Author Topic: Ridiculous Gate-keeping Requirements???  (Read 501 times)

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Offline NotSoNew

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Ridiculous Gate-keeping Requirements???
« on: January 20, 2020, 11:12:12 pm »
I've been looking at myself in the mirror lately, happy with how things are starting to come along, but I'm starting to feel more and more like I need to get my bottom surgery started. I've always wanted meta, and from what I'm finding online, it looks like Dr. Crane will be my best option (which would also be my first time leaving the East Coast, so that aspect is kinda intimidating to me, as I have no idea what cross-country travel might be like).

That aside~

From the looks of it, I need to have 2 separate mental health professionals sign off that I'm ready for surgery.

The thing is, I don't go to therapy or anything. I've got absolutely no need for it, therefore, why would I waste my time? The only time I've ever gone was in order to fill the requirements of 5 sessions that were pushed on me before I was allowed to take hormones, and I hated every single moment of it. My therapist even sent me home early each session 'cuz she agreed that it wasn't necessary, I obviously needed this, and therapy wasn't going to do anything more for me.

My top surgery didn't require any of that nonsense. I just went in, told them I need it done, and they're like, We believe you, and we'll help you! Why is bottom surgery different?

I've wanted this literally my entire life, I've even been set on the same meta results that I had initially picked out back in high school (over 10 years ago). Plus, I started transition 4 1/2 years ago, and the only time I stopped hormones was due to financial troubles. I'm well into adulthood, I can make my own decisions, so why am I not allowed to just request this on my own desires?

I'm so annoyed and frustrated. Not only is therapy not for me, but I feel violated in a sense being forced to undergo something so personal. But it's just ok for them to require this, like it's not going to be a huge waste of my time/money/sanity???

And why do I need to see 2 mental health professionals??? Shouldn't that only be the case if the first one is horrible, and you want to switch doctors??? WHY IN THE WORLD would I need a therapist, and a side therapist? AS A REQUIREMENT.

I'm gonna try calling them tomorrow for information, but this just has me so upset. I have a lot of health issues, and it's actually really difficult for me to maintain a private life outside of work, so the idea that I need to expend even more time and energy that I don't have in order to do something that won't accomplish anything and shouldn't be required in the first place is...just killing me right now.

All of this on top of having to get a SECOND top surgery, since they started growing back, and I absolutely cannot live like this....my surgeon's office has never even experienced this before, so that's cool...

I haven't had such a strong desire to get murdered in quite a while.........

Offline Ryuichi13

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Re: Ridiculous Gate-keeping Requirements???
« Reply #1 on: January 21, 2020, 12:24:54 am »
Honestly, I've not heard of needing two therapist letters before.  Usually its a letter from your therapist and one from your PCP.  Yes, its gatekeeping, but I also think its because people are still under the impression that "if you're trans, there's something mentally wrong with you, so we want to make sure you're okay with permanent results and won't sue."  Stupid way of thinking, really.   

I'm also interested in having meta, so I'm going to subscribe to this thread.  Keep us up to date on what happens, okay?  I hope things work out for you.  Stay strong!

Ryuichi   
"Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind." - Dr. Seuss




Offline Pammie

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Re: Ridiculous Gate-keeping Requirements???
« Reply #2 on: January 21, 2020, 05:16:36 am »
Honestly, I've not heard of needing two therapist letters before.  Usually its a letter from your therapist and one from your PCP.  Yes, its gatekeeping, but I also think its because people are still under the impression that "if you're trans, there's something mentally wrong with you, so we want to make sure you're okay with permanent results and won't sue."  Stupid way of thinking, really.   

I'm also interested in having meta, so I'm going to subscribe to this thread.  Keep us up to date on what happens, okay?  I hope things work out for you.  Stay strong!

Ryuichi
Not having gatekeeper processes seems very dangerous to me. There are many people who rush into things when they are actually either too early into the process or are actually not as clear or informed as they think they are!
Also, almost everyone believes they are very clear thinkers, totally objective and absolutely do not need therapy - in reality many of us really do need therapy to get clarity and options (I know I did)
It does the trans community a lot of harm when we can be accused of the whole thing being an uncontrolled anarchy
Just my view
I’m not suggesting the current process in any particular-country is anywhere near perfect though


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Offline Devlyn

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Re: Ridiculous Gate-keeping Requirements???
« Reply #3 on: January 21, 2020, 05:51:13 am »
I've been looking at myself in the mirror lately, happy with how things are starting to come along, but I'm starting to feel more and more like I need to get my bottom surgery started. I've always wanted meta, and from what I'm finding online, it looks like Dr. Crane will be my best option (which would also be my first time leaving the East Coast, so that aspect is kinda intimidating to me, as I have no idea what cross-country travel might be like).

That aside~

From the looks of it, I need to have 2 separate mental health professionals sign off that I'm ready for surgery.

The thing is, I don't go to therapy or anything. I've got absolutely no need for it, therefore, why would I waste my time? The only time I've ever gone was in order to fill the requirements of 5 sessions that were pushed on me before I was allowed to take hormones, and I hated every single moment of it. My therapist even sent me home early each session 'cuz she agreed that it wasn't necessary, I obviously needed this, and therapy wasn't going to do anything more for me.

My top surgery didn't require any of that nonsense. I just went in, told them I need it done, and they're like, We believe you, and we'll help you! Why is bottom surgery different?

I've wanted this literally my entire life, I've even been set on the same meta results that I had initially picked out back in high school (over 10 years ago). Plus, I started transition 4 1/2 years ago, and the only time I stopped hormones was due to financial troubles. I'm well into adulthood, I can make my own decisions, so why am I not allowed to just request this on my own desires?

I'm so annoyed and frustrated. Not only is therapy not for me, but I feel violated in a sense being forced to undergo something so personal. But it's just ok for them to require this, like it's not going to be a huge waste of my time/money/sanity???

And why do I need to see 2 mental health professionals??? Shouldn't that only be the case if the first one is horrible, and you want to switch doctors??? WHY IN THE WORLD would I need a therapist, and a side therapist? AS A REQUIREMENT.

I'm gonna try calling them tomorrow for information, but this just has me so upset. I have a lot of health issues, and it's actually really difficult for me to maintain a private life outside of work, so the idea that I need to expend even more time and energy that I don't have in order to do something that won't accomplish anything and shouldn't be required in the first place is...just killing me right now.

All of this on top of having to get a SECOND top surgery, since they started growing back, and I absolutely cannot live like this....my surgeon's office has never even experienced this before, so that's cool...

I haven't had such a strong desire to get murdered in quite a while.........

Big hug!

Two letters is pretty much standard procedure. Who writes them depends on the circumstances. From the WPATH Standards of Care:

Referral for surgery
Surgical treatments for gender dysphoria can be initiated with a referral (one or two, depending on the type of surgery) from a qualified mental health professional. The mental health professional provides documentation - in the chart and/or referral letter - of the patient's personal and treatment history, progress, and eligibility. Mental health professionals who recommend surgery share the ethical and legal responsibility for that decision with the surgeon.

One referral from a qualified mental health professional is needed for breast/chest surgery (e.g., mastectomy, chest reconstruction, or augmentation mammoplasty).
Two referrals - from qualified mental health professionals who have independently assessed the patient - are needed for genital surgery (i.e., hysterectomy/salpingo-oophorectomy, orchiectomy, genital reconstructive surgeries). If the first referral is from the patient's psychotherapist, the second referral should be from a person who has only had an evaluative role with the patient. Two separate letters, or one letter signed by both (e.g., if practicing within the same clinic) may be sent. Each referral letter, however, is expected to cover the same topics in the areas outlined below.


I was a happy, well adjusted, confident, genderfluid being, and told my PCP I didn't want, nor felt that I needed therapy. She set me up with two appointments, the first with a therapist, the second with a psychiatrist. Both were 45 minute sessions a week apart. Both were easy peasy discussions of where I had been in life, and where I was headed in life. Both resulted in a surgery referral letter.

You can rail against the system, or you can roll with it. I see in your earlier posts that you don't pay for insurance. I was paying for mine, and the letter appointments weren't covered, so each one cost me an extra $155. Between premiums and deductibles, my surgery cost me $12,500. Roll with it, grasshopper, roll with it.  :)

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Offline Rakel

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Re: Ridiculous Gate-keeping Requirements???
« Reply #4 on: January 21, 2020, 07:02:12 am »

From the looks of it, I need to have 2 separate mental health professionals sign off that I'm ready for surgery.

The thing is, I don't go to therapy or anything. I've got absolutely no need for it, therefore, why would I waste my time?

The gatekeeping today is not nearly as bad as it was 50 years ago, when I first considered transitioning. Many more hoops to jump through back then and to make matters worse, the psychological counselors were totally clueless. They had no idea about what was going on in my head. They were operating under false assumptions and caused several suicides by blocking someone who needed help and was denied.

The therapists letters today are just to make sure that you are of sound mind and can make your own decisions that you can live with for the rest of your life. Believe it or not, there are people who have unrealistic expectations and will blame others for their own questionable decisions.

You seem to know exactly what you are doing and quite similar to my own decision process. I just went into my therapist office, sat down and told them what I was dealing with and what I intended to do about it.  With just a few visits, they both agreed that I was fully aware of the consequences, good and bad, of transitioning. Then they gave me my letters and I said thank you and the next stop was to my surgeons office.

My advice is, just do it and get that requirement past you.





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Offline Ryuichi13

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Re: Ridiculous Gate-keeping Requirements???
« Reply #5 on: January 21, 2020, 10:50:50 am »
I still think of it as gatekeeping. 

You can have your tubes tied, have massive amounts of silicon injected into your lips or your boobs or butt enhanced to ridiculous sizes, and not need letters from anyone, yet if you want your genitals altered in any way, you basically need to have "notes declaring that you're not crazy." 

Sure, there are those of us that may rush into it, and that is their decision, but making anyone other than the transgender community need these kind of letters, when there is no other segment of the cis community that needs such letters for any kind of surgery is still gatekeeping.

Thank you all for this discussion, it really has made me think.

OP, I agree with the others.  For now, if you want your surgery, you will have to pass through the gates set up by WPATH.  Sure, we're not crazy for needing this potentially life-saving surgery, but for now, cis society may think that we are.  And because we have to live in this country, it is a step we must undergo, no matter how humiliating it may be.

I wish you the best of luck, either way you decide to go.

Ryuichi

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Offline NotSoNew

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Re: Ridiculous Gate-keeping Requirements???
« Reply #6 on: January 21, 2020, 12:01:59 pm »
"Gate-keeping is for the safety of the community."

The fact that I could literally walk into a tattoo studio and have the word "f****t" tattooed on my forehead without needing a mental health professional's signature, I could get a hundred plastic surgeries and literally ruin my body in every way imaginable, and any regret would fall onto the person consenting, BUT I can't be trusted to make a decision about this single surgery simply because of the trans identity?? That. Is. <not allowed>.

It's similar to the way they don't allow women to have hystos unless they are over 26, "in case" they change their minds about having kids (the only exceptions made are if a doctor can PROVE that it needs to come out ASAP). We don't get full rights over our reproductive organs, despite it not being anyone else's business, frankly (at least women get full rights over their parts once they hit 26, though).

It's the idea that my words, my experiences, my feelings aren't valid on any level...unless it's coming out of the mouth of a middle-man. How is that not nonsense???

Listen, I get that gender within our minds is muddy at best, and a lot of people do rush into things that they later regret. That's literally the point of informed consent. And people who make these decisions have no right whatsoever to pass the blame of their bad choices onto people who were trying to help.

I understand if they don't want to operate on someone if they are underage, or even someone under 21, I get it, whatever.

But there is NO logical reason to prevent a 30 year old man from getting a penis.

Informed consent should be all that's required for adults.

I've been trans my whole life, I came out at 17, been going by a male name for 7 years, been on hormones for 4-5 years, top surgery 4 years ago (and again, so certain on my identity that I'm going to have to pay for a SECOND top surgery)....NONE of this matters unless I've said it to someone in the mental health field first??? And then there's the fact that they would have to agree that they believe me, which is something I worry about not only because of the area I live in, but because my first hormone prescribing doctor lied all over my charts and made up a bunch of LIES to prevent my transition. And THAT is specifically why this kind of gate-keeping is NOT ok/ fair practice.

And I know people like to say that therapy is good for everyone, but that's not the case, so don't push your ideals onto me. I was forced to see a therapist before starting hormones the first time (again, another way they tried to keep me out of transition -- YES, at a transgender-specializing clinic, no less!) My therapist AGREED that I had no reason to be there, she always cut our appointments short because there was nothing to talk about, and my last hour-long session was only 20 minutes long, because we both felt it a waste of time in my case.

I think a lot of people should see therapists? I think it should be pushed onto people in transition. But I on no level think it should be REQUIRED. If a person isn't receptive to therapy, it isn't going to help anyway. Ergo, Waste. Of. Time. Sanity. Money.

Y'all can roll over and look the other way, but gate-keeping in this aspect is just another way to reinforce the idea that being transgender is a mental health issue. It is not. We're not all basket-cases, we're not hormonally swayed in our decision-making, we're not all suffering from an identity crisis.

I know who I am. I know what I want my body to look like. I want to be able to just sign my name, hand over my money and get it done. I don't need someone going through my life story with a fine-tooth comb, looking for signs that I might not be who I say I am.

And I realize that things used to be worse, and I'm glad for all the progress that has been made in recent years. But that still doesn't change the fact that people endlessly continue to stand in our way and ask us to bare our entire selves just so that they can say, "I believe you."

Cis men and women don't have these requirements for genital surgery. It's literally just transgender folks. And as long as medical professionals keep up these walls of requirements, hoping to keep out as many people as possible, the world will continue to look at us as having "mental disorders".

Offline NotSoNew

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Re: Ridiculous Gate-keeping Requirements???
« Reply #7 on: January 21, 2020, 12:22:25 pm »
I was a happy, well adjusted, confident, genderfluid being, and told my PCP I didn't want, nor felt that I needed therapy. She set me up with two appointments, the first with a therapist, the second with a psychiatrist. Both were 45 minute sessions a week apart. Both were easy peasy discussions of where I had been in life, and where I was headed in life. Both resulted in a surgery referral letter.

You were able to get a referral after just one appointment??? They made me go to 5 appointments just to get on hormones, at a friggin' INFORMED CONSENT clinic. And the people in this area are incredibly ignorant to transgender issues. So I can't imagine they would give me a letter anywhere near as easily, and I have genuine concerns of getting paired with a doctor who isn't willing to and has no intentions of giving a letter of approval. My first hormone doctor put on a smile, pretended she was trying to help me for years, but really, she was underdosing me on hormones and lying in my paperwork in order to prevent my transition.

If anyone's wondering why I'm so frustrated about this, it's because people left and right get access to all this stuff so easily, but for some reason in my case, every single aspect of life is <pooing> on my transition. The only people in the entire process who've truly been on my side is my top surgeon's office, where I also get my hormones now. And guess what? I don't feel like I'm transgender when I walk in there. I feel just like an average person.

THAT'S how it should be.

But no, here I am, forced to undergo something unnecessary. I have to pull my luck and hope I don't get some secretly transphobic doctor who has no intentions of giving approval from the start. I could potentially see someone for months and they can just decide, No, I'm not gonna do this for you. (Again, not talking out my arse, it's literally been my first-hand experience in the past.)

There are transphobic doctors, there are doctors who don't believe that gay transmen are real, there are doctors who just want to milk all the money out of you that they can with unnecessary appointments. My experience with every kind of doctor thus far in life has been HORRIBLE, they're basically all narcissists with inflated egos, and the only reason they got into medschool is MONEY. And these are the people actually standing at the gates, deciding who gets let into the Land of the Valid. And THAT is why I'm so worried/frustrated/ready to yeet myself off a cliff.

Offline Dex

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Ridiculous Gate-keeping Requirements[emoji47]
« Reply #8 on: January 21, 2020, 01:51:56 pm »
I get it, my dude.

It is frustrating. I had my meta (stage 1) done by Dr Crane and my stage 2 done at Crane’s center by Dr Santucci.

I, too, had been dressing as male pretty much since I could verbalize my own style choices. I came out to my (now) wife about a year into our relationship (we’ve been together 13 years now), started formally transitioning through hormones 6 years ago (my informed consent doc did also require 3 months in counseling which was only 3 sessions), had top surgery 6 years ago, had a hysterectomy/oophorectomy 4 years ago, and then decided on meta 2 years ago.

I went as a cash pay patient (I work in catholic healthcare, they cover none of my transition related expenses) and Crane’s office did require one letter from a therapist for me. I know the requirements are far more strict if you are attempting to use insurance to pay for the surgery. I do believe insurance requires two letters in order to pay for it.

I was able to do my consult with Dr Crane before needing the letter. I only had to have it submitted at least a month prior to my surgery date.

For my one letter, I asked Dr Crane’s office if they had recommendations as I wasn’t currently in the care of a mental health professional and hadn’t been for some time. They gave me a few places that did online/phone consults in order to evaluate you from the WPATH perspective. I chose one and had one visit over the phone. It was a cash expense for me, but was easy and painless. She wrote me the letter and that was it.

If you’re going through insurance, the letter requirement may be an insurance requirement and not the doctor’s requirement. It may also be more restrictive on where the letters come from. I could go on all day about insurance and how they will try to get out of paying anything they can. That’s the nature of their business.

I know it is frustrating. It’s also easy for me to say all this now on the backside of going through it all. I’m about 1.75 years post stage 1 and just short of a year post stage 2. I know there was a ton of anxiety for me leading up to the surgeries to make sure everything was perfect, that I’d completed everything from letters to travel plans to budgeting and paying for the surgery out of pocket. I get it. It’s stressful. But control the things you can and play the game when you have to. I guarantee you the end result is worth it despite all the stress and the anger. Is it right? No... it’s not. But it is what it is and just about every bottom surgeon I researched in the US had some sort of letter requirement (not to mention if you’re going through insurance the requirement isn’t often up the the provider).

Yes, it’s hoops you have to jump through. Yes, it can be stressful. One step at a time.

With that being said, I am 100% happy with my decision both to go with meta and to go with Drs Crane and Santucci. I had a great outcome and I’m very happy with how it all went. Their office was great to work with and I felt very cared for.

I may pursue a small touch up surgery at some point in the near future for a couple minor aesthetic things I’d like dressed up but, overall, super super happy with the outcome.

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