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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.

Transgender/Transexual

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.

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Week 62 – Day 7 : Life’s not slowing up!!

Published May 3, 2015 by Katier Scott

Wow  I think this is the latest post but the last week has been pretty busy. That busy I completely forgot to get my latest blood test done, so NEED to get that sorted next week before I run out of hormones. That said my GP would do a repeat as I’ve been on this dose of 6mg for a while but still a chance it’ll go to 8 at some point.

Blood test should also include some immunity tests for my nursing which saves the NHS doing them a second blood test, bundle the two into one.

My new job still isn’t sorted, but it’s making progress. The company I’ll be working for started a new ‘recruitment’ office which included I think a lot of new staff so it’s been tricky at times as I get the impression there has been some communication issues between departments within that office. For example one person told me via email they couldn’t contact the manager of the regional office I’ll be working with, I got a bit frustrated so contact the girl who’s my ‘point of contact’ at the recruitment centre and she sorted everything she could.. in about an hour!!

But the company seem to be a company who do actually care for their employee’s (important in the job I’ll be doing) and the DBS problems aren’t their fault so I’m just about keeping my patience.

This week has also been filled with Roller Derby which will be mainly covered in my other blog but that was really enjoyable but I’ll pay for it tomorrow!!

My next Voice Therapy appointment is next week which will be the third appointment and first proper appointment aimed at voice rather than posture. I’ve found the posture stuff very frustrating because I feel she’s telling me I ‘NEED’ to do ‘xyz’ to be a woman.. given I rarely get seen as anything other than a woman (until I speak) I never feel like the way I walk and carry myself is an issue. Some bits are general ‘good’ practice so don’t mind those but I did feel she pushed that side a bit too heavily. Didn’t adapt to a girl who actually doesn’t have issues in public, just wants to improve her voice mainly related to telephone and similar, although in public will be much appreciated.

Ironically these last two weeks my voice has been BAD.. I strained it badly cheering on Wolverhampton Honour Rollers in their epic win then followed it up with a cold which left my voice in a bad way. It’s starting to feel much better today though :).

Week 50 – Day 5 : Bumps in the Road (Part 1)

Published February 6, 2015 by Katier Scott

I’ve decided to split this weeks post into three parts as I feel it’s going to be easy to read and give me feedback on. On the subject of feedback I really would appreciate thoughts and feedback on, especially, the first two posts. If you wouldn’t mind sharing them around too via whatever medium you found me by that would be really appreciated. I don’t normally ask, people will come here via whatever means because they find the blog interesting, however I have a few things to talk about that I’d really appreciate some feedback and thoughts on.

Porterbrook Gender Clinic in Sheffield have up to now been very good to me, with very prompt appointments and while their procedures are a little antiquated up to now I haven’t complained because compared to other clinics their appointment times are superb. Generally 4-6 weeks, no more than 8 between appointments compared to 4-6 months or more for Charing Cross for instance.

As such their insistence on seeing me four times before putting me on T-blockers etc. I tolerated as it was still only around 6 months of appointments which I could cope with. I then received an appointment to see a consultant I hadn’t seen before which as they know I’m talking about surgery was fine by me. It would be one of the two I needed, Dr Shetty would provide the other – jobs a goodun…

Unfortunately Dr Shetty then phoned me to tell me the appointment was ‘in error’ and that he would have to see me then they would refer me to Leeds for a s.. hang on Leeds? What?

It turns out that, I’m guessing on the back of the old PCT agreements not only do their initial assessments not follow NHS guidelines which stipulate 2 assessments before hormones or other treatment, not the 4 they do, but they also currently send you off to another GIC, which is even further from home to the tune of at least another hours travelling and £10-15 in petrol, but they have.. wait for it.. WAITING TIMES!!

Given the aforementioned guidelines only mentioned ‘a consultant not directly involved in your primary care’ and that CHX, Nottingham and I’d guess at least Sunderland all do their second consultation internally, then there would seem to be no reason for them not to use the consultant I’ve yet to meet as the second consultation.

On top of that I was also told that they won’t refer until I’ve been on their books 12 months. Given most patients arrive ‘fresh’ on their system that would be entirely reasonable, if a little rigid. However in my case I’ve been in the NHS GIC pathway for 20 months now, full time for 4.5 years and the guidelines state ’12 months RLE for surgery’ – they don’t even mention hormones which is slightly off, but that’s irrelevant.

I have no problem with things like 12 months RLE, hormones for 12 months etc. – they are entirely reasonable timescales to ensure that you are comfortable with the changes etc. – however delays for the sake of the delays ‘because that’s how we always do it’ are definitely in my opinion unacceptable, and making twice as hard for me to plan for my future because rather than squeezing surgery in before training to be a nurse, assuming I get an offer of course, I’m faced with a very uncertain time scale.

I’m waiting for a phone call from my GP to discuss a way forward as while I don’t want to unduly rock the boat, I do want to fight delays for the sake of delay – time delays.

However I’d also like your guys thoughts, hence the initial paragraph, what do you think?

Week 49 – Day 4 : More pills to take!!

Published January 30, 2015 by Katier Scott

I can’t believe there are only three weeks to a year since I started this project and I’ve managed to do at least one post and photograph every day. Last week I posted a concept for the cover and chose a title for the book and with that in mind I’ve decided to post a few more concepts and ideas over the next few weeks. This week I think I’ll post up the first draft of an introduction for the book, then I’ll do concepts for the main pages. I hope you’ll find these entries as interesting as everything else I post and any and all feedback will be appreciated.

This week we finally got a Oestrogen reading my GP was happy with and, in a show of how much my confidence has improved, I didn’t see my normal GP, but the other main GP at the practice. Turned out he’d also worked with a Gender Dysphoric patient and was able to quickly get up to speed with my blood results.

Oestrogen was low which I expected but it was a reading that we feel is accurate so my dosage has been increased to 6mg, or 3 tablets a day. My Testosterone has also dropped noticeably and is now 0.15 which is below the female normal range so that’s on target and no changes are needed there.

So that’s good, this week has been a bit up and downy as my first gig got double booked so I was cancelled and am currently first gigless. The open Mic on Sunday was a bit spotty although still a positive experience and my friend who is doing my guitar playing for me and I are going to continue to practice every Tuesday which will allow me to improve (alongside me practising on my own of course) and at the next open Mic at the end of February we are planning on debuting ‘Born a Woman’ which is the song which inspired the title of the book, was the first song I wrote, and is essentially my life story in a song!!

I’m going to see if I can record that performance and if it comes off and sounds ok will post it in this blog. My new job hasn’t been confirmed yet which is a little frustrating, I hate waiting for things, it makes me nervous! Similarly today is effectively 2 weeks since my interview for the nursing place and I haven’t heard back yet, so my nerves are definitely a little shakey at the moment.

As you can see however, despite little bumps in the road, including Coventry University rejecting my application without ever contacting me in any form – which was very bad customer service – I’m still looking to the positive side of things and I think that the core point of this blog, life must go on and even when things are going well, nothing is going to be entirely smooth.

That’s it for now, this short post is still 500 words!! Hope you enjoy the book snippets as they appear.

Week 33 Day 2 – Do I have any blood left!!!

Published October 7, 2014 by Katier Scott

The last couple of weeks have had my arms starting to look like I’m a drug taker!!! Well ok I am.. but only Hormones 🙂

After a scare a year ago my Doctor has been monitoring my blood for purposes other than the Hormones which meant that in the last week I’ve had two blood tests and have another coming up. The one coming up is the one pertinent to this post and if anyone can answer the question it’ll be interesting to know.

When I did my latest Hormones check bloodtest I deliberately had the test about 24 hours after my last taking of tablets. It came out at 80, while the previous reading, on the same 4mg/day, was just over 500 but I’d taken the tablets that morning.

The Doctor actually didn’t mind my bit of deliberate shenanigans as it got her thinking about when the best time to do the tests is. After all we want the hormones to have an effect all the time and dropping to that level is less than ideal. So yep, expecting a test again soon a specific number of hours after I take the tablets to try to judge the level more accurately.

What I would like to know, however, is do any of you have your blood tests a specified time after you take your hormones?

Week 16 Day 2 – New GIC!!

Published June 10, 2014 by Katier Scott

Had my first appointment yesterday at my new GIC as I have moved from Charing Cross to Porterbrook in Sheffield. First impressions were interesting because on the face of it Charing Cross is a much nicer clinic as the surroundings are, believe it or not, actually nicer at CHX. However it’s not about the surrounding, it’s about the personnel, and so far I’ve overall been pleased with Sheffield.

The biggest difference between the two is the support staff I believe, they seem a lot more interactive and helpful than Charing Cross and, of course, they have a reputation of 3 months between appointments, CHX has typically at least double that.

So how did the appointment go?

I think the outcome was good, however it was all a bit rushed. I had problems getting to Sheffield due to torrential rain on the run from Derby up to the city and had sat nav issues both of which conspired to make me 20 minutes late. I then had to get changed out of very wet biker gear so we didn’t start until nearly 30 minutes late. 

The consultant was nice, although communication was a little tricky due to him not being a native English speaker, and he insisted on typing his notes 2 finger style – both of which made the consultation more than a little fragmented.

However the outcome I believe is that he’s putting me in for Voice therapy, happy for me to continue on hormones, and happy for me to look at T-blockers. I’m not clear if he was happy to recommend me for surgery which is a shame but it seemed a positive meeting to all good.

Unlike CHX, Sheffield sort the appointments once the patient has left so I don’t know what my next appointment will be or when. It also looks like normally Sheffield would sort hormone prescriptions themselves, whereas CHX brief the GP and then the GP actually monitors. He wanted to put a appointment in to ensure I got a fresh prescription, however my GP has a plan which I believe she is happy to stick to and therefore the plan is to get blood tests done at GP, send the results to Sheffield, and get them to brief my GP on the T-blockers while continuing the Estrogen regime unaltered.

So that’s it for this week, I’ve now got myself a little challenge, I’m going to start a new gaming channel on youtube so it’ll be interesting to see how that goes.