To be transsexual and survive is one of the most traumatic situations a person can be in. It causes incredible isolation coupled with justifiable fears of rejection and ridicule. During sex reassignment the individual has no choice but to find a path through a wilderness.

British gender identity clinics generally only monitor, either by design or through underfunding. It is usually presumed that "someone must" be offering professional back-up, consultants and GPs each assuming the other (or somebody) is surely already providing assistance. In practice, assistance rarely exists. Unlike all other medical conditions, no doctor suggests any plan of action or route maps. The patient is left to their own devices yet has never reassigned before and therefore has no hindsight whatsoever. Unfortunately the doctor, who has logged the progress of other ts patients, doesn't always do anything with this collated information.

A common error is for onlookers to assume the person should appear to resemble one particular sex prior to treatment, saying e.g., You don't look much like a woman to me. Such remarks might be well meant but they can be extremely hurtful and are pointless because treatment and time can completely alter appearances and mannerisms. Further, non ts people often resemble the other sex in the eyes of beholders. One would not say to a crippled person who is trying to resolve their disability, You don't look much like an athlete to me.

There is no point in telling the person to accept their body as it is "for now". If they could do that they wouldn't be transsexual. Such suggestions are said with good intent but are useless and leave the sufferer feeling that nobody understands that they cannot switch on or off their identity. Perhaps only those in the situation can wholly comprehend this; it is difficult to explain.

There may be an epicene period of visual ambiguity and apprehension, with the individual trying hard to dispel habits drummed in over many years by the wrong peer group. During this phase the onlooker may perceive an apparent man, woman, or a mixture. This is a most difficult time for the sufferer who needs to have any mistakes gently brought to their attention, nobody seeing them self as others do.

Transsexual people do not act as members of the apparently opposite sex; they are members of that sex psychologically. It is not that the individual has to learn new habits and mannerisms, rather they have to un-learn those ingrained by the wrong peer group and societal pressures in the past. The un-learning period can present difficulties to onlookers if they receive muddled identity signals from the person. It may not be easy to refer to them as e.g., she if they have yet to emerge, unscathed from the end of the epicene period. To refer to them as e.g., he may cause very big hurt and again the feeling that nobody cares to understand, which consequently creates even more isolation. It means the speaker is using the person's body as the reference, which in turn makes the listener think their whole identity is regarded as unimportant which, in such circumstances, is what is happening. This destroys the sufferer's self worth.

Ts people regularly report that during the initial stages of reassigning they felt in need of permission to do so. Nobody can grant such permission but extensive delays can be caused if the patient is waiting for a doctor to advise when to begin social reassignment. This unique difference between ts and other conditions is not always properly explained by doctors. With other conditions the patient is not expected to self diagnose and self treat and is likely to incur doctor's wrath if they do. The patient is not to automatically know this is not the case with ts. It too often goes unexplained, sometimes causing a waste of several years.

Ts>females (ts>f) usually require electrolysis to eradicate facial hair growth. One would expect this and all other clinically necessary treatments to be available at NHS expense since it is not merely cosmetic and nobody chooses the condition. As a rule, electrolysis has to be financed entirely by the sufferer them self and isn't cheap.

In truth ts is a disability (society makes it so). Like many others, the condition may render the sufferer transiently unemployable for a time as one example illustrates. For electrolysis to be possible the person must have one to three days hair growth before each session of electrolysis (which ideally will be weekly, funds permitting) otherwise the electrolysist can neither see nor treat the hair follicle. By the time they have found out how to obtain treatment, the person may be unable to face the world in the wrong role, especially when facial hair is like a neon sign. [This is further discussed in the chapter, VISUAL PRESENTATION, in TRANSSEXUAL SYNDROME.]

Electrolysis is a ponderous affair, typically taking three or four years to complete, assuming finances permit weekly treatment of sufficient duration (at least one, preferably two, and not more than four, hours per week), else it will take much longer.

Ts>f-s are sometimes told not to worry whether anybody is looking at them whilst this facial hair growth has to be tolerated each week. It is not a question of worrying: how many people could tolerate being seen as a bearded woman? The ts>f psyche is female whether pre- or postoperative and the "wrongness" of the wrong body increases more quickly and intensely as time passes. Don't worry if the local thugs set about you? It happens. What others think is eclipsed by what the person them self thinks; everyone deserves self respect.

The usual procedure for applying for NHS electrolysis is for the GP to refer to a local consultant dermatologist, who in turn may refer to his or her electrolysist. In rare cases where referrals even reach this stage the local health authority may be sympathetic, realising that electrolysis is clinically necessary, but have insufficient resources to grant it. NHS electrolysis clinics are seldom geared to cope with patients requiring more than a small amount of treatment. Whoever most needs NHS electrolysis generally won't get it.

In that event the authority can fund electrolysis by a private practitioner. This may require negotiation by the GP and dermatologist but they are usually unaware (and may deny) that such a procedure exists. The patient then finds them self caught in the middle of a permanent communications breakdown. Many doctors consider all patients to be idiots, disbelieving their knowledge of what is and isn't available. One doesn't have to be transsexual to encounter this difficulty, but it helps.

Throughout the world GICs encourage patients to be well versed in all aspects of their treatment. With few exceptions the patient is in the invidious position of being better informed than, and having to educate, their family doctor who probably won't appreciate the fact and is quite likely to brand them an imbecile. This can cause incredibly long - and dangerous - delays in progress of treatment. Changing to another GP may not help when the majority of GPs know nothing about ts or its treatment. Far too many wrongly label ts a mental illness, offering patronisation only. Notes are passed on to the next GP who assumes them to be accurate. NHS electrolysis, indeed NHS anything, for ts patients is therefore rare. Ts is one condition in which treatment is usually determined by the patient's ability to pay.

That less educated GPs do not habitually take transsexual patients seriously can cause very severe and wholly unnecessary problems for the sufferer. Far too many GPs believe that sex reassignment is not their business; it certainly is. Probably the most useful function of the parochial carer is that of arbitrator between the various agencies concerned.

Although wise to the various aspects of treatment itself, there is no reason to suppose the patient will be familiar with NHS (or private sector) administrative procedures. With not infrequent alterations to those, the Health Service employee might not be familiar with them either. A lot of treatment (not only for ts) has been and is delayed whilst such tangles were (are) sorted out, if indeed they are. It is too common for the patient to have explained the processes of treatment all along, repeating what they have been told by the GIC consultant, but for the GP to have ignored them. This is pertinent when careful timing can save a life. It is not possible to give a true account of the problems faced by ts sufferers without criticising general practitioners at large. Many GPs are the direct cause of the biggest problems.

Most ts people spend decades trying to suppress the effects of the syndrome which increase exponentially (becoming worse more quickly as time passes) whilst untreated. By the time they begin to seek professional help they are likely to have reached a stage where some regular progress has to become visible; and quickly. Reassignment being no simple affair, there is every possibility that at this critical stage they are standing on a knife edge and NEED knowledgeable support. Their chances of finding it locally are slim.

As a direct result of minimal professional support, a titillative media, ignorance and prejudice amongst professional and lay people alike, and one of the most uncaring legal situations in Europe, suicide statistics amongst (preoperative) ts sufferers are alarmingly high.

Prior to reassignment, over ninety-five per cent of ts-born people seriously contemplate, attempt, or commit suicide. Postoperatively the statistic is the same as for everyone else: well below one per cent. Ironically, the other group in which suicidal feelings run high, but less so, is GPs. Being a GP is a choice; being born transsexual is not.

It may be necessary for the sufferer to move home, possibly losing their family amid all the other traumatic events they will be experiencing. Locating new accommodation at this time can be difficult and help doing so would usually be appreciated. On recommendation from a professional supporter some local councils include ts sufferers in the category "vulnerable group" which, of course, is accurate. This assumes social services and the housing manager are not themselves bigoted. Many are.

In the event of unemployment help may be needed in securing all benefits due. In some circumstances the DSS may offer a loan to assist with the establishment of a new wardrobe since, again, this is clinically necessary and not cheap.

There should be no thought that the individual is "inadequate" if they cannot attend to all these things them self. There is so much to attend to, all of it radical. Anyone else is unlikely to have to deal with so many, and such major, alterations and negotiate a serious chronic condition virtually unaided and cope with such big trauma all concurrently, whilst also facing the possibility of rejection by their family, possible physical violence from uncouth passers by and severe financial hardship caused by society's attitudes towards something it doesn't understand. There is, too, always the chance of finding gutter press journalists and photographers on the doorstep.

Initially, the ts person's need to avoid being misunderstood can result in a deluge of explanations which are liable to turn recipients off via over-kill. It is often said that transsexual people must learn patience, but seldom that others must reciprocate.

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