Informed Consent - what is it?

[Penny Gurl]

It's my understanding that if you wanted to get your services though them you would have to make it out to Chicago at least twice to start.  Once for the blood work as they require up to date work though there lab and a second for the advocate/ fallow up medical appointment. But once you are stable medically then you can have your meds shipped.. I live in the suburbs and have them shipped to me so I don;t have to run out there.  And I'm sure they would want to have a fallow up some time after HRT starts to make sure that your body is adjusting correctly. But ultimately you'd have to contact them directly to see what they say.   I really don't know if they would transfer your lab results, that's something for the pros to decide.

[Umiko]

well, unless they can do video calls, imma have to try something else becuz the 3 month wait isnt something i can handle with my current state

[suzifrommd]

so wait, as long as you have informed constant, you basically bypassed the 3 month therapy requirement? 

There is no 3-month therapy requirement. There is no therapy requirement at all. The current WPATH standards of care are very clear on that.

Any therapy requirement comes from the medical practitioners themselves, perhaps based on an outdated understanding of the SOC.

[Umiko]

There is no 3-month therapy requirement. There is no therapy requirement at all. The current WPATH standards of care are very clear on that.

Any therapy requirement comes from the medical practitioners themselves, perhaps based on an outdated understanding of the SOC.

wait, so i dont need 3 months  all i know is that i'm not stable enough to go on without transitioning and my endo has made that clear without verbalizing, becuz she recommended i get a psych eval done, my secondary therapist has also commented on what am going to do when i tell him whats going on and everyone around me can tell that something needs to happen or i will break down though they dont know i'm trans. thus why i'm wondering if i ask my secondary therapist for a letter, would he give it to me though he isnt really a gender therapist but does have enough experience becuz 2 of his patients were trans or even my pcp who would be willing to if she could

[suzifrommd]

wait, so i dont need 3 months 

Refer to the WPATH standards of care (http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf), bottom of page 28:

A mental health screening and/or assessment as outlined above is needed for referral to hormonal and surgical treatments for gender dysphoria. In contrast, psychotherapy—although highly recommended—is not a requirement.

Show that to your doctor, if it helps.

[Umiko]

Refer to the WPATH standards of care (http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf), bottom of page 28:

Show that to your doctor, if it helps.

so i show this part to my doctor? i already have well document information and my mental labels arent connected to me be transgendered. i just wanna make sure i do this right before going to my doctor or therapist for a letter.

[suzifrommd]

so i show this part to my doctor? i already have well document information and my mental labels arent connected to me be transgendered. i just wanna make sure i do this right before going to my doctor or therapist for a letter.

I can't promise that he'll accept it. The standards of care are guidelines but it's up to each doctor whether to follow it. If you're not sure, I'd call his office and ask.

[Umiko]

I can't promise that he'll accept it. The standards of care are guidelines but it's up to each doctor whether to follow it. If you're not sure, I'd call his office and ask.

k, and my last concern. though he had 2 patients who were trans, is it possible he can still write me my letter if i ask him to?

[suzifrommd]

k, and my last concern. though he had 2 patients who were trans, is it possible he can still write me my letter if i ask him to?

Again, I'm afraid that's a question for him.

[Umiko]

Again, I'm afraid that's a question for him.

ok, last question, could my pcp give me a letter? becuz my endo said have my pcp call her when i'm ready

[TaoRaven]

Let me just add this for those in the Denver / Colorado Springs area, looking for an informed consent provider: http://www.stevehindesmd.com/

My initial prescription for HRT was via this route. Expect an interview, an extensive blood panel and physical exam, and a very informative (even for us "know-it-alls"...lol) briefing on benefits, risks, and realistic expectations of HRT.

Two appointments, about two weeks apart, and I had my 'script.

Incidentally, there are also mental health professionals that will write an SRS letter after as little as a single session over Skype. This varies depending on the case and the person in question, obviously...but there are many people out there who believe that we shouldn't have to "prove" ourselves to anyone to get the care that we need.

[Umiko]

if i ask my therapist for a letter even though he doesnt have that much experience, can he still write one for me?

[aleon515]

@Liliana:
There is no magic period of time (3 months say). The therapist might not know anything and write the letter. OTOH, getting them to write about something they don't know anything about might be a bit hard!! Some endos don't really go by the letter at all. I know one here that doesn't at all. She talks to you and makes her own decisions. I would clear this up before making an appt with the endo.

@Penny Gurl, yeah this sounds like the kind of ideal Informed Consent type program. I would guess 1-2 physical appts, plus blood tests would be considered appropriate.

The WPATH provides for the Informed Consent approach.

BTW, I did have counseling, but my counselor was not at interested in gatekeeping. I think therapy/counseling is a good idea for many trans people (okay for many people). I just don't like for the concept of gatekeeping. I also believe, from what I have seen, that is more discriminatory towards trans women than trans men.

--Jay

[Spiritwlker]

The informed consent part didn't come into play with my therapist, only with my endocrinologist. The endo (in painstaking detail) went over all the risks associated with taking testosterone as well as all the physical changes I would experience. I saw her in her office three times for essentially the same discussion. "Do you really want to take the injections?" Yes. "Do you understand you will be at risk for polycythemia, and that thickening of your blood may cause a blood clot that might precipitate heart attack or stroke?" Yep. "You'll get facial hair and body hair." Uh huh. "Your menses will stop." God I hope so. "Your voice may deepen and you will have growth of your clitoris." Yes I understand. "The shots are painful." I get that. "So you're sure then? You really want to do this?" Yes. "You can change your mind later but some of the changes will be permanent." Yep.

All of that business is getting informed consent.

[EmmaD]

I'm on page 104 of the SOC v7, under the section labeled "Criteria for Feminizing/Masculinizing Hormone Therapy". Item #1 says "Persistent, well-documented gender dysphoria".

I have to read that as saying that the WPATH wants a diagnosis of gender identity dysphoria before hormones are prescribed. (Is there some other way to read it?)

Because there is no one presentation for our condition - each of us seems to experience it totally differently - diagnosis criteria is highly open to individual interpretation, and each local practitioner will have their own test, right?

I am in Melbourne, Australia.  Applied here, the WPATH requirements accommodate the range of GID experienced by those being assessed.  What seems to be a block is that if I have not thought of myself as a female from my earliest memory and have opposed by birth gender continuously, the process is seen as (and could be applied to result in) gatekeeping. 

My experience here is that I am not at that extreme (I knew that) and the assessment served mainly to discount any other issues. After we had completed that work (mine took a few months - I have more years to cover!!) the informed consent part was very quick and perfunctory.  I once referred to it to my therapist (not the Psychiatrist doing the assessment work) that the process is one of "very well-informed consent" meaning the Psychiatrist was well informed about me before I gave my informed consent.  She didn't disagree.

Open to individual interpretation? Yes and I think that is right.  Necessary?  Perhaps.  Frustrating? Yes but I persevered as it is the only avenue open here but not onerous in my case.  Harmful? For me, no. But I didn't have any issues around access to the process that some encounter or any great and immediate distress arising from GID -just slowly getting to the end of my rope.  Beneficial? I'm still out on that one!

A few years ago (and others may recall it better than I can), there was court case here where it was found that sufficient screening/psych assessment may not have occurred.  By "informed consent only" standards, arguably more than enough was done.  In a legal sense, perhaps not enough.  What is left as an unknown is that in cases like that, would more therapy made any difference?  Maybe, maybe not.  We are dealing with individuals here, not a herd.  One size doesn't fit all.

[aleon515]

@Spiritwalker, well sounds like the endo was on the informed consent thing, but if you had to get a therapist letter, not so much.
@Emma, I don't know sounds more gatekeeping. Not everyone has experiences from early childhood. In fact, some people do not even know til later in life. In retrospect maybe I did have them from later in life, but I would clearly NOT have been a non-informed consent candidate. Doubt some countries would have let me start T at all. I couldn't figure out if you went thru a couple months or years of therapy though. But I consider months of therapy not informed consent by the way that I have heard the rationale for it to be.

I think coerced therapy does more harm than good. I think it puts the relationship between therapist and client in a position where the person is trying to convince the therapist they are trans enough, instead of concentrating on the working stuff out. It probably even in some cases endangers people's lives where the therapist is not informed enough on trans issues. It discriminates against non-binary people who have non-conforming gender identities by expecting a certain type of transgender narrative. I don't think there is any research that coerced therapy has actually helped people avoid mistakes.

I think the concept, as I understand it is harm reduction: 1. It is safer to get hormones which are controlled medically than off the street somewhere. 2. That the incidence of suicide is very high in the trans community and that hormones could be life saving.

I think cheap (and perhaps free) and available therapy would help more people. Make it available and people will come and treat adults like adults.

I do not believe that the SOC are a legally binding document, but for what it's worth I think that in a session or two it would be possible for someone to determine if the person is legally able to consent (i.e. in a legal way find out if the person is mature enough and sane enough to offer legal consent).

--Jay

[Amy1988]

I keep reading and seeing comments about informed consent access to HRT, I thought it may be helpful to see it from the professional view.

Quote:
There appears to be some confusion around the notion of "informed consent". Within the medical community informed consent is considered a core principle of practice and it is considered standard practice to obtain informed consent prior to any medical intervention. To obtain informed consent the physician must be satisfied that the patient has been given comprehensive information about the proposed treatment. This would include information about the expected effects of the treatment, the possible risks or complications and any alternatives to the proposed treatment. In addition the physician must be satisfied that the patient has the capacity to consent to treatment. In other words, the physician must conduct an assessment of whether the patient has the cognitive ability to make a decision and is free from coercion. This can be a very complex assessment and needs to address the patient's ability to understand information about treatment; their ability to appreciate how that information applies to their situation; their ability to reason with that information; and their ability to make a choice and express it. In all situations therefore it is important that a physician conducts a comprehensive assessment to ensure that the treatment being prescribed is safe and appropriate. Informed consent therefore is not "treatment on demand".

A number of clinics in the US and Canada have developed protocols in relation to accessing hormones based on an informed consent model. Examples of these clinics include: Tom Waddell Health Centre (San Francisco), Catherine White Holman Wellness Centre (Vancouver), Fenway Community Health Transgender Health Program (Boston) and Howard Brown Health Centre (Chicago). A core feature of all these protocols is that a comprehensive assessment is made prior to prescription of hormones to assess the appropriateness and safety of prescribing hormones for any individual requesting hormones. In some of these protocols (eg Fenway) the assessment must be conducted by a mental health professional. WPATH has reviewed these protocols and states "The difference between the Informed Consent Model and SOC, Version 7 is that the SOC puts greater emphasis on the important role that mental health professionals can play in alleviating gender dysphoria and facilitating changes in gender role and psychosocial adjustment."

Yeah red tape nanny state BS. This is the reason i self medicate.  I would prefer to be under a doctors care but they make you jump through too many hoops so I self medicate and I may have to self castrate. 

[Amy1988]

Cindy, I wonder if a better term for what we've been referring to as "informed consent" would be "informed consent only."

I.e. all surgeons use informed consent for all procedures, but gender reaffirming procedures tend also to have other requirements. (GID diagnosis from a doctor who will often ask us to jump through hoops to prove it to him, etc.)

Exactly!  String you along just to take your money.  They don't care about people like us so they feel justified ripping us off.

[Umiko]

well honestly, my endo just said go to her when i'm ready which means i just get the informed consent, have a note from my doctor saying i'm stable enough to start hrt, yada yada yada but it stills seems like i'm being put through to many hoops and all my therapists and doctors see that clearly i'm trans from all my attacks, how i conduct myself, and my speak patterns, hell i'm asked on a constant bases from a friend on how to wow her boyfriend or what he is thinking and i'm like "girl, i have no idea" and she is like yes you do cuz your a male. there are so many other things but thats just the tip. i even got 2 therapists just to get through my week without losing my mind. i just hope this works out becuz quiet frankly, i dont know how long my mental will last if this keeps up

[kelly_aus]

Yeah red tape nanny state BS. This is the reason i self medicate.  I would prefer to be under a doctors care but they make you jump through too many hoops so I self medicate and I may have to self castrate.

Exactly!  String you along just to take your money.  They don't care about people like us so they feel justified ripping us off.

Firstly, attitudes like this are why trans people have a dubious reputation in the wider community.
Secondly, try dealing with professional gender therapists, ones with established and well known reputations.. I did and have had no issues - although I do seem to be a little more pragmatic and realistic than some.