4:09 AM
" Juliet Jacques returns to the Gender Identity Clinic, hopeful of a long-awaited hormone prescription. Will she get the answer she wants to hear?
The wait for my second Gender Identity Clinic appointment felt very different to that for my first, although it lasted nearly as long. The time between my local psychiatric referral and my initial visit to 'Charing Cross' had been fraught with anxiety about whether or not I'd be allowed to continue on the NHS pathway. More confident on leaving that I would, the five-month wait for my next consultation – due to last just thirty minutes – was characterised not by apprehension but anticipation, especially as the literature I received before my first visit told me that 'hormones may be prescribed after the second appointment'. Finally, the time when my body would match my essence seemed in sight.
Friends tried to talk me out of my impatience: five months will fly by, they said. Especially with the World Cup on, I thought. Wrongly, it transpired, as each game felt longer than the last. Anyway, I got on with life, the social aspects of my transition continuing to settle into an agreeable groove, and soon enough I returned to the West London Mental Health Trust's surgery for my second appointment.
This was with my supporting clinician, Dr Lenihan, who would provide a second opinion on my suitability to transition. One complaint that perpetuates about the GIC is that the doctors play good cop/bad cop, one being sympathetic towards the patient and the other reproaching him/her for any failure to comply with real life experience protocol.
Although usually when working with two people, one invariably gets on better with one than the other, this was not my experience. The set-up, I reflected, was like that of PhD supervision, with the process seeming just as strenuous at times. Not to mention taking just as long. My main complaint was that I found myself being asked very similar questions as by Dr Davies. I told my third clinician about how I realised my transsexual impulse, and my relationships with family, friends and colleagues, amongst other things; perhaps, I consider, I'm relatively rare in addressing all these challenges in my acquired gender before my local psychiatric assessment. The most striking, new question is 'Do you write the column?' I smile and say 'Yes.' Preventing the appointment (if not this article) from descending into an unbearable postmodern farce, Dr Lenihan moves on.
Then comes an even more loaded question: 'What kind of child were you?' 'An unbearably precocious one,' I tell her. After my well-rehearsed narrative of my transgendered youth, Dr Lenihan asks if I have ever self-harmed, or if I take any medication. I mention my anti-depressants, asking if they will affect my treatment. Absolutely not, she says, enquiring how much I drink, then whether I smoke or take any recreational drugs.
She asks, she says, because this may explain any irregularities in the results of my blood test, taken nearly half a year ago. I have high cholesterol, she tells me, which won't affect my treatment, but remains something I should address. This, I explain, is due to a lack of exercise and a diet consisting primarily of bread and cheese. As I start to wonder how the French populace survives, Dr Lenihan reveals my current testosterone and oestrogen levels.
My testosterone level, she says, is 19.9. Dr Lenihan doesn't explain the measurement, but she says it is around average for people of my age born male-bodied. Researching it later, I understand why she doesn't: no matter how many times I read this explanation of nanomoles per litre, it doesn't make sense to me - though that said, I couldn't even grasp long division at school. I must have been off sick the day we covered this. My measurement must be reduced to three nmol/L: I imagine that this will be done with the aid of an anti-androgen as well as hormone tablets, but she does not mention it. My oestrogen level is 125 picomoles per litre (pmol/L) – slightly above average, but I need to be at the pubertal female level of 400-600. She tells me that the GIC will prescribe 2mg of oestradiol per day, rising to 4mg after a few months, if I handle well the physical effects of treatment.
Having been told what I want to hear, I imagine that from now on, these physical effects and the 'Charing Cross' appointments will likely form the future milestones of my journey, having negotiated the major social hurdles that I'd anticipated. However, I have a big decision to make. Their prescription will take at least a month to reach my GP: Dr Lenihan tells me that I should spend that time thinking about whether or not I want to save some sperm, as the hormones will render me infertile, possibly within six months. If I decide that I do, I discuss how to do this with my doctor. On the train back to Brighton, wondering if and how my body or my life might change by my next appointment with my primary clinician in five months' time, I call my GP and make an appointment.
• Juliet Jacques's column appears fortnightly. You are invited to post comments and questions for Juliet below, and are very welcome to share your own experiences."
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