Healthcare gatekeepers

These are the main healthcare professionals you will need to deal with in your transition. If, at any stage, you find you cannot get on with your healthcare provider, or you are not confident in their abilities or the advice you are being given, seek to change. Not all healthcare providers are skilled or experienced with trans* patients and their issues, so make sure you are seeing someone who is or, if they are not yet skilled, someone who is sympathetic to your situation and willing to do their research. Don’t assume that because your GP is unhelpful, all GPs will be unhelpful – it doesn’t work like that! For every GP who does not want to deal with trans* patients, there are many more supportive and interested ones.

Things you can do to help
There are a number of things that you can do to help with your consultations:

  • Do your homework about transitioning so that you become knowledgeable about the process and can plan ahead
  • Prepare for consultations by knowing what you want to get out of the interview
  • Be clear and concise in the consultation – don’t ‘kitchen sink’ – realistically doctors can only deal with one or two issues at a time
  • Stay calm and stick to the facts – try not to get emotional as it won’t help you think or communicate clearly
  • Be patient with the professional if they ask you to recap your history for them, or they are new to trans* issues, or they don’t seem to understand what it is you are asking them to do
  • Double-check with the healthcare professional if you think something isn’t right – they are human and can make mistakes, too
  • Don’t be afraid to ask the healthcare professional to explain something you don’t understand, and to ask again if you still don’t understand it
  • Finally, become the expert on you and your transition

Your Jersey GP or doctor
Their role in your transition is one of co-ordinator and referrer to the various agencies that you need to access. You can expect them to undertake the following tasks for you:

  • Providing a non-judgemental sounding-board for all and any healthcare concerns you might have during your transition
  • Researching the options available to you and providing you with a choice of options and their implications
  • Writing a letter of referral to a gender therapist (if going the private route into the UK system)
  • Writing a letter of referral to a Jersey psychiatrist (if going the public route into the UK system)
  • Writing a letter of referral to Jersey’s endocrinologist
  • Writing letters of referral to surgeons specialising in gender reassignment techniques (if going the private route)
  • Writing prescriptions for hormone therapy (if not being done through the endocrinologist)
  • Writing a letter of confirmation that you are undergoing gender reassignment for those authorities that require it
  • Providing pre-surgery confirmation that you are physically fit to undergo surgery
  • Taking blood samples as requested by your other healthcare providers
  • Liaising with your other healthcare providers to share information about your transition
  • Monitoring your transition by taking an interest in your general well-being and progress

Your Jersey psychiatrist (if going the public route into the UK system)
Your Jersey psychiatrist will not be a specialist in the field of gender care. The demand for gender care in Jersey is not big enough to warrant a specialist being employed. Their role in your transition is one of referrer to the Charing Cross Gender Identity Clinic in the UK. You can expect them to undertake the following tasks for you:

  • Providing a non-judgemental stance on your desire to transition
  • Providing you with a choice of options and their implications
  • Writing a letter of referral to the Charing Cross Gender Identity Clinic
  • Writing a letter of referral to Jersey’s endocrinologist (or your Jersey GP might do this)
  • Liaising with your other healthcare providers to share information about your transition

Your gender therapist
Some trans* people don’t strike up a rapport with their therapist at the first go and this makes it hard for them to have confidence in the advice they are being given. This may be to do with the manner of the therapist or it may be to do with the preconception that some trans* people have about their gender therapist. Unfortunately, some trans* people see their gender therapist as the person with the ultimate power to say ‘no’ to their desire to transition, which immediately sets up a confrontational or defensive position. This is not how you should approach gender therapy. Gender therapy is your opportunity to explore whether transitioning is right for you. If your gender therapist asks you difficult questions sometimes, it is because they want you to think about aspects of transitioning you have not considered, or not considered fully. It is not because they are blocking you from accessing treatment. Respect your therapist’s experience in their field and work with them to achieve your goals. If you have given the therapist a chance to build a rapport with you and it is still not happening as you would wish, seek to change.

You can expect your therapist to undertake the following tasks for you:

  • Providing you with a resource to test the feeling you have that you are transgender
  • Explaining the options available to you and providing you with a choice of options and their implications
  • Working with you to plan your transition and to suggest the order of steps to be taken to transition
  • Writing a letter suggesting a course of hormone treatment, the starting dose and progress of dosage to your GP or psychiatrist in Jersey
  • Writing letters of referral to surgeons specialising in gender reassignment techniques
  • Writing a letter of confirmation that you are undergoing gender transition for those authorities that require it
  • Liaising with your other healthcare providers to share information about your transition
  • Monitoring your transition by checking your mental well-being at intervals

DoctorYour endocrinologist
Their role in your transition is to prescribe and monitor your hormone therapy to ensure that your body is absorbing the prescribed hormones at the correct rate and the changes that those hormones bring about are happening. You can expect them to undertake the following tasks for you:

  • Writing prescriptions for hormone therapy (if not being done through your GP)
  • Taking blood samples or requesting you arrange with your GP to take blood samples at intervals
  • Liaising with your GP to share information about your transition
  • Monitoring your hormone levels to ensure that they are normal
  • Providing advice on the affects of hormone therapy on your body

Your surgeon
Their role in your transition is to provide you with the selected reconstruction surgery that you require to assist the hormone therapy with the physical changes to your body. You can expect them to undertake the following tasks for you:

  • Writing or advising on the prescriptions you need following surgery
  • Taking blood samples or requesting you arrange with your GP to take blood samples pre/post-surgery
  • Liaising with your GP to share information about your transition
  • Performing the surgery you have requested, as you have requested it and to the highest standard
  • Monitoring your progress post-surgery until you are discharged from the hospital
  • Providing pre-surgery explanations and advice on the affects of the surgery on your body
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