"Gender Identity Clinic bottleneck"

Like many people seeking of cross-sex hormones and surgery I do not need psychiatric help and it is inappropriate to make me see a psychiatrist as a prerequisite to getting these treatments. Elective surgery and hormone regimens do not normally require two separate psychiatric assessments- it is an unusual, excessive barrier for patients who are compos mentis and one that is uniquely placed upon trans patients.

I have found the assessments themselves consist of humiliating cross-examinations where the questioner's underlying assumption is that the patient is just a confused member of the gender imposed on them at birth. My informed consent to treatment was not enough- instead I had answer invasive and irrelevant questions on all aspects my life past and present, as a psychiatrist seemed to hunt for cracks in my account to use as a reason to delay or deny my treatment. I had to answer the same questions over and over again with subsequent appointments, as if I would have changed my mind, without me getting any closer to the treatments I'm actually seeking. All this is justified as getting to know me better, apparently not understanding that I am approaching the clinic for the very specific reason of needing HRT and surgery, not to have someone oversee my entire life and transition. The only thing they should be asking is whether I am a medically suitable candidate for HRT and surgery and whether I consent to them.

Time was wasted on giving basic advice (some not even medically related) that most people are perfectly capable of googling at the start of their transition, not after years of waiting for a first GIC appointment. The clinic's holistic approach does not acknowledge its role as a major obstacle to transition. There were attempts to deter me from or otherwise water down the treatments I'm seeking, for instance suggesting a breast reduction instead of breast removal surgery. This is offensive and a cis man needing gynaecomastia surgery would never be asked this. The processes towards getting treatments are also made opaque, for instance they won't refer patients for genital surgery until they have discussed it in two separate appointments (with at least a year's wait in between) and they do not tell you this on your first appointment.

I have found it impossible to have a trusting relationship with a care provider under these circumstances. These assessments provide no benefit to me and function as nothing more than a barrier to prevent me accessing transition medicine.  I have come to view the clinic as something I have to battle through to get to the doctors who will actually treat me.

After all this, promises to progress my treatment were not followed through. I was assured during my appointments that I would be sent doctor's letters, details on surgical teams, and that referrals would be made, but in 18 months none of these have materialised despite multiple email and phonecall reminders from me. This clinic has wasted years of my life, insulting and belittling me along the way and I have nothing to show for it.

Defenders of GICs like the Tavistock will say that they are simply struggling to cope with demand but I believe it is GICs that are creating the bottleneck without actually providing transition medicine. In my opinion HRT and surgery referrals should be accessible directly through primary care as they are in other countries. Instead of perpetuating a system that can be harmful to patients and costly to the NHS, it should do what transgender advocacy groups have been recommending for years now and retire GICs for good.