Nottingham's Extended Assessment Pathway - 3 Months On...
Hi all! You may have seen a couple posts from me in the past months - one about soon having an EAP appointment, and one about what happened after. At the request of the lovely u/corvid72, I'm making a post that outlines what the EAP is about, since there's no resources online beyond my posts and a couple other comments on reddit, really. Hang tight pls, this post will be a big one.
What is the Extended Assessment Pathway?
To my knowledge, NCTH has the highest rate of patients seen for their first and second appointments - with only a three year wait, you might think that NCTH gets you on HRT and onto the operating tables faster than any other clinic. While that's probably true in part, there's caveats to this. The one I'm talking about currently is the Extended Assessment Pathway, which I'll refer to as EAP throughout this post to make it easier on me.
Once you've had your first and second appointment, your doctor will likely place you on the Extended Assessment Pathway depending on whether they think they need more time to evaluate whether transition will be best for you. Chances are, if you've waited the 3 years to be seen the first time, then the year between appt 1 and 2, you're probably in it for the right reasons, but whatever.
What is my experience with the EAP?
I was placed on the EAP not far off 3 years ago. This was, in part, because I admitted I was unsure of what I truly wanted from a medical transition in terms of surgeries. I told Dr Bouman that I hadn't really thought that far, and he gave me this look like "Why are you here then?" - but also because I want to have a child in the future and would need to get sperm put in storage.
The fertility side of things took about 9 months from that appointment to everything being done with, including emailing them to tell them it was done and I was ready to move on. How naive I was.
After fertility, I had another 17 month wait (a total of 28 months now, 2.5 years) before I would see a Dr Soundararajan (who is honestly so lovely btw) for the first of possibly up to six appointments.
What are the EAP appointments like?
I found out a couple months before my first EAP appt. that I had been booked in for it. In usual fashion, the letter took about 3 weeks to arrive, but I receive all comms via text, post & email. The email was painfully vague and I was racked with fear that it would be another gatekeepy appointment.
First, Dr S talked me through what the appointments are:
- Hour long appointments, which allow you a space to talk deeply about your "history" as a trans person
- Scheduled every 1-2 months with the same doctor
- Up to 6 appointments will be made and on the final one, you are told if you meet the criteria for a Gender Incongruence diagnosis.
Of these six appointments, I was told straight off the bat that I would only need two or three, at the end of my first. These appointments focused mainly on my social transition, though as I have done some efforts towards a medical transition, those were covered too - things like how much your family supported you, relationships, education where covered in the first, while the second touched on my younger life: how I was, how I saw myself and how aware I think I was in retrospect, as well as some about employment and which processes I've taken regarding legal stuff.
These appointments are in-person too, at the clinic, and she made an attempt to book both of them for the same time on the same day of the week, which I appreciated. It did not interfere with work, thankfully.
And at the end of my 2nd appointment, I was told "You definitely meet the criteria for a diagnosis of gender incongruence" and I felt a wave of relief wash over me.
What next?
Well, now that I've been told I'm officially, medically a transgender, I've got an appointment in just over 3 weeks where she will discuss medication with me; I currently DIY cypro and will be off that and put on decapeptyl. I'm not sure how my estrogen regimen will change, as I'm on 4 pumps gel a day and I don't think its enough yet. There will also be a discussion in that appointment about referrals to further treatments/services such as hair removal and bottom surgery.
Thanks for reading as much of this as you have, feel free to ask any further questions about my experience. I'd love to be as much help as I can, especially since there's no other resource about the EAP online.