Shunning Medical Hoops, Transgender Patients Turn to ‘Informed Consent’ Model

[Felix]

Campus Progress
Shay O'Reilly
http://campusprogress.org/articles/shunning_medical_hoops_transgender_patients_turn_to_informed_consent_m/

While much media attention is paid to gender confirmation surgery, it's hormone replacement therapy that often makes the largest difference in the lives of transpeople. Patients frequently report that hormone therapy makes their body feel more comfortable or more like home—more importantly to many, hormones masculinize or feminize the body, helping trans people be read correctly as their gender.

But accessing these hormones can be very difficult, even for patients who are assertive and aware of what they want. Doctors often follow outdated standards, requiring a pathological diagnosis, extended counseling, or even a dangerous "real life experience" period in which non-passing individuals must live in their preferred gender role. Rather than jump through these seemingly endless and expensive hoops, trans people sometimes turn to dangerous black-market alternatives.

Fortunately, there's an increasingly popular alternative: clinics like  Howard Brown, which offer transgender patients hormone prescriptions using an "informed consent" model that centers a patient's autonomous choice.

[Joelene9]

  I am under the informed consent model with my provider.  He does the blood liver and kidney function tests to make sure the hormones I am getting are not doing harm as well as the testosterone level staying down.  The caveat here is that he wants me to present as female before my next visit in June or he will drop me from his providership.  It is to protect his license.  I do want to present as female, but I was denying myself women's clothes in my house and visits to the women's sections of the stores in the past 28 years.  This plus my middle aged inertia is holding me back here. 
  Joelene

[Felix]

  I am under the informed consent model with my provider.  He does the blood liver and kidney function tests to make sure the hormones I am getting are not doing harm as well as the testosterone level staying down.  The caveat here is that he wants me to present as female before my next visit in June or he will drop me from his providership.  It is to protect his license.  I do want to present as female, but I was denying myself women's clothes in my house and visits to the women's sections of the stores in the past 28 years.  This plus my middle aged inertia is holding me back here. 
  Joelene

I think he'd feel pretty secure in his license if he had more experience with trans patients. If for some reason he was challenged on this detail of your healthcare by his state medical board or colleagues or insurance companies, even the most ignorant or old-fashioned authorities understand harm reduction and he can point to that. Inflexible RLE requirements lead to pharmaceutical black markets and dangerous self-administered treatment. Not to mention all the other arguments against forcing patients to adhere to rigidly-defined transition timelines and strategies.

[Joelene9]

  He does.  He contribute some of his time to the local LGBT chapter.  He has other trans patients. 
  Joelene

[SandraJane]

  He does.  He contribute some of his time to the local LGBT chapter.  He has other trans patients. 
  Joelene

Does he require "presenting as" as a requirement for them also?

[Penny Gurl]

If you have to "present female" then it may not be a true informed consent.  The Howard Brown Clinic in Chicago is set up on the informed consent system.  Basically it's three or more apts starting with a Medical exam, then a Hormone Advocate meeting, to discuss the effects of hormones then finally the first treatment.  I'll be going to Howard Brown in a few weeks for my first medical meeting and I can post on how the process is.  The great thing is that it's a clinic and open to all and they give YOU the choice on how you can manage your transition.

[spacial]

Seems to me, what he means by presenting.

If he means you must wear a skirt or dress, pad out a bra and wear makeup, that isn't presenting as a woman. That is presenting as a particular woman.

I try to make my appearance feminine, reflecting myself and how I feel about myself.

I don't wear makeup because I don't feel I want to. I won't pad out a bra or anything else. I don't have breasts. I don't need to pretend I do. If I had breasts I would wear a bra.

I actually wear the same brand and style of shoes as my wife and many others. They are not, by any description, women's shoes. They are just shoes. Something like this: http://store.drmartens.co.uk/c-150-refined-womens.aspx

I'm wondering if that approach might be more in keeping with how you feel and your Dr's professional concerns?

[Jamie D]

The article associated with Felix's post contains an embedded hyperlink back here to Susan's.

Congratulations on being ahead of the game.

[Felix]

The article associated with Felix's post contains an embedded hyperlink back here to Susan's.

Congratulations on being ahead of the game.

I can't find what you're referring to, but if I've missed something then good catch and thank you!

And Joelene I wish you ambition and peace in your transition and your dealings with the guy. Sounds like he's not mean, just not thinking the same way a lot of us are.

[Joelene9]

  Thanks, all.  My Dr. was adamant at the last appointment on presenting.  He did mention that a lot of his other TG patients were presenting as female with their first appointment with him.  He was the first Dr. to prescribe HRT to me though.  From that last appointment, it put me in a tailspin over this for 2 months now.  I already lost providers from death and insurance drops.  I feel like I am back to square one.  It is a "What now?".
  Joelene

[Jamie D]

I can't find what you're referring to, but if I've missed something then good catch and thank you!

And Joelene I wish you ambition and peace in your transition and your dealings with the guy. Sounds like he's not mean, just not thinking the same way a lot of us are.

Go to your article.

Scan down to the 8th paragraph, beginning with the words "Clients at many...".  There is a link which reads [PDF].  Click on that and read what comes up in the first section, "What is informed consent?"

Hey Felix, when you post a good reference like this, it deserves to be thoroughly read!

[Felix]

Go to your article.

Scan down to the 8th paragraph, beginning with the words "Clients at many...".  There is a link which reads [PDF].  Click on that and read what comes up in the first section, "What is informed consent?"

Hey Felix, when you post a good reference like this, it deserves to be thoroughly read!

I did thoroughly read it, and I like the writing so I went and read a bunch of other articles the guy wrote, but I'm dense sometimes. Thanks for the specifics.

[Felix]

Okay I just checked and yes we are listed as a source right up in the beginning of the document. That's lovely.

Thanks Jamie.

[spacial]

  Thanks, all.  My Dr. was adamant at the last appointment on presenting.  He did mention that a lot of his other TG patients were presenting as female with their first appointment with him.  He was the first Dr. to prescribe HRT to me though.  From that last appointment, it put me in a tailspin over this for 2 months now.  I already lost providers from death and insurance drops.  I feel like I am back to square one.  It is a "What now?".
  Joelene

Joelene,

At the risk of seeming to pester you with the same suggestion, it depends upon how he defines presenting.

Stand on a street corner and look at women.

Are they all dressed up to the nines? Do they all wear skirts? Do they all put make up on?

Is it really necessary to pad out a bra if you don't have breasts?

Presenting as female is, I suggest, demonstrating a committment to what you are trying to do. That last thing that Dr wants is for you, when reality bites, to say you made a mistake.

[Jamie D]

I did thoroughly read it, and I like the writing so I went and read a bunch of other articles the guy wrote, but I'm dense sometimes. Thanks for the specifics.

It deserves to be thoroughly read ... by all those who follow your posts.

You come up with some good stuff!