Post op regret and detransition - informed consent and psychotherapy

[stephaniec]

well, I can only speak for my self and don't know if it applies to others. I've had pretty much extensive therapy all my life, I happen to love ripping apart my mind and putting it back together again through the psychoanalytic  process. I admit to being a little weird. I hadn't been in therapy for 20 years. I lost my job and had other major psychological problems do to my dysphoria. I had been seeing a social worker trained in psychology 2 weeks prior to losing my job because I couldn't handle the loneliness anymore, then I lost my job and ended up in the hospital psyche ward. The overnight psychiatrist ask me what was wrong and I told her I wanted to be a woman. They first tried to give me antipsychotic drugs , but that didn't last long because I have a condition where my mind physically reacts negatively to anti depressants and antipsychotics . the antipsychotics have to do with dopamine suppression and chemically my brain can't function properly when the dopamine is block by the  mechanism. The thing was that I was mentally triggered by the side effect of breast growth from both the antidepressants and the antipsychotics. I've wanted female hormones since high school but had no idea of the process to get them. I lived in the denial by trying to be the male I was supposed to be , so I refused to admit I was transgender , but back to the therapy, I decided I needed to do estrogen to save my life and wrote a short letter to the medical team involved in my treatment they agreed and my life began. So yes its up to you.

[AnonyMs]

I'd like to add to this discussion. While I've not had SRS I have started to plan for it.

I believe strongly in informed consent, and to me informed consent means that someone is informed of the consequences of their decisions, and is capable of giving consent. "Capable" being judged by a psychiatrist since that is their area of expertise (i.e. they are not nuts). By that standard WPATH is not informed consent, since there is a requirement for 1 year RLE, and I disagree with WPATH. I also I believe it does not include a diagnosis of being transgender or not. I have no opinion on people who are not mentally capable giving consent, or children, as I don't know anything about that.

When I started HRT I did it DIY, and I partly did so as I didn't want a diagnosis of a psychiatric disorder (it was more that 5 years ago). There's some definite downsides to that. So I informed myself, visited a therapist over the course of a year, then started HRT. My only regret is not starting sooner.

Due to not transitioning I've been suffering depression and started seeing a psychiatrist. I was very conflicted at first, as I really needed help, and there's no point in seeking help if I don't tell the truth, but telling the truth carries the risk that should I decide to proceed with SRS then the truth might prevent me getting it. Fortunately as with HRT, and as others have mentioned, there are ways around that, so I went ahead anyway, and its been very helpful. I wouldn't be concerned visiting medical professionals if it really were informed consent and that would be a great relief. If there was serious gatekeeping then more than likely I'd end up convincing myself and the psychiatrist that I needed SRS just due the the pressure on me not to mess it up. Fortunately Sydney is blessed for transgender people and I feel I'm getting the help I really need.

I also believe that everything around this subject is very biased by moral/cultural influences. Life is full of risk, but there's something special about this subject where people feel the need to tell others what to do. Driving kills vast number of people, as does smoking and alcohol, but there's not too much preaching about that. We accept some personal limitations for the benefit of society since these do affect other people but generally get a license, or be of the required age and you're fine. Others have mentioned cosmetic surgery - good point. Yes there's a risk of making a mistake. That pretty much applies to everything in life. I regret more that anything not realizing I'm trans when I was young. What an idiot. With gate keeping there's a risk of others making mistakes for you - I'm not ok with that at all. Increasing or decreasing the amount of gate keeping is not going to change the fact that people will get hurt, only change the number who get hurt on either side of it. I think the total good/bad either way is a matter if speculation, but if I'm going to get hurt I want it to be my choice.

Finally, things seem to be getting better for transgender issues these days, and I'd rather have a system put in place while we can that allows no personal biases by medical practitioners to refuse treatment. Its a slippery slope once that happens, and if things turn against transgender people in the future then that will cause no end of trouble. I understand that getting an abortion in some parts of America is practically impossible, even though its legal. I'd hate to see all our hard won freedoms going the same way.

[Martine A.]

Hi.

I consider getting into the US informed consent branch. Because I am now in a gatekeeping system, the topic of regret on the 'quick' informed consent may come up during my talk with therapist, so I wanted to have some data. I found this topic looking for actual data on regret ratio at the 'quick' informed consent. But there seems to be no data on regret rate, is there any?

Re gatekeeping, so far here one should have reckoned with 6-8 months waiting before first ever appointment for mandatory psychological 'diagnostic'. Then one month or so between each session. Uncertain how many sessions. No private health care option available. Absolute control over hormone access. I read that in UK waiting time can be 3 years before first appointment, but I also heard they have private health care that provides an alternative.

After tasting the above, I can only vote up for the 'quick' informed consent. I would also vote up for having an exam where people can prove they are well aware of what HRT is about and what one should know. Specifically designed to shake wish of those who would rather wait a little longer or see a therapist. That is the way to return the key in people's hands.

Still, are there any actual data on the regret ratio for the 'quick' informed consent option? I would be happy to consume them.

[TinaVane]

Anybody know the detransition numbers for when somebody went with the complete GRS

[AnonyMs]

Anybody know the detransition numbers for when somebody went with the complete GRS

I bet its a while lot less than the suicide rate of those who get that far.

[TinaVane]

I bet its a while lot less than the suicide rate of those who get that far.

Hhhmmmm which is not that high when they get the complete surgery right ?


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[Martine A.]

Yea, my question goes for those who returned from / regretted HRT. That is where the gatekeeping is. It is a little hard to use existence of 'quick' informed consent pro-actively in a discussion without knowing numbers. Not knowing numbers only allows defensive position in case the other side mentions it.

[TinaVane]

Well me myself I been off and on on hrt but only because of financial reasons


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[Deborah]

I went off HRT two times.  Once I was DIY and after gaining a bunch of weight and watching my blood pressure rise I started getting chest pains.  So I stopped because I thought I was killing myself.  The second time I was DIY and it was too expensive with my situation at the time.  Both times I regretted that I had to stop.  This time I'm doing it right with DRs and with insurance and not regretting anything.  Plus my health has improved this time.

FWIW.  I'm not against informed consent but for me counseling was very valuable in putting my mind at ease.


Sapere Aude

[calicarly]

I'm in the UK and I think things here are done the right way. Essentially there's private care in which you can do informed consent and the national healthcare service NHS deals with it a
In a little bit more of a gate keeping way, but it really doesn't feel that way, you can tell that due to the fact they are public healthcare, they have to filter out people who might regret transitioning. I can understand why. They have a limited amount of funds and they are trying to do the most they can rather than just handing out HRT to every person who comes in asking for it. I was told by my consultant how it's quite often the least patient of people the ones who end up not transitioning in the end or were just exploring.yet they demand HRT on the first visit. Which I consider wouldn't onky be financially irresponsible but medically irresponsible also. If people want instant HRT then they can have private care and they can pretty much have their HRT within a few weeks max.

Mod Edit:Removed TOS 9

[kira21 ♡♡♡]

I'm in the UK and I think things here are done the right way. Essentially there's private care in which you can do informed consent and the national healthcare service NHS deals with it a
In a little bit more of a gate keeping way, but it really doesn't feel that way, you can tell that due to the fact they are public healthcare, they have to filter out people who might regret transitioning. I can understand why. They have a limited amount of funds and they are trying to do the most they can rather than just handing out HRT to every person who comes in asking for it. I was told by my consultant how it's quite often the least patient of people the ones who end up not transitioning in the end or were just exploring.yet they demand HRT on the first visit. Which I consider wouldn't onky be financially irresponsible but medically irresponsible also. If people want instant HRT then they can have private care and they can pretty much have their HRT within a few weeks max.

Well the nhs is very variable depending on who you get to see and the times are crazy,  so the variability of feedback on the nhs will be massive.

Also,  many cannot afford private healthcare and really shouldn't have to when they have already been paying for the nhs their whole working lives.

For me,  I had transition including all docs months before nhs even got to my first appointment and they still made me follow the same process as a questioner because 'everyone gets the same process here'  meaning that I would have had to wait about 2 years until HRT if I hadn't have taken matters into my own hands. By having a gatekeep ing service with such long delays,  the nhs is creating a self medding problem. 

[calicarly]

Well the nhs is very variable depending on who you get to see and the times are crazy,  so the variability of feedback on the nhs will be massive.

Also,  many cannot afford private healthcare and really shouldn't have to when they have already been paying for the nhs their whole working lives.

For me,  I had transition including all docs months before nhs even got to my first appointment and they still made me follow the same process as a questioner because 'everyone gets the same process here'  meaning that I would have had to wait about 2 years until HRT if I hadn't have taken matters into my own hands. By having a gatekeep ing service with such long delays,  the nhs is creating a self medding problem. 

We agree Kira, but this post is about post op regret and de transitioning. Sadly it is the people who are in that group , and the people who seek help but never transition at all that there's all this gate keeping, which makes things tougher for us transgender patients. I'm an ideal world we should be the priority and who get helped through. But there's a much bigger number of people that have to be filtered out than people realize. And so GIC's focus on preventing them from transitioning to keep them safe instead of us as I mentioned above. I guess I came across sort of wrong. I mean that in regards of regret and de transition the UK is a place where they prevent this as much as possible but at least people can access private care in the mean time. I know how lengthy waiting times are and they have been getting worse by the day. Same in Canada. GIC's are getting fuller and waiting times for surgery longer and longer. if only there was a quick an easy test to prove ->-bleeped-<- like a neurological test. Then we wouldn't have to suffer as much. But there isn't. Even then, you think we are hard done to here in the UK? I would love for you to meet all the trans women in many states in the US (where I'm originally from) who's insurances refuse to cover anything trans related, insurances they also pay with their hard work. I just don't believe in all this self deprecating attitude here in the UK. It's not great, but I've never known of a genuine patient being outright denied service like in many other countries.

[AnonyMs]

We agree Kira, but this post is about post op regret and de transitioning. Sadly it is the people who are in that group , and the people who seek help but never transition at all that there's all this gate keeping, which makes things tougher for us transgender patients.

I'll preface this with saying I'm not living in the UK, and not had any trans experience there either. I'm in Sydney and I have money, so my personal experience is quite different.

My impression of the UK is that there's a lot of gatekeeping. As one example I keep reading how people are being asked to do RLE before HRT even though its not supposed to happen anymore, and even that's only recent change.

I have the feeling that your consultant is justifying a poor system with poor arguments. Just because they have Dr in front of their name doesn't make them worthy of respect.

If you make the system difficult enough you would no doubt reduce the incidence of post-op regret. Only the most determined would ever get though it. You mighty lose a few to suicide along the way of course, but that's nobodies fault is it. On the other hand if you make it really easy their would probably be more regret, but less suicide, and and who's going to get the credit for each of those?

And suicide is only part of it, because even if you survive its still mental torture and all the damage that goes along with it.

Informed consent is about making sure people are mentally capable of making their own choices, and allowing them them do so. You can argue that the NHS is paying so they need to get value for money, but I given how the entire thing works I don't think that's what its about. Its all about authority and control.

I can't imagine how non-binary people get though it all. And for someone like myself I'd have big problems as I need HRT and likely SRS and I've no intention of social transition anytime soon.

[kira21 ♡♡♡]

Oh,  I am not self depreciating...  I know,  certainly in terms of SRS we have it better than most places, just by virtue of it not being immediately out of pocket.

In terms of HRT I would say we are a bit behind.  We need informed consent. I think if our system had that at the beginning and we can get waiting list down some it would be great.  It doesn't mean I won't point out how we can do it better though and our system does have flaws, like the choice between waiting years or self medding that a lot of people face.

[calicarly]

I'll preface this with saying I'm not living in the UK, and not had any trans experience there either. I'm in Sydney and I have money, so my personal experience is quite different.

My impression of the UK is that there's a lot of gatekeeping. As one example I keep reading how people are being asked to do RLE before HRT even though its not supposed to happen anymore, and even that's only recent change.

I have the feeling that your consultant is justifying a poor system with poor arguments. Just because they have Dr in front of their name doesn't make them worthy of respect.

If you make the system difficult enough you would no doubt reduce the incidence of post-op regret. Only the most determined would ever get though it. You mighty lose a few to suicide along the way of course, but that's nobodies fault is it. On the other hand if you make it really easy their would probably be more regret, but less suicide, and and who's going to get the credit for each of those?

And suicide is only part of it, because even if you survive its still mental torture and all the damage that goes along with it.

Informed consent is about making sure people are mentally capable of making their own choices, and allowing them them do so. You can argue that the NHS is paying so they need to get value for money, but I given how the entire thing works I don't think that's what its about. Its all about authority and control.

I can't imagine how non-binary people get though it all. And for someone like myself I'd have big problems as I need HRT and likely SRS and I've no intention of social transition anytime soon.

This is what I mean about the culture of complaining, you've read from the British patients about the gatekeeping at GIC's, obviously you never heard that informed consent does exist in this country too. Just not at the GIC. And even if you pay to see the specialist for a fee privately, the meds can be prescribed by your GP, so you do not take the hit of paying for them like in other countries. They call it shared care here. It is only the GIC who requires RLE for further treatment.

Trying to find out why having money would make your experience quite different than UK patients? Being cared for by the NHS doesn't mean they don't have money Hun.they all have their own individual circumstances.

I am always trying to better understand non binary people and I will say I understand most non binary have unique ways of expression which makes transition difficult in some ways particularly with it not being the norm, so respects to you on that and wishing you a smooth ride.

[calicarly]

Oh,  I am not self depreciating...  I know,  certainly in terms of SRS we have it better than most places, just by virtue of it not being immediately out of pocket.

In terms of HRT I would say we are a bit behind.  We need informed consent. I think if our system had that at the beginning and we can get waiting list down some it would be great.  It doesn't mean I won't point out how we can do it better though and our system does have flaws, like the choice between waiting years or self medding that a lot of people face.

Amen girl I pretty much agree on everything you've said here, room for improvement there's tons, I just feel like I can "almost" see why  informed consent is only available privately for now here, how does a public healthcare system make sure informed consent can  be given yet not too quick that it becomes a financial/medical irresponsibility particularly when being looked at with a magnifying glass by the media which often sensationalises trans medical spending. I so agree tho, there has got to be a way. I'm sure there must be other countries with public healthcare and they might be using informed consent within it and if that is the case then we ded are behind in that regard and they could mimic that from elsewhere.