Standards of Care

[Renae.Lupini]

This is one of those topics not too many people ever discuss. I figured I would see how much the SOC play a part in each of our lives.

[tinkerbell]

Have you ever actually read the Standards of Care that the medical community uses to instruct us on how to live our lives?

Yes, I have read the Harry Benjamin Standards of Care, and I agree with them.  I liked the old version better though. 

tink

[Ms.Behavin]

I read it too.  While at first I thought It was well harsh,  my experence is that all in all it's fair.  Some things it's not go to go rushing in on.  I've enjoyed the experence (well most of it ) so far. 

Beni

[seldom]

Have you ever actually read the Standards of Care that the medical community uses to instruct us on how to live our lives?

Yes, I have read the Harry Benjamin Standards of Care, and I agree with them.  I liked the old version better though. 

tink

Why would one like the older versions?  They are absurdly outdated and I would argue in many cases ignorant. 
The current version has a much more realistic, broad and flexible definition of TS than any previous version.  It is moving towards realizing that being TS is not necessarily a mental disorder, but rather a clinical condition.  Rather we are born this way, but we are not insane by any means.  Version 6 was a huge step forward.  It also dropped some of the rather stiff definitions of transsexuality, and the absurd concept of focusing on when onset was as well as focusing on behaviors. Not only that the issue of transmen, while not solved, took a step in the right direction.  Basically it finally recognized each trans persons experiences and feelings are differant, as well as treatment level, and boxing people in is not effective way to treat trans people of the clinical condition, and may in fact result in treatment being blocked.   

How anybody can prefer the older version to this one is beyond me.  The current version is much more flexible and was a huge step in the right direction.   

[taru]

Don't agree with HBSOC.

I think the system should only be making sure that persons requesting the hormones, ops etc are sure (maybe a waiting period of a month), know the medical consequences and not too obviously lunatic. Other than that, I don't think there should be requirements for obtaining care.

[Sarah Louise]

I have read the HBSOC.  Whether I agree or not doesn't really make much difference.  Those are the standards for now.

Sarah L.

[Lisbeth]

My answer: "None of the above."

Yes, I've read them.  I agree with some, disagree with some, and think there are some glaring holes.

[Kate]

I figured I would see how much the SOC play a part in each of our lives.

It really hasn't been part of my transition experience. I studied every word of the SOC before beginning all this, and yet in the end it turned out my therapist doesn't pay attention to it really, and I sure as heck didn't either. And when I finally got my HRT letter and saw a doctor, it turns out he would have managed my care even without a letter.

Only now that I'm starting to plan ahead for SRS is it affecting me, as I'm looking for a psych to do that second referral letter, trying to make sure I'm fulfilling the "fulltime for a year" requirement and so on. So I guess this is the first time the SOC restrictions and requirements are actually affecting me really.

~Kate~

[katia]

you're more likely to disagree with the dsm if you don't fit its criteria; yet, as sarah louise has pointed out, those are the standards for now, and if we want to proceed with our transition, we have to adhere to them.

[Keira]

Well, you don't have to deal with  the SOC anymore if
you don't want to.

Plenty don't and I've seen them post op and there's
no visible difference between them and a "SOC girl"
(a new kiind of sock pupper ;-).

So, for some, especially those who like direction,
order and answers in their lives, SOC is well suited.
For others, it feels like an unbearable prison.

Now, that SOC is a bit more personalized than before,
maybe this feeling of a prison will subside.

Of course, there are the one who think its between heaven and hell (like me).
I started DIY on hormones because I couldn't
bear how to endure the whole crap anymore
and I knew I'd get them anyway later.

But, for SRS, going through good old SOC
(actually, by the time I'll have SRS I'll probably be 2.5 years into RLE
the way I'm going).
For me, the social disphoria and general discomfort with my body was by far the worse, so I needed hormones and transition ASAP...
I haven't had any relationships all my life so my
penis is an ugly useless beast that I place in a dark cage all day, but I can bear it a little while longer and thus SRS can wait.

[seldom]

you're more likely to disagree with the dsm if you don't fit its criteria; yet, as sarah louise has pointed out, those are the standards for now, and if we want to proceed with our transition, we have to adhere to them.

There is A HUGE difference between the DSM-IV and the SoC.
The DSM-IV flat out says that HRT and SRS are ineffective as a treatment.
The SoC states that the way to treat TS successfully is through therapy, HRT and SRS, and these treatment methods are effective. 

The DSM-IV's statement is a huge reason why SRS is not covered by insurance company.  There is a movement to bring the DSM (DSM-V) more in line with what is in the Standard of Care.  Even the standards of care do not use the definition for TS in the DSM, rather it uses the ICD definition.  In fact there is movement to change the DSM, and a more realistic definition in the DSM is expected. 

I have huge standards with the DSM-IV, but the SoC as it stands is a well written set of guidelines which are flexible. 

[Judge Yourself]

I can see why they are deemed to be 'unfair' and how people disagree, i'm just more inclined to be glad they exist at all

[Kara]

My take is this, If this is a medical treatment, let insurance cover it. If not, don't put up so many walls unless you plan on also making every attention seeking breast implant patient see a therapist.

[Ms Bev]

I've always been a maverick, just ask Marcy, does Beverly follow convention?  Yeah, if it makes sense to me, seems fair to me, helps me in a timely manner.
Me....I tranitioned solo (I don't recommend this potentially dangerous thing to anyone else).  That's usually me, foolishly walking the highwire without a net. 
Really, I couldn't bear the thought of endless psych sessions, and other permissions.  This decision was on me.  Even if the educated medical professionals prescribed my care, I would be taking the same risks, albeit, with them looking over my shoulder here and there with blood work, etc.

I feel great today, at ease in a female body.  When I look at the HBSOS, it makes me shudder to think how long I would have waited, starting mid-50's as I did.  I now have a wonderful doctor who specializes in GID, and she understands my desire to have all my other medical care provided by women only, preferably "family", and sees to all my referrals.  Sorry all, I know I should be banging the SOC drum, but can't find my way to doing so.

Good Health And Well Being To Us All,

Bev

[seldom]

My take is this, If this is a medical treatment, let insurance cover it. If not, don't put up so many walls unless you plan on also making every attention seeking breast implant patient see a therapist.

There are really not that many walls.
And for insurance companies to cover this there needs to be an effective treatment program in place and proven.  The SoC provides that.  The more established they are, the more likely things will be covered. 

With that being said, the MAJOR issue right now is with the DSM-IV.  That is the reason most people see why there is significant issues with insurance providers.  For one the diagnostic guidelines are crap, for two there is no clearly stated course of treatment that basically says, this is the only effective way to treat this.  These changes are probably coming in the DSM-V.  Basically it will match the described treatment path of the SoC (triathic treatment).  Much of issue with insurance companies does stem from the DSM.  If the DSM was clear, they would have a hard time justifying the exclusion.

[tinkerbell]

When is the DSM-V coming out?

2011

tink

P.S.  I don't know what to call you anymore.

The naming of cats is a difficult matter,
It isn't just one of your holiday games;
You may think at first I'm mad as a hatter
When I tell you a cat must have three
different names.

First of all, there's the name
that the family use daily,
Such as Victor, or Jonathan,
George or Bill Bailey--
All of them sensible everyday names.
There are fancier names
if you think they sound sweeter,
Some for the gentlemen,
some for the dames;
Such as Plato, Admetus,
Electra, Demeter--
But all of them sensible everyday names.

But I tell you,
a cat needs a name that's particular,
A name that is peculiar, and more dignified,
Else how can he
keep up his tail perpendicular,
Or spread out his whiskers,
or cherish his pride?

Of names of this kind,
I can give you a quorum,
Such as Munkustrap, Quazo or Coripat,
Such as Bombalurina, or else Jellyrum--
Names that never belong
to more than one cat.

But above and beyond
there's still one name left over,
And that is the name that you will never guess;
The name
that no human research can discover--
But The Cat Himself Knows,
and will never confess.

When you notice a cat in profound meditation,
The reason, I tell you, is always the same:
His mind is engaged in rapt contemplation
Of the thought, of the thought,
of the thought of his name:
His ineffable effable
Effanineffable
Deep and inscrutable singular Name.


Also, apologies for the thread hijack. Y'all may continue.

That was beautiful.  Thanks  .  I now return all of you to your regular programming.

tink

[Kara]

i think it's interesting that some like the standards and others think they're ridiculous. some adore their therapists, and others think they're a big waste of time. on the face of it, it seems to have something to do with commitment -- those who are really determined to live this from day one, 'don't need no stinkin' SOC', and those who have had doubts, saying omg, this can't really be happening -- need them very badly. but surely, there are many different kinds of girls. i'm not an assertive girl, or noisy, or boisterous, like some girls. i'm a quiet girl. i tend to get walked all over sometimes, to not know how to get what i want. girls like me would be truly be lost without our therapists and the standards of care. 

I love my therapist, I just hate the fact that when I start hormones, I have to go prove to some stranger that I need them. Just makes me feel bad that decisions that could change my life or more or less end it, are in someone elses hand. I don't like that I am not sure that I will be allowed to transition.

[Keira]

I DIY'd for a year, my GP's supposed to take over soon. My therapist, who does follow SOC was slightly annoyed when she found out six months ago, hey, but what is she going to do.  I studied so much about hormones before starting that I probably read a thousand pages, including dozens of thick studies; I feel I could be an endo.

Anyway, I could also go to Thailand next year, or wait for the therapist's letter if I want to do it in the US or Canada. But, since I'm not as much in a hurry for SRS than I was to transition and start HRT, I'll stick it out with the therapist and wait for the letters.

I do think that SOC is more usefull for a certain type of personality, which needs more direction. I never was like that, but I appreciate its usefullness for some. For me, I am more self-directed. I know when I was ready for HRT and didn't start before that, and I know when I'll be ready for SRS (probably in another 18 months) cause I need to solve some things before moving on.

[seldom]

The thing is I had major issues to address, parts of my life that needed to be deciphered. 

I personally love my therapist, and I see why the SoC are there.  I am not brash by anyways, I am meticulous.  I plan everything.  Everything up to the point of seeing the therapist was well laid out.  I like to go through steps, just to be safe.  I need to do this.  But I am careful, always thinking, never rash.
Some people do not need the SoC to transition, but for those who like the plan it gives us a guidebook as well.  I am not one to jump into things without thinking things throughly and making sure everything is in the proper place.   

With that being said, messing around with hormones on my own scared the hell out of me.  I rather jump through some hoops for three months, and have medical oversight.  I like making sure everything is absolutely right.  I value my life, and I need to change my life.  Why risk something that I can change.

It is not that I had many doubts, any doubts were erased after the sentence in my first therapy session. 

I am quiet (well in real life), but it is not that I am troubled, I am not overwhelmed.  I guess its my inner librarian.  She has a very clear direction for me, but there is a right place for the pieces of my life. 

I did need my therapist though for reassurance, to work out my fears of coming out as well as the consequences.  I wanted to sort things out before hormones. I still had quite a bit to overcome.  I wish I could have started them a month earlier.  But the wait did not bother me, because I was told clearly...after three months you will get your letter. 

For people like me therapy is helpful and the SoC offers a great guideline, but even the standards recognize that they are not for everybody.  I may be getting less and less out of therapy. 

[Shana A]

I've always liked TS Eliot's poem about cats, so true I read the SoC a number of years ago, I think it was in 1993 or 1994. Although there were various things I disagreed with at that time, I basically played by the rules regarding therapy, RLT, etc. I'm assuming that was the older version, I'd like to read the new updates. I'm very much in favor of seeing the DSM-IV changed.

zythyra