Susan's Place Transgender Resources

Community Conversation => Transitioning => Gender Correction Surgery => Topic started by: Marissa on November 30, 2013, 05:24:42 PM

Title: Informed Consent SRS
Post by: Marissa on November 30, 2013, 05:24:42 PM
Are there any good SRS surgeons anywhere (e.g. Thailand) who follow an informed consent model instead of the WPATH IJT SOC? In other words, where one can sign a release and pay to receive SRS right away without waiting a year and having letters.  I just think the world would do well to dispense with a lot of the gatekeeping. ;)
Title: Re: Informed Consent SRS
Post by: sarahb on November 30, 2013, 05:50:29 PM
I don't have an answer to your question, but I do agree that the whole 1-year RLE and 2 letters is way too much to require. Everything else only requires a signature, and really SRS is the only one that isn't even visible to the world.
Title: Re: Informed Consent SRS
Post by: Jamie D on November 30, 2013, 05:53:38 PM
There used to be, but I'm not sure I would use their services.
Title: Re: Informed Consent SRS
Post by: LauraGirl on December 02, 2013, 12:59:28 AM
For dr Suporn, you only need one letter from your gendertherapist stating you live at least one year fulltime as a woman at the moment of surgery and you take HRT, again at least one your at the time of your planned surgery. You don't need two letters.
Title: Re: Informed Consent SRS
Post by: Jessica Merriman on December 02, 2013, 01:10:19 AM
Jamie is right. I would not use the services of anyone who would do it without precautions, such as letters, or offer a deep discount. I may be one of the only one's here who actually appreciate the time it takes for SRS in the U.S.A. It gives you time to really consider all the possibilities and establishes good mental health attitudes. Please don't rush this important process. Joules has a great point as well. Good luck girl.
Title: Re: Informed Consent SRS
Post by: Marissa on December 02, 2013, 08:39:17 PM
Thanks for the relies and info everyone! I first started looking into SRS in 1998, so I don't think I'm rushing, but maybe I am getting impatient. LOL  :laugh:

I'm having a really tough time finding doctors who have even heard of WPATH here in Maine.  If anyone knows of any good endocrinologists from Boston north, I need to find one of those too. Maybe I could even go to Canada.  I've been meaning to get a passport anyway.  I also need FFS (especially rhinoplasty) but not sure how much I can afford.  Is surgery a lot cheaper in Thailand?  I have Medicare which currently won't pay for any of these surgeries AFAIK.

Thanks again!
Mara
Title: Re: Informed Consent SRS
Post by: Tammy M on December 02, 2013, 08:49:45 PM
If you have been looking into SRS since 1998, you have had time to meet any WPATH requirements and you haven't started HRT or RLE yet, you can do those steps and wait a little longer.  I have a friend in Maine who is on HRT and full time.  If you send me an email I can get her doctor's information for you.  I couldn't imagine anyone getting HRT without at least 1 yr on hormones, It will be 2 yrs for me, and the RLE is very well worth it because you need time to adjust to your new life.  Good luck!
Title: Re: Informed Consent SRS
Post by: Flan on December 02, 2013, 09:14:48 PM
Quote from: Marissa on December 02, 2013, 08:39:17 PM
I'm having a really tough time finding doctors who have even heard of WPATH here in Maine.  If anyone knows of any good endocrinologists from Boston north, I need to find one of those too.
The closest is probably a planned parenthood in Vermont that offers LGBT services.
Title: Re: Informed Consent SRS
Post by: Marissa on December 02, 2013, 09:26:55 PM
Quote from: Tammy M on December 02, 2013, 08:49:45 PM
If you have been looking into SRS since 1998, you have had time to meet any WPATH requirements and you haven't started HRT or RLE yet, you can do those steps and wait a little longer.  I have a friend in Maine who is on HRT and full time.  If you send me an email I can get her doctor's information for you.  I couldn't imagine anyone getting HRT without at least 1 yr on hormones, It will be 2 yrs for me, and the RLE is very well worth it because you need time to adjust to your new life.  Good luck!

Thanks, Tammy.  I should have mentioned that I researched transitioning and SRS in '98 but unfortunately I decided not to move forward with it back then and I've only been transitioning for about 6 months.  I'm on HRT, but I would really like to see an endo (can't say anymore here due to ToS).  I have some RLE, only part-time though.  I would like to go full-time but not until I get more shoes. LOL 

Maybe you're right about waiting being wise, although I still resent having to prove myself to a therapist.  As far as I'm concerned, the only one with the right to make that decision for me is me.  I'll email you about the info, or you can email me if you like at marissa.acadia at gmail.com.  :)

~Mara~
Title: Re: Informed Consent SRS
Post by: Marissa on December 02, 2013, 09:29:08 PM
Quote from: Flan on December 02, 2013, 09:14:48 PM
The closest is probably a planned parenthood in Vermont that offers LGBT services.
Thanks Flan, is there a location in Vermont in particular, or should I just google them?
Title: Re: Informed Consent SRS
Post by: Flan on December 02, 2013, 10:10:20 PM
Quote from: Marissa on December 02, 2013, 09:29:08 PM
Quote from: Flan on December 02, 2013, 09:14:48 PM
The closest is probably a planned parenthood in Vermont that offers LGBT services.
Thanks Flan, is there a location in Vermont in particular, or should I just google them?
I didn't go very deep in the search since the 2 locations that were top of the results (that offer services) are likely an equally annoying distance (70 miles) away.
Title: Re: Informed Consent SRS
Post by: kinz on December 03, 2013, 02:23:30 AM
Quote from: Marissa on December 02, 2013, 08:39:17 PM
Thanks for the relies and info everyone! I first started looking into SRS in 1998, so I don't think I'm rushing, but maybe I am getting impatient. LOL  :laugh:

I'm having a really tough time finding doctors who have even heard of WPATH here in Maine.  If anyone knows of any good endocrinologists from Boston north, I need to find one of those too. Maybe I could even go to Canada.  I've been meaning to get a passport anyway.  I also need FFS (especially rhinoplasty) but not sure how much I can afford.  Is surgery a lot cheaper in Thailand?  I have Medicare which currently won't pay for any of these surgeries AFAIK.

Thanks again!
Mara

hi mara! i'm drawing from a sheet i pulled up when i looked up informed consent clinics, so here's what i've got so far:

fenway health (http://www.fenwayhealth.org/site/PageServer?pagename=FCHC_srv_services_trans) - boston, ma
mayra cruz-polanco - boston, ma. no url, but i'll throw in the name since it came up.
ellen rottersman (http://therapists.psychologytoday.com/rms/prof_detail.php?profid=49028&sid=1314819251.9557_14320&lastname=Rottersmann) - brookline, ma. not informed consent, but she explicitly states that she is quick in evaluating/writing letters & does sliding scale care.

Quote from: Tammy M on December 02, 2013, 08:49:45 PM
If you have been looking into SRS since 1998, you have had time to meet any WPATH requirements and you haven't started HRT or RLE yet, you can do those steps and wait a little longer.  I have a friend in Maine who is on HRT and full time.  If you send me an email I can get her doctor's information for you.  I couldn't imagine anyone getting HRT without at least 1 yr on hormones, It will be 2 yrs for me, and the RLE is very well worth it because you need time to adjust to your new life.  Good luck!

hey, i feel like this probably isn't the right attitude to bring into a post like this. when someone is asking for support, resources and advice to say that someone should be doing something some other way that doesn't necessarily align with how they want to do things is frustrating and unhelpful. at least that's how i feel when the same happens to me. i feel like it's somewhat common for people to defend or champion gatekeeping as sort of a "necessary evil" or a duty or responsibility that trans people have to doctors & the community in order to transition. i think that's a really ugly habit and that it's really important to dispel it, because what marissa said is right—the only one with the right to make the decision of what's right for her is her.  it's up to each individual to decide whether they "need to adjust" to what may or may not be a "new life", and so telling people they don't know enough about themselves to make the right decision—well, i think that's wrong.

to be frank, marissa, i think as far as srs goes you may have trouble finding anyone who doesn't follow wpath/soc, which is kind of disappointing, i know, but them's the breaks. what you may be able to do is have someone who is willing to work with you to interpret the soc in ways that are most beneficial to you, and understand the need for your own autonomy and decisionmaking regarding surgery. the same goes with an IC endocrinologist. best of luck regardless :)
Title: Re: Informed Consent SRS
Post by: Jamie D on December 03, 2013, 02:31:41 AM
Quote from: Jessica Merriman on December 02, 2013, 01:10:19 AM
Jamie is right. I would not use the services of anyone who would do it without precautions, such as letters, or offer a deep discount. I may be one of the only one's here who actually appreciate the time it takes for SRS in the U.S.A. It gives you time to really consider all the possibilities and establishes good mental health attitudes. Please don't rush this important process. Joules has a great point as well. Good luck girl.

Just to follow up on what Jessica was saying here, this link is a cautionary tale about doctors who follow no sort of standards...

http://www.ifge.org/news/1998/june/nws6118d.htm

Title: Re: Informed Consent SRS
Post by: Sophia Hawke on December 03, 2013, 03:07:15 AM
I wouldnt trust a doctor who doesnt play by the generally accepted rules with a surgery as invasive/life impacting/and dangerous as SRS.  I personally think as far as surgeries go, spending the extra cash to go to the best would be well worth it.  And if im not mistake, the waiting list for the best doctors is fairly long anyways.
Title: Re: Informed Consent SRS
Post by: Jessica Merriman on December 03, 2013, 03:08:50 AM
Quote from: Jamie D on December 03, 2013, 02:31:41 AM
Just to follow up on what Jessica was saying here, this link is a cautionary tale about doctors who follow no sort of standards...
http://www.ifge.org/news/1998/june/nws6118d.htm

For the record I DO NOT defend gatekeeping practices of unknown duration. One thing you have to consider in following the current rules is that medical providers are putting themselves in harm's way if they say prescribe HRT to a person who can not be on it because of underlying medical problems. Informed consent is great to a point. They still are under oath not to cause harm. All we need is a few cases where people use political or financial pressure on the medical community to provide service, it goes badly for the patient and then we all have problems finding medical professionals who will care for us at all. They will drop HRT and SRS in a heartbeat. The rules protect us from losing providers and services. I am one of few I guess who thinks this kind of life altering process should be slow and steady and not a blind rush with regrets later. Just my opinion though.
Title: Re: Informed Consent SRS
Post by: kinz on December 03, 2013, 09:33:58 AM
Quote from: Jessica Merriman on December 03, 2013, 03:08:50 AM
For the record I DO NOT defend gatekeeping practices of unknown duration. One thing you have to consider in following the current rules is that medical providers are putting themselves in harm's way if they say prescribe HRT to a person who can not be on it because of underlying medical problems. Informed consent is great to a point. They still are under oath not to cause harm. All we need is a few cases where people use political or financial pressure on the medical community to provide service, it goes badly for the patient and then we all have problems finding medical professionals who will care for us at all. They will drop HRT and SRS in a heartbeat. The rules protect us from losing providers and services. I am one of few I guess who thinks this kind of life altering process should be slow and steady and not a blind rush with regrets later. Just my opinion though.

yes, but.

the reason that medical providers are "putting themselves in harm's way" is because it's considered acceptable to withhold these services, and chalk it up to things like "unreliable trans people" or whatever. people don't stop prescribing lifesaving medical care like dialysis because of "a few cases"—why should the same be true of trans medical care?

sometimes "slow and steady" is not what a patient needs. sometimes they need to get out of an extremely bad, dark situation as quickly as possible, due to the amount of pain it's causing. and i think if patients know that's what they need, it's wrong to say "you aren't qualified to make this decision for yourself", especially given that trans people have been treated paternalistically like that for so long. hrt and srs can be lifesaving procedures, and i wish medical care worldwide began to reflect that.

(as an addendum informed consent MEANS you assume the potential risks of a procedure, up to and including regret. so to say that doctors are risking their jobs by providing informed consent seems to me to be a strange claim to be sure, unless there's a jurisdiction where doctors can get slammed by it regardless.)
Title: Re: Informed Consent SRS
Post by: Sophia Hawke on December 03, 2013, 09:46:29 AM
Quote from: transtrender on December 03, 2013, 09:33:58 AM
yes, but.

the reason that medical providers are "putting themselves in harm's way" is because it's considered acceptable to withhold these services, and chalk it up to things like "unreliable trans people" or whatever. people don't stop prescribing lifesaving medical care like dialysis because of "a few cases"—why should the same be true of trans medical care?

sometimes "slow and steady" is not what a patient needs. sometimes they need to get out of an extremely bad, dark situation as quickly as possible, due to the amount of pain it's causing. and i think if patients know that's what they need, it's wrong to say "you aren't qualified to make this decision for yourself", especially given that trans people have been treated paternalistically like that for so long. hrt and srs can be lifesaving procedures, and i wish medical care worldwide began to reflect that.

(as an addendum informed consent MEANS you assume the potential risks of a procedure, up to and including regret. so to say that doctors are risking their jobs by providing informed consent seems to me to be a strange claim to be sure, unless there's a jurisdiction where doctors can get slammed by it regardless.)

I'm honestly considering SRS if there enough cash after a year of being on hormones and being FT over say FFS, trache shave ect.   A yeah being fulltime on hormones, is going to be like the blink of an ey with all the growing and learning keeping me distracted from the other bits i hate.  I'm betting my priorities will likely changed during that time too with regard to my transition.  For SRS i dont think being a year fulltime and on hormones is much to ask to be honest.  For hormones, informed consent should be enough. Hormones are mostly reversable easily,  and  as long as its safe for you to be on them(and sometimes even if it isnt, if things are that bad).
Title: Re: Informed Consent SRS
Post by: Tristan on December 03, 2013, 12:55:40 PM
as Morpheus would say. there is always a way out of the matrix  8)
someone you know may have the answers
Title: Re: Informed Consent SRS
Post by: Jessica Merriman on December 03, 2013, 02:37:42 PM
Quote from: transtrender on December 03, 2013, 09:33:58 AMsometimes "slow and steady" is not what a patient needs. sometimes they need to get out of an extremely bad, dark situation as quickly as possible, due to the amount of pain it's causing.

Even if rushing puts them in a worse situation by not being adequately prepared?
Title: Re: Informed Consent SRS
Post by: Sophia Hawke on December 03, 2013, 02:40:56 PM
Quote from: Jessica Merriman on December 03, 2013, 02:37:42 PM
Even if rushing puts them in a worse situation by not being adequately prepared?

Worse than death?
Title: Re: Informed Consent SRS
Post by: musicofthenight on December 03, 2013, 03:27:04 PM
Someone who is a suicide risk I guarantee has problems beyond gender dysphoria.  No, I don't have any proof beyond pointing out that people in good mental health choose to live through unspeakably horrible things more often than you might think.

It would not serve this person to treat their body without also treating their mood disorder.  Yes, gender issues may be where it all began, but the bullying and, especially, self-bullying they've suffered are every bit as real and, by that point, have burned themselves into the basic chemical processes of their brain.

Can a person in psychiatric crisis really give informed consent anyway?

Assuming cost is no longer a barrier, I still think it's better to get that person into therapy, offer anti-depressants and HRT, out of crisis, and then SRS is an option.
Title: Re: Informed Consent SRS
Post by: Sophia Hawke on December 03, 2013, 04:24:40 PM
Quote from: musicofthenight on December 03, 2013, 03:27:04 PM
Someone who is a suicide risk I guarantee has problems beyond gender dysphoria.  No, I don't have any proof beyond pointing out that people in good mental health choose to live through unspeakably horrible things more often than you might think.

It would not serve this person to treat their body without also treating their mood disorder.  Yes, gender issues may be where it all began, but the bullying and, especially, self-bullying they've suffered are every bit as real and, by that point, have burned themselves into the basic chemical processes of their brain.

Can a person in psychiatric crisis really give informed consent anyway?

Assuming cost is no longer a barrier, I still think it's better to get that person into therapy, offer anti-depressants and HRT, out of crisis, and then SRS is an option.

I do agree therapy/hrt/ then later SRS.  I personally dont think anti-depressants are good and if anything should come after HRT unless the person has obvious mental illness.  I let my GD go for so long it became absolutely overwhelming and put me into a bad place.  I personally dont believe im capable of direct suicide under just about any circumstance. But indirectly, either through incredibly heavy drug use or some kind of self harm, yeah. I've def thought about removing certain parts i just dont want.  Being in transition though has given me a new lease on life, and thoughts are just thoughts for me, i know if ill really do something and will get help in that situation.

The thing is,if i thought for absolutely certain i wasnt going to get the help i needed, i wouldnt continue living in extreme misery.  I personally feel that some Symptoms are GID and GD are pretty difficult to sort out from the rest.  I also get the impression that alot of trans people commit suicide because they think they cant or wont get the help they need.  And to some degree, i personally believe that GID causes other problems that get worse the longer you let it go, and could go away with transitioning. And alot of stuff, is things you just have to work through instead of drugging it away. 

Before i started transitioning, i had crippling social anxiety.  I could barely speak to anyone in public or sometimes even move or think.  Now, that im transitioning, im working through that naturally by being out as my true self and working through it.  The people who dont treat me like a girl still bring out my anxiety and my GD(i know they are trying), But its a process and im growing up for the first time really.
For me personally, medications, are an option now for after ive naturally worked through stuff best i can(life is hard no doubt) and eliminated my GD(or at least as much as i ever can).  Then and only then will i put medications back on the table.

I do still also believe, a year dressing/hrt, is a good mile stone for SRS.   Isnt orchi something thats on the table before that though?  I also think, a first year on HRT, if you are trying to do everything you can do with your transition, there will be alot of non surgery stuff to deal with over that time.  Dealing with the social aspects alone can take years.  Make-up, clothes, presentation will also evolve bringing to a more "mature" you.

This is all from my perspective of course.  Everyone is different, has different feelings and needs different things.  A person who's ready to die would never go to informed consent, i just see the willfull self destruction as a general thing that gets done when people think they arent going to be able to get what they need. Also, basically all the informed consent doctors are at some point going to insist that your in therapy and that they either get a letter of some kind or have some contact with your therapist.  That was virtually all the informed consents ive looked up and it was alot.

This post is waaay long and drawn out and stuff.  Sorry about that.
Title: Re: Informed Consent SRS
Post by: musicofthenight on December 03, 2013, 07:39:19 PM
Just like a collapsed lung is a body health problem, suicidal and parasuicidal impulses and actions are mental health problems. 

I have stared down that particular monster - I don't know exactly how I avoided it, but I had some creative and respectably practical ideas for a school murder-suicide.  It's not something I want to talk about - there are people hurting enough to actually do that crap who shouldn't be given ideas - but I thank God I didn't develop the will to execute them.

But I do wish someone had noticed.  Nobody believed I was unhappy, and after a few years I stopped believing my own feelings.  Still struggling with that part today.



I do not mean anything disparaging or - worse - dismissive by this, but in this world it's hard to be trans-anything without sustaining injury from the internal and external stresses.  Mental health concerns are par for the course; this does not make anyone's gender identity any less valid.  It does mean we're all (to some extent) crazy here.

Is it too hard to get approval for SRS?  Yes, I think so, especially in publicly-funded healthcare.  (Privately-funded has the equivalent problem of paying for it - both are problems of managing scarcity.)  On the other hand, try getting your gallbladder removed on self-diagnosis alone, try to pay for it.  Heck, even your appendix.  The policy ain't right, but it is more-or-less consistent with how other surgeries are managed. 

Well, except some cosmetic procedures, ones that don't involve remapping tissue without destroying sensation, or general anaesthesia and weeks to months of recovery.


If someone says "I need X or I'll kill myself," there is a good chance they in fact need X - but they also must not threaten self-harm as a bargaining tool.  The world is cruel and might just call the bluff, plus that tactic is darn hard on relationships - it's ultimately a bad strategy for getting what you need.
Title: Re: Informed Consent SRS
Post by: GendrKweer on December 03, 2013, 11:39:34 PM
A few thoughts from someone who has had SRS, and made a bit of a stink about the definition of RLE and what it means to "live as a woman":

1) I had SRS with Dr Suporn a year and a half ago. Went great, highly recommend him, etc. He required one letter, and then his psychologist interviews you also. I get the impression that he is willing to do the op without any letters, just having his own guy talk to you the day before. Not very professional IMHO, but it is worth asking Sophie about. (She is his email liason, and gets some inexplicably bad reviews here, but I can tell you she's sweet as pie as long as you are respectful, in my experience. And yes, I went back recently for a cosmetic revision, which she also arranged, just as nicely).
2) I am sure there are others who would do this, but Suporn is one of the best two or three in the world. The rest I have heard might end up doing poor, irreversible work. Don't skimp on SRS, even if it means waiting longer to save up! Some of the stories on here are amazing, and terrible.
3) Being on HRT is a wonderful thing. I was on HRT for two years. BUT I had a different definition of what it means to be a female. So I took great issue with the so called real life requirement. For a lot of people, however, it is not a bad thing, simply because although you can sort of drag as a male once the surgery and hormones are done, you won't want to (and in some cases, won't be able to after a while; hormones are lovely things, not to mention silicon breast implants:) If you have a conservative job you must retain, or family, or live in Emirates or something, there might be reasons to remain in stealth. It should be your choice alone. Luckily, the rules were recently relaxed/rewritten allowing for you to not have RLE as long as you have a very good reason for not doing so. There are a few online therapists who are excellent who understand this and will help you even over skype. I don't want to get flamed for being to specific, but there is one in Boulder, Colorado who is excellent, and one in Denver Colorado who is most certainly not. PM me if you are in those areas and I'll happily share.

Either way, you shouldn't have any problems getting the surgery. The problems however might arise after the surgery, if you either have gone to a cut rate doctor, or haven't mentally prepared yourself for what you're in for.
Title: Re: Informed Consent SRS
Post by: Marissa on December 04, 2013, 12:01:32 AM
Thanks, D.  I'm glad you posted that because I've been looking into the different surgeons and their techniques and I was just saying today that I like Suporn's method.  I don't have a problem with the letter requirement except philosophically. I just hope it doesn't take too long.

I guess those who said not to go with a questionable surgeon got through to me and I've decided to go with an accomplished doctor.

I'm still looking but Suporn currently at the top of the list.

Thanks, everyone!  :)