MtF surgery

All surgery is optional. You should not feel that you have to have surgery to validate your transition from M to F. You should have surgery because you want to have surgery and for no other reason.

Bottom surgery
This refers to genital reconstruction surgery (GRS), ie. a penectomy and orchidectomy to remove the male genitalia and plastic surgery (vaginoplasty, clitoroplasty, labioplasty and repositioning of the urethra) to provide you with a genital appearance that is virtually indistinguishable from natal born women. The phases of the operation are done in one procedure under general anaesthetic and takes about five hours. The Looking Glass Society has a great section on the variety of surgical methods and their advantages and disadvantages.

When considering bottom surgery, manage your expectations. Post-surgery interviews reveal that 98% of transwomen are satisfied with the physical results of their surgery. However, the surgery is irreversible so you need to consider the emotional implications carefully. You will not be able to have children after surgery (unless you make a deposit with a sperm bank first), you may find that your relationship with your partner changes dramatically post-surgery, with potential loss, and genital surgery won’t change how people behave towards you in public life.

There are no surgeons available on the island to undertake this procedure so you will need to go to the UK or abroad if you want GRS. If you are being treated through the NHS, you will be offered a list of approved surgeons to choose from. If you wish to go privately, you can choose from surgeons in private practice all over the world. However, you will need to research the best person for your needs and your budget.

Do your research. Look at the numerous blogs and YouTube videos uploaded by transwomen describing their experiences. Visit some of the forums for transwomen and post questions asking about their experiences. Don’t forget to ask about any emotional reactions to the surgery as well as the physical results. Most transwomen are happy to share this information.

surgeryOther surgery
This comes in several parts. The Looking Glass Society explains the range of surgical options available to transwomen. It is exceedingly rare for any of these procedures to be funded through the health service. If you wish to undergo one of these options, you should be prepared to fund it privately.

You will not be surprised to learn that there are no surgeons with the required skills to perform these operations in the island. You are therefore looking at travel costs again and, because of the complexity of some procedures, several trips to the UK or abroad may be needed.

Facial feminising surgery and rhinoplasty
This refers to plastic surgery to feminise the face and/or remodel the nose. Some transwomen find that, even after HRT, their facial features retain a heaviness that is masculine in appearance and does not allow them to pass as they would like to. Cosmetic surgery can help to alleviate this problem.

Thyroid chondroplasty (tracheal shave)
For transwoman who have a very prominent ‘Adam’s Apple’, this procedure can reduce it by making a small horizontal incision in a natural crease-line on the neck and removing part of the thyroid cartilage.

Augmentation mammoplasty (breast enlargement)
Even after one or two years on HRT, some transwomen are unhappy with the breast growth resulting naturally. They, therefore, consider having implants. There are a number of options available now that are alternatives to silicone so do your research to find out which would suit your requirements best.

Hair transplantation
HRT will thicken the existing hair but many transwomen who transition later in life find that they retain a male pattern hairline. Hair transplantation can be effective in “filling in” the gaps at the front of the hairline to produce a more feminine line.

The same advice applies to these surgeries as for GRS: manage your expectations and do your research thoroughly.

An open letter to our trans partner

I am the wife of a trans woman who transitioned during our marriage. I am writing this to support partners as there are significant areas in common for us all but each of our paths on this journey may be very different. I also write to the trans person and just hope you both talk to each other. We want to keep our marriages intact.

There is no clear cut care pathway for partners here so do not be afraid to seek help and counselling. This journey can’t be done alone. Local GPs and counsellors are not specialists, so the more we speak up the more awareness will be raised. This is not a life choice for either of us; something that took me years to understand. I still ask myself: ‘why me’?

I had advanced notice before we got engaged that my husband was cross dressing since childhood. She agonised over telling me but we still got married and have now been together for over 30 years and married for 27. The prognosis for staying together is much higher if surprises and shocks are limited. We decided never to have children and life is a lot less complicated. However, it was still a shock when my partner decided to transition and, before I could understand the implications, she was self-medicating secretly. I went through hell. Women are good listeners and can be sympathetic, but I don’t like dishonesty, hiding or deception. We can detect little signs, and you may think your partner is having an affair if female clothing is found in the house which does not belong to you.

Helen and Betty 1For the trans partner: please remember that this is like a bereavement but with no body and no funeral. If you are going to throw clothes from your previous gender away warn your partner and, perhaps, allow us to keep some sentimental items – even if just for a while, so we can grieve in our own time. Acknowledge this grieving process is just like any other, it HURTS!

Keep open channels of communication at all times and also agree to stop talking if it is getting too much. My counsellor suggested we have a password to use if this is happening, and we then agree to talk later at an agreed time. So far that works for us.

The trans person may be tempted to rush into transitioning (coming out, HRT, ‘real life experience’ and possibly surgery) because it is a lifelong desire to change gender. For the partner, it is a constant ‘in your face’ tornado of selfish wants that completely ignores and threatens the relationship. The effects of HRT on the mind and the body are visibly shocking and can be upsetting for the partner who knew another person intimately. Thankfully, there are now several good books out there and web sites. Bear in mind that by ‘outing’ yourself as being trans, you do the same to your partner and they may be concerned about what others think. The partner of a trans person may worry about peoples’ perceptions: are we a lesbian couple, sisters, sisters-in-law…?

Our particular relationship has been strong enough to overcome this. My partner first attempted a kind of dual life of living as a woman outside work many years ago, but this time around its permanent and that was a big adjustment for me. In transition we now tend to avoid the same haunts we frequented because waiting staff would recognize me and wonder if I have a new relationship as we sit at the same table ordering the same favourite meals. Even in places we have never been to, the ‘couple’ in us still comes out as we say ‘we’ the whole time when talking. I have to be very blunt here and say a part of our success is that my partner is completely convincing and I doubt if I would remain if she was not. Do not ‘carry the monkey’: other peoples’ reactions are their problem not yours. Who to tell and when is up to you. We have now told all our best friends and family, but my partner’s family proved to be the most negative.

For me this is not a linear process either. I have not gone smoothly from timid enquiry, anger, depression, thinking and reading to acceptance. Some days are better than others. Several times I revisit each emotion forwards and then backwards. This is where counselling helps. You are not alone. Also, bear in mind this is no-one’s fault so try not to blame when you are at your most angry to accuse. If you think that is easier said than done, I totally agree as I am guilty of doing that often – even now. I was quite shocked in one professional counselling session in the UK to be told I had in fact married a woman all along! To be told it was all to do with conception, what happens in the womb and the brain was earth shattering. Read, read and read. I have found it quite fascinating, painful and absorbing.

Having gone through more than a woman should for love, my partner wants a Gender Recognition Certificate. In 2014 with same sex marriage legal, the process is still unclear for married people where a partner transitions and, yet, retains the same legal rights. The irony that we already live as same sex couples after surgery is lost on them.

To end on a lighter note; there have been many fun moments, e.g. I now get to buy more clothes than before as she understands the need, but co-ordinating what to wear out can be a laugh. In the end love is more important than gender.

(Photograph is not of the post author but of Helen Boyd and her partner, Betty Crow. Helen is the author of She’s Not the Man I Married.)

Transgender basics

Transgender Basics is a 20 minute educational film on the concepts of gender and transgender people. Two providers from The Center’s Gender Identity Project (GIP) discuss basic concepts of gender, sexual orientation, identity and gender roles. Three transgender community members share their personal experiences of being trans and genderqueer. The film targets service providers and others working with the LGBT community, but it also provides a fascinating glimpse into gender and identity for the general public. “Our culture likes to make things simple, and gender isn’t.” Carrie Davis, Transgender Community Organizer, in Transgender Basics.

MtF finance

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.

financeBelow 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.

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.

hormonesThere 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.

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

 

MtF resources

UK Charities
GIRES
The Gender Trust
Gendys Network
Gender Matters
The Beaumont Society
Mermaids (for children and teen support)
Depend (for friends and family support)
Press for Change (for legal issues)

Links
NHS transgender advice – NHS Transhealth
Transitioning on the NHS information from a transwoman – Writings of a Trans Activist
UK based forum predominantly for MtF friends and advice – TransgenderZone
UK based advice for transwomen – The Angels
UK comprehensive medical advice for transwomen – Looking Glass Society

US based resource for all things MtF – Transsexual Road Map
US based online magazine for transwomen – Femme Secrets
US based online magazine for transwoman – Lynn’s Place
US based advice for transwomen – Susan’s Place
US based advice for transwomen – Laura’s Playground
US based advice for trans* people – Trans Health

Wigs – Alternative Hair, Jersey
Laser hair removal – Aesthetic Laser Clinic, Jersey

Complete make-over service, dresses, shoes, lingerie, cosmetics, wigs, breastforms – TransLife
Dresses, shoes, lingerie, cosmetics, wigs, breastforms – Suddenly Fem
Shoes, lingerie, cosmetics, wigs, breastforms – The Fantasy Girl
Shoes, lingerie, breastforms – Classic Curves

booksBooks
On Becoming a Woman: A Transsexual and Transgender Guide for Transitioning From Male to Female by Jennifer Corbett (2014)
My New Gender Workbook: A Step-by-Step Guide to Achieving World Peace Through Gender Anarchy and Sex Positivity by Kate Bornstein (2013)
Transgender 101: A Simple Guide to a Complex Issue by Nicholas Teich (2012)
Grrl Alex: A Personal Journey to a Transgender Identity by Alex Drummond (2012)
Helping Your Transgender Teen: A Guide for Parents by Irwin Krieger (2011)
The Transgender Guidebook: Keys to a Successful Transition by Anne Boedecker (2011)
Becoming Drusilla: One Life, Two Friends, Three Genders by Richard Beard (2009)
The Transgender Child: A Handbook for Families and Professionals by Brill (2008)
She’s Not the Man I Married: My Life With a Transgender Husband by Helen Boyd (2007)
The Transgender Companion (Male to Female): The Complete Guide to Becoming the Woman You Want to Be by Jennifer Seeley (2007)
Finding the Real Me: True Tales of Sex and Gender Diversity by Tracie O’Keefe (2003)

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.

evolution-womanJersey 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.

MtF change of name

The order in which you sort out your documents is important as you do not want to be left without photographic ID or in the position of having conflicting IDs. The order we deal with the documents below is the order in which we would suggest that you arrange to have them changed.

Deed Poll
Once you have decided on your new name, you can either visit an advocate or the Samedi Section of the Judicial Greffe. Ask them to prepare a deed poll changing your name. They may ask you for the usual photographic ID and proof of address. They may also ask you for your birth certificate or, if you have changed your name before, your marriage certificate or previous deed poll.

They will then prepare the deed poll, which does not specify your gender. It will say something similar to: “Know all men by these present (which are intended to be enrolled in the Rolls of the Royal Court of Jersey) that I, the undersigned XXX, a British subject, having been born in XXX, on XXX, and being ordinarily resident in the Island of Jersey at XXX, do hereby absolutely renounce and abandon the use of the said forenames of XXX and in lieu thereof adopt the forenames of XXX.

“For the purposes of evidencing such a change of name, I hereby declare that at all times hereafter in all records, deeds, documents and other writings and in all actions, suits and proceedings as well as in all devises and transactions, matters and things whatsoever and upon all occasions, I, the said XXX shall use and subscribe the said forenames of XXX, in lieu of the said forenames of XXX and I hereby authorise and request all persons whomsoever at all times to designate, describe and address me by such adopted forenames of XXX in lieu of the said forenames of XXX.”

The deed poll is then signed by you with your old and new signature and witnessed by your advocate or someone at the Greffe. At the next available sitting, the deed will be registered by your advocate with the Royal Court. You are not required to attend court.

Once your deed poll has been registered, you will be given an original copy of it. You must keep this document safe, just as you would a birth certificate. Because it is not a good idea to let anyone have the original of your deed poll, ask your advocate/the Greffe if they will provide you with certified copies of it. You will need at least 5 copies to give to various authorities.

documentsSocial Security
The easiest way to alter your record at social security is to visit the department in La Motte Street with a copy of your deed poll and your current social security card. This may mean asking your employer for your current card (if you are still on the old style card that had to be held by your employer). The new registration cards do not have to be held by your employer – employers take a copy and you keep the card. The social security helpdesk staff will change your record while you wait and provide you with a new registration card and health card. You will then need to show this to your employer for their records.

Income Tax
Writing to the Income Tax Department is the best way to ensure that your name is changed on their records. Make sure that you include your tax ref somewhere in the letter. Enclose one of the copies of your deed poll, ask the department to change your name on all their records and ask them to send you a replacement ITIS effective rate notice in your new name. It should take about 1 week and you will then need to give this to your employer for their records.

Driving Licence
Your parish hall will issue a new driving licence in your new name. You will need to complete the application form, provide one of your deed poll copies, provide two passport photos and surrender your old licence. The application form asks for your sex but this information does not appear on the face of the driving licence as your title or your sex. It appears to be used internally for the parish to be able to address letters to you so select F and your correspondence will come addressed to Ms.

It will take about 2 weeks for you to get your new driving licence during which time you cannot do anything further about your change of name. You need to wait until you get your driving licence back before doing the next document change.

Other
Now you have photo ID and correspondence from the income tax dept, you can set about changing your details with your bank, your credit card providers, the utility companies, your insurers, etc. Some of these may want to also see your deed poll.

Passport
The Customs and Immigration Department will issue a new passport in your new name. You will need to complete the application form, provide one of your deed poll copies, provide two passport photos, a letter from your GP or gender therapist and surrender your old passport. The application form asks for your title but not your sex, strangely, as your sex does appear on the face of your passport. Make it clear that your title is now Miss or Ms. For those who are Dr or Rev, you may need to write a covering letter of explanation.

It will take about 6 weeks for you to get your new passport during which time you will not be able to travel abroad so make sure that you time your application carefully.

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