So my fourth appointment at Nottingham gender clinic is behind me – and the news is that I have NOT been prescribed estrogen. Which, after two and a half years of waiting, kinda sucks.
But I’ll get to that bit later. I couldn’t sleep a wink on Sunday night. I wasn’t particularly stressed, I just get insomnia and frequently break my body clock. This was just another one of those nights.
I got up at 5am and started to get ready, even though my appointment wasn’t until 9.30am. I decided that, seeing as driving to Nottingham in the rush hour takes bloody eons, I was gonna be brave and travel in on the train.
As this was to be my first journey on a train en femme, I decided I was going to dress down a bit. I wouldn’t have worn a skirt or dress anyway as it was 1C outside and the worst frost of the winter.
So I opted for combats and a new black jumper (what is the point of three-quarter-length sleeves – they do NOT keep your arms warm?!) and my big black winter coat. I had fake boobs and my wig, so was presenting as female, but looked pretty androgynous really. Apart from my daisy-patterned Rocket Dog trainers, I guess.
And then out I headed into the world, feeling scared as I’ve not been out en femme in my little town much before. The ground was sparkling with rock salt and frost, each trying to outdo the other.
I walked past a blokey bloke standing by the lamppost on the corner of the street (there’s a song in there) and then past a couple of guys unloading casks of beer outside the local pub. Could have done with a pint for Dutch courage.
The town centre itself was really peaceful. It was still early, so most sensible people were still in bed. I wondered if it would be as quiet at the railway station.
I headed over the bridge, turned a corner and saw dozens of dozens of people standing on the platform. Great! I was feeling pretty nervous at this point.
I got my ticket from the machine and then stood on the platform with everyone else for ten minutes or so, waiting for the train, which mercifully was on time.
Nobody stared, nobody seemed to care – they were more occupied with stamping their feet and blowing into their hands to keep warm. It was a freezing cold Monday morning and everyone was grumpy, on their way to work. The last thing they could have given a shite about was little me.
The train arrived – a crappy little “bog unit” of two carriages. It was old, dirty and had no heating. But at least I managed to bag a seat, next to a chap in his 60s. Others weren’t so lucky.
And then off we trundled, stopping at towns and villages on the way to Nottingham. Not a single stare. I even felt confident enough to do a #transontrains selfie. It’s quite amusing looking at the Twitter hashtag now – loads of transwomen I know looking super confident on trains, and then me, looking petrified!
I was tweeting quite a few of the girls during the journey, and they were all giving me moral support – both for the journey and the appointment. After all, if all went well, the clinic would instruct my GP to start prescribing estrogen.
It didn’t help that I was so, so tired. I just wanted to sleep. I didn’t have the energy for a big, scary train ride. we pulled into Nottingham, past the array of “Vomit” graffiti tags near the station and then off I stepped on to the platform.
I felt loads more confident being in a big, multi-cultural city than in my little town, where shed loads of people KNOW ME! And, with the aid of Google Maps, off I trotted to the gender clinic, which is now on Broad Street. It was moved over the festive period, and this was my first visit. The old one was in Oxford Street.
I was half an hour early but decided to head in there anyway as it was FREEZING. The lovely receptionists showed me through the waiting room and gave me a form to fill in to announce my arrival (didn’t get that at the old clinic). My handwriting looked awful as my hands were so cold.
There were no other trans types but there was a whiff of disinfectant and half a dozen cleaners chatting very loudly to each other and to people on the other end of mobile phones. Pipe down, ladies! I’m tired! At least it was toasty warm.
My appointment was actually split into two – the first with an endocrinologist, who was to go through my blood test results, and the second with Sally Robins-Cherry, my fantastic psychotherapist. So one to check all’s well physically and the other to check the same mentally. All bases covered.
Eventually, the endo came into the room and introduced himself as “the hormone doctor”, Dr Sands – a really kind and amiable chap with a glint in his eye.
We headed downstairs into the basement into a cooler room and he dug out his copy of my blood test results. I was pretty concerned about them because my prolactin results were high – read about that here.
But he didn’t seem too concerned, especially as I explained I had no symptoms of prolactinoma. “They’re highish but not the sort of levels we’d worry too much about,” he said, adding that my antidepressant could also be responsible.
“One thing that can put it up is having a needle stuck in your arm,” he added. “We’ll probably just keep an eye on it.”
Brilliant! The prolactin level had been my biggest concern – and all was well.
Next, I popped up on to the couch for him to listen to my heart and breathing – probably a little tricky for him to get past my corselette and fake boobs, but he seemed to manage! All was fine there.
And then we went through more blood test results – cholesterol (fine), liver function (ditto), kidney function (that, too).
He kept stopping to ask if I was alright and what I thought of the process so far. I was feeling great – I’d really perked up.
Then we went through the serum testosterone results. Mine was 24 – normal for a biological male, but we’d need to be getting that down to zero ideally.
Estradiol (estrogen) was a similar story – a reading of 93. We’d be needing to get that up to between 400 and 600.
And then things took a turn for the worse as we came to look at the haemoglobin results. Haemoglobin is a red protein responsible for transporting oxygen in the blood, but I bet you knew that already.
“The total haemoglobin is slightly elevated,” said the good doctor. “Your blood is thicker than it should be, so it might need looking into. It might mean a referral to a haematologist to sort that out first.”
My reading is 165 – slightly higher than the 150 maximum threshold. I have more red blood cells than I need, too.
“It is something we need to worry about because you’re thinking of going on estrogens,” he added. “The main worry is the DVT.”
Great, more worry! He was referring to the DVT I suffered in the summer of 2015 when I was taking phytoestrogens – the event which led to me asking my GP for a gender clinic referral “to do it properly” in the first place. Read about all that here.
To be honest, I’d not really considered my DVT ahead of going into this appointment. I’ve had no flare-ups since, it was treated and it went away. But having had a DVT means I’m at increased risk of having another. And estrogen further increases that risk. And thick blood? So, yeah, I can see his point.
“It is a significant risk,” he went on. I was taking shorthand notes, btw. “Some doctors refuse to prescribe estrogens [to people after a DVT]. We might need to compromise and go for patches, which are far safer from the point of view of blood clotting. I have to look at the risks as well as the benefits. Normally, I would have gone ahead with the patches [for you].”
Thanks, blood cells! He also said it might be necessary to aim for a lower estrogen level than a higher one, so more 400 than 600.
So there ya go. I’m off to the haematologist to get his or her opinion. And while I was initially disappointed at yet more delays, it’s better to get this right rather than having another DVT. Let’s not forget those blighters can prove fatal if they travel to the brain (stroke), heart (heart attack) or lungs (pulmonary embolism). No thanks.
I remember speaking to a haematologist after my DVT back in 2015 and asking her about taking estrogen then. She said one simple solution would be to just stick me back on blood thinners, such as warfarin. If that’s what it takes, bring it on.
Dr Sands then asked me if I’d like a testosterone blocker as well as estrogen, and I said yes I would, thank you very much. Those are usually introduced about six months after beginning HRT, he said, asking if I knew about the side effects “down there”. Of course.
And then he did my blood pressure, which was a little high (natch!) but nothing to worry about. So now I wait for my referral to the haematologist. My life seems to be a never-ending whirl of hospitals, clinics and doctors’ surgeries. And needles!
I realise this post is becoming like War and Peace so, if you’ve got this far, well done, the end is in sight. This website’s not the clickbait kind. I want to write about real experiences – and hopefully help people who are in the same boat.
So my next appointment was with Sally. Upstairs this time. She asked me how I was, and I told her I was disheartened because of the new delays.
She does empathy very well, does Sally. I guess that’s kind of a handy skill for a pyschotherapist to have. She said: “I’ve never known anybody not get their meds, even when they have a complex medical history.
“It just needs careful monitoring. As far as we’re concerned (we being the psychotherapists team), you’re ready.”
Which was fabulous to hear. Then we had a bit of a chat about everything from my parents and work to TERFs and progesterone (not prescribed to transwomen in the UK yet but big in the States).
Finally, I asked her about electrolysis to finish off zapping the hairs on my face. 21 sessions of self-funded laser has got most of them but I’ll need electrolysis, via the NHS, to get the remaining white hairs (no pigment for the laser).
For those interested, up to £1,575 of funding per patient is available for this, which would pay for about 20 sessions. I doubt I’ll need anything like that many, though, as most of my facial hair is long gone.
And I signed up for the voice therapy service, which is also available via the clinic. I just figure that if I’m going to do this transition, I might as well do it properly. Apparently, the waiting list is quite short, and I’ll need weekly sessions. If anyone wants to know more about voice therapy, click here.
I finished by giving Sally some really positive feedback I’d seen left on a forum by other transwomen who’d been in her care. That made her day.
Then it was back into the frozen wastes of Nottingham, where I ordered a coffee at a fabulous sandwich shop, and headed back to the train.
I felt completely fine walking back through my town back home. As Sally says, all of this gets easier the more times you do it. Practise makes perfect.
Thanks for reading, folks, and have a flipping amazing Pancake Day!