Regular readers will know that my most persistent fear since being referred to the Gender Identity Service (GIS) has been that at some point a clinician was going to shake their head sadly and inform me that, in their considered opinion, I wasn’t far enough along the scale of gender dysphoria to justify their support. I would be gravely informed that there are many far more deserving people than me on the ever-lengthening GIS waiting list, and that I should step aside and make way for the genuine cases needing real help with transitioning.
Despite the many reassurances by friends and loved ones that I truly had nothing to worry about, I’ve never been able to completely shake these doubts from my mind. On the whole I’m doing OK, if not thriving, yet I know of those whose gender dysphoria has manifested itself in substance abuse and self-harm, and who’ve desperately needed transition simply to keep their sanity. Surely people like that would be prioritised over the likes of me, having experienced a relatively calm and straightforward journey? Illogical though it may sound, whilst the vaguest possibility remained that I could be deemed unworthy of support I’ve held back on a number of important or irreversible comings out and conversations lest I later needed to row back and explain, “Sorry, I got it all wrong. I’m not really transgender at all. Forget I ever said anything.”
A couple of weeks ago I had my latest GIS appointment. I’d been informed it was yet another assessment session, however this time it would be with a consultant who, I was told, would be in a position to pronounce a diagnosis – or not as the case may be – and from there help me figure out what (if anything) needed to happen next. I’d no idea whether this would be an instantaneous decision or whether the various medics I’ve seen would need to go away, compare notes and discuss my case before reaching their considered opinion. Having some experience of how the process works for other conditions I know how complex and drawn out it can get, and how easily it is for the world and her dog to get involved, to the extent where diagnosis is almost made by commitee. The NHS with which I’m familiar is not exactly renowned for its decisiveness.
Anyhow, so it was that a couple of weeks ago I trod the now familiar path to the GIS clinic. My appointment was first thing in the morning, so I had to factor in the rush-hour traffic and the fact that the population of Leeds increases by some 50,000 once the colleges and universities are up and running after the summer break. I still made it with half-an-hour to spare; those who know me will not be surprised…
I was seen bang on the appointed time – again. It must be said that timekeeping is one of this clinic’s many virtues. Alison, the Lead Professional who I’d met the time before met me with a smile, ushered me into the consulting room and introduced me to Dr Lucy, the consultant, who greeted me warmly and explained what was going to happen. She apologised that there would probably be some repetition of questions asked previously, but she wanted to go over some of the things that I’d discussed with Alison, explore some areas in a bit more detail and then talk about what would happen next. Without going into the detail, it was again a case of making sure the three pillars of physical, psychological and social health were still sound and in place. I guess for some people, a lot can happen in four months.
I don’t know how typical I am, but I’ve never felt fazed or uncomfortable during any of these sessions even though I’ve been asked to explore some pretty intimate areas of my life. It feels natural, even cathartic, talking about things that have been bottled up all these years and never shared with a soul – more like a pleasant conversation that any kind of analysis or assessment, even when discussing very personal matters that once upon a time I’d have been embarrassed about. Eventually we got around to talking about hopes and fears, at which point I mentioned amongst other things my fear of not being ‘trans enough’, and that a diagnosis was important to me as I needed that external validation. I was told that apparently this isn’t uncommon, which I found reassuring.
After almost an hour, Dr Lucy put down her pen and looked up from her notes and said she was happy to confirm a diagnosis of gender dysphoria, and to talk about the next steps. I don’t mind admitting, I had a ‘moment’ as the words sank in. The relief was overwhelming. So that’s it, it’s official – an independent assessment. Nobody can dispute the fact or take it away now. I’m officially transgender – and I’m proud.
Dr Lucy said she was happy to make a referral straight to the endocrinology clinic, though with the inevitable caveat that I can expect another wait of three to four months. It is what it is so there’s no point fretting about it – plus there are plenty of things I can be cracking on with in the meantime. I’ve realised that hormone therapy doesn’t have to be the be all and end all of transition, any more than surgery – about which, incidentally, my mind remains perhaps a little bit more open now than it was. I don’t have to think about it just yet.
I understand of course this is only the end of the beginning – I have another appointment with Alison in a month’s time to sit down and discuss a care pathway, and to figure out what support is available and relevant to me. It was so nice to be able to arrange a time there and then, rather than having to undergo more suspense of hanging about waiting for a letter to arrive!
Interestingly, the GIS seem quite laid back about the next steps. Based on what I’ve read over the past few years in forums and the blogosphere I was expecting lots of ‘terms and conditions’ e.g. nothing can happen until I’ve changed my name, or provided evidence that I’ve transitioned at work, lived ‘in role’ for a year, etc. etc. The reality couldn’t be any different – what I’ve been told is that as far as the GIS is concerned there’s no particular order in which things need to happen. They’re happy with the progress I’ve made thus far, I can contiue at my own pace and they’ll be there to support where they can.
I have to say at this point that, based on my own experience I can’t for the life of me understand the criticism and carping I’ve encountered about GIS clinics over the past few years, for example on social media, in the blogosphere or from support groups. In fact I remember very clearly at one of the first short-lived support group meetings I went to, one of the things that put me off was that so much time was taken up by people whinging that Dr X or Dr Y wouldn’t prescribe this or that medication, or that reception staff were rude and unhelpful – in fact the constant carping and finding fault was one of the reasons I decided support groups weren’t for me. I can only speak from experience but personally, I’ve received nothing but caring, attentive support from the GIS. Appointments have run to time, I’ve been treated with nothing but the utmost respect and sensitivity and been given helpful advice while expectations have been kept realistic. The only downside has been the interminable waiting times, but the GIS is far from the only service in the NHS suffering from cuts in the face of increased demand for their services. The clinic staff can’t be blamed for that. So far, I’ve been thoroughly impressed by the professionalism and quality of service I’ve encountered.
So what does this all mean for me? The simple answer is nothing and everything. Life goes on and the diagnosis doesn’t mean I’m going to suddenly become full-time overnight. There’s still work to do and conversations to be had, but I feel there’s been a tectonic shift in how I’m thinking about transition. It’s no longer something that’s in the distant future any more, and is going to happen within months rather than years. It’s become a definite and not a maybe – a when rather than an if. It feels like at last I’ve been given permission to transition.
I can hear the cries of ‘nobody should need permission’, but bear with me and I’ll try to explain. In a world full of rules, I’ve always been the sort of person who tends to stick to them – I’m one of life’s obedient souls. If a road sign says 30mph then that’s the speed I’ll drive at – my philosophy is that rules are there for a reason, not that rules are made to be broken. I’m the sort of person who feels guilty if a policeman so much as looks at me suspiciously. One person close to me who knows my attitude to rules annoyingly well did once tell me once that it makes my entire journey towards transition seem so out of character, except I replied that in transitioning I’m at last trying to live to the rules that should have been put in place some fifty-odd years ago.
I’ve always known that I’m on the right path, and that the decision taken three-and-a-half years ago to finally acknowledge who I am was undoubtedly the right one. I’ve taken the journey since one step at a time, and will continue to do so. If you’re the same kind of person as me then you’ll understand that despite all the logic suggesting that it’s unnecessary, independent, professional validation that – d’you know what? – I’m not making this thing up in my head, that my gender dysphoria is genuine and not a figment of my imagination, is akin to the moment when, as a child, we’re given permission on Christmas morning to open our presents. We’d known since about 4am they were there and that no-one would come and take them away, but – most of us, anyway – didn’t just start tearing open the wrapping paper until we had permission. But when that permission came, we savoured the moment and it made the experience exquisite. I hope that metaphor makes sense – it’s the best I can think of.
So now I just want to crack on with my social transition as soon as feasibly possible. Medical and cosmetic interventions almost feel incidental to making that leap of faith to live full-time as the women I was born to be. A few pieces of the jigsaw remain, but most are in place now, and the final picture is clearer than it’s ever been.
Thanks for reading, more soon.