Hey loveliests  

We wrote a post back in June, which we recommend reading first for context if you aren't aware of the situation.

In short, the practice manager from our GP surgery emailed us this afternoon with a copy of the response from the local ICB. As expected, it was a "no".

"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."

It's not something we can afford privately or could save up for, for reasons we won't rehash. (We've written some longer update posts back in late April and late May.)

Our only remaining option now is a fundraiser, but we need to work out how to do so without needing to disclose our surname, since we can't have our alias identified with our full name  

#trans #transgender #VoiceTraining #VoiceFeminisation #VoiceFeminisationSurgery #VFS #VoiceDysphoria #NHS #NHSEngland #EOEGS #PALS #IFR #ICB #ICS #GDNRSS #GAHT #GDPR #DSAR #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+ #queer #GenderAffirmingCare

Hey folks  

So, we're going to try to keep this post shortish for our own wellbeing and sanity, as well as yours.

We will, however, frontload some abbreviations and links:

• EOEGS - East of England Gender Service
• Gender Clinics
  • Aka GIC (Gender Identity Clinic) or, solely by the NHS, Gender Dysphoria Clinic (GDC)
• IFR - Individual Funding Request
• ICB / ICS - Integrated Care Board / System
• GDNRSS - NHS Gender Dysphoria National Referral Support Services
• GAHT - Gender-Affirming Hormone Therapy
• FFS - Facial Feminisation Surgery
• VFS - Voice Feminisation Surgery
• GP - General Practitioner
• PALS - Patient Advice and Liaison Service
• PHSO - Parliamentary and Health Service Ombudsman

We have already written up about some of our early experience of trying to get gender-affirming care from the NHS in an article for TransActual, but that was published back in October 2023, so it's more than a little outdated now 😅

Back in August 2023, we knew it was possible to request funding for gender-affirming surgeries not routinely covered by the NHS via IFRs. These are submitted to your local ICB, who will likely refuse funding unless you've made a really good funding case.

(It's worth noting here that such gender-affirming surgeries are recommended by WPATH's SOC8: the NHS just disagrees and refuses to follow the international recommendations.)

Nonetheless, we mostly just wanted the chance to put our case forward for VFS. A standalone bilateral orchidectomy and FFS were there, but as lower priorities, since it was our voice causing us the most issues.

(We won't list all of our voice dysphoria issues here, but basically we've been doing voice feminisation training since December 2021 and we're nowhere near even the lowest-end voice goals. Our voice leads to us getting regularly misgendered both on the phone and even in person 😞 We've done our genuine best for years and VFS is very much our last resort.)

We are going to give selective details of what's happened since, but we'll first cut to key points: the EOEGS (our gender clinic) has been refusing to comply with their responsibilities for approaching 2 YEARS and no-one within the NHS will hold them to account.

First they denied responsibility for IFRs and tried to say it was our GP's responsibility. So, we went to our local ICB to ask them and got given the details for the NHS England IFR team, who told us -- in no uncertain terms -- that it was the responsibility of the EOEGS to submit these for us. That was back in very early 2024.

We forwarded this to the EOEGS, and then followed it up with them at our 3rd appointment (Q1 2024). They still denied responsibility, so we forwarded on the proof again. And waited. 3 months later (Q2 2024), we chased... and waited again.

Near the end of Q3 2024, the EOEGS finally wrote up the notes from the 3rd appointment (~6 months ago), and mailed them to us and our GP in the post (no digital copy or email)... with multiple factual errors  🤦‍♀️

So, we scanned the letter, turned it into a PDF, then highlighted and corrected all the errors. We then politely emailed it across to the EOEGS, CCing in our GP, along with a clear restatement of outstanding issues and requests.

As the quarter ended, we got an offer of a 4th appointment (more surgical referral gatekeeping nonsense) next quarter. Then silence, yet again.

Q4 2024 came around. The EOEGS claimed that the IFR issue was still with its "service lead". We raised it at the 4th appointment. No answers. Only further promises to look into it and get back to us.

As 2024 ended, we went back to the NHS England IFR team. They confirmed once again that our gender clinic was shirking their responsibility over IFRs. So, we chased the EOEGS for the last time that year. No response ever came.

As we moved into 2025, we reached out to GDNRSS to ask for guidance and help. They responded quickly, but advised that the only thing we could do was to raise a complaint with PALS.

So, that's what we did, CCing in the EOEGS, and made it very clear that this was only being done as a matter of last resort.

By now, as you can imagine, we weren't expecting anything great. However, we hadn't been mentally prepared for the combination of incompetence, lack of reading comprehension, and institutional malice that followed.

They'd send us a complaint response that didn't show any understanding of our complaint. We'd go back and clarify the issues again, and suggest a call to discuss it. They'd investigate more, say that they'd pass along our request for a call, delay the response, and then send another one which again failed to address the core issues.

By Q2 2025, we reached the point where they refused to take the complaint forward any further, and just directed us to the PSHO, which is very much biased towards whatever the current government wants.

In other words, we'd run out of options to hold the EOEGS accountable 😞

NGL: in combination with multiple other factors, this kind of broke us, and we simply had none of the time, energy, spoons, or motivation to follow up any further.

After a few weeks, however, we decided on 2 last-ditch options available to us:

On the 1st point, the ticking clock for that started just a few days ago. Officially they have 1 calendar month to comply, but can request up to 3 calendar months if the request is deemed complex. We are under no obligation to agree to this as the data subject.

On the 2nd point, the senior partner had a call with us over the issues, then asked whether we could compile all the info on everything for him. We said it would be difficult for us, but agreed, so he booked a follow-up appointment for us on 2025-06-09 (yesterday).

NGL: going through all the emails and documents again, then summarising them into a chronological sequence of events, was very, very difficult for many reasons, but primarily because it meant going back through everything and reliving the cumulative trauma of it  

Nonetheless, we finished compiling it all just a couple of hours before the appointment. A "summary" document that spanned 4 sides of A4 and all the relevant "receipts" (digital documents like emails and PDFs), covering from August 2023 to June 2025.

Whilst the senior partner said it will take him time to go through it all, the key thing is that he agreed to submit the IFR for us.

It honestly made us teary just to have someone actually care enough to truly listen and be willing to discuss it with us  

Of course, this is just the beginning of another long, drawn-out process. It's likely going to take at least several weeks until we even get to the stage of working together to put together the best case possible, let alone getting the IFR submitted. It could even be months.

Even when it's submitted, it'll then be up to our local ICB to review the submission, and they will almost certainly find a reason or reasons to deny the application.

We're still not expecting this to succeed. We just wanted to have the chance to have at least one request submitted and reviewed.

The EOEGS and other NHS departments spent a level of magnitude more time, energy, and resources denying us the right to even consider submitting IFRs for us because, we suspect, they didn't want to set a precedent of trans patients in England utilising their rights.

Or maybe just because they didn't want to comply.

Whatever happens with the eventual IFR submission, at least we'll have tried every way we can think of to get the NHS to fund a basic gender-affirming surgery that would massively improve our daily quality of life.

If by some miracle the IFR is approved, it'll give us and maybe others a small glimmer of hope.

But realistically-speaking, at least then we can create a fundraiser for VFS with a clear conscience that we tried everything else we could first 🥺

If you got this far, thank you for reading this  Feel free to boost it, if you want others to read it too  

#trans #transgender #VoiceTraining #VoiceFeminisation #VoiceFeminisationSurgery #VFS #VoiceDysphoria #NHS #NHSEngland #EOEGS #PALS #IFR #ICB #ICS #GDNRSS #GAHT #GDPR #DSAR #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+ #queer #GenderAffirmingCare

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