Monika: Today, in most countries, trans women typically do not have to undergo a real-life test in order to access gender-affirming medical care. Historically, some medical guidelines, like the older WPATH Standards of Care, required a real-life experience of living full-time in the gender you identify with before certain medical interventions, especially surgeries. Did you have to undergo such a test?
Tina: Oh, the Real Life Test, that was honestly one of the most intense periods of my transition. For me, it wasn’t just about living as a woman; I had to do it while keeping my job. Imagine trying to navigate your gender identity in a workplace where everyone only knew you as male, it was nerve-wracking. I remember having a heart-to-heart with my employer, and he asked me straight up, “Do you think you can do this?” Of course, I said yes, because I had no other choice if I wanted to move forward.
Monika: What did the Real Life Test actually involve for you day to day?
Tina: The Real Life Test, or RLT, was basically a trial period. You lived and worked as your true self, full-time, in all aspects of life, for a year or two, sometimes just three months, depending on your situation. It meant to show that you could handle life as a woman and that the transition was genuine.
During this time, you usually saw a gender psychologist, maybe a psychiatrist, and they confirmed that you have gender dysphoria. If all went well, you would get recommendations for hormones from an endocrinologist and, eventually, approval for gender-affirming surgery.
It’s not easy, though. You’re stepping into a world where everyone had a fixed image of who you were, and you had to gently, but firmly, redefine it. For me, it was stressful and exhilarating all at once. But looking back, I can honestly say it was a crucial step that taught me resilience, patience, and how to trust myself.
Monika: I guess the Real Life Test was not just about living as a woman, it required preparation.
Tina: Absolutely. The Real Life Test was far more than just throwing on a dress and calling it a day. It’s about planning and thinking through every aspect of your life to set yourself up for success. For me, it started with the big-picture decisions, whether I would stay in the city I was in or move somewhere new, whether I would transition at my current job or start fresh somewhere else, and how to handle the social dynamics with family, friends, and colleagues.
Monika: What kinds of preparation mattered most to you at that stage?
Tina: There were practical considerations: figuring out how to manage facial hair with electrolysis while maintaining a feminine appearance, whether to have facial feminization surgery or hair transplants before, during, or after the transition, and even details like hair styling, wardrobe, and overall presentation. I had to think about all of it, because these small details make a huge difference in how confidently you can live day to day as yourself.
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| On the way to London to see Russel Reid at the Institute. |
Monika: How did you prepare yourself emotionally for the reactions of others?
Tina: I realized early on that you never quite know how others will react. Some you expect to be supportive may struggle, and others you worry about might surprise you. Misconceptions about being transgender can be tough to face, but they’re rarely personal. Preparing yourself for potential rejections and knowing how to handle them calmly is part of the process.
On the practical side, there’s paperwork: legal name changes, updating IDs, bank accounts, and other documents. You have to be organized because everything matters. And of course, choosing a GRS surgeon is a big step that requires research and patience, because waiting lists can be long and results vary.
All of this might sound overwhelming, but taking the time to plan and consider each step really made my Real Life Test manageable. It’s a lot of work, but looking back, I can say that being prepared made the experience so much smoother and ultimately much more empowering.
Monika: How did you handle telling Lin about your transition, given how important she was in your life?
Tina: That was one of the hardest moments of my life. Lin was my darling, my partner, and such a huge part of my world. The situation came to a head one Saturday night when we went to a Valentine’s evening at the Crown Hotel. From the start, things weren’t going well, my medication, like Androcure, was knocking me out, and I was struggling just to stay awake. Lin, of course, misread it as boredom, and after a while, she got upset and decided to go home early. That night ended, and it was the last time we slept together.
The following morning, I knew it was crunch time. I sat Lin down and told her the truth. I broke out in floods of tears and couldn’t stop crying. Lin put her arm around me and said she was glad I had told her. I apologized, saying I couldn’t deceive her any longer. She started crying too. We talked, and I felt like I’d stabbed the person I cared about, but I knew it had to come out. The next Monday, walking to work through a snow blizzard, Lin called me on my mobile, and I just cried the entire way. Maybe it was the hormones, maybe the sheer emotion, I don’t know, but I’d never cried so much in my life. That day, and the moments afterward, were about coming out. Never easy, but at least it was out in the open.
Monika: Do you remember your first visit to Russell Reid at the London Institute?
Tina: Oh, that day, April 5th, is etched in my memory forever. I was absolutely nervous, a total bag of nerves, as Lin and I traveled from Nottingham to London on the express and navigated the Underground. Walking into the London Institute on Earls Court Road, I was shaking almost uncontrollably. The receptionist noticed and tried to calm me down, saying, “Tina, don’t worry, when you come out, you’ll be smiling.” At the time, I found that hard to believe.
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| At the Institute in London. |
Tina: Meeting Russell Reid was incredible. He turned out to be a true gentleman. Our session went far longer than the hour I had booked, about 90 minutes, and I really opened my heart to him. He listened, and after hearing my story, he said he had no doubts that I was transsexual in every way and probably had been for most of my life. He promised to help me reach my goal. I told him how I’d lived with this problem for decades, trying on many occasions to suppress it, but the feelings of femininity just kept growing, tearing me apart inside. He was very sympathetic and recommended that I be prescribed female hormones.
I told him I was already taking them, purchased online from Thailand, and he was completely fine with that. He asked what dosage I was on and confirmed it was appropriate. Then he wrote me a legal prescription for six months, along with documents stating that I was transsexual, under his care, and on hormone treatment and antiandrogens. He even prepared letters for my employer and for updating my legal documents, like my passport.
Finally, he dictated a detailed letter to my doctor in Nottingham, asking if he could oversee my treatment alongside Russell on a patient-share basis. That day was overwhelming, emotional, and yet incredibly validating, it marked a turning point in my transition.
Monika: What was it like having Lin with you at the London Institute that day?
Tina: Oh, that day was beyond anything I could have imagined. Lin came with me, and it was the first time she saw me fully as Tina in person. She was genuinely amazed, and her words really made my day, she said, “I’ve got to admit, you really look the part, and I’d go as far as to say you look better in this role than your male one.” Hearing that from someone I cared so deeply about was just incredible.
While I was in Russell Reid’s office for about 90 minutes, Lin waited in the reception. Another one of Russell’s patients arrived, a fellow trans woman, and Lin got talking to her. By the time I came out, Lin told me how touched she was by the other lady’s story and how kind and warm-hearted she seemed. It really highlighted Lin’s own empathy and big heart. We then caught the Tube back to King’s Cross, walked over to St. Pancras, and got the express back to Nottingham. I was on cloud nine the entire journey home. The receptionist had been right, leaving Russell Reid’s office, I had a smile plastered across my face. That day wasn’t just an appointment; it was a huge milestone, another vital step forward in fully becoming Tina.
Monika: Soon you had your second consultation with Russell Reid.
Tina: That trip was a whole different experience because I went on my own this time. The London Underground was tricky due to the bombings near King’s Cross, so I had to navigate a long detour through Euston and Victoria stations to finally reach Earls Court. It was a steamy, exhausting day, but I made it, and walking into the London Institute, I felt a mixture of nerves and determination.
Monika: How did that second meeting unfold?
Tina: Russell greeted me warmly and invited me into his office. We went over a lot of things, my credit cards, my personal organization, and all the progress I’d made since my last visit. I told him about my plans to travel to Bangkok for surgery with Dr. Chettawut, all three operations booked, and my intention to live full-time 24/7 at work. He seemed very satisfied with how I was managing everything.
Then he asked if I wanted my referral, and I nearly lost it, I felt an overwhelming sense of pride and excitement. I could hardly contain myself from jumping up and hugging him. I told him, “I would just love it, Russell, you have made more than just my day,” and we shared a smile. He said, “Tina, I consider you have abided by the rules laid out in your transition and followed the guidelines in this country, and I’m going to give you your referral.” My face literally lit up with joy, it was a monumental moment, the culmination of years of struggle and perseverance, and a huge step forward in fully becoming Tina.
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| At Dr. Chettawut's Clinic in Thailand. |
Monika: What progress did you make by this point with your preparations for surgery?
Tina: Everything was really moving forward nicely. I had received my surgical letters from Dr. Chettawut in Bangkok, one for my breast augmentation and tracheal shave, and another for my SRS operation. A few things had come up that made me want to move my SRS date forward by a few months, so I contacted Dr. Chettawut asking for the end of January 2006 and was waiting for his reply. My electrolysis was progressing well, too, and I’d recently switched to a new specialist, Sally. She seemed fantastic, and in the short time I’d been seeing her, we built a friendly relationship and chatted a lot, it really made the whole process more comfortable.
I also had my airline tickets with Eva Airways and my female passport all sorted, just needing to book coach travel down to London Heathrow closer to the date. I decided to purchase a set of Duratek stents, and Alison at Duratek handled it quickly, she even rang me for my credit card details and we ended up chatting about SRS in Thailand. She jokingly offered me a job in Saskatchewan, but I had to decline, no way with that weather! After so many years of struggle and turmoil, it felt incredible to see my life finally aligning with my true inner self. It was like stepping into a whole new world, where my identity and my body could finally match, and everything I’d fought for was starting to fall into place.
Monika: Can you tell me about your journey to Thailand for your SRS in January 2006?
Tina: Well, the big day finally arrived, January 21, 2006. I was collected from Nottingham and taken to the coach station for the trip down to Heathrow. Armed with my two trolleys, hand luggage, and my surgical letter, I checked in with EVA Airways, even managed to get an aisle seat, and treated myself to a bottle of pink champagne. Onboard the 777, I had a block of three seats to myself, so I made a little bed and tried to rest during the 11-hour flight. No chatting like last time, just me, the crew, and the sky compass tracking our progress. Landing in Bangkok was surreal; the smells of the orient hit me as soon as I stepped off the plane, and passport control went smoothly. I collected my luggage, ready to begin the part of my journey I’d dreamed of my whole life.
Monika: What was it like arriving in Bangkok and getting settled before your consultation with Dr. Chettawut?
Tina: Arriving in Bangkok was surreal. I worried about whether anyone would be there to meet me, but as I pushed through the crowd at the airport, I heard someone shout “TINA!” It was one of Dr. Chettawut’s girls and his driver, they greeted me warmly, and at that moment, I felt an incredible sense of relief and joy. We drove through the bustling streets to the Baan Siri Hotel, and I was overjoyed to be given the same room I’d stayed in on my last trip, room 815, which had sentimental value for me. I unpacked, organized my clothes and toiletries, and set up my laptop with the CS-Lox cards I’d brought for internet access. Everything felt familiar, yet charged with anticipation for the days ahead.
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| On the River Kwai. |
That evening, I realized I needed laxatives for my pre-op prep. Venturing out in the early hours to a 7/11 felt strange and a little unnerving, people must have wondered why a European woman was wandering the streets at that hour, but it was necessary. After returning to the hotel, I finally allowed myself to rest, knowing I needed to be clear-headed for my consultation with Dr. Chettawut the next morning. It was a mix of excitement, nervousness, and a sense that the biggest step of my life was just hours away.
Monika: Could you describe your consultation day with Dr. Chettawut?
Tina: The clinic looked immaculate: polished tiles on the floor, white wood paneling on the walls, and an overall spotless, professional appearance. Tair came over immediately and gave me a huge hug, asking how I had been since my last trip in October 2005. I took a seat, and moments later, Dr. Chettawut appeared with a big smile, enthusiastically greeting me: “Tina, how are you?” He leaned over to shake my hand, and I returned the smile, saying I was fine, thank you. He led me into his office next door and asked me to undress so he could examine me. I removed all my clothes and lay on the bench/couch against the back wall. He carefully examined the donor area and commented that he didn’t see any problems, which was reassuring regarding my SRS preparation.
Monika: Please walk me through the moments right before you were taken into the hospital for your SRS.
Tina: With my little trolley case packed and just a liquid diet because of the cleansing routine, and after visiting the toilet several times, we waited for the driver to arrive at the hotel to take me to Vibharam Hospital. After a short while, the phone rang, it was the reception saying the driver had arrived and was waiting downstairs. At that moment, a thousand thoughts were crashing through my mind, but I knew there was no turning back, not that I had ever considered it anyway.
Monika: What was going through your mind as you left the hotel?
Tina: We made our way down to the hotel lobby, and Dr. Chettawut’s driver was there waiting. He quickly loaded my little case into the boot of the car, and we headed off on what was just a short drive to the hospital. After sitting in the main reception area, several forms were brought for me to sign while I awaited the tests I was told would be done.
Eventually, I was led to a side room where blood was taken, along with an ECG, my weight to determine anesthetic dosage, and finally my blood pressure. It’s a strange feeling, knowing you’re only hours away from an SRS that would permanently remove your manhood, but this was what I wanted, so I was happy.
Monika: And what happened once you were shown to your room?
Tina: I was taken to the escalator, then onto a lift, and to a ward consisting of many private rooms. We entered room 811. Paula and I had one of those big emotional moments that seem to happen at points like this, and then she left. One of the nurses came in and left a bowl of soup covered in cling film to keep it warm. I was instructed to rest and given some small blue pills, which I was told were laxatives, accompanied by a glass of very cold water from the refrigerator.
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| Dr Chettawut at his clinic in Bangkok with his wife Tair. |
I looked at my watch, it was 1:50 pm, and began changing into the two-piece hospital garments that had been left for me. After that, I tried to lie on my bed and relax, though I couldn’t really because I was slightly hyped up. I put on the silk robe I had brought with me and sat, looking at my mascot, Tigeress, who sat facing me on top of the TV. Tigeress had a four-leaf clover around her neck and would accompany me on all six trips to Thailand. I just looked at her and smiled.
I knew I would never remember every detail, so these pages are edited from the notes I made in a small notebook I had with me at the time.
END OF PART 3
All photos: courtesy of Tina Marie Phillips.
© 2025 - Monika Kowalska
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