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In a special episode of the GenderGP podcast, Marianne is joined by our own Chief Operating Officer, Katie Tiplady-Startin, to talk about which services we offer, who can use them, and how we work to make gender-affirming healthcare accessible to everyone who needs it.

If you have been affected by any of the topics discussed in our podcast, and would like to get in touch, please contact us via the Help Centre. You can also contact us on social media where you will find us at @GenderGP on Twitter, Facebook and Instagram.

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Links:

Gillick competency and body autonomy for transgender youth | GenderGP

Bell and Mrs A v The Tavistock | GenderGP

How GenderGP Operates | GenderGP

 

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The GenderGP Podcast

GenderGP Q&A: How To Use The Service

 

Hello, this is Dr. Helen. Webberley welcome to our GenderGP podcast, where we will be discussing some of the issues affecting the trans and nonbinary community in the world today. Together with my co-host Marianne Oaks, a trans woman, herself, and our head of therapy.

 

Marianne Oakes:
Good afternoon everybody, and welcome to the GenderGP podcast. Today, we’re going to try and answer some questions that we frequently get asked by our patient groups and by new people coming to the service, and to help me do that, I’ve got the wonderful Katie. Instead of me trying to introduce her because she is a multi-talented person, I’m going to ask Katie to introduce herself. So welcome Katie, and would you like to just tell the listener a little bit about yourself?

Katie Tiplady-Startin:
Thank you, Marianne. I’m not entirely sure I’m going to live up to that introduction, but I’ll do my best. So I’m Katie. I started working with Helen Webberley way back in the day. I was the first person that she brought into GenderGP. Some of you will have seen my name on messages and information on the website over the years. But now my role is Chief Operating Officer at GenderGP, and that actually encompasses all of the patient services. So the wellbeing teams, the medical teams, the, the pathway teams that most people would have had some interaction with if you’re, if you’re with the service. And my day-to-day role is basically to keep everything ticking along, making sure that it’s still working well, and if we need to change anything that, you know, we do that quickly and well, so hopefully I can answer some of these frequently asked questions, but I think the key to say is that GenderGP is moving with what’s needed. So some of the answers that you might hear from this episode might be different if you’d have looked at the website two, three years ago.

Marianne Oakes:
I just wanted to add as well, Katie, uh so the listener understands, when me and Helen get things wrong, Katie’s the one that, the one that slaps our legs and keeps us all in check. In fact, if anybody gets anything wrong on the team, there is a lot to remember working at GenderGP and, and there’s only one person who we can rely on to make sure we’re all going in the same direction and that’s Katie. So,

Katie Tiplady-Startin:
Oh, do I need to send you something Marianne? Send you a present for all of that lovely, all of those lovely things.

Marianne Oakes:
The first question that, I think everybody asks this, I think anybody coming to the website probably got this undermined as well, who can actually access the services of GenderGP? Well, what would your view be on that?

Katie Tiplady-Startin:
Anybody. It doesn’t mean that everything that we’ve got in place now can apply to everybody, but as we’ve seen over the years, we will work out a way with people depending on what’s needed. So by that, I mean trans or nonbinary individual based in an EU country, it’s very easy to say, yep, we can, we can assist that person for counseling, medication, et cetera. For a young person based in those areas, that’s fine too. If you start moving outside of what we’d sort of consider our sort of normal area of operation and into the Americas, Africa, places like that, we’d have to start looking at logistics, but in my time we don’t turn people away. We work out how to help them. And actually that also applies to parents, partners, you know, you know yourself Marianne, you do family counseling, couples therapy, you know, it’s more than just medication. So actually accessing our services. The first question is, what is it you need from the service? And then the next question we ask ourselves is, okay, how do we get that for you? But there’s no age limit. There’s no geographical problems. Yes, we know there are restrictions in certain areas and things. We have to work around, you know, all of those things, but we would never say no because of something that is just who you are and what you’re doing. And that’s also GPs, pharmacies, anyone who wants to talk to us, we’ll talk to anybody.

Marianne Oakes:
Interestingly enough, I was just thinking there, I think just to reiterate, gender diversity, or gender dysphoria, if we want to say affects more than just a patient, it does affect, you know, family members. It affects parents, siblings, wider family, grandparents, and anybody actually that wants any support in supporting somebody in their family or a family friend can actually access the service to some degree. I think it’s important to state that as well.

Katie Tiplady-Startin:
Definitely.

Marianne Oakes:
One word that Helen is always using that I think is, should be somewhere in our motto – we’re adaptable. So yeah, we have thousands of patients, but every one of them is an individual and every one of them comes with a, a challenge for us. And we love the challenge and that’s what keeps our job interesting.

Katie Tiplady-Startin:
It’s not one size fits all, but we know what works.

Marianne Oakes:
Yeah.

Katie Tiplady-Startin:
That’s the kind of, the balance that we have to strike. That sort of falls with the, one of the other major questions that we get asked. And I know in your sessions, you’ll be asked this a lot Marianne, is how much is this going to cost me? It’s obviously where, if you’re in a country that, because we work all over the world, you know, some people will be used to the concept of private care, but if you’re in the UK, for example, you won’t use it as much. And actually our services are accessible. So I could reel off a bunch of figures, but I don’t think that that necessarily [illegible] exactly how we work. So there are preset set up fees. There are subscription fees that we ask people to pay in order to continue the service and cover the costs of providing support. But they are flexible and there is room and we will, we don’t turn away. So we will work with individuals, but yeah, the website has fee information and there’s those sorts of things. But the reason it’s, it’s never quite concrete is because we, we work with people to help them. I think that’s a reasonable way of putting it.

Marianne Oakes:
It depends what you need from us, so it’s hard for us to say, “oh, it’ll cost X amount”. If you come to us and you want regular counseling and you want us to do blood tests and you want us to do all the prescriptions, then obviously it’s going to cost more, but we will always endeavor to make it as affordable as possible. You know, we only exist because we get paid, we get no outside funding. If we could get charity status or something like that, but there’s just no way that it’s going to happen in this sector of healthcare. But we do, we do do our best. We have got the, the charitable fund, which is probably going to be a separate podcast altogether, but just on a basic overview. Yeah. It depends what you want from us.

Katie Tiplady-Startin:
Yeah, definitely.

Marianne Oakes:
What’s our approach to assessments. I think me and Helen sit in a lot of these podcasts, debating the word assessment.

Katie Tiplady-Startin:
It’s not a word we like, we really use as much as, as all of that is it.

Marianne Oakes:
The way I approached this, Katie, and I’m happy for you to tell me I’m wrong. But, I get the, I get asked the question a lot. GenderGP are a, another provider, certainly where adults concerned. I think there’s only us to can work with children anyways. So that’s never going to be a challenging question, but tell me if you are 18 and over there are other care providers, and I see it on social media all the time – “who’s better?”, “which one should I go with?” my response to anybody that ever asks me that direct is it depends what you need. I believe all transgender and gender, gender diverse people deserve a choice of models of care. And we have a very specific model of care that suits a lot of people. But I would say that if you’re going to choose a provider, go and look at what the model of care is. So, for example, we’re gender affirming. So you come and tell us you’re trans, we’ll go, “right, what can we do for you? How can we help?” Whereas you’ll go to another care provider and they’ll say, “right, we need to make sure you are trans, go and speak to a clinical psychologist or psychiatrist. They will decide if you are trans and then we’ll decide how we’re going to help.” There’s none of that at GenderGP. And I’m not saying that that is it’s, it’s any, either model is right for everybody. If you’ve got doubts about your gender, if you really feel you need that level of intervention, you should go and see the right people. So I don’t think it’s about, who’s better, it’s about who’s right for us. The outcomes are very similar, but it isn’t about who’s better or worse. I don’t know what you think to that Katie.

Katie Tiplady-Startin:
Yeah. No, I completely agree. And I think it comes down to that ultimate thing that actually it’s about choice. It’s about patient choice. You get choice. You can choose which dentist you go to. You can choose which doctor you register, wherever if you’re in the catchment, you can choose. In so many areas of healthcare, people have choices, but this area it’s almost like people get funneled and they feel, oh, that’s the only place I can go. And actually, yes, there are limitations. So if it’s somewhere you have to travel and you struggle to travel, then you know, that’s not going to work for you. So that’s where a service like GenderGP does work because there’s no need to travel, but actually for some people they feel that need, and I totally understand, to sit in a room with someone, and therefore a service that’s purely online might not fit. So there’s, there’s lots of different areas. But for me, I think one of the, the most important parts and certainly on the side of the work that I’m on more, or see more of, which is the sort of written work, actually gatekeeping is a term that we hear a lot. And we hear people say, when I go to the NHS services, they gatekeep. When I go to the Swedish services, they, you know, they’re just trying to stop me from getting the treatment. And I know that sometimes it can feel like anyone who sort of turns round to you and says, actually, you know, is this the right treatment? Not, is it the right choice, but is it the right treatment as in, is this particular pill, the right one for you, can respond to that as if it’s gatekeeping as well. And so it’s really important for me and something that I train all of our team members in, is that our role is to facilitate the correct treatments for someone. So actually sometimes it is saying, let’s be safe. You know, if you have X medical condition, you can’t have Y treatment. And that’s just because it’s a medically contra-indication so that you cannot do that. However, and this is all in, our medical team have all confirmed this. But however, that doesn’t mean that we won’t say, but you could have this and you can do that. And I think our approach is we’re not here to stop you, but we are here to make sure that it’s safe for you. And that safety is about the medical safety and also support. You know, if, as you said earlier, it affects everyone around you, but also if you’re trying to do it on your own, it’s very difficult for some people. So there’s a mix of safety that we have to ensure is there, but it’s a facilitation rather than a sort of forcing.

Marianne Oakes:
And just to add to that as well. I think we’ve got to remember I always encourage anybody, So if I speak to somebody before they start the appraisal pathway, I always encourage them, I said, just be honest, don’t, you know, if it’s something you don’t know or if you’ve got a question you’ve, you must ask us, you will never be refused treatment. But what we want to do is put a treatment plan together that suits your needs. If you need some support with your mental health, we’re not going to force you into therapy, but we’re going to strongly advise it. You are going to have the how can I say, you’re going to get the best advice, the worst you’ll ever get from GenderGP is best advice. And I say the worst you’ll get, it might not fit with what you wanted, but we’re not going to go outside of best practice. And I did mention appraisal pathway earlier. So I think Katie,

Katie Tiplady-Startin:
Do you want me to give a little bit of a rundown? I spotted those words actually. And appraisal pathways is a GenderGP coined term which we’d love you all to spread out into the world, um and into the ether, which is the concept rather than assessments and psychological journeys or, or really medicalized terms, the appraisal pathway is, is quite simply a journey from contacting GenderGP to treatment, whatever treatment that is. And we will appraise the information you give us. We’re not assessing it. We’re not checking it. We’re not, you know, fact checking or anything like that or any of those things. But what we are doing is appraising the information you give us and going, right, so this person is in this situation, this is the protocol that we can apply to that, and therefore this is the medication or treatment or care plan or treatment plan or, or those sort of terms that we can apply at the end of this pathway. So that’s the appraisal pathway. And then once you’ve done that, you’re on our pathway, which is taking you wherever you’re going. So the point is that it’s all sort of heading in the same direction, but everyone’s got their own path. We have people who come to microdose. We have people who want to fully transition. We have people who want to explore just some counseling. We have people who want to start on a very small dose and really slowly, carefully workup because a person’s situations and they all have the same shape of pathway, but they’re all individual for each person. And actually once we’ve sort of moved onto that sort of treatment pathway and we stay on there, that’s when we start the monitoring. And that’s when we start checking on medications on a regular basis. So we have blood tests that we ask people to get, and we ask people how they are actually, that’s the most important question.

You know, how are you doing what’s going on for you? And then we ask people to also have a session. And by doing that, we keep that conversation going. We make sure that pathway is correct because it might be that you get to a fork in the road and you go, “actually, I’m going to go left where I thought I was going to go right, but I’ve changed my mind. I want to go that way now”. And we go off that way and that’s why we do those blood tests, and we do that checking regularly to make sure everything’s all right. And I know you do sessions with people at those stages as well, don’t you Marianne? And you sort of talk to people.

Marianne Oakes:
Well, as the wellbeing team, we’ve developed, haven’t we. And you know, the truth of the matter is in the early days I recognized straight away, there was some people coming, that were kind of being headed towards medication, and actually that isn’t what they’d come for, they’d come just to talk to somebody. And that’s where the wellbeing team, we had the bare bones of a wellbeing team that were doing pathways sessions, but we opened it up and thought, actually there’s a need for, for counseling. And you know, I’m going to re restate as well that it’s, for everybody concerned, you know, don’t be a mother who’s really angry that your child is transitioning. It’s okay to be angry. Isn’t what you expect. And it’s not something you were prepared for. Your identity’s being challenged there as well, come and vent to one of the counselors, you know, don’t do it to your child, do it to a counselor, get a good angle on it. One other thing I just wanted to mention before we move on to for the questions as well, is there is no requirement for a formal diagnosis of gender dysphoria at GenderGP.

Katie Tiplady-Startin:
Good point Marianne. Say that again I think.

Marianne Oakes:
There’s no requirement for a formal diagnosis of gender dysphoria. If you come to GenderGP, we take it as read that you’re suffering some degree of dysphoria. We do not need a psychiatrist or a clinical psychologist to confirm that with us. So yeah, that’s really important to know. Doesn’t always make everybody feel comfortable, and if you wanted a formal diagnosis, we can point you in the direction where to go and get one, and then come back if you still thought we were the right service.

Katie Tiplady-Startin:
Well, you should have put that in a big, bold letters on the front page of the website. There was no formal requirement. And I think actually, if you think about it, I just thought of a little analogy so I hope I’m not going down a rabbit hole here, but you say to someone I’m hungry, that person doesn’t say “no you’re not, you’re not hungry. Why are you saying you’re hungry?” Then you get, no, my stomach’s hungry. I’m hungry. That person might have a piece of toast or a sandwich or, or whatever it is. It might be different for each person, but it still satisfies that hunger. And it’s not up to us or anybody else to say, this is what you must be. You know? And I know that’s a bit of a silly analogy, but I think it’s quite an important one. And I just wanted to say on the parent point as well, Marianne, I’m a parent. I don’t have any children who are trans or nonbinary, but I am a parent. And I know that I have them varying ages. And I know from small things that when one of my children makes a decision that isn’t what I’m expecting or confesses to something that I’m not expecting, or just is or their behaviour changes or whatever it is, it strikes at the heart of me. You know, there is a question, “have I done this? Have I caused a problem? Have I upset them?” Have I, if a trans child says to the parent I’m trans and the mum goes, “why didn’t you tell me before?” It’s not that they’re annoyed at the child, they’re assuming that they’ve done something wrong, which is why their child hasn’t spoken to them. And it’s okay to feel that, but it’s not okay to hide that. I think it’s really important to access support, because it is a transition for everybody. It is changing for everybody. And we need to acknowledge that. And I have to say to the teenagers, you need to acknowledge that as well. So, you know, it is everyone. And I have a teenager at the moment and he doesn’t acknowledge anybody else’s existence. So I totally get it. But you know, the parents have it hard too.

Marianne Oakes:
We are an online clinic. How do we monitor patients’ blood tests and how do we make sure that they are well and how are they getting on?

Katie Tiplady-Startin:
Well, I touched on it a little bit before saying, you know, we, we have blood tests and things that we request, but the key is actually, I’m going to use one of my favorite things is, it’s organization and data. So we are very aware that this is not selling handbags. This is an important thing that we’re doing with people. We also have a lot of patients. So my role is actually I have to bring it back down to the data and the patients and the information that we hold. So yes, we’re an online clinic, but the benefit of that is that we have everything written down. So we know what happens with every patient who contacts us. And we know when to contact them back because we’ve got it really clearly in information there. So my role in our systems is to just basically say, right so this person has been with us now, their final review or the date they had, their first prescription was X. Therefore they will need their first blood test on Y, and we will contact them a month into treatment and say your bloods are due on this date, your follow-up session with a wellbeing team member is due on this date, please do these things. When they ask us for a prescription again, because we do ask the people request a repeat prescription. Don’t know if you’ve noticed this, but we, we do that rather than just issuing a repeat prescription. And that’s one of the little tricks that we do, which is actually to say, contact us. We’re trying to keep the patient in contact. If we do an automatic, which you can’t actually do with prescriptions of a certain length anyway, but if we were to do an automatic repeat, we wouldn’t have that same communication with people.

Marianne Oakes:
Again, this is my understanding is that what we want is to put responsibility onto the patient as well, to look after themselves. You know, we, we don’t want to spoonfeed them because actually they’re not going to be with GenderGP the life, and actually the medication that you’re starting is a medication for life. And I know I’m, I’m under the NHS. I have to organize all my own doctor’s appointments, have to organize all my own blood tests. Nobody rings you up and said, oh, by the way, you’re due this or due that. And actually that’s going to be a future. So we don’t want to start and spoonfeed people. So, you know, we do expect people to take a bit of responsibility for their own for their own care. What, the question I just wanted to follow up with though, Katie, hopefully I’ve not confused the patients So if I was a patient now and I needed to get a blood test done, what my options?

Katie Tiplady-Startin:
Ooh. I feel like I’m being quizzed on that one.

Marianne Oakes:
Your starter for 10.

Katie Tiplady-Startin:
There are currently four for UK patients. And there are slightly fewer options for those outside of the UK, but bear with me, we will get more options. But the first, best and most useful option is for your GP or local doctor to do it for you. So if you can get your GP, if you’re in the UK or your local health doctor or your private practitioner, whomever you see, to do your blood tests on a regular basis, then that’s going to save you money. And it’s the best way to do it. We want that. We want your doctor involved. We want them to know about your care. We want them to understand your care. Ideally we want them to take over your care. So that’s option one, my favorite option. Option two is that you use a private service. Now GenderGP has blood testing services, either home kits or venous sample taking. So you can choose those as well. If you’re, if you’re squeamish, you have any issues with needles, then it’s probably better to go for a venous sample. I don’t know if you’ve ever done one of the fingerprint tests, but I have, and unfortunately I bleed really well and it was really messy. So, you know, for some people it’s absolutely fine and it works really well, but there are alternatives. You do not have to struggle with the home testing kit.

Marianne Oakes:
What’s a venous test?

Katie Tiplady-Startin:
Out the sorry, that’s technical. You get so used to using these words, they just kind of fall out of your mouth, but, out of the vein. So as you would if you went to your doctor for another type of blood test. So then once you’ve done those, then the other option is that you source an appropriate service yourself which unfortunately for some people under the age of 18, isn’t possible from a lot of other services. We only work with services that will work with people under the age of 18 as well. If you’re outside of the UK, then there are lots of private services out there that can help. And actually in some countries they do tests by saliva rather than blood. So, and that is actually as accurate, certainly in Denmark and Sweden and Finland, I believe. So Scandinavian countries like saliva, from my information there’s lots of those and a lot of those do home kits as well. But back to the UK, the vitreous sample or the vein sample, the service we use has 170 clinics all over the UK, including Northern Ireland and, and one very close to Cornwall. They haven’t quite got Cornwall covered yet, Cornwall’s a bit of a tricky, tricky area, but they did have one in Plymouth, which is, if anyone knows the area, Plymouth’s kind of cool.

Marianne Oakes:
So they can have a G7 conference in Cornwall, but we can’t have bloods taken.

Katie Tiplady-Startin:
Indeed.

Marianne Oakes:
I feel like, I just want to give a plug here as well. If you are, if you have a needle phobia and getting bloods is really, really difficult, we can help with that as well through online hypnotherapy. So bear that in mind. Just one other thing I want to say before we finish with this particular question is it’s interesting Katie, as we start chatting, how we, we do default to the language that we would use and the language that we wouldn’t necessarily use on a daily basis for informed consent. So whilst we’re saying that we don’t need a formal diagnosis of gender dysphoria, we are operating on informed consent. That is giving you responsibility for your journey, our tagline, putting you in charge of your journey. So, yeah. I think important to reiterate that. Yeah.

Katie Tiplady-Startin:
And we’ve involved consent. I’ll just add a little bit there if that’s okay, with informed consent does come the requirement to, is probably the only thing that we do check is that you understand what’s going to happen. You understand the risk versus reward of the treatment that you’re requesting. Now I’m sure if Helen was here, I’m going to do my best, I won’t do an impression of her cause I got told off once for doing that. But if she were here, she would say, you know, it is not a risky treatment. We are swapping the hormone profiles from male to female, female to male or neutralizing as far as we can. It’s not risky treatment, but there are side effects. You know, there are side effects of medications that we pick up from the pharmacy all day long, you know, paracetamol or ibuprofen, anti-histamines all these medications that we buy and take. They have side effects potential, as do these medications, but they are actually low risk because cis women have oestrogen and we don’t take it away because there’s a risk. However, we do ask because of informed consent, it is your responsibility to understand and check. And that’s going back to your point about honesty, Marianne. So the more honest you are when you’re doing that appraisal pathway form, telling us your medical history, telling us your family, medical history, the better treatment we can provide, the better information we can give, the better suited we can do.

Marianne Oakes:
I think that’s really important as well. Isn’t it that, you know we can’t stress honesty enough. We’re not here to not give you the treatments that you want, but we can’t give you the best treatment plan for you if we don’t know the full truth. And if you’re not informed, don’t pretend to be, we will inform you. We have all the information that you would need. And just to support what you were saying there as well, all these medications that we use generally speaking, and don’t take this as medical advice, but you can check, are issued on prescription within primary care in general use. So, you know, we’ve got to keep that in mind that this is not what would be deemed high risk medications, like some cancer drugs and things like that. It’s all low risk. The only thing is that if you was to give estrogen to a man who’s not a trans woman, then it’s not going to like, what’s going to come with it.

Katie Tiplady-Startin:
Yeah. But the side effects are the side effects that is safe, for example, with testosterone, particularly testosterone treatment, all of the side effects that are listed are the ones we’re looking for apart from fatigue, moodiness. But if we’re giving it to a teenager, we’re expecting that moodiness and fatigue anyway. So it’s standard side effects and we are putting the body as the doctors would say, you know, through a second puberty, hopefully the first puberty if we can sort it out soon enough, but if it’s the second puberty, we are doing that, so there are things there, but yeah, as you said, the term is off-license, and there’s a lot made out of this term of off license as if it’s an issue, but actually an awful lot of treatments that you get from your GP are actually not being given to you for the licensed purpose. Um so there are some medications, to chuck a name out there, Gabapentin, a lot of people would have heard of Gabapentin and it’s considered a used mostly as a pain med, but it can be used for people with things like restless leg syndrome or anxiety because it, it calms the nervous system down and that’s off license. And again, everything we give to people with the consent and the information confirms this is an off-licensed use of this medication, but that’s not a problem it’s done all the time with lots of things.

Marianne Oakes:
All off-license means is, it wasn’t developed for the use that we’re using it. These are secondary uses, but that’s happening right across the whole pharmaceutical industry I would imagine.

Katie Tiplady-Startin:
Oh yeah definitely.

Marianne Oakes:
Moving swiftly along there,

Katie Tiplady-Startin:
This is a bit of a [inaudible] vessel. Usually it’s me going, “come on, come on.”

Marianne Oakes:
Um how long are the waiting lists? I think I know the answer to this.

Katie Tiplady-Startin:
Well, it depends what you’re asking about, but if it’s about consultations as in a meeting with someone, an information gathering session, a discovery session, or, and I can explain what they are if you want me to, but you’d probably be better off doing that, but 48 hours. And that’s just because that’s the minimum I’ve set the system to is 48 hours so that our wellbeing team and our pathway team and our doctors who do the consultations have a bit of information. As far as actually getting onto treatment. If it is hormone treatment that you’re looking for, there’s no waiting list for your form to be looked at. We look at all, maximum two working days. So if something came in on a Friday, it would be looked at by the Tuesday. And to access treatment, we quote around four weeks. Now, I want to be really, really, really, really clear on this, four weeks is a ballpark figure based on absolutely no issues, everything going through fine, being able to book the wellbeing team member you want for your information gathering session, some people want certain people and they might not be available. You might be on holiday, for example would there being no needs for any additional treatment as there being no blood test requirements? So not everyone has to have blood tests to start treatment. So it is a kind of a ballpark figures. Some people go through faster than that, but some people take longer. And again, it comes down to this point of this is about the individual having the treatment, so we can give four weeks, but I can’t say every single person between the age of 18 and 35 who lives in a house that’s yellow, will get it for three. I can’t do that kind of thing. I can’t sort of narrow it down, but what I can say is we will never take longer than we need to.

Marianne Oakes:
So my question is what’s special about yellow houses.

Katie Tiplady-Startin:
Well, they’re very pretty.

Marianne Oakes:
Just to kind of add to that, to support what you just said there, Katie, the reality is if your doctor was going to do the prescriptions for you and we have to liaise with them, we can’t, we can’t make them respond in a, in a reasonable amount of time. So when there’s a third party agency involved, it can take longer. I would say four to six weeks, generally could be quicker, could be a bit longer, but the truth of the matter is where third parties are concerned, it goes out of our hands .if getting onto medication was really important, so if you, as somebody who’s hit puberty or your child’s just hit puberty, they’re really, really anxious, just use GenderGP services and work with the other stuff in the background, and you would get there in a timely manner. What we don’t want to do is see that child spiraling down while the doctor’s twiddling their thumbs, that while they’re GP’s twiddling their thumbs, so.

Katie Tiplady-Startin:
I would just add to that. We consider puberty starting to be an emergency situation. We understand that if puberty is racing on, there isn’t time to waste. So, you know, just keep telling them to talk to us. And if we understand that urgency and what’s actually going on, and again, that there are concerns around the mental health impact of that wrong puberty. We need to know that because that will affect how we respond to things. It’s not going to stop us from helping, because we know that the majority of time getting on that puberty blocker, it’s going to make a significant difference.

Marianne Oakes:
Yeah, well, without question, since December we’ve been asked, does the

Katie Tiplady-Startin:
What happened in December?

Marianne Oakes:
Did the Kiera bell case against the Tavistock make it illegal for us to help children under the age of 16? Do you want to answer that Katie?

Katie Tiplady-Startin:
I will answer. I’m not legal, legal person, but the short answer is no, it didn’t because they were looking at the gender identity development service, Tavistock, or Tavi a lot of people know it as, they were looking at their protocols, not ours, gender GP, wasn’t part of that service. And actually there’s been further rules around consent and, and looking at those things and parents can support, and that there are questions around Gillick competency and all of those things. And that will all be answered. And we know that the appeal is being heard next week. We know that there will be more information coming out, and we know that we will continue to give you as much information as we can on the website. If you just go have a look at our blog type in Bell, you’ll find more information, particularly confirming that parents can legally consent. If you are a young person under the age of 16 in the UK and you do not have parental support, please get in touch. It doesn’t mean we can’t help you, but we have to make sure that we cover all bases, but it’s not illegal for GenderGP to support young people in getting the care that they need. What is in question is the Tavistock protocols around helping people.

Marianne Oakes:
So basically, I think what people need to understand is it, the medication wasn’t made illegal to give to under sixteens, it was the model of care that the Tavistock had adopted that was seen to be inappropriate.

Katie Tiplady-Startin:
Yeah, that’s my understanding.

Marianne Oakes:
We use a different model of care, basically, it’s as yet to be challenged. And, you know, we’ve got lots of happy patients. Hopefully it will never be challenged, but we’re confident if it was because our model of care, we haven’t invented the wheel here. We are following other centers of excellence from around the world. And actually we would evidence by saying, well, if you look at that, that, that, and that we’ve got all the evidence, which sadly the Tavi didn’t. The other thing to remember is there’s still, Gillick competency is still regarded as a measure of a young person’s ability to consent to treatment across the medical board. So, you know, if a young girl wants to go and get on the contraceptive pill without her parents, knowing that she can do as long as she can demonstrate Gillick competency. So that’s still in place that, that hasn’t changed.

Katie Tiplady-Startin:
I think it’s a really important point. Gillick competency is the right of a child to access treatment that’s correct for them. So I think we’ll put some notes into the podcast notes so people can research more of that in their own time. But the main point is trans children the same as any other child, they have the same rights, so they can confirm their care. If they have capacity, if they are able to understand, and they are able to communicate, why can’t they make those choices? Is that all the questions we get asked, do you reckon? Just pop back to how much everything costs, actually. I had a thought about that, right at the top of our conversation, we were talking about how much does it all cost. And I know that sometimes people feel that things are hidden. And I think through this conversation we’ve discussed loads about the fact that this is individual pathway. So if someone comes to us and says, I just want to be on treatment, and I just want to do the minimum sessions, we go, okay, that’s fine. Because of that, you know, we, we just say these are the costs. So then if they come back to us in a few months’ time and say, oh, I want a letter for this. Then there’s a cost. And sometimes people feel that we’ve hidden that, but actually it’s just about, we tell you what you need to know at the time, but it is all available. So I was just going to say, if anyone does want to sort of, is worried about potential future costs, we can discuss that with everyone as well.

Marianne Oakes:
I think it’s only right that we stress as well. It’s not like these surcharges. We don’t kind of get people to sign up to the service and then suddenly start saying, oh, well, you’re going to need this insurance. Oh, now we need to sell you this. Or usually once your care package is in place, unless you ask us for something else, let’s just say you were 12 months into your hormone treatment. And suddenly thought, actually I’m struggling to move forward. I’ll have some counseling. Well, that of course is going to be extra cost, but it’s all there on the website. You’re not going to kind of be suckered, tend to pay more than you should if it’s too expensive, always talk to us because we will always find, there’s always somebody on the team, we’ll do your reduced rates as well. So if we know, we can’t tell you exactly what it’s going to cost because everything is created as part of the care plan. But once you know your care plan, then that’s you’ll know what you’re going to be paying. I think that’s what we’ve got. It’s tailored.

Katie Tiplady-Startin:
Yeah. That’s the word you’re looking for. If your size changes, you need a new suit. So we have to re-tailor that. We have to, [illegible]. And actually the way we work in that way is quite unique, the fact that we adjust and change, it’s also the fact that we have so many patients and quite a small team relatively to the number of patients, but we don’t have long waiting lists at GenderGP. I wonder if you you’ve got more experience of talking directly to young people and you know, the impact of the waiting list in other places other than GenderGP, what do you think the waiting list is so long for young people elsewhere?

Marianne Oakes:
Well, the reason they’re so long is because the model of care isn’t suited to their needs. And I think the social discourse around transgender healthcare, certainly for young people is, is just not, it doesn’t help the clinicians, you know I get shouted at sometimes from Helen Webberley when I show too much empathy for some of the NHS clinicians. And then if I, you know, slag them off, she’ll slate me as well. The truth of the matter is it’s really difficult. I couldn’t imagine being an NHS clinician, working with young people, given the social climate at the moment. And I think what what’s happening is everybody’s stalling. They’re looking after their own professional integrity. You know, they almost feel doing nothing means they’re causing no harm when actually that is fundamentally wrong when working with young people in transgender healthcare, when may be in other areas of medicine, doing nothing is, is an alternative. Certainly where transgender health care is concerned, doing nothing is, is devastating to many young people. I think the problems with waiting lists are they are endless, you know, somebody will say, oh, you’re on a, an 18 month waiting list. And then 18 months is up and they say, oh no, it’s going to be another six months now. And then six months, oh, it’s got, and before, you know, it you’ve waited three years. And actually in that three years, you didn’t know where you were on that waiting list. You didn’t know when that care was going to come. So your mental health, certainly for young people. And if they’re going through the puberty, God’s truth, you know, I tell the story of one client I worked at happens to not be a GenderGP patient as it happens, but they went to the Tavistock, aged 12, they had two to nearly three years of therapy to decide to start them on blockers. So they were pushing 15, their bones had fused in that time, they are now going to be endlessly five foot tall, which, you know, I don’t want to say we should put people, you know, that there’s anything wrong with being five foot tall. Well, there was no need for that to happen for them that if they could have had the blocker in a more timely fashion, the exploration of gender would have been far more creative, far more productive. Making people wait, making young people wait for a long time, their life time is short already. So the percentage of their life that’s being wasted at a young age is far greater than somebody who’s 60. And that’s why it becomes such a difficult process for them. I don’t know if that’s

Katie Tiplady-Startin:
You know, I’d like to pose a question for us to think about maybe, you know, something that we could talk about in the future, which is, you know, you’ll see in most areas of therapy, it’s considered important, be stable before you start therapy. So a lot of people will be put onto, you know, they might have a crisis and they go onto an antidepressant, or this is outside of sort of trans identity questions, but individuals will be asked to stabilize before they start in-depth counseling in order to be able to access that counseling and consider and, you know, truly come at it with a sort of clear mind. But what we’re asking trans children to do is be distressed where we could actually reduce that distress so that they can access that therapy in a more convenient way. Certainly for me, that seems like a sort of,

Marianne Oakes:
I kind of go on record as saying on occasions that you’re asking somebody to explore their gender without any kind of medical intervention at any kind of age, it’s like sending a learner driver on a motorway, it could be a disaster waiting to happen. That doesn’t mean to say, hey, we’ve got to go and pump everybody full of hormones, just so that they can explore their gender, but it’s gotta be a considering, it’s gotta be part of a pathway that promotes good healthy exploration of gender. And at the end of the day, just to kind of round this up nicely at the end of the day, what GenderGP is here to do is to help people to explore their gender in a meaningful way and something that people don’t talk about. We do have patients that come to us thinking they want hormones and then go away and find actually they can function in the world without transitioning. And they’re just happy to know that their gender has been acknowledged. Maybe they’ll come back in the future, but not everybody actually has to go ahead and transition, but we need them to work that out for themselves. We cannot tell them that. I think this has been a fantastic episode, Katie. I’m hoping the listeners going to agree with me.

Katie Tiplady-Startin:
I hope so too!

Marianne Oakes:
Yeah. And thank you for joining me. I’m hoping we get to do more of these as well. Thank you for listening and keep a look out for future episodes.

 

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