what happens at Charing Cross GIC

This was sent me by Dr Stuart Lorimer, who works at Charing Cross, and I’ve posted it here because it is a useful counter to the myths that are always doing the rounds about Gender Identity Clinics, usually promoted by people who have never been there. I’ve been there, and this is how it is.

WLMHT GENDER IDENTITY CLINIC (GIC) MYTHS
The WLMHT (“Charing Cross”) Gender Identity Clinic has existed in one form or another since the early 1960s, and clinical practice is constantly evolving. It is perhaps inevitable that, in that time, a number of false beliefs and misconceptions have arisen.

Not all these beliefs are “myths” in the sense of having always been untrue – some stem from the way the GIC operated in the past, or the approaches of previous clinicians – but all are outdated, and unreflective of current treatment protocol.

The following, then, are examples of commonly held beliefs about the WLMHT GIC which are untrue:

You have to wear a skirt to the GIC
Perhaps the most widely cited misconception, this is not the case. As part of the Real Life Experience (RLE), male-to-female transitioners are expected to present themselves in female role 100% of the time, and sometimes it is relevant to discuss this in clinic appointments. However, the range of feminine apparel is, obviously, wide and varied, and cannot simply be reduced to “wear a skirt”.

A less common variant holds that female-to-male transitioners must wear a suit and tie to be taken seriously at the GIC. This too is without basis.

You have to be living “in role”
Not the case. We see people who experience gender related distress; some are pre- transition, some do not undergo transition at all. All are valid referrals to our service.

You have to want surgery
Not at all. Not everyone needs or wants gender related surgery.

You have to be suicidal
On the contrary, it is important that those undergoing transition be stable, physically and psychologically. It is not unusual for us to see people who have, as a result of their gender distress, been depressed – sometimes to the point of suicidality – but we would hope that, as transition progresses, this gradually improves.

You have to be heterosexual
We have heard health professionals say this of the clinic, but it is patently ridiculous. It would be grossly unethical of us to insist on heterosexuality in our patients.

You can’t admit to doubt
Transition is, for many, a major life change and it would be unusual to have no doubts whatsoever. You should feel comfortable discussing feelings of doubt with your clinicians.

You have to give a standard trans narrative
As the UK’ s largest gender clinic, we see a huge diversity of people, and neither wish nor expect you to tailor your own experiences to a set of clichés. Just be honest.

The GIC will start you at the beginning again
This was our practice in decades past. In the last decade or so, it has been standard practice to acknowledge previous time spent in the preferred gender role. Typically, we “back date” the start of transition to the start of living in role full time as well as making an official name change or equivalent.

The GIC will stop your hormones
No. Our concern is that you take hormones safely. We routinely carry out blood tests at the first appointment, and may advise accordingly, but we generally do not ask people to stop hormones on which they are established.

The GIC will penalise you for having gone private/self-medicated
Obviously, we cannot approve of self-medication as it can be dangerous and often leads to a poorer result than that gained under medical supervision. However, we recognise that it is a modern reality, though, and do not penalise you for it. The same is true of previous contact with private practitioners.

It will take forever
Within the limits of available NHS resources, we aim to provide a timely and efficient service.

They deliberately play Good Cop/Bad Cop
Different clinicians have different approaches, and will form different therapeutic relationships with their patients. Choice of clinician is determined by availability of appointment slots, not by any sort of organised Good/Bad Clinician policy.

November 2010

37 Responses to what happens at Charing Cross GIC

  1. Pingback: Charing Cross, and Millbank | Being Drusilla

  2. Delia says:

    That all looks very fair to me – but I’m only me. Life can be tricky enough when one is fortunate enough to be born into more or less the right shape. Many years ago I briefly taught [in different places and at different times] a couple of pupils with gender identity issues and I’m learning so much from you. “Sympathy” and caring can go a long way but information is also key.

  3. Jane Wharam says:

    What a useful post, Dru. Myths can take on a life of their own, particularly in an already complicated field, and often only add to the problem. Well done for myth-busting!

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  5. Lesley Stafford says:

    About the wearing a skirt “myth”. I do know one (now) fully transitioned young woman who was briefly held back from gender confirmation surgery because the psych. asked for second opinion held that her always wearing jeans showed a lack of commitment. Not that this situation lasted long!

  6. Dru says:

    As you probably know, Lesley, the internet forums have no shortage of people criticising Charing Cross on them, often citing things that happened a long time ago, or happened to someone else. In at least some of those cases, the people involved come across as having major unacknowledged issues beyond those cited.

    Not knowing the person you mention, I can’t comment on how reliable her version of things is; I can only repeat that the ‘mythbusting’ list chimes with my own experience. I did encounter one of the ‘old guard’ a couple of times, and was a little upset and underwhelmed by his approach. But he is retired now.

    • Chloe says:

      Are you referring to Dr. Montgomery by any chance, Dru?

      • Dru says:

        Not Dr Montgomery, Chloe. I never encountered him.

      • steviejayne says:

        I can confirm that they don’t operate a “must wear skirt” policy. I completed my journey some years back now and didn’t wear a skirt to any appointment. After all, it’s not about the clothes we want to wear but personality/body.

  7. Thanks so much for this myth busting array of information, as someone less than calmly waiting for my first appointments to arrive, it is a weight off my shoulders on several counts. I reguarly speak with people successfuly transitioned by Charring Cross and who are pleased with the results – I cannot wait, and look forward to the rest of my trans life ;-)

  8. Dru says:

    Hurrah! Result. Good luck, and enjoy the ride, Elizabeth!

  9. M says:

    I have a question.
    I am FTM transexual and I will have my second appointment soon at the GIC.
    I would like to change my name. I am not on testosterone yet. What if I won’t be allowed to go through the process after I change my name?

    I know that clinic prefers people to change their name before they will prescribe hormones, at least this is what I read.
    I would be grateful for any answers.

    Marcin

  10. Dru says:

    Hi, M

    It used to be the case that you had to formally transition before hormones would be prescribed. I’ve posted up the care pathway that was sent to me in 2003, as a separate page on this section; though I expect that you already have one from the clinic you’re attending. As I say at the top of that page, it is for historical interest, and shouldn’t be taken as current.

    I can’t give you a hard and fast answer, really. Everyone’s case is unique. But I might suggest that you don’t need permission from a GIC to transition, or to take hormones. I see them as facilitators, advisers, and of course gatekeepers- they are able to offer help, and access to services which it might be difficult or expensive to obtain otherwise. But ultimately, your transition is your own business, and you should do only things that you are comfortable with, and in your own time.

    Sorry, I’m trying to be helpful. Feeling at all reassured?

  11. Pingback: ‘What sort of woman do I want to be?’ | Life and style | guardian.co.uk | Political Analysis

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  13. Brianna smith says:

    Its taken me three years to reach my third app., to charing cross and I am still not on hormone treatment. It looks unlikely that I will ever go on treatment. The reason being that because of my age there is a greater risk of blood clots. I’d like to know if I can ask for breast augmentation as my right. I’m due at charing cross on 20th sept and would like to carry some ammunition with me. Brianna.

  14. Dru says:

    I’m pretty sure that BA is discretionary and dependent on need, Brianna. The GIC *could* recommend it, but it would be your PCT who would fund it. Unless you were to do it privately, of course. This advice is my own opinion; I’ve relayed your question to the TransBristol group, to see if anyone has further opinions to offer.

  15. Brianna Smith says:

    Thanks for the help Dru… I’m really to the point of tearing my hair out… Nobody at charing cross gic will commit to an answer… My Psychologist seems to be of the opinion that it would be offered me… After all this time I would have thought something would have happened… Brianna.

  16. Jackie Ricotta says:

    I am angry at the moment, otherwise I might not be so tempted to reply to your “myths” post. I am so glad that you found the GIC at Charing Cross so wonderful, but I have just returned from there with my 23 year old son, who has spent two years (1 of those spent waiting for the local GP to do something and the other year waiting for the 2 disappointing sessions at the GIC) only to be told by his assessor that she is not sure that he really wants to transition and he can’t have the hormones. He has to go back in a year. He is so unhappy with who he is I very much doubt that he will be alive in a year for her to correct her badly made assumption. They are dreadful people, playing god with people’s lives and I cannot begin to tell you how much I despise them. Do they get some sort of perverse pleasure in the power that they hold. DO they think that people have made this life-changing decision lightly. I have spent the last year on suicide watch and I don’t think that either of us can make it through another year. Be warned, these people make arbitrary decisions based on a two 1 hour sessions that could destroy your life and they shouldn’t be allowed anywhere near people with gender dysphoria.

    • tarakfraser says:

      Dear Jackie,

      Personally, I found my first encounter with the NHS Local Doctor to be so deplorable that I went private, lack of empathy or willingness to understand. I did not think I could cope with treated like a patient number, who should feel grateful for the NHS. I know some people think its easier going private, its just different, in that have to organise everything. I like that to be honest so I can plan them around my life…

      Now, I personally think the level of councelling on the NHS is substandard at best, I go to regular councelling and have done since starting my own voyage in Sept 2012. This has helped me deal with most things life throws at me…

      May I suggest, you try and find some local councelling for your son. I do not know where you live in the UK..Please bear in mind its important to find the right councellor for your son, whom they can talk to etc..This might help in dealing with your fear of Suicide as well as deal with thoughts and feeling on Gender Disphoria etc..

      Best Regards

      Tara

      • Jackie Ricotta says:

        I cannot even begin to tell you about how poor the GP service was. When my son first approached them he told them the problem and said he wanted to see a psychaitrist. They said no and if he wanted to see someone he would have to have some private counselling. They didn’t even tell him that he had the GIC option. A year later, when he was close to suicide he told me. I then wrote to the practice manager threatening to sue them and amazingly we got an appointment the next day. The GP assigned to this is appaling though. During the appointment he said to my son ” I would like to see you through this as I already have a transgender patient, although I didn’t realise until I put my hand up his skirt to examine him and found a pair of balls”. I sat there dumbstruck at such an inappropriate comment. When we got outside my son expressed his amazement that the doctor had thought it in any way appropriate to say that to him. I went to the doctors last week as I was at the end of my tether and really stressed and had the misfortune to be assigned to this same GP nd when i told him that the GIC had rejected him and would be writing to him and I didn’t know what to do he said “”you can find £120,000 and pay for it privately.” A bit later in the conversation he said to me “well I don’t think he is transgender anyway because he doesn’t fancy boys”. What! So because he isn’t currently gay he can’t possibly be transgender. What is the matter with this man. And he is a health “professional”. Guess which practice manager is getting another letter?

      • tarakfraser says:

        Hi Jackie,

        Well I don’t know where the GP got the idea of £120k..? Can I suggest you search for a counsellor in pink therapy (www.pinktherapy.com), these are counsellors that cover all spectrum in the GBLT, they accept people for who that are and they do not see it as something to cure..they help people accept themselves and deal with the other issues that are problems in their lives… mine was Guilt, family break-up, kids, fear…

        I was subsequently asked by the same Dr if I had been cured yet? when I me her again some 3-4 months later. I am afraid ignorance has no boundaries and GP’s are no different or councelors who I have heard say similar things in terms of ignorance, they don’t believe it to be a illness. I talked to the Head practice Dr and told her I expected treatment not commentary (I just avoid the crap Dr).

        Private Costs – Gender Specialist £200 a session for an hour (every 3 months), Councellor £30 – £50 a session, operation £11k approx, so not sure where the GP get the idea of £120k.

        Are there any support groups around your area that might help..?

        All the best,

        Tara

      • tarakfraser says:

        Jackie,

        Dru, makes a lot of valid points. The main one is your Son needs to take control of their transition a lot of people actually start the process without CHX in terms of telling family, work, neighbours etc as they working towards being full-time in society, changing name legally, working full-time can all be done without CHX.. you don’t need CHX to help you with these items.

        I suggest you don’t waitrely on CHX and get going..on the path. Best advice I was given before I started, you and only you will know when you are ready to deal with it.. and take it as fast or as slow as you can handle it, it may even mean stopping, stepping back… it does not matter it is up to you…

        Tara

  17. Dru, This would be useful in work, we hear very confusing things from some people we treat, and I think this would help the clinicians, can I print it out and take it in for them?

  18. Martha says:

    Jackie, really sorry to hear about your son’s situation. What has ‘he’ said about how the encounter went? If I can be of any help I will.

  19. Jackie Ricotta says:

    He says he doesn’t know what he said to her that would have given her any doubts as to him wanting to transition. We have discussed it and from what he says I do not know either. He did say to her that he does not go out as his “female” self as often as he would like as he has concerns about abuse and ridicule as he does not think he looks feminine enough to carry it off in public at the moment which was why he was so hopeful about getting his hormones and maybe that was what did it but if it is she has no right to use that against him. He has told family, friends and work that he is female and it is hard enough to do that so what level of commitment she wants is beyond me. Did she want him to turn up in a pink tuto and blonde wig? I do know that at least her poor sense of judgement has given him the spine and determination to fight her decision.

    • Dru says:

      Trying to see things from the assessor’s point of view- it is (at least was) normal not to prescribe hormones until the patient has formally transitioned. I remember feeling equally daunted by the prospect, not least because I was working in an engine room at the time…. I got round that problem by getting my hormones by other means, and when I finally got to Charing Cross a few years later (my PCT was broke for some time and couldn’t afford to refer me there) -they accepted it as a done thing. But then I had already been fully tranistioned for some time by then, anyway, and had only gone back for referral for surgery.

      But ultimately, what I learned along the way was that the GIC were not in the business of shepherding me onto a conveyor belt that would pop me out at the other end as a Compleat Woman. You do need to take control of your own life as best you can; and if you want to transition, then the best thing to do is to transition. Your child is to go back to CX in a year’s time? Do they intend to go, and if so, what do they intend to have done for themself between now and then?

      The GP sounds like a shit, by the way; can you not change practice?

  20. Jackie Ricotta says:

    I’m afraid that half of the problem is not understanding what the process is. No-one at the GIC seems to be willing to impart useful information.

    On your point that my son needs to manage his own transition that is what he has decided to do. I have arranged a hair appointment and a beauty appointment, electrolysis and am currently looking for a voice coach. I told him he didn’t need these people to validate who he was and that he would make a beautiful woman without their help. I think that he looks in the mirror, sees the facial hair (although there is very little) the square jaw and the male he has been for the last 23 years and thinks he will never be who he wants to be. When I look at him I see a the woman he wants to be (although that is painful), all he needs is to believe in himself. I can’t imagine how hard this is for him but he was so pleased when I told him he can pass for a woman without the hormones his face lit up (like a guilty pleasure or an unsolicited compliment). My heart breaks for him.

    The eyelash tint, nails, hair, eyebrow shaping, and a lesson on how to use make-up to shape his face will hopefully help him to see what a lot of us already see. I will keep you updated.

    P.S. Still bloody angry at the GIC. A little advice and guidance wouldn’t go amiss.

    P.P.S. Yes his GP is an arse.

    • Jackie, Your child might want to consider laser hair removal rather than electrolysis, depending on how much hair is present. Electrolysis treats single hairs, and is operator dependent. Laser treats all the hairs within the size of the laser end piece, in one shot. So a whole face can be treated at one appointment. Lasers can’t treat blond hair, there has to be colour for the laser to target. It is expensive, but go somewhere with experience of people who transition, and who have proper training and experience. I wouldn’t recommend beauty salons, look for a centre that has different lasers for different uses and vast experience, as there are so many variables which make the treatment effective or not. Good luck to you and your child.

    • Dru says:

      Have you read the page describing the care pathway?
      http://beingdrusilla.wordpress.com/trans-resources/the-care-pathway-at-a-gender-clinic/
      …it is about 10 years old, and may not represent exactly the current practice, but may be helpful; did the clinic send anything similar to you?

      Support from peers is helpful- possibly essential – in the search for useful information, from people who’ve been there and done that; using the health service as a trans patient will inevitably make you an ‘expert patient’. Finding and joining internet forums is an easy way; there are also local groups in many places. The obvious caveat is that information received should also be viewed discriminatingly; there are plenty of loose cannons whose shoutiness is in inverse proportion to the reliability of their facts..

  21. Jackie Ricotta says:

    Thanks for the tip

  22. Jackie Ricotta says:

    All my help has come from the internet, my support group for the parents and partners of transgender and various people I have contacted due to what I have found whilst “Googling”. Thank god for the internet! I find contacts, make calls, talk to people. For instance, it was a wonderful gentleman at The Gender Trust who told me to fight my GP, that they weren’t allowed to say no. I do not think he will ever know what he did for us and I can never thank him enough.

    As for the GIC we have had absolutely nothing from them apart from continued forms my son had to complete to say he still wanted to attend. Its almost like they are hoping that because they keep you waiting for so long you will change your mind! I am sorry but I really have no respect for them and it may be that we have just been very unlucky in our clinicians but they have been the most unhelpful and secretive people I have ever had the misfortune to deal with. It really is the most perplexing of things as one would have thought that, as they chose to specialise in this area, they wanted to make a difference, or perhaps it is just morbid curiosity on their part.

    We have tried to find local groups but the groups seem to be mainly gay and lesbian groups that have tagged transgender on, or groups for transvestites, who are not following the same path as my son is taking and so would probably not have the information we would need and whereas they may well have had a few members who could have helped I am always concerned that this is a decision that is his alone, with no outside influences.

    I have made him an appointment at the doctors on Monday so that he can go and swap to another GP in the practice. Unfortunately I live in a very small town and there is little choice when it comes to GP’s but the doctor I have made him an appointment with is a lovely man and slightly younger than the other GPs so I am hoping he will be a little more open-minded.

    I will keep you posted.

    • Dru says:

      As I’ve said elsewhere, my experience of the clinicans at CX has been very positive, with one exception (and he’s retired now). It’s my understanding that the admin staff at CX are the weak point in the line of communications. Which is scant consolation. There are other GICs; it might be worth considering a referral to one of them instead.

  23. Jackie Ricotta says:

    I have heard a rumour that the WLMHT GIC is putting all appointments/treatments on hold. This is the second time I have heard this from two different sources. Does anyone know anything?

  24. Martha says:

    Hi Jackie, Sadly, in the often fraught area of gender transition treatment, the rumour mill is easily triggered. I have an appointment there in about a fortnight.

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