Experiences of trans and gender diverse young people

I’d like to see the psychiatrists give up their power over us. I would like to see more trans, I’d like to see healthcare built around trans people’s knowledge and needs of ourselves rather than them just being about having power over us, and us having to jump through hoops in order to acquire the things that we need. I’d like to see more trans people involved in our healthcare, but not necessarily as like psychiatrists, cos we want to abolish psychiatrists, so maybe we don’t want to train as psychiatrists, that wouldn’t be great. Because we’ll be coming to you, and like yeah, it’d be like I generally want to see more just more trans specific services because I want trans services to be like available throughout healthcare services, you know, we need more like easy accessible things, and like I don’t, I feel like there are some things that are really specialist and they’re important, and when it comes to healthcare provisions but also like there’s loads of stuff that could easily be done through a GP, safely and that’d be great. And also like there’s a lot, I think there’s a lot of things about like oh, certain things are irreversible, and like sure, like surgeries maybe are quite, quite invasive and seemingly irreversible, seemingly, I have to say seemingly. But it’s, so much, so many things are like already framed around a fear of doctors getting sued, because, and not about like, and like that is like, I mean like that’s like a comment I’ve heard I think almost like, maybe, like most of the GIC people, people who work for GIC challenge, say, as it’s like are you more worried about that than actually providing the healthcare that people might need. And, but also it’s okay if people change, like if, like trans is about movement, it’s not just from like one direction to another, like it’s okay if, if hormones work for somebody for some part of their life, and then they decide oh maybe I don’t want to take these anymore. Like that’s fine, like, yeah. We just need to like just be facilitating more, a need for more options. Like people need options, people need to see opportunities, like it’s not, not everything is the end of, is like the life or death, like you know you do this and that’s it. It’s, cos it doesn’t work like that.

Yeah so the old process was you go to your GP, and they refer you to the community mental health team, they tick you off, and then a funding negotiation basically happens, negotiation, and they say, “Oh we can work, NHS Wales will fund your transition,” and they’ll hand over that money to NHS England, and your care will be taken care of by Charing Cross, and you’ll be put on that waiting list. Now luckily we have a, this is I’m hoping the system, like the rest of the UK will also adopt, because I do think it’s better, especially so you get referred to the Welsh Gender Service, and at the moment there’s only one clinic in [city], the hope is to expand that to different parts of Wales, and they will see you for your initial appointment, essentially. And they’ll talk like, you’ll talk to a not a psych, again there’s no actual psychiatrist or anything like that but it’s just someone who’ll like, and they are trained in the gender stuff, and stuff like that.

And there’s, and so there’s no, so your GP can directly refer you, so there’s no like middle person to like negotiate or gate-keep with, and they’ll talk to you and they’ll like they’ll ask you like what kind of care do you want. And essentially and that doesn’t matter if you’re a binary trans person or a non, or a non-binary. So if you, if you have an idea of what care you want, or if you need to be talked through that, like what they can do for you, that is something they can do. Which is much more affirming in care, especially so.

Like so the Welsh Gender Service, they don’t, they don’t they can’t refer you to surgery yet, that’s still done via Charing Cross, so but they can do everything but that. They can do a surgery sign-off, so you can get your initial signature, so they’ll like discuss your options, so they’ll be like for, obviously I’ve only experienced the AMAB trans fem route, so it’ll be like, “We’ve got HRT, we’ve got we can refer you to voice therapy, we can obviously get the HRT sorted and we can also think about discussing surgery options in the later appointment when you feel comfortable, or whatever.”

And so yeah, and so essentially that’s basically it, and then it gets, goes to primary care, which is where it should be realistically, so they’ll be like, okay we’ve told your GP this is what you need, and so your GP will prescribe it to you and they’ll monitor your bloods and stuff, like that, so you don’t have to travel to the Welsh Gender service again and again, and they’ll be like and at the moment like, so the eventual goal of the system is that all GP’s will be able to prescribe and do it, but some GP’s still don’t feel as comfortable doing it yet.

So in the interim, I say interim, I think it may become semi-permanent to an extent, I think it has, there’s a local gender team, and so this is a gender team in each county so like regardless of where you are in Wales there will be a gender team in each county and they will do, they will do the prescriptions and if there’s no nurse that won’t do the jabs in your practice for example, they’ll also do the jabs. They’re like that’s what’s happening to me, so I’m going to the local, I’ll go to the local gender team, and that means especially for people in Wales with terrible travel links especially, like going from North to South and stuff, so if say someone gets referred from the North to the Welsh Gender Service, they may have their initial appointment in [city], but the rest of it will be communicated through the local gender team. So, they’ll just have to see them instead of having to travel.

Which it makes sense to do it in a primary care model, and that’s the hope that like, we’re trying to set the standard and we’re trying, I’m in, helping with talk with people like I’m actively been talking with the government and well the group I’m part of, and like we were involved in putting, getting that statement put out by the Welsh government. And we’re hoping, one of the aims for these future meetings too is to expand the service to under 18’s, because at the moment Wales also doesn’t have an under 18 service. They still have to be referred to Tavistock and go through that route. And we’re hoping to make, essentially give what we’ve got the primary care model we’ve got now, and essentially do it for under 18’s too.

So the thing that really stands out to me is that when I tried to access Trans healthcare services prior to having the conception that I wanted to be a binary Trans man as that was how I identified, I really felt a lot of pressure to have all the answers going into the GP or going into even CliniQ actually, going into any health service I felt this pressure to have a very cut and dry conception of what my gender was and how, what trajectory I wanted to take and what services I needed and whether that was medical or non-medical and I felt like there needs to, it needs to feel safe in order to like for someone to, to not have the answer to any of those questions. And for them to feel like they’re still gonna be held in the same way and receive the same level of service as someone that knows that they wanna medically transition and has like has an idea of like a timeline in terms of like, you know, surgeries. Because I think that yeah I think people who are sort of less sure about these things can kind of get lost on the wayside. And they, yeah and they risk not being able to sort of have the same level of care in services, yeah.

Abolish gender identity clinics, informed consent, hormones for all over 16’s because that’s you know, Gillick competent stuff* and then for potentially for under 16’s on a case by case basis you know, as assessed or as discussed and, you know, found appropriate by their doctors I think is probably the best way forward, I might be, you know, might be happy I could be wrong on that, I don’t know enough about, you know, under 16’s healthcare specifically but I think it’s something that needs to be done, you know, you can’t just blanket say no, none of it, I think it depends on the person it may be appropriate or it may not be appropriate and it depends also on their family and how accepting their family’s going to be. If their family is, you know, unaccepting of this person being Trans it may not be appropriate for them to have hormonal therapy or at that point puberty blockers for example may be appropriate because, you know, you don’t necessarily need to tell your parents or they may not necessarily know. But that’s another kind of issue entirely, but yeah I think maybe informed consent models are good which should definitely be for over 18’s and, you know, or over 16’s and then case by case informed consent for anyone younger that it applies to although again, you know, no-ones saying that seven year olds should be having surgery or hormones, I’m certainly not saying that [laughter]. And just, yeah in general our healthcare providers be more aware and yeah just not these arbitrary gate keeping long windows that are there as a relic of the past essentially.

*See here for a discussion on this Giordano, S., Garland, F. and Holm, S., 2021. Gender dysphoria in adolescents: can adolescents or parents give valid consent to puberty blockers? Journal of Medical Ethics, 47(5), pp.324-328.

It’s an uncomfortable thing. Most trans people that I know have an ambivalent at best relationship, like binary trans people at the least have an ambivalent at best relationship with their genitals. So, you know, going to the sexual health clinic is not fun, ever for anyone. Whatever can be done to normalise and explain the decisions that’s been made and why things are structured the way they are structured. And again like, I don't know, part of me sometimes feels like, oh no are we asking too much, but like, is it too much to be asking that non-gendered language be used? Use they use like, you know, and again, I know people sort of well TERFs (Trans Exclusionary Radical Feminist)* in particular get up in arms about people with vaginas but just like, you know, biological female. Like, you know, that’s something. Though not necessarily a woman. You know, I don't know. Like, again, do I have the answers for this? No. I know what I’d like. But like do I think that would necessarily be acceptable to a cis majority population, no. Do I think ultimately, you know, it’s always a balance between what we’re going to be able to demand for ourselves and what we’re not going to be accepted for asking for, sometimes. Maybe it’s a bit pessimistic.

*See here for an introduction Pearce, R., Erikainen, S. and Vincent, B., (2020). TERF wars: An introduction. The Sociological Review, 68(4), pp.677-698.

I think it would be really nice to see like changes from like pretty much like the beginning of the process of like you go to your GP, the form is inclusive, people are trained to use inclusive language, you know you don’t need to have a title if you don’t want to, but if you do that’s like a Mx option. And I think just… I think healthcare services as a whole really need to like de-pathologize , there needs to be like moving away from, again putting people into boxes, and thinking you know well there’s cis male, cis female, and here are the issues that they have, because it impacts everybody right, it impacts so much in terms of like what healthcare is provided, what services are offered, what problems are considered, you know. You hear all the time people with like uteruses, and wombs and stuff like that, like always their health, you know is often very problems are dismissed and problems aren’t identified where they might be, you know like with endometriosis and stuff like that, and that comes from this like really I think ingrained framework of like just ticking boxes, and just having these biases of like what, what problem might be caused by and like not being able to adapt to like the person in front of you. And I think having like trans specific healthcare services I think is really important, because I just think it’s, you know in the same way that we have like mental health services, like to have really like thoughtful, with like good training spaces for people to go where, you know, in an ideal world, you know is like people will understand what services I need to access here, and you know you could, like again in an ideal world you can trust the people in these spaces to know options for you, and for your specific needs. You know I would, yeah, I would love to see more of that in mainstream healthcare as well, and in your GP’s stuff like that. But yeah. I’m sorry, Utopian dreaming.

Well, they need to train more clinicians at the GIC. They need twice as many as they have now. Three times as many don’t just bring in two more people and don’t start to, you know, train them now for ten years in the future. Bring in a lot of people. Train them up and move to a bigger venue and just you need to be able to cope with the number of people who need this service. And like and just stop asking, stop asking us about our sex lives. Stop asking us about stuff that isn’t relevant, you know. Stop asking me about my childhood when I transitioned two years ago. Ask me about my trans, ask me about my transition, you know? Like just, do away with the, you know what also hormones have to be more readily available. A trans person should be able to go to the GP and say, I want hormones and get hormones, because it is not going to cost the NHS that much. And it is not that risky and people should be able, people know what they need, and yeah. That like greater access to hormones is a really, really big thing because that causes so much anxiety for trans people in this country. Training up more people at the GIC. More GICs. Like, yeah, why not? More greater awareness among trans like trans specialists and healthcare professionals in general about who trans people are and who non-binary people are and like, you know, what dysphoria is and what it entails.

Education. Information. Even it if means giving NHS staff, you know, like ideas of like pronouns and updating of systems and that kind of thing. I think there needs to be also a slight deviation from the NHS and like the government and legislation. I think the paperwork of one becomes so much the remit of another, so the idea that my medical transition will be held off because of a name change that I do or don’t make, when that has nothing to do with my health, is a bizarre two-step. I think doctors need support and training, particularly GP’s. I think we need more doctors, certainly more specialists, so that the waiting lists can cut down. And investment, there just needs to be an investment in, in understand that this is going to continue to be something that, that if numbers are anything to go by, it’s increasing year on year. Which means you can’t just go with how things are, and it would be great I think to see the UK take gender and things seriously. I think the thing that’s exciting I guess from a medical perspective is that they have the opportunity to be at the top of the field, for showing what it is that standardised state care could do, and how to embrace the challenges of it. It would be great to see more of that rather than the dread of, “Oh no, we’ve got to learn another thing about something that we don’t really care about.” Cos that’s a boring idea.

So many thing [laughs]. Shorter wait times at the clinics, mostly. But that would require, I mean, we need more gender specialists in general so that we can reduce the waiting times and a better funded NHS for that as well. Better informed GPs is something I’ve already mentioned. And just a slightly more tolerant society, as ridiculous as that sounds would be a relief.

Shorter waiting times. More doctors, better informed doctors and less gate keeping.

How do you think that could be done best?

[Laughs] Overhauling our entire medical system. [Laughs]. No, I think we need better incentives for doctors so that we get more doctors so better funded NHS in general as well. More gender specialists. I think that’s one of the key reasons the waiting list is so long is just because there aren’t enough doctors. And with a growing trans population they can’t meet the demand and that’s why the lists are getting longer and longer and longer.

And then maybe if we had more doctors and there was less, it was seen as something in its own right, rather than a subsidiary of well, less so for Tavistock now, but was previously a subsidiary of the mental health services when obviously transness isn’t a mental health issue. And so being able to get away from that kind of stigma and if it was kind of recognised in its own separate branch, not separate, but kind of individual branch of, of medicine and healthcare. We might also be able to get a better standard for treatment across the board.

It's ridiculous. And it's disgusting. I understand there has to be a wait, a wait, for a while. And I understand that, you know, they can't just rush and see everyone immediately. And when you get there I understand they have to do assessments and they have to do assessments and checks to make sure you are making the right decision and stuff. But, it's too much. And I understand, the idea of the six months assessment I think is when the waiting list was so short, someone could come out as trans, get referred, a month later, they could go and talk. So, of course they do a six months assessment and then possibly another six month assessment. So that person would be forced to live as their, you know, their true gender for a certain amount of time and make sure they were comfortable with it. But now that the waiting list is two years long, by the time someone's got to the top of the list, they've already been living as their assigned gender, not their assigned, their true gender for two years and they don't need an assessment anymore, because, you know, not for more than a couple of weeks or a few questionnaires. You know, they've already been doing it for two years. I think it's, it it's too long of a wait.

And especially with being moved to the adult list. If you're moved off the child list, all that happens is you get moved to the bottom of the adult list. There is no separate thing. There's no, well, this adult's been waiting six months, but you've been waiting two years so you go above. It's nothing like that. It's just, sorry, bottom of the list, pretty much. Unless you've already had your assessment done in which they only move you up by about six months. I’m like, it's ridiculous. There are people who have been waiting, who will get to the top of the adult list and they've been waiting four years which is what they're trying to do for me. The NHS clinics are trying to do for me and they've been waiting four years. Some trans people aren't gonna live through four years of this or they're just not gonna make it, the stress, you know, people who already have mental health problems as well, you know, and then have this on top of them. They won't, either they won't make it or they'll develop more problems, you know, the number of trans people especially trans men who develop eating disorders because they're trying to help their body in some way, because they're, you know, desperately don't want to be viewed as, as female and they just can't wait any longer. You know, you get people self-medicating which causes health problems and they die from self-medicating and stuff and it's, the wait is horrible.

And you know, I think that the Tavistock especially don't understand just how awful it is to wake up every day in a body that is wrong. How awful dysphoria is. How awful it feels to be misgendered. How awful it feels to be trans when all, when you know 100% for certain all you want is your hormones. And they seem to think that, ''Oh you think that you're it's gonna magically fix your problems.'' No, we don't think it's gonna magically fix our problems. I think it's gonna magically get rid of half of my dysphoria, because I'll have the hormones and I think they don't, they don't get just how awful it is to wait that long and then just be moved. And then, you know, when you get there and it's a six months assessment, it's ridiculous. They need to take into account that now the wait is a very long time and therefore when people get there, suddenly going through ''We're gonna do a six months assessment and are you sure you want hormones?'' All of that is just, it's offensive that they do that when you get there, so.

Big one for me is I think the lack of support. You know I don’t see the GIC as somewhere that should be just as assessment-based place, that your only interaction with them is being assessed. Support prior to you know, there’s a huge waiting list for the GIC’s, I get that, they can only see people as quickly as they can see people on limited resources, a hundred percent understand that, but the fact that there is nothing between that point of referral and the point of, and the point of getting to that first appointment really, really does worry me. You know you think, the, you know the vulnerable positions that a lot of people are going to be in, the mental health implications of that are huge. Yeah, I just feel like there’s a, there’s a lack of a space to discuss things with anyone. You know you sort of go to the GP and have to, feel like you have to be in a position where you’re sure enough to convince them to refer you, and then the next person you interact with is the one who’s assessing you to decide whether you can have hormone treatment or not. Or whatever it is you’ve gone there to, to access. Nowhere in the middle is there anyone to, to, where it feels like you can have an actual discussion with, and work things through. And for me I feel like I’ve only had that through going and seeking private counselling to find that space. So, it, in the healthcare setup as it is now, I do feel that is lacking.

I have no bitterness towards the NHS or professionals, because it’s under a lot of strain and it’s a bit annoying when you get referred to Tavistock or the other closest gender clinic or wherever that may be or CAMHS even and the waiting list is like a very long time. I think Tavistock I find still on the waiting list. I still have about fifteen months which is, I think by that time I might be eighteen, I’m not 100% sure, but I might be eighteen by that point. I might just take my name off Tavistock actually, because I think I’d be like holding up dead space on that list. It’ll be quicker to refer myself as an adult, but. It’s just, I think, as a whole, mental health needs a bit more like funding support for young people needs funding, ‘cos it’s not just trans people. Like, if you get better support for people who are struggling and unable to cope healthily, that will help general mental health. I know it’s not like mental health trans like it’s not like they go hand in hand, because as much as they’re very closely linked, just because you improve one doesn't mean you’re necessarily improve the other like you can give someone a million and one healthy coping mechanisms and they will still feel terrible gender dysphoria from time to time or they’ll still feel incredibly like unhappy with their life. If you give more support to people and give them spaces to talk about it, because to be quite frank not everyone finds it enjoyable when the school has mental health days and tells them, hey, are we gonna talk about our issues. Not everyone enjoys that, but if you give them the spaces to reach out then I think it would be a lot better.

So this is something that of course I am so passionate about. Just due to my awful, terrible experience and the fact that I'm still, I'm still going through this at this stage and I feel like I'm not able to live my full life yet until you know this final thing has been done for me. So it's a case of I know that with any luck I may be complete by 35. But imagine, imagine spending 35 or 36 years of your life miserable not being able to actually live it. Like it just is it's absolutely bizarre, so bizarre. And you know I can't understand why it takes so long for you know for people to get the treatment that they need. I mean even covid, I mean covid has slowed things down for a lot of people but there are things that can be done in order to keep the service moving. Like there's things like some of the consultations that you have, that can easily be done over zoom etc. So I don't understand why they're not making any efforts to find any sort of workaround the things. The truth is just because they generally do not care. They do not give a shit and it needs to change. It has to change because it's not humane to make people continue on like this. Like the recent fuckup with the bottom surgery now. There's people who are half done so imagine, imagine you've gone through years of all of this and you know you’ve decided to get the bottom surgery but you're half done, your genitals are half done. You're going around for years with half done. When I'd say half done, you've got like what a phallus and you've got no balls, you just got a phallus that you can't use and some people they can't even wee out of it. Some people can, some people can't, it’s a case of they’re walking around like that. Like imagine the impact on that person's mental health to obviously they was already waiting years to get to the next stage and then all of a sudden now finding out there's absolutely no surgeons in this country that can actually do the rest of their stages that they need. And then they have no idea when they going to sort it out. They actually told us, July this year, they were meant to find a new provider. Still not done, we’re in December. So it's a case of, imagine the mental health of these people, imagine just little things that you want to do so much as, you want to date someone or whatever. Now imagine having to every single time explain why you are half done. Like I don't understand how people can be left like this, it's not right. It's not right and it needs to be improved because it's, the thing is this is something that I am so passionate about it's hard for me to find the words because it really angers me as well. Because this is people's lives, like people's lives that are not being able to be lived just because other people in charge do not care. 

I think the biggest thing that needs to change is the Tavistock and it is difficult to even confront that because it feels like it needs such a major overhaul that it feels almost impossible to change it. You know, I’ve listed previously what I’d like to see changed about phone calls instead of meetings and all that but I think that is certainly part of it, the Tavistock shorter waiting times easier accessibility to blockers less of a focus on trans medicalism and more of a focus on there being medical aspects to transition for some people but not all people and acceptance on the validity of maybe not wanting that medical transition so much and maybe being happy just with social transition. But certainly the Tavistock I think just needs a major overhaul and CAMHS is the best, I think the best it can be I think they struggle because they’re under resourced and I’m sure the Tavistock is to an extent but I still think that even within how the Tavistock’s working right now it could do better with its resources so really yeah and overall, an overhaul of the Tavistock in all the ways that I mentioned before would be great to see.

I would like to see general practitioners and general services become more practically affirming of trans people, and by practically affirming, I mean not just saying, not just doing the bare minimum, not just saying, “I support you, I think what you’re doing is great,” but actually training themselves to have the knowledge to support people, support trans people to not have to co-ordinate their own care, and to not have to explain to the professionals and educate the professionals themselves. I guess I would love for the onus to not, and the pressure to not be on trans people to educate their own healthcare professionals. That’s how I’d like to see it change.

And I know that that has to start, that has to start with the education, and that has to start with trans people. So, you know I know that that has to start somewhere, but I don’t think it has to happen in a clinic room. I think that I’d like to see healthcare professionals and healthcare systems as a whole adopting a willingness to be educated in a, in more formal settings.

And I think it’s right that trans people lead the way on that, but then we need to, we need to be putting ourselves forward and not feel pressured into having do, having to do that if that makes sense? If that distinction makes sense.

I would obviously as I don’t think there’s a single trans person who is okay with the fact that the waiting lists are four years long right now. So, I would love to see those change, and obviously that comes with greater funding for support for gender specific, gender clinics essentially, and gender specific healthcare, that’s probably asking a bit too much. But then again is it? I don’t know. I don’t think it is.

And I would love to see projects like this, I mean this, a project essentially and this research is, I think an excellent example of how we change the, how we change the culture of healthcare, and how we change, how trans, how we as trans people interact with healthcare, cos whilst I’d hope that this educates trans young people like you said, and just trans people like me in general, cos I’d love to get so much out of the stuff that you’re gonna produce. I would like to hope that maybe healthcare professionals also are able to access this, because ultimately I feel like this is the level that they need, and that’s, maybe this isn’t the right format but it’s these kinds of things that they need to know about, that they don’t.

Mental health services in particular as well. Cos I a big kind of bug bear about that and a big, a big passion about that. Trying to think if there’s anything else really. Certainly regarding kids, I think, you know the service that my, that the CAMHS service that I work for has a, the GD pathway, gender dysphoria pathway, is a great example of how services can support trans kids and trans young people, and trans people in general, you know if, if the community mental health team in adults mental health services had the same kind of support group, that in itself could be transformational for, for trans people, it doesn’t have to be for young people. So those are the sorts of spaces I’d like to see as well, that promote people’s mental health. So, I hope it’s not too much to ask is it, all of that? I don’t know. Those are the things that I’d love to see, and able to see improvements there.

Yeah, I think the thing that, there needs to be people that are experts and are going to show that expertise, I can’t be the expert in my own healthcare. That’s not always the best situation. I mean sometimes it’s a good thing but it’s like more often than not I need people that know something, at least know something. And I can see on a regular basis. I don’t know, I think that it just needs to be, well it needs to be more with it, I guess. Honestly, I don’t know. Like I think for me if I had seen them on like, a less, if there was less of a wait time and they were closer, that service would have been fine. It still wouldn’t have been like the best thing ever, but it would have been fine, it wouldn’t have been like the kind of mess it is now. I think it’s all just you know, it just needs to be like accessible at some point. It’s nothing really, that’s the first thing that needs to happen before anything else, and I don’t know, I don’t see the point of like tinkering around the edges when you’ve got that huge gaping failure. It just doesn’t matter. It just, it doesn’t matter like you can, like I don’t care, and I guess this is very like, the way it is to me is kind of a very classical transsexual, but it’s like you can’t really change language, you can’t really change like, at some points it needs to be there, it needs to actually function. And it doesn’t.

How would you like to see healthcare services change in the future?

For them to be actually free fair and equal. To prioritise Trans health but like prioritise Trans healthcare but not prioritise it above anything else because it’s an, it’s a service that should be accessed as much as any other service should be able to be accessed and it just means that NHS needs a whole lot more funding and the ways that we think about Trans people needs to transform it needs to change and the longest you should wait is like a couple of weeks before you like, the process needs to just, the process is built on a basis of like transphobia, it’s built on a basis that like Trans people don’t know themselves, that we need however X amount of time before we can truly decide like once we’ve actually, it’s just built on like a very harmful and toxic structure and so just, for that to just be completely overhauled and just make services accessible to whoever needs them.

And The amount of waiting is absolutely ridiculous. No other sector has to wait this long for anything, just to be seen. And on top of it they don't provide any mental health care. I don't know how that’s, I don't know how that's been allowed. It needs to change, it needs to improve. We need to have more gender clinics, we need to have more people trained in this. We need to have people who are trained that are actually passionate about this, that want to help, want to be there. Because the people are there right now they don't want to be there they don't care, they don't care about us, they don't want to be there. We need people who want to be there, we need trans people in these positions, we need trans people in powerful positions because this cannot continue the way it is. Like how is it that I have to wait until I'm late 30s may even 40 to live my life. Like it's very distressing, the fact I have to now go on for god knows how long like this. Obviously I've, you know I've masculinised, I've had my top surgery. Now obviously my issue is, I have to always explain myself to, you know when it comes to say dating or whatever, I have to explain myself. Or even just to use, just go to the toilet sometimes like obviously there's that luxury of when you’re a guy and you've got a penis like you can just wee anywhere, that convenience. Then it’s like, people like “oh just do that” don’t have to explain it. Why do I have to explain that? It needs to improve there's too many people who are not living their best life because of this and they need to get mental health people who are trained socially in this to help us while we wait. Because that's the least, that's the bare minimum that can be done to help while we're waiting for this stupid amount of time. But you know I have every hope that the more that I get involved with focus groups, with things like this, I just hope that you know there's that change, that change will come in slowly but surely. When more people start talking about it, when trans people start becoming influencers, when trans people start appearing on reality TV shows. All these things like that I do have the hope that these things will change for us but obviously we just have to be strong and hold on. But you know, the NHS they really need to buck up their ideas because the thing obviously that's personal to me at the moment is the bottom surgery. And I don't see why they can't give us the option to go abroad while they're waiting to get a new vendor because this is not a service. I'm a hard-working ciizen, I pay my taxes, I'm entitled to the treatment I need, just like every other person that walks into an NHS hospital etc. It's just wrong that you know that we're been denied that one thing that you know we're supposed to have. That sort of you know, is a human right, we're getting denied that you know. Just a good quality life that is literally it. So I just hope that you know someone out there can hear our experiences and have a bit of compassion and speak to those people in power and get this done for us because this, it can't continue like this, it can't.