#icb — Public Fediverse posts

Hey folks

Been trying and failing to write this post for a few days now.

Mood, health, energy, time, chores, obligations, and responsibilities kept getting in the way.

So, we're gonna summarise everything as much as we can, and try and limit our emotional response to it.

Important context

• We have been trying to get meaningful gender-affirming healthcare through the NHS since April 2021.
• We had tried to get clear information on surgery options, particularly genital reconfiguration surgery (GRS) options, for years, but never got clear options: only vague wording.
• We were almost certain sure that no form of penile-preserving vaginoplasty would be available, so we narrowed our choices to peritoneal pull-through (PPT) vaginoplasty or a bilateral orchidectomy.
  • We didn't and don't want penile inversion vaginoplasty (PIV) or vulvoplasty (aka zero-depth vaginoplasty).
• We finally passed all hurdles through an NHS pilot scheme (East Of England Gender Service; EOEGS) in late 2024.
  • This is under the Nottingham Centre for Transgender Health (NCTH).
• Our surgery referral was only sent over to a private hospital by the NHS Gender Dysphoria National Referral Support Service (GDNRSS) in late 2025.
• We had an initial assessment meeting with that private hospital this week.

Information from meeting

• The NHS will not fund PPT vaginoplasty unless there's medically no other option (i.e., last resort).
  • Basically only if you've got "inadequate donor site skin" for other methods.
• Despite offering PPT privately, the hospital considers PIV the "gold standard", and was heavily biased against PPT, advising that PPT:
  • "is not self-lubricating";
  • has "more granulation tissue" and "more complications associated with it";
  • typically has a "worse surgical outcome";
  • "turns into skin" in the long run;
  • is more likely to "stenose" and "scar".
• No form of penile-preserving vaginoplasty is available (as we thought).
• The NHS will not fund the hospital to do standalone bilateral orchidectomies for any referrals sent to them via GDNRSS.
• The specific (and only surgeon) we had asked to be referred to did not pick up our referral.
  • Worse, a surgeon we absolutely do not want to go anywhere near picked up our case!!!
• We discovered that NHS gender clinics sit in on their Multi-Disciplinary Team (MDT) meetings to discuss patients' surgery requests!!!

Outcomes for us

After considering options and offers, we resignedly sent an email to the private hospital, requesting that they refer us back to GDNRSS, advising that:

• The GRS options were explained to us, but we did not find them suitable.
• The surgeon who offered to take our case was not suitable.
• We wish to discuss next steps with the GDNRSS.

Sadly, an individual funding request (IFR) will almost-certainly be required, but the gender clinic has previously refused to submit any IFRs for us, so we're kinda very likely to be screwed here.

For anybody not aware, IFRs get submitted to your local integrated care board / system (ICB/ICS) in England. They'll only agree to fund something if:

• There are "exceptional clinical circumstances" to support the request.
• The IFR clearly demonstrates "clinical exceptionality".

Although technically an NHS GP can submit an IFR, unless it comes from the NHS gender clinic with a detailed explanation of why they can't / won't fund the surgery and why it's necessary, the local ICB funding team will just reject the request.

This is sadly a major issue for us, as we've raised multiple complaints against our gender clinic for their awful service (or rather lack thereof) and they've stopped responding to any of our emails now, so there's little to no chance of them even agreeing to submit an IFR for us, let alone doing one with a decent chance of being accepted.

We don't know what the current price is for a bilateral orchidectomy, but it was up to about £6k a year or two back, so it's probably more like £7K to £8K now :Sighing_Face:

In other words, nothing we could afford privately any time in the next decade.

So... yeah 🙃

If you wondered why our posts have been a little bit more bleak the last few days, this is among the reasons 😅 (There are sadly many other things contributing too.)

It's our own fault really for even trying to go through the NHS route and thinking that maybe, just maybe, they wouldn't continually fuck us around.

Anyway, that's the toot.

#NHS #NHSEngland #EOEGS #NCTH #trans #transgender #NonBinary #enby #FemEnby #GRS #GAS #vaginoplasty #orchidectomy #GenderAffirmingHealthcare #IFR #ICB #ICS #FuckTheNHS #FuckTheUK #DesegregateTransHealthcare #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+

Hey folks

Been trying and failing to write this post for a few days now.

Mood, health, energy, time, chores, obligations, and responsibilities kept getting in the way.

So, we're gonna summarise everything as much as we can, and try and limit our emotional response to it.

Important context

• We have been trying to get meaningful gender-affirming healthcare through the NHS since April 2021.
• We had tried to get clear information on surgery options, particularly genital reconfiguration surgery (GRS) options, for years, but never got clear options: only vague wording.
• We were almost certain sure that no form of penile-preserving vaginoplasty would be available, so we narrowed our choices to peritoneal pull-through (PPT) vaginoplasty or a bilateral orchidectomy.
  • We didn't and don't want penile inversion vaginoplasty (PIV) or vulvoplasty (aka zero-depth vaginoplasty).
• We finally passed all hurdles through an NHS pilot scheme (East Of England Gender Service; EOEGS) in late 2024.
  • This is under the Nottingham Centre for Transgender Health (NCTH).
• Our surgery referral was only sent over to a private hospital by the NHS Gender Dysphoria National Referral Support Service (GDNRSS) in late 2025.
• We had an initial assessment meeting with that private hospital this week.

Information from meeting

• The NHS will not fund PPT vaginoplasty unless there's medically no other option (i.e., last resort).
  • Basically only if you've got "inadequate donor site skin" for other methods.
• Despite offering PPT privately, the hospital considers PIV the "gold standard", and was heavily biased against PPT, advising that PPT:
  • "is not self-lubricating";
  • has "more granulation tissue" and "more complications associated with it";
  • typically has a "worse surgical outcome";
  • "turns into skin" in the long run;
  • is more likely to "stenose" and "scar".
• No form of penile-preserving vaginoplasty is available (as we thought).
• The NHS will not fund the hospital to do standalone bilateral orchidectomies for any referrals sent to them via GDNRSS.
• The specific (and only surgeon) we had asked to be referred to did not pick up our referral.
  • Worse, a surgeon we absolutely do not want to go anywhere near picked up our case!!!
• We discovered that NHS gender clinics sit in on their Multi-Disciplinary Team (MDT) meetings to discuss patients' surgery requests!!!

Outcomes for us

After considering options and offers, we resignedly sent an email to the private hospital, requesting that they refer us back to GDNRSS, advising that:

• The GRS options were explained to us, but we did not find them suitable.
• The surgeon who offered to take our case was not suitable.
• We wish to discuss next steps with the GDNRSS.

Sadly, an individual funding request (IFR) will almost-certainly be required, but the gender clinic has previously refused to submit any IFRs for us, so we're kinda very likely to be screwed here.

For anybody not aware, IFRs get submitted to your local integrated care board / system (ICB/ICS) in England. They'll only agree to fund something if:

• There are "exceptional clinical circumstances" to support the request.
• The IFR clearly demonstrates "clinical exceptionality".

Although technically an NHS GP can submit an IFR, unless it comes from the NHS gender clinic with a detailed explanation of why they can't / won't fund the surgery and why it's necessary, the local ICB funding team will just reject the request.

This is sadly a major issue for us, as we've raised multiple complaints against our gender clinic for their awful service (or rather lack thereof) and they've stopped responding to any of our emails now, so there's little to no chance of them even agreeing to submit an IFR for us, let alone doing one with a decent chance of being accepted.

We don't know what the current price is for a bilateral orchidectomy, but it was up to about £6k a year or two back, so it's probably more like £7K to £8K now :Sighing_Face:

In other words, nothing we could afford privately any time in the next decade.

So... yeah 🙃

If you wondered why our posts have been a little bit more bleak the last few days, this is among the reasons 😅 (There are sadly many other things contributing too.)

It's our own fault really for even trying to go through the NHS route and thinking that maybe, just maybe, they wouldn't continually fuck us around.

Anyway, that's the toot.

#NHS #NHSEngland #EOEGS #NCTH #trans #transgender #NonBinary #enby #FemEnby #GRS #GAS #vaginoplasty #orchidectomy #GenderAffirmingHealthcare #IFR #ICB #ICS #FuckTheNHS #FuckTheUK #DesegregateTransHealthcare #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+

Hey folks

Been trying and failing to write this post for a few days now.

Mood, health, energy, time, chores, obligations, and responsibilities kept getting in the way.

So, we're gonna summarise everything as much as we can, and try and limit our emotional response to it.

Important context

• We have been trying to get meaningful gender-affirming healthcare through the NHS since April 2021.
• We had tried to get clear information on surgery options, particularly genital reconfiguration surgery (GRS) options, for years, but never got clear options: only vague wording.
• We were almost certain sure that no form of penile-preserving vaginoplasty would be available, so we narrowed our choices to peritoneal pull-through (PPT) vaginoplasty or a bilateral orchidectomy.
  • We didn't and don't want penile inversion vaginoplasty (PIV) or vulvoplasty (aka zero-depth vaginoplasty).
• We finally passed all hurdles through an NHS pilot scheme (East Of England Gender Service; EOEGS) in late 2024.
  • This is under the Nottingham Centre for Transgender Health (NCTH).
• Our surgery referral was only sent over to a private hospital by the NHS Gender Dysphoria National Referral Support Service (GDNRSS) in late 2025.
• We had an initial assessment meeting with that private hospital this week.

Information from meeting

• The NHS will not fund PPT vaginoplasty unless there's medically no other option (i.e., last resort).
  • Basically only if you've got "inadequate donor site skin" for other methods.
• Despite offering PPT privately, the hospital considers PIV the "gold standard", and was heavily biased against PPT, advising that PPT:
  • "is not self-lubricating";
  • has "more granulation tissue" and "more complications associated with it";
  • typically has a "worse surgical outcome";
  • "turns into skin" in the long run;
  • is more likely to "stenose" and "scar".
• No form of penile-preserving vaginoplasty is available (as we thought).
• The NHS will not fund the hospital to do standalone bilateral orchidectomies for any referrals sent to them via GDNRSS.
• The specific (and only surgeon) we had asked to be referred to did not pick up our referral.
  • Worse, a surgeon we absolutely do not want to go anywhere near picked up our case!!!
• We discovered that NHS gender clinics sit in on their Multi-Disciplinary Team (MDT) meetings to discuss patients' surgery requests!!!

Outcomes for us

After considering options and offers, we resignedly sent an email to the private hospital, requesting that they refer us back to GDNRSS, advising that:

• The GRS options were explained to us, but we did not find them suitable.
• The surgeon who offered to take our case was not suitable.
• We wish to discuss next steps with the GDNRSS.

Sadly, an individual funding request (IFR) will almost-certainly be required, but the gender clinic has previously refused to submit any IFRs for us, so we're kinda very likely to be screwed here.

For anybody not aware, IFRs get submitted to your local integrated care board / system (ICB/ICS) in England. They'll only agree to fund something if:

• There are "exceptional clinical circumstances" to support the request.
• The IFR clearly demonstrates "clinical exceptionality".

Although technically an NHS GP can submit an IFR, unless it comes from the NHS gender clinic with a detailed explanation of why they can't / won't fund the surgery and why it's necessary, the local ICB funding team will just reject the request.

This is sadly a major issue for us, as we've raised multiple complaints against our gender clinic for their awful service (or rather lack thereof) and they've stopped responding to any of our emails now, so there's little to no chance of them even agreeing to submit an IFR for us, let alone doing one with a decent chance of being accepted.

We don't know what the current price is for a bilateral orchidectomy, but it was up to about £6k a year or two back, so it's probably more like £7K to £8K now :Sighing_Face:

In other words, nothing we could afford privately any time in the next decade.

So... yeah 🙃

If you wondered why our posts have been a little bit more bleak the last few days, this is among the reasons 😅 (There are sadly many other things contributing too.)

It's our own fault really for even trying to go through the NHS route and thinking that maybe, just maybe, they wouldn't continually fuck us around.

Anyway, that's the toot.

#NHS #NHSEngland #EOEGS #NCTH #trans #transgender #NonBinary #enby #FemEnby #GRS #GAS #vaginoplasty #orchidectomy #GenderAffirmingHealthcare #IFR #ICB #ICS #FuckTheNHS #FuckTheUK #DesegregateTransHealthcare #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+

Hey folks

Been trying and failing to write this post for a few days now.

Mood, health, energy, time, chores, obligations, and responsibilities kept getting in the way.

So, we're gonna summarise everything as much as we can, and try and limit our emotional response to it.

Important context

• We have been trying to get meaningful gender-affirming healthcare through the NHS since April 2021.
• We had tried to get clear information on surgery options, particularly genital reconfiguration surgery (GRS) options, for years, but never got clear options: only vague wording.
• We were almost certain sure that no form of penile-preserving vaginoplasty would be available, so we narrowed our choices to peritoneal pull-through (PPT) vaginoplasty or a bilateral orchidectomy.
  • We didn't and don't want penile inversion vaginoplasty (PIV) or vulvoplasty (aka zero-depth vaginoplasty).
• We finally passed all hurdles through an NHS pilot scheme (East Of England Gender Service; EOEGS) in late 2024.
  • This is under the Nottingham Centre for Transgender Health (NCTH).
• Our surgery referral was only sent over to a private hospital by the NHS Gender Dysphoria National Referral Support Service (GDNRSS) in late 2025.
• We had an initial assessment meeting with that private hospital this week.

Information from meeting

• The NHS will not fund PPT vaginoplasty unless there's medically no other option (i.e., last resort).
  • Basically only if you've got "inadequate donor site skin" for other methods.
• Despite offering PPT privately, the hospital considers PIV the "gold standard", and was heavily biased against PPT, advising that PPT:
  • "is not self-lubricating";
  • has "more granulation tissue" and "more complications associated with it";
  • typically has a "worse surgical outcome";
  • "turns into skin" in the long run;
  • is more likely to "stenose" and "scar".
• No form of penile-preserving vaginoplasty is available (as we thought).
• The NHS will not fund the hospital to do standalone bilateral orchidectomies for any referrals sent to them via GDNRSS.
• The specific (and only surgeon) we had asked to be referred to did not pick up our referral.
  • Worse, a surgeon we absolutely do not want to go anywhere near picked up our case!!!
• We discovered that NHS gender clinics sit in on their Multi-Disciplinary Team (MDT) meetings to discuss patients' surgery requests!!!

Outcomes for us

After considering options and offers, we resignedly sent an email to the private hospital, requesting that they refer us back to GDNRSS, advising that:

• The GRS options were explained to us, but we did not find them suitable.
• The surgeon who offered to take our case was not suitable.
• We wish to discuss next steps with the GDNRSS.

Sadly, an individual funding request (IFR) will almost-certainly be required, but the gender clinic has previously refused to submit any IFRs for us, so we're kinda very likely to be screwed here.

For anybody not aware, IFRs get submitted to your local integrated care board / system (ICB/ICS) in England. They'll only agree to fund something if:

• There are "exceptional clinical circumstances" to support the request.
• The IFR clearly demonstrates "clinical exceptionality".

Although technically an NHS GP can submit an IFR, unless it comes from the NHS gender clinic with a detailed explanation of why they can't / won't fund the surgery and why it's necessary, the local ICB funding team will just reject the request.

This is sadly a major issue for us, as we've raised multiple complaints against our gender clinic for their awful service (or rather lack thereof) and they've stopped responding to any of our emails now, so there's little to no chance of them even agreeing to submit an IFR for us, let alone doing one with a decent chance of being accepted.

We don't know what the current price is for a bilateral orchidectomy, but it was up to about £6k a year or two back, so it's probably more like £7K to £8K now :Sighing_Face:

In other words, nothing we could afford privately any time in the next decade.

So... yeah 🙃

If you wondered why our posts have been a little bit more bleak the last few days, this is among the reasons 😅 (There are sadly many other things contributing too.)

It's our own fault really for even trying to go through the NHS route and thinking that maybe, just maybe, they wouldn't continually fuck us around.

Anyway, that's the toot.

#NHS #NHSEngland #EOEGS #NCTH #trans #transgender #NonBinary #enby #FemEnby #GRS #GAS #vaginoplasty #orchidectomy #GenderAffirmingHealthcare #IFR #ICB #ICS #FuckTheNHS #FuckTheUK #DesegregateTransHealthcare #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+

Hey folks

Been trying and failing to write this post for a few days now.

Mood, health, energy, time, chores, obligations, and responsibilities kept getting in the way.

So, we're gonna summarise everything as much as we can, and try and limit our emotional response to it.

Important context

• We have been trying to get meaningful gender-affirming healthcare through the NHS since April 2021.
• We had tried to get clear information on surgery options, particularly genital reconfiguration surgery (GRS) options, for years, but never got clear options: only vague wording.
• We were almost certain sure that no form of penile-preserving vaginoplasty would be available, so we narrowed our choices to peritoneal pull-through (PPT) vaginoplasty or a bilateral orchidectomy.
  • We didn't and don't want penile inversion vaginoplasty (PIV) or vulvoplasty (aka zero-depth vaginoplasty).
• We finally passed all hurdles through an NHS pilot scheme (East Of England Gender Service; EOEGS) in late 2024.
  • This is under the Nottingham Centre for Transgender Health (NCTH).
• Our surgery referral was only sent over to a private hospital by the NHS Gender Dysphoria National Referral Support Service (GDNRSS) in late 2025.
• We had an initial assessment meeting with that private hospital this week.

Information from meeting

• The NHS will not fund PPT vaginoplasty unless there's medically no other option (i.e., last resort).
  • Basically only if you've got "inadequate donor site skin" for other methods.
• Despite offering PPT privately, the hospital considers PIV the "gold standard", and was heavily biased against PPT, advising that PPT:
  • "is not self-lubricating";
  • has "more granulation tissue" and "more complications associated with it";
  • typically has a "worse surgical outcome";
  • "turns into skin" in the long run;
  • is more likely to "stenose" and "scar".
• No form of penile-preserving vaginoplasty is available (as we thought).
• The NHS will not fund the hospital to do standalone bilateral orchidectomies for any referrals sent to them via GDNRSS.
• The specific (and only surgeon) we had asked to be referred to did not pick up our referral.
  • Worse, a surgeon we absolutely do not want to go anywhere near picked up our case!!!
• We discovered that NHS gender clinics sit in on their Multi-Disciplinary Team (MDT) meetings to discuss patients' surgery requests!!!

Outcomes for us

After considering options and offers, we resignedly sent an email to the private hospital, requesting that they refer us back to GDNRSS, advising that:

• The GRS options were explained to us, but we did not find them suitable.
• The surgeon who offered to take our case was not suitable.
• We wish to discuss next steps with the GDNRSS.

Sadly, an individual funding request (IFR) will almost-certainly be required, but the gender clinic has previously refused to submit any IFRs for us, so we're kinda very likely to be screwed here.

For anybody not aware, IFRs get submitted to your local integrated care board / system (ICB/ICS) in England. They'll only agree to fund something if:

• There are "exceptional clinical circumstances" to support the request.
• The IFR clearly demonstrates "clinical exceptionality".

Although technically an NHS GP can submit an IFR, unless it comes from the NHS gender clinic with a detailed explanation of why they can't / won't fund the surgery and why it's necessary, the local ICB funding team will just reject the request.

This is sadly a major issue for us, as we've raised multiple complaints against our gender clinic for their awful service (or rather lack thereof) and they've stopped responding to any of our emails now, so there's little to no chance of them even agreeing to submit an IFR for us, let alone doing one with a decent chance of being accepted.

We don't know what the current price is for a bilateral orchidectomy, but it was up to about £6k a year or two back, so it's probably more like £7K to £8K now :Sighing_Face:

In other words, nothing we could afford privately any time in the next decade.

So... yeah 🙃

If you wondered why our posts have been a little bit more bleak the last few days, this is among the reasons 😅 (There are sadly many other things contributing too.)

It's our own fault really for even trying to go through the NHS route and thinking that maybe, just maybe, they wouldn't continually fuck us around.

Anyway, that's the toot.

#NHS #NHSEngland #EOEGS #NCTH #trans #transgender #NonBinary #enby #FemEnby #GRS #GAS #vaginoplasty #orchidectomy #GenderAffirmingHealthcare #IFR #ICB #ICS #FuckTheNHS #FuckTheUK #DesegregateTransHealthcare #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+

Hey loveliests :NotoEmojiPinkHeart:

We wrote a post back in June, which we recommend reading first for context if you aren't aware of the situation.

In short, the practice manager from our GP surgery emailed us this afternoon with a copy of the response from the local ICB. As expected, it was a "no".

"Regrettably, we cannot approve your funding request as there is no evidence to show this patient is likely to gain significantly more clinical benefit from Glottoplasty surgery than might be normally expected for the general population of patients with the condition or circumstance i.e. gender dysphoria and neurodiversity. Unfortunately, we are not able to take purely psychological issues into consideration."

It's not something we can afford privately or could save up for, for reasons we won't rehash. (We've written some longer update posts back in late April and late May.)

Our only remaining option now is a fundraiser, but we need to work out how to do so without needing to disclose our surname, since we can't have our alias identified with our full name :Sighing_Face:

#trans #transgender #VoiceTraining #VoiceFeminisation #VoiceFeminisationSurgery #VFS #VoiceDysphoria #NHS #NHSEngland #EOEGS #PALS #IFR #ICB #ICS #GDNRSS #GAHT #GDPR #DSAR #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+ #queer #GenderAffirmingCare

Hey loveliests :NotoEmojiPinkHeart:

We wrote a post back in June, which we recommend reading first for context if you aren't aware of the situation.

In short, the practice manager from our GP surgery emailed us this afternoon with a copy of the response from the local ICB. As expected, it was a "no".

"Regrettably, we cannot approve your funding request as there is no evidence to show this patient is likely to gain significantly more clinical benefit from Glottoplasty surgery than might be normally expected for the general population of patients with the condition or circumstance i.e. gender dysphoria and neurodiversity. Unfortunately, we are not able to take purely psychological issues into consideration."

It's not something we can afford privately or could save up for, for reasons we won't rehash. (We've written some longer update posts back in late April and late May.)

Our only remaining option now is a fundraiser, but we need to work out how to do so without needing to disclose our surname, since we can't have our alias identified with our full name :Sighing_Face:

#trans #transgender #VoiceTraining #VoiceFeminisation #VoiceFeminisationSurgery #VFS #VoiceDysphoria #NHS #NHSEngland #EOEGS #PALS #IFR #ICB #ICS #GDNRSS #GAHT #GDPR #DSAR #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+ #queer #GenderAffirmingCare

Hey loveliests :NotoEmojiPinkHeart:

We wrote a post back in June, which we recommend reading first for context if you aren't aware of the situation.

In short, the practice manager from our GP surgery emailed us this afternoon with a copy of the response from the local ICB. As expected, it was a "no".

"Regrettably, we cannot approve your funding request as there is no evidence to show this patient is likely to gain significantly more clinical benefit from Glottoplasty surgery than might be normally expected for the general population of patients with the condition or circumstance i.e. gender dysphoria and neurodiversity. Unfortunately, we are not able to take purely psychological issues into consideration."

It's not something we can afford privately or could save up for, for reasons we won't rehash. (We've written some longer update posts back in late April and late May.)

Our only remaining option now is a fundraiser, but we need to work out how to do so without needing to disclose our surname, since we can't have our alias identified with our full name :Sighing_Face:

#trans #transgender #VoiceTraining #VoiceFeminisation #VoiceFeminisationSurgery #VFS #VoiceDysphoria #NHS #NHSEngland #EOEGS #PALS #IFR #ICB #ICS #GDNRSS #GAHT #GDPR #DSAR #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+ #queer #GenderAffirmingCare

Hey loveliests :NotoEmojiPinkHeart:

We wrote a post back in June, which we recommend reading first for context if you aren't aware of the situation.

In short, the practice manager from our GP surgery emailed us this afternoon with a copy of the response from the local ICB. As expected, it was a "no".

"Regrettably, we cannot approve your funding request as there is no evidence to show this patient is likely to gain significantly more clinical benefit from Glottoplasty surgery than might be normally expected for the general population of patients with the condition or circumstance i.e. gender dysphoria and neurodiversity. Unfortunately, we are not able to take purely psychological issues into consideration."

It's not something we can afford privately or could save up for, for reasons we won't rehash. (We've written some longer update posts back in late April and late May.)

Our only remaining option now is a fundraiser, but we need to work out how to do so without needing to disclose our surname, since we can't have our alias identified with our full name :Sighing_Face:

#trans #transgender #VoiceTraining #VoiceFeminisation #VoiceFeminisationSurgery #VFS #VoiceDysphoria #NHS #NHSEngland #EOEGS #PALS #IFR #ICB #ICS #GDNRSS #GAHT #GDPR #DSAR #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+ #queer #GenderAffirmingCare

Hey loveliests :NotoEmojiPinkHeart:

We wrote a post back in June, which we recommend reading first for context if you aren't aware of the situation.

In short, the practice manager from our GP surgery emailed us this afternoon with a copy of the response from the local ICB. As expected, it was a "no".

"Regrettably, we cannot approve your funding request as there is no evidence to show this patient is likely to gain significantly more clinical benefit from Glottoplasty surgery than might be normally expected for the general population of patients with the condition or circumstance i.e. gender dysphoria and neurodiversity. Unfortunately, we are not able to take purely psychological issues into consideration."

It's not something we can afford privately or could save up for, for reasons we won't rehash. (We've written some longer update posts back in late April and late May.)

Our only remaining option now is a fundraiser, but we need to work out how to do so without needing to disclose our surname, since we can't have our alias identified with our full name :Sighing_Face:

#trans #transgender #VoiceTraining #VoiceFeminisation #VoiceFeminisationSurgery #VFS #VoiceDysphoria #NHS #NHSEngland #EOEGS #PALS #IFR #ICB #ICS #GDNRSS #GAHT #GDPR #DSAR #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+ #queer #GenderAffirmingCare

Hey folks :TransHeart:

So, we're going to try to keep this post shortish for our own wellbeing and sanity, as well as yours.

We will, however, frontload some abbreviations and links:

• EOEGS - East of England Gender Service
• Gender Clinics
  • Aka GIC (Gender Identity Clinic) or, solely by the NHS, Gender Dysphoria Clinic (GDC)
• IFR - Individual Funding Request
• ICB / ICS - Integrated Care Board / System
• GDNRSS - NHS Gender Dysphoria National Referral Support Services
• GAHT - Gender-Affirming Hormone Therapy
• FFS - Facial Feminisation Surgery
• VFS - Voice Feminisation Surgery
• GP - General Practitioner
• PALS - Patient Advice and Liaison Service
• PHSO - Parliamentary and Health Service Ombudsman

We have already written up about some of our early experience of trying to get gender-affirming care from the NHS in an article for TransActual, but that was published back in October 2023, so it's more than a little outdated now 😅

Back in August 2023, we knew it was possible to request funding for gender-affirming surgeries not routinely covered by the NHS via IFRs. These are submitted to your local ICB, who will likely refuse funding unless you've made a really good funding case.

(It's worth noting here that such gender-affirming surgeries are recommended by WPATH's SOC8: the NHS just disagrees and refuses to follow the international recommendations.)

Nonetheless, we mostly just wanted the chance to put our case forward for VFS. A standalone bilateral orchidectomy and FFS were there, but as lower priorities, since it was our voice causing us the most issues.

(We won't list all of our voice dysphoria issues here, but basically we've been doing voice feminisation training since December 2021 and we're nowhere near even the lowest-end voice goals. Our voice leads to us getting regularly misgendered both on the phone and even in person 😞 We've done our genuine best for years and VFS is very much our last resort.)

We are going to give selective details of what's happened since, but we'll first cut to key points: the EOEGS (our gender clinic) has been refusing to comply with their responsibilities for approaching 2 YEARS and no-one within the NHS will hold them to account.

First they denied responsibility for IFRs and tried to say it was our GP's responsibility. So, we went to our local ICB to ask them and got given the details for the NHS England IFR team, who told us -- in no uncertain terms -- that it was the responsibility of the EOEGS to submit these for us. That was back in very early 2024.

We forwarded this to the EOEGS, and then followed it up with them at our 3rd appointment (Q1 2024). They still denied responsibility, so we forwarded on the proof again. And waited. 3 months later (Q2 2024), we chased... and waited again.

Near the end of Q3 2024, the EOEGS finally wrote up the notes from the 3rd appointment (~6 months ago), and mailed them to us and our GP in the post (no digital copy or email)... with multiple factual errors :Sighing_Face: 🤦‍♀️

So, we scanned the letter, turned it into a PDF, then highlighted and corrected all the errors. We then politely emailed it across to the EOEGS, CCing in our GP, along with a clear restatement of outstanding issues and requests.

As the quarter ended, we got an offer of a 4th appointment (more surgical referral gatekeeping nonsense) next quarter. Then silence, yet again.

Q4 2024 came around. The EOEGS claimed that the IFR issue was still with its "service lead". We raised it at the 4th appointment. No answers. Only further promises to look into it and get back to us.

As 2024 ended, we went back to the NHS England IFR team. They confirmed once again that our gender clinic was shirking their responsibility over IFRs. So, we chased the EOEGS for the last time that year. No response ever came.

As we moved into 2025, we reached out to GDNRSS to ask for guidance and help. They responded quickly, but advised that the only thing we could do was to raise a complaint with PALS.

So, that's what we did, CCing in the EOEGS, and made it very clear that this was only being done as a matter of last resort.

By now, as you can imagine, we weren't expecting anything great. However, we hadn't been mentally prepared for the combination of incompetence, lack of reading comprehension, and institutional malice that followed.

They'd send us a complaint response that didn't show any understanding of our complaint. We'd go back and clarify the issues again, and suggest a call to discuss it. They'd investigate more, say that they'd pass along our request for a call, delay the response, and then send another one which again failed to address the core issues.

By Q2 2025, we reached the point where they refused to take the complaint forward any further, and just directed us to the PSHO, which is very much biased towards whatever the current government wants.

In other words, we'd run out of options to hold the EOEGS accountable 😞

NGL: in combination with multiple other factors, this kind of broke us, and we simply had none of the time, energy, spoons, or motivation to follow up any further.

After a few weeks, however, we decided on 2 last-ditch options available to us:

1. Raise a DSAR (Data Subject Access Request) under GDPR to request a copy of any and all communications mentioning us (directly or indirectly) and our requests by all organisations and individuals involved.
2. Reach out to the senior partner at our GP surgery, via the practice manager, to ask if they'd consider submitting an IFR for us for at least VFS.

On the 1st point, the ticking clock for that started just a few days ago. Officially they have 1 calendar month to comply, but can request up to 3 calendar months if the request is deemed complex. We are under no obligation to agree to this as the data subject.

On the 2nd point, the senior partner had a call with us over the issues, then asked whether we could compile all the info on everything for him. We said it would be difficult for us, but agreed, so he booked a follow-up appointment for us on 2025-06-09 (yesterday).

NGL: going through all the emails and documents again, then summarising them into a chronological sequence of events, was very, very difficult for many reasons, but primarily because it meant going back through everything and reliving the cumulative trauma of it :PleadingFace:

Nonetheless, we finished compiling it all just a couple of hours before the appointment. A "summary" document that spanned 4 sides of A4 and all the relevant "receipts" (digital documents like emails and PDFs), covering from August 2023 to June 2025.

Whilst the senior partner said it will take him time to go through it all, the key thing is that he agreed to submit the IFR for us.

It honestly made us teary just to have someone actually care enough to truly listen and be willing to discuss it with us :FaceHoldingBackTears:

Of course, this is just the beginning of another long, drawn-out process. It's likely going to take at least several weeks until we even get to the stage of working together to put together the best case possible, let alone getting the IFR submitted. It could even be months.

Even when it's submitted, it'll then be up to our local ICB to review the submission, and they will almost certainly find a reason or reasons to deny the application.

We're still not expecting this to succeed. We just wanted to have the chance to have at least one request submitted and reviewed.

The EOEGS and other NHS departments spent a level of magnitude more time, energy, and resources denying us the right to even consider submitting IFRs for us because, we suspect, they didn't want to set a precedent of trans patients in England utilising their rights.

Or maybe just because they didn't want to comply.

Whatever happens with the eventual IFR submission, at least we'll have tried every way we can think of to get the NHS to fund a basic gender-affirming surgery that would massively improve our daily quality of life.

If by some miracle the IFR is approved, it'll give us and maybe others a small glimmer of hope.

But realistically-speaking, at least then we can create a fundraiser for VFS with a clear conscience that we tried everything else we could first 🥺

If you got this far, thank you for reading this :TransHeart: Feel free to boost it, if you want others to read it too :BoostsOKPrideSymbol:

#trans #transgender #VoiceTraining #VoiceFeminisation #VoiceFeminisationSurgery #VFS #VoiceDysphoria #NHS #NHSEngland #EOEGS #PALS #IFR #ICB #ICS #GDNRSS #GAHT #GDPR #DSAR #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+ #queer #GenderAffirmingCare

Hey folks :TransHeart:

So, we're going to try to keep this post shortish for our own wellbeing and sanity, as well as yours.

We will, however, frontload some abbreviations and links:

• EOEGS - East of England Gender Service
• Gender Clinics
  • Aka GIC (Gender Identity Clinic) or, solely by the NHS, Gender Dysphoria Clinic (GDC)
• IFR - Individual Funding Request
• ICB / ICS - Integrated Care Board / System
• GDNRSS - NHS Gender Dysphoria National Referral Support Services
• GAHT - Gender-Affirming Hormone Therapy
• FFS - Facial Feminisation Surgery
• VFS - Voice Feminisation Surgery
• GP - General Practitioner
• PALS - Patient Advice and Liaison Service
• PHSO - Parliamentary and Health Service Ombudsman

We have already written up about some of our early experience of trying to get gender-affirming care from the NHS in an article for TransActual, but that was published back in October 2023, so it's more than a little outdated now 😅

Back in August 2023, we knew it was possible to request funding for gender-affirming surgeries not routinely covered by the NHS via IFRs. These are submitted to your local ICB, who will likely refuse funding unless you've made a really good funding case.

(It's worth noting here that such gender-affirming surgeries are recommended by WPATH's SOC8: the NHS just disagrees and refuses to follow the international recommendations.)

Nonetheless, we mostly just wanted the chance to put our case forward for VFS. A standalone bilateral orchidectomy and FFS were there, but as lower priorities, since it was our voice causing us the most issues.

(We won't list all of our voice dysphoria issues here, but basically we've been doing voice feminisation training since December 2021 and we're nowhere near even the lowest-end voice goals. Our voice leads to us getting regularly misgendered both on the phone and even in person 😞 We've done our genuine best for years and VFS is very much our last resort.)

We are going to give selective details of what's happened since, but we'll first cut to key points: the EOEGS (our gender clinic) has been refusing to comply with their responsibilities for approaching 2 YEARS and no-one within the NHS will hold them to account.

First they denied responsibility for IFRs and tried to say it was our GP's responsibility. So, we went to our local ICB to ask them and got given the details for the NHS England IFR team, who told us -- in no uncertain terms -- that it was the responsibility of the EOEGS to submit these for us. That was back in very early 2024.

We forwarded this to the EOEGS, and then followed it up with them at our 3rd appointment (Q1 2024). They still denied responsibility, so we forwarded on the proof again. And waited. 3 months later (Q2 2024), we chased... and waited again.

Near the end of Q3 2024, the EOEGS finally wrote up the notes from the 3rd appointment (~6 months ago), and mailed them to us and our GP in the post (no digital copy or email)... with multiple factual errors :Sighing_Face: 🤦‍♀️

So, we scanned the letter, turned it into a PDF, then highlighted and corrected all the errors. We then politely emailed it across to the EOEGS, CCing in our GP, along with a clear restatement of outstanding issues and requests.

As the quarter ended, we got an offer of a 4th appointment (more surgical referral gatekeeping nonsense) next quarter. Then silence, yet again.

Q4 2024 came around. The EOEGS claimed that the IFR issue was still with its "service lead". We raised it at the 4th appointment. No answers. Only further promises to look into it and get back to us.

As 2024 ended, we went back to the NHS England IFR team. They confirmed once again that our gender clinic was shirking their responsibility over IFRs. So, we chased the EOEGS for the last time that year. No response ever came.

As we moved into 2025, we reached out to GDNRSS to ask for guidance and help. They responded quickly, but advised that the only thing we could do was to raise a complaint with PALS.

So, that's what we did, CCing in the EOEGS, and made it very clear that this was only being done as a matter of last resort.

By now, as you can imagine, we weren't expecting anything great. However, we hadn't been mentally prepared for the combination of incompetence, lack of reading comprehension, and institutional malice that followed.

They'd send us a complaint response that didn't show any understanding of our complaint. We'd go back and clarify the issues again, and suggest a call to discuss it. They'd investigate more, say that they'd pass along our request for a call, delay the response, and then send another one which again failed to address the core issues.

By Q2 2025, we reached the point where they refused to take the complaint forward any further, and just directed us to the PSHO, which is very much biased towards whatever the current government wants.

In other words, we'd run out of options to hold the EOEGS accountable 😞

NGL: in combination with multiple other factors, this kind of broke us, and we simply had none of the time, energy, spoons, or motivation to follow up any further.

After a few weeks, however, we decided on 2 last-ditch options available to us:

1. Raise a DSAR (Data Subject Access Request) under GDPR to request a copy of any and all communications mentioning us (directly or indirectly) and our requests by all organisations and individuals involved.
2. Reach out to the senior partner at our GP surgery, via the practice manager, to ask if they'd consider submitting an IFR for us for at least VFS.

On the 1st point, the ticking clock for that started just a few days ago. Officially they have 1 calendar month to comply, but can request up to 3 calendar months if the request is deemed complex. We are under no obligation to agree to this as the data subject.

On the 2nd point, the senior partner had a call with us over the issues, then asked whether we could compile all the info on everything for him. We said it would be difficult for us, but agreed, so he booked a follow-up appointment for us on 2025-06-09 (yesterday).

NGL: going through all the emails and documents again, then summarising them into a chronological sequence of events, was very, very difficult for many reasons, but primarily because it meant going back through everything and reliving the cumulative trauma of it :PleadingFace:

Nonetheless, we finished compiling it all just a couple of hours before the appointment. A "summary" document that spanned 4 sides of A4 and all the relevant "receipts" (digital documents like emails and PDFs), covering from August 2023 to June 2025.

Whilst the senior partner said it will take him time to go through it all, the key thing is that he agreed to submit the IFR for us.

It honestly made us teary just to have someone actually care enough to truly listen and be willing to discuss it with us :FaceHoldingBackTears:

Of course, this is just the beginning of another long, drawn-out process. It's likely going to take at least several weeks until we even get to the stage of working together to put together the best case possible, let alone getting the IFR submitted. It could even be months.

Even when it's submitted, it'll then be up to our local ICB to review the submission, and they will almost certainly find a reason or reasons to deny the application.

We're still not expecting this to succeed. We just wanted to have the chance to have at least one request submitted and reviewed.

The EOEGS and other NHS departments spent a level of magnitude more time, energy, and resources denying us the right to even consider submitting IFRs for us because, we suspect, they didn't want to set a precedent of trans patients in England utilising their rights.

Or maybe just because they didn't want to comply.

Whatever happens with the eventual IFR submission, at least we'll have tried every way we can think of to get the NHS to fund a basic gender-affirming surgery that would massively improve our daily quality of life.

If by some miracle the IFR is approved, it'll give us and maybe others a small glimmer of hope.

But realistically-speaking, at least then we can create a fundraiser for VFS with a clear conscience that we tried everything else we could first 🥺

If you got this far, thank you for reading this :TransHeart: Feel free to boost it, if you want others to read it too :BoostsOKPrideSymbol:

#trans #transgender #VoiceTraining #VoiceFeminisation #VoiceFeminisationSurgery #VFS #VoiceDysphoria #NHS #NHSEngland #EOEGS #PALS #IFR #ICB #ICS #GDNRSS #GAHT #GDPR #DSAR #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+ #queer #GenderAffirmingCare

Hey folks :TransHeart:

So, we're going to try to keep this post shortish for our own wellbeing and sanity, as well as yours.

We will, however, frontload some abbreviations and links:

• EOEGS - East of England Gender Service
• Gender Clinics
  • Aka GIC (Gender Identity Clinic) or, solely by the NHS, Gender Dysphoria Clinic (GDC)
• IFR - Individual Funding Request
• ICB / ICS - Integrated Care Board / System
• GDNRSS - NHS Gender Dysphoria National Referral Support Services
• GAHT - Gender-Affirming Hormone Therapy
• FFS - Facial Feminisation Surgery
• VFS - Voice Feminisation Surgery
• GP - General Practitioner
• PALS - Patient Advice and Liaison Service
• PHSO - Parliamentary and Health Service Ombudsman

We have already written up about some of our early experience of trying to get gender-affirming care from the NHS in an article for TransActual, but that was published back in October 2023, so it's more than a little outdated now 😅

Back in August 2023, we knew it was possible to request funding for gender-affirming surgeries not routinely covered by the NHS via IFRs. These are submitted to your local ICB, who will likely refuse funding unless you've made a really good funding case.

(It's worth noting here that such gender-affirming surgeries are recommended by WPATH's SOC8: the NHS just disagrees and refuses to follow the international recommendations.)

Nonetheless, we mostly just wanted the chance to put our case forward for VFS. A standalone bilateral orchidectomy and FFS were there, but as lower priorities, since it was our voice causing us the most issues.

(We won't list all of our voice dysphoria issues here, but basically we've been doing voice feminisation training since December 2021 and we're nowhere near even the lowest-end voice goals. Our voice leads to us getting regularly misgendered both on the phone and even in person 😞 We've done our genuine best for years and VFS is very much our last resort.)

We are going to give selective details of what's happened since, but we'll first cut to key points: the EOEGS (our gender clinic) has been refusing to comply with their responsibilities for approaching 2 YEARS and no-one within the NHS will hold them to account.

First they denied responsibility for IFRs and tried to say it was our GP's responsibility. So, we went to our local ICB to ask them and got given the details for the NHS England IFR team, who told us -- in no uncertain terms -- that it was the responsibility of the EOEGS to submit these for us. That was back in very early 2024.

We forwarded this to the EOEGS, and then followed it up with them at our 3rd appointment (Q1 2024). They still denied responsibility, so we forwarded on the proof again. And waited. 3 months later (Q2 2024), we chased... and waited again.

Near the end of Q3 2024, the EOEGS finally wrote up the notes from the 3rd appointment (~6 months ago), and mailed them to us and our GP in the post (no digital copy or email)... with multiple factual errors :Sighing_Face: 🤦‍♀️

So, we scanned the letter, turned it into a PDF, then highlighted and corrected all the errors. We then politely emailed it across to the EOEGS, CCing in our GP, along with a clear restatement of outstanding issues and requests.

As the quarter ended, we got an offer of a 4th appointment (more surgical referral gatekeeping nonsense) next quarter. Then silence, yet again.

Q4 2024 came around. The EOEGS claimed that the IFR issue was still with its "service lead". We raised it at the 4th appointment. No answers. Only further promises to look into it and get back to us.

As 2024 ended, we went back to the NHS England IFR team. They confirmed once again that our gender clinic was shirking their responsibility over IFRs. So, we chased the EOEGS for the last time that year. No response ever came.

As we moved into 2025, we reached out to GDNRSS to ask for guidance and help. They responded quickly, but advised that the only thing we could do was to raise a complaint with PALS.

So, that's what we did, CCing in the EOEGS, and made it very clear that this was only being done as a matter of last resort.

By now, as you can imagine, we weren't expecting anything great. However, we hadn't been mentally prepared for the combination of incompetence, lack of reading comprehension, and institutional malice that followed.

They'd send us a complaint response that didn't show any understanding of our complaint. We'd go back and clarify the issues again, and suggest a call to discuss it. They'd investigate more, say that they'd pass along our request for a call, delay the response, and then send another one which again failed to address the core issues.

By Q2 2025, we reached the point where they refused to take the complaint forward any further, and just directed us to the PSHO, which is very much biased towards whatever the current government wants.

In other words, we'd run out of options to hold the EOEGS accountable 😞

NGL: in combination with multiple other factors, this kind of broke us, and we simply had none of the time, energy, spoons, or motivation to follow up any further.

After a few weeks, however, we decided on 2 last-ditch options available to us:

1. Raise a DSAR (Data Subject Access Request) under GDPR to request a copy of any and all communications mentioning us (directly or indirectly) and our requests by all organisations and individuals involved.
2. Reach out to the senior partner at our GP surgery, via the practice manager, to ask if they'd consider submitting an IFR for us for at least VFS.

On the 1st point, the ticking clock for that started just a few days ago. Officially they have 1 calendar month to comply, but can request up to 3 calendar months if the request is deemed complex. We are under no obligation to agree to this as the data subject.

On the 2nd point, the senior partner had a call with us over the issues, then asked whether we could compile all the info on everything for him. We said it would be difficult for us, but agreed, so he booked a follow-up appointment for us on 2025-06-09 (yesterday).

NGL: going through all the emails and documents again, then summarising them into a chronological sequence of events, was very, very difficult for many reasons, but primarily because it meant going back through everything and reliving the cumulative trauma of it :PleadingFace:

Nonetheless, we finished compiling it all just a couple of hours before the appointment. A "summary" document that spanned 4 sides of A4 and all the relevant "receipts" (digital documents like emails and PDFs), covering from August 2023 to June 2025.

Whilst the senior partner said it will take him time to go through it all, the key thing is that he agreed to submit the IFR for us.

It honestly made us teary just to have someone actually care enough to truly listen and be willing to discuss it with us :FaceHoldingBackTears:

Of course, this is just the beginning of another long, drawn-out process. It's likely going to take at least several weeks until we even get to the stage of working together to put together the best case possible, let alone getting the IFR submitted. It could even be months.

Even when it's submitted, it'll then be up to our local ICB to review the submission, and they will almost certainly find a reason or reasons to deny the application.

We're still not expecting this to succeed. We just wanted to have the chance to have at least one request submitted and reviewed.

The EOEGS and other NHS departments spent a level of magnitude more time, energy, and resources denying us the right to even consider submitting IFRs for us because, we suspect, they didn't want to set a precedent of trans patients in England utilising their rights.

Or maybe just because they didn't want to comply.

Whatever happens with the eventual IFR submission, at least we'll have tried every way we can think of to get the NHS to fund a basic gender-affirming surgery that would massively improve our daily quality of life.

If by some miracle the IFR is approved, it'll give us and maybe others a small glimmer of hope.

But realistically-speaking, at least then we can create a fundraiser for VFS with a clear conscience that we tried everything else we could first 🥺

If you got this far, thank you for reading this :TransHeart: Feel free to boost it, if you want others to read it too :BoostsOKPrideSymbol:

#trans #transgender #VoiceTraining #VoiceFeminisation #VoiceFeminisationSurgery #VFS #VoiceDysphoria #NHS #NHSEngland #EOEGS #PALS #IFR #ICB #ICS #GDNRSS #GAHT #GDPR #DSAR #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+ #queer #GenderAffirmingCare

Hey folks :TransHeart:

So, we're going to try to keep this post shortish for our own wellbeing and sanity, as well as yours.

We will, however, frontload some abbreviations and links:

• EOEGS - East of England Gender Service
• Gender Clinics
  • Aka GIC (Gender Identity Clinic) or, solely by the NHS, Gender Dysphoria Clinic (GDC)
• IFR - Individual Funding Request
• ICB / ICS - Integrated Care Board / System
• GDNRSS - NHS Gender Dysphoria National Referral Support Services
• GAHT - Gender-Affirming Hormone Therapy
• FFS - Facial Feminisation Surgery
• VFS - Voice Feminisation Surgery
• GP - General Practitioner
• PALS - Patient Advice and Liaison Service
• PHSO - Parliamentary and Health Service Ombudsman

We have already written up about some of our early experience of trying to get gender-affirming care from the NHS in an article for TransActual, but that was published back in October 2023, so it's more than a little outdated now 😅

Back in August 2023, we knew it was possible to request funding for gender-affirming surgeries not routinely covered by the NHS via IFRs. These are submitted to your local ICB, who will likely refuse funding unless you've made a really good funding case.

(It's worth noting here that such gender-affirming surgeries are recommended by WPATH's SOC8: the NHS just disagrees and refuses to follow the international recommendations.)

Nonetheless, we mostly just wanted the chance to put our case forward for VFS. A standalone bilateral orchidectomy and FFS were there, but as lower priorities, since it was our voice causing us the most issues.

(We won't list all of our voice dysphoria issues here, but basically we've been doing voice feminisation training since December 2021 and we're nowhere near even the lowest-end voice goals. Our voice leads to us getting regularly misgendered both on the phone and even in person 😞 We've done our genuine best for years and VFS is very much our last resort.)

We are going to give selective details of what's happened since, but we'll first cut to key points: the EOEGS (our gender clinic) has been refusing to comply with their responsibilities for approaching 2 YEARS and no-one within the NHS will hold them to account.

First they denied responsibility for IFRs and tried to say it was our GP's responsibility. So, we went to our local ICB to ask them and got given the details for the NHS England IFR team, who told us -- in no uncertain terms -- that it was the responsibility of the EOEGS to submit these for us. That was back in very early 2024.

We forwarded this to the EOEGS, and then followed it up with them at our 3rd appointment (Q1 2024). They still denied responsibility, so we forwarded on the proof again. And waited. 3 months later (Q2 2024), we chased... and waited again.

Near the end of Q3 2024, the EOEGS finally wrote up the notes from the 3rd appointment (~6 months ago), and mailed them to us and our GP in the post (no digital copy or email)... with multiple factual errors :Sighing_Face: 🤦‍♀️

So, we scanned the letter, turned it into a PDF, then highlighted and corrected all the errors. We then politely emailed it across to the EOEGS, CCing in our GP, along with a clear restatement of outstanding issues and requests.

As the quarter ended, we got an offer of a 4th appointment (more surgical referral gatekeeping nonsense) next quarter. Then silence, yet again.

Q4 2024 came around. The EOEGS claimed that the IFR issue was still with its "service lead". We raised it at the 4th appointment. No answers. Only further promises to look into it and get back to us.

As 2024 ended, we went back to the NHS England IFR team. They confirmed once again that our gender clinic was shirking their responsibility over IFRs. So, we chased the EOEGS for the last time that year. No response ever came.

As we moved into 2025, we reached out to GDNRSS to ask for guidance and help. They responded quickly, but advised that the only thing we could do was to raise a complaint with PALS.

So, that's what we did, CCing in the EOEGS, and made it very clear that this was only being done as a matter of last resort.

By now, as you can imagine, we weren't expecting anything great. However, we hadn't been mentally prepared for the combination of incompetence, lack of reading comprehension, and institutional malice that followed.

They'd send us a complaint response that didn't show any understanding of our complaint. We'd go back and clarify the issues again, and suggest a call to discuss it. They'd investigate more, say that they'd pass along our request for a call, delay the response, and then send another one which again failed to address the core issues.

By Q2 2025, we reached the point where they refused to take the complaint forward any further, and just directed us to the PSHO, which is very much biased towards whatever the current government wants.

In other words, we'd run out of options to hold the EOEGS accountable 😞

NGL: in combination with multiple other factors, this kind of broke us, and we simply had none of the time, energy, spoons, or motivation to follow up any further.

After a few weeks, however, we decided on 2 last-ditch options available to us:

1. Raise a DSAR (Data Subject Access Request) under GDPR to request a copy of any and all communications mentioning us (directly or indirectly) and our requests by all organisations and individuals involved.
2. Reach out to the senior partner at our GP surgery, via the practice manager, to ask if they'd consider submitting an IFR for us for at least VFS.

On the 1st point, the ticking clock for that started just a few days ago. Officially they have 1 calendar month to comply, but can request up to 3 calendar months if the request is deemed complex. We are under no obligation to agree to this as the data subject.

On the 2nd point, the senior partner had a call with us over the issues, then asked whether we could compile all the info on everything for him. We said it would be difficult for us, but agreed, so he booked a follow-up appointment for us on 2025-06-09 (yesterday).

NGL: going through all the emails and documents again, then summarising them into a chronological sequence of events, was very, very difficult for many reasons, but primarily because it meant going back through everything and reliving the cumulative trauma of it :PleadingFace:

Nonetheless, we finished compiling it all just a couple of hours before the appointment. A "summary" document that spanned 4 sides of A4 and all the relevant "receipts" (digital documents like emails and PDFs), covering from August 2023 to June 2025.

Whilst the senior partner said it will take him time to go through it all, the key thing is that he agreed to submit the IFR for us.

It honestly made us teary just to have someone actually care enough to truly listen and be willing to discuss it with us :FaceHoldingBackTears:

Of course, this is just the beginning of another long, drawn-out process. It's likely going to take at least several weeks until we even get to the stage of working together to put together the best case possible, let alone getting the IFR submitted. It could even be months.

Even when it's submitted, it'll then be up to our local ICB to review the submission, and they will almost certainly find a reason or reasons to deny the application.

We're still not expecting this to succeed. We just wanted to have the chance to have at least one request submitted and reviewed.

The EOEGS and other NHS departments spent a level of magnitude more time, energy, and resources denying us the right to even consider submitting IFRs for us because, we suspect, they didn't want to set a precedent of trans patients in England utilising their rights.

Or maybe just because they didn't want to comply.

Whatever happens with the eventual IFR submission, at least we'll have tried every way we can think of to get the NHS to fund a basic gender-affirming surgery that would massively improve our daily quality of life.

If by some miracle the IFR is approved, it'll give us and maybe others a small glimmer of hope.

But realistically-speaking, at least then we can create a fundraiser for VFS with a clear conscience that we tried everything else we could first 🥺

If you got this far, thank you for reading this :TransHeart: Feel free to boost it, if you want others to read it too :BoostsOKPrideSymbol:

#trans #transgender #VoiceTraining #VoiceFeminisation #VoiceFeminisationSurgery #VFS #VoiceDysphoria #NHS #NHSEngland #EOEGS #PALS #IFR #ICB #ICS #GDNRSS #GAHT #GDPR #DSAR #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+ #queer #GenderAffirmingCare

Hey folks :TransHeart:

So, we're going to try to keep this post shortish for our own wellbeing and sanity, as well as yours.

We will, however, frontload some abbreviations and links:

• EOEGS - East of England Gender Service
• Gender Clinics
  • Aka GIC (Gender Identity Clinic) or, solely by the NHS, Gender Dysphoria Clinic (GDC)
• IFR - Individual Funding Request
• ICB / ICS - Integrated Care Board / System
• GDNRSS - NHS Gender Dysphoria National Referral Support Services
• GAHT - Gender-Affirming Hormone Therapy
• FFS - Facial Feminisation Surgery
• VFS - Voice Feminisation Surgery
• GP - General Practitioner
• PALS - Patient Advice and Liaison Service
• PHSO - Parliamentary and Health Service Ombudsman

We have already written up about some of our early experience of trying to get gender-affirming care from the NHS in an article for TransActual, but that was published back in October 2023, so it's more than a little outdated now 😅

Back in August 2023, we knew it was possible to request funding for gender-affirming surgeries not routinely covered by the NHS via IFRs. These are submitted to your local ICB, who will likely refuse funding unless you've made a really good funding case.

(It's worth noting here that such gender-affirming surgeries are recommended by WPATH's SOC8: the NHS just disagrees and refuses to follow the international recommendations.)

Nonetheless, we mostly just wanted the chance to put our case forward for VFS. A standalone bilateral orchidectomy and FFS were there, but as lower priorities, since it was our voice causing us the most issues.

(We won't list all of our voice dysphoria issues here, but basically we've been doing voice feminisation training since December 2021 and we're nowhere near even the lowest-end voice goals. Our voice leads to us getting regularly misgendered both on the phone and even in person 😞 We've done our genuine best for years and VFS is very much our last resort.)

We are going to give selective details of what's happened since, but we'll first cut to key points: the EOEGS (our gender clinic) has been refusing to comply with their responsibilities for approaching 2 YEARS and no-one within the NHS will hold them to account.

First they denied responsibility for IFRs and tried to say it was our GP's responsibility. So, we went to our local ICB to ask them and got given the details for the NHS England IFR team, who told us -- in no uncertain terms -- that it was the responsibility of the EOEGS to submit these for us. That was back in very early 2024.

We forwarded this to the EOEGS, and then followed it up with them at our 3rd appointment (Q1 2024). They still denied responsibility, so we forwarded on the proof again. And waited. 3 months later (Q2 2024), we chased... and waited again.

Near the end of Q3 2024, the EOEGS finally wrote up the notes from the 3rd appointment (~6 months ago), and mailed them to us and our GP in the post (no digital copy or email)... with multiple factual errors :Sighing_Face: 🤦‍♀️

So, we scanned the letter, turned it into a PDF, then highlighted and corrected all the errors. We then politely emailed it across to the EOEGS, CCing in our GP, along with a clear restatement of outstanding issues and requests.

As the quarter ended, we got an offer of a 4th appointment (more surgical referral gatekeeping nonsense) next quarter. Then silence, yet again.

Q4 2024 came around. The EOEGS claimed that the IFR issue was still with its "service lead". We raised it at the 4th appointment. No answers. Only further promises to look into it and get back to us.

As 2024 ended, we went back to the NHS England IFR team. They confirmed once again that our gender clinic was shirking their responsibility over IFRs. So, we chased the EOEGS for the last time that year. No response ever came.

As we moved into 2025, we reached out to GDNRSS to ask for guidance and help. They responded quickly, but advised that the only thing we could do was to raise a complaint with PALS.

So, that's what we did, CCing in the EOEGS, and made it very clear that this was only being done as a matter of last resort.

By now, as you can imagine, we weren't expecting anything great. However, we hadn't been mentally prepared for the combination of incompetence, lack of reading comprehension, and institutional malice that followed.

They'd send us a complaint response that didn't show any understanding of our complaint. We'd go back and clarify the issues again, and suggest a call to discuss it. They'd investigate more, say that they'd pass along our request for a call, delay the response, and then send another one which again failed to address the core issues.

By Q2 2025, we reached the point where they refused to take the complaint forward any further, and just directed us to the PSHO, which is very much biased towards whatever the current government wants.

In other words, we'd run out of options to hold the EOEGS accountable 😞

NGL: in combination with multiple other factors, this kind of broke us, and we simply had none of the time, energy, spoons, or motivation to follow up any further.

After a few weeks, however, we decided on 2 last-ditch options available to us:

1. Raise a DSAR (Data Subject Access Request) under GDPR to request a copy of any and all communications mentioning us (directly or indirectly) and our requests by all organisations and individuals involved.
2. Reach out to the senior partner at our GP surgery, via the practice manager, to ask if they'd consider submitting an IFR for us for at least VFS.

On the 1st point, the ticking clock for that started just a few days ago. Officially they have 1 calendar month to comply, but can request up to 3 calendar months if the request is deemed complex. We are under no obligation to agree to this as the data subject.

On the 2nd point, the senior partner had a call with us over the issues, then asked whether we could compile all the info on everything for him. We said it would be difficult for us, but agreed, so he booked a follow-up appointment for us on 2025-06-09 (yesterday).

NGL: going through all the emails and documents again, then summarising them into a chronological sequence of events, was very, very difficult for many reasons, but primarily because it meant going back through everything and reliving the cumulative trauma of it :PleadingFace:

Nonetheless, we finished compiling it all just a couple of hours before the appointment. A "summary" document that spanned 4 sides of A4 and all the relevant "receipts" (digital documents like emails and PDFs), covering from August 2023 to June 2025.

Whilst the senior partner said it will take him time to go through it all, the key thing is that he agreed to submit the IFR for us.

It honestly made us teary just to have someone actually care enough to truly listen and be willing to discuss it with us :FaceHoldingBackTears:

Of course, this is just the beginning of another long, drawn-out process. It's likely going to take at least several weeks until we even get to the stage of working together to put together the best case possible, let alone getting the IFR submitted. It could even be months.

Even when it's submitted, it'll then be up to our local ICB to review the submission, and they will almost certainly find a reason or reasons to deny the application.

We're still not expecting this to succeed. We just wanted to have the chance to have at least one request submitted and reviewed.

The EOEGS and other NHS departments spent a level of magnitude more time, energy, and resources denying us the right to even consider submitting IFRs for us because, we suspect, they didn't want to set a precedent of trans patients in England utilising their rights.

Or maybe just because they didn't want to comply.

Whatever happens with the eventual IFR submission, at least we'll have tried every way we can think of to get the NHS to fund a basic gender-affirming surgery that would massively improve our daily quality of life.

If by some miracle the IFR is approved, it'll give us and maybe others a small glimmer of hope.

But realistically-speaking, at least then we can create a fundraiser for VFS with a clear conscience that we tried everything else we could first 🥺

If you got this far, thank you for reading this :TransHeart: Feel free to boost it, if you want others to read it too :BoostsOKPrideSymbol:

#trans #transgender #VoiceTraining #VoiceFeminisation #VoiceFeminisationSurgery #VFS #VoiceDysphoria #NHS #NHSEngland #EOEGS #PALS #IFR #ICB #ICS #GDNRSS #GAHT #GDPR #DSAR #TransRights #TransRightsAreHumanRights #LGBTQ+ #LGBTQIA+ #queer #GenderAffirmingCare

Hey folks :FediverseSymbol:

Per the details of this earlier post, we had our 4th appointment with the NHS East of England Gender Service (EOEGS) today.

The worst thing about that appointment was that it was at 13:30-14:30, which put us into a kind of neurodivergent purgatory / paralysis, where we felt like we really couldn't get on with the day until the appointment, as it was all we could think about pretty much.

We did manage to distract ourselves for a while by passing feedback to Union Medico over the syringe holders they provide for their 90° Super Grip auto-injector. We're planning to do a full review of that for everyone this week.

Anyway, the appointment went well. The doctor (cis guy, he/him) pretty much made it clear that he just needed to gather more info for the referral, and that he didn't expect there to be any issues. He asked whether it would be okay for a trainee colleague to sit in on the call, which we were fine with, especially as we're pretty sure she was trans herself. At the very least, she gave off good vibes.

Despite being anxious AF the whole time, and having to play the good-little-trans-patient to pass through the gatekeeping, it was just a serious of questions about medical history, what we were after, the risks, the reasons for wanting this, whether we had stored gametes etc.

Despite the many risks (e.g., fistula; granulation tissue; prolapse; etc), long recovery time, and the need for very regular dilation for ages, we agree that the benefits are worth it.

The doctor seemed suitably impressed by our knowledge and sources (e.g., Gender Construction Kit; TransActual), as well as the limited options on the figurative #NHS menu for trans gender-affirming surgeries.

If you're trans fem, your options via the NHS are:

• Penile inversion vaginoplasty (PIV).
  • Creates a neovagina using material from the penis turned inside out ("inverted").
• Penoscrotal flap vaginoplasty.
  • Creates the vagina using material from both the penis and scrotum.
  • Typically done if you've not got much material to work with 😅
• Cosmetic vaginoplasty.
  • Creates a vulva and labia (labiaplasty), and a clitoris (clitoroplasty) from the penis (and scrotum if needed), but without a neovagina.
  • Aka vulvoplasty or zero-depth.

Please note the lack of:

• Peritoneal pull-through (PPT) vaginoplasty.
  • A newer technique that involves several incisions into the abdomen and using internal peritoneal tissue to create the neovagina.
• Penile-preserving vaginoplasty.
  • Creates a neovagina using peritoneal tissue, without removing the penis.
  • Aka penile preservation vaginoplasty, phallus-preserving vulvovaginoplasty, etc.
• Standalone bilateral orchidectomy.
  • Removes the testes and scrotum.
  • Sometimes known as a bofa-ectomy.

The NHS, as standard, also does not offer:

• Facial feminisation surgery (FFS) of any kind.
• Voice feminisation surgery (VFS).
  • We're seeking an endoscopic modified Wendler glottoplasty by Chadwan Al Yaghchi at the London Voice & Swallowing Clinic in London.
• Breast augmentation (BA).
• Full facial hair removal.
  • It varies by nation, but England offers 8 laser sessions, 16 hours of electrolysis, or a combination thereof.
  • For context, we've had over 40 hours of electrolysis (thermolysis) thus far on our face and neck with a highly-experienced (and fast) electrologist, and there are still a few stragglers.

There is a mere sliver of a fraction of a chance that we might get the NHS to fund some of our additional needs, which they don't currently provide: Individual Funding Requests (IFRs).

We're not going to sugarcoat it: the IFR route is highly likely to fail for us :FaceExhaling: Your "clinical circumstances" must be "exceptional" and the benefit clear in order to "receive benefit from a treatment or service that isn’t routinely offered by the NHS".

Even getting the EOEGS to accept that it was their responsibility to fill in any IFRs required us to contact NHS England's dedicated team for IFRs. They were not particularly happy about this.

Despite making them aware of their IFR responsibilities in March 2024, they have seemingly still not put any procedure in place for IFRs.

The doctor made notes about this during our appointment, along with our bespoke requests, and advised that he would follow this up with the first doctor involved, as well as the person in charge. (Can't remember the precise term. Service lead? Clinical lead?)

Anyway, once we've got them to fill out the bleeping IFRs, those will then be submitted to our local Integrated Care Board (ICB).

They used to be called Clinical Commissioning Groups (CCGs), but suddenly changed the name and structure back in July 2022.

To make the structure even less clear, each ICB sits under a broader Integrated Care System (ICS).

We'll continue to share info on how it all goes, but realistically we expect all our requests to be denied, as they likely won't want to set a precedent or cough up the funding.

However, at least we'll then know that we've tried every official route we could before setting up any kind of crowdfunding campaign(s).

#NHS #NHSEngland #trans #transgender #TransFem #healthcare #TransHealthcare #EOEGS #UnionMedico #gatekeeping #vaginoplasty #PIV #PPT #orchidectomy #BofaEctomy #FFS #VFS #FacialFeminisationSurgery #VoiceFeminisationSurgery #glottoplasty #HairRemoval #ICB #ICS #IFR #IndividualFundingRequest #IntegratedCareSystem #IntegratedCareBoard #queer #LGBTQ+ #LGBTQIA+ #LaserHairRemoval #LaserHairReduction #electrolysis #thermolysis #neurodivergent #neurodivergence

Hey folks :FediverseSymbol:

Per the details of this earlier post, we had our 4th appointment with the NHS East of England Gender Service (EOEGS) today.

The worst thing about that appointment was that it was at 13:30-14:30, which put us into a kind of neurodivergent purgatory / paralysis, where we felt like we really couldn't get on with the day until the appointment, as it was all we could think about pretty much.

We did manage to distract ourselves for a while by passing feedback to Union Medico over the syringe holders they provide for their 90° Super Grip auto-injector. We're planning to do a full review of that for everyone this week.

Anyway, the appointment went well. The doctor (cis guy, he/him) pretty much made it clear that he just needed to gather more info for the referral, and that he didn't expect there to be any issues. He asked whether it would be okay for a trainee colleague to sit in on the call, which we were fine with, especially as we're pretty sure she was trans herself. At the very least, she gave off good vibes.

Despite being anxious AF the whole time, and having to play the good-little-trans-patient to pass through the gatekeeping, it was just a serious of questions about medical history, what we were after, the risks, the reasons for wanting this, whether we had stored gametes etc.

Despite the many risks (e.g., fistula; granulation tissue; prolapse; etc), long recovery time, and the need for very regular dilation for ages, we agree that the benefits are worth it.

The doctor seemed suitably impressed by our knowledge and sources (e.g., Gender Construction Kit; TransActual), as well as the limited options on the figurative #NHS menu for trans gender-affirming surgeries.

If you're trans fem, your options via the NHS are:

• Penile inversion vaginoplasty (PIV).
  • Creates a neovagina using material from the penis turned inside out ("inverted").
• Penoscrotal flap vaginoplasty.
  • Creates the vagina using material from both the penis and scrotum.
  • Typically done if you've not got much material to work with 😅
• Cosmetic vaginoplasty.
  • Creates a vulva and labia (labiaplasty), and a clitoris (clitoroplasty) from the penis (and scrotum if needed), but without a neovagina.
  • Aka vulvoplasty or zero-depth.

Please note the lack of:

• Peritoneal pull-through (PPT) vaginoplasty.
  • A newer technique that involves several incisions into the abdomen and using internal peritoneal tissue to create the neovagina.
• Penile-preserving vaginoplasty.
  • Creates a neovagina using peritoneal tissue, without removing the penis.
  • Aka penile preservation vaginoplasty, phallus-preserving vulvovaginoplasty, etc.
• Standalone bilateral orchidectomy.
  • Removes the testes and scrotum.
  • Sometimes known as a bofa-ectomy.

The NHS, as standard, also does not offer:

• Facial feminisation surgery (FFS) of any kind.
• Voice feminisation surgery (VFS).
  • We're seeking an endoscopic modified Wendler glottoplasty by Chadwan Al Yaghchi at the London Voice & Swallowing Clinic in London.
• Breast augmentation (BA).
• Full facial hair removal.
  • It varies by nation, but England offers 8 laser sessions, 16 hours of electrolysis, or a combination thereof.
  • For context, we've had over 40 hours of electrolysis (thermolysis) thus far on our face and neck with a highly-experienced (and fast) electrologist, and there are still a few stragglers.

There is a mere sliver of a fraction of a chance that we might get the NHS to fund some of our additional needs, which they don't currently provide: Individual Funding Requests (IFRs).

We're not going to sugarcoat it: the IFR route is highly likely to fail for us :FaceExhaling: Your "clinical circumstances" must be "exceptional" and the benefit clear in order to "receive benefit from a treatment or service that isn’t routinely offered by the NHS".

Even getting the EOEGS to accept that it was their responsibility to fill in any IFRs required us to contact NHS England's dedicated team for IFRs. They were not particularly happy about this.

Despite making them aware of their IFR responsibilities in March 2024, they have seemingly still not put any procedure in place for IFRs.

The doctor made notes about this during our appointment, along with our bespoke requests, and advised that he would follow this up with the first doctor involved, as well as the person in charge. (Can't remember the precise term. Service lead? Clinical lead?)

Anyway, once we've got them to fill out the bleeping IFRs, those will then be submitted to our local Integrated Care Board (ICB).

They used to be called Clinical Commissioning Groups (CCGs), but suddenly changed the name and structure back in July 2022.

To make the structure even less clear, each ICB sits under a broader Integrated Care System (ICS).

We'll continue to share info on how it all goes, but realistically we expect all our requests to be denied, as they likely won't want to set a precedent or cough up the funding.

However, at least we'll then know that we've tried every official route we could before setting up any kind of crowdfunding campaign(s).

#NHS #NHSEngland #trans #transgender #TransFem #healthcare #TransHealthcare #EOEGS #UnionMedico #gatekeeping #vaginoplasty #PIV #PPT #orchidectomy #BofaEctomy #FFS #VFS #FacialFeminisationSurgery #VoiceFeminisationSurgery #glottoplasty #HairRemoval #ICB #ICS #IFR #IndividualFundingRequest #IntegratedCareSystem #IntegratedCareBoard #queer #LGBTQ+ #LGBTQIA+ #LaserHairRemoval #LaserHairReduction #electrolysis #thermolysis #neurodivergent #neurodivergence