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nearly 5 years of trying to progress through this dehumanising, anxiety-inducing, decorating, belittling, gatekeeping, outdated process completely worthless  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

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+

Once again reminding people that testis-preserving #vulvoplasty / #vaginoplasty is a real thing that exists. All they do is #tuck them up in the inguinal canal and suture it shut before going to work on everything else.

There is no reason for anyone to undergo an #orchidectomy and then have to be on #testosterone. If you want that, and your surgeon doesn't offer that, find another surgeon.

It's disheartening to run into #transgender / #nonbinary people who have had it and didn't know the options, and I run into so many people who are weighing the drawbacks, I really want this to be common knowledge.

#SRS / #GenderAffirmingCare is for YOU, and you should be comfortable asking for whatever it is you want. These people are very experienced cosmetic and genital surgeons, and they can often do whatever you ask them to do.

#surgery

Post-egg cracking time is weird   

By the very start of April 2025, it will have been 4 years since the shell of our egg finally officially cracked. And as it finally cracked, it smashed to pieces.

It both feels like a lifetime ago and only yesterday that we were still questioning whether or not we were trans... or just (for perfectly cis reasons) someone who wanted to be a gal 🤦‍♀️ (Oh, that poor sweet summer child )

Note to any eggs and/or questioning folks reading this: by definition, cis people don't want to be a gender other than the one assigned to them at birth 😅

By NHS England standards, we've made more progress than most do within that timeframe. We've beaten our away through:

• 2 appointments to get the NHS to agree we're indeed trans 🙄
• A further appointment about starting HRT and giving us a surgical referral 🤨
• Almost 6 months for them to send a basic letter about starting HRT to our GP 😖
• Yet another appointment to get a second required surgical referral  

For anyone in a country with somewhat functional healthcare for trans people, this is actually fast by NHS England standards. Many people wait 3-5+ years for their first appointment alone.

The fact that we've got to the point of getting some limited electrolysis covered (16 whole hours) and joined a surgeon's waiting list to discuss bottom surgery options is great by NHS standards, but it's shite by international standards.

From a certain point of view, we know we should be grateful. However, we can't help but feel resentful for how many years of dehumanising hoops and hurdles trans people have to jump through in the UK just to receive basic gender-affirming care. And this is just our perspective as an adult: there is currently no gender-affirming care whatsoever for trans youth via the NHS 😭

Gender-affirming care doesn't exist in a vacuum. Whilst we're always happy to see others getting the care they need faster, we won't lie: it's hard not to feel jealous when someone 2-3 years into their transition:

• Was able to start HRT injections on prescription via informed consent.
• Was able to get several life-improving gender-affirming surgeries. E.g.:
  • Standalone bilateral orchidectomy.
  • Vaginoplasty.
  • Facial Feminisation Surgery (FFS).
  • Voice Feminisation Surgery (VFS).
  • Breast Augmentation (BA).

For those who don't already know, NHS England doesn't even routinely approve standalone bilateral orchidectomy, FFS, VFS, or BA. And yes, whilst it is technically possible to get solely your nads yeeted, it typically:

(a) is done in place of vaginoplasty; or
(b) requires approval of an Individual Funding Request (IFR) by your local Integrated Care Board / System (ICB / ICS), which will be reviewed on a per patient basis.

Again, whilst you can technically apply for funding for FFS, VFS, and/or BA via IFR:

• It's really unlikely to succeed; and
• You first have to convince your gender clinic to actually submit them for you.

For us, BA isn't something we want, but FFS and VFS very much are   However, we're still waiting for our gender clinic to agree to submit IFRs for us! We've actually had to raise a complaint about the clinic refusing to do so 😔

Anyway, that's enough venting for now.

#NHS #NHSEngland #trans #transgender #TransFem #healthcare #TransHealthcare #gatekeeping #orchidectomy #BofaEctomy #FFS #VFS #FacialFeminisationSurgery #VoiceFeminisationSurgery #glottoplasty #IFR #IndividualFundingRequest #queer #LGBTQ+ #LGBTQIA+

Hey folks  

We've made previous posts about our progress through the NHS East of England Gender Service (EOEGS), which you can find under the #EOEGS hashtag. Our last post was here.

We followed up with the EOEGS about our request for them to submit Individual Funding Requests (IFRs) on our behalf and gave them until the end of 2024 to respond.

When they inevitably refused to give us any further update over this, as we sadly expected, we raised a complaint against the EOEGS and its service lead via NHS England. It's currently under investigation at the time of writing this post.

Just to clarify, we don't expect any quick response or any positive outcome from this complaint. On the contrary, we expect them to come up with some excuses as to why they can't and won't do has been asked of them, despite NHS England's IFR team informing the EOEGS that it's their responsibility to submit IFRs on behalf of trans patients under their care pathway.

So, why are we doing this then? A few reasons really.

• It's the right thing to push NHS England to fulfil their obligations and responsibilities.
• If we succeed, it could positively affect other trans people in England.
• It may highlight the multiple failures of the EOEGS (especially the service lead) to the higher-ups at NHS England.
• It's the only realistic chance we have of getting the gender-affirming care we need, as we cannot afford it privately ourselves.

Even if can get them to raise IFRs for us, there's no guarantee that they will succeed. In fact, it's more likely that they won't, but at least we'll have set a precedent that NHS England gender clinics have to raise them.

And once we've been rejected, we can then create fundraisers guilt-free, knowing that we've done everything we could first to get NHS England to give us the gender-affirming care we need to alleviate gender dysphoria 

We don't and won't ever judge anyone else for not going down this route before creating fundraisers. We just suffer a lot from feelings of imposter syndrome and not being worthy of care, so in our mind we can only allow ourselves to reach out to others for help once we've exhausted all routes open to us first  

This is all only necessary because NHS England refuses to cover Facial Feminisation Surgery (FFS), Voice Feminisation Surgery (VFS), and standalone bilateral orchidectomy as standard for trans fem patients 🤦‍♀️

So yeah. That's where we're at.

#NHS #NHSEngland #trans #transgender #TransFem #healthcare #TransHealthcare #gatekeeping #orchidectomy #BofaEctomy #FFS #VFS #FacialFeminisationSurgery #VoiceFeminisationSurgery #glottoplasty #IFR #IndividualFundingRequest #queer #LGBTQ+ #LGBTQIA+

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

I found out tonight that apparently you can request to keep your testes for "religious reasons" after an orchidectomy (aka orchiectomy) and it's very difficult for a surgeon to say no if you live somewhere with religious anti-discrimination rules.

Do with this information what you will 😏🤭

#trans #transgender #TransFem #orchidectomy #orchiectomy #orchi #vaginoplasty #LGBTQ+ #LGBTQIA+

Congratulations to anyone who had a successful bilateral orchidectomy this month.

You've officially won "no nut" November 😌🤭

#NoNutNovember #orchidectomy #orchi #trans #transgender #TransFem #IrreverentHumour