My big letter...

I have been jumping at the postbox every day for the last month waiting for my letter from the clinic  (it was sent to my GP - I requested a copy).  Today it finally arrived and I am delighted!  Finally something has happened after all the waiting - now I just have to organise my hormone treatment with the GP, so hopefully it really shouldn't be long till I start (hence pic).


I thought those of you who follow my adventure might be interested in what it said so here is an edited version  (I've taken out the personal bits - even I'm not that much of a publicity whore - ha ha) : 


I saw the above named in the Gender Identity Clinic on the 20th May 2010 where she said 'I am here to carry on with my transition'.


Family history is probably well known to you, parents are alive and well as are the patent's two older brothers.  This patient is married with a son of 9.  There is said to be no family history of illness, suicide or homosexuality.


Medical history is significant for a fractured wrist but very little else.  It is not my impressions that this patient has Klinefelter's Syndrome as she seems too bright and also doesn't have a female carrying angle.


She is on no prescribed medication, doesn't smoke, drinks within a safe limit and doesn't take any illicit drugs.


Her psychiatric history began at the age of 5 when she wouldn't void and she also saw a psychiatrist when she was aged 20 at university when she had panic attacks.  More recently she has seen a counsellor in association with gender identity issues.


She has a reasonably wide and supportive circle of friends and has been married since 1997 to a wife who is not too upset by her change of gender role.  


This patient derives her finances from her job, she works for Maidstone Borough Council in the Rates and Revenues Department and has worked in female clothes since 2005 and in a clearly and officially female role since July 2008.


She live with her wife and son in mortgaged accommodation which is suited to their needs.


Considering gender development she first cross-dressed at 13 wearing her mother's underwear and did so fairly steadily thereafter being caught by her mother and soundly told off.


She first bought her own female clothes at the age of 18 and first went out cross dressed at the same age when she went for a nocturnal walk.


She first went out in daylight cross dressed at the age of 23 when she went shopping with her wife.  Her cross dressing appears to have been sexual until she was aged about 18 years but not since.


She was born in Chatham to a father who was a builder and a mother who was a housewife, both being Evangelical Christians.  She was a quiet, shy oddball at school but came into her own when she joined pop groups from the age of 16 although she achieved no commercial success.


She left school at 18 with some A levels and went to Greenwich University studying Sociology in which she got an upper second degree, the only one in her class to do so.  She then worked with intellectually disabled adults for three years before moving to her current job.


When I saw her she was markedly thin with a height of 5ft 11in and a weight of 9st 3 and a half pounds.  This gives her a body mass index of 18.1, just below the bottom end of normal.  She had a pronounced thyroid cartilage but otherwise presented well in a female role.  When I asked her what she wanted she said she was enthusiastic to receive hormone treatment and a thyroid cartilage shave and ultimately gender reassignment surgery and a Gender Recognition Certificate.


With regard to diagnosis, I would see her as somebody with secondary transsexualism arising out of a background of initially fetishistic and subsequently dual role transvestism.


With regard to the thyroid cartilage shave this would appear very much to be indicated and I am happy to support a referral in this regard which will be made to the ENT surgeons at Charing Cross Hospital.  It is also appropriate for her to be treated with oestrogens and I would be grateful if she could be given Estradiol Valerate (Progynova) at a dose of 2mgs a day rising after three months to 2mgs twice a day.  


In concert with this she needs to be given a gonadotrophin releasing hormone analogue and I would recommend Decapeptyl at a dose of 11.25 mgs every three months which is to say precisely the dosage and regime used in prostate cancer.


Please note that for the first two weeks of this treatment there needs to be additional dosing with Cyproterone Acetate at a dose of 50mgs a day in order to offset the initial androgen flare that accompanies the onset of treatment with a gonadotrophin releasing hormone analogue and which is followed by a precipitated decrease in native androgen production.  Accordingly the Cyproterone Acetate shouldn't continue after the first two weeks as prolonged use can be associated with depression, lethargy, fatigue and deranged liver function tests.


We aim with this patient to achieve a serum oestradiol level of between 400 and 600 and the dose should be increased by 2mgs aliquots at three monthly intervals until this is achieved.


We wouldn't consider this patient as a candidate for surgery until she has stabilised on a hormone regime which gives exactly the same hormonal effect as would pertain after gender reassignment surgery since it will be better for her to find out in advance of this surgery whether this situation is one she is happy with.