Dear Sirs,

Let me start with the facts of the matter.

In April/May of 2013, shortly before my 60th birthday, I finally came to the realisation that I identify as transgender, male-to-female.

Around July of 2013 I approached my GP seeking to start on the path to eventual transition.

At that time I was (incorrectly) referred to the Psychology Unit in Dunfermline. Their response was simply to state that they did not handle such cases as they required “specialist treatment”, and they basically referred me out to the Third Sector with a message of “You’re on your own”. My GP had no further advice to give.

Over the next few months in online conversations with other transgender women I eventually discovered the correct procedure that should have been followed, and returned to my GP in the October armed with information which I should not have had to research in the first place as it comes from the NHS.UK website.

Later that month I received notification of my referral to the NHS Lothian Gender Clinic at the Chalmers Centre in Edinburgh.

Due to funding shortages the waiting times for appointments at Gender Clinics are horrendous, and getting longer by the day, and unfortunately the situation was not helped by the extended sick leave of one of the (I believe two) Gender Specialists there. At the time I received my initial letter from the clinic I was informed that waiting times for first appointment were 6 to 8 months, but that was subsequently amended to 8 – 10 months.

I finally attended the Clinic in June 2015 for an initial assessment, and this was followed by an appointment in October at which a plan was agreed whereby I would start on Testosterone Blockers in November with a view to Estrogen Patches commencing in January 2016.

A letter was sent from the Clinic to my GP in this regard but, as transpired from phone calls I made to my GP’s surgery around the middle of November while querying why I had heard nothing further, that letter did not apparently state that it would be the responsibility of my GP to administer the injections.

I contacted the Clinic again and asked that they write to my GP spelling things out in words of one syllable and a letter dated 23rd November was duly sent, although it didn’t actually arrive at my GP’s until around 9th/10th December, at best, then had to be scanned before eventually arriving in my GP’s workload last Friday.

Yesterday, 16th December, I received a telephone message from my GP in which she stated that the Triptorelin (Testosterone Blocker) that I was supposed to be getting is not in the list of medications which the Pharmacy Department of Fife Health Board allows her to prescribe and that she would be contacting them in this regard.

I have no idea when I will hear anything further.

At every stage in this process so far it has become apparent that I, as the patient, have to drive the whole thing by doing the necessary research and even sorting out miscommunication between various arms of the NHS network. As if being transgender in itself doesn’t come with more than enough problems attached to it.

This year LGBT Health and Wellbeing in Edinburgh ran a Needs Assessment in Fife looking at what needs to be done to offer support to the LGBT community within the Kingdom. I would recommend any and every relevant individual within NHS Fife to contact them for a copy of the results as they are very interesting, especially given that as a first approach to the issue and the fact that there is no organised LGBT network in the area it will only have scratched the surface regarding the numbers of people involved. That assessment shows that there will be many transgender individuals in Fife who need reliable and effective support from the NHS. In my experience, and from the information I have gleaned from others around the country, that support is often lacking and many GP’s are not aware of the correct procedures they should be following. This, in turn, adds to the distress transgender people experience and is completely avoidable.

I am inclined to ask whether NHS Fife has the vaguest idea what it’s doing as far as the care of transgender patients is concerned, but perhaps I’ll bite my tongue on that for now.

So that leaves me asking the following questions …

How has NHS Fife been able to treat transgender patients in the past (especially male-to-female), and how satisfied have those patients been with the service they have received? Has any research into this ever been done?

What training or information, if any, with regard to the identification and care of transgender patients does NHS Fife provide to its’ front line staff, and when standard procedures for the treatment of patients are changed how is this communicated to them?

Is NHS Fife aware of the heightened suicide rate among the transgender population, and what steps does it recommend to its’ front line staff should be taken by way of coordinating with the Gender Specialists regarding the provision of Counselling Services (which are identified in the web page above as one of the provisions transgender patients are entitled to) in order to minimise this risk and support those patients’ overall mental health, especially given the inordinately long waiting times for appointments?

What is the point of even having specialist Gender Clinics when the treatments they recommend are not able to be prescribed due to a lack of foresight by the patient’s local NHS Trust? Why is this issue a Postcode Lottery?

Having written this letter as a blog post, in addition to the usual responses I specifically look forward to replies from anyone in an official capacity.

Yours faithfully,

Tish Wolfsong

E: tishwolfsong@yahoo.co.uk

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Note: As this is an open letter I will be following it up over the next few days by detailing the particular personal stresses this situation has put me under for the past few weeks, and identifying one additional area where I feel there is a gap in the care approach which particularly needs addressing.