There are Catholics in hell for eating steak on Good Friday. And there are Anglicans in hell for eating the meat course with the salad fork.
I won’t go to hell for being all kinds of queer, I’ll go to hell for not following proper safety protocol with used sharps. She told me I need a sharps container and wrote me a prescription to get one from the pharmacy. When I saw the name on the scrip, I knew my conversation with the receptionist had not been in vain. It’s written for “Miss Les.”

Feeling Sleepy

When last I posed about my adventures with the NHS, I had just gotten a prescription from a completely uncertain doctor. She had no idea if she’d written me the right amount of the right type of T nor whether or not I should have to pay for it. She didn’t even know what kind of needles I would need. She went to ask a nurse but couldn’t find one. She promised me a referral to an endocrinologist, so that somebody with experience could be checking on things. I agreed this was for the best.
If I had stayed in the states, I would have 10 weeks of testosterone left on my initial prescription, so as long as I’m getting an equivalent amount to what I was first prescribed, it’s ok that nobody has checked up on me yet. And I went asking around on the internet and the doctor had, indeed, given me an equivalent amount. So I took my prescription note to the chemist (British word for “pharmacy”) to get it filled, the day before I was due for my shot. They had to order it.
I find injecting to be stressful as hell, so I didn’t actually hurry to pick it up the next day. I arrived on Friday, a day late, to get my T. The pharmacist gave me 3 ampoules and 30 needles! But they were insulin needles. They only held 1 CC and the needle part was about half the length needed for intramuscular injections. And, I mean, I like to have spare needles, so I can practice on oranges a few times before I stab myself, but ten per shot is a little excessive. Ten per shot of totally the wrong needle is beyond useless. The pharmacist (chemist?) said he could order 2 CC needles for me . . . in a case of 100 for £20. That’s a fairly major investment on my part, not just economically. If I stay on the same kind of T, instead of switching to the once every three week formulation most frequently used by European ftms, that’s enough needles to last me 4 years. If I practice with an orange every time, that’s 2 years worth of needles. I was kind of hoping to switch from injecting to some other form, like a patch or implant or whatever. That’s a hell of a lot of needles. He promised to order them. They would arrive on Saturday. Two days late for my shot.
I got home and found I had one needle left from before. yay. Obviously, I’d prefer to have an extra (one time I took the cover off of a needle and promptly gouged into my thumb. So much for that needle.), but if I only have one, then I only have one. I watched a youtube video about how to DIY it, just to double check that I’m doing it right (more or less, I’m fine) and I put on some Steve Reich phasing music to feel happy and relaxed. I did the prep. Wash my hands. Figure out where I’m going to stab myself (left leg). Clean it. Clean the top of the ampoule before . . wha? What’s this? It’s made entirely of hard plastic. Where do I stab it? How do I get the T out of this thing?
I looked at the clock. 17:15. I looked at the web page for my Doctor’s Surgery (British word for “office”). Oh christ, they’re closed until Monday morning.
I was already a day late.
I don’t know how to describe what this feels like. People who have taken the pill or whatever can probably relate, on some level, since they’re messing around with their hormones also. The goal of the T dose taken by an FTM is to cause masculinization, but also to overwhelm his ovaries so they just give up. It’s early menopause. Which is fine, because he’s got new artificial hormones to keep him going. It’s better living through chemistry! Except that’s only as good as the pipeline coming to you.
When I started T, I still had a fair amount of anxiety, so I’d never typed the name of my drug into google. I thought reading the information might freak me out, since, you know, I got freaked out kind of easily. Oh my god, this is the most sought after steroid for weightlifters. There are body builders who take more every day than I take in two weeks. Well, I guess I don’t need to worry about dying of an overdose or something. They all report the same effect I did. More energy. More stamina. Easier to make muscles. All this physical energy and strength.
Missing a dose for several days, though, isn’t just going back to baselines levels. My baselines hormone levels have been shut down. It’s going to zero. Not only am I below the normal male range, I’m below the normal female range. I’m at nothing. I feel like. I don’t know. I want to take a nap. A really really long nap.
I feel like I’m underwater, somehow. You know how it sounds when you’ve got your head underwater and somebody’s shouting at you? You can hear it, but it sounds strange and distorted and barely understandable. I feel like that sounds.
I can get through a few days of this with tea (caffeine is a little like T. (if only there was T tea)) and chocolate. In Harry Potter, you recover from dementors by eating chocolate. It sort of revives you from having stared into the abyss. That’s the most true part of those books. But, now, I dunno. I got nothing. I don’t want to eat. I don’t want to walk around. I don’t want to make music. I don’t want to make tea. I don’t want to eat the chocolate sitting by my bed. I just want to sleep. And not, like, with a longing, just like a default. It’s like staring in the abyss, but the nothing staring back at you isn’t infinitely horrifying in it’s emptiness. It’s not horrifying at all. It’s like the abyss is made up of shuffle board courts and corporate team meetings and sandwiches made of wonder bread and waiting rooms and BBC Gardening shows. It’s not dread, it’s complete numbness. The mummy’s curse causes dread. But being a mummy is all white bandages and laying in a box and nothing ever happening, just a really long nap.
A half hour goes by and I haven’t even noticed. I could stare at the wall for days.
Of course, some part of my body has noticed this state of affairs and is rousing itself to action. It’s kicking at my ovaries telling them to wake the hell up and do something about this. I really don’t want them to wake up. stay asleep. Stay asleep. It’s only another day. I’d rather be a eunuch.
Is it bad for me to oscillate like this? How the hell should I know? Probably it’s not good. It doesn’t seem like it could be. When I made a list of pros and cons, this possibility was at the top of the con column. I’m tethered to doctors and prescriptions and chemists and needles and and and. Not that being anxious all the time constituted total freedom.
I don’t want to sound like I’m complaining. I’ll get through this. I don’t regret my decision. Not that I have the energy for regret.
I want to go abroad this summer for a few weeks. I don’t see how I can work that out and my prescription at the same time. Especially since the referral that came was for a shrink. I have to jump through some hoops in May and probably June. There must be a way, obviously. I’m sure I’ll work it out. And it’s not like I don’t have a fuckload of options. When I go to play a gig in the states in July, there’s 10 weeks of T I’ve still got prescribed to me. I’d rather not have to fork over the $$ for it, but I know it’s there if I get stuck.