Wednesday, 25 May 2011

The Narrative

    Later this week, I'll have my first GIC appointment. I'll go along as my everyday scruffy bloke and I'll tell the truth, answer all questions as best I can. My agenda is to seek help, not to pursue any particular treatment at all costs.
    It's interesting, being an observer within our community and being someone who is doing their best to avoid a hormone prescription rather than doing everything possible to secure one. When you announce you are going to the GIC, you are bombarded with advice. A lot of it is exactly as I've outlined in the paragraph above, just tell it like it is. But there's another thread of advice: that the only way to secure treatment is to tell them what they supposedly want to hear. Enter the Narrative, the Set List Of Things You Are Supposed To Say And Do To Get Your Hands On Hormones.
    We are a community of desperate people. It's part of our condition. In some, that desperation manifests itself in an obsession with accessing particular medical treatments whether they are appropriate or not. This is why we see people self-medding with internet hormones, or even flying off early to Thailand for backstreet GRS from one of their less reputable surgeons.
    It is this desperation that has evolved the Narrative. If you are worried that you won't sound trans enough to get the hormones, so the story goes, here's what you have to say and do.
    It seems you are supposed to appear (as an MtF) in girl mode. How else can they know you're serious? In fact, as I understand it how you present only matters to them if you are undergoing your Real Life Experience and they are at pains to point this out. I have heard tales of people turning up as bloke and changing in the GIC loo, how crazy is that! In my case I believe confidence is the best thing to present, and since I'm telling the doctor I want to stay as a bloke for my wife it makes sense to turn up as the bloke. I can do girl to good effect, simply in this case it doesn't make sense.
    And then there is the life story. You're supposed to spin the stereotypical yarn of the girl trapped in the boy's body, you've known since birth, you hate this and that part of yourself, you're supposed to gloss over the fact you've made it through five decades, marriage and a family successfully as a bloke, because you were Never Really a Bloke and You Knew It All Along. I've heard this story as it evolves in the minds of others, and even I can tell the people who are laying it on thick. I'm sure the doctors at the GIC will have heard it often enough to distinguish those whose narrative really did happen that way.
    It's easy to become frustrated with the hurdles imposed by the Standards of Care. Especially the somewhat stricter version adopted by the NHS. I'm sure we could all pick holes in some of the the things they require, or treatments they won't provide. But when faced with people giving them the Narrative, you start to understand why they have such rules, and why they sometimes seem unfairly biased against us. Don't get me wrong, if I wasn't doing everything I can to avoid it I'd be waving a deed poll and wanting to start my RLE as soon as possible too so I could be ready for GRS in two years time, but I hope I'd still be telling it like it is.
    I can't help thinking that it's the Narrative and its effect on the medical profession that's responsible for some of those extra hurdles we face at what is a rather difficult time. And that really isn't helping anyone.


  1. Your experiences will be interesting; I think you may find the GIC not really geared up to support you.

    My own experience - seeking help to keep the lid on - my status then - long term dual role - was disappointing. I got the impression this wasn't taken seriously.

    I do wonder about the structure of the services. "Gender identity clinic" suggests a clinic for those struggling with identity - that was never a issue for me, I knew my identity, I suspect you do as well.

    Maybe they should be "transitioning support clinics" as I think, in reality, that is what they are geared up for.

    As I say, your experiences will be interesting.

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  3. The point you make is a good one Jenny but I maybe disagree on the hormone bit. As I see it this is one of the few 'tests' there is to establish if transition is a good step, or indeed if the use of them is enough to halt the suffering. Furthermore there is a body of evidence tha says if your brain is not cross sex wired the application of hormones will be upsetting and painfull. Indeed I know a very long term CD who tried them but gave up as they 'f@@ked' her up badly (her words)
    To me they should almost be a first stop in treatment like the SOC sugests

  4. I have no doubt that the staff at the GIC are both caring and dedicated professionals but where they fell down for me was their linnear approach to treatment - limited acess to talking therapy or hormonal treatment after a period of RLE. I was hoping for so much more from the UKs centre of excellence for GID. 

    Perhaps I was unprepared, with expectations too high, but I felt crushed when all they could offer was an inferior treatment plan to that which I already had - monthly group therapy vs weekly 1-2-1's. 

    I know things have changed since my last visit almost 4 years ago and so I very much hope you get the support and treatment to help you stay as the "scruffy bloke" for Mrs J


  5. What Karen said.

    There are a vast range of shapes and sizes of human beings, manufacturers know this but still only really cater for a small group of "standard" people. There is a fear that the GICs are also a bit like this. We are all waiting with bated breath to see if they can help you with what is perhaps in all honesty the help most of us want and need. Even now only a small percentage dare step into the limelight and make a change with all the hazards it entails. Countless thousands live lives of cloistered inner struggle to live a role which they feel is fake and false to their true selves.

    Only if and when you taste the freedom to express your true self do you realise just how much life you have missed.

    Best of luck.

  6. I hope it will prove a positive experience. I believe it has the makings of one, since you have a good attitude and there are some good people there. I hope it's enjoyable, even.

  7. Great post.

    Sometime I feel like t T-community just spouts back a lot of pre-written dialogue they've heard before instead of thinking for themselves.

    I hate the narrative. There is NO narrative. Everyone's story is different.

    Just be honest. With yourself and with others. That is the only way to know what is best for you.

    But then you already do that.

  8. While I agree to some extent, trans people didn't create that narrative, the medical establishment did. And yes, doctors have been, er, encouraging trans people to conform to it for a long time. Please don't dis trans folk for doing what they have to do in order to access the medical technology they want to access.

  9. P.S. I hope your appointment goes well. I'm interested to hear what they can offer you (if anything!)

  10. Morning all, and thanks for your comments.

    I have not set my expectations high for this visit, I know there's not a huge amount that they can do for me. But they're all someone in my position has got, so I have to take whatever they have to offer. My alternatives would be either to capitulate or to wait around until I'm in a much worse state, neither of which would be of much use.

    I had not considered the evolution of the Narrative through encouragement by the medical profession. From what I have read of transitioners long past it makes sense though. However I would counter by saying that in the regime I am facing the Narrative is no longer necessary and the doctors are at pains to say so.

    I agree on hormones, I was simply trying to say that I understand why they take the stance they do.

  11. Do I detect a note of cynicism here Jenny? On the face of it, yes, there is a 'narrative' but as one of the girls have pointed out, there are many different people each with their own story and agendas. I think the 'narrative' is merely a way of describing what has to happen on the road to transition. That's just a matter of fact. As far as the GIC is concerned and as their name suggests, they are merely a Gender IDENTITY Clinic. Supposedly they are there to help those who are struggling with their gender identities. For some that means helping them to understand and accept their feelings, for others it may mean that they need to take the journey to full transition and for some it will be to confirm what they already know in their hearts. The whole reason for the GIC's existence is to offer help and to give advise specific to a patient's needs. As we all know it isn't too difficult to get through the psychiatrist's screening if we really wish to do so. I am of the opinion that most who seek help already know in their hearts what they want. Of course that isn't the case for everyone and I suppose having counsel is then very important. For those whose intentions are to fully transition, they will already know most of the proceedures that follow because they have taken the effort to find out for themselves first. For them it isn't a case of shoe-horning themselves into a mould but merely one of being informed beforehand. For those not wanting to transition, they need not know these things but they might not know what options are open for themselves, what help they can get, so although they know there is a problem they have to confirm that one, they are not going bonkers, two, they are not alone and three there is help available.
    Gosh I talk too much! Anyways Jenny love, I hope the GIC 'interview' goes well and that you do indeed come out of it a little more informed, relaxed and confident than when you went in. Love

    Shirley Anne xxx

  12. Dear Jenny,
    We are very much in the same boat re not transitioning for the sake of our wives and I am at a loss to understand what one can gain from a visit to CX.
    Someone did mention to me that hormones could/might help in helping having to live in the wrong body, but there again it might make our pain even worse.
    Are you clutching at straws dear?
    Love Jae

  13. Shirley Anne
    At my first experience of a GIC, I said I was trying hard to stay with my wife as a man and was looking for help. Their (paraphrased) response. We can't help you - go away and cry. Not much in the way of patient and need led practice really.

  14. It would seem to me from my VERY unlearned POV that if one were wanting to remain a "bloke" that perhaps a bit of testosterone might help.

  15. @Anne

    I believe testosterone treatments have been tried to no good effect. In my own case, my T wasn't low, but that didn't affect the need to do what I did. All T did was make me horny.

    Jenny, this is a really interesting post. From what I understand, nixwilliams is right. The Narrative came out of the way early practitioners would treat MTF people. They expected conformity to a stereotypical model.

    I do think, however, that there is a difference between needing something and wanting it very very badly. And that it's proper to fulfill a need, but not necessarily a strong desire without actual need. I wrestled with that early in my process and concluded that I did indeed have a need, but I have definitely seen counter-examples. I only hope that they do find a way to feel right and be happy.

  16. Morning all,
    The GIC are at pains to point out that they are not just a transition sausage factory, however the impression I have received is that this has not always been the case. And as in Karen's case not all the GICs follow exactly the same practice. Only time will tell what I am eventually offered.

    Jae, you and I walk the same path. (For those of you who aren't in my art of the world, Jae is someone I know through my local support group) Would hormones help us? Easy enough to get outside the NHS, but it's never so simple is it, especially for someone married. See Becca's blog for her take on that path.

    Would testosterone help? Sadly not. I already have too much of the stuff. Fully functional bloke, me. As Ariel says, T therapy is just another of the many failed treatments tried on us. As it happens I found the mitigating effect of Finasteride on my DHT to be something of a blessing, taking away as it did some of the overt male things.

    Expressing this as want versus need is a very good way to put it, I hadn't considered it thus. I desperately wanted to be a girl all my life, from as early as I can remember. However it only became a need in the last three, maybe four years, as all the ways I'd kept a lid on it stopped working. Yes, it's proper to fulfil a need, but I'm not ready to do so at the expense of my wife's happiness without doing my best to avoid it.