#birthing center NH

[birthcottage]

Midwives Center In NH

At Birth Cottage, our midwives center in NH is dedicated to providing experienced and compassionate care for your pregnancy and birth journey. Our team of experts understands the significance of this special time in your life and is committed to ensuring a safe and healthy birth experience for you and your baby. We offer personalized care plans that are tailored to your unique needs and preferences, encompassing comprehensive prenatal care, labor support, and postpartum care. With our guidance and expertise, you can trust us to provide excellent outcomes and support for you and your growing family. We are here to listen, educate, and empower you throughout this transformative journey.

[dayseternal-blog]

Summary: The folktale of the Japanese summer festival Tanabata, the story of Orihime’s and Hikoboshi’s love.

Rated M.

Finally updated after 4.5 years for NaruHina Fair, NH Month 2023 Day 8: World Mythology 💝

"The Cowherd and the Weaver Girl" - Chapter 4: With well wishes and prayers

It was gut-wrenching.  

He thought that he was already at his worst, at his lowest point, but it didn’t compare to when he heard that Hinata was pregnant.

In fact, really pregnant.  It was the talk of the celestial realm.  Everyone looked at him with pity.  

Each look his way reminded him of his failures.  He lost his wife.  And now he would never be a father to his child, to his rumored son.

To his children. 

When he heard that Hinata had given birth to twins, his heart ached only worse, only harder for his family.  He worried incessantly for her health, wishing that he could support her, be there for her, or at least, just once, lay eyes on her and his newborns.

He overheard acquaintances and friends saying that he changed.  That he was no longer the vivacious, dependable lord he once was. 

He could hardly care less.  

There was no one he wanted to see, no one he wanted to talk to, no one he wanted to seek out for comfort and assurance more than his wife.  Anyone else would just be someone else, just another awful reminder of what he had lost.

But new hope flooded him when he got the message from Tentei to meet Orihime at the Amanogawa.  He let unchecked tears of happiness form and fall, and he rushed to the misty riverbank to wait for her.

When she appeared, he felt out-of-body, his entire existence centered on her distant figure and the precious little lives she held in her arms.  

He stood there, still, waiting in restless anticipation.  Waiting.  Waiting.  

Until it became apparent.

That was all he would ever do for her.

Hope mutated into fear. 

Then shocked denial.

Into despair.

He watched her collapse to her knees at the riverbank, and he stood there frozen, dull, his eyes the only thing burning with any sort of emotion.  The rest of him was empty, as if all else, all vitality, all motivation, had been sucked out of him.  

He would never hold her.

He would never hold his children.

He would only get to see them, their vague, small forms.  Once a year.  For one night.

The Amanogawa would forever separate them.  

He closed his burning eyes and yelled out in anguish then, but it was hardly a sound compared to the thundering of the mighty river.  He let himself fall to his knees, to forcefully express his misery into the ground with his fists.  The Heavenly Sky King was untouchable.  He had only himself to blame.  

When he finally found the desire to at least burn her distant image into his memory, he was astounded at the sight of thousands of birds gathering at the far bank.  His heart skipped, jumping to cautious hope again when he saw her step up on the backs of the birds.

-

With each step, she gained confidence, until she was running across the magpies’ bridge, desperately rushing to her lover.  

She saw the birds keeping her pace, flitting beneath and before her to extend the path to the opposite end.   

Midway, her chest burned, her legs felt numb, her arms were tired with the weight of her children, but she refused to stop.  She could see the edges of his form sharpening, the blue of his eyes brightening.  

She pressed onward until the shout of her name was clearer to her ears than her heavy gasps for air.

Naruto ran to the water’s edge.  Once the magpies appeared before him, he didn’t wait, he couldn’t wait.  

He exchanged looks with the birds, who invited him forward, and without any more hesitation, he stepped up on their backs to meet her.   

“Hinata!” He caught her exhausted form and swept her up as she clutched their children.  He kissed her, reveling in the lips he missed so much, in her tired breaths against his cheeks.

“Naruto,” she whispered, her breath on his lips a blessing.

He held her tighter, finding that even her tear-streaked face, her puffy lids, and her pink-stained eyes made a more breathtaking picture than his memories of her. 

The magpies returned them to the banks swiftly.

He set his wife down carefully, his arms never fully leaving her, his gaze never leaving his children.

Their eyes were blue, like his.  One child’s hair, golden, like his.  The other child’s a midnight blue, like Hinata’s.  

She passed them to him, and he held them close, their weight filling the holes of his heart.

“Thank you,” Hinata whispered to the magpies as they began to fly away.

He turned to the remaining ones, reminded to express his appreciation.  “Thank you,” he called, his voice still hoarse from his earlier cries.  “Is there anything I can do to repay you?”

“We wish for nothing other than your happiness and continued love.  We will be at your service,” a magpie responded.

Naruto and Hinata exchanged looks of amazement before thanking the magpies once more.

-

The morning passed swiftly in carefree play.  Their children ambled through the fields surrounding Naruto’s home, exploring nature exactly the way Hinata had imagined.  Their curious voices rang across the grasses, unchecked babbles of excitement with no one to scold them to behave and be quiet.

Hinata explained the symbolism on their children’s clothing, roadmaps of their little lives so far, and Naruto found he could trace each important milestone, from first steps to first manifestations of holiness, along his wife’s embroidery.  She spoke of their routine in the palace, the monotony of their children’s rigorous training and academics despite their young age.

“They don’t get to play?” he asked, incredulous and disturbed.

“Oh, they do, but it’s not enough…They have too much energy for the caretakers to handle, and my father…Tentei, he has me working so much, I cannot take them out of the palace often enough...”

The shadows across Naruto’s face lightened at the sound of their children’s bubbling laughter.  He picked them up, bouncing them in his arms to their absolute glee, and walked them across the field to his grazing cattle.

Hinata watched with bated breath as Naruto introduced their children to his famed herd.

Having never seen any of the heavenly beasts before, they adored their father’s cattle with wide eyes, eager petting, and affectionate hugs.  The gentle beasts allowed them to sit on their backs as they grazed and wandered around the field.

By the end of lunchtime, both children preferred their father’s strong arms and broad chest to rest against than their mother’s slight frame.  They fell asleep that way, snuggled into his body.

With ease, Naruto laid them down in his bed, and Hinata kneeled close to admire them with him.

He sighed, heart heavy with love and sorrow.  “Thank you, Hinata, for raising them so well.  They’re beautiful.  They’re perfect.  I’m sorry, I’m so sorry I couldn’t be with you all this time.”

She leaned her head against his arm, humming her disagreement.  “I’m sorry, too, Naruto-kun, that we haven’t been here with you.”

He turned to hold her better, and they kissed their tears away, murmuring how much they had missed each other and renewing their promises of devotion.  Moving to a nearby room, they gave outlet to their frustration, longing, and adoration in intimate, warm embrace.  Tracing and relearning each other’s shapes and comfort, they held and moved with each other eagerly, desperately, then tenderly.

In the remaining moments of their children’s nap, and with Hinata snuggled into his side, Naruto brought up the delicate issue he could sense was weighing on his wife’s mind.  “I’m sure you’ve considered this…would you let me have them?”

She nodded, tears already refilling her eyes despite how she had mentally prepared.  “It would be better for them.  I’ve never seen them so relaxed.”

He thumbed away the silent tears damp on her cheeks.  “You would let me take them on my journeys across the star plains?”

“I trust you.”

He pressed his forehead to hers gently, breathing her in.  “I promise to take care of them.  I’ll teach them everything I know.”

“I know you’ll take care of them,” she whispered.  “There’s so much more for them here than in the palace.”

“They won’t have you, though.  They’ll miss you.”  He looked into his wife’s eyes, the ones that had enamored him from the moment he saw her.  “I’ll miss you,” he murmured.

“Mm, I’ll miss you.  I’ll miss them.”  Her breath shook, her voice choked with suppressed tears, yet she found her thoughts tumbling out all at once.  “It will only be one year that we’ll be apart.  My father can’t break his promise.  Even if he’s angry with me, he can’t retaliate against our decision and he will have to let us reunite every year.  One year will feel like nothing after the eternity of not knowing if we’d ever get to see each other again.  So this will pass quickly, and,” she took a steadying breath, “I’ve…I’ve discussed this with our children already.”

Surprised, he watched the grief in her expression harden into determination.  “You have?”

“Yes.  I didn’t know if you would agree, but I told them your stories just in case.  I told them that they might join you on your adventures, that they would grow up to be strong and smart like you.”

“Hinata,” he breathed out, amazed and moved.  He held her close.  “I won’t let you down.  Thank you.  Thank you so much.  I love you.”

She rested her head into his chest and listened for the strong beat of his heart.  “I love you, Naruto-kun.”

-

When the twins awoke, the rest of the afternoon flew by in preparation for their journey.  Hinata held them close whenever she could for as long as she could before they wiggled out of her grasp.  She helped Naruto pack the necessary belongings.

And all too soon, the time came for her to journey back to Raira.

The magpies took the family halfway across the Amanogawa, where they shared a parting embrace.

“Listen to your father.  Be good,” she murmured to her twins, planting kisses on their cheeks and foreheads.

“Yes, Okaa-sama.”

Naruto chuckled at their diligent answer.  It was hard to imagine the children of the famed Orihime being too much for the palace caretakers when he himself as a kid couldn’t have even been bothered to give anyone such a polite response.  “We’ll be too busy and on the move for them to be naughty.”  He gave his wife a reassuring smile.

She held each of their faces, committing their matching, electric blue eyes to memory.  “I love you all.  I will see you all again very soon.”  Already, she could feel new inspiration for her art dazzle through her mind, this temporary sorrow and determined hope to be immortalized in binding thread.

“Take care, Hinata.”  Naruto found strength in Hinata’s bright gaze.  He clutched their children to his heavy heart, endlessly grateful for the living, beautiful proof of their love.  “By the time we reunite, our children will have traveled to the zenith of Northern Genbu.  They’ll be able to name all the cattles’ starhouses.”

She found herself smiling with pride and excitement even as the calls of the magpies intensified with the turning of the celestial bodies at the horizon.  She held on to her children’s hands for as long as possible before the magpies separated them, and even then, she smiled and called after them, and they did the same.

Returned to Raira, she watched as their distant forms at the opposite bank of Akira were enveloped in the thickening mist of the thunderous flow of the Amanogawa.

And not allowing herself to wallow in her self-imposed solitude, she set to work.  Weaving and embroidering, she lavished fabrics with glorious designs of her family’s tale, surrounding her workshop with prayers for their good fortune.

Impressed with her meticulous, auspicious work on display, visiting clients spread her story through the courts, and the tale of the power of Orihime and Hikoboshi’s love swept across the Symbols of the heavens into every god’s ear, down to the mortal realm below.

With the well-wishes and prayers of worshiping human maidens, young couples, and other mortal sympathizers, the skill and value of Hinata’s weaving grew, and Naruto and his children safely passed through every crossing.  Their status and fame brought prosperity to the heavens.  Tentei couldn’t punish his daughter any worse than he already had.

On the seventh day of the seventh month, magpies, more numerous than the first time, bridged the Amanogawa’s banks again.

Successfully reunited, the family rejoiced in each other’s presence and growth, and the rest of the world celebrated with them.

[religion-is-a-mental-illness]

By: Lisa Selin Davis

Published: Apr 11, 2024

A long-awaited report out this week found that medical professionals in the UK who advocate for gender transition in children are misguided ideologues.

Written by British pediatrician Dr. Hilary Cass, The Cass Review, which is nearly 400 pages and took more than four years to compile, comes to the following conclusions:

Thousands of vulnerable young people were given life-altering treatments with “no good evidence on the long-term outcomes of interventions to manage gender-related distress.” 

“It has been suggested that hormone treatment reduces the elevated risk of death by suicide in this population, but the evidence found did not support this conclusion.”

“Social justice” ideology is driving medical decision-making, and “the toxicity of the debate” has created an environment “where professionals are so afraid to openly discuss their views.”

Activists insist the science on this matter is settled, but Cass’s tone recalls a stern British nanny calmly explaining to unruly children how to get their room in order. She shows us that everything about this issue is unsettled, and unsettling. For instance, she notes that “social transition”—when very young children assume other gender identities—is an “active intervention” that may set youths on a path to medical transition. And it may even make gender dysphoria worse.

The review, commissioned by England’s National Health Service, comes after more than a decade of whistleblowing by clinicians at the country’s Gender Identity Development Services, or GIDS, which was established in 1989 (but mostly off the radar for its first 20 years, because few children and families sought its services). 

These whistleblowers detailed how kids were fast-tracked to medication while a culture of fear grew around raising any concerns, even as demand for youth gender medicine exploded. Eventually, the NHS decommissioned GIDS and hired the neutral, no-nonsense Cass to detail what went wrong and what to do right moving forward.

Her report made the further damning conclusions:

Clinicians “are unable to reliably predict which children/young people will transition successfully and which might regret or detransition at a later date.”

A disproportionate number of patients were “birth registered females presenting in adolescence. . . . a different cohort from that looked at by earlier studies.”

Many parents feared their children had been medicalized by professionals who didn’t take other difficulties into account, “such as loss of a parent, traumatic illness, diagnosis of neurodiversity, and isolation or bullying in school.”

There is a lack of strong evidence to show that puberty blockers “may improve gender dysphoria or overall mental health.”

The majority of gender-dysphoric patients in early studies found that their symptoms desisted during puberty, with most coming out as gay or bisexual later.

Cass notes that “for most young people, a medical pathway will not be the best way to manage their gender-related distress.” She supports expanding the treatment to regional, holistic centers, essentially ending the specialist gender clinic model. That treatment should be based on unbiased psychological care, and robust and consistent evaluation tools must be developed so reliable evidence can finally be gathered. 

This final report—and an interim one Cass issued in 2022—echoes what a number of Western nations, such as Finland and Sweden, have found when they reviewed their own youth gender services. It also underscores what we see in the United States: poor quality research, an unstudied population, and detransitioners traumatized by the treatment they received.

Today, red states are banning the medicalization of gender dysphoric youth, while some blue states have declared themselves medical sanctuaries for minors seeking transition. Medical associations—from the American Academy of Pediatrics to the American Psychological Association—continue to support the “affirmative” model criticized by Cass in her report. 

In her review, Cass directly addresses the 9,000 young people who have moved through gender treatments via the NHS, stating bluntly: research “has let us all down, most importantly you.” 

The U.S. needs to form a truly bipartisan commission that looks at the evidence regarding youth gender medicine. As things stand now, we will continue to be stuck in a perpetual culture war, with parents and distressed kids paying the price.

[ukrfeminism]

15 minute read

An overhaul of medical care for transgender minors is exacerbating bottlenecks in England, Reuters found, leaving thousands of patients in limbo and adding to years-long treatment delays. The crisis comes amid a broader debate on appropriate care for rising numbers of teens seeking help in Europe and the United States.

DOVER, England - On an October morning in the living room of a modest family home in this coastal town, Miles Pitcher, 17, received a message that would change his life.

It came from GenderGP, a private online health service that treats people suffering from gender dysphoria – the distress of identifying as a gender different from the one assigned at birth. The doctors had reviewed his case, the message said, and would prescribe the testosterone that would help Miles develop the facial hair, deeper voice, broader physique and other characteristics aligned with his gender identity. It would put an end to the menstrual periods he dreaded.

Miles gestured at his phone, speechless. He shook his head, and, beaming, showed the message to his mother as their pet dog Moose bounded around the room.

"Finally," he said. "Something being done."

Miles, assigned female at birth, has identified as male since he was 14. Yet until he got that message, he was stuck in limbo for three years, one of at least 8,000 young people in England and Wales waiting to receive gender care from the state-funded National Health Service (NHS) as of October, a Reuters review of NHS documents shows.

The UK government has promised to overhaul the youth gender care system, after it was deemed inadequate by England's regulator of health and social care. Some clinicians had complained that England's only state-run youth gender clinic was too quick to offer medical treatments to young people. And many families protested over the distressingly long wait for a first appointment – an average of nearly three years, a Reuters analysis of the clinic's records found.

In July, the NHS said it would close the sole clinic, known as the Tavistock, next year and replace it by spring 2023 with regional centers to better accommodate a fast-growing patient population. Its plan calls for the centers to operate under new treatment guidelines, informed by the best available medical evidence for treating transgender adolescents and the most in-depth review of care conducted by any country.

But the reality is already falling short of those ambitions, creating new delays and uncertainties, according to Reuters interviews with transgender teens and their families as well as physicians and government officials involved. They described a deeply flawed system that is now hobbled by a toxic political climate around gender care.

Young people like Miles say their only option is to turn to private providers such as GenderGP, which is registered in Singapore and thus operates beyond the supervision of the NHS. The company says under-18-year-olds make up a growing portion of its UK patient population, with about 800 youth currently on its books.

"I wish we didn't have to exist," said Dr Helen Webberley, who founded GenderGP with her husband. Both once worked for the NHS. "But we are years away from the NHS pulling themselves together on this."

The NHS's proposed new treatment guidelines were altered after they were reviewed earlier this year by a Conservative government wary of medical interventions for transgender adolescents, Reuters found. Gender clinicians say the proposals now depart from international treatment protocols, which support gender-affirming care. Pioneered more than 20 years ago in the Netherlands, such care can include everything from supporting a social transition – using a person's preferred pronouns and name – to counseling and medical interventions, including drugs that pause puberty.

The Tavistock, based in London, continues to see existing patients. But first appointments for people who have been on its waiting list since 2019 have slowed to a trickle as staffing and morale drop ahead of the closure, according to NHS data and four people involved in the reorganization. More than 1,500 young people recently referred with gender dysphoria are being kept on a separate list for the future regional centers, with no clarity on when or how they will be treated, three NHS sources told Reuters.

Once assigned to a waiting list, young people have been effectively locked out of state-provided mental health counseling and other specialist support related to their gender dysphoria, because those services were offered only through the gender care system they are waiting to join. Delaying medical treatment also means young people mature in bodies that don't align with their gender identity – changing that in later life is more difficult.

The NHS said in a statement to Reuters it is expanding healthcare services for young people with gender dysphoria in line with recommendations from the review, and working on better supporting those on the waiting list. It has previously said it "strongly discouraged" families from turning to private or unregulated providers.

"These have been an exceptionally challenging couple of years for our patients and their families, with a lot of toxicity in discussions around their care and chronic uncertainty about its future," Dr Polly Carmichael, director of the youth gender clinic at the Tavistock, said in a statement to Reuters.

The Department of Health and the Prime Minister's office declined to comment for this story.

Both sides in the polarized debate are turning to the courts: patients who say they've waited too long, and others who say the NHS moved too fast. At the end of November, transgender rights advocates challenged NHS England in the High Court over long wait times for both youths and adults seeking treatment. In 2020, a young woman who had detransitioned from being a transgender man challenged the Tavistock's use of puberty blockers in the same court.

Long wait lists are common within the NHS, but its statistics show the three-year wait for transgender youth is extreme. Most young people with a "non-urgent" eating disorder get specialist help within three months of being referred, the figures show. On average, young people seeking mental health support wait just over a month for a first appointment, according to a government analysis of NHS England data.

One mother shared with Reuters a letter she received from the NHS in February after she followed up on her daughter's October 2021 referral to determine when she might receive attention. The letter said a decision would be made at some point from early 2022 on whether the child "is likely to meet the access criteria" for gender care. She has heard nothing since and suspects her child isn't even being considered for NHS help.

"We are on a waiting list for a waiting list," said the mother, Rose, who asked to be identified by her first name only to protect her daughter's privacy.

"She basically feels suicidal every single day." The NHS declined to comment on the case.

"STOP HURTING YOURSELF"

Miles plans to study archaeology at university and is a keen rugby player. He has felt like a boy for as long as he can remember, but recalls a moment of delight at the start of a new school year when he was around 9.

The teachers were handing out colored notebooks and lanyards based on gender: blue with wizards and astronauts for boys, pink for girls. He was given blue books – "and wizards and astronauts over everything," he said.

"It was not like 'I'm trans,' but just this amazing sense of joy within myself, 'This feels amazing, and I don't know why.'"

By age 11, as puberty began, Miles entered an all-girls' secondary school. He was bullied by classmates for not wearing a bra or conforming to female norms. To fit in, he tried to be ultra-feminine, wearing skirts and make-up, having his eyebrows threaded, wearing false nails.

"My mood really dropped," he said. After about a year, "I realized, I can't do this anymore. I hate this." Miles was barely leaving his room. He began cutting himself, over a period of four or five months. "In my mind, it was just easier to deal with physical pain than mental pain."

His mother, Connie Pitcher, noticed the regular, precise lines on his arms. When she asked why he was distressed, Miles said he was struggling to understand his sexuality.

"I said, 'I don't care if you're gay, straight, or whatever – I just want you to stop hurting yourself,'" Connie said. The family considered seeking mental health help, but worried about long waiting lists.

"We saw him really, really dip," she said. "We were struggling with what to do. Because there is really no support."

The World Health Organization, which informs health policy worldwide, does not have detailed guidelines for this area of healthcare for youth. It says it works closely with the World Professional Association for Transgender Health (WPATH), a U.S.-based non-profit that has drawn up the most widely adopted standards of care.

These say a young person's exploration of gender should be respected and supported, and that medical interventions for young people at or after puberty should be one option, after a comprehensive assessment.

Research from the Netherlands paved the way for that medical treatment, establishing a model requiring adolescents who sought care to be assessed for about six to 18 months. If they had persistently expressed gender dysphoria since early childhood, lived in supportive homes, and had no other complicating mental health diagnoses, they could be offered puberty suppression, followed by hormones, and later, in some cases, surgery.

Since then, the number of young people seeking gender care has surged in parts of Europe and the United States, supported by greater awareness and the availability of professional treatment. They continue to face threats of violence and discrimination, as well as political efforts in some countries to block that care.

At the same time, some gender-care professionals have questioned the lack of definitive evidence on the long-term impact of puberty blockers or hormones on minors. Puberty blockers are not licensed in the United Kingdom or United States for treating gender dysphoria and the NHS says it is not known how they may affect brain development or long-term bone health in young people. Hormones, only available for older adolescents, cause potentially irreversible changes such as a deeper voice, and can cause infertility. Other changes, including breast development, are reversible only with surgery.

Those professionals are also concerned that as the number of pediatric patients has surged, so has the number of youth whose main source of distress may not be persistent gender dysphoria. Some may have mental health problems that complicate their cases.

"THE WRONG TREATMENT"

While not all English youths with diverse gender identities seek medical help, for those who do, a doctor or professionals including social workers or teachers are the first port of call. Any one of them can refer a youth for gender care, which so far has only come through the Tavistock – formally known as the Gender Identity Development Service, or GIDS – run by the Tavistock and Portman NHS Foundation Trust.

The clinic became a focal point for opponents of youth gender care in the UK in 2018 when an internal report compiled by Dr David Bell, a former senior psychiatrist and staff representative at the Tavistock, was leaked to national media. Bell, who did not treat young people, cited accounts from 10 unidentified colleagues who were working with transgender youth and came to him with concerns, including that some patients were "rushed through" to medical treatment without proper evaluation when they finally got an appointment.

"It was not just the wait," Bell told Reuters. "It was also a wait for the wrong treatment."

Bell now advocates against starting a gender transition before adulthood. He is at the fore of a group of mental health professionals who argue that accepting a child's new gender identity without exploring other underlying issues is clinically irresponsible, and puts them on a track to potentially irreversible changes that they may later regret.

The Tavistock has consistently defended its methods of treatment. Subsequent inquiries by outside investigators into care at the clinic did not raise concerns about patients being referred too quickly to medical interventions. However, they did criticize a lack of standardized assessments, adding that "it was not possible to clearly understand from the records" why care decisions had been made, according to a 2021 report from the regulator of health and social care, the Care Quality Commission.

The report rated the clinic as "inadequate" on these grounds, on the long waiting lists, and on concerns that teams treating patients did not always include the full range of experts required.

Another major challenge came in the 2020 lawsuit. Keira Bell, a young woman who detransitioned after what she said was improper care at the Tavistock, asked the court to rule on whether youths should receive puberty blockers. She alleged that the information provided by the Tavistock was not adequate, and said youths under 18 were not able to give informed consent to treatment. The High Court effectively banned their use for under-16-year-olds, a ban that was overturned last year on appeal. Bell did not respond to a request for comment.

The Tavistock told Reuters its current protocol requires meeting patients at least three to six times over some months before any recommendation for medical treatment. The timeline would be longer in complex cases. If the clinician, parents and the young person agree, puberty blockers may be prescribed from the onset of puberty, usually after the age of 10 or 11. The clinic only introduces hormone treatments after 16. Surgery is not an option before age 18 under NHS rules.

The clinic estimates that its staff referred only between 10% and 20% of young people for medical interventions, indicating what team members have described as its cautious approach. This year to August, 125 adolescents received referrals for either puberty blockers or hormones, the clinic told Reuters.

An ongoing review commissioned by the NHS highlighted another problem. Led by Dr Hilary Cass, a prominent pediatrician, the review found that practitioners across the country might be referring patients with gender concerns to the Tavistock without first addressing mental health issues such as depression, according to an interim report released in February. Such practices may have contributed to the clinic's fast-growing waiting list, the report said.

Annual referrals to the clinic have surged from 210 a decade ago to 5,234 in the financial year that ended in March 2022.

According to NHS documents seen by Reuters, there were 7,696 minors on the waiting list for a first appointment as of July. Just over 1,000 young people were referred to the Tavistock from April to October and are awaiting attention, the clinic says.

"I'M STILL YOUR CHILD"

In 2019, a 13-year-old Miles began exploring his relationship with his changing body, wearing baggy clothes. He cut his hair short and began sampling videos from transgender teens on YouTube.

At first, "it was denial – those guys are cool, but I'm not like them," he said. "Then slowly, I thought, 'what they're talking about is exactly what I feel. So maybe I need to actually look at this.'"

He came out to his close friends, who were supportive. In February 2020, Miles left a letter on his bed for his parents, just before heading to school.

"Dear Mum and Dad," it read. "I am transgender. I identify as male. I'm still your child."

His mother was taken aback. "I was a little bit fearful, because I didn't understand it," Connie said. She texted Miles at school. "We'll talk about this in a few days," she wrote. "We love you."

That November, an NHS doctor referred Miles's case to the Tavistock. Miles was excited, hoping to receive puberty blockers but realizing that, given the long waiting list, he was likely to be too mature for them by the time he was seen.

As he waited to hear from the clinic, he began his social transition, dressing like a boy and using male pronouns. He started to wear a binder to conceal his breasts and, on occasion, padding known as a packer inside his underwear to give the look of male genitalia. He took a contraceptive pill to limit the frequency of his periods.

Last year, he legally changed his name – his parents paid, as a gift for his 16th birthday. Miles now studies at school in a co-educational class. He is attracted to boys.

By July this year, Miles was uneasy, having heard nothing from the Tavistock clinic. He contacted them to ask about his referral. They had no record of it.

"That was a crash and burn," Miles said. "I've had two years of my life thinking it was happening, for nothing. It sounds extreme, but it feels like the NHS has failed me as a trans person. Because I'm just left in limbo. No-one really knows what to do."

Miles's doctor referred him a second time. But a few weeks later, when he checked with the clinic again, it still had no record of him. Neither his doctor nor the Tavistock would comment on his case.

"INCREDIBLY DISTRESSING"

Other young people and their parents across England are also at a loss. Waiting "isn't an option when you've got a child in distress," said Rose, whose daughter has been on a waiting list since October 2021.

Her daughter's case shows how hard life for young trans people can be - even when they do get care.

Assigned male at birth, Rose's daughter told her parents how unhappy she was in her changing body at age 12, two years ago. A few months later, knowing about the NHS waiting list, Rose sought help from family members to pay for private care from Dr Aidan Kelly, a clinical psychologist now in private practice who worked with youth at the Tavistock for five years.

Kelly diagnosed their daughter with gender dysphoria in August 2021, and she socially transitioned a month later. Now 14, she is taking puberty blockers prescribed overseas by a registered pediatric endocrinologist whom Kelly declined to identify. Kelly remains involved in her care.

In June this year, Rose's daughter tried to take her own life, cutting herself and attempting to drink bleach. She had previously been referred for NHS mental health care, but did not receive attention until she tried to kill herself, Rose said. The NHS then prescribed antidepressants.

A different private practitioner has also recently diagnosed the teen as autistic. Rose declined to make her daughter available to Reuters for comment due to the teen's distress.

"I'm just trying to do things to keep my child here," said Rose. The treatments are helping, she said, but her daughter is still struggling.

Another mother, Liz, said her teenager has been on the Tavistock waiting list for three years after being referred by their family doctor. Assigned female at birth, the child came out as a transgender boy at school, but Liz and her husband do not use his chosen pronouns. Instead, they use a gender-neutral nickname, saying that they want to keep their child's options open.

Liz said the child has autistic traits, depression and childhood trauma, and has experienced years of severe homophobic bullying. Liz declined to make the child available for comment.

She worries that the teen, now 16, could receive gender medication without taking into account these other issues. The family has received no NHS gender care or mental health support since the referral, she said. The family is also frightened to entrust the teen to a system that is set to be replaced because it has been judged to be failing young people.

Most of all, Liz is afraid of her child making a mistake.

"If I knew this was the route" for the child to grow "into a healthy well-adjusted adult, that would be a different question," she said. "But I don't have that kind of information."

In a statement to Reuters, the NHS's Healthcare Safety Investigation Branch said the "incredibly distressing" wait for gender care "created a significant patient safety risk for young people."

In April, the investigation branch released a report into the death of a young transgender man before his 19th birthday, outlining how he had complained of the long wait for care before committing suicide. He was first referred to the Tavistock at 16. The clinic itself referred the incident to the investigators, saying it was "vital" that services worked together to better protect vulnerable young people.

There is evidence that transgender youth face a higher risk of suicide, but whether that risk has increased for adolescents in England who are waiting for care is not well understood. The Cass report said in February that many young people's mental health deteriorated while in a holding pattern.

"DROWNING IN THE MIDDLE"

For young people already in the system, the NHS has said care at the Tavistock clinic would continue unchanged ahead of its closure. NHS documents reviewed by Reuters show only a few dozen appointments are available for new patients each month, down from between 75 and 120 for most of last year, despite the growing waiting list.

Staffing has also dipped as several psychologists have left or, like Kelly, entered private practice. The Tavistock said in board documents that staff morale is low and told Reuters it does not have the capacity to meet demand.

The deadline for shuttering the clinic has also slipped, to late June 2023 at the earliest, two people familiar with the plans said, although the NHS is still aiming to open two new sites in spring next year, with up to seven more to follow. People who have been waiting the longest will be prioritized.

The NHS is also working on a system to cope with the backlog and improve support for those on the new list, a spokesman said.

But clinicians say polarized views around gender care will make finding staff challenging.

"The people who have gender-critical views call you child abusers and monsters, and then there are a lot of angry families accusing you of gatekeeping. And you're just drowning in the middle of it all," said Dr Laura Charlton, a clinical psychologist who left the Tavistock in 2020 after six years and now only treats adults.

The gender-care revamp became further entangled in political upheaval after Prime Minister Boris Johnson resigned in September. Both his successors, Liz Truss and Rishi Sunak, voiced their opposition to the use of what they described as "irreversible" measures for transgender young people earlier this year.

Neither Truss nor Sunak's office responded to a request for comment for this story. Sunak has said under-18s should be protected from "life-altering treatments."

A few weeks into Truss's tenure, in September, the NHS briefly posted a draft of its proposed new treatment guidelines on its website, then removed them. The guidelines were re-released on Oct. 20, the night Truss resigned.

A Reuters review of the original draft shows key passages were changed by the time they were re-released.

Both versions of the guidelines say only medical professionals may refer young people for gender care, and call for a meeting between clinicians before a child is added to the waiting list. New clinics will be led by medical doctors rather than psychologists, they say.

The guidelines also say young people who, like Miles, obtain medicines from providers that are not regulated in the UK should be referred to local authorities – such as police and social services – once the NHS takes on their case.

The NHS has said separately it would only prescribe puberty-blocking drugs for transgender teens "in the context of a formal research protocol." It has not specified how gender-affirming hormones would be prescribed, although it also suggests enrolling young people into a clinical trial in the future.

However, the revised guidelines say adolescent patients would require a gender dysphoria diagnosis from a specialist clinician before their social transition would be supported by the NHS, rather than, as at present, relying on the statements of an adolescent.

The changes around social transition appeared after the draft was sent through government approval processes within the Department of Health and the Prime Minister's Office, rather than the NHS or gender experts, two people involved in the process said.

For government employees to not recognize a young person's preferred gender identity without a medical diagnosis would run counter to the way gender-affirming care has been practiced both in England and globally. The proposed requirement was not endorsed by the doctors involved in the Cass review, said people briefed on the matter. There was no such requirement around social transitioning in the original draft.

The draft plan has been criticized by medical groups specializing in transgender health around the world.

"This represents an unconscionable degree of ... intrusion into ... everyday matters such as clothing, name, pronouns, and school arrangements," WPATH, along with a number of allied regional and national groups, said in a statement in late November.

"We've spent 20 years trying to reduce barriers to care. And now we're seeing barriers put up," Dr Marci Bowers, president of WPATH and a gender surgeon in the United States, told Reuters in response to the NHS guidelines.

Spokespeople from the Health department and the Prime Minister's office declined to comment. The government is considering public feedback on the proposals and expects to publish final guidelines early next year.

"EVOLVING EVIDENCE BASE"

England is not the only country in Europe that is changing its approach.

In Finland and Sweden, healthcare officials are limiting access to puberty blockers and hormone treatments, citing concerns that the risks may outweigh any benefit for adolescents, particularly those struggling with mental health problems.

Until 2020, adolescents expressing gender dysphoria in Finland could generally access puberty blockers and hormones, but that year its national healthcare council released guidelines for transgender care. These recommended supporting "identity exploration" and mental health treatment as the first steps to ensure that any psychological issues are addressed. The council said medical intervention for transgender minors "is still an experimental practice."

Health officials in Sweden changed course after finding many adolescents seeking treatment had diagnoses beyond gender dysphoria.

In February, Sweden's National Board of Health and Welfare revised its recommendations on puberty blockers and hormone treatment for adolescents. It recommended the treatments be given within a clinical trial. Until a trial is in place, it said, the drugs should only be given to people who fit the original Dutch model of persistent gender dysphoria with no mental health issues.

"It's not an easy decision," Thomas Linden, a director at the board, told Reuters. "Some people are in great need of medical attention. Others are at risk of being harmed if they are given the same treatment. We really need better precision in the diagnosis."

Kelly, the former Tavistock clinician, said even as knowledge changes and governments review policies, clinicians must not deny young people care.

"We need to practice within an evolving evidence base – and that doesn't mean do nothing," he said.

"A NORMAL TEENAGER"

It took just one week after Miles's first full online appointment for GenderGP to agree to prescribe testosterone. The company, which operates in more than 40 countries, says its practices are consistent with WPATH and other international care guidelines.

GenderGP has no age limits to care, or minimum time periods before recommending prescriptions, including puberty blockers, to young people, co-founder Helen Webberley told Reuters. Its usual time-frame is within four to six weeks, she said, although complex cases take more assessment. Parental consent is not always required.

Miles said he hesitated about turning to GenderGP. The Webberleys have both been sanctioned by official medical tribunals for gender care they have provided since setting up their online clinic in 2015. The General Medical Council (GMC), the national watchdog that sets standards for doctors and maintains a register of those deemed fit to practice, referred both cases to the tribunals after concerns were raised by other doctors involved in caring for the same patients as the Webberleys.

Founder Dr Michael Webberley was struck off the British medical register this year after the tribunal found he had failed several patients by not conducting proper tests or assessing them robustly enough, both before and after recommending hormones or puberty blockers. The tribunal concluded that he was working outside his specialty as a gastroenterologist.

His wife, Helen, is currently suspended from practice after a separate hearing found she did not adequately explain the potential fertility impacts of medical treatment to a patient seeking help with gender-related distress.

Both deny that they failed their patients and appealed, although Michael Webberley's appeal was dismissed by the High Court in early December. They told Reuters that they currently do no clinical work for GenderGP.

There is little NHS or independent data available on how many young people seek care privately. GenderGP says the share of under-18-year-olds among its more than 8,000 UK patients is rising, which it attributes to the lack of care offered through the NHS.

The Webberleys transferred their ownership of GenderGP to a Hong Kong-based company, Harland International, in 2019 to avoid the controversy associated with them, they said. The company is now registered in Singapore as GenderGP PTE Ltd, with Dr Helen Webberley as a director. Harland could not be reached.

The clinic's prescribing doctors are all based overseas and regulated within their home countries – from the United States to European Union countries. EU-based doctors can prescribe to UK patients under rules drawn up after Brexit. Some GenderGP therapeutic counselors are UK-based.

Miles's parents say they are happy with GenderGP, but worry that the lack of NHS care will lead young people to unscrupulous online providers or even to self-medicate.

The NHS doesn't cover the cost of Miles's private treatment Read full story. He is paying for his care with his wages from working at a local restaurant, and can recite the company's charges by heart. He says he had reservations about using testosterone but decided to go ahead.

"I know it can affect fertility," he said. "And it sounds weird, but baldness, because it runs in my family."

He applies a testosterone gel to his arms every morning, normally before heading to school. The gel dries and then cracks, like a face mask, when first applied, he said, then sinks in.

Miles has not told his co-workers that he is transgender. To them, along with his friends at an archaeology group that he digs with in Dover, he is just a young man. Yet he still plays for a girls' rugby team, until the effects of the testosterone kick in.

"I'm going to be able to start living my life as I want to," he said. "I want people to see that just because I'm trans, that doesn't affect who I am. I'm still a normal teenager."

The Tavistock, based in London, continues to see existing patients. But first appointments for people who have been on its waiting list since 2019 have slowed to a trickle as staffing and morale drop ahead of the closure, according to NHS data and four people involved in the reorganization. More than 1,500 young people recently referred with gender dysphoria are being kept on a separate list for the future regional centers, with no clarity on when or how they will be treated, three NHS sources told Reuters.

O nce assigned to a waiting list, young people have been effectively locked out of state-provided mental health counseling and other specialist support related to their gender dysphoria, because those services were offered only through the gender care system they are waiting to join. Delaying medical treatment also means young people mature in bodies that don't align with their gender identity – changing that in later life is more difficult.

The NHS said in a statement to Reuters it is expanding healthcare services for young people with gender dysphoria in line with recommendations from the review, and working on better supporting those on the waiting list. It has previously said it "strongly discouraged" families from turning to private or unregulated providers.

" These have been an exceptionally challenging couple of years for our patients and their families, with a lot of toxicity in discussions around their care and chronic uncertainty about its future," Dr Polly Carmichael, director of the youth gender clinic at the Tavistock, said in a statement to Reuters.

The Department of Health and the Prime Minister's office declined to comment for this story.

Both sides in the polarized debate are turning to the courts: patients who say they've waited too long, and others who say the NHS moved too fast. At the end of November, transgender rights advocates challenged NHS England in the High Court over long wait times for both youths and adults seeking treatment. In 2020, a young woman who had detransitioned from being a transgender man challenged the Tavistock's use of puberty blockers in the same court.

Long wait lists are common within the NHS, but its statistics show the three-year wait for transgender youth is extreme. Most young people with a "non-urgent" eating disorder get specialist help within three months of being referred, the figures show. On average, young people seeking mental health support wait just over a month for a first appointment, according to a government analysis of NHS England data.

One mother shared with Reuters a letter she received from the NHS in February after she followed up on her daughter's October 2021 referral to determine when she might receive attention. The letter said a decision would be made at some point from early 2022 on whether the child "is likely to meet the access criteria" for gender care. She has heard nothing since and suspects her child isn't even being considered for NHS help.

"We are on a waiting list for a waiting list," said the mother, Rose, who asked to be identified by her first name only to protect her daughter's privacy.

"She basically feels suicidal every single day." The NHS declined to comment on the case.

"STOP HURTING YOURSELF"

M iles plans to study archaeology at university and is a keen rugby player. He has felt like a boy for as long as he can remember, but recalls a moment of delight at the start of a new school year when he was around 9.

The teachers were handing out colored notebooks and lanyards based on gender: blue with wizards and astronauts for boys, pink for girls. He was given blue books – "and wizards and astronauts over everything," he said.

"It was not like 'I'm trans,' but just this amazing sense of joy within myself, 'This feels amazing, and I don't know why.'"

By age 11, as puberty began, Miles entered an all-girls' secondary school. He was bullied by classmates for not wearing a bra or conforming to female norms. To fit in, he tried to be ultra-feminine, wearing skirts and make-up, having his eyebrows threaded, wearing false nails.

"My mood really dropped," he said. After about a year, "I realized, I can't do this anymore. I hate this." Miles was barely leaving his room. He began cutting himself, over a period of four or five months. "In my mind, it was just easier to deal with physical pain than mental pain."

His mother, Connie Pitcher, noticed the regular, precise lines on his arms. When she asked why he was distressed, Miles said he was struggling to understand his sexuality.

"I said, 'I don't care if you're gay, straight, or whatever – I just want you to stop hurting yourself,'" Connie said. The family considered seeking mental health help, but worried about long waiting lists.

"We saw him really, really dip," she said. "We were struggling with what to do. Because there is really no support."

The World Health Organization, which informs health policy worldwide, does not have detailed guidelines for this area of healthcare for youth. It says it works closely with the World Professional Association for Transgender Health (WPATH), a U.S.-based non-profit that has drawn up the most widely adopted standards of care.

These say a young person's exploration of gender should be respected and supported, and that medical interventions for young people at or after puberty should be one option, after a comprehensive assessment.

Research from the Netherlands paved the way for that medical treatment, establishing a model requiring adolescents who sought care to be assessed for about six to 18 months. If they had persistently expressed gender dysphoria since early childhood, lived in supportive homes, and had no other complicating mental health diagnoses, they could be offered puberty suppression, followed by hormones, and later, in some cases, surgery.

Since then, the number of young people seeking gender care has surged in parts of Europe and the United States, supported by greater awareness and the availability of professional treatment. They continue to face threats of violence and discrimination, as well as political efforts in some countries to block that care.

At the same time, some gender-care professionals have questioned the lack of definitive evidence on the long-term impact of puberty blockers or hormones on minors. Puberty blockers are not licensed in the United Kingdom or United States for treating gender dysphoria and the NHS says it is not known how they may affect brain development or long-term bone health in young people. Hormones, only available for older adolescents, cause potentially irreversible changes such as a deeper voice, and can cause infertility. Other changes, including breast development, are reversible only with surgery.

Those professionals are also concerned that as the number of pediatric patients has surged, so has the number of youth whose main source of distress may not be persistent gender dysphoria. Some may have mental health problems that complicate their cases.

"THE WRONG TREATMENT"

While not all English youths with diverse gender identities seek medical help, for those who do, a doctor or professionals including social workers or teachers are the first port of call. Any one of them can refer a youth for gender care, which so far has only come through the Tavistock – formally known as the Gender Identity Development Service, or GIDS – run by the Tavistock and Portman NHS Foundation Trust.

The clinic became a focal point for opponents of youth gender care in the UK in 2018 when an internal report compiled by Dr David Bell, a former senior psychiatrist and staff representative at the Tavistock, was leaked to national media. Bell, who did not treat young people, cited accounts from 10 unidentified colleagues who were working with transgender youth and came to him with concerns, including that some patients were "rushed through" to medical treatment without proper evaluation when they finally got an appointment.

"It was not just the wait," Bell told Reuters. "It was also a wait for the wrong treatment."

Bell now advocates against starting a gender transition before adulthood. He is at the fore of a group of mental health professionals who argue that accepting a child's new gender identity without exploring other underlying issues is clinically irresponsible, and puts them on a track to potentially irreversible changes that they may later regret.

The Tavistock has consistently defended its methods of treatment. Subsequent inquiries by outside investigators into care at the clinic did not raise concerns about patients being referred too quickly to medical interventions. However, they did criticize a lack of standardized assessments, adding that "it was not possible to clearly understand from the records" why care decisions had been made, according to a 2021 report from the regulator of health and social care, the Care Quality Commission.

The report rated the clinic as "inadequate" on these grounds, on the long waiting lists, and on concerns that teams treating patients did not always include the full range of experts required.

Another major challenge came in the 2020 lawsuit. Keira Bell, a young woman who detransitioned after what she said was improper care at the Tavistock, asked the court to rule on whether youths should receive puberty blockers. She alleged that the information provided by the Tavistock was not adequate, and said youths under 18 were not able to give informed consent to treatment. The High Court effectively banned their use for under-16-year-olds, a ban that was overturned last year on appeal. Bell did not respond to a request for comment.

The Tavistock told Reuters its current protocol requires meeting patients at least three to six times over some months before any recommendation for medical treatment. The timeline would be longer in complex cases. If the clinician, parents and the young person agree, puberty blockers may be prescribed from the onset of puberty, usually after the age of 10 or 11. The clinic only introduces hormone treatments after 16. Surgery is not an option before age 18 under NHS rules.

The clinic estimates that its staff referred only between 10% and 20% of young people for medical interventions, indicating what team members have described as its cautious approach. This year to August, 125 adolescents received referrals for either puberty blockers or hormones, the clinic told Reuters.

By July this year, Miles was uneasy, having heard nothing from the Tavistock clinic. He contacted them to ask about his referral. They had no record of it.

" That was a crash and burn," Miles said. "I've had two years of my life thinking it was happening, for nothing. It sounds extreme, but it feels like the NHS has failed me as a trans person. Because I'm just left in limbo. No-one really knows what to do."

Miles's doctor referred him a second time. But a few weeks later, when he checked with the clinic again, it still had no record of him. Neither his doctor nor the Tavistock would comment on his case.

"INCREDIBLY DISTRESSING"

Other young people and their parents across England are also at a loss. Waiting "isn't an option when you've got a child in distress," said Rose, whose daughter has been on a waiting list since October 2021.

Her daughter's case shows how hard life for young trans people can be - even when they do get care.

Assigned male at birth, Rose's daughter told her parents how unhappy she was in her changing body at age 12, two years ago. A few months later, knowing about the NHS waiting list, Rose sought help from family members to pay for private care from Dr Aidan Kelly, a clinical psychologist now in private practice who worked with youth at the Tavistock for five years.

Kelly diagnosed their daughter with gender dysphoria in August 2021, and she socially transitioned a month later. Now 14, she is taking puberty blockers prescribed overseas by a registered pediatric endocrinologist whom Kelly declined to identify. Kelly remains involved in her care.

In June this year, Rose's daughter tried to take her own life, cutting herself and attempting to drink bleach. She had previously been referred for NHS mental health care, but did not receive attention until she tried to kill herself, Rose said. The NHS then prescribed antidepressants.

A different private practitioner has also recently diagnosed the teen as autistic. Rose declined to make her daughter available to Reuters for comment due to the teen's distress.

"I'm just trying to do things to keep my child here," said Rose. The treatments are helping, she said, but her daughter is still struggling.

She worries that the teen, now 16, could receive gender medication without taking into account these other issues. The family has received no NHS gender care or mental health support since the referral, she said. The family is also frightened to entrust the teen to a system that is set to be replaced because it has been judged to be failing young people.

M ost of all, Liz is afraid of her child making a mistake.

"If I knew this was the route" for the child to grow "into a healthy well-adjusted adult, that would be a different question," she said. "But I don't have that kind of information."

In a statement to Reuters, the NHS's Healthcare Safety Investigation Branch said the "incredibly distressing" wait for gender care "created a significant patient safety risk for young people."

In April, the investigation branch released a report into the death of a young transgender man before his 19th birthday, outlining how he had complained of the long wait for care before committing suicide. He was first referred to the Tavistock at 16. The clinic itself referred the incident to the investigators, saying it was "vital" that services worked together to better protect vulnerable young people.

There is evidence that transgender youth face a higher risk of suicide, but whether that risk has increased for adolescents in England who are waiting for care is not well understood. The Cass report said in February that many young people's mental health deteriorated while in a holding pattern.

"DROWNING IN THE MIDDLE"

F or young people already in the system, the NHS has said care at the Tavistock clinic would continue unchanged ahead of its closure. NHS documents reviewed by Reuters show only a few dozen appointments are available for new patients each month, down from between 75 and 120 for most of last year, despite the growing waiting list.

Staffing has also dipped as several psychologists have left or, like Kelly, entered private practice. The Tavistock said in board documents that staff morale is low and told Reuters it does not have the capacity to meet demand.

The deadline for shuttering the clinic has also slipped, to late June 2023 at the earliest, two people familiar with the plans said, although the NHS is still aiming to open two new sites in spring next year, with up to seven more to follow. People who have been waiting the longest will be prioritized.

The NHS is also working on a system to cope with the backlog and improve support for those on the new list, a spokesman said.

But clinicians say polarized views around gender care will make finding staff challenging.

"The people who have gender-critical views call you child abusers and monsters, and then there are a lot of angry families accusing you of gatekeeping. And you're just drowning in the middle of it all," said Dr Laura Charlton, a clinical psychologist who left the Tavistock in 2020 after six years and now only treats adults.

For government employees to not recognize a young person's preferred gender identity without a medical diagnosis would run counter to the way gender-affirming care has been practiced both in England and globally. The proposed requirement was not endorsed by the doctors involved in the Cass review, said people briefed on the matter. There was no such requirement around social transitioning in the original draft.

T he draft plan has been criticized by medical groups specializing in transgender health around the world.

"This represents an unconscionable degree of ... intrusion into ... everyday matters such as clothing, name, pronouns, and school arrangements," WPATH, along with a number of allied regional and national groups, said in a statement in late November.

"We've spent 20 years trying to reduce barriers to care. And now we're seeing barriers put up," Dr Marci Bowers, president of WPATH and a gender surgeon in the United States, told Reuters in response to the NHS guidelines.

Spokespeople from the Health department and the Prime Minister's office declined to comment. The government is considering public feedback on the proposals and expects to publish final guidelines early next year.

"EVOLVING EVIDENCE BASE"

England is not the only country in Europe that is changing its approach.

In Finland and Sweden, healthcare officials are limiting access to puberty blockers and hormone treatments, citing concerns that the risks may outweigh any benefit for adolescents, particularly those struggling with mental health problems.

Until 2020, adolescents expressing gender dysphoria in Finland could generally access puberty blockers and hormones, but that year its national healthcare council released guidelines for transgender care. These recommended supporting "identity exploration" and mental health treatment as the first steps to ensure that any psychological issues are addressed. The council said medical intervention for transgender minors "is still an experimental practice."

Health officials in Sweden changed course after finding many adolescents seeking treatment had diagnoses beyond gender dysphoria.

In February, Sweden's National Board of Health and Welfare revised its recommendations on puberty blockers and hormone treatment for adolescents. It recommended the treatments be given within a clinical trial. Until a trial is in place, it said, the drugs should only be given to people who fit the original Dutch model of persistent gender dysphoria with no mental health issues.

"It's not an easy decision," Thomas Linden, a director at the board, told Reuters. "Some people are in great need of medical attention. Others are at risk of being harmed if they are given the same treatment. We really need better precision in the diagnosis."

Kelly, the former Tavistock clinician, said even as knowledge changes and governments review policies, clinicians must not deny young people care.

"We need to practice within an evolving evidence base – and that doesn't mean do nothing," he said.

"A NORMAL TEENAGER"

It took just one week after Miles's first full online appointment for GenderGP to agree to prescribe testosterone. The company, which operates in more than 40 countries, says its practices are consistent with WPATH and other international care guidelines.

GenderGP has no age limits to care, or minimum time periods before recommending prescriptions, including puberty blockers, to young people, co-founder Helen Webberley told Reuters. Its usual time-frame is within four to six weeks, she said, although complex cases take more assessment. Parental consent is not always required.

Miles said he hesitated about turning to GenderGP. The Webberleys have both been sanctioned by official medical tribunals for gender care they have provided since setting up their online clinic in 2015. The General Medical Council (GMC), the national watchdog that sets standards for doctors and maintains a register of those deemed fit to practice, referred both cases to the tribunals after concerns were raised by other doctors involved in caring for the same patients as the Webberleys.

Founder Dr Michael Webberley was struck off the British medical register this year after the tribunal found he had failed several patients by not conducting proper tests or assessing them robustly enough, both before and after recommending hormones or puberty blockers. The tribunal concluded that he was working outside his specialty as a gastroenterologist.

His wife, Helen, is currently suspended from practice after a separate hearing found she did not adequately explain the potential fertility impacts of medical treatment to a patient seeking help with gender-related distress.

Both deny that they failed their patients and appealed, although Michael Webberley's appeal was dismissed by the High Court in early December. They told Reuters that they currently do no clinical work for GenderGP.

There is little NHS or independent data available on how many young people seek care privately. GenderGP says the share of under-18-year-olds among its more than 8,000 UK patients is rising, which it attributes to the lack of care offered through the NHS.

The Webberleys transferred their ownership of GenderGP to a Hong Kong-based company, Harland International, in 2019 to avoid the controversy associated with them, they said. The company is now registered in Singapore as GenderGP PTE Ltd, with Dr Helen Webberley as a director. Harland could not be reached.

The clinic's prescribing doctors are all based overseas and regulated within their home countries – from the United States to European Union countries. EU-based doctors can prescribe to UK patients under rules drawn up after Brexit. Some GenderGP therapeutic counselors are UK-based.

The Tavistock, based in London, continues to see existing patients. But first appointments for people who have been on its waiting list since 2019 have slowed to a trickle as staffing and morale drop ahead of the closure, according to NHS data and four people involved in the reorganization. More than 1,500 young people recently referred with gender dysphoria are being kept on a separate list for the future regional centers, with no clarity on when or how they will be treated, three NHS sources told Reuters.

Once assigned to a waiting list, young people have been effectively locked out of state-provided mental health counseling and other specialist support related to their gender dysphoria, because those services were offered only through the gender care system they are waiting to join. Delaying medical treatment also means young people mature in bodies that don't align with their gender identity – changing that in later life is more difficult.

The NHS said in a statement to Reuters it is expanding healthcare services for young people with gender dysphoria in line with recommendations from the review, and working on better supporting those on the waiting list. It has previously said it "strongly discouraged" families from turning to private or unregulated providers.

"These have been an exceptionally challenging couple of years for our patients and their families, with a lot of toxicity in discussions around their care and chronic uncertainty about its future," Dr Polly Carmichael, director of the youth gender clinic at the Tavistock, said in a statement to Reuters.

The Department of Health and the Prime Minister's office declined to comment for this story.

Both sides in the polarized debate are turning to the courts: patients who say they've waited too long, and others who say the NHS moved too fast. At the end of November, transgender rights advocates challenged NHS England in the High Court over long wait times for both youths and adults seeking treatment. In 2020, a young woman who had detransitioned from being a transgender man challenged the Tavistock's use of puberty blockers in the same court.

Long wait lists are common within the NHS, but its statistics show the three-year wait for transgender youth is extreme. Most young people with a "non-urgent" eating disorder get specialist help within three months of being referred, the figures show. On average, young people seeking mental health support wait just over a month for a first appointment, according to a government analysis of NHS England data.

One mother shared with Reuters a letter she received from the NHS in February after she followed up on her daughter's October 2021 referral to determine when she might receive attention. The letter said a decision would be made at some point from early 2022 on whether the child "is likely to meet the access criteria" for gender care. She has heard nothing since and suspects her child isn't even being considered for NHS help.

"We are on a waiting list for a waiting list," said the mother, Rose, who asked to be identified by her first name only to protect her daughter's privacy.

"She basically feels suicidal every single day." The NHS declined to comment on the case.

"STOP HURTING YOURSELF"

Miles plans to study archaeology at university and is a keen rugby player. He has felt like a boy for as long as he can remember, but recalls a moment of delight at the start of a new school year when he was around 9.

The teachers were handing out colored notebooks and lanyards based on gender: blue with wizards and astronauts for boys, pink for girls. He was given blue books – "and wizards and astronauts over everything," he said.

"It was not like 'I'm trans,' but just this amazing sense of joy within myself, 'This feels amazing, and I don't know why.'"

By age 11, as puberty began, Miles entered an all-girls' secondary school. He was bullied by classmates for not wearing a bra or conforming to female norms. To fit in, he tried to be ultra-feminine, wearing skirts and make-up, having his eyebrows threaded, wearing false nails.

"My mood really dropped," he said. After about a year, "I realized, I can't do this anymore. I hate this." Miles was barely leaving his room. He began cutting himself, over a period of four or five months. "In my mind, it was just easier to deal with physical pain than mental pain."

His mother, Connie Pitcher, noticed the regular, precise lines on his arms. When she asked why he was distressed, Miles said he was struggling to understand his sexuality.

"I said, 'I don't care if you're gay, straight, or whatever – I just want you to stop hurting yourself,'" Connie said. The family considered seeking mental health help, but worried about long waiting lists.

"We saw him really, really dip," she said. "We were struggling with what to do. Because there is really no support."

The World Health Organization, which informs health policy worldwide, does not have detailed guidelines for this area of healthcare for youth. It says it works closely with the World Professional Association for Transgender Health (WPATH), a U.S.-based non-profit that has drawn up the most widely adopted standards of care.

These say a young person's exploration of gender should be respected and supported, and that medical interventions for young people at or after puberty should be one option, after a comprehensive assessment.

Research from the Netherlands paved the way for that medical treatment, establishing a model requiring adolescents who sought care to be assessed for about six to 18 months. If they had persistently expressed gender dysphoria since early childhood, lived in supportive homes, and had no other complicating mental health diagnoses, they could be offered puberty suppression, followed by hormones, and later, in some cases, surgery.

Since then, the number of young people seeking gender care has surged in parts of Europe and the United States, supported by greater awareness and the availability of professional treatment. They continue to face threats of violence and discrimination, as well as political efforts in some countries to block that care.

At the same time, some gender-care professionals have questioned the lack of definitive evidence on the long-term impact of puberty blockers or hormones on minors. Puberty blockers are not licensed in the United Kingdom or United States for treating gender dysphoria and the NHS says it is not known how they may affect brain development or long-term bone health in young people. Hormones, only available for older adolescents, cause potentially irreversible changes such as a deeper voice, and can cause infertility. Other changes, including breast development, are reversible only with surgery.

Those professionals are also concerned that as the number of pediatric patients has surged, so has the number of youth whose main source of distress may not be persistent gender dysphoria. Some may have mental health problems that complicate their cases.

"THE WRONG TREATMENT"

While not all English youths with diverse gender identities seek medical help, for those who do, a doctor or professionals including social workers or teachers are the first port of call. Any one of them can refer a youth for gender care, which so far has only come through the Tavistock – formally known as the Gender Identity Development Service, or GIDS – run by the Tavistock and Portman NHS Foundation Trust.

The clinic became a focal point for opponents of youth gender care in the UK in 2018 when an internal report compiled by Dr David Bell, a former senior psychiatrist and staff representative at the Tavistock, was leaked to national media. Bell, who did not treat young people, cited accounts from 10 unidentified colleagues who were working with transgender youth and came to him with concerns, including that some patients were "rushed through" to medical treatment without proper evaluation when they finally got an appointment.

"It was not just the wait," Bell told Reuters. "It was also a wait for the wrong treatment."

Bell now advocates against starting a gender transition before adulthood. He is at the fore of a group of mental health professionals who argue that accepting a child's new gender identity without exploring other underlying issues is clinically irresponsible, and puts them on a track to potentially irreversible changes that they may later regret.

The Tavistock has consistently defended its methods of treatment. Subsequent inquiries by outside investigators into care at the clinic did not raise concerns about patients being referred too quickly to medical interventions. However, they did criticize a lack of standardized assessments, adding that "it was not possible to clearly understand from the records" why care decisions had been made, according to a 2021 report from the regulator of health and social care, the Care Quality Commission.

The report rated the clinic as "inadequate" on these grounds, on the long waiting lists, and on concerns that teams treating patients did not always include the full range of experts required.

Another major challenge came in the 2020 lawsuit. Keira Bell, a young woman who detransitioned after what she said was improper care at the Tavistock, asked the court to rule on whether youths should receive puberty blockers. She alleged that the information provided by the Tavistock was not adequate, and said youths under 18 were not able to give informed consent to treatment. The High Court effectively banned their use for under-16-year-olds, a ban that was overturned last year on appeal. Bell did not respond to a request for comment.

The Tavistock told Reuters its current protocol requires meeting patients at least three to six times over some months before any recommendation for medical treatment. The timeline would be longer in complex cases. If the clinician, parents and the young person agree, puberty blockers may be prescribed from the onset of puberty, usually after the age of 10 or 11. The clinic only introduces hormone treatments after 16. Surgery is not an option before age 18 under NHS rules.

The clinic estimates that its staff referred only between 10% and 20% of young people for medical interventions, indicating what team members have described as its cautious approach. This year to August, 125 adolescents received referrals for either puberty blockers or hormones, the clinic told Reuters.

By July this year, Miles was uneasy, having heard nothing from the Tavistock clinic. He contacted them to ask about his referral. They had no record of it.

"That was a crash and burn," Miles said. "I've had two years of my life thinking it was happening, for nothing. It sounds extreme, but it feels like the NHS has failed me as a trans person. Because I'm just left in limbo. No-one really knows what to do."

Miles's doctor referred him a second time. But a few weeks later, when he checked with the clinic again, it still had no record of him. Neither his doctor nor the Tavistock would comment on his case.

"INCREDIBLY DISTRESSING"

Other young people and their parents across England are also at a loss. Waiting "isn't an option when you've got a child in distress," said Rose, whose daughter has been on a waiting list since October 2021.

Her daughter's case shows how hard life for young trans people can be - even when they do get care.

Assigned male at birth, Rose's daughter told her parents how unhappy she was in her changing body at age 12, two years ago. A few months later, knowing about the NHS waiting list, Rose sought help from family members to pay for private care from Dr Aidan Kelly, a clinical psychologist now in private practice who worked with youth at the Tavistock for five years.

Kelly diagnosed their daughter with gender dysphoria in August 2021, and she socially transitioned a month later. Now 14, she is taking puberty blockers prescribed overseas by a registered pediatric endocrinologist whom Kelly declined to identify. Kelly remains involved in her care.

In June this year, Rose's daughter tried to take her own life, cutting herself and attempting to drink bleach. She had previously been referred for NHS mental health care, but did not receive attention until she tried to kill herself, Rose said. The NHS then prescribed antidepressants.

A different private practitioner has also recently diagnosed the teen as autistic. Rose declined to make her daughter available to Reuters for comment due to the teen's distress.

"I'm just trying to do things to keep my child here," said Rose. The treatments are helping, she said, but her daughter is still struggling.

She worries that the teen, now 16, could receive gender medication without taking into account these other issues. The family has received no NHS gender care or mental health support since the referral, she said. The family is also frightened to entrust the teen to a system that is set to be replaced because it has been judged to be failing young people.

Most of all, Liz is afraid of her child making a mistake.

"If I knew this was the route" for the child to grow "into a healthy well-adjusted adult, that would be a different question," she said. "But I don't have that kind of information."

In a statement to Reuters, the NHS's Healthcare Safety Investigation Branch said the "incredibly distressing" wait for gender care "created a significant patient safety risk for young people."

In April, the investigation branch released a report into the death of a young transgender man before his 19th birthday, outlining how he had complained of the long wait for care before committing suicide. He was first referred to the Tavistock at 16. The clinic itself referred the incident to the investigators, saying it was "vital" that services worked together to better protect vulnerable young people.

There is evidence that transgender youth face a higher risk of suicide, but whether that risk has increased for adolescents in England who are waiting for care is not well understood. The Cass report said in February that many young people's mental health deteriorated while in a holding pattern.

"DROWNING IN THE MIDDLE"

For young people already in the system, the NHS has said care at the Tavistock clinic would continue unchanged ahead of its closure. NHS documents reviewed by Reuters show only a few dozen appointments are available for new patients each month, down from between 75 and 120 for most of last year, despite the growing waiting list.

Staffing has also dipped as several psychologists have left or, like Kelly, entered private practice. The Tavistock said in board documents that staff morale is low and told Reuters it does not have the capacity to meet demand.

The deadline for shuttering the clinic has also slipped, to late June 2023 at the earliest, two people familiar with the plans said, although the NHS is still aiming to open two new sites in spring next year, with up to seven more to follow. People who have been waiting the longest will be prioritized.

The NHS is also working on a system to cope with the backlog and improve support for those on the new list, a spokesman said.

But clinicians say polarized views around gender care will make finding staff challenging.

"The people who have gender-critical views call you child abusers and monsters, and then there are a lot of angry families accusing you of gatekeeping. And you're just drowning in the middle of it all," said Dr Laura Charlton, a clinical psychologist who left the Tavistock in 2020 after six years and now only treats adults.

Miles's parents say they are happy with GenderGP, but worry that the lack of NHS care will lead young people to unscrupulous online providers or even to self-medicate.

T he NHS doesn't cover the cost of Miles's private treatment. He is paying for his care with his wages from working at a local restaurant, and can recite the company's charges by heart. He says he had reservations about using testosterone but decided to go ahead.

"I know it can affect fertility," he said. "And it sounds weird, but baldness, because it runs in my family."

He applies a testosterone gel to his arms every morning, normally before heading to school. The gel dries and then cracks, like a face mask, when first applied, he said, then sinks in.

Miles has not told his co-workers that he is transgender. To them, along with his friends at an archaeology group that he digs with in Dover, he is just a young man. Yet he still plays for a girls' rugby team, until the effects of the testosterone kick in.

"I'm going to be able to start living my life as I want to," he said. "I want people to see that just because I'm trans, that doesn't affect who I am. I'm still a normal teenager."

[cmutty]

37 days!

37 days from the time my wife’s water broke, on the Fourth of July, until our 5+ pound baby was finally able to come home. He wasn’t due until 8/30 and we had no reason to believe this third baby would come any earlier than his older brothers (36 and 38 weeks). But early he was and the past month was one of the hardest we’ve ever experienced as a family.

We were visiting family in VT when my wife (Peg) suddenly gave me a look of panic that stopped me in my tracks. I thought I had done or said something wrong but it turned out it was her water breaking at just under 32 weeks. We didn’t panic. She got herself situated in the bathroom while I got the kids situated, called the in-laws to get them home, and hurried to pack stuff so we’d be prepared at the hospital. We kissed the kids goodbye not knowing what awaited us at the hospital.

The UVM medical center emergency room is out of this world. On the way we envisioned a number of burn victims from fire works (it was 7/4) but didn’t have time to inspect the clientele as we were busy getting through security. Thankfully a staff member realized my wife was in labor so she could skip the metal detector…I was less lucky. We were quickly screened and brought to Labor and Delivery where we had a beautiful view of the lake but more importantly confirmed Peg was in labor. We weighed our options with the Drs who thought we could safely drive ourselves to Boston but our receiving hospital (MGH) couldn’t recommend we attempt it. She received the antibiotics to delay labor, the steroids to expedite lung development, and we received a list of hospitals between Burlington and Boston in the event labor progressed and we needed to make an emergency stop. All I could think about was delivering our baby somewhere along 89 in VT or NH which would have been a disaster. Back to the in-laws house to say good bye to everyone (including the older boys) and off we sped back to Boston.

The drive was mostly smooth sailing with the exception of a batch of white out rain near Barre, VT. We couldn’t see the car in front of us for a stretch and I was white knuckled enough driving with a wife in labor. There was no sweeter feeling as checking off each hospital on our list as we got closer to Boston. Our biggest concern was road closures in the city given it was the Fourth of July and the fireworks were 3 hours away. Google delivered us and I dropped Peg off at the front door before parking the car and racing up to Labor and Delivery on the 14th floor.

Turns out this happens often and women end up in an antepartum unit where they’re closely monitored and not able to leave the hospital. Peg’s water broke just before 32 weeks and the goal was to keep her pregnant until 34 weeks. The thinking is, at that gestational age the risks of an infection outweigh the growth benefits of any more time in the womb. So I packed her clothes, bought her a book of NY Times crossword puzzles, and picked up some favorite foods from TJs to last what we hoped would be two weeks.

The best part (for me) was the roommates! Each had their own stories to unpack from the single mom with a boyfriend who got told not to come to the birth, to the mother who claimed to know enough about medicine that she didn’t need to be there, or to the mother of twins who was in and out before visiting hours even came. A tv show, movie, or documentary could be compelling as people try to live with what little privacy a curtain provides. We would cuddle in the hospital bed and try our best to pretend we were the only ones in the room but there were constant reminders of the roommates. We did manage to watch most of Ted Lasso together which was enjoyable and helped pass the time.

Had this been our first pregnancy a two week stay at MGH would have been more “manageable.” But having two kids and a dog at home meant very few opportunities to visit Peg. Thankfully all three were still in VT for the first few days. When Grandma brought them to Brookline she stayed for a couple days. The next week was a struggle! I’ve been a stay at home parent for four years but that doesn’t prepare you for being a single parent with a dog for over a week. Luckily Morgan was scheduled for day camp that week so we had scheduled walks and some structure to the days. The hardest part was we couldn’t find a single baby sitter which meant I was unable to visit Peg during that stretch. But my mom arrived the following week and the boys went off to Maine for a few days and I was able to visit Peg again and be there for the birth.

On 7/19 we hit the 34 week mark and it was on to the induction. I got to the hospital on the early side and the day dragged on as we waited for a room. We kept getting told they were having a busy day on Labor & Delivery and that we were next on the list for an open room. We finally got the call around 5 and were moved to coincidentally the same room our first son was born in. The view of Cambridge and the Charles is remarkable from that side of the building. We were sure to snap a pic of the sunset that evening and settled in for what looked likely to be a long night.

They had used Pitocin for our first two pregnancies and this one would be no different. Pitocin starts and progresses contractions to speed up labor. It was necessary for our first baby as he was 36 weeks when Peg’s water broke and they wanted him out quickly. My wife experienced pre-eclampsia with the second pregnancy so Pitocin was once again necessary. It wasn’t my wife’s plan for this little guy as labor can progress quicker than is comfortable and the side effects post labor can be disorienting while you’re trying to bond with your new baby. It was unfortunately necessary this time too given she was 34 weeks. She looked at me when they connected the IV and said, “I’m in control.” Our mantra for the evening was born and every time she was having a bad contraction or things were feeling difficult we would say together “I am in control.” It seemed to help and like a champ Peg used Nitrous Oxide as her only pain management for the third time. She was in control. The other major difference was a desire to be able to stand which she didn’t get for her second delivery. The flexibility exercises and standing really helped to the point she was dilating and the nurse said, “I don’t want you giving birth to this baby on the floor,” and she was as quick as she could moved back into the bed.

The nurse’s “friends” appeared from nowhere which was good because around 6am the whole thing came to a head. She was fully dilated, ready to push, and he was out and with us in no time. According to the doctor, Morrison practically flew into their arms weighing a monstrous 5lbs and 1oz which we all agreed wasn’t that small for a 34 week old baby. I chose not to cut the cord as I was crying from the pure joy of our ordeal finally being over.

The preemie team and Pediatrician descended upon him to inspect and assess what he needed for care. The Pedi assured me he looked very healthy for his age and even pointed out his testicles had descended which was unusual for that age. They conferred and finally told me he’d be brought to Special Care which is the step down from the NICU but still the appropriate level of care for him given his age. The following hour would be one of the most tumultuous of my life as his health appeared to steadily decline and my wife was wheeled away for an operation.

My wife had a history of a sticky placenta and this one was no different. Removing it requires anesthesia, which Peg hadn’t needed while delivering Morrison but was unavoidable now. I remembered this feeling of fear as I said goodbye to Peg but this time I didn’t want to stay in the delivery room as our son was being wheeled down to Special Care. I followed the bassinet and found it amusing they wheeled the kid whose initials are MM to the O side of the room. Hospitals can’t charge as much for Special Care as they can the NICU which means the former tends to have cozier conditions. This room had 4 babies at varying stages from bassinet only to full on isolette which we would eventually come to accept as our son’s temporary home. Everything seemed normal when we got there and I was feeling optimistic that maybe a few days would be enough for Morrison. I went to check on Peg’s status but the nurse was with her in surgery. I debated waiting but opted to return to our baby. When I got there they had made the decision to deliver low flow oxygen through a tube in his nose. He was not a fan of the tube just like his grandfather and they were constantly replacing and taping it. I returned to Peg’s room but she was still not back from surgery and it was getting to be the point where it seemed like someone would have found me by now had something gone wrong. Within 10 minutes they were rolling her back into the room and a massive sense of relief overcame me to see her again. We caught up on Morrison’s status and I went back down to check on him. This time the NP was delivering CPAP as his lungs weren’t expanding enough to deliver oxygen and I nearly hit the floor at the sight. They suggested I take a seat which I did to try and comprehend what was happening to our baby. I returned to get Peg and bring her down to Morrison, hoping this time there wouldn’t be something new for the nurses to explain. Once she was settled we made the decision that I would drive with Gammie to Maine to pickup the older two boys from Grandma. We decided Gammie should drive since I had not slept as Peg had just be in labor overnight. We got back to Brookline and settled the boys in for the night so I could spend it in the hospital with Peg and Morrison. She was discharged the next day she was finally able to go home to our family except one.

Leaving the hospital without your newborn child has got to be one of the worst feelings of our lives. Having brought two home already there was this sense of abandonment or loss as we got in the car and consoled each other. Getting home was easy, being home must have felt strange for Peg after so much time away. We made a plan to go visit Morrison after the older kids were in bed and packed some things for the car ride. As we got in the car I noticed a missed call from a 617 number and immediately called it back. The caller ID said MGH and we would spend the next few minutes frantically getting different nurses until we finally got some answers. Morrison needed surgery and we needed to get there ASAP if we wanted to see him before he went to the OR.

The drive to MGH would be straight forward for a Saturday night had we not been frantic with fear, guilt, and all the emotions of a parent having just received the call. I dropped Peg off at the door and called grand mothers to let them know what limited info we had at the moment. His nurse had discovered his belly was hard and distended. He likely had a perforation of his intestines and they needed to operate to discover and repair the hole. We were informed that the chief of pediatric surgery was being called in to perform the operation. It should only be a few hours. The anesthesiologist had an accent and it wasn’t long before he noticed my rugby shirt which of course became the topic of conversation. I would have preferred to focus on our son but so it goes. Off he went and we were escorted to what would become his room in the NICU. There Peg could get some sleep and I sat up waiting for news on our son.

The wait was grueling. The Drs had made his operation sound routine but for us it was a life or death situation for our two day old. I remember my brain thinking how was this my fault and why did we think we should have another kid. That said I was reassured he was in the best place for a baby with these conditions and that he was in “good hands.” Around 2am the anesthesiologist was the first to appear with the good news that everything was ok. I woke Peg and he was shortly after wheeled in with what felt like 40 Drs and nurses. The chief found us among the chaos to let us know the operation was successful, the hole was significantly bigger than they had anticipated, and they had removed a section of his intestines to make the repair more secure. They didn’t think it would have a long term impact on his health and there would just be some regular followup to ensure everything is healing. Relief! Once things had calmed down I said goodbye to Peg so someone could be home when the older kids woke up to let them know what had happened while they slept.

The next week in the NICU was a blur. He wouldn’t be allowed to eat for a few days to a week. The intubation tube could come out within a day but he would still need oxygen. We could hold him from time to time and had 24/7 access but it still felt like the nurses were raising our baby. Which was for the best. We came up with a visiting schedule that coincided with Peg’s pumping schedule and the kid’s schedules. My mother left that following Wednesday and Peg’s mother arrived seamlessly that afternoon. That was around the time we started to feed him very small amounts of milk which seemed like a huge milestone for us. The NICU proved to be a rather uneventful experience and we even got a few family visits in.

At the end of that week we had a family meeting where it was clear that Morrison was progressing and could move back to Special Care. One step closer to home! We left as they were just waiting on a bed. That night he was moved to bed M :) While we were excited for the move it meant we would have less accommodations. We still had 24/7 access but what we wanted was for him to come home. Visiting the hospital was beginning to wear on us, more so for Peg, as the weeks were beginning to turn into a month. He would need to be out of the isolette, regulate his body temperature, and able to drink 90% of his milk from a bottle. Anything not finished from a bottle would be fed through a tube in his nose. The next few days would be critical to getting him home based on advice we had received.

A friend who had a 28 week baby a few years ago was advising us through the process from the 4th. His biggest piece of advice was being there and managing the feedings. If we didn’t take the initiative to ensure he drank his entire bottle in the allotted 30 minutes. We (I) took this advice to heart and felt like I needed to do whatever it took to get our son home. Any feeding that only went 20-30% in his mouth felt like a loss as I watched the rest go through a tube. One feeding was not going well as he started to fall asleep with the bottle in his mouth. I did my best to stir him and get him to take the bottle until a nurse noticed and thought he was rejecting and I was forcing the bottle on him. Her reaction to the situation felt blown out of proportion as she started to throw words around like “aversion” and I handed him over to tube feed. I didn’t realize the extent to which I had triggered the nurse until a social worker came in to scold me about our son developing an aversion. They really tried to reinforce that he would develop at his own pace and a switch would flip. I wasn’t impressed and we started to feel like maybe he would be better at another hospital and called our Pediatrician for her advice. She reassured us he was in good hands and broke the news that there would be no transfer. We took a day off from visiting and regrouped to trust and be patient with the process.

The next few days he showed steady progress and we were beginning to feel optimistic! He was getting to 80% and soon the feeding tube would come out to test if he could reach 100%. He passed the test and before we knew it we received the call that he was ready to come home. We dropped Morgan off at robot camp, Malcolm with some close friends, and we were on our way to pickup Morrison who was finally getting discharged…37 days later.

[majhee]

Top 10 Private Maternity Hospitals in London

Choosing a private maternity hospital in London is an important decision to make. With so many great facilities, narrowing your choices might take time and effort. Here's a look at ten of London's best private maternity hospitals, each with its strengths and specialties.

1. Grosvenor Gardens Healthcare is a highly reputable private maternity hospital in London. Grosvenor Gardens Healthcare provides a beautiful delivery experience centered on customized care. They have a staff of highly qualified consultants who give excellent treatment to both moms and babies.

Website: Grosvenor Gardens Healthcare

Location: 2 Grosvenor Gardens, London, SW1W 0DH (Belgravia) and 17 Croxted Road, London, SE21 8SZ (Dulwich)

2. The Lindo Wing in St. Mary's Hospital: The Lindo Wing, which is internationally famous, is popular among celebrities. It is part of St. Mary's Hospital and provides a quiet and peaceful birthing experience with access to the hospital's world-class professionals.

Website: The Lindo Wing at St. Mary’s Hospital

Location: South Wharf Road, London W2 1BL

3. The Portland Hospital for Women & Children is one of the UK's top private maternity hospitals. They provide a broad range of maternity services, including antenatal care, birth, and postnatal care. They are known for their cutting-edge facilities and stellar reputation.

Website: The Portland Hospital for Women & Children

Location: 205-209 Great Portland Street, London, W1W 5AH, United Kingdom

4. The Kensington Wing at Chelsea and Westminster Hospital: The Kensington Wing provides a personalized approach to maternity care in a luxurious setting. They have a team of highly skilled consultants and midwives who offer a full range of maternity services.

Website: The Kensington Wing at Chelsea and Westminster Hospital

Location:  369 Fulham Road, London, SW10 9NH, United Kingdom

5. Queen Charlotte’s and Chelsea Hospital: Part of the Imperial College Healthcare NHS Trust, Queen Charlotte’s and Chelsea Hospital is a world-renowned center for women’s health. They offer a full range of maternity services, including care for high-risk pregnancies.

Website: Queen Charlotte’s and Chelsea Hospital

Location: Du Cane Road, London, W12 0HS, United Kingdom

Additional Options to Consider:

6. The Royal Free Hospital: Renowned for its neonatal intensive care unit, The Royal Free offers a comprehensive maternity service with a focus on high-risk pregnancies.

Website: The Royal Free Hospital

Location: Pond Street, Hampstead, London, NW3 2QG, United Kingdom

7. University College London Hospital (UCLH): UCLH offers a modern maternity unit with a focus on family-centered care. They have a team of experienced consultants and midwives who provide care for both straightforward and complex pregnancies.

Website: University College London Hospital (UCLH)

Location: 235 Euston Road, London, NW1 2BU, United Kingdom

8. King’s College Hospital NHS Foundation Trust: King’s College Hospital offers a high standard of maternity care, with a focus on innovation and research. They have a team of specialists who can care for complex pregnancies.

Website: King’s College Hospital NHS Foundation Trust

Location: Denmark Hill, London, SE5 9RS, United Kingdom

9. Spire Bushey Hospital: Spire Bushey Hospital is a private hospital located in north London. They offer a range of maternity services, including antenatal care, delivery, and postnatal support.

Website: https://www.spirehealthcare.com/spire-bushey-hospital/

Location: Heathbourne Road, Bushey, Hertfordshire, WD23 1RD, United Kingdom

10. The HCA Healthcare London Clinic: The London Clinic offers a personalized approach to maternity care in a comfortable and discreet setting. They have a team of experienced consultants and midwives who can care for both straightforward and complex pregnancies.

Website: The HCA Healthcare London Clinic

Location:  35 Weymouth Street, Marylebone, London, W1G 8BJ, United Kingdom

This list is just a starting point, and the best private maternity hospital for you will depend on your individual needs and preferences. Be sure to research each hospital carefully and take a tour of the facilities before making your decision.

Read More:

Private Maternity Hospital in London

Private GP in London

Private Gynaecologist in London

[nexthitjcink]

spotlight: SAGA

Our spotlight for today is on NH's first and only original group as of now, SAGA. Dubbed the "Queens of Girl Crush" they have made their mark as one of the best selling, most acclaimed and popular girl groups in K-Pop history.

Their debut as NH's first girl group was highly theorized on and anticipated. The group went through many different lineup changes while NH tried to make sure their first group would be the best it could. NH wanted a group that was versatile talent and concept wise, though they. They were met with pretty fast success that they have sustained with frequent releases and promotions. In more recent years the girls have begun to shift to more solo ventures, but remain close and supportive of one another. Rumors have been spreading that some or all of the girls plan to depart from NH, but none have been confirmed. Their last comeback was in May 2022, and fans are desperate for another release from the international superstars.

MEMBERS

Kim Mia aka "Mia": Leader, Main Vocalist, Lead Dancer

Born 1995 in Toronto, Canada

Rumored to be related to an executive at NH, but that has never been confirmed or denied

She had the longest training person (6 years), highly anticipated debut. She was called "Mini-Hwa" pre-debut because of her vocal skills.

The first member release solo music, starting with Happy in 2020.

Has been publicly dating NOON's Jaewon since June 2023.

Known in the fandom as the "dad" of SAGA, since she shows her love in more quiet and subtle ways. She is very protective and supportive of the other members.

Lee Soyeon aka "Soul": Lead Rapper, Sub Vocalist, Visual

Born 1996 in Daegu, South Korea

Has gone on multiple health related hiatuses

Well known actor and model, established her own clothing brand "RE:Born" in 2021 under NoHarm

Known in the fandom as the "mom" of SAGA. When they lived in the dorms she would often cook and clean for the members. "Without Soul, our dorm would look like a boy group" - Angel (Vlive, 2017)

Bae Eunji aka "Jiji": Main Dancer, Vocalist, Rapper, Center

Born 1996 in Seoul, South Korea

Often leads group dance practice sessions and is known to be very strict.

Has a background in theater, started doing musicals in 2020 under her birth name "Bae Eunji"

She is a part of the group's sub-unit, So Far, with Angel

Voted as the most unlike her on stage persona (she's shy and introverted off stage)

Kittikhun Wattayachit aka "Luna": Main Rapper, Producer

Born 1997 in Bangkok, Thailand

Her debut marked her as NH's first and only non-Korean idol.

Since 2019 she has written on all of SAGA's albums and is a well known writing for other groups/artists.

Almost left Next Hit & SAGA after not being paid for the songwriting and producing she began participating in for SAGA in 2018. She has since negotiated with NH and paid for all of her previous writing credits.

She is the most private about her personal life. The members did not meet her family members until 5 years after the group's debut when they had a concert in Thailand.

Kim Soomin aka "Angel": Lead Vocalist, Maknae

Born 1997 in Seoul, South Korea

She was not in the original lineup of SAGA (as shown in the original pre-release song, 4 Walls), but was added right before debut after only 6 months of training.

Before debut she was a child actor and starred in many commercials and had small roles in dramas.

She is a part of the group's sub-unit, So Far, with Jiji.

She has a large presence in variety shows, and hosts her own radio show.

She is the most social member (voted by members), but also the most tardy. As a rookie, the group had a rule that you had to pay 500 won for every minute they were late to practice, Angel had to pay 30,000 won over six months.

DISCOGRAPHY

PRE DEBUT

DEC 14 2015 4 Walls

GROUP RELEASES/TOUR

FEB 14 2016 SAGA: The Beginning (1st Mini-Album): Whistle & AutomaticMAY 02 2016 Playing with Fire (1st Single): 불장난 (Playing with Fire) SEP 19 2016 Crystyle (1st EP): Hobgoblin - First win, win Rookie of the Year at MAMA 2016 JUN 05 2017 I Like That (2nd Single): I Like That - Soul goes on hiatus mid-promotions after injury on stage OCT-NOV 2017 SAGA: The Stage: 1st National Tour & One show in Japan - Encore of last tour date (in Seoul), Soul appears on stage to perform 4 Walls and announce comeback with all members with their first full length album JAN 01 2018 A Perfect SAGA 1st Album 피카부 (Peek-A-Boo) JUN 12 2018 Black Dress 2nd Extended Play: Black Dress - First All-Kill NOV 11 2018 Bad Boy 3rd Single: Bad Boy & English Version - After Korean promotions, group travels to the US to promoted English version of the track. They are nominated for 'Choice International Artist' & 'Best Music Video' at Teen Choice Awards (lose both) SEPT-DEC 2018 SAGA New World: The 1st World Tour - Sold out tour with dates in Asia, US, Canada, and Brazil. Criticized for having small venues than the demand would dictate. APR 08 2019 Lion 4th Single: Lion - 1 million pre-sale, they perform at Billboard Music Awards, where they are nominated for 'Top Social Artist' (lost) OCT 26 2019 No.1 3rd EP: No - Win Best Female Group at MAMA 2019 MAY 11 2020 Psycho 5th Single: Psycho - Article goes viral criticizing them for being "influencer idols" (due to their lack of b-sides and albums 4 years in). The girls perform at Coachella 2020. AUG 28 2020 Ice Cream 6th Single: Ice Cream - Collaboration with Selena Gomez, only promoted in the US AUG 10 2021 A SAGA Story 2nd Album: DUMDi DUMDi - Released Netflix documentary SAGA: The Story, which discussed the album's creation (Luna, Angel, Mia, and Jiji worked on writing, Luna on production, and Soul styled their outfits for the photobook) OCT 09 2021 A SAGA Story: Epilogue: Lovesick Girls - Win Record of the Year at MAMA 2021 JAN-MAR 2022 The Legend Of SAGA The 2nd World Tour - Sold out tour with dates in Asia, North & South America, & Europe. All girls have a solo stage and So Far has an interlude. MAY 03 2022 The Festival 2nd Mini-Album: Feel My Rhythm & Birthday - "Feel My Rhythm" released as a pre-released single, promoted a week before album release.

SOLO & UNIT RELEASES

MIA: DEC 14 2020 What Do I Call You 1st EP: Happy SO FAR: JAN 23 2021 Monster 1st EP: Monster MIA: MAY 31 2021 안녕 (Hello) 1st Mini-Album: 안녕 (Hello) LUNA: NO 24 2022 Money 1st Single Money MIA: OCT 27 2022 My 2nd EP Drive

[hell-ama-official]

what are the 28 cities of Hell

Do you want me to list all of them?

Alright. Although Hell has many settlements, most of them are considered towns. To be considered a city of Hell, a town must

1. have over 1'000'000 permanent citizens 2. be located on a major route, have a major production complex or historical importance.

Alright. You asked for this. Here we go.

Culturally important settlements: Dis, Pandemonium, Treachery's Peaque

The quinfecta of historic cities on major route crossings: City of the Damned, City of the Tarantula, City of Jaws and City of Dead, as well as City of Vultures (more commonly called Vulture City).

Major production cities: Shadowshire, Marchegri, New Pandemonium, Balchar-on-Styx, Aqcheid, Sudmouth

Major route (inland) cities: Graxahl, New Pandemonium, 29th City, Drochenech, City of Delirium, Fiendsborough, Ashbostbie, Abaddon's Abysm, City of Jaws, Ossiswick, Marchegri, Malden, Carniscul Major route (gate) cities: Interitusby, Lament's End, New Akeldama (prev. Ap. Judasfield)

Edit: Minor addition to this post. New Pandemonium is listed twice because both criteria currently apply to it. It is located on the main route and is known for its food production and industrial agriculture. It is consistently voted as the third most beautiful city in Hell, which is mostly caused by the fact the city was placed in a strategic location and has good street planning, unlike cities that emerged naturally.

The list of twenty-eight Hell cities by location:

Northern Hell: Treachery's Peaque, Dis, Fiendsborough, City of the Damned, City of Vultures, Balchar-on-Styx, Interitusby, Drochenech, City of Dead

Southern Hell: Shadowshire, Graxahl, Lament's End, 13th City, New Pandemonium, City of the Tarantula, Abaddon's Abysm, Sudmouth, City of Jaws, Marchegri

Western Hell: Pandemonium, New Akeldama, Ashbostbie, Malden, Ossiswick, City of Delirium

Eastern Hell: Carniscul, Aqcheid, Morbidluteum

Exceptions

Out of all of these, City of Dead, Drochenech and Interitusby are considered "minor" cities, as their population dropped below one million after they were granted city status; in case of Drochenech and City of Dead the population decline was caused by the 1933 NH pandemic, in case of Interitusby the cause is the abysmally low birth rate.

13th City and New Pandemonium, while qualifying for city status by criteria 1, fail to exhibit any traits qualifying them for the seventh; they are considered cities only because of extraneous circumstances:

13th City was founded by Satan as an outskirt for 29th City, which in itself is not considered a city, to push it past the million citizen mark without having to invite people into the closed town itself; however, her influence turned out to not be enough as Lucifer vetoed her claim that the cities are connected, as they do not share neither their population, their economy nor transportation, and declared the 29th City an enclave town within 13th City instead. New Pandemonium is a city of importance because it is located in the area of South-Western Hell that otherwise would not have a major city; for that reason the biggest city was chosen as the administrative center for purposes of handling the administrative, judiciary and healthcare systems in that region, and in 1955 granted the City status.

Phew! That was a long one. If you got to the end, congratulations! This was also an exhausting and boring one. Just some final words left:

This classification is accurate as of October 19, 2023. It might not stay accurate if minor cities lose their city status, or if any of industrial cities crosses over into the 1'000'000 citizen territory. This classification exists primarily for logistical, civil engineering, land use and developmental management. It doesn't matter otherwise.

[wutbju]

West Lebanon, NH - Beverlee Hastings Merrill, age 90, widow of the late Joseph H. Merrill, Jr., passed away on Sunday, November 27, 2022, at the home of her daughter, Nancy Peavey, in Enfield, NH.

Born at home on November 21, 1932, in Corinth, VT, to George and Bernice (Huntley) Hastings, she attended the small village Cookeville School, graduated from the Bradford Academy, Class of 1950, and attended Bob Jones University, Greenville, SC.

She moved to Hanover, NH, in 1952 to work at Dartmouth College Library. She married Joseph Merrill of Hanover at the United Church of Christ at Dartmouth College on September 15, 1956. He pre-deceased her on July 22, 1998. Married for almost 42 years, they spent most of their married life in the Hanover/Lebanon area as Joe pursued his career in Printing Management and they had their four children – Lisa, Lori, Nancy and Jonathan. Joe grew with Dartmouth Printing Co. In 1988, after 31 years with Dartmouth Printing, they moved out of town for the next eight years – first to Stratham on the NH seacoast for a position with Bradford & Bigelow in Danvers, MA, and then to The Printing House/Homes & Land magazine in Tallahassee, FL. They returned "home" to Lebanon in 1996 to be near their large, extended families.

Employed in the health care field for many years, Beverlee become a unit secretary at Dartmouth Hitchcock Medical Center for 11 years (1977-1988). When moving to the NH Seacoast, she found fulfillment as a one-to-one companion with Interim and the Portsmouth Regional Private Duty Association in Hampton Beach, Rye Beach, Exeter, Portsmouth and Kittery Point, ME (1989-1991) and then in Tallahassee FL (1991-1996). She was deeply committed to the elderly, especially those with acquired memory-loss disorders. To make their days and moments special, she became a compassionate activity assistant/educator at the Leon County Adult Day Care Center in Tallahassee for three years, and upon returning to the Upper Valley, at Genesis Health Care/Lebanon Center for the next six years (1996-2002). For years after her retirement from Genesis, her former co-workers and residents' families told her they remembered her as "that Hat Lady" in her many vintage, decorative crazy hats.

She was a Hospice volunteer for 23 years, beginning in the early years of the Hospice movement in the Upper Valley. She went on to connect with Seacoast Hospice in the Exeter-Portsmouth area and Big Bend in Tallahassee before returning to be a volunteer again in the Upper Valley after her retirement.

Retirement to Beverlee was "simply shifting gears" with time to read all night, take long naps, do some traveling with friends and family – and time to delve more deeply into family genealogy and local history. She drove about to Town Clerk's offices seeking out documents of her ancestors' births, deaths and marriages, making copies, gathering them, with their stories, into notebooks as a legacy for her children and future descendants. With the help of her nephew Kevin Hurst, she produced a book – Bev's Memories. She gave copies of the book to her children, her siblings and cousins.

She got her wish to do some traveling with family and friends, visiting Scotland, Nova Scotia, Arizona, Colorado, California, the Smoky Mountains and multiple trips to Florida to visit her sisters and old Tallahassee friends. She flew to Minnesota to finally meet a pen pal she had connected with while both were in grade school.

Moving to the Quail Hollow senior living community in 2007, she remained active locally in the Lebanon Woman's Club and the Rusty Reds and Scarlett O'Hatters of Quail Hollow's Red Hat chapters. Gradually slowed down by a weak back and poor balance, her passion for social interaction and involvement never wavered. She took great pride in being the overseer of the Quail Hollow Bi-Annual Give Away-Take Away Weekends, the Kilton-Quail Hollow Lending Library project and Quail's rotating art galleries.

She is survived by her loving family – her four children, Lisa (Dean) Rowe of Shrewsbury, MA, Lori Kay of White River Junction, VT, Nancy (Jeff) Peavey of Enfield, NH, and Jonathan (Sue) Merrill of West Lebanon, NH; her ten grandchildren, Allison (Jim) Ladio, Stephanie (Tyler) Frost, David Rowe, Andrew Kay, Leslie Kay, Benjamin Peavey, Joshua (Megan) Peavey, Nathan Peavey, Jessica (Brendan) Demich, Lindsey Merrill; and six great-grandchildren, Rowen and Salem Ladio, Ava and Wesley Peavey, Zoe Frost and Cecilia Demich.

She is also survived by her sister Peg Wilmott of Naples, FL, and brother David (Sue) Hastings of North Haverhill, NH; and multiple sisters-in-law and brothers-in-law. She will be remembered by 30 nieces and nephews and their families, and many cousins.

In addition to her loving husband, Joseph Merrill, she was pre-deceased by her sisters Joyce Chapman and Bernice (Bunny) Hurst, her brother George (Bert) Hastings, as well as multiple sisters-in-law and brothers-in-law.

Her remains have been cremated and will be scattered by her family at locations that were especially meaningful to Beverlee. She wished that there be no calling hours or services.

[birthcottage]

Midwives Center In NH

At Birth Cottage, our midwives center in NH. provides experienced care for your pregnancy and birth. Our team of experts offers personalized care plans tailored to your unique needs, aiming to ensure a safe and healthy birth experience for you and your baby. Trust us to provide compassionate care and excellent outcomes for you and your growing family.

[plan-d-to-i]

(google translate again, yeah)

(I forgot to thank you for the last answer, I really didn't know that the drama used the music of my compatriot, it was a pleasant surprise for me)

I don't know if anyone has asked you this before, but do you think JC was good with WWX as a kid?

I mean not just their childhood, but the time of their training in Gusu.

I really love JC, and I understand perfectly well that he is the most dick in character, but I love him precisely during my studies at Gusu, I can not give any arguments that then JC was directly GOOD to WWX, but he is clearly cared a little about him and even ... worried? at least that moment after the punishment where JC helped WWX get to the room...

Yay - I'm so happy to hear about Stravinsky :)

Hahah loving jc as the dick that he is is the way to do it! go for it. :) also, sorry this was so delayed I wanted to reread the Cloud Recesses arc so it would be fresh in my mind before answering.

In terms of jc the Cloud Recesses arc is perhaps the most 'mellow' we see him aside from the Lotus Pod Extra but for me it's still impossible to find him a worthwhile person. I can already see the faults in his character that I know will only get worse as he grows older. Canonically I don't see how he would have any friends studying in the Cloud Recesses if he didn't come as a package deal w Wei Wuxian. I mean I doubt jiang cheng would have any friends without WWX period. In fact jiang cheng doesn't make any friends over the course of 13 years. He's also unable to find a wife bc of his temperament and behavior...

What we can glean about their relationship in the Cloud Recesses arc (and even the Lotus Pod Extra) is that any time WWX gets a kind word or understanding from someone, jiang cheng scoffs at it. Any time someone shits on WWX, jc is there to agree, to relish the idea of WWX being punished, and shit on him some more. He would be an immensely exhausting person to be around. He doesnt believe in WWX's ideas and ingenuity, (as NHS does for example), he doesn't believe WWX is hurt, he always assumes the worst of him, he doesn't believe LWJ might like WWX. The only thing he ever seems to believe is that WWX will dishonor YunmengJiang and that WWX should be punished. So for a kid who supposedly wants his father's approval so badly he instead constantly acts like his mother's mouthpiece/minion. He reprimands WWX like he's trying to become Madam Yu 2.0. I see jc stans all the time being like oh he had to keep WWX in check bc WWX was such a lOOooose canon, for the good of the Clan!! lol listen JFM didn't give a f...about WWX's behavior (in his letter to LQR) why are you so concerned? JFM would have preferred for jc to try & save his peers in the Xuanwu cave or at least to understand why that was the correct course of action rather than for him to just sit in front of the class in the Cloud Recesses and tell WWX off for giving LQR as good as he got, while actually still breaking the rules himself but eschewing punishment.

salt up here, quotes below :

Even when Nie Huaisang picks up on the fact that WWX is being treated unfairly by LQR, jc dismisses it and piles on WWX instead.

Nie Huaisang said, “Old Man Lan really seems like he’s coming down especially harshly on you. Every time he reprimands someone, it’s always you.” Jiang Cheng grunted. “He deserves it. What kind of answer was that? He can get away with saying that sort of nonsense at home, but he had the nerve to say it to Lan Qiren’s face. He was practically asking for the old man to kill him!”

But does WWX get away with ANYTHING in Lotus Pier? When we know he is punished constantly for EVERYTHING? This is jiang cheng fully being his mother's mouth piece. It's not something WWX would get away with, it's something jc knows JFM wouldn't mind. Which is why he's so pissed off. Which begs the question if JFM would not be upset with WWX's behavior why does jc need to criticize him? Again :

A dark expression shadowed Jiang Cheng’s face, and his voice was filled with anger. “Why are you so proud of yourself? What is there to be proud of?! Is being told to get out some amazing accomplishment? You’re making our entire clan lose face!”

and his glee at the idea that WWX will be punished leaves a bad taste in one's mouth considering how WWX was perpetually punished in Lotus Pier by jiang cheng's mother for... existing.

Jiang Cheng smiled grimly. “Now that you’ve thoroughly offended both Lan Wangji and Lan Qiren, you’re basically dead tomorrow. No one’s going to clean up your corpse either.”

and again

Without the old one, only the young one remained. This would be easy to deal with! Wei Wuxian rolled off the bed and laughed while putting on his boots. “Heaven’s charmed clouds are blessing me with shade.” Jiang Cheng was beside him polishing his sword with loving care when he decided to spill cold water over Wei Wuxian’s head. “Just wait until he gets back. You can’t escape punishment.”

Where others like NHS see value in WWX's thoughts

Nie Huaisang thought for a while. “Actually, I thought what you said was very interesting,” he said, not entirely able to hide his envy and yearning.

jc is always dismissive of WWX's ideas. These are inventions that WWX realizes. Demonic cultivation in the first conversation and The Spirit-Attraction Flag and The Compass of Evil in the second:

“Enough,” Jiang Cheng warned. “Whatever nonsense you spout, you better not head down that sort of dark road.”

-

Changing the topic, Wei Wuxian said, “If only there was something like fishing bait that could draw the water ghosts in. Or, something that could point in the direction they’re hiding, like a compass, that sort of thing.”

“Lower your head and watch the water,” Jiang Cheng said. “You’re letting your fantasies run wild again. Concentrate on looking for water ghosts like you’re supposed to.”

“Hey, mounting swords and flying was also only a fantasy once!” Wei Wuxian said.

He's also a hypocrite. Because even though he berates WWX for misbehaving, he himself breaks the rules. He drinks, he even goads WWX into buying liquor, the only difference is that he doesn't get punished for it, and he doesn't feel like coming forward and getting punished for it :

Naturally, Jiang Cheng was too embarrassed to talk about what Wei Wuxian had been up to. After all, all of them had egged him on to go and buy alcohol, and they all deserved to be punished as well. He could only speak vaguely. “It’s nothing. It’s nothing. It’s not that bad! He can walk. Wei Wuxian, why haven’t you gotten off yet?”

It's no wonder WWX is so impressed by LWJ's integrity in spite of his social status, when he's clearly used to the other dynamic :

“Lan Zhan, I really admire you,” Wei Wuxian said sincerely. “After I told you that you had to punish yourself too, you actually did it. You didn’t let yourself off at all. I can’t argue against that.”

A dynamic which is shown repeating in the Lotus Pod Extra where WWX is the only one to get punished for sunbathing, and which repeats here when Wei Wuxian here stops jiang cheng from confronting Zixuan over YanLi's honor (and jc's) and does it himself.

Zixuan :“Why don’t you ask what about her could make me satisfied?” he said in return.

Suddenly, Jiang Cheng rose. Wei Wuxian pushed him away and stepped between them, smiling coldly. “You think you’re very satisfactory? As though you have the right to be so picky!”

Zixuan: “If she’s unhappy, then let her break off the engagement! I certainly don’t cherish your wonderful disciple-sister. If you cherish her so much, why don’t you take it up with your father? Doesn’t he love you more than his own son?”

After hearing the last sentence, Jiang Cheng’s eyes narrowed, and Wei Wuxian was no longer able to contain his own fury. He flew at Jin Zixuan, his fist raised.

WWX takes the punishment alone. Same way he offers to do when he hurts himself falling from a tree because jc threatened him with dogs. meanwhile jc is gleeful to see him being punished.

[Wei Wuxian] was kneeling on the stretch of pebble road to which Lan Qiren had assigned him when Jiang Cheng walked over from afar and mocked him. “You’re kneeling so obediently.”

“It’s not like you don’t know I have to do this all the time.” Wei Wuxian’s voice filled with schadenfreude. “But this Jin Zixuan guy, there’s no way he hasn’t been pampered and spoiled rotten since birth. No one’s ever forced him to kneel, I’m sure of it. If he doesn’t wind up crying for mommy and daddy today, I’m not named Wei.”....

Wei Wuxian "...It’s a good thing you didn’t do anything.”

“I was going to. If you hadn’t pushed me away, the other side of Jin Zixuan’s face would be hideous too.”

“Stop it. His face is uglier for being lopsided."

WWX is happy to have spared jc from getting into trouble but jc makes the whole thing about himself anyway (like everything else ever) and is upset JFM would rush over for WWX - in his mind. Even though JFM clearly had to rush over to meet with Jin Guangshan not to coddle WWX in any way.

"Jiang Fengmian had never rushed to another clan in less than a day because of him. Regardless of whether what happened was big or small, or good or bad." Never

WWX on the other hand tries to be observant of jc's feelings and reassure him & distract him from his moods :

When Wei Wuxian saw Jiang Cheng’s melancholy expression, he thought he was still upset with what Jin Zixuan said. “You should leave. You don’t need to keep me company any longer. If Lan Wangji comes again, he’ll catch you. If you have time, you should find Jin Zixuan and watch his pitiful kneeling.”

Later in the book after nearly dying in the Xuanwu cave WWX leaves his sick bed to run after jc and comfort him after his mother's rant, even though WWX had to listen to his parents (and himself) being slandered by YZY. jc doesn't spare any thoughts for how other people might be feeling or suffering. His entire perception of the world is centered around himself. To him even WWX's greatest fear doesn't generate empathy, only amusement or later on a form of torture.

From that point onward, they made trouble everywhere together, and if they encountered a dog, Jiang Cheng would always chase it away for him, then enjoy a peal of derisive, unbridled laughter at Wei Wuxian’s expense beneath whichever tree the boy had leapt atop.

he grew up on the streets, often having to fight for food with vicious dogs. After several bites and chases, he gradually became extremely scared of all dogs, no matter the size. Jiang Cheng laughed at him because of this quite a lot of times.

This brings me to the last point. jc's resentment of WWX's interest in Lan Zhan, or in a serious friendship outside of him. I see so many ppl say that bc WWX fought he was kicked out of the Cloud Recesses early... but was he?

Jiang Cheng was somewhat taken aback. “Lan Wangji? What was he doing here? He still has the nerve to come see you again?”

“Yeah, I think his bravery is laudable if he still has the nerve to come see me. His uncle probably told him to check on me and see if I was kneeling properly.”

Jiang Cheng’s instincts were sending him ominous signals. “So were you kneeling properly?”

“I was then,” Wei Wuxian replied. “But I waited for him to walk away a bit, then took a tree branch, lowered my head, and dug out a hole in the dirt near me. It’s the pile right by your foot—there are ant tunnels there. It took me so much effort to find them. Anyway, I waited for him to turn back and see my shoulders shaking. He had to have thought I was crying, so he came back and asked. You should have seen his face when he caught sight of the ant tunnels!

“…” Jiang Cheng said, “Why don’t you just get the hell out and go back to Yunmeng? I bet he never wants to see you again.”

Thus, that evening, Wei Wuxian packed up his things, got the hell out, and went back to Yunmeng with Jiang Fengmian.

Repeatedly throught his stay in the Cloud Recesses even while NHS was observing that LWJ's behavior around WWX was strange and unique, jc was telling WWX he is hated and bothersome. When WWX wanted to apologize to LWJ jc is completely dismissive of it :

“He hates me already? I was thinking of apologizing to him,” Wei Wuxian said.

“Oh, so you want to apologize now? It’s too late!” Jiang Cheng said derisively. “He’s exactly like his uncle. He thinks you’ve been wicked ever since you were an embryo, so it’s beneath his dignity to pay you any attention.”

Later on when WWX mentioned wanting to invite LWJ to Lotus Pier jc categorically says no.

“Jiang Cheng had on a stern expression, “Let’s make this clear. I don’t want him to come, anyhow. Don’t invite him.”

BONUS

jc also always doubts WWX. He suspects him immediately of wrongdoings. He doesn't believe that getting hit with the discipline ruler in Cloud Recesses actually hurt him until LXC confirms that WWX might take more than a few days to heal. He doesn't understand WWX is in actual trouble from the Waterborne abyss and assumes he's fooling around luckily Lan Zhan is there to rescue him:

The disciple’s lower body had already been swallowed by the black whirlpool. It spun faster and faster, and he continued to sink deeper and deeper, as though something hidden beneath the water was pulling down on his legs.

Mounted on Sandu, Jiang Cheng had risen calmly until he was about sixty meters above the whirlpool before he looked down. Filled with displeasure at what he saw, he shouted and dove down. “What are you up to now?!”

The suction force inside Lake Biling grew ever stronger. Wei Wuxian’s sword was optimized for agility, and consequently, its strength happened to fall just short, and they were nearly pulled to the surface of the lake. Wei Wuxian steadied himself and held on to Su She with both hands.

“Someone help! If I can’t pull him up soon, I’ll have to let go!” he shouted.

Suddenly, the back of Wei Wuxian’s collar tightened, and his body was lifted into the air. He twisted his neck and saw Lan Wangji holding him up with one hand.

He maintains this same mindset when he tries to whip LWJ and WWX as they're attempting to leave Lotus Pier after the ancestral hall confrontation when WWX passes out.

Is jc evil in the Cloud Recesses ? No. He's just an annoying, basic, disagreeable asshole who doesn't bring anything positive to someone like WWX. People like jc become obsessed with kind, outgoing, generous people, people who don't set boundaries on what they give and what others take in their friendships. Even though they're dependent on them for their social interactions, because who else would socialize with them willingly, they resent them in equal measure, but at the same time they wouldn't be drawn to another selfish, self centered piece of shit person like themselves.

On a personal note, even Cloud Recesses jiang cheng is someone I would exclude from any personal friend group. Friendship with him is adding a minefield of jealousies and snide comments to every interaction. Things that then others will need to compensate around because he won't compromise or empathize w issues outside of his own concerns.

Translation source : x

[aighozt]

Shivagange - Mountain in Karnataka Banglore

Shivagange is a mountain peak with a height of 804 metres and Hindu pilgrimage center located near Dobbaspet, in Bengaluru Rural district India. It is situated 25 km from the town of Tumakuru and 54 km from Bengaluru.The sacred mountain is shaped as a shivalinga and a spring flows near locally called "Ganga", thereby giving the place its name. It is also known as Dakshina Kashi (Kashi of the South) and has various temples such as Gangadhareshwara temple, Sri Honnammadevi Temple, Olakal Teertha, Nandi Statue, Patalagang Sharadambe temple and several theerthas such as Agasthya theertha, Kanva theertha, Kapila theertha, Pathala Gange

Sri Honnammadevi Temple is inside the cave. Sri Gavi Gangadhare Temple is also inside the cave. Gavi means Cave, Gangadhareshwara means Parameshwara having Gange on the top. Every January, on the day of Sankranthi festival, the marriage function of Sri Gangadhareshwara and Sri Honnammadevi (Parvathi) is conducted. At that time it is claimed Ganga holy water comes from the rock at the top of hill and that holy water is used to solemnise the dhare ritual of the marriage function.

This location was originally under the control of Hoysala kings and the queen Shanthala, wife of Vishnuvardhana, who committed suicide as she did not give birth to a son. The hill was fortified during the 16th century by Shivappa Nayaka. These fortifications currently lie in ruins.The founder of Bengaluru, Magadi Kempegowda, also made improvements to the fortifications and kept a portion of his treasure within it.

A month-long cattle fair is held during Sankranthi month (around January) every year, which is a market place for bullocks.

By Air

55km from Kempegowda International Airport. Devanhalli

By Train

Bangalore City and Yesavantpur is nearest Railway station 40Km

By Road

KSRTC Buses are available and one can hire Taxis. 7Km from the Bangalore Tumkuru NH 48. From kempegowda bus station Bangalore it is 50km away.

[ibijau]

I’ve sent you an ask like this before but like. reverse au where nhs’ goal is wrh instead of jgy - imagining little nhs with his father’s blood on his saber unable to stop bawling but insisting that he has to go on trial for the murder of his father - being furious when he’s not pronounced guilty because it has to be someone’s fault - little nmj crying sympathy tears and trying to guard huaisang against whatever’s making him cry -

lxc only starts to let go of his jealousy of how frivolous sect leader nhs is allowed to be when wrh attacks nhs in the middle of a cultivation conference and is bravely defeated by now-jgy and lxc sees nhs first realize through his tears that wrh may have been the one to kill his father - he lets go of it entirely as he begins to suspect the decimation of the main branch of the wen clan took a lot more hard work than chance

oops, I went for something centered around the Nie brothers with this orz

It was just the three of them in that room when it happened, and though Mingjue is quite young, he is brought to testify at that trial his da-ge insists on having. When the elders ask, he explains that he had closed his eyes and didn't see much. He doesn’t tell them that his da-ge had just ordered him to close them. If it’s relevant, his da-ge will say something.

But Huaisang stays silent, except for some quiet sobbing.

“You didn’t see, but you heard,” one elder insists. “So what did you hear?”

“A-die was angry,” Mingjue replies, eyes darting toward his brother. “He was shouting at us.” He hesitates. “It’s words da-ge says I’m not allowed to know and if I use them around grown-ups I’ll be in trouble.”

The elders smile weakly at this well-behaved boy of seven.

“Just for today, you can say it. We need to understand, er-gongzi.”

Mingjue glances again at his brother. He only speaks again when his da-ge nods at him through his tears.

“A-die said that I was just the son of a whore and he was tired of me scheming against da-ge,” Mingjue recites, the accusation branded onto his mind. He can still hear the exact tone of his father’s voice, feel the power of his unrestrained aura oppressing him to the point he nearly fainted. “A-die also said that da-ge was a disgrace anyway and he was going to get rid of both of us and have real sons, instead of a Wen and a bastard. Then I heard blades hitting, and A-die shouted a-die couldn't hurt me, and there was a fight, and then everything was very quiet and da-ge said I needed to go get help.”

The elders nod solemnly. Huaisang sobs harder, his face awash with tears. He presses both hands against his mouth in an effort to keep quiet, so he won’t disturb the trial too much, but it’s not very efficient. Their cousin Zonghui, standing next to him, pats Huaisang’s shoulder to try to calm him.

“What did you see, before you left the room?” one elder asks.

Mingjue doesn’t answer right away. It’s fine to take time to remember, they told him early on, so he does that. In truth though, it’s not like he could ever forget the sight of his brother, usually so soft and funny, standing over the still twitching corpse of their father. He hasn’t forgotten that their father was breathing and even moaning when he left. He recalls, also, how different his da-ge had looked with his bloody sabre in hand, that hard look on his face.

When Mingjue had returned with help, his father had stopped breathing, and there was no hardness left to Huaisang who had dropped his sabre and was sobbing in a corner.

“There was a lot of blood,” Mingjue says, which isn’t a lie.

His eyes catch Huaisang’s. His da-ge, who doesn’t let anyone insult him for his mother, who told Mingjue many nice stories about her, since he never got to meet her. His da-ge who encourages him even when others say that the son of a servant shouldn’t be given the education of a young master, shouldn't dare to be better than children of higher birth. His da-ge, lazy and spoiled, but always putting in the effort when he feels Mingjue needs protecting.

It’s Mingjue’s turn to protect him now.

“I onlyremember the blood, and that I was scared,” he claims.

This time, it’s a lie.

But he can’t let them hurt his da-ge.

-

At the issue of that trial, it is decided that Huaisang acted out of self defence, and cannot be too harshly punished for the murder of his father. He has to offer sacrifices to the heavens and make public penance, but there won’t be lasting consequences, and he still gets to be sect leader.

Uncle Wen would not allow for anything else, Mingjue hears some of the elders whisper.

Uncle Wen went through a lot of trouble to make sure Qinghe Nie stopped bothering him, they also say. And now his sister’s child is ruling the only sect that used to stand up to him.

Huaisang laughs when Mingjue repeats this to him one night, while his da-ge puts him to bed for the night. Everything else has changed, but not this: Huaisang makes the time to take care of his didi, and Mingjue worries for his da-ge. Making time is harder than it used to be, the worries have become bigger than before, but fundamentally it’s still the same.

“Don’t listen to what those old farts say,” Huaisang advises as he tucks Mingjue under his blanket. “And don’t let them catch you listening, either. They’ll think you’re going to repeat things to me.”

“I do repeat things to you,” Mingjue points out. “And they shouldn’t be saying things like that. It’s not right to speak about people behind their back. A-die said people should speak their grievance in the light, or not at all.”

Huaisang smiles, and pets his hair.

“A-die was a good man,” he says. “Don’t let anyone make you forget that. A-die was the best man in the world. The way he was at the end, that wasn’t him. He was kind, and he loved you, and he was the best man any of us will ever meet… but this isn’t a world for good men.”

Mingjue frowns. His da-ge has always said odd things, but it has gotten worse lately.

“Da-ge is good too,” he mutters, unable to express the worry starting to form in his chest.

What he means is this: if good men are struck down by a cruel world, then his da-ge, who is good, might be at risk of dying. The thought terrifies him, and he would do anything to keep his da-ge alive. He lied for him at the trial, and he can do it again.

Huaisang laughs again.

“Don’t you worry about me!” he snickers, ruffling his brother’s hair. “I’m not good at all. Haven’t you heard people complain how little good I am?”

“You’re lazy not good, not bad not good,” Mingjue corrects. "Not like uncle."

Da-ge's good humour is shattered, replaced by a severe frown which makes him look too much like he did, that night their father died. Mingjue doesn't like it.

"MingMing, you remember the rule about uncle, right?"

"I don't say anything bad about uncle where others can hear," Mingjue meekly recites. "Only da-ge can say if it's safe to talk about uncle. Sorry. I know you didn't say."

"It's fine this time, but be more careful. Uncle is dangerous. He killed a-die, he'll kill us too if he realises we're not on his side. And we're not. Whose side are we on?"

"Each other," Mingjue dutifully replies.

He knows it's the right answer, but only if they're alone. If there are sect elders, Mingjue must claim loyalty to the sect. If they are in front of Wen Ruohan, he must say family. But the truest of truth is that he'd do anything for his da-ge, and da-ge has proven more than once he'd do anything for Mingjue.

"You're a good boy," da-ge said, ruffling his hair once more. "Don't think too much about these things. Da-ge will take care of all the problems for you."

"But I can help!"

"Yes you can," Huaisang agreed, pinching his cheek. "You can help by doing as you're told. Can you do that?"

Past events prove that Mingjue, on the whole, isn't good at doing what he's told, not when he thinks he's told to do something stupid. Sometimes, he makes a big argument about that. He's young, not stupid, and he doesn't want to do things just because grown-ups have ideas about how things should be.

But da-ge looks really tired tonight, and Mingjue doesn't want to become yet another problem on his brother's mind. So he nods dutifully.

It makes da-ge smile, so it was probably okay to lie.

[aethelflaedladyofmercia]

Birth of a Star

Another Good Omens Prompt from the DIWS server! This one suggested by @angel-and-serpent - and it’s a good one - Crowley Realizes he’s in Love!

Can also be found on my AO3 - hop over and leave a comment!

Night had fallen while the angel slurped down a truly impressive number of mollusks and Crowley sampled several cups of wine that was more than drinkable. The conversation meandered – work, politics, music, theater – and slowly, he felt his bad mood melt away, one terrible joke at a time.

All the while they reclined upon the couches, facing each other across the table, Crowley felt an odd warmness bubbling inside, percolating a little stronger every time Aziraphale smiled in his direction, or even just asked him a question. Something as simple as that, how are you finding the city? He couldn’t put his finger on why it affected him so, except that no one – no one – had asked him anything of the sort. Not in the entire time he’d been in Rome.

In fact, come to think of it, not since the last time he’d spoken to Aziraphale.

As they stepped out into the street, he caught himself thinking that maybe…maybe this city wasn’t so bad after all. Not if it brought evenings like this.

Aziraphale walked beside him, looking up at the sky. “Oh, it’s too cloudy to see the stars. More’s the pity. I always like to see them, you know.”

“Do you?” Crowley hated it. Didn’t even look at the sky, not if he could help it.

“Oh, of course. They’re so lovely. Truly works of art. I always envied the Starmakers, you know, the angels of Creation. Such a glorious task.”

“I…I was one of them, you know.” He didn’t know why he was saying it. The wine was the easy excuse, coiling warm in his belly, but he didn’t think that was the case. It took more than an amphora or two to loosen his lips. But something inside of him seemed trying to work itself out, something that had sat, listening to Aziraphale all night and…perhaps…wanted to reach back across the divide. “I helped build the stars.”

“Did you? Oh, that’s – that’s truly wonderful! Why, I can’t even imagine – what a gift, Crowley!”

“Nh. Well. Not anymore.” He tried to smile as he said it, but his face wouldn’t cooperate. He tipped his head back to stare at the clouds. Misty and cold and distant, like the remnants of the fires that once had run inside him. “Only angels can Create. Demons Manifest. Not the same thing.”

“Oh, my dear…” He felt a soft hand brush his arm, just for a second, before pulling quickly away. “I’m so…truly sorry. That was a great loss, I should think. I can’t even…”

“S’not that bad,” Crowley sniffed, walking a little faster.

“But it is!” Aziraphale hurried to catch up. “Why, I’ve always wished I could Create! It’s a true wonder, to be able to – to shape the raw matter of the universe. I even tried—” He stopped, horrified.

“You’ve tried making stars?” Crowley’s eyebrows shot up. Would this angel ever cease to surprise him? “You’re a Guardian, aren’t you? That’s forbidden!”

“I…” Aziraphale looked at him, aghast. “Oh, no I-I-I didn’t mean…that is…naturally a Guardian would never attempt an act of Creation that’s…that’s…that would be a breach of-of everything…”

“You can tell me,” Crowley leaned against the concrete side of an insula, the shop window beside him boarded up for the night. “Let me guess. Blew up in your face? Forces too much for you to control?”

But the angel turned pink, looking suddenly a little angry. “I’ll not be mocked by you, Crowley. You know perfectly well nothing happened!” He slumped a little. “How could it? I’m not designed that way. I never had the spark of Creation in me.” Then, in a softer voice, “You truly had something special, Crowley, something the rest of us…”

Something about his posture, his tone of voice, the air of utter defeat, made Crowley’s heart shudder in his chest. “Look, you want to know a secret?”

The words were out before he knew what was happening. He shouldn’t tell Aziraphale this; he’d never told anyone this. The questions he’d asked – the things he’d learned – had led to his Fall. He wouldn’t put anyone through that, not his worst enemy, and Aziraphale was far from that. But one little secret would be safe. He pushed off from the wall, stepping closer, leaning in to put his mouth close to Aziraphale’s ear, so that his sharp cheekbone brushed lightly against the soft curve of Aziraphale’s face, sending shivers of lightning through his body.

 “There’s no reason you can’t,” he whispered. “All angels were created the same. The classifications, the categories, the ranks…it’s all lies.”

Aziraphale’s head snapped up. “You – that’s – Crowley!” But he didn’t pull away, didn’t shout. His voice was almost as hushed as Crowley’s own. “That’s got to be blasphemy of – of some kind. The Archangels—”

“The Archangels want you to think they’re different. That they’re better somehow. They aren’t.” He stepped back to look Aziraphale in his wide blue eyes. “And any angel is capable of Creation.”

“You’re lying.” But he didn’t sound like he believed it. “This is a trick…a temptation…”

“I can prove it. I can teach you to make stars, right now.”

He bit his lip, eyes wide as a dwarf star about to go nova. “Oh, I…I…” The angel glanced up at the cloudy sky again. “Could you really?”

“Hold out your hands. Like this.” Crowley cupped some air between his palms. Hesitating, Aziraphale followed suit. “Now close your eyes. Run your fingers through the atoms. Can you feel them? Feel their weight? You just need to find the smallest ones, the lightest. Those are Hydrogen. Don’t worry, they’re everywhere.” Aziraphale’s brow furrowed in concentration, reminding Crowley of the first time he’d tried to light that fire, accidentally smothering it with every grasping attempt. “Don’t struggle. Just…feel for them. A little at a time. Pull them into the center and push them together.”

For a long moment, nothing seemed to happen.

Then, slowly, a tiny spark ignited at the center of his hands, glowing, growing, expanding as atoms crashed into each other, colliding, fusing. Shining.

The first star Crowley had ever made had been a tiny, fitful thing, flickering between his fingers, fading now and again, but oh, how he’d loved it. Carried it everywhere until he was told it would never be strong enough, had to be dissipated and made anew.

Aziraphale’s was healthy, strong, lovely. A perfect star. He should have been jealous, but he felt proud.

When the core was the size of a marble, Crowley carefully reached over and plucked it free – no need for this to explode in the center of the world’s largest city.

He hadn’t realized how much he missed it, the endless heat between his fingers, illuminating the darkest places within him. He felt lighter than air, he felt alive, he felt –

He felt like he was home.

“No, I told you Crowley, it’s no good. I can’t…” Aziraphale’s eyes fluttered open and landed on the tiny glowing bead between Crowley’s fingers. “Is that…it can’t be…”

“You made it, Angel. All you.” Crowley handed it back, carefully placing it on Aziraphale’s palm. A wave of cold struck him, sharp as the ice in the deepest pits of Hell, the moment the bead left his fingers. But somehow, he didn’t care.

Aziraphale held it up to his face and the glow lit him, the pure, perfect light filling him, like a candle covered in glass. The starshine danced off his eyes. And his smile, oh, Crowley didn’t think he’d ever seen anything more beautiful than that. He wanted to stare at him, drink it all in, hold on to this moment forever.

And then it all ended when Aziraphale held out his hand, giving him the star back. “What? Angel, that’s yours—”

“No, it isn’t. It’s ours. I never could have made this without your help. And I think you should have it.”

Crowley tried to step back, bumping into the wall behind him. “No - look - I relinquish my claim, whatever you need to hear.” He couldn’t believe Aziraphale actually wanted to give it to him. Surely it was just some polite nothing.

“Ah. Then it is mine to bestow upon whom I choose.” Aziraphale’s soft fingers caught Crowley’s hand, lifted it, until he felt the spark of celestial fire pressed into it again. “You must understand, I love it dearly. But...I can make another. You can’t.” He wrapped Crowley’s fingers closed around it, gave them a gentle squeeze. “It’s as radiant as you are, my dear friend. Please, take good care of it.”

Crowley stared down at the little perfect light, the piece of his past he’d never thought to reclaim, and found that his eyes were wet, that he had to blink back tears, for the first time in four thousand years. A warmth filled him, one that had nothing whatsoever to do with the star.

He looked up at Aziraphale and, quite without meaning to, smiled.

“Ah, that’s more like it,” the angel said, with a smug little grin. “You’ve been so sullen it was giving me indigestion. Perhaps now we can have a proper conversation.” He turned and walked away, as if nothing had happened, as if nothing at all had passed between them, with that bastard smile that Crowley loved—

Crowley loved—

Ah. Shit.

Crowley loved Aziraphale.

[pyehacker]

The time it takes to get hrt is absolutely insane like i spent years before i even dared to come out to my parents and contact a clinic, then got put on a waiting list for a year, immediately got put on a program but that took another year before it started. I try to be happy that at least my country doesnt require diagnosis anymore but i dont think they understand how damaging those years in limbo are

Yeah limbo is exactly how I’d describe it. I almost don’t feel like a real person sometimes beceause I know I’m waiting for change that will let me get to what feels like a starting point, but I’ve somehow got to live like this isn’t hanging over me in the meantime lol. It took years to come out to my parents as well. The doctor I spoke to last month did not seem to be understanding at all about my hesitation to tell them, even though the UK has been the center of a massive transphobic storm since 2018, where fuel is constantly being poured on the fire. You’d think a doctor specialising in trans people would understand 🤔

God, also the fact they require you to have basically fully socially transitioned before you can start medically transitioning is insane. I’m pretty sure even the most ignorant cis person would assume you’ve started medically transitioning before coming out lol

My opinion is that HRT should be on an informed consent basis, like birth control or HRT for menopausal cis women. Obviously it’s a bit more complex but it should be between patient and doctor like literally any other medication. Psychiatrists shouldn't be involved. And the doctors here who work for the NHS should not also have private practices where they charge £300+ an hour. They seriously claim this is not a conflict of interest; even though the waiting times for NHS care is what pushes people into going private in the first place. I wouldn’t voluntarily spend ££££ to get hormones if I had any real option.

[birthcottage]

Midwives Center NH

Birth Cottage Midwives Center in NH encourages mothers to take an active role in their own care, make educated decisions, and look back on the birthing process with satisfaction.