I was going to start this article as more of just a vague tweet thread, but then I was like… No, no, I think it would be better if I kind of went into it in more of a blog/article format, because I have a lot of feelings about how my physical transition is going to be going, and I just want to sort of get my feelings on paper.
I’ve been out as a transgender dude for about seven or eight years, since I was approximately fifteen, and even before then I was very much a boyish child, had my hair cut short, was often mistaken for a boy (not entirely accidental…) and so on.
Thanks to the Gender Recognition Act here in Ireland, it says M on my hospital bracelet, and my dead name is not only long dead, but dead in a different country, so no one here in Ireland would typically be at all familiar with it.
I dress masc, I use he/him pronouns, and I only ever introduce myself as a dude — point of fact, a lot of the time I tend to tell strange cis folk that randomly demand if I’m trans (which some of them do, and I hate it), I tend to just say I have a hormone deficiency or pretend to not know what trans people are.
Partly because fuck cis people, and it’s honestly none of their business whether I’m trans or not, but also because typically when someone asks one weird invasive question other weird invasive questions typically come to follow, which in general is just abhorrent.
BEFORE I GO ON, I would like to reiterate that this whole piece is based off of my PERSONAL EXPERIENCES, and that subsequently there are some content warnings for medical abuse and particularly medical gaslighting, and that I’m also going to be making some criticisms of the services I can access.
I think there’s a narrative around what pittance of transgender healthcare services we have that for us to criticise problems within them is to be ungrateful, but I can be glad that I can access the medication I need and also criticise the process in which it’s given.
Other content warnings — I’m going to be talking about my own transgender body and dysphoria experiences, and I will be talking about my own weight gain in positive terms, but just note that talking about some body elements might be triggering for trans dudes with their own dysphoria.
How I got my medication:
So I basically want to sort of work through how I got to this particular point, how it’s felt getting hold of my hormones up to now, and also trying to be (kindly?) realistic about how well I currently pass and what the wishlist is when it comes to physical transition.
Honestly, this is a thinking-out-loud sort of thing, and is really intended for the benefit of other trans men and other transmasculine folks, because I think more access to other people’s stories and experiences is always something encouraging for me (as I write this I’m watching videos about other guys’ experience on T), and especially when people are talking about the NOT positive things, it can be helpful to know there’s a sense of solidarity there.
Everything I’m talking about in here is based on my own experiences, both positive and negative, and many of them, honestly? Have sucked. But also, for all that, I’m a pretty confident guy, I’m feeling pretty great about the position I’m now in, and I’m genuinely feeling positive about looking forward.
So, I’m from the South of Wales in the UK, and moved to Ireland about four years ago.
I actually began the process of applying for HRT through the NHS back in the UK a while back. Through the NHS, I got a psychiatric referral, where the idea is that a psychiatrist will sit down with you and interrogate you to decide if you’re REALLY transgender.
I would say I was about seventeen when I went for my first psychiatric referral, and it was honestly one of the dehumanising, most painful experiences of my life. I had to run over to the clinic at around nine o’clock in the morning, this being an outbuilding on a campus I’d never been to before, and when I walked in, I was met with a very hostile cisgender woman.
Upon meeting me, she immediately remarked upon how thin I was, quite aggressively. I said, haha, yes, I am quite thin, and sat down.
She demanded to know if I had eaten breakfast today — I explained that, in fact, no, I hadn’t. My plan had been to go to the clinic for this referral, then walk down to the pub and have a cooked breakfast afterward, which would be a nice reward.
“Have you got anorexia?”
“Uh… no? I’m naturally very thin and I haven’t got the greatest sense of time passing, so sometimes I forget meals, but I do my best to eat well, and I’ve actually been trying to gain weight.”
“You look like you have an eating disorder.”
“Oh, okay… Well, about testosterone — “
“How do you feel about your weight?”
This interrogation continued for the entirety of the session. I cannot tell you how utterly demoralised and disgusted I felt afterward, especially because I’ve always been underweight and have always done my best to stay on top of meals. Fast metabolism, distractibility, and no reliable memory do not a commitment to regular meals make, especially as a teenager, but as you can imagine, this sharp interrogation made me feel sick to my stomach, especially because all of my actual concerns were thrown aside in favour of a completely fictionalised diagnosis for which this woman — whom I had never been before introduced — had no evidence, except that I was thin and hadn’t eaten breakfast yet on a Saturday morning.
So that put me off for years.
When I came over to Ireland, I was still nervous for the longest time about starting testosterone, and perhaps nine months ago, I finally went to my GP here in Galway City and explained that as a trans dude, I would very much like to begin HRT, and therefore would like a referral to the endocrinology clinic.
She said, cool, gotcha. That isn’t my area of expertise at all, but I’ll set up the referral for you right away, and do that for you.
Fast-forward… so many, many months, and nothing had materialised at all.
I made the decision to begin my physical transition by working through GenderGP, which is a private service intended to connect trans people with necessary healthcare, and started out based in the UK, but is now based in the EU.
Then, I got a letter in the post. The letter was from the HSE, and to paraphrase it heavily, it basically said, listen, we know you’ve been on the waiting list for HRT for a real long time… Could we take you off? That list? We just don’t want to care for you.
They had a little thing for you to clip off and send back if you DID, in fact, still want HRT — which I did, incredibly. I was beyond furious when it happened, because the HSE’s trans healthcare service genuinely lost dozens of trans healthcare records, and they’re not at all known for putting in a great amount of effort — getting a letter that effectively said, “Hey, you know how you’re trans? Have you maybe changed your mind? Please? Pretty please?” did little for my distrust in that service.
I became more dysphoric, like a lot of men did, when the pandemic lockdown really set in, and I called my doctor and asked if I could see where I am on the waiting list, and she referred me to the University Hospital.
The guy in the Diabetes Unit (being the endocrinology unit, but they mostly cover diabetes), said that there was a tiered set of waiting lists, where there’s like, people in need of urgent care, people in moderate need of urgent care, and then like, low-urgency ones — I was on the mid-tier list, where the goal was to get me a referral within a year. To clarify that, that’s not a referral FOR actual medication — that would just be a referral to talk to someone ABOUT being trans, after which would come way more hurdles to jump.
So I registered with GenderGP.
Now, I just want to go through the prices of GenderGP up front. I will say it again: GenderGP is extortionately expensive, separate to the actual medication, and I feel incredibly lucky that I’m able to afford it. Do I think GenderGP is a great service?
No. Not really.
In fact, I find GenderGP to be very obstinate, intentionally avoidant of meaningful patient interaction, and in general just badly organised and difficult to use and to contact.
And yet for all that said, I’d still recommend them to another trans man, because like… Dude, what other option do we have?
So to go through the prices of GenderGP at the outset:
- £195 “set-up fee”
- £30 subscription fee, which covers medical advice and private prescriptions. I would note that medical advice ONLY covers what would be given to you over GenderGP’s weird patient-dodging email contact forms, and if you want to talk to someone over video, you have to pay £65 for the privilege.
- £65 compulsory “information gathering session” — this was about an hour over Skype I spent talking with a woman about what it felt like to approach growing up as trans dude, etc. She told me multiple times she was not a medical health professional, and stressed many times that it was not medically relevant, but was just for “information gathering”.
- £50 for blood tests. I declined to get my blood tests done with GenderGP, and instead, chose to get them done by my GP — initially, GenderGP said it was compulsory for me to get blood tests before being prescribed medication. When it turned out the money for doing the blood tests would be going to my GP, and not to them, they said that as I was young and healthy, the blood tests didn’t matter.
Throughout the process of applying through GenderGP, I thought that my doctor would be supportive of my physical transition, especially as I’d been working through the locum doctor as my own GP was on maternity leave.
Once GenderGP sent through their recommendation, I thought, oh, champion, and forwarded their many-paged information packet, on top of their recommendation for medication. Effectively, what they do is prepare a huge amount of resources for a GP to be able to prescribe the correct medication, explain how it works, and then trans patients can go through their transition under the care of their own GP, who they know and trust.
My GP called me a few days after this to tell me that, as she’s not an endocrinologist, she doesn’t feel comfortable prescribing any of my medication for HRT, and that she doesn’t want to accept liability for it.
This, in itself, I didn’t take issue with.
What I did take issue with was the incredibly long explanation she tried to go into about how she’s “so sorry” that I’m “being forced to rely on this private service”, and tried several times to push to me that GenderGP is a sketchy organisation, and that I shouldn’t go through them.
I made it clear to her that as soon as another option arose, I would take it, and in the meantime, I would continue with GenderGP.
This sucked, obviously!
I interrupted her apology, because I didn’t think it was really useful to me or to her — I sort of said, listen, I respect that you’re concerned about your medical liability, but if you don’t want to treat me, you don’t want to treat me, and therefore, I don’t want to discuss this stuff with you anymore.
She also said she would not want to do any other blood tests in future, because she didn’t want to accept responsibility if anything went wrong — as far as I see it, refusing to help a patient keep on top of how their medication is affecting them is not great medical care, but hey-ho, that’s just my opinion.
So I contacted GenderGP, explained what had happened, and paid £8 to receive a paper prescription that, as an EEA prescription written by a registered doctor within the EU, I’d be able to just go into any pharmacy that accepted private prescriptions and pick up the medication I needed.
I fucking wish.
So, in the meantime, I recently suffered my first severe asthma attack, and in the aftermath of that, I had to call my doctor and explain what had happened, ask about changing the dosage of the steroids and other asthma medications I’m on, et cetera. During the conversation, the locum doctor tried to change the subject to me starting testosterone. She, too, told me she was very sorry they weren’t able to prescribe the medication I needed, and tried to ask me questions about what I was going to do through the private service, even though I was trying to talk about my asthma, and the medications I needed for that.
Not great.
The next day, I was hospitalised following another asthmatic flare, and when she called me up about that after, she once again tried to change the subject to my HRT and the anxiety it must be calling me.
I stated, this time far more bluntly, that if at the GP they were unwilling to deal with the aspects of my physical transition, I did not want to discuss the ins and outs of the treatment I’m receiving for it with them, particularly because the conversation does not, in fact, seem to be about my physical health, but instead about their feelings as cis people, and having to brace myself to talk about something they’ve said they don’t want to even be involved with is deeply unpleasant.
My paper prescription finally arrived yesterday, and I took it to my local pharmacy to pick up as well more asthma meds.
The prescription GenderGP sent was not great-looking. GenderGP has two options for people living in Ireland when it comes to getting a prescription — you can either get a paper prescription from an EEA doctor that you can then just take into a pharmacy, or you can get a ClearChemist prescription and pick it up via a ParcelMotel. I opted for the former, and it was not printed on what I’d call proper prescription paper — it was just a piece of A4 with my doctor’s name and practice on it, information about my name and DOB, and then the actual prescription.
So when I went into the pharmacy, I wasn’t hugely surprised when the pharmacist looked at it sceptically and uncertainly, and when she said she wanted to check the practice out, I said that was fair enough.
I had been prescribed 2 pumps of Testogel,which is a topically applied testosterone gel, per day, and in Ireland this is not like… a hugely uncommon medication — obviously, trans dudes use it, but it’s prescribed for low testosterone in cisgender men and for ED, etc. So I did ask if they stocked Testogel, and she said, yes, of course.
I handed her the prescription, and she looked at it, and then told me that it was required for prescriptions from EU doctors to be copied out by one’s GP. I said I’d never heard that before, and that I had been informed that so long as one’s doctor was licensed to practice within the EU, and the prescription was valid, it should be valid in a pharmacy here.
She looked very sceptical, and then said, listen, leave the prescription with me, and I’ll call you back tomorrow.
Calling me back today, she informed me that Testogel is not licensed for use in Ireland — which like… Given that she stocks it? Uh huh. Sure, Jan. While initially I respected her focus on due diligence, now I obviously feel way less trustful that that was her intention, especially because I am, you know, visibly not a cis man.
I called another pharmacy in town and asked how they’d feel about me coming in with my private EU prescription, which was prescribed in Bucharest. They said, yeah, sure, come right in — I went right in, I paid the €124 for my 2 bottles of Testogel (yeah, I know, painful for me also), and then I left. It was great, it was amazing, 10/10, it was the most basic transaction of “here’s my prescription, cool, here’s your medication” that one dreams of.
So that is the road so far.
I came home, I’ve taken my first ever dose of Testogel, nothing has happened thus far because I only took it a few hours ago, but as you can imagine, I feel pretty great about it.
I would rather not be on Testogel, personally, and would prefer to be on the injection, because I find the textural elements of Testogel to be really unpleasant and nasty, and I would vastly prefer a regular injection, but in the meantime I’m going to be focusing on the Testogel to adjust to a higher T level.
Particularly because my GP is unwilling to assist in my transition, it’s going to be harder for me to get hold of my shots, because I don’t know how to self-inject and would want to get some training for it first, and honestly, emotionally? I’m like, listen, I’ll cross that bridge when I come to it, and just stick with the Testogel for now.
I finally have an appointment with the endo clinic in Galway in September, and honestly, my plan is to continue on with my private HRT stuff, and then see what the situation is while transitioning under the HSE’s watchful, gatekeeping eye, which honestly, I’m not excited about, but anything to make my HRT easier to access.
What I want from my physical transition:
So, I’ve wanted to start testosterone for a very long time, and that’s honestly been like, the biggest thing I’ve wanted, and I’ll get into the specifics of what I particularly want from HRT as I get into it in a minute.
I want top surgery, but honestly, I’m relatively flat-chested, and have never been bigger than a very modest B-cup, and am typically a rounded A-cup, so I’m hoping that with the fat redistribution that comes from T on top of some pec exercises, I might not need top surgery all that much.
Because of chest constriction issues and problems I have breathing in super tight things, I’ve only ever attempted binding once or twice in my life, but typically I tend to wear a lot of very layered clothes, especially waistcoats and vests. I do favour what I’d call a 19th century silhouette and that sort of dandy style, but when it is hot and I just wear a t-shirt, I absolutely feel really uncomfortable with the swell of my chest, and so I would like for like… if not the fat redistrubtion I would hope for, I would get top surgery in the future.
I personally have never really been interested in phalloplasty or other elements of bottom surgery, but I’ve wanted a hysterectomy and oophorectomy for the longest time, because honestly, I don’t want that shit in my body at all, and I’m willing to sort of chuck it out, free to a good home, et cetera.
I know a lot of men worry a lot about the shape of their waist or the broadness of their thighs, but as I said, I kind of favour the 19th century gentleman’s silhouette, and a narrow waist and wider hips look really good to me. I think so long as I wasn’t quite so top-heavy, I’d kind of be delighted to lean right into that, you know?
My main issue at the moment is that when I do manage to put weight on, it always sinks immediately into my chest and my arse, and they’ll feel like they’re just doubling in size in the space of a week, and I think that’s one of the physical aspects I’m most in desire of — not necessarily for particular redistrubtion of fat I already carry, but when I put some fat on, to not blow up like a fetishist’s hentai doll.
Weight gain is absolutely a generalised goal, because I’m a very slim guy, and I would like to just be a little bit bigger — my dad is quite a big, stout guy, and while I’m not expecting a huge amount of weight gain, I would just like to put on a bit of healthy weight. The biggest thing I worry about as far as being as thin as I am is genuinely how cold I am all the time — it feels like there’s no insulation on my body whatsoever sometimes, and I’m hoping that the combo of testosterone weight gain and testosterone temperature heightening will sort that out.
In terms of the rest of my wish list, like…
I want a moustache. I want a moustache so very, very badly — I actually already have some dark fuzz that’s visible on my lips, and I’m really hoping that with the natural fuzz I already have on my cheeks and jaw, and especially my lip, that I’ll find it a little bit easier to grow some facial hair, but I know that won’t happen overnight, so in the meantime I will simply yearn.
I would like to have a lower voice — I tend to speak naturally in a relatively high register, and I’m really looking forward to my voice lowering somewhat in pitch, as well as gaining a little more resonance. I’ve been going around interrogating cis male members of my family, particularly my grandfather and father, and both of them told me that their voices broke all at once, and I’m like, ah… The holy grail…
I’ve been watching a lot of like, videos about different trans experiences, but I’ve been trying to think more about my family, because obviously genetics plays such a huge part of it — and that is a lot of why I’m hoping I’ll be able to put on a bit more weight. A lot of the men in my family also have pretty strong beards, too, and while I don’t really imagine myself as having a beard, I really like the idea of being able to experiment with it and mess about with it.
I would like to find it easier to put on muscle when I do exercise, and to build that up — I’m not ever going to be a gym shark or anything, but I would like to just be a bit bigger and more muscular, but honestly, I kind of think of that as to be part of gaining a bit of weight more than anything else.
I think the other main thing I’m hopeful about moving into this transition is just in… not crying all the time. I’m a pretty easy crier, and it’s always so embarrassing, especially when I’m not actually feeling all that sad or distressed, but am just hormonally overwhelmed, and I utterly abhor it, and would very much like to just… not do that.
I admit, I’m not really worried about acne — I never had any acne as a teenager, and while I do get some spots, I’m not an extremely spotty guy, and I asked around some cis men in my family if they had any extreme acne as teens, and everybody said no, it’s like… fingers crossed.
Things I’m anxious about:
So, my da is like… bald. I’m anxious about that. With that said though, most of the other men in my family have pretty great heads of hair, with good hairlines, and so I’m hoping to be able to keep the good hair as time goes on.
I think when it comes to my voice there’s a lot of anxiety — not because I don’t want it to get deeper, but like… I’m a singer and a musician, and while I no longer really do stage performances or the like, primarily because of voice-related dysphoria, the thing that I’m anxious about is that learning to use one’s post-puberty voice as opposed to one’s pre-puberty one is very much a matter of learning to play with a new instrument, and I’m aware that I’ll probably have a great deal of work ahead of me when it comes to learning to sing with a new register and range.
I have a very wide range as a singer, where I can go up to like, a lot of the soprano range (not without effort, I can do Christine in Phantom or Joanna in Sweeney Todd pretty well) and also go down to a decentish tenor (think Tony in West Side Story), and obviously the hope is that I’ll be able to retain the extent of my vocal range but just slide it down the register, but it’s obviously impossible to know what’s gonna happen until it happens.
The difference between my head voice and chest voice in terms of development is so noticeable, even to laymen, simply because the dysphoria when it comes to my head voice is so strong, and so I’m like… Oh, well, when it comes to doing a male head voice, if I do retain a higher range, I feel like because the resonance might be different, I might feel better?
But, ho, as I said, it’s impossible to tell. I’m hopeful for a good result, but this is obviously extremely impossible to predict, and depending on how I feel about my voice in a month or two, I think I might hire a vocal coach — particularly one who ordinarily works with teen boys, perhaps — but I’ll just have to see, you know, what the story is.
Final Thoughts
Honestly, like…
For all I have had an exceedingly rough few weeks, months, and indeed, years, when it comes to finally getting hold of my testosterone, I feel so excited at having gotten hold of it, and I’m really excited to kind of keep track of my progress and see how things go as I proceed with it.
It feels like a huge milestone in my life and such a positive one, and as I go on, it’s just like… Ah!
Yeah.
Here’s to some more years of feeling like the world is this open, I guess.
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