#chx

It was Ely's birthday on the 31st!

Te amo y sé que no soy lo que buscas pero quiero ser tu motivo.

Te amo y este sentimiento no podre borrarlo de mi mente

Perderte era uno de mis mayores miedos hasta a sucedió

Te perdí de una forma inconsciente

Creaste en tu cabeza algo que no iba a suceder y ahora debo aferrarme a la idea que no volveré a oírte, ni sentirte y ni reirme

No sé como enmendar mi error, no sé como explicarte lo mucho que te amo y lo importante que eres para mí

Solo sé que necesito un refugio, donde pueda dejar todo aquello que pesa durante el día.

No sé cómo puedo recuperar aquello que perdí que le daba tanta alegría a mi vida.

Aún no me aferro a la idea que no te volveré tener porque tomaremos rumbos distintos.

Siento como todo lo que brilaba comienza a oscurecer.

No sé cómo detener el tiempo, enrredarme en tus brazos y besar tus labios, aunque sea por última vez.

[ Skip forward to the next appointment, with the endocrinologist, in August 2018 ]

On Tuesday I had my first appointment at my gender identity clinic for about a year and a half. My clinic is Charing Cross (CHX), and the doctor I saw was Dr Stuart Lorimer.

A weird administrative tanglement meant it took a formal complaint to get another appointment, and I’ve been waiting a very long time to see someone. Normally I would have been discharged by now, but because I was a nonbinary guinea pig for my top surgery (November 2014, 2.5 years ago) I was required by the lead clinician (Dr James Barrett) to keep attending the clinic for 3 years following top surgery so that they could see whether the treatment has been helping me. If my treatment was successful, they would treat more nonbinary patients.

For a while now I’ve been feeling a lot better dysphoria-wise. On a personal level my family are starting to use my new (5-year-old!) name more often, everyone knows me as Cassian and uses they/them pronouns fairly well, etc. On a societal level things are shifting in a positive direction, with talk of legal recognition on the horizon, out nonbinary characters in TV shows, more celebrities breaking the gender rules in both binary “directions”, and more celebrities coming out as nonbinary. In terms of my own body, my chest is gradually becoming more awesome (I am on the waiting list for a second revision surgery) and having a hysterectomy was a Very Good Life Choice.

But ever since I found out voice dysphoria was a thing, I’ve known it’s something I experience. On bad mental health days especially I feel all the time like my voice is wrong, not authentically me. Most days it is noticeable when I sing or hum to myself. A while back I had one appointment with the speech and language therapist at CHX and it was helpful for showing me how it might feel if my voice was deeper, but attending more appointments and then doing voice exercises all day every day for the rest of my life was just not possible.

As much as I hate being gendered female by my voice, I would also hate if people gendered me male by my voice too. At the start of my transition back in 2011 or so, around 6 years ago, my GP in Swansea referred me to an endocrinologist. He was not specialist in trans things, and I didn’t know enough either. I asked if there was a hormone I could take that was neither masculinising nor feminising but would prevent osteoporosis, and he told me no. I decided that testosterone was not for me, because as much as I hated being read as female, I knew that being read as male was not for me either. Why take testosterone for life when my ovaries were producing perfectly good hormones for free?

Now I know more. I’ve picked up along the way that it’s possible to take a very low dose of testosterone, which causes changes much more gradually, and you can stop taking it without problems when you feel it’s a good idea.

I told all of this to Dr Lorimer, and he was satisfied that I’d thought it through. We talked about what I’d dislike about testosterone (changes to any hair anywhere), and what I’d not mind or like (genital changes, body fat distribution, muscular changes). He told me that the changes I want or don’t mind tend to happen sooner (voice, genitals), and changes that I don’t want tend to happen later (hair). And taking a lower dose means all the same stuff happens but much slower, meaning you can fine-tune your transition and stop when you need to, before anything happens that you don’t like.

So Dr Lorimer has approved me for low-dose testosterone! He will check with Dr Seal, the CHX endocrinologist, and I might need to go back to see Dr Seal if he has any questions. I may also need to get some blood tests, which can happen at my local GP surgery. Once we’ve made sure it’s safe for me to take testosterone and there’s a prescription that fits my needs they’ll recommend a prescription to my GP and I can get the meds locally. :)

I don’t feel super excited yet, because I feel like there’s a few more hurdles to jump, but I do feel like this is pretty positive! A lot of GICs make you attend two appointments to get hormones, and at CHX that means 8 months of waiting. But I guess because the clinic know me and I’ve been living in role for 5 years and I’ve been thinking about hormones for a long time and I’ve tried speech therapy, they felt pretty happy that I knew what was best for me.

The longer I’ve been attending CHX, the happier I’ve been. I’ve seen Dr Lorimer more times than any other doctor, which helps - he has a reputation for being the most nonbinary-friendly! And I think the clinic is overall becoming more accepting and understanding about nonbinary people generally. The NHS are currently consulting on a care pathway (ending September 2017, 2 months from now) that explicitly talks about nonbinary transitions and states that nonbinary people struggle to access equal care to binary trans people, which is a huge deal, so things are definitely moving forward. At the same time I’m very aware that a lot of nonbinary people, especially those assigned male at birth, have had a very difficult time in the UK and at CHX. I’ve been lucky because I unintentionally tick all their boxes for “probably successful transition” and I made a good test subject. I’m hoping that things keep moving in a good, inclusive, supportive direction for nonbinary people so that eventually other people can be treated even better than me.

~

THE TIMELINE

A continuation of this previous post.

Worked out I was nonbinary and trans in November 2010.

Came out first to Tumblr in December 2010.

Went to my GP in April 2011, and was referred to the community mental health team (CMHT) and an endocrinologist. The CMHT no longer need to refer you - the GP can refer you directly to your GIC.

First appointment with CMHT re: nonbinary transness in May 2011. Second in August 2011, with someone higher up.

Referred to Charing Cross Gender Identity Clinic by CMHT in Sept/Oct 2011.

Went to see the local endocrinologist Dec 2011, and discussed hormones, and came to the conclusion that there was no hormone that met my needs yet.

My first appointment was 2nd April 2012, about 6 months after I was referred by the Community Mental Health Team.

I’ve been pretty consistently asking for chest reconstruction surgery and no hormones.

At my fourth GIC appointment in October 2013, the CHX clinician says they’ll have a surgery decision about me made in a few days.

In January 2014, after 3 months of my doctors discussing it, I got a letter saying I was being recommended for chest reconstruction under certain conditions.

In April 2014 I had a half-hour appointment at CHX for discussing those conditions, which was very informative on the NHS and how they feel about nonbinary people.

I was referred to my surgeon (Victoria Rose) at the beginning of May.

At the end of May 2014 I had a letter from my surgeon asking me to call and make an appointment for an initial consultation.

Two months later, in July 2014, I went to that consultation. I had a pre-op the same day, and was then put on the waiting list. I was on the waiting list for 4 months.

In November 2014 I was contacted and given a date for surgery - with less than two weeks’ notice.

My surgery date was 18th November 2014 - three years and two months after first being referred to my GIC. Everything was fine and good. Here’s my preparation and some before and after pics.

Here’s the 8-week top surgery follow-up in January 2015.

I was referred to Charing Cross GIC in August 2015. I’ve had my initial assessment there, and my nine month follow up assessment is booked for this June, which is theoretically when I’d be starting hormones if I was following their timescale.

Last September I decided this was way too long (I was gonna have a breakdown and buy testosterone online), and that I could afford to pay the £220 required by gendercare for an initial appointment with them, which I knew was likely to result in a prescription for bridging hormones, which would start me nicely on testosterone to be followed up under the NHS.

This winter I was, as I had hoped, recommended testosterone by gendercare pending my baseline hormones being checked by their endocrinologist. This is the same endocrinologist who works at Charing Cross GIC. Unfortunately my DHT levels were abnormally high, so I have to get my hydroxyprogesterone checked, etc, before I can start. It also means that very likely I will need to see this endocrinologist before I can start testosterone.

His next available private appointment is in June. His next available NHS appointment is in fucking October. I can’t really afford to pay to see him, but fuck it, I’m going to have to because I really can’t wait till October.