m-to-i SRS - how soon is too soon?

[kellb]

Because you think it's ellective when, it is in fact medically indicated following a certain diagnosis.

Well, hey now, I don't know about that.  Firstly, everything in life is "elective" - we can always 'choose' life as it is now.  It just might not be the life you want or can endure for very long...

Secondly, I find in my case that the longer I introspect and contemplate what's wrong with me, the more I understand that something is actually -wrong-.  Not just sub-par or not-as-good-as-I'd-like, but wrong.  Like being born without a leg; I can live without a leg.  But I'll be damned if I'm going to live that way, or have people tell me I have to 'make do'!

[Serenation]

I don't think that's according to WPATH. This is a small extract from WPATH, where DSD is the term they use for intersex.

"However, certain criteria for treatment (e.g., age, duration of experience with living in the desired gender role) are usually not routinely applied to people with a DSD; rather, the criteria are interpreted in light of a patient's specific situation (Meyer-Bahlburg, 2011)."

There's more than that, but it suffice to say according to WPATH it does make a difference. I believe its quite common for doctors to say they follow it without actually doing so. I wonder if some of them have even read it.

I don't think there's a main clinic in Australia. The states are all quite different, and much to my surprise Sydney's great.
That's the common view on how it works, but its not the only way. I know of other cases, but I saw a YouTube video last week of a Sydney girl who had 1 psych interview and got her surgery letter for Thailand. She was obviously ready, and it would have be pointless to drag it out of the sake of following some paperwork. Perhaps she's even here?
Yes, but you can go back to work way before then, and if you're trying to hide it from anyone you could think of it being be anywhere from 4 weeks to a few months.
While that's the usual path I don't think its the full story. Socially transitioning right now would likely be  be a disaster for me, and if/when I get SRS I'm not going to socially transition before or after. I'm quite certain I can get what I want; I have the money and ability to choose my own path.

Monash is the biggest gender clinic in Australia and is the only government funded clinic in Australia, perhaps that has changed now but that was the case for the last decade at least, a girl from Sydney was having SRS in Melbourne when I did also.

And yes anyone can go to Thailand with minimal fuss. One of my friends wanted to bypass wpath and did exactly that.

[Serenation]

Unfortunately, that's simply not an option for me.  I'm not a woman and have no wish to be one; I'm a big stocky hirsute "male" and it's pretty obvious that I'm hardly about to change that.  I teach at a university, which makes me something of a semi-public figure - a public transition to and then fro would be career suicide.  That said, I've read through WPATH7, and nothing in it suggested to me that I'm asking for the impossible.  My biggest fear is that they will say "Meh, you can live with out it - make do."

Why were Australia's services closed down?  I would be interested in spinning off a new thread to discuss the State of the Union so far as SRS in Oz works.

from the SMH, Trudy Kennedy has since passed away and the clinic reopened. With Dr Fintan Harte at the helm.

AUSTRALIA'S only sex-change clinic has been temporarily shut down and its controversial director forced to quit amid growing claims that patients with psychiatric problems have been wrongly diagnosed as transsexuals and encouraged to have radical gender reassignment surgery.

The Sunday Age has been told at least eight former patients of the Gender Dysphoria Clinic at Melbourne's Monash Medical Centre believe they may have been misdiagnosed. Some have tried to commit suicide while struggling to live as the opposite sex after the irreversible operations.

But as the clinic has limited patient follow-up, it is difficult to determine how many patients may have been adversely affected by the surgery.

Three former patients have recently taken legal action against Monash and the clinic's doctors.

Psychiatrist Dr Trudy Kennedy — who is being investigated by the state's medical board — says officials at Southern Health, which operates the service, told her she could no longer run the clinic she co-founded 34 years ago.

The 73-year-old claims she is being made a scapegoat after the recent legal action. "I have been hung out to dry. They just want to blame it all on me. I have not made one single decision here, they are all team decisions," Dr Kennedy said.

One former patient, "Andrew", who was 21 when he had his penis and testicles replaced with a false vagina, was awarded damages after claiming Dr Kennedy misdiagnosed him as a transsexual in the late 1980s.

Since the surgery, he has twice tried to take his own life and has undergone operations to reconstruct a penis and remove breast implants. He says he will never be able to have children, is unable to work and feels like a "mutilated freak".

In the past few weeks, a 66-year-old who also underwent surgery to become a woman following a diagnosis by Dr Kennedy, settled his claim out of court. The man, who was sexually abused by his mother for seven years from the age of eight, was referred for a sex-change operation in 1996 despite another psychiatrist, stating in his medical notes that "surgery would make little difference" to his life.

Dr Kennedy said Southern Health's executive director of mental health, Anne Doherty, told her on March 31 that she was no longer in charge of the clinic, which has been closed until July while an internal review is conducted.

Southern Health did not disclose who had been appointed as the new director, but said in a statement that the clinic was committed to "delivering high-quality gender assessment services".

Dr Kennedy claims the same "political forces" that tried to shut down abortion clinics are trying to close the gender dysphoria facility, which has performed sexual reassignment surgery on more than 600 people — a third of all referrals — since it was founded in 1975 by Dr Kennedy and Austrian-born Dr Herbert Bower, who died in 2006.

The temporary closure comes five years after a State Government probe found a catalogue of problems with the way the clinic diagnosed and treated people with gender-identity issues.

The 2004 review, led by Victoria's chief psychiatrist, was never made public, but a copy obtained by The Sunday Age shows the review found that countless patients were given sex changes without proper mental health checks before or after surgery.

A second review in 2006 found half of all patients had significant psychiatric conditions, such as borderline personality disorder and psychotic depression, but many were still operated on. There was no evidence that patients' underlying mental problems were treated or their risk of suicide monitored.

The reviews also found most patients had been prescribed hormones almost immediately and in some cases were referred to a plastic surgeon before being sent for psychiatric assessment.

Almost all of the clinic's staff also practise privately. While Dr Kennedy faces an informal hearing of the Medical Practitioners Board, The Sunday Age understands that no other doctors who work at the clinic are under investigation.

Consultations are Medicare-funded but surgery costs about $10,000 and is carried out in private hospitals including Masada, in St Kilda, and Beleura, in Mornington. Surgery is performed only on patients who have been diagnosed as "true transsexuals" suffering gender dysphoria, which causes feelings of being born in the wrong body and creates a deep desire to change sex.

Dr Kennedy believes that gender dysphoria is a biological condition that can be cured by surgery. But other experts say childhood abuse and underlying psychiatric conditions often cause gender confusion that can be alleviated with psychotherapy.

Another of the clinic's patients — a woman with a history of sexual abuse who had both breasts removed before putting a stop to further surgery — is now trying to have Dr Kennedy disciplined through the Medical Practitioners Board.

Anne Shortall, a lawyer from Arnold, Thomas & Becker, who represents the former patients, said the results of the surgery were psychologically devastating. "This operation is so incredibly extreme … you're changing someone's gender in a situation where if you are wrong there's virtually no recourse to put it right again. Then they're turned away when they go back to the clinic to say, 'I'm not able to live in this role, I need help'," Ms Shortall said.

The Sunday Age has been told at least five other former patients, some of whom live interstate, have contacted a Melbourne support group, fearing they have been misdiagnosed as transsexual.

Dr Kennedy insists no patient was encouraged to have surgery. She admits post-operative follow-up was limited, making it difficult to gauge how many people regretted surgery, but blames this on lack of funding and staff shortages.

Dr Kennedy insists all patients were offered psychotherapy — a claim contested by the aggrieved patients and the government reviews. She also denies that patients were diagnosed without being assessed against internationally recognised criteria for gender-identity disorder.

The Sunday Age sent 22 questions to Southern Health, whose short response did not outline what had been done to address the reviews' concerns, except to say that "substantial progress had been made towards implementing the recommendations".

Sally Goldner, of Transgender Victoria, said she was aware of some cases of misdiagnosis but believed 95 per cent of patients were happy with their treatment.

She said lives of transsexuals would be at risk if the clinic closed. "The suicide rate in our community is 40 per cent … You'd have lines of tombstones without this service," she said.

*Names have been changed.

For help go to www.beyondblue.org.au, call Suicide Helpline Victoria on 1300 651 251, or Lifeline on 131 114.

[AnonyMs]

Monash is the biggest gender clinic in Australia and is the only government funded clinic in Australia, perhaps that has changed now but that was the case for the last decade at least, a girl from Sydney was having SRS in Melbourne when I did also.

I guess my point is that it well still be true but  I have no idea; Monsash means nothing to me here in Sydney. I've heard the name but that's about it. I know even less about the other states. The doctors I've seen here are awesome, and have been very supportive. Given that I'm being a bit difficult that's an enormous relief. I would work around the system without any hesitation, but it turns out I don't need to.

Thailand is a more accepting culture than most, and while that's very useful its that's not my main interest. Personally I can afford to go anywhere I want and I'd choose Dr Suporn in Thailand because I think he's the best. My understanding is that I could get surgery practically anywhere even though I've not socially transitioned, but that will have to stay a theory as I prefer Thailand.

[Serenation]

Dr Suporn has rules also, though I have no idea how firm these rules are.

ALL patients undergoing SRS MUST provide an original, signed document from a qualified psychiatrist or psychosexual specialist, confirming as a minimum that:

They have been diagnosed with Gender Identity Dysphoria.

SRS is indicated in their case, and is the recommended treatment.

Ideally, the referral should also confirm that:

They have been living full time as a woman for at least 12 months prior to surgery or - if not - gives an explanation as to why that has not been possible in their case. It is accepted that RLT is not a practical possibility in some countries.

They have been undertaking a course of female hormone replacement therapy (HRT) unless there are medical reasons (to be indicated) that such a course is not advised in their case.

[kellb]

ALL patients undergoing SRS MUST provide an original, signed document from a qualified psychiatrist or psychosexual specialist, confirming as a minimum that:

They have been diagnosed with Gender Identity Dysphoria.

So those of us who are happy with their identity and merely body-dysphoric are simply out of luck?  Does it matter what gender I am if my body is wrong?  It's funny how difficult it can be to be differently-different.

[kellb]

Because you think SRS  an elective procedure someone can just choose to have when, it is in fact it can only be performed by trained professionals and only when found to be  medically indicated by meeting certain diagnostic criteria.

I'm curious as to why you feel that this is my belief?  I don't think I've said anything to that effect, and it's certainly not what I think.  Obviously, it's desirable to me to not give that impression!  Can you please help me correct my explanation?

[Cindy]

Monash is not currently (fully) funded. There are no adult trans services funded by the public system. The RMCH Unit is funded to $6mill, in most states we can get the kids into treatment under 'endocrine' disorder.  Qld is funded by a private donation. This may/will change since I presented a case to Federal Parliament  and Warren Entsch got angry about Qld so has intervened.

I am currently taking the SA Gov to the Human Rights Commission. If we can use that as a test case things may change.

We have to fight for rights and some times the hardest bit is the learning curve of how to fight effectively, I now have professional lobbyists and pro bono lawyers willing to help but it has taken me a few years to learn.

We do have support, ANZPATH is fighting like hell in Australia but we are dealing with state governments with no money and a Federal government that has different priorities.

[kellb]

Cindy, I can tell you you're doing the lord's work.

[Cindy]

Cindy, I can tell you you're doing the lord's work.

Thank you, I decided a long time ago that no one would go through what I went through.

[Serenation]

So those of us who are happy with their identity and merely body-dysphoric are simply out of luck?  Does it matter what gender I am if my body is wrong?  It's funny how difficult it can be to be differently-different.

irony for something they consider cosmetic surgery isn't it.

[SorchaC]

I wasn't going to comment but what the hell 

I'm not sure that it is going to matter whether they consider you to be transgendered or not. What will matter to the Psyche will be are you aware of yourself and are you able to fully appreciate what you want. The Psyche will conclude where you fit into the criteria for writing a letter if they consider surgery is what you need.

The specifics of the surgery are surely something between you and whoever performs it? Finding a surgeon who is willing to leave the testes in place could also be a challenge as most will have developed a technique that involves removing them.

I wish you all the best in finding the road to the end of the path and look forward to seeing how you go

Hugs

Sorcha 

[kellb]

Everyone in this thread deserves hugs!

Thank you all so much!

[Isabelle]

I've heard of transgenders that want to keep their shaft and glans, but behind it have labia, introitus and vaginal canal. Personally I don't know if thats anatomically possible....... But this person seemed pretty certain a surgeon would do it.. I think you may struggle getting one of the better known surgeons to do what you're after, but, someone totally will.

[GendrKweer]

Sorry if someone else mentioned it already, but the only "problem" I see in your plan is retaining the testes... I don't quite see how that would work, or possible health issues down the line. If you somehow have them stitched into place into their old spots (a permanent "tuck" i suppose) then there might be a heightened risk of testicular cancer and/or certainly an inability to do any regular examinations... It would also seem very uncomfortable, but that's just a personal thing...

[kellb]

That seems to be the major sticking point everyone raises.  They would be moved up to where ovaries usually live, in the inguinal canal.  It's a procedure that has been done before (eg. for Tess Cowen by Toby Meltzer), but it's pretty unusual.  Then again, I'm an unusual guy!

I very much feel that that's where they -should- be, according to my internal body image.  I have taken to calling them "boyvaries".  Cryptorchidism carries a small cancer risk, but one that I'm comfortable with.  And yes, I would need regular ultrasounds to keep an eye on them.  There should be no discomfort with them relocated to the abdomen; they'd be quite safe there unless someone punches me in the lower belly groin.

[actualist]

   Because I'm genetically male and present as male, I don't believe I'll need lived experience (I pass as my cis-gender pretty well, I think).  I want to keep my testicles, up in the inguinal canal, so that I won't need HRT.  I want to freeze sperm because I've yet to have a family, but I was planning to do that anyway because partner is male and we're looking into surrogacy.  My partner is simply amazing and totally supportive (although he'll miss my cock, he'll gain a pussy to play with - good thing he's bi!). Money is not too much of a problem for me.  Assuming I somehow manage to get the two legal psyche evaluations, in theory I could get this done as soon as I can arrange a surgical team and time off work*.

This post really resonates with me because I'm looking into having a the bottom surgery while keeping my testicle(s). I'm 26 and have contemplated having a vagina instead of a penis since puberty. The thought has been occurring increasingly until I finally had to take it seriously when I got into my 20's. I want to keep male physique and leave my body chemistry close to the same. So far moving my testes to the inguinal canal seems to be the more promising approach to keep my testosterone leveled without medication.

I want to have kids so I am holding off on starting heavily into the process until I get a couple buns in the oven. So far the only person I've told is my best friend/future baby-mama. Similar to how I came out as a gay man, I'm telling the people who are close enough to be impacted. Once those people are aware, I can then shift some of my focus from the outside world's perspective back to mine. The ticking of my biological clock is setting the pace for me. I plan to have 1-2 kids within 5yrs and in that time I will continue to develop myself and gain insight into the person I've always been and what I'm willing to do to express that. I've researched some doctor's and psychiatrist, but I am staring off with talking to people who have gone through grs. There are also support programs available through work and my local LGBT community (found a few).

Since I've began accepting myself, more and more people at various stages of transition have began entering my life. I take this as a sign that the resources I need to make the decision on whether to go through with the surgery is presenting itself. The actual surgery and recovery makes me hesitant, as it should. I hear it will be difficult to get through the red tape and find a surgeon to do this, but that step in the process is a little too far out to hinder me at this point.

[Thanks for the post Kellb. It's been a struggle for me to find posts in various forums on maintaining male appearance and having the bottom surgery while keeping testicles. It's a bonus that you're an engineer, I am as well.]

[kellb]

Well, to answer the point I raised at the beginning of this thread, I'm pleased to report that I've finally gotten my letter with no RLE, and now have a date booked with a well-known surgeon.  As it is, I was told I could not keep my testicles, or they would not do the surgery.  So, it was a choice of going with the surgeon of my preference and losing the testicles, or else continuing to shop around.

After much self-reflection and discussion with my partner, we decided that I'd be fine without them.  As is, I've banked plenty of sperm and I can get testosterone hormones, so that's no biggie.  I'm not entirely resolved on how losing my boyvaries will effect my mental self-image, but for now I think I'll be "ok" with it.

In regards to the "how soon is too soon?" question, my date is in early 2018, so I'll have a long period to reflect and make sure this is really right for me before I go under the knife.  I can't see that happening, though - I'm pretty excited for it!