My Response to the Care Quality Commission

I received a letter back in December from the CQC regarding my “experience of receiving care and treatment at the Charing Cross Gender Identity Clinic”. This was my response.

Ref: INS1-2206743716


I’d like to tell you about my experience of Charing Cross Gender Identity Clinic. I was referred to them early in 2014. I heard nothing for months and phoned the clinic a couple of times to make sure that they had received my referral. I finally had my first assessment (with Dr. Lenihan) in December of that year – about a 9-10 months wait.

After seeing her, on my way out I made an appointment for my second assessment in May 2015 with Dr. Lorimer. At the time, given how long I had waited for my first appointment, I thought a mere five month wait wasn’t too bad!

However, a few weeks before the date I received a phone call from the clinic telling me that the doctor was unavailable due to a holiday and they would have to cancel my appointment. It’s difficult to express just how crushing a blow this was. I had expectations of finally getting approval for the treatment that would allow me to move forward with my life and for that to be taken away from me was devastating.It triggered months of severe depression, affecting my physical health, my work and the relationship with my wife. Things only started to improve after I finally received a letter giving me a new date to see Dr Lorimer, on January 15th (last Friday).

So, I turned up at the clinic (45 minuted early because of the vaguaries of public transport into London) only to be told that I didn’t have an appointment: hadn’t I gotten the message the week before telling me that it had been cancelled (again!).

Obviously I hadn’t got the message; there’s no way I’d endure the travel into London just for fun! I don’t think it’s acceptable to simply leave a voicemail with no guarantee that it will be picked up. For me communication by letter or email would be better (I have anxiety issues using the phone and don’t pick up calls where the number is withheld or unknown to me; I also do not answer calls during work hours).

Anyway, I’m currently here, over 13 months since my first assessment, fighting depression again with no end in sight for this limbo I find myself in. Given what I was told by the admin staff about Dr. Lorimer’s health problems I really can’t see at the moment that I’ll ever progress to the point where I can begin to receive treatment (HRT, surgery). All this waiting is beyond unreasonable.

I don’t think the woefully inadequate level of service provision for trans people is in any way acceptable. In what other sector of the health service would such waiting times be remotely acceptable, especially given the hugely detrimental effect it has on people’s well-being and quality of life?


Alex Forshaw (Ms.)

How To Come Out As Trans – Part 1

You’re trans. You intend to transition from your current assigned-at-birth presentation to live your life in a way that feels right. What next?

Where to start?

Most of us have family, maybe a partner, maybe children. The people who are closest to us, the ones who believe they know us. One way or another they’re going to find out at some point that we’re not the person they thought they knew.

The first step is the hardest. Telling the first person involves a whole lot of trust. You hope with all your heart that they will accept you but you fear deeply that they will reject you.

I started by dropping increasingly broad hints to friends I felt I could trust, gauging their reactions. If it had gone badly I think I’d have been reluctant to move forward and I’d have maybe given in to the stirrings of suicidal thoughts: I felt so strongly that I couldn’t go on pretending to be someone I’m not.

A couple of weeks later I told a close online friend how I felt, who I really was, and they were wonderfully supportive. At this point my depression was putting such a strain on my marriage that we were at breaking point: we were practically separated. I came out to my wife: at that point I figured things couldn’t get worse whatever her reaction.

I didn’t have a plan beyond that moment. I didn’t know if I’d lose everything, be on my own. That was no longer as important to me as living the rest of my life as a woman. Some people called me brave but I don’t accept that. I did what I had to do to survive the crisis in my life. If I’d been brave I’d have come out earlier instead of hiding it for decades because of my fear of rejection.

For may trans people in relationships coming out breaks that bond. It’s not easy to accept but it’s the truth that most marriages will not last long after one of the partners comes out as trans.

Being open and coming out might be “the right thing” but telling your partner that the person they are with, that they thought they knew so well, is not who they believed them to be will be a huge shock. People react differently but it’s not uncommon for there to be anger, grief, denial and other emotions that are very similar to losing a loved one.

The trouble is that not being honest about who you are can be equally destructive. If it is revealed by somebody else it undermines trust on top of their other reactions to finding out the truth. If you continue to hide it it will damage your mental health and the effects of that can also destroy a marriage, even lead to your death.

It’s such a hard call to make and I can’t tell anybody else what to do for the best. My personal feeling is that it is best to be honest and to tell your partner sooner rather than later. Yes, there is a significant risk that they will reject you and that can be devastating. But the alternatives are equally bleak.

If they find out from someone else then you are guilty of keeping a huge secret from them, destroying feelings of trust. If you continue to deny the truth of your gender identity you will probably harm yourself mentally.

Even if they accept you as trans that does not mean that your relationship is secure. Gender is a factor in sexual attraction for many people and a partner who is strictly hetero- or homosexual may find it difficult if not impossible to remain attracted to you.

If this all sounds very negative and hopeless then I’m sorry, but for the majority of trans people in relationships when they come out, the relationship does not survive. Some do: mine did, and indeed is stronger than before. But mine is the exception. The uncomfortable, brutal truth is that you cannot expect your relationship to continue after coming out. Even if it does then it will almost certainly be in a different form.

The Thief Of Time

I’ve been putting off writing this post. No, seriously, I must have fired up the WordPress editor ten times now and each time I’ve found some distraction to take me away from writing.

Procrastination. Deferring tasks until the last minute and then rushing to complete them by the deadline.

It’s not that I sit there idle, wasting the minutes and hours while I could be working productively. I rarely have any difficulty finding activities to satisfy my need for interesting stimulation.

It’s rather that I need a certain level of stimulation to engage with a task. To feel motivated enough to start it. Dishes pile up in the kitchen sick because although it only takes about five minutes to wash them (I’ve timed it–doesn’t everyone?), and I don’t find the task onerous, I fail to summon enough interest in the activity until it’s nearly bed time and I feel a sense of urgency.

As a child homework presented the same obstacles, except for the few instances such as essay writing that I felt enthused about. To be honest, most homework is a mind-numbingly tedious repetition of what was already learned in that day’s lesson. I used to complete most assignments in the break time before class.

The same afflicts me at work to this day. I’ve been known to spend hours or days coding on personal (although still work-related) projects at the expense of what I’m due to deliver. That work gets put off until I feel that the time remaining fits my gut feeling of the effort required. Having said that, I have a good track record of delivering on time.

That last point is important. I’m fulfilling my obligations. In many ways I view my procrastination as a positive thing. The focus that is instilled in me by the pressure of the impending deadline concentrates my mind wonderfully.

Where otherwise I might tentatively poke around, mind not completely on what I’m doing and consequently making bad choices and failing to consider problems in sufficient depth, instead it’s like a finely-tuned engine running at its peak. It becomes easy to sink into the comfortable mental flow where it all just happens without the sensation of effort.

There’s a fine line between the energizing pull of a looming deadline, fueling the fires of creative endeavor, and a crippling anxiety triggered by fear of failing in my task. I’ve become adept–at least in the absence of external factors that strew tacks in my path–of maintaining my balance on that razor’s edge.

It’s exhilarating, such a sense of capability, of almost unbounded potential. It feels as if I can achieve anything I set my mind to. The sheer pleasure! It’s an addicting experience but one that appears to cause no harm.

They call procrastination the “thief of time” but I disagree. For me it’s a form of time management that maximizes my overall productivity, the key to unlocking my highest abilities. Far from stealing time from me it gives me the ability to use my time to its fullest potential.

That Was The Year That Was

I’m sitting here on this, the last day of 2015, reflecting on my experiences over the past twelve months. It’s been a year of ups and downs but I feel I’m moving into the New Year from a good place.

This was the first full year I lived 100% as myself, Alexandra. I’ve found a self-confidence I didn’t know I was capable of: when I first transitioned I was anxious about being seen in public but now, thanks to a lack of negative reactions from people I’ve encountered, I find I feel relaxed and able to simply be myself.

This was also the year I met in person one of the many friends I’ve made online, the lovely Sonia Boué. After exchanging comments on our respective blogs and communicating via Facebook it was such a pleasure to finally meet at an art exhibition and spend time together.

On the work front things weren’t so good for a while: the company I’d worked at for over eight years replaced their CEO and merged with another company, which affected the structure of the department I worked in as well as the ambiance of the place. I no longer felt comfortable or happy there and when a chance to move on presented itself I took it.

I didn’t get hung up on the possibility of encountering difficulties trying to get hired as a trans woman: I just went in there and interviewed, and had the luxury of being able to choose between offers. Three months later I’m confident I made the right choice: I’ve managed to make some friends in my new workplace and I’m building a social side to my work life.

My wife Anne’s mobility has declined to the point where she now needs a wheelchair when we go out. I’ve become quite skilled at pushing it: I rarely collide with things any more, as well as learning how to spot and negotiate the bumps that would otherwise jar the chair and cause her discomfort. She doesn’t like these restrictions on her independence, but at least the chair means she’s not totally house-bound.

Within the last couple of weeks I received the unwelcome news that my father was seriously ill and in a care home; two days before I had arranged to visit him I was informed that he had been taken into hospital, requiring treatment. I’d not seen him for six years, since my mother’s funeral, and had hardly spoken to him in that time.

He didn’t know about my transition and it took a while before he realized who had come to visit him. He did keep calling me by my old name, but I let it go: in that place and at that time it wasn’t important. I only spent an hour and a half with him before I had to leave for the four hour drive home, but it was good to see him again. The change in him over the course of my visit was gratifying: having started out quiet and listless, by the time I left he was talking in quite an animated way and seemed to be much more positive and happy. It was a good experience for both of us.

As rewarding as the reconnection was with my father, it doesn’t compare with the real high point of my year. That number one spot goes to my daughter, Char, who got in touch with me this summer. Since then we’ve been getting to know each other after such a long separation and we’re getting along well, becoming good friends. We had a fantastic day out together yesterday that the blustery weather couldn’t dampen.

I could dwell on all the time I missed while she was growing up into the young woman I’m getting to know now, but that would be pointless: it’s over and in the past. What’s important is that she’s given me this second chance and I can’t express how much that means to me.

So all that remains is to wish you all a very Happy New Year, and I hope that 2016 will be equally memorable for all the right reasons. Thank you!

A Day In The Life

It’s a miracle I ever find time to write. Between corrupting the young and working towards the downfall of civilization you’d think I’d never have even a couple of minutes to freshen my lipstick. Ah, the trials and tribulations of being a trans woman.

I’m kind of sorry to admit that the truth is a little less interesting. I get up in the morning, brush my teeth, take my meds and eat breakfast before showering. Then I shave the hated stubble from my face, dress in work-appropriate clothes, make a cup of tea and breakfast for my wife.

Once that’s done I can make up my face, tidy my hair and head off to work. Doesn’t sound much, but I can usually stretch it out beyond an hour and a half. By the time I get to work it’s 8:30. Straight in front of the keyboard to check the results of overnight tests and catch up on emails, and then 8 hours of miscellaneous software development.

I’ll admit I do pop off from time to time for a little chat with the girls and an occasional smoke (I’ll have to be giving that up before they’ll sign off on my HRT). Oh, and I do visit the bathroom now and then. I’ve even been known to get a drink of water or eat lunch!

Before I know it it’s nearly 5 and time to drive home. Maybe I’ll call in at a local store for some groceries, or maybe I’ll head straight home. Once in the door it’s time to change into my PJs and take off the makeup. I cook dinner for the two of us. OK, that’s an exaggeration: I usually just pop something in the microwave because I can’t be bothered!

I spend a bit of time with my wife, a bit of time online, and a bit of time watching my current series on Netflix (it’s Luther at the moment; before that was Jessica Jones) and all too soon it’s 10pm and time for bed where we read for a while before lights out.

Yup, that’s my life (and I enjoy the comfortable, regular routine of it). Now I don’t have intimate knowledge of what other trans women get up to in the privacy of their homes but I’d be willing to put money on it being as utterly normal as my own life.

You see, that’s the shocking truth of it: trans people are not any different from other folk. I sometimes (when I get a spare few minutes) wonder what some people imagine we get up to: what I’ve heard of their fantasies seems to suggest we’re some kind of sexual equivalent of Olympic athletes, but with S&M gear and a fixation on teasing straight men.

Well, I’m not averse to a bit of bondage myself but I’m a happily married woman with no desire to seek out any other sexual partner. And if I’d wanted a relationship with a man that’s what I’d have looked for (and hopefully found). As for teasing, I wouldn’t know flirting if I tripped over it on the sidewalk.

Oh, yes, I do sometimes wear a short skirt and knee-high leather boots. Why? Because I like it. There’s a certain confidence and power that comes from dressing in a way that can draw attention, that emphasizes particular attributes of my body. It makes me feel good about myself, which as far as I’m concerned is a damn good reason for doing it. I honestly don’t care what anybody else thinks of it!

When I was still pretending to be male I wore all black, nondescript shirt and jeans, trying not to be noticed. I didn’t think much of myself back then. Maybe I’m compensating for that now, but the way I see it is that at over 6 ft in heels I’m going to stand out regardless so I might as well feel comfortable and confident doing it.

The thing is, as I wrote in the past, I used to feel I was hiding behind a mask. That what people saw wasn’t the real me. I’m not hiding these days: what you see is pretty much the image of myself I carry in my mind. I never realized the strength and confidence I’d feel once I settled into presenting authentically.

It’s not that I don’t feel the same anxiety I always did when around other people. It’s that I am able to handle that anxiety because I’ve not got some secret I’m trying to maintain. I’m free to be myself, and I’m having a whale of a time!

Three Day Quote Challenge – Day 3

Only a day late for the third and final part after being nominated for this challenge by FeministAspie.

The rules of the challenge are as follows:

  • Thank the blogger who nominated you.
  • Publish a quote on 3 consecutive days on your blog. The quote can be one of your own, from a book, movie, or from anyone who inspires you.
  • Nominate 3 more bloggers each day to carry on this endeavor.

“Love is a small word, but allow yourself to be consumed by the sensation and the world becomes a place of infinite possibility.” — Emma Zurcher-Long, I Am Emma – Emma’s Hope Book

This is a beautiful quote, and I feel the choice of words perfectly sums up the feeling. Love absolutely is consuming. Like fire it appears alive in the way it possesses you, drives you. It’s no accident that people write of “burning love”, calling it “all-consuming”.

What begins as a spark can quickly grow, rising beyond control to take you over. It colors everything you see or hear, forces its beat onto the rhythms of your life. There is immense power in love.

Harnessing that power, riding it, you find that it carries you far beyond what you ever thought possible. It creates opportunity, opens doors, keeps you moving forward even in the face of seemingly-insurmountable obstacles.

Learning to love yourself gives confidence; it gives you strength to push and expand your limits. It lets you view failures along the way as temporary setbacks rather than calamities, and takes the sting from what would otherwise be hurtful remarks from other people.

Love grows from sharing. Showing love to others lifts them and you both. Your own love gains strength, multiplying exponentially with each touch.

Three Day Quote Challenge – Day 2

This is my second post after being nominated for this challenge by FeministAspie. Two down, and just one to go.

The rules of the challenge are as follows:

  • Thank the blogger who nominated you.
  • Publish a quote on 3 consecutive days on your blog. The quote can be one of your own, from a book, movie, or from anyone who inspires you.
  • Nominate 3 more bloggers each day to carry on this endeavor.

Today’s quote is from an article by the engineer Lynn Conway, one of my personal role models:

“If you want to change the future, start living as if you’re already there.” ― Lynn Conway, The Many Shades of ‘Out’ – Huffington Post

Lynn Conway has the distinction of twice having directly affected my life for the better. First, she laid much of the groundwork for the development of modern silicon chips through her work in the 70’s at the Xerox Palo Alto Research Center. It’s no exaggeration to say that without her pioneering work in this field we would not have the wealth of powerful, affordable computing devices that are so ubiquitous in today’s world, and I would not discovered the love of software development that has formed my chosen career.

Second, and in some ways even more important to me than her work in electronic engineering, is that like me she is transgender. She was the first trans woman I read about to whom I could relate, with her strong engineering background and the respect she earned has in her field (she was elected a Fellow of the IEEE and a Member of the National Academy of Engineering). Reading her story gave me confidence that I could be accepted and successful as a woman in a male-dominated, technical industry.

When I came out and started my transition I had a lot of fears about being rejected by those around me, about losing my job, home, security. But I realized, thanks to her story, that if it came down to it I could start over and build a new life for myself. I’m good at what I do: the opportunities would present themselves in time.

If I wanted a better future for myself it was clear that I had to burn those bridges, step off that well-worn path and strike out in my own direction. I had to start living my honest, authentic life and trust that eventually others would see me as I see myself.

It is in large part due to the decades of advocacy work by Lynn and many others that more and more trans people today are able to be open about their situation and not face almost universal prejudice and hatred. While we’re not there yet and many trans people still suffer harassment, discrimination and violence, there have been concrete steps toward legal recognition and protection in many jurisdictions as well as much greater awareness and acceptance among people at large.

Three Day Quote Challenge – Day 1

I was nominated for this challenge by a blogger who I love to read because she has a definite knack for getting to the heart of issues and writes with a heartfelt passion about her subjects: FeministAspie.

The rules of the challenge are as follows:

  • Thank the blogger who nominated you.
  • Publish a quote on 3 consecutive days on your blog. The quote can be one of your own, from a book, movie, or from anyone who inspires you.
  • Nominate 3 more bloggers each day to carry on this endeavor.

So, without further ado, here is my first quote.

“Sometimes you wake up. Sometimes the fall kills you. And sometimes, when you fall, you fly.”
Neil Gaiman, The Sandman, Vol. 6: Fables and Reflections

It’s something I read last month (I’ve recently read the whole Sandman series of graphic novels) and it struck a chord with me. You see, recently I left my job, accepting the offer they had made me (I can’t discuss details: that’s part of the contract). After eight and a half years it felt rather like stepping off a cliff: here I am, not knowing where I’ll end up, walking away from what had been a comfortable existence.

But the thing is, I wasn’t happy with where I was and it took such as drastic step for me to realize it. I’d stepped off the cliff and suddenly there I was, falling. It’s funny, but I made this image a couple of years ago (just before I transitioned):


I’d been visiting friends in West Bay (where much of Broadchurch was filmed: this is the iconic cliff seen from the opposite angle), and I was in a really bad place, mentally. But I guess the caption I added was appropriate to my optimistic nature, “Sometimes when you jump off the cliff you find you can fly.”

So that’s why I felt the connection to Neil Gaiman’s words in Sandman. I don’t know if I ever woke up but I can tell you that I have learned to fly.

I’m here, now, as the person I always felt myself to be inside. So many things have happened recently. I lost my mother 6 years ago today. I found out from my brother today that my father is in a care home with terminal cancer. And yet I am in a good place mentally. I feel good about myself, and isn’t that the finest tribute I could make for my parents? That they raised someone who has found the strength to be true to herself.

I’m going to visit my father next week (thanks to those of you who commented a few weeks ago when I wrote about him being taken into hospital and my subsequent feelings). My daughter is accompanying me, which is a help: he doesn’t know yet about my transition and it will be a comfort to me to have someone with me.All these negatives might have brought me down, but the truth is that after so many years of hiding and denying my true self nothing can overcome my new-found confidence and feeling of self-worth. These days I face the world as the person I see inside, and the way that people accept me as myself makes me feel so happy. I truly have learned to fly.

Rewriting History

“You were never much of a man.” Anne has said this to me several times since I transitioned; I know exactly what she means and love to hear it. From puberty onwards when I started to become aware of gender I didn’t identify with any of the male role models around me.

I couldn’t put a name to how I felt; I saw part of a documentary (back in the 1980’s) which I couldn’t tell you the title of. It was about a middle-aged trans woman but her circumstances were so far removed from my own that I failed to see any connection to my own life.

So all I had were people treating me as male. My mum bought me boys’ clothes, I attended an all boys school from age 11 to 16, I played rugby. Any comments on how I looked or acted were male-oriented, either praising my conformance to the stereotypes or criticizing me when my act was unconvincing.

In my teens when I was considered old enough to be left at home alone I would decline to accompany the rest of the family to rugby matches. Instead I’d wait for them to leave and then raid my mother’s closet, dressing in her clothes for an hour or so. I’d look at myself in the mirror and feel so happy seeing a girl reflected there. I used to dream that I could travel Alice-like through the looking glass, become that mirror-girl.

I hated my male genitalia. I’d dream of cutting them off but was always too afraid of the pain and risk of death to attempt it. I always avoided showering after games at school because I couldn’t even bear the thought of anybody else seeing those parts I hated so much.

It’s easy to look back from where I am now and wish I’d said something then, started my transition before my voice dropped and my hair started to grow out on my face, recede at my forehead and become thin on top. But I didn’t have the concepts back then to even begin to explain, and I’d have been terrified at the thought of trying to explain to my parents (who probably knew even less about such things than I did).

Obviously I can’t change what happened: the events of the past are immutable. But what I can change is how I speak about my past. I’ve completely stopped using male-specific terms to refer to myself at earlier stages of my life. I was a child, not a boy; I was in my 20s, then my 30s. It’s straightforward in the present: I’m a woman and that’s that.

In my own mind I consider myself to have always been female. I don’t consider that I was socialized as male: being autistic I never felt that I fitted in anyway and didn’t form many relationships with my peers. I was always happier when left to my own devices with a stack of books, box of Lego and my computer. I didn’t participate in playground games with either boys or girls; instead I’d be reading, building trains and space ships, or writing programs.

I don’t consider my gender to be defined at all by my interests; rather it is an aspect of my identity. I simply know it as a fact of my existence, exactly the same as most other people. My mind informs my reality. That’s the reason it doesn’t feel right to talk about myself ever having been a boy or a man. I’m a woman whose body turned out wrong. One small error led to the development of male characteristics and I need medical treatment to correct it.

I tried. I tried hard for years to live up to the expectations of those around me who saw me as male. But it felt false. It was a charade, never feeling natural. I was wearing a mask, playing a part. Pretending to be what everybody else thought I was. No more. I’m through with denying who I know myself to be inside.

The new job helps a lot. Nobody there knew me pre-transition so they all just treat me as who I am. There’s no reservation in behaving the same way towards me as towards any other woman in the office: it feels very natural and comfortable. I feel accepted as myself. It might be hard for somebody who’s not trans to fully appreciate the importance of this, how validating it is to know that I’m around other people who see me as I do myself.

Distant Family

I got a message from my brother last night wanting my phone number; he called me later. Our father is in hospital. It’s been more than 2 years since I had any contact with him (or my brother for that matter). Seems that it’s never good news that brings the family together.

The lack of contact had nothing to do with my gender transition: it started well before I came out. Just… separate lives I guess.

I don’t know much about what’s going on at this point–although it’s more than I knew this time yesterday. I didn’t know he’d been undergoing chemotherapy for myeloma. I didn’t know he’d been having back trouble that led to a fall before his recent hospitalization. (Until my daughter told me last month, I hadn’t heard that he’d remarried.)

I’m informed that he’s to have an MRI scan Monday and we should know more following that. My brother’s going to phone me when there’s more news.

I’m not sure how I feel yet. I never had the same closeness to him that I did to my mother. I have very few memories of doing stuff with him; mostly going to rugby matches (usually with my brother). But he got me my first computers, provided that means for me to discover my passion for programming.

I’m thinking about whether I’ll make the journey to see him: my brother tells me he’s not very lucid much of the time, and I live about 250 miles away. More than that, I don’t know what I’d say: we don’t have a lot in common and to be honest, as I said earlier, we live separate lives. I suppose it might sound callous, but if he weren’t family there’d be no connection between us these days.

Still, there’s a lot of history there, living under the same roof for nearly half my life. I’m torn between the lack of a current relationship and a sense of filial duty.