Transvox - Listeners Q&A. Dealing with a first GP appointment

[00:00:00] Hi, hi and welcome back to Transvox with me this week, resplendent in her new BBC sewing bee. Jazzy Tina Turner, a friend stress is my friend and colleague Jenny, how are you Jenny? I'm so well thanks, Jill, how are you? Give us a shimmy.

[00:00:28] I'll try, don't think it'll show very well on camera then. I don't know if you watch the British sewing bee. Watch this series, I've watched it previously so I'd like to join it.

[00:00:41] The doing a diva week and one of those sewers this time is a drag artist and a drag creator and so has had a more obless time creating all sorts of dodgy SNMs of outfits has been actually great and of course the nature of the

[00:01:01] thing is the person who's the very, very best so as being kicked off because they have no idea how to be a diva. I should watch it. I might watch Tom Clatchel for that sort of thing to let those programs. Yeah, I do like a reality program.

[00:01:16] I know you like the pottery throw down. That's the stuff that's stuck. Yeah, if it's pride, you know, but other than everybody's good anyway. Well yeah, I do like those, they're good. You know, it's a few minutes sometimes I think. Yeah. And talking about humanity.

[00:01:31] Well, we've got a couple of listeners questions today. And I don't want to live a while which is something that we've talked about a bit before. But the first one comes from Geraldine who's based in Bristol of all places and

[00:01:48] and is saying fairly new to our paraphrase it's quite a long letter if you don't mind or it wasn't a letter was an email so you know, that was me falling back back in the past 1840s vernacular. The pigeon delivered this year to the bit.

[00:02:03] So basically what she's saying is in a nutshell with a paraphrase is trans, quite recently, trans being questioning once the going to see the doctor for the first time doesn't know what to expect is somewhat worried that the doctor won't think

[00:02:17] she's serious because she spent quite a long, a little time thinking she's not expressing herself that well and not in terms of what she wears and how she goes about the world and such like so she's really at the beginning of the journey.

[00:02:32] Once the doctor talked to the doctor, but quite worried because she's heard a lot of Facebook groups and such like that the doctor's going to quite negative and such like so what she's asking is have I any advice? Have we got any advice to have reduct as meeting?

[00:02:46] GPs meeting. What should my expect and what happens if things don't go well? So I think that's a good question to you. It's a kick us off with and I know you work in the NHS and we know that primary care is really important for us trans people.

[00:03:00] I don't where do you start? Yeah, it's an interesting one. Don't really work in primary care but I know quite a bit about primary care and I've lived some training to stuff in a couple of GPs surgeries.

[00:03:11] It's a really good point because really that's the first point for many people transition in if you want to help from the NHS that's the route now. You have to go through your GP to get your details changed within the NHS as well.

[00:03:24] I would hope that things are much better than some of the stories we used to hear in the past. I would hope that generally people will get an accepted and welcome from the GP. I can't say we can guarantee that because it sort of depends on

[00:03:43] the way that we can do it. I guess individuals because they're all private contractors on the GP and they do some tend to operate a, sort of the different than each other. I mean, back in 2005 when I went into just went to,

[00:03:56] went to reception so that I wanted to change from details and position and then to be able to. In the end, Jenny and this sort of tucked away did that and that was it for then on right? I think things are a little bit more. Involved now.

[00:04:14] But yeah, I think preparing for this a good idea is good in here because it's really difficult to know you're not very sure. The appointments are not very long, rather than the UK with the GP, and it's sort of three or four minutes. Trying to get out.

[00:04:27] It's something to think about. I guess it depends what you want from the GP in the first place. You're looking at changing your details. I thought I'd get to do that.

[00:04:38] But if what you say is you want some help in re referred to one of the gender identity clinics, then that's a bit you need to perform. I don't know about you, Jill. I'd had to say look, you know, this is not on a whim.

[00:04:53] I know now that that's what I wish a path I wish to take and kind of a referred in terms gender dysphoria, isn't it? Gender and call diagnosis. But is to go and say I would like to be refer to one of the general identity clinics.

[00:05:11] Yes, that's what you would say. Yeah, I think it's really interesting because so I've been doing this probably more recently than you and also both of us work with groups of trans people in different stages of transgender journey. And I think you've hit the little on the head.

[00:05:35] The first thing is that you need to know why you're going. So some people are going because they want to change their details. That is fairly straightforward, as you say. Even though let's say you face someone who was almost hostile,

[00:05:47] they still will do that and they will still, you know, it's not right in even to do that. So the second thing is a referredal to a gender identity clinic. The third thing is you might want to discuss shared care

[00:05:58] with a private medical provider, but you want to do shared care. So they seem to be the, and of course obviously this general health and well being, which of course is a, which is a fourth thing and no doctor can to turn you down.

[00:06:10] It is specially gender on that thing. But if you're going into talk about specific gender things. The first thing I'd say is you have to be prepared for it to be a slight, host-good lottery. So in, in, where are I am?

[00:06:26] I have moved from one part of the county to another. It's the same group practice and the doctor, as last time, was very, very hopeless. And the first one, I was absolutely brilliant. So it almost comes down to the doctor you see on that moment.

[00:06:42] So if you go in and you're not happy and it's not working and you're still okay, I want to bring this upon the two-in-end. You can also go back out and you can make an appointment with another person.

[00:06:52] And, and if you want to, you can actually say to the receptionist when you're booking the appointments, I want to talk about gender identity. So could you put me into a, could you pick, get me in a point

[00:07:01] with the person who's most likely to be helpful and sympathetic about this? And, and I find that, I find that, Saturday being the case. I, I usually find it, and I want you to find Jenny. I usually find that the receptionists are the most sympathetic,

[00:07:14] the most pragmatic, just be easily because they've got to get through a hundred calls. So they're not making judgments. They're just, listen to what you're saying. Okay, I'll put you to about, put you through this person. So that's, that's the first point of contact.

[00:07:28] And I genuinely think that most, most of the receptionists, if you're booking online, for example, so if you're ringing up and booking over the phone, I think that's the, the easiest place to test it out

[00:07:39] and just say hey, I want to, I want to come, I want to change my gender. I want to change my gender details. I don't want to talk about referral. Can you come, you, can you,

[00:07:47] can you, can you fix me with a person that's most likely to do that? And in some cases you might, I want to actually ask for a double appointment as well. Yes, I mean, I represent a, I have with my past representatives,

[00:07:59] a number of, um, who's actually some GPs. So I'm biased because I think they do an amazing job at the front line, which could be really tough for me. Because there are four frustrations, can often be taken out and I will move,

[00:08:12] but not to be frustrated, you know, if, if, with the NHS, with the reception, and that's just, just trying to do right for everybody. And so I think that's really good. I think, I think, I mean, I have heard stories about absolute negative responses from some GPs.

[00:08:29] Whether that's more historical, I would, I would expect now that because of the increase in awareness and everything else, a GP wouldn't be overtly hostile. I think, whether there's an element in the postcode of ignorance around the subject.

[00:08:48] I think is definitely true. I mean, I'm not as, it's a while since when, it's in my last GP last time, but it was to do with my hormones and levels. And you know, we sort of, that's sort of what I don't really know.

[00:09:02] I'm, they'd rely on me to educate them a little bit. And so, whether there's, that's the biggest issue at the moment is sort of that ignorance point. And I suppose the other thing is, you know, going to the GP because you want in some support

[00:09:19] and if you're exploring your gender identity, you want to support. I don't know how much help there is there. If you're not, I mean, I felt it was, I didn't feel nervous about it all when I went. It's quite easy. I'd made my mind up.

[00:09:34] I was going to do, and I went to told them what I was going to do. And so forth, whether it's, well, the list, it's a general day in general, they said that they're pretty, they've come to that because we all come to their conclusions.

[00:09:48] We all have to work through themselves. I mean, hopefully, Bristol, it seems like a breastest city with a new green party MP and things. So you would hope that would be part of the country where you get a welcome, sort of reception on that.

[00:10:07] So yeah, I think that, in a sense, it's just a house what you're going to say and what you want to say would be something useful when you sit down and it can be, and you talk about this with people.

[00:10:18] Sometimes you can be, oh my God, how do I actually form the words? What do I actually want to say? You know, and if it is, look, I'm getting to, I'm trans, you know, transitioning. This is what I'm looking for, which may be that, so gender identity.

[00:10:38] Or just generally you're just telling them you want to train to details, because you don't have to go to the gender identity clinic. You don't have to, again, medical health from the NHS, you don't have to do that with a waiting list.

[00:10:50] So long, it's, it must be really frustrating. So, I mean, I think, I think there's a difference if you don't want to change the details yet, but you want to be referred. That might be interesting. Yeah. I know I've changed the details.

[00:11:08] Is that sort of a formal thing to do with that? It's a change of gender and change of detail. Yes. So, Jenny's going to, Jenny's going on by everyone's going in and out. Just so much of a sense of the plan that I'm trying to open the job.

[00:11:19] Well, what do you, well, you've been with that, let me talk about the shared case situation because it's something I definitely have experienced about it. Okay. So, you sound brilliant about it, right? So, the shared care thing is something that is more challenging thing.

[00:11:32] So, I don't think about it. If you go online, you see all sorts of stories about supposed rights that we have. Okay? And, and doctors practice supposedly has to do this that, and the other, again, see the qualities that blah, blah, blah, blah, blah.

[00:11:48] What I would say is that, and what my understanding is that the shared doctor does not have to do shared care with you, especially when you're perhaps using a private practitioner, a private prescribing services outside of the country. And it's not regulated by the GMC.

[00:12:05] So, there are one or two of those organisations which I like that. You have a stronger case when the prescribing authority is, or the private provider is within you, okay? But even so, it seems to me that it's again quite a sort of a post-code lotter,

[00:12:19] because a lot of it seems to come down to budgets. And I have no people who have been refused shared care, who've gone back in the field, who've threatened all sorts of things and complaints and blah, blah, blah. And they have been, eventually, been granted shared care.

[00:12:34] But also, I've heard a people who just gone from one and one, one surgery to a different doctor and they get it. So, I really, I really think the good thing about what we're saying here is

[00:12:43] if you're not, was there any sort of resistance, you met with any sort of negativity? And sometimes that negativity is real negativity. What it is, it's that thing where we're so wound up sometimes. If you don't get like a big warm sort of welcome and embrace,

[00:13:00] you just get that sort of more matter of fact response. That isn't negative. That's just someone who's a private practitioner. That's someone who's a practitioner looking and evaluating the facts of the case. And I think sometimes we're expecting more of a much more on a motive

[00:13:14] to real reaction to what we're getting. I had a doctor's problem yesterday, but when we fell out roly, that didn't mean a good advice and treatment. So, you know, I think there's a difference between emotional objectivity here. And I think, you know, expect a factual conversation

[00:13:33] and expect them to ask you questions which you might get a bit or see as a bit of being emotional. But would they just have to ask you things like, have you done this? Do you think there's a lot of people who are not having a girl

[00:13:47] by asking questions what they're doing is worth doing. And I think once you know that, you can take the emotion of it. It's fine. You're talking to a medical professional and medical professionals

[00:13:58] talk to lots and lots of people who come in and talk about all sorts of difficult things all day long. You want to be one of the regular situations that any doctor faces. So, actually for some of them, they don't know much as Jen says.

[00:14:13] But also some of them are quite happy to spend a bit of time because they don't run across many transgender people that often. And so for them it can be quite interesting to talk to you. Yes, yes it is.

[00:14:23] That's really well, really good point that I think any surgeries and bigs in cities. I imagine they will have come across trans patients by now. I think there's a bit at any time, but you're right. And certainly rural areas maybe. So, just the issue of share care.

[00:14:41] I'm not sure because I've never gone through that process. What that actually means is that is that many your GP's working alongside a private gender, especially in terms of your prescriptions and things like that. What does it actually mean in practice? Because I don't fully understand it.

[00:14:59] Yeah, that's a good point actually. So what happens in a shared care situation is that you use a private prescribing body. So basically they will prescribe you the hormones you need. So to get hormones yourself by the care, which is a very bad idea, or you go private.

[00:15:14] And what happens? So there was rather than having to wait for the referral to the gender identity clinics. You go private. You go to a private medical institution. You may have an interview or whatever the obstacles they do in fit.

[00:15:27] They accept your trans, they accept that you need a prescription and the issue of the prescription. And they'll often send you the drugs as well with the hormones. Then what happens after that is you need regular blood tests.

[00:15:40] And it's what women by shared care is, what about the blood care tests? So in other words, how are you monitoring? How are you judging whether you're able to change your dosage? Just your dosage right should have be changed.

[00:15:52] Should you have a different dose, a different drug, a different delivery mechanism. Some people prefer gels and passes and injections. And so what the shared care is, is that after the prescriptions arrive and you start putting stuff into your body, it's how are you dealing with it?

[00:16:10] And that's what shared care is. So what would happen if the doctor refused your GP refused that? But you've got the prescriptions. Do you continue to use your private subscriber?

[00:16:23] So what happens is this is what happens for me is because I don't get shared care with my GP, then I have to go privately to get my own blood tests done. So I got this one or two or three organizations in the country.

[00:16:40] And they allow me to do a testosterone and other estrogen tests. You go along, you have the blood tests, the sender that results back to you individually and then you send them onto your medical, the prescription provider and the accept those.

[00:16:55] But what you end up with that interaction is you get very little professional advice. So sometimes the prescription providers are okay, you can book a continuing appointment with AED, where the doctor, again, paid for.

[00:17:11] Or you can see as soon as you're into the private health system, it becomes very expensive very, very quickly. And so the idea is if you if your doctor will not do, or will not prescribe your hormones, it's a real gift to have the ability to,

[00:17:27] that's a child care. That's really interesting but on what basis, and the doctor refused that then, and they do it on their medical opinion. They must justify it, you can't just say I refuse to do it because... Well, hopefully I've heard various reasons, some of which is budget,

[00:17:45] some of which is you shouldn't be taking those, you shouldn't be doing those, you're on the private system, you should be staying in the private system. And it's as simple as that, you're going a private route there for you,

[00:17:56] you need to stay in the private route, we don't have the resources, don't have the funds and most critically, some of the private medical prescribers, because they're outside of the country, they don't like the fact that you prescribe that, because that's really, really difficult.

[00:18:10] But also there are asking for drug tests and blood tests three months later. And so it actually becomes quite an onerous situation to be providing three months free, blood tests and checkups and such, like... And of course, if you're thinking about it, and there's not many of us,

[00:18:28] but that soon mounts up on the practices workload and budget. And especially if you're getting drugs from outside of the country, so you can sometimes sort of circumnavigate that by using organisations based in the UK

[00:18:42] and there are a couple, you can do your own research, just not for me to recommend these organisations. But the one I use is outside of the UK, and they have also such troubles

[00:18:52] and they're not regular by the GMC and they're difficult to deal with and they're expensive and certainly two or three surgeries aren't going to mention then they when they've done the research and come back, they said we're not prepared to do check with that organisation.

[00:19:07] But we would be able to prepare to do check with another organisation. So is that the most famous one that people hear about if you're not going to manage it? Yes, I'm going to manage it.

[00:19:16] Yeah, I do have a few of these, some anecdotal stories about the way they operate. But surely if you're taking hormones, that's been prescribed through or even if you've got that separately. Surely you could argue it's negligent of a GP to say,

[00:19:42] well I'm not going to check you healthy with your blood tests. Yeah, you're the person. I'm not quite in the two. If you go to the GP and say, I'm abusing, I'm addicted to your abusing and not comparing

[00:19:57] if you say, I'm doing something that could potentially harm the GP as well. And I've got a budget, don't really care. Yeah, that does seem odd to me. Yeah, but it's the same as smoking. It's the same as smoking isn't that?

[00:20:11] I mean, no, it's not the same as smoking. It's not the same as smoking, so it's a very bad example. I think the problem is no, it comes back down to some of the NHS guidance this out there. I mean, I know I'm no expert on this.

[00:20:24] I know if you go into the transactual website, there's better guidance for this. But there's a big difference between what people are meant to do and what happens in real life. And that's why I say moving to different practices allows you to understand that.

[00:20:38] And some of this, Jenny really does come down to ignorance and some of the doctors I've spoken to say, I mean, really, I mean, this is a genuine thing. I'm on the outskirts of Newcastle and I was the first Transgender person who'd ever been through the door.

[00:20:50] Well, I mean, and I mean, you know, I'm eight minutes from the centre of Newcastle bonsai. Well, there are many, there are many, there must be practices that do have a lot of gender experience.

[00:21:03] And what I've found is the best place to go just to get sense of advice. It's got the sexual health unit because actually they're the most used to dealing with trans people, because they see them a much more regular basis.

[00:21:14] So true, I work in my job at the University of Work with a lot of sexual health services and they are closer to the whole LGBT community's the whole because of the work they do. And yes, that is very, that's a very interesting.

[00:21:32] I just, you know, as we talked to it, I just can't understand this concept of a patient. Some of you who's taking hormones for gender, just for you, right? There isn't it, a safety issue around blood test, make sure levels are right.

[00:21:47] And yet a doctor can go, well, I'm not going to do that because you went, probably. I could understand the logic of it if people were just choosing to go private because we had a system where you could access the parts of the internet just you need to.

[00:22:02] But with the weightiness at four or five years, that can't make any sense to me because you can't even go well and you could do this to the internet just you can't. You're going to wait for five years.

[00:22:12] So I just don't know how that's a sustainable position, even if you are even if the people is empty, trans at heart. Because a trans person is taking hormones, it's going to take them. So it's important, we don't do it on a win, you know?

[00:22:29] Yes, and I like to say this comes down to guidance and it seems to be, it seems to be a bit of a lottery. And I know, and I don't have to look at this, shared care with private providers.

[00:22:44] This is on the, which websites, this is the BME website. And I'll say, I've gone past that. Share care with private providers, not recommend a due to the general NHS constitution principle of keeping a clear as separation as possible between private and NHS health.

[00:23:01] So share care is entering into a shared care arrangement. We have implications for governance equality, as well as promoting health inequalities. A private position, seek an access to their care completely transferred to the NHS, which is the problem.

[00:23:16] So what's happening, it's almost like the guidance says there shouldn't be any shared care and what a lot of doctors are doing is giving shared care. Well, the argument to make, and this might, I guess this might be different for transmen because another may be more side effects.

[00:23:31] And I'm not saying that it shouldn't in terms of testosterone. But estrogen could be prescribed by the GP's. Yes, but the testosterone. Yeah, no, but that way you say the whole of the NHS, but GP's are refusing to do that.

[00:23:46] And yeah, I think my understanding is there's nothing to stop a GP is the not prescribing HRT in Eastern, for instance, to a, a trans patient is there. I don't know, will mean they refer to the gender identity clinics.

[00:24:02] I got, he has this, he has something interesting, all shared care arrangements of voluntary. So we're even where agreements from Chris, in our own place practices can decline shared care and question clinical and capacity grounds.

[00:24:15] The responsibility for the patients can angle and prescribe it then remains the responsibility of the provider provider and this is the problem. So actually, it's almost like you flip it round if you read this because actually anyone has given you shared care is given you a massive gift.

[00:24:28] And often the reason there is sometimes a way you get shared care is that if you've been self prescribing so if you've been, I know a lot of people have been self medicating, go into the doctor. Yeah, and the doctor has given them something to tide them over.

[00:24:41] But they can only, my understanding is that in the, in that you can't prescribe stuff to trans people. And actually, being through the gender identity clinics because they're the people that have to make the decision. Well, they were trans.

[00:24:55] It's interesting, that wasn't the case for me. I got prescribed by psychiatrist. Yeah, well, I thought it was a specialist. It was a liaison psychiatrist. They had no real, that was the path. But they weren't experts in gender identity at all. No, that's not the God.

[00:25:14] I mean, it was fine. I got prescribed it. So I was on, I was on the, I was on the, before I went to the gender identity clinic when they just continued it.

[00:25:21] Frankly, if they just made, if they actually just allowed it to go to psychiatrist to actually to get, I mean,

[00:25:28] I know it's not what we probably want to see, but there's more trees to get the point with the psychiatrist than it is to get in the point that with a gender identity clinic. And there you go.

[00:25:38] But I, I, I, I, I, I, I, I, I, I, I, I, I piss this wrong because it's not mental illness. So they should be, I mean, it should, it should, until, I mean, this is a video and I guess people are going until such time,

[00:25:48] gender identity clinics are, are capable of, you know, providing service to patients because they're not at the moment. The way to the safari long, that's on, that's on, that's on, do what you can't expect so many to wait for five years.

[00:26:02] So until such times there needs to be other arrangements. But the challenge here is that people are waiting longer and longer for all appointments. And I think I said this to you once before.

[00:26:13] They had, they had the need for a new hip and they waited, they waited over a year. And as a result of the fact that a treatment took so long, they now need a new knee.

[00:26:25] And then, and the, and the, and the consultants surgeons are saying, if you'd had this operation when it was necessary, which was over a year ago, you wouldn't have needed a new knee because the hip damage is such exacerbated in the name of that.

[00:26:37] And we know that, and the patients are waiting longer and longer and longer. Yeah, I don't think they're pulling the point, but it's like a tip, I take the point, well, I take the point on that because the NHS is still learning these, these funded.

[00:26:50] There's a different, there's a different one's a different level, different scale. You're waiting for five years to get a set, not even getting treatment, right? And that predates the poor waitingless rise that we've seen in the last few years.

[00:27:05] It has been a longstanding under resource of just not enough clinics. Yeah, great. I couldn't even put it so deadly. I think it's just so far down the list of priorities. So, I mean, we're all got experienced by some of that.

[00:27:19] Will there, a friend of my friend, I know, has, has, has, went to the doctors and was, and they said to them, you've got a problem with something on your head. It's a real urgent thing we need you to get assessed.

[00:27:32] And it was going to take weeks and weeks or weeks a week to get assessed. So what they did is they went privately, and they've had the operations, everything's done,

[00:27:40] and they've come through the whole process and just got their appointment from the National Health Service to get assessed. Now that's for, and it, and it had, it was a malignant moment. So that's what's going on in the National Health Service.

[00:27:52] That's part of the problem. And I know we get it up with tickers, we have to work years and years and years. But frankly, you know, I'd rather, I'd rather the National Health Service could seem me within a week,

[00:28:01] whether the malignant, malignoma, and I could worry less about that. Yeah, I've got six issues for her. I've got six issues. Of course, but it's not a zero, some thing. It's not a zero. No, I agree. I agree. I agree. I agree. I agree. I agree.

[00:28:18] And there's a separate clinics that, if we're resource, or if, in the main, GPS is just building up to do the prescription themselves. Yes.

[00:28:21] Fundamentally, what you do through your shared care remotely with the GP police elsewhere is nothing that the GP couldn't do with a bit more knowledge in terms of the simple fact of prescribing and particularly the history and something they prescribing every day.

[00:28:36] You and I both, you and I violently agree on this situation. We don't. And it's a thing about basically if you have, if you do have self-ideating, it works well and it's not, you know, everybody, you know, whatever.

[00:28:50] And then we go to a doctor, you say, I am trans, and it's okay. There may be some safe concert. You're going to pass which makes sense.

[00:28:57] There should be some sort of, there's some sort of discussion or, you know, conversation because these are powerful drugs that they are prescribing. So that would be a normal duty of care conversation that should then get on and prescribing and we're going to go.

[00:29:12] And then all of the rest of the service could then easily go through a sort of more specialised thing, you know, so-dreams and such like, which you would expect to do anyway. I mean, why was treated differently in the first place is the biggest issue in that situation?

[00:29:25] Well, that's definitely true. Yes. It's just one thing. When we did the Prime Minister, both of us together at the same week, I'll be Prime Minister. What was which job would you like in the cabinet? Which job dialogue in the cabinet? Yeah.

[00:29:39] I'm a Prime Minister because I'm the right person. Yeah, you're more Prime Ministerial than I am. I mean, I would definitely like, so if I wanted to go and see lots of sport and things, the culture that one,

[00:29:53] what come in, but the full title is going to show the traditional culture and sport and media, I could enjoy that. Yeah. I'd love to do it. How sexy really, but it sounds like a hell of a job. You know, it's a big job.

[00:30:06] I don't know about, and for an office and go traveling that before. I'm not, I'm not thinking that's slightly many different trends of hers. There would be a, could have a, not a cabinet level, but could have a many different, a many different, a minis to

[00:30:21] Belgiumity, Coup plus people. How about that? Right. So come back to, I've just realized how far we've strived for this thing. We have straight. So look, let's go back to Jail's In-Squestion.

[00:30:30] So basically, go be confidence on the, on the vast majority of times that you're going to say your GP, it will be a positive. It will be an, and neutral experience and you will be treated professionally, get what you want.

[00:30:44] Sometimes they're particularly positive and they're on the other occasion, sometimes they're not as positive as you hope. They're quite negative, which case you go back and say, I'd like a different appointment with a different person.

[00:30:53] Just like you would do, if you went in, instead I got a tummy ache and you saw your doctor and he didn't like the results and he came back and he said,

[00:30:59] I'd like to speak somebody else. And we have the same writers everybody else to do that. So Geraldine, Get yourself an order like Jen says, just rehearse the words in your head and you'll probably find that there'll be absolutely nothing. You're going at law, just be absolutely fine.

[00:31:13] Let's know how you get on in fact. How about that? Indeed. Now great advice. Yeah. Good luck to anybody who's going to GP for the first time for their gender identity. It's a great first step. I think it's a milestone to reach. Kissing it.

[00:31:30] It is? And I think we've definitely plumbed the shallows of our knowledge today. So what I'd always say to you is get onto the NHS website and if you are worried in your anxious about going, sometimes you don't want to see a doctor first, I have done,

[00:31:45] no people do this, just get in there. And the point with the nurse practitioner is just to, because they definitely more warm and accepting than some doctors. And I know I have done training for nurses right across the country and I know you have as well Jen.

[00:31:58] And the quality of care that nursing staff can sometimes do is just as good as doctors, what they do is put your mind at rest a bit first. Well, at 99 percent of the point, 9 percent that people are fine.

[00:32:10] If you're with an organisation or charity that supports trans people, a lot of those charities, I know the one that you and I get involved with, they do this. They will do and they will do in a company visit with you if you are really anxious

[00:32:25] and there's no one in your own family who can do that. So, if you get stuck, reach out to your local trans support unit and that we have private charities, they'll help you. Good advice.

[00:32:38] Well, I think I was going to do a second question all about also, so group you stuff to do with work, but let's leave that another time. Thank you, Jillian.

[00:32:46] I was a fab question and it's always lovely to hear from people from Brazil and have a good week and I'll speak to you soon, Jen. Yes, see you soon, Jill. Bye bye, everyone. Thanks for listening to this episode of Transvox.

[00:33:05] It's been a joy to have you with us. If you want to make contact with us, you can contact us at Jillian at Transvox.com.uk and if you'd like to support the work we do, please go to Patreon and go to page Transvox.

[00:33:22] And all of our money goes to our nominate charity and Jen, you've chosen the charity for the next number of episodes which one of you chosen. Our charity is called Beyond Reflections, which is a charity that provides support

[00:33:35] and counseling to trans people, non-binary people and their friends and their families across the UK. And the amazing charity doing some amazing work really important so please if you can give. Great.

[00:33:47] And if you want to go and have a look at Beyond Reflections, it's beyond hyphenreflections.org.uk And as I say, if you'd like to make a contribution to what we're doing because we love to help the people who are well-pots.

[00:33:58] Again, if you've got ideas for the show, things you'd like to ask us, questions, comments, applause or Rick Bazz feel free to send it all into Jillian at Transvox.co.uk Until the next time, goodbye! Bye-bye!