Gender Clinics

All posts tagged Gender Clinics

Week 82 – Day 4 : What’s expected of me?

Published September 11, 2015 by Katier Scott

I’ve seen several posts of this ilk from people who are about to go through treatment for Gender Identity Disorder GID. They are naturally nervous about the whole process and unsure what to expect. Also, while things have improved, myth and rumour still exist. On top of there there’s the confusion of terms and what they mean, why do I use GID and not ‘trans’ related terms?

Gender Identity Disorder

So I’ll start at the ‘top’, what is Gender Identity Disorder and it’s closely related cousin, Gender Dysphoria (GD)?

GID is simply a medical condition where the brain’s gender doesn’t match that of the body. Generally this is simply the brain is gendered male, and the body female, or the other way round. But some people feel more androgynous about their gender and thus may consider themselves ‘no gender’ or maybe they switch genders depending on the situation. All this people can be considered to have GID, as their ‘Mental’ Gender Identity is in Disorder with their physical one. Current medical research points to GID occurring in the womb, during any babies development they all start as a female, regardless of the DNA, the body initial develops in a female shape. At some point in the development, hormones and other chemicals trigger the body and brain to ‘gender’. It is two separate sets of chemical signals that cause this and thus if one signal fails for some reason, then you get GID.

GID has different feelings for different people and this is one reason why gender is considered to be fluid, these days, and not simply male/female. People with severe GID may also develop GD, which is a mental condition where they are massively uncomfortable with their bodies and thus GD can trigger other conditions such as anxiety and depression. Hence while GID is absolutely NOT a mental condition, the fact it’s generally treated by Mental Health is a good thing because while the condition itself isn’t mental, it can definitely cause people to have mental health issues.

GID is treated by changing the persons physical body to match that of the gender of their brain, using hormones and surgery. For MtF it’s oestrogen and testosterone blockers, for FtM the reverse. Hormones have the effect of causing fat to be redistributed to gender appropriate parts, e.g. onto the hips on a female, body hair to become gender appropriate, I believe it changes your body odour, can help reverse Male Pattern Baldness (or cause for FtM) and causes breast growth for MtF and Beards for FtM. Surgery is considered optional but if done consists of the following :-

For Male to Female patients :

  • Vagioplasty, or the non vagina variant – i.e. the groin area is given surgery to make it physically look female, and a working vagina may be created – this is optional depending on the wishes of the patient.
  • Breast enhancement – I believe this is treated exactly as for any other female.
  • Feminine Facial reconstruction – Feminising of the face.
  • Laser/electrolysis hair removal – while not technically ‘surgery’ it is a medical procedure needed to remove beards.

For Female to Male patients

  • Penal construction – this is improving, but something that I believe is less common than Vagioplasty’s.
  • Mastectomy – this is the ‘big operation’ for men, as it makes their chest area appear for more masculine and removes the need for binders.
  • There may be other FtM medical procedures I’m not aware of, but these are the main two.


So that’s the medical side covered, I don’t use the terms ‘Transgender’ or ‘Transexual’ because I feel they are heavily mis-used, a bit antiquated, and harder to understand. It’s easy to explain it as a medical condition, but Transgender and Transexual can easily appear to be a fetish or similar, and that results in misunderstanding and confusion. Transgender is meant to be an overall term for all people who have some form of preference that sits outside of the ‘gender norm’, so that includes cross-dressers, transvestites, drag queens, anyone who while they consider themselves their birth gender, enjoy elements of the other gender – plus those who have GID.. confusing much? Transsexual is underused and is the term that SHOULD be used when referring to anyone with GID, but because I don’t see it used, but instead the confusing transgender term is used, I think both terms need to be assigned to history. A new term can be used for those who are ‘gender variant’ and simply use GID for those with GID. Simplez!!

Gender Clinics

OK so what are Gender Clinics looking for?

Well being a condition that, while not a ‘mental illness’ is still a ‘mental’ condition, it’s not something you can simply take a blood test and diagnose, so Gender Clinics expect to see you taking on ‘norms’ for your gender. It can feel like a box-ticking exercise, but truth be known all they are expecting you to do is live life the same as anyone else of your gender.

So to make this easy to understand I’m going to create a fictional character, I’ll use a MtF lady called Mary. Any likenesses to anyone are 100% co-incidental and everything is based on my own knowledge gained, based on my own experiences and things I’ve read or been told.

Mary is somewhat of a recluse, she’s nervous about going at ‘as Mary’ in public, and when she does tends to have just had a shave roughly brush her slightly receding hair, and put on gender neutral clothes with no effort to try to ‘feminise’ her appearance through things like fake boobs. She is also unemployed and if she does go out as Mary to social settings it is with Transgender groups or to LGBT venues.

The Gender Clinic aren’t happy they are seeing Mary actually taking on a female gender role in a form that makes them happy she actually has GID. So they request she tries to get a job, or voluntary work, and works on her appearance through the use of fake breasts, more feminine clothing – they also suggest she sees someone for make-up tips – NOTE: Makeup doesn’t have to be much, I often go to appointments just with foundation on, but you need something to hide beard shadow. Mary hasn’t changed her name or documents either, so they also request she does so through a deed poll and presents them at the next appointment.

They talk and find out that Mary used to enjoy walking, but hasn’t done this for a while so they suggest she finds a walking group and joins them.

All the gender clinic are asking is for her to start actually living and socialising as a woman, contrast that to my first appointment. I arrived, dressed in jeans and a female cut top, wearing simple make-up and a wig (as I have male pattern baldness). I was socialising at the local open Mic and had both a job, and was doing voluntary work. At my second appointment, 6 months later, they put me on Hormones, and this blog was born.

I wasn’t doing anything ‘clever’ or special, I was simply getting on with life and doing things I enjoyed with people who fast became friends. That’s all a Gender Clinic wants to see, you living your life in a role typical for your gender. Gender Clinic’s have never asked me to do anything, because they’ve always been happy that I was doing that. I also transitioned before I got to the gender clinic. As soon as I moved out from my ex-wife, I immediately switched genders, changed my name as quickly as possible and all associated documents. My new bank account was in female gender and I presented as female immediately, and non-stop since. This meant when I got to the Gender Clinic in July 2013, I had already being living as myself for three years, so they really didn’t have any issues.

Contrast that to Mary, or even someone who turns up (for example) presenting Male, then Changes to Female when at the Gender Clinic, and you can see the contrast. Now don’t get me wrong, everyone’s situation is different, we have different levels of support (I’ve been super lucky in that my family has always been supportive and my best friend at Uni has stuck with me throughout) – friends may or may not stick with you, but ultimately everyone has control of what they do.

It is incredibly tough, my transition since moving out has been a long journey, but at least I’ve had support. But if your married, having kids, unsupportive family – it’s incredibly tough, and takes a strong person to make the switch.. but ultimately at some point you have to say ‘enough’s enough’ this is what I am, and I need to live that way. If you can do that before arriving at a Gender Clinic it’ll make things a lot smoother, but certainly isn’t essential.


Week 42 – Day 3 : The Real Life Test

Published December 10, 2014 by Katier Scott

This weeks blog post is brought to you courtesy of this article in the Metro from last Saturday which was apparently written by a transman who clearly doesn’t understand the Real Life Test, or as it’s more correctly called Real Life Experience, and it’s purpose. This isn’t the first time I’ve witnessed a transperson clearly misunderstanding and indeed I mentioned the same subject previously in week 39.

This article sparked a lively and interesting debate on one of the groups I am part of and included a group who, despite forming approximately 50% of all Gender Dysphoric patients, I see contributing to groups quite rarely – Transmen. I know a few transmen but know little about the challenges they face compared to transwomen.

The lack of knowledge has never been for want of not knowing, indeed I mentioned something similar in this blog a few months ago, however this thread, coupled with the article, was the first time I’d seen ‘inside’ the world of a transman. The article, while showing a distinct lack of understanding about RLE, did highlight one issue that I found interesting, that of ‘time of the month’. Obviously Mens toilets don’t have sanitary facilities so, unless they are fortunately enough to be on contreceptives that stop time of the month from happening, the use of public toilet facilities must be awkward.

As such some transmen feel hormones are essential before they live full time, however during the discussion it was clear that actually the issues for both genders are pretty similar. We both find that hormones ease the transition and it was clear that the people in the discussion all were comfortable with their gender way before they finally reached a trans clinic.

Which is why RLE is a non-issue, it really isn’t a hoop or a checkbox excersize. Why not? Because if you are truly gender dysphoric that chances are you’ll start living as the correct gender before even meeting a GIC, and even if you wait till the GIC tell you too – you’ll still be waiting 3-6 months minimum for hormones, plus at least 2-3 months before anything really starts to be noticeable.

This is because all treatment that requires assessment, rather than diagnosis, needs a minimum of two people to assess and be happy to refer. This is standard practice and not unique to gender dysphoric treatment, any work such as Breast Enhancement or other cosmetic surgery also falls into the same policies.

As the main thing GIC’s want to see is simply that your willing to get on with your life in the correct gender, RLE shouldn’t be seen as a ‘block’ or a ‘test’, indeed even something you should be ‘asked’ or ‘told’ to do. Why? Because it should be more comfortable for you and should be you just living your life.

I don’t know whether I’ve said before, but in my case I did the last year at Uni as a women (while still living at home and having to take the male role there), then moved out and instantly lived full time as a woman. It felt the natural thing to do and I’ve never looked back, so when I finally got onto the medical pathway it was easy for them to put me onto Hormones very quickly.

If someone, however, comes to a GIC still living as their birth gender then there probably is some help needed and thus moving into living in the correct gender might be tougher for them – which ironically means they need it more. If they arrive and haven’t done anything themselves, then the chances are it means they know something is wrong, but need help sorting themselves out before transitioning – which means in their case they will ultimately be asked to spend time in role and the 12 months requirement makes sense to ensure that both the patient and the clinic are confident that they are gender dysphoric.

There are, additionally, plenty of cases of patients forcing themselves onto hormones, and even through the op ( usually privately) then committing suicide or changing mind afterwards.

As such a staged approach, no matter how frustrating it may seem for those of us who are extremely confident and comfortable with our gender, is the only logical way to work through a transition. Is 12 months too long for the RLE part of assessment? I really don’t know, I was up to 3 years before I got to the GIC, and with waiting times of about 12 months plus two appointments being the minimum for most GIC’s before you get hormones, it’s probably a moot timescale if you do it yourself.

So my advice is simple, if your confident you are gender dysphoric, especially if you have been referred to a gender clinic, then start living as yourself as quickly as possible. I appreciate there can be a caviet to that, I delayed as long as I could as I had family and kids to consider – BUT I knew what I was and made the switch as quickly as possible when I could.

Don’t get me wrong, transitioning is a HUGE step, even if your comfortable with your gender dysphoric ‘status’ but your going to have to make that jump at some point, so get the ball rolling as quickly as you can. It’ll make the whole thing smoother in the long run.

Of course if your transitioning while working, it’s probably a good idea to talk to people before transitioning, at least to HR – and take some information with you. But don’t let any job stop you, especially in this day and age transitioning is something people are more aware of. As I’ve mentioned before I’ve worked with a HUGE range of people including lots of vulnerable people, with no problems.