Poll: Should the medical community require RLE for SRS or should it be optional?

[Devlyn]

I thought following WPATH was for people asking insurance to pay for their surgeries? I thought people paying with cash could just go to the doctor and get the treatment they want.

Not my experience. Surgeons wanted some indication that we had been evaluated by a therapist and that we wouldn't regret our surgery.

You paid out of pocket, or with your insurance?

[suzifrommd]

Not my experience. Surgeons wanted some indication that we had been evaluated by a therapist and that we wouldn't regret our surgery.


You paid out of pocket, or with your insurance?

Out of pocket.

[Maybebaby56]

As I've said before, requiring RLE before offering treatment is like sending a recruit into battle in order to train as a soldier.

I know there are some arguments for it, for instance it can prove your determination. It can also save the health carers money and I suggest this is the main reason for RLE. There might be a stampede were obstacles not put in the path.

However, it's an arse-about-face way of dealing with this in my opinion. At the very least, hormones should be prescribable prior to RLE as they are part of the enabling towards transition. Surgery in various guises can be optional. It's incredibly hard for some people to live in another gender without offering some of the medical benefits towards it at the start of 'RLE.'

There's also a mahoooosive gender binary agenda that propels this way of thinking, which may be changing slowly.

Well said, Richenda.

I understand the motivation behind the RLE requirements, but I do not agree with them. Cis-women do not go out into the world with the wrong genitalia, or in constant fear of being outed as the wrong gender. How is that "real life"?

I do understand that experiencing how women, cis or trans, are actually treated in society may be a shock for some.  At my age (I am 58) I really wouldn't care.  I have had a lifetime of male privilege, and I am near the end of my professional career, so missed promotions or raises wouldn't bother me.  Socially, being talked over, ignored, disrespected or intimidated would be hard to deal with, but I really don't know how that has any bearing on being allowed to have SRS. 

I assume the argument is that if you find RLE traumatic you wouldn't want SRS.  For me, that makes no sense. It's transition that's hard, and for me, I would rather have SRS first and then do my "RLE", because I want every psychological advantage. 

I already don't function as a male sexually, even before starting HRT.  I haven't had sex in more than three years, and maybe only twice the last six. (I say "maybe" because it was so unsuccessful I don't know whether it counts as sex.)  I have no use for a penis. I love the female form, and even if I were abstinent, I would rather have a nice, pretty vagina.

The guidelines are just that, guidelines not rules set in stone. Most doctors only require a letter from two mental health providers one required to be an MD.  Most providers will only give the letters after one year RLE and most insurance companies also require the 1 year RLE before they will pay for coverage. 

If you are willing to pay cash it is very possible to get your letters and have the surgery without having to go through the 1 yr RLE.  I know at least one member here who was able to get her surgery without having completed 1 year RLE.

This is good to hear.  My therapist told me much the same thing.  I find the WPATH guidelines very intrusive and they are going to make my transition harder.

~Terri

[Devlyn]

Out of pocket.

OK, thanks. To answer the original question, I guess RLE is fine if it considers all of the possible living experiences. Examples given: Man with vagina, woman with penis, man with breasts, woman without breasts, genderless, etc. And clothing choices during that year? pffffft, don't even try it. What are the medical professionals trying to evaluate, fashion sense or medical needs?

[janetcgtv]

I believe in having the RLE as a requirement.
Although I believe that individually it is not necessary before SRS.

I am for it for the very few who regret having SRS and because it gives ammo to our enemies to use against us when this happens.

[BeverlyAnn]

I'm in the optional group with the caveat the person not going through RLE should be heavily screened before any letters are written for GCS. 

[cheryl reeves]

I for one strongly believe in rle, for of your wanting to be female or male you should start living that role everyday to see how it feels...would you buy a car without test driving it first to see how it handles and fits your personality? I don't understand the balking at rle, they make prosthetics to help you along..so what's wrong with the test drive before before buying the body you want?

[kira21 ♡♡♡]

I for one strongly believe in rle, for of your wanting to be female or male you should start living that role everyday to see how it feels...would you buy a car without test driving it first to see how it handles and fits your personality? I don't understand the balking at rle, they make prosthetics to help you along..so what's wrong with the test drive before before buying the body you want?

RLE doesn't test drive having a vagina. I have a lesbian friend who dresses in what would be considered a male style and know plenty of other women who do that too.are they unprepared to own the vaginas they have?  What RLE gives you is a test drive of wearing a skirt and fitting into archaic notions of gender roles. How does that prepare you for having a vagina?

[cheryl reeves]

RLE doesn't test drive having a vagina. I have a lesbian friend who dresses in what would be considered a male style and know plenty of other women who do that too.are they unprepared to own the vaginas they have?  What RLE gives you is a test drive of wearing a skirt and fitting into archaic notions of gender roles. How does that prepare you for having a vagina?

Buy a prosthetic vagina,I know it's not the same but it's cheaper then grs and gives you an idea of what being fem is like.

[kira21 ♡♡♡]

I thought we were discussing the validity of rle as a tool for preparing you for grs? Are you suggesting wearing a prosthetic for a year as rle?

[Deborah]

This is TMI but I tried that once.  IMHO it's a huge waste of money.  It doesn't work as well as tucking and is intensely uncomfortable.


Sapere Aude

[XKimX]

I suspect that RLE has more to do with the fear of a need to protect surgeons from liability claims than it does with predicting the success of a SRS patient.  SRS may be necessary for our emotional health, but hardly affects our physical health.  If we are expecting other people to pay (the taxpayers or private insurance), then they get to make the rules, but if your choice is not a burden on anyone else, then surgery on demand should be the rule.  FFS is more life-changing than is SRS, but much easier to get "on demand" to paying customers.  Same for BA.  Anyone can buy boobs of any size they want, however ridiculous, without anyone else's permission and no prior requirements to see if you really want to be that size. And I think we can attest that developing boobs on HRT, or obtaining them by a BA, is more life changing that is SRS.

WPATH seems to be the home of a lot of "old think" and reacting to fears that have not been shown to materialize.

Many people regret some of their own decisions, but as adults no one questions that they have the right to make those mistakes.  Why should SRS be any different, and people with gender dysphoria be put in some special class that needs to be controlled and protected by "the experts."

This is not to say that RLE can be very useful to some, or that there is anything wrong with RLE.  But mandate it as a requirement is wrong.

[Maybebaby56]

^^^ This^^^

Very well put. I agree completely.

~Terri

[Serenation]

I suspect that RLE has more to do with the fear of a need to protect surgeons from liability claims than it does with predicting the success of a SRS patient.  SRS may be necessary for our emotional health, but hardly affects our physical health.  If we are expecting other people to pay (the taxpayers or private insurance), then they get to make the rules, but if your choice is not a burden on anyone else, then surgery on demand should be the rule.  FFS is more life-changing than is SRS, but much easier to get "on demand" to paying customers.  Same for BA.  Anyone can buy boobs of any size they want, however ridiculous, without anyone else's permission and no prior requirements to see if you really want to be that size. And I think we can attest that developing boobs on HRT, or obtaining them by a BA, is more life changing that is SRS.

WPATH seems to be the home of a lot of "old think" and reacting to fears that have not been shown to materialize.

Many people regret some of their own decisions, but as adults no one questions that they have the right to make those mistakes.  Why should SRS be any different, and people with gender dysphoria be put in some special class that needs to be controlled and protected by "the experts."

This is not to say that RLE can be very useful to some, or that there is anything wrong with RLE.  But mandate it as a requirement is wrong.

My clinic got shut down by adults who made mistakes, everyone else had to suffer because of it. (though RLE didn't stop that from happening)

Why do people assume you can't be a tomboy in RLE? Just wear what you are going to wear. There is a big difference between being a boy in jeans and t-shirt in society than there is being a girl in jeans and a t-shirt in society.

Can someone educate me on why an MTF doesn't want to live as female

[Maybebaby56]

Can someone educate me on why an MTF doesn't want to live as female

This was never the issue, dear. The issue was the WPATH dictates how one must transition.  My point is that it's my transition, my body, and my life. Transition is often difficult and scary, and we must each find our own paths. My path would include SRS first, then RLE, but then I would be penalized by having to pay out of pocket for something my insurance covers.

As you pointed out, RLE does not guarantee a more successful outcome. As XKimX said, it sounds more like a liability clause to protect medical professionals than a concern for the patient, and apparently it doesn't even do that. One already has to be vetted by two mental health professionals. That should be enough.

With kindness,

Terri

[AnonyMs]

Can someone educate me on why an MTF doesn't want to live as female

Divorce and career/money to name two.

[Oliviah]

I think RLE is important.  Not for hrt, but certainly for such a life altering procedure as GRS.  This isn't like getting your ears pierced or a tattoo.  The consequences of regret are extreme, and just letting people alter themselves surgically can be devastating.  There is enough regret in the realm of cosmetic surgery to warrant more gate keeping there that we shouldn't put an already vulnerable population more at risk.

Transition regret is real.  I know a few.  Once you get the surgery it is much much harder to reintegrate as your old gender. 

[AnonyMs]

I think RLE is important.  Not for hrt, but certainly for such a life altering procedure as GRS.  This isn't like getting your ears pierced or a tattoo.  The consequences of regret are extreme, and just letting people alter themselves surgically can be devastating.  There is enough regret in the real of cosmetic surgery to warrant more gate keeping there that we shouldn't put an already vulnerable population more at risk.

Transition regret is real.  I know a few.  Once you get the surgery it is much much harder to reintegrate as your old gender.

I don't know anyone who's detransitioned, but I don't understand why having SRS would make it "harder to reintegrate as your old gender."? I'm interesting in presenting male afterwards, which is similar to detransitioning from a certain point of view, and I don't see any difficulty with it. If you were not transgender then I could see a possibility, but how would you manage to take HRT so long in that case?

I'm not part of the vulnerable population in any normal sense of the word. Not all of use are.

[Jessika]

Rather it's required or not, HOW can a Doctor monitor your RLE? Are they going to assign an agent to you for a year to follow you around to make sure you are what you say?

How is there PROOF that you are doing it?

I myself WILL do the RLE because I know that when the time comes for me to go full time, I can stop wearing Halloween Costumes throughout the year in certain places where my "Current" legal name MUST be matched how I look.

I'm at the point where I'm afraid to present male in front of Family and Friends! Yes..It used to be the other way around in the past, but in certain settings I am still forced to present Male (Halloween Costume reference).

Over time it will change. 

[kira21 ♡♡♡]

I think RLE is important.  Not for hrt, but certainly for such a life altering procedure as GRS.  This isn't like getting your ears pierced or a tattoo.  The consequences of regret are extreme, and just letting people alter themselves surgically can be devastating.  There is enough regret in the real of cosmetic surgery to warrant more gate keeping there that we shouldn't put an already vulnerable population more at risk.

Transition regret is real.  I know a few.  Once you get the surgery it is much much harder to reintegrate as your old gender. 

SRS has some of the lowest regret rates of any surgery.  By putting psych evaluations as mandatory for it,  when they are not for equally life changing medical procedures such as ivf,  you are saying that we are not capable of making our own evaluations.  Then there is the issue of the  fact that wearing a skirt doesn't prepare you for having a vagina.