“Real Life Experience” with trans healthcare in the UK

The wait time for an initial appointment with the Gender Identity Clinic in Charing Cross is about 12 months. In that appointment the doctor is supposed to verify your gender identity and pathologize your personal history, and five months later you’re given another appointment during which they might prescribe you some gender-affirming hormones. That initial appointment only comes after being referred by a psychologist/psychiatrist from your local Community Mental Health Team (CMHT), to whom you must be referred by your GP.

The CMHT in Hackney is dreadfully transphobic (but then, the whole process of referral is inherently transphobic). After being referred by my GP—who stared at my like I was an alien when I told him I’m trans—I waited for 10 weeks to see a psychologist. She didn’t know what the word “transgender” meant, and for the remainder of the evaluation insisted it was a noun. Every question was underpinned by her attempt to find out what traumatic event made me into “a transgender”.

“When did you start living as a boy?” my psychologist asked.

I reiterated—“I am a boy, so I’ve always lived as a boy. What do you mean?”

“When did you stop wearing dresses?”

“Boys can’t wear dresses?”

It was obvious that if I said I were non-binary I would be labeled “confused” and told to come back when I had “decided”.

In the end she referred me, and now I’m waiting to get an appointment at Charing Cross. They say it will be in about 12 months. They’ve been saying that for the past 12 months.

That you need to be referred at all is transphobic. You need multiple medical “experts” to externally verify your gender identity, as if you’re not credible, as if they know more about you than you do.

If you go private, you can self-refer to a gender-specializing clinic—that is, if you have wealth, you can bypass the barriers of the GP referral and the referral from a CMHT. They’ll do their own assessment and prescribe hormones as appropriate like at Charing Cross, but the wait times are only 2 weeks for the initial appointment, and 1 further week of waiting for blood work before you get a prescription. It costs about £725, plus follow-up appointments (£140 each) and prescription refills (£195 for three months’ worth). Sometimes the private clinic prescribes mandatory counseling, which costs £150 for an hour-long session.

After hormones, you must pass the “Real Life Experience” test before being considered for gender-affirming surgeries, whether you use the NHS or go private. You must prove your sincerity, your trans authenticity by overtly expressing the gender identity you claim—in a normative, conservative, girls-wear-pink/boys-don’t-cry sort of way. There is apparently no thought given to the fact that it’s fucking difficult to “live as” (i.e. express) your gender identity without medical treatment; that it’s fucking difficult to pass and insist on your “preferred” pronouns when your body doesn’t conform to normative gender expressions. Without hormones and surgery, you can only go so far in signifying your gender: you can bind your breasts, change your intonation, and hide your curves in baggy clothes but it’s an exhausting daily battle. How can you “live” (read: pass) as your “preferred” gender if no one picks up on the gender cues you’re desperately sending? How can you implicitly assert your gender identify if everyone misgenders you?

Fuck conforming to cis narratives and expectations of gender. Fuck passing.

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