Question?

[JAQUELINE]

Hello girls and guys I have a question to ask. I don't know if anyone can answer but here goes. I have been seeing a gender therapist  for a month and a half. Things are going good, she said I seem very stable and calm. For the most part I am, sure I have dysphoria days but I always pull through it. I have been diagnosed with bipolar with psychotic features(I know, it sucks). Also been in the hospital a few times. gender therapist knows, I had to fill out my medical history on intake day.  She hasn't said anything about it. Would it keep me from getting on hrt? My psychiatrist doesn't get along with my concept of gender identity. Would my gender therapist  eventually talk my psychiatrist before writing my referral letter. If so I will probably never get to transition. Also, my psychiatrist wants me to sign a release format so she can talk to her but I recline to do so. They are different parts of my life and gender identity is none of her damn buisness. Thank for listening  girls and guys any feedback is appreciated.

[LizK]

Hi Jacqueline

Wow that does suck to have all that going on. I am not a Dr or an expert of any kind. I would guess that if you were unwell and having difficulties it could be more difficult...nothing that can't be overcome.

Sounds to me its more between you and your gender therapist and if you are concerned you could ask her if she is planning to speak to your psychiatrist. This may elevate all your fears.

Liz

[Dena]

In writing the letter, the primary point is to decide if you are capable of making your own decisions and that no other condition affect your judgement. The psychiatrist only needs to certify that and nothing else. I don't see a reason why it should prevent you from receiving a letter.

[AnxietyDisord3r]

Well, when I got my letter my psychologist had never spoke to my psychiatrist. Also, my psychiatrist never pressured me to sign any release. Only time I've done so is for them to write letters to my DOT doctors so I can keep my DOT card while on psychiatric medication. When I went on HRT I did disclose to my psychiatrist I was on it.

Psychiatrists in general know even less about trans than psychologists do, and psychologists only get to know about it because we talk about it with them. I've had lots of therapists (not to mention doctors) none of whom knew I was trans unless I told them and then they were surprised.

If you don't have a good trusting relationship with your psychiatrist, maybe time to shop for a new one.

My psychiatrist thinks I have bipolar disorder because of how I responded to SSRIs. I explained that I have ASD and the way I reacted is actually normal, but my "expert" student psychiatrist confidently explained that I don't show any signs of ASD. (My PhD psychologist begs to differ.) The fact that I don't show any signs of bipolar other than an adverse drug reaction is apparently irrelevant. I've stopped caring about this misdiagnosis because it got me on better meds. Whatever works....

[SadieBlake]

If you've had a fraught relationship with your psychiatrist, I can see where that will feel invasive. For me there was no bar at all to getting hrt however I've been in therapy for gender identity (along with depression) for 20 years so my PCP didn't question that. Some docs may require a letter.

That said, your gender therapist is probably going to want to talk to your psychiatrist for any letter of referral - the hurdles for SRS are bigger, I don't know if that's relevant for you. For that to happen, yes you would need to give a release. You and your psychiatrist don't need to agree on definitions for you to receive HRT and as far as I know estrogen and testosterone hrt aren't contraindicated with any drug therapies.

WPATH guides what physicians must do to treat your gd/gid and your psychiatrist is more or less obligated to work towards your best health. If you refuse to allow the consultation I would be concerned you may have to engage in more extensive therapy to proceed with transition, especially if that eventually means GRS.

If I were in your shoes, I'd consider the following .... for GRS you would eventually need 2 letters, one must be from a PhD psychologist (I think an MD psychiatrist also works for that). If your other issues may be eased by HRT then your first doc has no reason to stand in the way. On the other hand I know I've seen a pshrink who had a different view of being female than I did and I think that was partly cis-gender assumptions on the other hand transition wasn't on the table then so it didn't really matter. My present therapist/psychiatrist isn't all that well versed in gender issues and wanted to consult with an expert. What came out of that was she now fully understands my gid and just yesterday has agreed on writing a letter for GRS.

If your psychiatrist really can't be anything but a roadblock then you may ultimately need to see a 3rd shrink. Meanwhile I'd  say talk openly with both of them and see if you can get comfortable with the release.

I know that's  vague, perhaps you can elaborate more on your difference with psychiatrist on gd?

Seeing the post made while I was writing, on the one hand I agree that psychiatrists sometimes know less than psychologists, happily mine while not specifically experienced has learned quickly and personally I love that as an MD  she understands when I talk about biochemistry and that's  been a great support as we've been able to get me past crippling depression.