#but first we have to ask for a gp referral to an nhs gender identity clinic

[tesco-finest-aromantics]

hhhrrrrrr why is medical transition so complicated in this country

[a-room-of-my-own]

A trans lobby group helped to draft NHS plans for treating children questioning their gender, The Telegraph can disclose.

Susie Green, then chairman of the charity Mermaids, was part of a task group reviewing services at the Tavistock and Portman NHS Foundation trans clinic.

The service specification, which outlines treatment for children, included details on how “hormone blockers will now be considered for any children under 12”. The relationship between Mermaids and senior NHS employees is laid bare for the first time in documents seen by The Telegraph.

The Tavistock claimed that it did not have emails or minutes of meetings with Ms Green but after the information regulator threatened court action, it released more than 300 pages.

They show that Ms Green had a direct line to Dr Polly Carmichael, Tavistock’s director, and demanded to be regarded as a professional so she could refer ­children for treatment when their GPs refused. Ms Green, who has no known formal medical training, held an advisory role on two of the studies that the clinic was involved in on the long-term effect of gender identity.

The service specification, which is still available on the NHS England website, was due to be replaced in 2020 but was put on hold when the Government ordered the independent Cass Review into the clinic.

The Tavistock said: “Like many NHS services, GIDS [gender identity development service] works with a range of third-sector patient support groups and charities that have different views about how the service can improve.”

Mermaids said its “primary focus is to support the mental and physical wellbeing of trans and non-binary young people throughout the UK”.

Ms Green said it was “not a secret” that she was involved in the service specification”.

An NHS spokesman said: “We have started implementing advice from Dr Cass and we have held a public consultation on a new interim service specification, which will be published in the coming weeks.”

'The Tavistock were really in thrall to these activists'

They are the documents that the NHS Tavistock gender clinic claimed did not exist. More than 300 pages of emails and minutes that lay bare for the first time the extent of Mermaids’ involvement in England’s only clinic for transgender children.

The controversial transgender charity has long been named by some whistleblowers as one of the reasons why the Tavistock lost its way, with claims that activists pressured staff to prescribe potentially life-altering drugs.

Now The Telegraph can reveal how Susie Green, then chairman of Mermaids, had a direct line to the clinic’s director Dr Polly Carmichael and was able to make referrals even when a child’s GP repeatedly refused.

The documents lay bare the depth of her involvement in the service, including helping to redraft the service specification and advising on a number of trials designed to inform the way they treated young patients.

The Tavistock and Portman NHS Trust had originally refused to release the details of the meetings between 2014 and 2018, relying on an exemption under Freedom of Information law which said it would have a “disproportionate or unjustified level of disruption, irritation or distress”.

When the Information Commissioner’s Office (ICO) asked them to justify that refusal, the Trust withdrew it and said that following “an extensive search of emails … the Trust does not hold the requested information”.

The ICO said that “on the balance of probabilities” it did hold the information and threatened to refer them to the High Court unless they complied with the request from a parent. The Tavistock has now released 322 pages of communications between 2014 and 2018.

They include emails between Dr Carmichael, who still works at the Tavistock, and Ms Green, who has left Mermaids and now works for an online GP which prescribes puberty blockers. In one exchange from 2016, Ms Green contacted the head of the service to question the decision of staff to refuse a referral she had made.

Upset not to be seen as a professional

Ms Green, who has no known medical training, said that she was told “that the referral was not validated or risk-assessed by a professional” and that is why it was rejected.

She added: “I can only assume from this statement that I am not seen as a professional? I am now very confused, as my understanding was that your service would accept referrals from Mermaids, but this statement appears to suggest the opposite….

“If you do NOT accept referrals from Mermaids due to the fact that I am not a professional I would like to know the reasoning behind this? Referral by a non-healthcare professional is acceptable from schools, social services etc, and my understanding has been that Mermaids referrals were accepted.

“Your admin person made it clear that immediate action was needed or this referral would be refused, so can I ask for a level of urgency to be applied to dealing with this issue?”

Dr Carmichael replied: “We do accept referrals from third sector groups and I know that you have helpfully sent in referrals in the past. This continues to be the case. Third sector groups often play a vital role in supporting young people and their families and we greatly value their involvement.”

Referrals 'unsupported by their GP'

Ms Green sent referrals for young people who were “unsupported by their GP” and in one case she sent the referral noting that the GP “has consistently refused to refer”.

The documents show that as early as 2014 she was involved in the “redraft of the service specification” for the NHS’s gender identity development service (GIDs) for children. She was one of the 10 people who attended a meeting.

Others include Dr Carmichael, who chaired the session, Rob Senior, the Trust’s medical director, Prof Gary Butler, a University College London Hospital consultant who is now the clinical lead for the children’s gender clinic, and Bernard Reed, the founder of the campaign group the Gender Identity Research and Education Society.

The minutes show they agreed that they would act as a “task and finish work group” and that “the content of the discussions were expected to remain within the group”.

They noted the initial findings of “research into the age for hypothalamic blocker treatment” which “suggest that the blocker could be prescribed from early puberty”.

The Tavistock has not provided minutes relating to any further meetings of the group, despite notes stating that they would meet two to three times and share details of their review. As a result, Ms Green’s contributions remain unclear

Greater emphasis on medical treatment

A new service specification was published by NHS England in 2016, which placed greater emphasis on medical treatment for children.

The new specification said for the first time “that hormone blockers will now be considered for any children under the age of 12 if they are in established puberty”.

It also updated the “informed consent” section to state that: “Age alone does not determine capacity to give consent. If it is concluded that a client has sufficient autonomy and understanding of what is to be offered, plus other key eligibility and readiness criteria have been met, they can consent to treatment.”

The involvement with the service specification came as Mermaids were putting pressure on the Tavistock to lower the age for cross-sex hormones to 14, as Dr Carmichael revealed in an interview at the time.

The charity was also calling for a reduction of time that teenagers had to spend on puberty blockers before they were prescribed cross-sex hormones.

In one email chain Ms Green was involved in, her fellow campaigner Mr Reed questioned if there “are proposals to speed up” the process. He noted that children had to be on puberty blockers for six months to a year before being given cross-sex hormones, which they had to wait until they were 16 to access.

In the response in November 2016 Sally Hodges, one of the Trust’s directors, said that “the situation is rapidly changing” as the service had received more money and “Polly Carmichael is in touch with Susie to ensure that you have the most accurate and up-to-date information”.

Gender reassignment at 16

Ms Green, who now works for Gender GP, an online service which prescribes cross sex hormones, had taken her own child – who was born male – to the US for puberty blockers before their 16th birthday. On their 16th birthday she took them to Thailand for cross-sex surgery.

In one exchange she sought “clarity” from Dr Carmichael on whether the Tavistock would treat children whose parents had sought hormone blockers or cross-sex hormones privately either because of waiting lists or because the drugs were not prescribed on the NHS to under-16s.

“This would be a huge weight off parents’ minds,” she wrote. “Many want to access blockers privately for their children due to the distress caused by ongoing pubertal changes and the huge wait to be seen and assessed, but are then caught in a position of having to fund blockers indefinitely themselves.”

Dr Carmichael replied that she was “very sorry to hear that there has been confusion” and said that “individual circumstances vary widely and so it would be a case-by-case basis”.

She said if the child was already seeing an endocrinologist through the Tavistock they would be removed from their care if they started getting drugs privately, though could still have therapy. But she added that patients “may choose at a later date to be referred to the endocrine clinic, if for example they started cross-sex hormone treatment outside the service at an earlier age than the service offers”.

Charity boss invited to take part in research

In 2018, Dr Carmichael emailed Ms Green again to invite her to take part in research which was supported by the National Institute for Health Research (NIHR). She wrote: “We are in the process of submitting an application to NIHR to follow younger service users. It would be great if Mermaids would be involved.”

Ms Green replied that she would be “delighted to look at working with you on the NIHR application and delivery”.

The study looking at the development of gender identity in children aged 3-14 started in 2019 and it was hoped that it would “inform health and education providers”.

Stephanie Davies-Arai, founder of Transgender Trend, said: “The Tavistock were really in thrall to these activists. They were ideologically captured.”

Ms Davies-Arai, who campaigns for evidence-based healthcare, said that she had first contacted the Tavistock in 2016 amid concerns about the treatment they were offering and was told that they would welcome her input as they were keen to hear from different voices.

However, when she emailed Dr Carmichael with concerns, she got no response.

Ms Green said that it was “not a secret” that she was involved in the service specification and she applied to be involved “as the CEO of the largest UK (and probably European) charity to support transgender children, young people and their families”.

She said that she was “pleased” that the new specification “removed an arbitrary age range” for hormone blockers and agreed to consider them for children under 12.

[cassolotl]

TESTOSTERONE!

SO! Today was big, but also feels weirdly uneventful!

Remember back in July 2017, when I said that my GIC clinician was happy to refer me to the clinic’s endocrinologist for low-dose testosterone? Today was my appointment!

It was with Dr Seal, who was very helpful and professional. Here’s how it went and what he told me.

He asked me a lot of questions about my family history, particularly with regard to gender/sex difference, breast cancer and heart problems. The heart-related questions were because men and other testosterone people are more likely to have heart attacks and heart disease. The breast cancer question was because I need to still check my chest for lumps, since I still have mammary tissue in my chest (despite the double mastectomy). He also investigated my hormone situation (no uterus or cervix, but working ovaries, history of endometriosis, how long my cycles were when I had periods, etc.) and we talked about sexual health stuff too. He measured my height, weight and blood pressure.

He asked why they left my ovaries in, which is something it makes a lot of sense for him to ask, but also people don’t often ask me that. I said that at the time I didn’t know whether I wanted to go on testosterone or not (it was a couple of years ago), and since they were working and healthy I might as well leave them in and continue to get free osteoporosis-preventing hormones for many years to come. Also I kinda like my hormonal cycles now that I don’t have hideous pain and bleeding. He seemed pretty satisfied about all of this, and didn’t seem to be expecting or pressuring me to be Full Dude on any of this stuff.

We then talked about my body and where I would like it to be on a male-female spectrum (bang in the middle) and where I feel it is (sort of halfway between female and neutral). He was very clear that we were talking about purely physical characteristics, and not gender identity or anything psychological/emotional.

We talked about each physical change that would happen as a result of taking testosterone, how I felt about each change, and whether they were reversible, and in which order they were likely to happen.

He said that genital growth tends to happen in the first few months, and is usually about 1-2 inches, and is not reversible or preventable.

He said that voice pitch changes very gradually, and starts to accelerate and break at 9-12 months. Voice changes are not reversible.

Around the same time as the voice breaking, facial hair tends to start growing around the lips and jawline, and I would look (for want of better words) like a woman who’s a little bit hairy. (He was aware that he was maybe being a little insensitive here, but I understood that there wasn’t really another good way to get his meaning across.)

He said that I might see some redistribution of fat - smaller hips, and bigger arm muscles.

Body hair. Basically what it sounds like, and it tends to happen early on. Can be removed with various temporary and permanent hair removal treatments.

Baldness. I thought he said boredness, and I was like, okay, that’s one I didn’t know about... I forgot to ask him if this was less likely with a low dose!

Mood changes. This can happen right away. He said I might feel more aggressive, my sex drive might kick up a notch, etc.

Loss of hormonal cycles. Basically testosterone levels out the hormonal cycle that involves ovulation and triggers menstruation when you have the appropriate bits, so you’re likely to lose any periods that you do have and you don’t get those ups and downs that come with that.

I can’t remember any more!

So the main reason I want testosterone is to make my voice sound more ambiguous. The ideal situation is that someone hears my voice and can’t tell whether I’m a man or a woman. Aside from my hips (which are hard to change without full-dose testosterone and a path to full dudeness), my voice is the one thing that’s making people say “oh sorry, I mean madam” right now.

Here’s how I feel about everything on the list:

Genital growth - neutral to positive.

Voice pitch - very positive!

Facial hair - neutral to negative, but it’s treatable.

Redistribution of fat - positive.

Body hair - neutral to negative, but it’s treatable.

Baldness - negative.

Mood changes - they’d be temporary, provided my ovaries kick in as expected once I’m done testostering myself. (He said that since I am young there’s less likelihood of early menopause from T + hysterectomy.)

Loss of hormonal cycle - negative, but it stops when I stop taking T.

I feel like there were more things that I’m missing out!

Anyway, he was happy to go ahead and recommend that my GP prescribe testosterone in a gel, which is easier to manage with the low doses. I can use more gel if my docs agree to a higher dosage, without having to get a new prescription - and I can stop using it and see things go back to normal immediately, which gives me more control as a nonbinary person seeking an ambiguous pitch.

So that’s exciting! And he was pretty great at getting my pronouns right when he was taking notes into his voice-to-speech doodad, which is always nice. :) He said that the recommendation letter would go out ASAP, and then because I hadn’t had blood tests recently he sent me to the Charing Cross Hospital drop-in for blood tests (5-10 mins walk away, 30 mins wait).

Overall, a very successful trip. :D

The reason it feels strangely uneventful though is because nothing happens until my GP gets the letter, and I will know when that happens because I get CCed on it. And then I’m thinking that I would like to not start the hormones until I am seeing a gender therapist every two weeks at CHX, which could take a while - I need to email and get back on the waiting list.

~

Update 14th Sept: I got the prescription recommendation letter through! So the timeline for Charing Cross NHS GIC endocrinology letters looks like this right now:

Appointment: 6th August 2018

Letter written: 24th August 2018

Letter received: 14th September 2018

About 1 month and 1 week between the appointment and the letter being received.

~

Previously, on Cassian’s Transition:

A continuation of this previous post.

Worked out I was nonbinary and trans in November 2010.

Came out first to Tumblr in December 2010.

Went to my GP in April 2011, and was referred to the community mental health team (CMHT) and an endocrinologist. The CMHT no longer need to refer you - the GP can refer you directly to your GIC.

First appointment with CMHT re: nonbinary transness in May 2011. Second in August 2011, with someone higher up.

Referred to Charing Cross Gender Identity Clinic by CMHT in Sept/Oct 2011.

Went to see the local endocrinologist Dec 2011, and discussed hormones, and came to the conclusion that there was no hormone that met my needs yet.

My first appointment was 2nd April 2012, about 6 months after I was referred by the Community Mental Health Team.

I’ve been pretty consistently asking for chest reconstruction surgery and no hormones.

At my fourth GIC appointment in October 2013, the CHX clinician says they’ll have a surgery decision about me made in a few days.

In January 2014, after 3 months of my doctors discussing it, I got a letter saying I was being recommended for chest reconstruction under certain conditions.

In April 2014 I had a half-hour appointment at CHX for discussing those conditions, which was very informative on the NHS and how they feel about nonbinary people.

I was referred to my surgeon (Victoria Rose) at the beginning of May.

At the end of May 2014 I had a letter from my surgeon asking me to call and make an appointment for an initial consultation.

Two months later, in July 2014, I went to that consultation. I had a pre-op the same day, and was then put on the waiting list. I was on the waiting list for 4 months.

In November 2014 I was contacted and given a date for surgery - with less than two weeks’ notice.

My surgery date was 18th November 2014 - three years and two months after first being referred to my GIC. Everything was fine and good. Here’s my preparation and some before and after pics.

Here’s the 8-week top surgery follow-up in January 2015.

July 2017 - Dr Lorimer approves a referral to Dr Seal (endocrinologist) for low-dose testosterone.

Today’s post was written 7 years and 9 months after I worked out I was nonbinary.

[spaceyqueer]

anyone in the UK who insinuates the NHS is just handing out hormones to trans people, particularly trans kids, like it's f*cking candy clearly have no idea how agonising and long the system actually is.

if you're lucky, you might get your first appointment two years after referral. if you're unlucky, it could be four or five (I'm currently in my third year going on fourth waiting for a single appointment). There's no guarantee you'll walk away from that appointment with a prescription; and considering we get referred to gender identity clinics via our general practitioners (GPs) means said GPs can, essentially, decide if you're trans enough to meet their criteria for referral, and if you're not well good luck convincing them. For some people I know it's taken multiple appointments with their GP, pleading to get referred, before it happens.

If you are seriously of the belief that trans people get insta-hormones the minute they ask for a refferal for the gender identity service, you might need to check your brain for symptoms of gullibility to right wing propaganda.

[noramoya]

Owen Jones Friday 15 August 2014 Nine months ago, Jake Mills texted his girlfriend one final time to tell her he loved her – and then he tried to kill himself. "I genuinely felt that I was a burden to a lot of people's lives," the 25-year-old Liverpool comedian says. "A lot of people say suicide is a selfish act but, in that frame of mind, if you're about to kill yourself, you just don't see anything better." Although Jake had been visiting a counsellor, he was just telling her what he thought she wanted to hear. "She discharged me and told me that I was healthy and better. But actually I wasn't better, I was just better at lying." Jake was rescued by his girlfriend and has been confronting his depression ever since. But for all too many men, there is no rescue. Last week, millions were shocked by the suicide of beloved actor Robin Williams. The aftermath has provoked a long-neglected debate about mental health and suicide. A cursory look at the statistics in Britain suggests it is dearly needed. Suicide is the biggest killer of men between 20 and 49, eclipsing road accidents, cancer and coronary heart disease. It is also predominantly a male disorder. Of the 5,981 suicides in 2012, an astonishing 4,590 (76%) were men. And yet while Britain has high-profile campaigns on, say, testicular cancer or driving safely, the biggest killer of men under 50 is not getting the attention it deserves. Jane Powell is the founder and director of Calm, the Campaign Against Living Miserably, which specifically deals with male suicide. "If you're a mum, a dad, a loved one, you want to worry about the biggest threat," she says. "And yet we worry about assault levels, rather than the real killer – suicide." She makes a provocative case: that while breast cancer does kill men, we rightly focus on it as a female disease. In the same way, suicide prevention has to focus on men. "We need to name the issue," she says. Why are so many more men killing themselves than women? "Is it biologically set in stone that men take their own lives – or is it cultural?" Powell asks. "If you look at how the suicide rates have changed, how they go up and down, you can see that it's cultural – it's about what we expect." And this is what is so troubling about male suicide. Women are actually more likely to suffer from depression, but more likely to seek help when they encounter trouble. The uncomfortable truth is that stereotypical forms of masculinity – stiff upper lips, "laddishness" – are killing men. Ant Meads, a 35-year-old based in Coventry, tried to end his life nearly two years ago. Growing up, he had undiagnosed obsessive compulsive disorder (OCD). "I was 18, working in a concrete yard, surrounded by big burly men doing manual labour, and I was a stick insect," he recalls. Whenever his hands were dirty, he felt nauseous, so he wore gloves all the time. "I got bullied every single day when I was there, I was the 'little special princess who has to have his special gloves'. It was the first time I realised that I was not living up to the ideal of what a man should be." His OCD would get worse, until he was too anxious to leave the house. "I was failing myself, my family, society, because I couldn't do what every man was supposed to be able to do." He was left with a sense of worthlessness, of letting people down. When he first told his father that he was depressed, he told him to "get over it". It wasn't just relatives: doctors told him to "get on with it" as well. When a doctor finally referred him to psychiatric care, Meads faced a six-week wait before finally being seen by a community liaison officer, who disputed whether he had OCD because – unlike other patients – his hands were not chapped. "It's this horrible idea of what a man is supposed to be," he explains. "It's a general feeling, evident in the fact that so many men commit suicide, because they're not living up to this mythical idea." This sense that men should not speak about their feelings is not always overt; nor does it necessarily manifest itself as bullying. Fabio Zucchelli, 29, has had depression since his early teenage years. "I noticed that I was low for very long periods, and it developed into what people term clinical depression," he says. "It certainly held me back in many ways, up to my early to mid 20s ... There have been long periods when I've felt not able to work at all." Zucchelli says he didn't suffer from "self-stigmatising issues", and has been able to talk about his feelings with professionals. "The main issue I've had with feeling able to talk about mental health difficulties is with male friends, who just find it really uncomfortable. I haven't had anyone defriend me because of it, just a lot of discomfort." When the 35-year-old Labour MP John Woodcock announced last December that he was depressed, he was confronting a double stigma: not just as a man talking about his mental health, but as a politician discussing a personal issue that is all too often portrayed as a weakness. "I've been really struck by the number of men who have come up to me – often in my constituency – like ex-shipyard workers who have struggled for 10 years, who have been keeping it quiet," he tells me. "We do operate in a culture where men, by and large, talk about their feelings less. They're self-conscious about talking about weakness, there's this male sense of 'shrug and get on with stuff'." This type of male identity is cemented at a very young age. According to research by the LGB charity Stonewall, 98% of gay pupils and 95% of teachers hear "that's so gay" or "you're so gay" at school; nearly as many hear "dyke" or "poof" thrown around as insults. "It's so much wider than gay or bisexual men," says Stonewall's spokesman Richard Lane. "Men hear 'man up' and 'stop being such a poof'. It's a real barrier in talking about mental health issues." Rather than being entirely about anti-gay hatred, there is an element of "gender policing", of abuse directed at men who do not conform to a stereotype of masculinity. "Asking for help is seen as an affront to masculinity," says the writer Laurie Penny, who has extensively researched mental health issues and written about her own experiences. "This is deeply, deeply troubling, because it means when you're taking that first step when you're suffering a mental health difficulty, reaching out for help is made doubly hard. The rules of masculinity prevent you from asking for help or talking about feelings." According to Penny, depression is often accompanied by a sense of shame, of not deserving help, "and when messed-up gender roles are thrown into the mix, it's going to become even more troubling". She has no doubt that gender policing "ruins lives across the board". Mind is one of Britain's main mental health charities; according to its research, just 23% of men would see a GP if they felt low for more than two weeks, compared with 33% of women. "One of the more common ways men deal with it is self-medicating with alcohol and drugs," says the Mind spokeswoman Beth Murphy. "They start going to the pub, block feelings, hide feelings, drink, then do it more, and it becomes a cycle. The drugs and alcohol can end up as big a problem as the mental distress in the first place." Indeed, research has suggested that men are twice as likely as women to develop alcoholism. In the late 1990s, it was men in their 20s who were most at risk from suicide; today it is men in their 40s. As Murphy points out, it's the same cohort, and is evidence of "scarring": of being unemployed at a young age, and suffering from long-term consequences, including higher rates of unemployment and lower wages in later life, as well as mental distress. According to research by Samaritans, those in the poorest socioeconomic circumstances are 10 times more likely to kill themselves than those in the most affluent. Both men and women experience poverty, of course – but it is men who are more likely to kill themselves if they are poor. And the help simply is not there for men, EVEN IF THEY SEEK IT. When Ant Meads finally saw the doctor who instantly recognised his OCD and began a referral for specialist care, he faced a nine-month wait. "Imagine you're suicidal, you need to see a psychiatrist, and you're told the current waiting list is nine months. How do people cope?" Meads is adamant that he would not be alive had his employer not referred him to private healthcare. He believes there needs to be far more government investment and a national advertising blitz about men and mental health. But the winds are blowing against Meads's calls: mental health trusts are making cuts amounting to 20% more than those made by other hospitals; mental health services have cut beds by nearly 10% in the past three years, and mental health organisations have warned that cuts to such services are risking people's lives. "I'm really concerned about it," says Woodcock. "We've now made the commitment that mental health should have parity with physical conditions in the NHS, but we're not close to delivering that parity." Unless this changes, he suggests, "we'll fail many people who will suffer mental health conditions, or even suicide, when they can be helped." Challenging unreconstructed masculinity is surely a priority, too. The organisation Calm has launched an initiative called "#mandictionary", encouraging men to take on "archaic male stereotypes" and "define themselves on their own terms". Men speaking out – as they have done in this article – helps, too, encouraging others to come forward. "From a personal point of view, I'd never admit to anyone I was depressed, I didn't even want to be on antidepressants because of the stigma attached," Jake Mills explains. "I thought I'd be addicted to them and weak." Now he uses his comedy to raise the issue. "The best decision I made in my life was announcing it, going on Twitter. I've had enough, I'm not hiding from it any more." Speaking out and challenging the stigma of mental health is certainly courageous. And doing so may just help to save the lives of other men who are suffering in agonising, lonely silence. "

[ukftm]

How do you get top surgery like where do you start and what is the process. Also what are the waiting times, particularly for dr kneeshaw but also could you tell me which surgeon i could have surgery with the quickest. All in the nhs. I'm 18. Thanks

In order to have top surgery on the NHS you have to go through a Gender Identity Clinic.  In most parts of the UK you need to be referred to a GIC by your GP (the exception being if you are in Scotland and wish to go to Sandyford in Glasgow).  This post might help if you’re going to ask your GP for a referral.  The waiting times for GICs vary, but are generally at least a year at the moment, if you have any particular ones in mind we can try to give you a rough idea of how long you might be waiting for a first appointment.

Once you start seeing the GIC they’ll usually have an assessment period of at least 6 months.  After this they will discuss testosterone (if this is also something that you want), and then top surgery.  Most GICs will want people to have been on testosterone for at least 6 months before referring for top surgery, although this can sometimes vary.  If you want top surgery without testosterone then it’s not uncommon for them to wish to wait a while longer before making a referral for surgery as they’re generally more cautious about what they see as non-standard pathways.

After the GIC has given you a referral to a top surgeon then the waiting times depend on the particular surgeon.  I believe Mr Kneeshaw’s waiting time is approximately 7–8 months from referral to surgery at the moment, but this may well change by the time that you’re referred, especially if you’re not yet seeing a GIC.  Some surgeons with shorter waiting lists are Professor Drew in Cornwall, and Mr Sankar in Kettering, but it’s important to consider more than just waiting times when choosing a surgeon—if you prefer another surgeon’s results then it’s worth waiting a couple more months for them.

~ Alex

[ukftm]

Hey! I've checked through your private transition resources and through a lot of other sites too. The problem is that all private places only really accept to see those who are at least 18+ (I've just turned 17). Do you know any that would see me? Or should I just start the process through the NHS?

Unfortunately none of the three reputable private clinics see under 18s.

Starting the process of getting to see the NHS would be a good idea, and in fact some adult GICs will now put you on their waiting list as you’ve turned 17, although some will only accept referrals from people who are already 18.  You could also ask for a referral to youth services instead, or as well as a referral to an adult GIC, but as their waiting times are quite long they may not be able to fit in a full assessment before you age out of their service.

Assuming that you’re in England, here’s what each of the adult GICs have to say about referrals and ages, although it might be worth contacting those that you think you might like to be referred to in order to doublecheck:

Nottingham - “We will see anyone over the age of 17 who experiences distress about their assigned gender. We also accept referrals of 16 year olds who will be 17 at the time of their first appointment.”The Laurels - “Providing you are aged 17 or over and registered with a GP in England, they will be able to refer you to the West of England Specialist Gender Identity Clinic.”Newcastle - “The service is available to people over the age of 17 years who live in England.“Charing Cross - “We are an adult Gender Identity Service and as such accept referrals from service users aged 17 years and 9 months and above.” Although according to a reddit post, this only seems to be for people coming up from Tavistock, for anyone else being referred by their GP it seems as though they need to be 18.Sheffield - “All adults irrespective of gender, age (usually 18 years of age or over), ethnicity, sexuality, culture or physical abilities” - no indication whether they will accept the referrals from younger people who will be 18 by the time of their first appointment.Leeds - “Leeds Gender Identity service offers assessment and support to people aged 18 and above with Gender Dysphoria.” - no indication whether they will accept the referrals from younger people who will be 18 by the time of their first appointment.Daventry - no age related information given.

~ Alex