Traditional therapy isn’t really well equipped to deal with gender dysphoria. It isn’t well equipped to deal with minority oppression. So, like when I’ve spoken to therapists they’ve tried their best to, you know, get on board and support me. But they also don’t know anything about trans people. So, I’ve often spent like entire appointment sessions just explaining like what being trans even is. How it makes me feel. And then they’ve given me advice that’s a very like outsider advice. It isn’t helpful. it’s well intentioned, but not helpful.

Can you describe the advice?

Yes like one time, the therapist suggested I go see a consultant like a beauty consultant who dealt with mostly cross dressers, but some trans people as well. But it was kind of like they’ll stick you in a nice dress and wig and then take you to a café shop. That’s like the package and you pay for it. But not only did that not really interest, cos I’m not really interested in just being like a woman for a day. I was already at a point where like appearance wise I didn’t need wigs and I didn’t need dresses. I had all that I needed. It wasn’t appropriate for not only my stage in the transition, but also for how I felt about myself.

Saw the GP in February, early February 2017 to ask for a referral to the Gender Identity Clinic what I found is that [clears throat] he wouldn’t give me the referral unless I saw a psychiatrist first because I had read online about what was absolutely required. I knew that wasn’t necessary. So, I decided to go for a second opinion. What I found is my second opinion didn’t know anything about it. So, they went to my first opinion doctor for a second opinion. Because this has all taken place like multiple [clears throat]. Because this had gone on like multiple weeks, multiple appointments and I was training to be croupier in the casinos. I just got, got exhausted by it and I was just like, fine, show me the hoops and I’ll jump through them. They referred me to a psychiatrist, but it was a telephone appointment rather than a in person’ one, which never happened to me before. And I thought it was quite odd cos it’s something at least you’d think it was something that you’d want like quite, if you are gonna do a psychiatrist’s assessment, you’d want it to be in person where you can get like a full impression of someone.

Anyway, the telephone appointment comes around and I call at the designated time and the nurse picks up says he’s too busy right now. Call back in like fifteen, twenty minutes. So, I do that and the nurse picks up again says, the psychiatrist has handled the case and sent it back to the GP. I was thinking, what’s the point in a psychiatrist appointment if they are not gonna see you or speak to you. But I also naively assumed that because he just sort of handled it and sent it back so casually, it was because he knew he didn’t need to do anything with it and it could just be sent onto the Gender Identity Clinic, anyway. Went back to the GP in a couple of weeks and they said they had received nothing from the psychiatrist which was disappointing. But I thought maybe it’s just stuck in the bureaucracy, the system, maybe. And I again naively assumed that my GP would contact me with the results. Two months pass, still no contact at this point I am quite frustrated because I already knew how long the waiting times are and I know the sooner I get on it the better. So, I go back, he says, he got the letter two week two months prior and so not long after I visited them and the psychiatrist had advised them not to refer me to the Gender Identity Clinic, which was just bizarre. Again, this person hadn’t seen to me. Hadn’t spoken to me. And decided all on their own that I wasn’t fit for a referral to the Gender Identity Clinic which again by NHS standards shouldn’t even be required. So, like I started tearing up in the GP appointments, because I was not only angry that it’d been rejected, but I was angry that the GP hadn’t even told me it’d been rejected. And because of that response, the GP sort of begrudgingly gave me the referral which was just eye rolling because they could have done that in the first place. So, that was August, I think, August 2017. So, if you think I’d gone for the referral in February and I got it in August that delayed my entire referral by what like five, six months which as we know now, waiting times that are like a year and a half at the earliest and up to like two and a half, three years for some services.

I learned that it was a thing that you could do and that you didn’t, if you had the money, you didn’t necessarily have to wait for a GP under the NHS. I think knowing going into it just how long the waiting times I knew that I couldn’t wait. It didn’t really feel like a choice for me. I looked at so many different medical guidelines for prescribing hormones kind of learned exactly what the dosages were and what your hormone levels should be. I knew more about it than the GP and so like while there is probably an impulse to say that I am being reckless and that I don’t know what I’m doing. A lot of the people that I’ve spoken to inside the NHS knew less about it than me. So, yeah. I bought them, grey market on a website that I knew I could trust because so many other trans people had accessed it so many testimonies that I could be pretty safe knowing that it was a legitimate source and that people were having results. So I guess I started that in sort of 17th March 2017 I think is the official date. —

So, what is the grey market?

Grey market is basically online pharmacies that can sell you the hormones I don’t think there is any that operate in the UK. You are buying them overseas. I think, at the time, I bought mine from like France maybe. That one shut down. I started buying them from New Zealand. You just buy the drugs straight up and you don’t get any advice. You just sign a consent form then you’ve got like age verification as well and that’s what I had to go through. Other that, it’s a fairly simple process. it’s like buying anything online, really.

It was quite intimidating, at first. Again, it didn’t feel like I had a choice. I felt like my mental health would have just kept falling and falling and falling if I didn’t do this for myself. I knew if I went to a GP about it they would just tell me not to do it. And that wasn’t an option for me and so definitely like the first few months I was on it was quite like worrisome like I didn’t know. Even though I knew what the side effects were, like what to look out for. What dosages to take. What hormone levels should be. it’s still like quite a big thing and to go through that unsupported was worrisome. The further like time went along and the more I started seeing results and being like wow it’s happening. It reduced any like anxieties to sort of nil, basically. And nowadays like it’s so normal for me. I kind of like worry that by the time I actually get HRT through the NHS, it’s gonna be like lower standards of care than what I’m giving myself.

I didn’t notice anything for about a month. I know I was in the shower and I was just rubbing my shower gel over myself and that’s when my hand kind of went over a lump and my first instinct because everything you’re taught by GPs and stuff is like lumps can mean cancer or something and so I panicked. And then I realised oh, it’s underneath a nipple. That’s not cancer, that’s the first, very first stages of breast development. I was so jazzed. I was like, yes, yes, yes. Stepped out the shower and just panic. At that point, it didn’t really feel, up until that point it didn’t really feel real. You’ve just taken like a pill like you take Ibuprofen except these will radically change your body. It wasn’t that I disliked anything. I was like, yes, yes. But it was just like I knew I was now committed to a process that would last years potentially cause strife in the family, potentially lose friends. Potentially struggle just emotionally. You know, hormones don’t automatically make you pass. I had those concerns too. There was just a lot of unknowns. I think a couple of days after that I sort of settled down, even having that sort of panic moment. I still didn’t stop taking the medication. So, I think that was my body telling me, you’re on the right track.

Next thing was sort of body odour. From being like quite smelly, if I didn’t shower every single day like stinking like horrible if I didn’t shower. But then like waiting til I showered until like the next morning I didn’t have any like body odour. I was like, that’s odd. As it developed I started smelling different body odour. It was quite nice to be honest which is a big change because I used to bury myself in deodorant just to prevent any sort of smell. Obviously, I still need to shower and I still need to like use deodorant, but I no longer have that sort of sort of paranoia about smelling cos it’s different. it’s not bad. Next after that was skin started to smooth it was quite nice, but very sort of gradual. Takes like quite a long time to happen throughout your body and then like the texture changed quite a bit like evolved quite a bit over time too.

How many months are we talking?

For skin changes, I know it’s changes for at least a year starting from about the three month mark. Cos it’s so like incremental, it’s hard to know and it’s like just when it started and when it stopped. But like that’s the general timeframe. I think the body fat redistribution was next. I started noticing like small, small changes around the six month mark. The process, as a whole must have taken a year and a half, two years, I think. Again like, the thing with like transitioning, at least medically is that like with HRT is that all these changes are so like small that you can’t accurately measure like how much things have changed or like how fast. I think besides that the only thing, the only thing that hormones have done for me is breast development continuing and that takes years. Two and a half years, I was still noticing changes. I don’t notice changes so much anymore. But I just can’t say for sure if it’s stopped or not.

it’s just those things that you mentioned that changed and nothing else.

Uh hum.

Okay. Was there anything you were expecting that didn’t happen?

Mmmno. Again very well informed before I even stepped like one foot near an oestrogen tablet. So, I knew exactly what to expect and I think reading testimonials as well from other trans people meant that it’s like I tempered my expectations and I knew not to expect anything too fast on any of the results can vary quite wildly. And sometimes results can also just be dependent on hormone levels if they’re not quite right. You might not be getting the full effect there was some things that I’d hoped for, of course. But nothing necessarily unrealistic.

Were there any surprises at all?

didn’t expect breast development to happen so soon. I forgot pelvic tilt I got a lot more flexible which I totally didn’t expect that was something cos I can be very inflexible. I had had like a back injury so that I didn’t really do anything like that could strain my back. I got like, a certain example in primary school I used to sit like cross legged on the floor like in assemblies and stuff. And when I became a teenager, I couldn’t do that anymore. It was too uncomfortable. And transitioning, I was able to do it again. I don’t know whether that was because of like body fat redistribution or something to that effect. Like pelvic tilt is a thing it effects posture so my posture changed and what am I trying to say? Posture changed and yeah, I could like, I could physically feel my bones where I couldn’t before. And that wasn’t just because of body fat either because body, body fat came first. And initially I couldn’t feel anything and then like a year or so I started to feel the bones. I would occasionally get like some discomfort around my pelvis too, which I can only assume was things sort of moving a bit.

When you say body fat distribution, where does it go?

Mostly thighs, lost all the fat and muscle from my arms, basically. I mean, still a bit of flabbiness there. But yeah they’re a lot skinnier. Normally, I just have like a flat a flat sort of waistline and then just like an indent yeah, like a lot of fat round here. Butt changed to like shape of it with fat. Mostly on my legs it’s where it’s like most noticeable. I think that’s it.

Were those happy changes?

Yes. I liked em all.

I think short term, at least know what the process is like up to date like I said, my own experience with the GP was like an old system where like a psychiatrist appointment was mandated. That’s not required anymore. Wasn’t required when I originally asked him for that referral. So just being up to date on what the process is for our current system is like the baseline. If you want to go further being able to prescribe bridging hormones would be great and not that complicated. Again, it’s treated as a specialised field, but you could get a very good knowledge on the subject with a few hours of reading you probably already have access to those if you are working in the NHS as a GP.

I think affirming people when they do come to you come out as trans is great. Even something as simple as like asking pronouns can show that you are on board and you are supportive I think a lot of trans people might be hesitant to go into full detail or reveal some things about themselves if they don’t feel that the GP is going to be on board.

I think blood tests need to be provided without any pushback or resistance just a matter of care and safety. it’s my understanding that things like voice therapy and ways of hair removal can be offered at a GP level. Correct me if I’m wrong but if the person asks for that and providing it can help smooth over the waiting times for GICs. Learning about sort of what local LGBT groups are available. As well as LGBT specialised therapists. Help provide the best care and support for the patients. Even talking to other GPs in the practice about trans healthcare like encouraging them to get involved will matter a lot in the short term at least until it’s mandated for GPs to know this stuff.

I’d love to see informed consent. They do it in America and it works.

Could you describe what that is? What you understand that to be?

You basically sign a consent form after having a talk with your doctor about what the treatment is. What the effects are. Any like additional concerns particularly felt like something like being trans would be how you get treated differently, socially and stuff if you were to go on HRT. it’s mostly just discussing what the care entails and then saying, do you want to go forward with this?

The thing about informed consent is that you know it doesn’t have to be the only thing. If you’re not sure that you should still be able to have the option of being referred to specialised therapist or getting some kind of assessment and informed consent usually doesn’t involve surgery at least major surgery like GRS so you’d still have the GICs for that purpose, but because the like hormones and basic level stuff could be handled by the GP through informed consent you could cut the waiting lists down by half or more, cos like so many people that are accessing GICs just for hormones and stuff.

My first experience with voice therapy was just learning about it on the internet through forums, a lot of self-help stuff because specialists are few and far between I was quite frustrated with it though because again, a lot of conflicting information and some, some stuff that sort of had a perspective on voice therapy kind of seems even harmful, maybe, like there is definitely ways you can practice on your voice that will damage it if you’re not doing it properly. I originally didn’t work on it because I didn’t have too intense dysphoria surrounding it. That only sort of ramped up as I started to progress on hormones started to look more and more as a woman and then it was my voice that was letting me down and not my appearance. My first like official experience with voice therapy was through a local LGBT group. They referred me to a specialist. It was just to try out like free trial appointments. And it was a group one and so there was a bunch of four people there.

I wasn’t too crazy about it cos they had like a particular approach that was sort of quirky, I guess. Kind of had to do these weird body movements as you made sounds. You weren’t just practising with your voice. You did all these weird movements. I think that was just like her way of getting people engaged, but it didn’t vibe with me too well. So, I didn’t go back. I mean, to get any more I would have had to pay anyway. But I didn’t wanna go back. So, I bought a book online it’s a very boring title. I’ve forgotten what it is now. It’s like, Transgender Voice Therapy. But it’s written by like NHS practitioners. It’s quite good. It’s got like a ton of different exercises in it. I would just practice doing them every day for about like twenty minutes. Yeah, I think the hardest part of my voice therapy was just keeping a routine, keep going back to it. I did it for about 6 months. And eventually just got burned out because of work and stuff. And not having any privacy as well. Can be weird to do all these sounds and stuff where you’re in within earshot of other people. And then, after that I just tried to incorporate what I had learned into my sort of everyday voice and how I sound now is like about a year and a half’s worth of just practising outside of that routine. Obviously, not perfect but it’s a lot better from where I started from.

Did you notice it helping?

When I first, when I first recorded myself and sounded feminine it was quite exciting. I was really happy about that. It was, of course, only something I could achieve speaking very carefully into a microphone after having practiced it like 100 times. It still felt great to reach that point. At the point I’m at now. I’m able to pass at least vocally in very, very short conversations. The longer I talk, the more my voice cracks and breaks. If I don’t have a clear throat or I’m dehydrated that can effect my voice too. it’s still quite temperamental. But again it’s like I’ve come a long way in terms of my voice. I have like a fairly deep voice. I kept getting mistaken on the phone like before I transitioned for like a 40 year old man. So, yeah. Thumbs up [Laughs].

What tips would you give to people?

Definitely keep a glass of water with you while you are practising. Generally if you find your voice’s like breaking off, you can just stop like swallow if you need to and if you just need to clear your throat or take a sip of a drink that can like reset yourself. Like it’s generally better to if you find yourself like falling off and not being able to like maintain something, you can just stop, take a break, start again. it’s a lot better than just forcing trying to like brute force it. Start small, basically, like you mentioned before about humming exercises and like humming can start from like very deep hums and slowly bring yourself up like you don’t have start like super high. I think a lot of the advice that I’ve taken in has been about understanding where sound comes from and just getting a feel for your own body. I think most particularly and I mean I talk from a trans woman’s perspective. When you are talking in a masculine way without any prior voice training. You voice tends to come from here and put your hand on your chest you will hear like a lot of vibrations when you talk. Sort of the aim is to bring that up and so you will start hearing it from here and like here. At least that’s the sort of like end goal. There’s obviously a lot more that goes into your voice than that. I think a lot of trans people tend to focus a lot on pitch and that by itself won’t make a feminine voice. I think a lot of trans people also try and look for shortcuts. One of those is like a larynx, I’m saying that trick where you sort of like lift up your larynx and you’ll suddenly sound feminine and that’s not really the case. If you try and brute force movement there it can be quite painful and it can damage your voice. I don’t think it damages it permanently, but you can cause yourself to have like a sore throat for a week just by doing that. it’s so unnecessary when you have all these other ways to practice. I was gonna say something, but I’ve forgotten. Another one of these shortcuts is surgery. When I went to the trial voice therapy with the local LGBT Centre there was quite a lot of people there who expressed an interest in surgery. But prior to doing any voice therapy, I think this is a bit brash obviously your body, your choice, but surgery is quite invasive and you might not necessarily get the results you want. It can even have complications that can set you even further back. And most of these trans women can get a feminine voice just through practice. Even if you think you’ve got like a voice that’s too deep to be feminine or you think like your starting point is so low to the ground you can still get there. You might even get there faster than other people. Like once you know the process and how to practice, you start to understand just what your voice can do.