Noelle

I got that in, we started getting it in like June 2018 facial hair removal just on the face not much to say about it. You sit on a table they blast air at you and then stab you with a laser. It feels like pin pricks, basically. How much pain it causes depends on your pain tolerance as well as the power of the laser. There are different kinds of laser hair removal. I think IPL is the one you want to avoid. There’s two different types you can like just research this if you don’t know. There’s one that’s sort of like an at home kind of remedy that doesn’t really have any proven reduction and then there’s a more powerful one that just blasts it out of existence. But how effective that is depends a lot on your hair type and generally it works better on light skin and dark hair. And you might have to go back for top up appointments and stuff can be really expensive if you have to keep going back. I got like six treatments for like £350 and that got most of it. A year on from it, I’m starting to get hairs back and so I need to go back for more top ups. I’m not entirely sure ‘cos still, still early days with a top up appointment will finish me or if I’ll have to keep going back every year and kind of hoping that I don’t. It can irritate your skin as well. You might get like spot breakouts, that’s what happened to me. But something like a half an hour appointment to do your face. Did that once every three months or two, I think.

My first experience with voice therapy was just learning about it on the internet through forums, a lot of self-help stuff because specialists are few and far between I was quite frustrated with it though because again, a lot of conflicting information and some, some stuff that sort of had a perspective on voice therapy kind of seems even harmful, maybe, like there is definitely ways you can practice on your voice that will damage it if you’re not doing it properly. I originally didn’t work on it because I didn’t have too intense dysphoria surrounding it. That only sort of ramped up as I started to progress on hormones started to look more and more as a woman and then it was my voice that was letting me down and not my appearance. My first like official experience with voice therapy was through a local LGBT group. They referred me to a specialist. It was just to try out like free trial appointments. And it was a group one and so there was a bunch of four people there.

I wasn’t too crazy about it ‘cos they had like a particular approach that was sort of quirky, I guess. Kind of had to do these weird body movements as you made sounds. You weren’t just practising with your voice. You did all these weird movements. I think that was just like her way of getting people engaged, but it didn’t vibe with me too well. So, I didn’t go back. I mean, to get any more I would have had to pay anyway. But I didn’t wanna go back. So, I bought a book online it’s a very boring title. I’ve forgotten what it is now. It’s like, Transgender Voice Therapy. But it’s written by like NHS practitioners. It’s quite good. It’s got like a ton of different exercises in it. I would just practice doing them every day for about like twenty minutes. Yeah, I think the hardest part of my voice therapy was just keeping a routine, keep going back to it. I did it for about six months. And eventually just got burned out because of work and stuff. And not having any privacy as well. Can be weird to do all these sounds and stuff where you’re in within earshot of other people. And then, after that I just tried to incorporate what I had learned into my sort of everyday voice and how I sound now is like about a year and a half’s worth of just practising outside of that routine. Obviously, not perfect but it’s a lot better from where I started from.

Did you notice it helping?

When I first, when I first recorded myself and sounded feminine it was quite exciting. I was really happy about that. It was, of course, only something I could achieve speaking very carefully into a microphone after having practiced it like 100 times. It still felt great to reach that point. At the point I’m at now. I’m able to pass at least vocally in very, very short conversations. The longer I talk, the more my voice cracks and breaks. If I don’t have a clear throat or I’m dehydrated that can effect my voice too. It’s still quite temperamental. But again it’s like I’ve come a long way in terms of my voice. I have like a fairly deep voice. I kept getting mistaken on the phone like before I transitioned for like a 40 year old man. So, yeah. Thumbs up [Laughs].

What tips would you give to people?

Definitely keep a glass of water with you while you are practising. Generally if you find your voice’s like breaking off, you can just stop like swallow if you need to and if you just need to clear your throat or take a sip of a drink that can like reset yourself. Like it’s generally better to if you find yourself like falling off and not being able to like maintain something, you can just stop, take a break, start again. It’s a lot better than just forcing trying to like brute force it. Start small, basically, like you mentioned before about humming exercises and like humming can start from like very deep hums and slowly bring yourself up like you don’t have start like super high. I think a lot of the advice that I’ve taken in has been about understanding where sound comes from and just getting a feel for your own body. I think most particularly and I mean I talk from a trans woman’s perspective. When you are talking in a masculine way without any prior voice training. You voice tends to come from here and put your hand on your chest you will hear like a lot of vibrations when you talk. Sort of the aim is to bring that up and so you will start hearing it from here and like here. At least that’s the sort of like end goal. There’s obviously a lot more that goes into your voice than that. I think a lot of trans people tend to focus a lot on pitch and that by itself won’t make a feminine voice. I think a lot of trans people also try and look for shortcuts. One of those is like a larynx, I’m saying that trick where you sort of like lift up your larynx and you’ll suddenly sound feminine and that’s not really the case. If you try and brute force movement there it can be quite painful and it can damage your voice. I don’t think it damages it permanently, but you can cause yourself to have like a sore throat for a week just by doing that. It’s so unnecessary when you have all these other ways to practice. I was gonna say something, but I’ve forgotten. Another one of these shortcuts is surgery. When I went to the trial voice therapy with the local LGBT Centre there was quite a lot of people there who expressed an interest in surgery. But prior to doing any voice therapy, I think this is a bit brash obviously your body, your choice, but surgery is quite invasive and you might not necessarily get the results you want. It can even have complications that can set you even further back. And most of these trans women can get a feminine voice just through practice. Even if you think you’ve got like a voice that’s too deep to be feminine or you think like your starting point is so low to the ground you can still get there. You might even get there faster than other people. Like once you know the process and how to practice, you start to understand just what your voice can do.

Saw the GP in February, early February 2017 to ask for a referral to the Gender Identity Clinic what I found is that [clears throat] he wouldn’t give me the referral unless I saw a psychiatrist first because I had read online about what was absolutely required. I knew that wasn’t necessary. So, I decided to go for a second opinion. What I found is my second opinion didn’t know anything about it. So, they went to my first opinion doctor for a second opinion. Because this has all taken place like multiple [clears throat]. Because this had gone on like multiple weeks, multiple appointments and I was training to be croupier in the casinos. I just got, got exhausted by it and I was just like, fine, show me the hoops and I’ll jump through them. They referred me to a psychiatrist, but it was a telephone appointment rather than a ‘in person’ one, which never happened to me before. And I thought it was quite odd ‘cos it’s something at least you’d think it was something that you’d want like quite, if you are gonna do a psychiatrist’s assessment, you’d want it to be in person where you can get like a full impression of someone.

Anyway, the telephone appointment comes around and I call at the designated time and the nurse picks up says he’s too busy right now. Call back in like fifteen, twenty minutes. So, I do that and the nurse picks up again says, the psychiatrist has handled the case and sent it back to the GP. I was thinking, what’s the point in a psychiatrist appointment if they are not gonna see you or speak to you. But I also naively assumed that because he just sort of handled it and sent it back so casually, it was because he knew he didn’t need to do anything with it and it could just be sent onto the Gender Identity Clinic, anyway. Went back to the GP in a couple of weeks and they said they had received nothing from the psychiatrist which was disappointing. But I thought maybe it’s just stuck in the bureaucracy, the system, maybe. And I again naively assumed that my GP would contact me with the results. Two months pass, still no contact at this point I am quite frustrated because I already knew how long the waiting times are and I know the sooner I get on it the better. So, I go back, he says, he got the letter two week two months prior and so not long after I visited them and the psychiatrist had advised them not to refer me to the Gender Identity Clinic, which was just bizarre. Again, this person hadn’t seen to me. Hadn’t spoken to me. And decided all on their own that I wasn’t fit for a referral to the Gender Identity Clinic which again by NHS standards shouldn’t even be required. So, like I started tearing up in the GP appointments, because I was not only angry that it’d been rejected, but I was angry that the GP hadn’t even told me it’d been rejected. And because of that response, the GP sort of begrudgingly gave me the referral which was just eye rolling because they could have done that in the first place. So, that was August, I think, August 2017. So, if you think I’d gone for the referral in February and I got it in August that delayed my entire referral by what like five, six months which as we know now, waiting times that are like a year and a half at the earliest and up to like two and a half, three years for some services.

I think short term, at least know what the process is like up to date like I said, my own experience with the GP was like an old system where like a psychiatrist appointment was mandated. That’s not required anymore. Wasn’t required when I originally asked him for that referral. So just being up to date on what the process is for our current system is like the baseline. If you want to go further being able to prescribe bridging hormones would be great and not that complicated. Again, it’s treated as a specialised field, but you could get a very good knowledge on the subject with a few hours of reading you probably already have access to those if you are working in the NHS as a GP.

I think affirming people when they do come to you come out as trans is great. Even something as simple as like asking pronouns can show that you are on board and you are supportive I think a lot of trans people might be hesitant to go into full detail or reveal some things about themselves if they don’t feel that the GP is going to be on board.

I think blood tests need to be provided without any pushback or resistance just a matter of care and safety. It’s my understanding that things like voice therapy and ways of hair removal can be offered at a GP level. Correct me if I’m wrong but if the person asks for that and providing it can help smooth over the waiting times for GICs. Learning about sort of what local LGBT groups are available. As well as LGBT specialised therapists. Help provide the best care and support for the patients. Even talking to other GPs in the practice about trans healthcare like encouraging them to get involved will matter a lot in the short term at least until it’s mandated for GPs to know this stuff.

Traditional therapy isn’t really well equipped to deal with gender dysphoria. It isn’t well equipped to deal with minority oppression. So, like when I’ve spoken to therapists they’ve tried their best to, you know, get on board and support me. But they also don’t know anything about trans people. So, I’ve often spent like entire appointment sessions just explaining like what being trans even is. How it makes me feel. And then they’ve given me advice that’s a very like outsider advice. It isn’t helpful. It’s well intentioned, but not helpful.

Can you describe the advice?

Yes like one time, the therapist suggested I go see a consultant like a beauty consultant who dealt with mostly cross dressers, but some trans people as well. But it was kind of like they’ll stick you in a nice dress and wig and then take you to a café shop. That’s like the package and you pay for it. But not only did that not really interest, ‘cos I’m not really interested in just being like a woman for a day. I was already at a point where like appearance wise I didn’t need wigs and I didn’t need dresses. I had all that I needed. It wasn’t appropriate for not only my stage in the transition, but also for how I felt about myself.

I learned that it was a thing that you could do and that you didn’t, if you had the money, you didn’t necessarily have to wait for a GP under the NHS. I think knowing going into it just how long the waiting times I knew that I couldn’t wait. It didn’t really feel like a choice for me. I looked at so many different medical guidelines for prescribing hormones kind of learned exactly what the dosages were and what your hormone levels should be. I knew more about it than my GP and so like while there is probably an impulse to say that I am being reckless and that I don’t know what I’m doing. A lot of the people that I’ve spoken to inside the NHS knew less about it than me. So, yeah. I bought them, grey market on a website that I knew I could trust because so many other trans people had accessed it so many testimonies that I could be pretty safe knowing that it was a legitimate source and that people were having results. So I guess I started that in sort of 17th March 2017 I think is the official date.
 
It was quite intimidating, at first. Again, it didn’t feel like I had a choice. I felt like my mental health would have just kept falling and falling and falling if I didn’t do this for myself. I knew if I went to a GP about it they would just tell me not to do it. And that wasn’t an option for me  so definitely like the first few months I was on it was quite like worrisome like I didn’t know. Even though I knew what the side effects were, like what to look out for. What dosages to take. What hormone levels should be. It’s still like quite a big thing and to go through that unsupported was worrisome. The further like time went along and the more I started seeing results and being like wow it’s happening. It reduced any like anxieties to sort of nil, basically. And nowadays like it’s so normal for me. I kind of like worry that by the time I actually get HRT through the NHS, it’s gonna be like lower standards of care than what I’m giving myself if that makes any sense.