I sent the new patient enquiry to the gender clinic, which was:
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Dear Dr [name]
I am writing to book an initial assessment appointment please, which I gather from your website will be opening up this month for dates from September onwards.
In answer to the four introductory questions detailed on your website:
a) Name and pronouns
My preferred name is Nicola (although my legal name is still my given name of Mark). Nicola is the girl's name that my parents had chosen for me had I been born female.
My gender identity is female and so I prefer she/her pronouns. Although I am not “out” to most people in my life who assume I am male, as I appear, I do find it grating to hear myself described as he/him/a man, especially the latter, I find that really difficult to hear.
b) Gender concerns
I was born male and have lived all my life (49 years) ostensibly as a boy and latterly as a man. However, from around the age of eleven and the onset of puberty I had a strong feeling that I wished I was a girl (and latterly woman). At the time, in the 1980s, I had no language for this, and no concept even that transgender was a thing, until I saw the BBC documentary 'A Change of Sex' around the age of sixteen and suddenly realised that 'a transsexual' (as they called it then) was what I was, and that it was medically possible for me to actually become a girl. During my teens, I had begun wearing my mother's clothes in secret, but the era and culture I grew up in was not tolerant of anyone who was not 'normal', and 'transvestites' were subjects of ridicule. So I hid my secret and was ashamed and fearful. And that has basically been my life. I've always wished I was a woman, I know I am transgender and that transition is possible, but I have hidden who I am and lived as a man as I have always feared the consequence of losing everything if I ever did it.
I may have hidden who I am, but I wouldn't say that I have repressed my trans feelings. I have had a secret female wardrobe my whole adult life, to be able to dress female in secret when I'm alone, or to wear items under male outer clothing so I can feel feminine.
My personality is female and I have always gravitated to female friendship groups and all my close relationships have been with women. I struggle to relate to men and male conversation. I really don't fit in with all male groups, and I find them uncomfortable to be around. Women seem to find it easy to be my friend, perhaps sensing that I am 'one of them', but that has the consequence of not seeing me as a potential partner. I am married, so this no longer is a concern, but I did experience difficulty in establishing relationships when younger.
I'm confident that I know who I am and that I wish I was a woman.
If my fairy godmother appeared, the first of my three wishes would, without hesitation, be: turn me into a woman. In the real world however, transition is a massive thing, with consequences in every part of my life and the fear of that is what has held me back until now.
Having read the WPATH definition of gender dysphoria, my experiences and feelings appear to align with a number of the indicators. The aspect of the definition that I am less clear on is what constitutes distress or impairment, given that I have managed to live my life up to now, and function reasonably successfully. Having reached my fiftieth year, I feel that my opportunity to make a change is passing me by, hence I need to know whether what I believe I feel is real and something I can act upon, or it isn't and I need to move on in a different way.
c) Steps already taken
The most important, and difficult, step has been talking to my wife about my gender concerns. There remains a lot to talk about and resolve, but the conversation was begun, which was the hardest step. She is not happy about the idea of my transitioning, but she is supporting me thus far.
I am not 'out' in my day-to-day life.
In February 2023 I contacted my GP to advise that I wished to explore transition and what support they would offer should I use a private provider. They were willing to offer a referral to an NHS gender identity clinic, but warned about the very long waiting list. They refused to work alongside any private gender clinic. This was a set-back and impacted my confidence and belief that I could do this.
In terms of social transition, I have experimented with presenting female in public, and gaining real-life experience of being visible as a trans woman. This has mostly taken place away from my home town, to be anonymous. My experience so far has been for fairly short periods, but in very public places, such as a busy shopping centre or coffee shops. Although initially very nervous, I quickly discovered that many people simply don't notice, and that where people do stare or pass comment, I can cope with that. After doing this a few times, I became relaxed about being out presenting female, to the point that I now can quickly settle into it and more-or-less forget that anything is different, I just feel 'normal'.
d) What I would like to get from the service
As I said above, I believe I know who I am and what I want, but it is such a huge thing and with such far reaching consequences, it is extremely scary and difficult to make that decision on my own and to trust my own instincts and that my feelings are real. I accept that there is no "test" for transness, so "proof" one way or the other is not really possible, but I am seeking the reassurance of an expert diagnosis.
If the diagnosis is gender dysphoria, then my wish is to act upon it and to transition and to live my life as a woman going forward. For me, this means physically changing my body as well as socially transitioning. I would therefore be looking for referrals for hormone therapy, voice coaching and after the required period of living as a woman, referral for reassignment surgery.
If the diagnosis is not gender dysphoria, then I would need to find out what my gender-related feelings actually do mean. This diagnosis could give me clarity and potentially enable me to draw a line under the idea of transitioning. However, writing this, my feelings are that I would be disappointed if that is the outcome, so that I may need support in dealing with that.
I hope this email has not been too long, since your website did say "brief" description of the issues! I could write many pages, but have tried to stick to just the key points.
I work in the same city as your practice, so would like to undertake the assessment in-person at your practice, if possible.
Regards
Nicola.
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It took me a while to get happy with my drafting, but once I was, I simply clicked Send. I felt no hesitation in doing so. There was no nagging doubt of whether I should actually do this, no hovering over the button and shall I / shan’t I? Just: email is good enough - Send.
I got a reply on Friday asking if I wanted to register and book for an appointment in November. They did thank me for my thoughtful and considered email, although they probably say that to everyone. It is nice to receive emails that begin “Dear Nicola”. I like that, it feels good.
I’ve now been sent a link to the full patient registration form, which is very long. I shall fill this in over the weekend.
The thing which I’m finding slightly unexpected is how calm and certain I feel in doing this. I’m not nervous. Not hesitant. Not scared. Not excited actually. Just calm. I’m taking this as a sign that I’m doing the right thing for me and what I truly want.
My friend K has very sensibly advised me that I should not book anything without keeping my wife informed and I know she is right. That is going to be another difficult conversation I’m sure, but better than the one we would have if she finds out after I’ve already done it.
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