What advice would you give to doctors and nurses working with trans youth?

I would advise them to understand the difficulties that they face and it’s, you know, it’s not just the difficulties in how theyre feeling, but it’s, you know, the situations that they face at school, in college, at university. They need to be educated and they need to take some responsibility for educating themselves for understanding and providing that care to their patients.

We told the wider family. I think the older members, grandparents, for example have struggled a little really to get their heads around it properly and not struggled with the concept that she’s trans, to they, you know, theyre accepting of that. But they struggle to get the pronouns right, because theyve been so used to saying he/him for so many years. It’s very difficult for them to, at their age, to change that round.

They accept the kids up to their 20th birthday. So she was 18 when she came out. And in part of my internet searching, I came across Mermaids and I emailed them straight away just because I didnt know what we were faced with. So, we got a call very quickly actually within a day I think I got a call from one of the support workers at Mermaids. And I joined their parents’ forum immediately. And then after six weeks I was allowed to progress onto a social media forum for supporting parents. And they had meet ups once every month. So I went, [name of participant’s child] and I went to the first meet up she found it a bit awkward actually, because there was a lot of younger kids. And actually she’s really quite well adjusted. But I find it quite helpful to be able to talk to other parents and share experience. And sometimes, actually, our experience, on the whole, apart from the difficulty with the GPs and everything has been very positive because we chose to embrace the change. It’s been less traumatic, I guess, you know, we deal with issues and what have you as they arise. And it’s quite nice to be able to share positive stories with other families who are maybe struggling who can then kind of see that there is some light at the end and that things can be alright.

What advice would you give to parents or carers of young trans and gender diverse people?

To fight for the care that they deserve. So if theyre faced with a GP who is, you know, it’s, it’s their first point of call, their everyday point of call for all things medical. If they are not willing to help they need to fight to get that help.

I think it’s absolutely unacceptable, really unacceptable, because a lot of these these kids and young adults and adults that come out theyre, theyre struggling mentally. You know, theyre suffering dysphoria around their body, around their gender. And, you know, if I went to the doctors with a pain in my abdomen and they couldnt work out, you know, they couldnt fix it there and then they would refer me onto a specialist and I would get seen within a reasonable length of time, you know, and, and this is no different. They should be they should be given immediate treatment. And if they cant, at the moment they need to look at the service that’s being provided and the funding that’s been made available to it. And you know, they, they need to provide a service that’s suitable for demand and at the moment it’s not fit for purpose.

It was a big concern for her because she had a receding hairline and so part of the surgery was to pull that forward to make it look like she had a full head of hair. She had a very prominent brow, masculine brow, so that was being shaved. Very prominent masculine nose so that was being reshaped and then her Adam’s apple was being shaved as well. So that surgery took place last August. It was a big surgery to have done. There was an unexpected complication in that she lost the sight in her right eye as part of that. So, that added an additional dimension for her to have to deal with over and above the surgery itself and just generally being transgender. So, you know, she’s proven that she’s resilient. The surgery was like I say, it was a big deal, because it was four hours worth of four different procedures that were all happening at once. But it was something that was really top of her agenda to help her be able to move forward and to ease her kind of body dysmorphia that she had.

So we were supportive. You know, I was quite shocked. I had lots of tears. But never in front of [name of participant’s child]. I learned to paint a smile on my face whenever she was around. So that, you know, she had enough to go through without you know, her dad and I and other members of the family adding any stress to that. So it was important that we maintained a unified and supportive front which is what we did. It wasnt always easy in the earlier days. But yeah, it got easier as time went on. And I think, as a family as well we decided that the only way to move forward was to embrace the change you know, there’s, there’s no way that you know, we were gonna force her to live as a boy. You know, and actually we didnt have the right to even try to suggest that, you know, this was, this is her life. It has to be it has to be lived by her in her way. So it was our responsibility to support her.

And we immediately went to our current GP practice I foolishly thought, of course, theyll help us immediately and I was, I was horrified with what we were faced with. So they referred us straight away to the Gender Identity Service which was good. Led us to believe that that would be quite quick process. When wed spoke to the Gender Identity Service they said it’s gonna be at least an 18 month wait before you even get seen. So we went back to the GP. Id done lots of research, looked at the GMC guidelines that encouraged GPs to provide bridging medication if they felt able to. And that was the important bit, because that’s a get out clause for them all.

Well, We don’t feel experienced enough to be able to do thi. So I had many a discussion with our current GP felt they were very condescending I complained, I wrote letters of complaint to the practice itself to the GMC, to NHS England, to the CQC, to our local commissioning group. And pretty much felt like I was getting nowhere. But, I think the attitude of that particular practice was just not acceptable. They were dismissive. They were condescending and I didnt like it at all and so Id been talking with a friend and she said, there is another practice in another village that’s kind of the other way from the first one. And she said, they, you know, theyre really nice, well run practice. Why don’t you try there? So I went to them and I said, Are you transgender friendly? I’m not moving if I’m gonna end up in the same position. Oh yes, yes, we are. So made an appointment and went in with [name of participant’s child] and again, the first thing we were told was, No, we, we cant provide you with any bridging hormones at all. So I found myself going down the same route again of complaining to the world wide news, only I went to my MP this time as well and said, This is wholly unacceptable. You know, at that time we had started with a private service, internet based service, because it was the only way we could get some kind of help. And probably took about three months, I think of having assessments, you know, psyche assessments and stuff for [name of participant’s child] to get her first hormones. But at least then she felt like she was on a bit of a, bit of an even keel because I think the hormones that were going on inside her body were kind of matching how she identified. But a, above everything her big concern was that she was losing her hair. Her hair was receding and that had to stop. Waiting 18 months, I mean, she could have been half bald by then. I mean, it was just unacceptable that you know, they didnt, they didnt respond to that, the health professionals. So I wrote to the lead partner in the practice and said, You need to, you need to think about doing this. This is not acceptable. So she invited us in and I took all the guidance I could find, all the information I was trying to be as reasonable and a, as balanced as I could in presenting that to her. Because I said, if something happens to my child because you will not treat her, I will hold you responsible. And I said, I feel like you’re not treating her out of either prejudice or you’re choosing not to, you know, when youve got the opportunity. And, she wasnt, she didnt like me saying that at all. She took offence at that. So I kind of had to just be, you know, I didnt want to get into a conflict situation with them. I was genuinely trying to persuade them to provide assistance. So she said, Well, weve got a practice meeting, well discuss it there. And we got a letter after that that said, no, we will not treat [name of participant’s child].

What was the reason they gave you?

They just said, well they said because we were using an internet service they wouldn’t provide monitoring bloods for that. And they didnt feel they had the expertise to actually take over the prescribing, even though they are prescribing HRT for women, all day, every day. And it’s essentially the same. So I was continuing to complain to all the bodies that I could complain to. And I wrote back to them and I said, this is a list of everybody that I’m complaining to about your practice. I would urge you to reconsider your decision and they did reconsider their decision. So she called us in and said, We genuinely don’t feel able to do the prescribing ourselves, but what we will do is we will refer your child to an endocrinologist. Let them come up with a prescription and then well take over the bridging medicatio and that’s exactly what happened.

I think there’s a number of barriers. One of them is prejudice so I think there’s a lot of that within general practice. One of them is around experience, so they don’t think they have the experience. And there’s possibly something that can be done about that. If they, you know, if theyre given the guidance that they would prescribe in the same way as they prescribe HRT then maybe that would be sufficient for them to feel like they can to feel like they can provide this bridging medication. Education, there’s a lack of education for GPs around what transgender is and what care they actually need. So, I think there’s a sort of awareness and maybe some patient pathways that could be could be drawn up that would say, well, actually, if you don’t feel like you can do this, you could refer in this way and that may possibly also help, and funding as well. So one of the arguments I had with our first practice was that they said, We are not funded to provide your child with blood tests. As did the second GP practice actually. We are not, we are not funded to provide you with blood tests to monitor your, you know, monitor her hormonal parameters. And then in the next breath I was seeing a social media post from the second practice that was saying, Ah, free blood tests for everybody. And I was like, ah, yeah, the select few potentially, not for everybody. And I actually put that, It’s very rare I would put something on Very rare I would put something on you know, social media that’s not, you know, that kind of meaningful in that way. And they put a comment on it to say, This is not the forum for that, for this. And I replied to them and I said, Well actually, it is, because you wont listen to me in any other way. And it’s from that point that’s when they started to listen. So, yeah, funding is another one. Oh, and guidelines, sorry. The GMC guidelines are quite clear around providing bridging medication, but it gives them a get out. So, the minute they feel like theyre unable to prescribe or unable to help they can just throw their hands in the air and say, No, I’m sorry you’re just gonna have to wait for the, you know, the gender service. And I think that’s wrong. So, I think GPs should have to take a level of responsibility for looking after their transgender patients without having that kind of get out. So, those guidelines need to be a little more prescriptive.

It’s more around and it’s really hard to really hard to articulate. But it’s the way they look at us. And the tone of voice that they use and the look in their eyes and I know, you know, it’s it might sound daft, but actually to be sitting there under the kind of gaze that almost feels like it’s bordering on ridicule is very, very uncomfortable. You know the first the first GP you know, very nice, soft voice and everything, but you could just see in his eyes it was just, it was not something that he was comfortable with at all. You know, he was keen to make the referral and just kind of get us out of there. And was keen not to really have, to have any involvement in any kind of bridging care for [name of participant’s child]. And then the clinical lead and so he suggested, Well if you know youve got a problem with this I suggest you write into the clinical lead. They gave me the name of the clinical leads. I wrote into that clinical lead. And he questioned why I was even bothering writing to him, because he hadnt, in this, the letter it said, I havent seen your child for half a decade. It was like trying to make it sound better, that he hadnt seen my child for such a, such a long time. But that wasnt that the practice hadnt seen her. He personally hadnt seen her. So yeah, it, they almost didnt take our concerns very seriously at all. You know, had I been writing in about something else, I don’t know having not dealt with a broken arm correctly or what have you. I do feel they would have taken that far more seriously than the fact that I was writing in about transgender care.

They just said, well they said because we were using an internet service they wouldn’t provide monitoring bloods for that. And they didnt feel they had the expertise to actually take over the prescribing, even though they are prescribing HRT for women, all day, every day. And it’s essentially the same. So I was continuing to complain to all the bodies that I could complain to. And I wrote back to them and I said, this is a list of everybody that I’m complaining to about your practice. I would urge you to reconsider your decision and they did reconsider their decision. So she called us in and said, We genuinely don’t feel able to do the prescribing ourselves, but what we will do is we will refer your child to an endocrinologist. Let them come up with a prescription and then well take over the bridging medicatio and that’s exactly what happened. So we had the appointment with the endocrinologist I think in February of this year. And prescribing started immediately. They put her on much better medication than she was on before. I don’t mean better, but sort of potentially stronger and a proper T blocker, that she’s on now, which is, you know, better for the hair loss and, and everything. And you know, and she feels really good. So we stopped using the internet provider, who had been brilliant, really brilliant throughout. But it’s great to have somebody in our local practice now who somebody that we can see face-face and, you know, we feel like [name of participant’s child]’s care is a part of her trans care is a part of her overall medical care, rather than us having to take that part out to somebody else who was willing to treat her.

And then we talked about how to tell her dad, because to be fair, Ive been married to him, Ive been with him for such a long time. But I couldnt actually – because this had come as such a shock – I couldnt actually genuinely tell how he was gonna take it. So when it came to when she finally agreed that I could tell him, so she told me I think on the Friday night and agreed that on the Sunday morning I could tell him. And I told him in pretty much the same way as she told me. I showed him the text. And he read it and he said, Oh well that’s a relief. I thought you were gonna tell me shed got arrested. Obviously not using female pronouns though, at the time. Yeah and that’s, that’s how we kind of got underway.

I think it’s absolutely unacceptable, really unacceptable, because a lot of these kids and young adults and adults that come out theyre, theyre struggling mentally. You know, theyre suffering dysphoria around their body, around their gender. And, you know, if I went to the doctors with a pain in my abdomen and they couldnt work out, you know, they couldnt fix it there and then they would refer me onto a specialist and I would get seen within a reasonable length of time, you know, and this is no different. They should be they should be given immediate treatment. And if they cant, at the moment they need to look at the service that’s being provided and the funding that’s been made available to it. And you know, they need to provide a service that’s suitable for demand and at the moment it’s not fit for purpose.

Probably from around the age of 15,16 we were aware that there was something going on, but we didnt really understand, as parents what that was. We tried to be sort of supportive and boost her confidence and, and what have you. But really she was a girl, trying to be a boy we didnt know that at the time. So she was just turned 18 when she came out. She came out to me actually by text. So shed messaged me to say, shed been out for a night out, messaged me to say, would I open the gate for her and I said, I will do but Ill be in bed when you get home. And she said, No, please wait up, I need to talk. So I knew whatever it was that had been going on for all this time that I was gonna find out what it was. And to be fair, I thought she was gonna tell me that she was gay. And Ive spent a lot of time telling all my kids, I don’t have any concerns or I don’t care what they are as long as it’s legal and theyre happy that’s all that mattered. So that’s what I expected and then just shortly after getting that message to say, please stay up, I got a very long text. And it was one that shed apparently written probably about two years before, had sat on a phone for all that time and shed never dared press the send button. So she pressed the send button and read it and I was very shocked, to be fair, because I didnt really understand what trans was about. But I messaged her back and I just said, drive carefully, cause it was late and it was winter and it was quite, quite icy. And I said, Ill have the kettle on when you get home. And we just sat and talked into the early hours of the morning, really. And that was the start of our journey, really.