Informed consent - what does it mean to you?

[JoanneB]

To me "Informed Consent" leaves a gatekeeping psyc eval out of the equation. It is simply the MD "Informing" you of all the effects of HRT, both physically and perhaps psycho-social things like "How will your spouse feel" or "How would work be if you had a pair of bouncy girls?". As with any medical treatment side effects are a given, even if they may be desired. And of course, any CYA medical/physiological testing like a blood workup, family history etc..

Now, in this litigious day and age I can see docs wanting, better yet needing, a CYA letter, just in case. This I can understand the medical community saying/recommending a CYA letter. At the very least to make doctors think before simply prescribing HRT.

At the end of the day just why should HRT be any different from any other not really medically necessary drugs like ED medications, hair loss, botox injections? Same goes for the disparity for what would otherwise be typical cosmetic surgeries.

[AnonyMs]

Very interesting, I had never heard of the 60-70% statistic of those of us who are not in need of mental health interventions. I'm one of those 70% and I firmly believe that being transgender does not require therapy - it's society that needs therapy so that they can realize we are fully functioning wonderful human beings.

But I can also see it from a doctor's perspective who has to weigh the fact that HRT may lead to infertility among other health risks. However, every drug known to man has side effects and prescribing any medication always carries some sort of risk. So, no, I don't think evaluation by a mental health professional should be required for informed consent. Your doctor should tell you x, y and z are the possible side effects of gender affirming hormones as an FYI.

I think the issue is that some fraction of that 30% would be harmed if they just got what they asked for. Perhaps they are not mentally capable of making an informed decision. Or possibly they are OCD rather than trans and don't know it. How is a non-psych meant to diagnose that?

So do we sacrifice those people for the sake of the rest of us? We do already in so many other aspects of life, so perhaps society thinks its ok, but at least we should understand the trade-off that we're making.

I don't think the current system came from that basis though. It evolved from thinking we're all crazy, and is gradually becoming more in line with us being normal responsible members of the community.

[Emileeeee]

I feel like it should mean, "Here sign this. Okay here's your script." It didn't turn out that way for me though. I had to do a 1 hour psych eval, then I got the script after signing the form. It wasn't too bad though. They weren't trying to diagnose me during that. They just wanted to know that I knew what I was getting into and that I knew the risks for the hormones. It wasn't gatekeeping. It was kind of like just a formality.

[melissa_h]

The first place I had looked at was closer to me than the clinic in Chicago... But seemed intentionally expensive and judgy

http://www.pathwayscounseling.com/transgenderprogram.html

I think that's part of my objection to additional required evaluation... If you're trans and sure about it, why require 3 psych sessions?   


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[AnxietyDisord3r]

The first place I had looked at was closer to me than the clinic in Chicago... But seemed intentionally expensive and judgy

http://www.pathwayscounseling.com/transgenderprogram.html

I think that's part of my objection to additional required evaluation... If you're trans and sure about it, why require 3 psych sessions?   

So, I can relate to this. I avoided treatment through above board channels back in the early 2000s because I did not want to deal with another old school Neo-Freudian therapist who was going to tell me I was gay/trans because of family issues (trust me, I had plenty of family issues), have to pay out of pocket and feel bad. I wanted treatment no questions asked but I don't think that existed in Boston at that time. In fact, I've seen where other trans people ran into serious gatekeeping in the mid 2000s. I was terrified to mess around in the black market so I didn't do that either.

I knew, but I was still questioning, because if you weren't hyper-feminine/hyper-masculine, and couldn't parrot the standard rubbish at the time, you might not "really" be trans. I knew a number of people who were non binary and got top surgery and not hormones, so I fixated on getting top surgery to kind of ease the discomfort.

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[luna nyan]

Ah-ha – well forgive me but I'm going to use this to practice one of my model answers for my forthcoming exams, as this question is indeed one which has come up in medical finals before.

Informed consent is not equivalent to treatment on demand.

It means that a patient has consented to a procedure having been given a proper level of understanding of the relative risks and benefits of the procedure, the precise process involved, and has been appraised of any commonly available alternative approaches.

It does NOT mean that a patient is assuming all of the risk, it just means that the patient has been fully informed of all the possible options and then properly allowed to express their own preference, which has been taken fully into account.

As a patient it gives you the right to request or refuse a specific approach, but it does not mean that the clinician is the obliged or indeed cleared to follow that if they do not agree that the treatment has a reasonable chance of benefit.

Take 5 points for Gryffindor.

Just note that the level of understanding risks needs to be to the patient's satisfaction.  So in some cases, a downright technical explanation, including obscure complications will be required should the patient need them.

So the issue here on this thread seems twofold to me:
1.  Healthcare worker definition of informed consent - arises after a diagnosis and treatment option are presented to the patient and the patient agrees to treatment after being informed of risks/benefits to said options.
2.  Layman definition for transgender individuals is - I think I'm on the trans spectrum, and lemme at the meds already.

Medico-legally, as it stands, for the health care professional, 1, is the only one that will stand up in court.  The issue is that it can be a lengthy and difficult to arrive at a diagnosis going through the traditional channel.

So is the issue more a case of improving access and speed to get to the diagnosis?  Gatekeeping sucks, but if done correctly will protect all parties.

[freebrady2015]

So the issue here on this thread seems twofold to me:
1.  Healthcare worker definition of informed consent - arises after a diagnosis and treatment option are presented to the patient and the patient agrees to treatment after being informed of risks/benefits to said options.
2.  Layman definition for transgender individuals is - I think I'm on the trans spectrum, and lemme at the meds already.

Medico-legally, as it stands, for the health care professional, 1, is the only one that will stand up in court.  The issue is that it can be a lengthy and difficult to arrive at a diagnosis going through the traditional channel.

So is the issue more a case of improving access and speed to get to the diagnosis?  Gatekeeping sucks, but if done correctly will protect all parties.

Thanks for this clarification. And yes, I do think the major huge issues are improving access and speeding up the process. I don't think it should ever take someone more than two months from their first doctor visit to being treated. I disagree with those who think therapist letters should be required for getting a prescription for hormones, just for the simple fact that there is no therapy needed for being transgender. Depression, anxiety etc can arise from being trans but those are separate diagnoses.

[AnxietyDisord3r]

Thanks for this clarification. And yes, I do think the major huge issues are improving access and speeding up the process. I don't think it should ever take someone more than two months from their first doctor visit to being treated. I disagree with those who think therapist letters should be required for getting a prescription for hormones, just for the simple fact that there is no therapy needed for being transgender. Depression, anxiety etc can arise from being trans but those are separate diagnoses.

I think it's fairer to say that there is no psychotherapy that can cure, alter, or resolve gender variation, but therapy can aid in the patient's ability to cope.

Just like some people go to therapy during a divorce, not necessarily for depression or anxiety (which can occur) but because their whole life and identity have just been upended and they need to sort that out. Some people prefer to go to religious councilors for issues like this, others talk to therapists.

Trans people often go through periods of struggling with identity, as well as face family issues related to their coming out. They may also have difficulty coping with society. So a lot of trans people do need psychotherapy services at some point in their lives related to their condition and there shouldn't be any shame in accessing such services.

[freebrady2015]

I think it's fairer to say that there is no psychotherapy that can cure, alter, or resolve gender variation, but therapy can aid in the patient's ability to cope.

Trans people often go through periods of struggling with identity, as well as face family issues related to their coming out. They may also have difficulty coping with society. So a lot of trans people do need psychotherapy services at some point in their lives related to their condition and there shouldn't be any shame in accessing such services.

Didn't mean to imply that therapy isn't helpful or that there is any shame in seeking it. I just wanted to point out specifically that being trans in and of itself isn't a mental health problem. I've gone to and am going to a gender educated therapist and it's very helpful and healthy. But a lot of times I wonder if in an alternate society and culture this would be completely silly to need to talk to a professional about your gender identity. Just my own thoughts..