What if gender was not divided in two?

When we’re born, a doctor instantly deems us to be one of two things: male or female. But gender isn’t just between our legs. It’s also between our ears. So, what happens when how we look on the outside clashes with how we feel on the inside? Do we settle? Do we change? And at the end of the day should gender really be as big a deal as society wants us think it is? In this talk Decker Moss explores these issues and more, as he struggled through not only one but two major gender-related transitions in his life.

Tips to help you find your voice

Introduction to transgender voices and an interesting app for iPhones and Samsung Galaxy 3 that can be downloaded here.

What does your voice sound like to other people? Vocal coach Chris Beatty explains how you can hear what others hear.

For the guys, how to develop a deep voice:

For the girls, this is the first in a series of nine videos by DeepStealth:

Press and media advice

Trans* Jersey is very happy to answer questions from the press and media about trans* issues. All enquiries should be addressed to: admin@transjersey.org in the first instance.

The following interview is a parody of typical media interviews with transgender people, with Janet Mock asking Alicia Menendez – who is cisgender – many of the same questions she routinely has to deal with as a transgender woman. The video highlights the way that even trans-welcoming media personalities can objectify and dehumanize their transgender guests by focusing on their bodies and medical histories. Take 5 minutes to watch it here before you plan your interview questions.

Janet-MockResources for journalists reporting on transgender issues or interviewing transgender people from –

Trans Media Watch
GLAAD
Press Complaints Commission

Resources for transgender interviewees from –

Trans Media Watch
Massachusetts Transgender Political Coalition

 

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

Trans* studies and reports

Studies and reports of relevance when considering anti-discrimination legislation –

GIRES report on trans mental health in the UK (2012)
TGEU and ILGA-Europe report highlights legal and healthcare issues in the EU (2012)
National Center for Transgender Equality and National Gay & Lesbian Taskforce report on transgender discrimination in the USA (2011)
GIRES report on gender variance in the UK (2009)
The Equalities Review report on UK trans* people’s experiences of inequality and discrimination (2007)

Studying-book

NHS leaflets

This is the range of NHS leaflets available for trans* patients explaining the various aspects of the NHS service –

An introduction to trans* issues
A guide for NHS practitioners treating trans* patients
GIRES guide to your rights to care and treatment under the NHS
A guide to NHS funding and waiting times
A guide to hormone therapy
A guide to lower surgery options and procedures for transwomen
A guide to lower surgery options and procedures for transmen
A guide for families with trans* children or teenagers
nhs

FtM hormones

In order to transition from female to male, transmen take one hormone for the rest of their lives: testosterone.This is usually the first medical step on your transition journey after changing your name and possibly living as your preferred gender for a short period of time. The Female to Male guide has detailed information about testosterone here. It is a US based guide so be aware that the pages about cost do not apply in Jersey and the UK.

Your GP or doctor in Jersey is very unlikely to prescribe hormone therapy for you. They will not have the necessary skills in gender care to decide whether hormone therapy is right for you. It will be your gender therapist who will start you on testosterone. However, they will need to send their recommendation for your starting dose and the subsequent progress of your dose to your GP or psychiatrist in Jersey. Depending on what version of testosterone you have been advised to take, your GP or psychiatrist may be able to write the prescription for you or arrange for you to see the island’s endocrinologist, either privately or through the health service, who will write the prescription for you. Testosterone is a life-long commitment for transmen and the cost of the hormone is not cheap so the majority of transmen will elect to get help through the States of Jersey’s usual free prescription scheme.

hormonesThere are a number of different forms in which testosterone can be administered (injections (monthly or quarterly), subcutaneous slow-release capsules, gels, patches) and Jersey offers most of the versions available. However, not all the versions of testosterone delivery are on the GPs’ list of drugs they can prescribe. The States of Jersey’s endocrinologist has access to a much wider range of testosterone delivery methods through the hospital’s pharmacy.

Whether your GP or psychiatrist can prescribe the type of testosterone delivery recommended by your gender therapist or not, they will almost inevitably have to refer you to Jersey’s endocrinologist at some point for monitoring of your hormone levels. The endocrinologist is based at Overdale in the Department of Metabolic Medicine or can be seen privately at the Little Grove, St Lawrence.

Even if you start by seeing the endocrinologist privately, you can ask them to refer you through the health service for all follow ups. You will need to see the endocrinologist regularly, at least to begin with. The endocrinologist will monitor your blood to ensure that the testosterone is being absorbed and used correctly by your system. They will ask you to ask your GP to arrange to take blood tests as needed. The results will be returned to the endocrinologist who will then discuss them with you. Once your hormone levels are steady and at the same level as a natal male, your visits to the endocrinologist will become less frequent and you need only telephone their office to request repeat prescriptions, which are sent down to the hospital pharmacy where they are filled within about 48 hours and where you collect them.