Where can I find out how long a pre-op has to live as a man or woman?

Where can I find out how long a pre-op has to live as a man or woman?

Real Life Experience


The best way to answer this, and bearing in mind that we are looking for scripts centred in the UK, is to break the answer into two categories, NHS and the Private route.

Both of these have a minimum requirement for the RLE (Real Life Experience – see below the extract from the Gender Dysphoria -Treatment page on NHS Choices)

Real life experience (RLE)

If you want to have gender confirmation surgery, you will first need to live in your preferred gender identity full time for at least a year. This is known as real life experience (RLE) and will help confirm that permanent surgery is the right decision.
Once your hormone treatment is under way, you can start as soon as you are ready with the support of your clinic. The length of RLE varies from person to person, but is usually between one and two years……..

However, if you present yourself for treatment, and you consider you have already done a years RLE, the NHS does not backdate this and you have to start from a point they dictate. If you are taking the private route,  the average is about 1 year, but they will consider demonstrable proof of existing RLE. There will also be variations on this from gender psychiatrist to gender psychiatrist.

At this point many readers may be noticing the elephant in the room. What exactly is RLE in practice? Think of it as the everyday things that one does to interact with society but presenting in a demonstrably different way to your currently outwardly showing gender. Here is a non exhaustive list to get your head around the idea: -

    • Presenting in the new gender via clothing, hair, make-up etc 24/7
    • Interacting with the general public in the everyday ie
      • Travel
      • Work
      • Shopping
      • Communication
      • Entertainment. eg. meals, cinema etc
    • Presenting to family, friend and colleagues

It should be noted that the above is for the UK only and the time scales and process (if there is one) will differ from country to country. So if one of your characters is trans and transitioned elsewhere in the world, their experience will probably be different and you may need to research their own journey in respect to their county.

There are of course no guarantees that a person will pass their RLE and as such may be refused surgery, or in the case of the private sector refused a letter of recommendation of surgery.

You should also respect the fact that RLE is a daunting time for most trans people. This is often compounded by how well they pass in society. Passing gets harder the older you get,  as your body will have had longer for testosterone to work on the body. The average age of someone transitioning is generally accepted to be 42 and for them it truly is the answer to life, the universe and everything.

Another point to note is that there are a section of trans people that do not wish to have operations or have existing medical conditions that prohibit them from proceeding. These are known as non-op. These individuals are not be considered any less trans.

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