Information on hormones and hormone therapy from a US based gender therapist. Some of the advice offered is relevant to the USA only so you should use these videos as a general guide and check out the specifics of hormone therapy and your situation with your own gender therapist:
hormone
Medical treatment of trans* people
Because there are no specialist gender healthcare professionals in Jersey, all trans* islanders have to go abroad for treatment. Most will, at least initially, go to the UK. Therefore, any issues that trans* organisations have with the UK healthcare system are shared by Jersey trans* individuals.
In addition to producing a report on the health of trans* individuals, GIRES also identifies three main areas of concern:
Multiple referral for treatment
Current treatment protocols often require two referrals before cross sex hormones, or chest reconstruction, or genital surgery, etc are authorised. This causes delays. No other medical treatment requires two referrals so why are trans people singled out for a “special” treatment protocol.
Refusal to treat
If a trans person has been treated for gender dysphoria in the private system or overseas, that person’s treatment on the NHS may be delayed. No other such patient is refused treatment on the NHS for any other condition.
Health providers must be challenged to provide the equality analysis that justifies treating trans people in a different manner from other service users.
Delays in receiving treatment for young people
A young trans person can benefit hugely from an early medical intervention to ensure that the damage done, both physically and psychologically, from an inappropriate puberty can be minimised, where there is a clear clinical need established.
Delaying treatment for young people can have a disproportionate impact. A delay of (for example) three years in treating a 30 year old gender dysphoric person will not significantly change the physical outcome on the transition as the individual will have already developed adult sexual characteristics. However, for the 11 year old, the situation is completely different. However, both patients will suffer psychological stress due to the delay.
Again, Health providers must be challenged to provide the equality analysis that justifies treating trans people in a different manner from other service users.
As we have stated elsewhere, it should be noted that Jersey trans* people can avoid some or all of the above problems if they have the resources to navigate the system privately or semi-privately. In which case, they may not find the above to be an issue in their transition.
MtF hormones
In order to transition from male to female, transwomen usually take two hormones for the rest of their lives: estrogen and progesterone.Pre-orchidectomy surgery they may also take anti-androgens. 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 Looking Glass Society has detailed information about HRT (hormone replacement therapy) here.
Your GP or doctor in Jersey is very unlikely to prescribe hormone replacement 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 HRT. 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 versions of HRT 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. HRT is a life-long commitment for transwomen and the cost of the hormones is not cheap so the majority of transwomen will elect to get help through the States of Jersey’s usual free prescription scheme.
There are a number of different forms in which HRT can be administered (injections, subcutaneous slow-release capsules, gels, patches) and Jersey offers most of the versions available. However, not all the versions of HRT 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 HRT delivery methods through the hospital’s pharmacy.
Whether your GP or psychiatrist can prescribe the type of HRT 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 hormones are 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 female, 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.
MtF 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 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.
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.
There 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.
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.
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 