In this section, we provide information on some of the most frequently-asked questions (FAQs).
Looking for answers to questions?
The White Book : A Really Indispensable Manual For Inhabiting A Trans Man’s Being.
A Really Great Book - Over 175 A4 pages including:
All for £15 incl p&p (US $35).
Order your copy from:
If ordering from outside the UK, do not send personal checks, only Banker’s Drafts made out to FTM Network or cash will be accepted. Any profits go to maintaining the FTM Network.
The White Book is written and edited by Dr. Stephen Whittle, a trans man who began living in his new role over 20 years ago. A Senior lecturer in Law, he is also co-ordinator of the FTM Network, as well as being vice president of Press For Change.
The White Book is written in an easy and accessible style, to enable female to male transsexual and transgender people (including those who are exploring whether they are female to male) and their families and friends, to get to grips with many of the scary and difficult issues that trans men have to face. It is meant to make life easier — and that is what it does. This is a guide book for living — not hiding.
These listings are of doctors, clinics and other services which have been found by other trans men to be pleasant and helpful.
The editor is not recommending or endorsing any of these services or any doctor. It is up to each individual to ensure that before they give their consent to any treatment, that they have obtained a full explanation of it, and understand both the explanation and the risks that are involved in any treatment. All of the doctors mentioned would require a referral from your GP.
Please help keep this list up to date, please send amendments to FTM Network, BM Network, London, WC1N 3XX or email membership@ftmnetwork.org
For a free list of local counsellors telephone the British Association of Counsellors on: 01788 578328.
SEXUAL / RELATIONSHIP PROBLEMS: Want some help? Details of local psychosexual therapists and counsellors can be obtained from the British Association of Sexual and Relationship Therapy, PO Box 13686, London, SW20 9ZH, Tel: 0208 543 2707
By Stephen Whittle
All of these timings are approximate and I can make no guarantees as regards the efficacy of the NHS services.
For convenience, there is a separate page for each year.
First Year of transition - Ground Zero!
Ask for a referral to one of the specialist Gender Identity Clinics (GICs) such as Charing Cross Hospital (see Resources List in this manual). Your GP will expect you to explain why you want this appointment.
If your GP refuses to refer you, contact you local Family Practitioner Committee to get details of other GPs in you area, and change your GP.
While you wait for appointments consider seeking some private counselling to address some of the issues that you wish to discuss. GICs rarely have the funding to provide counselling, or psychotherapy.
Also consider meeting some other Ftms - and learn everything you can from them.
Check your GP has actually written the referral letter - if not - cry! It always gets them moving - alternatively threaten to take your mother in to see them.
… for the GIC. If you haven’t got one by now, see your GP again.
Think about the name that you are going to choose for yourself. Pick something sensible: Scully is not sensible, you are too old to have been named by your parents after a recent television character.
Remember your age and try and fit in with what would have been appropriate at the time of your birth.
(If you are considering changing your surname, please read our guidance on surnames in the FAQ page on choosing a name).
This will normally be a 1 hour appointment, wherein you will be assessed as to whether you have any psychiatric illness which is making you wish to seek gender reassignment. This is rarely the case, but there are a few psychiatric disorders that make people think they want to change sex.
As a very general rule of thumb, if you get up at a reasonable time in the morning, you keep your clothes reasonably clean, you go to work or college regularly and you don’t think that Princess Diana (or Ulrika Jonsson or Gazza or any other similar person) is giving you special messages through your television you will not have one of these rare psychiatric disorders.
If you really do intend to go through gender reassignment, attend the clinic looking like you are serious in wanting it - if Ftm do not go wearing a dress - try and reassure the doctor that you know your own mind, and all that that entails. Wear appropriate gender clothing - for example, as if you were going for a job interview, as a man, for the local DIY Superstore, i.e. smart trousers, a shirt, maybe a tie, polished shoes, a sports or leather jacket. Don’t be over the top, a 3-piece suit, unless it is your normal wear and you are already working as a man, is a little too up front.
Try not to be too nervous - they are meant to be there to help you, but help them by reassuring them, in your dress and manner, that you are aware of what you are doing, that you realise what is possible and what is not, and that you realise the difficulties ahead of you. The clinic will normally then give you a second appointment 3 months later.
Make sure that you have a job, or are at college by the time you attend the next appointment.
Attend 2nd Appointment at GIC. If you can show that you are working, or attending a full time college course, or a full time volunteer worker, or even an unemployed local councillor, the clinic will give you the go-ahead (if you wish) to start the real life test. If you are in agreement, at this time, the clinic will write to your GP and authorise them to prescribe you male hormones.
Next injection: - the cycle starts again, family and loved ones resort to day trips out to escape from you and your newfound moody-ness. Partners find that they need a constant headache to get some of the jobs around the house done, and you think that you might need glasses soon at this rate.
Menstruation: next period is likely to be very slight. Hopefully that should be the end of menstruation for the remainder of your life. But give it another month and see what happens before you burn all the tampax and panty liners. Breast Binding: Sort out now how you are going to bind your breasts comfortably and so that you can still breathe. Start to sort out your wardrobe - you really are not going to ever again wear that dreadful dress that you wore to sister’s wedding
Periods completely ended now - Hooray, voice begins to deepen and break, Those who don’t know what is happening start to ask you about the cold you have, and sometimes on the phone strangers call you Mr.
3rd Appointment at the GIC - report back how fantastic you feel and ask them to put you on the waiting list for a mastectomy. Now is the time to think about formalising matters and making the transition from female to male. This is going to be the biggest day of the rest of your life.
Change your name by statutory declaration and start to change all your paperwork, such as driving licence, tax records etc. (For a step-by-step guide, see the FAQ section on changing your name).
our boss, or personnel director, and take 2 weeks off work to enable staff to be told. It also gives them time to practice your new name, to get over most of the gossip, and it means you have a little time to live full time as a man in your social life, first, which is a little easier.
The first day in work as yourself
At this point also consider whether to tell your parents.
Why leave it this late? Well for a start it is too late for them to hassle you and to try and persuade you not to start hormones, secondly you have built up an external support network in case they refuse to see you ever again, and thirdly you will feel a lot more confident about yourself.
Your parents will not like what you are going to do. A few are very understanding and they cry in the privacy of their own bedroom. Some divorced or separated parents start to use you as a weapon in their own personal war - “it’s all your fault and they way you treated her when she was six” etc. Some shout and scream and say they never want to see you again. Some are quiet but say they never want to see you again. Some cry a lot in front of you, however they rarely say they don’t ever want to see you again.
Either way it is rarely a pleasant scene. Think about telling them over the phone or by letter if you are not feeling up to the crap. In reality as you tell your parents, you have to remember that in 99.9% of cases, things will be a lot different in 3 years time, they may well not be perfect, but it is rare for Ftm’s to be excluded forever from families. In some cases, this may well be the start of the open and honest relationship that you were all looking for in your family and it may well be a route through to something much better than you have ever had before.
4th Appointment at GIC - insist they put you on the waiting list for a mastectomy. Tell them who you would like them to refer you to. They will probably say they can’t because the surgeon is ‘out of area’ - but insist on a surgeon who is experienced in performing mastectomies on Ftm’s.
Voice well and truly breaking now and a few hairs break through. You may want to grow a beard - but shave them. Men either have beards or they shave their faces, they do not grow ‘bum fluff’ over their chins.
Grow a moustache (of sorts).
Consider dieting to remove a few of the pounds you have put on.
You will be off work for around 2 weeks, depending upon heaviness of job.
Cut down or stop smoking for the operation and for several months afterwards to maximise bloodflow to nipples.
Grow your first real beard.
A series of major events:
Make sure that after everything you have been through that from now on you live life to the full. It is not a dress rehearsal and if you don’t bungee jump in this life you are never going to have the opportunity again.
Go to see your counsellor again and discuss the issues over whether you want to have phalloplasty or not.
When taking male hormones (generally some form of testosterone) you are changing your hormonal morphology to that of a physiological male, so you adopt all the possible health risks that ordinary males have - ie. an earlier risk of heart attack, high blood pressure etc. However you do cut your risks of developing women’s diseases such as breast cancer, and thrombosis etc. So just when you thought life was getting better, healthy living is back in fashion!!!:-
A good male hormone regime will produce results fairly quickly. After the first 2 injections, taken fortnightly, of a hormone preparation such as Sustanon 250, your period should stop completely. In 12 to 26 weeks your voice should begin to break, and will be completed after 9 months to 1 year.
Testosterone is unlikely to make you grow, but many younger FTM’s (under 25) do report some small growth in height, and some say their feet get bigger. What does get bigger is the clitoris. This can develop until it can be as long as 5cm when erect, and it often becomes far more sensitive. Most FTM’s report an incredible increase in sexual libido when taking testosterone, and masturbation often becomes the order of the day (at least for a couple of years).
Many also report a huge increase in appetite, and it is really important to watch your weight particularly when waiting for surgery. Excessive fat around the breasts makes a mastectomy much more difficult.
Beard growth is more problematic to gauge- and its rate of growth (along with body hair) will probably vary with your ethnic origin, your family history, to try and work out what is likely to happen look at your brothers or father.
Baldness is a problem faced by FTM’s as well as ordinary men. However it does appear to be a less frequent problem. Technically to work out your likely baldness pattern you should look at your uncles on your mothers side of the family - but this doesn’t seem to be a rule that works too often. There is little you can do to avoid baldness if it is going to happen, but DO NOT stop taking your hormones to avoid baldness. It is better to be bald than to suffer from brittle bones. Furthermore baldness is meant to be a `sign of virility’.
The early testosterone treatments had certain problems, basically those forms taken as tablets such as methyl testosterone, and restandol, were metabolized through the liver - so there was some risk of liver damage and there is 1 reported case in the literature of liver cancer, there are also several of `jaundice’ though this is generally temporary. There are also several of increased blood pressure, some of `eye’ problems ie. cataracts.
But - you have to remember that the reported cases are very few. Nowadays though, most endocrinologists (doctors who specialise in hormonal medicine) reccommend testosterone injections, as they are only partly metabolized through the liver, and there have been fewer reports of associated problems.
The biggest danger in fact is from not taking hormones. After a period of time on testosterone, the ovaries cease working and producing oestrogen. Also if you have a hysterectomy then obviously there is no oestrogen production (except for a very small amount from the brain). This means that if you don’t take testosterone, you have no hormonal base at all. The risk is of developing Osteoporosis. More commonly know as `brittle bone disease’, this is what elderly ladies suffer from after the menopause. It is what makes their spinal columns shrink in size, and makes them prone to broken hips. The prevention of osteoporis is by taking Hormone Replacement Therapy. In the case of women this is obviously oestrogen (they don’t want to grow beards!!), but testosterone does the job just as well.
In the 1970’s very little was know about the risks of not taking hormones at all, or of taking oral preparations such as methyl testosterone. However by 1980, it was acknowledged that intra-muscular injections of testosterone were far better for FTM’s, and those males who needed such treatment (generally those with scrotal cancer) as they were not directly metabolized by the liver.
But this was only known in very specialised and limited circles - and on the whole the doctors treating FTM’s were not amongst those in the know. However by 1985, it was recommended treatment that intra-muscular injections (generally Sustanon) either as Sustanon 250 every 2 to 4 weeks, or Sustanon 100 every 10 to 14 days, should be the general dose of testosterone for FTM’s.
Many people had their hormones discontinued in the 1980s and it wasn’t until the early 1990s that it was realised that they were under a great risk of developing osteoporosis. Now in 1996 it has been thought that the dosages should be as follows:
(These are figures given by the team working at the Free University of Amsterdam, under the endocrinologist and leading world expert on the endocrinology and treatment of transsexual people; Professor Louis Gooren.)
Osteoporosis can now be treated - if you think you might be at risk, ask for a bone scan, and discuss the results with a specialist. A calcium supplement now could save many problems in the future - but this is only necessary if after several years on hormones, you then had a gap of several years.
It is now recommended that all FTM’s need a hysterectomy, preferably in the early years of treatment. There is an increased risk of developing pre-cancerous cells in the cervix. However there are risks associated with such major surgery, and it can also affect sports performance etc.
However it is important to realise that techniques in genital surgery are constantly advancing, and you need to discuss with any doctor you might be considering having genital surgery with whether s/he would prefer you to postpone a hysterectomy in order to save tissues which may prove useful at any time when a phalloplasty is performed.
To keep your options open - have a hysterectomy that is performed by extraction through the vaginal canal, or via a lateral incision (up/down) rather than an incision across the torso.
Lists of local support groups.
Note that local groups are sometimes quite small and run on an ad-hoc basis, so the deatils here may not always be up-to-date. Please tell us if you think that our imformation here is inaccurate or outdated.
Your Health Authority has Refused to Fund Your Gender Reassignment Treatment - What Next?
Firstly - the decision to provide any medical treatment or not is a clinical decision - i.e. it is the role of the doctor involved to decide your medical needs - it is not the role of an administrator.
So - in effect, in the case of trans men, if a psychiatrist and a surgeon think that hormones, a mastectomy or a metoidioplasty or phalloplasty is the correct treatment for you, then it is simply up to the health authority to fund it. They cannot refuse that funding, and if they do so, then you have a right to have the decision reviewed by the courts - only that can be a long and costly process.
In effect you need to tell them that you will seek a judicial review of their decision on the basis that they do not have the power to make such a decision. That sometimes works - but it is hard work, and not something to be taken up lightly.
Secondly in the case of Reg v North West Lancashire Health Authority, Ex p A and others CA: Auld, Buxton and May LJJ: 29 July 1999, said
“Although a health authority had acknowledged that transsexualism was an illness, the policy it had adopted in relation to the allocation of resources for dealing with people with the condition treated it as an attitude or state of mind which did not warrant medical treatment. The ostensible provision that the policy made for exceptions in individual cases amounted effectively to the operation of a blanket policy against funding treatment for the condition because it did not believe in such treatment.
…… Regional health authorities had to establish priorities. It made sense to have a policy for the purpose, and might be irrational not to have one. In his Lordship’s view a policy towards transsexualism low in an order of priorities of illnesses for treatment was not in principle irrational, provided it genuinely recognised the possibility of overriding clinical need and required each request for treatment to be considered on its individual merits.
The authority’s recognition that transsexualism was an illness was at best oblique and lacked conviction. Its policies should, but did not, properly reflect the medical judgment that it was an illness. The failure properly to evaluate it as an illness was not mitigated by the allowance for the possibility of exception in case of overriding clinical need. The authority’s stance was not a genuine application of a policy subject to individually determined exceptions. It was similar to a blanket policy.”
So your health authority must look at your individual case. Undoubtedly they will argue here that they have, but they must assess your clinical need based on whether or not you are transsexual, not on some completely unrelated matter e.g. are you in a stable relationship.
If you are unemployed or on a reduced level of income, you may be eligible for Legal Aid which means that the legal action will cost you nothing. It will also be possible to protect your identity so that if you go to court and the case is reported in the newspapers, your name will not appear.
Remember although these setbacks may be very irritating or depressing, your aim is to get your treatment on the NHS in the end and if you follow these steps, it is highly likely that you will be successful. So, even it is very understandable that you may feel very depressed or suicidal it is important to stay calm and to appear to be in control. It will definitely not help your case if it possible to argue that you are mentally unstable.
These pages set out the steps to take in changing your name.
Think about the name that you are going to choose for yourself.
Pick something sensible: Scully is not sensible, you are too old to have been named by your parents after a recent television character.
Remember your age, and try to fit in with what would have been appropriate at the time of your birth.
You should also consider whether you want to change your surname. Some trans people choose to do so, and it is perfectly legal and acceptable … but if you want to maximise your privacy and make life easy, it may be better not to change your surname.
This may sound strange, but the reason is that if you do change your surname, the documentation will be more complicated when you obtain a gender recognition certificate.
(If you are not thinking of changing your surname, you may prefer to skip the rest of this page. The explanation is rather complicated!)
These complications mean that if you have to produce your birth cert, it will harder to maintain privacy about your transsexual history. Many trans people won’t mind about that, but you should consider whether it matters to you, or might matter in the future.
The effect on the documents depends on when you were born: procedures for birth certificates changed some time in 1969. The precise reasons are very complicated, but here’s a fuller explanation if you want it:
If you were born after 1969, your new birth certificate will show your new surname, which will be different to that of your parents. There are other people in this situation (not just trans people), but it is unusual. So it may mean that some questions are asked about your birth certificate—it may not matter very often, but it’s not a good situation to get into if you want to maximise your privacy.
The situations where this matters are rare, but it is something to consider.
If you were born before 1969, things get even more complicated if you have changed your surname.
Your original birth certificate does not record the child’s surname—in those days, a child was assumed to take the father’s name (if recorded), or the mother’s name if no father was recorded. That makes it difficult for anyone who had changed their surname, so you will be offered a choice between a post-1969-style birth certificate or the earlier format.
However, if you choose the post-1969 format, someone to whom you produce your birth cert may notice that a pre-1969 birth should not be recorded in that format, and might ask difficult questions.
So the registrar will offer you the choice of having a pre-1969-style birth cert, which will look the same as for other people born in the same era. This option would cause a lot of complications, so it looks like a bad option.
For example, suppose your parents were Janet and John Smith, who named you Ann, and when you transitioned your changed your name to Eric Jones. If you get a pre-1969-style birth cert, it will show your name as Eric, and your parents’ name as Smith so your name would be Eric Smith.
This would be difficult, because you were never known as that! You would now have a contradiction in your paper-trail: a statutory declaration which shows your name changing from Ann Smith to Eric Jones, and a birth cert for Eric Smith.
There could be two ways around this:
Once you have chosen your name, the first thing to do is to prepare a statutory declaration of name change.
A solicitor will charge you a fee (usually betwen £20 and £50) for drafting your statutory declaration. However, you can type your own statutory declaration, and then pay a much smaller fee to have it sworn (or "notarised").
You can draw up a statutory declaration based on the sample below ... but you will probably find it easier to use our online name-changer, which will create it for you.
(We do recommend that you use the online name-changer. There is less chance of making a mistake!)
This is what a statutory declaration should look like:
Note: The format varies, depending on whether you are changing your first names, your surname or both. This sample is for someone who is only changing their first names.
I Jane Maria Campbell of 123 High Street, Somewheretown, Borsetshire BX45 1QA
DO SOLEMNLY AND SINCERELY DECLARE as follows:-
| SIGNED AND DECLARED at | ) |
| in the County of | ) |
| ) | |
| this day, the of 200 | ) |
| ) | |
| Before me | ) |
| ) | |
| Solicitor/Commissioner for Oaths | ) |
Once you have chosen your name and prepared your statutory declaration you need to swear it in front of someone who is authorised to notarise it.
It is then a very good idea to get several notarised copies of your statutory declaration. That way, you will rarely have to use the original copy, which you can keep safely at home.
You will usually have to pay a small fee for each copy.
There are two sets of people who can do this:
A magistrate’s clerk can notarise your statutory declaration for a fixed fee of under £10.
You can find your local magistrates court in your telephone book, or the Court Service website includes an list of addresses of all the magistrates courts
You may need to make an appointment.
To notarise a statutory declaration, a solicitor must be a registered “notary”. Nowadays, nearly all solicitors are notaries, and a quick phone call to any solicitor’s office will tell you who the notary is in that office, and how much they will charge.
Fees can vary widely, so it is advisable to shop around. In one town, a trans person recently obtained three quotes for swearing a statutory declaration : £5, £30 and £60!
To facilitate the change of name on statutory documents as discussed below, you will need to send:
The letter from your doctor must be similar to that shown below. It must state that the change you are undergoing is permanent. Without this, many of the authorities such as the passport office will not make the necessary changes.
You can change a range of documentation (see the following sections of this FAQ), by sending both your Statutory Declaration and the doctor's letter along with a short note simply explaining that you are undergoing gender reassignment from female to male and that you need your documentation changing to recognise your new name and gender.
Technically you should always send the original documents by Registered Post, ensuring you enclose the return postage and any extra cost required to ensure that they are returned by Registered Post. Most solicitors will certify photocopies of your statutory declaration for a very small fee.
However, apart from the Passport Office, it would now appear that most of these bodies will now accept photocopies of your Doctor’s letter and your statutory declaration.
Headed paper with address of GP, Doctor, GIC or consultant.
Medical Reference No. xxxxxxxxxxxxx
Date.
To whom it may concern
This is to confirm that my patient [Mr.] [Full name] has been diagnosed as having gender dysphoria and is currently undergoing gender reassignment to the male role. This change is to be permanent. As part of this process he has changed his name by Statutory Declaration from [Ms.] [Old full name] to [Mr.,/Miss./Ms.,/Mrs.,] [full name]
Your assistance in making the relevant changes to your records and in preserving full confidentiality would be appreciated.
Doctor, GP or Consultants signature
Being transsexual presents no problem as far as banks or building societies are concerned. They will apply exactly the same criteria in the case of credit assessment as for anyone else.
The bank will change your name as a matter of course once it has received a certified copy of your statutory declaration. The bank will also require a signature card with your new signature or in the case of a second account the signature which you will use for the operation of that account.
Again altering details on these and requesting new ones will present no problems. Simply send a covering letter to the credit card company together with a copy of your statutory declaration requesting a change in your name and requesting that new cards be issued in that name.
Do however watch out for the fact that certain credit card companies utilise gender checking as a form of security. On some credit cards the gender may be stated in which case it is easy to see the alteration but on some others such as Barclaycard there is no gender indicator as there are only initials. The use of initials is a deliberate part of the security system in that if your card is ever checked for any reason then the first thing the shop assistant is asked of the cardholder is the gender of the cardholder. Therefore make sure that the credit card is tied to an account in your preferred name.
You need to get a form from your post office to apply for a driving licence.
The Driver and Vehicle Licensing Agency (DVLA) now issues only photocard-style driving licenses, so you will now be asked for a photograph which will be included on your new licence. Try to get a photo which you will be happy with for some time in your new role, and make sure that it complies with the DVLA's criteria.
Send the form, along with a covering letter, to the DVLA in Swansea together with a copy of your Doctor's or Psychiatrist's letter and a copy of your Statutory Declaration and your old driving licence. (The DVLA's website includes a useful page on How to Apply for your Driving Licence & How much it will cost.)
If you change your name and hold a current driving licence you must inform the DVLA without delay. Failure to do so is an offence under section 99 of the Road Traffic Act 1988.
The covering letter should state that:
* you wish your legal name on the licence amended to the of your new legal name, and
* that the gender code be altered to that of your new role.
You must ensure that the gender code is changed and not just your name as explained below.
Your driving licence will include a "driver number": it's item No. 5 on the front of the photocard. This number includes a gender code.
Your driver number will look something like this: ROBIN512185CJ9ME
The full code is explained in the DVLA's guidance on paper driving licenses (the same coding system is used on photocards), but what matters here are middle six digits in bold: in the example above 512185.
On your driving licence, your date of birth and sex is shown in the number. On a man's driving license, the second digit must be '0' or '1'.
For example:
The gender code is in the second digit of the DVLA number: '0' or '1' for a male, or '5' or a '6' for a female. So a female born on the seventh of June 1943 would be shown as 456073.
This can be stated as follows:
The DVLA code for a man born on 7 June 1943 is: 406073:
Conversely, the DVLA code for a woman born on 7 June 1943 is: 456073:
You can see clearly that the gender code is 5 or 6 is added for female. It is of course a complete give away to the police if they should ever inspect your licence. To avoid embarrassment, you should ensure that the female gender code is deleted.
Send a certified copy of your statutory declaration with your doctor’s letter together with a letter from yourself quoting your National Insurance (NI) number to the central office of the Department for Work and Pensions (DWP) as follows:
The DWP will acknowledge your change of name and style of address and reply in a standard letter stating that in effect that the change will have no effect to any legal entitlement to state benefits, especially the state pension. You may also receive a plastic NI numbercard which will show the new title and name but there will be nothing on the card to indicate any change of name or previous name.
Note that you when you inform the DWP of your change of name, you should also inform the Inland Revenue at the same time.
The entitlement to a state pension, following decision CP/76 of the National Insurance Commissioner is that a transvestite or a transsexual person’s right to a state pension will be by reference to your original biological sex. This follows the Corbett doctrine and means that if were born a man you will receive your pension at 65 and if you were born a woman you will receive it at 60. The fact that the retirement age for state pensions for both men and woman are now being equalised by the year 2020 will then make no difference to entitlements or retirement ages.
The national insurance number will not be changed by the DWP and the central office of the DWP in Newcastle will record your previous legal name as well as your new one and may be viewed on the DCI computer by any authorised employee of the DWPS. All employees of the DSS are bound to keep information confidential unless required by the courts or the police through special section A. The DWP central index of your National Insurance number will also be annotated and flagged that you are to be treated as male for some purposes and female for others.
A transsexual person is entitled to Jobseeker’s Allowance in the same way that every other person is, and will also be treated in the same way for the payment of national insurance contributions. If you are unemployed then the Unemployment benefit office and Job centre will also be aware of your previous details and will require to be informed of your change of status. Employees of the unemployment benefit office are again bound by confidentiality.
Send a letter, and the documentation required, in confidence, to your Inspector of Taxes — the address is available from your employer’s personnel or wages office.
Mark the envelope as “private and confidential” of the tax office which deals with your affairs and quote your National Insurance number and Tax reference (available from your wages office or often it is on your wages slip).
Your income tax records will always be changed and any further correspondence will always be addressed in your new legal name. If you advise the DWP of your change of status, then you must advise the Inland Revenue at the same time … but you should not of course notify these changes until you have also informed your employer.
To obtain a new NHS Medical Card you should write to your local Family Practitioner Committee [address available from your GP], requesting a Medical Card in your new name, and enclosing the letter from your Doctor or Psychiatrist as outlined above together with a copy of your Statutory Declaration and your old NHS Medical Card.
Your new Medical Card number will be a completely new number, though the last three figures which are the ID suffix will remain the same. Your new number will also have a special prefix of an A or a Z which denotes that an alteration or variation in unspecified status has taken place.
You may also wish to change your name on various documents such as examination certificates. All you need do is to write to the examination bodies concerned, enclosing a certified copy of your statutory declaration. There may well be a fee for such a service and you should enquire beforehand.
Some University examination bodies have recently refused to alter the name on the degree certificates of some transsexual people. If this happens, then initially write an appeal to the examinations office, with supporting evidence such as your statutory declaration and doctor’s letter. If again refused, then contact the Lesbian and Gay officer of the students union, who will ensure that you have support when you make a formal appeal to the University Senate body, though it would be surprising if the University insisted upon taking the matter that far.
If you own a house or flat in your own name, you must change your name on the proprietorship register at the district land registry where your property is registered.
You need to forward a covering letter stating the address of your property together with the registered title number of the property concerned and enclose a certified copy of your Statutory Declaration. If your property is mortgaged then you must also inform your building society or mortgagee.
If you are not sure where your property is registered you should contact the solicitor who handled the purchase of the house for you as they will generally know which registry you should contact.
You can obtain a new passport showing you as ‘Mr’ and ‘male’.
All you need do is to complete the passport application together with the statutory fee and send this with a copy of your Doctor’s or Psychiatrist’s letter and a copy of your Statutory Declaration. (The Passport Service’s website includes a page on the cost of applying for a passport).
You must also send your old passport back if you have one. If you have not held a passport before, then you must also send your original birth certificate to the passport office.
You should send your passport application to:
The FAQ section on changing your documents includes specific advice on major documents.
But there will be many other bodies which you will need to inform, including:
Produced by the National Osteoporosis Society, February 2004
(The NOS website hosts the original version of this document, in Microsoft Word format. It is reproduced here with permission.)
During childhood and adolescence, bones grow in size and density. Bone needs to be stimulated to grow and become strong and also requires a good supply of calcium. Both diet and exercise help to do this. A well balanced, calcium rich diet and regular exercise such as running, skipping, brisk walking, aerobics and weight training all help to strengthen bones. At puberty, the bone density receives a boost as the effects of oestrogen and testosterone increase bone mass.
Both sex hormones are necessary to bone health as once they decline or are stopped (as in replacement therapy for a transsexual person), bone density begins to be lost. This is because the cells which break down bone, without the influence of the hormones, begin to work faster than the cells making new bone so a deficiency in bone density occurs.
Osteoporosis literally means “porous bones”. The bones in our skeleton are made of a thick outer shell and a strong inner mesh filled with collagen (protein), calcium salts and other minerals. The inside looks like a honeycomb, with blood vessels and bone marrow in the spaces between the struts of bone. Osteoporosis means some of these struts become thin or break without too much force. It often remains undetected until the time of the first fracture. The wrist, hip and spine are the sites at which fractures most commonly occur.
Women are more at risk of developing osteoporosis than men due to their lower peak bone density and the rapid loss of bone density at the time of the menopause.
In the male to female transsexual person, testosterone production is stopped. Oestrogen, with or without a progestogen, is taken to give a more feminine appearance. In the female to male transsexual person the opposite applies. Both of these sex hormones (testosterone for men and oestrogen for women) are necessary to maintain bone density. The transsexual person becomes at risk of developing osteoporosis if the sex hormones (replacement or natural) are discontinued leaving them with no hormones of either kind. The female to male transsexual person may also experience menopausal symptoms due to the lack of their bodies’ natural oestrogen and irrespective of whether they stop hormonal treatment or not, tend to lose bone density. Hormone therapy needs to be continued on a long term basis to prevent osteoporosis.
There are several risk factors for developing osteoporosis and these include:
A lack of oestrogen caused by:
A bone density scan called a dual energy x-ray absorptiometry (DXA) scan is the most accurate way to measure the density and strength of bones and also risk of fracture. The scan is a simple, painless procedure that uses very low doses of radiation and takes only a few minutes. The usual sites of measurement are the hip and lower spine but sometimes the forearm (wrist) is used.
The normal ranges of these measurements are dependent upon the sex of the individual. In people who have had medical or surgical interventions to change their sex, experts believe that the range of measurements used should be those which reflect the sex of the individual at birth because these most closely reflect the skeletal size and fracture risk for an individual.
One of the major risks associated with female hormone use is deep vein thrombosis (DVT), although this is less likely using a patch form of oestrogen replacement. This is the formation of a blood clot usually in the lower leg. Blood clots can occur in other places such as the lungs. This is known as a pulmonary embolism (PE). Although rare, a PE can be life threatening. Oestrogen therapy is usually discontinued prior to any type of major surgery. It is therefore, important to discuss this with your consultant as immobilisation during and following surgery will also increase the risk of a blood clot developing. Initially, the female hormone oestrogen can cause nausea but this should disappear as the body becomes used to the treatment. Fluid retention and a raised blood pressure (hypertension) may also be seen with oestrogen therapy.
If a progestogen is used with the oestrogen, mood swings similar to pre menstrual tension (PMT) may occur. Not all transsexual women are given a progestogen as this is given to help mimic the hormonal cycle experienced by women but not all wish to have this effect.
Following administration of anti androgens (drugs which block testosterone production in the male to female transsexual person), there may be an increased risk of stroke and arteriosclerosis (thickening of the arterial walls due to ageing or high blood pressure often called ‘hardening of the arteries’) and liver disease. The side effects associated with testosterone replacement therapy include acne, cardiovascular disease and in some cases, abnormal liver function. Hormone replacement therapy (HRT) should only be used with medical supervision where its effects should be monitored.
There are several drugs licensed for the prevention and treatment of osteoporosis. These include the bisphosphonates, alendronate (Fosamax), risedronate (Actonel) and cyclical etidronate (Didronel PMO). These are non hormonal, specific drugs to prevent bone density loss and reduce the risk of fractures. These treatments are only available from GPs or consultants and are only prescribed for those people with a low bone density, fractures or risk factors for osteoporosis. They are not routinely given as a preventative measure. They are effective in treating osteoporosis in people with low levels of either oestrogen or testosterone and so are potentially useful in people who, for medical reasons, are no longer able to take oestrogen.
Factors that can help to maintain healthy bones are a well balanced diet with adequate calcium rich foods, regular weight bearing exercise, avoiding smoking and keeping alcohol consumption to within the Governments recommended limits.
The Gender Trust
PO Box 3192
Brighton
BN1 3WR
Tel: 0700 079 0347
E-mail: info@gendertrust.org.uk
Website: www.gendertrust.org.uk
FTM Network
BM Network
London
WC1A 3XX
Tel: 0161 432 1915
Fax: 0161 432 1915
E-mail: stwhittle@ntlworld.com
Website: www.ftm.org.uk
Further information about bone health and osteoporosis is available from the NOS, Camerton, Bath, BA2 0PJ. Telephone 01761 471771 or the NOS Helpline - 0845 450 0230.
Penile Prosthetics and and ‘Stand and Pee’ Devices