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This is a long thread about UK trans healthcare during the pandemic. It is an alarm call, and a plea for support and information.
I'll finish with resources for mutual aid and mental health support. Stonewall have good resources here: https://www.stonewall.org.uk/about-us/news/covid-19-%E2%80%93-how-lgbt-inclusive-organisations-can-help
I'll finish with resources for mutual aid and mental health support. Stonewall have good resources here: https://www.stonewall.org.uk/about-us/news/covid-19-%E2%80%93-how-lgbt-inclusive-organisations-can-help
I'm going to talk about GIC suspensions, surgery cancellations, interruptions to hormone provision, critical support needs, and how we can begin dealing with this.
If you need help right now, please contact one of the organisations here: https://www.stonewall.org.uk/about-us/news/covid-19-%E2%80%93-how-lgbt-inclusive-organisations-can-help
If you need help right now, please contact one of the organisations here: https://www.stonewall.org.uk/about-us/news/covid-19-%E2%80%93-how-lgbt-inclusive-organisations-can-help
(1) Gender Identity Clinics, the NHS pathway for trans people.
Some GICs are cancelling all appointments, some moving some to phone. Many waitlists are frozen. Sandyford, Scotland's main provider, announced a total suspension of support for trans folk.
https://www.sandyford.scot/sexual-health-services/gender-identity-service/
Some GICs are cancelling all appointments, some moving some to phone. Many waitlists are frozen. Sandyford, Scotland's main provider, announced a total suspension of support for trans folk.
https://www.sandyford.scot/sexual-health-services/gender-identity-service/
Where care is available it is drastically reduced, & for many there is no NHS support at all. Before the pandemic, the minimum wait to even begin discussing care was 2 years. Now we have months longer before the NHS provides *anything*. https://www.bbc.co.uk/news/health-51530274
I understand why this is: the entire NHS has necessarily been mobilised to prioritise crisis critical care and to minimise pandemic transmission. The result for trans folk, as for many disabled & ill folk, is a suspension of life-saving care, which further strains other services.
(2) Surgeries.
Trans surgeries are largely cancelled. People who've been waiting many years, staking mental health on an upcoming surgery, now have a much longer wait. Again, this has a major effect on mental health and thus on support services. https://www.pinknews.co.uk/2020/03/23/coronavirus-trans-healthcare-gender-reaffirming-essential-surgery-cancelled-vice/
Trans surgeries are largely cancelled. People who've been waiting many years, staking mental health on an upcoming surgery, now have a much longer wait. Again, this has a major effect on mental health and thus on support services. https://www.pinknews.co.uk/2020/03/23/coronavirus-trans-healthcare-gender-reaffirming-essential-surgery-cancelled-vice/
I've heard reports that people who need surgery *revisions* are also facing cancellations. (Is there clear info on this anywhere?) In some cases, where problems have occurred, this can have a lifelong effect on physical health; in many cases a lifelong effect on mental health.
Further, the most extensive surgeries have a minimum 12-week recovery period, in which extensive personal support is needed. All folk in surgery recovery are in high-risk groups for infection, and all are bed-bound for some period, exactly when support is most strained.
(3) Hormones.
Those in the GIC system, with GP surgeries largely closed, have questions about how they get prescriptions renewed. If their hormones are injectable, they don't know how they'll find a nurse to provide this. Has any information been released?
Those in the GIC system, with GP surgeries largely closed, have questions about how they get prescriptions renewed. If their hormones are injectable, they don't know how they'll find a nurse to provide this. Has any information been released?
Here's a sample letter for writing to your GP to ask for an extended prescription : https://twitter.com/BhEvren/status/1239890384177844224
I've also seen NHS guidance on hormone switches and relaxing restrictions, but can't find it now. Does anyone have it?
I've also seen NHS guidance on hormone switches and relaxing restrictions, but can't find it now. Does anyone have it?
For people bridging (getting a GP prescription for harm reduction reasons pre-GIC care) or self-medding, these issues are more acute. We're less likely to get a prescription renewal, less likely to find a healthcare professional to do injections.
At least one private trans health practitioner has had a crisis in communications recently, with many reports of waiting over a week for a reply, and no clear explanation from the health provider. All private trans health will have increased demand due to suspension of GIC care.
Grey market internet pharmacies, which many of us rely on for hormones, are reporting shortages. I don't know if this is supply chain issues or stockpiling. Vanuatu, which is a major provider in this area, has suspended flights, so IHP has shut down orders.
These issues are especially pronounced for trans people who need testosterone, as it is a controlled substance, and more likely to be injected, so all strains on the network are much worse.
Withdrawal from hormones, or changing prescription, has serious physical and mental health effects, which many trans people now have to prepare for, again when all support services are closed or strained.
So a personal story. Content note: mental health, suicide.
I've had chronic depression & anxiety throughout my life, with bouts of suicidality. I tried everything to treat it: exercise, mindfulness, therapy, CBT, yoga, diet, everything. It never abated. Until I started estrogen.
I've had chronic depression & anxiety throughout my life, with bouts of suicidality. I tried everything to treat it: exercise, mindfulness, therapy, CBT, yoga, diet, everything. It never abated. Until I started estrogen.
The 18 months I've been on estrogen have been my happiest & calmest ever. After an entire life with a significant episode at least every two months, I haven't had a single spell of major depression since HRT.
I have one month of hormones left & don't know how I'll get more.
I have one month of hormones left & don't know how I'll get more.
(4) Support work
Trans folk are more likely to be disabled, isolated from family and community, in poverty, in a high-risk of infection group. We are more in need of personal support work and less able to access it.
Trans folk are more likely to be disabled, isolated from family and community, in poverty, in a high-risk of infection group. We are more in need of personal support work and less able to access it.
Covid Mutual Aid is doing fantastic work, and getting personal support to many who need it. But I've spoken with trans folk who've been harassed and assaulted in their community & so are afraid to access local community aid.
https://covidmutualaid.org/
https://covidmutualaid.org/
State support work has been cut. I've spoken to trans folk whose support workers and personal assistants are self-isolating, with no alternative provision, or who are no longer able to help with shopping or prescriptions. We are being cut off from vital support.
[HORMONE UPDATE.
Here are resources for clinicians on providing hormones for trans people. It can be used to help advocate for yourself:
- https://www.ngicns.scot.nhs.uk/wp-content/uploads/2020/03/Hormone-Treatment-Alternatives-Covid-Chalmers-Final-190320.pdf
- https://gic.nhs.uk/gp-support/updates-on-physical-interventions/
Thanks @mtj273 for the links]
Here are resources for clinicians on providing hormones for trans people. It can be used to help advocate for yourself:
- https://www.ngicns.scot.nhs.uk/wp-content/uploads/2020/03/Hormone-Treatment-Alternatives-Covid-Chalmers-Final-190320.pdf
- https://gic.nhs.uk/gp-support/updates-on-physical-interventions/
Thanks @mtj273 for the links]
SO
These are the four areas where trans health is in most critical need. In many areas we're facing a total suspension of healthcare, with no information yet about alternative provision. With the pandemic escalating, I don't know when the NHS will be able to provide anything
These are the four areas where trans health is in most critical need. In many areas we're facing a total suspension of healthcare, with no information yet about alternative provision. With the pandemic escalating, I don't know when the NHS will be able to provide anything
This means we need:
- Funded trans orgs to provide healthcare info and advocacy alongside mental health and community support
- Mutual aid networks to be created to provide trans-specific support and healthcare needs
- Everyone to work on sharing info and combatting isolation
- Funded trans orgs to provide healthcare info and advocacy alongside mental health and community support
- Mutual aid networks to be created to provide trans-specific support and healthcare needs
- Everyone to work on sharing info and combatting isolation
A) FUNDED ORGS
Our NGOs have moved fast to shift things online and provide crisis support and mental health support. I'll put links next. But this is a plea to those reading this: we also need healthcare support *beyond the NHS*. We need you to bend rules. & we need info ASAP.
Our NGOs have moved fast to shift things online and provide crisis support and mental health support. I'll put links next. But this is a plea to those reading this: we also need healthcare support *beyond the NHS*. We need you to bend rules. & we need info ASAP.
Here are some links:
- Galop's trans advocacy line: http://www.galop.org.uk/trans-advocacy/
- Galop's abuse and anti-violence helpines: https://www.galop.org.uk/how-we-can-help/
- LGBT Foundation's helpine: http://www.lgbt.foundation/helpline
- Switchboard's LGBT+ phone, text and email helplines: https://switchboard.lgbt/
- Galop's trans advocacy line: http://www.galop.org.uk/trans-advocacy/
- Galop's abuse and anti-violence helpines: https://www.galop.org.uk/how-we-can-help/
- LGBT Foundation's helpine: http://www.lgbt.foundation/helpline
- Switchboard's LGBT+ phone, text and email helplines: https://switchboard.lgbt/
- Gendered Intelligence's support for trans youth: http://genderedintelligence.co.uk/support/trans-youth
- Transgender Northern Ireland's support directory, with more announced soon: https://transgenderni.org.uk/
- Transgender Scotland, an STA-moderated group: https://www.facebook.com/groups/tgscotland/
- Transgender Northern Ireland's support directory, with more announced soon: https://transgenderni.org.uk/
- Transgender Scotland, an STA-moderated group: https://www.facebook.com/groups/tgscotland/
B) MUTUAL AID
We need trans-specific mutual aid networks who can support isolated trans folk who can't access the main aid groups, & who can help trans folk access hormones & other gender-affirming care in the absence of the GIC. We were already building them: now it's critical.
We need trans-specific mutual aid networks who can support isolated trans folk who can't access the main aid groups, & who can help trans folk access hormones & other gender-affirming care in the absence of the GIC. We were already building them: now it's critical.
I'm working with Edinburgh people on a local QT aid network. If you're queer and/or trans and want to help with this, get in touch. We're building this week.
Think about how you can build this in your local community. Who can you talk to, where you can get support?
Think about how you can build this in your local community. Who can you talk to, where you can get support?
QueerCare are providing vital support and resources for queer and trans mutual aid. Follow their work ( https://queercare.network/ ) and donate ( https://paypal.me/queercare )
If you set up a local group, sign it up to QueerCare to be a support provider: https://twitter.com/queercarenet/status/1239636492202450945
If you set up a local group, sign it up to QueerCare to be a support provider: https://twitter.com/queercarenet/status/1239636492202450945
When building a mutual aid group:
- Pace yourself. You can't do everything, or do it alone. Start now, but take your time, and work in a group.
- Anyone can do it, but everyone needs advice and support. Covid Aid UK have excellent resources: read them. https://covidmutualaid.org/resources/
- Pace yourself. You can't do everything, or do it alone. Start now, but take your time, and work in a group.
- Anyone can do it, but everyone needs advice and support. Covid Aid UK have excellent resources: read them. https://covidmutualaid.org/resources/
C) SHARE INFO
Trans people have always supported each others' transitions. Always, more of us have been outside the NHS than in it. Now, those of us in the NHS system will need the advice and support that's been there all along. Our networks need to embrace more people now.
Trans people have always supported each others' transitions. Always, more of us have been outside the NHS than in it. Now, those of us in the NHS system will need the advice and support that's been there all along. Our networks need to embrace more people now.
What do you know about trans health, and how can you responsibly share it? Can you train people to safely inject? Do you know a good and safe supply of hormones? Can you make webpages that better bring info together? Do you have a platform to share crucial info from?
Do you have an NHS trans health connection you can use to share crucial info about hormone and surgery support? Do you have an in with an NGO you can use to push them to collate healthcare info? Can you train a local mutual aid network in trans issues and combat prejudice?
If you have any reliable information on anything I've raised in this thread, please share it with me, in confidence if needed, and I'll share it myself.
With anxiety running very high, information and reassurance is precious right now.
With anxiety running very high, information and reassurance is precious right now.
D) COMBAT SOCIAL ISOLATION
I included links to some social support above.
What The Trans!? podcast have set up a Discord server for UK trans ( https://twitter.com/WhatTheTrans/status/1240058308972732422) but it requires vetting and it may take time to join.
I'm in another small trans Discord; DM for details.
I included links to some social support above.
What The Trans!? podcast have set up a Discord server for UK trans ( https://twitter.com/WhatTheTrans/status/1240058308972732422) but it requires vetting and it may take time to join.
I'm in another small trans Discord; DM for details.
Can you set up a WhatsApp group for local trans and QT folk? Do it now. Do the same for whatever social media or online communication platform you're happy in.
But we also need to reach more offline people. Do you like phonecalls? Can you set up a phone tree where trans folk can talk to each other and make friends? Can you set up a regular group call? How can you go beyond your usual networks to reach isolated trans folk?
We are each other's support, now more than ever. Let's see each other through.
The situation is serious, but we have each other.
This is the end of the thread I'd planned. I'll add resources as they come in below.
I love you.
The situation is serious, but we have each other.
This is the end of the thread I'd planned. I'll add resources as they come in below.
I love you.
***Update: bloodtests & check-ups****
Something I missed is interruptions to blood tests (which check hormone levels) and other check-ups, crucial to maintaining physical health while transitioning.
Does anyone have info on alternative routes? https://twitter.com/CChinneide/status/1242428828431126528
Something I missed is interruptions to blood tests (which check hormone levels) and other check-ups, crucial to maintaining physical health while transitioning.
Does anyone have info on alternative routes? https://twitter.com/CChinneide/status/1242428828431126528
***Update: intramuscular self-injection guides***
Here are medically-approved guides for T self-injection. Before you use these, try to find someone local who can train & supervise you (if you can do this folk let know):
- https://fenwayhealth.org/wp-content/uploads/2015/07/COM-1880-trans-health_injection-guide_small_v2.pdf
- http://www.med.umich.edu/cancer/files/im-self-injection.pdf
Here are medically-approved guides for T self-injection. Before you use these, try to find someone local who can train & supervise you (if you can do this folk let know):
- https://fenwayhealth.org/wp-content/uploads/2015/07/COM-1880-trans-health_injection-guide_small_v2.pdf
- http://www.med.umich.edu/cancer/files/im-self-injection.pdf
***Update: injections from GP practices***
I've had multiple personal reports from folk who had hormone injections cancelled, but who then rang up & were able to get injections at a GP surgery. I've seen no official guidance and this may vary area to area. Always worth trying.
I've had multiple personal reports from folk who had hormone injections cancelled, but who then rang up & were able to get injections at a GP surgery. I've seen no official guidance and this may vary area to area. Always worth trying.
Update: private trans health clinics
Some private clinics, such as the London Transgender Clinic, are now offering video call appointments, *including for new patient intake*, which previously needed in-person assessment. A list of clinics is here: https://genderkit.org.uk/resources/gender-services/
Some private clinics, such as the London Transgender Clinic, are now offering video call appointments, *including for new patient intake*, which previously needed in-person assessment. A list of clinics is here: https://genderkit.org.uk/resources/gender-services/
Update: Medichecks, blood tests
Medichecks, which some private patients use, have suspended in-person appointments for blood tests. Postal tests may still be possible (will update) from these sources: https://www.reddit.com/r/TransDIY/wiki/index#wiki_uk_blood_tests
Medichecks, which some private patients use, have suspended in-person appointments for blood tests. Postal tests may still be possible (will update) from these sources: https://www.reddit.com/r/TransDIY/wiki/index#wiki_uk_blood_tests
Update: CliniQ
CliniQ, which many self-medders use for health checks and hormone injections, have suspended all routine appointments and walk-in services. If you've used them before and need a hormone injection, a doctor will discuss needs by email: https://cliniq.org.uk/
CliniQ, which many self-medders use for health checks and hormone injections, have suspended all routine appointments and walk-in services. If you've used them before and need a hormone injection, a doctor will discuss needs by email: https://cliniq.org.uk/
Update: isolated trans folk in unsupportive situations
Galop has released a resilience in isolation guide, with further links and resources: http://www.galop.org.uk/wp-content/uploads/Trans-Resilience-in-Isolation.pdf
Jacob Edwards & KC have made a system to send you supportive text messages daily: https://www.validationstation.net/
Galop has released a resilience in isolation guide, with further links and resources: http://www.galop.org.uk/wp-content/uploads/Trans-Resilience-in-Isolation.pdf
Jacob Edwards & KC have made a system to send you supportive text messages daily: https://www.validationstation.net/
Update: GenderGP
GenderGP is offering new paid services for trans folk struggling to access treatment during lockdown. They can speed up intake for GIC patients: https://www.gendergp.com/help_centre/special-measures-during-covid-19/
Reddit is a good source of experiences of different providers: http://reddit.com/r/transgenderUK/
GenderGP is offering new paid services for trans folk struggling to access treatment during lockdown. They can speed up intake for GIC patients: https://www.gendergp.com/help_centre/special-measures-during-covid-19/
Reddit is a good source of experiences of different providers: http://reddit.com/r/transgenderUK/
Update: Scotland
STA have spoken to Scottish GICs, and say that GICs should be able to help trans folk struggling to access GP services right now, even if you're not currently a GIC patient. If you try this, let me know how it goes! https://twitter.com/ScottishTrans/status/1243556825318010890
STA have spoken to Scottish GICs, and say that GICs should be able to help trans folk struggling to access GP services right now, even if you're not currently a GIC patient. If you try this, let me know how it goes! https://twitter.com/ScottishTrans/status/1243556825318010890
Update: GenderCare
GenderCare are now doing videocall appointments, including for intake.
However, unrelated to corona, they now no longer do bridging prescriptions and require endocrine review before prescribing: https://www.facebook.com/drstuartlorimer/posts/2681396515416781
GenderCare are now doing videocall appointments, including for intake.
However, unrelated to corona, they now no longer do bridging prescriptions and require endocrine review before prescribing: https://www.facebook.com/drstuartlorimer/posts/2681396515416781
Update: other private clinics.
Harley St is doing video appointments only ( https://www.harleystgenderclinic.com/ ).
YourGP is doing phone appointments only and has restricted hours ( https://your-gp.com/gp-services/all-gp-services/gender-clinic/gender-dysphoria-consultation/).
I don't know if either is offering intake at this time: if you know, tell me!
Harley St is doing video appointments only ( https://www.harleystgenderclinic.com/ ).
YourGP is doing phone appointments only and has restricted hours ( https://your-gp.com/gp-services/all-gp-services/gender-clinic/gender-dysphoria-consultation/).
I don't know if either is offering intake at this time: if you know, tell me!
Update: Charing Cross / Tavistock & Portman GIC
CX is not currently doing new hormone prescriptions or surgery referrals. https://gic.nhs.uk/gic-limited-service-in-view-of-the-covid-19-outbreak/ (thanks @litch_group for info).
The same is true of Sandyford. Are any GICs doing intake or new prescriptions? If you know, DM me.
CX is not currently doing new hormone prescriptions or surgery referrals. https://gic.nhs.uk/gic-limited-service-in-view-of-the-covid-19-outbreak/ (thanks @litch_group for info).
The same is true of Sandyford. Are any GICs doing intake or new prescriptions? If you know, DM me.
Update: Chalmers
Unlike Sandyford, Chalmers is condicting some appointments by phone, but not all, and in-person appointments are all cancelled. They have actively advised GPs on maintaining hormone prescriptions: https://www.lothiansexualhealth.scot/gender-identity-clinic/gender-identity-clinic-and-coronavirus-covid-19/
Unlike Sandyford, Chalmers is condicting some appointments by phone, but not all, and in-person appointments are all cancelled. They have actively advised GPs on maintaining hormone prescriptions: https://www.lothiansexualhealth.scot/gender-identity-clinic/gender-identity-clinic-and-coronavirus-covid-19/
Research
Here's an international study on the effect of the COVID-19 pandemic on trans healthcare. I've participated & recommend it as the data may be useful. Content note: It asks for a history of health & life circumstances, including mental health: https://transcarecovid-19.com
Here's an international study on the effect of the COVID-19 pandemic on trans healthcare. I've participated & recommend it as the data may be useful. Content note: It asks for a history of health & life circumstances, including mental health: https://transcarecovid-19.com
Update: internet pharmacies
Vanuatu has resumed some freight flights, which means that Vanuatu-based pharmacies have resumed shipping, but warn of long shipping delays.
Vanuatu has resumed some freight flights, which means that Vanuatu-based pharmacies have resumed shipping, but warn of long shipping delays.
Update: CX / Tavistock & Portman
The GIC has issued technical guidance to GPs on maintaining hormone prescriptions: https://gic.nhs.uk/gp-support/issues-around-hormone-therapy-due-to-the-coronavirus-situation/
(This guidance has been updated from an earlier version & no longer downplays the physical & mental health effects of hormone withdrawal)
The GIC has issued technical guidance to GPs on maintaining hormone prescriptions: https://gic.nhs.uk/gp-support/issues-around-hormone-therapy-due-to-the-coronavirus-situation/
(This guidance has been updated from an earlier version & no longer downplays the physical & mental health effects of hormone withdrawal)
A trans team has built a new website to share information about trans healthcare during the pandemic (and beyond). http://transhealthuk.noblogs.org has:
- Pandemic FAQs
- Which GICs are still operating what services
- Private clinic services, prices, and pandemic response
Share widely!
- Pandemic FAQs
- Which GICs are still operating what services
- Private clinic services, prices, and pandemic response
Share widely!
Update: Aberdeen and Leeds GICs
Both Aberdeen and Leeds GICs have now suspended all services. (Confirmed directly with GICs.) Aberdeen said "temporarily" and Leeds said "at least 6 months". I don't yet have information on alternative provision.
https://transhealthuk.noblogs.org/covid-19-gender-identity-clinics/
Both Aberdeen and Leeds GICs have now suspended all services. (Confirmed directly with GICs.) Aberdeen said "temporarily" and Leeds said "at least 6 months". I don't yet have information on alternative provision.
https://transhealthuk.noblogs.org/covid-19-gender-identity-clinics/
Update: Nottinghamshire GIC
- all appointments continuing by phone and video
- no drop in clinical activity but this is "subject to staffing levels"
- continuing to recommend hormone treatment
- waiting list 30-36 months, taking new referrals
(all confirmed directly via email)
- all appointments continuing by phone and video
- no drop in clinical activity but this is "subject to staffing levels"
- continuing to recommend hormone treatment
- waiting list 30-36 months, taking new referrals
(all confirmed directly via email)
Update: Self-Injection
This thread from an Irish endocrinologist has useful advice and guides for trans patients: https://twitter.com/karljneff/status/1243485186802810881
This thread from an Irish endocrinologist has useful advice and guides for trans patients: https://twitter.com/karljneff/status/1243485186802810881
