Should someone be allowed SRS who is not planning to present as a female?

[Myarkstir]

A while after my family learned of my dysphoria something weird happened. One of my uncles who went a bit weird after a huge burnout (normal unless he skips his pills) suddenly decided he was transgender. Of course no one took him seriously and for him it is a good thing. But it illustrates a point. For therapists it is not gender dysphoria that troubles them, but the fear of allowing srs to someone WITH a serious mental illness (like my uncle). So they make it hard for all of us.

If someone's dysphoria is so that they want to be male with female parts then yes they should have it. It is not our place to judge. Though i would expect the medical profession to be really hesitant to do it. It would be a difficult fight .

[Allyda]

Hmmmmn, I'm almost afraid to respond. But here goes:

I'm a Transgendered Intersexed woman who by way of my core identity, who I am, and who I've always been, am binary. I've been living full time as the girl/woman I've always been now for going on 6 years. Those of you who know me know that for me, having SRS is absolute as I have severe crippling genital dysphoria to the point that for me, SRS will be a life saving surgery.

Having said the above, should I be denied this lifesaving surgery just because I don't have a therapist? I have an Endo and other Doctors, but I live in a rural area of Florida and am unable to find a therapist within reasonable distance who will treat me. And I've made a sincere effort for over a year. Not because I need therapy mind you. I'm very secure in my femininity and know who I am. I've been looking for a therapist soley because I need a letter from one, to have the life saving surgery I so desperately need. Oh there are a few therapists around, either they don't treat trans patients or they don't take my insurance or they have zero experience with gender issues. But should I, a person who has lived full time for the last 6 years, who always presents as the woman she/I am be denied surgery simply because I'm not fotunate enough to live within reasonable distance of a therapist who will treat me?

As you can see, I clearly demonstrate an exception to the norm. My neighbors and friend have never doubted my femininity, in fact I'm seen as cis by most all of them. However my upcoming SRS may currently be in jeopardy because I need a letter from a therapist, a therapist I don't have. And as I've stated in my earlier response, I won't survive another year without this life saving surgery.

I only mention this very true representation of my current situation to make a point. There are circumstances for both we binary, and non binary individuals where the individual will suffer greatly if denied SRS for whatever reason. Blanket sets of rules cannot function unless exceptions are made where needed.

Peace everyone.

Ally

[Jessica Merriman]

But should I, a person who has lived full time for the last 6 years, who always presents as the woman she/I am be denied surgery simply because I'm not fotunate enough to live within reasonable distance of a therapist who will treat me?

No you should not be denied or anyone else. The only issue is most require the letters as it is now. Some day hopefully it will change. I feel like this: I hate speed limits on roadways, but unfortunately it is the law I comply or be fined. This is how WPATH has chosen to include in their protocol. It is not right, but it is the law or common practice. 

[Allyda]

No you should not be denied or anyone else. The only issue is most require the letters as it is now. Some day hopefully it will change. I feel like this: I hate speed limits on roadways, but unfortunately it is the law I comply or be fined. This is how WPATH has chosen to include in their protocol. It is not right, but it is the law or common practice. 

My surgeon's office staff is trying to find me one that will see me virtually. So that will work hopefully. Wheels are in motion. They're just spinning in a rut right now.

Ally

[Bombadil]

With increasing frequency, we've been seeing forum members speak of a need for gender surgery without socially transitioning. E.g. living post-op as a male with a vagina. They're looking for a way to do this.

The reasoning is usually something like this:
* They have body dysphoria but not social dysphoria.
* Lots of men live perfectly happy lives with vaginas. We have dozens of them posting on our FtM forum.
* Going through an RLE requires needless effort on their part and an uncomfortable year and is not helpful in decided how they want their body shaped.
* The WPATH requirement for RLE is a "guideline" and not a "rule".

Most of the time they are actively discouraged from doing this, often by the site staff. Their reasoning:
* RLE is a good idea because doctors require it.
* This is a huge step, and it's not unreasonable to require a patient to spend a year thinking about it.
* If you're not ready to live as a woman, you're probably not ready for SRS either.

What do you think? Should someone be allowed SRS who is not planning to present as a female?

If the question is simply if someone who does not identify as a tradiional male (whatever that is) or traditional female (whatever that is) can get SRS, then the answer seems pretty simple to me. I think a lot of the debate in this thread has focused on the process the person should go through, not whether they should be allowed SRS. In my opinion some process to make sure the person will be able to cope with the results of surgery is good. What the process is, I don't know. Should someone be allowed SRS to attain female parts who is not going to present socially as female? If that is what will make the person a healthy, functioning person then yes, they should.

I think some process to make sure a person will be able to cope with the results of any surgery is good. I had a hysterectomy for medical reasons. I really needed it. My doctor and I still had a conversation about how I would cope. This is because she was a good doctor. Having said that, I really wish she had prepared me for the fact that I had a very large fibroid growing outside my uterus and there was a high likelihood of adhesion's and ongoing issues from that.  So I don't necessarily think about communication as "gate keeping".

I do know my therapist has talked about NOT writing me a letter for top surgery. Yes, it's gatekeeping but it's not because of some gender bias. I don't like that but she's right. I am mentally ill. I freely admit I don't always take care of myself as I should and that's the basis of her concern. And honestly this is the first time in my life, where I have someone seriously looking out for my well-being. So as much as I don't like the gatekeeping, I also don't resent it.

[GendrKweer]

My surgeon's office staff is trying to find me one that will see me virtually. So that will work hopefully. Wheels are in motion. They're just spinning in a rut right now.

Ally

Ally: Dr Amy Winchester of Boulder Colorado might help via skype. She's a lovely woman and specializes in LGBT issues. Give her a call if you're still having trouble finding someone...

http://www.therapytribe.com/listing/amywinchester.html

[Jen72]

First off start with that at the moment I am still questioning and feel HRT will aid me as to what path will follow.  I do understand that is my position and everyone has a different path so to speak. Yet as Jessica has pointed out time and again the medical profession needs some kind of evaluation as proof and or willingness shown to make such a drastic change. To that I whole heartedly agree both for the medical profession and the individual there should be some sort of evaluation as well as some time period to make sure this decision is not made on a whim or fetish. Yet if you can prove to a therapist that you indeed are an exception then there is no reason for refusal (read farther down). Sane or not we all make stupid choices and this would be a irreversible one.

To throw this slightly off topic but since both are irreversible and drastic changes doctor assisted suicide for the terminally ill.  I realize dangerous waters speaking of suicide but it is my belief that it should be allowed but like anything that drastic and irreversible it should be evaluated on a case by case basis.

Of course the latter would have to be done more on an immediate basis but as for GRS it should require an open minded evaluation with some criteria for allowance.  Now the hard part of course is the fact of being open minded medical community and legal implications hence the criteria. We have to work with what we have but it should also be updated appropriately within reason of course and this will all take time. I really do feel for anyone with the dysphoria as I feel I do have some of my own but that is the thing I understand how does ones convey feelings if they have no evaluation of some sort. If we could just say I have intense pain does that mean we can go to any medical facility and just get really strong pain medication. The answer is no. We have to seek a doctors approval aka an evaluation.

All of that being said and hammered yes there needs to be some evaluation as it sits now the evaluation should be at the discretion of the therapist and individuals evaluation of themselves. The big but part is what that evaluation is and I will take a guess that the RLE does fit the majority but not all. In the later case a therapist should be able to make a decision (perhaps with another therapists aid) in order to make exceptions to a rule or standard if you will. That is the real problem is that there is no leeway in the system to make exceptions where appropriate.

Just my opinion and wow a lot of heavy reading. Oddly this has helped me decide well kind of decided that GRS may not be for me yet have the option available is wise.

[✰Fairy~Wishes✰]

People should be able to do what makes them happier. It doesn't matter what gender they want to present as.
If they want reassignment, they deserve it.

[stephaniec]

I don't know , but it seems to me that if someone came into a surgeon's office and asked to have their eyes removed because light made them suicidal ,you think maybe there should be some established rules as  to the necessity  of granting this persons desire.

[Allyda]

Ally: Dr Amy Winchester of Boulder Colorado might help via skype. She's a lovely woman and specializes in LGBT issues. Give her a call if you're still having trouble finding someone...

http://www.therapytribe.com/listing/amywinchester.html

Thanks I'll definitely give her a call. This has been so so frustrating for me I can't put it into words. I appreciate the link, again, thanks.

Ally

[suzifrommd]

I've found the posts here very interesting. It's helped solidify my feeling about the subject.

Maybe it's my latent right wing streak coming out, but I don't want a world where adults frequently hear "we know better than you what you want".

It's humiliating hearing someone, whether from the government, a doctor, or anyone else tell me that what I want to do is bad for me (in their estimation) and therefore I'm forbidden to do it. Before my transition, it basically never happened. But now, as a trans person, I'm assumed to be incompetent in ways I'm not sure I understand, and I've heard this message in all sorts of forms.

Yes, this might lead to regret. In the same way that banning people from climbing mountains would save a lot of people's lives. Make skiing illegal, and Chaz Bono would still have his father. Outlaw horseback riding and Christopher Reeve would still be alive. But the people who engage in these activities have decided that the benefits outweigh the risks, because this would be a bleaker world without those sports.

Also true, as people point out, increased regret would would make SRS less "successful" and therefore spoil coverage for the rest of us. In addition to pointing out that this is a rather self-centered point of view, (would you REALLY like people to be denied treatment they they'd need in order for yours to be covered?) I'd ask whether this should be extended to other life-saving procedures. Should transplants be avoided in high-risk subjects because it would decrease the success rate and might make doctors less likely to perform them?

So I'd like to see a world where authority figures avoid forbidding people from doing what they think they need to do unless it's absolutely necessary.

What if they're wrong?

[Jessica Merriman]

Should transplants be avoided in high-risk subjects because it would decrease the success rate and might make doctors less likely to perform them?

As a Paramedic I can sadly say that this is being done now. It is not right, but it still happens everyday. 

[Jen72]

Kind of an addition to what I said previously but for the most part there should be some roadblocks.  However at the moment the may be a bit stringent one would hope it might become more relaxed in the future. If no roadblocks or evaluations etc are done it would be to an extreme chaos or lack of law. Some control for a procedure should be warranted. 

As to the organ transplant thing I can understand why it is the way it is.  Yes it sucks but if you think of it if there are only so many organs we must put some priority as to were they go until we can meet the demand.  Hopeful thinking for the future where we can make organs but we aren't there yet. Pardon me if it seems harsh not my intent just a realist.

[jody]

as i understand it originally srs was for those who wanted to present and live full time as female. the difficulty has come about that presenting as female now has many variations. one key question would be why a male wants a vagina yet still present as a man.is there hidden female desires or is that the only way that person can comfortably settle their mind. there has to be certain stepping stones to determine the true desire of the person. the current guidelines can be looked on as incorrect for such people but the realization that the spectrum of transgender is wider than when the guidlines were written has overrun the medical profesion. i also think that they have no guidelines for shall we say mixed gender. what is in question is whether the service can cope with the diverse range of trans people and currently i belive the answere is no.

[Taka]

in norway, the law says a person needs to undergo srs, or a least sterilization, before they can change their legal gender.
you hear that, all of you women who can't afford the surgery?

if you were to be stuck as legal males no matter how much you live as women, fully and wholly, how terrible wouldn't that be?

shouldn't the norwegian system chsnge for the sake of those who can't get the surgery?

and when new needs are discovered, wouldn't it be better to change the system?
i don't like to hear "that's just the way things are" as an argument of why things should remain the same way as they are right now.
i want a serious discussion about whether it would be beneficial to the man who wants a vagina, to chanhe the system so he also can get what he says he needs. and what consequences that may or may not have.

systems can be changed. revolutions have happened before.
i think it's better to discuss principles instead.

should an adult man be allowed to rule over his own body, as long as he can afford it, and is generally sane?

[mac1]

......................................
systems can be changed. revolutions have happened before.
i think it's better to discuss principles instead.

should an adult man be allowed to rule over his own body, as long as he can afford it, and is generally sane?

Certain standards must exist. Amputating legs, arms, fingers, etc. would definately be extreme and should not be a matter of choice.

Hysterectonies and masectomies are routinely performed for medical reasons and don't have any real affect on a person's well being. Female breast augmentation and reduction and male breast reduction are routinely performed on demand.

Why not: male breast augmentation; male penectomy and castration; female vaginectomy; and female clitoris enlargement? What negative effects would they have?

[JLT1]

Because of what I am, I understand a non-binary life quite well.  It just isn't for me.  However, I recall reading about a trans-woman who had gone all the way through SRS and was miserable.  She was searching for herself and thought she would find it with SRS but she didn't.  She decided to stop E and started T again.  Well, about three months after starting T, she started feeling good.  Then, a few weeks later, she started dating again.  At the end of the story, he was quite happy and had found himself as a guy with a vagina.  I thought it was strange but it was working so, great!

On the other hand, treatment of a non-binary person is complex.  I just hope people work through all issues before permanent change.  It could be difficult to determine if someone dislikes their genitals because they are binary and SRS might be appropriate or if they suffer from body dsymorphic disorder, where SRS would not be appropriate..

Hugs,

Jen

[JLT1]

Allyda,

WPATH standards do not apply to intersexed individuals.   You should not need a letter from a psych. 

Hugs,

Jen   

[EchelonHunt]

Hysterectonies and masectomies are routinely performed for medical reasons and don't have any real affect on a person's well being. Female breast augmentation and reduction and male breast reduction are routinely performed on demand.

I disagree. Hysterectomy and masectomy can have HUGE effects on a person's wellbeing, whether they are a cisgender women, transmen or otherwise.

A cisgender woman - if she were to have these removed for medical reasons, I assume she would be devastated, especially if she desired to have biological children and/or she might feel less of a woman for having those surgeries. A transgender man - on the other hand, would feel much relief because such body parts will no longer be holding him back anymore. A non-binary person can feel similar to how the relief a transman feels but not in the manner of reaffirming their male identity, it would be reaffirming their non-binary identity - in my particular case, it would be my desire of a sexless body.

You are correct - female BA, reduction and male breast reduction are performed on demand and they are usually done cosmetic reasons but they improve the well-being of the individual immensely - granted if they identify as cisgender or transgender MTF/FTM.

Why not: male breast augmentation; male penectomy and castration; female vaginectomy; and female clitoris enlargement? What negative effects would they have?

When you put it in black and white terms like that...

For a cisgender men and women who identify as men and women - this would be disastrous.

For those who identify under the transgender umbrella (this includes cisgender men who desire a vagina but keeping their male chest and identity), it would be different.

Honestly, I don't know why this is even a debate anymore. People should be allowed to remove or modify their genitals, especially to elevate body dysphoria - regardless of their gender identity and what they present as to the world, they should go under a psychological evaluation like anyone who would be seeking SRS and they should be treated as human beings while doing so. Once they are of sound mind and fully aware of the consequences, they should be allowed to sign a waiver and receive a letter for such surgery.

None of this silly genderism double standard that affects people who are under the transgender umbrella and those identify outside the binary.

[VeryGnawty]

The correct answer is: yes.  It's your body, so it's your business.  Unless in fact it is someone else's body.  Which, would be very awkward.