Why 1 year wait for SRS

[Laura_7]

Honestly a lot of the answers, deception of RLE and palpable anger in this topic scare me. We all have to play by the rules. They are set by WPATH and adopted by most countries. You don't have to agree with them, but they will remain anyway. Channel that anger somewhere constructive.

Its not rules its guidelines.
There are some local regulations stateside in thailand, which only apply to foreigners.

There were young people who were severely dysphoric ... with all consequences.
Imagne the headlines if they had no way out.
They were accomodated.

Some guidelines may make sense but imo always remember its about people.
With the onset of the internet people have information and can compare.
So they can see where there are rules deemed necessary and where not.
People usually have an evaluation by one or two psychologists.
Is there more needed ?
People can discuss if it is ... or not.


*hugs*

[suzifrommd]

Honestly a lot of the answers, deception of RLE and palpable anger in this topic scare me. We all have to play by the rules. They are set by WPATH and adopted by most countries. You don't have to agree with them, but they will remain anyway. Channel that anger somewhere constructive.

No. We don't have to play by the rules. We can have the rules changed. They were made by cisgender people who do not believe trans people have the decision making skills to figure out for themselves how long we should wait before SRS.

Personally, I believe that channeling my anger toward people who insist on imposing their will on me and trying to end the oppression IS constructive.

[stephaniec]

I know I'm in the minority on this subject , but for me personally it's good to wait a year. when I finally put everything together where the opportunity was there for me to do it I thought of things I never thought about. I realized in my particular case I needed a lot more planning than the instantaneous fulfilling of the need. Given my age I'm still in the strategy stage , but I realized there's a lot to process. I know my circumstances are somewhat different , but I have to consider my age , my physical disability , how I'm going to be able to care for myself until I heal enough because I'm alone. There are just a whole boat load of things I never considered through all those years of wanting it. To me a year is quite short and gives you enough time to plan and prepare for a smooth healing process. Also 1 year compared to the rest of your life is quite reasonable. This is just my own opinion which would seem to me reasonable for all that's involved in an operation that has a major impact on ones life.

[Jenna Marie]

Stephanie : You're actually a great example, because you *choose* to wait. The thing is, anybody could choose that. The issue is having it forced on us. (I'm sure you'd be unhappy if the rules said you had to wait 10 years, or 15...) I think you're smart, and you're right to make sure you're ready emotionally and prepared for the aftercare.

[melissa_h]

I know I'm in the minority on this subject , but for me personally it's good to wait a year.

Honestly, I think its likely somewhat rare that everyone has their life in a perfect enough order to jump right in and make every single change within a 3 month timeframe.

That being said though, I think it should be up to the patient to determine their priorities, and for the doctor to help make those priorities as safe as possible to accomplish.  I like that you used the phrase "for me personally", to me, that's what this very individual journey is all about.

FFS can be just as impactful on a person as SRS .... but doesn't seem to have anywhere near the same restrictions.  That's odd to me, but not surprising given there's likely a slightly different code of conduct for plastic surgeons vs internal medicine.

If someone is on HRT for a year before coming out, and then decide they want SRS .... forcing 1 year of RLE seems excessive.  Finding practicioners who treat guidelines as guidelines is important.

And yes, the idea of being evaluated by multiple people to get "letters", proof, validation, permission. is a fairly harsh thing for people to go through and adds cost to an equation that doesn't really need to be there for everyone.

[KayXo]

I had SRS back in 2005 and spent very little time living as a woman in society because I didn't feel comfortable being a woman with a penis. I told my psych I would have a much easier time living if I had a vagina and so, she wrote me a letter, followed by another one written by a psychiatrist who was shocked at how womanly my arms were LOL (passing well sometimes helps to get you a letter more quickly). It was that easy, spent barely any time living as a woman pre-op and had my SRS. No regrets whatsoever.

[Devlyn]

From Wikipedia. Bolding is mine. 

"The Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People are non-binding protocols outlining the usual treatment for individuals who wish to undergo hormonal orsurgical transition to the other sex. Clinicians' decisions regarding patients' treatment are often influenced by this standard of care (SOC).

Prior to the advent of the first SOCs, there was no semblance of consensus on psychiatric, psychological, medical, and surgical requirements or procedures. Before the 1960s, few countries offered safe, legal medical options and many criminalized cross-gender behaviors or mandated unproven psychiatric treatments. In response to this problem, the Harry Benjamin International Gender Dysphoria Association (now known as the World Professional Association for Transgender Health) authored one of the earliest sets of clinical guidelines for the express purpose of ensuring "lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfillment." These standards are still the most well-known; however, other sets of SOCs, protocols and guidelines do exist, especially outside the USA."


The WPATH is a self appointed group acting on behalf of the medical profession. ICATH ia also a self appointed group, they act on behalf of the patient. I know which approach I prefer.

Hugs, Devlyn

[AnonyMs]

FFS can be just as impactful on a person as SRS .... but doesn't seem to have anywhere near the same restrictions.  That's odd to me, but not surprising given there's likely a slightly different code of conduct for plastic surgeons vs internal medicine.

For me, FFS would have a massive and possibly devastating impact on my life, while SRS would have none (apart from in my head).

I don't understand why people regard SRS as having such an impact. You're trans, its not like its a big deal. You don't walk around naked, so its not like anyone can see. I think its just some kind of social taboo where there can be no rational thought.

[April_TO]

I'm a bit confused with our discussion. I don't think the OP was told that she can't have the surgery and has to do a year RLE. The wait is based on her province wait list for GCS since it is a first come first served basis. However, everyone can go anywhere and get all the necessary surgery even if you just realized you were transexual yesterday. You will just be required to pay.

Unfortunately, in Ontario where I live I have to wait almost 2 years due to a long wait list of patients trying to go for socially funded GCS. It's just how the system works when you are using socialized health care.

[KayXo]

I don't think the OP was told that she can't have the surgery and has to do a year RLE.

That was my understanding if she wants the op to be covered and this has nothing to do with wait list but instead has all to do with the 1 yr rule.

[melissa_h]

Why 1 year ?

Was the original question.

I think the true answer is that covered, "elective" procedures are generally given a lower priority on staffing in a socialized setting. 

That being said, some may invoke the one year concept as a "best practice" as a defense against offering the service more quickly.  Not sure if it was actually confirmed that the 1 year concept was the reason for the delay.

[Paige]

I'm a bit confused with our discussion. I don't think the OP was told that she can't have the surgery and has to do a year RLE. The wait is based on her province wait list for GCS since it is a first come first served basis. However, everyone can go anywhere and get all the necessary surgery even if you just realized you were transexual yesterday. You will just be required to pay.

Unfortunately, in Ontario where I live I have to wait almost 2 years due to a long wait list of patients trying to go for socially funded GCS. It's just how the system works when you are using socialized health care.

Hi April_TO,

I live in Ontario as well.  The province came out last fall I think and said they would open the funding approval process up to more clinics than just CAMH.  I know Sherborne Health Clinic was talking about it.   Have you heard if any of these other approval sites are up and running yet.

Thanks,
Paige

[Rejennyrated]

But you won't be qualified to make that decision since you're not a psych, and you also get to pass off legal responsibility on to that psych.

I'm curious your thoughts on non-binary people who want SRS?

It is actually becomming increasingly likely that I will be training in psych so while your argument holds true for about three years it will eventually likely become an incorrect assumption.

As for non binary people I don't see a problem. I don't call myself non binary because I just don't feel the need to analyse my identity to that extent. However others might easily assume that I was NB bcause I'm definitely a mixture of masculine and feminine traits, and I don't care a jot about "gender", the ONLY thing I ever cared about was that I wanted the physical bits to be female.

So I dont see any issue - to me its obvious that the only thing that matters in respect of SRS is what sex you percieved yourself to be physically and as far as that is concerned the RLE IS and always should be about presenting as that PHYSICAL sex - NOT about some airy fairy notions of "gender".

I know of lots of people who have successfully done their MTF RLE in the UK while always wearing tousers and "going drinking with the boys" - the only thing they did differently in that time was to physically feminise their bodily appearance - and none of them ever had an issue with the psychiatrists involved...

I think the problem may be that there are maybe still antiquated psychiatrists and therapists out there who are still insisting on the old fashioned "if you want to be a women you must always wear makeup skirts and take up flower arranging" concept of RLE which, in the circle that I move in, frankly went out with the Ark! I certainly never did any such thing and that was over 30 years ago... nor would I ever expect others to be asked to do so.

In short perhaps the problem is that we have a totally different conceptualisation of what an RLE involves.

[April_TO]

Hi Paige,

I just had my assessment yesterday by my clinical therapist which will then be used as a secondary recommendation for GCS along with my primary health provider. She said it will then be submitted to OHIP for approval and recommendation for GCS which will take a few months. Followed by Brassards wait list lol.

The only improvement in the new process is that you can get evaluated faster. But the wait list isn't going to change and I am willing to wait patiently

Ask your gender therapist now for an assessment and your MD as well to get it started. You must be aware of it's risk and share why it is important for you. Basic questions that I know you can handle.

Hope this helps.

April

Hi April_TO,

I live in Ontario as well.  The province came out last fall I think and said they would open the funding approval process up to more clinics than just CAMH.  I know Sherborne Health Clinic was talking about it.   Have you heard if any of these other approval sites are up and running yet.

Thanks,
Paige

[Riley Skye]

It's been a year since I got my surgery and the year wait is definitely needed. It gives you much needed time to live and adjust to being a woman, it gives time to build the much needed support system for recovery. I personally don't think one should consider surgery until they're comfortable living as a woman because it is so intense, most intense thing many of us will ever do. With all that said it is absolutely amazing to have gone through it and I am so grateful that I was given the opportunity to have it

[Paige]

Hope this helps.
April

It did.  Thanks for the reply.
Paige

[AnonyMs]

It is actually becomming increasingly likely that I will be training in psych so while your argument holds true for about three years it will eventually likely become an incorrect assumption.

As for non binary people I don't see a problem. I don't call myself non binary because I just don't feel the need to analyse my identity to that extent. However others might easily assume that I was NB bcause I'm definitely a mixture of masculine and feminine traits, and I don't care a jot about "gender", the ONLY thing I ever cared about was that I wanted the physical bits to be female.

So I dont see any issue - to me its obvious that the only thing that matters in respect of SRS is what sex you percieved yourself to be physically and as far as that is concerned the RLE IS and always should be about presenting as that PHYSICAL sex - NOT about some airy fairy notions of "gender".

I know of lots of people who have successfully done their MTF RLE in the UK while always wearing tousers and "going drinking with the boys" - the only thing they did differently in that time was to physically feminise their bodily appearance - and none of them ever had an issue with the psychiatrists involved...

I think the problem may be that there are maybe still antiquated psychiatrists and therapists out there who are still insisting on the old fashioned "if you want to be a women you must always wear makeup skirts and take up flower arranging" concept of RLE which, in the circle that I move in, frankly went out with the Ark! I certainly never did any such thing and that was over 30 years ago... nor would I ever expect others to be asked to do so.

In short perhaps the problem is that we have a totally different conceptualisation of what an RLE involves.

I can't say I agree with your first post, but I definitely do with this one. In comparison the first one feels almost like your arguing a point without necessarily believing it. I expect I'm wrong and I don't understand you very well (I've read a lot of your other posts, but somehow never felt the need to say anything before).

Are you going to work with trans people? I'm sure you can make an enormous difference if you do.

Was this bit "we have a totally different conceptualisation of what an RLE involves" referring to me or "antiquated psychiatrists" in the previous paragraph? (its definitely not me).

I'm curious now what you think of my case. Just curious, it has no bearing on how I think or what I'll do. I want SRS but I don't want to socially transition before or afterwards - ie no RLE. Yet I am binary, and RLE would from a certain point of view mean presenting female. On the other hand I intend to live as male, so RLE would be doing that instead.

Assume for the sake of argument that I'm fully informed and sane. At this point in my life I've decided social transition is a last resort, and I'd only do it to avoid depression and/or suicide. Its not an ideal choice, more like the lesser of two evils.  So I decided that if I get to the point where I can't deal with it any more, where I have to do something, then I'll have SRS because, well, why not. It might work, at least for a while.

I seem to be in a tiny minority, and I can't understand why. It seems a very logical approach to the problem, at least when you're older.

I'm in favor of informed consent for SRS, using the medical meaning of it.

[KayXo]

As AnonyMs's post shows, the rules may sometimes be too rigid. Some may be perfectly fine with SRS without the need for social transitioning. Have the authorities accounted for the various type of people within the transgender community? Not quite. Rather, they see it one way and one way only (my way or the highway!). Black and white, no gray. This is wrong. But, people like you, AnonyMs, must share this with the authorities so they become more aware. I've come across others like you before whose goals are the same and some have had to follow the less travelled route to get to their goal. No regrets so far but who knows?!

[warlockmaker]

Thus topic together with the preference for surgeons seems to bring on the  very biased views we have and so much anger.

I can honestly say that those that have gone thru RLE ...for whatever the reason ..old rules, finances etc feel that this is what everyone has to go thru...' I have paid my dues and you all have to'.. ' i know its the best thing for you' then there is the other camp that feels it's a bunch of baloney and that we have the right to make our choices in life.

We already have to get 2 letters from therapists and that in itself is sufficient....no other surgeries submit individuals to such indignities.

[stephaniec]

please I emphasize the fact that this is just my opinion and I have absolutely no control in the enactment or enforcement  of the rules, but I've been on this forum for 3 years and heard all the arguments for and against. I really can't understand why planning and making sure this decision is what is going to help you is such a bad idea, Again I mean no harm or controversy and this is totally my own personal opinion which has absolutely no bearing on anyone else. As an extreme example a person under only informed consent can walk into the hospital and set up a surgery date and within a week go under the knife and have their genitals rearranged.