Letter for surgeon: A full-on rant

[JennX]

Find two new therapists. Make no reference to the old ones when you find the new ones. They have issues with your transitioning. I won't speculate as to what they are and who cares, but they have them and they won't go away. Find some new providers. These two are done. My SRS surgeon (and all others I interviewed) were willing to take my 2 letters a year in advance, as most were booked up that far ind advance. If these two "professionals" had a clue about writing referral letters and dealing with such issues, and surgeons booking times, they'd already know this. Move on.

[Zumbagirl]

When I did my transition, my first therapist knew about my name change, and my work experience, FFS, electrolysis process, etc. I could easily prove I had lived my 1 year as a woman. She did tell me upfront that i would need to do the 1 year RLE, so shortly after my 1 year was up I asked for my letter. I showed her all the things that were in the standards of care for the letter content for surgery. A few weeks later I had my letter. I then got in to see a psychiatrist and gave him the first letter. I had only 1 session. I was given a quiz and a simple meeting with the doctor and he asked where his letter needed to be sent, and I gave them dr Brassard's fax number. A few days later I received a fax receipt from the doctor and an original signed copy of the letter. Then I knew I was officially done with ole Harry Benjamin. From that day to the day I walked into Dr Brassard's office and said lets do this thing, was around 2 years from he date I received the letters. By then I had been living almost 3 years as a woman. I actually delayed the surgery because I wanted to invest in genital electro.

There is no requirement written down anywhere that one needs to have surgery letters just "before" the surgery. Mine were dated a few years before my surgery date, but that didn't seem to bother Dr Brassard. In fact within 5 minutes of showing up the letters actually didn't matter anymore. The fact that I was there and had paid for the surgery meant I actually wanted it.

The only reason why I can think that either your therapist or psychiatrist won't do the letter right away, is either old fashioned thinking or perhaps they are doubting your resolve?

[suzifrommd]

The only reason why I can think that either your therapist or psychiatrist won't do the letter right away, is either old fashioned thinking or perhaps they are doubting your resolve?

I'm wondering if it has to do with the fact that my date is only five days after my RLE year ends?

[Zumbagirl]

I'm wondering if it has to do with the fact that my date is only five days after my RLE year ends?

Have you done your full 1 year? How far is your surgery from today? You probably can do what you are asking but it takes exceptional planning skills. Just thinking back on it now it's amazing all the straggly little details like passport, arranging time off from work (and the mountain of paper work that took), never mind the cash aspect, travel arrangements and probably a whole bunch of immediate post op things that I  sure I am forgetting now.

[LordKAT]

I believe this one is a case of no passport needed as she is staying in country.

[suzifrommd]

Have you done your full 1 year? How far is your surgery from today? You probably can do what you are asking but it takes exceptional planning skills. Just thinking back on it now it's amazing all the straggly little details like passport, arranging time off from work (and the mountain of paper work that took), never mind the cash aspect, travel arrangements and probably a whole bunch of immediate post op things that I  sure I am forgetting now.

My surgery is in June. No passport is needed - it's only about 2 hrs away by car. I'm not sure I understand your concerns. It's seven months away. I have more than enough time to do what needs to be done, Are you assuming no arrangements can be made before my RLE is up?

[Eva Marie]

Suzi-

I believe that you did the right thing by backing the letter off a few notches before you sent it. IMO badgering the therapists will not change their mind, and in doing so you may actually cause them to dig their heels in and prolong the time that they will require to get your letter.

Only you can decide whether or not to stay with your current therapist or find another one. I find it distressing how her position changed after your visit with the 2nd therapist, and I'd want an explanation for why that happened before proceeding - that's a severe breach of trust.

Anyway, I wish you good luck with all of this as you move forward!

~Eva

[makinmagic]

Wow, so sorry you're going through this. My advice would be to drop all communication and to find ANOTHER therapist who would be willing to do so. There are PLENTY of them who do the consults over Skype and their letters are accepted by everyone. I did so for my second letter, all it took were 30 minutes over Skype and $250.
I was extremely lucky with the first letter too. I saw this therapist only twice and made it clear right away that I don't need therapy, I just need a letter. Both letters were accepted by McGinn no problem.

[TaoRaven]

Suzi-

doing so you may actually cause them to dig their heels in and prolong the time that they will require to get your letter.

The fact that this is even a possibility shows how broken the traditional gatekeeping system is.

NO ONE gets to decide for me when and whether I become whole. We have enough options these days, we don't have to put up with this kind of carrot-on-a-stick scenario.

[suzifrommd]

There are PLENTY of them who do the consults over Skype and their letters are accepted by everyone. I did so for my second letter, all it took were 30 minutes over Skype and $250.

Would you be willing to share the name and contact info for the Skype therapist?

[Ltl89]

Hey Suzi,

Quick question, why do you feel upset about having to wait for the letter?  I'm not saying it is or isn't right for you to wait for the letter or that the reasoning was a bit questionable, but I was curious to hear why the waiting aspect annoyed you so much.  I thought most therapists take their time before writing letters to approve someone for SRS and was surprised to hear it was uncommon for the second therapist to not write a letter immediately.  Personally, if I was in that therapist's shoes, I would probably want to get to know the patient a bit more than one session before I recommend that they go through SRS.  It's great that his colleague has already assessed you, but it's understandable that he would want a little more time to make his own assessment.   While it is your right to make the decision to have SRS, he has to write the letter and it makes sense that he would want to make sure he is attaching his name to something he is comfortable with.  It's unfortunate the system is set up this way, but it is and lawsuits are not uncommon.  Having said that, you also want the person who evaluates you to understand your situation.  If you feel that the therapists in question are not supportive of your decision (and I can understand why you have reached that conclusion) then you may want to see a therapist who is more knowledgeable on trans issues.  Make sure you are being evaluated by the proper people. 

[suzifrommd]

Hey Suzi,

Quick question, why do you feel upset about having to wait for the letter? 

* The reasons he gave didn't make sense. One of them involved the state of our separation negotiations which (1) should have nothing to do with whether I am psychologically or materially ready for surgery, and (2) has a good chance of not improving between now and surgery. The other was that, though he could find no problems with my readiness at this time, I might become unready at some time between now and the surgery.
* My therapist had told me he wouldn't give me a hard time.
* I am a 52-year old professional woman with a master's degree who raised two children, supervised a team that programmed the computer on a 2 billion dollar satellite, and successfully managed my affairs for more than 30 years of adulthood. It is humiliating, dehumanizing, and patronizing to be told he knows better than I what is good for me.
* A psychologist is charged with evaluating my psychological and practical readiness for surgery. He is NOT charged with giving a personal or professional opinion of whether I "should" have surgery. That's simply not his job. If he finds there are no psychological impediments, and that I'm making necessary preparations, he MUST support my surgery. Period. End of sentence. He simply can't say (as this doctor said), well I can't see anything wrong with your readiness but I'm not going to write your letter yet anyway.

That is gate keeping.

[suzifrommd]

I talked with my therapist, this afternoon. Highlights of the call:

* She was "very surprised" that he refused to write my letter. It felt really good to hear her say that - that she didn't agree with the way he dealt with me.
* Initially she said she didn't think writing a letter now would do any good, that I should wait until a couple weeks before surgery when my RLE was nearly complete. After about 20 minutes of discussion I had her convinced that if she's willing to write the letter then saying "I intend to complete my RLE", why couldn't she say the same thing now. She agreed to write my letter right away.
* She's going to talk to him, and try to get him to write a letter. I let her know that no matter what, I wasn't going back to him for another visit, so if he won't do it without that, she'll find me someone else to go to.

Hearing her say that this was not the way she thought it should go, really felt validating.

[FrancisAnn]

Actually, I think it's 190 reasons - the $190.00 he charged me for the session. He hinted something about maybe wanting to see me again.

You and I see "transwoman". Gatekeepers see "money tree".

It's all about the $. Find someone else if you can. They all leach off our desires & needs for one normal life.

[Ltl89]

Hey Suzi,

Glad things are working in your favor at the moment!

[Zumbagirl]

It's all about the $. Find someone else if you can. They all leach off our desires & needs for one normal life.

If you think about how much will be spent on electrolysis, hormones, blood work, new clothes, surgery, legal documents, etc, all the stuff that goes with the gender transition, the therapy is one of the cheapest items on the list.

[JLT1]

If you think about how much will be spent on electrolysis, hormones, blood work, new clothes, surgery, legal documents, etc, all the stuff that goes with the gender transition, the therapy is one of the cheapest items on the list.

For the person undergoing transition, therapy is cheap.  For the person providing the therapy, it is their livelihood.  So, a few more visits really doesn't hit the budget of the person who is transitioning but can help the income of the therapist. 

If I spend two years in therapy and $190 per week with two weeks missed per year for vacation, it's $19,000 to the therapist.  My share, under my insurance, is $1168.  There is motivation for an unscrupulous therapist. My therapist is great.  Some are not.  Suzifrommd ran into a bad one.

Jen 

[suzifrommd]

A recap for those who don't want to read the thread history: My surgeon is asking for two referral letters. My GT wrote one, and recommended another local therapist to write another whom she assured me wouldn't give me trouble. Despite the fact that I'm a well adjusted, competent, intelligent, informed woman who has made every necessary preparation for surgery, this therapist declined to write my letter.

An update: My therapist suggested I write him an email asking for a letter, now that I'm deeper into my RLE. His answer was that he needs to see me again (and, of course, pay him another $190.00). The initial visit was too early in my RLE for him to make a conclusion. I'm frustrated, because it's clear I would have saved the one-ninety if I had waited, but NOBODY TOLD ME THAT!!!

However, I made inquiries to other therapists. I found two others who were willing to do it, but they seemed like they were going to charge considerably more than $190.

So I bit the bullet today, and made a second appointment with the doctor.

What I think I look like:



What the healthcare community thinks I look like:

[calicarly]

So why haven't you gotten the divorce? I know it has nothing to do with it. But sometimes that's all these people want, an excuse to say no... Don't give em any.. I hope the ball is rolling now for you... Sucks that this person would take your money like that and give you nothing... Sounds to me like the guy had his own agenda, although you know in the world we live in, all they think about is wether they could get used by someone for something and that means them being like overly cautious with things that have nothing to do with why you went there in the first place!

[calicarly]

I meant SUED lol