In Pursuit of Trans Healthcare: the NHS Psych Eval

psychologist: Hello, I’m Dr ––. I’m going to ask you some questions for your initial assessment.
me: Wait, do you know why I’m here?
psychologist: You tell me.
me: I’m not seeking ongoing treatment. I’m here because I’m transgender, and I’d like a referral to the Gender Identity Clinic.
psychologist: You’re a transgender? … What does that mean?
me: It means my gender identity does not match the gender I was assigned at birth.
psychologist: … What does that mean?
me: … When I was born, the doctor assigned me “female” based on my perceived sex characteristics; I don’t identify as female, I identity as masculine/male.
psychologist: So you’re biologically female.
me: No, assigned female at birth.
psychologist: And you want a referral to the gender change clinic?
me: No, Gender Identity Clinic, GIC.
psychologist: How did you hear about the identity change clinic?
me: Gender. Identity. Clinic. I googled it.
psychologist: Have you done anything about it yet?
me: ? I’m here? I’ve asked people to use male pronouns?
psychologist: OH you use “he”?
me: Yes, please use “he/him/his” in my reference letter.
psychologist: Have you had any operations?
me: No, that’s why I’m here, I’d like to get access to trans healthcare through the GIC.
psychologist: What kind of operations do you want?
me: I want to go on hormones—testosterone—and to get top surgery.
psychologist: ?
me: To get my breasts removed.
psychologist: Do you do anything to your breasts now?
me: I bind them.
psychologist: ?
me: I bandage them down or use sports bras to flatten my chest.
psychologist: What about your privates?
me: (Seriously?) You mean getting a phalloplasty?
psychologist: *practically salivating*
me: … I haven’t decided yet.

psychologist: How long have you been a transgender?
me: … Always.
psychologist: How long have you wanted to be a boy?
me: … I am a boy. I’ve wanted to identify as male for a long as I can remember, but I didn’t have the language or understanding of trans identities to know that was an option.
psychologist: What age?
me: Three? As a toddler?
psychologist: How long have you been dressing up as a boy?
me: What does that mean—wearing trousers? Can girls not wear trousers?
psychologist: Well, you know, girls wear pink and frocks.
me: … I’ve been confidently identifying as male for about a year.
psychologist: You said you felt like a boy as a child, tell me more about that.
me: I said I wished I could identify as male since I was a toddler.
psychologist: When you were growing up did you play with boys’ toys?
me: Yes, but that’s not all that gender is…
psychologist: Were your friends mostly boys?
me: No, a mix.
psychologist: Tell me about secondary school.
me: When I went through puberty I started performing femininity really hard because I wanted to conform and to be attractive to my peers.
psychologist: So you wore dresses?
me: Your reductive idea of femininity is tiresome. Yes.
psychologist: When did you start dressing like a boy again?
me: You mean, when did I start identifying as trans? A few years ago.
psychologist: Was there a moment, or a person (or a reason)?
me: Not really, I mentioned off-handedly that I wished I was a boy to someone and they said “Oh, you mean you’re transgender?” and I’d never heard that word before; I didn’t know it was feasible, that I could meaningfully change my gender expression. So I did some research.
psychologist: Books, or google?
me: Both.

psychologist: What’s your sexual orientation?
me: You know that’s not relevant to my gender identity, right?
psychologist: … Well, ok, but please answer the question.
me: Queer/pansexual.
psychologist: What does that mean?
me: It means fuck you that my attraction to people isn’t contingent on their gender.
psychologist: ?
me: This isn’t a weird thing, you know… (how do you not know about this).
psychologist: Don’t worry, I’m not here to judge. We get all kinds of people with all kinds of problems.
me: I don’t care if you judge me, and I don’t have a problem. I meant this is not unusual and you should know what it means.
psychologist: So you’ve been with boys and girls.
me: And people who don’t identify as male or female.
psychologist: *ignoring that* When was your first sexual experience?
me: What do you mean by that?
psychologist: When did you first have proper intercourse?
me: Do you mean penetrative sex?
psychologist: *shy* Yes.
me: What if my first sexual experience was with someone with a vagina, would that not count?
psychologist: Uhhhhhhhhhhhhh ok so it was with a girl?
me: No, I’m just asking. Why does it matter what gender the other person was?
psychologist: These are standard questions.
me: (Well they suck)
psychologist: Do you use protection?
me: I have an IUD. I use condoms when I’m with new partners.
psychologist: As a transgender, how do you find the IUD?
me: Convenient.

psychologist: Tell me about your childhood.
me: It was fine.
psychologist: Do you get along with your father?
me: No, we’re not in touch.
psychologist: So he and your mother separated? *gross implied moral superiority of heteronormativity*
me: Yes, when I was in university.
psychologist: Did they fight a lot? Did you see them fight?
me: No, they didn’t fight.
psychologist: Why don’t you talk to him?
me: We just don’t get on.
psychologist: Was he abusive?
me: No, just conservative and boring.
psychologist: Are you close with your mother?
me: Yes, and she’s supportive.
psychologist: Really?
me: *annoyed* Yes, really.
psychologist: Does anyone in your family have mental health problems?
me: My mom has panic disorder; she takes meds for it and she’s fine, she’s happy.
psychologist: Any your brother?
me: No, he doesn’t.
psychologist: Were you bullied at school?
me: No.
psychologist: Did you want to be a boy because your brother got more attention from your mother than you did?
me: What? No, and he didn’t.
psychologist: Were you sexually abused?
me: No.
psychologist: Are you depressed?
me: No I’m not depressed; I’m happy.
psychologist: How are your energy levels?
me: Great, I’m healthy and I get plenty of sleep.
psychologist: Do you experience stress or anxiety?
me: Only the normal levels.
psychologist: Have you ever been suicidal or self-harmed?
me: No.
psychologist: (Why are you transgender?)
me: (Fuck off.)

 I need diagnosis for Gender Identity Disorder in my referral to the Gender Identity Clinic to ensure they’ll see me, but I am not disordered and there is nothing wrong with me. (Stop pathologizing me.)
psychologist: Gender Identity Disorder?
me: It’s the DSM-V diagnosis for trans people. *fed up of doing your job for you*
psychologist: Oh, you know the DSM-V? What are the check-box criteria, and how many boxes do you tick?
me: (Right because psychology is just tick-box diagnoses, I hate you) The criteria is a continued experience of gender dysphoria.
psychologist: But all women experiences dysphoria when they PMS—
me: No, when I say “dysphoria” I’m using the trans-context where it means a discomfort/disconnect between gender identity and the body (and I’m not a woman).
psychologist: Do you hate your body?
me: No—I want to change it but I don’t hate it—that would be sad, wouldn’t it?
psychologist: You’re familiar with the DSM, have you been to a psychologist before?
me: Yes.
psychologist: What for? (What’s wrong with you?)
me: I was a moody teenager, sending kids to shrinks was the thing to do.
psychologist: Moody? (What’s wrong with you?)
me: Yes, moody. Not depressed, not anxious, just moody. (I’m not even going to mention my actual mental health history or history of abuse because it will reinforce your bullshit narratives about “why” I’m trans.)

psychologist: How has being a transgender affected your life?
me: Well, every single interaction I have is gendered.
psychologist: What does that mean?
me: It means that people treat me differently depending on how they perceive my gender.
psychologist: What does—
me: It means that if they think I’m a girl they treat me differently than if they think I’m a boy.
psychologist: What? Really? Can you give me an example?
me: When I was presenting as feminine, I got a lot of street harassment; now that I present as masculine, I don’t.
psychologist: Street harassment? *suddenly interested*
me: People commenting on my appearance, cat-calling me, that kind of thing. It’s a common lived experience for people who present as feminine (how is this news to you).
psychologist: So girls don’t pay attention in the same way? lol
me: >: | You obviously have no understanding of gender, or gendered violence?
psychologist: Is that why you’re—
me: No. Stop asking why; there is no why.
psychologist: This is how psychology works; if you had a heart problem I would get you a scan, but we can’t physically scan your mental health so we diagnose based on personal history.
me: I know enough about psychology to know that if you’re searching for single pivotal traumatic moment when I was trans-ified, you’re doing it wrong.
psychologist: You don’t need to answer anything you find too personal. Let me know if there’s anything you don’t want included in your reference letter.
me: I don’t want anything which isn’t relevant to my gender included, because it’s… not relevant. All that should matter to them is that I identify as transgender. That’s all you need to say.
psychologist: But they’ll want to know.
me: Then they can ask me.
psychologist: Ok, stop patronizing me and shut up leave it with me. Is there anything else?
me: Can you change my gender marker on your records? The letters I get from this clinic say “Ms”.
psychologist: Uhhh I don’t know if we can do that.
me: You can. I’ve had it changed on the records at my GP. I’m not even asking to change my name, just the gendered prefix.
psychologist: Uh well um I’ll ask the secretary (no). Is that all?
me: Your lack of understanding of trans and LGBTQIA issues at large is staggering and quite upsetting. If I was less confident in my identity, your ignorance and problematic language would reinforce negative narratives about gender and trans identities that could have really fucked me up. You are the first point of contact for people who need help, and given that LGTBQIA people experience disproportionate mental health problems due to our heteronormative and stigmatizing society, I’m frankly offended that you did not handle this better. That’s all.

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