Becoming complete by subtracting something

Wiki

This page is moved to https://eunuchfriends.miraheze.org/wiki/Obtaining_hormone_replacement_(NHS)

Introduction

This article outlines some of the routes to treatment and pitfalls along the way.

It assumes that the patient has been open about their desire for castration and has involved their GP in their decision.

Presenting with testicles smartest removed is reported to give improved progress through the maze to treatment.

Via gender identity clinic

So far this route has proved fruitless. The line know previous attempt (by Eunuchorn) resulted in a “we don’t do eunuchs” response.

A key strategy here is to ask for a quick response if they cannot help. They may be happier to simply reject you if you are open about wishing to transition to eunuch … this rejection becomes important later on in the process.

Reputedly, one could attempt to “play” the system, which would involve waiting anywhere from six to ten years for a first appointment, then taking testosterone blockers and estrogen, then having an orchidectomy – all of which requires two psychiatric assessments.

Effectively, one needs to pretend to desire to transition from male to female sand then change one’s mind.

Via the GP

If you’re lucky and have a sympathetic and experienced doctor, your GP will agree to prescribe testosterone so that its ready upon your return. If you’re not lucky, you’re going to have to hope that it can be sorted quickly once you return.

GPs can prescribe pretty much anything “off licence” provided they feel qualified and experienced. However, even if they are both of these things, they may refuse for reasons of their own and cite legitimate reasons as cover.

Some GPs may accept a prescription from a private endocrinologist, however that may not translate into an NHS prescription. If it dries not, then you are left paying for testosterone treatment at full cost.

Via Endocrinology

The best route to hormone therapy so far has been too have the orchidectomy and then seek a referral to an NHS endocrinology department, however there are a few gotchas that may need to be overcome.

It is possible that the referral may be rejected with an “inappropriate service” response; you may not hear directly and the reason may not be immediately apparent. In this case a lot of phone calls and chasing Matt be necessary, both to the endocrinology department to establish the reason and then to the GP to redo the referral.

There are two reasons for rejection encountered so far:

Attempting to arrange hormones ahead of surgery: in this instance your GP will just have to redo the referral after the operation.

Gender issue: the department sees the matter as a gender identity issue. Endocrinology departments at NHS hospitals aren’t “commissioned” to deal with gender issues and will want to offload into the Gender Identity Clinic.

An early rejection from the GIC can play a crucial role here, because with it you can say to the endocrinology department that the GIC cannot help you; that makes your lack of hormone production their problem and the referral can proceed.

Chase your referrals, possibly ahead of time; you should be given an idea of when you will hear from endocrinology or the gender clinic (if you go that route); I tried both and the gender clinic lost my referral!

The hospital’s endocrinology department aren’t commissioned and may not be experienced with gender identity issues. Their main concern is your health and they will make decisions based on that. They do have a duty to listen to your desires during treatment and you may need to be assertive in expressing your needs.

If you are lucky, your endocrinologist may be sympathetic to your needs and advise and prescribe accordingly.

Via private endocrinologist

This route has not been tested. Whilst it may yield a more rapid treatment (and the effects of long-term testosterone depletion are bad for the male body), it may not be possible to convert the prescription into something that there NHS is prepared to take on and it is thought that going private may give the NHS cause to make obtaining further treatment more difficult.

It is not possible to consult a private endocrinologist without them involving your GP.

However, the Gender Identity Clinics do say that they will take on treating anybody no matter how hormones have been obtained originally – however we the section above on GIC for problems on this route.

Via the black market

This route is untested.

NHS prepayment certificate

An NHS prepayment certificate can save a significant amount of money for people not entitled to free prescriptions.

An NHS prescription in 2024 costs £9.90 per item. The certificate costs £114.50 for twelve months.

Making complaints

I’ve personally experienced difficult GPs, rejections of referrals, and lost referrals! You must be proactive at all times chasing and tracking referrals and associated documents. I have also encountered the “Catch 22” of the endocrinology/GIC gap in responsibilities.

Making a complaint can unblock processes and expedite treatment.

You can make a complaint online using the links on https://www.england.nhs.uk/contact-us/feedback-and-complaints/complaint/ – don’t be afraid to complain, it can be a vital tool in getting the treatment you need.

Summary

There is no official route to treatment for eunuchs and nullos, so the pathways will differ drastically from area to area. A sympathetic and experienced GP could mean that you only have a few days or a couple of weeks to wait for treatment. Otherwise, the processes could take months (the experience of eunuchorn.uk was eight months from surgery to being able to apply the first dose of T gel).

  • One has to present as castrated in order to start the process towards hormone therapy in the NHS.
  • Experience will differ enormously from doctor to doctor and NHS region to NHS region.
  • Make use of the complains process to unblock and expedite your treatment.
  • Be assertive: everybody along the route think they are gatekeepers to treatment and may exercise prejudice and judgement in whether to open the gate and what options they able available to you.
  • You have a right to be treated.
  • You have a right for your treatment preferences to be respected.