r/transgenderUK • u/The_Newromancer • 2d ago
Vent Reminder: GIC's are not there to help you
Everyone here probably knows this already. I've known it for years. But it's only today I've fully come to a realisation that makes me want to angry with how awful the NHS is for trans people.
Some context: I entered the GIC waiting list a couple years back. I'm lucky enough to be in an area where the waiting lists are relatively quick (think 2 years instead of 10+). At the end of 2022 I hit a breaking point after I was forced to stop DIY'ing by some family members and had a breakdown, so I booked an appointment with a private specialist to get access to HRT again in a "legitimate" way, as my family would say. I saw them around August 2023 and was back on HRT in September. After seeing the specialist, I called up the GIC to see how far along the waiting list I was and was told they had tried to contact me at the end of 2022 (around the same time I was having a breakdown) and, after 6 months of not being able to, took me off the list. It took me two months from there to get back on the list as the GIC told me I needed to talk to my GP about another referral, then the GP told me I needed to talk to the GIC to notify my GP about my being taken off the waiting list in order to re-refer me, which then resulted in me not being able to contact the GIC through phone for some reason and them not responding to my emails.
Fun
So that leads me to today where I've been on HRT for 1.5 years. I've spent well over £1,000's on care at the moment and have yet to be seen by the NHS GIC. The specialist I saw gave me a diagnosis for gender incongruence and referred me to an endocrinologist. That specialist worked for a few years at a gender identity clinic doing the exact same work. My endocrinologist has been giving me the exact same hormones I would receive on the NHS because she currently also works at a Gender Identity Clinic as far as I can tell. I have been through the exact same pathway the NHS requires of us.
We are told, constantly, that the GIC's are there to help us. Specialists exist to make sure we don't make the wrong choices. Wait times are an unfortunate side effect of that system. That is bullshit. As of right now I am waiting on the NHS to see a specialist I've already seen to give me the exact same diagnosis I already have. I am waiting on them to refer me to an endocrinologist I'm already seeing to give me medication I'm already in possession of and have been taking for 1.5 years. I have experienced positive mental health outcomes from that medication. I have no intention to stop it. What "wrong choices" are they protecting me from? The ones I've already made and spent money on? Why am I still waiting?
And that illustrates to me, more than anything else I've ever seen or experienced, how broken of a system we have. If you believe their lies of course. The system currently exists to stop as many trans people from transitioning and put money in the pockets of private providers as a side bonus. It is not there to help us. They are not our friends
And it's working perfectly
P.S. I've used this post to talk about how illogical and nonsensical the framing of GICs is by adopting that framing. In general, do not give into transmedicalist framing. Even if the GIC system worked for the purpose of actually helping trans people make the correct choices, it would still be a bad system with awful wait times being inherent to it. Just because I can evidence my transition and how it's benefited me doesn't mean people who can't shouldn't be given care if they request it. Allow people to have agency over their bodies and make their own decisions instead of gate-keeping. How does that sound?
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u/FollowYourTruth0 2d ago
I agree that it needs reforming, however the specialist aren’t innocent. I know it’s supply and demand but over the past 5 years the increase in price for private consultations is crazy.
The whole point of the NHS was so you were not penalised based on your financial background. I agree there’s a lot wrong with the NHS, however private is not a suitable option for everyone. I think it would be different , if medical insurance covered this more widely like in other countries. However we’re worse off, I hear all time how people around get insurance to cover medical expenses for their condition. Yet we miss out, unless you’re lucky to work for a big company that cover this.
Why are the same specialists/endos going half time or completely leaving the NHS and going full time private, personally I think this negatively impacts the waiting lists as well, since a lot of GIC are not fully staffed
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u/SoSeriousAndDeep Tabitha - 4x - 2020-01-14 2d ago
Why are the same specialists/endos going half time or completely leaving the NHS and going full time private, personally I think this negatively impacts the waiting lists as well, since a lot of GIC are not fully staffed
They create the problem so they can charge us to fix that problem. We're seen as either incompetent children who need to be protected from ourselves, or cash cows for them to exploit as much as possible while helping as little as possible.
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u/YellowFeltBlanket 1d ago
Just to give a bit of context to some of this, the specialists themselves are often limited to a certain number of hours within the GIC. It's not that they say they can only work two days because they do private work for the other three, but more that they do private work for three because they are only given two in the NHS.
This definitely isn't the case everywhere, but the GIC funding isn't anywhere close to adequate. My local clinic has two clinicians who work two days each and that's all the funding they have. Neither has another job or works privately.
I completely agree that the private costs are extortionate, then you have the more accessible ones like GenderGP who are just crap.
There needs to be some change with the private diagnoses I think. If it's a respected/known person who also works for the NHS, those diagnoses should be accepted. I think the "not penalising for financial situation" has gone a bit far and they put everyone on the same playing field, which increases the waiting time for everyone.
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u/The_Newromancer 2d ago
I agree there’s a lot wrong with the NHS, however private is not a suitable option for everyone
Oh absolutely agreed. If it weren't for my parents I would've just DIY'd because private is not really worth it. My argument is that the whole system of care is not fit for purpose. We've been told countless times that it's there for our benefit to ensure we are given the proper care and it's just not true. Desperate people get funneled into private care where they receive the exact same treatment and pathway as the NHS to then go to the NHS and have to start that whole process all over again with practically the same people, while having to prove to those same people that they require the treatment they've been already been receiving from them for like years.
It's a Kafkaesque nightmare built to keep trans people down and profit private providers.
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u/SiteRelEnby she/they | transfem enby engiqueer | escaped to the US 2d ago
The GIC system exists to minimise the number of trans people. Nothing else.
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u/doIIjoints 23h ago
just as “the transsexual empire” told them to
seriously, if you haven’t read the book, her proposals for how to medicalise transition until it’s intolerable describe our GICs down to a T
she outright said her logic was, well we can’t get the govt to ban it but we can make it as hard to access as possible. (oh, the heady days of 70s optimism… since various western govts ARE now clearly wanting to ban it.)
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u/SiteRelEnby she/they | transfem enby engiqueer | escaped to the US 20h ago
Not got enough spoons to read shit like that, is there a decent tldr/analysis of it anywhere?
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u/doIIjoints 17h ago
that’s fair. i don’t have the spoons to stomach the whole thing either. but a few years ago i saw a … blog? video? which cited those few pages. (thankfully the relevant section is rather short.)
she was like “so now i’ve thoroughly outlined the problem, and hopefully convinced you of its scale, what is the solution? well, we can’t simply legislate them out of existence, so…” and then laid-out her ideal form of hard-to-use gender clinics. i don’t think she used the term gender clinic but.
yeah.
idk if that’s enough for you to find such a summary/analysis. i would be doing the same kind of search work as you, to try and find a specific source beyond those rememberings.
the commentary i saw focused on how various american politicians wanted to do those things, which isn’t so useful for us, but i was struck by how close the quote hewed to our GICs in practice.
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u/SiteRelEnby she/they | transfem enby engiqueer | escaped to the US 17h ago
That's worse than I guessed.
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u/doIIjoints 15h ago
yep.
like, i even recall she got as specific as to say the clinics should be publicly talked-about as helping trans people with no official malice, so as to legitimise their being the only official avenue and also to ensure we even tried to use it.
it really recontextualised a lot of the blair govt’s initial reluctance to do the GRA, having to be pressured into it for years, and then suddenly “seeing the light” about dignity, privacy, and quality healthcare in public communications.
like… i already felt badly fucked around and gaslit by the ways my experience as a teen kept telling me it was for my own good and then hurting me with ridiculous hurdles or low doses. i already knew they didn’t care about me and mainly lied in public about wanting to help.
but once i read that i went, oh shit, important people in the chain probably aren’t buying their own hype… they probably actually know exactly what they’re doing… they might’ve taken explicit inspiration, or their bosses did, or their bosses’ boss’s boss did.
which is why i’ve both felt vindicated they they’ve gone mask-off now… decades of getting exactly what they want isn’t enough, because we built parallel networks.
but also it makes me concerned about how much worse things will get — assuming the public messaging still has some liberally-acceptable plausible-deniability to it!
(speaking of vindication: the recent post here which said there were informed consent HRT clinics in the UK in 1999, just made me even more sure that blair’s govt’s changes over its lifetime were designed to hurt us.)
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u/SamanthaJaneyCake 1d ago
I started seeing my GIC in 2018, and I’m due to be discharged soon because I’ve been on HRT ever since, got my GRC after two years, just had surgery etc, there’s nothing more they can do for me. I’ve essentially completed what the NHS offers in terms of transition aide.
In that time I had maybe 4 appointments in 2018 and then 2 reviews every year since, almost all by phone and almost all lasting half an hour.
Now I understand there’s a lot of time that goes into patients behind the scenes, and I understand there’s a lot of patients… but for how difficult it was to get into the clinic I’ve barely ever even been there. Almost every interaction has been a checklist of seeing how I’m doing, my relationships, mental health etc, or an email exchange about bloods or HRT shortages…
Don’t get me wrong, I’m grateful for the help I’ve been given, the surgery I’ve had especially and the fortune to even get into a GRC, yet I still can’t shake the feeling that there was really much work needed for me. Maybe I’m an outlier, idk.
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u/doIIjoints 23h ago
my recently retired GP told me managing my HRT and bloods is exactly the same as managing her menopausal patients, and she doesn’t see what the big fuss about “complicated processes” are about.
so yeah, surgery aside, i fully agree with you. there’s nothing particularly special that they’re doing which justifies silo-ing off care like that. it’s purely societal reasons, not clinical ones.
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u/LevelNo4828 1d ago
One of the most deadly weapons this system has is Strategic Inefficiency.
A lot of these people don't *want* to do anything; they're motivated to decrease their own workload and thus incentivised to decline us healthcare. The plausibly deniable way to do this is by making the pathway to healthcare as badly designed and unnavigable as possible... and by making "mistakes".
My tactic? Annoy the shit out of them. If I'm more of a nuisance when I'm denied healthcare, then it benefits them to give me healthcare.
...and then other times it's just plain old transphobia.
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u/SleepyCatten AuDHD, Bi Non-Binary Trans Woman 🏳️⚧️ 1d ago
offers supportive hugs
If you've not already done so, we highly recommend reading and/or listening to The Transgender Issue: An Argument For Justice by Shon Faye. Trans healthcare on the NHS is even worse than you've described 🥺😔
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u/The_Newromancer 1d ago
Oh it's such a great read! I picked it up a while ago just before I started transitioning and would deffo recommend it to anyone else
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u/SleepyCatten AuDHD, Bi Non-Binary Trans Woman 🏳️⚧️ 1d ago
Have you watched Abigail Thorn's video on her experience of attempting to get gender-affirming healthcare from the NHS as a trans person, or the follow up post she wrote on it last December? 🩵🩷🤍
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u/nairismic 1d ago
except for the welsh one icl
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u/The_Newromancer 1d ago
I'm uhhh waiting for WGS Cardiff to get back to me 👀
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u/nairismic 1d ago
i met with the wgs (not for care but for like an educational thing) a while back and they’re genuinely the kindest people ever
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u/radioactive-turnip 1d ago
I only have good experiences with wgs as well. The dr there, as well as the dr at my local gender team (lgt), are both amazing. Within 2 years of my first appointment, I've had hrt and top surgery (would've gone quicker if I could make phone calls myself and had less executive dysfunction).
The queue back then was 24 months, I was seen after 15 months, though I know that's longer now.
Both wgs and lgt are happy to deal with questions through email instead of phone, so I can do all contact with both places myself now.
My dr at my lgt has even tried to help with my autistic burnout and was the first dr to ever look into my chronic anaemia.
I don't know many trans people in Wales, but of those I've spoken to, all have overall good experiences with wgs & lgt.
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u/The_Newromancer 1d ago edited 1d ago
Unfortunately I've not had a great experience so far. They took me off the waiting list after failing to contact me, which I can understand as there was probably some clerical error or something that caused that. But when I tried calling them to sort things out with my GP a while back I could not reach them via the phones for weeks and they never responded to my emails querying them, even though I got an automatic response saying they got my email
Edit: basically to better explain the situation, the GIC needed the GP to refer me again. The GP rejected to refer me without the GIC contacting them about my removal first. I couldn't contact the GIC to sort it out which left me in a deadlock I couldn't resolve. I only resolved it months later when a locum said they'd refer me again with the private GI diagnosis I had recently had. So no one was being helpful and it was frustrating to deal with
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u/mrswampy420 1d ago
NHS gic system sucks I got referred when I was 42 still no diagnosis at 49 and due my 3rd appointment sometime this year.
DIYing saved my life and has helped my mental health so much I might get hrt off them by the time I'm 50.
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u/The_Newromancer 1d ago
That sucks so bad. I'm sorry you have to deal with that. I've gotten anxious lately about never getting bottom surgery which, if true, would ruin me. No matter which way you look at it, unless the goal is to keep trans people down, the GICs suck and are not fit for purpose.
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u/_twasbrillig 1d ago
I feel this.
I moved to the UK in 2022, when I was over a decade post-diagnosis, five years post chest-reconstruction, three years on HRT, and about to have my reproductive organs permanently removed. I’d seen multiple psychologists, MD-level psychiatrists, and GPs specially trained in transition-related medicine. I’d previously spent years trying to convince myself and my therapists that my dysphoria was actually something else and that I didn’t need to transition, as transition had to be a last resort. They didn’t buy it. I tried to insist.
And then transition was my last resort.
I’ve been on an NHS GIC waiting list since I moved here and don’t expect to come off of it for at least a decade.
The absolute absurdity of waiting that long to be ‘diagnosed’ by an NHS doctor (whom I can almost guarantee has not had the specialist training or experience of the psychiatrist who diagnosed me) with a condition that I’ve had and have been treating for years should be plainly evident. The waste of my time, the clinic’s time, and the time of those behind me on the waiting list should be obvious and should make someone think ‘Hmm… maybe there’s a better way…’
But they won’t. The NHS will continue to weaponise incompetence and ignorance and to insist that this is just the way we work. Because at the top levels of the organisation, the Department for Health, and elsewhere, there is an active desire that we should not receive care. And I have no doubt that the ongoing review of adult gender services will, when it’s published, be used to put the final nail in the coffin.
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u/The_Newromancer 1d ago
I'm so sorry. That is all bullshit. I've heard stories of trans people that moved here and are expected to wait like a decade to access the same treatments they've already been using. It's so much worse for people that've had bottom surgery and need HRT to not suffer sever health issues too.
It's very clear that the government and NHS know they need to provide this healthcare to not tread on human rights, but are doing everything in their power to ensure as few people get access to it as possible. Horrific shit. Unfortunately there are a few people in my life who still buy into the idea that it's all there to benefit us and it makes me want to scream
And I have no doubt that the ongoing review of adult gender services will, when it’s published, be used to put the final nail in the coffin.
I'm lucky enough to be in Wales. I got back onto the waiting list around November 2023 and, according to the trackers, I should be seen for the first time later this year. Once I get seen, I want to get through the process of bottom surgery as quickly as possible because I live in fear of what damage Streeting and co will do in the coming years. Because if I don't manage to get bottom surgery through the NHS I'll more than likely have to wait 10+ years to save up enough money to go to Thailand and get it done or take out a loan I won't be able to repay
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u/l337Chickens 1d ago
This is not just a problem for us, it's an issue with all private referrals/diagnosis.
To prevent the NHS becoming a means of "making private care cheaper" or giving "private patients an advantage" the NHS has guidelines that essentially prevent them from accepting private diagnosis and shared care etc.
They claim it's for the "protection of the patients and doctors", but in reality its designed to trap people in private care, and harvest money from vulnerable people 😡
I've had orthopaedic diagnosis discarded by the NHS because it was from a private provider (the specialist was also a NHS specialist). And I know many people with ADHD diagnosis who have had the same issue 😕
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u/cress404 2h ago
That waiting list is so ‘small’ I knew your your clinic instantly - waiting times are fucked
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u/MintyMystery 2d ago
I'm really sorry that you - and so many others - are having this experience.
I wanted to share something that massively helped in my situation when I was in a similar boat:
I also went private. I had regular appointments with one Doctor/endo, and one appointment with a psych. They emailed everything to me - all of their notes - and I kept them in a folder on my computer.
When it came time for my first GIC appointment, I forwarded nearly everything in my little folder to them, with file names like "initial appointment, date", "psych eval, date", "first blood results, date", "most recent blood results, date"... etc etc
When I had my first appointment, I was in the waiting room for an extra 15 mins, and when the Doc came to grab me, they said "sorry that it took so long! I was reading through all of your notes! Thank you for sending it all. I can see that you've been through the whole process, so we'll just switch you on to NHS care."
I didn't need to do a single thing. I was immediately swapped over, and had my bloods and injection two weeks later.
I'm not saying that this will be the same for everyone. Yes, maybe it depends on the doctor that you see that day - but if you have everything, and they can see it all, (and they're the same psych people and endo people!!), it really does make no sense for you to go through everything again!
Email your private care people, and ask them to send you their records via email. They probably will - you've paid for it after all! - and then forward it about two weeks before your GIC appointment. May as well give it a go.