In 2015, I went into years of debt by spending £8,000 I didn’t have on a gender transition. It could, or rather, should, have been funded by the NHS, as transitions became a state funded procedure in 2004 under the Gender Recognition Act.
However, getting your gender transition paid for is not as easy as one would hope.
The mere seven NHS Gender Identity Clinics in the UK are overloaded, with waiting times sitting between 33 to 36 months and appointments currently being assigned to people referred to the services in September 2017. This is despite NHS guidelines stating that wait times for such consultations should never exceed 18 weeks. There was a chance the NHS could have paid for my transition, but only if I waited years. That would have meant spending years in a body in which I felt like an imposter – and that just wouldn’t have been possible.
My biggest problem was my chest. I was 5’4”, with a pair of 28Gs on the front. This was responsible for about 90 percent of my dysphoria at the time. To amend this, I needed top surgery – medically referred to as a bilateral mastectomy – which is the removal of breast tissue to create a more “masculine” physique. But the journey to this surgery had many different pit stops. It was a bumpy ride.
It’s easy to assume that this surgery can be a choice. The majority of people who do sport 28Gs have made throwaway comments about wanting their chest to be smaller for the sake of comfort and ease. For me, it wasn’t about not wanting the back pain or the face-value discomfort of the inevitable, if accidental, elbowing they receive on a night out. They made me want to die. The dysphoria I was living with, which was mostly caused by my chest, made me increasingly suicidal. It acted as unrelenting reminder that I was not in the right body. I was going to kill myself if I didn’t have this surgery.
The first step was asking my GP for a referral to a NHS Gender Identity Clinic for a discussion around getting the surgery. My GP put in a few calls, but told me there was no chance of this being a speedy process. It would take two years of real life experience as a man, then maybe hormone therapy, then a conversation about top surgery. This all adds up to a wait of more than three and a half years, which would be impossible to cope with.
Frankly, I would have killed myself before ever reaching the NHS pathway, so I had to look elsewhere. I contacted a private Gender Identity Clinic in London, and was given an appointment three months later at the cost of around £250.
Behind the front door of the specialist clinic was a completely new world with a completely different approach. Instead of my appointment being fraught with the battle to be listened to properly, the private clinic had a positive approach. The consultant and I spoke about my feelings, life up to that point, name changes, research, family, transphobia at home and at work – everything. Who I was and what I needed was taken into account and the psychiatrist concluded I was an obvious candidate for top surgery.
A surgeon did a physical assessment and then, in November 2015, I had the procedure. A week later, I popped back to the hospital to have the binder removed and the staples taken out, and that was that. Once hospital visits, hotel stays, vehicle rental and assessments had been factored in alongside the cost of the actual surgery, the process came in at £8,000.
After I had top surgery, it was like a literal weight was taken off me. I was high with the relief. I’d spent years suffering with a misery so thick I didn’t remember it didn’t have to be like that. That it doesn’t have to be like that.
The overwhelming positive relief, however, was undermined by the anxiety caused by the debt that this life-saving surgery cost me. Debt that hung around for more than three years, long after my scars had healed.
The main method of debt and repayment management was a refined art of fiscal juggling, using financial literacy skills to grab new 0 percent interest deals whenever they popped up and constantly having a job.
I was lucky, because I knew about finances and could work my way through bank jargon, meaning I could always hop to a better deal and I could spin all the plates to stop them crashing down at heartbreaking cost. But other people in the same situation as me, without the tools I had at my disposal, might not find it so easy.
While this process was well managed - and means I can now say I’m debt free – it was anxiety-inducing. There were months I dropped into the red with my bank, months I’d stay late at the office every day for a fortnight to get some overtime pay, months I’d stress about how I was supposed to get repairs done or insure my car or pay a bill because I didn’t have any wriggle room.
We always talk about how we have universal healthcare in this country and how it’s the best thing in the world. If you have an emergency, it is. But it’s hardly universal when an entire group like trans people are forced to wait years to even see a professional, never mind actually start any treatment to help assuage their dysphoria or assist a transition. A truly universal healthcare system would never put me - and others going through transitions - in this precarious and dangerous situation.
The way the NHS treated me brought on an intense feeling of shame, almost like if I’d been cisgender, I wouldn’t have been in debt at all. If I’d just been cis like everyone else, I’d never have needed to spend the money, to have the surgery and to go into debt.
While gender dysphoria is multifaceted, and affects every person differently, many people – such as me – find it to be so significant that it can lead to severe mental health problems, including suicidal thoughts and ideations.
Mental health problems are significant among the transgender community, with statistics showing that 88 percent of transgender people had experienced depression and 84 percent had thought of ending their life.
Many individuals and campaigners, such as Gendered Intelligence, a UK charity run by trans people for trans people, are calling for gender transition treatments and surgeries to therefore be more accessible.
The NHS treats the whole process like it’s elective and we have the luxury of time. That we’re just choosing to be the way we are. They make you feel as though you don’t “need” it – that you can wait. I resent having to pay for my top surgery and being abandoned by the NHS. But, at the same time, it was the best money I’ve ever spent. I don’t even care about the scar. I had to have this surgery to stay alive.
If you or anyone you know have been affected by the issues raised in this story, please use the following resources for help and support. In the UK and Ireland, the Samaritans phone lines are open 24/7, at 116 123. In the US, if you're in crisis, the National Suicide Prevention Lifeline is at 1-800-273-TALK (8255). You can also contact the Crisis Text Line by texting TALK to 741741.
As told to @bethanymrd