13 July 2012
Gender dysphoria is a medical condition where a person feels that there is a mismatch between their biological sex and their gender identity.
In the UK, it is estimated that one in 12,000 people is receiving medical help for the condition.
Sheffield Health and Social Care NHS Foundation Trust manages the Porterbook Clinic, one of just eight specialist clinics in the UK, which gives medical help and psychological support to men and women with gender dysphoria.
Here, former service user, Michelle Penn, aged 45, describes her journey to becoming the woman she always knew herself to be.
Growing up the 1970s Michelle Penn always knew from an early age she was different to her friends.
Born a boy, and called Michael, she knew from the tender age of eight she was a girl who was living in the wrong body.
With the internet not yet invented and transgender issues only rarely discussed in the newspapers or on TV in the 1970s, Michelle had no way of knowing that she had gender dysphoria. And it would only be decades later at the age of 41, that she would finally make the physical transition to becoming a woman.
“When I was about six I didn’t understand why, but I knew I was different. By the age of eight I knew I was a girl. But I couldn’t talk about this to anyone, it was the 1970s, I was living in a traditional working class mining town where men were men.
“From an early age, in my mind I was Michelle, but I never said anything to my parents. Luckily, I liked playing football and I played with action men and superhero toys, so I was never bullied at school, as it wasn’t obvious to others I was different.
“The feeling of being in the wrong body grew and grew. When I was older I would secretly try on my mum’s clothes when she was out, as wearing women’s clothing just felt right.
“But from the ages of 14 to 26, I went into complete denial. I’d left school at 18 and become a hairdresser and at the same time I developed an interest in body building. I remember being so confused, telling myself ‘I can’t be a woman’ even though, deep down, I knew I was.”
Michelle met Julie when she was 17, they married when Michelle was 18 and went on to have two sons a few years later.
Michelle suppressed her true feelings until her mid 20s, when she admitted to Julie how she really felt, explaining that she wanted to undergo treatment to physically become a woman.
“I was fearful she would leave but she is an amazing person who’s coped with it and she has been fantastic, so supportive,” said Michelle.
As their children were then at primary school, and fearing they would be bullied, the couple agreed Michelle would wait to make the change until they were grown up.
In 2008, at the age of 41, she began the process of transition, with the first stage being to explain the situation to their now grown up sons.
Michelle said: “Our sons were understandably shocked, and at first they really struggled with it. But they are now both supportive, as they can see that I am happier now and Julie and I remain close and committed to each other.”
Michelle had to dress and live as a woman for two years to prove that she could manage to live in the opposite gender.
During her transition, Michelle was supported by experts, including those at Sheffield’s Porterbrook Clinic, which is managed by Sheffield Health and Social Care NHS Foundation Trust. She was referred to the service by her local health authority in North Nottinghamshire.
She saw two psychiatrists who both confirmed she had gender dysphoria and a range of supportive care was offered. As part of this she saw an image consultant – whose job it was to advise on clothing, hair and make-up. But she felt no advice was needed as Michelle had already perfected her look.
Michelle was also offered sessions with a speech therapist – but as she had already trained herself to raise her vocal range to sound feminine, she did not need help.
Her physical transformation involved taking hormones to grow breasts and finally undergoing surgery which completed the transformation from male to female.
She has no regrets and finally, at 45, feels she is living in the right body.
Michelle added: “I am very happy and so glad to have had the treatment. It feels like I’ve always been like this, and I feel a million dollars. I know how fortunate I am to have such supportive family and friends.”
Expert piece: Transgender services in Sheffield:
Transgender people come from all walks of life – contributing as lawyers, doctors, nurses, dentists and builders, with many living ordinary and unremarkable lives without anyone realizing their background.
The gender dysphoria clinic is based at the Porterbrook Clinic in Nether Edge, which has a broad role in offering advice on sexual and relationship issues and is managed by Sheffield Health and Social Care NHS FoundationTrust.
The gender dysphoria clinic started in 1974 with around 12 patients a year who were offered advice but were treated elsewhere in the country. The service then significantly expanded in 1998 and since then has developed a range of advice, treatment and support services. Staff have also been instrumental in developing treatment guidelines which are used nationally and internationally.
The clinic now sees approximately 50 new patients a year, and at any one time is supporting around 160 people at different stages of their treatment.
Professor Kevan Wylie, consultant in sexual medicine at SHSC, said that changing attitudes mean that people are now more willing to come forward to ask for help.
Prof Wylie, who sits on a number of national and international committees and advisory boards including the European Society for Sexual Medicine (ESSM) and the World Association for Sexual Health, said: “We have seen a change across society in the last 15 years. Society has become much more understanding of transgender issues. With the internet there is much more support and understanding available.”
People are referred for treatment by their GP and will have a psychiatric assessment to ensure they have no underlying mental health issues.
The service offers an initial assessment programme, and as part of this service users will be offered psychological support to help decide if any additional support is needed before embarking on treatment to change to the opposite gender.
Prof Wylie said: “About a third of our patients choose to have more psychological support. They are making a life-changing decision and it is important to ensure they fully understand that for example that once you start hormone treatment changes in the body, such as the loss of fertility, are irreversible.”
For patients who progress into the treatment programme after recommendations from the multidisciplinary team, a process called the 'real life experience' is encouraged.
The individual is encouraged to live fully in the chosen gender role with advice, support and hormonal treatment from staff in the clinic.
For example, transgender women’s support can involve speech therapy to help alter their voice, learning how to walk in a more feminine way, or to choose clothes that will work for them and won’t draw undue attention.
The process of transition between genders can involve at least a year of living in the intended role, hormone therapy and surgeries. But there is no set pattern as some people will, for instance, have been living in the opposite gender for some years before seeking further treatment.