Trans* Jersey has now produced a Pathway to Care leaflet for islanders wishing to transition. The full document can be downloaded here.
The leaflet has been produced in consultation with the various States of Jersey health departments that are used when a person transitions in Jersey.
It is suggested that you download the leaflet, print it and take a copy with you when you go to see your GP.
In due course, Trans* Jersey will be providing all the island’s GPs with a copy of the leaflet.
Trans* Jersey met with Helen O’Shea, Managing Director of the General Hospital, and Richard Jouault, Managing Director of Community and Social Services, today. As a result, we have now had the pathway to care for trans* islanders confirmed, and it is as shown.
Trans* Jersey will be working on getting this into a form that can be distributed to all GPs’ surgeries so that, as the first point of contact for trans* people, doctors know who to refer to and can advise their patients on the pathway to care.
This is the first of our 2014 manifesto goals to be realised. We are, therefore, grateful to the States of Jersey’s health service professionals for their openness and time to assist us, and to those trans islanders who shared their experiences of the health service in Jersey and the UK.
Trans* Jersey’s manifesto defines the problems faced by transgender, transsexual, genderqueer, androgynous, bigender and intersex Jersey residents in 2014 and explains what actions we intend to take to address these issues.
Trans* Jersey believes that the island’s trans population is being patchily served by GPs and the States of Jersey Health and Social Services (“H&SS”) Department. This is due to the lack of clear guidelines for healthcare professionals working with trans patients. Individual clinicians within the H&SS Department are not seen to be at fault and, once the H&SS Department has been accessed, experiences of care have been good to excellent, largely through the efforts of the clinician acting on their own initiative. However, the initial route into healthcare for trans patients is unclear. The evidence suggests that the quality of healthcare provided is also influenced by the tenacity and perseverance of the trans individual being treated.
Trans* Jersey supports the calls by trans* organisations in the UK that the process for procuring a gender recognition certificate (“GRC”) needs revision. The Gender Recognition (Jersey) Law 2010 allows for a GRC from a recognised jurisdiction to be passed in the Royal Court. Any revisions that happen to the UK Gender Recognition Act 2004 as a result of the consultation happening with trans* organisations will, therefore, directly affect trans islanders. At present, Jersey has no mechanism by which to issue a GRC. However, this may change if trans* organisations within the UK are successful in calling for the Gender Recognition Act to be scrapped and for the issuance of a GRC to be an administrative process driven by the trans individual.
Trans* Jersey is committed to ensuring that all States of Jersey legislation that directly affects trans* islanders is scrutinised and responded to on behalf of the Jersey trans* community in order to safeguard our human rights. Trans* Jersey is currently preparing a response to both the States of Jersey consultation on sex discrimination and the imminent debate on equal marriage. Trans* Jersey will also be reviewing all legislation in force to ensure that there are no revisions that need to be called for.
Trans* Jersey believes that equal marriage legislation is essential to ensure that trans islanders are not discriminated against, and that any equal marriage law introduced in Jersey should not contain the so-called Spousal Veto. Trans islanders who are married or in a civil partnership at the time of their transition have no option currently but to get divorced before they can acquire a full GRC. On the granting of a full GRC, the couple may formalise their partnership again by having another wedding ceremony. This situation is patently in violation of all human rights.
Trans* Jersey believes that education is the key to many of the issues faced by trans* individuals in society and is therefore committed to providing opportunities and resources to cisgender islanders in order that they can learn more about the trans* population. In the coming months, Trans* Jersey will be seeking conversations with private schools and the States of Jersey Education, Sport and Culture (“ES&C”) Department about including trans* issues within the sex education curriculum.
These are not the only issues faced by trans* individuals in Jersey, but they are the most important ones to be addressed. We are a small group with no financial backing. This manifesto is, therefore, necessarily realistic in its aims. It is not possible to hit all targets at once so we are being selective. Once progress has been made on these issues, we can turn our attention to other areas where reform is needed.
You can download the complete manifesto as a pdf here.
The infographic below is a first attempt to map the pathway to care for transgender/transsexual Jersey residents seeking to transition. It is based on personal testimonies of islanders who have transitioned and, due to the confusing nature of the system at present, may not match your experience. Please email us if you think you can contribute to our findings.
Apart from cost, the main difference between the public and private routes to care is choice of practitioner and speed. There are set procedures that the public system have to follow when treating trans* patients that include statutory waiting times where the patient must live as their preferred gender before being permitted hormone therapy and/or surgery. These waiting times, largely, fall away when going the private route.
Trans* Jersey is working to clarify the pathway below with the States of Jersey Health and Social Services Department. The question of funding is particularly unclear.
Even if you take the publicly funded healthcare route to manage your transition, the costs are higher for trans* islanders than for trans* individuals in the UK because we have to travel to see the specialists who can assist us to transition.
For those transwomen with island medical insurance policies, you will find that they specifically do not cover any treatment relating to gender reassignment.
Below are some of the costs that you will need to fund whichever transition route you follow:
Travel
Flights to the UK for consultations with your therapist. You will need to budget for more than one visit. Depending on how your therapy goes, you could be visiting regularly for a while. The cheapest flights from Jersey to the UK are on the Gatwick route so take this into consideration when you and your GP select your therapist. Your appointment should only be an hour so you should be able to get over and back in the day. Also, remember to budget for the Gatwick Express into London and transport in London.
GP visits
You will need to visit your GP more regularly than usual to keep them updated on progress, to ask for referrals, to have bloods taken to check your hormone levels and to ask their advice on a range of issues. Budget for about one every two months during your first two years of transition.
Change of name
The costs given below are approximate. They may change.
Deed poll prepared by Jersey advocate and sworn in Royal Court: £435
New driving licence: £40
New passport: £75
Passport photographs: £5
See the change of name page for more details.
Devices for passing
Some transwomen like to use breastforms and gaffs to assist them in passing. Breastforms start at about £30 and can go up as high as £750 for realistic skin tone, shape and nipples. Gaffs are around £35-£50. For more information about suppliers see the help page.
Below are some of the costs that are optional depending on how you manage your transition. You may elect to go completely private, completely public through the States and NHS systems, or do a mixture of private and public:
Gender therapy
For those who wish to see a gender therapist privately in the UK, an hour’s consultation will cost about £200.
Hormone therapy
For those who wish to see an endocrinologist privately in Jersey, an hour’s consultation will cost about £280.
Surgery
Bottom surgery (GRS): costs vary depending on the surgical procedure being undertaken. Orchiectomy: £3,000 app. Cosmetic genital reconstruction surgery without vaginoplasty: £9,500 app. Vaginoplasty (penile inversion): £10,800 app. Colon vaginoplasty: £13,000 app.
If you go abroad for surgery, don’t forget to add in the travel, accommodation and food costs. For GRS, for example, you won’t be able to fly for a least a week afterwards, which means a hotel bill. Full recovery time is six to twelve weeks.
Top surgery: costs vary depending on the type of breast augmentation surgery being undertaken. There are two types of implant commonly used. However, you can expect to pay between £3,500 and £5,000.
Facial feminising surgery: costs vary depending on the surgery being undertaken, and there is a large range of procedures you can have done. You can pay anything from £1,000 for a minor procedure to £10,000 for a full facelift.
See the surgery page for more details of MtF surgery.
Funding
The truth is transitioning costs the trans* individual and, because it is still seen as a choice rather than a necessity, especially by insurers, there is little financial help available.
Try to put away £100 of your salary every month into a transition fund or hold a ‘transition fund’ event where friends and family show their support by donating as much or as little as they want without embarrassment.
Don’t fund your transition through credit cards or pay-day loans. These are the worst ways to borrow money as the interest rates are so high. If you need to borrow, talk to your bank about a loan. Trans* Jersey has contacted NatWest bank in Jersey and they have confirmed that they would do a personal loan for treatment or surgery and that anyone who approached them would be treated sensitively and with discretion. Criteria for the loan would be the standard requirements, ie. any person wanting a loan will need to bank with NatWest for 6 months, have a regular income mandated to the account and be able to afford the loan. Anyone seeking this sort of facility can contact Tanya Nerac, Assistant Relationship Manager, in the first instance who is one of our trans* allies.
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 transwomen, 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.
Jersey has the necessary skills on the island to administer your hormone therapy, which will be a lifelong commitment to taking estrogen, progestogen and antiandrogen in some form. 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 hormones and the doses 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 woman. However, you may elect to undergo one or more surgical procedures to further feminise 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 transwomen 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.
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:
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:
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:
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:
Your 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:
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:
The first place any trans* person should go for support is their doctor or GP. If you do not think your GP is comfortable handling your case, do not be afraid to change to another GP in the practice or move practices. Your GP is the gatekeeper to many of the trans* services and medical procedures you will need to access so their support is crucial.
For those trans individuals who are going the public healthcare route into the UK system, the Community Mental Health Service (Adult Mental Health or Child and Adolescent Mental Health) at La Chasse is where their GP should refer them and where their psychiatrist will be based. For those wishing to see a psychiatrist privately, there are several practitioners in Jersey who have clinics at The Little Grove, St Lawrence. However, patients will still need to be referred there by their GP.
For those trans individuals who elect to undergo hormone therapy, the Department of Metabolic Medicine at Overdale is where their GP should refer them and where their consultant will be based. For those wishing to see an endocrinologist privately, there is a clinic at The Little Grove, St Lawrence. However, patients will still need to be referred there by their GP.
If you are unsure what you should do and just want to talk to someone in confidence, the Jersey branch of the Samaritans can be telephoned on 725555 or 08457 909090 or contacted by email at jo@samaritans.org
Trans* islanders seeking legal advice regarding their rights in Jersey can get free, confidential and impartial advice from the Citizens Advice Bureau.
Trans* islanders who wish to change their name by deed poll will need the services of a legal practice. Again, as with your GP, ensure that your advocate is sympathetic to your needs and do not be afraid to change if he or she does not seem comfortable handling your case.
As a trans* person you may be subject to discrimination or harassment as an employee or as a customer of a business. If you find yourself in this position, Jersey Advisory and Conciliation Service (JACS) can provide you with free, confidential and impartial advice regarding your rights.
Transwomen as a demographic are particularly vulnerable to physical abuse and attacks. In the unlikely event that you have been the victim of an attack in Jersey, you should call the States of Jersey Police (emergency no. 999, telephone no. 612612) as soon as possible to report the crime. If you want to speak to the LGBT community liaison officer, you should ask for PC710 Emma Poulliquen or email the LGBT community liaison team.
If you are in the UK, the Metropolitan Police give this advice for reporting a crime online and, specifically, regarding hate crime. If you are not sure whether you have been the victim of a hate crime, read the City of London Police guidelines.
Finally, when dealing with all these agencies, remember Jersey is a small place and your case may be the first of its kind for the person you are dealing with. Be patient with them and explain clearly what you need them to do for you. You will find that most islanders are not transphobic and will do their best to help you.
Young People
If you are under 16, there are some specialist agencies in Jersey that can help you. All the agencies listed above will also help you – they are not just for adults.
If you are the victim of harassment, bullying or abuse, at home or at school, because of your gender expression, you should contact The Multi-Agency Safeguarding Hub (MASH) who work with lots of different childcare agencies to keep young people safe. They are based at the Bridge and can be contacted by telephone on 449213 or by email at enquiries-MASH@gov.je
If you just want to talk to someone in confidence about gender issues, you can contact YES by telephone on 08007 350121 (freephone) or 766628 or by email at yes@youthservice.yc.je All calls or emails to YES are treated in the strictest confidence.
Even if you take the publicly funded healthcare route to manage your transition, the costs are higher for trans* islanders than for trans* individuals in the UK because we have to travel to see the specialists who can assist us to transition.
For those transmen with island medical insurance policies, you will find that they specifically do not cover any treatment relating to gender reassignment.
Below are some of the costs that you will need to fund whichever transition route you follow:
Travel
Flights to the UK for consultations with your therapist. You will need to budget for more than one visit. Depending on how your therapy goes, you could be visiting regularly for a while. The cheapest flights from Jersey to the UK are on the Gatwick route so take this into consideration when you and your GP select your therapist. Your appointment should only be an hour so you should be able to get over and back in the day. Also, remember to budget for the Gatwick Express into London and transport in London.
GP visits
You will need to visit your GP more regularly than usual to keep them updated on progress, to ask for referrals, to have bloods taken to check your hormone levels and to ask their advice on a range of issues. Budget for about one every two months during your first two years of transition.
Change of name
The costs given below are approximate. They may change.
Deed poll prepared by Jersey advocate and sworn in Royal Court: £435
New driving licence: £40
New passport: £75
Passport photographs: £5
See the change of name page for more details.
Devices for passing
Some transmen like to use packers and binders to assist them in passing. Packers start at about £12 and can go up as high as £500 for realistic peeing and playing packers. Chest binders are around £35-£50. For more information about suppliers see the help page.
Below are some of the costs that are optional depending on how you manage your transition. You may elect to go completely private, completely public through the States and NHS systems, or do a mixture of private and public:
Gender therapy
For those who wish to see a gender therapist privately in the UK, an hour’s consultation will cost about £200.
Hormone therapy
For those who wish to see an endocrinologist privately in Jersey, an hour’s consultation will cost about £280.
Surgery
Top surgery: costs vary depending on the type of chest surgery being undertaken. There are two methods commonly used. However, you can expect to pay between £5,000 and £10,000.
Bottom surgery: Hysterectomy: £7,500-£12,500. Costs vary depending on the type of penile construction surgery being undertaken. Metoidioplasty: £10,000-£15,000. Phalloplasty: this is complex requiring numerous procedures so you are looking at anything from £25,000 upwards.
If you go abroad for surgery, don’t forget to add in the travel, accommodation and food costs. For chest surgery, for example, you won’t be able to fly for a least a week afterwards which means a hotel bill.
See the surgery page for more details on FtM surgery.
Funding
The truth is transitioning costs the trans* individual and, because it is still seen as a choice rather than a necessity, especially by insurers, there is little financial help available.
Try to put away £100 of your salary every month into a transition fund or hold a ‘transition fund’ event where friends and family show their support by donating as much or as little as they want without embarrassment.
Don’t fund your transition through credit cards or pay-day loans. These are the worst ways to borrow money as the interest rates are so high. If you need to borrow, talk to your bank about a loan. Trans* Jersey has contacted NatWest bank in Jersey and they have confirmed that they would do a personal loan for treatment or surgery and that anyone who approached them would be treated sensitively and with discretion. Criteria for the loan would be the standard requirements, ie. any person wanting a loan will need to bank with NatWest for 6 months, have a regular income mandated to the account and be able to afford the loan. Anyone seeking this sort of facility can contact Tanya Nerac, Assistant Relationship Manager, in the first instance who is one of our trans* allies.
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.
Jersey 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.
Trans* Jersey 