Daventry, Northamptonshire, UK. You have generously allowed me to present some aspects of my life. There have been gaps as I have endeavoured to emphasise that which has been affected my situation. I have been challenged to distill whatever has been learnt and what can be usefully imparted. This is not only to those similarly afflicted but to the world at large, including families and the entire range of associates.

 

 

 

A priority is to impart the certainty that our condition is a birth defect, no different than others such as spina bifida or cleft pallet. There is now more than adequate confirmation that male or female neurological programming can be male or female, quite independent of the obvious physical attributes imputed by our chromosomes. That neurological programming defines us as a female person.

 

A second priority follows. Many of us have religious faith, manifest to different degrees and in different ways. I can only refer to the Christian interface. Let no one accept that there is anything in scripture which imparts a moral or theological aspect to our condition or its treatment. Over the centuries, with many translations, fitting many historical circumstances, scripture can be misused selectively to support any argument. Means of refutation are available in the same sources.

 

My God could rejoice with me that I am now whole.

 

There is a problem with children manifesting our condition. This can and will only be resolved when an objective physical means of diagnosis is available. This will surely happen but is some way off. I can remember my childhood, but see the two sides of this situation. Treatment is a one way journey but so is suicide. Advice and guidance to parents is vital and this must be imparted by experts who can be seen to have no personal axe to grind. The crucial component is giving hope and confidence to the young patient until there is adequate certainty of the diagnosis.

 

From the childhood appearance of our incompatibility problem another consideration arises. In this instance I can only speak from my experience and that of many people I have gotten to know. In every case, there has been a manifestation of incompatibility as soon as there is conscious distinction between male and female. I would be very concerned if a person presented themselves with the condition arising only when adult, unless there was a very compelling reason.

 

The teenage years and puberty are difficult enough for all parents and children. Those like us need very special support to just survive, as feeling at ease is out the question. I cannot erase the memory of my growing physical male sexual manifestations in conflict with the active mental female sexual demands. We are so different that no general advice can be recommended. But there must be no doubt that you are trying to understand although sharing is impossible. This you must demonstrate with unquestioning love and ability to listen.

 

The cost of treatment and its availability cannot be ignored. Where a state health service is available there is usually that which has become known in the United Kingdom as the UK Postcode Lottery [1]. Where you live often matters more than how urgent is the condition. Where privately funded treatment has to be the choice, most insurers do not accept our condition as within their treatment schedules and the cost is commonly outside many family budgets. Added to the obvious consultancy and surgical procedure costs are the equally essential requirements such as epilation and speech training. As with many health problems there is no immediate answer but let us not forget that the problem exists.

 

The first port of call for most patients is their general practitioner (GP). Many of us are fortunate in having received knowledgeable supportive advice. It is regrettable that some GPs are still ignorant and dismissive. Medical education and regulatory bodies need to take action.

 

Caution is essential when proceeding to surgery. When the selection of a surgeon follows directly from psychiatric referral there can be confidence. There are still reports of substandard surgery, where a desperate patient is on their own. There is no substitute for personal recommendation.

 

We all receive hormone treatment and some may be concerned at the suggested risks involved with such long term medication. Clearly there are medical conditions which require caution in the use of hormones. But let us remember that compared with a natal woman, most of us are unlikely to have a similar duration of female hormone exposure. Quality of life is vital. I can only quote my partner Joyce, “No or low HRT leads to GBH!” [2]

 

Stealth is a term we often meet when some of us are reviewing their life style. I can accept that there are situations where revelation of ones past presentation has to be avoided. Nevertheless my experience indicates that openness has enormous advantages. The problem of stealth is one of maintenance, never knowing who is going to appear and spill the beans.

 

Where it is not precluded, allowing colleagues and associates to be part of our integration is often taken as a compliment. If there is an individual adverse reaction they are soon put to shame. The vital requirement is that we present ourselves as totally normal, dare I say, ordinary women. My past, to quote a British civil service maxim, only arises on a “Need to know” basis.

 

I function in every way, physically, mentally as a very happy contented woman, now an old woman. So do I have I any regrets? I have only one. It is never having been young and never having produced a family of my own. Perhaps this is really excusable envy.

 

[1] The UK Postcode Lottery is conducted in the United Kingdom as an aid to charity. It works by using an entrant's postcode plus a unique three-digit number as their ticket number. For example: NE1 1AB 001.

The uncertainties entailed when obtaining adequate and relevant health care can be likened to a chance event, much like the lottery. In the United States, an equivalent expression would be a crap shoot.

[2] HRT is a common acronym for Hormone Replacement Therapy. GHB (grievous harm to the body) is a play on words that refers to gamma-hydroxy butyrate (GHB), a neurochemical compound that occurs naturally in the body. It is a sedatuve depressant with anaesthetic properties, slowing down activity in the brain and other parts of the central nervous system. Undesirable in women, the GHB compound has been synthesized and is the source of drug abuse in a number of countries.

 

 

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