1st May 2009
SEXUAL HEALTH SERVICES @ Wheatbridge
Wheatbridge Road
Chesterfield
Derbyshire
S40 2AB
Dear ********
I understand that you would like to consider talking therapy to explore some issues related to sexuality.
We can provide this service for you in the Sexual and Relationship therapy service based at Wheatbridge. Therapy Sessions are for 50 minutes weekly or fortnightly as required.
In common with all NHS Sexual and Relationship therapy services we do have a waiting list which at the moment is approximately 5-6 months.
Yours Sincerely
********* **********
Sex & Relationship Therapy Service
6th July 2009
SEXUAL HEALTH SERVICES @ Wheatbridge
Wheatbridge Road
Chesterfield
Derbyshire
S40 2AB
Dear Mr ****** ****
An appointment has been made for you to attend the Sex & Relationship Therapy Service located at Wheatbridge Health Village
Time: 9:30am
Date: Friday 17th July
Please report to reception who will inform the therapist on your arrival.
Yours Sincerely
********** *************
Sex & Relationship Therapy Service
10th December 2009
SEXUAL HEALTH SERVICES @ Wheatbridge
Wheatbridge Road
Chesterfield
Derbyshire
S40 2AB
F.A.O. Dr Patel
Dear Patel
****** came to see you recently to discuss a referral to the Nottingham Gender Clinic and you asked that I provide further information to support his request.
I have seen ****** on nine occasions for assessment and supportive therapy for his Gender Identity concerns.
Background Information
Since ****** was 6-7 years old he has had thoughts and dreams of being female. He preferred to play with his sisters dolls and can remember often playing dress up as a girl at his grandmothers house.
He never felt comfortable growing up as a male and feels that being a woman would feel more normal for him.
At around the age of 15-16 years he started dressing in his sisters clothes when the family was out. He then moved onto buying his own wardrobe.
He had a brief relationship with a woman a few years ago but did not want to continue this for the fear of the effect of having to disclose his true identity one day.
****** left home aged 21 years to live in Widnes, but felt it was not a safe place to 'come out'. He then worked in Spain for a while before moving to Bakewell but felt this was too close knit a community to 'come out'.
He spent 10 years dressing up as Emma in private.
In early 2008, concerned at the barriers of telling his parents and work colleagues and expressing his true gender identity, ****** got a job in Spain, hid his female wardrobe and tried to make a new start. However, he became quite depressed and contemplated suicide on a few occasions. He came back to the UK Christmas 2008 and 'came out' to his parents and siblings. This has been a difficult journey for them all but his mother and sisters are supportive although relationships with his father and elder brother are still difficult.
****** gets support from internet forums and since returning from Spain meets members of these forums when he goes out socially as Emma.
****** does not find dressing up as Emma sexually arousing. It feels natural and he feels more confident as Emma. He does find it exciting to be doing something out of the ordinary.
****** has recently told his manager and work colleagues and they have been very supportive. He recently went to the staff Christmas party as Emma and has recently begun to attend therapy sessions as Emma.
****** is currently living at his parents house but would like to get his own place next year where he will feel free to live as Emma full-time.
****** feels constrained by not wanting to upset his family by living as Emma when they are around and confines himself to live as Emma just in his bedroom at present. He is planning some facial electrolysis in the New Year.
I feel now is an appropriate time for him to be referred for assessment given their expertise in gender identity concerns, and am assuming there will be a waiting time for assessment.
Yours Sincerely
******** ********
11th January 2010
Nottingham Gender Clinic
Mandala Centre
Gregory Boulevard
Nottingham
NG7 6LB
Telephone: (0115) 960 2820
Website: www.nottinghamshirehealthcare.nhs.uk
F.A.O. Dr Patel
Dear Doctor Patel
Many thanks for referring your patient to our clinic. I hereby confirm that your patient is now on our waiting list, which is currently approximately six months. For further information regarding our clinic and it's protocol, I kindly refer to our website, which can be found in the right top of this letter.
Kind Regards,
Dr ****** ********
Consultant Psychiatrist/ Sexologist
16th February 2010
Nottingham Gender Clinic
Mandala Centre
Gregory Boulevard
Nottingham
NG7 6LB
Telephone: (0115) 960 2820
Website: www.nottinghamshirehealthcare.nhs.uk
Dear Mr *******
You have been referred to the Nottingham Gender Clinic. This clinic was established by the Nottingham Health Authority and is run by an expert team in this area. I enclose an appointment for you to be held on..
Wednesday 3rd March 2010m at 10am
Please confirm that you will be able to attend by sending back the cut off slip at the bottom of this letter. Unfortunately, there is a long waiting list for initial assessments at present but let us know if the time is inconvenient and we will endeavour to arrange an alternative appointment. Otherwise, we look forward to seeing you at that time.
Yours Sincerely
Dr ******* ******
Consultant Psychiatrist/Sexologist
21st July 2010
Nottingham Gender Clinic
Mandala Centre
Gregory Boulevard
Nottingham
NG7 6LB
Telephone: (0115) 960 2820
Website: www.nottinghamshirehealthcare.nhs.uk
F.A.O. Dr Patel
Dear Dr Patel
We met with Emma at the Nottingham Gender Clinic on the 20th July 2010. This was the third and final part of the assessment. Emma attended with her mother.
In summary, we support a diagnosis of gender identity disorder and entry to our treatment programme. Emma has brought documentary evidence of name change to support this. The patient is required to live full-time as a woman for 2 years dated from 20th. During this period Emma is required to attend regular appointments as required by the Nottingham Gender Clinic and undergo investigations and monitoring with respect to feminising hormone therapy. Emma is also expected to provide evidence of occupational activity in her chosen gender role.
In preparation for hormone therapy, I would be very grateful if you would organise bloods to include..
FBC, U&Es, creat, LFTs, lipids including cholesterol, Prolactin, Oestradiol, LH, FSH, SHBG and testosterone levels. I would be very grateful if you could forward the results onto us.
I would also be grateful if you would perform a physical examination to include BMI, blood pressure and cardiovascular status, as well as a cursory genital examination. The latter is important for future genital surgery. In particular, the skin needs to be in the best possible condition for future skin grafting. It is also important for us to know about previous circumcision and abnormally small genitals as these may affect future surgical options. I would be grateful if you could let us know the results of these investigations.
Emma will be seen again by Dr ******* on the 9th August 2010 at 2:00PM when the possible effects and risks of hormone treatment will be explained. Emma will be asked to give signed consent to hormone treatment. We would then be very grateful to you for prescribing feminising hormone treatment but will advise regarding the hormones, dosing and monitoring required.
Yours Sincerely
Dr ******* ******
Consultant Psychiatrist/Sexologist
9th August 2010
Nottingham Gender Clinic
Mandala Centre
Gregory Boulevard
Nottingham
NG7 6LB
Telephone: (0115) 960 2820
Website: www.nottinghamshirehealthcare.nhs.uk
F.A.O. Dr Patel
Dear Dr Patel
I met with Emma at the Nottingham Gender Clinic on the 9th August 2010. Many thanks for carrying out the blood investigations, apart from a low WBCs (at 2.9) with concomitant low neutrophil count (at 1.2) and eosinophil count (at 0.0) there were no major abnormalities; I guess her WBC needs to be kept under review. There is certainly no contra indication to start female hormones.
Today we discussed the benefits and risks of female hormone treatment and we also discussed fertility; Emma would like to have her sperm frozen en I gave her information regarding organising this; it is not funded by the NHS. Emma has also signed a consent form regarding hormone treatment.
I would be grateful if you could start Emma on:
Oestradiol Valerate 1mg bd
We shall gradually increase the Oestradiol until a level of 500-700pmol/L is reached. Should the testosterone level remain within the normal range (when optimum feminisation levels are reached) we may consider additional treatment with an anti androgen, such as Goserelin.
Emma has a follow up appointment on Monday 11th October at 4:00PM
Yours Sincerely
Dr ****** ****
Consultant Psychiatrist/Sexologist
11th October 2010
Nottingham Gender Clinic
Mandala Centre
Gregory Boulevard
Nottingham
NG7 6LB
Telephone: (0115) 960 2820
Website: www.nottinghamshirehealthcare.nhs.uk
F.A.O. Dr Patel
Dear Dr Patel,
I met with Emma at the Nottingham Gender Clinic on 11th October 2010. Many thanks for prescribing her Oestradiol Valerate 1mg bd.
All is going well with Emma; she offered no complaints, other than that she has noticed some mood swings since starting her hormone treatment.
She is currently attending our voice coaching group which she thoroughly enjoys. I intend to increase her Oestradiol further during her next appointment.
Emma has a follow up appointment on Monday 13th December 2010 at 2:00PM
Yours Sincerely
Dr ******** *******
Consultant Psychiatrist-Sexologist/Lead Clinician
13th December 2010
Nottingham Gender Clinic
Mandala Centre
Gregory Boulevard
Nottingham
NG7 6LB
Telephone: (0115) 960 2820
Website: www.nottinghamshirehealthcare.nhs.uk
F.A.O. Dr Patel
Dear Dr Patel,
I met with Emma at the Nottingham Gender Clinic on 13th December 2010. Many thanks for prescribing her Oestradiol Valerate 1mg bd.
All is going well with Emma; she offered no complaints, other than that she has noticed some mood swings since starting hormone treatment.
She has completed the voice coaching group which she found useful. I have given her a clinic letter with which she can apply for a passport in her acquired gender.
I would be grateful if you could increase her Oestradiol Valerate to 2mg bd. I would also be grateful if you could carry out the following blood investigations at the end of February 2011.
LFTs, Oestradiol, Testosterone and Prolactin
It is important that the Oestradiol is taken as a trough level, which means the bloods should be taken in the morning and that Emma should not take her Oestradiol tablets until after her bloods are taken!
Emma has a follow up appointment on Monday 14th March 2011 at 1:00PM
Yours Sincerely
Dr ****** *******
Consultant Psychiatrist-Sexologist/Lead Clinician
14th March 2011
Nottingham Gender Clinic
Mandala Centre
Gregory Boulevard
Nottingham
NG7 6LB
Telephone: (0115) 960 2820
Website: www.nottinghamshirehealthcare.nhs.uk
F.A.O. Dr Patel
Dear Dr Patel
I met with Emma at the Nottingham Gender Clinic on 14th March 2011. Many thanks for carrying out the blood investigations which showed an Oestradiol level of 293 pmol/L, Testosterone level of 8.9 nmol/L and Prolactin of 150 mu/l. Many thanks also for prescribing her Oestradiol Valerate 2mg bd.
All is going well with Emma; she offered no complaints; she enjoys her work; her family is supportive and she has a good social network; she is awaiting for her new passport to arrive; she is looking forward to going on a week's holiday to Skegness with her sister; she is thinking to participate in a refresher voice coaching course in May or June this year; she has had a number of facial laser treatments; she is happy with how she looks. In conclusion, I am happy with Emma's progression through the Real Life Experience Programme; in June she has been living fully in her acquired gender for one year.
Emma has a follow up appointment on Monday 13th June 2011 at 1:00PM
Yours Sincerely
Dr ***** *******
Consultant Psychiatrist-Sexologist/Lead Clinician
14th June 2011
Nottingham Gender Clinic
Mandala Centre
Gregory Boulevard
Nottingham
NG7 6LB
Telephone: (0115) 960 2820
Website: www.nottinghamshirehealthcare.nhs.uk
F.A.O. Dr Patel
Dear Dr Patel
I met with Emma at the Nottingham Gender Clinic on the 13th June 2011. Many thanks for prescribing her Oestradiol Valerate 2 mg bd.
All is going well with Emma; she bought herself a car, is looking for another job which offers better career (and financial) opportunities, and is looking forward to going on holiday with her sister. She is progressing well through the Real Life Experience Programme and is clearly consolidating her gender role. She appears happy and relaxed.
She has now been one year in the Real Life Experience Programme and, if everything continues and progresses as before, she will be eligible for sex reassignment surgery in the summer of next year. Given her relatively high level of Testosterone and in order to achieve optimum feminisation, I would be grateful if you could prescribe her the following, in addition to her Oestradiol:
Goserelin 3.6mg on a monthly basis
Goserelin is an analogue of the Gonadotrophin releasing hormones and a more effective alternative than the traditionally used Cyproterone acetate. A usual dose of Goserelin would be the use of a subcutaneous implant of 3.6 mgs once every 4 weeks or a larger dose using the 3 monthly preparation. This produces reversible (chemical) gonadectomy. By super-stimulation of the pituitary, the Gonadotrophin releasing hormone receptors are down regulated and the pituitary rapidly becomes unresponsive, leading to cessation of secretion of the gonadotrophins. LH and FSH levels fall to hypopituitary levels and testosterone ad di-hydrotestosterone levels decline to very low levels equivalent to a post-gonadectomy state. If the treatment is stopped, the receptors regenerate and gonadotrophin secretion resumes.
There is therefore a state of reversible hypogonadism. Gonadotrophin releasing hormone therapy is usually continued until a gonadectomy is carried out. Suppression of the levels of androgens and their effects given this way allows the full effect of administrated Oestradiol to become apparent without the use of excessive dose of female hormones.
Immediately before the third injection I would be grateful if you could carry out the following blood investigations:
FBC, U&Es, creat, LFTs, Oestradiol, Testosterone, and Prolactin.
It is important that both the Testosterone and Oestradiol level are taken as a trough level which means that Emma should not take her Oestradiol tablets the morning she has her bloods taken (but take them afterwards)
I would be grateful if you could forward me a copy of these results when they become available.
I have made a follow up appointment for her on:-
Monday 19th September 2011 at 11:00AM
Yours Sincerely
Dr ****** ******
Consultant Psychiatrist-Sexologist/Lead Clinician
19th September 2011
Nottingham Gender Clinic
Mandala Centre
Gregory Boulevard
Nottingham
NG7 6LB
Telephone: (0115) 960 2820
Website: www.nottinghamshirehealthcare.nhs.uk
F.A.O. Dr Patel
Dear Dr Patel
I met with Emma at the Nottingham Gender Clinic on the 19th September 2011. Many thanks for prescribing her Oestradiol Valerate 2 mg bd. Many thanks also for administering the Goserelin injections. Today I have issued her with a 3 month prescription of Goserelin 10.8 mg.
She did not offer any complaints. She is progressing well through the Real Life Experience Programme and is clearly consolidating her gender role. She appears happy and relaxed. She enjoys her job. She has good and supportive relationships within her family. She is trying to build up a social life in her acquired gender. We discussed various issues today, including future relationships, dating and having children. Emma has a solid, down-to-earth view of things and has clearly reflected on most of these pertinent issues. She is aware that each gain, also represents a potential loss.
I would be grateful if you could carry out the following blood investigations, immediately before her third Goserelin injection:
LFTs, lipids including cholesterol, Oestradiol, Testosterone, and Prolactin.
It is important that both the Testosterone and Oestradiol level are taken as a trough level which means that Emma should not take her Oestradiol tablets the morning she has her bloods taken (but take them afterwards)
I have made a follow up appointment for her on:-
Wednesday 14th December 2011 at 9:00AM
Yours Sincerely,
Dr ****** *****
Consultant Psychiatrist-Sexologist/Lead Clinician
13th December 2011
13th December 2011
Nottingham Gender Clinic
Mandala Centre
Gregory Boulevard
Nottingham
NG7 6LB
Telephone: (0115) 960 2820
Website: www.nottinghamshirehealthcare.nhs.uk
F.A.O. Dr Patel
Dear Dr Patel,
I met with Emma at the Nottingham Gender Clinic on the 13th December 2011. Many thanks for carrying out her blood investigations and faxing these through today; they showed an Oestradiol level of 727 pmol/L, a Testosterone level of 1.2 nmol/L and a Prolactin of 218 mU/L. All other relevant results were within normal limits. This is an excellent result.
Many thanks also for prescribing her Oestradiol Valerate 2mg bd and for administering the Goserelin injections. Today I have issued her with a repeat 3 month prescription of Goserelin 10.8 mg.
As reported previously, things are ticking over nicely for Emma and no major changes have occured. Obviously she is very busy during the Christmas period and only has one day off a week. She is looking forward to taking a holiday in January. Today we also discussed sex reassignment surgery (SRS) and Emma will reflect on which surgeon she would prefer. We also discussed the benefits and risks of SRS, and Emma appears to have a good grasp of these, as well as having realistic expectations. We agreed that I will proceed to ask for a second opinion for readiness for surgery around June 2012.
At present I do not think it is necessary to re-check her bloods and will write to you about this after I have seen Emma again, which is on:
Tuesday 13 March 2012 at 10:00 AM
Kind regards,
Yours Sincerely,
Dr ****** *********
Consultant Psychiatrist-Sexologist/ Lead Clinician
13th March 2012
Nottingham Gender Clinic
Mandala Centre
Gregory Boulevard
Nottingham
NG7 6LB
Telephone: (0115) 960 2820
Website: www.nottinghamshirehealthcare.nhs.uk
F.A.O. Dr Patel
Dear Dr Patel,
I met with Emma at the Nottingham Gender Clinic on the 13th March 2012.
Many thanks for prescribing her Oestradiol Valerate 2 mg bd and for administering the Goserelin injections. Today I have issued her with another 3 month prescription of Goserelin 10.8 mg.
Emma has sustained serious burns to her right lower arm during an accident at work, and although it looks dry and not infected I have urged her to make an appointment at your surgery to see if anything can be done.
There is little to report in terms of her transition. No problems were reported. Emma remains stable in her acquired gender role and has clearly consolidated this. Today we discussed the risks and benefits of sex reassignment surgery and I will refer her to my colleague Dr ******* ********, who assessed Emma initially, for a second recommendation for surgery, as I feel Emma is ready and has fulfilled all the requireme3nts of the Real Life Experience Programme. Understandably she is worried about surgery, but also very much looking forward to it so that "she can be complete" as she puts it.
I have made the following appointments with her on:
Monday 11th June 2012 at 11:00 AM with Dr ***** ****** for a second recommendation for sex reassignment surgery
Monday 11th June 2012 at 12:00 noon with myself
Should you have any queries please do not hesitate to contact me.
Kind regards,
Yours sincerely,
Dr ******* **************
Consultant Psychiatrist-Sexologist/Lead Clinician
11th June 2012
Nottingham Gender Clinic
Mandala Centre
Gregory Boulevard
Nottingham
NG7 6LB
Telephone: (0115) 960 2820
Website: www.nottinghamshirehealthcare.nhs.uk
Charing Cross Hospital
Fulham Palace Road
London
W6 8RF
P: 020 3311 1234
W: www.imperial.nhs.uk
Fulham Palace Road
London
W6 8RF
P: 020 3311 1234
Fulham Palace Road
London
W6 8RF
P: 020 3311 1234
F.A.O. Dr Patel
Dear Dr Patel,
I met with Emma at the Nottingham Gender Clinic on the 11th June 2012. Many thanks for prescribing her Oestradiol Valerate 2mg bd and for administering the Goserelin injections. Today I have issued her with another 3 month prescription of Goserelin 10.8 mg.
Emma has seen Dr ***** ******** today for a second recommendation for sex reassignment surgery. As soon as I have recieved Dr *******'s letter I will refer Emma to Mr Bellringer and Mr Thomas at Charing Cross in London. I am unsure what the waiting times are at present, but I advised Emma to call their secretary at Charing Cross within a couple of months to see where she is on their list.
I would be grateful if you could carry out the following blood investigations in the next month or so:
FBC, U & Es, creat, LFTs, Oestradiol, Testosterone and Prolactin.
It is important that the Oestradiol level is taken as a trough level which means that Emma should not take her Oestradiol tablets the morning she has her bloods taken (but take them afterwards). Many thanks for forwarding me the results.
I have made a follow up appointment with her on:
Monday 8th October 2012 at 11:00 AM
Should you have any queries please do not hesitate to contact me.
Kind regards,
Yours Sincerely.
Dr ****** ********
Consultant Psychiatrist-Sexologist/Lead Clinician
13th August 2012
Charing Cross Hospital
Fulham Palace Road
London
W6 8RF
P: 020 3311 1234
W: www.imperial.nhs.uk
Dear Emma,
I am pleased to inform you that an appointment has been made for you:
Date/Time: Thursday 20th September 2012 at 11:30am
Clinic: Gender Identity Surgery
Location: 179-183 Fulham Palace Road above the Sainsburys Local on Greyhound Road
Yours Sincerely
Outpatient Booking Centre Administrator
24th September 2012
Fulham Palace Road
London
W6 8RF
P: 020 3311 1234
W: www.imperial.nhs.uk
Dear Emma,
Re: Appointment for the Pre-Admission Assessment clinic
You are currently on our Waiting List for Surgery. It is important that before you are admitted for your operation, you must attend our PRE-ADMISSION ASSESSMENT CLINIC on Tuesday 19th FEBRUARY 2013 at 13:00. On the day of your appointment, please go to the PRE-ADMISSION ASSESSMENT CLINIC, 6TH FLOOR, 6 WEST, WEST WING, MAIN TOWER BLOCK, CHARING CROSS HOSPITAL.
The purpose of this appointment is to make sure that you are medically fit to have an anaesthetic and to check your details. You will also have the opportunity to discuss any queries or concerns about your operation with a pre-admission assessment nurse. You should allow at least 1 - 2 hours for your appointment or longer if you require more tests.
Yours Sincerely,
Booking Team
Admissions Department
24th September 2012
Charing Cross HospitalFulham Palace Road
London
W6 8RF
P: 020 3311 1234
W: www.imperial.nhs.uk
Dear Emma,
You are currently on Mr Bellringer's/Mr Thomas' waiting list for surgery. It is important that before you are admitted for your operation you are fully examined to ensure you are fit to undergo your proposed surgery and so that any pre-operative investigations can be carried out.
For this purpose, please attend the Pre-Assessment clinic at 179-183 FULHAM PALACE RD (above the Sainsburys Local on Greyhound Road) on
Tuesday 19th February 2013 at 14:00
Depending on the number of investigations required, you may need to spend between one to four hours at the Hospital. Please bring with you a list of any medications you are currently taking.
Yours Sincerely,
Waiting List Manager
24th September 2012
Charing Cross HospitalFulham Palace Road
London
W6 8RF
P: 020 3311 1234
W: www.imperial.nhs.uk
Dear Emma,
Re: Admission for Surgery
I am pleased to confirm the arrangements for your admission to Charing Cross Hospital on Monday 25th March 2013 at 11:00. On the day of your admission, please go straight to the MARJORIE WARREN DAY & STAY ward, on the Ground Floor, South Wing Annexe of Charing Cross Hospital.
Yours Sincerely,
Admissions Co-ordinator
Very interesting reading, thanks for putting them up!
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