Informed Consent - Who Has It?

[ThatTallGirl]

Hello all, I was doing some snooping around on the internet and found a rather nice article about Informed Consent, who accepts it, and other great information about HRT.
Take a look!

http://dl.dropboxusercontent.com/u/932389/Trans/Stepping%20Forward%20-%20Informed%20Consent%20Clinics.pdf

[Jennygirl]

As far as I know, all of California is under informed consent

[Jamie D]

Thanks, TallGirl.  That is the most updated version of the listing I have seen.

Nice to see you again.

[ThatTallGirl]

Nice to be back.

[MeghanAndrews]

That's a comprehensive list. Informed Consent is a Clinic-by-Clinic, Doctor-by-Doctor thing. It would be awesome if this list were spread far and wide

[Ltl89]

I'm sort of using a hybrid of therapy and informed consent.  My therapist is more flexible with the guidelines and will give hrt letters for patients when they are ready (if they ever are).  Instead of saying, you need 3 months, she will judge each person as a individual.  I think that's the best way to go.  Then again, I might be saying that because I got my letter really early (first endo appointment tomorrow!!!!).

For those who are using informed consent, please be sure transitioning is what you really want and that you don't need any emotional assistance through the process.  Some of us don't need therapy because they're positive of who they are and feel they can handle everything themselves.  That's great.  If you fall into that camp, god bless you.  But if you don't fit in there then please consider whether informed consent is right for you.  Personally, I'm certain of who I am, but I do feel the need to have a therapist help me through the difficulties of transitioning. 

Informed consent is great for the right person, but it's not for everyone.  Just like transitioning in general. So if you are considering going down that route, make sure you are prepared for everything that will come.

Good luck to everyone planning on starting

[Erin Kay Howell]

Its nice to see houston and dallas on that list. My therapist says that all of texas is now an informed concent/AMA state.

I hope hes right .. it would reduce the waiting reqiured and let my anxiety reduce a little hahaha.

[Jamiep]

Wow, several places listed for some major cities across Canada, several in Ontario including my Doctor in Mississauga. One that should be on the list is Sherbourne Health Center in Toronto an excellent place if you live within their boundary, some of my friends go there.

Jamie

[aleon515]

I don't know why informed consent would keep you from going into therapy. I wanted to have therapy but got my T thru somewhat of an informed consent sort of way. I didn't need to worry about the letter and talk to a therapist without worrying "how I sound" and so on. I feel that the client/therapist relationship is damaged by it being about whether or not they sign some letter.

--Jay

[spacial]

https://www.susans.org/wiki/Informed_consent

Perhaps this could be updated.

[aleon515]

I don't think the list is all that updated.

--Jay

[Joanna Dark]

I don't know why informed consent would keep you from going into therapy. I wanted to have therapy but got my T thru somewhat of an informed consent sort of way. I didn't need to worry about the letter and talk to a therapist without worrying "how I sound" and so on. I feel that the client/therapist relationship is damaged by it being about whether or not they sign some letter.

--Jay

I agree completely. The whole dynamic is changed when you are talking to somebody with the hopes of getting a letter. We are adults and should be treated as such. I think therapy is a great tool but if you feel like you can't say certain things because some may think you are "not trans enough" it severely damages the relationship. For instance, and apparently it is no longer true since other members from Sweden have informed me that it is not, but once upon a time in Sweden you had to score an F64 (whatever that is) to receive HRT. Obviously if someone feels they can't score that way then they will lie. I have known I am trans since age 10 and I feel like if I said some things about myself I would be denied therapy even though I am pretty femme and not very masculine at all. But I wouldn't say certain things because of a letter. Informed consent is a great method and the M.O. of the Mazzoni Center.

[Ltl89]

I agree completely. The whole dynamic is changed when you are talking to somebody with the hopes of getting a letter. We are adults and should be treated as such. I think therapy is a great tool but if you feel like you can't say certain things because some may think you are "not trans enough" it severely damages the relationship. For instance, and apparently it is no longer true since other members from Sweden have informed me that it is not, but once upon a time in Sweden you had to score an F64 (whatever that is) to receive HRT. Obviously if someone feels they can't score that way then they will lie. I have known I am trans since age 10 and I feel like if I said some things about myself I would be denied therapy even though I am pretty femme and not very masculine at all. But I wouldn't say certain things because of a letter. Informed consent is a great method and the M.O. of the Mazzoni Center.

I don't know why informed consent would keep you from going into therapy. I wanted to have therapy but got my T thru somewhat of an informed consent sort of way. I didn't need to worry about the letter and talk to a therapist without worrying "how I sound" and so on. I feel that the client/therapist relationship is damaged by it being about whether or not they sign some letter.

--Jay

Those are some good points.  Some therapists are terrible gatekeepers and that isn't fair to do to one's patient either.  I didn't have that problem, but I know many do.  I suppose I could have easily have started through informed consent and gone to therapy at the same time.  Then again, my therapist seems to practice a hybrid system.  So, I think that dual system could work very well for some.  Of course, not everyone even needs therapy either.

Still, I really think those who are on the fence shouldn't go through informed consent.  While transitioning is great for many of us, it can be disastrous for others.  I'm very careful about endorsing this method for everyone because some people reading this site might go through everything only to regret it.  There are people out there that shouldn't be taking hormones.  It's there decision to do so, but it would be harmful to their life if they were to go through everything.  If someone is certain of themselves, go right ahead and start the process.  It's great that it's available and fully endorse the usage of informed consent for the right person.  But if you have concerns or doubts, you should really consider an alternative method.  Hormones have serious effects and it's not worth taking a risk if you don't know that is what you want.  Same thing with transitioning in general.  This is a decision that should be made with lots of consideration and certainty. 

To anyone reading this that's considering starting hrt, I wish you lots of luck.  Follow the path that best suits you and your individual needs. 

[Joanna Dark]

At the same time though there are probably people who need HRT and who don't get it because of gatekeepers don't think they are trans enough or pass well when a lot of the process has to do with feeling comfortable in one's own skin not satisfying some arbitary criteria. I mean who can really decide who needs it and who doesn't? Therapy is def good and can discourage some from transitioning who prob shouldn't be doing it but I worry about the flip side: those that need to do and can't.

[Ltl89]

At the same time though there are probably people who need HRT and who don't get it because of gatekeepers don't think they are trans enough or pass well when a lot of the process has to do with feeling comfortable in one's own skin not satisfying some arbitary criteria. I mean who can really decide who needs it and who doesn't? Therapy is def good and can discourage some from transitioning who prob shouldn't be doing it but I worry about the flip side: those that need to do and can't.

I totally agree.  That's why informed consent is a blessing and should remain an option.  I'm just saying that people who write things like "help, I think I'm trans" may want to consider looking more deeply into things before delving in.  Those who say, I'm trans and need help starting, are in a different category.  Informed consent may be a wise choice for someone in the latter category, but those in the former one may wish to tak further consideration of the consequences before starting.  We all have different treatment needs. 

[aleon515]

Still, I really think those who are on the fence shouldn't go through informed consent.  While transitioning is great for many of us, it can be disastrous for others.  I'm very careful about endorsing this method for everyone because some people reading this site might go through everything only to regret it.  There are people out there that shouldn't be taking hormones.  It's there decision to do so, but it would be harmful to their life if they were to go through everything.  If someone is certain of themselves, go right ahead and start the process.  It's great that it's available and fully endorse the usage of informed consent for the right person.  But if you have concerns or doubts, you should really consider an alternative method.  Hormones have serious effects and it's not worth taking a risk if you don't know that is what you want.  Same thing with transitioning in general.  This is a decision that should be made with lots of consideration and certainty. 

To anyone reading this that's considering starting hrt, I wish you lots of luck.  Follow the path that best suits you and your individual needs.

My therapist is hired by the transgender center. He told me straight out that he was not there to decide for me whether I should have surgery or T or whatever. He'd sign anything I wanted him to sign. The decision to transition is mine. Though it's somewhat of a moot point. I don't know of anybody here that doesn't do some version of informed consent. I think it helped our relationship because I wasn't trying to screen myself to not look like I wasn't "trans enough".

Even if I saw someone who wanted a letter I could decide that I needed more therapy, and I could decide that I didn't want to see that person anymore. So I really make the decisions. I didn't decide to go on T for sure til I was in therapy about 5 months.  I don't know why you wouldn't trust yourself to make decisions.

I agree that some people detransition. It might seem that these people were not prevented from transitioning because of "bad therapist" maybe. But I feel there are statistically some people who will not be happy with transitioning because it doesn't solve all your problems. You go "OH is this all there is" and then think longingly of your other state. Transitioning is a process and some people go back on a process.


--Jay

[Ltl89]

My therapist is hired by the transgender center. He told me straight out that he was not there to decide for me whether I should have surgery or T or whatever. He'd sign anything I wanted him to sign. The decision to transition is mine. Though it's somewhat of a moot point. I don't know of anybody here that doesn't do some version of informed consent. I think it helped our relationship because I wasn't trying to screen myself to not look like I wasn't "trans enough".

Even if I saw someone who wanted a letter I could decide that I needed more therapy, and I could decide that I didn't want to see that person anymore. So I really make the decisions. I didn't decide to go on T for sure til I was in therapy about 5 months.  I don't know why you wouldn't trust yourself to make decisions.

I agree that some people detransition. It might seem that these people were not prevented from transitioning because of "bad therapist" maybe. But I feel there are statistically some people who will not be happy with transitioning because it doesn't solve all your problems. You go "OH is this all there is" and then think longingly of your other state. Transitioning is a process and some people go back on a process.


--Jay

Again, I agree that informed consent works well for many and I love that it exists.  I'm pretty much using it myself, just with the care of a therapist.  Also, I believe the patient should make the decision.  It's our lives and we should have a say.  So, I'm 100 percent for informed consent.

Having said that, if one doesn't know if this is what they want, then maybe they shouldn't immediately jump into starting everything through informed consent.  I've been around long enough to see people say they want hormones and at the same time don't know what they really want.  For someone like that, they would be better off investigating what they really want before proceeding.   Informed consent should be promoted and valued, but it shouldn't be the starting point of everyone's transition.  If you are confused, then maybe you should look deeper into it.  It's a big step and you should feel comfortable about your path.  And we all have encountered people who are confused and not fully certain about this before.  I think it would be a mistake to encourage those individuals to start before they have really considered what they want and know their path.  That's all I'm saying.

[aleon515]

So how do you make certain that the "right people" go to someone who does informed consent, instead of the "wrong people" without mandating therapy or something. I'm glad that I went into therapy but really happy no one told me I had to.



--Jay

[Jamiep]

@learningtolive,
I agree with your mature & liberal approach to informed consent. It truly isn't for everyone. Especially those in teens or a little older that are struggling with who they are, that is mostly when you require a therapist to gain the information to make a decision and the guidance to move forward to transition if that is the answer and keep that person safe. For me a Eureka moment about 10 years ago searching for & finding answers in the last 3 to 4 years ago via Melanie Anne Phillips videos & web site, blog, the Gay Liberation Network video interview with a biologist re clinical tests, video I think is titled "stop bigotry by psychiatrists against transgender people," confirmed Melanie's statements about how the first 12 to 14 weeks in the womb Momma's fluids can penetrate the soft skull tissue & influence the brain as to gender, even crossdressing. About 18 months to a year ago I finally realized my Eureka moment was my female brain breaking through & painfully primal screaming at me. I have watched many transwomens' vlogs, my Toronto friends in transition & all I have read by many amazing friends here sharing there journey, this educated me into what to expect & I am ready to try transition via informed consent. Hope I have said this correctly & haven't unintentionally slighted anyone. My apologies if I have.

Jamie

[Ltl89]

So how do you make certain that the "right people" go to someone who does informed consent, instead of the "wrong people" without mandating therapy or something. I'm glad that I went into therapy but really happy no one told me I had to.



--Jay

I think you are misunderstanding what I'm trying to say (probably because I'm explaining it poorly).  I don't want to attempt to create a system that makes certain the right or wrong people go through one method or anything.  Mandating therapy is a bad idea in my opinion.   I believe it is all up to the patient themselves to determine whether they would benefit from having additional consideration regarding hrt.  I'm not saying someone should make that decision for you.  The patient will know themselves best and should determine whether informed consent is right for them.  The system can't watch out for people that may be making a mistake.  It's your own life and only you can claim responsibility for your decision when starting hrt.  However, I do want those on the fence who are confused to give some extra thought about whether they should proceed with informed consent.  I leave it up to the individual to decide whether they need it, but I encourage everyone to be smart and make sure they are certain that they really want to transition.  If you are someone on the fence and still feel confused, you can go through informed consent without anyone stopping.  I'm fine with that because I don't feel anyone can tell you what to do with your body.   If you make a mistake you will have to live with it.  However, I would prefer people consider not making a mistake out of general compassion and hope that someone lives a happy life.  After all, transitioning would be terrible for a non trans person (and even for some trans people themselves). Therefore, I really want to encourage  people within that camp to think a little more before acting.  By that camp, I mean people who are confused about their gender and whether transitioning is right for them.  Either way, I don't intend to create a system of gatekeeping.  I'm just saying think before you act because this is a big decision and you want to make sure you're certain.  My concern has nothing to do with those who are certain about transitioning, such as yourself and many others here on the board.