Question for a Friend

[Shang]

A good friend of mine, who currently lives in Canada, was wondering what she should avoid conversation wise with a psychologist or psychiatrist in regards to trying to get permission to transition.  She has had a rather nasty experience with the psychological community in regards to being trans* so now she's wary and she would like to know what are some topics she should bring up and what she shouldn't bring up.

Thank you for your help!

[kelly_aus]

I can only comment on my own experiences here in Australia, but I've not found a single issue that would have prevented me from transitioning..

The fact that I'd lived most of my life as a gay guy, had been a prostitute, was drug addict as well as a bunch of other things were not an issue..

About the only thing I can think that may cause an issue would be serious mental illness - and that should only cause a delay while that is dealt with..

[Jess42]

I would say to tell her to be honest with her therapist on all levels. Tell the therapist why she feels transgender and go from there.

[Sol Luca]

Um, Hi ^//^

I'm the friend Arawn is talking about. He was kind enough to help me out by starting the conversation because I was too shy, and I am ever so grateful!

I guess, I'm worried that I might say the wrong thing and they won't take me seriously. Because I've felt this way all my life, I knew I was a girl as young as 6, pretty much as soon as I learned the difference. The thing is though, I'm not fully comfortable with transitioning at this point in my life. My family is extremely homophobic, religious types, and my father has been violent in the past both with me and towards the gay demographic in general. I cannot leave home right now, and they will not accept me transitioning. (I'm 19 by the way)

Besides that, I don't mind acting male. In public, I am fine with acting male, because when I get home I can be more myself (in the safety of my room. Which is enough for now). It doesn't cause my discomfort to act male because I know I can be myself when I get home.

What does cause my discomfort, and depression, is the state of my genitals. I have wrestled time and time again with the thought of at-home surgery and I know far more then it's safe for me to know. I have long-term depression (depressive disorder) for about 6 years now, and I'm on meds for it. One of the things that has caused me the most pain and the most depression is gender dysphoria. Dysphoria is my main depressive trigger and does, and has, led to thoughts of suicide (and even attempts).

What I'm saying is, is that I want to have gender surgery, I want them to fix my genitals and make me female. But I, at this point in my life, am not ready for a full transition. However I know that if I don't get something done soon, I could be on my way to a very unfortunate ending at the tie of a noose.  Meds only go so far, they help with the symptoms of depression, but they don't make it go away.

I'm worried that if I tell them this, if I be honest, they'll give me only one choice; all or nothing. And I really don't want to have to make that choice; on the one hand I'm not ready for a full transition, and I don't really need one at this point because that isn't what's causing me distress. On the other hand, if I don't get anything at all, I could very well kill myself. And I've tried. Twice.

I am okay with not looking like a girl in public, I'm even okay with looking a bit manly, what with some body hair and such. As long as I know that I am female under my clothing, that is more than enough to make me happy. Very happy.

But I'm afraid they won't listen to me, they won't take me seriously as transgender, and they'll deny me.

[LordKAT]

I too, worried more about the state of my body than social acceptance, and it is still that way for the most part. The social acceptance is bonus and I would never change that. I had no qualms about going for it all as the extra has just made life easier, not harder. The more the hormones worked on me , the more I needed it to be complete. Perhaps the same will happen with you.

You may find that once you have more acceptance socially as your true self, that you want it.  If you want to just do the hormones for a while, until you can get surgery, you can easily do that. A good therapist will work with you whatever your feelings are at that time, or this.

[Sol Luca]

To be honest I'd rather have it the other way, get the surgery first and then worry about hormones. Like I said, looking male doesn't cause me stress; Being male does. If that makes sense. I think it might cause me just as much stress to transition when I'm not ready to, as it would to remain in a body that I don't feel comfortable with.

[Beth Andrea]

Current standards for gender dysphoria is not "all or nothing." Dr's know there are a range of satisfactory choices in how far one needs to go in their transition.

Be honest with your therapist. Yes, you had a bad experience with one...but so long as you don't get a religious one or one that is otherwise openly biased against TS people, you should be fine. By being honest, they will be able to help you learn coping skills as well as self-acceptance...part of which is recognizing that you, as an adult, are able to make and act on decisions which are in your best interest.

Good parents will accept their child, no matter what.

imho

Good luck!

[Teela Renee]

In my experiences with them, tho they can be baised, its easy to tell if they are.  After you tell them your trans and want to transition. Their job is to hound you and listen to your answers to make sure thats truely your issue and not abunch of underling stuff you have failed to pick up on your own.                    Be honest with your theripist.  Cause trust me, if you got other issues that your not taking care of, sometimes they get alot worse on HRT cause your more sensitive to them.

[Jess42]

Sol Luca. Sounds like you are extrememly conflicted over the issue of transitioning. We are all different, I have no problem with the gentals but I absolutely hate body hair and the ridding of it helps me tremendously feel female. Long hair helps too along with other subtle things. Have you tried these? You can pretty much hide or make excuses fairly easy if you don't want to let it out as to why you do these things.

If you are telling the therapists that you don't feel it's right for you to transition at this time but you hate the male genetalia you have, they are probably going to try to take you into another direction of self discovery as to why you feel this way. If your not they may be picking up on the conflict.

I look to my genetalia as to having an outie instead of a innie. It doesn't dictate my internal psychological gender or sense of identity inside. I know who I am and it really isn't anyone else's business and anyone that doesn't like it, well that's their problem.

Any therapist should take these feelings seriously most definately when it comes to suicidal thoughts or actions. Don't worry about not being taken seriously because they do take suicide extremely seriously. Also the therapy is for you not them. It is supposed to make you discover your feelings so be completely honest with them because it's not about them but rather you.

The best I can tell you is to keep seeing a therapist and keep in mind that you are responsible for who you are in the world, not your bodyparts. Dysphoria sux and the best way to defeat it is to see yourself in a different light. Positive image reinforcement can help. Ask your therapist about it and he/she should be able to provide direction on how to do it. Hypnotherapy can also help. Also feminizing yourself in the way of grooming/beauty habits, androgenous clothing and looks can counteract the dysphoria somewhat. There's no guarantee it will help but it helped and still helps me tremendously.

As for suicide, please don't. I know you hurt and I have felt pain similar to yours. It is an "out" for you but for those that love you it leaves them broken and guilt ridden. I won't lie because I have thought about it many times myself but I don't want to hurt the ones that I love and love me. Plus there is always tomorrow and that is the thing I am most opptimistic about. You have a lot of brothers and sisters that have gone through, going through now and will be going through the same things you are. You can learn from the ones that have been there, lean on the ones that are experiencing the same thing and then help someone else get through it. So yes, you are extremely important and are not alone and you are loved.

[Sol Luca]

I have long hair, yes. I'm Native American so it's kinda a requirement XD

I have tried doing those things. Getting rid of body hair, and the like. Even dressing as a woman. To be honest, I'm ambivalent about it. It doesn't help with the feelings of dysphoria, but nor does it make it worse. I've even been seen by a few of my friends, and while they were very supportive, and that was nice, the outward appearance of looking female didn't change that I still felt Wrong because my genitals don't match up.

I would like to transition. But completely doing it, really has no effect on my issue, which is genital gender dysphoria. If and when I do, it will be for aesthetic purposes, and I will enjoy it very much. But it won't solve my problem, which is pretty much immediate (my last suicide attempt was just last month. That's why I've been getting my arse in gear to try to fix my depression, at least a little bit, so it doesn't happen again).

[Beth Andrea]

There is a wide range of outcomes in the transition process...some cross-dress, some get rid of body/facial hair, others dress and "are" in public, etc.

The way doctors tend to see it, is the genitals (of either M or F) is a major element of self-identity, and if they are gone, there are major psychological effects to consider. (That's why cis-men cringe when they hear about those of us who wish to have SRS). Typically, they want to see you do something to show that this will not be an issue for you, hence the formerly required "one year Real Life Experience" (which is generally not required anymore).

I think that a doctor will do the surgery, but you do want to explore the possibility, however much you may deny it, that after the surgery (and you are still presenting as a man) you may find that you want the man-parts back...which will not happen.

SRS is permanent, and depending on your mental status, age and/or maturity you may or may not be able to think rationally through this...this is why the therapist is needed.

[Sol Luca]

Mhm. I know that some trans* have different ways of coping than others. My way is to do that, at least for now, present as male.

""Typically, they want to see you do something to show that this will not be an issue for you, hence the formerly required "one year Real Life Experience" (which is generally not required anymore).""

REALLY? That's not a requirement anymore? ^//^ If that's true, then great!

And yeah, I understand. But, just because I'm young doesn't mean I don't feel the way I do. Many trans* start to transition before my age; my little sister's boyfrind is trans, and is getting his first set of hormones this August, and he's only 15. I've felt this way for most of my life, and I know what I want and what I need. At least, where this area is concerned. I want to get re-assignment, and not only am I okay with spending the rest of my life that way, I look forward to it. To getting to feel a little bit more on the outside, how I do on the inside.

I do plan on seeing a therapist first though. I'm kinda tentative to, because my last run-in with the medical community had my doctor telling me "You are NOT a woman. It is only an illusion."  <- True fact.

PS: For those messaging me, I'm a new member so I can't message you back. Sorry. :/

[Beth Andrea]

Mhm. I know that some trans* have different ways of coping than others. My way is to do that, at least for now, present as male.

""Typically, they want to see you do something to show that this will not be an issue for you, hence the formerly required "one year Real Life Experience" (which is generally not required anymore).""

REALLY? That's not a requirement anymore? ^//^ If that's true, then great!

And yeah, I understand. But, just because I'm young doesn't mean I don't feel the way I do. Many trans* start to transition before my age; my little sister's boyfrind is trans, and is getting his first set of hormones this August, and he's only 15. I've felt this way for most of my life, and I know what I want and what I need. At least, where this area is concerned. I want to get re-assignment, and not only am I okay with spending the rest of my life that way, I look forward to it. To getting to feel a little bit more on the outside, how I do on the inside.

I do plan on seeing a therapist first though. I'm kinda tentative to, because my last run-in with the medical community had my doctor telling me "You are NOT a woman. It is only an illusion."  <- True fact.

PS: For those messaging me, I'm a new member so I can't message you back. Sorry. :/

That's when you say, "Ok, thanks for your opinion, but I will be leaving now." And do so!

No qualified therapist would deny how a person presents, since at worst it's a coping mechanism for a far worse condition, at best it is a true statement which is how the person truly is.

Current standards are the WPATH Standards of Care (version 7).

Interesting...there is a timetable of sorts for feminizing effects of MtF HRT on page 25 of the PDF (FtM on page 24)....but further down on the same page there is a "no guarantees" statement.

[Rachel84]

I'm Canadian as well, I live a few hours away from Toronto, and do all my stuff with doctors from there.  From everything I've been told (and my own research), getting SRS while still living as a male isn't happening, at least if you go through a surgeon in Canada.  RLE is a requirement, as is getting reference letters from a doctor or psychologist who will confirm that you are living in the opposite gender and that surgery is the right path for you.  I doubt there is a competent surgeon in Canada who would do SRS on someone who is just walking in of the street.  Sorry, if this isn't what you wanted to hear, but I thought you should know how things work in Canada.

As for your therapist, you're over 18, so your legally an adult, and whatever you talk about with them remains privileged.  They cannot discuss it with your parents or anyone else without your permission.  I don't know what part of Canada you're in but you probably have more luck finding a therapist and doctor/endo who is experienced with transgender patients if you live near a big city (Toronto, Vancouver, Montreal all have lots of support for TGs).  With them, honesty is the best policy.  Explain your situation,  chances are they will try to help in some way or another. 

I know how bad depression can be, and how suicide may seem like the easier path, but getting treated by a professional therapist and doctor can make all the difference.  Just being able to get your problems off your chest can change your outlook on life.  You don't have to transition tomorrow, but getting involved in therapy is a great start to the process. 

I hope this helps

[Sol Luca]

helps....no.....but thanks

but...damn....ugh....

I'm in ontario

<.<

I do plan on going through the psychiatrists/therapists and stuff. But like this whole post is about, I'm worried about them not accepting me as trans because I'm not ready to fully transition yet. But if I don't get a gender change I know I'm going to end up killing myself. As I said my last attempt was just last month.

[Ltl89]

helps....no.....but thanks

but...damn....ugh....

I'm in ontario

<.<

I do plan on going through the psychiatrists/therapists and stuff. But like this whole post is about, I'm worried about them not accepting me as trans because I'm not ready to fully transition yet. But if I don't get a gender change I know I'm going to end up killing myself. As I said my last attempt was just last month.

If you go to a qualified therapist, I wouldn't worry.  They are there to help you.  Just be honest and share how you feel.  There was a time where I wasn't sure if I could make transitioning work, and sometimes I still doubt/fear whether everything will work out well in the end, but that doesn't change that I am trans.   I have told my therapist about my fears about not passing and societal rejection and she has been very understanding about the fact that I am taking baby steps into my transition and presenting socially as female.   A qualified therapist will understand that and work on guiding you through those fears.  Don't worry too much about any concerns that you may have about transitioning.

In terms of the surgery, most people need to transition first before they qualify for srs.  It's unlikely a surgeon would operate on you before doing so. 

[Sol Luca]

Okay I did my own research (I did a few sites, but I'll just post wikipedia's entries here since that's the most used). If I can use this, if the follow their own rules, I should be okay.

Quote: ""Provisions related to the necessity of real-life experience (noting that requiring real-life experience in an incongruous anatomical/social role can be both mentally harmful as well as physically dangerous to the individual) have been particularly under fire.""

Quote: ""Although professionals may recommend living in the desired gender, the decision as to when and how to begin the real-life experience remains the person's own responsibility.""

And the best one: ""Previous versions of the SOC stated that an RLE for genital surgery was an absolute requirement that could not be skipped or ignored. However, the seventh version of the SOC appears to be less stringent, and does not state anything of the sort. In addition, WPATH emphasizes that the SOC are merely clinical guidelines, and that they are intended to be both flexible and modifiable to meet the circumstances of the patient and the preferences and judgement of the clinician. Hence, the latest version of the SOC potentially allow for the RLE to be completely skipped."""

It's ridiculous, and seems to me particularly damaging in the case of transwomen because it's not just disrespecting the needs of a trans* person, it's also...kind of really sexist. Like, "You can't actually want to be a girl if you don't want to wear makeup and heels and do nothing but look traditionally pretty, right? Because all actual women want those things, right?"

For me it's a serious issue because gender dysphoria has led to suicide attempts. I don't just want to get surgery, I need it. To save my life. Quite literally.

However, it's something that I don't really feel the desire to share with the world, if that makes sense. Being treated as male is not what is causing the depression; having the parts of a male is.

I wish I could just get what I need to get done, and then go back to my life. I'll be much happier.

But it seems the whole damn medical community thinks that transgender = transexuality automatically. That I want to live "as a woman". To be honest, I don't really care; living as male is Not what's causing the issue, BEING one is.

I'm concerned they won't do anything unless I get real-life-experience living as a woman for a year. Which is silly, because that, I repeat, is not what's causing the issue. They'll force me to do that for absolutely no reason, because once the surgery is done I'll go back to pretending I'm 100% male. So the point of it is just to gate-keep.

They think, "If you're trans you must want to live as the opposite sex".

Well, no. I disagree. It means I AM the opposite sex and I need my body to match what I feel. My actions, the clothing, and the rest of what I show to the world, is my business and mine alone. Afterall, what's the harm in being a tomboy?

I guess I don't fit into their binary system of gender. Besides which, I'd like to point out that the cases of post-surgery regret in the trans community, from what I've read, is very low.

I'm just sick of everything being about a two-sex system. You're either male or female, and MUST CONFORM to those roles.

Well, I'm sorry, but that just ain't the case. There's more to gender than just black and white. What if you're grey..? Or silver..? Or even chrome? I mean...gah. People need to learn that identity doesn't fit inside the convenient little boxes you wanna make for it.

I am female. I need to get surgery to, literally, save my life. I don't care about passing as a woman, I don't care about pretending to be male. At the end of the day, I'll go home and be myself and I'm okay with that. I want to do this for me, not for everyone else. I think the care of a patient should fit that person's needs.  Why would you prescribe a medication to someone who is not ill from the thing that the medication is to cure? Transitioning, at this point in my life, is not what I want. I'm not sure yet, if it will ever be. But I do want surgery, I need it, or I'm afraid I'll kill myself, and the chances of that increase the longer I have this..thing...dangling between my legs. Either that or home surgery, which could lead to death anyway.

[kelly_aus]

It's ridiculous, and seems to me particularly damaging in the case of transwomen because it's not just disrespecting the needs of a trans* person, it's also...kind of really sexist. Like, "You can't actually want to be a girl if you don't want to wear makeup and heels and do nothing but look traditionally pretty, right? Because all actual women want those things, right?"

That's a shocking sterotype.. I live as a woman, albeit a fairly butch one.. I dress in a fairly masculine fashion most of the time, I can count on 1 hand the number of times I've worn makeup in the last 3 years since I came out. And I do NOT wear heels.

I guess I don't fit into their binary system of gender. Besides which, I'd like to point out that the cases of post-surgery regret in the trans community, from what I've read, is very low.

There's a reason that post-op regret is low and it's mostly because of the exact requirements you are complaining about.

Have you spoken to a therapist? I'd highly recommend it..

[Sol Luca]

I don't believe in that stereotype, I was just saying that that's what the attitude seems to be.

And perhaps. I'm just so frustrated that I would be forced to do something that has nothing at all to do with why I'm seeking help in the first place.

I didn't realize what I was doing was complaining. I thought I was more along the lines of, being honest about how I feel. Including what frustrates me and what I'm going through.

Not yet. But the ball is rolling. My first session is next Wednesday.

[Ltl89]

Okay I did my own research (I did a few sites, but I'll just post wikipedia's entries here since that's the most used). If I can use this, if the follow their own rules, I should be okay.

Quote: ""Provisions related to the necessity of real-life experience (noting that requiring real-life experience in an incongruous anatomical/social role can be both mentally harmful as well as physically dangerous to the individual) have been particularly under fire.""

Quote: ""Although professionals may recommend living in the desired gender, the decision as to when and how to begin the real-life experience remains the person's own responsibility.""

And the best one: ""Previous versions of the SOC stated that an RLE for genital surgery was an absolute requirement that could not be skipped or ignored. However, the seventh version of the SOC appears to be less stringent, and does not state anything of the sort. In addition, WPATH emphasizes that the SOC are merely clinical guidelines, and that they are intended to be both flexible and modifiable to meet the circumstances of the patient and the preferences and judgement of the clinician. Hence, the latest version of the SOC potentially allow for the RLE to be completely skipped."""

It's ridiculous, and seems to me particularly damaging in the case of transwomen because it's not just disrespecting the needs of a trans* person, it's also...kind of really sexist. Like, "You can't actually want to be a girl if you don't want to wear makeup and heels and do nothing but look traditionally pretty, right? Because all actual women want those things, right?"

For me it's a serious issue because gender dysphoria has led to suicide attempts. I don't just want to get surgery, I need it. To save my life. Quite literally.

However, it's something that I don't really feel the desire to share with the world, if that makes sense. Being treated as male is not what is causing the depression; having the parts of a male is.

I wish I could just get what I need to get done, and then go back to my life. I'll be much happier.

But it seems the whole damn medical community thinks that transgender = transexuality automatically. That I want to live "as a woman". To be honest, I don't really care; living as male is Not what's causing the issue, BEING one is.

I'm concerned they won't do anything unless I get real-life-experience living as a woman for a year. Which is silly, because that, I repeat, is not what's causing the issue. They'll force me to do that for absolutely no reason, because once the surgery is done I'll go back to pretending I'm 100% male. So the point of it is just to gate-keep.

They think, "If you're trans you must want to live as the opposite sex".

Well, no. I disagree. It means I AM the opposite sex and I need my body to match what I feel. My actions, the clothing, and the rest of what I show to the world, is my business and mine alone. Afterall, what's the harm in being a tomboy?

I guess I don't fit into their binary system of gender. Besides which, I'd like to point out that the cases of post-surgery regret in the trans community, from what I've read, is very low.

I'm just sick of everything being about a two-sex system. You're either male or female, and MUST CONFORM to those roles.

Well, I'm sorry, but that just ain't the case. There's more to gender than just black and white. What if you're grey..? Or silver..? Or even chrome? I mean...gah. People need to learn that identity doesn't fit inside the convenient little boxes you wanna make for it.

I am female. I need to get surgery to, literally, save my life. I don't care about passing as a woman, I don't care about pretending to be male. At the end of the day, I'll go home and be myself and I'm okay with that. I want to do this for me, not for everyone else. I think the care of a patient should fit that person's needs.  Why would you prescribe a medication to someone who is not ill from the thing that the medication is to cure? Transitioning, at this point in my life, is not what I want. I'm not sure yet, if it will ever be. But I do want surgery, I need it, or I'm afraid I'll kill myself, and the chances of that increase the longer I have this..thing...dangling between my legs. Either that or home surgery, which could lead to death anyway.

I understand the frustration.  However, you need to be realistic about the surgery.  Most surgeons require you to be full time for a year before they would consider operating on you.  The ones that don't have this requirement are risky.  I imagine you want the surgery in hopes to be a fully operational post-op (weird way of putting it, but you get the gist).  IF that is the case, you want a surgeon who would be able to ensure your safety and the chances that you will be satisfied with the results.  Home Surgery is just a fancy word for suicide.  You will not be able to do this on your own.  You will either die in the process or come out mutilated.  I understand the stress that this presents to you, but you can't think this is a better scenario than waiting for 2 years to qualify for a safe procedure.  Try to be as patient as possible as difficult as that may be.