HT through informed consent- are safeguards needed?

[Kaya_Kai]

So, there is an informed consent center in Denver which my therapist has already referred me to for hormone treatment. Informed consent allows one to begin hormones before all the red tape that is normally required. I personally would like to go through with it, the long transition period should be enough time for me to know if it's right. However, after all this time reading about how long it takes just to get on hormones it almost feels like cheating.

I was just curious what your views are on the issue, do you think it's enough to allow hormone therapy with nothing more than discussion of risks and signing a piece of paper? Is some red tape necessary? Should their be a certain level of "gatekeeping" to make sure people don't transition incorrectly?

I want to get a little more information and viewpoints before making my own decision.

[Laura_7]

People are individuals.

Maybe you have already thought about all of this for quite some time.
Others have known from a young age.

Others feel they want a good therapist to guide them along.

There is no one answer for all imo.

Imo its a necessary opportunity. Its up to people what they make of it.


hugs

[emyrinth]

I'm doing informed consent. My insurance is paying for it. I got a diagnosis on file with a single non gender therapist but my own research is more than enough to carry me through most of it.  I'm fine with having as little red tape as possible for me. Others may have different needs though.

[suzifrommd]

I needed to understand the ways in which my body will never be the same again. I also educated myself about how those changes will impact the way the world interacts with me.

Once I understood and accepted these things, I was ready for hormones.

[ChiGirl]

I'm about to start HRT through informed consent.  I thought I should go through an endocrinologist, but just about everybody I've talked to has told me to go the informed consent route.  It doesn't mean you're doing it on your own, it just frees up some red tape.  If you're comfortable with it, go for it.  Not everyone has that opportunity. 

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[emyrinth]

Some endos do informed consent. Mine is one of them.

[AnonyMs]

Kaya_Kai, I'm a bit confused by your question. I'm not sure if your asking if informed consent in general needs more safeguards, or if if should personally wait a bit longer.

Personally I'd like to buy any and all drugs and treatments without having to ask anyone else for permission. If other people want to ask permission to live their lives that's fine, just so long as they don't mess with me. Sadly that's not the world we live in. Society is more complex that that.

I spent a year seeing a therapist before starting HRT, and that was entirely my choice. I've always had access to HRT, but chose to wait. If you're not ready then don't start.

I think informed consent is a very good thing, although I'm not entirely sure its implemented correctly. Informed consent has a medical/legal meaning, that someone is informed about what they are doing, and is mentally capable of consenting. You can't consent if you're crazy for example, or under a certain age. I'd expect determining if you are sufficiently sane is the job of psychiatrist, not a doctor, especially in the gray area where people have mental problems (as many of us do). The difficulty when you put too many things in the way is that you get gatekeeping, and right now I believe there's far more mistakes being made due to gatekeeping than too lax requirements with informed consent. There's always going to be mistakes; it's how we choose to balance freedom and the resulting problems that defines our society.

[Rachel]

I am in Philly PA an where I go it is informed consent. I did my intake and was a mess. I was referred to a Gender Therapist and 6 months later I was able to start Hormones. In my case it was absolutely the right thing for my provider to not allow me hormones. It would have been too much for me to handle at the time.

I know trans-woman that are in recovery and had to wait 3 months before hormones were prescribed.

Informed consent includes and examination and in my case intake and it is monitored. My PCP has thousands of trans under their care.

[Marlee]

Split the words apart for a sec.  "Informed" means you have done the research. "Consent" means you are agreeing that you have done that sufficiently that you are releasing them from any liability for it. In essence, it makes you your own gatekeeper. A key tho is, will the provider also conduct the monitoring and any necessary adjustment to dosage?

[emyrinth]

My endo gave me some docs to read over that was all rehashing stuff I knew. I could have signed off on it and handed it back to him right there but I decided to read over it anyway. He also gave me a 5 minute run down on the effects of e and spiro. Again nothing I didnt know. Informed consent assumes that you have the mental capacity to sign unless there is forknowledge that your abilities are compromised (ie you look high, smell drunk, or are a truly hot mess) So no your endo/ gp does not determine whether you are mentally capable the standard assumption is that you are.  At the hospital I work at everything we do to anyone who is not unconcious/ emergent/ bat splat crazy falls under informed consent in the initial admission process in a form called Consent to Treatment.  We have people sign stuff all the time with the assumption that they are capable until evidence shows they are not.

[iKate]

I am doing informed consent at a LGBT clinic in NYC.

I also have a therapist.

To me informed consent is not less safe than having a therapist. You have a few months before you can change your mind and detransition anyway. So it's not like when you take the first pill you're locked into transition. That to me is the major reason for gatekeeping, in that they want to make sure people don't harm themselves and truly need hormone therapy.

Most informed consent clinics will counsel you first though.

[AnonyMs]

Split the words apart for a sec.  "Informed" means you have done the research. "Consent" means you are agreeing that you have done that sufficiently that you are releasing them from any liability for it. In essence, it makes you your own gatekeeper. A key tho is, will the provider also conduct the monitoring and any necessary adjustment to dosage?

I like that a lot. I've given myself such a hard time, its the perfect description. It's true on multiple levels.

I'm not sure there would be much need for informed consent if the medical profession just did their jobs properly. Unfortunately they are just as human as everyone else, and all too often don't. So for better or worse we are starting to take that role on ourselves, and I believe that's as it should be. I want to live in a society where we have freedom and responsibility in as many things as possible.

[fairview]

IF I understand your post correctly, my opinion would be that you are not a candidate for going informed consent. If there were safeguards in place for informed consent it would be a contradiction of terms. Just my opinion.

Doctors by their Hippocratic oath swear to do no harm. I think informed consent for anything is an extension/modern modification  of that oath by ensuring that what we do not cause harm or more harm without the supervision of a medical professional. If I were a doctor and a patient presented to me that she was going to self administer x-sex hormones no matter, ethically speaking I would be caught in a quandary. Having this knowledge and doing nothing may cause harm by omission. If I intervene without informed consent and without the patient going through all the formal therapy requirements and RLE being signed off I could be hung out to dry in the court systems.  In fact in today's litigious society, ending up in court is possible for both situations. The paperwork advising us of the outcome, sides of x-sex hormone treatment is their legal shield in the court system and a patient's loophole to obtain medical treatment.

[AnonyMs]

Doctors by their Hippocratic oath swear to do no harm. I think informed consent for anything is an extension/modern modification  of that oath by ensuring that what we do not cause harm or more harm without the supervision of a medical professional. If I were a doctor and a patient presented to me that she was going to self administer x-sex hormones no matter, ethically speaking I would be caught in a quandary. Having this knowledge and doing nothing may cause harm by omission. If I intervene without informed consent and without the patient going through all the formal therapy requirements and RLE being signed off I could be hung out to dry in the court systems. In fact in today's litigious society, ending up in court is possible for both situations. The paperwork advising us of the outcome, sides of x-sex hormone treatment is their legal shield in the court system and a patient's loophole to obtain medical treatment.

You could also lose the trust of your patients who will then do their best to avoid telling you anything. That could cause even more damage in the long term. I don't think doctors want to be seen as the enemy; its not going to help anyone.

The "official" position, as stated by WPATH, is to prescribe and supervise HRT if someone is self-administering as harm minimization.

[Cindy]

Just my experience and advice from professionals in the area. About 60% of people fronting up for therapy have no issues and after an explanation of informed consent are ready for HRT and to start ther journey, about 40% aren't, it is very difficult to identify yourself as being in the 40%.

I was certain I was in the 60%, after some brief talks I realised I would be a lot happier with some help to deal with issues from my past. I am so glad I did. It did delay HRT a little, but when I was ready it was a very smooth ride.

One thing I will add, I prescribe drugs for oncology conditions, most of my clients have researched their therapy through Google etc. yet they have no idea what they are walking into. I realise that is a different scenario, but I do believe there is no self research that is as good as the professional opinion from an experienced professional who has been working in the particular area of Medcine.

When doing research on yourself there is a tendency to put yourself in either the best outcome group, or the worse outcome group, a bit like if you are an optimist or a pessimist. The GOOD professional does not use emotional opinion. Just the facts for each individual in a dispassionate scientific way.

[FTMax]

I went through informed consent to start HRT. I think the process is a little more involved than what you've put it down to.

I got in touch with my clinic asking if I needed a referral from a therapist to start HRT. They said no, and to make an appointment. I came in, got vitals taken, and had blood work done. I met with my doctor and went over my entire medical and mental health history to see if there was anything there that may be an issue. Then we went over HRT and the specifics for female to male individuals, to include: what it would most likely do, what it definitely would not do, what it could potentially do, and things that would be irreversible once they'd happened. We talked about different medication types, common dosages, and what to expect for the first few months. She gave me the form to take home to continue to read over. She made sure I knew that there were mental health professionals on staff at the clinic in case I ever wanted to talk to someone. Three weeks later once my blood work was back, I came in and got my first dose.

Does it stop people from transitioning that shouldn't? Probably not. Anybody can look around on forums like this and figure out what the "mainstream trans narrative" is. They can lie about their mental health or past addictions they might've had. But ultimately, they're only prescribing HRT to adults who they've informed of the risks involved, and who have consented to starting HRT anyway. IMO, the process I went through was very adequate for my needs. But I've known I was trans for years and had been delaying transition for several years until I had more money saved. For people that aren't sure, they might really need to talk it through with an affirming therapist.