Cult of Shiv Admin Team @AdminTeam

SleepyCattenHey folks :FediverseSymbol: Per the details of <a href="https://cultofshiv.wtf/@SleepyCatten/113427424061767656" target="_blank">this earlier post</a>, we had our 4th appointment with the <a href="https://ncth.nhs.uk/east-of-england-service" target="_blank" rel="nofollow noopener noreferrer">NHS East of England Gender Service (EOEGS)</a> today.The worst thing about that appointment was that it was at 13:30-14:30, which put us into a kind of neurodivergent purgatory / paralysis, where we felt like we really couldn't get on with the day until the appointment, as it was all we could think about pretty much.We did manage to distract ourselves for a while by passing feedback to Union Medico over the syringe holders they provide for their <a href="https://unionmedico.com/90-super-grip/" target="_blank" rel="nofollow noopener noreferrer">90° Super Grip</a> auto-injector. We're planning to do a full review of that for everyone this week.Anyway, the appointment went well. The doctor (cis guy, he/him) pretty much made it clear that he just needed to gather more info for the referral, and that he didn't expect there to be any issues. He asked whether it would be okay for a trainee colleague to sit in on the call, which we were fine with, especially as we're pretty sure she was trans herself. At the very least, she gave off good vibes.Despite being anxious AF the whole time, and having to play the good-little-trans-patient to pass through the gatekeeping, it was just a serious of questions about medical history, what we were after, the risks, the reasons for wanting this, whether we had stored gametes etc.Despite the many risks (e.g., fistula; granulation tissue; prolapse; etc), long recovery time, and the need for very regular dilation for ages, we agree that the benefits are worth it.The doctor seemed suitably impressed by our knowledge and sources (e.g., <a href="https://genderkit.org.uk/" target="_blank" rel="nofollow noopener noreferrer">Gender Construction Kit</a>; <a href="https://www.transactual.org.uk/" target="_blank" rel="nofollow noopener noreferrer">TransActual</a>), as well as the limited options on the figurative <a href="https://cultofshiv.wtf/tags/NHS" class="mention hashtag" rel="tag">#NHS</a> menu for trans gender-affirming surgeries.If you're trans fem, your options via the NHS are:<ul><li>Penile inversion vaginoplasty (PIV).<ul><li>Creates a neovagina using material from the penis turned inside out ("inverted").</li></ul></li><li>Penoscrotal flap vaginoplasty.<ul><li>Creates the vagina using material from both the penis and scrotum.</li><li>Typically done if you've not got much material to work with 😅</li></ul></li><li>Cosmetic vaginoplasty.<ul><li>Creates a vulva and labia (labiaplasty), and a clitoris (clitoroplasty) from the penis (and scrotum if needed), but without a neovagina.</li><li>Aka vulvoplasty or zero-depth.</li></ul></li></ul>Please note the lack of: <ul><li>Peritoneal pull-through (PPT) vaginoplasty. <ul><li>A newer technique that involves several incisions into the abdomen and using internal peritoneal tissue to create the neovagina.</li></ul></li><li>Penile-preserving vaginoplasty.<ul><li>Creates a neovagina using peritoneal tissue, without removing the penis.</li><li>Aka penile preservation vaginoplasty, phallus-preserving vulvovaginoplasty, etc.</li></ul></li><li>Standalone bilateral orchidectomy.<ul><li>Removes the testes and scrotum.</li><li>Sometimes known as a <a href="https://www.tumblr.com/assumptionprime/704086413418938368/seizing-the-opportunity-you-ever-feel-like-your" target="_blank" rel="nofollow noopener noreferrer">bofa-ectomy</a>.</li></ul></li></ul>The NHS, as standard, also does not offer: <ul><li><a href="https://en.wikipedia.org/wiki/Facial_feminization_surgery" target="_blank" rel="nofollow noopener noreferrer">Facial feminisation surgery (FFS)</a> of any kind.</li><li><a href="https://en.wikipedia.org/wiki/Transgender_voice_therapy#Voice_feminization" target="_blank" rel="nofollow noopener noreferrer">Voice feminisation surgery (VFS)</a>.<ul><li>We're seeking an endoscopic modified Wendler glottoplasty by Chadwan Al Yaghchi at the <a href="https://lvsclinic.com/voice-feminisation-surgery/" target="_blank" rel="nofollow noopener noreferrer">London Voice & Swallowing Clinic</a> in London.</li></ul></li><li><a href="https://en.wikipedia.org/wiki/Breast_augmentation" target="_blank" rel="nofollow noopener noreferrer">Breast augmentation (BA)</a>.</li><li>Full facial hair removal.<ul><li>It varies by nation, but England offers 8 <a href="https://en.wikipedia.org/wiki/Laser_hair_removal" target="_blank" rel="nofollow noopener noreferrer">laser</a> sessions, 16 hours of <a href="https://en.wikipedia.org/wiki/Electrology" target="_blank" rel="nofollow noopener noreferrer">electrolysis</a>, or a combination thereof.</li><li>For context, we've had over 40 hours of electrolysis (<a href="https://en.wikipedia.org/wiki/Electrology#Thermolysis" target="_blank" rel="nofollow noopener noreferrer">thermolysis</a>) thus far on our face and neck with a highly-experienced (and fast) electrologist, and there are still a few stragglers.</li></ul></li></ul>There is a mere sliver of a fraction of a chance that we might get the NHS to fund some of our additional needs, which they don't currently provide: <a href="https://www.england.nhs.uk/long-read/individual-funding-requests-for-specialised-services-a-guide-for-patients/" target="_blank" rel="nofollow noopener noreferrer">Individual Funding Requests (IFRs)</a>.We're not going to sugarcoat it: the IFR route is highly likely to fail for us :FaceExhaling: Your "clinical circumstances" must be "exceptional" and the benefit clear in order to "receive benefit from a treatment or service that isn’t routinely offered by the NHS".Even getting the EOEGS to accept that it was their responsibility to fill in any IFRs required us to contact NHS England's dedicated team for IFRs. They were not particularly happy about this.Despite making them aware of their IFR responsibilities in March 2024, they have seemingly still not put any procedure in place for IFRs.The doctor made notes about this during our appointment, along with our bespoke requests, and advised that he would follow this up with the first doctor involved, as well as the person in charge. (Can't remember the precise term. Service lead? Clinical lead?)Anyway, once we've got them to fill out the bleeping IFRs, those will then be submitted to our local <a href="https://www.nhs.uk/nhs-services/find-your-local-integrated-care-board/" target="_blank" rel="nofollow noopener noreferrer">Integrated Care Board (ICB)</a>.They used to be called Clinical Commissioning Groups (CCGs), but suddenly changed the name and structure back in July 2022.To make the structure even less clear, each ICB sits under a broader <a href="https://www.england.nhs.uk/integratedcare/" target="_blank" rel="nofollow noopener noreferrer">Integrated Care System (ICS)</a>.We'll continue to share info on how it all goes, but realistically we expect all our requests to be denied, as they likely won't want to set a precedent or cough up the funding.However, at least we'll then know that we've tried every official route we could before setting up any kind of crowdfunding campaign(s).<a href="https://cultofshiv.wtf/tags/NHS" class="mention hashtag" rel="tag">#NHS</a> <a href="https://cultofshiv.wtf/tags/NHSEngland" class="mention hashtag" rel="tag">#NHSEngland</a> <a href="https://cultofshiv.wtf/tags/trans" class="mention hashtag" rel="tag">#trans</a> <a href="https://cultofshiv.wtf/tags/transgender" class="mention hashtag" rel="tag">#transgender</a> <a href="https://cultofshiv.wtf/tags/TransFem" class="mention hashtag" rel="tag">#TransFem</a> <a href="https://cultofshiv.wtf/tags/healthcare" class="mention hashtag" rel="tag">#healthcare</a> <a href="https://cultofshiv.wtf/tags/TransHealthcare" class="mention hashtag" rel="tag">#TransHealthcare</a> <a href="https://cultofshiv.wtf/tags/EOEGS" class="mention hashtag" rel="tag">#EOEGS</a> <a href="https://cultofshiv.wtf/tags/UnionMedico" class="mention hashtag" rel="tag">#UnionMedico</a> <a href="https://cultofshiv.wtf/tags/gatekeeping" class="mention hashtag" rel="tag">#gatekeeping</a> <a href="https://cultofshiv.wtf/tags/vaginoplasty" class="mention hashtag" rel="tag">#vaginoplasty</a> <a href="https://cultofshiv.wtf/tags/PIV" class="mention hashtag" rel="tag">#PIV</a> <a href="https://cultofshiv.wtf/tags/PPT" class="mention hashtag" rel="tag">#PPT</a> <a href="https://cultofshiv.wtf/tags/orchidectomy" class="mention hashtag" rel="tag">#orchidectomy</a> <a href="https://cultofshiv.wtf/tags/BofaEctomy" class="mention hashtag" rel="tag">#BofaEctomy</a> <a href="https://cultofshiv.wtf/tags/FFS" class="mention hashtag" rel="tag">#FFS</a> <a href="https://cultofshiv.wtf/tags/VFS" class="mention hashtag" rel="tag">#VFS</a> <a href="https://cultofshiv.wtf/tags/FacialFeminisationSurgery" class="mention hashtag" rel="tag">#FacialFeminisationSurgery</a> <a href="https://cultofshiv.wtf/tags/VoiceFeminisationSurgery" class="mention hashtag" rel="tag">#VoiceFeminisationSurgery</a> <a href="https://cultofshiv.wtf/tags/glottoplasty" class="mention hashtag" rel="tag">#glottoplasty</a> <a href="https://cultofshiv.wtf/tags/HairRemoval" class="mention hashtag" rel="tag">#HairRemoval</a> <a href="https://cultofshiv.wtf/tags/ICB" class="mention hashtag" rel="tag">#ICB</a> <a href="https://cultofshiv.wtf/tags/ICS" class="mention hashtag" rel="tag">#ICS</a> <a href="https://cultofshiv.wtf/tags/IFR" class="mention hashtag" rel="tag">#IFR</a> <a href="https://cultofshiv.wtf/tags/IndividualFundingRequest" class="mention hashtag" rel="tag">#IndividualFundingRequest</a> <a href="https://cultofshiv.wtf/tags/IntegratedCareSystem" class="mention hashtag" rel="tag">#IntegratedCareSystem</a> <a href="https://cultofshiv.wtf/tags/IntegratedCareBoard" class="mention hashtag" rel="tag">#IntegratedCareBoard</a> <a href="https://cultofshiv.wtf/tags/queer" class="mention hashtag" rel="tag">#queer</a> <a href="https://cultofshiv.wtf/tags/LGBTQ" class="mention hashtag" rel="tag">#LGBTQ</a>+ <a href="https://cultofshiv.wtf/tags/LGBTQIA" class="mention hashtag" rel="tag">#LGBTQIA</a>+ <a href="https://cultofshiv.wtf/tags/LaserHairRemoval" class="mention hashtag" rel="tag">#LaserHairRemoval</a> <a href="https://cultofshiv.wtf/tags/LaserHairReduction" class="mention hashtag" rel="tag">#LaserHairReduction</a> <a href="https://cultofshiv.wtf/tags/electrolysis" class="mention hashtag" rel="tag">#electrolysis</a> <a href="https://cultofshiv.wtf/tags/thermolysis" class="mention hashtag" rel="tag">#thermolysis</a> <a href="https://cultofshiv.wtf/tags/neurodivergent" class="mention hashtag" rel="tag">#neurodivergent</a> <a href="https://cultofshiv.wtf/tags/neurodivergence" class="mention hashtag" rel="tag">#neurodivergence</a>

SleepyCattenPrior to today's appt., I'd pre-emptively got this info:* Peritoneal pull-through (<a href="https://cultofshiv.wtf/tags/PPT" class="mention hashtag" rel="tag">#PPT</a>) <a href="https://cultofshiv.wtf/tags/vaginoplasty" class="mention hashtag" rel="tag">#vaginoplasty</a> is not currently commissioned by NHS England, but Tina Rashid does do it privately. * Individual Funding Requests (IFRs) for gender-affirming surgeries not commissioned by NHS England should be submitted by the EOEGS to the local Integrated Care Board (<a href="https://cultofshiv.wtf/tags/ICB" class="mention hashtag" rel="tag">#ICB</a>).It proved to be very useful for my appt., where GICs often get confused over their responsibilities.2/

SleepyCattenI got answers back from Tina Rashid's private secretary.Including all fees, the private cost of PPT vaginoplasty is currently £37,120 GBP.As far as they're aware, NHS England hasn't commissioned PPT, which is why it's not available yet via the NHS 🤦‍♀️<a href="https://cultofshiv.wtf/tags/PPT" class="mention hashtag" rel="tag">#PPT</a> <a href="https://cultofshiv.wtf/tags/vaginoplasty" class="mention hashtag" rel="tag">#vaginoplasty</a> <a href="https://cultofshiv.wtf/tags/surgery" class="mention hashtag" rel="tag">#surgery</a> <a href="https://cultofshiv.wtf/tags/NHS" class="mention hashtag" rel="tag">#NHS</a> <a href="https://cultofshiv.wtf/tags/GIC" class="mention hashtag" rel="tag">#GIC</a> <a href="https://cultofshiv.wtf/tags/trans" class="mention hashtag" rel="tag">#trans</a> <a href="https://cultofshiv.wtf/tags/transgender" class="mention hashtag" rel="tag">#transgender</a> <a href="https://cultofshiv.wtf/tags/transition" class="mention hashtag" rel="tag">#transition</a> <a href="https://cultofshiv.wtf/tags/TransFem" class="mention hashtag" rel="tag">#TransFem</a> <a href="https://cultofshiv.wtf/tags/TinaRashid" class="mention hashtag" rel="tag">#TinaRashid</a> <a href="https://cultofshiv.wtf/tags/LGBTQ" class="mention hashtag" rel="tag">#LGBTQ</a>+ <a href="https://cultofshiv.wtf/tags/LGBTQIA" class="mention hashtag" rel="tag">#LGBTQIA</a>+

SleepyCattenI raised a query FAO Tina Rashid, a surgeon who performs PPT at Parkside Hospital (Nuffield Health), to confirm whether peritoneal pull-through (<a href="https://cultofshiv.wtf/tags/PPT" class="mention hashtag" rel="tag">#PPT</a>) <a href="https://cultofshiv.wtf/tags/vaginoplasty" class="mention hashtag" rel="tag">#vaginoplasty</a> is available for NHS patients referred via a gender identity clinic.The answer?"peritoneal pull-through is not currently available to patients who are seeking surgery through NHS pathways."Sigh :FaceExhaling:<a href="https://cultofshiv.wtf/tags/NHS" class="mention hashtag" rel="tag">#NHS</a> <a href="https://cultofshiv.wtf/tags/GIC" class="mention hashtag" rel="tag">#GIC</a> <a href="https://cultofshiv.wtf/tags/trans" class="mention hashtag" rel="tag">#trans</a> <a href="https://cultofshiv.wtf/tags/transgender" class="mention hashtag" rel="tag">#transgender</a> <a href="https://cultofshiv.wtf/tags/transition" class="mention hashtag" rel="tag">#transition</a> <a href="https://cultofshiv.wtf/tags/TransFem" class="mention hashtag" rel="tag">#TransFem</a> <a href="https://cultofshiv.wtf/tags/TinaRashid" class="mention hashtag" rel="tag">#TinaRashid</a> <a href="https://cultofshiv.wtf/tags/LGBTQ" class="mention hashtag" rel="tag">#LGBTQ</a>+ <a href="https://cultofshiv.wtf/tags/LGBTQIA" class="mention hashtag" rel="tag">#LGBTQIA</a>+

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