Informed Consent

[Jasper93]

Jasper - Make a couple more posts and you'll be able to PM. I forget if it's 10 or 15 posts.

Will do! Was there a huge waiting list for HBHC?  And, approximately how long did it take to obtain hormones through them?  I've been really anxious to start transitioning ever since I learned of how close I am to an informed consent clinic, and even more anxious in that I'm developing this hunch that starting transition in college will be less stressful than doing so in the workplace. 

[Jasper93]

Also, this is relevant but also maybe somewhat off-topic -- so I apologize for that -- but is 20 (almost 21) a suitable age to begin transition (MTF)?  I've done some reading, and it seems that the most beneficial age to begin transitioning would be before puberty, but for me, that was ten years ago.  I have this deep-rooted fear that I'll undergo transition and not pass (as most in my position would). 

[Blue Senpai]

Also, this is relevant but also maybe somewhat off-topic -- so I apologize for that -- but is 20 (almost 21) a suitable age to begin transition (MTF)?  I've done some reading, and it seems that the most beneficial age to begin transitioning would be before puberty, but for me, that was ten years ago.  I have this deep-rooted fear that I'll undergo transition and not pass (as most in my position would).

It has been noted that hormones tend to work better when younger.
You can pass, but some have an easier time than others judging by how they looked before HRT.

[JourneyFromConfusion]

If you are thinking of the clinic in Chicago that I'm thinking of (the one I attend), then no, you don't need to be a resident of the state. I'm in a transgender group on Facebook and many come from surrounding states (Wisconsin for example) to use the facilities. To avoid a trip out here, why not give them a call and mention you want to do an intake patient interview, but are not from Illinois. I'm sure they won't bar you from coming and if they cannot accomedate you, they will certainly give you helpful resources.

[Jasper93]

If you are thinking of the clinic in Chicago that I'm thinking of (the one I attend), then no, you don't need to be a resident of the state. I'm in a transgender group on Facebook and many come from surrounding states (Wisconsin for example) to use the facilities. To avoid a trip out here, why not give them a call and mention you want to do an intake patient interview, but are not from Illinois. I'm sure they won't bar you from coming and if they cannot accomedate you, they will certainly give you helpful resources.

This is excellent news to me! However, what is an intake patient interview?

[traci_k]

Jasper,

Intake interview - read one of the posts above. I'm unaware of a waiting list. It was come in the night they have the doctor there, get a physical and probably bloodwork. How soon after to get the script I don't know.If you are doing informed consent to avoid the "gatekeeper" to hrt, please remember that they are there more to help you understand what you are about to do than prevent you from getting hormones. It might be best to familiarize yourself with the WPATH SOCs.

starting HRT is only the beginning. Depending how far you wish to take transition, most surgeons do require a psychiatrist's letter for SRS. As for passing, depends on body structure, as for looks FFS is available but come with a price, not to mention laser or electrolysis hair removal. Most insurances don't cover most trans related care - yet.

Again, best advice look up HBHC website and e-mail or call their program coordinator.

Best Wishes,

[Jasper93]

Jasper,

Intake interview - read one of the posts above. I'm unaware of a waiting list. It was come in the night they have the doctor there, get a physical and probably bloodwork. How soon after to get the script I don't know.If you are doing informed consent to avoid the "gatekeeper" to hrt, please remember that they are there more to help you understand what you are about to do than prevent you from getting hormones. It might be best to familiarize yourself with the WPATH SOCs.

It isn't that I want to avoid the "gatekeeper" per se, but more that I'm your typical broke college student whose insurance may or may not cover who-knows-how-many therapy sessions.  If therapy were to only span a matter of weeks, however, I would actually prefer that over going to HBHC.  I've also read the entire WPATH Standards of Care document, and it sounds pretty much verbatim like what I've experienced since I was only 6.

[TaoRaven]

I went the Informed Consent path myself. No waiting list of any kind. Made an appointment, did blood work, had an interview. Follow up appointment a week later and walked out with a prescription.

Vital IC resources:

http://www.icath.org/

and of course

https://dl.dropboxusercontent.com/u/932389/Trans/Stepping%20Forward%20-%20Informed%20Consent%20Clinics.pdf

Good luck. This whole thing doesn't need to be made more expensive and stressful than it already is.

Oh....another tip: when it comes to laser and electrolysis....go to an actual dermatologist. Fewer sessions, better results, less $$ in the long run.

[traci_k]

Jasper,

I don't remember where I read about someone wanting to avoid the "gatekeeper" but I just mentioned that because some people will try to go around the system, often with disastrous results and much regret. Being much older and having suffered GD for many years, I want to help younger people make the right decision and get into treatment early so they don't have to suffer all the years some of us older girls have. So please take no offense if I seem a little questioning. The idea of informed consent, while on the surface seems like a great idea in eliminating one of the barriers many trans-men and women can avail themselves to, may also lead to people who may not be trans attempting to transition.. Understand that there are many other consequences, not only potential health risks of transitioning, somewhat alone. Hormones are very powerful substances and transition should be undertaken lightly. That's all. Seeing a counselor helped me tremendously and I highly recommend seeing one.

One thing you might try is checking into any student health insurance. I know in Illinois, schools offering such insurance are now including trans-care as part of their coverage. Indiana probably isn't as open-minded, but it may be something to look into.

Also look for a PM, I'm sending you the name of the trans-woman in charge of HBHC's transgender program.

Hugs,

[Brenda E]

Without coming across as Debbie Downer, I think traci_k makes some really good points.  I'm not sure informed consent should be where this journey starts, Jasper.  You mention that you do have health insurance, so first of all, I'd check that to check what kind of counseling it does cover.  Most insurance plans, while not covering trans-related care, will certainly cover general counseling for many of the mental issues that often accompany gender dysphoria.  That would be a great place to begin.

It's not an "either/or" situation when it comes to informed consent and the traditional therapy route.  You can do both; go the informed consent route simultaneously with getting a little therapy if you like, or perhaps a couple of sessions with a counselor to make sure that there's no obvious issues and then jump into HRT via informed consent.

I guess what I'm saying is that if therapy is available and it's cost-effective, use it.  It doesn't have to slow down your access to hormones.  Informed consent is completely independent and you can take advantage of it at any time.  You could even get on hormones and then seek some therapy if you think that would be a better route.  There's countless tools available to people during transition, and not everyone benefits from reaching for the sledgehammer of informed consent right away.

Informed consent should be just that - informed.  It's not a shortcut, and one way to make sure you're adequately informed about the risks is to visit a therapist.  It's not just about learning the effects and side-effects of the hormones; informed consent also means that you're fully informed about yourself too and whether or not you're mentally prepared for the massive changes the hormones will have on your body, your mind, and your life.

[Jasper93]

Jasper,

I don't remember where I read about someone wanting to avoid the "gatekeeper" but I just mentioned that because some people will try to go around the system, often with disastrous results and much regret. Being much older and having suffered GD for many years, I want to help younger people make the right decision and get into treatment early so they don't have to suffer all the years some of us older girls have. So please take no offense if I seem a little questioning. The idea of informed consent, while on the surface seems like a great idea in eliminating one of the barriers many trans-men and women can avail themselves to, may also lead to people who may not be trans attempting to transition.. Understand that there are many other consequences, not only potential health risks of transitioning, somewhat alone. Hormones are very powerful substances and transition should be undertaken lightly. That's all. Seeing a counselor helped me tremendously and I highly recommend seeing one.

One thing you might try is checking into any student health insurance. I know in Illinois, schools offering such insurance are now including trans-care as part of their coverage. Indiana probably isn't as open-minded, but it may be something to look into.

Also look for a PM, I'm sending you the name of the trans-woman in charge of HBHC's transgender program.

Hugs,

Traci_k,

Thanks for looking out for me and other young people!  I've taken no offense to what you've said so far.  I could see how informed consent could potentially foster disaster, but at the same time, I keep thinking I'd fare very well -- much better than I am now.  If anything, I'd rather take what others see as a huge risk and regret it, than to never take a risk at all.

Regarding the student health insurance, my school does not offer that, unfortunately, even though it's undoubtedly the liberal hub of Indiana.  To that point, however, there are a plethora of trans-friendly counselors in my college town, and I see this as an alternative option.  The only thing is that I've harbored an unwavering desire to transition since I was very young, and I know, without a doubt, that the only thing that would make me happy would be transitioning -- regardless of what a therapist would tell me. :/

Also, I received the PM and responded.  I don't see my reply in my outgoing messages, however, so let me know if you didn't receive it.

Jasper

[Jasper93]

Without coming across as Debbie Downer, I think traci_k makes some really good points.  I'm not sure informed consent should be where this journey starts, Jasper.  You mention that you do have health insurance, so first of all, I'd check that to check what kind of counseling it does cover.  Most insurance plans, while not covering trans-related care, will certainly cover general counseling for many of the mental issues that often accompany gender dysphoria.  That would be a great place to begin.

It's not an "either/or" situation when it comes to informed consent and the traditional therapy route.  You can do both; go the informed consent route simultaneously with getting a little therapy if you like, or perhaps a couple of sessions with a counselor to make sure that there's no obvious issues and then jump into HRT via informed consent.

I guess what I'm saying is that if therapy is available and it's cost-effective, use it.  It doesn't have to slow down your access to hormones.  Informed consent is completely independent and you can take advantage of it at any time.  You could even get on hormones and then seek some therapy if you think that would be a better route.  There's countless tools available to people during transition, and not everyone benefits from reaching for the sledgehammer of informed consent right away.

Informed consent should be just that - informed.  It's not a shortcut, and one way to make sure you're adequately informed about the risks is to visit a therapist.  It's not just about learning the effects and side-effects of the hormones; informed consent also means that you're fully informed about yourself too and whether or not you're mentally prepared for the massive changes the hormones will have on your body, your mind, and your life.

Brenda E,

Thanks for the input.  Regarding the health insurance, I do intend to call and check what all it covers.  I'm slightly intimidated by the proposition of going through therapy, however, on grounds that one of the trans-friendly therapists' websites in my area mentions that insurance companies are very intrusive (and maybe even a little unfair) in regards to covering trans-related issues, owing to her out-of-network provider status.

Also, obtaining hormones via informed consent and THEN going to therapy doesn't seem so frightening to me.  I feel that, in such a scenario, I'd get to see results AND simultaneously get to discuss complications that have arisen (or may arise) as a result of this.  It seems a whole lot less  stressful than having a therapist pick at my brain for months to discern whether or not my claim that I feel like the entirely wrong sex is legitimate.  That, in and of itself, is actually terrifying.

Lastly, it seems that I'll be applying health insurance either way.  I'm not out about ANYTHING pertaining to my sexuality to any of my family members, let alone my mom, whose employer's insurance covers me.  As such, does anyone know whether or not health privacy laws would apply if I were to seek therapy, etc.?  In other words, this would be kept confidential from my mom, right?

The goal here is to start transitioning before I literally turn insane -- even if undercover -- and come out to my family once I'm independent in the next year or so.  To make a long story short, my mother, though nice, is your textbook fundamental Christian.  This, in amalgamation with her being very violent at times would spell disaster if she discovered a secret of this nature. :/

Jasper

[traci_k]

Regarding the insurance and privacy. There should be some degree of privacy. However, since mom is the primary insured, she will probably get a copy of Explanation of Benefits which may or may not go into a whole lot of detail. So that may possibly out you or not. She may wonder why you were seeing a doctor in Chicago.

Other good reasons for seeing a therapist include them helping you figure out your reasons you're convinced you're trans, but also give ideas how to cope with GD, also some help with femininity coaching and assignments to ease transition, laying out a transition plan and how to come out to family, friends and others.

Counseling doesn't have to be expensive either. Many companies offer Employee Assistance Programs for psychological care. I told my therapist I was there for depression. Once in the office I told her it was depression about not being female and she understood and we took it from there. So, EAPs maybe another avenue, once you are working, of seeing a therapist at little to no cost. Again, with informed consent you don't need a "letter," but my therapist wrote one anyway at my request. Its kind of comforting knowing that someone else agrees with you that HRT is a viable route to go to obtaining relief from GD.

Hugs all,

[TaoRaven]

Just to interject a bit...Physicians and Therapists who support the Informed Consent model aren't PEZ dispensers that give out prescriptions on demand. The people are professionals who will make sure that you are on the right path and know what you are getting into, as well as making sure that you are healthy and physically ready for this process.

The potential for "disaster" is really no greater than through the "traditional" route....but it's a lot less expensive and time consuming.

Is there a risk that someone who is not really trans* could end up starting HRT?? Sure.....and no therapist is perfect either. People will slip through the net, regardless of what systems are put in place.

BUT....there is an opportunity for those who are trans* to begin transition earlier and with less of a time and monetary investment...potentially saving lives. Some of these people could otherwise turn to self medication, or dysphoria could simply overwhelm them, leading to suicide.

[Blue Senpai]

Just to interject a bit...Physicians and Therapists who support the Informed Consent model aren't PEZ dispensers that give out prescriptions on demand. The people are professionals who will make sure that you are on the right path and know what you are getting into, as well as making sure that you are healthy and physically ready for this process.

The potential for "disaster" is really no greater than through the "traditional" route....but it's a lot less expensive and time consuming.

Is there a risk that someone who is not really trans* could end up starting HRT?? Sure.....and no therapist is perfect either. People will slip through the net, regardless of what systems are put in place.

BUT....there is an opportunity for those who are trans* to begin transition earlier and with less of a time and monetary investment...potentially saving lives. Some of these people could otherwise turn to self medication, or dysphoria could simply overwhelm them, leading to suicide.

Personally, I would go the traditional therapist/letter route if you have uncertainties of any kind. I would only used the informed consent route if you're really sure it's what you want, you've done massive amounts of Internet search, looked through transition blogs and ave an idea on how to make transition go as smoothly as possible. Of course, provided you have stellar mental health because it is not a decision to make lightly and not one to make when you have emotional baggage irrelevant towards gender dysphoria. There are consequences.

[Jasper93]

Just to interject a bit...Physicians and Therapists who support the Informed Consent model aren't PEZ dispensers that give out prescriptions on demand. The people are professionals who will make sure that you are on the right path and know what you are getting into, as well as making sure that you are healthy and physically ready for this process.

Thanks, I think.  Not to seem rude myself, but I'm a little offended that someone has deduced that I think of informed consent providers as "PEZ dispensers".  I realize that health providers are in fact professionals, who are there both to help patients AND to educate them.

[JourneyFromConfusion]

Just to interject a bit...Physicians and Therapists who support the Informed Consent model aren't PEZ dispensers that give out prescriptions on demand. The people are professionals who will make sure that you are on the right path and know what you are getting into, as well as making sure that you are healthy and physically ready for this process.

The potential for "disaster" is really no greater than through the "traditional" route....but it's a lot less expensive and time consuming.

Is there a risk that someone who is not really trans* could end up starting HRT?? Sure.....and no therapist is perfect either. People will slip through the net, regardless of what systems are put in place.

BUT....there is an opportunity for those who are trans* to begin transition earlier and with less of a time and monetary investment...potentially saving lives. Some of these people could otherwise turn to self medication, or dysphoria could simply overwhelm them, leading to suicide.

I agree. All you have to do is go to Tumblr and know what to say about your dysphoria and you can theoretically get around any gatekeeping that may be in place. I personally cannot afford the therapy sessions I have right now (I'm doing this on my own free will as I'm about to start HRT) at $75/session after insurance pays. The point of informed consent is to make sure you're mentally stable enough to make such a decision. If they feel otherwise, no, they will not prescribe you hormones. You have to be over 18 to do it and I honestly think that part of your own transition in anything is to deeply analyze your motives (whether it be transitioning or even getting a tattoo). A therapist is there to be a medical professional, but as I said, with social media today, reading up on a few blogs/videos on YouTube, you can finesse your way around it and bam! You are diagnosed with Gender Dysphoria. I've seen people get a letter in 2-3 sessions going the WPATH route and it makes me wonder just how accurate a diagnosis can be in that short amount of time. I went to my therapist at least 5+ times just to sort things out and it wasn't until I had the help of a therapist that it clicked that I'm not internalizing misogyny (this is/has been my biggest fear), but that I truly am unhappy and it's affecting every aspect of my life.


With that said, I want to say this: I don't think we should depend on a diagnosis, but I don't think anyone should go into transition without a therapist because god forbid you are wrong (WPATH or Informed Consent), they may see it before you do if you're being honest and it can keep a lot of heart ache down.

[JourneyFromConfusion]

Thanks, I think.  Not to seem rude myself, but I'm a little offended that someone has deduced that I think of informed consent providers as "PEZ dispensers".  I realize that health providers are in fact professionals, who are there both to help patients AND to educate them.

Oh. To answer, the reason there's a waiting list is because this clinic helps LGBT people so they are constantly taking on new patients. At least, that's what one transwoman has told me that scheduled an intake interview.

[Jasper93]

Personally, I would go the traditional therapist/letter route if you have uncertainties of any kind. I would only used the informed consent route if you're really sure it's what you want, you've done massive amounts of Internet search, looked through transition blogs and ave an idea on how to make transition go as smoothly as possible. Of course, provided you have stellar mental health because it is not a decision to make lightly and not one to make when you have emotional baggage irrelevant towards gender dysphoria. There are consequences.

Your input is appreciated!  I do think of myself as absolutely positive that I wish to transition, and am even shooting myself in the foot on grounds that I haven't even begun yet.  I'm your textbook case: someone who has struggled with this since I was a little kid.  Notwithstanding, I take others' advice to heart, in realization that they have nothing but my best interest in mind.

[Jasper93]

Regarding the insurance and privacy. There should be some degree of privacy. However, since mom is the primary insured, she will probably get a copy of Explanation of Benefits which may or may not go into a whole lot of detail. So that may possibly out you or not. She may wonder why you were seeing a doctor in Chicago.

I've read a lot about the Explanation of Benefits, and it seems that I'll be safe since I'm over 18.  Although, there were cases I had read about wherein the Explanation of Benefits accidentally outed someone to their parents for obtaining medical care, even if they were over 18.

But obtaining help is an absolute necessity -- to the point that I'd just pay for myself if I felt that insurance would put me into danger with my mother.  I can't let her bar me from obtaining help for this deep-rooted problem.  As naive as it may sound, I'm also working on 21 years old: older than the age at which she gave birth to me.