Earlier this month, the day finally came that I’d been anticipating for just over two years since taking that momentous, tentative step of asking my GP for a GIS referral. After many months of waiting, anticipating and worrying I finally had a date for my first real GIS appointment. I say real to distinguish it from the screening appointment last August, which isn’t to say that particular session wasn’t in any way authentic. It’s just that this time I knew I was at the start of something a bit more meaningful – or at least hoped so.
The appointment letter – copied to my GP – included a note that the GIS needed up-to-date results for a number of blood tests. I could have predicted that the tests that were done at the point of referral all that time ago would be wasted but hey, that seems to be the way things are. My ever-efficient GP surgery beat me to it, and actually phoned me before I contacted them to make an appointment, so at least full marks to them for that. I duly went to see the vampire phlebotomist a few days later and several phials of the red stuff were sent off for analysis. On closer inspection of the letter I noticed that the tests were a bit different to the ones I’d had done previously, and for the first time included hormone levels.
The fact that I’d already attended the screening session last August made a big difference, both emotionally and practically, and had mostly reassured me on that most thorny of topics – was I trans enough, although the passing of time had caused some of those doubts to come out to play again. This time the mantra was less about being trans enough, more about how deserving my case appeared in comparison to others who may be coping less well than me, and who were in rather more dire straits mentally or physically, especially with scarce NHS resources being spread as thinly as they are. My mind was cast back to some of the people I’d met at my early forays to the local support group, and the mental health or addiction issues they were facing concurrently with their transition. In comparison I seemed to be coping too well.
Came the day, and in practical terms at least I knew this time where to go and where I could park my car, so no dry runs were needed. Even so, I still set off leaving far more contingency time than I needed (those who know me will understand this isn’t uncommon…), and having sailed through the unusually light traffic, arrived with almost an hour to spare before my appointment. I gave a thought for those I know who in some cases have to travel hundreds of miles by rail or coach to their GIS appointment, and take two or three days out of their lives for each consultation. I silently thanked the powers-that-be that fate decreed I only had to travel from one side of the city to the other.
It may sound a bit complacent, but as I sat in my car whiling away the time listening to Ken Bruce, I realised I’d given no thought to the issues that a few short years ago tended to consume me about how I looked, did I ‘pass’ and what others’ reaction might be. That’s not to say that when I was getting ready earlier I’d not thought about making sure I looked presentable, but what had changed was that it was no longer from the perspective of fear or uncertainty. I was simply a woman wanting to look her best for a particular situation, rather than trying to fool anyone into thinking I was anything other than who I am, if that makes sense. That change in thinking has been quite subtle in recent months, and recognising it made me feel positive that something significant had shifted in my head.
I presented myself at the reception in good time and sat to wait for my appointment. I have to say that based on my experiences thus far, this particular GIS seems to manage time very well indeed.
Unfortunately, I still read the occasional horror story of patients waiting several hours to be seen, but right on time a friendly face popped round waiting room door and invited me into the consulting room. Anna introduced herself as my Lead Clinician and said she’d be with me throughout the process, explaining that even though I’d be seeing different specialists she’d be my point of contact for any queries, and generally be ‘in my corner’.
During the following hour-and-a-half it felt like we were covering much of the same ground as in my screening appointment last August. Anna recognised this and apologised for the repetition, but explained that for many patients eight months can be a long time, and much can change – for good or ill. This made complete sense, plus she said it gave her the opportunity to get to know me first-hand as a person, rather than just a ‘case’ through someone else’s notes. One or two personal areas were explored in a bit more depth than before, but overall the process was about making sure I was still OK in the ‘three pillars’ of physical, psychological and social health and well-being. Perhaps disappointingly, no reference was made to the results of the blood tests, which in fact hadn’t been looked at and Anna said weren’t actually necessary until the next stage. I think we can all guess what’s going to happen before my next appointment.
As we went along, the transition process was explained to me. Not surprisingly, this is going to involve yet more waiting as Anna told me that following her own assessment based on our meeting, she would arrange for me to see one the team’s consultants – there are two now, both of whom I was assured are very nice and friendly. Apparently, even in a nurse-led pathway only a doctor can still make a formal diagnosis. That’s the next key stage on the critical path, and it seems nothing can happen until that prognostication is made, but once it has been then all manner of support kicks in. She estimated a wait of about three months to see a consultant, considering that we’re approaching the holiday season which can reduce availability. Seems fair enough to me – everyone’s entitled to a break. After that I’ll be referred to an endocrinologist – a further estimated three month wait – and assuming all’s well health-wise I’ll be prescribed my first HRT at that point.
I got the impression that there’s been some relaxation of qualifying periods to allow the GIS to treat more patients. I may yet be proved wrong, but I sense that the GIS is adopting a more pragmatic approach, at least to the early stages of treatment. Whilst there was no question about needing to demonstrate at least 12 months Real Life Experience (RLE) before surgery can even be considered, it would seem that if someone has come this far in the process, that they’re sound in mind, body and spirit and various practicalities have been addressed – e.g. legal name change and being ‘out’ in sufficient areas of one’s life – then it will be taken as an adequate indication that the patient is serious and HRT – whilst not quite a ‘done deal’ – will follow with less fuss than perhaps it may have done previously.
As the session drew to a close, Anna apologised if it had felt a bit gruelling. I said that was the last word I’d have used to describe it, and that everything had felt really positive. On reflection, I suppose we had explored a few more sensitive topics than before (which I’m not going to go into detail about here – sorry!) but it had all felt necessary, relevant and appropriate.
So I’m well and truly ‘in the system’, but do I feel any different about it? I certainly feel calmer and more positive about the future than I have done for ages and, importantly, my faith in the process has thus far been vindicated. As I wrote in my last blog, everyone’s experience with their respective GIS seems to be different, but so far I’ve found the people I’ve encountered knowledgeable and friendly, and there’s no question that they only want to help. I’ve never once felt ‘challenged’ or that I’ve had to go out of my way to justify myself. On the downside, the months of waiting continue to be the worst thing, but Anna pointed me in the direction of some coping strategies in case I find myself in too much of a dip again, which we both agreed was likely. She also said not to forget about rewarding myself on the good days, or for progress made. As if I needed an excuse to go shopping after my appointment.
Whilst I’m still officially without a formal diagnosis yet, Anna was able to dispel most remaining concerns about being ‘trans enough’ or sufficiently deserving of support. Seemingly these are very common doubts, and Anna reassured me that I seemed a relatively straightforward case (her words) and that she couldn’t foresee any problems.
I titled this post Groundhog Day originally because so much of this appointment mirrored that of my initial screening appointment last year, but then I began thinking about that particular film – in particular how it ends [spoiler alert for anyone who’s not seen it – look away now].
Groundhog Day isn’t just about repetition; it’s about the central character trying to become a different person (albeit not exactly through choice, at least not at first). Trial and error, measuring the changes they make against the world until finally getting it right and walking out of Groundhog Day into a bright new future. The analogy might not be perfect, but I can see similarities with my own situation. So much has happened in the past three years or so since those early days of nervously venturing out into the world, expecting ridicule but receiving nothing but support and encouragement. There have been plenty of giant leaps and momentous steps, but most of the changes have been small and subtle – changes in thinking as much as in practical terms. Transition no longer seems a remote possibility or something that only happens to other people. It’s becoming a reality, and while my overall philosophy remains ‘one step at a time’, I’m beginning to see some light at the end of the tunnel at last.
Significantly, the GIS appointment has given me the clarity and confidence to confront the remaining social issues I need to tackle. One in particular was broached within a week of my appointment, but for now I’ll keep you in suspense and simply say that I’ll explain more in a future post.
Thanks for reading.