You don't know what you got 'till you ain't got it

It's something well-known, that before any major surgery we trans women must come off our HRT for a period of a few weeks. There's a risk of blood clots, and the effect of coming off is said to be rather difficult as you go from the hormone balance of a young person to that of a 90-year-old in a matter of days.

I can say with complete confidence that this prospect holds little fear for me, because I have been there. For quite a few months I've had next-to-no estrogen or testosterone, and it's something I only got to the bottom of a few weeks ago.

About two years ago, I started my HRT. I was already a couple of years full-time, but had delayed HRT for fertility treatment. I received my hormone patches, and eagerly applied them. In due course after about a year, I received anti-androgen injections, and awaited the changes they would bring.

People say that the switch from T to E in this way can be a rough ride, but it didn't quite work that way for me. I didn't get the hot flushes some people report, instead I got spots, lethargy, intense dysphoria again, and unexpectedly a return of some of the male aspects down there that I thought were long gone. Oh well, I thought, this is the rough ride, it'll pass.

But it didn't, in fact it got worse. And then I had a blood test. Followed by an URGENT letter from my endocrinologist, then an URGENT appointment. About a week after the last of my two trips, so about a month ago. I had precious little of either hormone, and it needed fixing urgently.

What had happened was this: they start you on a very low dose and increase it gradually. In my case, they never increased it, and I remained on the low dose. So I never had the extra E to replace my missing T, and turned into hormonally a very old lady. A state which persisted from the end of last summer until now. I've been prescribed two different upward steps of estrogen patches and have been promised more, and I've also been given industrial strength calcium and vitamin D supplements in case my bones have lost any calcium.

This was very clearly a lapse in the standards of my care, and I told them so. I've been to the NHS's complaints service, but it's worth considering what I am hoping for. I see little point in asking for a head on a plate, as this was obviously an administrative cockup.

Instead, I've asked for three things. First, an accelerated return to proper hormone levels for me. Then, a couple of things for the rest of their trans patients, now and in the future. A commitment to keeping our HRT under constant review, to make sure nobody falls through the cracks as I did. And then for each trans person to receive a clear timetable, on date X we will look at increasing your dose to achieve Y  estrogen level in your blood, and so on.

In myself, I'm feeling a lot better for finally getting the right HRT. I have several steps to go, but it's on its way. Fortunately I don't think I had any other problems for my intensive stay without HRT, it probably wasn't long enough for that.

I can however add this episode to the long list of my being messed around by medical services related to my transition. When I started all this I was a software developer, now I'm a full-time paid journalist. You can be sure I'll write about all this one day somewhere it'll matter.

Taking Back Control, transition edition

    I've been a little quiet here of late, but with good reason. When your transition is stalled for several years by circumstances beyond your control it can sometimes take a very long time indeed to get back on the treadmill. In my case I found a shortcut, and took it.
    It would normally make me a bit uneasy, taking a brief sojourn into the private sector to get something that could take me two or three more years in the NHS, but since the NHS GIC took a huge dump on me that has already cost me two or three years I feel I've served my time. So in the middle of last month I went to see a couple of private doctors to get my GRS referral letters. They are both people I've never seen before, but since they both have NHS practices I have plenty of friends who've seen them at their GICs.
    This was my first experience of private gender medicine, and all I can say is that it's a very different place from the NHS. Not necessarily better, just different. I only needed two appointments, so the cost was fairly modest in the scheme of private medicine. Enough for a significant belt-tightening for a couple of months, not enough to bankrupt me.
    What makes it different is the access. I had arranged both appointments two and three weeks in advance, by email on my mobile phone, over the course of a half hour walk in the countryside with my friend R. A quick online payment for each, and I was good to go.
    Going to each necessitated a train to London, and since I was there for a day I arranged to meet friends both times. A visit to Tim Hunkin's arcade in Holborn with the first set of friends, then a week later a rather nice cafe with friend 2. She felt she had to warn me it was very discreetly a kink cafe, but as I pointed out: "I Googled it".
    The two clinics were slightly different, one was at the private equivalent of a GP's surgery, the other at a very flashy clinic whose main business was plastic surgery. And immediately upon sitting down in the waiting room it became obvious the main difference between the private and the NHS sector. It may seem an obvious thing to say, but for the first time in my life I was sitting among those transitioners for whom transition is something that can be bought rather than something that is a drawn-out process. I'm used to the GIC waiting room crowd, a mixture of fresh-out-of-the-closet first timers and people who've been in the system for years. The emphasis there is on Real Life Experience, living in role, and due to the delays in the system the patients haven't got much else to do but get on with it. So while the first time MtFs in an NHS GIC waiting room are a little overdone on the presentation front, most of them are in jeans and trainers, lived-in everyday clothes from whatever they are doing with their lives.
    By contrast the private waiting rooms, especially the latter one, were full of high-speed transitioners anxious to get to their goal in as little time as possible. I hesitate to go into detail because it's not really appropriate, but if I say the tone was probably more Sparkle than Trans Pride Brighton you may get my meaning. I have little doubt that within very little time all of those people I saw will have had their visit to the surgeon and consider themselves fully transitioned, but will they really have socialised in the same way as the girl who's been full-time going through the process at an NHS GIC for three or four years and is only just receiving her first surgical referral? I worry that maybe they won't have.
    Both doctors were professional and straightforward, and since I had all the paperwork necessary to prove both my HRT and my time living in role I received an assent from each of them. A few weeks for the paperwork to be processed, and there they are. Back into the system. No idea when my time will come, and when it does I'll probably be rather circumspect about it online because blow-by-blow GRS accounts can be triggery as hell, but at least now I know my day will come. One day.