Pronouns: She / Her
Shash is a trans woman. Her family did not respond well to her coming out as trans which she says contributed to poor mental health. She started her transition in 2016 which began with feminising her appearance and using she/her pronouns. At this time she was homeless and sofa surfin but found accommodation at her university although struggled with her finances.
Shash chose to self-medicate with feminising hormones due to long waiting times for NHS care. She feels lucky to have a good knowledge of medicine which has helped her with this and navigate the risks. However, her care has now been taken over by an NHS gender service. The first changes such as breast development began at about 3 to 6 months but other changes such as fat redistribution took a lot longer. She says it’s only been 18 months, like there’s still a lot more changes to com.
Shash views transition as on ongoing process, not something that can be finished and health practitioners need to view it as such. She has been very active with LGBT groups, in particular creating safe spaces for other LGBT people of colour. She says it is crucial to check that what you are doing is intersectional and taking into consideration the most marginalised in the community.
Shash says the media is not great wish we had more trans writers and reporters rather than cis people writing about our experiences
She would like to see trans healthcare transform to a primary care focused model centring on the informed consent of trans patients. To young people she says carry on thrivin and take care of each othe whilst also reminding them that their elders will fight for yo.
The sexual health clinic Shash attended was really good. She talks about the assumptions made and how she and the healthcare team dealt with it.
Age at interview 23
I went to the like sexual health clinic and like obviously they gave me like the female form, because they read me as a female, on the day and it asked for things that aren’t relevant, you know, like, like, oh when was your last period? Have you been pregnant? And things like that where, things that I couldn’t answer because they just weren’t applicable and there was no questions about you know the fact that I had a penis, you know, like, it was an awkward thing.
But like I was fortunate in the, like and I think luckily like I went to, I went to talk to them, and they were like, Oh we’re so sorry, we don’t have like a form that, so, I’ll give you both, both of them, so tick whatever applies and then, and they were really apologetic and like really like you know, they, they felt bad. They, they genuinely did, they didn’t want you know anyone to feel like, especially because you’re going to a sexual health clinic, it’s already an awkward situation for cis people I imagine and so like on top of that being trans as well, so yeah, like that was the essential, and like so yeah I had like the blood test or whatever and like pee in a cup I think it was, I can’t remember exactly. Yeah and then like that was it essentially, and they’d send me the results and like, You’re all clear
But there’s, I know like, I think it was weird because like technically I would have been a candidate for PrEP, like I would have been possible, like because I know in Wales I think it has started in England now as well, but Wales they have a scheme for PrEP essentially, you’re put on PrEP if you’re like bisexual, like if you’re considered like sleeping with bisexual men or something like that, I can’t remember exactly, the exact thing. But like and it applied for trans women too, and stuff like that. And there was, so technically I would have been, but like it didn’t come up because at the time I was like sleeping with a cis woman, so it wasn’t an issue. And I’ve not, I was monogamous and not seeing other people.
So, yeah but like that was something they offered and considered, so they’ve been really good I’d say here at least. They’ve been like, you know they’ve been as far as the experience no like, I didn’t feel like I was being, like they were there to you know make sure I didn’t have any STI’s and they did it, to be honest. The only complaint was really the forms and they were really apologetic about it, so I can’t really even then, it was just kind of like they weren’t, like they, they were just being their happy friendly selves, they weren’t like, Oh, you’re a trans person or anything like that. So, it was pretty good.
Shash talks about trans healthcare as lifesaving’ treatment.
Age at interview 23
I wish they understood what the like I wish they understood that trans healthcare is not a, an elective kind of treatment, or something like that, you know. It is a lifesaving and an emphasis on the lifesaving, like trans people are, like suffering from not getting the healthcare they need. And like it does cause them genuine distress, it causes, like I, like people have been traumatised from their like experiences of healthcare, and like it’s not, for so, one thing I’d say is like GP’s is to be educated and educate yourselves attend any like training that’s offered that’s around gender, gender things as general, because I know, I know it does happen, I know it’s, it can, it’s mostly optional that’s the unfortunate thing, really. it’s not really, it’s not mandated in any way, even in med school and stuff like, so do educate yourselves. Make, like, and if in doubt I guess, always make, contact like the GIC or one of the local GIC’s or like whatever, because more than, more, more often than not they are willing to help, try and help you navigate a trans patient’s care. Even though if they are like inundated by requests, at least just sending an email can’t hurt, you know.
Like and it’s not, and like, and a lot of the time trust what like, to an extent what trans people say to you because they would’ve probably learnt a lot about this in, than you have, in like your few months of med school, like wherever it’s been. You know like this is a lived experience for them. This isn’t like, this isn’t something they can just read a module on and skip, you know, or like just attend a, this is a something they’ve been going through day in day out. So when trans people tell you about like what they’re experiencing or what they need, they are not like just saying it for the kicks, you know like, that, it’s something they genuinely feel like they need. And it’s, could change their lives for the better.
And it’s and another thing is like not to conflate like gender dysphoria something with something mental health related, because that’s something that popularly happens, and it’s definitely, it’s not a mental health condition. And it’s what like, and treat it as, it’s something that needs to be treated but it isn’t something that needs to be like. Trans isn’t the illness, gender dysphoria is the illness here and gender dysphoria is what you’re treating. they’re still going to be trans at the end of the day and so making sure that they’re like one of the easiest things you can do, like even just to start with is changing their pronouns, preferred name on the system, and making sure especially for non-binary patients because I know it’s tricky whatever system they use, tends to only have a binary gender system, make sure you put the pronouns, or in the notes at least, to, and this is especially important because the amount of times, it’s not the GP’s that’ll be the transphobic people, it’s the receptionists and it’s, you don’t want to have to be going into an appointment and in a room full of patients to hear your dead name or something like that. You don’t want that. So like, you want your patients to be comfortable and one of the things you can do easily is changing the name and pronouns.
Shash wants to see a primary care model’ of trans healthcare with the eventual goal’ for all GP’s to prescribe.
Age at interview 23
Yeah so the old process was you go to your GP, and they refer you to the community mental health team, they tick you off, and then a funding negotiation basically happens, negotiation, and they say, Oh we can work, NHS Wales will fund your transition and they’ll hand over that money to NHS England, and your care will be taken care of by Charing Cross, and you’ll be put on that waiting list. Now luckily we have a, this is I’m hoping the system, like the rest of the UK will also adopt, because I do think it’s better, especially so you get referred to the Welsh Gender Service, and at the moment there’s only one clinic in [city], the hope is to expand that to different parts of Wales, and they will see you for your initial appointment, essentially. And they’ll talk like, you’ll talk to a not a psych, again there’s no actual psychiatrist or anything like that but it’s just someone who’ll like, and they are trained in the gender stuff, and stuff like that.
And there’s, and so there’s no, so your GP can directly refer you, so there’s no like middle person to like negotiate or gate-keep with, and they’ll talk to you and they’ll like they’ll ask you like what kind of care do you want. And essentially and that doesn’t matter if you’re a binary trans person or a non, or a non-binary. So if you, if you have an idea of what care you want, or if you need to be talked through that, like what they can do for you, that is something they can do. Which is much more affirming in care, especially so.
Like so the Welsh Gender Service, they don’t, they don’t they can’t refer you to surgery yet, that’s still done via Charing Cross, so but they can do everything but that. They can do a surgery sign-off, so you can get your initial signature, so they’ll like discuss your options, so they’ll be like for, obviously I’ve only experienced the AMAB trans fem route, so it’ll be like, We’ve got HRT, we’ve got we can refer you to voice therapy, we can obviously get the HRT sorted and we can also think about discussing surgery options in the later appointment when you feel comfortable, or whatever
And so yeah, and so essentially that’s basically it, and then it gets, goes to primary care, which is where it should be realistically, so they’ll be like, okay we’ve told your GP this is what you need, and so your GP will prescribe it to you and they’ll monitor your bloods and stuff, like that, so you don’t have to travel to the Welsh Gender service again and again, and they’ll be like and at the moment like, so the eventual goal of the system is that all GP’s will be able to prescribe and do it, but some GP’s still don’t feel as comfortable doing it yet.
So in the interim, I say interim, I think it may become semi-permanent to an extent, I think it has, there’s a local gender team, and so this is a gender team in each county so like regardless of where you are in Wales there will be a gender team in each county and they will do, they will do the prescriptions and if there’s no nurse that won’t do the jabs in your practice for example, they’ll also do the jabs. they’re like that’s what’s happening to me, so I’m going to the local, I’ll go to the local gender team, and that means especially for people in Wales with terrible travel links especially, like going from North to South and stuff, so if say someone gets referred from the North to the Welsh Gender Service, they may have their initial appointment in [city], but the rest of it will be communicated through the local gender team. So, they’ll just have to see them instead of having to travel.
Which it makes sense to do it in a primary care model, and that’s the hope that like, we’re trying to set the standard and we’re trying, I’m in, helping with talk with people like I’m actively been talking with the government and well the group I’m part of, and like we were involved in putting, getting that statement put out by the Welsh government. And we’re hoping, one of the aims for these future meetings too is to expand the service to under 18’s, because at the moment Wales also doesn’t have an under 18 service. They still have to be referred to Tavistock and go through that route. And we’re hoping to make, essentially give what we’ve got the primary care model we’ve got now, and essentially do it for under 18’s too.
Shash talks about how her attraction and libido has changed as she has gone through her transition.
Age at interview 23
I feel like now especially during like during transition like what, what counts as intimacy has changed. I feel as well, like I feel as more assured of like, not just, I’m not like talking just about HRT either like, genuinely like because I’ve started feeling more like myself I feel like the bar for what I feel as intimacy goes higher because I feel like I value myself more, and I want my partner to value me more as well. So that bar for intimacy goes higher, so like I started moving away from casual like hook ups I guess to more like relationships, I guess. And more like trying to find, and it made me like genuinely think about bettering myself in the hopes of like finding a partner, in a way, you know like and, it’s, like I knew I was definitely someone who wanted a partner, I wasn’t asexual, like even though my sex drive went down, I wasn’t like asexual or a-romantic at the end of it, like I still had a sex drive, and still wanted to be intimate, and have like a relationship with someone, so like, but it became a point where like I was genuinely looking for something that would last, instead of just a hook-up I guess, and that was, I think partially like not, and I like, I don’t want to actuate all to HRT because I feel like it wasn’t all HRT. I genuinely think it was the act, like the concept of transitioning, being a better self, better version of myself, more my authentic self, that led me to that point where I’m confident in belong, like I could feel like I could be with someone, if that makes sense.
Like I could genuinely picture it in my head like a, I could, I wanted, I want to like have that kind of life, like a partnership and that kind of thing, and that’s yeah, and like I noticed like I was looking, the things I looked for in attraction was very different now, like it was like well just, like things like the way that people hold themselves, the way they talk about themselves, or the way they speak, or so like if they were very like, if someone would talk about themselves in a more self-involved way that like, that made have used to been not much of an issue for me in the past, but now it’s kind of like it almost became like, oh, not, not something I’m particularly interested, or like depending on how they interact with other people and stuff, like I’d start a, like feeling more in tune with myself and then being unintentionally more in tune with looking at how other, like if I’m looking at a potential partner, if I’m talking and I’m like analysing them I guess, is the best way to be about it, yeah.
Shash describes the impact of COVID-19 on gender services they had to put a pause on things’ but were still trying to do video call appointments.
Age at interview 23
So, it’s at the moment it’s about the same as Charing Cross, which is about twenty, twenty-six months I want to say, something like round about two years. The hope is that it will ramp up, the issue was obviously Covid happened, so they were going to start ramping it up before the lockdown and stuff happened, obviously they had to kind of put a pause on things to get, because figuring out what’s gonna happen, so they’ve kind of figured out to, like they’d, things have started to get opened up and get rolling again, but also they were still trying to do appointments they could, so those were through Zoom, like Zoom appointments and stuff like that, so they were still trying to see people.
I’m, like I’m happy to say like the people who are working in the Gender Service do really care about their patients, and do really want to see, like I, are actively trying to make it better for their patients, their care and stuff so like they feel like there’s trans people working in the service too, and stuff like that. So it’s, like it’s lovely to see and like having seen it, so like yeah, the hope is that eventually it’ll ramp up and the waiting list will get smaller. Because like this was, there was like, this is, this service has been in the talks for like years, like, and I mean years. Like I’ve not been, like I’m like I’ve been involved but nowhere near the one of the people, like it’s been two decades at least, and talking to the, some, some of the trans people involved in the fighting of this, for this, it’s like, it was a slow process and the hope is that like now that we’ve shown to an extent that this is working, and it’s benefitting trans people, that we can get more things moving essentially.
Shash describes the physical and emotional changes she experienced with feminising hormone therapy.
Age at interview 23
To begin with I think it was, the first few changes I like, it was like head space I guess, if that makes sense. I don’t know what it was exactly, I always, I find it hard to explain but like it was like a, like a fog had lifted essentially. And I don’t know why especially, like that, I know some other people have a weird, similar experience if that makes sense, it’s like really hard to put into words but it’s like I was, whether it’s like a combination of psychological and neuro-chemical I don’t know, but there was a definite feeling of like feeling a general better mood in general, I guess. And not, and it wasn’t the same way as like something like I’ve had before, but like genuinely like I felt like I was thinking clearer, that kind of thing, and you know like I was more assured in my own body, I felt more like myself in some way. And that’s the best way I can really explain it.
And then, then skin changes was the next one, I think. That was like I was feeling like, like I used to have quite oily skin and then now it’s dry, it’s just really dry, and I used to have quite bad acne and then I’d get no break outs whatsoever, still to this day which is amazing. It makes my partner eternally jealous.
And then yeah so like yeah and then obviously there’s the sexual thing, so like I, like caught, like I wouldn’t get random erections anymore, no kind of like morning wood as it was, and then there’s no kind of like it, it would take a lot more effort to like get an erection I guess. Like it was still possible, like it’s still possible but it’s not necessarily like, Oh here’s a breeze and then there’s an erection you know. Like the, like there’s no worry of that anymore, which is genuinely the most amazing thing, cos it makes every, like just, yeah that, just the, the lack of random erections is genuinely so much, so much easier to deal with.
Yeah I think, and then like you start to, and then, and then from then on it’s like you get nipple sensitivity, and like so like I think the breast buds started to form, and then so that’s quite like, it’s not painful, but it’s very sensitive as, and then like if you bump into something it’d like physically hurt, that kind of thing. And like, so you’re essentially going through like initial stages of puberty at this point.
So like you know that would happen and then like my, like hair didn’t grow as fast, I think. Which was weird, like and like my hair was less greasy I think like I didn’t, like I genuinely, I had to condition my hair if that makes sense, like I didn’t just shampooing it wasn’t enough anymore, like I had to, like take care of it in a sense. And then my hair growth like took less time, meaning like when I shaved for example, like I’d only have to shave every other day eventually, like, so now like usually, I used to have to shave every day to get a close, close as possible shave so I’d feel less dysphoric, and then it became like oh I can shave every other day now, so I don’t feel as dysphoric and then that was quite nice.
And then yeah and then like fat redistribution, and stuff like that. Like the shape of my body started to change, and like it only really became like really apparent to me is when I tried like an old pair of jeans, like that was like men’s fitting jeans I guess, and I just couldn’t get like my, my thighs into them for some reason. And it was the weirdest like experience because like it wasn’t like I’d changed height or anything, or like changed like my weight was generally the same. You know like it wasn’t and so, it was kind of like affirming idea that it was working but also annoying cos it meant that I had to like get better fitting jeans [laughs].
Yeah that’s, and it’s quite, there’s quite a lot of orgasms feel different, that’s one of the big things I feel like, I don’t know if it’s mentioned much but it’s definitely something that I was like, I’ve had some experience with other trans women and it’s just I know a lot of like trans women have like that obviously your sex drive decreases, and I know some, some trans women who like their sexuality has changed. For me I’ve had like different, like I’ve felt differently about people now I guess, as a, the way I feel attraction is slightly different. How like I feel a bit more, like physical attraction isn’t as a, like emotional attraction is much bigger of a bar that I have to cross before I feel like genuinely intimate with someone, like and then things like yeah, I think that’s all I can think of at the moment, yeah.
Shash describes the information she has on Vaginoplasty and Orchidectomy surgeries and how she feels about them.
Age at interview 23
So for GRS, so I’m planning on getting there’s three options on the NHS at the moment, so there’s either penile inversion, or something like I can’t remember what’s, it’s like a superficial vagina, vaginoplasty where it’s there’s no actual depth, it’s just, it looks like a vagina and it doesn’t really work like one, but it looks like it, for all intents, or, and or orchidectomy which is just the removal of the testicles, and I’ll be going for that one, purely because I don’t if I was to get something like a vagina I don’t want penile inversion. So that’s the only thing they offer. So, I thought go with this at least, and that means I could stay off blockers, I don’t need to take blockers anymore. I don’t think I have to take oestrogen just make life a little bit easier in general.
Shash says, I don’t think I’ve ever spoken to anyone who’s been able to separate their trauma.
Age at interview 23
it’s hard, like, I don’t think I’ve ever spoken to anyone who’s been able to separate their trauma like that, like ever. Like I don’t think it’s possible. Like I can’t separate any of my trauma, like, the, so like if even just from symptoms, like and not even like thinking, like my symptoms don’t manifest in a way where it’s specifically linked to each specific trauma, traumatic event, like that’s not how it works.
And so like, it was, it’s that kind of like understanding, like that even like trauma itself and like even like, or anything like mental health like, it can be intertwined in, like it’s all enmeshed together, and like for, for like cis doctors like to be like, Oh you can separate it like this, or this, and it feels just, I don’t know, it does, it doesn’t seem right even from like just as, like if, just thinking about it doesn’t, doesn’t feel right to like separate them like that, because like who thinks in that kind of block fashion, like about themselves?
Like who thinks about their life events in a, like when it comes to, especially trauma or anything, or like a depression or anything, who thinks about their like events in like a linear fashion? You know like there’s issues of like things jumping back to each other, and like the way we think and like everything is, I know they’re taught this in school, like I know, like I’ve been there, like I, I know this is the, this is what they teach you, like they tell you that the things are a mess, and nothing’s like separate like that neurologically, and so and so like and, the way we think, we, the way we process memories and stuff, so it’s just, it baffles me that like they can say this to your face like and say like, Oh yeah, well you need to finish your transition or, You need to only talk about this specific thing and it’s just like, how? How can you like say that with, with confidence? Like how can you like say with, like put, your like education and like what you’ve worked towards behind you and say that with a 100% confidence, when it’s just flat out wrong?
Shash talks about the stigma associated with the Hijra community and how it has affected her.
Age at interview 23
I mean like growing up, and stuff like obviously I’m from India so a lot of the time the Hijra Community and that kind of, like there’s a slur that that they use in Tamil which is ombothu, which literally means the number nine, and it’s like it’s meant, it’s meant to be demeaning and derogatory and like showing like, and it’s specifically for AMAB trans folk who present trans feminine. And it’s, yeah and there there’s a lot of like stigma associated and there’s, because in India a lot of those, a lot of trans people live in poverty, like extreme poverty, and obviously for like even a man there’s a worry that like you know I’d end up in that kind of situation, my biggest worry was also in India at the time when I was trapped, like if I came out like where would I go? Cos there was no real, like I know the UK support’s not great either, but like in comparison it’s miles better. Like there’s no legal, real legal protection until recently and you know like there’s just, it was scarier, like the only idea of trans people existing I had in India at the time, was like you know trans people in poverty. So that was just a genuinely frightening thing.
And then, yeah, and like a lot of the time it’d be like obviously exposure to trans people in general in media and stuff was always kind of negative or the butt of a joke, even in, and I know that, it wasn’t like I was just consuming Western media either, I was also consuming the media from like, from mother tongue and that stuff. So even then it’d be played off as a joke and stuff like that.
And so yeah it was just, it was tricky and that was one of the biggest worries I had, like coming out, was like I’d be seen as a joke, or a caricature of like, well just I’d be seen as like a mockery of the, of a woman I guess. And that was just kind of like, it was demoralising, it was a large part of the reason like I struggled so much to tell my family, and I struggled so much to even like think about transitioning, because there was such a road block of, what if I’d look hideous I guess, like you know, and it sounds weirdly superficial, but in, it really did mean like, I meant like I don’t want to, like I, I didn’t want to hate myself more than I already did, if that makes sense, like, you know. And that’s just like, like you become accustomed and you’d be like oh yeah, I can get by with this, with this body and look, I guess, for now.
Shash says [self-medding] worked well for me [but] I would not recommend it unless it’s the last option.
Age at interview 23
it’s worked well for me. I would not recommend it unless it’s, like literally the last, last option, because there is not, I’m, I’ve made the effort to try and research and do all this kind of stuff, but it’s not something that’s, I think it’s also kind of something to acknowledge that most people who do self-med that I know of, so far, and this is, there’s not really much data on it because obviously people feel tricky about self-medding in general. So those people who do self-med do seem to be a bit knowledgeable about what they’re doing.
And so that’s been pretty good. What I do think is like it’s definitely easier for AMAB people to self-med, due to test, due to oestrogen not being a controlled substance. I’ve, I know a lot of AFAB people who want to take testosterone to you know transition, struggle and wanting to self-med, and it’s just like it’s just, I can’t recommend it in any way, like even as a last option because I, well I wouldn’t be like, obviously they’d have to do the research because I wouldn’t, like and one other thing I tell people when they self-med or if they are thinking of self-medding is you are on your own, you can’t rely on your doctor, or me, or anyone else. You are, that’s what it means, self-medding, you are taking care, an agency of your own care, and that comes with risks, and so full well understand that like you are like largely on your own.
And one thing I do to say about people who are self-medding, do tell your GP regardless, the, they, one thing your GP will say, what your GP will probably say is please try and stop. And if you’re lucky they might bridge you, but don’t expect it. don’t expect bridging to happen, or anything like, or if you’re lucky the monitoring may happen, might not. But why I’m saying like to tell the GP is because it’s like similar with drug use or anything like that like recreational drug use, telling your GP is important because they’re not cops, they’re not going to take it away from you, or call anyone on you. they’re there to take care of you, and so if something does go wrong, in the event like something does go wrong and that you end up in hospital, they at least have an idea of what’s happened to you, so they can help. Cos that’s the first thing the doctors will ask for is your GP records, if they can get it, and then if that’s on somewhere on record, it could help you in the end. And so don’t, always tell your GP.
Another thing, like self-medding is like there is resources out there and it is it definitely much more reliable and easier for as I said AMAB people, due to the availability of oestrogen, the availability of anti-androgens which is the drugs that block testosterone, so it is so yeah, and like there’s always the, one thing I’d say is like I guess, if you see something marketed on Amazon, or like eBay, or anything like, like that seems sket, like seems somewhat sketchy, and doesn’t have the relevant drug in the title, and you can’t find it on like BNF or Drugs.com or something like that, that is most definitely not HRT. That is most definitely some, something that’s probably just herbal crap or something, at worst it’s something that’s vitamins or something at best, even. At worst it’s something like St. John’s Wort or some herbal remedy which can seriously interact with medication you’re already taking, which is scary.
So yeah like yeah self-medding, it’s something like I’ve had people approach me about in the sense of like they are considering it, and I’ll be like, I can’t tell you what to get or do, I can tell you what I’ve done, I will provide you resources so that you can do it safely as possible, but at the end of the day you’re on your own. And like I, it’s, it seems cruel to like wash my hands of that kind of responsibility, but at the end of the day I’m not a doctor, I’m not an endocrinologist, I’m just someone who’s done it themselves, and it’s something I always tell like people like, you, this isn’t something that’s, you can do on a whim. Or expect any help for, really.
Shash describes buying clothes, getting her hair cut and changing her name and pronouns.
Age at interview 23
The first few steps was like I guess from like from like aesthetic stand point I guess it was kind of like a bra was the most important step I guess, because it was just kind of like well, even though I didn’t have boobs the idea of boobs existing was an affirming thing I guess, and then it’s just and like growing out my hair and kind of things, and so I’d have like really bad, like I’d like my family would always tell me to go and get my hair cut, and that became a huge source of issues with my family, so like I was always meant to get my, keep my hair short regardless. I wasn’t allowed to grow it out in any way. So that became a huge source of contention. So like I’d get extremely dysphoric and extremely anxious about going to any barber because I feel like regardless of what they did to my hair, like it’s still going to be short so it was, I’d just kind of shut down at that point.
So yeah, like growing my hair out, and like wearing some form of like bra or something like that, made it look like I had breasts, and then things like when I was socially transitioning I guess a lot, a lot of was just like using pronouns and referring to me with like you know feminine descriptors, like not using the words like dude or that kind of thing.
And like it’s a tricky line in the sense of when those words are acceptable to me, I guess. Like it’s dependent with friends and stuff, and like, I, because I still use, I grew up using the word dude, with my friends I guess, and it just kind of like, and I know for some people it becomes, it’s not particular thing, so I’m always careful of when I use it, but like I don’t mind it when it’s my friends using it to me, whereas if it’s like you know because we know each other and they know me, and there’s no doubt of them not knowing me as like a woman or anything like there’s no, like when they say it, it’s not like, I think it’s a strange thing that language is, although the meaning of language and words and stuff depends upon the person that it’s coming from.
So yeah, a large part of it was like yeah trying to you know get people to use my pronouns and stuff, and then I did like you know trying to get the gender markers changed and stuff like that, eventually, yeah, you know like hoping to apply for a GRC at some point, so even though like I was hoping the GRA reform would be through by now, but that’s obviously not happening for the near future so, so looking into applying via the old process, if possible. And even that’s frightening.
And I like, I know that’s, that in itself is a privilege for me because like they acknowledge my gender, you know that’s, then like I know I’ve got a lot of my non-binary friends, they were hoping to be legally recognised, that’s kind of just disappointing, yeah.
Shash gives her advice to teachers, educate yourself on trans issues [and be] affirming.
Age at interview 23
When teachers and education staff oh, it’s, I mean I don’t know how, I mean I haven’t been in school for a while, so heaven knows how it is right now, but as far as I can say it’s just, make sure you use the pronouns and their preferred name when a kid says, do not disclose they’re trans, or sexuality, anything like that’s personal to them to their parents, because it’s illegal, it’s, would put them in risk, in possible danger. So it’s a safeguarding thing.
Another thing is just when, like especially for trans kids and stuff a teacher is sometimes the only form of like the only person they can talk to about things, and be, be ready to like signpost them if you can, if you’re not able to talk about some things or like treat them like they’re not wrong to be thinking the way they are, if that makes sense. Like they, like give them space, encourage them to like find people like them, I guess, if that make sense, like because the one of the most things that can be in school especially is that it can be so isolating when you’re like different from everyone else. And helping them find other people just like them, whether that be in staff or other pupils, if possible. It could make a world of difference for that kid.
And especially like, even if you don’t believe that, even if you don’t believe in trans, trans people or whatever, but like even if they’re hanging out with other trans people, like it means they do better in your class, surely that’s enough? Like if they will be a healthier and happier person, and as a teacher you should want that, and like, so trying to educate yourself on trans issues and being affirming and reject any of that Transgender Trend nonsense that you might get in the post or whatever, just get, get rid of that listen to trans people.
Shash describes the racism in medical training a lot of [people of colour] learn to hide pain.
Age at interview 23
Yeah, I think medical racism, especially, I think one could possibly put more emphasis on that in a way, especially with the way of our current culture, but like it is a genuine thing like, like you know these archaic text books as well, that kind of thing, but also just the understanding of like that there is differences in the sense of what ethnicity means, and like risk factors and stuff like that.
But there’s also like things which are just not true or like, and it’s kind of it’s tricky especially, like I just, especially like there’s the issue of like I haven’t really experienced it myself but I know other PoC women have, and it’s kind of like where their pain is not taken as seriously and it’s a serious issue of like I can’t, oh, it’s happen, it happens in America, or there’s so many documented cases now, but like it happens here too.
But like I said, like a cis black woman will go into a surgery or something and they’ll, she’ll say like I’m having crippling like abdominal pain or something like that and they’ll be like, Oh it’s just your period but, and then it’ll be like they’ll go home and then it’ll still continue, days and it’s like well the doctor said it was my period so I’ve got to, like what else am I going to do at this point? And like it’ll turn out to be something very serious, and it’s kind of like, it’s taking that pain seriously I guess, and like really asking about what, what issues, like what, what, like taking to an extent, because there is like a, and it’s partially due to how, like society works on the fence of, because we live in a society that benefits white people. It just is.
And so a lot of PoC learn to hide pain, if that makes sense. They learn to like minimise the pain they’re feeling. So, a lot of the time it is kind of understanding about like when they’re saying they’re in pain, they are in pain. Because a lot of the time like, so I think it’s, the thing that best explains it, trying to explain this is like white people will, if they get ill with just almost anything, a lot of the time they will just rush to the doctor, like straight up, and that’s because they feel comfortable and confident doing so.
But whereas PoC on the other hand tend not to, and that’s pure, that’s due to like the issues of racism and and it’s because it’s become a weird cycle. And it’s kind, to kind of break that cycle essentially is like for doctors to understand and, like empathise with us that, and also kind of like just like take the kind of pain seriously, and stuff like that. Like I know I’ve been bad for it, I’ve minimised my own pain, even though like I should go to the doctor for something, like you know, and I’m terrible for it in the sense of like I’ll tell other people to go to the doctor for it, but when it comes to myself I’ll minimise it for myself because like I don’t want to put, I don’t want to be a burden essentially, that’s the issue, and like a lot of, it’s kind of an entrenched kind of, well I don’t know, maybe it’s a thing within, I guess it is, it is a thing within like PoC communities where like the sense of being a burden is an, a worry, especially on like, because like on your family or something. Like you don’t want to add more cost or anything like that, or like cause more issues and that’s, that’s the thing that you kind of want to avoid.
But yeah medical racism is something that’s, needs to be taken seriously, especially when it’s, especially now, with not only the Black Lives Matter’ movement, but also Covid, it’s terrible. it’s like so many of like the front, like we don’t know quite why, we know to an extent, but obviously studies are gonna be, there’s still going to be ongoing way after this but like as preliminary stuff shows that like BAME people are more effected by Covid, and the theory is that it’s because that BAME people seem more expendable as front line workers, and I really hope that isn’t the case, but it seems more and more likely. But I also want to like people to understand, especially with the word BAME, because that’s the way that it’s, that they using an acronym, and it’s like, the, it means, it’s a meaningless word in medicine really, it really is, because like in medicine, like BAME covers too many ethnicities for it to actually matter.
Like it’s not, like we talked about it on the panel but something like DVT affects people with more melanin differently to from people with less, you know like and so it is very much like a complete useless word in term of medicine, so when people like, so like yeah it’s, and want like skin conditions and things appear differently on like and people like it’s a common, a common thing that PoC people will minimise, like heart attacks, like pain from heart attacks. And say that it’s like less, and like you know and that can cause a risk factor. So it’s like trying to, it’s a hard, it’s a hard thing, especially for something like pain, to understand that like it is, because it is very subjective in a sense, but like it’s too, it’s trying to make it a bit more relatable to your own pain scale, if that makes sense. And try and say like, when we’re doing like the one to ten pain scale, like when, when you say like, Oh ten is like crippling pain,’ is the same kind of crippling pain that they’re feeling in a way, like is that what they mean? But yeah, that’s about it really.
Shash says that finding a good GP is one of the hardest things.
Age at interview 23
So the initial time I tried to get referred actually, to the GIC was in [city], I went to, and this was my GP, this has been my GP since as far as I can remember, and they, like even though we moved around [city] and technically out of the catchment area with like my family and stuff, we still stayed registered to this GP because you know it was a family doctor, kind of thing. Like a genuine, it felt like you know in the traditional sense, you know like , and so like I went to him and he, he’d said, I didn’t know much of what the process was at all, so I tried talking to him like, and this is when I initially just came back from [country] and stuff, and like I told him I was like, Oh I’ll need to see or We’ll need to get you to see a psychologist is what he said, I think, or a psychiatrist. I can’t remember, I always get the two mixed up and confused.
And so yeah, and so he said that, and I didn’t hear from him at all, no contact. He had like my phone number and stuff and no he could have, but no referral information or anything like that. So I just left it, I was too, I was too busy dealing with other things to catch up or chase up, but like then obviously I realised like, oh wait a minute, he shouldn’t have done that, he should have just referred me to the GIC, there was no, he was gatekeeping me. So like that was kind of demoralising, like obviously I was in [country] by this time, so I wasn’t exactly going to go back to him as a GP.
But and I did get registered for a GP I kind of, I kind of did something a little bit cheeky I guess, is kind of like I made sure to like, so I’d book an appointment and look up the GP’s name and stuff, because obviously there’s several GP’s in a practice usually, and so I’d like, I’d kind of like make a mental note of everything that goes on this appointment and feel like okay this GP like, and I think at this point I was kind of self-medding, and it was kind of, the aim was to try and get bloods monitored, and like a referral in place. It was tricky, so this, this, the first one I had was like, she put my referral through, I think.
Again it was very touchy about it because the, a lot of people are awkward about it for some reason, and like GP’s in general, I’m just like I’m trying to tell you the process here, like I’m mapping it out for you and I was still trying to, so like, I was okay, this, I’ll cross this GP off, essentially off the list, and I went to a different one. And eventually I found one at my practice, she was lovely, and she’s continued to be lovely, and she’s actively like looked out for like my care and stuff, and like, so it has been that kind of trying to find like a trans friendly GP to an extent.
And like I know that’s an experience for a lot of people, and in fact I, it’s got, like we on our mutual aid group like we run a cart, like a transwales.card.co kind of thing, which is like, it’s currently broken but we have a map on there saying look, which GP’s are trans friendly and that kind of thing, because like you know a large part, like it’s something like I’m even considering telling people to like, when they move or like change, their lease ends up and they’re moving, try to move to a catchment area of a GP that is trans friendly because it would make sense for you, in the long run, but also, and like it’ll just make your lives just easier to deal with, like we don’t have to fight every step of the way if we can find a GP that will help you.
And so yeah like, and luckily like she’s been very good. Like even though like, and this is like even though I was self-medding she didn’t obviously, she didn’t prescribe me bridging hormones, but she was willing to monitor me and keep an eye on my like levels I guess in, in the sense of she’ll give me the blood test reports and I will deal with it in my own time, because again she can’t say anything, and for fear of like her losing her license and stuff. And I understand that, like it’s not, she’s not an endocrinologist, I’m not expecting like her to know and like me doing, I know, me and my own knowledge is a completely different thing.
But yeah so, yeah like finding a good GP is one of the hardest things I guess, in a, like trans health. Because so much of your care goes through your GP and just, and like it’s, it’s very obvious to find like, if you find a trans friendly GP most likely it’s been, they’re not just trans friendly, they are just friendly in all kinds, like they will be less stigmatised against mental health and stuff like that, so you more openly discuss it with them, and they’ll be take, like I, I’ve had people talk about like just not even, they’re not trans but they’ll talk about their mental health and be like, Yeah they just put me on meds, and shooed me away kind of thing, like you know, or like, They haven’t taken me seriously or anything like that. And it’s just, yeah so like finding a good GP can really change, especially like when it comes to like trans healthcare, it can make a big difference.