One of the most disconcerting things you can experience when visiting the doctor is seeing your GP open up Internet Explorer and start googling. As a nervous transgender teenager, I was completely terrified. GPs are meant to be a first point of contact for the general population; somebody we turn to for answers, not more questions. But for transgender people, a lack of knowledge by doctors is to be expected.
However, a few minutes and a few searches later (no doubt more training on trans issues than she had received in her entire career) my GP felt enough of an authority on the subject to recommend a swift and decisive course of action. That action? Absolutely nothing; according to a cursory browse of the internet, as well as a couple of pages from a book, she determined that the NHS could not treat me until I was eighteen years old. Many trans people have such problems getting a referral to a Gender Identity Clinic (GIC).
Although the NHS does in fact accept transgender patients of all ages, I didn’t know this – I had no idea that much of what I had been told was completely false. I returned to the GP one year later to claim my golden ticket: a referral to the Charing Cross Gender Identity Clinic. Frankly speaking, I was mentally very unwell but still optimistic for the future. However, things were not going to be that simple. The time from referral to first appointment at the Charing Cross GIC is currently estimated at twelve months – I personally had to wait closer to 18 months. To make matters worse, the length of time people spend on waiting lists is increasing. Patients at Charing Cross are being discharged at roughly half the rate they are being received. Clinics in places like Leeds have estimated waiting times of up to four years. Either way, it is a far cry indeed from the imposed legal limit of 18 weeks.
Approximately two and a half years after the first time I visited the GP, with extremely poor mental health, I’m able to attend my initial appointment at the GIC. The clinic itself, having acquired a slightly magical quality in my imagination over the years, struck me as bland and inconspicuous. Although located above a Sainsbury’s outside the official bounds of the hospital, it serves the entirety of London as well as approximately half of England. A waiting list of over a thousand people, and I had finally made it!
Having now registered at a certain nearby health centre, more roadblocks for my gender transition readily appeared. The failure of my GP to monitor the levels of sex hormones in my blood for six months, until I personally intervened, was one of them. Not only is such casual negligence a problem for transgender people, but some GPs may outright refuse to prescribe some medication required by a Gender Identity Clinic, claiming that it is too expensive. Although problems like these are no doubt intolerable for cisgender patients, it has become the norm for transgender people. In particular, there is the need to essentially infantilise your GP, as you have to assume they have zero knowledge in trans healthcare. You have to find out from other trans people on the internet (nobody else is available to help you) and tell your GP the best way to treat you, because they will not know.
I find myself looking at the fourth anniversary of that first visit to the GP in the summer later this year. With my dosage being increased and my blood levels being monitored properly, hopefully I will be on the correct dosage of hormones by the time that day comes.
For a demographic with an attempted suicide rate of almost 40%, the NHS displays little urgency when treating transgender patients. I have had immense difficulty trying to cope with the NHS system and it has become the defining struggle of the first twenty years of my life. There are people who will not get through the system alive, or commit suicide shortly into hormone therapy. A former tutee of my father was one such person. I do not know his name, as he was referred to only as “the woman who thought she was a man” in conversation, but perhaps we should take a moment to remember him when we talk about transgender healthcare.