Pros & Cons of Early SRS

[Karla]

What's the earliest in Transition, that anybody's had her bottom surgery done?

I am looking into the possibility of doing it as soon as possible, even though I am only part time; for the following reasons:

• It's covered by my current employer's insurance... but in the volatile world that we live in, who knows how that may change tomorrow?


• It enables legal document changes and a seamless Go Live as a legal woman, by the time that I'm ready for full time;


• As a full time female, the physical recuperation period would be already over, and i could enjoy myself.

Much appreciate the wisdom here.... thoughts?

Thanks,
Karla

PS Haven't seen this topic discussed before.  Shouldn't we be thinking out-of-box, rather than allowing ourselves to be encumbered by the way things were done in the past?

[Doctorwho?]

In terms of age the youngest was about 13...

In terms of length of RLE done I know one girl extremely well (no names no pack drill) who technically did no RLE whatsoever and she is still well adjusted and happy after around 30 years post op...

HOWEVER - these are very exceptional cases... and what you have to understand is that from the doctor's perspective, in the absence of a definitive medical test that we can do to see if you are Trans or not, a doctor is being asked to do an irreversible operation, which if performed inappropriately, WILL do you harm. Thus you are effectively asking us to risk violating a founding principle of our hippocratic oath "First Do No Harm."

Unsurprisingly most doctors, me included when I qualify, WILL want some sort of proof that you are not going to have regrets, and like it or not, currently, doing an RLE is the best we have. It doesn't guarantee success - but at least it demonstrates that you have some idea of what life MAY be like on the other side...

So I am afraid that from a medical point of view, unless the operation could somehow be made reversible, or there could be some form of accurate genetic screen test or brain scan or something to give a reliable and less subjective diagnosis - the requirement for an RLE period is simply NOT going to reduce - in fact if anything it will probably progressively increase with each person that de-transitions (and possibly sues the doctors) after surgery.

So if you all want fast surgery - then I would suggest you use forums like this to literally do your utmost to actively discourage anyone who who any sign of any doubt. When the trans community gets all "come on in the water is lovely" and encourages people to go for SRS who are not 100.0% sure - it becomes its own worst enemy, because with every failure the pressure for an ever harsher, longer RLE tests builds.

Sorry that's not what you will want to hear I know - but unfortunately this is a situation where it takes two to tango - and while I'm sure most doctors understand and are sympathetic to the fact that the RLE situation places you under stress, they also have to weigh that up against the potential loss of their medical licence if they were found to have operated on someone inappropriately.

[mrs izzy]

So if you all want fast surgery - then I would suggest you use forums like this to literally do your utmost to actively discourage anyone who who any sign of any doubt. When the trans community gets all "come on in the water is lovely" and encourages people to go for SRS who are not 100.0% sure - it becomes its own worst enemy, because with every failure the pressure for an ever harsher, longer RLE tests builds.

Total agreement. I see so many here with starry eyed and high hops for the easy way. The magical make me happy HRT pill. The way to the front of the line with out having to deal with the gatekeepers. Skipping any pain that might come in the process of transition.
All this scares me, then in a few post down i see someone de-transition posts, and i made a mistake.

So yes i agree with you on this post. Maybe we are wrong but as someone who has been around many years and know many who have GID i would have to say slow down it is not worth rushing anything with this......
Izzy

[TaoRaven]

I personally advocate the Informed Consent path....

...meaning, I feel that adults should be able to make adult decisions about their lives and bodies. Thankfully, there are many doctors, therapists, and others who agree with this. You may want to research  "ICATH" and "Informed Consent"...there are lists of doctors and resources that you can use, and therapists that will give you letters that you can use for reputable surgeons.

That said, while I support anyone's right to make these decisions...it is not always wise. Personally, I feel that a couple of years of HRT, and living full time is simply the smart way to go. Your body will change a lot during HRT, and things will move and settle in various ways.

For the same reason that many suggest waiting until after a couple of years of HRT to have breast augmentation surgery, it may be a good idea to wait for SRS until the body has had a chance to do it's thing.

However, we each have our own path. And I support our right to find it, and walk it.


And, I am fond of saying...I could go have my entire body tattooed green, my tongue cut in half, have horns surgically implanted into my head, and call myself a lizard....with no therapist letters, no RLE, nothing but my own judgement and money. We are who we are, and I cannot think of any reason at all why we should be singled out and treated as mental patients for simply wanting to live life as a whole person.

[Zumbagirl]

Total agreement. I see so many here with starry eyed and high hops for the easy way. The magical make me happy HRT pill. The way to the front of the line with out having to deal with the gatekeepers. Skipping any pain that might come in the process of transition.
All this scares me, then in a few post down i see someone de-transition posts, and i made a mistake.

So yes i agree with you on this post. Maybe we are wrong but as someone who has been around many years and know many who have GID i would have to say slow down it is not worth rushing anything with this......
Izzy

+3. I also am in agreement. I always say this is an evolution not a revolution. It happens very slowly over many years and there is no way to know if a gender transition will make you happy without taking that first step, the RLE. The changes are slow, the social transition takes time and the legal aspect is slow.

[Zumbagirl]

I personally advocate the Informed Consent path...

And, I am fond of saying...I could go have my entire body tattooed green, my tongue cut in half, have horns surgically implanted into my head, and call myself a lizard....with no therapist letters, no RLE, nothing but my own judgement and money. We are who we are, and I cannot think of any reason at all why we should be singled out and treated as mental patients for simply wanting to live life as a whole person.

You can certainly call yourself a lizard but there is one thing that separates a green bodied, forked tongue, lizard man (or woman) from a post-op transsexual. You can still reproduce and have children. That makes things different. A thousand piercings and hundreds of body mods, even boob jobs, are not the same as SRS. None of those changes requires the removal of your sex organs and refashioning them into something else. That's why it will always be different and require a higher standard.

[mrs izzy]

You can certainly call yourself a lizard but there is one thing that separates a green bodied, forked tongue, lizard man (or woman) from a post-op transsexual. You can still reproduce and have children. That makes things different. A thousand piercings and hundreds of body mods, even boob jobs, are not the same as SRS. None of those changes requires the removal of your sex organs and refashioning them into something else. That's why it will always be different and require a higher standard.

Ditto, ditto and ditto.

Izz

[Karla]

Thanks to all those who replied, whether you agreed or disagreed with me

I am asking for some technical reasons why early SRS would not work...

What i neglected to mention was i have 6 months of RLE from 1987.   I stopped hormones unwillingly, faced with no job, a worthless college degree (remember Black Monday and the hiring freezes which followed?)  Faced with being jobless & homeless, I choked it all down and pronounced myself 'cured', stomped Karla down into the depths of my psyche with jackboots... and spent the next 25 years regretful and angry.

Oh, I know.... I more than know.   

These rules are made by folks who have never known hardship.  Have never stood in our shoes, personally subjected to those rules.

Yes, the body changes during HRT.   Certain 'raw materials' atrophy... and then the surgeon needs to consider skin grafts to create a vagina. 

I'm curious how many suicides (particularly teen suicides) might be prevented, by the removal of gatekeepers to HRT and SRS.

Can't we bury Harry Benjamin and move on?

I personally advocate the Informed Consent path....

...meaning, I feel that adults should be able to make adult decisions about their lives and bodies. Thankfully, there are many doctors, therapists, and others who agree with this. You may want to research  "ICATH" and "Informed Consent"...there are lists of doctors and resources that you can use, and therapists that will give you letters that you can use for reputable surgeons.

That said, while I support anyone's right to make these decisions...it is not always wise. Personally, I feel that a couple of years of HRT, and living full time is simply the smart way to go. Your body will change a lot during HRT, and things will move and settle in various ways.

For the same reason that many suggest waiting until after a couple of years of HRT to have breast augmentation surgery, it may be a good idea to wait for SRS until the body has had a chance to do it's thing.

However, we each have our own path. And I support our right to find it, and walk it.


And, I am fond of saying...I could go have my entire body tattooed green, my tongue cut in half, have horns surgically implanted into my head, and call myself a lizard....with no therapist letters, no RLE, nothing but my own judgement and money. We are who we are, and I cannot think of any reason at all why we should be singled out and treated as mental patients for simply wanting to live life as a whole person.

[kelly_aus]

Just a quick comment..

If I'd been able to 'fast track' my SRS early on, I'd probably have had it.. And then regretted it. The 2 and a bit years I've been on hormones have allowed me to get to a place where I'm happy as I am. I don't need SRS to feel 'complete'.

The current process enabled me to avoid what could have been a very big mistake..

[Cindy]

The statistics are quite interesting.

In Adelaide a popn of 1.5million, most Trans*people have been treated at the same practice. Suicide pre SRS has been zero. Post SRS there have been 9. Four of which were using on demand consent.

In Whittle's study in the UK N>2000, pre SRS suicide rate was 33% (the oft quoted figure) post SRS the rate was 27%, no significant difference.

I'm unsure of the use of the term 'gatekeeper' it is often used in the trans*community as a disparaging and hateful comment. In practice ALL medics are gatekeepers in any procedure. They have to be by definition of the work.

[kelly_aus]

The statistics are quite interesting.

In Adelaide a popn of 1.5million, most Trans*people have been treated at the same practice. Suicide pre SRS has been zero. Post SRS there have been 9. Four of which were using on demand consent.

In Whittle's study in the UK N>2000, pre SRS suicide rate was 33% (the oft quoted figure) post SRS the rate was 27%, no significant difference.

I'm unsure of the use of the term 'gatekeeper' it is often used in the trans*community as a disparaging and hateful comment. In practice ALL medics are gatekeepers in any procedure. They have to be by definition of the work.

I almost ruined the zero pre-SRS stat earlier this year..

And I've never seen my medics as 'gatekeepers'.. Just professionals with ethics..

[suzifrommd]

I'm now 3 months into my RLE.

It's not giving me a clue whether or not SRS is right for me. It's telling me whether living as a woman socially is right for me (it is). I still don't know whether my life would be better or worse with SRS and living as a woman won't tell me that. (Though I've come to the conclusion, independent of my RLE, that I will never be comfortable with a body that doesn't have a vagina.)

I've come across several Susan's members and trans women IRL who say they need a female body but have no desire to live socially as a woman. They'd be perfectly happy hiding the shape of their new genitalia and continue living as a man.

Why won't we let them?

After all, we have no problem with trans women living socially as women hiding male genitalia for the rest of their lives. Why not the reverse?

I think the concept of the one-year RLE was devised under the false notion that physical and social transition always MUST MUST MUST go hand-in-hand.

Why?

[Karla]

Suzi,

Excellent, insightful points and final question, 'why'.

And 'Why won't we let them'?   I'm not seeing a 'we' from our global community, doing the letting; rather, I see a new crop of old men.

'Standards', a quarter century ago, disqualified me from HRT through an endocrinologist, for being a lesbian.   Loving according to your heart, just wasn't in the ken of old men who presumed to decide for us.  I suppose I'm too outspoken as well    <hands on hips>

As for ethics, if there were ethics, doctors wouldn't be injecting our children with every new formaldehyde-laden vaccine that comes out of Big Pharma, whilst forcing women at risk to wait months to get a mammogram.  After my friend's child died from a flu vaccine, my trust in the medical establishment was shaken to the core.

This is not a battle that I have the resources to fight.... indeed, spironolactone has taken away much of my desire to tilt at windmills.

Which leaves me just like everyone else... getting as much information as possible and making my own plan.   The right to choose for myself but for nobody else.

Each person is unique; therefore the lawnmower of standards, nipping off any head that raises itself above the herd, makes no sense.  It may be convenient for professionals to insulate themselves from lawsuits.   I won't fight it, but I also won't believe in the standards of yesteryear just because a majority do.

I'm now 3 months into my RLE.

It's not giving me a clue whether or not SRS is right for me.... Why won't we let them?

I think the concept of the one-year RLE was devised under the false notion that physical and social transition always MUST MUST MUST go hand-in-hand.

Why?

[Zumbagirl]

I'm now 3 months into my RLE.

I think the concept of the one-year RLE was devised under the false notion that physical and social transition always MUST MUST MUST go hand-in-hand.

Why?

I think this all dates back to the good old Christine Jorgensen days. Back then it was srs first, hormones and social transition. I think doctors began to realize that wasn't working. They didn't want to operate on people who regretted it as soon as the anesthesia wore off. So they came up with the standards of care. If you want the surgery and want to live as a girl then prove it. It's pretty simple really. The people who were really motivated and wanted it jumped through the hoops got the surgery and then disappeared. The ones who regretted forced doctors and shrinks to keep re-evaluating the system. And that's what we have today. The real test toying is that pesky RLE. If you can endure the slings and arrows of  that one year and STILL want the surgery, then you are probably a good candidate. In reality we all know its not perfect but it seems to work pretty darn well.

If you want srs surgery on demand then its not really a question for us but a question of medical ethics. Would it be ethical for a doctor to perform a surgery that prevents reproduction if such an operation has the possibility of being detrimental to that's persons life? In the absence of answering that question we have the standards of care as the only reliable yard stick that determines whether such a medical undertaking is beneficial or not.

[Northern Jane]

Can't we bury Harry Benjamin and move on?

EXCUSE ME??!! Harry was the greatest advocate for the medical treatment of transsexuals that the world ever had! Without him, shrinks would still be putting us in institutions for "testosterone therapy" and frontal lobotomies! He believed transsexualism had a physiological basis, not psychiatric, and believed it should be treated as such - but I may be biased because I was diagnosed by Harry in 1966. The "garbage" came later and not from Dr. Benjamin!

I think this all dates back to the good old Christine Jorgensen days.

That is strange - I never heard of anyone regretting transition/SRS until Rene Richards. Christine didn't (to the best of my knowledge) despite the unwanted publicity.

Back then it was srs first, hormones and social transition. I think doctors began to realize that wasn't working.

That is NOT true! Hormone therapy was started as long before SRS as possible and living in one's target gender was a requirement! Fair or unfair, "passing" was an absolute requirement. (I KNOW - I was there!)

[LilDevilOfPrada]

Well Thailand made the min age for it there 21 a few years back. Any age works if your deemed fit and had your full time period met for it.

[kinz]

These rules are made by folks who have never known hardship.  Have never stood in our shoes, personally subjected to those rules.

I'm curious how many suicides (particularly teen suicides) might be prevented, by the removal of gatekeepers to HRT and SRS.

Can't we bury Harry Benjamin and move on?

this. as far as i'm concerned, the only people who have any right to decide whether and/or when they want srs are trans people themselves. the role of doctors, therapists, and psychologists in this is to advise about the benefits and drawbacks of the surgery, as well as whatever surgical risks may be involved. it should not be their role to tell us what we are are or aren't allowed to have based on their understanding of how we're supposed to be or how we're supposed to look.

[K8]

The book "True Selves" lists ten reasons someone might request SRS when that won't meet their needs but instead will make things worse for them.  Transitioning, both socially and physically, is a BIG deal.  It's not like deciding to take up skydiving or getting a tattoo, which require only informed consent.  A gender change affects every aspect of your life.  While I have some issues with the Standards of Care, I believe there still needs to be a process to weed out those who only think transition would be a good idea from those who need it. 

Are you willing to bet your life on something you haven't tried?  Something on which you have gotten only minimal guidance?  Just getting a vagina doesn't make you a woman and doesn't make you able to live as one.  We all want a quick fix, but perhaps we should be a little cautious before doing something that will irreversibly and drastically change our lives.

- Kate

[TaoRaven]

You can certainly call yourself a lizard but there is one thing that separates a green bodied, forked tongue, lizard man (or woman) from a post-op transsexual. You can still reproduce and have children. That makes things different. A thousand piercings and hundreds of body mods, even boob jobs, are not the same as SRS. None of those changes requires the removal of your sex organs and refashioning them into something else. That's why it will always be different and require a higher standard.

Oh, I don't know...how quick do you think anyone would be to hop in the sack with a lizard person??

Seriously though, this would have a MASSIVE impact on this person's life...dating / marriage, employment, social stigma....the list goes on. I actually think it's quite an appropriate analogy, especially since we have the option of banking sperm before SRS. In fact, I think we might have things a little better off than poor Mr. Lizard, as long as we pass well.

But people do these things....they use their adult right to decide what is best for them in their lives, and make it happen. And they don't need to spend years in therapy, and voluntarily accept the diagnosis of a mental disorder to do it.

I suffer from a birth defect. I was born in a male body. There is no logical reason in my mind that I should not be able to enjoy the benefits of modern medicine, just like any other American, and pay to have my defect surgically corrected at my own judgement.

But I also don't think that any one should be able to tell me how large my soft drink can be

[Danielle Emmalee]

I think as long as you are assessed to be mentally competent enough to make another legal decision you should be allowed to make this one.  Other decisions we may make have equal or greater capacity to have drastic consequences on our lives and aren't regulated at all - having sex without protection, binge drinking, self harm up to and including suicide (not actually illegal in most places anymore). 


[edit: just wanted to point out that I do see that the difference between this and the other decisions I listed is that you are asking someone else (a doctor) to assist you and they may feel bad about helping you do something that you might regret later.  So clearly the rules are in place not for our protection but for the protection of the health care providers.  Does this make it right?]