Therapy too far in advance? Do I need it at all?

[Jameson]

I'm going to have top surgery likely within a couple of years. I recognize that there are surgeons who will do this without a therapist letter and use informed consent. I would like to have the largest selection of surgeons to choose from. As such, I'm thinking it would be a good idea to have 'the letter' just in case. I've never had therapy for anything, don't feel like I need it in particular, but am not as resistant to it as I used to be. I'm an older guy and pretty settled about most things. Mainly the reason I ask now is because I have good insurance that would cover an (in-network) therapist for this year. So my questions for folks are these:

How long is a therapists letter good for? (USA)

Does it ever 'expire'?

How many sessions are required for WPATH or other standards?

Are there other standards I need to be aware of?

Any input appreciated

[FTMax]

From the WPATH SOC:

"Criteria for mastectomy and creation of a male chest in FtM patients:
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 (if younger, follow the SOC for children and adolescents);
4. If significant medical or mental health concerns are present, they must be reasonably well
controlled.

Hormone therapy is not a prerequisite."

I don't think the letters expire, though they are dated for the day they're written, and they usually contain some kind of information about how long you were in therapy and when that was. In my personal experience, I paid $320 for a "top surgery letter package" with an online therapist. The price included 6 sessions and a letter written to my surgeon of choice. I only actually did 3 sessions over the course of 3 weeks, and my letter was mailed to me after that.

WPATH says only one referral is required for top surgery, so as long as you meet the other criteria above, just find a therapist who's willing to work with you. I felt very similar to you. I was not confused about my gender identity after about 8 years of dwelling on it before starting to transition. I don't have any other issues to work through. I was not thrilled about having to tell someone about my entire life to get their approval to have a surgery that I feel is medically necessary. So after having issues with my original therapist, I looked for someone who would make the best use of my time and get me what I needed when I needed it. I don't think you'd have any issues waiting until 6ish months before surgery to speak to a therapist and get a letter.

[Bimmer Guy]

I'm going to have top surgery likely within a couple of years. I recognize that there are surgeons who will do this without a therapist letter and use informed consent. I would like to have the largest selection of surgeons to choose from. As such, I'm thinking it would be a good idea to have 'the letter' just in case. I've never had therapy for anything, don't feel like I need it in particular, but am not as resistant to it as I used to be. I'm an older guy and pretty settled about most things. Mainly the reason I ask now is because I have good insurance that would cover an (in-network) therapist for this year. So my questions for folks are these:

How long is a therapists letter good for? (USA)

Does it ever 'expire'?

How many sessions are required for WPATH or other standards?

Are there other standards I need to be aware of?

Any input appreciated

Hi, Jameson.  As ftmax says, if you want it quick and easy, you can use this one specific online gender therapist.  What is the name of the guy, ftmax?  I know that Alexthecat used him, too.

There is no expiration dates, but I would get it within the year.

WPATH does not have any standards around therapy anymore.  There are "gender therapists" who say they are using WPATH standards, but they are not using the updated ones, from 2012.  I would go for the online guy if you know for sure what you want and don't want your options of surgeon limited, as you say.

[FTMax]

Hi, Jameson.  As ftmax says, if you want it quick and easy, you can use this one specific online gender therapist.  What is the name of the guy, ftmax?  I know that Alexthecat used him, too.

Brett-

I went to Graham Peveller after a few failed sessions with Melissa Leonhardt. I've read varied things about him online, but I had an overall excellent experience and found him to be very affirming and easy to talk to. I would highly recommend him to anyone looking to go the online route for their therapy.

[Bimmer Guy]

Brett-

I went to Graham Peveller after a few failed sessions with Melissa Leonhardt. I've read varied things about him online, but I had an overall excellent experience and found him to be very affirming and easy to talk to. I would highly recommend him to anyone looking to go the online route for their therapy.

Right!  Graham Peveller. Thanks.

[King Malachite]

I would personally suggest figuring out what surgeon you want to go to first, because that might make the process easier for you to go through.



For example, I knew that I would be choosing Dr. Garramone, and he requires a letter.  I went to an online therapist a couple of years ago and had about 3 or 4 sessions.....a session every 3 months at $160 per session.  I didn't have my last session until around this past September, when I needed the letter to sign up for a top surgery scholarship.  I didn't win, but I went ahead and booked and had my letter ready, and there was no issue. 

Your best bet would be to identify the surgeon you want, and personally ask him/her if the letter has to be "hot off the press".  Personally, I don't think it matters as long as you HAVE the letter, because guys get their letters of recommendation all the time for hormones, yet are years away from ever being able to pay for top surgery.

[Jameson]

This is great information guys!

I had no idea that online was an option, I'm definitely saving those names. I guess the reason for checking into it now is that I have insurance that would cover it and I'm semi-retired so I have plenty of time on my hands. Sort of a might as well get it done sort of thing. I haven't selected a surgeon yet so I would get a catch-all letter or general diagnosis and maybe it would only need a touch up right before? I hate the idea of spending hundreds of dollars when I have the chance to do it free this year. I'm certainly going to have the chance to spend plenty on everything else.

Here's a weird bit; for me, I was always afraid of/angry about the idea of going to therapy for anything ever. It's just in the last couple of years I've felt more 'take it or leave it' without feeling all defensive about it. I don't know why, but it's odd. I think part of it was a long time ago was that when I was a young teen I was sent to be 'fixed' and of course I never spoke (1970's). Always resented the idea. Geeze, that didn't take long to get over! 

Anyway, I was thinking today that maybe it would be smart to do some, even though I'm not sure what it would be about/like, in order to have a longer paper trail since it's free. Of course I just moved to timbuktu a few months ago and the place isn't exactly teeming with them. I've located a couple so far, judging by their pictures (you'd think I of all people would know better), I have a choice of a couple of extremely straight looking, VERY young looking females, they both claim LGBT experience. One of them however, hosts a bi-weekly group session for TG persons on hormones. While that isn't me (yet/ever?), at least I know she's seen an actual TG person.

Hmm, gonna have to ponder this one.

Anyone strongly advocate getting vs not-getting therapy? Why?

[Ayden]

I was in the same boat. I honestly didn't feel that I needed therapy. If anything it was just a required step to go through.

I also did the online route because my hometown in Alaska isn't exactly boiling over with therapists period. What I found was actually, it was nice to just to talk. My therapist let me talk through my life story. I'm a very private person by nature but in that setting I didn't feel so guarded. I was in my own living room, usually in my pajamas since it was so early and I could talk through a lot of small things I had kept bottled up. It's been a few years, but I believe it was about 6 sessions in 3 months.

As I said, I didn't feel I needed therapy and my therapist actually agreed with me. Like you I had a few very negative experiences with psychiatrists when I was younger and it put me off of wanting to see a therapist at all. But, I can honestly say, it didn't do me any harm to talk with her, and I actually enjoyed several of our conversations.

The letter I got wasn't specifically for surgery and I originally gave it to my endo. The same letter was sent from my endo to my surgeon (Dr. G clone here) and he had no problem accepting it even though it was a bit dated. I do want want to add however, that I'm a US citizen who currently lives overseas so that may have factored into my letter being accepted even though it was a few years old.

If you have any idea of what surgeon you want, I would give their office a ring and ask about the required paperwork and how current it needs to be.

[Jameson]

Hey Ayden,

That sounds like a pretty good approach, just try it with an open mind. I guess since I'm not threatened by it anymore and it's free I could use it as a check up and see if there are any sore spots to look at. One of the things that I was wary of is that I've known a couple of folks who have been in therapy forever and frankly they seem a little overdone. Maybe I just want someone to tell me I'm okay, who knows. But yeah, I just moved to Idaho recently and it's a bit of a needle in a haystack. However I need to go local to use my insurance and I can always check it out and if it doesn't work, no loss except for a little time.

I really like that there are online options though in case I need a letter and don't have one. I know of a surgeon I want to look into, I want to stay on the west coast if possible, I guess it wouldn't hurt to just ring them up and see what the requirements are, and then if I see another I can do the same.

Thanks!

[Call me Ray]

I'd look at the requirements for the surgeon you would like to go to. The surgeon I have my consult with requires the letter to be dated no more than 1 year previous to the surgery.