#dog treats singapore

[online-pet-shop-singapore]

Wondering if your dog can eat raw duck meat? Want fresh pet food nearby Singapore? Visit Apantry online store today!

From duck meat, beef liver, fresh raw meat of Kangaroo and fish, you can find complete nutrition for your furry friends.

[captainadamwat]

Dog treats in Singapore refer to a variety of snack options that are specifically made for dogs. These treats can serve as a reward for good behavior, a way to promote dental health, or simply as a way to show love and affection to your pet. 

[fictional-character-obsessor]

Carlos Sainz x Supermodel!Reader- Relationship Headcannons

My Carlos is one of my favourites so I had to make this 🥰

Warnings: None (I don’t think, let me know if you find any)

• You and Carlos are Ferrari’s golden couple. You’ve been together several years, since his time at Renault.

• You have a chilli necklace that was a gift from Carlos for your one year anniversary which you almost always wear.

• You speak English and Spanish natively and also Italian so fit right in as a Ferrari WAG along with Charlotte who is like your sister. If Charles and Carlos think they spend a lot of time together then you and Charlotte must be almost chained to each other.

• Alexandra is lovely too, you haven’t known her very long but you both get along well.

• You’re a supermodel with designer and high-street brands like Alaïa, Prada, Paige, Zara and Alexander McQueen but since Carlos began racing for Ferrari, you were signed for Ferrari Style, Puma and Ray Ban so you often are at the same events for work.

• Carlos attends all your Ferrari Style shows. He’s on the front row anyway because he’s a Ferrari driver but he’d still be there if he wasn’t anyway.

• Whenever you want to tease Carlos, you call him Carlitos which makes him blush like mad.

• You are very good at padel, as good as Carlos. Often, you have doubles matches with Charles and Charlotte. It’s either couple vs couple or boys vs girls which is often a challenge of who can tease the other more.

• While being excellent at padel, you are bad at golf.

• In the several years Carlos and you have been a couple, you have gone from being absolutely awful at golf to being poor at it.

• Quite often you simply play golf with Carlos to tease him with the short skirts.

• Rupert and you get on great too, if you’re away for a race and Carlos and him are training you’ll often join Team 55 to get some exercise and also to tease Carlos with Rupert.

• You’re Guzmán’s favourite background character in the DONTBLINK episodes. You think you’re being sneaky but the fans always find you in the background.

• You’re a private couple. Private but not a secret. Everyone on the grid knows you’re a couple.

• You may be a private couple but your phone is full of Carlos Memes from Instagram and Twitter.

• Piñon is Carlos’ and your baby. You love Mati and Oli too but Piñon is your child.

• Carlos, you and Lando are like a child and their parents. It started in McLaren but you’re still close even though Carlos is now at Ferrari

• Your camera roll is 50% Carlos photos and 50% Piñon photos. It’s hard being a dog mum ok.

• You’ve gained a few of your own fans at the races, some who like your style such results in Instagram pages documenting looks you’re seen wearing.

• You have dozens of Carlos/Ferrari bracelets which fans give you.

• You cried with happiness at Silverstone 2022. Carlos deserved the win and you were overjoyed to be able to see him finally achieve it first-hand.

• All the emotions peak in Singapore 2023 when Carlos gains his second win. It’s been such a hard season for both Ferrari boys. Carlos has worked so hard and he can finally reap the reward of his hard work.

• He gazes at you from the top step of the podium as you gaze back up at him with tears of joy in your eyes.

• Charles teases you and Carlos about what goes down in his driver’s room before the races. You both always tell him he’s got no proof. 😉

• The Sainz family love you. Blanca and Ana are like your sisters. Carlos and Reyes are lovely and treat you like one of their daughters. Caco is like your big brother and you both team up to tease poor ‘Carlitos’

• At both Ana and Blanca’s wedding, Carlos’ family members and family friends are asking when you will marry. They point out he’s the last Sainz sibling that isn’t married.

• ‘Sois una pareja preciosa y estáis bien preparados’ his family repeat.

• At both Ana and Blanca’s weddings, both bouquets were given to you by the brides.

• You think you’re too young at the moment to marry. Carlos thinks otherwise.

• ‘I have an engagement ring querida’ he tells you as you slow dance at Blanca’s wedding after-party. ‘I will ask you to marry me soon. All these weddings have made me want to settle down’

• Since the first summer of you and Carlos being a couple, you’ve gone to Mallorca with the Sainzs.

• Lying on a yacht in Mallorca or drinking gazpacho with Carlos’ family has become one of your favourite parts of the summer break.

• You always end up going on a girls trip with Blanca and Ana around Mallorca before returning to show Carlos, Guillermo and Rodrigo what you’ve bought.

• Every year, you go on a night time boat ride with Carlos which is one of the many highlights of the trip.

• You thought that England was your home when Carlos was at Renault and McLaren but now you realise that Italy is your favourite. The food, the people and the weather is everything.

• Carlos’ carbonara is incredible. You’re both foodies so date night often becomes one of you cooking, or going out for a meal to one of your favourite Italian restaurants.

• Carlos and you are everything to each other and neither of you can see your lives without each other.

[captainnameless]

any maxy + gp or lando + jon/will or charles + andrea crumbs??

Max + GP

It’s post Singapore ‘23, Max is alright. GP knows, but he is a little deflated. A drop is imminent and Daniel’s stuck on all sorts of data duties, still not back in the car.

The call if he could keep an eye on Max had been expected and accepted without a fuss. Max is already pouting when they step out of the elevator and make their way to Max’s hotelroom.

GP takes a quick look around before he’s intertwining his fingers with Max’s, pulling him along. “Let’s go, buddy.”

“When’s Daddy coming?” Max asks, following GP with a slight resistance in his step.

It’s an expected question, GP knows where he ranks on Max’s favorites list and while he’s proud to know he’s high up there, there’s no shame in admitting Daniel’s #1 stop is out of reach.

“He’ll get here as soon as he’s able, alright? It might be a while.”

It pulls a whine out of the younger and GP quickly swipes the room card to the door so they can have their privacy.

Luckily Max accepts his shower without a fuss, and GP feeds an overly tired Max little bites of his room service meal.

Max is determined to stay awake, eventually gives in to a cuddle when GP promises to wake him up when Daniel gets here.

Daniel gets there late, GP’s watching some B-list moved with dimmed audio while his hand places absentmindedly with little strands of Max’s hair while the younger’s face is pressed into his thigh, body stretched out onto the couch, thumb barely in his mouth still, Leo sat on GP’s other thigh where Max had put him.

Daniel coos, and it pulls a smile from GP who stills his hand.

“How’s he?” Daniel asks, kicking off his shoes.

“Ok.” GP nods, attention back on the boy. “He’s been a good boy, wanted to stay up for you. Eventually settled on being woken up once you got here.”

Daniel grimaces a little. “Let’s pray he goes back to sleep after.”

“He probably will, today was a lot. Think he just wanted a cuddle from you.”

“Well I’m not one to deny.” Daniel replies, moving over to the couch and gently crouching down, brushing his hand over Max’s exposed cheek. “Muffin,” Daniel breathes. “Daddy’s home.”

Lando + Jon

Jon’s bad at the discipline part, even though he’s seen Carlos steer Lando into a corner more than a handful of times, he’s too sensitive to the puppy dog eyes and crocodile tears, even with Lando being the menace that he is today.

Bribes, he’s good at bribes though.

“Lando,” Jon says, trying not to sound exasperated after trying to get Lando to do this one exercise for over 10 minutes now. “If we get the workout done before 3, I’ll take you to get a frozen yogurt instead of you having to eat your smoothie bowl.”

It gets Lando up and going easy enough, and with slightly threatening reminders of said frozen yogurt they get done what they need to do.

“Shower, then a treat.” Jon says, watching Lando scurry off into the gym showers and appear again in record time.

When he’s handing Lando back to Carlos at the end of the day the younger starts babbling about his froyo immediately.

Carlos smiles. “Were you such a good boy that you got a treat?”

“No,” Lando says, “Only a little bit.”

Jon bites his lip, at least Lando’s honest, but the look Carlos gives him shows he knows exactly what has happened and Jon squirms like he might be the one in trouble with Carlos now.

“You know I can’t help it.” Jon rushes to defend himself, taking a step back out of reach just in case with an apologetic smile.

Carlos sighs, ushers Lando towards Jon. “Did you say thank you?”

Jon gets a hug instead.

Charles + Andrea

Andrea has been around Charles for forever, it feels like, he knows the boy inside out. Knows about what helps him relax, be a better driver, even if he’s usually not too involved in that.

Usually.

“Hi.” Carlos says when Andrea opens the door to his hotel room, Charles in partially hidden behind Carlos, his cheeks vibrantly pink, eyes tired and a little wet.

“You know I don’t ask often,” Carlos continues. “But could you put him down for a nap? He’s exhausted, I have a meeting I can’t take him too. I couldn’t reach anyone else.”

Charles whines from behind Carlos, buries his face into Carlos’ side and only now does Andrea realize that Charles is clutching Carlos’ hand, the other one clutches a soft looking elephant attached to a small blanket.

“Of course,” Andrea says immediately, steps out of the doorframe to let them both in. He figures he knows what this meeting is about if Charles can’t come with, not anything Ferrari which is a sensitive subject still and explains the wetness in Charles’ eyes.

Carlos steps inside, takes Charles with him and then gently tries to move the younger out of hiding, facing him.

“Cuoricino,” Carlos says, brushing his thumb over Charles cheek. “Be a good boy for Andrea, ok? Have a nice nap? I’ll be back as soon as I can.”

“No.” Charles pouts, scowl on his pretty face while he sucks in a breath.

Carlos sighs, gives Andrea a look before turning back to Charles. “Charlie,” he starts, “if you sleep time will go a lot quicker, no?”

Charles seems to contemplate that but doesn’t answer, pout growing as his eyes grow wetter.

Andrea moves over into their space, keeps his voice nice and calm. “We have a bit of a cuddle first, hm?” He says, and opens his arms a bit.

Charles is rarely one to deny a cuddle, and an emotional overly tired Charles does not deny one at all, stumbling into Andrea’s embrace with a shaky sigh. “Bravo, Tesoro.” Andrea hums, wrapping Charles up. “Can we say bye to Carlos?”

It’s best to move that part quickly, both Carlos and Andrea know so Carlos moves over to press to quick kisses to Charles’s head. Murmurs his i love you’s before quickly going out the door. “Grazie, Andrea.”

Andrea waves him off, gently maneuvers both him and Charles towards the couch ones the door closes and encourages Charles to get comfortable, watches him bring his thumb up to his mouth while the pout disappears, little blanket twisted around his fingers to brush at his face.

“Dormire.” Andrea says.

[wejustvibing]

As much as it hurts not seeing him with them anymore because he truly loved that team and there was even talks about him being a future ambassador for them forever even when he retires but i can’t help but feel the treatment he got ever since 2021 didn’t help at all it was one of the most heartbreaking moments in his life and they didn’t take his side like they should… and they brought us toto’s lap dog and he’s taking credits for everything and ignoring lewis in everything never gonna forget lewis’s obvious heartbreak in singapore this year or even worse the qatar one where they literally humiliated him by shoving a camera to his face and apologizing to woody and not giving a damn about his feelings..💔

It hurts because this is so not the way it was supposed to end between them at all for sure a lot of Mercedes employees adore lewis and are just shocked and broken over this news

And Ferrari is just i don’t know what to say if they’re not gonna be in a winning path it’s just a waste of time for him and more stress them being racist is no surprise this whole sport is tbh and they’re all disgusting i know lewis can handle it well he’s been doing it since he was a kid but i just need to see him back to his winning thriving ways and for him to finally being happy that’s it i most definitely wanted to be at the place he called home for more than a decade but it is what is and him being happy and relieved is what really matters to me.

P.S, can’t wait for toto to realize how big of a fuck up did he do when he treated lewis like this the past years and i wont be even sad if mercedes is gonna be witnessing a downfall after he leaves🙂

"It hurts because this is so not the way it was supposed to end between them at all for sure"

that part is the realest when i think about it from his point of view. he's had to make this decision, he's had to put himself first under whatever circumstances, the reality of which we might never get to know. this is not some "natural end" like toto has said. but anyway i'm glad he's separated himself enough to understand the reality over wasting time chasing something that's probably only imaginary. once he did that, it must have been a simple pros and cons decision because what really is the difference between merc and ferrari rn for him to stick around with one and getting mistreated vs starting afresh where he feels wanted with the other? none to me. besides, most brains behind the glory days have already left (some are even at ferrari) must have taken a lot freeing himself from the shackles of "we're family" and "this is my home" mentality and i'm so proud of him for doing that. he could have waited out the rest of his years in his comfort zone blaming how things are not improving. instead at 40yo he's betting on himself all over again and taking risk and charge of his own fate. you just have to respect it for what it is

[russilton]

Alright I’m listening to beyond the grid, my notes are going here if I have any:

- THIS WAS RECORDED RIGHT AFTER SINGAPORE?? bruh poor guy

- Shov calling George up to comfort him bruh I love shov he looks after his guys

- “Oh my god he’s hit the wall- then I hit the wall” is unintentionally a hilarious delivery

- Legit glad to hear this growth in George, he’s changed his mindset on how much he criticises himself and he’s sticking to that promise last year where he said he wanted to exist more outside of the track, find his passions and person away from the job.

-“He lets Lewis get away with it! but when it comes to me it’s like- [he has all these safety warnings] but I can’t wrap myself up in bubble wrap”

- don’t put baby in the corner he wants to do the extreme sports too

- [Toto can’t treat Lewis like his kid because Lewis was a household name before Toto joined the sport, but he signed me as a 16 year old I guess so it’s not paternal but-] it’s paternal George

- George really lives 200m from Toto and Susie oh my god child

- He did in fact say all three of them (Lewis, George, Toto) are learning to free dive, sometimes together because he finds it RELAXING

- George is learning to spend more time under water and not push it but Toto however keeps trying to go deeper and deeper

- BOX BREATHING! (it’s fantastic for panic attacks by the way, I fuckin love box breathing)

- “I can feel the car through my bottom” George drives with his ass confirmed (it was among other things but those aren’t as funny)

- he never felt not at home in the team in 22, since he’s been part of the family for years, it was more that the whole team was feeling unstable because of its new place not in a winning position

- “in 2021 max won the championship… or at least there was a battle” this man is trying so hard not to start an argument about 2021

- “at what age did it become a career and stop being fun” “probably when I was 11 years old..” oh so you’ve been experiencing the horrors for a decade that tracks

- without Toto’s funding George thinks he never would have touched F1, in his days you didn’t get picked up by F1 teams during karting, and without Toto funding his journey, George couldn’t have been able to continue beyond F4. That’s why he stressed so heavily his need to win that year or he might have lost it all.

- new baby is his brothers, his sister just has her husband and a dog lmao

- on imola and Valtteri: “I did give him a phonecall!… which he did not answer.. but we’ve never spoken about it” “is that because you never speak at all?” “No! No we’ve spoke all the time, around drivers parades and around the paddock” (they get on well now, it’s just considered part of the job, but George has learned from it, and how to accept sometimes going for more than the maximum only ends badly)

- Austin is George’s 100th Race

George ends the podcast monologuing about Lewis and how excited it was to be racing without max in Singapore

- George prefers Brazil to potentially winning Sakhir, because he wouldn’t have felt like he truly earned it, because he wouldn’t have put the work into the W11, and he wouldn’t have had lewis’ pressure

Tldr: he feels like he truly earned his Brazil win because he had to fight the Goat for it

- “Brazil it- it truly felt earned, for all of the hard work everyone had put in, for all of the hard work I had put in, the pressure that I was under from Lewis for the last fifteen laps of the race I think, because he is the greatest driver of all time, and you know every single weekend I go out, practice, Quali, race, you are direct compared to the greatest driver of all time, and having that sort of fair fight was extraordinarily rewarding for me and uh, and why it is an incredibly satisfying position for me to be in, and an incredibly privileged position for me to be in because not many drivers get that chance”

- “I don’t think I’ve ever been pushed as hard in my career as I have in these last year and a half (against Lewis) and that gives me the confidence I can do it”

- “I recon I’ve got a good 15 years left in me”

[songmingisthighs]

atinytwt is so stupid and toxic oh my god i just saw someone "shading" kq for jongho ???? like okay let me put down my points

a. we don't actually know how they decide to let or allow jongho to only receive injections and medication. jongho's condition was explained by an indonesian orthopedic surgeon who said that NORMALLY injection and medication COULD aid and alleviate the pain but considering jongho's occupation and activity (i.e. dancing), recurrence is expected and it needed a more permanent solution. also, jongho is a grown ass adult, let's not baby him too much (despite me wanna go goochie goochie goo and tuck him into bed with warm milk and cookies) and think that jongho is incapable of making a huge decision for his own health no matter the consequence

b. "kq put them in crazy schedules" it's literally the pitfalls of being idols my ghawd do you want them to not tour and expand their reach and just sit pretty with one comeback a year ??? sure, they could do that but they'll need money to get better production quality like you buying one album per comeback or one album per version is not enough to even cover the shoe budget, do you think those things are cheap ??? considering album sales are not pure as it's separated as distributor and company and from the company's cuts, it's further broken down and ateez will only get a sliver if any, they have to depend on miscelaneous schedules like radio, tv shows, joint concerts, festivals, etc. And no it's not unfair because there are calculations put in place and no matter what you do, the cuts will never be enough but at least from what we see, ateez is living rather well

c. compared to the big 4 (ion even wanna get into TS, cube, mld, mbk, etc. bc yuck) kq is a far better situation for ateez and xikers. like we haven't heard much from xikers, but we know that ateez praises kq. hongjoong even said that kq's ceo goes everywhere with them on tour (hj said this on the singapore concert) except for the show in manila bc he had a prior engagement. and dude, the gifts the ceo gave ateez and the fact that kq didn't put ateez on diets they don't want and how the staff interacts with ateez and ateez with the staff. idk, i've only been seeing green flags so far. ofc no one is perfect but again, compared to jyp who made momo eat only ice cubes to achieve her target weight so she can debut, or shoving all of seventeen in one tiny ass dorm that didn't seem like there were any blankets around during pre-debut, or putting the members on a leash and treating them like dogs like infinite, i actually love kq. I've liked kpop for over a decade now, since i was like in 5th grade and i've truly never seen a happier group than ateez.

is there a way to not read stupid ass posts on twt or x or wtv and just save pictures from there ??? really i have low tolerance in stupidity bc i have to deal with my own on a daily basis

[berylcups]

Dolce’s Full Bio 🍭

Name: Sadako Kyari

Allias (if applicable): Dolce

Namesake: Dolce & Gabbana; Kyari Pamyu Pamyu

Nicknames: Dolcezza, Sada, short stack, short cake, cup cake,

Nicknames for others: Bǎobèi, Tiánxīn, Kě’ài,

Age: 22

Birthday: October 12th

Death day: April 2nd 2001

Cause of Death: drowning; falling into the canal from getting disoriented from hypoglycemia

AMAB/AFAB/Intersex: AFAB

Gender Identity: Cis Female

Height: 5’0

Weight: 100lbs

Handness: right

Hair Color: dark navy blue

Eye Color: teal

Type of Voice: soft, lilted calm. Gets higher pitch when angry

Eyesight:. 20/20

Race: Singaporean Chinese and Japanese

Hometown: Bukit Panjan Singapore

Current Residency: Napoli Italy

Moral Alignment: Neutral evil

MBTI Personality Type (Optional): ESTJ-A

Medical & Dental Health: Hyperthyroidism- is always hungry and feels too warm

Did not develop Wisdom teeth

Mental health:

Severe abandonment issues, OCD, Bipolar Disorder,

Scars/burns/birthmarks/tattoos: Dog bite scar on right ankle

Criminal Record: 2 murders pre-passione

Awards & Education: grew up trilingual- Mandarin, English-Singlish dialect, and Japanese.

Learned Italian from scratch when she was put into boarding school in Napoli. Excelled in geometry, Italian, and Art class.

Went to college for fashion design and excelled but stopped halfway through due to murdering her 2 classmates that sabotaged her coming of age kimono.

Past Experience:

Dolce had to make the choice of who she wanted to live with- her inattentive mom and stepdad that treats her with contempt or her irresponsible father that pays attention but doesn’t always make the right choices.

She picked her father much to his hidden dismay. She traveled a lot with her father as he took hits out for Dio.

He eventually put her in a boarding school in Napoli Italy so she would have some sort of stability. He would visit every so often about once a month. Right before she graduated he suddenly stopped showing up. She didn’t take it too well, he either died due to the hazards of the job or he abandoned her. She has trust and abandonment issues because of this.

Once she started college she went for the fashion designer path. She made some friends along the way and some who weren’t as well meaning as others. 2 students wanted to get ahead of her and decided to sabotage her fashion class final-her coming of age kimono, basically making her fail.

Dolce snapped. With the loss of her family, her hard work, and now her dream of becoming a designer, Dolce felt like life has no meaning for her anymore. She stopped at nothing to find out who destroyed her work and punish them accordingly.

She hunted down and murdered both sabotagers. She killed 1 in the showers with a switchblade she hid in her nether region and the other in her dorm with a seam ripper.

Risotto Nero ran into a distressed Dolce with a large foul smelling suitcase that she was trying to dump into the Sarno river.

Finding her suspicious he interrogates her and finds out the contents of the suitcase to be 2 missing girls from the news that are partially melted and decomposed including the skeleton being melted.

She begs for his silence and not alarm the police so she can stay in Italy. Him being interested in her stand powers let her slide if she joins his hitman team.

She had a lot to prove to the murderous men but they already had been exposed to Calamari and their strange stand powers and proved themselves to be competent.

So they gave Dolce slightly a little more slack than when Calamari started. Calamari with their forensic knowledge helped Dolce to destroy the bodies.

Dolce being the charismatic and ambitious person she is was able to sweet talk herself into a permanent position in the hitman team. That still didn’t excuse her from the usual teasing from the rest of the gang of course. In order to be a hitman you need some thick skin.

Thoughts on love:

Love is a powerful thing that Dolce obsesses over. She only got any love and attention from her maternal grandparents and their Filipino caretaker until her grandparents passed away from cancer and old age. She was neglected and abandoned by her parents so she feels the need to get love and to receive love intensely. It doesn’t matter if it’s physical, emotional, or platonic love. She’s starved of it and she needs it.

Love is the one thing she cannot buy nor a skill that can be mastered. It’s the one thing she wants more than money or fame.

She’s determined to have a family and a partner and to love them more than her parents could ever love her.

Sexual and/or Romantic Identity: Pansexual;Panromantic- masculine leaning

People they like:

She likes people who are open and honest. She likes surrounding herself with people who know what they want. She’s not interested in those who beat around the bush or are into formalities. Be straightforward with her and she will respect you. On the other hand, she feels the need to protect and befriend the shyer soft spoken people. She wants to be around people who have passion and dedication- people with dreams. She’s your hype girl and cheerleader. She might not know anything about what you’re into but she will support you 100% of the way and take the time to learn about your passions.

She also has a soft spot for the elderly and highly respects her elders, excluding her parents.

People they hate:

Dolce looks calm and calculated but… there are a lot of kinds of people that she absolutely hates.

She hates deadbeat parents. Seeing parents not paying attention to their kids as they beg for affection and attention just set a fire inside her. If she has a chance she’d beat that deadbeat whore/bastard with an inch of their life if she had a chance to without traumatizing the kid. Despite that, Dolce is also hypocritical. there’s nothing more than she hates than seeing a happy family. If she can’t buy or work towards it, it will drive her crazy. She never had loving attentive parents and seeing others get that enrages her. She gets a sick satisfaction from targets begging for their lives and to think about their family. She might torture them more by threatening the families lives too or just outright kill the guy in spite for caring about their family.

She hates anyone who gets in the way of her dreams. She has a strong will and won’t allow anyone to stop her. She’s ambitious to the max. She hates her ex friends/ classmates for sabotaging her fashion designs and bullying her. She absolutely hates Giorno because his dream clashes with hers. She wants the drug money for herself and her team. Despite that, she admires Giornos unstoppable ambition and yet it annoys her and she wants to destroy it. She’s so ambitious to the point of self destruction. She knows she won’t be able to live her dreams if she self-destructs but her desire to destroy her enemies outweighs her desire for her dreams.

She hates Mista because he’s a nuisance that’s in her way. Getting shot in the arm and ruining her shirt already puts you on her shit list. She wouldn’t love more than to see him get frozen to death or watch him melt into a disgusting puddle of filth.

Dreams for the future:

Her true dreams died the minute her final project- coming of age kimono was sabotaged.

In passione her dream is to obtain the drug money and achieve enough wealth and power in order to make her father want to come back and be proud of her so they can be a family again. She also dreams of tying the knot with her partner and having a family. But she wants to be the one to pop the question to her ice gremlin.

Relationships(name a person that they have a connection to and what their relationship is like[friend, enemy, Ex, current lover, family , etc.]):

Kaede Kyari - Maternal Grandmother- Deceased

Hiroshi Kyari - Maternal Grandfather- Deceased

Sachiko Kyari -Estranged Mother

Unnamed Abusive stepfather - Estranged

Rubber Soul - Absent/Deadbeat Father

–

Ghiaccio- Best Friend & Partner

Melone- Best friend

Risotto- Leader

Formaggio- good friend

Pesci- good friend

Sorbet- parental figure

Gelato- parental figure

Illuso- tolerates in small doses

Prosciutto- tolerates in small doses

Quotes (what do they say often? What’s their life’s motto?):

“Wah lau!(omg) ONLY 20 million lira? Between all of us??? No fair!”

“Hěn hǎo!”(very good !)

“Tā mā de!” ( oh fuck/damn it!)

“I am NOT CHINESE. I speak Chinese. I am from SINGAPORE. How about you travel the world a bit mirror man???”

“To take a leaf out of one’s book means to copy what someone else does. The leaf means loose leaf paper, to rip a page out of a book and plagiarize the information. Oh… you still think it’s stupid ? I know it’s upsetting to you but it isn’t worth getting worked up over it, BǎoBèi.”

“God! You know it gets me frisky when you’re forceful and angry!”

Hobbies; fashion design, sewing, knitting, Chinese calligraphy , practicing Italian, teaching Chinese (she can be harsh when it comes to others not knowing their tones),

Habits & quirks :

has an oral fixation- so she’s always sucking on lollipops or chewing gum or sucking on hard candy

likes to pace around the room- hates standing /sitting still,

eats twice the amount of carbohydrates and sugar a normal person eats for her stand,

She is equally Singaporean Chinese and Japanese but identifies more as Singaporean Chinese since living with her father the longest.

Gets up ridiculously early-5am,

Her morning routine must never be interrupted or else her whole day is “ruined”

She has OCD and has some strong superstitions,

She transliterates all of Italian cities and foods in katakana so she can pronounce them better

Others find it “quirky “ or weird but her vehicle of choice is a creeper van. She says it’s for extra storage, but based on the suspicious stains she might have been using her van for “work” as well. And “its all I can afford !” She claims.

Pet peeves: hates writing in red ink-believes ones life is cut short when names are written in red

People not using correct tones for Chinese words-

Cutting noodles and pasta

People only liking things because it’s “popular” and not just liking them to like them. (Ex-liking Rolex watches only because they are expensive)

Misidentifying her nationality

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Notes: I hope I made my Dolce interesting enough… I’ve been working on her back story for about two years 😭 she was originally going to be a part 4 character but I had a random thought while watching part 5… what if she went delulu for the most feral gremlin looking mofo ever??? Nerds need love too so I slapped her and Ghia together and it just STUCK. I can’t undo it. They are inseparable 😭💖💙 I’m sorry lmao

[ukrfeminism]

15 minute read

An overhaul of medical care for transgender minors is exacerbating bottlenecks in England, Reuters found, leaving thousands of patients in limbo and adding to years-long treatment delays. The crisis comes amid a broader debate on appropriate care for rising numbers of teens seeking help in Europe and the United States.

DOVER, England - On an October morning in the living room of a modest family home in this coastal town, Miles Pitcher, 17, received a message that would change his life.

It came from GenderGP, a private online health service that treats people suffering from gender dysphoria – the distress of identifying as a gender different from the one assigned at birth. The doctors had reviewed his case, the message said, and would prescribe the testosterone that would help Miles develop the facial hair, deeper voice, broader physique and other characteristics aligned with his gender identity. It would put an end to the menstrual periods he dreaded.

Miles gestured at his phone, speechless. He shook his head, and, beaming, showed the message to his mother as their pet dog Moose bounded around the room.

"Finally," he said. "Something being done."

Miles, assigned female at birth, has identified as male since he was 14. Yet until he got that message, he was stuck in limbo for three years, one of at least 8,000 young people in England and Wales waiting to receive gender care from the state-funded National Health Service (NHS) as of October, a Reuters review of NHS documents shows.

The UK government has promised to overhaul the youth gender care system, after it was deemed inadequate by England's regulator of health and social care. Some clinicians had complained that England's only state-run youth gender clinic was too quick to offer medical treatments to young people. And many families protested over the distressingly long wait for a first appointment – an average of nearly three years, a Reuters analysis of the clinic's records found.

In July, the NHS said it would close the sole clinic, known as the Tavistock, next year and replace it by spring 2023 with regional centers to better accommodate a fast-growing patient population. Its plan calls for the centers to operate under new treatment guidelines, informed by the best available medical evidence for treating transgender adolescents and the most in-depth review of care conducted by any country.

But the reality is already falling short of those ambitions, creating new delays and uncertainties, according to Reuters interviews with transgender teens and their families as well as physicians and government officials involved. They described a deeply flawed system that is now hobbled by a toxic political climate around gender care.

Young people like Miles say their only option is to turn to private providers such as GenderGP, which is registered in Singapore and thus operates beyond the supervision of the NHS. The company says under-18-year-olds make up a growing portion of its UK patient population, with about 800 youth currently on its books.

"I wish we didn't have to exist," said Dr Helen Webberley, who founded GenderGP with her husband. Both once worked for the NHS. "But we are years away from the NHS pulling themselves together on this."

The NHS's proposed new treatment guidelines were altered after they were reviewed earlier this year by a Conservative government wary of medical interventions for transgender adolescents, Reuters found. Gender clinicians say the proposals now depart from international treatment protocols, which support gender-affirming care. Pioneered more than 20 years ago in the Netherlands, such care can include everything from supporting a social transition – using a person's preferred pronouns and name – to counseling and medical interventions, including drugs that pause puberty.

The Tavistock, based in London, continues to see existing patients. But first appointments for people who have been on its waiting list since 2019 have slowed to a trickle as staffing and morale drop ahead of the closure, according to NHS data and four people involved in the reorganization. More than 1,500 young people recently referred with gender dysphoria are being kept on a separate list for the future regional centers, with no clarity on when or how they will be treated, three NHS sources told Reuters.

Once assigned to a waiting list, young people have been effectively locked out of state-provided mental health counseling and other specialist support related to their gender dysphoria, because those services were offered only through the gender care system they are waiting to join. Delaying medical treatment also means young people mature in bodies that don't align with their gender identity – changing that in later life is more difficult.

The NHS said in a statement to Reuters it is expanding healthcare services for young people with gender dysphoria in line with recommendations from the review, and working on better supporting those on the waiting list. It has previously said it "strongly discouraged" families from turning to private or unregulated providers.

"These have been an exceptionally challenging couple of years for our patients and their families, with a lot of toxicity in discussions around their care and chronic uncertainty about its future," Dr Polly Carmichael, director of the youth gender clinic at the Tavistock, said in a statement to Reuters.

The Department of Health and the Prime Minister's office declined to comment for this story.

Both sides in the polarized debate are turning to the courts: patients who say they've waited too long, and others who say the NHS moved too fast. At the end of November, transgender rights advocates challenged NHS England in the High Court over long wait times for both youths and adults seeking treatment. In 2020, a young woman who had detransitioned from being a transgender man challenged the Tavistock's use of puberty blockers in the same court.

Long wait lists are common within the NHS, but its statistics show the three-year wait for transgender youth is extreme. Most young people with a "non-urgent" eating disorder get specialist help within three months of being referred, the figures show. On average, young people seeking mental health support wait just over a month for a first appointment, according to a government analysis of NHS England data.

One mother shared with Reuters a letter she received from the NHS in February after she followed up on her daughter's October 2021 referral to determine when she might receive attention. The letter said a decision would be made at some point from early 2022 on whether the child "is likely to meet the access criteria" for gender care. She has heard nothing since and suspects her child isn't even being considered for NHS help.

"We are on a waiting list for a waiting list," said the mother, Rose, who asked to be identified by her first name only to protect her daughter's privacy.

"She basically feels suicidal every single day." The NHS declined to comment on the case.

"STOP HURTING YOURSELF"

Miles plans to study archaeology at university and is a keen rugby player. He has felt like a boy for as long as he can remember, but recalls a moment of delight at the start of a new school year when he was around 9.

The teachers were handing out colored notebooks and lanyards based on gender: blue with wizards and astronauts for boys, pink for girls. He was given blue books – "and wizards and astronauts over everything," he said.

"It was not like 'I'm trans,' but just this amazing sense of joy within myself, 'This feels amazing, and I don't know why.'"

By age 11, as puberty began, Miles entered an all-girls' secondary school. He was bullied by classmates for not wearing a bra or conforming to female norms. To fit in, he tried to be ultra-feminine, wearing skirts and make-up, having his eyebrows threaded, wearing false nails.

"My mood really dropped," he said. After about a year, "I realized, I can't do this anymore. I hate this." Miles was barely leaving his room. He began cutting himself, over a period of four or five months. "In my mind, it was just easier to deal with physical pain than mental pain."

His mother, Connie Pitcher, noticed the regular, precise lines on his arms. When she asked why he was distressed, Miles said he was struggling to understand his sexuality.

"I said, 'I don't care if you're gay, straight, or whatever – I just want you to stop hurting yourself,'" Connie said. The family considered seeking mental health help, but worried about long waiting lists.

"We saw him really, really dip," she said. "We were struggling with what to do. Because there is really no support."

The World Health Organization, which informs health policy worldwide, does not have detailed guidelines for this area of healthcare for youth. It says it works closely with the World Professional Association for Transgender Health (WPATH), a U.S.-based non-profit that has drawn up the most widely adopted standards of care.

These say a young person's exploration of gender should be respected and supported, and that medical interventions for young people at or after puberty should be one option, after a comprehensive assessment.

Research from the Netherlands paved the way for that medical treatment, establishing a model requiring adolescents who sought care to be assessed for about six to 18 months. If they had persistently expressed gender dysphoria since early childhood, lived in supportive homes, and had no other complicating mental health diagnoses, they could be offered puberty suppression, followed by hormones, and later, in some cases, surgery.

Since then, the number of young people seeking gender care has surged in parts of Europe and the United States, supported by greater awareness and the availability of professional treatment. They continue to face threats of violence and discrimination, as well as political efforts in some countries to block that care.

At the same time, some gender-care professionals have questioned the lack of definitive evidence on the long-term impact of puberty blockers or hormones on minors. Puberty blockers are not licensed in the United Kingdom or United States for treating gender dysphoria and the NHS says it is not known how they may affect brain development or long-term bone health in young people. Hormones, only available for older adolescents, cause potentially irreversible changes such as a deeper voice, and can cause infertility. Other changes, including breast development, are reversible only with surgery.

Those professionals are also concerned that as the number of pediatric patients has surged, so has the number of youth whose main source of distress may not be persistent gender dysphoria. Some may have mental health problems that complicate their cases.

"THE WRONG TREATMENT"

While not all English youths with diverse gender identities seek medical help, for those who do, a doctor or professionals including social workers or teachers are the first port of call. Any one of them can refer a youth for gender care, which so far has only come through the Tavistock – formally known as the Gender Identity Development Service, or GIDS – run by the Tavistock and Portman NHS Foundation Trust.

The clinic became a focal point for opponents of youth gender care in the UK in 2018 when an internal report compiled by Dr David Bell, a former senior psychiatrist and staff representative at the Tavistock, was leaked to national media. Bell, who did not treat young people, cited accounts from 10 unidentified colleagues who were working with transgender youth and came to him with concerns, including that some patients were "rushed through" to medical treatment without proper evaluation when they finally got an appointment.

"It was not just the wait," Bell told Reuters. "It was also a wait for the wrong treatment."

Bell now advocates against starting a gender transition before adulthood. He is at the fore of a group of mental health professionals who argue that accepting a child's new gender identity without exploring other underlying issues is clinically irresponsible, and puts them on a track to potentially irreversible changes that they may later regret.

The Tavistock has consistently defended its methods of treatment. Subsequent inquiries by outside investigators into care at the clinic did not raise concerns about patients being referred too quickly to medical interventions. However, they did criticize a lack of standardized assessments, adding that "it was not possible to clearly understand from the records" why care decisions had been made, according to a 2021 report from the regulator of health and social care, the Care Quality Commission.

The report rated the clinic as "inadequate" on these grounds, on the long waiting lists, and on concerns that teams treating patients did not always include the full range of experts required.

Another major challenge came in the 2020 lawsuit. Keira Bell, a young woman who detransitioned after what she said was improper care at the Tavistock, asked the court to rule on whether youths should receive puberty blockers. She alleged that the information provided by the Tavistock was not adequate, and said youths under 18 were not able to give informed consent to treatment. The High Court effectively banned their use for under-16-year-olds, a ban that was overturned last year on appeal. Bell did not respond to a request for comment.

The Tavistock told Reuters its current protocol requires meeting patients at least three to six times over some months before any recommendation for medical treatment. The timeline would be longer in complex cases. If the clinician, parents and the young person agree, puberty blockers may be prescribed from the onset of puberty, usually after the age of 10 or 11. The clinic only introduces hormone treatments after 16. Surgery is not an option before age 18 under NHS rules.

The clinic estimates that its staff referred only between 10% and 20% of young people for medical interventions, indicating what team members have described as its cautious approach. This year to August, 125 adolescents received referrals for either puberty blockers or hormones, the clinic told Reuters.

An ongoing review commissioned by the NHS highlighted another problem. Led by Dr Hilary Cass, a prominent pediatrician, the review found that practitioners across the country might be referring patients with gender concerns to the Tavistock without first addressing mental health issues such as depression, according to an interim report released in February. Such practices may have contributed to the clinic's fast-growing waiting list, the report said.

Annual referrals to the clinic have surged from 210 a decade ago to 5,234 in the financial year that ended in March 2022.

According to NHS documents seen by Reuters, there were 7,696 minors on the waiting list for a first appointment as of July. Just over 1,000 young people were referred to the Tavistock from April to October and are awaiting attention, the clinic says.

"I'M STILL YOUR CHILD"

In 2019, a 13-year-old Miles began exploring his relationship with his changing body, wearing baggy clothes. He cut his hair short and began sampling videos from transgender teens on YouTube.

At first, "it was denial – those guys are cool, but I'm not like them," he said. "Then slowly, I thought, 'what they're talking about is exactly what I feel. So maybe I need to actually look at this.'"

He came out to his close friends, who were supportive. In February 2020, Miles left a letter on his bed for his parents, just before heading to school.

"Dear Mum and Dad," it read. "I am transgender. I identify as male. I'm still your child."

His mother was taken aback. "I was a little bit fearful, because I didn't understand it," Connie said. She texted Miles at school. "We'll talk about this in a few days," she wrote. "We love you."

That November, an NHS doctor referred Miles's case to the Tavistock. Miles was excited, hoping to receive puberty blockers but realizing that, given the long waiting list, he was likely to be too mature for them by the time he was seen.

As he waited to hear from the clinic, he began his social transition, dressing like a boy and using male pronouns. He started to wear a binder to conceal his breasts and, on occasion, padding known as a packer inside his underwear to give the look of male genitalia. He took a contraceptive pill to limit the frequency of his periods.

Last year, he legally changed his name – his parents paid, as a gift for his 16th birthday. Miles now studies at school in a co-educational class. He is attracted to boys.

By July this year, Miles was uneasy, having heard nothing from the Tavistock clinic. He contacted them to ask about his referral. They had no record of it.

"That was a crash and burn," Miles said. "I've had two years of my life thinking it was happening, for nothing. It sounds extreme, but it feels like the NHS has failed me as a trans person. Because I'm just left in limbo. No-one really knows what to do."

Miles's doctor referred him a second time. But a few weeks later, when he checked with the clinic again, it still had no record of him. Neither his doctor nor the Tavistock would comment on his case.

"INCREDIBLY DISTRESSING"

Other young people and their parents across England are also at a loss. Waiting "isn't an option when you've got a child in distress," said Rose, whose daughter has been on a waiting list since October 2021.

Her daughter's case shows how hard life for young trans people can be - even when they do get care.

Assigned male at birth, Rose's daughter told her parents how unhappy she was in her changing body at age 12, two years ago. A few months later, knowing about the NHS waiting list, Rose sought help from family members to pay for private care from Dr Aidan Kelly, a clinical psychologist now in private practice who worked with youth at the Tavistock for five years.

Kelly diagnosed their daughter with gender dysphoria in August 2021, and she socially transitioned a month later. Now 14, she is taking puberty blockers prescribed overseas by a registered pediatric endocrinologist whom Kelly declined to identify. Kelly remains involved in her care.

In June this year, Rose's daughter tried to take her own life, cutting herself and attempting to drink bleach. She had previously been referred for NHS mental health care, but did not receive attention until she tried to kill herself, Rose said. The NHS then prescribed antidepressants.

A different private practitioner has also recently diagnosed the teen as autistic. Rose declined to make her daughter available to Reuters for comment due to the teen's distress.

"I'm just trying to do things to keep my child here," said Rose. The treatments are helping, she said, but her daughter is still struggling.

Another mother, Liz, said her teenager has been on the Tavistock waiting list for three years after being referred by their family doctor. Assigned female at birth, the child came out as a transgender boy at school, but Liz and her husband do not use his chosen pronouns. Instead, they use a gender-neutral nickname, saying that they want to keep their child's options open.

Liz said the child has autistic traits, depression and childhood trauma, and has experienced years of severe homophobic bullying. Liz declined to make the child available for comment.

She worries that the teen, now 16, could receive gender medication without taking into account these other issues. The family has received no NHS gender care or mental health support since the referral, she said. The family is also frightened to entrust the teen to a system that is set to be replaced because it has been judged to be failing young people.

Most of all, Liz is afraid of her child making a mistake.

"If I knew this was the route" for the child to grow "into a healthy well-adjusted adult, that would be a different question," she said. "But I don't have that kind of information."

In a statement to Reuters, the NHS's Healthcare Safety Investigation Branch said the "incredibly distressing" wait for gender care "created a significant patient safety risk for young people."

In April, the investigation branch released a report into the death of a young transgender man before his 19th birthday, outlining how he had complained of the long wait for care before committing suicide. He was first referred to the Tavistock at 16. The clinic itself referred the incident to the investigators, saying it was "vital" that services worked together to better protect vulnerable young people.

There is evidence that transgender youth face a higher risk of suicide, but whether that risk has increased for adolescents in England who are waiting for care is not well understood. The Cass report said in February that many young people's mental health deteriorated while in a holding pattern.

"DROWNING IN THE MIDDLE"

For young people already in the system, the NHS has said care at the Tavistock clinic would continue unchanged ahead of its closure. NHS documents reviewed by Reuters show only a few dozen appointments are available for new patients each month, down from between 75 and 120 for most of last year, despite the growing waiting list.

Staffing has also dipped as several psychologists have left or, like Kelly, entered private practice. The Tavistock said in board documents that staff morale is low and told Reuters it does not have the capacity to meet demand.

The deadline for shuttering the clinic has also slipped, to late June 2023 at the earliest, two people familiar with the plans said, although the NHS is still aiming to open two new sites in spring next year, with up to seven more to follow. People who have been waiting the longest will be prioritized.

The NHS is also working on a system to cope with the backlog and improve support for those on the new list, a spokesman said.

But clinicians say polarized views around gender care will make finding staff challenging.

"The people who have gender-critical views call you child abusers and monsters, and then there are a lot of angry families accusing you of gatekeeping. And you're just drowning in the middle of it all," said Dr Laura Charlton, a clinical psychologist who left the Tavistock in 2020 after six years and now only treats adults.

The gender-care revamp became further entangled in political upheaval after Prime Minister Boris Johnson resigned in September. Both his successors, Liz Truss and Rishi Sunak, voiced their opposition to the use of what they described as "irreversible" measures for transgender young people earlier this year.

Neither Truss nor Sunak's office responded to a request for comment for this story. Sunak has said under-18s should be protected from "life-altering treatments."

A few weeks into Truss's tenure, in September, the NHS briefly posted a draft of its proposed new treatment guidelines on its website, then removed them. The guidelines were re-released on Oct. 20, the night Truss resigned.

A Reuters review of the original draft shows key passages were changed by the time they were re-released.

Both versions of the guidelines say only medical professionals may refer young people for gender care, and call for a meeting between clinicians before a child is added to the waiting list. New clinics will be led by medical doctors rather than psychologists, they say.

The guidelines also say young people who, like Miles, obtain medicines from providers that are not regulated in the UK should be referred to local authorities – such as police and social services – once the NHS takes on their case.

The NHS has said separately it would only prescribe puberty-blocking drugs for transgender teens "in the context of a formal research protocol." It has not specified how gender-affirming hormones would be prescribed, although it also suggests enrolling young people into a clinical trial in the future.

However, the revised guidelines say adolescent patients would require a gender dysphoria diagnosis from a specialist clinician before their social transition would be supported by the NHS, rather than, as at present, relying on the statements of an adolescent.

The changes around social transition appeared after the draft was sent through government approval processes within the Department of Health and the Prime Minister's Office, rather than the NHS or gender experts, two people involved in the process said.

For government employees to not recognize a young person's preferred gender identity without a medical diagnosis would run counter to the way gender-affirming care has been practiced both in England and globally. The proposed requirement was not endorsed by the doctors involved in the Cass review, said people briefed on the matter. There was no such requirement around social transitioning in the original draft.

The draft plan has been criticized by medical groups specializing in transgender health around the world.

"This represents an unconscionable degree of ... intrusion into ... everyday matters such as clothing, name, pronouns, and school arrangements," WPATH, along with a number of allied regional and national groups, said in a statement in late November.

"We've spent 20 years trying to reduce barriers to care. And now we're seeing barriers put up," Dr Marci Bowers, president of WPATH and a gender surgeon in the United States, told Reuters in response to the NHS guidelines.

Spokespeople from the Health department and the Prime Minister's office declined to comment. The government is considering public feedback on the proposals and expects to publish final guidelines early next year.

"EVOLVING EVIDENCE BASE"

England is not the only country in Europe that is changing its approach.

In Finland and Sweden, healthcare officials are limiting access to puberty blockers and hormone treatments, citing concerns that the risks may outweigh any benefit for adolescents, particularly those struggling with mental health problems.

Until 2020, adolescents expressing gender dysphoria in Finland could generally access puberty blockers and hormones, but that year its national healthcare council released guidelines for transgender care. These recommended supporting "identity exploration" and mental health treatment as the first steps to ensure that any psychological issues are addressed. The council said medical intervention for transgender minors "is still an experimental practice."

Health officials in Sweden changed course after finding many adolescents seeking treatment had diagnoses beyond gender dysphoria.

In February, Sweden's National Board of Health and Welfare revised its recommendations on puberty blockers and hormone treatment for adolescents. It recommended the treatments be given within a clinical trial. Until a trial is in place, it said, the drugs should only be given to people who fit the original Dutch model of persistent gender dysphoria with no mental health issues.

"It's not an easy decision," Thomas Linden, a director at the board, told Reuters. "Some people are in great need of medical attention. Others are at risk of being harmed if they are given the same treatment. We really need better precision in the diagnosis."

Kelly, the former Tavistock clinician, said even as knowledge changes and governments review policies, clinicians must not deny young people care.

"We need to practice within an evolving evidence base – and that doesn't mean do nothing," he said.

"A NORMAL TEENAGER"

It took just one week after Miles's first full online appointment for GenderGP to agree to prescribe testosterone. The company, which operates in more than 40 countries, says its practices are consistent with WPATH and other international care guidelines.

GenderGP has no age limits to care, or minimum time periods before recommending prescriptions, including puberty blockers, to young people, co-founder Helen Webberley told Reuters. Its usual time-frame is within four to six weeks, she said, although complex cases take more assessment. Parental consent is not always required.

Miles said he hesitated about turning to GenderGP. The Webberleys have both been sanctioned by official medical tribunals for gender care they have provided since setting up their online clinic in 2015. The General Medical Council (GMC), the national watchdog that sets standards for doctors and maintains a register of those deemed fit to practice, referred both cases to the tribunals after concerns were raised by other doctors involved in caring for the same patients as the Webberleys.

Founder Dr Michael Webberley was struck off the British medical register this year after the tribunal found he had failed several patients by not conducting proper tests or assessing them robustly enough, both before and after recommending hormones or puberty blockers. The tribunal concluded that he was working outside his specialty as a gastroenterologist.

His wife, Helen, is currently suspended from practice after a separate hearing found she did not adequately explain the potential fertility impacts of medical treatment to a patient seeking help with gender-related distress.

Both deny that they failed their patients and appealed, although Michael Webberley's appeal was dismissed by the High Court in early December. They told Reuters that they currently do no clinical work for GenderGP.

There is little NHS or independent data available on how many young people seek care privately. GenderGP says the share of under-18-year-olds among its more than 8,000 UK patients is rising, which it attributes to the lack of care offered through the NHS.

The Webberleys transferred their ownership of GenderGP to a Hong Kong-based company, Harland International, in 2019 to avoid the controversy associated with them, they said. The company is now registered in Singapore as GenderGP PTE Ltd, with Dr Helen Webberley as a director. Harland could not be reached.

The clinic's prescribing doctors are all based overseas and regulated within their home countries – from the United States to European Union countries. EU-based doctors can prescribe to UK patients under rules drawn up after Brexit. Some GenderGP therapeutic counselors are UK-based.

Miles's parents say they are happy with GenderGP, but worry that the lack of NHS care will lead young people to unscrupulous online providers or even to self-medicate.

The NHS doesn't cover the cost of Miles's private treatment Read full story. He is paying for his care with his wages from working at a local restaurant, and can recite the company's charges by heart. He says he had reservations about using testosterone but decided to go ahead.

"I know it can affect fertility," he said. "And it sounds weird, but baldness, because it runs in my family."

He applies a testosterone gel to his arms every morning, normally before heading to school. The gel dries and then cracks, like a face mask, when first applied, he said, then sinks in.

Miles has not told his co-workers that he is transgender. To them, along with his friends at an archaeology group that he digs with in Dover, he is just a young man. Yet he still plays for a girls' rugby team, until the effects of the testosterone kick in.

"I'm going to be able to start living my life as I want to," he said. "I want people to see that just because I'm trans, that doesn't affect who I am. I'm still a normal teenager."

The Tavistock, based in London, continues to see existing patients. But first appointments for people who have been on its waiting list since 2019 have slowed to a trickle as staffing and morale drop ahead of the closure, according to NHS data and four people involved in the reorganization. More than 1,500 young people recently referred with gender dysphoria are being kept on a separate list for the future regional centers, with no clarity on when or how they will be treated, three NHS sources told Reuters.

O nce assigned to a waiting list, young people have been effectively locked out of state-provided mental health counseling and other specialist support related to their gender dysphoria, because those services were offered only through the gender care system they are waiting to join. Delaying medical treatment also means young people mature in bodies that don't align with their gender identity – changing that in later life is more difficult.

The NHS said in a statement to Reuters it is expanding healthcare services for young people with gender dysphoria in line with recommendations from the review, and working on better supporting those on the waiting list. It has previously said it "strongly discouraged" families from turning to private or unregulated providers.

" These have been an exceptionally challenging couple of years for our patients and their families, with a lot of toxicity in discussions around their care and chronic uncertainty about its future," Dr Polly Carmichael, director of the youth gender clinic at the Tavistock, said in a statement to Reuters.

The Department of Health and the Prime Minister's office declined to comment for this story.

Both sides in the polarized debate are turning to the courts: patients who say they've waited too long, and others who say the NHS moved too fast. At the end of November, transgender rights advocates challenged NHS England in the High Court over long wait times for both youths and adults seeking treatment. In 2020, a young woman who had detransitioned from being a transgender man challenged the Tavistock's use of puberty blockers in the same court.

Long wait lists are common within the NHS, but its statistics show the three-year wait for transgender youth is extreme. Most young people with a "non-urgent" eating disorder get specialist help within three months of being referred, the figures show. On average, young people seeking mental health support wait just over a month for a first appointment, according to a government analysis of NHS England data.

One mother shared with Reuters a letter she received from the NHS in February after she followed up on her daughter's October 2021 referral to determine when she might receive attention. The letter said a decision would be made at some point from early 2022 on whether the child "is likely to meet the access criteria" for gender care. She has heard nothing since and suspects her child isn't even being considered for NHS help.

"We are on a waiting list for a waiting list," said the mother, Rose, who asked to be identified by her first name only to protect her daughter's privacy.

"She basically feels suicidal every single day." The NHS declined to comment on the case.

"STOP HURTING YOURSELF"

M iles plans to study archaeology at university and is a keen rugby player. He has felt like a boy for as long as he can remember, but recalls a moment of delight at the start of a new school year when he was around 9.

The teachers were handing out colored notebooks and lanyards based on gender: blue with wizards and astronauts for boys, pink for girls. He was given blue books – "and wizards and astronauts over everything," he said.

"It was not like 'I'm trans,' but just this amazing sense of joy within myself, 'This feels amazing, and I don't know why.'"

By age 11, as puberty began, Miles entered an all-girls' secondary school. He was bullied by classmates for not wearing a bra or conforming to female norms. To fit in, he tried to be ultra-feminine, wearing skirts and make-up, having his eyebrows threaded, wearing false nails.

"My mood really dropped," he said. After about a year, "I realized, I can't do this anymore. I hate this." Miles was barely leaving his room. He began cutting himself, over a period of four or five months. "In my mind, it was just easier to deal with physical pain than mental pain."

His mother, Connie Pitcher, noticed the regular, precise lines on his arms. When she asked why he was distressed, Miles said he was struggling to understand his sexuality.

"I said, 'I don't care if you're gay, straight, or whatever – I just want you to stop hurting yourself,'" Connie said. The family considered seeking mental health help, but worried about long waiting lists.

"We saw him really, really dip," she said. "We were struggling with what to do. Because there is really no support."

The World Health Organization, which informs health policy worldwide, does not have detailed guidelines for this area of healthcare for youth. It says it works closely with the World Professional Association for Transgender Health (WPATH), a U.S.-based non-profit that has drawn up the most widely adopted standards of care.

These say a young person's exploration of gender should be respected and supported, and that medical interventions for young people at or after puberty should be one option, after a comprehensive assessment.

Research from the Netherlands paved the way for that medical treatment, establishing a model requiring adolescents who sought care to be assessed for about six to 18 months. If they had persistently expressed gender dysphoria since early childhood, lived in supportive homes, and had no other complicating mental health diagnoses, they could be offered puberty suppression, followed by hormones, and later, in some cases, surgery.

Since then, the number of young people seeking gender care has surged in parts of Europe and the United States, supported by greater awareness and the availability of professional treatment. They continue to face threats of violence and discrimination, as well as political efforts in some countries to block that care.

At the same time, some gender-care professionals have questioned the lack of definitive evidence on the long-term impact of puberty blockers or hormones on minors. Puberty blockers are not licensed in the United Kingdom or United States for treating gender dysphoria and the NHS says it is not known how they may affect brain development or long-term bone health in young people. Hormones, only available for older adolescents, cause potentially irreversible changes such as a deeper voice, and can cause infertility. Other changes, including breast development, are reversible only with surgery.

Those professionals are also concerned that as the number of pediatric patients has surged, so has the number of youth whose main source of distress may not be persistent gender dysphoria. Some may have mental health problems that complicate their cases.

"THE WRONG TREATMENT"

While not all English youths with diverse gender identities seek medical help, for those who do, a doctor or professionals including social workers or teachers are the first port of call. Any one of them can refer a youth for gender care, which so far has only come through the Tavistock – formally known as the Gender Identity Development Service, or GIDS – run by the Tavistock and Portman NHS Foundation Trust.

The clinic became a focal point for opponents of youth gender care in the UK in 2018 when an internal report compiled by Dr David Bell, a former senior psychiatrist and staff representative at the Tavistock, was leaked to national media. Bell, who did not treat young people, cited accounts from 10 unidentified colleagues who were working with transgender youth and came to him with concerns, including that some patients were "rushed through" to medical treatment without proper evaluation when they finally got an appointment.

"It was not just the wait," Bell told Reuters. "It was also a wait for the wrong treatment."

Bell now advocates against starting a gender transition before adulthood. He is at the fore of a group of mental health professionals who argue that accepting a child's new gender identity without exploring other underlying issues is clinically irresponsible, and puts them on a track to potentially irreversible changes that they may later regret.

The Tavistock has consistently defended its methods of treatment. Subsequent inquiries by outside investigators into care at the clinic did not raise concerns about patients being referred too quickly to medical interventions. However, they did criticize a lack of standardized assessments, adding that "it was not possible to clearly understand from the records" why care decisions had been made, according to a 2021 report from the regulator of health and social care, the Care Quality Commission.

The report rated the clinic as "inadequate" on these grounds, on the long waiting lists, and on concerns that teams treating patients did not always include the full range of experts required.

Another major challenge came in the 2020 lawsuit. Keira Bell, a young woman who detransitioned after what she said was improper care at the Tavistock, asked the court to rule on whether youths should receive puberty blockers. She alleged that the information provided by the Tavistock was not adequate, and said youths under 18 were not able to give informed consent to treatment. The High Court effectively banned their use for under-16-year-olds, a ban that was overturned last year on appeal. Bell did not respond to a request for comment.

The Tavistock told Reuters its current protocol requires meeting patients at least three to six times over some months before any recommendation for medical treatment. The timeline would be longer in complex cases. If the clinician, parents and the young person agree, puberty blockers may be prescribed from the onset of puberty, usually after the age of 10 or 11. The clinic only introduces hormone treatments after 16. Surgery is not an option before age 18 under NHS rules.

The clinic estimates that its staff referred only between 10% and 20% of young people for medical interventions, indicating what team members have described as its cautious approach. This year to August, 125 adolescents received referrals for either puberty blockers or hormones, the clinic told Reuters.

By July this year, Miles was uneasy, having heard nothing from the Tavistock clinic. He contacted them to ask about his referral. They had no record of it.

" That was a crash and burn," Miles said. "I've had two years of my life thinking it was happening, for nothing. It sounds extreme, but it feels like the NHS has failed me as a trans person. Because I'm just left in limbo. No-one really knows what to do."

Miles's doctor referred him a second time. But a few weeks later, when he checked with the clinic again, it still had no record of him. Neither his doctor nor the Tavistock would comment on his case.

"INCREDIBLY DISTRESSING"

Other young people and their parents across England are also at a loss. Waiting "isn't an option when you've got a child in distress," said Rose, whose daughter has been on a waiting list since October 2021.

Her daughter's case shows how hard life for young trans people can be - even when they do get care.

Assigned male at birth, Rose's daughter told her parents how unhappy she was in her changing body at age 12, two years ago. A few months later, knowing about the NHS waiting list, Rose sought help from family members to pay for private care from Dr Aidan Kelly, a clinical psychologist now in private practice who worked with youth at the Tavistock for five years.

Kelly diagnosed their daughter with gender dysphoria in August 2021, and she socially transitioned a month later. Now 14, she is taking puberty blockers prescribed overseas by a registered pediatric endocrinologist whom Kelly declined to identify. Kelly remains involved in her care.

In June this year, Rose's daughter tried to take her own life, cutting herself and attempting to drink bleach. She had previously been referred for NHS mental health care, but did not receive attention until she tried to kill herself, Rose said. The NHS then prescribed antidepressants.

A different private practitioner has also recently diagnosed the teen as autistic. Rose declined to make her daughter available to Reuters for comment due to the teen's distress.

"I'm just trying to do things to keep my child here," said Rose. The treatments are helping, she said, but her daughter is still struggling.

She worries that the teen, now 16, could receive gender medication without taking into account these other issues. The family has received no NHS gender care or mental health support since the referral, she said. The family is also frightened to entrust the teen to a system that is set to be replaced because it has been judged to be failing young people.

M ost of all, Liz is afraid of her child making a mistake.

"If I knew this was the route" for the child to grow "into a healthy well-adjusted adult, that would be a different question," she said. "But I don't have that kind of information."

In a statement to Reuters, the NHS's Healthcare Safety Investigation Branch said the "incredibly distressing" wait for gender care "created a significant patient safety risk for young people."

In April, the investigation branch released a report into the death of a young transgender man before his 19th birthday, outlining how he had complained of the long wait for care before committing suicide. He was first referred to the Tavistock at 16. The clinic itself referred the incident to the investigators, saying it was "vital" that services worked together to better protect vulnerable young people.

There is evidence that transgender youth face a higher risk of suicide, but whether that risk has increased for adolescents in England who are waiting for care is not well understood. The Cass report said in February that many young people's mental health deteriorated while in a holding pattern.

"DROWNING IN THE MIDDLE"

F or young people already in the system, the NHS has said care at the Tavistock clinic would continue unchanged ahead of its closure. NHS documents reviewed by Reuters show only a few dozen appointments are available for new patients each month, down from between 75 and 120 for most of last year, despite the growing waiting list.

Staffing has also dipped as several psychologists have left or, like Kelly, entered private practice. The Tavistock said in board documents that staff morale is low and told Reuters it does not have the capacity to meet demand.

The deadline for shuttering the clinic has also slipped, to late June 2023 at the earliest, two people familiar with the plans said, although the NHS is still aiming to open two new sites in spring next year, with up to seven more to follow. People who have been waiting the longest will be prioritized.

The NHS is also working on a system to cope with the backlog and improve support for those on the new list, a spokesman said.

But clinicians say polarized views around gender care will make finding staff challenging.

"The people who have gender-critical views call you child abusers and monsters, and then there are a lot of angry families accusing you of gatekeeping. And you're just drowning in the middle of it all," said Dr Laura Charlton, a clinical psychologist who left the Tavistock in 2020 after six years and now only treats adults.

For government employees to not recognize a young person's preferred gender identity without a medical diagnosis would run counter to the way gender-affirming care has been practiced both in England and globally. The proposed requirement was not endorsed by the doctors involved in the Cass review, said people briefed on the matter. There was no such requirement around social transitioning in the original draft.

T he draft plan has been criticized by medical groups specializing in transgender health around the world.

"This represents an unconscionable degree of ... intrusion into ... everyday matters such as clothing, name, pronouns, and school arrangements," WPATH, along with a number of allied regional and national groups, said in a statement in late November.

"We've spent 20 years trying to reduce barriers to care. And now we're seeing barriers put up," Dr Marci Bowers, president of WPATH and a gender surgeon in the United States, told Reuters in response to the NHS guidelines.

Spokespeople from the Health department and the Prime Minister's office declined to comment. The government is considering public feedback on the proposals and expects to publish final guidelines early next year.

"EVOLVING EVIDENCE BASE"

England is not the only country in Europe that is changing its approach.

In Finland and Sweden, healthcare officials are limiting access to puberty blockers and hormone treatments, citing concerns that the risks may outweigh any benefit for adolescents, particularly those struggling with mental health problems.

Until 2020, adolescents expressing gender dysphoria in Finland could generally access puberty blockers and hormones, but that year its national healthcare council released guidelines for transgender care. These recommended supporting "identity exploration" and mental health treatment as the first steps to ensure that any psychological issues are addressed. The council said medical intervention for transgender minors "is still an experimental practice."

Health officials in Sweden changed course after finding many adolescents seeking treatment had diagnoses beyond gender dysphoria.

In February, Sweden's National Board of Health and Welfare revised its recommendations on puberty blockers and hormone treatment for adolescents. It recommended the treatments be given within a clinical trial. Until a trial is in place, it said, the drugs should only be given to people who fit the original Dutch model of persistent gender dysphoria with no mental health issues.

"It's not an easy decision," Thomas Linden, a director at the board, told Reuters. "Some people are in great need of medical attention. Others are at risk of being harmed if they are given the same treatment. We really need better precision in the diagnosis."

Kelly, the former Tavistock clinician, said even as knowledge changes and governments review policies, clinicians must not deny young people care.

"We need to practice within an evolving evidence base – and that doesn't mean do nothing," he said.

"A NORMAL TEENAGER"

It took just one week after Miles's first full online appointment for GenderGP to agree to prescribe testosterone. The company, which operates in more than 40 countries, says its practices are consistent with WPATH and other international care guidelines.

GenderGP has no age limits to care, or minimum time periods before recommending prescriptions, including puberty blockers, to young people, co-founder Helen Webberley told Reuters. Its usual time-frame is within four to six weeks, she said, although complex cases take more assessment. Parental consent is not always required.

Miles said he hesitated about turning to GenderGP. The Webberleys have both been sanctioned by official medical tribunals for gender care they have provided since setting up their online clinic in 2015. The General Medical Council (GMC), the national watchdog that sets standards for doctors and maintains a register of those deemed fit to practice, referred both cases to the tribunals after concerns were raised by other doctors involved in caring for the same patients as the Webberleys.

Founder Dr Michael Webberley was struck off the British medical register this year after the tribunal found he had failed several patients by not conducting proper tests or assessing them robustly enough, both before and after recommending hormones or puberty blockers. The tribunal concluded that he was working outside his specialty as a gastroenterologist.

His wife, Helen, is currently suspended from practice after a separate hearing found she did not adequately explain the potential fertility impacts of medical treatment to a patient seeking help with gender-related distress.

Both deny that they failed their patients and appealed, although Michael Webberley's appeal was dismissed by the High Court in early December. They told Reuters that they currently do no clinical work for GenderGP.

There is little NHS or independent data available on how many young people seek care privately. GenderGP says the share of under-18-year-olds among its more than 8,000 UK patients is rising, which it attributes to the lack of care offered through the NHS.

The Webberleys transferred their ownership of GenderGP to a Hong Kong-based company, Harland International, in 2019 to avoid the controversy associated with them, they said. The company is now registered in Singapore as GenderGP PTE Ltd, with Dr Helen Webberley as a director. Harland could not be reached.

The clinic's prescribing doctors are all based overseas and regulated within their home countries – from the United States to European Union countries. EU-based doctors can prescribe to UK patients under rules drawn up after Brexit. Some GenderGP therapeutic counselors are UK-based.

The Tavistock, based in London, continues to see existing patients. But first appointments for people who have been on its waiting list since 2019 have slowed to a trickle as staffing and morale drop ahead of the closure, according to NHS data and four people involved in the reorganization. More than 1,500 young people recently referred with gender dysphoria are being kept on a separate list for the future regional centers, with no clarity on when or how they will be treated, three NHS sources told Reuters.

Once assigned to a waiting list, young people have been effectively locked out of state-provided mental health counseling and other specialist support related to their gender dysphoria, because those services were offered only through the gender care system they are waiting to join. Delaying medical treatment also means young people mature in bodies that don't align with their gender identity – changing that in later life is more difficult.

The NHS said in a statement to Reuters it is expanding healthcare services for young people with gender dysphoria in line with recommendations from the review, and working on better supporting those on the waiting list. It has previously said it "strongly discouraged" families from turning to private or unregulated providers.

"These have been an exceptionally challenging couple of years for our patients and their families, with a lot of toxicity in discussions around their care and chronic uncertainty about its future," Dr Polly Carmichael, director of the youth gender clinic at the Tavistock, said in a statement to Reuters.

The Department of Health and the Prime Minister's office declined to comment for this story.

Both sides in the polarized debate are turning to the courts: patients who say they've waited too long, and others who say the NHS moved too fast. At the end of November, transgender rights advocates challenged NHS England in the High Court over long wait times for both youths and adults seeking treatment. In 2020, a young woman who had detransitioned from being a transgender man challenged the Tavistock's use of puberty blockers in the same court.

Long wait lists are common within the NHS, but its statistics show the three-year wait for transgender youth is extreme. Most young people with a "non-urgent" eating disorder get specialist help within three months of being referred, the figures show. On average, young people seeking mental health support wait just over a month for a first appointment, according to a government analysis of NHS England data.

One mother shared with Reuters a letter she received from the NHS in February after she followed up on her daughter's October 2021 referral to determine when she might receive attention. The letter said a decision would be made at some point from early 2022 on whether the child "is likely to meet the access criteria" for gender care. She has heard nothing since and suspects her child isn't even being considered for NHS help.

"We are on a waiting list for a waiting list," said the mother, Rose, who asked to be identified by her first name only to protect her daughter's privacy.

"She basically feels suicidal every single day." The NHS declined to comment on the case.

"STOP HURTING YOURSELF"

Miles plans to study archaeology at university and is a keen rugby player. He has felt like a boy for as long as he can remember, but recalls a moment of delight at the start of a new school year when he was around 9.

The teachers were handing out colored notebooks and lanyards based on gender: blue with wizards and astronauts for boys, pink for girls. He was given blue books – "and wizards and astronauts over everything," he said.

"It was not like 'I'm trans,' but just this amazing sense of joy within myself, 'This feels amazing, and I don't know why.'"

By age 11, as puberty began, Miles entered an all-girls' secondary school. He was bullied by classmates for not wearing a bra or conforming to female norms. To fit in, he tried to be ultra-feminine, wearing skirts and make-up, having his eyebrows threaded, wearing false nails.

"My mood really dropped," he said. After about a year, "I realized, I can't do this anymore. I hate this." Miles was barely leaving his room. He began cutting himself, over a period of four or five months. "In my mind, it was just easier to deal with physical pain than mental pain."

His mother, Connie Pitcher, noticed the regular, precise lines on his arms. When she asked why he was distressed, Miles said he was struggling to understand his sexuality.

"I said, 'I don't care if you're gay, straight, or whatever – I just want you to stop hurting yourself,'" Connie said. The family considered seeking mental health help, but worried about long waiting lists.

"We saw him really, really dip," she said. "We were struggling with what to do. Because there is really no support."

The World Health Organization, which informs health policy worldwide, does not have detailed guidelines for this area of healthcare for youth. It says it works closely with the World Professional Association for Transgender Health (WPATH), a U.S.-based non-profit that has drawn up the most widely adopted standards of care.

These say a young person's exploration of gender should be respected and supported, and that medical interventions for young people at or after puberty should be one option, after a comprehensive assessment.

Research from the Netherlands paved the way for that medical treatment, establishing a model requiring adolescents who sought care to be assessed for about six to 18 months. If they had persistently expressed gender dysphoria since early childhood, lived in supportive homes, and had no other complicating mental health diagnoses, they could be offered puberty suppression, followed by hormones, and later, in some cases, surgery.

Since then, the number of young people seeking gender care has surged in parts of Europe and the United States, supported by greater awareness and the availability of professional treatment. They continue to face threats of violence and discrimination, as well as political efforts in some countries to block that care.

At the same time, some gender-care professionals have questioned the lack of definitive evidence on the long-term impact of puberty blockers or hormones on minors. Puberty blockers are not licensed in the United Kingdom or United States for treating gender dysphoria and the NHS says it is not known how they may affect brain development or long-term bone health in young people. Hormones, only available for older adolescents, cause potentially irreversible changes such as a deeper voice, and can cause infertility. Other changes, including breast development, are reversible only with surgery.

Those professionals are also concerned that as the number of pediatric patients has surged, so has the number of youth whose main source of distress may not be persistent gender dysphoria. Some may have mental health problems that complicate their cases.

"THE WRONG TREATMENT"

While not all English youths with diverse gender identities seek medical help, for those who do, a doctor or professionals including social workers or teachers are the first port of call. Any one of them can refer a youth for gender care, which so far has only come through the Tavistock – formally known as the Gender Identity Development Service, or GIDS – run by the Tavistock and Portman NHS Foundation Trust.

The clinic became a focal point for opponents of youth gender care in the UK in 2018 when an internal report compiled by Dr David Bell, a former senior psychiatrist and staff representative at the Tavistock, was leaked to national media. Bell, who did not treat young people, cited accounts from 10 unidentified colleagues who were working with transgender youth and came to him with concerns, including that some patients were "rushed through" to medical treatment without proper evaluation when they finally got an appointment.

"It was not just the wait," Bell told Reuters. "It was also a wait for the wrong treatment."

Bell now advocates against starting a gender transition before adulthood. He is at the fore of a group of mental health professionals who argue that accepting a child's new gender identity without exploring other underlying issues is clinically irresponsible, and puts them on a track to potentially irreversible changes that they may later regret.

The Tavistock has consistently defended its methods of treatment. Subsequent inquiries by outside investigators into care at the clinic did not raise concerns about patients being referred too quickly to medical interventions. However, they did criticize a lack of standardized assessments, adding that "it was not possible to clearly understand from the records" why care decisions had been made, according to a 2021 report from the regulator of health and social care, the Care Quality Commission.

The report rated the clinic as "inadequate" on these grounds, on the long waiting lists, and on concerns that teams treating patients did not always include the full range of experts required.

Another major challenge came in the 2020 lawsuit. Keira Bell, a young woman who detransitioned after what she said was improper care at the Tavistock, asked the court to rule on whether youths should receive puberty blockers. She alleged that the information provided by the Tavistock was not adequate, and said youths under 18 were not able to give informed consent to treatment. The High Court effectively banned their use for under-16-year-olds, a ban that was overturned last year on appeal. Bell did not respond to a request for comment.

The Tavistock told Reuters its current protocol requires meeting patients at least three to six times over some months before any recommendation for medical treatment. The timeline would be longer in complex cases. If the clinician, parents and the young person agree, puberty blockers may be prescribed from the onset of puberty, usually after the age of 10 or 11. The clinic only introduces hormone treatments after 16. Surgery is not an option before age 18 under NHS rules.

The clinic estimates that its staff referred only between 10% and 20% of young people for medical interventions, indicating what team members have described as its cautious approach. This year to August, 125 adolescents received referrals for either puberty blockers or hormones, the clinic told Reuters.

By July this year, Miles was uneasy, having heard nothing from the Tavistock clinic. He contacted them to ask about his referral. They had no record of it.

"That was a crash and burn," Miles said. "I've had two years of my life thinking it was happening, for nothing. It sounds extreme, but it feels like the NHS has failed me as a trans person. Because I'm just left in limbo. No-one really knows what to do."

Miles's doctor referred him a second time. But a few weeks later, when he checked with the clinic again, it still had no record of him. Neither his doctor nor the Tavistock would comment on his case.

"INCREDIBLY DISTRESSING"

Other young people and their parents across England are also at a loss. Waiting "isn't an option when you've got a child in distress," said Rose, whose daughter has been on a waiting list since October 2021.

Her daughter's case shows how hard life for young trans people can be - even when they do get care.

Assigned male at birth, Rose's daughter told her parents how unhappy she was in her changing body at age 12, two years ago. A few months later, knowing about the NHS waiting list, Rose sought help from family members to pay for private care from Dr Aidan Kelly, a clinical psychologist now in private practice who worked with youth at the Tavistock for five years.

Kelly diagnosed their daughter with gender dysphoria in August 2021, and she socially transitioned a month later. Now 14, she is taking puberty blockers prescribed overseas by a registered pediatric endocrinologist whom Kelly declined to identify. Kelly remains involved in her care.

In June this year, Rose's daughter tried to take her own life, cutting herself and attempting to drink bleach. She had previously been referred for NHS mental health care, but did not receive attention until she tried to kill herself, Rose said. The NHS then prescribed antidepressants.

A different private practitioner has also recently diagnosed the teen as autistic. Rose declined to make her daughter available to Reuters for comment due to the teen's distress.

"I'm just trying to do things to keep my child here," said Rose. The treatments are helping, she said, but her daughter is still struggling.

She worries that the teen, now 16, could receive gender medication without taking into account these other issues. The family has received no NHS gender care or mental health support since the referral, she said. The family is also frightened to entrust the teen to a system that is set to be replaced because it has been judged to be failing young people.

Most of all, Liz is afraid of her child making a mistake.

"If I knew this was the route" for the child to grow "into a healthy well-adjusted adult, that would be a different question," she said. "But I don't have that kind of information."

In a statement to Reuters, the NHS's Healthcare Safety Investigation Branch said the "incredibly distressing" wait for gender care "created a significant patient safety risk for young people."

In April, the investigation branch released a report into the death of a young transgender man before his 19th birthday, outlining how he had complained of the long wait for care before committing suicide. He was first referred to the Tavistock at 16. The clinic itself referred the incident to the investigators, saying it was "vital" that services worked together to better protect vulnerable young people.

There is evidence that transgender youth face a higher risk of suicide, but whether that risk has increased for adolescents in England who are waiting for care is not well understood. The Cass report said in February that many young people's mental health deteriorated while in a holding pattern.

"DROWNING IN THE MIDDLE"

For young people already in the system, the NHS has said care at the Tavistock clinic would continue unchanged ahead of its closure. NHS documents reviewed by Reuters show only a few dozen appointments are available for new patients each month, down from between 75 and 120 for most of last year, despite the growing waiting list.

Staffing has also dipped as several psychologists have left or, like Kelly, entered private practice. The Tavistock said in board documents that staff morale is low and told Reuters it does not have the capacity to meet demand.

The deadline for shuttering the clinic has also slipped, to late June 2023 at the earliest, two people familiar with the plans said, although the NHS is still aiming to open two new sites in spring next year, with up to seven more to follow. People who have been waiting the longest will be prioritized.

The NHS is also working on a system to cope with the backlog and improve support for those on the new list, a spokesman said.

But clinicians say polarized views around gender care will make finding staff challenging.

"The people who have gender-critical views call you child abusers and monsters, and then there are a lot of angry families accusing you of gatekeeping. And you're just drowning in the middle of it all," said Dr Laura Charlton, a clinical psychologist who left the Tavistock in 2020 after six years and now only treats adults.

Miles's parents say they are happy with GenderGP, but worry that the lack of NHS care will lead young people to unscrupulous online providers or even to self-medicate.

T he NHS doesn't cover the cost of Miles's private treatment. He is paying for his care with his wages from working at a local restaurant, and can recite the company's charges by heart. He says he had reservations about using testosterone but decided to go ahead.

"I know it can affect fertility," he said. "And it sounds weird, but baldness, because it runs in my family."

He applies a testosterone gel to his arms every morning, normally before heading to school. The gel dries and then cracks, like a face mask, when first applied, he said, then sinks in.

Miles has not told his co-workers that he is transgender. To them, along with his friends at an archaeology group that he digs with in Dover, he is just a young man. Yet he still plays for a girls' rugby team, until the effects of the testosterone kick in.

"I'm going to be able to start living my life as I want to," he said. "I want people to see that just because I'm trans, that doesn't affect who I am. I'm still a normal teenager."

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One for two. COZY can be a side table, at meanwhile, it’s can also be your pet’s lovely house. Craft with chemical-free odorless beech plywood and grey striped PVC rattan weave, this pet house is big enough for cats and small to medium dog breeds. The grey cotton canvas pillow included. ✔️NAME: Side Table Pet House – COZY ✔️ DIMENSIONS & PRICES: W355 x L355 x H410mm ✔️ FEATURES: -The table top and bottom are 18mm thickness beech plywood with warm and clean textures. Hard and stable. -Grey striped PVC rattan weave body is breathable. It allows air to pass through freely, inside will always be fresh and dry. -Easy on air. All chemical-free material emits low or no formaldehyde. -Solid beech wood legs.Strong and steady. -All materials are treated against wood pests. -The grey cotton canvas pillow included. It’s soft, dust-resistant, and easy to maintain. -Not too big, not too small, just the right size for cats or small to medium-sized dogs. ✔️ COLOR: Available in one color only. Same as display in picture. 👁‍🗨lofthome.com #petslover #furniture #furnituregoals#interiorstyling #interiordesign #livingroominspiration #condo #furnituredesign #affordablefurniture #homedesigns #furniturestyling #Singaporewedding #pinteresthomes #Livingroomdesign #furnitureinspo #SGdecor #sghdb#sgid #homeanddecor #minimaliststyling #homefurniture #lofthomefurniture #livingroomgoals #SingaporeTatler #renonation #sgfurniture #SGevents #bto #sginteriors (at Singapore) https://www.instagram.com/p/CpubBNSLRBN/?igshid=NGJjMDIxMWI=

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Every 2 big tubs consist 1 whole bird!

SINGLE PROTEIN diet consists of only duck meat, bones, liver, gizzard & Annie's natural blend.

Cage free duck is used and you can be certain it's free from nasty growth hormones & antibiotics.  

Duck is rich in iron and it provides dogs with a lean, easy-to-digest protein source and a great source of amino acids, which helps to support strong muscles. Fantastic replacement of chicken for furkids with allergy.

Ingredients - Malaysian cage free duck whole, including its bones, liver and gizzard, Annie's blend 

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Antibacterial and Antifungal Spray for Dogs - Hachiko Singapore

Hachiko Singapore offers an advanced Antibacterial and Antifungal Spray for Dogs, providing powerful protection against skin infections. This gentle spray helps to treat and prevent bacterial and fungal issues, soothing irritated skin while promoting a healthy coat. Safe for regular use, it's ideal for keeping your pet clean and comfortable. Trust Hachiko Singapore for quality pet care solutions!

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French Bulldog Puppies for Sale in Singapore: What You Need to Know

If you’re on the hunt for French Bulldog puppies for sale in Singapore, you’re in for a treat! French Bulldogs, with their distinctive bat-like ears and playful personalities, have become one of the most popular dog breeds worldwide. Their compact size and affectionate nature make them ideal companions for urban living, especially in bustling cities like Singapore. This article will guide you through everything you need to know about finding the perfect French Bulldog puppy in Singapore, from understanding the breed to locating reputable sellers.

Understanding the French Bulldog Breed

History and Characteristics

The French Bulldog, often affectionately known as the "Frenchie," is a small breed that originated in France. They were initially bred to be a miniature version of the English Bulldog. Known for their muscular build, short snout, and large, expressive eyes, French Bulldogs are both adorable and unique in appearance.

These dogs are characterized by their:

Size: Typically weighing between 16 to 28 pounds.

Ears: Distinctive "bat" ears that stand erect.

Coat: Short and smooth, requiring minimal grooming.

Temperament: Friendly, playful, and affectionate, making them great family pets.

Why French Bulldogs Make Great Pets

French Bulldogs are renowned for their loving and easygoing nature. They are excellent companions for singles, couples, and families alike. Here are a few reasons why they make fantastic pets:

Adaptability: They adjust well to apartment living due to their small size.

Low Exercise Needs: While they enjoy playtime, they don’t require extensive exercise, making them suitable for busy individuals.

Affectionate: Frenchies are known for their strong bond with their owners and their desire to be part of the family.

Finding French Bulldog Puppies for Sale in Singapore

Reputable Breeders

When searching for French Bulldog puppies in Singapore, it’s crucial to choose a reputable breeder. Responsible breeders prioritize the health and well-being of their dogs and ensure that they are bred ethically. Here are some tips to find a trustworthy breeder:

Research: Look for breeders with positive reviews and a good reputation in the local community.

Visit the Breeder: Always visit the breeder’s facility to see the living conditions of the puppies and their parents.

Health Clearances: Ensure that the breeder provides health clearances for the puppies, including tests for common genetic conditions like hip dysplasia and brachycephalic obstructive airway syndrome (BOAS).

Online Platforms

Several online platforms and websites list French Bulldog puppies for sale in Singapore. Some popular options include:

Local Classifieds: Websites like Gumtree Singapore and Carousell often have listings for French Bulldog puppies.

Specialized Breeder Websites: Many reputable breeders have their own websites where you can view available puppies and learn more about their breeding practices.

Social Media: Join local pet groups and forums on platforms like Facebook and Instagram to connect with breeders and other French Bulldog enthusiasts.

Adoption and Rescue

Adopting a French Bulldog from a rescue organization or shelter is another option to consider. While French Bulldogs are a sought-after breed, some may find themselves in need of a new home. Here’s how you can find French Bulldogs available for adoption:

Local Rescues: Check with local dog rescue organizations and shelters. Some may have French Bulldogs or know of rescue groups specializing in the breed.

Breed-Specific Rescues: Organizations dedicated to French Bulldogs often have listings of available dogs and can guide you through the adoption process.

What to Consider Before Buying

Costs

Owning a French Bulldog can be a significant financial commitment. The initial cost of purchasing a puppy from a reputable breeder in Singapore can range from SGD 3,000 to SGD 6,000, depending on the puppy’s lineage, health, and other factors. Additionally, consider ongoing expenses such as:

Veterinary Care: Regular check-ups, vaccinations, and preventive treatments.

Grooming: Though their short coat is low-maintenance, occasional grooming is still necessary.

Food and Supplies: High-quality dog food, toys, bedding, and other essentials.

Health Considerations

French Bulldogs are prone to certain health issues due to their unique physical traits. Be aware of the following conditions:

Respiratory Issues: Their short snouts can cause breathing difficulties, especially in hot weather or during strenuous activities.

Skin Problems: They may suffer from skin infections and allergies, so regular cleaning and skin care are essential.

Eye Problems: Conditions like cherry eye and corneal ulcers can occur, so keep an eye on their eye health.

Training and Socialization

French Bulldogs are intelligent but can be a bit stubborn. Consistent training and early socialization are key to ensuring your puppy grows into a well-behaved adult dog. Invest time in basic obedience training and expose your Frenchie to different environments, people, and other pets to help them become well-rounded.

Conclusion

Finding the perfect French Bulldog puppy for sale in Singapore involves careful consideration and research. By choosing a reputable breeder, considering adoption options, and preparing for the financial and health aspects of dog ownership, you’ll be well on your way to welcoming a delightful Frenchie into your home. Their playful demeanor and loving nature make them an excellent addition to any family, bringing joy and companionship into your life. Whether you’re a first-time dog owner or a seasoned pet parent, a French Bulldog is sure to steal your heart.

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What’s the Finest Way to Feed Your Turtle?

Proper feeding is vital to the permanency and good of your turtle. A fit diet should consist of fresh vegetables, premium commercial turtle food, and, depending on the species, infrequently, sources of protein like insects or tiny fish. Since a turtle's nutritional necessities might vary over time, make sure the food is appropriate for its size and age. Since turtles often like to eat while swimming, it's also critical to supply food for them in the water. Uphold the water quality by routinely cleaning the feeding part, and watch your turtle's eating patterns to make sure it is getting the correct nutrients.

Essential Pet Care Items: From Turtle Food to Dog Supplies

Locating Reputable Dog Supplies in Singapore

Having access to good Dog Supplies Singapore is important for providing proper care for your pet. The correct materials may increase your dog's health and happiness, from healthy dog food to sturdy toys and cozy bedding. To make sure you can get all you need in one location, look for a trustworthy pet store that stocks a large selection of dog supplies. Having the correct materials close at hand helps taking care of your pet easier and more efficient, even if you're observing for specific goods, leashes, or grooming tools.

Online Store for Turtle Food and Feed

Selecting the Online Store for Turtle Food and Feed is crucial because of their specific dietary necessities. An easy option to get high-quality nourishment provided to your turtle's particular needs is to purchase food and feed for them online from trustworthy stores. Seek out establishments that proposal a extensive range of products, such as fresh veggies, freeze-dried insects, and commercial turtle pellets. For the fitness, growth, and over-all wellbeing of your turtle, a balanced diet is vital. You may compare substances and values when you shop online to be sure you're getting the utmost deal likely.

Choosing Dog Shampoo That's Best for Sensitive Skin

Particular caution must be taken though bathing dogs with sensitive skin. It is likely to avoid irritation, dryness, and itching by choosing the appropriate dog shampoo for sensitive skin. Because these constituents might exacerbate skin issues, look for shampoos free of harsh chemicals and artificial smells. Your dog will stay clean and relaxed through a mild solution that calms and hydrates the skin. Skin infections can be evaded and allergies can be managed through regular bathing and the precise shampoo.

Hypoallergenic Dog Shampoo for Itchy Skin

To address determined itching in your dog, reflect using a hypoallergenic dog shampoo specifically intended for itchy skin. Shampoos formulated through hypoallergenic ingredients aim to reduce allergic reactions and dismiss skin irritation. These shampoos often have natural components through relaxing makings, such aloe vera or oats. By boosting healthier skin and coat, regular use of a hypoallergenic shampoo can help minimalize scratching, inflammation, and discomfort.

Dermcare Aloveen Conditioner: Why Use It?

Dermcare Aloveen Conditioner is a countless option for pets whose skin is dry or inflamed. The determination of this conditioner's formulation is to intensely hydrate the skin, making it smooth and glossy. Pets through delicate or allergy-prone skin will particularly advantage from it. This conditioner can help seal in moisture and lessen irritation after shampooing, enlightening your pet's comfort. Use on a regular basis to preserve the natural sheen and improve the texture of your pet's coat.

Where to Buy Effective Pet Cancer Supplements Online

providing for your pet's health develops even more crucial while handling severe illnesses like cancer. Effective supplements for treating pet cancer are obtainable online to assist you manage your pet's illness and improve their quality of life. These supplements are designed to counteract the opposing effects of cancer therapies, lower inflammation, and improvement the immune system. To assurance your pet gets the finest treatment likely, while making an online purchase, pick trustworthy retailers who deliver premium, veterinarian-approved supplements.

Crucial Vet Supplies for Dogs

Maintaining your dog's health might be made simpler if you have necessary veterinary supplies at home. Things like bandages, insect repellent, and basic medical supplies are essential for quickly tending to minor health concerns. In addition, keeping these supplies on hand will allow you to give your dog rapid care in an emergency, keeping them safe and healthy. It is significant to keep your veterinarian supplies stocked so you can always handle your dog's medical requirements.

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How Pet Spray Singapore Can Help Your Pet Eliminate Skin Problems?

Would you prefer an all-natural way to soothe your pet’s skin rashes and other infections? If you are interested in getting natural products for your pets, then you should consider using Nativeneem’s neem pet spray. As the owners of the pets it is our wish to have the pet as happy as possible and in addition to this have a healthy one. We also want to note that our pets are not protected from skin disorders which can be attributed to fleas, mites, fungus, bacteria and so on. Do not reach for some commercial chemical treatment, rather opt for a milder natural plant-based remedy.

Nativeneem has an all natural neem Pet Spray Singapore that is used in treating itchy skin, hot spots, rashes as well as infections in dogs, cats and other small animals. Main component of the product is neem oil, which is rich in azadirachtin – a natural substance that acts as an antifungal, antibiotic, and an anti-inflammatory agent to heal the skin and combat infections. Neem oil is mild and very effective in most cases of promoting skin and coat health in your pets.

Besides neem oil, other natural ingredients found in Nativeneem pet spray include tea tree oil, turmeric oil and lavender oil. These extra components enhance the antimicrobial activity and also promote healing and reduce inflammation. The pet spray can also be used to wash the skin, no matter whether you are in between baths or after a Benjamin – whenever your pet appears uncomfortable.

Nativeneem is an organization that deals with the organic treatment of diseases commonly affecting pets using the traditional Indian natural cure, Ayurveda. The neem pet spray is a safe and natural solution for relief in a hurry from the gentle, holistic approach. These include the neem shampoo bars, healing balms, oral care gels and more. Visit our online shop and check out the wide range of natural remedies that can be beneficial for your dog, cat or any other fuzzy friend you have at home right now! The pet of yours needs not simply good but the very best.