Last time I accessed gynaecology care in the UK:
Hospital 1 assumed my referral was a mistake, unceremoniously dumped me off the waiting list. My lovely GP was annoyed ('do they think I'm a moron?'), wrote back to them to spell it out.

They refused to treat me anyway. (Yes, I know this was illegal under EA2010. On the other hand - would you want to see a gynaecologist who doesn't want to treat you?)

Lovely GP suggested I go to hospital 2, where he'd done some of his training, which he thought might be more cosmopolitan. They accepted my referral. I turned up (decided to go formally dressed, figured others in the waiting rm might assume I was a student or something)

Had the *weirdest* consultation of my life. As far as I can work out, the consultant had met James Barrett of CHX GIC at some function a yr or 2 ago, and now believed he knew all about the trans pathway. However, he wouldn't talk to me directly, so all relayed via SHO

SHO: The consultant says you need to be referred to CHX GIC.
Me: No I don't. I was diagnosed years ago, I've been on hormones for years. There is no point in me going to CHX (SHO leaves room to consult with consultant).

SHO - Co nsultant is certain all gynae care for trans people is provided by James Barrett's team is CHX
Me: James Barrett is a psy chiatrist. He cannot provide gynae care (SHO leaves to consult again. Repeat a couple of times)

Eventually I persuade SHO to ring CHX in front of me. I hear them say they don't offer gynae care. However, they 'helpfully' offer to fax through a list of surgeons they've referred people to before. We get the list. It's mastectomy surgeons.

I think the poor old SHO is getting embarrassed by now. We talk through what I need. He agrees 'Oh yes, we can do that no problem, but that's not the pathway. The consultant is sure you need to go somewhere else.'

It's pretty obvio we're not going to win this one. I leave. Fortu nately I see my mate a few weeks later, and he tells me the name of a gynaecologist at hospital 3 who has treated several trans men. I go there and fortunately he will treat me.

There's still a few problems. I have to go to a hospital with "For Women" emblazoned on everything. I have an ultrasound, which requires a full bladder. After that you need to pee - but the 'For Women' hospital doesn't have any patient loos for men.

I'm warned my surgery is more likely to get 'bumped', because they're going to have to beg a ward placement from another department. Post surgery the nurses keep offering me a pee bottle that doesn't work for my anatomy (although my notes must say I've had a gynae procedure)

Some one asks me a deeply personal quesiton about my future genital plans. But hey, I got care.

Public health messages occasionally recognising that trans men and non-binary people might exist and need gynae care is nice, but it is not even approaching the bare minimum of recognising and addressing the functional barriers that exist.

There's sometimes a suggestion that somehow all this will be fixed by writing "SEX: F" on things. But with the possible exception of the admin in hospital 1 who bumped me off the list, no-one at any stage was confused about the approximate configuration of my anatomy.

I'm certainly not. I know perfectly well what bits I do and don't have. But I have those bits while being called 'Michael', and while being seen by everyone I meet as male and a man. That's material reality.

You don't have to approve of it, but it's the situation that exists, and that UK and EU law consistently recognises should reasonably be able to exist in a democratic pluralist society. So either I can access healthcare I need, or I can't. That's the choice.