#initial appointment

Initial Appointment: Done

So today I had my first appointment at Planned Parenthood in Philadelphia: the ultimate goal with them is to start taking T. Here’s how my appointment (and the process of getting it) went.

1.) I called Planned Parenthood in Philadelphia to schedule my appointment- we found a time that worked with my schedule. I made this appointment about a week and a half ago (for time reference). The person that scheduled my appointment told me that in a little while a financial advisor was going to call me. They were supposed to go through the costs of the appointment (both with and without insurance), what the appointment was going to entail, and answer any questions that I had. About 15 minutes after hanging up the phone I got a call from the financial advisor. She was fantastic: she went through all of the specifics of what my appointment was going to entail, she broke down all of the costs for the appointment (with and without insurance) and answered every single question I had.

2.) Today: I arrive at Planned Parenthood with the fantastic news that I only have to pay a $30 copay for the entire visit today (thank you Keystone Health Plan East). Their new intake form- they updated it within the last year- is relatively inclusive. It asks for your legal name, your preferred name, gender with a variety of options, preferred pronouns, etc. After filling out the intake forms, I waited for about 5 minutes before I was called back using my last name. They had me sit in a room and the financial advisor that I had spoke to on the phone talked me through how the appointment was going to go again and gave me a packet of information. The packet of information included the physical, emotional, short term and long terms effects of T on a person. Then another person came in- I believe they were a nurse- that went through a medical/personal history questionnaire with me. They asked me about my family’s history with certain health conditions, my sexual history, my current health situation (alcohol, tobacco, illegal drug use, etc.), and other things too. WARNING they will ask you about your genitals and they may use anatomical terms so please be aware of that. After the questionnaire was complete they pricked my finger for a blood sample to check my hemoglobin levels. Last but not least, the doctor came- she was a super nice lady- she asked if I had any questions or concerns about taking T, she told me what kind of a dosage that I would be on, and asked if I would like to get the shot that day. 

That was basically my whole visit in a nutshell. It was pretty nice and easy- I say that because I’ve never been too freaked out about doctor’s offices or anything like that. 

With all of this being said I would like to just say some things that I think are important about this visit with Planned Parenthood.

1. Planned Parenthood operates on an informed consent model which means that you don’t need to be seeing a gender therapist or anything in order to get a prescription for testosterone. However, they do try to educate you in the best ways that they know how on the physical and emotional effects of testosterone on the human body. 

2. Every person is different and they may react to testosterone in different ways- you have to take the good with the bad

3. I ultimately didn’t start taking testosterone during this appointment because I was by myself and I thought that it would be best for me to have another set of eyes and ears there on the day that they teach me how to self-inject. I ultimately think it was the best decision for me. 

On Thursday 11th January 2018 I had my first appointment at the Nottingham Centre for Transgender Health. This post is an account of my appointment as a memory aid for me, and I hope the information in it is also helpful to other trans people. I wanted to go into this appointment to learn more about taking testosterone and prove that I was able to make informed decisions about my transition. 

I was nearly late because I got lost and had to google maps my way there, but I made it in time. The entrance is very inconspicuous and so I had to go in and ask if it was the centre for trans health, which fortunately it was! They took a minute to find my name on their appointment list - turns out I was down under my birth name lmao. Anyway I went through to the waiting room where I waited about 10 minutes and various staff walked through. There were a middle aged woman and a girl who looked about my age waiting too.

I was seen by a clinician called Deborah McKenzie who was nice enough. I was quite nervous and probably came across more clinical than her tbh. My appointment was in a little interview room with 4 squishy chairs. The first thing she did was get me to sign another one of those booklets about conflating records since the clinic must have lost my first one. Then we discussed my immediate family and she drew a family tree, and for some reason needed to know my sibling’s birth sex even though I didn’t see how it was relevant. She asked me for a short account of my ‘trans life history’ (phrase my own): essentially how I behaved as a child, how I learnt I was trans, important trans moments, how long I’ve been out for etc. I was anticipating this since I’d been reading online and it was pretty straightforward. She wanted to know if I was out to my family, and whether they respected my gender/pronouns, and I clarified for her I wasn’t out to my entire family since I see them pretty infrequently, but that I was out to 98% of people in my day to day life.

When I was referred to Notts I was living in Cambridge and they had my GP and home address from when I was in Cambridge on my forms, which I’d explained to my new GP in Edinburgh who recommended I wait until my first appointment with the GIC to change my details since the NHS funds GICs separately in Scotland and England, and usually people living Scotland cannot be referred to Notts. I mentioned this to Deborah McKenzie and she explained that it was important for them to have up to date addresses and doctor’s contact details and that the situation could be loopholed but I’ve forgotten how precisely. So anyway she gave me this piece of paper from my file with my details on and I changed my GP’s info, and also changed my gender, name, and title since they were from 2 years ago and inaccurate.

We discussed my medical history: she asked about current and past medications, and if I’d ever taken any meds for mental health. She also asked if my gender and mental health problems were related and I made it clear that my gender identity was not affected by my mental health, but my dysphoria did negatively affect my mental health. We also spoke about binding and I mentioned how I can’t bind as much as I would like because of my asthma, and told her I probably bind for approx. 2x4hr/week.

She also said since I’m nb I should tell my GP to make a note of that so when I’m on T and getting bloods done, and the blood lab calls my GP because my levels are whacked for my legal sex, my GP can iron that out without extra stress coming my way.  

We talked about freezing my eggs, and the implications of testosterone on my fertility. Apparently egg freezing/storage is sometimes available on the NHS, but my GP would have to apply for funding for it and I should do some research into the various options. She suggested I discuss it further at my second appointment then they would write to my GP but I honestly think I will go to my GP before my next appointment, as applying for funding could take months.

I asked about the structure of future appointments and how the clinic facilitates testosterone prescription, and she said I’d have a second appointment of a similar structure to the first with a different clinician. In my second appointment I’ll be given information about the blood tests I’ll need to have before my third appointment. Then 10-12 weeks later I’ll have a third double appointment with both clinicians and also see an endocrinologist, where we’ll discuss my individual treatment plan. I can bring a family member or friend to this appointment but it’s not a requirement. I’m angling pretty hard for starting T after this third appointment, and she said that all being well the clinic would send a letter to my GP the next day advising they prescribe me testosterone. It’s a fair way off yet but I’m planning to be in contact with my GP and pharmacy in the weeks before this appointment to minimise delays on their end! I mentioned wanting to start on a low dose of T, and she said their protocol is to start everyone on a low dose, and review bloods and adjust the dose as necessary every 3 months, at least to begin with.

At the end of the appointment she asked if I had any questions, and I asked A), if I could still donate blood on T (yes), and B), if I could claim NHS compensation for my train fares (no).

I had changed my name by deed poll two days previously so I mentioned this to her and she said I should inform my GP about it, and at the end of the session I went to sit in the waiting room while she took a photocopy of it. She asked if I smoke because she must have completely forgotten to ask in the interview room (I don’t, and I know their policy is not to prescribe hrt to smokers until they’ve quit for at least three months). The girl was still there and was talking to a friend who seemed to have just come out of their appointment, and I could very faintly hear the receptionists listening to Arethra Franklin’s ‘I say a Little Prayer’. My clinician was away for about 10 minutes and gave me my next appointment, 20th March with Walter Bouman, when she came back.

I thought that was it but she asked me back to the interview room for a few minutes because she wanted to discuss my referral to the GIC in Edinburgh. I said that my GP in Edinburgh had referred me to the GIC, and that the wait was around 10-12 months so I was hoping to start T via Notts, them transfer my care to Edinburgh once they offered me an initial appointment. She told me that it could be possible to transfer my care to Edinburgh after the third appointment, with Notts recommendation that they prescribe me T immediately, which would mean I would pay less for train fares for my further checkups. I am a bit hesitant to go with this idea because it seems likely to me that Edinburgh would also want to assess me which could delay me starting T by a good few months, which she agreed was a possibility. We decided this was something for me to go away and think about and potentially discuss with Edinburgh GIC before my next appointment.

I’m getting ready for my first GIC appointment in a few days and thought I’d write down what’s happened so far:

On 13/12/17 I recieved a letter from Nottingham Centre for Transgender Health asking me to call them to arrange an appointment. I called them up a few days later and arranged my initial appointment for 11/01/18. I also asked them to change my name in their system to Beck- they asked if I had a deed poll, I said I didn’t, but they still changed the name for me.

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