ABSTRACT
Thomas said that he had been managing pretty well until he was referred for, but refused, gender reassignment surgery at an NHS hospital. Since that time he reported that he did not think he could cope, and saw no way forward. In your second session with Thomas he informs you that he has appealed against the decision of the hospital to refuse him the operation. In order to bolster his appeal he requires you to write to the admitting surgeon informing him that, in your view, if he is not granted the surgery, he will almost certainly commit suicide. Subsequent to this session you receive a telephone call from his wife in which she asks you directly what the chances are of keeping her husband and saving her marriage. As you listen, you are struck by the warmth, compassion and depth of feeling she has for her husband.
