Therapist vs psychiatrist

[AbraCadabra]

Hi all,
I had mentioned MY "gate-keeper" (SA) earlier on and finally took a more close look at his last report I requested. (First one was just a load of rambling, quite pathetic and embarrassing for him, IMHO)
You may recall I'd asked the SBAH "gender team" at that meeting to consider "inversion" rather then colon-section (turns out they not experienced so simply refused, and send my hiking... either have your belly cut 12" and shut up, or you too old, etc.)

Following all this I then got "GIDNOS" (Gender Identity Disorder Not Otherwise Specified) pinned on in the 2nd letter by this guy... because: I was *not enough cross-dressing* and *had insufficient fantasies* at an earlier age, sort of in my 30s and 40s? and that I was *too old* (64)

Told them they can stick it in "file 13" (rubbish bin).
Before that altercation at the hospital about not wanting their only "policy-procedure" offered, "colon-section" I was his guys best transitioner! How thing can change, eh.

Having had spend some quality sessions with my psychologist (in parallel with the psychiatrist, I had an inkling) none of these funnies, GIDNOS, etc. came up what so ever.

Any one to comment?
Axelle

[Stephe]

Hi all,

Before that altercation at the hospital about not wanting their only "policy-procedure" offered, "colon-section" I was his guys best transitioner! How thing can change, eh.

Any one to comment?
Axelle

This parallels my experience. First session was short and seemed pleasant. She said something like "I think your ready for HRT" near the end but no letter forth coming. She set up another visit. During this second one I mentioned that I feel like -I have to get her permission to do this- and suddenly the whole thing changed.  She became short and almost to the point of being rude. They ask us to speak our minds but then punish us if we say something they don't like. Honestly, it felt like I was back in grade school. They have a -very- limited viewpoint on what is the "correct" behavior from a transgendered person and we are as varied as the population is. Some people don't realize they have gender issues till later in life. They have been there, they just didn't recognize them for whatever reason. Being a gender variant 20 years ago was NOT something that was openly tolerated or accepted.

Times have changed a lot and I'm happy for future generations that this will be easier for them to deal with. But until we change this whole "Standards of care" crap to informed consent, this gatekeeper problem is going to continue..

[Stephe]

I do not ever recall posting how much i love the standards of care...if you can link some of my posts where I said I am for the standards of care or that i declared we are a mental disorder, then I would love to see it.

While i do not love the standards of care and hug it to bed every night, I have no quarrels against it. If it goes away or if it stays, I could really care less. I guess that would make me in the middle of it all. With that said, I think the standards of care actually helps weed out those who are truly suffering from GID and those with a multi personality disorder. Hate me if you must, but I met a lot of men and women who thought they were trans and it ended up being something else entirely other than trans related issues in their lives.

Define "a lot"? I don't know a lot of transgendered people, much less a lot who thought they were trans but had something else.There are VERY few people who actually have MPD. This is the same excuse the medical community uses for continuing their behavior. Your arguments here are strongly defending the WPATH.

If someone can't transition without a therapist, no problem, go see one. Some people can't leave their house without therapy, doesn't mean I should have to have therapy for ME to leave mine. The fact YOU needed the help of a therapist to do this is meaningless to this discussion.

BTW you asked for past example of your support of DSM, I saw this and seemed to be a pattern of support for the continuation of this nonsense. Again maybe you can share the "MANY PLACES" that cover this now? It's my understanding at least in the US it is almost universally NOT covered by any insurance plans anymore.

https://www.susans.org/forums/index.php/topic,100760.msg750474.html#msg750474

[Stephe]

""They do not refuse hair removal to men.""

The first place I went for a consultation told me they won't do it without a therapist letter and they also said they do a lot of trans women and "know about this". Actually they had a lot of positive feedback online from various transwomen as being a good place to go and were "understanding". I guess you can call me a liar if you'd like I can only post from my personal experience.


""SRS, though, is another story. It implies the destruction/modification of healthy organs without a medical reason. One of physicians' primary guideline is "do no harm" and, without a medical reason, they should not do something that would harm the patient more than it will help them. Without any diagnosis (without a problem), however, medically speaking, SRS is removing the patient's fertility and, to some extent, removing some possibilities from them.""


So please explain how having a vasectomy or a tubal ligation doesn't fit this same description?  I can freely go have a invasive procedure to make me sterile (informed consent) but require extensive therapy and be declared "having a mental disorder" letter to do this another way?


""Theorically, this does not apply to breast augmentation, as no definite harm is done to the body in the procedure and the body keeps all of its functions intact. The person is merely exposed to consented, limited risks, and this does not justify its being blocked. If it did, all purely cosmetic interventions would be blocked.""

But again, the same WPATH nonsense is applied. And MANY women would argue your "no definite harm is done to the body in the procedure" point. And how does HRT not fit "The person is merely exposed to consented, limited risks" yet it has this same WPATH nonsense blocking it as well.

""Apart from that, if no diagnosis justifies an intervention such as SRS, it will logically be regarded as facultative and purely cosmetic, just like botox injections. This poses serious insurance issues.""

So who exactly in the USA still covers SRS under health insurance today?

http://www.tsroadmap.com/reality/insurance.html

"This is usually the hardest to get covered. Many policies specifically exclude SRS.

A little background: SRS was routinely covered in the US until a couple of medical articles came out in the late 1970's showing high suicide rates among post-operative women. This came at the same time a couple of prominent gender clinics were closed, notably Johns Hopkins.

The insurance companies pounced on these events as a chance to decry the procedure as elective, cosmetic, or experimental."

[Annah]

Define "a lot"? I don't know a lot of transgendered people, much less a lot who thought they were trans but had something else.

I do lectures/guest speaking on human sexuality and human gender studies and I would say about 30% of people who labeled themselves as "transsexual" told me that through therapy they realized they had other issues that were creating a secondary characteristic of transsexualism. And when they started their transition they were just as sure of it as you are as sure of yourself.  You say, "fine, let those who need therapy get it but still take it out" well, many of these people would have never sought out therapy to transition and then their true underlying issues would have never surfaced until it was too late.

To me, 30% is a lot of people if WPATH did not exist to have had genital reconstruction surgery.

WPATH is not some major evil organization designed to suppress us. True, there are some therapist and doctors who "milk" the system and abuse it but WPATH is designed to help us ease into this transition.

You may brag that you can do this all by yourself and that is your right, but do not dismiss the other men and women who really need the support group and guidance to get them there.

[Annah]

So who exactly in the USA still covers SRS under health insurance today?

http://www.tsroadmap.com/reality/insurance.html

"This is usually the hardest to get covered. Many policies specifically exclude SRS.

TSroadmap is antiquated. Andrea's srs insurance page hasn't been updated in 5 years.

Here are companies today that includes SRS:

Coca Cola
Campbells Soup
Walt Disney
State of Conn. Teacher Association
The Government of Louisana
HRC
Johnson and Johnson
Aetna Insurance (private plan)
AmeriHealth
Anthem Blue Cross Blue Shield
Blue Cross Blue Shield for:
Massachusetts
Minnesota
Michigan

Ameriprise Financial Inc
Avaya Inc. 
Barclays Capital
Bingham McCutchen LLP
Booz Allen Hamilton Inc.
Cardinal Health Inc.
Chrysler LLC
Cisco Systems Inc.
Clifford Chance US LLP 
Covington & Burling LLP
Cummins Inc.Deloitte LLP
Deutsche Bank
Diageo North America
DLA Piper
E. I. du Pont de Nemours and Co. (DuPont)
Eastman Kodak Co.
Ernst & Young LLP
Exelon Corp.
Faegre & Benson LLP
Food Lion LLC
Ford Motor Co.
Fried, Frank, Haris, Shriver & Jacobson LLP
Genentech Inc.
General Motors Corp.
Google Inc.
Herman Miller Inc.
Intel Cigna
International Business Machines Corp. (IBM)
Katten Muchin Rosenman LLP
Kimpton Hotel & Restaurant Group Inc.
Kirkland & Ellis LLP
KPMG LLP
Kraft Foods Inc.
Latham & Watkins LLP
Littler Mendelson PC
Marsh & McLennan Companies Inc.
McGraw-Hill Companies Inc., The
Microsoft Corp.
Morrison & Foerster LLP
Nike Inc.
Northern Trust Corp.
PG&E Corp.
Pillsbury Winthrop Shaw Pittman LLP
Replacements Ltd.
Robins, Kaplan, Miller & Ciresi LLP
Shearman & Sterling LLP
Sonnenschein, Nath & Rosenthal LLP
Sun Microsystems Inc.
Sutherland Asbill & Brennan LLP
White & Case LLP
Yahoo! Inc.

Cigna Private plan
Emblem Health
HealthNet
Health Partners (Minnesota)
Medica

University of Pennsylvania
Penn State
Goldman Sachs
Bank of America

City and County of San Francisco
IBM
AmEx
AT&T
Wells Fargo
Eastman Kodak
Sears
Morgan Stanley
Price Waterhouse
State Farm

New York Life Insurance
Angell Palmer and Dodge Law Firm
City of Berkley

And about 40 more companies are thinking about adding srs to their policies in Jan of 2012...so give me a few more months and Ill expand that list for you.

You take WPATH out of DSM and all these companies will have to take SRS out of their policies.

The insurance companies pounced on these events as a chance to decry the procedure as elective, cosmetic, or experimental."

If you get want you want by taking WPATH out of the picture, then the insurance companies dreams will come true to have it as elective, cosmetic, or experimental.

Again maybe you can share the "MANY PLACES" that cover this now? It's my understanding at least in the US it is almost universally NOT covered by any insurance plans anymore.

You are incorrect.

[A]

About your experiences with refusal of procedures, SRS excluded, on you, it is not about the SoC. It's about a bad interpretation of them by local legislators and/or enterprises. In a court, they would have no valid argument against you, unless your place's law is badly written.

About vasectomy, it is contraception and the only thing it deprives the patient of is the ability to procreate, without affecting hormone production or sexual capacity or posing serious risks. Physicians do not consider they do arm this way, as accidental procreation could end up in avortion or a bad life for a child. Plus, a vasectomy is (even though people don't usually do it) theorically reversible. It's just cutting a couple tubes.

I don't know about the US, but quite a few countries worldwide spend tax money on this, and they certainly wouldn't if it were not medically justified.

[Taka]

And until we know better, transsexualism is a condition that causes a generally high degree of discomfort and requires a medical intervention for its effects to be negated, partially or entirely. And no physical anomaly has been found. Therefore, unless another cause is identified, it is a mental disorder.

actually, physical anomaly has been found in several studies. just look up "causes of transsexualism" on wikipedia, the references seem to be good in that article. the anomalies that have been found suggest that transsexualism might be a form of intersex rather than a mental disorder, as the brain and genes are physical and measurable parts of the body

[Annah]

actually, physical anomaly has been found in several studies. just look up "causes of transsexualism" on wikipedia, the references seem to be good in that article. the anomalies that have been found suggest that transsexualism might be a form of intersex rather than a mental disorder, as the brain and genes are physical and measurable parts of the body

The articles and studies are great but they need a lot more research and work for it to be considered conclusive by various Medical Journals.

However, the research looks promising.

Now, to play devil's advocate (I have to...Im a Divinity student LOL):

Let's say these studies become conclusive and proof for a physical inheritance trait among transsexuals. Now, what would happen to the person who calls themselves transsexual, are firmly convinced they are transsexual and just know beyond a shadow of a doubt they are transsexual. What if these tests are done on that person and it shows, physically, they have no transsexual traits that were considered standard by those physical tests?

Would she still be considered transsexual?
Would her insurance company still pay for her treatments?

[A]

In that case, Annah, it would mean the studies were not as conclusive as they were supposed to be, and if enough cases appear, more studies will have to be done because the found cause was not obviously the only one, OR another "illness" that causes similar symptoms will have to be identified, or the person may have another problem, which will have to be identified.

[Taka]

@annah: thank you for writing that. i'm thinking the same thing myself actually, it's just such pain to write it out, and you even did it better than i could do..

it would be a shame if they became conclusive proof, but i think they should still at least be taken as an indicator that there may be biological causes for ->-bleeped-<-, and that this therefor needs to be studied by more than just psychologists in order to find the best possible medical treatment for all the different variations, and not only those who are strictly transsexual and in need of full srs (as the situation is in many countries). and perhaps also be classified as something other than a mental disorder (but still something that might have to be treated medically)

[AbraCadabra]

Anna,
good information but the US is not the rest of the world where some of us happen to live also. Yet WPATH is for the rest of the world, and it manifold interpretations also due to the differing country's laws.

I do see your *local* (US) argument, yet NOT ONE single company in SA would pay for gender therapy neither does ANY of the medical aid providers. Period. IT IS ALL DUMPED INTO THE SAME SLOT AS e.g. BA, cosmetic surgery...

BTW, Europe is even more tight wrapped then SA – or fancy like to have 3 years RLE with no HRT? Be my guest, honey!

Food for thought,
Axelle

[AbraCadabra]

Sorry one more though, please indulge me.
If things are so great in the US with so many companies, and medical health care providers paying for SRS and HRT ---- how come that about 80% of "us" are pre- or non-op and so many stating they can't afford the $$$?
Somehow that doesn't fit. Or are all those unemployed or working for the wrong companies, having the wrong medical provider, hey?
Companies used to ask females if they were pregnant before they got the job --- now they'll ask if you are pre- or non-op by any chance...? Be interesting to follow this lot.
Axelle

[jamie nicole]

Sorry one more though, please indulge me.
If things are so great in the US with so many companies, and medical health care providers paying for SRS and HRT ---- how come that about 80% of "us" are pre- or non-op and so many stating they can't afford the $$$?
Somehow that doesn't fit. Or are all those unemployed or working for the wrong companies, having the wrong medical provider, hey?
Companies used to ask females if they were pregnant before they got the job --- now they'll ask if you are pre- or non-op by any chance...? Be interesting to follow this lot.
Axelle

Personally, I'm going to Thailand and have paid out of pocket for everything.  I wouldn't say things are great in the US but there is definitely and increasing level of tolerance and understanding which is why more and more are offering selective procedures under healthcare plans

[A]

Axelle, many companies may pay for SRS, but you have to keep in mind that most Americans (was it 80%? I need to see Sicko again) have no insurance whatsoever, and even though I know little about it, I SERIOUSLY doubt the new state insurance covers this. And most health insurance companies, if not all, will constantly try to avoid covering something they should be covering by invoking weird reasons. I saw a woman who would have died of her cancer because of her insurance company if a bank had not lent her the money to pay for treatment. (The same movie.)

[AbraCadabra]

Thanks for that insight A.
It puts some of the earlier comments into perspective.
Also if I recall if all was quite so good as it came across in favour of WPATH et al, then Anna would not have her church to ask for donations, or would she?
I mean: so much for this gender insurance cover in your part of the world.

In ours (SA) we know exactly where we stand: YOU GET NOTHING, and ALL expenses, ALL, be out of pocket.

Exception? One only SA state hospital were you are used as a cancer training object, have to wait for years (3 or more), a protocol that takes 3 years or longer to complete, one off-putting visual result (oh my, have seen the original), a misplaced urethra (too far forward), a scar running from hipbone to hipbone, followed by never receding abdominal swelling, and a clit like an 8 year old boy's sticking out in an unremitting erection for ever, plus a stapled together sigmoid colon (staples stay inside you for ever) --- to boot 1 year plus gate-keeper interrogations with some idiot of a psych that dislike females. Plus additional interrogations at the gender team meetings preceding each of the 3 step ops involved. Welcome to the real world.

Hey, girls --- I would not have it. So got kicked out.
Anyone out there that likes to shout HERE may put their hand up --- its for free!
Get what you pay for... yep.
Gosh golly,
Axelle

[Annah]

Sorry one more though, please indulge me.
If things are so great in the US with so many companies, and medical health care providers paying for SRS and HRT ---- how come that about 80% of "us" are pre- or non-op and so many stating they can't afford the $$$?
Somehow that doesn't fit. Or are all those unemployed or working for the wrong companies, having the wrong medical provider, hey?
Companies used to ask females if they were pregnant before they got the job --- now they'll ask if you are pre- or non-op by any chance...? Be interesting to follow this lot.
Axelle

1. She asked about US companies. SO I provided information pertaining to US companies. Given time I can provide companies in other countries as well. However, since the question was directed at the United States, I provided the US list.

Furthermore, a lot of countries are global and the SRS benefits do extend to those outside of the US

2. Also your quote here:

If things are so great in the US with so many companies, and medical health care providers paying for SRS and HRT ---- how come that about 80% of "us" are pre- or non-op and so many stating they can't afford the $$$?

Because so many of the transgender people have NO idea where to look to get these services. Take Stephe for example. She was convinced that SRS coverage was universally not possible to be accepted in the US and their companies. I, in turn, showed a vast list of companies in the US that does have SRS and HRT in their policies.

So to answer your questions, how come that about 80% of "us" are pre on non op and so many stating they can't afford the money is because:

1. (not to sound rude) But they haven't been resourceful. Many of us just complain a lot without really being proactive. TS just assume no one will pay for it so then they just give up. I showed over 70 companies that accepts SRS...there are hundreds more that I do not know about and there are 40 more in the next four months that are adding it to their policies. People assuming there is no places to get coverages are just assuming.

My graduate degree is pretty much being paid for because I am transgender. I am getting my M.Div/Ph.D because I looked and found two scholarships that gives money to people who identify as transgender. I am sure many TS would have thought it was impossible to get a scholarship for being TS....much less going to a Seminary with it.

I have churches raising money for my Sexual Reassignment Surgery. Again, I am sure many TS would never thought to look for a church for help when it came to SRS.

So my answer is "resourcefulness"

Many girls don't know because they do not look. Again, outside of the US, I do not know, but the question was directed at the US so I had answered it within the realm of the US

[A]

Wow, Annah, you are very special. You should become a professional counselor. I personally didn't think it was possible to get such things. I was convinced the US was a hell where you cannot be taken care of if you cut your finger or study past high school unless you have a fortune because both cost just this, a fortune.

You are a magnificent example of surviving in an hostile land.

[jamie nicole]

Wow, Annah, you are very special. You should become a professional counselor. I personally didn't think it was possible to get such things. I was convinced the US was a hell where you cannot be taken care of if you cut your finger or study past high school unless you have a fortune because both cost just this, a fortune.

You are a magnificent example of surviving in an hostile land.

that's not true at all.  Many many Americans have insurance thru their employers.  Those who have retired have Medicare (insurance for the retired and disabled), all of the states have Medicaid, which is insurance coverage for the poor.  American hospital emergency rooms cannot deny you treatment if you have the inability to pay. 
The problem lies within the coverage of SRS and transgender care to which Annah has done the research to show which employers offer transgender health care in their coverage.  There is not a healthcare crisis in the United States, there is a healthcare "cost" crises. 

[Annah]

Wow, Annah, you are very special. You should become a professional counselor. I personally didn't think it was possible to get such things. I was convinced the US was a hell where you cannot be taken care of if you cut your finger or study past high school unless you have a fortune because both cost just this, a fortune.

You are a magnificent example of surviving in an hostile land.

Im kinda a glass half full girl. While I do realize there are many negative things going on in the US, I also recognize there are so many opportunities here. The key is to just research the hell out of everything.

If I just made my decisions by other trans who told me life was horrible and I would end up being homeless or a prostitute, I have no idea where I would have ended up.

But I refused to listen to those point.

I looked everywhere to find whatever I could to make the system best work for me. I learned a long time ago that vetting frustrations on a website, may be therapeutic at first, may still not change the situation you are in.

You just gotta go out there an explore your options. They are out there.