Transgender medical care

I am on several trans facebook groups. One is for activists, and discusses trans in the media. Another is a support group, and there are two strong themes there- how long the poster has to wait for my psychiatric referral, and how wonderful it is to have their operation at last. Often people give daily updates when they are in hospital: they are so happy! You would see your GP and say “I am trans.” You want NHS psychiatric referrals to confirm this, because that is the way to get hormones and surgery; anyone can change their name and clothes. You see a psychiatrist locally, who refers you to a specialist gender clinic. Before you see the gender clinic, you are certain of what you want. You are trans, and you need a medically supervised transition. Your friends online, and perhaps IRL too, tell you that is what they want and how wonderful it is finally to have it.

You have the idea transition is the answer to your problems, and then you join trans groups which confirm that. All you hear is confirmation, and the idea that true trans folk need Gender Confirmation Surgery is still strong even if we also hear that not all trans folk have it.

Problems with dilation come up now and again, but not enough to convince pre-op people that there are serious difficulties.

You see a psychiatrist and say you know you are trans, and have known this for years, or for all your life. Ideally that psychiatrist would explore with you- who are you, really? Why do you want this? What is it in you that you call “trans” or “female” or “feminine”? But you see them for an hour once every six months, and that is impossible in the time available. It needs a depth and direction of psychotherapy they are not equipped to offer, even if you were in a place to participate in it.

There are also psychiatrists who will see patients privately. Mine used hormones as a diagnostic tool: he would prescribe them to every patient who consulted him. He said fantasists would balk at taking them, and never come again. I feel desperate people would know that this was what they were supposed to do, and take the hormones.

I, being desperate, knew this was what I was supposed to want and took the hormones. If you transition, they help you pass.

I transitioned in April 2002 at work. I thought, even though I don’t know if in five years I will be trying to live as a man, I need to do this now. I did not want The Operation immediately. I found I wanted it more and more as time went on. I had it in February 2004. In Autumn 2003 I was depressed, and my GP gave me more and more Citalopram. In February I ceased being depressed, and remained not depressed though the GP steadily reduced the anti-depressant. I thought that was proof that the operation was right for me.

And now I say I was poisoned and mutilated, the operation is a sham, a con, we want it because of social pressure and minimal medical intervention confirms we can have it because we really want it. There is no place for a psychiatrist to probe beneath the desire for the operation, even if they wanted to. We resent the delay, and resent the “gatekeepers” who might stop us having the operation we want. I did.

This is the way to happiness and acceptance! I knew I was not a man, I repeatedly curled in a ball on the floor weeping “I am not a man, I am not a man, I am not a man, I am not….” At the Sibyls we talked of it. We knew transition was terribly difficult, and we might not make a go of it, but there was no question that it was the difficulty stopping me, not any doubt that “I am trans therefore transition including surgery is right for me”.

How could I refuse the way to happiness and acceptance? I knew I wanted it, at a time when I was unclear about wanting anything else.

The social pressure is still there. There are a variety of messages- here I read Gender non-conforming kids – such as boys who like dolls or girls who hate dresses – aren’t trans. Trans people feel a disconnect between the person they’re seen as and expected to be and the person they actually are. What neat boxes! Why should anyone imagine they really knew which box fitted them?

I was poisoned and mutilated. Transgender medical care did not protect me from that. It could not.

Self-discovery while presenting male would have been difficult. Transition without hormones would too. I would not have passed as well. The operation removed my depression, and meant I could swim and wear trousers comfortably. It was good for me, and so this second-best, good enough is so enduring. We know what we want, and are desperate to get it.

9 thoughts on “Transgender medical care

  1. Being a 66-year-old trans woman, my natural hormone levels are not too dissimilar to those of a post menopausal woman – or so my doctor told me a couple of years ago. He also told me that my life would be at risk if I were to receive HRT. I already had surmised that, as all of the blood work was done as the result of having had two separate incidents of Deep Vein Thrombosis – one of the cautionary side effects of HRT. I really don’t feel the need to have the HRT experience that would be more like that of a pubescent woman, anyway, so I’m pretty much OK with where my hormone levels are at. I regret not having had the chance to try HRT, but not so much that I’d have allowed it to kill me. I suppose you could say I am living proof that HRT is not necessary to be a happy trans woman (emphasis on living).

    It’s been my observation that HRT can either fuel a transition or fool the trans woman. I think that it would be more of a fuel for me, just because I’ve had to do without it. If the doctor told me I could go on a low-dose regimen, I would do so more out of curiosity than anything else. It certainly would not fool me into a transition at this point, as I have already transitioned far enough in my own mind. I have seen tragic results for trans women who had begun HRT before they’d gotten their head straight on transition. It may have fooled them for a period of time, but I think it also inhibited their ability to progress fully in transition. Too often, I believe, the medical profession – especially psychiatrists – prescribe drugs as an easy fix. There is nothing easy about a gender transition, however.


      • Being fooled by the effects of hormones could actually lead to a false transition – or, at least one that is different from the one I have been experiencing. I know two people who have undergone hormone therapy, ultimately because they wanted to look more convincing as a woman when they cross dressed. Now, they live most of their lives as men with bound breasts. I am also aware of some drag performers who took estrogen to up their act, but that is different from my cross dressing friends who thought that the HRT would turn them into the women they thought they wanted to be. It seemed to do so for them, at first, and each would go on endlessly about how it just felt so great. Neither was willing to give up their male lives, and the privilege that went with it, however. HRT was only a fuel for their fantasies; a fool’s errand, indeed. They do enjoy flaunting their real boobies when cross dressing, though.

        I can look back at my own puberty to see how the powerful effects of testosterone fooled me. I know now that my gender identity was strongly on the feminine side of the scale before my male puberty began. By the age of 17, I gave up fighting the T, though, and went on to live a typical male existence for many years. I had been fooled into believing that it was the right thing to do. My feminine identity would reveal itself only in momentary flashes, which I would quickly push back down to a deep and dark place. Many years later, I came to the realization that the testosterone may have changed my body, but it did not change my gender identity.


        • What you say may not be victim blaming, but comes too close for my liking. When transition goes wrong, people are too prone to say, ah, it must have been a mistake to begin with. It’s the transitioner’s fault. And as for you not fighting the T, we make stories about ourselves and our experiences. That is an interesting understanding. T suppressed your feminine identity, and so you did not transition then but you did later. Do you imagine it is somehow better to transition earlier? Does that make anyone more “authentic”? Either none of us are authentic, or all of us are. Dividing us into perverts and real trans folk puts all the blame on the victims.


          • As for my story, that was nearly fifty years ago. The social climate was so different then, but I do think that I would have benefited from testosterone blockers earlier on. At least, that would be a way to be more sure about myself. But, no, it was not testosterone that suppressed my feminine identity. I made that conscious decision myself based on the knowledge I had at the time – mostly that I was so aware of what the testosterone was doing to me, and I had no way to defeat it. I did not dislike some of the effects that testosterone provided, and they were strong enough that I felt it was better to give in to it than to end up a teenage suicide victim.

            Authenticity, I think, can only be measured by the individual and at any given moment. I am hopeful that I am going in the right direction, but there are so many forks. I am as authentically myself today as I was yesterday, or even fifty years ago – but I am also different today than at any time in my past. We are all victims of circumstance, but that does not necessarily mean there need be blame. My mother, eleven years ago on her death bed, uttered her last words: “It’s nobody’s fault.” She may have meant it in the more general sense, but a large part of it was about my gender identity, of which she had been aware since I was very young. Yet, we never discussed it. That little tidbit, from a woman who was so very judgmental, was quite profound. I remember it every time I start to be judgmental, myself, and I certainly don’t subscribe to victim blaming. For those who may have perversions, I don’t know that all of them identify themselves by them, and I wouldn’t presume to either. We are, each of us, the only ones who can determine our own identities. We are who we are every instant of every day we’re alive. That’s all. Passing judgment on others only distracts one from the opportunities to relish in her own existence.


  2. i’ve heard of many trans people saying that they told their psychiatrists what they ‘thought they wanted to hear’ instead of how they really felt in order to be allowed to be given hormones ect. seems like a cold system


    • Welcome, Maddie. Thank you for commenting. We had a name for it, years ago: we called it The Script. Tell The Script and you would get what you wanted. Rose Tremain’s novel Sacred Country had a trans man caught lying by his psychiatrist, who refused to treat him further. I don’t know if that ever happened, or happens now.

      The medical services are not there to bring you to some ideal of health and sanity, but to bodge, and patch you up, so you can function a bit longer. In my case, this has had long term costs. Over about ten years, transition was good for me, and possibly had other circumstances been different I would not be regretting it now.

      Liked by 1 person

  3. I’m a 44 year old transgender lady that’s still pre-everything but I really don’t care about HRT and what others may say about me all I really want is SRS sense I first heard about it as a child I thought there’s a way to fix me, this being long before I know anything about gender, no one and nothing has influenced me to want this gust my own hate of my body and knowing inside I’m not right, I have the mind and body of a woman with male sex organze, I gust want to be fixed so I feel right.


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