3.1 Supporting clients around medical transition

Described image
Show description|Hide description

A cartoon of a trans-masculine person injecting testosterone into their thigh.

Activity 3.2: Patrick and Jake talk about hormones

Timing: Allow 20 minutes

In this activity you will watch a further extract from Patrick’s first session with Jake, in which he is gathering information in order to better understand Patrick’s transition experience.

As you watch the video, note down any questions you might have about what is being discussed. Also consider how Patrick talks about his experience of trying to access gender-transitioning-related hormones through the NHS.

Download this video clip.Video player: therapy_session_1_clip_2.mp4
Show transcript|Hide transcript

Transcript

JAKE:
So, you were talking about also you were self-medicating. So, what hormones are you taking?
PATRICK:
I'm taking testosterone injections, yeah.
JAKE:
You're having those injections.
PATRICK:
Yeah.
JAKE:
And do you get those bloods monitored at all, though, by anyone?
PATRICK:
No, I've never had them monitored. Like, I've asked my GP, and they won't do it because they don't know enough about the hormone, because it's not like an NHS prescription. They just won't even do it.
JAKE:
And did you talk to them about bridging hormones? Do they know much about that?
PATRICK:
No. I don't even what is bridging hormones? Because I don't even – is that where you –
JAKE:
Well, it's a part of the GMC guidelines policy that GPs have an opportunity to prescribe bridging hormones if they assess that the patient is someone that may be at risk, that's already self-medicating. So therefore, to take them off – they've stopped self-medicating – would be dangerous.
So, they have a right to do that. But I think the problem is a lot of GP's don't. And so, you're in a situation, which I think is quite common for a lot of trans people. They're not able to get their bridging hormones because GPs are not accessing their right to do that, either because of funding problems, because of their lack of awareness, and lack of training.
PATRICK:
Right. Yeah, I mean I didn't know that was even a thing. I can't imagine them doing that, to be honest, because my GP sort of made out as though – like, he kind of made out that all this waiting time is good because you need time to – I do kind of get that on one hand, of course.
But I've been waiting the whole – it's not just this time that I've come to him. It's my whole life. Do you know what I mean? But yeah, I don't know. I mean, I could talk to him about it, but I'm not sure he would actually do it.
JAKE:
And when is your GIC referral? When's that coming up?
PATRICK:
It's about 10 months away.
JAKE:
So, it's quite a long time.
PATRICK:
Yeah.
JAKE:
And had you considered going privately at all? Do you know much about the private options?
PATRICK:
I have looked into it, and I would love to, but I just don't think I can afford it. I'm self-employed at the moment, which kind of works best for me, because I get to, with – I don't know. I know it sounds a bit dramatic, but my anxiety really was getting in the way of the jobs.
And being self-employed for me is the best, because I get to be in charge of myself, I get to work from home. But it is unreliable in terms of when I get paid and stuff. And I already spend a lot on the self-medicating. I just couldn't afford to – I just can't afford to go privately. I just – yeah.
JAKE:
So, you're in this situation where you're just in this limbo state waiting, and – for what you want, basically, to get it almost kind of legitimised in some way.
PATRICK:
Yeah.
JAKE:
Yeah. I wonder how have you felt with the hormones? How have you felt – I mean, just looking at your beard, and it's wonderful. But how are you feeling around the taking hormones?
PATRICK:
Well, I mean, it has been amazing. Like, I do get to look at my face and be like, this is my face. I love that I've got a beard. Not everyone is as lucky as me to get a beard so quick, as well. I do – yeah, it is – it feels amazing to be on them.
But there's this constant dread in the back of my mind that I'm not on an NHS prescription.
JAKE:
Right.
PATRICK:
And it's sort of like – I suppose, yeah, just to even get people – that validation from my GP and from – just to be – by the medicals, to actually be like, we recognise you as male. Because I think what it is, is it feels like I'm sort of doing something wrong. Like it's a little dirty secret type thing that I'm doing, you know?
JAKE:
Like you're going to be found out or something like that. And does that feel – yeah, how does that feel for you, that state, you know, of this "dirty secret"?
PATRICK:
I think that's what – yeah, it just feels like I'm in a bit of a constant state of anxiety about it, really. Yeah.
I mean obviously my – my family and close friends know. But I guess I've sort of shut myself off a bit from the world. Like, if I bump into someone in town that knew me before I transitioned, and they're going to be like, what – like that's you, but –. Do you know what I mean? It's like, I don't know.
I think I feel like – I know I shouldn't, because I'm really proud of other people that have transitioned. But I feel the shame around it, I think just because everyone's kind of treated it as something – as something wrong. So, to actually get a medical prescription on the NHS would make me feel like, look, this is a real thing. The NHS have given me what I need.
JAKE:
So, do you think that means it gives you a sense of empowerment, that I can be seen for who I am, and move away from that experience of feeling shameful that there's – I am being acknowledged and believed and accepted in the identity that I am, that I say I am, because the NHS are almost affirming it for you proves just that power that they have to legitimise the hormone taking?
PATRICK:
Yeah. Yeah, definitely. That's definitely – and I want to get to that point. But it just feels like a million miles away till I actually get to that point. So, –
JAKE:
And what you're up against, Patrick, is just this terrible system. And I'm sorry that – that we're having to be in this place.
End transcript
Download
 
Interactive feature not available in single page view (see it in standard view).

Were there terms used by either Jake or Patrick that you did not understand? Test your understanding by pairing the following terms with their definitions.

Two lists follow, match one item from the first with one item from the second. Each item can only be matched once. There are 3 items in each list.

  1. Self-medicating

  2. Bridging prescription

  3. Bloods

Match each of the previous list items with an item from the following list:

  • a.Blood tests. In the context of medical gender transition, this means blood tests to establish that hormone and other biological indicators are at safe/appropriate levels

  • b.This allows a GP to consider giving, as a harm reduction strategy, a gender transition hormone prescription to a patient who is self-medicating while waiting to access hormones through NHS specialist services

  • c.Taking gender-affirming hormones without a prescription (private or NHS), e.g., accessing hormones from a friend or from an overseas pharmacy

The correct answers are:
  • 1 = c,
  • 2 = b,
  • 3 = a
By signing in and enrolling on this course you can view and complete all activities within the course, track your progress in My OpenLearn Create. and when you have completed a course, you can download and print a free Statement of Participation - which you can use to demonstrate your learning.

One thing that you may have noticed is that Jake is evidencing a deep understanding of Patrick‘s experience – he checks out safety aspects (e.g., is he having regular blood tests to check that there are no negative health outcomes from his self-medicating), he offers Patrick potentially useful information that might help his situation (e.g., about bridging prescriptions) and empathises from a place of understanding about the emotional distress caused by waiting. Having an understanding of what a trans client might be going through in relation to accessing trans healthcare helps them feel safe and understood.

3 Supporting clients through transitioning

3.2 Supporting clients who are waiting to transition