PLEASE BE AWARE THAT THIS ARTICLE DISCUSSES SENSITIVE TOPICS AND MATURE THEMES.
TRIGGER WARNING: TRANS HEALTHCARE, MEDICAL TRAUMA, INVASIVE EXAMINATIONS, AND SUICIDAL IDEATION/MENTAL HEALTH STRUGGLES.
I could have been prepared for the grief borne of no death. Instead, this is my last flag in the ground.
On 30 June 2026, I received a gut punch that I hope nobody else has to endure. This is where I am currently, reeling from a grief borne without a death, or even a loss of anything physical. That is now, but I want to take things back a little bit first because there is a story that gets me to today.
In January 2020, I finally allowed myself to give in to the undeniable fact that I could no longer fake my way through life as I had been doing, at least consciously, for well over a decade. I had to make a change or risk the seriousness of the consequences that would undoubtedly arrive swiftly if I remained in the pain of the status quo. Is this vague enough so far? Well, that comes from a profound fear, but that is a story for another day. I am transgender, and on January 3 2020, I spoke to my GP and asked for a referral to what is most commonly referred to as a GIC, a gender identity clinic. I was so relieved to have said this out loud at the time and ask for the help and support that I had known for some time that I actually needed.
Over the next two months, I would speak to a mix of three different psychologists and psychiatrists, a difference I at least found to be without distinction. You see, before my GP would send in my referral to my chosen gender clinic, he had told me that this was the procedure and protocol of the NHS for everyone like me. It wasn’t until I had been referred on to a fourth psych professional, who would tell me that the hoops I was jumping through with a smile on my face were, in fact, not the protocol or procedure or in any way standard.
Unfortunately, this conversation would not take place until 21 March 2020, which meant that by the time I spoke to my GP to call him out on this, we as a nation were in a complete social isolating lockdown. Lockdown would become the next excuse for the next ten months until I eventually moved areas, moved GP practice, and spoke to a doctor willing to send my referral over immediately.
Over the next few years, I would fight for my hormones, testosterone blockers, all once prescribed by my GP, but the proverbial hoops of the NHS would now litter the obstacle course that is gender transition in the 2020’s.
In November 2022, I was fortunate enough to be sat in the waiting room in the Nottingham Centre for Transgender Health, awaiting my first appointment with the Nottingham Service. The appointments would continue beyond this date to April 2024, when I received the news that I would be referred for psychiatric evaluation to decide if I was eligible for gender confirmation surgery, also referred to as ‘bottom surgery’, meaning the bottom half of the anatomy. In July 2025, I had appointments a few hours apart with the psychiatrists who would decide if I was mentally eligible for bottom surgery.
As you, dear reader, can probably tell, this was all successful, as we are still not talking about events even in this year.
In March 2026, I received a phone call from my chosen surgical centre to talk me through the process and the what-to-expect points. It was explained to me that, while I had eventually reached the top of the list to be called in for a pre-operative assessment, there was a rather large and looming issue.
You see, I also struggle day-to-day with chronic pain and mobility deficiencies and as a result, I take a daily cocktail of what I refer to as “keep going” medications, one of which is morphine. Morphine has the unfortunate possible side effect of slowing the user's breathing. Now, when someone who takes morphine is awake, not a problem; the user will hardly notice because their subconscious will do everything in the background to ensure that there is enough oxygen to keep going. However, when the morphine user is also given general anaesthetic, a separate medication with the same side effect, this can become a life-threatening issue. Because my chosen hospital did not have the capacity in the same way a full hospital would to look after someone with this potentially fatal issue, I was told that I would need to stop my morphine if I were to become a patient with them for surgery, and in any case, my file would be given to the anaesthetist to review. So, I acted with logic and determination and spoke to my GP. We agreed that while far from ideal, if I wanted this surgery, at this hospital, with this surgeon, I would need to stop this medication. So I did. Done. Until two days later, when the same administrator rang me and told me that they would be denying my request for surgery with them. I begged and pleaded, explaining what I had done, but it wasn’t enough because, for reasons I do not understand to this day, I was told that my morphine prescription was not the only reason, not that they could mention even one other reason.
Now I was hurt, upset, frustrated, and angry. I had been told no, in my ears at least I had. The actual next steps were that I would be referred to a different hospital, one that was likely to be able to cope with my physical limitations, pain, and my medication list. I would just have to wait.
Next came the time of not knowing. You see, I had waited nine months for this appointment after being told the wait would be only three months, so there was panic. I had finally reached the top of this indeterminably long list, but now could fall to the bottom. Although maybe I could be fortunate enough to have my place honoured by the new hospital. There was no way to know without asking the hospital directly. I made phone calls, but nobody knew where to send my call and with whom I needed to speak, so instead, I emailed. It took three weeks to get a reply, and when I did, it was just a general fact sheet of information for new referrals, nothing specific to my unique situation, so again, I emailed the team with the question I had relating to my specific situation reiterated.
This time I waited five weeks, and I was told that no, my place on the previous hospital's waiting list would not be honoured.
Now this was soul-destroying, well, at least it would have been. It should have been. By the time I saw this email, I had a second email from the same hospital. This one was offering me an appointment with them, the same appointment I was never quite offered by the first hospital.
Now we get to the events on 30 June 2026, the day that I do not wish anyone to undergo again.
Armed with my best friend, I made it down to this appointment, and once called in to the appointment room, I was asked over and over again about my readiness for this life-changing surgery. I was asked if I was sure I wanted it; I was asked if I had thought about it, researched it in any way. Obviously, I had researched it as much as I had thought about it, and thought about it as often as I had researched it. I had plans with my family and friends in place for what would happen in the first twelve weeks, as well as options for what could happen beyond the twelve-week post-operative point. What I did not know will sit with me for as long as the surgery would as well.
I was examined, an unpleasant and painful experience on its own. I had two surgeons, both in their late-twenties to early-thirties, with their heads disappearing from my view as I lay down on the hospital bed with my knees bent and ankles tight together, a not unfamiliar position for many cisgender women the world over. What I struggled with was the fact that the skin in the region of my body I have dysphoria over the most was being poked and prodded. Then came the squeezing, squeezing a notoriously tender area, checking the tubing, squeezing and pulling on both sides. Finally, the skin check – this is possibly the most important and most uncomfortable part of this experience: the penile skin is pulled to what feels like one hundred ten per cent of its maximum and moved in all directions; this is then followed by the same process for the scrotal skin.
Once the examination was over, we all took our seats and discussed their “findings” and my options. The options given were:
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An Orchidectomy – the removal of both testicles, possibly the scrotal skin if it is chosen to be removed by the patient.
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Something commonly referred to as a “zero-depth vagina” – it looks like a vagina; for the most part, it is a vagina, but there is no, or very little, depth of a neo-vaginal canal. The maximum depth is no more than one and a half inches.
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A shallow-depth vagina – this is a neo-vagina with a depth of between one and a half and four inches deep. During penetrative sexual intercourse, there can be significant pain due to the shallowness of the neo-vaginal canal.
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A full vaginoplasty – this is a neo-vagina created from the penile and, if required, scrotal and perineal tissue to create a neo-vagina with a canal depth beyond four inches.
Due to my anatomy and the effects that hormone replacement therapy has had on my body, I was offered a choice between options 1, 2 and 3. I explained, rather emotionally, that I had always had my heart set on option 4, something I have dreamed about for many years and was now in a position to get, except, I wasn’t, not without a plethora of new hoops to jump through and caveats to consider. To be eligible for the surgery I had always dreamed of having, I would need to submit myself to several “inconveniences”.
I would need to firstly leave the appointment without any scheduled next contact and would instead need to undertake twelve to eighteen months of hair removal on the scrotal and perineal areas; this would need to be completed entirely before I contacted again for an appointment.
Then, once this painful and lengthy process had been completed, I would need to wait four months before being seen back in clinic for them to once again inspect my most vulnerable area. If the area was found to be acceptably hairless, then I could move to the next stage.
I would be returned to the waiting list, not like before, where I would find this to be a matter of minutes; no, this would be a waiting list that I had been told at several points up until this appointment would be six weeks, but was in fact over six months. However, this was a different surgeon, a surgeon who is spread much thinner than the two surgeons in front of me. I was told that the waiting list for this new surgeon, the only person qualified in this specialist procedure, was a longer waiting list, but it was not known just how much longer.
I would also need to wait for funding to be approved for the hair removal; this could take a few months. I would need to wait for an actual appointment date beyond the four months that was required to wait after hair removal; this was likely to be another few months.
The new timeline looks like this:
30 June 2026 – this appointment.
End of August 2026 – funding for hair removal approved
February 2028 – hair removal is complete
June 2028 – four-month waiting period is over, and the phone call to request a new appointment is made.
September 2028 – pre-operative appointment (repeat of June 2026)
June 2029 – operation day (three years have passed since the first pre-operative appointment)
And the scariest thing of all, even beyond a possible three-year delay, was that while I would have to wait for this and do that over the next two years to be in the same position I had been twenty minutes earlier, I needed to be aware that the success rate of the procedure to ensure option ) was successful (and had not become a failure, resulting in the same outcome had I just had option 3 was seventy five per cent. A one-in-four chance that I would be two years older and no better off than if I had just selected option 3 today.
I have had four years since my first appointment with the Nottingham Centre for Transgender Health that I could have been prepping for this appointment; I could have had hundreds of hours of hair removal sessions, I could have been reading the information that detailed this appointment in far more detail than any of the tens-of-thousands of medical pages I have read have ever given.
I could have been prepared.
I could have been ready.
I might not be sitting here today, writing this out and all the while turning my mind through thoughts of detransition – not because I am not transgender, not because I am not a woman in every way that should matter, but because, from all the trauma, the abuse, the disability, fighting for the medication for my health, chasing of appointments for my health, chasing of appointments for my transition, fighting for my medication for my transition, fighting for my rights to remain, fighting to be seen, fighting to live, fighting to survive, fighting to thrive, fighting to make it better for me and hundreds-of-thousands like me, I am done, I am tired, I am hurt, I am heartbroken, I am numb. I do not know if I can continue any further beyond this point, and I may, instead of being able to live a happy life “complete” in my eyes, I may instead end up as some form of statistic.
I hope that someone reads this and learns from it so they do not live a day in my shoes. Beyond that, maybe someone reads this and thinks that it is wrong that a human being had to go through this in this way and fights to change it.
I am aware that as a transgender person in 2026, articles or social media posts discussing the issues of transgender healthcare hit hard with some and provoke hate in others. I am writing this not in defiance of that but in spite of that. I have been the voice for hundreds of transgender and gender non-conforming people over the years, another fight I have been in, but I write this as I have no voice left to use to shout, to defy, to support even. The weight of it all is simply too much. That being said, I have written this as a last stand – a final flag in the ground at the end of the battle, a last chance to rile up the troops. I write this in the hopes that the next generation feels ready to take up the mantle.
