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