Medical Insurance and WPATH RLE "Gatekeeper" Requirements

[DrBobbi]

Hi,

For those of us that have medical coverage that covers transgender care, please check your policy and see if there's a "Real Life Experience" (RLE), gatekeeper requirement before trans care kicks in. Here's an example of the language I'm looking for:

[real-life experience living as the desired gender is important to validate the individual's desire and ability to incorporate into their desired gender role within their social network and daily environment.  This generally involves gender-specific appearance (garments, hairstyle, etc.), involvement in various activities in the desired gender role including work or academic settings, legal acquisition of a gender appropriate first name, and acknowledgement by others of their new gender role.  With regard real-life experience, to the 2011 WPATH document specifically states:

The criterion noted above for some types of genital surgeries – i.e., that patients engage in 12 continuous months of living in a gender role that is congruent with their gender identity]

The duration of 12 months allows for a range of different life experiences and events that may occur throughout the year (e.g., family events, holidays, vacations, season-specific work or school experiences). During this time, patients should present consistently, on a day-to-day basis and across all settings of life, in their desired gender role. This includes coming out to partners, family, friends, and community members (e.g., at school, work, other settings).

Health professionals should clearly document a patient's experience in the gender role in the medical chart, including the start date of living full time for those who are preparing for genital surgery. In some situations, if needed, health professionals may request verification that this criterion has been fulfilled: They may communicate with individuals who have related to the patient in an identity-congruent gender role, or request documentation of a legal name and/or gender marker change, if applicable.]

Thanks.

-Z

[Alaia]

Yes, I have this with my insurance. Were you looking for some sort of feedback about it?

[Jamie D]

It is mind-boggling to think that there are still some places that require the RLE/RLT before allowing hormone therapy!

I am of the school of thought that "It's my body; it's my choice."

[Cindy]

There is a lot of interest for getting the SOC7 modified at the WPATH meeting in Bangkok in Feb.

[Alaia]

It is mind-boggling to think that there are still some places that require the RLE/RLT before allowing hormone therapy!

I should probably clarify that my insurance only requires the one year RLE before having gender affirming surgery. EEI only requires a letter from a therapist.
Personally, I thought my employer was on the progressive end of things in that they offered trans inclusive benefits at all--even if it is based on the WPATH SOC and not Informed Consent.

[Jessika Lin]

There is a lot of interest for getting the SOC7 modified at the WPATH meeting in Bangkok in Feb.

For removing the RLE requirement before SRS, yes? I really wish they would!

[Charley Bea(EmeraldP)]

What about those who do not dress the expected way? For example most women where I live tend to wear shorts and t-shirts or jeans and t-shirts. Hardly a stereotypical girl look(depending on ones own view of such things). Would that be counted?

[kelly_aus]

For removing the RLE requirement before SRS, yes? I really wish they would!

While I understand where you are coming from, I'm kinda glad I was made to wait a little. Without the delay. I may well have gotten SRS and ended up hating myself for it. I'm not alone in feeling this way..

I suspect that if the RLE requirement is removed, the post-op regret rate will climb - significantly.. Personally, I think it needs to exist, but a 6 month period should be sufficient.

[Jessika Lin]

While I understand where you are coming from, I'm kinda glad I was made to wait a little. Without the delay. I may well have gotten SRS and ended up hating myself for it. I'm not alone in feeling this way..

I suspect that if the RLE requirement is removed, the post-op regret rate will climb - significantly.. Personally, I think it needs to exist, but a 6 month period should be sufficient.

I'd be fine with a 1 year HRT requirement, although in all honesty if I could get it done now I would.

[Cindy]

There is a lot of interest for getting the SOC7 modified at the WPATH meeting in Bangkok in Feb.

More to clearly define IC. I don't think there is any interest in stopping RLE for surgery. There is no defined waiting time or RLE for HRT.

The criteria for hormone therapy:
Persistent well documented gender dysphoria
Capacity to make a fully informed decision and consent to treatment
Age of consent in a given country (if younger follow SOC outlined in section VI)
If significant medical or mental health concerns are present, they must be reasonably well controlled

[Paulagirl]

I began living full time before therapy, and HRT. When I asked my therapist about RLE, she simply said 'Your RLE is done, call me when you need a letter to that effect.' I love Canadian policies, and practices.

[Allyda]

I take it this WPATH thing doesn't apply to US residents?

[Cindy]

I take it this WPATH thing doesn't apply to US residents?

The Standards of Care were formulated under the auspice of WPATH which is based in the USA.

[Allyda]

The Standards of Care were formulated under the auspice of WPATH which is based in the USA.

So before I'll be able to have SRS I'll have to go through RLE? Don't get me wrong I have some time to go on hormones (hrt) before SRS, I'm just trying to be prepared for future obstacles. I'm pretty much living as a woman now and have been for nearly 5 years even before starting hrt recently. Just trying to find out everything I can. I doubt I'll need other surgeries (well, maybe the voice one if I can't train mine as it is) but to be whole I know I'll eventually need SRS.

[Cindy]

So before I'll be able to have SRS I'll have to go through RLE? Don't get me wrong I have some time to go on hormones (hrt) before SRS, I'm just trying to be prepared for future obstacles. I'm pretty much living as a woman now and have been for nearly 5 years even before starting hrt recently. Just trying to find out everything I can. I doubt I'll need other surgeries (well, maybe the voice one if I can't train mine as it is) but to be whole I know I'll eventually need SRS.

You need to discuss this with your medics but I would have thought that if you are already living as your identified gender that time should be included!

[Jill F]

The whole thing about making people live full time before HRT is ridiculous and is more likely to do more harm than good.  It is almost as cruel as the electro shock "therapy" we were subjected to in decades past. Dysphoric patients usually NEED cross-sex hormones to function properly.  All of the antidepressants and antianxiety meds in the world paled in comparison to estrogen for me. Most people don't even begin to resemble their true gender without them, and sometimes it takes at least a year before one even has a prayer of blending in.  I was fortunate enough to be able to go full time inside of 8 weeks of a low dose.

SRS is a different matter, but it should simply be ADVISED that one waits as long as they can.  It is permanent, after all.  I can see some merit in doing a "dry run" for an entire calendar year, to go through a cycle of holidays, birthdays, vacations, and work schedules to see how one feels day-to-day, but sometimes top surgeons' waiting lists can be the better part of a year and you won't be booked until the letters are in hand so you have to wait even longer.

I know my therapist and doctors are all going to Bangkok in February, and now I can't get all my appointments in until late Feb/early March for the orchi.

[Allyda]

Who knows maybe things will change in the next couple of years. As far as SRS, If I had the $$, the means, and a doctor that would do it I'd have it tomorrow. That's how sure I am about myself. I don't need a shrink who's probably half my age making decisions for me. I won't have it. I'll go out of country before I let my future be dictated by someone who hasn't had near the life experiences I have.

what worries me is I'm not the type of girl who wears dresses alot. I like my shorts and tank tops for most days I do live in Florida ya know. I don't know maybe I'm getting worked up over nothing. As Cindy says the fact I've been living as a woman for the last 5 years should count for something.

[Cindy]

There is nothing stated on how you present, it just says 'living congruent to your gender identification'.

BTW I'm not defending the thing! The SOCv7 is in the wiki  on Susan's you can all read it yourselves!


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

[Allyda]

There is nothing stated on how you present, it just says 'living congruent to your gender identification'.

BTW I'm not defending the thing! The SOCv7 is in the wiki  on Susan's you can all read it yourselves!


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

I didn't think you were, and I thank you for the information. I just can't stand the idea of my future happiness resting on the opinion of someone half my age, or worse, younger!, lol

[Jessika Lin]

What bothers me is having to rely on the opinion/judgement of someone who has, at best, a textbook or second-hand notion of what I'm going through and how I may be feeling about it.