gender

Trans* Jersey

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* Jersey

Jersey trans* law

Currently, there is only one piece of legislation in Jersey that is directly concerned with protecting transgender islanders: Gender Recognition (Jersey) Law 2010

This law deals with the process of issuing a gender recognition certificate (“GRC”), the legal effect of a GRC on existing marriages and civil partnerships, the general consequences of issuing a GRC, the prohibition on disclosure of information relating to a holder of a GRC, the requirement (or not) to alter public registers and clarification of those agencies exempt from the prohibition on the disclosure of information.

Jersey recognises that it does not have the required healthcare professionals who can make decisions based on appropriate evidence to grant an inidividual a GRC. The island, therefore, looks to bigger jurisdictions to undertake this process for its trans* citizens. Having obtained a GRC from a jurisdiction approved by Jersey, a GRC will then be granted by the Royal Court. Most islanders will, therefore, apply to the UK for a GRC, which can then be presented in Jersey’s Royal Court.

The UK’s Gender Recogntion Act 2004 covers the issuance of GRCs. The granting of a GRC is decided by The Gender Recognition Panel, a branch of HM Courts & Tribunal Service. It is formed from an administrative team and a judicial panel, made up of legal and medical members. The panel needs to be satisfied that the applicant has lived in their correct gender throughout the period of 2 years prior to the date of the application and intends to continue doing so until death. It is a matter for the panel to decide whether the medical evidence satisfies that test. The charity GIRES provides guidelines for applying for a GRC here.

law
It is to be noted that the LGBT Consortium in the UK have recently published a consultation paper stating that the Gender Recognition Act is no longer fit for purpose and requires reviewing.

Advantages of obtaining a GRC:

  • All legal documents, including your birth certificate, can be changed to your correct gender. Note: the States of Jersey will issue driving licences and passports in your correct gender without the requirement of a GRC.
  • A GRC prohibits those privileged with the information that a person is trans* from disclosing it to others. There are, however, quite a number of exceptions to this prohibition.

Disadvantages of obtaining a GRC:

  • If you are married or in a civil partnership, you will need to dissolve or annul the union before a full GRC can be obtained from the Royal Court. Note: this is not a requirement for marriages in the UK since the passing of the Marriage (Same Sex Couples) Act 2013.

New sex discrimination law

The States of Jersey launched a consultation on the next phase of discrimination legislation due to become law in September 2015. It includes gender reassignment discrimination.

This will be the second piece of legislation to directly concern trans* islanders. We therefore want hear your views in order to formulate a response to the consultation.

Please our consultation page to find out more about how you can get involved before 30 May 2014.

Trans* Jersey

FtM timeline

For those who are still questioning their gender, take some time to read this site, to surf the Internet and watch video clips uploaded by transmen, to read some of the excellent personal accounts of transitioning available as books from Amazon, and to feel comfortable with the idea that you are trans*. This is an important step and not one that should be hurried. It can take years to reach a point of ease with who you are.

However, it is worth reaching that point before you more forward with your transition, especially in Jersey. We all know how quickly news travels in small communities, more so than in a big city. You are unlikely to be able to keep your transition a secret in the island. You need to be prepared to ‘out’ yourself to all sorts of people in order to get their help and you can only do that if you are proud and confident about who you are.

Having reached a place where you know that you are transgender, your first point of contact is your doctor/GP in Jersey. Explain to them that you are unhappy with the gender assigned to you at birth and that you would like to start the process of transitioning. Ask your GP to write a letter of referral to a gender therapist (if going the privately funded route) or to a psychiatrist within the health services in Jersey (if going the publicly funded route).

There are no gender therapists in Jersey so you will have to go to the UK for counselling. Your GP can either refer you privately to a gender clinic of your choice or your Jersey psychiatrist can refer you through the NHS to the Charing Cross Gender Identity Clinic. The advantages of going private are that you control the timetable and can get things moving as quickly as you need to. The disadvantage is that you pay for private consultations (see the finance page). The NHS route is free but you are stuck with their timescale.

Remember that your therapist is not there to ‘judge’ you. They are there to help you make sure that transitioning is what you want to do. Therapy is a time for you to ask questions about transitioning, to be honest with yourself and answer the therapist’s questions as openly as you can, to think about alternatives to transitioning and to understand why they are not an option for you, and to double-check your feelings with an impartial and skilled observer.

Depending on how you and your therapist feel about your readiness to transition, the next step is either to change your name by deed poll to the name by which you want to be known going forward or to commence hormone therapy.

For more information about changing your name and all your documents, see the change of name page.

timelineJersey has the necessary skills on the island to administer your hormone therapy, which will be a lifelong commitment to taking testosterone. Your therapist will need to provide a letter to your GP or psychiatrist recommending that you commence hormone therapy, the appropriate delivery method of the testosterone and the dose that you require. Your GP or psychiatrist can then refer you to the island’s endocrinologist. This can be done privately, for which you will pay, or you can be referred through the States system, which is free.

For more information about hormone therapy, see the hormones page.

This may be as far as you wish to go in your transition. You may consider the changes made by the hormone therapy sufficient to allow you to pass as a man. However, you may elect to undergo one or more surgical procedures to further masculinise your body. If so, you will need to leave the island again for your operation(s). Jersey has no surgeons who can perform this specialist surgery. You will need to decide whether you wish to pay for surgery privately or whether you are prepared to wait for surgery in the UK through the NHS.

If you elect to have surgery through the NHS, you need to ask your NHS therapist to place you on the NHS waiting list.

If you elect to have private surgery there are two advantages: you can choose your surgeon, so you can choose to see anyone in the world who takes private patients, and the timing of your surgery is your choice. You should research your surgeon carefully, taking time to read testimonials from transmen who have had surgery with them. If you are unsure about your choice, ask your GP for their opinion.

Once you have selected your surgeon, contact them directly. You do not need to go back to your GP for a referral. However, the surgeon will undoubtedly want a letter from your therapist or GP referring you after you have made the initial contact.

For more information about surgery, see the surgery page.

Finally, take ownership of your transition. If you are not getting the answers you require from your health professional, keep asking until you do. Research as much as you can and prepare the questions you want answered before every consultation. Your Jersey GP may never have taken a patient through a transition process so you may need to guide them on what they need to do next for you.