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Hey folks  

Per the details of this earlier post, we had our 4th appointment with the NHS East of England Gender Service (EOEGS) today.

The worst thing about that appointment was that it was at 13:30-14:30, which put us into a kind of neurodivergent purgatory / paralysis, where we felt like we really couldn't get on with the day until the appointment, as it was all we could think about pretty much.

We did manage to distract ourselves for a while by passing feedback to Union Medico over the syringe holders they provide for their 90° Super Grip auto-injector. We're planning to do a full review of that for everyone this week.

Anyway, the appointment went well. The doctor (cis guy, he/him) pretty much made it clear that he just needed to gather more info for the referral, and that he didn't expect there to be any issues. He asked whether it would be okay for a trainee colleague to sit in on the call, which we were fine with, especially as we're pretty sure she was trans herself. At the very least, she gave off good vibes.

Despite being anxious AF the whole time, and having to play the good-little-trans-patient to pass through the gatekeeping, it was just a serious of questions about medical history, what we were after, the risks, the reasons for wanting this, whether we had stored gametes etc.

Despite the many risks (e.g., fistula; granulation tissue; prolapse; etc), long recovery time, and the need for very regular dilation for ages, we agree that the benefits are worth it.

The doctor seemed suitably impressed by our knowledge and sources (e.g., Gender Construction Kit; TransActual), as well as the limited options on the figurative #NHS menu for trans gender-affirming surgeries.

If you're trans fem, your options via the NHS are:

• Penile inversion vaginoplasty (PIV).
  • Creates a neovagina using material from the penis turned inside out ("inverted").
• Penoscrotal flap vaginoplasty.
  • Creates the vagina using material from both the penis and scrotum.
  • Typically done if you've not got much material to work with 😅
• Cosmetic vaginoplasty.
  • Creates a vulva and labia (labiaplasty), and a clitoris (clitoroplasty) from the penis (and scrotum if needed), but without a neovagina.
  • Aka vulvoplasty or zero-depth.

Please note the lack of:

• Peritoneal pull-through (PPT) vaginoplasty.
  • A newer technique that involves several incisions into the abdomen and using internal peritoneal tissue to create the neovagina.
• Penile-preserving vaginoplasty.
  • Creates a neovagina using peritoneal tissue, without removing the penis.
  • Aka penile preservation vaginoplasty, phallus-preserving vulvovaginoplasty, etc.
• Standalone bilateral orchidectomy.
  • Removes the testes and scrotum.
  • Sometimes known as a bofa-ectomy.

The NHS, as standard, also does not offer:

• Facial feminisation surgery (FFS) of any kind.
• Voice feminisation surgery (VFS).
  • We're seeking an endoscopic modified Wendler glottoplasty by Chadwan Al Yaghchi at the London Voice & Swallowing Clinic in London.
• Breast augmentation (BA).
• Full facial hair removal.
  • It varies by nation, but England offers 8 laser sessions, 16 hours of electrolysis, or a combination thereof.
  • For context, we've had over 40 hours of electrolysis (thermolysis) thus far on our face and neck with a highly-experienced (and fast) electrologist, and there are still a few stragglers.

There is a mere sliver of a fraction of a chance that we might get the NHS to fund some of our additional needs, which they don't currently provide: Individual Funding Requests (IFRs).

We're not going to sugarcoat it: the IFR route is highly likely to fail for us  Your "clinical circumstances" must be "exceptional" and the benefit clear in order to "receive benefit from a treatment or service that isn’t routinely offered by the NHS".

Even getting the EOEGS to accept that it was their responsibility to fill in any IFRs required us to contact NHS England's dedicated team for IFRs. They were not particularly happy about this.

Despite making them aware of their IFR responsibilities in March 2024, they have seemingly still not put any procedure in place for IFRs.

The doctor made notes about this during our appointment, along with our bespoke requests, and advised that he would follow this up with the first doctor involved, as well as the person in charge. (Can't remember the precise term. Service lead? Clinical lead?)

Anyway, once we've got them to fill out the bleeping IFRs, those will then be submitted to our local Integrated Care Board (ICB).

They used to be called Clinical Commissioning Groups (CCGs), but suddenly changed the name and structure back in July 2022.

To make the structure even less clear, each ICB sits under a broader Integrated Care System (ICS).

We'll continue to share info on how it all goes, but realistically we expect all our requests to be denied, as they likely won't want to set a precedent or cough up the funding.

However, at least we'll then know that we've tried every official route we could before setting up any kind of crowdfunding campaign(s).

#NHS #NHSEngland #trans #transgender #TransFem #healthcare #TransHealthcare #EOEGS #UnionMedico #gatekeeping #vaginoplasty #PIV #PPT #orchidectomy #BofaEctomy #FFS #VFS #FacialFeminisationSurgery #VoiceFeminisationSurgery #glottoplasty #HairRemoval #ICB #ICS #IFR #IndividualFundingRequest #IntegratedCareSystem #IntegratedCareBoard #queer #LGBTQ+ #LGBTQIA+ #LaserHairRemoval #LaserHairReduction #electrolysis #thermolysis #neurodivergent #neurodivergence

PSA about hair removal

This post is for anyone who's seeking hair removal, but especially for the many other trans / non-binary / agender girls / women / fems / folks I see being given misinformation by laser or electrolysis technicians, especially in the US and UK 🥺

Please note that we've not gone into all hair removal forms, such as waxing, epilation, sugaring etc., as there is less misinformation given about these.

Laser hair removal

• NOT suitable at all for tattoos!
  • There is a high risk of burning, scarring, and damaging the tattoo.
  • Not to be confused with tattoo removal lasers, which work differently to laser hair removal.
• Permanent hair reduction.
• Always shave the area closely beforehand. Laser is less effective if you do not shave, and can actually cause skin burns if the hair is too long.
• Ideally look for a clinic that uses something like a Candela GentleMax Pro or newer. Such machines are less painful & more effective than ones like any of the Alma Soprano devices.
• 6-8 sessions will typically be the sweet spot before moving on to electrolysis.
• Laser is sadly not universally effective with all combinations of skin and hair tones / colours. However, machines like the GentleMax Pro use a combination of a 755 nm Alexandrite laser for skin types I to III (lighter) and a 1064 nm Nd:YAG laser for skin types IV to VI (darker). You can find more info by searching for the Fitzpatrick scale.
• If the technician or clinic tell you not to use numbing cream, that's a massive red flag against their knowledge. A technician does not need pain feedback from you to know they're using safe levels!

Electrolysis

• Suitable for tattoos.
• Permanent hair removal.
• You must let the hair grow at least a few mm before a session.
• There are 3 different electrolysis methods. Flash thermolysis electrolysis uses short, high intensity bursts that are less painful. Galvanic is slower and more painful, but typically the most effective. Blend combines both methods. Each method has pros and cons, so ask your electrologist which method they recommend for you.
• Ask your electrologist for an estimate of how long it will take to clear an area, as their expertise and speed will vary. For example, NHS Scotland estimates it can take 250-400 hours to fully clear a face of facial hair. My own highly-experienced electrologist estimated 100-150 hours max for me, but has nearly cleared my face in under 40 hours. She's not yet taken more than about 120 hours to clear someone's face / neck fully.
• Again, numbing cream is not only absolutely safe, it's in fact highly recommended if you cannot afford local anaesthetic injections.
• For most folks, it's as much a mental challenge as it is about physical pain management. Even with numbing cream and strong painkillers, it's gonna hurt, especially in 2 hour+ sessions and around sensitive areas (especially the top lip and around the mouth).
• Aloe vera gel helps with post-electrolysis swelling and recovery.

Numbing cream

• The most common brand of numbing cream is EMLA, which is 2.5% lidocaine and 2.5% prilocaine.
• The strongest cream we'd previously found without prescription is Tattoo Numbing Cream, which is 5% lidocaine and 5% prilocaine.
  • We no longer recommend Tattoo Numbing Cream due to having found a stronger, more cost-effective Korean brand called J-Cain, which comes in higher strengths, but our initial testing with the 29.9% lidocaine version was that it wasn't much stronger, but we think we might have been actually sent the 15.6% version.
  • They typically do 10.56%, 15.6%, 19.8%, 25.8%, 29.9% creams in 500 g tubs, which are much more economical than the Tattoo Numbing Cream.
  • They also do 59.9% and 79.9% creams, but those those are potentially very dangerous in terms of lidocaine toxicity.
  • Please note that J-Cain seems to have a decent preservative in it, but it's not clear what penetration enhancer it uses.
• If you can get a strong lidocaine-prilocaine cream on prescription at an affordable cost, this is definitely something to consider.
  • Lidocaine and prilocaine form a eutectic mixture and work very well together.
  • You ideally want a cream with a decent penetration enhancer (like IPM).
• To help with absorption, exfoliate and clean the area before applying cream, apply 60-90 mins before a session, and cover in an air-tight, water-tight dressing (cling film / plastic wrap works well).
  • Please note that food-grade PVC wrap works far better than the non-PVC one now commonly sold in supermarkets.

Sadly, I can't provide much information on local anaesthetic injections. In the UK, they're typically arranged either by a medically-trained specialist at an electrolysis clinic or separately (such as at a dentist's) immediately before attending a session.

#HairRemoval #Laser #LaserHairRemoval #LaserHairReduction #electrolysis #electrologist #trans #transgender #enby #NonBinary #agender #transition #TransWoman #TransFem #queer #LGBTQ+ #LGBTQIA+ #LGBTQIA2S+

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