Jan

Mother of a trans daughter. Ethnicity: White British.
Jan realised that something was affecting her teenage daughter when she was about fifteen or sixteen years old but did not understand what that was. When her daughter was eighteen years old she messaged Jan saying that she needed to talk to her. Jan thought that her daughter was going to come out as gay. However, shortly after the first message she received another message that had been stored on her daughter’s phone for about two years, which explained that she was trans. Jan has had trouble with getting adequate medical care for her daughter. This has resulted in her seeking private care for her daughter in order to preserve and protect her mental and emotional wellbeing.
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Jan realised that something was affecting her teenage daughter when she was about fifteen or sixteen years old but did not understand what. When her daughter was eighteen years old she messaged her saying that she needed to talk to her. Jan thought that her daughter was going to come out as gay. However, shortly after the first message, Jan received another message that had been stored on her daughter’s phone for about two years, which explained that she was trans. Before Jan’s daughter came out a trans, she knew nothing and knew nobody who was trans. So, the day after her daughter came out, she spent a lot of time consuming the internet on everything about trans identities. She felt it was really important for her to inform herself so that she could best support her daughter. As her daughter had not yet told her father, Jan put together a plan to tell him. She showed him the original text that she had been sent by her daughter when she came out. Apparently, he responded by saying “oh well that’s a relief. I thought you were going to tell me he’d got arrested.”
When asked about her reaction to her daughter’s gender identity, Jan says she was very supportive even though she was shocked. She remembers crying a lot because she was scared about her daughter’s future. She was afraid that her daughter would struggle to present as a woman before her medical transition. Jan describes that her daughter was very tall and thin, with a receding hair line so her masculine features would stand out. Jan was really concerned how reactions to her daughter’s appearance before taking hormones would affect her mental health.
Nearly two years into her daughter’s transition, Jan says she has seen a positive difference in her daughter’s confidence. Her daughter was very unwavering on what her trans journey would be like. In particular, she was keen to get facial feminisation surgery as she was concerned about her masculine looking features. They decided as a family to schedule the surgery early on in her transition to make her more comfortable. She also consulted with her daughter’s GP and encouraged them to provide bridging medication. The GP did not feel comfortable with this, so even after complaining to the practice, local authorities and MP, Jan had to seek private care just so that she could support her daughter’s mental and emotional wellbeing.
Jan is confident that her daughter will receive good care from now on. She explains that she has finally found a GP that is on board and is actively trying to support her daughter. Jan’s concerns now relate to gender affirming surgery, but she has not yet done a lot of research into this. She has heard nightmare stories about the surgery going wrong on the NHS, and she has heard better stories of people who have had this surgery abroad. She is waiting to see what a gender identity service says about this before her and her daughter make any decisions though.
When asked about barriers in trans healthcare, Jan explains that the main one is prejudice. The second being experience and education. She comments that some GPs she has seen have had no idea what transgender is and what gender affirming care looks like. Jan goes on to say that there is a lack of a standard pathway for trans children and that there needs to be more awareness about this.
Jan says to parents of trans children to “fight for the care that they deserve.” She thinks it’s not fair that parents have to fight on behalf of their children, but that often children are not in a mentally secure place to articulate their needs the right way. She says health professionals need to understand the difficulties that trans children face and how it complicates all situations in their life.
Jan spoke about being aware that there was something going on for her daughter and described the experience of her daughter coming out to her as trans by text.

Jan spoke about being aware that there was something going on for her daughter and described the experience of her daughter coming out to her as trans by text.
Probably from around the age of 15,16 we were aware that there was something going on, but we didn't really understand, as parents what that was. We tried to be sort of supportive and boost her confidence and, and what have you. But really she was a girl, trying to be a boy we didn't know that at the time. So she was just turned 18 when she came out. She came out to me actually by text. So she'd messaged me to say, she'd been out for a night out, messaged me to say, would I open the gate for her and I said, ''I will do but I'll be in bed when you get home.'' And she said, ''No, please wait up, I need to talk.'' So I knew whatever it was that had been going on for all this time that I was gonna find out what it was. And to be fair, I thought she was gonna tell me that she was gay. And I've spent a lot of time telling all my kids, I don't have any concerns or I don't care what they are as long as it's legal and they're happy that's all that mattered. So that's what I expected and then just shortly after getting that message to say, please stay up, I got a very long text. And it was one that she'd apparently written probably about two years before, had sat on a phone for all that time and she'd never dared press the send button. So she pressed the send button and read it and I was very shocked, to be fair, because I didn't really understand what trans was about. But I messaged her back and I just said, drive carefully, cause it was late and it was winter and it was quite, quite icy. And I said, I'll have the kettle on when you get home. And we just sat and talked into the early hours of the morning, really. And that was the start of our journey, really.
Jan talked about telling her husband, her daughter’s father that their daughter was trans.

Jan talked about telling her husband, her daughter’s father that their daughter was trans.
And then we talked about how to tell her dad, because to be fair, I've been married to him, I've been with him for such a long time. But I couldn't actually – because this had come as such a shock – I couldn't actually genuinely tell how he was gonna take it. So when it came to when she finally agreed that I could tell him, so she told me I think on the Friday night and agreed that on the Sunday morning I could tell him. And I told him in pretty much the same way as she told me. I showed him the text. And he read it and he said, ''Oh well that's a relief. I thought you were gonna tell me she'd got arrested.'' Obviously not using female pronouns though, at the time. Yeah and that's, that's how we kind of got underway.
Jan felt the long waiting times were unacceptable and the service needed more funding to meet the growing demand.

Jan felt the long waiting times were unacceptable and the service needed more funding to meet the growing demand.
I think it's absolutely unacceptable, really unacceptable, because a lot of these kids and young adults and adults that come out they're, they're struggling mentally. You know, they're suffering dysphoria around their body, around their gender. And, you know, if I went to the doctors with a pain in my abdomen and they couldn't work out, you know, they couldn't fix it there and then they would refer me onto a specialist and I would get seen within a reasonable length of time, you know, and this is no different. They should be they should be given immediate treatment. And if they can't, at the moment they need to look at the service that's being provided and the funding that's been made available to it. And you know, they need to provide a service that's suitable for demand and at the moment it's not fit for purpose.
Jan felt the GP she saw with her daughter was dismissive and condescending in a way she felt they would not be about other health issues.

Jan felt the GP she saw with her daughter was dismissive and condescending in a way she felt they would not be about other health issues.
And we immediately went to our current GP practice I foolishly thought, of course, they'll help us immediately and I was, I was horrified with what we were faced with. So they referred us straight away to the Gender Identity Service which was good. Led us to believe that that would be quite quick process. When we'd spoke to the Gender Identity Service they said it's gonna be at least an 18 month wait before you even get seen. So we went back to the GP. I'd done lots of research, looked at the GMC guidelines that encouraged GPs to provide bridging medication if they felt able to. And that was the important bit, because that's a get out clause for them all.
Well, “We don't feel experienced enough to be able to do this”. So I had many a discussion with our current GP felt they were very condescending I complained, I wrote letters of complaint to the practice itself to the GMC, to NHS England, to the CQC, to our local commissioning group. And pretty much felt like I was getting nowhere. But, I think the attitude of that particular practice was just not acceptable. They were dismissive. They were condescending and I didn't like it at all and so I'd been talking with a friend and she said, there is another practice in another village that's kind of the other way from the first one. And she said, they, you know, they're really nice, well run practice. Why don't you try there? So I went to them and I said, ''Are you transgender friendly? I'm not moving if I'm gonna end up in the same position.'' ''Oh yes, yes, we are.'' So made an appointment and went in with [name of participant’s child] and again, the first thing we were told was, ''No, we, we can't provide you with any bridging hormones at all.'' So I found myself going down the same route again of complaining to the world wide news, only I went to my MP this time as well and said, ''This is wholly unacceptable.'' You know, at that time we had started with a private service, internet based service, because it was the only way we could get some kind of help. And probably took about three months, I think of having assessments, you know, psyche assessments and stuff for [name of participant’s child] to get her first hormones. But at least then she felt like she was on a bit of a, bit of an even keel because I think the hormones that were going on inside her body were kind of matching how she identified. But a, above everything her big concern was that she was losing her hair. Her hair was receding and that had to stop. Waiting 18 months, I mean, she could have been half bald by then. I mean, it was just unacceptable that you know, they didn't, they didn't respond to that, the health professionals. So I wrote to the lead partner in the practice and said, ''You need to, you need to think about doing this. This is not acceptable.'' So she invited us in and I took all the guidance I could find, all the information I was trying to be as reasonable and a, as balanced as I could in presenting that to her. Because I said, if something happens to my child because you will not treat her, I will hold you responsible. And I said, ''I feel like you're not treating her out of either prejudice or you're choosing not to, you know, when you've got the opportunity.'' And, she wasn't, she didn't like me saying that at all. She took offence at that. So I kind of had to just be, you know, I didn't want to get into a conflict situation with them. I was genuinely trying to persuade them to provide assistance. So she said, ''Well, we've got a practice meeting, we'll discuss it there.'' And we got a letter after that that said, no, we will not treat [name of participant’s child].
What was the reason they gave you?
They just said, well they said because we were using an internet service they wouldn't provide monitoring bloods for that. And they didn't feel they had the expertise to actually take over the prescribing, even though they are prescribing HRT for women, all day, every day. And it's essentially the same. So I was continuing to complain to all the bodies that I could complain to. And I wrote back to them and I said, this is a list of everybody that I'm complaining to about your practice. I would urge you to reconsider your decision and they did reconsider their decision. So she called us in and said, ''We genuinely don't feel able to do the prescribing ourselves, but what we will do is we will refer your child to an endocrinologist. Let them come up with a prescription and then we'll take over the bridging medication” and that's exactly what happened.
Jan felt that certain GPs are prejudiced against trans people – a problem that she felt was made worse by lack of funding and lack of more ‘prescriptive’ guidelines for GPs.

Jan felt that certain GPs are prejudiced against trans people – a problem that she felt was made worse by lack of funding and lack of more ‘prescriptive’ guidelines for GPs.
I think there's a number of barriers. One of them is prejudice so I think there's a lot of that within general practice. One of them is around experience, so they don't think they have the experience. And there's possibly something that can be done about that. If they, you know, if they're given the guidance that they would prescribe in the same way as they prescribe HRT then maybe that would be sufficient for them to feel like they can to feel like they can provide this bridging medication. Education, there's a lack of education for GPs around what transgender is and what care they actually need. So, I think there's a sort of awareness and maybe some patient pathways that could be could be drawn up that would say, well, actually, if you don't feel like you can do this, you could refer in this way and that may possibly also help, and funding as well. So one of the arguments I had with our first practice was that they said, ''We are not funded to provide your child with blood tests.'' As did the second GP practice actually. We are not, we are not funded to provide you with blood tests to monitor your, you know, monitor her hormonal parameters. And then in the next breath I was seeing a social media post from the second practice that was saying, ''Ah, free blood tests for everybody.'' And I was like, ah, yeah, the select few potentially, not for everybody. And I actually put that, It's very rare I would put something on…. Very rare I would put something on you know, social media that's not, you know, that kind of meaningful in that way. And they put a comment on it to say, ''This is not the forum for that, for this.'' And I replied to them and I said, ''Well actually, it is, because you won't listen to me in any other way.'' And it's from that point that's when they started to listen. So, yeah, funding is another one. Oh, and guidelines, sorry. The GMC guidelines are quite clear around providing bridging medication, but it gives them a get out. So, the minute they feel like they're unable to prescribe or unable to help they can just throw their hands in the air and say, ''No, I'm sorry you're just gonna have to wait for the, you know, the gender service.'' And I think that's wrong. So, I think GPs should have to take a level of responsibility for looking after their transgender patients without having that kind of get out. So, those guidelines need to be a little more prescriptive.
When Jan complained about her GPs refusal to do bridging prescriptions for her daughter, she felt that they didn’t take it seriously enough.

When Jan complained about her GPs refusal to do bridging prescriptions for her daughter, she felt that they didn’t take it seriously enough.
It's more around and it's really hard to really hard to articulate. But it's the way they look at us. And the tone of voice that they use and the look in their eyes and I know, you know, it's it might sound daft, but actually to be sitting there under the kind of gaze that almost feels like it's bordering on ridicule is very, very uncomfortable. You know the first the first GP you know, very nice, soft voice and everything, but you could just see in his eyes it was just, it was not something that he was comfortable with at all. You know, he was keen to make the referral and just kind of get us out of there. And was keen not to really have, to have any involvement in any kind of bridging care for [name of participant’s child]. And then the clinical lead and so he suggested, ''Well if you know you've got a problem with this I suggest you write into the clinical lead.'' They gave me the name of the clinical leads. I wrote into that clinical lead. And he questioned why I was even bothering writing to him, because he hadn't, in this, the letter it said, ''I haven't seen your child for half a decade.'' It was like trying to make it sound better, that he hadn't seen my child for such a, such a long time. But that wasn't that the practice hadn't seen her. He personally hadn't seen her. So yeah, it, they almost didn't take our concerns very seriously at all. You know, had I been writing in about something else, I don't know having not dealt with a broken arm correctly or what have you. I do feel they would have taken that far more seriously than the fact that I was writing in about transgender care.
Jan spoke about successfully getting a local endocrinologist involved in her daughter’s care, which included the prescription and monitoring of hormone medication.

Jan spoke about successfully getting a local endocrinologist involved in her daughter’s care, which included the prescription and monitoring of hormone medication.
They just said, well they said because we were using an internet service they wouldn't provide monitoring bloods for that. And they didn't feel they had the expertise to actually take over the prescribing, even though they are prescribing HRT for women, all day, every day. And it's essentially the same. So I was continuing to complain to all the bodies that I could complain to. And I wrote back to them and I said, this is a list of everybody that I'm complaining to about your practice. I would urge you to reconsider your decision and they did reconsider their decision. So she called us in and said, ''We genuinely don't feel able to do the prescribing ourselves, but what we will do is we will refer your child to an endocrinologist. Let them come up with a prescription and then we'll take over the bridging medication” and that's exactly what happened. So we had the appointment with the endocrinologist I think in February of this year. And prescribing started immediately. They put her on much better medication than she was on before. I don't mean better, but sort of potentially stronger and a proper T blocker, that she's on now, which is, you know, better for the hair loss and, and everything. And you know, and she feels really good. So we stopped using the internet provider, who had been brilliant, really brilliant throughout. But it's great to have somebody in our local practice now who somebody that we can see face-to-face and, you know, we feel like [name of participant’s child]’s care is a part of her trans care is a part of her overall medical care, rather than us having to take that part out to somebody else who was willing to treat her.
Jan felt the long waiting times were unacceptable and the service needed more funding to meet the growing demand.

Jan felt the long waiting times were unacceptable and the service needed more funding to meet the growing demand.
I think it's absolutely unacceptable, really unacceptable, because a lot of these these kids and young adults and adults that come out they're, they're struggling mentally. You know, they're suffering dysphoria around their body, around their gender. And, you know, if I went to the doctors with a pain in my abdomen and they couldn't work out, you know, they couldn't fix it there and then they would refer me onto a specialist and I would get seen within a reasonable length of time, you know, and, and this is no different. They should be they should be given immediate treatment. And if they can't, at the moment they need to look at the service that's being provided and the funding that's been made available to it. And you know, they, they need to provide a service that's suitable for demand and at the moment it's not fit for purpose.
Jan talked about her daughter’s motivation to have facial feminisation surgery and how the surgery had gone.

Jan talked about her daughter’s motivation to have facial feminisation surgery and how the surgery had gone.
It was a big concern for her because she had a receding hairline and so part of the surgery was to pull that forward to make it look like she had a full head of hair. She had a very prominent brow, masculine brow, so that was being shaved. Very prominent masculine nose so that was being reshaped and then her Adam's apple was being shaved as well. So that surgery took place last August. It was a big surgery to have done. There was an unexpected complication in that she lost the sight in her right eye as part of that. So, that added an additional dimension for her to have to deal with over and above the surgery itself and just generally being transgender. So, you know, she's proven that she's resilient. The surgery was like I say, it was a big deal, because it was four hours worth of four different procedures that were all happening at once. But it was something that was really top of her agenda to help her be able to move forward and to ease her kind of body dysmorphia that she had.
Jan spoke about the initial shock and her family’s decision to embrace the change and support her daughter.

Jan spoke about the initial shock and her family’s decision to embrace the change and support her daughter.
So we were supportive. You know, I was quite shocked. I had lots of tears. But never in front of [name of participant’s child]. I learned to paint a smile on my face whenever she was around. So that, you know, she had enough to go through without you know, her dad and I and other members of the family adding any stress to that. So it was important that we maintained a unified and supportive front which is what we did. It wasn't always easy in the earlier days. But yeah, it got easier as time went on. And I think, as a family as well we decided that the only way to move forward was to embrace the change you know, there's, there's no way that you know, we were gonna force her to live as a boy. You know, and actually we didn't have the right to even try to suggest that, you know, this was, this is her life. It has to be it has to be lived by her in her way. So it was our responsibility to support her.
Jan talked about how the grandparents struggled to get the pronouns right.

Jan talked about how the grandparents struggled to get the pronouns right.
We told the wider family. I think the older members, grandparents, for example have struggled a little really to get their heads around it properly and not struggled with the concept that she's trans, to they, you know, they're accepting of that. But they struggle to get the pronouns right, because they've been so used to saying he/him for so many years. It's very difficult for them to, at their age, to change that round.’
Jan talked about contacting Mermaids and sharing positive experiences with other families.

Jan talked about contacting Mermaids and sharing positive experiences with other families.
They accept the kids up to their 20th birthday. So she was 18 when she came out. And in part of my internet searching, I came across Mermaids and I emailed them straight away just because I didn't know what we were faced with. So, we got a call very quickly actually within a day I think I got a call from one of the support workers at Mermaids. And I joined their parents’ forum immediately. And then after six weeks I was allowed to progress onto a social media forum for supporting parents. And they had meet ups once every month. So I went, [name of participant’s child] and I went to the first meet up she found it a bit awkward actually, because there was a lot of younger kids. And actually she's really quite well adjusted. But I find it quite helpful to be able to talk to other parents and share experience. And sometimes, actually, our experience, on the whole, apart from the difficulty with the GPs and everything has been very positive because we chose to embrace the change. It's been less traumatic, I guess, you know, we deal with issues and what have you as they arise. And it's quite nice to be able to share positive stories with other families who are maybe struggling who can then kind of see that there is some light at the end and that things can be alright.
Jan felt that parents should be assertive in getting healthcare for their children when they face barriers.

Jan felt that parents should be assertive in getting healthcare for their children when they face barriers.
What advice would you give to parents or carers of young trans and gender diverse people?
To fight for the care that they deserve. So if they're faced with a GP who is, you know, it's, it's their first point of call, their everyday point of call for all things medical. If they are not willing to help they need to fight to get that help.
Jan talked about the importance of understanding the difficulties young trans people face and educating yourself as a health professional.

Jan talked about the importance of understanding the difficulties young trans people face and educating yourself as a health professional.
What advice would you give to doctors and nurses working with trans youth?
I would advise them to understand the difficulties that they face and it's, you know, it's not just the difficulties in how they're feeling, but it's, you know, the situations that they face at school, in college, at university. They need to be educated and they need to take some responsibility for educating themselves for understanding and providing that care to their patients.