How do you thnk transition should be done.

[Martine A.]

Do you have any option to go private at all there?

We don't have nationalized healthcare here which is why we aren't basically forced to wait.

N-ope. No private health care here. And meds are under strict control. People still self-medicate, but the tunnels for that are unknown to me. I could even get myself a good endo outside the country if I knew were to get the meds from.

[Lagertha]

What I was talking about is: Where do you exactly place the point to establish when therapy/RLE is needed for a surgical procedure?

Full Facial Feminization Surgery is a very major, invasive, drastic procedure (and oftenly faces can't simply be restored to the initial point) but therapy/RLE are not required for it. Same for other procedures. In fact you can go for Full Facial Surgery and Breast Augmentation in one shot, and no therapy/RLE.

Facial feminization surgery and breast augmentation are elective cosmetic surgeries, whether we like that fact or not. Genital reconstruction is not a cosmetic surgery.

So, where do you place the point?

You don't need any therapy or RLE if you choose to have full facial tatoo and hundred spikes out of your face. If you don't need therapy for that, you also shouldn't need therapy and RLE for faaaaaaar less dramatic and drastic facial feminization surgery. Although it can be life changing procedure it can't even compare with the life changing permanent effects of having dragon drawn all over your face, demon horns implants and metal spikes through your eyelids, nose and lips.

[AnonyMs]

I completely disagree with Roni on this. The fact that you got hormones so quickly, as did I (within 2 visits) is hardly the standard. Most trans people need to spend months and even years, and far more visits to the therapists and doctors before they are allowed to start HRT. Quite frankly the current WPATH standards need to be updated I think. In my mind, things go a bit like this, and every thing related to the medical transition should be covered via insurance, with perhaps a limit on number of visits to the therapist for example.

I think therapy is a great first step for most people, but for me personally it wasn't, and I wouldn't have it required. I believe the informed consent model is the most fair, and logical solution, although I think a more detailed explanation of what will happen may be required. Hormones should then be allowed after consent via an endocrinologist, with regular blood draws every 6 months to 1 year. Bottom surgery/orchiectomy should be covered sometime after the first year or so, and should require some real life experience.

The WPATH Standards of Care have been updated and there's no requirement for therapy before HRT or SRS. See version 7

Page 28 "Psychotherapy Is Not an Absolute Requirement for Hormone Therapy and Surgery"

Page 33 on the detailed criteria for HRT does not require therapy. It does require "A referral is required from the mental health professional who performed the assessment, unless the assessment was done by a hormone provider who is also qualified in this area.", which is essentially medical informed consent (SOC doesn't call this informed consent and discusses that model as a different thing).

Informed consent for HRT is usually taken to mean you ask for HRT and the doctor just gives it to you, but its not the medical definition. There's no checking that you're capable of consenting, which is what a psych should do.

Page 105 is the criteria for SRS, and it has no requirement for therapy either, just the addition of RLE to the detailed requirements. I'm a case where this is not suitable, and I disagree with the SOC on this.

I think informed consent for HRT and SRS is the correct model, with consent having the medial meaning. And sue any doctor that falsely says you're not capable of consent.

The SOC is not a law, and there are a few people who've had SRS without RLE. I can't say I've ever heard of anyone doing that and regretting it, but the numbers are very small.

[Ltl89]

I don't  really know how it "should be", but I'm glad that I'm seeing a therapist.  It's been very helpful for someone as insecure as I am.  I'm taking my time and moving forward at the pace I feel comfortable in and talking my concerns out and getting guidence through each step.  So I'm very pro therapy. However, I don't know how I feel about people beibg forced into therapy in order to transition.  In my opinion people have the right to do what they want with their own bodies and have the right to live as they choose.  If we aren't hurting anyone, why shoulf it matter to anyone else?  Then at the same time I think havinf safeguards can protect some people from taking a permanent and drastic that they may not have really wanted in the end.   Considering that detransitioning does happen from time to time, it could might prevent those few cases.  So I'm mixed on this. 

[Naomi71]

@Learningtolive

If someone indicates they could use some therapy and guidance, they should obviously be provided with that. I wonder however, if the people detransitioning didn't get any therapy. It's not like therapy would prevent people from making the wrong choices.

[AnonyMs]

I saw a therapist for a year before deciding to start HRT. At the end of it I started and I didn't ask for permission (letters). It was enough to know my own mind.

If you need therapy you should do it. Otherwise don't, but it shouldn't be a condition of getting it. It disrupts the theraputic relationship with them holding it over you. I told my psych that I'd be open with him about everything, and that if I ever asked for SRS letters and he didn't give it to me I'd just arrange it elsewhere. I think being honest helped me get the help I needed.

[Martine A.]

If you need therapy you should do it. Otherwise don't, but it shouldn't be a condition of getting it. It disrupts the theraputic relationship with them holding it over you. I told my psych that I'd be open with him about everything, and that if I ever asked for SRS letters and he didn't give it to me I'd just arrange it elsewhere. I think being honest helped me get the help I needed.

Exactly. It is perceived as a power game when they are the ones to say yes, no or not now. Assumed the trans person is shouting 'yes' repeatedly.

[Ltl89]

I agree that you need to trust your therapist wholeheartedly.   My therapist is probably the only person I could ever fully open up to because I knew that she was non judgemental and has a lot of history working with the trans community.  Unfortunately, not all of us can be so lucky to have that as many just label us as crazy.  It's really a tricky subject when so few people are educated on the topic and even many therapists are ignorant regarding the trans community.  And even the most ignorant people already have a strong opinion about us without really fully understanding the issue.  That's why I'm torn.  That and I do believe it's no one else's business what someone does with their life or body as long as they aren't hurtinf anyone.  That being said I still remain very pro therapy, you just need to find one you trust and feel comfortable with.

[AnonyMs]

I agree that you need to trust your therapist wholeheartedly.

My first therapist never knew who I was. I saw her for a year.

My second did, and I stopped going. I'd have gone longer, but he knew who I was.

My 3rd was my psych, and I was a bit desperate, so he knew who I was.

I don't know how I'd have managed if I needed letters from any of these people. I always arranged to get around it before seeing them so I'd feel safe.

Sounds nuts, I know.

[Martine A.]

The WPATH Standards of Care have been updated and there's no requirement for therapy before HRT or SRS. See version 7

Page 28 "Psychotherapy Is Not an Absolute Requirement for Hormone Therapy and Surgery"

Page 33 on the detailed criteria for HRT does not require therapy. It does require "A referral is required from the mental health professional who performed the assessment, unless the assessment was done by a hormone provider who is also qualified in this area.", which is essentially medical informed consent (SOC doesn't call this informed consent and discusses that model as a different thing).

I am afraid this is open for interpretations enough to stall us as much as they presently are. Further in text they explain while psychotherapy is not needed, screening/assessment of mental health is. There we go. Unfortunately, that is how things work here.

[AnonyMs]

I am afraid this is open for interpretations enough to stall us as much as they presently are. Further in text they explain while psychotherapy is not needed, screening/assessment of mental health is. There we go. Unfortunately, that is how things work here.

There's no need to interpretation. No doctor has to follow WPATH, and there's not a lot you can do about it apart from find a different one. On the positive side that means you don't have to follow WPATH yourself (or myself as the case may be), and can do what you want if you can shop around a bit.

I believe the screening/mental is supposed to be informed consent. If you are capable of consent then you can do it and they can't stop you.

I came across this today on another forum. It looks like they are suggesting a more flexible approach for surgery.

New Criteria for Sex Reassignment Surgery: WPATH Standards of Care, Version 7, Revisited
http://www.tandfonline.com/doi/full/10.1080/15532739.2015.1081086

[stephaniec]

thanks for the info

[Devlyn]

I am afraid this is open for interpretations enough to stall us as much as they presently are. Further in text they explain while psychotherapy is not needed, screening/assessment of mental health is. There we go. Unfortunately, that is how things work here.

There's no need to interpretation. No doctor has to follow WPATH, and there's not a lot you can do about it apart from find a different one. On the positive side that means you don't have to follow WPATH yourself (or myself as the case may be), and can do what you want if you can shop around a bit.

I believe the screening/mental is supposed to be informed consent. If you are capable of consent then you can do it and they can't stop you.

I came across this today on another forum. It looks like they are suggesting a more flexible approach for surgery.

New Criteria for Sex Reassignment Surgery: WPATH Standards of Care, Version 7, Revisited
http://www.tandfonline.com/doi/full/10.1080/15532739.2015.1081086

Link doesn't work, the site is down for maintenance. We have version 7 of the SOC right here in the wiki, though.

https://www.susans.org/wiki/Standards_of_Care_for_the_Health_of_Transsexual,_Transgender,_and_Gender_Nonconforming_People

Hugs, Devlyn

[AnonyMs]

Link doesn't work, the site is down for maintenance. We have version 7 of the SOC right here in the wiki, though.

https://www.susans.org/wiki/Standards_of_Care_for_the_Health_of_Transsexual,_Transgender,_and_Gender_Nonconforming_People

Hugs, Devlyn

The site seems to be back.

Its not the SOC but a new paper arguing for changes in the next version

ABSTRACT
The WPATH Standards of Care (SOC) Revision Committee are reassessing criteria for sex reassignment surgery. The major points of discussion for which WPATH might provide additional guidelines are: (1) gender binary defying surgery, (2) gonad retention for fertility preservation prior to hysterectomy in transmen and castration (+ vaginoplasty) in transwomen, (3) the necessity for two referrals from qualified mental health professionals who have independently assessed the patients, prior to performing genital surgery, especially for hysterectomy and salpingo-oophorectomy, (4) the minimum age of 18 as eligibility to undergo irreversible (genital) surgery procedures. We have performed a literature search focussing on these subjects in order to formulate a supported opinion for changing the SOC regarding these topics.

[cheryl reeves]

I believe you should get hrt with informed consent,grs on the other hand I believe in rle,i've known a couple of trans who transitioned without rle and regretted it. To me if you want to be female or male you should start living that role to see if it's what you want and to get comfortable in that role before surgery. I for one like both roles and am comfortable in both modes,since I'm both male and female .