#ifr — Public Fediverse posts

Hey folks :TransHeart: :NonBinaryHeart:

This isn't any of the posts we've been trying to write for ages, but haven't had sufficient spoons, executive function, emotional regulation, or uninterrupted time (particularly from unexpected daily life events) to write 😅🥺 :MentalHealthFlagHeart:

No: instead, this is just something adjacent to some of these things, which has been increasingly on our mind recently... particularly as it feels like we've been seening significantly more posts by other trans+ people we follow on fedi, as well as other places, discussing topics like:

• Their overall worsening feelings of gender dysphoria, or feeling like they're making no progress towards their own transition goals.
• Increasingly yearning for a particular gender-affirming surgery, especially if it either is -- or feels like it is -- impossibly far away or actually impossible.

:PleadingFace: :Sighing_Face:

In light of our own issues with the NHS, we did get to the point where we did a post asking folks to remember to use CWs for such posts, as even with lots of filters, we couldn't keep up 🥺😔 (In a later post, we advised that we had changed our filters back from hide completely to hide with a warning, but we're still having to filter out a lot.)

Anyway, we're getting off track again. (Today has been another of those kinds of days.)

We've been thinking a lot recently about how it would almost be easier for us if we were a binary trans+ woman with stereotypical transition goals that align with the binary expectation of the NHS and other medical systems 😔

If we had had noticeable, intense genital dysphoria in the way that they expect all trans+ folks to have, then maybe we'd've been willing to compromise over surgeon and techniques in order to get some form of genital reconfiguration surgery (GRS), and we'd've been able to progress there.

However, because we don't feel that way, could not mask our real feelings, and would not be comfortable with the limited options offered, we're now stuck in a limbo where we may basically get nothing through the NHS whatsoever.

Just to clarify, we're acutely aware just how completely cursed this line of thinking is, and how much dysphoria -- especially around genitalia -- can be debilitating for many 🥺😔

It isn't a matter of anybody having it easier or worse: everybody should be able to get their healthcare needs met. However, unless you "play the game" and "play along", you won't get anything.

But yeah... this is the dumb situation we're in.

Our dysphoria doesn't match the NHS's binary model, so we're now just waiting to hear back about how we go about complaining about pretty much everything and trying to get somewhere.

We won't though, sadly. It'd take a secular miracle for somebody to actually show a single iota of care for us as an actual person / entity.

We feel bad for the complaint handler, as given the way she's replied, we think she actually still cares 🥺😔

That job will break her if she doesn't leave it.

We've already had our request for voice feminisation surgery (VFS) declined, and we haven't even tried to get them to hear us out over facial feminisation surgery (FFS), as they'd laugh us out the door.

If you want to know how cruel the NHS system is, just read part of the below in relation to the first rejected VFS individual funding request (IFR):

The following criteria were used when considering whether there were exceptional clinical circumstances relating to your patient to support the IFR: 

* Are there any clinical features of the patient’s case which make them significantly different to the general population of patients with the condition in question at the same stage of progression of the condition? 

AND 

* Would the patient be likely to gain significantly more clinical benefit from the requested intervention than might be normally expected for the general population of patients with the condition at the same stage of the progression of the condition?

Your application was triaged by the Funding Team, and it was agreed that the information provided to support this IFR does not demonstrate clinical exceptionality.

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. 

However, if there is any further information you have to demonstrate exceptionality, we would be happy to reconsider this request. 

Yeah...

#GenderDysphoria #GenitalDysphoria #GenitalReconfigurationSurgery #GRS #GenderAffirmingSurgery #GenderAffirmingSurgeries #trans #transgender #enby #NonBinary #queer
#LGBTQ+ #LGBTQIA+ #NHS #EOEGS #NCTH #FuckTheNHS #VFS #FFS #IFR

Hey folks :TransHeart: :NonBinaryHeart:

This isn't any of the posts we've been trying to write for ages, but haven't had sufficient spoons, executive function, emotional regulation, or uninterrupted time (particularly from unexpected daily life events) to write 😅🥺 :MentalHealthFlagHeart:

No: instead, this is just something adjacent to some of these things, which has been increasingly on our mind recently... particularly as it feels like we've been seening significantly more posts by other trans+ people we follow on fedi, as well as other places, discussing topics like:

• Their overall worsening feelings of gender dysphoria, or feeling like they're making no progress towards their own transition goals.
• Increasingly yearning for a particular gender-affirming surgery, especially if it either is -- or feels like it is -- impossibly far away or actually impossible.

:PleadingFace: :Sighing_Face:

In light of our own issues with the NHS, we did get to the point where we did a post asking folks to remember to use CWs for such posts, as even with lots of filters, we couldn't keep up 🥺😔 (In a later post, we advised that we had changed our filters back from hide completely to hide with a warning, but we're still having to filter out a lot.)

Anyway, we're getting off track again. (Today has been another of those kinds of days.)

We've been thinking a lot recently about how it would almost be easier for us if we were a binary trans+ woman with stereotypical transition goals that align with the binary expectation of the NHS and other medical systems 😔

If we had had noticeable, intense genital dysphoria in the way that they expect all trans+ folks to have, then maybe we'd've been willing to compromise over surgeon and techniques in order to get some form of genital reconfiguration surgery (GRS), and we'd've been able to progress there.

However, because we don't feel that way, could not mask our real feelings, and would not be comfortable with the limited options offered, we're now stuck in a limbo where we may basically get nothing through the NHS whatsoever.

Just to clarify, we're acutely aware just how completely cursed this line of thinking is, and how much dysphoria -- especially around genitalia -- can be debilitating for many 🥺😔

It isn't a matter of anybody having it easier or worse: everybody should be able to get their healthcare needs met. However, unless you "play the game" and "play along", you won't get anything.

But yeah... this is the dumb situation we're in.

Our dysphoria doesn't match the NHS's binary model, so we're now just waiting to hear back about how we go about complaining about pretty much everything and trying to get somewhere.

We won't though, sadly. It'd take a secular miracle for somebody to actually show a single iota of care for us as an actual person / entity.

We feel bad for the complaint handler, as given the way she's replied, we think she actually still cares 🥺😔

That job will break her if she doesn't leave it.

We've already had our request for voice feminisation surgery (VFS) declined, and we haven't even tried to get them to hear us out over facial feminisation surgery (FFS), as they'd laugh us out the door.

If you want to know how cruel the NHS system is, just read part of the below in relation to the first rejected VFS individual funding request (IFR):

The following criteria were used when considering whether there were exceptional clinical circumstances relating to your patient to support the IFR: 

* Are there any clinical features of the patient’s case which make them significantly different to the general population of patients with the condition in question at the same stage of progression of the condition? 

AND 

* Would the patient be likely to gain significantly more clinical benefit from the requested intervention than might be normally expected for the general population of patients with the condition at the same stage of the progression of the condition?

Your application was triaged by the Funding Team, and it was agreed that the information provided to support this IFR does not demonstrate clinical exceptionality.

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. 

However, if there is any further information you have to demonstrate exceptionality, we would be happy to reconsider this request. 

Yeah...

#GenderDysphoria #GenitalDysphoria #GenitalReconfigurationSurgery #GRS #GenderAffirmingSurgery #GenderAffirmingSurgeries #trans #transgender #enby #NonBinary #queer
#LGBTQ+ #LGBTQIA+ #NHS #EOEGS #NCTH #FuckTheNHS #VFS #FFS #IFR

Hey folks :TransHeart: :NonBinaryHeart:

This isn't any of the posts we've been trying to write for ages, but haven't had sufficient spoons, executive function, emotional regulation, or uninterrupted time (particularly from unexpected daily life events) to write 😅🥺 :MentalHealthFlagHeart:

No: instead, this is just something adjacent to some of these things, which has been increasingly on our mind recently... particularly as it feels like we've been seening significantly more posts by other trans+ people we follow on fedi, as well as other places, discussing topics like:

• Their overall worsening feelings of gender dysphoria, or feeling like they're making no progress towards their own transition goals.
• Increasingly yearning for a particular gender-affirming surgery, especially if it either is -- or feels like it is -- impossibly far away or actually impossible.

:PleadingFace: :Sighing_Face:

In light of our own issues with the NHS, we did get to the point where we did a post asking folks to remember to use CWs for such posts, as even with lots of filters, we couldn't keep up 🥺😔 (In a later post, we advised that we had changed our filters back from hide completely to hide with a warning, but we're still having to filter out a lot.)

Anyway, we're getting off track again. (Today has been another of those kinds of days.)

We've been thinking a lot recently about how it would almost be easier for us if we were a binary trans+ woman with stereotypical transition goals that align with the binary expectation of the NHS and other medical systems 😔

If we had had noticeable, intense genital dysphoria in the way that they expect all trans+ folks to have, then maybe we'd've been willing to compromise over surgeon and techniques in order to get some form of genital reconfiguration surgery (GRS), and we'd've been able to progress there.

However, because we don't feel that way, could not mask our real feelings, and would not be comfortable with the limited options offered, we're now stuck in a limbo where we may basically get nothing through the NHS whatsoever.

Just to clarify, we're acutely aware just how completely cursed this line of thinking is, and how much dysphoria -- especially around genitalia -- can be debilitating for many 🥺😔

It isn't a matter of anybody having it easier or worse: everybody should be able to get their healthcare needs met. However, unless you "play the game" and "play along", you won't get anything.

But yeah... this is the dumb situation we're in.

Our dysphoria doesn't match the NHS's binary model, so we're now just waiting to hear back about how we go about complaining about pretty much everything and trying to get somewhere.

We won't though, sadly. It'd take a secular miracle for somebody to actually show a single iota of care for us as an actual person / entity.

We feel bad for the complaint handler, as given the way she's replied, we think she actually still cares 🥺😔

That job will break her if she doesn't leave it.

We've already had our request for voice feminisation surgery (VFS) declined, and we haven't even tried to get them to hear us out over facial feminisation surgery (FFS), as they'd laugh us out the door.

If you want to know how cruel the NHS system is, just read part of the below in relation to the first rejected VFS individual funding request (IFR):

The following criteria were used when considering whether there were exceptional clinical circumstances relating to your patient to support the IFR: 

* Are there any clinical features of the patient’s case which make them significantly different to the general population of patients with the condition in question at the same stage of progression of the condition? 

AND 

* Would the patient be likely to gain significantly more clinical benefit from the requested intervention than might be normally expected for the general population of patients with the condition at the same stage of the progression of the condition?

Your application was triaged by the Funding Team, and it was agreed that the information provided to support this IFR does not demonstrate clinical exceptionality.

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. 

However, if there is any further information you have to demonstrate exceptionality, we would be happy to reconsider this request. 

Yeah...

#GenderDysphoria #GenitalDysphoria #GenitalReconfigurationSurgery #GRS #GenderAffirmingSurgery #GenderAffirmingSurgeries #trans #transgender #enby #NonBinary #queer
#LGBTQ+ #LGBTQIA+ #NHS #EOEGS #NCTH #FuckTheNHS #VFS #FFS #IFR

Hey folks :TransHeart: :NonBinaryHeart:

This isn't any of the posts we've been trying to write for ages, but haven't had sufficient spoons, executive function, emotional regulation, or uninterrupted time (particularly from unexpected daily life events) to write 😅🥺 :MentalHealthFlagHeart:

No: instead, this is just something adjacent to some of these things, which has been increasingly on our mind recently... particularly as it feels like we've been seening significantly more posts by other trans+ people we follow on fedi, as well as other places, discussing topics like:

• Their overall worsening feelings of gender dysphoria, or feeling like they're making no progress towards their own transition goals.
• Increasingly yearning for a particular gender-affirming surgery, especially if it either is -- or feels like it is -- impossibly far away or actually impossible.

:PleadingFace: :Sighing_Face:

In light of our own issues with the NHS, we did get to the point where we did a post asking folks to remember to use CWs for such posts, as even with lots of filters, we couldn't keep up 🥺😔 (In a later post, we advised that we had changed our filters back from hide completely to hide with a warning, but we're still having to filter out a lot.)

Anyway, we're getting off track again. (Today has been another of those kinds of days.)

We've been thinking a lot recently about how it would almost be easier for us if we were a binary trans+ woman with stereotypical transition goals that align with the binary expectation of the NHS and other medical systems 😔

If we had had noticeable, intense genital dysphoria in the way that they expect all trans+ folks to have, then maybe we'd've been willing to compromise over surgeon and techniques in order to get some form of genital reconfiguration surgery (GRS), and we'd've been able to progress there.

However, because we don't feel that way, could not mask our real feelings, and would not be comfortable with the limited options offered, we're now stuck in a limbo where we may basically get nothing through the NHS whatsoever.

Just to clarify, we're acutely aware just how completely cursed this line of thinking is, and how much dysphoria -- especially around genitalia -- can be debilitating for many 🥺😔

It isn't a matter of anybody having it easier or worse: everybody should be able to get their healthcare needs met. However, unless you "play the game" and "play along", you won't get anything.

But yeah... this is the dumb situation we're in.

Our dysphoria doesn't match the NHS's binary model, so we're now just waiting to hear back about how we go about complaining about pretty much everything and trying to get somewhere.

We won't though, sadly. It'd take a secular miracle for somebody to actually show a single iota of care for us as an actual person / entity.

We feel bad for the complaint handler, as given the way she's replied, we think she actually still cares 🥺😔

That job will break her if she doesn't leave it.

We've already had our request for voice feminisation surgery (VFS) declined, and we haven't even tried to get them to hear us out over facial feminisation surgery (FFS), as they'd laugh us out the door.

If you want to know how cruel the NHS system is, just read part of the below in relation to the first rejected VFS individual funding request (IFR):

The following criteria were used when considering whether there were exceptional clinical circumstances relating to your patient to support the IFR: 

* Are there any clinical features of the patient’s case which make them significantly different to the general population of patients with the condition in question at the same stage of progression of the condition? 

AND 

* Would the patient be likely to gain significantly more clinical benefit from the requested intervention than might be normally expected for the general population of patients with the condition at the same stage of the progression of the condition?

Your application was triaged by the Funding Team, and it was agreed that the information provided to support this IFR does not demonstrate clinical exceptionality.

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. 

However, if there is any further information you have to demonstrate exceptionality, we would be happy to reconsider this request. 

Yeah...

#GenderDysphoria #GenitalDysphoria #GenitalReconfigurationSurgery #GRS #GenderAffirmingSurgery #GenderAffirmingSurgeries #trans #transgender #enby #NonBinary #queer
#LGBTQ+ #LGBTQIA+ #NHS #EOEGS #NCTH #FuckTheNHS #VFS #FFS #IFR

Hey folks :TransHeart: :NonBinaryHeart:

This isn't any of the posts we've been trying to write for ages, but haven't had sufficient spoons, executive function, emotional regulation, or uninterrupted time (particularly from unexpected daily life events) to write 😅🥺 :MentalHealthFlagHeart:

No: instead, this is just something adjacent to some of these things, which has been increasingly on our mind recently... particularly as it feels like we've been seening significantly more posts by other trans+ people we follow on fedi, as well as other places, discussing topics like:

• Their overall worsening feelings of gender dysphoria, or feeling like they're making no progress towards their own transition goals.
• Increasingly yearning for a particular gender-affirming surgery, especially if it either is -- or feels like it is -- impossibly far away or actually impossible.

:PleadingFace: :Sighing_Face:

In light of our own issues with the NHS, we did get to the point where we did a post asking folks to remember to use CWs for such posts, as even with lots of filters, we couldn't keep up 🥺😔 (In a later post, we advised that we had changed our filters back from hide completely to hide with a warning, but we're still having to filter out a lot.)

Anyway, we're getting off track again. (Today has been another of those kinds of days.)

We've been thinking a lot recently about how it would almost be easier for us if we were a binary trans+ woman with stereotypical transition goals that align with the binary expectation of the NHS and other medical systems 😔

If we had had noticeable, intense genital dysphoria in the way that they expect all trans+ folks to have, then maybe we'd've been willing to compromise over surgeon and techniques in order to get some form of genital reconfiguration surgery (GRS), and we'd've been able to progress there.

However, because we don't feel that way, could not mask our real feelings, and would not be comfortable with the limited options offered, we're now stuck in a limbo where we may basically get nothing through the NHS whatsoever.

Just to clarify, we're acutely aware just how completely cursed this line of thinking is, and how much dysphoria -- especially around genitalia -- can be debilitating for many 🥺😔

It isn't a matter of anybody having it easier or worse: everybody should be able to get their healthcare needs met. However, unless you "play the game" and "play along", you won't get anything.

But yeah... this is the dumb situation we're in.

Our dysphoria doesn't match the NHS's binary model, so we're now just waiting to hear back about how we go about complaining about pretty much everything and trying to get somewhere.

We won't though, sadly. It'd take a secular miracle for somebody to actually show a single iota of care for us as an actual person / entity.

We feel bad for the complaint handler, as given the way she's replied, we think she actually still cares 🥺😔

That job will break her if she doesn't leave it.

We've already had our request for voice feminisation surgery (VFS) declined, and we haven't even tried to get them to hear us out over facial feminisation surgery (FFS), as they'd laugh us out the door.

If you want to know how cruel the NHS system is, just read part of the below in relation to the first rejected VFS individual funding request (IFR):

The following criteria were used when considering whether there were exceptional clinical circumstances relating to your patient to support the IFR: 

* Are there any clinical features of the patient’s case which make them significantly different to the general population of patients with the condition in question at the same stage of progression of the condition? 

AND 

* Would the patient be likely to gain significantly more clinical benefit from the requested intervention than might be normally expected for the general population of patients with the condition at the same stage of the progression of the condition?

Your application was triaged by the Funding Team, and it was agreed that the information provided to support this IFR does not demonstrate clinical exceptionality.

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. 

However, if there is any further information you have to demonstrate exceptionality, we would be happy to reconsider this request. 

Yeah...

#GenderDysphoria #GenitalDysphoria #GenitalReconfigurationSurgery #GRS #GenderAffirmingSurgery #GenderAffirmingSurgeries #trans #transgender #enby #NonBinary #queer
#LGBTQ+ #LGBTQIA+ #NHS #EOEGS #NCTH #FuckTheNHS #VFS #FFS #IFR

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

Post-egg cracking time is weird :TransHeart: :NonBinaryHeart:

By the very start of April 2025, it will have been 4 years since the shell of our egg finally officially cracked. And as it finally cracked, it smashed to pieces.

It both feels like a lifetime ago and only yesterday that we were still questioning whether or not we were trans... or just (for perfectly cis reasons) someone who wanted to be a gal 🤦‍♀️ (Oh, that poor sweet summer child :GirlInTransHoodieHuggingFurry:)

Note to any eggs and/or questioning folks reading this: by definition, cis people don't want to be a gender other than the one assigned to them at birth 😅

By NHS England standards, we've made more progress than most do within that timeframe. We've beaten our away through:

• 2 appointments to get the NHS to agree we're indeed trans 🙄
• A further appointment about starting HRT and giving us a surgical referral 🤨
• Almost 6 months for them to send a basic letter about starting HRT to our GP 😖
• Yet another appointment to get a second required surgical referral :FaceExhaling:

For anyone in a country with somewhat functional healthcare for trans people, this is actually fast by NHS England standards. Many people wait 3-5+ years for their first appointment alone.

The fact that we've got to the point of getting some limited electrolysis covered (16 whole hours) and joined a surgeon's waiting list to discuss bottom surgery options is great by NHS standards, but it's shite by international standards.

From a certain point of view, we know we should be grateful. However, we can't help but feel resentful for how many years of dehumanising hoops and hurdles trans people have to jump through in the UK just to receive basic gender-affirming care. And this is just our perspective as an adult: there is currently no gender-affirming care whatsoever for trans youth via the NHS 😭

Gender-affirming care doesn't exist in a vacuum. Whilst we're always happy to see others getting the care they need faster, we won't lie: it's hard not to feel jealous when someone 2-3 years into their transition:

• Was able to start HRT injections on prescription via informed consent.
• Was able to get several life-improving gender-affirming surgeries. E.g.:
  • Standalone bilateral orchidectomy.
  • Vaginoplasty.
  • Facial Feminisation Surgery (FFS).
  • Voice Feminisation Surgery (VFS).
  • Breast Augmentation (BA).

For those who don't already know, NHS England doesn't even routinely approve standalone bilateral orchidectomy, FFS, VFS, or BA. And yes, whilst it is technically possible to get solely your nads yeeted, it typically:

(a) is done in place of vaginoplasty; or
(b) requires approval of an Individual Funding Request (IFR) by your local Integrated Care Board / System (ICB / ICS), which will be reviewed on a per patient basis.

Again, whilst you can technically apply for funding for FFS, VFS, and/or BA via IFR:

• It's really unlikely to succeed; and
• You first have to convince your gender clinic to actually submit them for you.

For us, BA isn't something we want, but FFS and VFS very much are :PleadingFaceWithRedHearts: However, we're still waiting for our gender clinic to agree to submit IFRs for us! We've actually had to raise a complaint about the clinic refusing to do so 😔

Anyway, that's enough venting for now.

#NHS #NHSEngland #trans #transgender #TransFem #healthcare #TransHealthcare #gatekeeping #orchidectomy #BofaEctomy #FFS #VFS #FacialFeminisationSurgery #VoiceFeminisationSurgery #glottoplasty #IFR #IndividualFundingRequest #queer #LGBTQ+ #LGBTQIA+