Help me understand why surgery is "Elective", "Non Essential"," Cosmetic"

[CorrieK]

Or Life & Death for that matter. Here I am ready to mutilate myself or worse because of lack of funds. My quality of life is terrible. I gorge on food because I am stressed, that certainly could lead to a premature death. All because in many ways I feel the perception is "Oh this is just something you want, not need" Given the choice I would rather be fighting cancer or something else than this..

There are so many reasons why I know this is necessary, as soon as possible. I am fine with hormones the rest of my life, but if surgery helps reduce the risk of taking them with lower amounts, why not?

As for surgery, there are almost countless reasons why it is necessary. Since I was little whats down there always felt foreign. I hated it. I even took measures to hurt or remove it myself in my teens. Fortunately there was no damage I am aware of, but those thoughts are still there. Whether I go to the bathroom or wear a skirt. I get so disgusted with myself. Then I think What happens if I die? I don't want to get buried as a male, but in my state that is exactly what will happen, not sure a will can overwrite the law. I am closing in on my 30s fast, the health risks will only increase.

Work makes me miserable sometimes. I have to check ids for credit cards and checks sometimes, and it depresses me seeing female on drivers licenses. Until I can have surgery, Oklahoma will not change it on my drivers license. I've tried using my original birth certificate that says female. I have tried everything I can think of, but despite being on hormones six solid years nothing. Despite having borderline natural C breasts, nothing.

So despite how pretty I may look, there is still that blemish down there, and another reminder of society trying to tell me what to me than what I am inside and slowly becoming outside. Tucking is so uncomfortable, and it anchors my thoughts down because it is a constant reminder of the ongoing struggle.

Even though no one hardly looks twice when I go out, I still neutral some days just because that confidence is not there, because I am afraid something with slip out or show. I worry more about that then my bad hairline. Hard to be a girly girl which is what I am.

As much as I love swimming, I have not been in many years. First I could not fit into that role of the guy swimmer (shirtless w/ trunks), and seeing all the girls in their bikinis made me feel like a freak. What happens if I go to the beach and something slips out? It is the same thing at work. So many women come in with their dresses and skirts and I can't do that. Mostly because our dress code forbids it, but even at a job where I could (and would love to), as long as the parts are down there I would be extremely uncomfortable. I just don't feel complete.

There is a huge safety issue as well. I walk to work many times a week. I am only 5'5, and fairly small. My mom died being hit by a car. My fear is that I will look like an easy target walking down the street. Certainly a young female is a bigger target to get robbed than a big dude. What happens if they want to do more? They find out I have guy parts and then what? Surely I would get beaten, or worse.

Which comes to the next point. What if I do meet a guy I want to be with? Spur of the moments happen, what if he gets a surprise he was not expecting? I would feel better about stealth, as with my social skills I am not sure I would have the heart to tell. Yes that sounds bad. Certainly would try to inform preop, but better safe than sorry. When I think of sex I always think of myself on the receiving end, and participating as woman.

Self pleasure the guy way makes me sick and I have not done it in several years any way. That doesn't mean I don't feel the need to let one out every now and then, but I do not have any discharge anymore and that has been amazing. Random erections are practically gone and I could not be more happy. I developed a nice rubbing/fingering technique that is I enjoy better than jacking it, but you can only adapt so far.

Basically as it as I cannot live the life I was meant to live without surgery. I thought by now after so many years of honest hard work and patience I would get there. Now I fear I will have to take a turn for the worse. I am to the point of entering the "adult industry" and committing several acts of fraud to get to where I need to be. I have handled legal matters, and they are nothing compared to what I am going through now. I just don't know how much I have left in me to stay strong.

The general perception, even among some of the surgeons, that this is an optional thing is driving me crazy.

[JoanneB]

To be blunt, the general perception of the male dominated health care industry is you gotta be nuts to want to cut of your nuts   It is often difficult to find a doctor to get HRT or a surgeon to a BA or other feminizing surgeries without a permission slip from a therapist. A BA is an elective surgery for women, a potential legal nightmare when performed on a male. Hence the CYA clearance letters.

I'm over 50 and felt different since the age of 4-5. Only a few years ago I actually confronted myself head on rather than hiding in the land of denial where I said I am just an ocassional cross-dresser. Which was often all I need to maintain sanity. Since then I found sort of a happy middle ground. I still need to work as a male, although I am seriously considering going full-time. Untill if/when that happens I found great joy in being part-time. I also started therapy and HRT over 3 years now. Plus I finally gained some self esteem, confidence, and no longer ashamed of being a TS. However, still some guilt since it not just my life affected.

One point I always remind myself of is to stop thinking in black and white terms. Life in the grey zone, while complicated right now, is far far more joyous then my previous 50 years on planet Earth.

[A]

Why is it not essential? There's the point of view that not all transsexuals desire it, even if they could afford it. But that aside, there's no real reason, except maybe the lack of rock-hard proof of the issue and the need. After all, the very status of it (neurological issue, malformation, mental disease...) is still subject to debate and research. It's presently classified a mental illness, and if that's what it is, then it's a pretty special case in that it's the only one that requires purely physical treatments, which could raise reticence in doctors.

Mostly, you don't have such a rock hard proof as with simpler diseases that it's necessary, so it's not a given that the person you're explaining it to will necessarily agree.

Why is it such a pain to get? The main reason is the old principle in medicine that is: do no harm. In short, do not intentionally damage or remove healthy organs. The removal of your testes being basically that, it causes an issue. I agree it's controversial, though, since those are pretty much ruined already, at that time, by the HRT you've been taking. But either way, the principles of medicine are old and old stuff changes slowly.

On top, it's an "exact science" (more or less), and as thus generally requires pretty much rock hard proof to change its practices. Just see how many insurance programs (including state-funded ones!) still don't consider obesity a health issue, but rather a cosmetic issue that's a risk factor for health issues; as a result, they'll pay tens of thousands if you have a heart attack because of your obesity, but won't pay training programs, diet counseling and such, which would be much cheaper.

Add to that the fact that on top of scientific proof, insurance programs (even more so private ones) also need the decision of someone who says "okay, we'll pay more, raise the costs, accept this new thing and pay for this new problem." And those people mostly thinking with their pockets and/or political surveys instead of their heads, you can see why they're reticent.

[Julie Wilson]

Life is not a diagnosis.  If you need something work to have it.  Immediate gratification would be nice but has never been part of my transition.  This is your life, how do you want to live it?

It doesn't matter what a doctor thinks, does it?

What matters is having the life you want and need, amiright?

[justmeinoz]

The whole subject of surgery and gatekeepers came up at my support group last night.  The Monash Clinic in Melbourne looks like it is starting to head back to the bad old days again, of gatekeeping, and not treating people as responsible adults. 
The sooner we can move to an informed consent model the better.  If you are an adult and you make a wrong choice, you ahve to accept that it was your choice.  Simple really, but we live in a culture of refusal to accept responsibility.
Several people related how they had sidestepped the system at various times, with one girl simply flying to the USA for an informed consent Orchi. 

Karen.

[A]

Maybe I'm weird, but I don't think pure informed consent is such a good idea. I do think the process, in many cases, should be lightened (antiandrogens during therapy, actual therapy instead of useless meetings, not more therapy than needed/wanted, less requirements for various procedures...) but to put upon patients the whole weight of the changes to come is irresponsible if you ask me.

After all, many people claim themselves transsexuals, are sure of their choice and would sign all the papers and start everything right away if given the occasion, but realise that wasn't the issue after a while.

My psychiatrist, for example, reports that over half of the patients who come to him (and that's past the GP referral and possibly a little bit of therapy, so it's not even the very beginning) and report being 100 % sure of their transsexualism get out with a different diagnosis, thankful not to have been let make a big mistake.

I think, just like with savage capitalism VS totalitary communism, finding a right middle point is what we need. And I think things are gradually getting better.

[Rita]

People fear what they do not understand, and this is a personal experience they can't even fathom no matter how it is explained.

I don't believe in any gate keepers, the whole notion that we need them is stupid.  I think 1 month on hormones is enough for someone to back down if its not for them.  Estrogen will probably make a real male depressed(besides the obvious risks of normal depression that estrogen brings), the loss of testosterone in that period of time will be the nail in the coffin. 

I don't believe in self medicating though, because it  is not a game to play on your own.  But many stories lead people into dangerous medication or even surgeries.

I believe some of those that did not pass the test probably just found a way to affirm masculinity.  But it also might not last forever..

[Gadgett]

This was something I never understood ether myself. Even in the TG community, I am found some who think the same thing.

With that, The most consisant thing I've noticed, is that everything is a gray area. We are the gray area when it comes to male and females. So in our own community, there will be light and darker grays.

In short, for some, like you and I, it is nessesary. For others however it isn't.

When I went to my TG meeting this weekend, I've found who found their peace by simply living their lives as both men and women. So this isn't an issue for them as they work as men, and live as women. But some of us need to be just male or females. This is what I believe is the confusion.

People don't understand us enough as it is and they are just beginning to scratch the surface. So to expect them to understand this concept is even harder. Give them time and the more they learn about us, the more they will begin to understand the differences between us. Just have faith and keep being true to yourself. Our day is coming.

~Gadg

[Pinkfluff]

I totally agree. I was just a the doctor last week (new doctor too since I'm new to New York) and she had the whole air of "so this is something you chose to do" when I told her about being on estrogen. I also get extremely irritated when people treat this condition as a mental illness or a choice. I know that for some people it may be a choice or a lifestyle, and that they can deal with they way they were born, but for others it is an absolute medical necessity, just as much as any other genetic disorder.

In some ways it makes me miss Florida. When I was in college in Daytona Beach I was even poorer than now and had only the school's health plan, but my doc and therapist were awesome. They seemed to know that this treatment is necessary for me to live a (somewhat) normal life and they were supportive of that.

I think that on some level people who think it is a choice do not understand that it's the gender of the person and not the body that determines who someone is. The argument about not wanting to do anything to healthy organs only holds if you view the person as someone who should have such organs. Obviously it is not normal (in the statistical sense) for a female to have male parts (or vice versa), so it is thus not healthy organs. From that it follows that treatment is medically necessary. It is a very hard thing for someone to leave a paradigm they've had their whole life and take up a new one though.

[A]

I'm okay with them calling it a mental illness (because officially and until the contrary is solidly proven, that's what it is), but I also dislike it when they say it's a choice. In a way, it is. In the same way that getting a treatment for cancer or getting a broken bone tended to are. We chose to live, but our condition isn't a choice... And yeah, whilst it may not be as much of an absolute medical necessity as getting your life physically saved, it's just as needed as antidepressants and/or therapy on a severely depressed person, corrective cosmetic surgery on someone whose face was deformed by a bomb or or the removal of a third, useless arm on a malformed person.

As for the healthy organ argument, I agree with you. I just wanted to explain why things aren't changing as fast as we'd like them to; to tell their reasons, not agree with them. In case it wasn't clear.

And yeah, making people understand the issue is quite a challenge. After all, there are no other trans-type issues not related to gender to compare with, we can't point out certain physiological factors or even explain the real mechanism of it since we don't understand it... Add to that the idea that apart from that issue, the idea has pretty much always been that sex = gender = organs and genes, and people could well find the issue nonsensical, as though we were telling them that there's a rectangle whose segments are equal but which isn't a square. But gradually, people are understanding the issue better.

It's a bit like AD(H)D some years ago. Many didn't understand it and it was easy to deny its existence. And then they found how some neurotransmitters in the brain are disrupted in ADHD patients, and described better how it manifests itself inside the patient's mind, and suddenly, it became much easier to explain. Let's hope we get to that point soon.

[justmeinoz]

I can't see that Informed Consent is a problem as long as the patient is truly informed of all the issues.  I was a member of the Police Force, and I find it galling in the extreme that after being employed in a position that allowed me to deprive someone of their liberty or even their life, and maybe even get a medal for it, that I can't decide what is good for myself.
It's "Elective, Non-essential and Cosmetic" only if you are not the one who NEEDS it!
Karen.

[A]

Because being informed doesn't mean you understand it. And saying you do doesn't mean you do. And thinking you're ready for it doesn't mean that you are. With the huge number of people who apply for treatment and aren't ready, or sometimes aren't even trans, it's plain irresponsible to put all the weight of that on the patient's will. A depressed and desperate patient often can't even understand themself for real.

Given that those people are vulnerable, they can't possibly be given a possibly worsening treatment without at least a psychological evaluation. It's statistically proven: the easier hormones are to get, the more suicides there are, because people are easily allowed to make critical mistakes. That would be akin to prescribing antidepressants to just anyone who says they're depressed and needs it. That's just not how it works.

There's a reason why prescription drugs are prescription drugs. They need to be taken only upon appropriate diagnostic and doctor's decision that the product is right. If it were just a concern of people overdosing, even ibuprofen would be a prescription drug, because I'm pretty sure you can overdose and die from that. No. It's that the drug is not suitable for taking with the patient's decision alone.

Not to mention that someone who signs an informed consent form and then is put into distress by the results of HRT, or because they've become sterile, because it wasn't for them, if you ask me, could easily sue the doctor/clinic for acting irresponsibly, pleading that in their psychological state, they were not able to truly give informed consent. And though it's not a guaranteed win, I believe it's not a guaranteed defeat either.