Informed consent HRT for crossdressers

[Devlyn]

We're having a discussion about who qualifies for HRT through informed consent in another thread, and I thought the discussion would be more visible with its own topic. The site Wiki describes informed consent as:

Informed consent is the concept that a patient who is informed of all the issues of a certain medical treatment may undergo that treatment on their own responsibility. It usually requires the signing of a special release form.

Of particular interest is informed consent in regard to transsexual hormone therapy and surgery. Hormonal Replacement Therapy (HRT) represents a valid therapeutic approach for those who have been diagnosed with Gender Identity Disorder / Dysphoria or as a Transsexual.

For reference, here are the Standards Of Care:

https://www.susans.org/wiki/Standards_of_Care_for_Gender_Identity_Disorders

The question is: Can a crossdresser with no GD receive Informed consent HRT?

Hugs, Devlyn

[Beth Andrea]

One would think so...but it would depend on the Dr doing the prescription.

Some Dr s are very conservative in their practice, others are more accommodating.

Imho

[Devlyn]

I'm reading it as needing a GD diagnosis to receive the treatment. I honestly don't feel that way. I know what to say to a doctor to get them, a couple ways, in fact. It wouldn't be right, though.

Thanks for replying, Beth! 

Hugs, Devlyn

[Megan Rose]

I had occasion to spend time with a trio of crossdressers one evening.   One of the three had been on HRT for several years, with no intention of transitioning.

They were getting their prescriptions from the same clinic that I was using.   Informed consent is alive and well in Seattle.

[Beth Andrea]

I'm reading it as needing a GD diagnosis to receive the treatment. I honestly don't feel that way. I know what to say to a doctor to get them, a couple ways, in fact. It wouldn't be right, though.

Thanks for replying, Beth! 

Hugs, Devlyn

And it can be read as "if GD is diagnosed, then SOP is to prescribe HRT, but if GD is not present or diagnosed, then informed consent may be used to get HRT"...because if one is diagnosed, then IC is not relevant. When would IC be relevant? When GD is not present or diagnosed.

Some might argue that this is stretching the rules a bit, but others would diagree. And as Megan notes, Seattle (and other places, I'm sure) is kind of tolerant towards TG people. Texas might not be...but if one can find a dr to prescribe...WOOT!

[Beth Andrea]

Random Googling turns up a multitude of pages...

Informed consent apparently does not require a diagnosis:

Source

   

[table 1] The Basic Features of Everyday Informed Consent
   

The physician (not a delegated representative) should disclose and discuss:
   
   

    The diagnosis, if known
    The nature and purpose of a proposed treatment or procedure
    The risks and benefits of proposed treatment or procedures
    Alternatives (regardless of costs or extent covered by insurance)
    The risks and benefits of alternatives
    The risks and benefits of not receiving treatments or undergoing procedures

Source: AMA 1998

[Devlyn]

I'm not casting anyone's integrity in doubt here, but do we know if doctors are prescribing to presenting crossdressers, or are people saying what the doctor "needs to hear"? Again, I'm not inferring that anyone is less than truthful.

Hugs, Devlyn

[Beth Andrea]

I'm not casting anyone's integrity in doubt here, but do we know if doctors are prescribing to presenting crossdressers, or are people saying what the doctor "needs to hear"? Again, I'm not inferring that anyone is less than truthful.

Hugs, Devlyn

Without asking people such intimate questions, we'll never know.

Here's a quote from ibid:

...As soon as I mentioned the purpose of my visit was to obtain a referral for their informed consent program,
she ((the doctor)) asked what my goals were in seeking HRT (since they do provide hormones to people who aren't necessarily trans, are
genderfluid, etc) and we started to discuss my options. She gave me a rundown of what I should and should not expect
from hormone therapy, what the potential side effects were and finally the pros and cons of pills vs. injections vs. patches...

[kelly_aus]

I'm not casting anyone's integrity in doubt here, but do we know if doctors are prescribing to presenting crossdressers, or are people saying what the doctor "needs to hear"? Again, I'm not inferring that anyone is less than truthful.

Hugs, Devlyn

Devlyn, I never had any serious amount of physical dysphoria - it amounted to little more than the thought 'Hey, this isn't quite right.' What messed with my head is that I knew who I was and how I was perceived by the world didn't match. Apparently this is a form of dysphoria and was more than enough for my therapist to agree that hormones would be a good thing for me. So I'm one that didn't fit the standard narrative at all..

[Newgirl Dani]

This is really an interesting debate and I'm going to respond 'without' reading any others, then I'll see where my views fall.  My very first reaction was to think 'no', for this reason, hrt is risky enough for those who's options are nill to none.  So the idea for a person who likes to crossdress (now I'll find out soon enough if wrong) and this activity being part time, once hrt begins it is not like a person can just travel backwards and forwards when one choose's.

OK, then I began to think, well it's their body, how can anyone dictate what they choose to do if the risks are known.

I do not know if this could be legally prevented because this is 'not' under the heading of anything that I'm aware of.  Now to see what others think  .   Dani

[Devlyn]

I admire your style, and your courage!

[Newgirl Dani]

Informed consent is the concept that a patient who is informed of all the issues of a certain medical treatment may undergo that treatment on their own responsibility. It usually requires the signing of a special release form.


Hugs, Devlyn

Hmmmm, this may be an even more interesting side question:  If the above is indeed true and Informed Consent has been signed, placed within the patient file and hrt treatment has begun, then the doctor for whatever reason (say using old reference materiel) decides to backtrack on medication, can the patient not only refuse but would not the doctor be obligated to continue the treatment unchanged?

[cindianna_jones]

I think informed consent conveys to the patient the risks they may be taking by taking the medication? Crap, I don't know. I did everything by Harry Benjamin's book. I didn't want to mess up my life any more than it was already messed up. I don't know that I'd have come along any faster. And since most of the money was in the Electrolysis, a few doctor visits didn't amount to much.

Cindi

[jeni]

This seems like a tricky question to me. I don't think IC would necessarily mean you can just walk in and expect treatment. The IC seems to me to mostly do away with the requirements of the SoC beyond merely being diagnosed as having GD. The issue with SoC isn't that it requires a GD diagnosis, it's that it requires other irrelevant or unsafe hoops be jumped through.

As to whether HRT would be appropriate without a GD diagnosis, I'm of two minds. I feel like a doctor should be prescribing medications to treat a condition, so I can see the argument that if you don't have a medical diagnosis, it would be unethical to provide medical treatment. But on the other hand, and I lean toward this being more sensible, there are lots of medical treatments that are considered both ethical and elective.

Actually, the more I think about it, I think the latter makes the most sense, if only for the practical reason that some people will self-medicate if they can't go through proper channels. Better to let them through the proper channels than to "protect" them into unsupervised medical treatments.

[Rachel]

The question is: Can a crossdresser with no GD receive Informed consent HRT?

I think it would depend on the doctor and location in the country. I go to Mazzoni in Philadelphia PA and they do informed consent. They are my primary care and they see a lot of trans and gender fluid patients. The only way to know is to find a trans clinic and try.

I think the doctors at my primary care want a ideal patient that is stable, clean and sober, smoke free, knows the risks and effects of HRT and accept the risks and effects. My primary care wants to do the best thing for the patient and not gate keep.

I think if a person identifies they would feel better with breasts, soft skin and curves with HRT then they must not feel as good about their body as it is presently. A feeling of unwell about one's body is GD, to me, and a valid reason for HRT.

[skin]

It would depend on the doctor, but the entire reason the informed consent model exists is to not require a GD diagnosis.  Here is the policy of the closest informed consent clinic to me on who can get an hrt prescription:

The person has the cognitive ability to make an independent decision. In other words, that person understands the potential risks and benefits of the choice and is able to anticipate how that choice may impact them now and in the future

and

The person has the information needed to make an informed decision.

So at this one if you say you need them and you prove that you understand the risks and have a realistic expectations of the benefits, you will get a prescription of your medical screening allows it.  I know clinics like that are few and far between but they do exist.

[AnonyMs]

I'm reading it as needing a GD diagnosis to receive the treatment. I honestly don't feel that way. I know what to say to a doctor to get them, a couple ways, in fact. It wouldn't be right, though.

I'm not casting anyone's integrity in doubt here, but do we know if doctors are prescribing to presenting crossdressers, or are people saying what the doctor "needs to hear"? Again, I'm not inferring that anyone is less than truthful.

I don't think that lying and integrity and right and wrong are such simple things.

I think lying to the doctor to get HRT if that's the only way is right. In a moral sense its right. I'm not sure how it happened, but I have a strict moral code and I absolutely hate doing the wrong thing. I've given a lot of thought to right and wrong over the years. Its a big deal for me, so much so that I've talked to my psych about it. I flat out lied to someone 20 years ago, and another one last year, and it bugs me still. I've lied very few times in my adult life, because usually it is wrong, but in this case its not. I refuse to do some things that others will, and on this post I'm probably out of step with everyone else.

Lying to save someone's life is usually not wrong, which I think shows that lying in itself is not wrong, it's the why and consequences that are important. In this case the doctor is in the wrong, and correcting that is right.

I'm starting to think this is why I've not felt shame at being transgender, because I truly don't recognize it as wrong. Its also my view on crossdressing.

I don't see lying as anything to do with informed content. The important part of that is that you are informed and have the mental capacity to consent. Anything outside of that is a moral judgement.

[Jasper93]

We're having a discussion about who qualifies for HRT through informed consent in another thread, and I thought the discussion would be more visible with its own topic. The site Wiki describes informed consent as:

Informed consent is the concept that a patient who is informed of all the issues of a certain medical treatment may undergo that treatment on their own responsibility. It usually requires the signing of a special release form.

Of particular interest is informed consent in regard to transsexual hormone therapy and surgery. Hormonal Replacement Therapy (HRT) represents a valid therapeutic approach for those who have been diagnosed with Gender Identity Disorder / Dysphoria or as a Transsexual.

For reference, here are the Standards Of Care:

https://www.susans.org/wiki/Informed_consenthttps://www.susans.org/wiki/Standards_of_Care_for_Gender_Identity_Disorders

The question is: Can a crossdresser with no GD receive Informed consent HRT?

Hugs, Devlyn

Yes, a crossdresser can obtain hormones through informed consent -- and honestly, even through WPATH.  I'll be completely 100% honest; WPATH nowadays isn't so stringent, and even I -- someone who has pretty much been a victim of the dreaded a-word-a-philia for as long as I can remember -- obtained hormones through WPATH in less than a month.  As far as informed consent goes, I decided to go that route after facing problems with my initial treating doctor, and it was pretty much like a PEZ dispenser, in reference to someone's analogy several months ago on my informed consent forum.  "Informed consent clinics aren't PEZ dispensers..."  Yeah, they sort of are, and this is a good thing for those who know that transitioning would make them happier.  There was a definite sexual component to my transition, as seems to be the case with some crossdressers, yet I can tell you that I've been happier than I ever imagined since commencing my transition 5 months ago.  Just my two cents.

[ImagineKate]

Informed consent is really all over the map.

Some will require you to talk to their counselor.

Some will just ask you to sign acknowledging the risks.

Some will want to find out of you have a therapist and if not you see their counselor.

Generally it is accepted that people with GD and who wish to medically transition can get hormones. Crossdressers are discouraged for some reason, but I'm sure some do anyway.

However I am genuinely curious and I mean no disrespect. If CDers are not transitionining then why do they need the hormones?

[Cindy]

Just my 5 cents. When I got my independent second review for surgery I was given a copy of the letter and I quote: Cindy displays no evidence of gender dysphoria, she requires surgery for gender incongruence, she desires her body to match her mental gender.

In talking to several psychiatrists their opinion has been that if a client requires HRT to allow him or her to live a normal happy normal life, that they understand the risks involved and that they have no untreated comorbidities then HRT is justified.

After all there is no restriction on a surgeon providing a BA to a male presenting person if the surgeon deems that such surgery is ethical.

There is a possible down side to this. The effects of HRT can be profound both physically and mentally.  A person who is primarily interested in crossdressing may find that it becomes socially and physically difficult to function as male due to such changes. I think this is a very personal issue that needs to be addressed by the individual.

It also needs to be rembered, that HRT tends to be far more effective than herbals in feminization, so if you have had positive results from herbals you may respond dramatically to HRT. This may not be what you desire.

As ever YMMV.