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Unreliable Narrator

I heard stories of other trans people’s gender diagnosis appointments, and how a diagnosis of autism can work against the trans person as they may not be deemed to have sufficient mental capacity to understand themselves, or lack sufficient life experience to ‘know for sure’. I panicked.

by Raven Gough

Content warning: references to self-harm

In 2019, just after my “egg cracked” and I came to terms with my transgender identity, I did what close family and friends recommended I do and sought the help of an LGBT allied therapist to help me come to terms with the new and frightening world I was stepping into. For the most part, we spoke about my anxieties, things that every budding trans person faces with presentation and socialising. After a few months of struggling to socialise my therapist brought up the possibility of being autistic. Fair enough, I’m not sure I spent more than 30 seconds per session making eye contact, and I often get sensory overload so the suggestion made sense. So, 6 months after requesting a referral to a gender identity clinic, I put in a request for an autism assessment.

Of course, much like everything in the NHS, autism assessment services are overworked with long waiting lists, and in the time between referral and my first appointment I had become much more familiar with the trans community. I heard stories of other trans people’s gender diagnosis appointments, and how a diagnosis of autism can work against the trans person as they may not be deemed to have sufficient mental capacity to understand themselves, or lack sufficient life experience to ‘know for sure’. I panicked. The day before my appointment I told the autism assessment centre that I was unable to attend and canceled. I wanted to make sure that I would be taken seriously.

In 2020 I contracted COVID, and in 2021 I commenced hormone therapy. As many of my trans siblings can attest to, the first 3-12 months of HRT can really impact physical health. The testosterone blockers and insufficient oestrogen dose for trans feminine people can cause fatigue and brain fog, not so much a second puberty but a mini menopause. At every appointment, I would be switched onto a new hormone delivery method in the hopes to get my levels up but to no avail, all the while my health steadily declined until 2022 when my symptoms started to get scary as I started losing physical sensation and mobility in my leg. Worrying my issues might be more serious, I booked a GP appointment again.

Now, I hadn’t yet managed to change my name and sex marker with the NHS (not for lack of trying), so to make things smoother I attended appointments ‘male’. The appointment went well, I was taken seriously, and a referral was put through to a neurologist for suspected MS. A month later of rapidly worsening symptoms and the impact on my mental health I ended up in A&E after self-harming. My spouse dealt with NHS direct for me, and meaning well, explained my transgender status. This is where things went wrong. The lady on the phone asked what genitals I had; in my follow-up appointment with the GP, now as a woman, my symptoms were no longer MS but fibromyalgia and I was prescribed anti-anxiety medication. At my neurologist appointment we spent more time talking about my hormones than my symptoms, and when talking about my chronic pain it was suggested that it might be self-inflicted like the marks on my arms. I am no longer taken seriously. 

After the basic tests and MRI came back normal, I can entertain the idea that maybe my symptoms are psychosomatic, they do get worse with my mental health, but where does that leave me? I can’t get that taken seriously either. When requesting psychiatric assessments I am referred to mental health charities who, unsurprisingly, aren’t qualified to help with my issues and I’m bounced back. I actually did attend my second autism assessment and they decided I didn’t meet the criteria, however, in a dramatic twist of irony after ending up in A&E again, the mental health nurse saw I had been assessed and decided for herself that I probably am autistic and they got it wrong. So maybe all my issues are just the autism after all! Thanks, doc, I’m cured.

National Lotter Community Fund logo next to LGBT+ Consortium Logo
This article was funded by The LGBT+ Futures: Equity Fund in partnership with the The National Lottery Community Fund.