Mastodawn

Hey folks

This isn't any of the posts we've been trying to write for ages, but haven't had sufficient spoons, executive function, emotional regulation, or uninterrupted time (particularly from unexpected daily life events) to write 😅🥺

No: instead, this is just something adjacent to some of these things, which has been increasingly on our mind recently... particularly as it feels like we've been seening significantly more posts by other trans+ people we follow on fedi, as well as other places, discussing topics like:

Their overall worsening feelings of gender dysphoria, or feeling like they're making no progress towards their own transition goals.
Increasingly yearning for a particular gender-affirming surgery, especially if it either is -- or feels like it is -- impossibly far away or actually impossible.

In light of our own issues with the NHS, we did get to the point where we did a post asking folks to remember to use CWs for such posts, as even with lots of filters, we couldn't keep up 🥺😔 (In a later post, we advised that we had changed our filters back from hide completely to hide with a warning, but we're still having to filter out a lot.)

Anyway, we're getting off track again. (Today has been another of those kinds of days.)

We've been thinking a lot recently about how it would almost be easier for us if we were a binary trans+ woman with stereotypical transition goals that align with the binary expectation of the NHS and other medical systems 😔

If we had had noticeable, intense genital dysphoria in the way that they expect all trans+ folks to have, then maybe we'd've been willing to compromise over surgeon and techniques in order to get some form of genital reconfiguration surgery (GRS), and we'd've been able to progress there.

However, because we don't feel that way, could not mask our real feelings, and would not be comfortable with the limited options offered, we're now stuck in a limbo where we may basically get nothing through the NHS whatsoever.

Just to clarify, we're acutely aware just how completely cursed this line of thinking is, and how much dysphoria -- especially around genitalia -- can be debilitating for many 🥺😔

It isn't a matter of anybody having it easier or worse: everybody should be able to get their healthcare needs met. However, unless you "play the game" and "play along", you won't get anything.

But yeah... this is the dumb situation we're in.

Our dysphoria doesn't match the NHS's binary model, so we're now just waiting to hear back about how we go about complaining about pretty much everything and trying to get somewhere.

We won't though, sadly. It'd take a secular miracle for somebody to actually show a single iota of care for us as an actual person / entity.

We feel bad for the complaint handler, as given the way she's replied, we think she actually still cares 🥺😔

That job will break her if she doesn't leave it.

We've already had our request for voice feminisation surgery (VFS) declined, and we haven't even tried to get them to hear us out over facial feminisation surgery (FFS), as they'd laugh us out the door.

If you want to know how cruel the NHS system is, just read part of the below in relation to the first rejected VFS individual funding request (IFR):

The following criteria were used when considering whether there were exceptional clinical circumstances relating to your patient to support the IFR: 

* Are there any clinical features of the patient’s case which make them significantly different to the general population of patients with the condition in question at the same stage of progression of the condition? 

AND 

* Would the patient be likely to gain significantly more clinical benefit from the requested intervention than might be normally expected for the general population of patients with the condition at the same stage of the progression of the condition?

Your application was triaged by the Funding Team, and it was agreed that the information provided to support this IFR does not demonstrate clinical exceptionality.

Regrettably, we cannot approve your funding request as there is no evidence to show this patient is likely to gain significantly more clinical benefit from Glottoplasty surgery than might be normally expected for the general population of patients with the condition or circumstance i.e. gender dysphoria and neurodiversity. Unfortunately, we are not able to take purely psychological issues into consideration. 

However, if there is any further information you have to demonstrate exceptionality, we would be happy to reconsider this request.

Yeah...

#GenderDysphoria #GenitalDysphoria #GenitalReconfigurationSurgery #GRS #GenderAffirmingSurgery #GenderAffirmingSurgeries #trans #transgender #enby #NonBinary #queer
#LGBTQ+ #LGBTQIA+ #NHS #EOEGS #NCTH #FuckTheNHS #VFS #FFS #IFR

SleepyCatten (@[email protected])

Content warning: Polite request for any trans+ folks on fedi who post about planning for, getting, or recovering from any gender-affirming surgeries, or thoughts about getting them thereafter, in light of the effect it can have on those who cannot get them

The Cult of Shiv

SleepyCatten Jan 31

RE: https://cultofshiv.wtf/@SleepyCatten/115981136984537860

Further to our previous, quoted post, we've already taken certain actions to reduce the intense (and worsening) negative emotions we're experiencing over seeing other posts from other trans+ folks over things like:

Their trans+ joy or euphoria.
Making amazing process with voice training.
Gender-affirming surgeries.
Being able to get decent care and support.

... and so on.

So far, we've muted several sub-Reddits we're subscribed to, so that they don't appear on our Reddit feed.

We intend to do the same shortly here by adding filters to put a CW on posts with certain keywords or hashtags that have become triggering to us

We genuinely loathe that we have to do this, but we do not know how else to continue to engage here otherwise.

We used to feel so happy for others who were able to get the gender-affirming care that they needed, even if we knew it wouldn't be available to us.

Now, it seems like all we feel is a mixture of jealousy, intense sadness, and... we guess a little resentfulness and bitterness, which in-turn makes us feel even worse 😔

We don't feel envious, as we want others to be able to get the care that they need. We're specifically jealous because the care we need has been -- and still is actively being -- denied to us.

We're beyond exhausted of having to self-advocate and beg for scraps of basic gender-affirming healthcare.

And that's before we even bring in the struggles we've had trying to get any kind of suitable other support, particularly with mental health, or just with life in general.

We're sorry, because you all deserve to celebrate your joy and to want to share it with friends and people online.

You all deserve to discuss this stuff openly without fear of triggering somebody else.

You all deserve to get all the care and support that you need, and to not have to hide it away.

We just currently cannot participate in it, because it's breaking us apart even more every time we see, read, or hear somebody getting or achieving something we also intensely desire or need, but have little-to-no realistic chance of ever achieving.

Sorry 😔

#trans+ #transgender #GenderDysphoria #healthcare #HealthcareInequality #TransGenocide #FuckTheNHS #FuckTheNHS #transition #FML #MentalHealth #LackOfTransJoy #LGBTQ+ #LGBTQIA+ #queer

Edit: Fixed a typo

SleepyCatten Jan 30

We don't have the spoons for a detailed post. We've written other posts recently giving updates on some of our struggles, but we needed to get the thoughts out of our head before sleep tonight 🥺😔

We're realistically facing a situation very soon where we'll officially be told that we're not going to get any gender-affirming surgeries from NHS England whatsoever, making the last nearly 5 years of trying to progress through this dehumanising, anxiety-inducing, decorating, belittling, gatekeeping, outdated process completely worthless

We already had to accept we could never get FFS.

We tried twice to convince them to give us VFS, but they said no, and gave us no actual further voice training help.

We knew that trying to get PPT vaginoplasty would be a longshot, but we never expected:

to have PPT basically badmouthed during a consultation;
to hear basic PIV or scrotal flap techniques described as the "gold standard" (!!!) for genital reconfiguration surgery (GRS);
to be told that the only surgeon who'd see us is one we'd never, ever trust or want anywhere near us, especially after having specifically requested another surgeon (the only one we'd trust in the UK for GRS); and
that we'd need to go back begging to our gender clinic -- which no longer responds to our emails at all -- to try to convince them to submit a funding request for a basic standalone bilateral orchidectomy and scrotectomy... which would have been required anyway as part of PIV or vulvoplasty!!!

We've reached the point where we don't think we can get any joy from seeing other trans+ folks' joy and euphoria from making progress in their own transitions, particularly surgeries, as we can't help but feel so painfully sad crushingly jealous and upset that we cannot get even the most basic care after waiting even longer 😔

And nope: we've zero chance of being able to ever even fund the cheapest of surgeries privately.

Apologies for the sad dump. We needed to write it all out to have any chance at getting to sleep soon

#EOEGS #NHS #NHSEngland #FuckTheNHS #FuckEngland #FuckTheUK #GenderAffirmingSurgery #GenderAffirmingHealthcare #gatekeeping #trans #transgender #NonBinary #TransFem #GRS #GenderDysphoria #transition #PPT #PIV #FFS #VFS #orchidectomy #FML #queer #LGBTQ+ #LGBTQIA+ #LackOfTransJoy

SleepyCatten Jan 19

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+

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SleepyCatten Nov 10

@jaelisp We're AuDHD, so trying to reconcile opposites is our daily struggle 😅

At a high-level, we see and resolve the seeming contradiction broadly as follows:

Nationalised health services, free at the point of use and paid for by taxation (national insurance contributions) are a fundamentally good idea at their core and have the capacity to be amazing.

That said, malicious forces will do everything within their power to erode any national public service, especially healthcare, for their own gain.

These malicious forces include (but are not limited to):

Private healthcare companies.
Free market capitalism ideologues / extremists.
US-style Christian extremists.
Fascists, racists, and bigots in general.
Corrupt politicians (i.e., seemingly most politicians, sadly).
Successive governments trying to make the service ever worse over multiple decades to justify slow, creeping privatisation.

It is not just being eroded from the outside either, sadly. There are ideological forces at work within the medical institutions themselves

We're talking (in no order) pervasive, insidious, institutionalised:

Transphobia.
Transmisogyny and misogyny
Ableism.
- Fatphobia and sizeism.
- Infantilisation of neurodivergent folks.
- Lack of accessibility, especially on contact options, appointments, and support needs.
- Stigmatisation of mental health struggles.
Queerphobia.
- Homophobia
- Biphobia and bi-erasure.
Racism and xenophobia.

etc.

Even the BMA reported on the systemic issues recently!

BMA - Survey finds medical profession more ableist than wider society, with hundreds of disabled and neurodivergent doctors leaving the workforce

Some issues are not the result of a lack of funding or expertise, but a fundamental refusal from the very top to change the way the system works.

On gender-affirming care, for example, The Transgender Issue: An Argument For Justice by Shon Faye breaks down how gatekeeping, long-waits, and transphobia were baked into the system from its creation.

Since its inception, access to trans healthcare has similarly been an ideological battleground. For those who need them, medical transition and contraception or abortion are – or should be – about the bodily autonomy of the individual, their right to mental well-being and the freedom to carve out their own destiny in defiance of prevailing gender roles. (These roles, should we need reminding, frame women as vessels for reproduction and trans people as threats to the strict separation of male and female sex roles on which patriarchy depends.) Access to abortion and access to trans healthcare are often attacked in similar ways: principally by overstating the incidence and likelihood of regretting either process, and an intense, disproportionate focus in the media on the stories of individuals who do regret their personal choices, as a way to undermine the principle of choice generally. Only about 5 per cent of women experience any degree of regret over their abortion. Multiple studies show the regret rate for gender reassignment surgery is even lower: about 0–2 percent. Despite this, the fear of regret has become a powerful tool used to justify the delay or withholding of treatment.

and

... it wasn’t until the 1960s that transsexualism became a formally recognized diagnosis within the British medical establishment. ... Medical support for trans people, however, was still rare. Throughout the 1960s and 1970s, individual trans patients continued to use the ambiguous and contested link between physical intersex traits and the psychological experience of gender dysphoria to get certain doctors to treat them – though, even then, few doctors would. A 1966 study in the British Medical Journal found that only ‘9% of psychiatrists, 6% of GPs, and 3% of surgeons’ would agree to actively assist transsexual patients. All of which effectively meant that trans people’s lives and destinies were dependent on the whims of a very small number of British doctors.

Shon goes into detail about the awful Dr John Randell, who worked in the gender identity clinic at Charing Cross Hospital, including one part that tells you all you really need to know about him:

Even when Randell had assisted with transition, patients often found him brusque, even cruel. ‘It hasn’t made you a woman, you know – you’ll always be a man,’ he reportedly told one trans woman who thanked him after surgery.

She sums up his pivotal involvement as follows:

It’s worth pausing to consider that the most powerful pioneer of trans healthcare in twentieth-century Britain was a cisgender male psychiatrist who believed neither in the reality of trans people’s deeply held identities nor that gender norms were socially constructed ideals that could be relaxed, challenged or abolished. He believed trans people were delusional about the reality of their situation and that at the same time they also needed to be highly competent mimics of gender stereotypes. He did not believe that they should be allowed freedom over their interpretation or expression of gender.

In short, the NHS could be great, but the current systems are fundamental rotten at their core. In order to fix the NHS, we would need to break both it and the medical institutions down, rebuild them, and then spend decades building them back up whilst engraining a culture of empathy, caring, and non-discrimination into the training of all staff (medical and non-medical) across the board.

#NHS #transphobia #transmisogyny #racism #bigotry #prejudice #GenderAffirmingHealthcare #ableism #FuckTheNHS #ShonFaye #BMA #queer #LGBTQ+ #LGBTQIA+

Survey finds medical profession more ableist than wider society, with hundreds of disabled and neurodivergent doctors leaving the workforce - BMA media centre - BMA

BMA press release.

The British Medical Association is the trade union and professional body for doctors in the UK.

SleepyCatten May 2, 2025

~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

SleepyCatten Apr 25, 2025

~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.

SleepyCatten Apr 18, 2025

~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 ✊

Oli T Jul 25, 2023

Only an NHS Mental Healthcare service would ignore an at-risk neurodivergent patient during a video call then discharge them for "social anxiety"

#FuckTheNHS #NotFitForPurpose

Oli T Jun 5, 2023

Just read an American stating "Our current anti-public health culture is incompatible with long-term survival" and holy shit, that's absolutely spot on for the UK too #FuckTheNHS