reasons for denying letter

[stephaniec]

what kind of reasons could a therapist ethically employ to denying a letter for srs. could you keep going to different therapists until you find one that will give you a recommendation .Will a surgeon that's received numerous denials accept one for recommendation.  would a surgeon in a foreign country be more amendable to numerous tries .  Just curious.

[suzifrommd]

Ethically? It depends on his ethics, of course. Ethically you can justify all sorts of things. "My practice is important, so requiring someone to come in for sessions they don't need is ethically justifiable since it allows me to continue practicing." "I once had a patient who was angry at me because she was unhappy with her SRS. I should try to protect my patients from that, because she was awfully unhappy, even if it means substituting my judgment for hers." "Deep down, we all know transgender people are just deluded. I'm protecting them by refusing their letter."

In my opinion, the ONLY ethical justification for denying a letter is if the patient has demonstrated herself not competent to make an informed decision.

The WPATH disagrees with me and sets out the following as their criteria for surgery:

1. Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country;
4. If significant medical or mental health concerns are present, they must be well controlled;
5. 12 continuous months of hormone therapy as appropriate to the patient's gender goals (unless
hormones are not clinically indicated for the individual).
6. 12 continuous months of living in a gender role that is congruent with their gender identity

So a therapist who is a WPATH member cannot ethically deny a letter to someone who meets those criteria.

[Jenna Marie]

My therapist said she'd had a man come in and admit freely that he considered himself a cis man but was trying to transition in order to escape a felony conviction on his record. (Not sure it works that way anyway...) That's the only letter she's ever denied.

I don't know how a surgeon would even know if someone therapist-shopped, if that's what you're asking.

[vlmitchell]

My recommendation: TRUST YOUR THERAPIST!!!

If you're not ready, you're not ready. Messing with this can/will/has risked and sacrificed lives in the name of impatience.

OTOH, if you're primary therapist says that you're good to go for SRS, the second opinion is a cakewalk.

For the love of all that is holy though, don't muck around with this stuff.

[stephaniec]

My therapist said she'd had a man come in and admit freely that he considered himself a cis man but was trying to transition in order to escape a felony conviction on his record. (Not sure it works that way anyway...) That's the only letter she's ever denied.

I don't know how a surgeon would even know if someone therapist-shopped, if that's what you're asking.

yea, its kind of what I was asking if someone could shop around for what they believed to be the right decision or are there safe guards . Just a curious question because of the difficulties of knowing the gate keepers are out there.

[Missadventure]

yea, its kind of what I was asking if someone could shop around for what they believed to be the right decision or are there safe guards . Just a curious question because of the difficulties of knowing the gate keepers are out there.

Granted, I'm nowhere close to getting GRS yet, so I haven't given it much thought... But, I can't imagine a therapist writing a letter saying "Don't do surgery on this person!" So, all one needs to do is keep looking around until they find a therapist they're comfortable with, who understands them and their needs as a patient, and is willing to write you a letter to get it done.

[Jenna Marie]

Yeah, as missadventure says, there are so many therapists out there and very very few will write a letter *against* surgery, so it's probably possible. The surgeons are far too busy to check up on people that way, even if they could; they're not going to contact every therapist you might have visited and ask about you.

[Satinjoy]

Mine told me he would write the letter, but that he did not think it a good move for me, and that in writing the letter the responsibility would be pretty much my own for the outcome.

That is a lot different from my hormone letter, which was supportive.

I trust his judgement and I pay him to watch out for my best interests.  For this time and place its a no go for me.

But noted is that he would advise against it - normally they don't do that - and would write the letter anyway, but in a way that transfers the responsibility to myself based on this time and set of circumstances and stage of the dysphoria.

My classification, if looked at from the Benjamin standards, would be stage 4.   Different goals, no desire for full time outward expression.  I am cool with being pre srs anyway, as long as I feel and look good in any stage of transition I choose to present at.

So it sems to me they'd write it anyway but make sure you understand their concerns, IF they didn't think it was cool.

I have no idea if that was helpful or not.  Its just where I stand with it and what my guy said to me.  I am not currently driven to SRS it is attractive but not a requirement for me to be happy.  Not right now anyway.

[stephaniec]

Mine told me he would write the letter, but that he did not think it a good move for me, and that in writing the letter the responsibility would be pretty much my own for the outcome.

That is a lot different from my hormone letter, which was supportive.

I trust his judgement and I pay him to watch out for my best interests.  For this time and place its a no go for me.

But noted is that he would advise against it - normally they don't do that - and would write the letter anyway, but in a way that transfers the responsibility to myself based on this time and set of circumstances and stage of the dysphoria.

My classification, if looked at from the Benjamin standards, would be stage 4.   Different goals, no desire for full time outward expression.  I am cool with being pre srs anyway, as long as I feel and look good in any stage of transition I choose to present at.

So it sems to me they'd write it anyway but make sure you understand their concerns, IF they didn't think it was cool.

I have no idea if that was helpful or not.  Its just where I stand with it and what my guy said to me.  I am not currently driven to SRS it is attractive but not a requirement for me to be happy.  Not right now anyway.

it seems like a good way for them to handle it, being honest

[Apples Mk.II]

5. 12 continuous months of hormone therapy as appropriate to the patient's gender goals (unless
hormones are not clinically indicated for the individual).

I'm two months away from doing 12 months, and three away from getting the letter in the next consultation, but I was 14 days off HRT on doctor's orders. Does this restart the period and I have to wait a whole year again? 

The shrink fully believes SRS will improve my life and will write the letter as soon as possible, but the endo's oppinion about if I am physically ready for it goes first.

[Allyda]

I worry about this because of my age, and the fact I do have a few chronic health problems, -none that would interfere with anesthetic and surgery though. I'm at least a year and a half, 2 years out from SRS but I would like to have VFS (Voice Feminization Surgery) as soon as possible as my voice is my only giveaway, at least in my opinion. In public though I'm always addressed and accepted as female though despite my voice. Oh well, I see my new Endo on the 13th. I'll ask him about it as he has transgender experience.