Informed Consent SRS

[musicofthenight]

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.

[Sophia Hawke]

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.

[musicofthenight]

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.

[GendrKweer]

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.

[Marissa]

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!