Hey folks

Been trying and failing to write this post for a few days now.

Mood, health, energy, time, chores, obligations, and responsibilities kept getting in the way.

So, we're gonna summarise everything as much as we can, and try and limit our emotional response to it.

Important context

• We have been trying to get meaningful gender-affirming healthcare through the NHS since April 2021.
• We had tried to get clear information on surgery options, particularly genital reconfiguration surgery (GRS) options, for years, but never got clear options: only vague wording.
• We were almost certain sure that no form of penile-preserving vaginoplasty would be available, so we narrowed our choices to peritoneal pull-through (PPT) vaginoplasty or a bilateral orchidectomy.
  • We didn't and don't want penile inversion vaginoplasty (PIV) or vulvoplasty (aka zero-depth vaginoplasty).
• We finally passed all hurdles through an NHS pilot scheme (East Of England Gender Service; EOEGS) in late 2024.
  • This is under the Nottingham Centre for Transgender Health (NCTH).
• Our surgery referral was only sent over to a private hospital by the NHS Gender Dysphoria National Referral Support Service (GDNRSS) in late 2025.
• We had an initial assessment meeting with that private hospital this week.

Information from meeting

• The NHS will not fund PPT vaginoplasty unless there's medically no other option (i.e., last resort).
  • Basically only if you've got "inadequate donor site skin" for other methods.
• Despite offering PPT privately, the hospital considers PIV the "gold standard", and was heavily biased against PPT, advising that PPT:
  • "is not self-lubricating";
  • has "more granulation tissue" and "more complications associated with it";
  • typically has a "worse surgical outcome";
  • "turns into skin" in the long run;
  • is more likely to "stenose" and "scar".
• No form of penile-preserving vaginoplasty is available (as we thought).
• The NHS will not fund the hospital to do standalone bilateral orchidectomies for any referrals sent to them via GDNRSS.
• The specific (and only surgeon) we had asked to be referred to did not pick up our referral.
  • Worse, a surgeon we absolutely do not want to go anywhere near picked up our case!!!
• We discovered that NHS gender clinics sit in on their Multi-Disciplinary Team (MDT) meetings to discuss patients' surgery requests!!!

Outcomes for us

After considering options and offers, we resignedly sent an email to the private hospital, requesting that they refer us back to GDNRSS, advising that:

• The GRS options were explained to us, but we did not find them suitable.
• The surgeon who offered to take our case was not suitable.
• We wish to discuss next steps with the GDNRSS.

Sadly, an individual funding request (IFR) will almost-certainly be required, but the gender clinic has previously refused to submit any IFRs for us, so we're kinda very likely to be screwed here.

For anybody not aware, IFRs get submitted to your local integrated care board / system (ICB/ICS) in England. They'll only agree to fund something if:

• There are "exceptional clinical circumstances" to support the request.
• The IFR clearly demonstrates "clinical exceptionality".

Although technically an NHS GP can submit an IFR, unless it comes from the NHS gender clinic with a detailed explanation of why they can't / won't fund the surgery and why it's necessary, the local ICB funding team will just reject the request.

This is sadly a major issue for us, as we've raised multiple complaints against our gender clinic for their awful service (or rather lack thereof) and they've stopped responding to any of our emails now, so there's little to no chance of them even agreeing to submit an IFR for us, let alone doing one with a decent chance of being accepted.

We don't know what the current price is for a bilateral orchidectomy, but it was up to about £6k a year or two back, so it's probably more like £7K to £8K now 

In other words, nothing we could afford privately any time in the next decade.

So... yeah 🙃

If you wondered why our posts have been a little bit more bleak the last few days, this is among the reasons 😅 (There are sadly many other things contributing too.)

It's our own fault really for even trying to go through the NHS route and thinking that maybe, just maybe, they wouldn't continually fuck us around.

Anyway, that's the toot.

#NHS #NHSEngland #EOEGS #NCTH #trans #transgender #NonBinary #enby #FemEnby #GRS #GAS #vaginoplasty #orchidectomy #GenderAffirmingHealthcare #IFR #ICB #ICS #FuckTheNHS #FuckTheUK #DesegregateTransHealthcare #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+

~7.5 mg (0.15 mL; 50 mg/mL concentration) estradiol enanthate injected intramuscularly into the vastus lateralis in our right thigh using our Union Medico auto-injector 💉🩹

On a side note, every DIY HRT injection we do always feels like holding up 2 middle fingers to the gatekeeping dickwombles within the NHS who continue to segregate gender-affirming healthcare for trans people and only offer outdated, shitty healthcare 🖕 🖕  

#TransDIY #OpenHRT #DIYHRT #HRT #TransFemHRT #transition #trans #transgender #NonBinary #TransFem #enby #femby #injection #injections #TransHealthcare #queer #LGBT+ #LGBTQ+ #LGBTQIA+ #LGBTQIA2S+ #AutoInjector #UnionMedico #FuckTheNHS #FuckGatekeepers #TransLiberation #DesegregateTransHealthcare

~7.5 mg (0.15 mL; 50 mg/mL concentration) estradiol enanthate injected intramuscularly into the vastus lateralis in our left thigh using our Union Medico auto-injector 💉🩹

Left it a bit late again, but it was due to very valid reasons. (These reasons were binge-watching season 2 of WondLa and then needing to put out the bins.)

On a side note:

• Fuck the UK Supreme Court.
• Fuck Keir Starmer.
• Fuck Wes Streeting.
• Fuck any Labour MP who has towed the party line and tolerated their bigotry.
• Fuck washed-up bigots living in castles.
• Fuck FWS and all other transphobic organisations.
• Fuck fake allies.

#TransDIY #OpenHRT #DIYHRT #HRT #TransFemHRT #transition #trans #transgender #NonBinary #TransFem #enby #femby #injection #injections #TransHealthcare #queer #LGBT+ #LGBTQ+ #LGBTQIA+ #LGBTQIA2S+ #AutoInjector #UnionMedico #FuckTheNHS #FuckGatekeepers #TransLiberation #DesegregateTransHealthcare

~7.5 mg (0.15 mL; 50 mg/mL concentration) estradiol enanthate injected intramuscularly into the vastus lateralis in our right thigh using our Union Medico auto-injector 💉🩹

Left it a little bit late (~3 hours after our calendar reminder), but it was completely by the books and entirely painless. Not almost painless: entirely. Literally no pain, not even on pulling out the needle slowly afterwards.

In case you're wondering why we continue with a weekly DIY injection after having put ourselves through YEARS of humiliating gatekeeping through the NHS, there are a number of reasons:

• The NHS doesn't offer injections or implants: only patches, gel, or pills.
• Patches are uncomfortable and, even with a covering film, tend to come off whenever we get sweaty.
• A weekly injection gives us a higher, stable (o)estradiol level than patches, improving our mood and negating the need for any anti-androgen or blocker (GnRH agonist or antagonist).

Every time we inject, it's honestly kind of like a massive middle finger to the fuckwits within the NHS who want to gatekeep and control our gender-affirming hormone therapy 🖕

This is one element of our healthcare that they cannot control ✊  

#TransDIY #OpenHRT #DIYHRT #HRT #TransFemHRT #transition #trans #transgender #NonBinary #TransFem #enby #femby #injection #injections #TransHealthcare #queer #LGBT+ #LGBTQ+ #LGBTQIA+ #LGBTQIA2S+ #AutoInjector #UnionMedico #FuckTheNHS #FuckGatekeepers #TransLiberation #DesegregateTransHealthcare

We don't know who need to hear this, but if you've been waiting for a sign, a push, or someone's permission to transition, this is it 

You only get one shot at life, so choose to be who you really are, rather than whom others say you are or whom they want you to be  

Transitioning isn't easy, and it won't make your struggles just go away, but it will make those struggles worth striving to overcome  

If you can't do so now due to any reasons, please note that it's never too late to start transitioning, and that there's a whole community of people who will support you 🩷

No matter what you think or anyone else tells you, you are trans enough, and you deserve happiness as yourself ✊  

We believe in you, even if you don't yet believe in yourself  

#trans #transgender #TransRightsAreHumanRights #ProtectTransKids #TransKidsDeserveToThrive #TransKidsDeserveToGrowUp #TransYouthAreLoved #TransKidsDeserveBetter #DesegregateTransHealthcare #queer #TransLiberation #LGBTQ+ #LGBTQIA+ #YesYouAreTransEnough

Hey folks

We all know how shite the Cass Review was/is, and how it's been universally discredited and rejected  

Alas, NHS England has now set its gaze firmly on a review of adult trans+ healthcare services 😞

We would love to believe that this is being done in good faith, but NHS England has never been on the side of trans people.¹ As such, we believe that the best we can realistically hope for at this stage is damage limitation  

To this end, we wish to highlight that the page linked above links to an Adult Gender Services Review survey, which is open to:

• current, and recent, patients who have been seen at one, or more, of the [Gender Dysphoria Clinics] in the past five years
• family and friends of patients who have used services in the past five years
• current staff members, and those who have worked at one, or more, of the centres in the past five years

Even if it doesn't change a thing, we should make our voices heard loudly and defiantly ✊        

So let's go all out and tell them what we actually want:

We don't want better gender clinics: we want them to be dismantled entirely, in favour of desegregated healthcare.

We don't want to be forced to get a formal medical diagnosis of being trans to access basic GAHT / HRT, to have the right to consent to gender-affirming surgeries, or to change our legal gender.

We want world leading gender-affirming healthcare, beyond the nonsense, unscientific biases that still exist even in WPATH SOC8.

They don't want to offer us this, and will do everything in their power to ignore us, but that doesn't mean that our voices shouldn't be heard.

Maybe trans liberation won't come today, but we need to fight for it at every stage  

Boosts are very welcome and will be very much appreciated, by the by  

#trans #transgender #NonBinary #agender #bigender #DemiBoy #DemiGirl #genderfluid #genderqueer #LGBTQ+ #LGBTQIA+ #LGBTQIA2S+ #queer #TransLiberation #TransLiberationNow #TransRights #TransRightsAreHumanRights #NHS #CassReview #LevyReview #depathologisation #demedicalisation #desegregation #DesegregateTransHealthcare #InformedConsent #survey

¹ You can read all about the awful history of trans healthcare provided by NHS England in The Transgender Issue: An Argument For Justice by Shon Faye.

Hey folks 🩷

Just doing a quick update to let you all know that we're still here, and we're still recovering from (and coping with) depression, anxiety, neurodivergent burnout, and migraines.

It's not all sunshine and rainbows, but we're doing a little better and keeping ourselves occupied, whilst also allowing ourselves time to rest... though sometimes Hannah has to remind us to pause or stop when we get hyperfocussed 😅

On another note, we've got our 4th appointment with the NHS East of England Gender Service (EOEGS) tomorrow, which we're totally not entirely anxious about 😅🥺

This one is to get a 2nd surgical recommendation from another NHS medical "specialist". We need 2 before we can even join any surgical waiting list, and we already got the 1st from our 3rd appointment... back in March 2024.

Technically we should have had that all sorted back during our 2nd appointment in August 2023, when they agreed that we did indeed meet the diagnostic criteria for gender incongruence (ICD-11, HA60), but NHS gender identity clinics (GICs) are a crumbling anachronism, designed intentionally to make the process drawn-out, difficult, and full of gatekeeping 😔

Of course, they couldn't just accept the gender incongruence diagnosis we got privately in July 2021... from someone literally recognised by the UK government as a gender specialist for the purposes of applying for a gender recognition certificate, and who still works for the NHS 😑😮‍💨🤦‍♀️

Plus the EOEGS then took nearly 6 months to send the final report and letter to my NHS GP before booking this 4th appointment and getting started on other requests.

On top of that, they made several factual errors in the report too 🤦‍♀️ We sent it back to them and our GP, with highlighted corrections. Our GP was most grateful for this, as it highlighted that the responsibility of Individual Funding Requests (IFRs) lies with the gender clinic, not the patient's GP.

So, yeah. We're a bit anxious right now 😅😖

#EOEGS #EastOfEnglandGenderService #NHS #NHSEngland #TransHealthcare #trans #transgender #UK #queer #LGBTQIA+ #DesegregateTransHealthcare #TransRightsAreHumanRights #TransLiberationNow #MentalHealth #depression #anxiety #neurodivergent #NeurodivergentBurnout

We've had a few sudden bursts of progress through the EOEGS.

If you want to see our previous posts, search under the #EOEGS tag.

Today we received an appointment email for 5th November to get a second surgical recommendation, such is required before you can join any waiting lists 🩷

We're still waiting to hear back from them (from March) over getting them to fill out Individual Funding Requests (IFRs) to submit to our local Integrated Care Board (ICB) for surgeries that are not routinely available on the NHS.

e.g.,

• Facial Feminisation Surgery (FFS)
• Breast Augmentation (BA)
• Voice Feminisation Surgery (VFS)
• Bilateral orchidectomy by itself

We've chased on the IFR issue, as we first raised the question with NHS England's IFR team, who made it crystal clear that the gender clinic has to fill out any IFRs, not the patient's GP.

#NHSEngland #NHS #trans #transgender #healthcare #DesegregateTransHealthcare

If you didn't catch the original thread about finally making some actual process through the EOEGS, please go read that first.

We're tired, and still burnt out (especially from writing that deed poll post), so here's the summary:

• NHS GP practice manager and senior partner got the letter.
• Both also were grateful for our corrections to the errors the East of England Gender Service (EOEGS) made.
• They immediately put 16 Evorel 100 mcg estradiol patches (every 4 weeks) and Decapeptyl (triptorelin) 11.25 mg (every 12 weeks) on repeat prescription for us.
• All approved with my existing electrologist. We know get 16 hours for free 😊
  • To put this in context, the current price for existing clients is £75 an hour. 16 hours of electrolysis is £1,200 GBP.

Of course we are definitely going to be using the HRT meds we're being prescribed: we wouldn't dream of continuing with DIY HRT and saving them up to give away to people who can't get access to either 😌

And whenever the NHS asks for a blood test, our estradiol level will show perfectly between 400 and 600 pmol/L, so that the dosage isn't reduced.

#trans #transgender #healthcare #TransHealthcare #GenderAffirmingHealthcare #NHS #NHSEngland #IFR #ICB #EOEGS #EastOfEnglandGenderService #TransRights #TransRightsAreHumanRights #TransLiberation #TransLiberationNow #queer #LGBTQ+ #LGBTQIA+ #LGBTQIA2S+ #DesegregateTransHealthcare

Hey folks  

What with our AuDHD burnout, real-life stuff, and other recent fedi dramas, we had had neither the time nor spoons to give you all an update.

To bring you all up-to-date, this has been our experience with the NHS:

• Late May 2021 - referred to the London GIC (aka Tavistock).
• Asked to be put on TransPlus pilot scheme waiting list, in case we became eligible.
• January 2022 - discovered the East of England Gender Service (EOEGS) pilot scheme and was transferred.
• November 2022 - 1st appointment with EOEGS. No care or support offered.
• Early in 2023, TransPlus rang to offer us an appointment 🤦‍♀️ We were not allowed to accept or transfer to them, because of NHS rules 😞
• August 2023 - 2nd appointment with EOEGS. Gender incongruence diagnosis agreed, but was told we'd need a further appointment to discuss HRT and other requests.
• March 2024 - finally got all requests in (HRT, surgerical, voice training, hair removal etc.)

Now, you think it wouldn't take long to send a letter from the EOEGS to my GP, right? Right? 😅😞

That 3rd appointment was on 12th March 2024. The letter wasn't printed untiil 28th August 2024: almost 6 months later 😑

On the plus side, my GP has now been sent this, can process it, and can start officially giving us prescriptions for meds... as soon as we sign a stupid declaration to receive meds that "are not licenced for the treatment of Gender Incongruence" 🤦‍♀️

They've also put down the wrong date on which we had our 1st appointment on the letter, so gonna need to update all parties of that. How do we know?

On a good note though, approval was granted also immediately for limited hair removal and we can continue to use our existing electrologist 🥰 It's the only part of the process that has been quick and easy 😅😑

It's a bit of a postcode lottery with the NHS, but the details we got said they'd fund 8 hours of laser OR 16 hours of electrolysis OR some combination of those.

We replied quickly to ask for 16 hours of electrolysis with our existing electrologist.

And yes: it will all be on our face and neck. Totally no other areas whatsoever, as the NHS doesn't cover that (with the exception of hair removal down below for any surgeries).

And it will totally take all 16 hours to finally finish off my face and neck.

Anyway, just thought you might like to know that it's only taken me about 1,188 days to get to this point (at the time of writing this post).

That's about 39 months: roughly 3 years 3 months.

And this is considered very quick by NHS standards (at least NHS England) 🙄

We still need a further review before we can even join the vaginoplasty waiting list (for Tina Rashid), let alone to get to the consultation stage  

And we're presently still waiting on the EOEGS to accept the ruling from the official NHS Individual Funding Request (IFR) team that it is the responsibility of the gender clinic (whilst under their care) to fill these out for any requested surgeries not offered as standard by the NHS.

e.g.,

• Bilateral orchidectomy (sometimes called a bofaectomy)
• Facial Feminisation Surgery (FFS)
• Voice Feminisation Surgery (VFS) (types include glottoplasty, cricothyroid approximation, laser assisted voice adjustment)

They originally were trying to argue that our GP would need to do it, so we went above them to check, and then sent the EOEGS the email chain.

These IFRs will need to be submitted to the IFR team at our local Integrated Care Board (ICB) for review. The local ICB will almost certainly refuse them all, so that they don't set any precedent and then have to pay for other gender-affirming care recommended by international experts. Nonetheless, at least we'll know we've exhausted all avenues before likely turning to crowdfunding or other means.

We might add to and/or edit this later, but we'll stop there for now and add some hashtags.

#trans #transgender #healthcare #TransHealthcare #GenderAffirmingHealthcare #NHS #NHSEngland #IFR #ICB #EOEGS #EastOfEnglandGenderService #TransRights #TransRightsAreHumanRights #TransLiberation #TransLiberationNow #queer #LGBTQ+ #LGBTQIA+ #LGBTQIA2S+ #DesegregateTransHealthcare