Is therapy absolutely needed and cost?

[MariaMx]

I think you missed my point completely. I was referring to "therapy" being necessary, as per the OP question. I wasn't referring to transitioning at all.

Thus my challenge remains, as stated.

Be safe, well and happy.
Lotsa huggs
Catherine

I'm still not sure I follow you. Do you mean 'necessary' as in 'required' or as in 'needed'? Therapy doesn't necessarily need to be required or needed. In my case two psychiatrists at the GIC made an evaluation of me and then went on to clear me for srs. No therapy required or needed.

[MariaMx]

People are sheep enslaved to the classist medical establishment. Thinking that the godlike wisdom of their betters qualifications entitles them to knowledge and advice unattainable by mear mortals such as ourselves.

Yes yes I know I'm being very dramatic and theatrical. But what I'm getting at is stop assuming people know better than you because some instutiton says they are and learn to think for yourselves!

I've talked to my share of therapists and psychiatrists both during transition and before, but to me their line of questioning always struck me as extremely transparent. I would always know what they were getting at and I never had a light bulb moment talking to any of these people.

[Catherine Sarah]

I do not recognize the legitimacy, scientific basis or competency of the medical establishment either psychiatry or psychology to be able to "deal with" these sorts of issues nor that these issues inherently need to be "dealt with" in the manner described.

I respect your idealogy on legitimacy, science and competency. As there has been no mention of 'prescribed manners/methods' for 'dealing' with 'issues', I'm at a loss to comment. The content is too vague.

And as an adult I do not recognize their authority to govern my life or my existence. I don't care what inane excuses supposedly in my own interest they contrive.

Again I respect you thoughts and feelings on the subject of psychiatric or psychological professionals authority. I believe their Standards and Duty of Care are less 'governing' and more consultative. In the end, as a patient, it is your responsibility to accept or decline their advise based on your own circumstances.

Isn't it sorta ironic, psychs treat us like children in giving us their advice and then call us children again if we elect not to follow it.

It's purely from my experience alone, from the numerous professional sessions I've had over the years, that I haven't been treated like a child. I have always felt the relationship has been based on adult understandings and outlook.

However I will add, that I have been subjected to several "Church" based so called therapy sessions, that have other agendas attached to them, which where not indicated at the time of the initial consultation. I was highly offended when we reached the point of "Pray the gay away" section of the session. But then again, these were  not professional psychiatric or psychological personnel.

Hence I reiterate, in accordance with the OP's original question, my challenge remains, as stated.

Be safe, well and happy.
Huggs
Catherine

[Catherine Sarah]

I'm still not sure I follow you. Do you mean 'necessary' as in 'required' or as in 'needed'? Therapy doesn't necessarily need to be required or needed.

In response to your query, certain assumption have to be made. AS it was the OP's question that raised the term 'necessary', I have assumed it was couched in the term of 'needed'. As to couch it in the term of 'required' I would have to decline answering the question as I do not know the country of origin the question was raised in. Every country has it's own 'requirements', unique to its own Standard/Duty of Care.

I hope this clarifies the matter.

Huggs
Catherine

[Randi]

Please supply the name and address of any competent and experienced transgender counselor who has a track record of making transgender people comfortable with their birth assigned sex.

I'd gladly pay money to anyone who could make me accept being in a male body.   They can't do that, you say? 

Why pay someone to tell me what I already know?

And I defy anyone to tell me they don't have stuff that needs to be dealt with.


Be safe, well and happy
Lotsa huggs
Catherine

[Asfsd4214]

I respect your idealogy on legitimacy, science and competency. As there has been no mention of 'prescribed manners/methods' for 'dealing' with 'issues', I'm at a loss to comment. The content is too vague.

Again I respect you thoughts and feelings on the subject of psychiatric or psychological professionals authority. I believe their Standards and Duty of Care are less 'governing' and more consultative. In the end, as a patient, it is your responsibility to accept or decline their advise based on your own circumstances.

It's purely from my experience alone, from the numerous professional sessions I've had over the years, that I haven't been treated like a child. I have always felt the relationship has been based on adult understandings and outlook.

However I will add, that I have been subjected to several "Church" based so called therapy sessions, that have other agendas attached to them, which where not indicated at the time of the initial consultation. I was highly offended when we reached the point of "Pray the gay away" section of the session. But then again, these were  not professional psychiatric or psychological personnel.

Hence I reiterate, in accordance with the OP's original question, my challenge remains, as stated.

Be safe, well and happy.
Huggs
Catherine

Maybe it's my age (early 20s), or that I talk back too much, but I have routinely been treated like a child.

The standards of care aren't so much the issue (I think they could be a lot better but they could be a heck of a lot worse), it's the interpretations of them and enforcers of them I take issue with.

[Catherine Sarah]

Please supply the name and address of any competent and experienced transgender counselor who has a track record of making transgender people comfortable with their birth assigned sex.

My experience is based on a selection of professionals in the Sydney area only. If you are within that region I can happily provide the contact details of several competent therapists.

I'd gladly pay money to anyone who could make me accept being in a male body.   They can't do that, you say? 

Nobody can make you accept anything that is against your will. That is Psych 101, day1 , lesson 1 for any aspiring Psychiatrist/Psychologist.

Why pay someone to tell me what I already know?

Well, if you are silly enough to engage a professional on that basis, that's your money. However it's the 'stuff' you don't know, you may benefit from. And Psychiatrist/Psychologist are trained in the art of determining whether such issues are evident.

People who have/are suffering PTSD/GID/depression etc, etc, can have multiple suppressed thoughts that only a professional may be aware of, that for the wellbeing of the patient is better 'dealt' with.

Rgds
Catherine

[NaviMacha7]

Well to reply to you all, I put necessary in both meanings; needed and required. Needed to actually make sure and required for a doctor to prescribe me the hormones. Something like that, anyway.

I probably should have mentioned that I do have problems before hand and I have actually needed a therapist since middle school. However I have not gotten one at all. (I blame my family for ignoring this). So I do believe it may be absolutely necessary for me to get a therapist. Although, at this point I am finding it difficult to find the help that I need. I have called about four places where they have psychotherapy/mental health services. One of those places put me on a waiting list, another one of those places didn't accept my health insurance and the other two just put me on an answering machine, told me to leave my name and number and haven't gotten back to me. I was planning on giving it till next month to find a way to start HRT, however I am aware of the effects of acting on impulse. I want to start HRT while I'm still 18 to have good benefits from it aesthetically. I feel like I really want this. I don't want my body to get any more masculine. 

[JenAtLast]

My experience is based on a selection of professionals in the Sydney area only. If you are within that region I can happily provide the contact details of several competent therapists.

Nobody can make you accept anything that is against your will. That is Psych 101, day1 , lesson 1 for any aspiring Psychiatrist/Psychologist.

Well, if you are silly enough to engage a professional on that basis, that's your money. However it's the 'stuff' you don't know, you may benefit from. And Psychiatrist/Psychologist are trained in the art of determining whether such issues are evident.

People who have/are suffering PTSD/GID/depression etc, etc, can have multiple suppressed thoughts that only a professional may be aware of, that for the wellbeing of the patient is better 'dealt' with.

Rgds
Catherine

I pretty much agree Catherine, but I can understand the OP's point, too.  This is such a complicated thing as we may be dealing with many other issues that have arisen around the GID thing.  I had the same view as the OP for a long time: why gatekeepers and why do I need them to tell me what I already know?  I finally began therapy at my wife's insistence and it has been at an eye-opening experience. 

There have been many things I have come to realize about myself and come to deal with as I have gone through the therapy process.  I am a better person for it...I know I am definitely stronger because of it.  While I resisted and resented needing to seek therapy, I am really really really glad I did.

While I am certainly no expert, I think the need for prolonged therapy may perhaps be needed more for older transpeople than younger ones.  Over time, as we get older many of us deal with more and more stuff: college, career, family, greater social and business contact circles, etc.  In other words, more junk to deal with.  And we NEED someone to help us through that as we have undoubtedly picked up habits/behaviors/mindsets that we may not even be aware of in the day-to-day struggle to survive with this burden.  Younger folks have less history less junk to deal with...so for them they may just need the  therapy as a guide to the right decision.  But at 48, I had no doubt what I wanted but sure as hell wound up needing to deal with stuff that never had crossed my mind.  I was once a nay-sayer, but now I firmly believe it is needed.  (And yes, my doctor told me what I already knew about the GID thing    ) 

EDIT: Getting the right therapist is critical.  I had appointments with 3 different ones (all with extensive trans-health experience) and I felt like only one was right for me. 

[Catherine Sarah]

Hi gats,

Good to hear from you, and that you are getting along reasonably OK. I trust things improve for you as time goes on. You have the right attitude in perseverance.

I've just revisited the OP and I believe it's all clarified within two statements.

Hello! I'm new here. I really want to start HRT but it's getting really hard to find a therapist. Is it absolutely needed before starting HRT? Also, does anyone know if medicaid covers HRT? If so, does it cover it in New York? Thank you!

From a purely grammatical perspective the OP is asking where therapy is a requirement to satisfy the requirements of an issuing HRT professional.  And furthermore in New York. So in all honesty I should have never replied to the OP, due to my lack of knowledge of the requirements of that region. And in my books, there is nothing worse than people not answering your question. So I apologise to the OP for being disrespectful and not providing better assistance.

While I am certainly no expert, I think the need for prolonged therapy may perhaps be needed more for older transpeople than younger ones.  Over time, as we get older many of us deal with more and more stuff: college, career, family, greater social and business contact circles, etc.  In other words, more junk to deal with.  And we NEED someone to help us through that as we have undoubtedly picked up habits/behaviors/mindsets that we may not even be aware of in the day-to-day struggle to survive with this burden.  Younger folks have less history less junk to deal with...so for them they may just need the  therapy as a guide to the right decision.  But at 48, I had no doubt what I wanted but sure as hell wound up needing to deal with stuff that never had crossed my mind.  I was once a nay-sayer, but now I firmly believe it is needed. 

Absolutely agree on all points.

EDIT: Getting the right therapist is critical.  I had appointments with 3 different ones (all with extensive trans-health experience) and I felt like only one was right for me. 

Again, that's just so critical. I couldn't agree more. I've sacked my Psych for that exact reason, however my therapist challenges me on several of my thought processes, and he is right, well mostly. Depends how grammatically correct in explaining myself.

Keep up the good work. You WILL get there.

Be safe, well and happy
Lotsa huggs
Catherine

[NaviMacha7]

Hi gats,

Good to hear from you, and that you are getting along reasonably OK. I trust things improve for you as time goes on. You have the right attitude in perseverance.

I've just revisited the OP and I believe it's all clarified within two statements.

From a purely grammatical perspective the OP is asking where therapy is a requirement to satisfy the requirements of an issuing HRT professional.  And furthermore in New York. So in all honesty I should have never replied to the OP, due to my lack of knowledge of the requirements of that region. And in my books, there is nothing worse than people not answering your question. So I apologise to the OP for being disrespectful and not providing better assistance.

Absolutely agree on all points.

Again, that's just so critical. I couldn't agree more. I've sacked my Psych for that exact reason, however my therapist challenges me on several of my thought processes, and he is right, well mostly. Depends how grammatically correct in explaining myself.

Keep up the good work. You WILL get there.

Be safe, well and happy
Lotsa huggs
Catherine

No, no, Catherine. I'm sorry if anyone had any misunderstandings! I wanted to know if anyone would RECOMMEND getting therapy beforehand as well as if I can even get prescribed for it without one. The area where I live is not that important because it was a more general question one what would probably be best in the long run rather than just being all willy-nilly and getting them myself. The question that is more Country/State specific would be if Medicaid covered HRT in New York/The United States.

[MadelineB]

I probably should have mentioned that I do have problems before hand and I have actually needed a therapist since middle school. However I have not gotten one at all. (I blame my family for ignoring this). So I do believe it may be absolutely necessary for me to get a therapist. Although, at this point I am finding it difficult to find the help that I need. I have called about four places where they have psychotherapy/mental health services. One of those places put me on a waiting list, another one of those places didn't accept my health insurance and the other two just put me on an answering machine, told me to leave my name and number and haven't gotten back to me. I was planning on giving it till next month to find a way to start HRT, however I am aware of the effects of acting on impulse. I want to start HRT while I'm still 18 to have good benefits from it aesthetically. I feel like I really want this. I don't want my body to get any more masculine. 

Like yourself, I had issues since middle school that I needed help with. Even if your insurance doesn't cover transition-related therapy or specifically doesn't cover treatment for gender identity disorder, it will cover therapy for depression, anxiety, etc. I selected a therapist who was experienced with helping transgender people in transition, which has made it much easier for her to help me with my depression, anxiety etc - and she also wrote me the letters I needed for HRT etc. She has literally been a life saver in my case, since transitioning brought up old emotions and traumas that I had buried for a lifetime.

I did look up NY state medicaid information for you. Hope this helps:

As recently as last September, a state commission recommended (September 29, 2011) that Medicaid begin covering SRS and HRT for transgender individuals. On September 30 then governor Cuomo, under pressure from his conservative wing, came out adamantly against it:
http://www.syracuse.com/news/index.ssf/2011/09/new_york_considers_covering_tr.html

I found a good analysis on the current status for NY medicaid recipients. I haven't been able to find any more recent discussions, so this is probably still the case:

http://www.housingworks.org/advocate/detail/in-defense-of-basic-health-care-for-transgender-new-yorkers
In Defense of Basic Health Care for Transgender New Yorkers
Posted October 18, 2011
By Pooja Gehi and Lauren Jones, the Sylvia Rivera Law Project

Coverage for all transition-related health care is currently excluded under New York regulation N.Y.Comp.Codes R.& Regs.tit.18,§505.2(l).  What this means is that medically necessary hormone care that costs as little as $20 a month is excluded from coverage only for transgender individuals.  This blanket exclusion leaves transgender Medicaid recipients unable to access health care that prevailing medical standards confirm is medically necessary for patients with Gender Identity Disorder (GID).
....
In fact, Medicaid regularly pays for treatments like hormone therapy for many diagnoses but refuses to pay for the same treatments for people with diagnosed GID.  The same is true for procedures such as mastectomy and orchiectomy.
....
For transgender Medicaid recipients in New York, the fight against this regulation has lasted for over a decade.

P.S. If you are near NYC, you might consider consulting the Sylvia Rivera Law Project:
http://srlp.org/services/legal

We provide legal services, such as advice, direct representation, and referral to other service providers - free of charge, on issues impacting transgender, gender non-conforming people, and intersex people.  Here are some of the types of legal help we offer:
--name changes and gender changes on ID, such as State ID, Benefits Cards, Social Security, Passports, and Immigration Documents (such as Green Card, I-94, or Naturalization Certificates)
--discrimination in group homes, homeless shelters, public restrooms, and drug treatment centers
--discrimination or harassment at HRA offices, or problems with state-run welfare, job, or health programs
--access to transgender health care for low income people, people in foster care, and people in prison
--social security appeals for trans people with psychiatric disabilities

[Asfsd4214]

My experience is based on a selection of professionals in the Sydney area only. If you are within that region I can happily provide the contact details of several competent therapists.

Nobody can make you accept anything that is against your will. That is Psych 101, day1 , lesson 1 for any aspiring Psychiatrist/Psychologist.

Well, if you are silly enough to engage a professional on that basis, that's your money. However it's the 'stuff' you don't know, you may benefit from. And Psychiatrist/Psychologist are trained in the art of determining whether such issues are evident.

People who have/are suffering PTSD/GID/depression etc, etc, can have multiple suppressed thoughts that only a professional may be aware of, that for the wellbeing of the patient is better 'dealt' with.

Rgds
Catherine

Sydney? Really? Ok give me the list, because the psychs I'm aware of in regards to transgender issues in sydney are about as bad as you get.

There is nothing, "only a professional may be aware of". Knowledge and competence does not always conform to arbitrary written qualifications.

[NaviMacha7]

Like yourself, I had issues since middle school that I needed help with. Even if your insurance doesn't cover transition-related therapy or specifically doesn't cover treatment for gender identity disorder, it will cover therapy for depression, anxiety, etc. I selected a therapist who was experienced with helping transgender people in transition, which has made it much easier for her to help me with my depression, anxiety etc - and she also wrote me the letters I needed for HRT etc. She has literally been a life saver in my case, since transitioning brought up old emotions and traumas that I had buried for a lifetime.

I did look up NY state medicaid information for you. Hope this helps:

As recently as last September, a state commission recommended (September 29, 2011) that Medicaid begin covering SRS and HRT for transgender individuals. On September 30 then governor Cuomo, under pressure from his conservative wing, came out adamantly against it:
http://www.syracuse.com/news/index.ssf/2011/09/new_york_considers_covering_tr.html

I found a good analysis on the current status for NY medicaid recipients. I haven't been able to find any more recent discussions, so this is probably still the case:

http://www.housingworks.org/advocate/detail/in-defense-of-basic-health-care-for-transgender-new-yorkers
In Defense of Basic Health Care for Transgender New Yorkers
Posted October 18, 2011
By Pooja Gehi and Lauren Jones, the Sylvia Rivera Law Project

P.S. If you are near NYC, you might consider consulting the Sylvia Rivera Law Project:
http://srlp.org/services/legal

We provide legal services, such as advice, direct representation, and referral to other service providers - free of charge, on issues impacting transgender, gender non-conforming people, and intersex people.  Here are some of the types of legal help we offer:
--name changes and gender changes on ID, such as State ID, Benefits Cards, Social Security, Passports, and Immigration Documents (such as Green Card, I-94, or Naturalization Certificates)
--discrimination in group homes, homeless shelters, public restrooms, and drug treatment centers
--discrimination or harassment at HRA offices, or problems with state-run welfare, job, or health programs
--access to transgender health care for low income people, people in foster care, and people in prison
--social security appeals for trans people with psychiatric disabilities

Thank you so much Madeline! 

[Cindy]

I have to admit I'm not treated as a child by anyone, and would gladly report any in the medical field to the Board if they dared to do so. My dealings with my psychiatrist were fun and intelligent. I was apparent to both of us that I had no co-morbid issues that needed dealing with. However I am aware that many people do so and it is wise at the least to get them understood and dealt with.

My major discussions have focussed on how I will (have) assimilate into the society I'm part of, and the discussions in this are  have been of great benefit. My psychiatrist has dealt with many TG people and is aware of the problems they have faced and lead me in a very mature manner to contemplate issues that I may face. To be honest some of the issues were difficult and his advice allowed me to find ways of dealing with them.

I certainly had no feeling that anyone was acting as a gatekeeper, indeed in my position I could very easily go to colleagues and tell them to prescribe for me. I chose not to as I recognise that the professionals I am dealing with have deeper knowledge in their area than I do. There are a limited number of endocrinologists in SA that are 'happy' to deal with TG people in particular and HRT in general, so it makes perfect sense, to me, to consult people who are foremost in their field.

Now a days my GP prescribes my routine hormones and my implants are carried out by my endocrinologist.

Asfsd4214
There is nothing, "only a professional may be aware of". Knowledge and competence does not always conform to arbitrary written qualifications.

There is no doubt truth in this, however, I would not allow someone to treat me that didn't have the written qualifications and the skill and experience that they testify to.

[justmeinoz]

I found using a Psychiatrist to help sort out some of the deeper questions I had was useful, especially as I still had a lot of trust issues following my marriage ending several years earlier.
I was concerned that these would adversely affect my future relationships if they were added to any unresolved gender concerns.
I am positive that some people really don't need counsellors at all, but they are like a spare tyre, handy to have.

Karen.

[snowboarderchic]

For me therapy was a necessity in the early stages. It helped me work through any insecurities I did have, and it was an unbiased person to talk with when I needed it the most.
My personal feeling is that one can only benefit from going to therapy, and it's most likely covered under your or your parents insurance plan.   

[MrTesto]

@NaviMacha7, it's not clear whether you are near NYC, and thus able to benefit from Callen-Lorde's clinic (linked by a previous commenter). C-L has trans health care which does not require therapy prior to starting hormones. So you could start there (or another informed consent hormones provider), and at the same time, get set up with a therapist. You could also attend some groups, often run by therapists, for instance those at the Gender Identity Project (www.gaycenter.org/gip/), which also has one on one therapy. These services have options for low income clients.

It sounds like you are clear about wanting to start hormones...and also about wanting to have support around some issues that might include trans stuff. So I don't see it as an either/or.

If you are somewhere else in NY state, there are still some options for low cost and/or sliding scale, but it would help to have a better sense of location. (PM is fine.) As far as medicaid, that might depend on the coding. In MA, which I'm more familiar with, the state and federally-funded plans do end up covering basic hormones and the pricier blood tests for medical monitoring.

[Julie Wilson]

Hello! I'm new here. I really want to start HRT but it's getting really hard to find a therapist. Is it absolutely needed before starting HRT? Also, does anyone know if medicaid covers HRT? If so, does it cover it in New York? Thank you!

When I first began transition I was ordering hormones on the Internet without a prescription.  The sites I ordered from don't even exist anymore.  I wanted to prove to others that I was legitimate and so I saw a therapist for a prescription and finally after three expensive sessions she set me up to see an endocrinologist who was known for treating trans women.  Looking back on this from about nine or ten years forward I would say that for me that was a complete waste of money.  A waste of money that I was in very short supply of.

However...  I do think that therapy can be very important.  There seem to tend to be co-morbid issues around GID but the problem is the stewed frog syndrome.  Most of us are like frogs in a pot of water on a stove.  Someone comes along and very slowly turns the heat up and we adapt, we don't ever realize we are suffering because we tend not to notice the gradual and we tend not to notice problems we have been living with for years, to us in our limited ability to perceive things in a grander view things seem "normal" even when normal is bad.

Most frogs remain in the pot until they are boiled alive.  It's what people do.  They come to accept things as "normal".  Problems become "invisible".  A therapist is someone who is trained to see things we are unable to see.  Therapists alleviate suffering, they tell us to get out of the pot of boiling water.  A typical reaction of the frog being boiled to death is, "Why are you trying to move me out of my comfort zone?"  The frog becomes offended by the therapist.  "I was seeing a therapist but she doesn't understand me and she doesn't even believe what I tell her."  "She makes me feel angry and uncomfortable so I stopped seeing her!"  So sayeth the frog.

I know there are issues I could use help with but my ability to afford therapy tends to be overshadowed by my ability to pay my mortgage or feed myself at present time. (Continuing theme really).

Anyway...

For your patience here is a reward.

You can simply go to a walk-in clinic and get a prescription for estrogen by telling them that you are a M2F transsexual.  At least that is what I did.  Other than that there remain sites on the web that will ship without a prescription.

Either way it is important to learn about hormones and their effects and dosages because often times doctors are not familiar with treating M2F patients.  The last doctor I saw relied upon me for the dosage, I told him the dosage I wanted and that's what he gave me.  It cost me about a hundred and twenty five dollars more to get a one year prescription but the medication was cheaper and probably better than what I could afford on the Internet.

[Kadri]

You can simply go to a walk-in clinic and get a prescription for estrogen by telling them that you are a M2F transsexual.  At least that is what I did.  Other than that there remain sites on the web that will ship without a prescription.

YES! That is exactly what I did (here in Australia) and just to make a point of it, I never went to that clinic unless I was presenting as female (which was about half the time anyway by then) Fortunately, these doctors did know their stuff about hormones, and I think they started me off on a fairly small dose to see what would happen before getting into the serious stuff. i think they really helped my transition along quite smoothly.

I feel happy that I didn't shell out money on therapists back then, even though I don't mind doing it now to get my SRS permission letter. The person I see does see some other things in me, and has made me think about them a lot, in quite a positive way.