"You won't see us again until after the operation" says my secondary clinician at the West London Mental Health Trust Gender Identity Clinic, supporting my main therapist's recommendation that I be referred for surgery. The questions – about whether I've made the right decision, about how family, friends and colleagues have reacted to my coming out and how I've dealt with transphobia – are over. Having lived and worked as female for two years, I've finally completed the Real Life Experience or, if you prefer, passed the Real Life Test (as it's also been known).
I thought I'd be jubilant, but leaving, I feel strangely indifferent. Perhaps this is because the referral represents a strange mid-point: I addressed the RLE's main challenges and became comfortable with my new reality so long ago that it seems surreal to link this official end to the (sometimes fraught) process of managing my social interactions; but 27 months after entering the pathway, I neither have a date for surgery nor any idea when I'll get one.
Before my first GIC appointment, I'd suspected that the RLE would constitute a box-ticking exercise, and began asking transsexual friends what boxes there were and how I could ensure they were ticked fastest. In practice, this involved little more than changing my name by deed poll and getting proof of when I starting working as female so my Test could begin from the date I provided.
I thought that once I met my supervisors, we could work together on any serious problems with loved ones, health, housing or employment, but by the time I actually saw them, I'd handled them all myself. There was virtually no 'therapy': just brief appointments, with basically the same questions asked each time, followed (usually weeks later) by a transcript saying that I was coping well, and reiterating that I should access the desired medical interventions at the earliest point allowed by GIC protocol.
By now, I've been on hormones for many months, having been granted access to them after my second GIC appointment. These have made my social interactions far easier, changing my appearance enough so that I 'pass' in casual, wordless encounters, or at least stop taking abuse from strangers in public spaces. As I became more confident, I realised that I'd underestimated the effect that this abuse had on my mental health, the full force of which only hit once I began to relax about it.
The new Standards of Care potentially allow the RLE to be abolished entirely, but speaking for myself, I would not have committed to anything irreversible (as did Miranda Ponsonby, transitioning via private healthcare in 1994) without some prior idea of the ramifications of living as female, or some sense that a professional would look after me where necessary. The consequences of a failed Real Life Test could have been very serious: it would not have been impossible to resume my previous identity, but while my relationships survived my coming out, I'm not sure how many would have withstood de-transition.
That said, I never seriously contemplated this, and instead found myself frustrated at the system's inflexibility. In particular, I struggled with the withholding of oestrogen until after the second appointment – the earliest that they can be administered according to GIC rules – especially as I'd lived as female far longer than the required three months.
With the possibility of seeing a private clinician who might produce a hormone prescription, or even buying them online (with attendant health risks), this seemed absurd, especially as they take months to have any visible or irreversible effect. However, there would be equity issues if some were immediately given medication and others weren't: the need to avoid litigation from those who feel they've been treated unfairly, or been rushed through before deciding, too late, that transition was not for them is paramount, particularly in the current financial climate.
Taking into consideration its history and the fact that it will doubtless continue to evolve, the new Standards of Care state that 'treatment for gender dysphoria has become more individualised', aware that there is no one-size-fits-all solution: the current model has many frustrations for those certain of themselves (and I count myself in this category) but after more than 50 years of trying to balance competing pressures from transsexual people and their critics, it's the best system that the experts have produced. That's not to be Panglossian: more to say that in my two (non-expert) years of navigating the pathway, I haven't come up with anything better.
