Update on 4th appointment with the NHS EOEGS; 2nd surgery referral; discussion of trans fem gender-affirming surgeries
Hey folks 
Per the details of this earlier post [cultofshiv.wtf], we had our 4th appointment with the NHS East of England Gender Service (EOEGS) [ncth.nhs.uk] 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 90° Super Grip [unionmedico.com] 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., Gender Construction Kit [genderkit.org.uk]; TransActual [www.transactual.org.uk]), as well as the limited options on the figurative #NHS menu for trans gender-affirming surgeries.
If you're trans fem, your options via the NHS are:
- Penile inversion vaginoplasty (PIV).
- Creates a neovagina using material from the penis turned inside out ("inverted").
- Penoscrotal flap vaginoplasty.
- Creates the vagina using material from both the penis and scrotum.
- Typically done if you've not got much material to work with
- Cosmetic vaginoplasty.
- Creates a vulva and labia (labiaplasty), and a clitoris (clitoroplasty) from the penis (and scrotum if needed), but without a neovagina.
- Aka vulvoplasty or zero-depth.
Please note the lack of:
- Peritoneal pull-through (PPT) vaginoplasty.
- A newer technique that involves several incisions into the abdomen and using internal peritoneal tissue to create the neovagina.
- Penile-preserving vaginoplasty.
- Creates a neovagina using peritoneal tissue, without removing the penis.
- Aka penile preservation vaginoplasty, phallus-preserving vulvovaginoplasty, etc.
- Standalone bilateral orchidectomy.
- Removes the testes and scrotum.
- Sometimes known as a bofa-ectomy [www.tumblr.com].
The NHS, as standard, also does not offer:
- Facial feminisation surgery (FFS) [en.wikipedia.org] of any kind.
- Voice feminisation surgery (VFS) [en.wikipedia.org].
- We're seeking an endoscopic modified Wendler glottoplasty by Chadwan Al Yaghchi at the London Voice & Swallowing Clinic [lvsclinic.com] in London.
- Breast augmentation (BA) [en.wikipedia.org].
- Full facial hair removal.
- It varies by nation, but England offers 8 laser [en.wikipedia.org] sessions, 16 hours of electrolysis [en.wikipedia.org], or a combination thereof.
- For context, we've had over 40 hours of electrolysis (thermolysis [en.wikipedia.org]) thus far on our face and neck with a highly-experienced (and fast) electrologist, and there are still a few stragglers.
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: Individual Funding Requests (IFRs) [www.england.nhs.uk].
We're not going to sugarcoat it: the IFR route is highly likely to fail for us 
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 Integrated Care Board (ICB) [www.nhs.uk].
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 Integrated Care System (ICS) [www.england.nhs.uk].
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).
#NHS #NHSEngland #trans #transgender #TransFem #healthcare #TransHealthcare #EOEGS #UnionMedico #gatekeeping #vaginoplasty #PIV #PPT #orchidectomy #BofaEctomy #FFS #VFS #FacialFeminisationSurgery #VoiceFeminisationSurgery #glottoplasty #HairRemoval #ICB #ICS #IFR #IndividualFundingRequest #IntegratedCareSystem #IntegratedCareBoard #queer #LGBTQ+ #LGBTQIA+ #LaserHairRemoval #LaserHairReduction #electrolysis #thermolysis #neurodivergent #neurodivergence
