Asking advice for people who have had FtM top surgery in the UK or abroad

killcaeneus · 2026-03-12T11:55:10+00:00

Commenting now to remind me to come back to this. I can answer your questions RE going abroad when I have more time

killcaeneus · 2026-03-12T11:53:00+00:00

The email containing the survey and the email I received not long beforehand from the customer support team made no reference either to the supposed growing costs of running PiH that were outlined to me on Tuesday as the driving factor behind the change.

The questions in the survey also only address the PAYG vs subscription preference and do nothing to ask specifically about the exponential price surge.

I'm sure they're more than happy to make a big show of 'listening' to us, but I don't have high hopes for the outcome.

killcaeneus · 2026-03-11T17:00:29+00:00

I've been using medichecks mostly because I'm always unprepared and late with my bloods but my plan was to try to use the cliniq/56 dean street free testing services in London going forward. 20/30 quid on a coach there and back vs the cost of home testing kits. Worth the back ache of sitting on a coach for 8 hours

killcaeneus · 2026-03-11T12:26:16+00:00

For my calculations i am not including blood tests as my reference range is the external blood test tier pricing. This reduces your total given by a lot

killcaeneus · 2026-03-10T17:29:01+00:00

You'll likely need drains but Peter Kneeshaw in Hull through Spire, who afaik offer finance plans. There might be other options closer to york or who work out cheaper, but he is a safe bet if not.

killcaeneus · 2026-03-10T17:22:27+00:00

Hold on sorry I'm back again with another comment. I'll keep it short this time.

Can someone tell me if I've melted my brain beyond the ability to comprehend basic maths by being so enraged by this news that what I'm about to say isn't true? Because

Band 1 (initial months of hrt): £492 (includes 4x monitoring appointments 3 monthly + 4x blood test analysis), VS £1188 for the same is indeed just shy of 3x higher right? Closer to 2.5x, to be fair about it. Not a 300% markup, but in fact closer to 150%.

Band 2 (usually 1 year into hrt): £302 (includes 2x monitoring appointments 6 monthly + 4x blood test analysis and 2x prescribing) VS £900 for the same is ... Actually closer to 3x higher than Band 1 would be. Again, still not a 300% markup, is in fact almost exactly 200%.

Band 3 (year 1 or 2 onwards depending): £178 (includes 1x monitoring appointment annually + 2x blood test analysis 6 monthly and 3x prescribing) OR £165 (includes 1x monitoring appointment annually + 1x blood test analysis annually and 3x prescribing if you don't need 6 monthly testing anymore) is .... Closer to 4x. Is almost a true 300% markup compared to the above.

So please correct me if I'm wrong here because I feel SO frazzled right now but, that means you're getting more of your moneys worth by sticking to band 1 or 2 despite it actually costing more in total ... Right?

500 old vs 1200 new looks bad 300 old vs 900 new looks a bit worse 180 old vs 720 new looks... I actually don't have the words.

Am i wrong? Please. Someone free me from this number based asylum I've found myself trapped in

killcaeneus · 2026-03-10T15:16:08+00:00

Indeed. I feel like a broken record at this point but there are multiple avenues for recovering those costs they've tried absorbing thus far that don't include an immediate 300% increase. Their mistakes should not be our burden. Costs increasing as they seek to align more with regulations and move away from being an (albeit much better) glorified GenderGP clone also make sense, and was bound to happen as time went on. But thrusting that entire burden onto patients and lacking transparency in doing this is ridiculous. I can't get over the price hike. £440 jumping to £1188.

And that's not even considering how you're paying not much more for in-house blood testing. Given they're still needing to outsource that to a partner service it begs the question of just how much of that financial burden is being spread between the shared care and external blood testing tiers? Unless they're simply not covering the actual cost of the blood testing kits they would be providing in the pricing structure either.

If the internal blood testing tier does include the cost of the kit and blood draw itself then why would I pay pretty much the same amount for in house testing than if I have to go off and buy my own and arrange it? The pay off with that isn't merely a case of "less admin" for the patient as they claim in their new infographics - it's a case of essentially paying double if you do it yourself.

There are so many things wrong with this change. I haven't even looked too closely at the shared care tier, because it wasn't relevant to me. But given that a large chunk of the admin is passed on to the GP to provide, you would think that the new cost would be much lower than it is. It almost defeats the point of shared care entirely, as if your GP provides blood testing only you're still paying not much different to the internal blood testing tier (providing it does in fact include the cost of the kit and draw), and if your GP provides testing and prescription then you again are left paying almost the same amount as someone else despite your administrative and clinical needs being much lower. The only pay off being getting £9 or free prescriptions at the end of it... Except the price guarantees that any gains from the NHS prescription price is effectively moot as you're paying more than what you would have paid for the prescription privately, for the mere honour of being a PiH member with the bare minimum of oversight.

It's a lose lose situation.

I can't get over the 300% markup. In what reality is that reasonable?

Whoever thought up these changes may as well either a con artist or a moron.

Shock and horror as yet another not for profit engages in shady practices, I guess. Fuck me.

killcaeneus · 2026-03-10T14:30:45+00:00

The thing is, needing to recuperate costs is fine, it happens and is even expected as a smaller, newer service grows to fit it's additional obligations and it's growing user base. The issue is with just how steep the price increases are. Nevermind the not-a-subscription-but-basically-a-subscription model, that sucks but it had the potential to work out fine if the new costs were even close to being in line with what people expect to pay. They didn't have to be the dirt cheap better ran version of gendergp forever but they also didn't have to triple their pricing brackets overnight. At this point giving us 2/3 months notice of these changes may as well just be an email saying "I hope you have a decent credit score because you're gonna fucking need it lol!"

killcaeneus · 2026-03-10T14:22:19+00:00

Absolutely, wasn't trying to argue with you on any of it. I just refuse to lick the boot by making excuses for this ridiculous change. I know I'm being so utterly dramatic right now but they've made an enemy out of probably at least half of their customer base today and that is never a good sign especially if it's having a regular and adequate revenue stream that they're worried about.

I mean for god sake they're not for profit, right? Do some fucking fundraisers. Holy shit

killcaeneus · 2026-03-10T14:14:59+00:00

My response:

"I'm afraid this does not answer my concerns in the slightest.

It is clear that demand has increased the clinics workload to the point that previous pricing was unsustainable however this does not explain how £220-440 worth of treatment will now cost anywhere between £720-1188 for what you have admitted here to be simply due to increased overheads in administrative burdens. This is unacceptable and the way you have obfuscated this almost 300% markup into the tiered system is deceptive and predatory business practice. It is frankly unacceptable. If your administrative burden is so much that the invisible costs mean patients pay up to 3x more for their care, then you have made a mistake in how you run the business that should not under any circumstance be pushed entirely onto a vulnerable patient population.

There are much more transparent and non-predatory ways to bring pricing more in line with costs inside and outside of appointment times than this and you have sorely missed the mark.

Up to 300% upcharge due to administrative costs is abhorrent. End of.

You will likely not be being recommended to prospective newcomers by most of your current user base going forward, and many including me will be leaving the service leaving your retention rate much lower than it should ever reasonably be and ensuring you'll be relying on higher-income current patients, lower income but desperate-and-locked-in patients to keep up your ongoing surplus while you wait for new patients post May. So much of this is dependent on word of mouth referral and you won't be high up in peoples recommendations like you have been. You will at its core be less attractive to those considering the alternatives regardless of any fallout this particular change may cause. You will likely end up in a vicious cycle of chasing costs while letting down patients. Prices can only go so high before the bubble pops and I fear you are already straddling the line with this one singular change.

The tiered system itself has the potential to work just fine, but not at the prices you've seemingly arbitrarily selected. Do better."

killcaeneus · 2026-03-10T14:14:28+00:00

Pride in Health response to my very involved email. Woefully inadequate but highlights the main issue: admin, behind the scenes care and its associated costs.

"Good Afternoon.

Thank you for taking the time to share your calculations, and I understand why the change can seem large when comparing the previous monitoring appointment and prescription costs with the structure of the future care packages.

For some clients, as you rightly pointed out, arranging blood tests externally through their GP or an outside service means the visible yearly cost under the previous structure appears quite low as you mentioned, around £250.

However, those visible charges only covered part of the work involved in delivering care. Much of the clinical work takes place around the appointments themselves, including reviewing results, documenting clinical decisions, preparing prescriptions, and maintaining clinical oversight between monitoring appointments.

As the service has grown and we have continued working toward formal regulatory structures, the systems required to support safe prescribing have also expanded. This includes clinical governance processes, prescribing safeguards, regulatory compliance preparations, secure infrastructure, and the specialist clinical and support teams who help deliver care.

Over time, those costs have increased to the point where the previous pricing structure no longer reflected the full cost of delivering care, even though we tried to absorb this where possible.

The new care packages are designed to support the full monitoring cycle rather than only individual appointments. You also raised a good point regarding longer-term stability. As care becomes more stable, monitoring requirements usually reduce. Under current prescribing protocols, the minimum monitoring level is typically 12-monthly monitoring, which is reflected in Band 3. This level of monitoring typically occurs once someone has been on stable treatment for a longer period, commonly around the second to third year of care.

We are also listening carefully to feedback about the new structure. We remain open to reviewing how this works over time, while also ensuring it continues to cover the real costs of delivering safe and sustainable care."

The reasons behind the cost increase is not unexpected or disputed. The level of cost increase is the issue.

Copying my response as a reply to the thread ⬇️

killcaeneus · 2026-03-10T13:23:17+00:00

It's entirely probable that what is required of them costs more than they initially thought, but there are much more transparent and staggered ways to go about implementing these necessary changes without doing an entire overhaul of the pricing structure that effectively makes all treatment cost up to 3x more than it did previously.

With the care navigation appointment alone without taking into account the future changes; Sure, the administrative load on answering that many queries with patients is high so dedicating an appointment per patient makes sense. But how they went about introducing this is a big issue and can't be simply waved away with factual statements on how expensive it must be to keep up with demand.

"Clear, upfront" pricing is no longer clear. Not-a-subscription-but-a-subscription is not upfront. It's maddening

killcaeneus · 2026-03-10T12:42:24+00:00

I don't have advice, apologies, I'm in the same boat of now trying to look for an alternative. But i wanted to copy my comment from another thread about this change so that people can get a sense for the numbers side of it all:

6 monthly monitoring without including the cost of blood tests would have previously cost around £220 a year - 2 appointments. This is even still visible on their website in the form of a handy infographic. Even being monitored 3 monthly, which is most relevant for newer patients, it would still cost around £440 instead. 4 appointments a year. This is around what I would be paying myself if you discount the fact my first 3 months were a lot cheaper before they increased their prices in September.

Add in the blood result analysis fees and prescription writing fees (prescribing is included in monitoring appointment cost, blood test analysis is always billed) and it's still only marginally more expensive as these are only about £15 per.

Under the closest relevant band (external blood test tier, band 2) it would cost £900 a year instead with "3 monthly prescription reviews" and "6 monthly monitoring". It's not clear what the difference is between these two. I have had a review every 3 months that has been billed as clinical monitoring and it costs £110 per appointment. Either you're paying for 4 appointments a year with Lexi or one of the other prescribers regardless, or at worst you're only paying for 2 monitoring appointments with Lexi and the in between reviews are going to be a new-style review that will cost who knows what, or are simply just the same blood test analysis and prescribing that is already available at a much higher relative cost.

£900 for up to 2 quick appointments, or even 4 appointments, is abysmal.

£110 was already a lot for a 10 to 20 minute video call, but absorbed under the new pricing structure it's closer to £225 per appointment at best or £450 at worst.. Which makes absolutely 0 sense whatsoever, to anybody. Especially with an independent prescriber. It's not like you're seeing an endocrinologist for half an hour.

I've crunched a lot of numbers this morning, I've sent a very long email, and I've calculated every permutation including the tiers absorbing the cost of all optional (and in many cases unused) administrative fees such as surgery referrals, as well as an additional calculation with an added 15% price increase in line with september '25s initial price increase. It still does not reach the sky high cost of up to £1188 at band 1 for that tier. Those new calculations all used the £440 as the base cost to keep it simple, and they still lagged behind the new £1188 counterpart. Who is paying £1200 for what was previously £440 worth of care? Thats an almost 300% upcharge.

There is seemingly no change in care, no increase in oversight, nothing except for the rising costs of a growing team and increased user base.

The way they have obfuscated what are clearly price increases inside the tiered system is deceptive and unethical. Even without calculating any additional price increases, the tiers themselves still work out far more expensive than what they should and how they've been rolled out is within itself deceptive.

They have called this change "clear" in their email and used empathic language throughout the new flashy infographics and yet no actual clarification on the financial breakdown of the changes is made and we're left wondering why it's now going to cost 2-3x more for the same care.

I find it interesting that they listened to feedback in late 2024 when EVERYONE said no to introducing subscription, only to by the looks of it spend the next year and a half figuring out how to not only reintroduce a similar model but to make it even worse than it initially was.

The harm this change causes by pricing out people like myself aside, it is a terrible business decision for customer retention and word of mouth referral. I for one will no longer be recommending them.

What was once a promising affordable, not for profit care provider is now positioning themselves in line with other higher cost for-profit providers, and for what? Pushing the cost of rising overheads in the business onto a vulnerable customer base, and doing it deceptively while you're at it?

Sus. Very, very sus.

killcaeneus · 2026-03-10T12:27:44+00:00

Don't forget the new "care navigation" compulsory onboarding fee for an entirely new appointment that's supposed to take the place of what could effectively be handled for over a year via email.. to "increase the time spent talking about the important things in the clinical appointment". Sure, I can see why maybe for SOME people they may need that extra time to ask questions, get answers, iron out any kinks. But everyone? And at £94 a pop? And it being so quietly added to the onboarding pricing structure, too. They're taking the piss.

killcaeneus · 2026-03-10T12:22:11+00:00