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I've done this before, but I'm going to do it again: a thread of my experiences with trans healthcare, both in the National Gender service and outside of it. #TransHealthcareNow
Please be aware that these experiences start at 15 years old. I was a child. This behaviour would be inappropriate to adults, but to a child, it is even more heinous.
I also want to add that the National Gender Service has changed a lot since my transition began - and I would argue not for the better. However, that is why my experience may not line up fully with other more recent stories - this started 5 years ago.
At 15 years old I went to CAMHS to be diagnosed with gender dysphoria. Diagnosis is an archaic and exclusionary approach to trans healthcare. In that process, I was asked intrusive questions about my sex and sexuality. I was 15 years old. The psych was at least 50.
My responses were, in my view, acceptable due to the fact that I had been in a long term relationship with a cisgender woman. I was assimilating to the heteronormative role for men.
At this same time, I received a diagnosis privately from a very supportive and affirming doctor. I only went to CAMHS because the National Gender Service had started rejecting diagnoses from this doctor, on the basis that he was too affirming/supportive of the community.
It is outlandish that the NGS would refuse a diagnosis solely because this doctor actually cared for and supported trans people in their transitional goals. He was fully qualified to provide diagnoses, and everyone I have spoken to who got a diagnosis from him recommended him.
When I was eventually given an appointment with the NGS, the endocrinologist I met initially played armchair psychiatrist, asking me similar questions to the psych I met in CAMHS. I was about to turn 16. Same intrusive questions about my body and my life.
This endocrinologist was far from qualified to ask those kinds of questions. She was far from qualified to make a call on my identity based on those questions. A lot of judgement was passed on me, my family, and my life, unnecessarily.
For reasons that have never been made clear to me, at 16 I was started on a very low dose of T, taking nearly a whole year to get up to my full dose that I have stayed at ever since.
I know very few people who started T as young as I did with the NGS, as they only took patients who were 16 and over. Based on my treatment and that of others, I believe this was due to my age, and not based in any scientific or best practise guidelines.
When I was 17, I had to get a form signed by the NGS to allow me to legally change my gender marker. This was an uphill battle. I was never given any clear reason why signing this form was such an act of parliament - especially since they had been treating me for over a year now.
At 18 I started to discuss surgery with the NGS. I stated I wanted top surgery, and that I was planning to go to Florida to see the surgeon I wanted. This decision was looked down on, as there was a top surgeon in Ireland at the time.
The NGS were very hesitant to sign referral forms to the surgeon in Florida - despite being an internationally respected top surgeon, who many people in Ireland have seen for surgery. I was actively questioned on why I refused to see the surgeon in Ireland.
I don't believe my choice of surgeon was any of the NGS's business, especially since they are qualified as endocrinologists, with no expertise in trans affirming surgeries. I made the right choice for me and they disliked it.
Around this same time, I briefly discussed bottom surgery options with the NGS. When I stated I was not interested in pursuing phalloplasty, I was told by the doctor that it "wasn't worth it" and that the surgery was "very low quality anyway".
While I have no desire for phalloplasty, that type of comment is a kick in the teeth to trans folks who have had phallo and whose lives have been greatly improved by their surgery.
I do not believe my experience to be the worst of the worst. I believe that is because a) my family is economically privileged in a way that many trans folks are not b) as a child my mother was a strong advocate for me, and as an adult I can strongly advocate for myself
and c) I am a binary, relatively masculine trans man, I'm white, I don't have a disability, and I'm relatively mentally healthy.
What I do think needs to be taken away from this experience is that trans young people experience the same bullshit, if not worse, from services like the NGS. When I was a kid, the kid's service in Crumlin didn't exist, but I know from speaking with peers that it's no better.
Trans young people need to be part of the conversation. Their voices need to be uplifted. They need to be heard. We cannot improve trans healthcare for some, and not all. Trans youth need support and affirmation - not to be tested and disbelieved.
#TransHealthcareNow for everyone. For nonbinary people, people of colour, disabled people, neurodivergent people, and young people. If those groups aren't with you, then you're not fighting for trans people - you're only fighting for yourself.
