Nearly eight months after my initial appointment at the Belfast Gender Clinic finally the treatments are beginning to arrive. Following seven months of sitting in a room with first one therapist, then the consultant director of the clinic who has taken on my case personally, I’m finally starting to see other people in other places. Within the last two weeks I have had my first sessions at both speech therapy and laser hair removal. And with only a couple of days to go until I clock up three months living full time as a woman, it feels like my transition is moving up a gear.
I had received a letters from both Belfast City Hospital (for speech therapy) and the Ulster Hospital (for laser) in late August. Pleasingly, Belfast City Hospital managed to send the letter to me in my new name at my new address. Less pleasingly, the Ulster Hospital managed to send it to my old name at my old address, which is still my ex’s address. And worryingly, they stated on the letter that if I didn’t confirm the appointment within 7 days I would be discharged. My ex remembered to hand me the letter on day 6. I queried the incorrect name and address when I called to confirm the appointment and was told that they always use the name and address quoted on the referral letter. Which was sent in April. It’s almost as if nobody there has realised that people commencing gender transition quite often have changes in personal details. At least Belfast City Hospital, who were sent a referral letter at the same time, seem to know how to read the current details off a computer screen. At least they were a bastion of NHS efficiency, right? Wrong.
My first speech therapy appointment was scheduled for 10.30am on Monday 22nd September. I still have the letter to prove it. I went into work for an hour beforehand and then arrived at the Speech & Language Therapy centre around five minutes early. There was no receptionist, simply a sign on the door which read “Welcome to Speech & Language. If you have an appointment please take a seat and your therapist will be with you shortly. If your haven’t been seen by 15 minutes after your scheduled appointment time, please call 028 90XX XXXX. So I sat in the deserted waiting area. And I sat. And I sat some more. The clock ticked past 10.45am. I called the number.
“Hello, Belfast City Hospital, Speech and Language”
“Hi, my name is Kirsty Roberts. I have an appointment with Catherine for 10.30 but I haven’t been seen yet.”
“Oh, right… er… she’s just finishing up with her previous patient, she should be with you shortly”
And I sat on. And sat on. The clock drifted towards 11am. A woman emerged from a different door and asked if I was Kirsty. I replied that I was.
“Hi, Kirsty, it was me on the phone a few minutes ago. There’s been a terrible mix-up. All of the speech therapists are at a conference today, so you might as well go. Catherine isn’t here and she won’t be here.’
“But I’m here at the right time, here’s my letter”
“Yes, I know, you’re right. It’s our mistake. I’m really sorry. Can you come at the same time next week?”
“Well yes, but er…”
“OK we’ll see you next week then”
And with that she was off, just before the thought occurred to me that she had blatantly lied to me about 15 minutes earlier. Not a lot I could do, but it was pretty annoying to have two hours wasted at a time when I am pretty busy in work, not to mention a couple of quid of car parking charges.
One week later on Monday 29th September I found myself in exactly the same seat in a similarly deserted waiting area. But this time at around 10.29, a different woman emerged from the correct door.
“Hi, I’m Catherine, come on through. I’m so sorry about the mix-up last week, it was my fault. Did you get the message I left on your voicemail apologising for the mistake?”
“No. No voicemails.”
“It was on your landline”
“I don’t have a landline”
She had left the message on my ex’s landline. So the ability to read update names and addresses doesn’t extend to phone numbers. Still, at least she was able to update phone and email contact details while I was with her.
Now, with all that out of the way, I have to say that Catherine was lovely. Really friendly and encouraging, and very empathetic. I was very surprised by the content of our discussion and what she was aiming to achieve. What I expected was a lot of actual vocal exercises, what I got was something more akin to a “how to pass” workshop.
Catherine began by saying that she felt my voice sounded reasonably feminine anyway. It’s ok I suppose. One thing I do think is that it’s fairly consistent. In the early stages of going out into the world as a woman I hadn’t learned what my female voice was going to sound like, and so consequently every time I opened my mouth it was a little adventure. I never knew who was going to pop out. But over time I gradually learned my voice and began to get a sense of what “my” voice sounded like. However, she did ask if there was anything in particular that I wanted to work on. My two responses were apparently far and away the most common two answers that she gets.
- Fewer telephone misgenderings
- More volume
She said that she had a few techniques that we can try that might be of use. She seemed particularly confident that she could help with the telephone voice. If that happened, if would be a major result. I live in hope that one day someone will madam me rather than sir me on the phone. In fact, I have taken to pre-empting that now by commencing phone calls with “Hi, my name is Kirsty” before the other person has a chance to say anything. Although once or twice even that has elicited a quizzical “Kirsty?” in response, as if to say “Really? Are you quite sure about that?” Anyway, she asked me to give her a bit of detail about how my transition was going, or indeed if it had even commenced, which I’ll not repeat here as there’s well over three years’ worth of blog posts to answer that question.
She then had a questionnaire that she went through with me, asking if my voice caused me anxiety. Apart from on the phone, no it doesn’t. She asked about what I did in work, if it was just office-based. I think she was quite taken aback when I told her that I manage around 80 client relationships throughout Northern Ireland, and I go and meet these business owners in their premises, and they have so far all been very supportive of my transition. Then she asked if there were any other situations in work where my voice was critical
“Well I’m giving a presentation to a room full of business bankers tomorrow morning”
She was definitely taken aback by that. (It went fine by the way). So she seemed quite pleased and impressed with how I was approaching integrating myself back into my personal and professional life as the new me.
I spoke for a while about the phone being a problem because the person on the other end of the call is missing all the visual cues to tell them that I’m female. All they’ve got is the voice. And this is when things went off in an unexpected direction. She said
“The visual cues are important. Probably more important than the voice. So I try to help my patients not just with their voice but with the other aspects too. I see some women coming in here at the same stage as you early in their transition, or even just before starting it, and there’s so much else to work on. The way they dress is not right, the make up is either badly done or over the top, the way they walk, the way they sit, their body language, hand gestures… but I don’t need to worry about any of that with you, it’s all as it should be. I mean, it’s just really obvious – you are female”
And with that I became rather emotional. She asked if I needed a tissue. Just about not. But I had to take a moment. Just to hear someone in her position say that to me. It meant so much. I mean, it’s obvious to me that I’m female, but affirmation like that just gives me so much more confidence. It was definitely the most emotional response I have had to anything that has happened in any sort of session via the Gender Identity Service. Much more so than the actual therapy, probably because it was so unexpected.
At last I did get some exercises to do, but they were silent. Running the tip of my tongue around my teeth for a minute, 30 seconds one way, 30 seconds the other. Then exaggerated open-mouthed chewing while rotating my jaw, like a cow chewing the cud for another minute, then another minute of closed-mouth pretend chewing, 30 seconds each side, like I had an invisible toffee in my mouth. Designed to loosen the back of my tongue to open up a larger cavity at the back of my mouth which will both help higher the pitch of my voice as well as helping my voice resonate there to aid with loudness. I’ll give it a go.
I have homework for the next appointment. I have to observe one man and one woman, and make notes about how they speak, variances in pitch, their body language, posture, gait, hand gestures etc. I’m going to us Graham and Beth from work as my guinea pigs, as they are the two people with whom I work most closely. I hope they don’t find out.
Just over a week later, on Tuesday 3rd October, was my first appointment at the laser clinic at the Ulster Hospital. I had been somewhat apprehensive of this, because my big fear has been that I was simply going to be told that my facial hair was too blonde/grey and there was nothing they could do for me. A year or so ago, before I had commenced electrolysis treatment, I had walked into a beauty salon (as Bob) who were advertising laser beard removal for men as a cost-effective alternative to shaving. I asked if they could do it for me. The woman took one look at me and said “No, you’re too blond, you’d need a lot of treatments and would spend a lot of money for probably not great results”. So the fear of being refused treatment was actually based upon a real experience.
When I phoned to confirm my appointment at the laser clinic once I had got the letter from my ex, I was told that I wasn’t allowed to shave for five days before the appointment. This frightened the life out of me. I would have, if not a beard, at the very least some 1986-vintage George Michael designer stubble after that length of time. Then when I actually got the appointment confirmation letter sent out it said I must not shave for a week before the appointment. An effing week! I have a job in a busy city centre office and need to present in a professional manner, I can’t be a bearded lady! I mentioned this to Dr Ingram at my last therapy session at the clinic, and he was fairly dismissive of the laser clinic’s demands. He pretty much said a week was ridiculous, and if my growth was any way strong (according to Lynda the electrolysist it is, worse luck) then 2 or 3 days would do them fine. So I made the appointment for a Tuesday, booked the Monday off work and resolved to have my last shave the previous Friday before work. In practice, I had a shave on the Saturday morning too because I had to go out, and it meant that I would also be reasonably presentable from a distance on the Sunday too. I also had some good indoors activity planned for the Monday, which I imagine will feature in my next post, but for now suffice to say that by the time I got up on Tuesday morning for my laser appointment I had if not quite a luxurious beard, certainly a very definite growth, to the point where my chin had ceased to be sandpapery and was verging on the furry.
I arrived a little early at the hospital and frittered away 15 minutes sitting in the car playing Words With Friends on the phone before braving the walk through to the hospital building. I say braving, because I was dressed in my usual manner, girly hair in place, block heel boots, handbag, eyeliner, mascara and, er, something approaching a beard. I don’t know if the people loitering around gave me funny looks because I resolutely didn’t look at anyone. The admissions office directed me down a long corridor towards the laser clinic, and I entered at around 9.05am for a 9.30 appointment. Two nurses, one of whom was a sister leading the clinic, were seated in the waiting area, and I immediately admitted I was very early. Not a problem, they said, but they were still waiting for the laser to warm up. They gave me an information sheet to read, and I sat for about 10 minutes before they called me in.
Almost immediately my worst fears were dispensed with. They were happy that there was plenty of darker facial hair for them to be working on, so they explained that I got 10 sessions, which would be 6-8 weeks apart. I mentioned that I have been undergoing electrolysis for the last 9 months to pick off the lighter hairs, and then I got a surprising reply.
“You’ll need to stop that for the duration of your treatment with us”
I did a quick bit of mental arithmetic.
“So that’s about 15 months?”
That was correct. I had heard both from Lynda at the electrolysis centre and also anecdotally that you couldn’t have electrolysis for 2 weeks before and 1 week after laser but none at all! This is going to extend out my facial hair removal even further. But what choice do I have? The sister then asked if I had started my hormone therapy yet. No, not yet. I was referred at the end of July and was told the waiting list was 4-6 months, so hopefully before Christmas but January at the latest. In that case, my “proper” laser treatment wasn’t going to start until January. Seems reasonable I suppose. Beginning the treatment while I still have testosterone-fuelled facial hair growth might be a sisyphean task. The good news is that they only needed me to have some facial hair growth today so they could actually see the pigmentation. When I’m doing it “for real”, I should shave the previous evening. Thank goodness for that.
“So we’re going to be trying a couple of test patches today”
OK. For some reason I wasn’t sure if that was going to happen. The nurse produced a plastic disposable razor, the sort that costs about £3 for a pack of ten in your local supermarket. The sort that I wouldn’t dream of using in a million years. She informed me that I should shave two patches of around a square inch each on either side of my chin.
“Fine. Do you have any shaving cream?”
“No. Just use the hand wash in the toilet”
For crying out loud, if I’d known they were going to do that I would have brought my own razor and gel from home. So much for looking after my skin!
I emerged with two bald patches on my face and was lead through to the treatment room. I lay down on the treatment bed, and the sister explained that she would be doing two patches. The left patch would receive IPL, Intense Pulsed Light, the type of “laser” that you would get in a beauty salon. The right patch would receive the full medical grade laser. OK. The nurse asked my to remove my glasses and put a pair of completely black goggles over my eyes, securing them tightly round the back of my head. I asked them to count me in so I knew when it was coming”
3.. 2.. 1..
The IPL was painful enough but oh my god the laser was excruciating. People have told me that if I can stick electrolysis, laser is not as bad. Utter nonsense. It is so sore, like someone flicking a very strong elastic band at your face over and over and over again, and you just have to take it. The pain was terrible. But what was even more frightening for me in my darkness was the almighty smell of burning. It was overpowering and unpleasant. How the hell am I going to stick a full-face session lasting 20 minutes? Every time the laser pulsed I pulsed, and reeled from the aroma of burning hair.
And after about 30 seconds, it was all over. More unpleasantness in that 30 seconds than in 9 months of electrolysis. I didn’t enjoy it at all. And to add further ignominious insult to injury, the nurse whipped off the goggles and took my wig with them.
It was over. See you in 3 or 4 months. I was given some more information sheets, and a letter for my GP. The letter was asking him to write me a prescription for EMLA cream, an anaesthetic cream that should numb my face for the next time. I wonder can you get something that temporarily dulls your sense of smell too. They also gave me a small tube of factor 50 sunblock to rub on my beard area before putting on my make up every day. There is to be no sun damage on my face at all.
I felt slightly better about the smell a few days later when I was at electrolysis (avoiding the test patched areas). Lynda told me that the burning was good. It proves it works. It’s burning hair. If my hairs weren’t being affected by the laser, they wouldn’t burn. So burning smell = effective treatment. I’ll try to embrace it in future.