In this guest blog post, Penelope Violet shares her first hand experiences of accessing treatment around the world.
Trans healthcare within the UK is, to put it as nicely as I possibly can, ‘in a state’. I’ve been fortunate enough to receive treatment in a couple of other countries, and I’d like to share those experiences, to give a first hand glimpse of how things could be. Since coming out in the UK, I’ve since moved twice. My travels have taken me back to my country of birth, Australia, and now I find myself in Germany.
When I was planning my return to Australia, I was terrified that I wouldn’t be able to access HRT there for some time. I’d discussed with other local trans people I knew who told me it’d taken three months from their first consultation with their GP, to speaking to a psychiatrist and having a couple of sessions, before finally getting access to HRT. I reached out to my family GP in Australia via email. I let them know the treatment I was currently on and sought reassurance that, given the circumstances, I’d be able to fast track the process to ensure that I’d go the least amount of time possible without HRT. They agreed to write prescriptions and support me to continue treatment while I found a specialist in Australia, and we booked an appointment for me to visit a couple of days after I landed.
After sleeping off my jet lag, catching up with some old friends and giving Mum the biggest hug she’s ever had, it was finally time for my appointment, so I very anxiously made my way to my GP’s office where I was expecting to be dead-named and have to update these kinds of details with the receptionist. To my surprise this had already been done, just based on my email correspondence with them. This honestly felt great, and got the whole thing off on the right foot. I went and sat down and waited until eventually my name was called (which always feels like a lifetime in Australia).
“Penelope!” the doctor called out. I collected my things and got up and followed them into their office, where I sat down and we had a nice chat to catch up on the many years I’d been overseas until we got on to the topic at hand. They really had no idea about trans healthcare and my needs, but they were eager to help. I took my current medication from my bag and showed them, explaining why I was taking each of them. Afterwards, they in turn explained what they would use each of these medications for and slowly, it all came together for them. They said that what I already had would not be available as public prescriptions but this was because Australia had other variants of the same medications so it’d be a bit more expensive. At this point I was just super grateful for the support, so accepted this. We moved on to my plans for finding specialist care. My GP was just as clueless as I was when it came to trans healthcare options in Australia, which in hindsight shouldn’t have surprised me given how small my hometown is. We agreed that I’d do some research and we’d have a follow-up appointment, if it were needed for a referral.
So off I went, getting in touch with the couple of trans people I knew in Melbourne to find the best solution for me. I was pointed to a couple of groups online and then eventually to a GP’s office, which had been recommended by the local trans community for being very inclusive, experienced and supportive. Unfortunately, they were not able to take me on right away but had a free appointment about a month later. Due to Covid-19 lockdowns, this became three months, but that wasn’t a problem as my family GP was happy to continue prescribing in the meantime.
Pictured: Me on the tram with a coffee in Melbourne June 2020. Covid advice at the time was not to wear masks.
Finally it was time for my first appointment, so off I went anxious to meet this new doctor. The new doctor started taking details, height, weight, how much you drink and smoke, the standard affair. We then moved on to a conversation about my ambitions and transition targets, it was a very good and thorough conversation but not really one I’d planned for or thought about much. Many of my conversations in the past had been about reaching my transition goal but not exactly what that actually looked like. After giving it a lot of thought and bouncing some ideas around, we had a plan for the future and how my treatment would progress, some things that we wanted to try, as well as some options in case some of those did or did not work as effectively as expected. It was such a great experience, I was in shock. It felt so wonderful to be validated, to be believed and to look at moving forward with that. It did feel a little bit sterile or medical for my liking but overall a really good experience.
We had a couple of follow up appointments to check on how things were going, and eventually I shared my plans of moving to Germany and we organised for a small stockpile of medication to give me time to find work and a specialist, once I arrived. Germany’s health insurance comes out of your wage, and I didn’t want to be relying on travel insurance for trans healthcare, because that sounded like a nightmare simply finding a company that would cover it.
Fast forward a few months, skipping over 26 hour flights, and struggling to find a flat in Berlin. I had now found myself a job, proper health insurance, and was approaching the end of my stockpile. I’d found a local trans group online and they’d recommended a GP in Berlin, so I logged onto their website to make a booking and was greeted by a list of their qualifications which included “sexual health activist” making me cautiously optimistic.
Pictured: Me travelling on the Ubahn (Berlin underground) in December 2020
After sitting in the waiting room for a few moments, I heard my name called and off I went into the office of the most friendly, positive and charismatic doctors that I’ve ever had the pleasure to encounter. I can only assume that not every doctor in Germany is as good as this one, but I cannot overstate how supportive, friendly, and genuine they are. They openly ask about topics which may be difficult for patients to bring up, explained everything in easy to understand ways, and addressed my anxieties before I even had the chance to voice them. Everything was just so easy and I’ve made some great progress on my transition in the short time I’ve been seeing them. As well as that they gave me great advice for navigating the German health insurance system and in-depth information on what I need to know.
The treatment here in Germany is excellent. Not once have I had to go to any specialist or endocrinologist, just your average day to day GPs. There’s no reason why your average NHS GP shouldn’t be able to treat trans patients. The wonderful service here in Germany is in stark contrast with my experience with the NHS, where I was met with doubt, disbelief and blocks to accessing services. In England I had to make several appointments just to find out if they’d do shared care with GenderGP. Eventually they agreed to do my blood tests for me, however they seemed to conveniently forget about this agreement each time it was time for a new one. One quote that will forever stick with me from my experience in London with the NHS was when I’d started HRT. I shared how great I felt and that I had started up with my hobbies again. The doctor’s response left me gobsmacked: “Well I wonder what would’ve happened if we’d given you a placebo”.
To leave you with one final thought, none of the treatments or medications I receive are specifically designed for trans people, (to my knowledge). They are all medicines that a doctor is capable of prescribing to cis people for other treatments. It makes me wonder what the purpose is of limiting access to these medications with long waiting lists and restrictive processes? It’s obviously not a medical safety concern, so why is it that medicines regularly prescribed for cis people are withheld from trans people?