Therapist Visit for HRT

[Lexxi]

Hello all,

I have a few questions that can only be answered for me here. I've been looking into what all I'll have to do to start HRT. It appears that my state requires patients to go to a therapist to get their approval first before they can start HRT. The thing I don't know though is do I have to go to my regular doctor first to get a referral to a therapist, or do I just find my own therapist and go there first? I'm not exactly sure how that works.

On a side note, if I have to go to my regular doctor first that's kind of scary for me. He's the very best doctor on the planet and I've been going to him for 30 years. However I know that he's pretty religious and I HATE the thought of losing him as my doctor if he's not open to trans people. In my honest opinion I don't think it would bother him, after all, he is a man of science. But the thought of taking that chance is causing me some concern.

I've learned that some therapists refuse to recommend HRT if the patient isn't living as a female full-time. I haven't come out to anyone yet but you lovely ladies here at Susan's so far, and I don't think I'm ready to come out publicly yet. (In fact I know I'm not because I have to protect my daughter for the time being.) Do any of you know if living the full-time female requirement is true? If it is, what are my best options?

Should I just take the leap and go into the therapist's office dressed as a woman even though that would be extremely uncomfortable for me right now? Or should I search for therapists who don't require that step? Or is that requirement part of the law? I just don't know.

This is all pretty confusing for me. Supposedly most states are getting away from discriminating against those in the LBGTQ community, but having that requirement is discrimination in my book. To top all that off, I live in the state of Indiana and I'm sure you've heard how anti-LBGTQ the government is in this state. There are two other states I can get to with a fairly short drive, so I don't know if maybe I should try one of them first. Sadly both of those states are very conservative too, so it might not be any better in one of them either. Then there's the fact that if I go to another state I'd be pretty far away from my doctor.

Anyway any help you all can give me would be greatly appreciated!!

Lexxi

[Lexxi]

Has anyone had the chance to give this post some thought? I don't have anyone in my realm that would have any idea. Plus I'm not out to them yet anyway.

Any advice would be greatly appreciated,

Lexxi

[Dani]

The Real Life Experience is not a requirement for hormones. It is sometimes not even a requirement for surgery. There are some surgeons who will operate in some circumstances. It is a good idea to have some RLE, especially if you intend to dress uber-feminine after surgery.

For myself and many others, we still live a more or less androgynous life. The comfort of T-shirts and shorts is primary for me.

When you see your therapist, just be yourself, dress comfortably in whatever you want. A therapist in more concerned about what is in your head, not your wardrobe.

[Allie Jayne]

The process seems to depend on where you are and the services available. Some places don't require a therapist visit at all, only an informed consent from the patient. I think it is wise to talk to a therapist as there can be so many different things to consider. My psychologist required me to convince her that I was trans and was aware of what I was. It should not make a difference how you present, but it is important to be comfortable to express yourself fully.

My psyche started off by telling me it usually takes three 55 minute sessions (@$200/session) to make a diagnosis, and asked me to tell her my story. At 40 minutes she stopped me and said she was convinced she was talking to a woman, and I should have transitioned many years ago. She asked me some control questions to satisfy standards and wrote me a referral to an Endocrinologist. I did have to get a referral from my GP so I could claim the cost of Psychology (I'm in Australia), but I found a new (female) GP as I wasn't comfortable coming out to my regular male GP.

Since then I've had to come out to doctors, receptionists, pharmacists, and I'm pretty sure the pathologist knows why I am having my oestrogen levels checked regularly.

Check your local requirements and services (my GP did not have a clue as I was the first TG patient she has had) and get the ball rolling!

Allie

[Cindy]

Your questions really need to be addressed according to what country and maybe where in that country you are. In Australia the process is basically very straight forward nowadays with informed consent pretty well basic for most clients. In the USA it varies from State to State, in Europe it varies from country to country and in the UK it just seems a long slog that works well but it is a very long slog if you can't go private. In Asia it appears not generally well medically supported.

If you are young it is (obviously) more difficult. If you have any mental health issues it is more difficult.

I - just personally - would recommend help from a well qualified and experienced gender therapist and preferably a medically qualified psychologist or psychiatrist. That opinion is based on personal experience and from many of us carrying PTSD issues from trying to live our difficult lives. YMMV.

[Lexxi]

Hi Dani,

I will be joining the ranks of the T-shirts and shorts class. I only wish I could dress uber-feminine. Unfortunately I'm an overweight giant and that just wouldn't look good. Even if after I lose all my unwanted weight, which I'm working on now, that won't do anything for my 6'4" frame. Maybe some day science will figure out a way to give me the skinny 5'4" body I'd like to have. Sadly I'm afraid I'd be too old to enjoy it by then. Ha ha ha...

Thank you for telling me about the best way to handle the therapist!! I figured it would be better to just be myself, so I couldn't understand why they'd require me to step outside my comfort zone right out of the gate.

Lexxi

[Lexxi]

Hi Allie,

Unfortunately I'm in the U.S. and my state requires a note or diagnosis from a therapist. Which I really don't mind going to see, so that won't bother me. I had just read somewhere that nearly all therapists require their trans patients to be "living the life" before they would give the recommendation for HRT. I've been researching therapists that specialize in gender identity. Sadly there aren't any I can find in my general vicinity. Or I should say if there are I'm having trouble finding them. I think the closest one I found was a 2 hour drive away. But hey I'll drive there if that's what it takes.

Thank you so much for your advice!! I'll be continuing my search today. Hopefully I'll get lucky.

Lexxi

[Cindy]

Try looking for a provider through WPATH

https://www.wpath.org/provider/search

At least they should know what they are doing.

[Lexxi]

Hi Cindy,

Thank you for the advice. I don't think I have any type of PTSD because I've kept my true self hidden for my entire life. But she's screaming to come out and I'm going to let her. I suppose I have had some mild depression though because I've never felt like I could be myself. Hopefully the therapist will see the need for me to start HRT.

You mentioned age but I think I'm fine there as I just turned 50 a couple of months ago. I can't wait to get this process started. I feel like I've waited entirely too long to do this.

Thanks again,

Lexxi

[Lexxi]

WOW Cindy,

Thank you for that link. Apparently the reason I was having trouble finding a therapist was because there's only one in a hundred mile radius. She treats all kinds of people, but she specializes in life transitions. Her webpage says she's transgendered allied. She sounds exactly like the kind of therapist I'm looking for.

Unfortunately she's running a 2 month long waiting list right now, so that's gonna put me a little behind where I want to be. But hey I'll do whatever I have to do to get started. I just sent her an email to get the ball rolling.

Thank you so much for sending that link!!

Lexxi

[steph2.0]

Hi Allie,

Unfortunately I'm in the U.S. and my state requires a note or diagnosis from a therapist. Which I really don't mind going to see, so that won't bother me. I had just read somewhere that nearly all therapists require their trans patients to be "living the life" before they would give the recommendation for HRT. I've been researching therapists that specialize in gender identity. Sadly there aren't any I can find in my general vicinity. Or I should say if there are I'm having trouble finding them. I think the closest one I found was a 2 hour drive away. But hey I'll drive there if that's what it takes.

Thank you so much for your advice!! I'll be continuing my search today. Hopefully I'll get lucky.

Lexxi

Lexxi,

I'd read that RLE (Real Life Experience) is a requirement in places like the UK (please correct me if I'm wrong) but that wasn't the case for me here in Florida. I did show up at my first therapist session wearing all women's clothing, but very androgynous. Just women's jeans and a white button down women's shirt. Not even a bra at that point. I had also read that it would take at least three sessions before I would be prescribed HRT (if at all, depending on the therapist's diagnosis), but as with Allie, by the end of the first session I had an appointment with an endocrinologist. Apparently I was quite convincing.

I agree with Cindy that you really need to seek out a therapist experienced with gender issues. You do not want to be the first trans person a therapist works with, not just for the sake of an informed diagnosis, but also for any future insurance requests. If you can find one who has a PhD in psychiatry or psychology, that will also smooth the way in the future. I'll be writing about that on my own thread...

Good luck, girl.


Stephanie

[KathyLauren]

In most places, you do not need a doctor's referral to see a therapist.  I chose to get a referral from my doctor because our insurance would pay if I was referred, but not if I self-referred.  When my original therapist retired and I needed another one for my GRS letters, I self-referred.

Most therapists and endos will follow WPATH guidelines.  Those suggest that you should see a therapist to ensure that you have a good understanding of what HRT will do to you, and to ensure that there are no mental health issues that would cloud your judgement. 

There is no requirement in the guidelines for RLE before HRT.  That requirement used to exist, and still may in some countries, but it is not supported by the WPATH guidelines.  Anyone who still has that requirement would be considered unprofessional.

As for what to wear to your first appointment, just wear whatever makes you comfortable.  I went to my first one in jeans and a women's T-shirt, with silver ear studs.  Basically in guy mode, but femmed-up a bit.  By the last one, I was in full girl mode, with a skirt and top.

[steph2.0]

Unfortunately she's running a 2 month long waiting list right now, so that's gonna put me a little behind where I want to be. But hey I'll do whatever I have to do to get started. I just sent her an email to get the ball rolling.

Unfortunately, this is something we all have to have to get used to. Two months is lightning speed compared to some places. In the UK and Canada it can take as much as two years to get an appointment, and surgeons like Marci Bowers have a four year waiting list. Nothing happens fast in transition. I hope you have the patience gene.

Keep a good attitude and keep chipping away at it. It does happen! I started my journey almost exactly two years ago, and by the end of this year I will consider myself done. I've been told I'm moving incredibly fast, but it feels like for-ever to me.


Stephanie

[Lexxi]

Hi Steph,

Thank you for the information! I just looked up the therapist that WPATH recommended. Apparently she's the only one near my vicinity. Her website says she specializes in Life Transitions, which I would think that Transgender issues would certainly qualify. She's Transgender Allied too.

Her website also says she's been a member of WPATH since 2017. Oh and she's a Psychological Associate, MA, LPA. Sadly she must not have her PhD though. But it looks like she specializes in Trans patients so I feel comfortable giving her a try. It makes me feel confident that WPATH recommends her.

I didn't know Trans issues had such long wait times. I'm glad to know though that 2 months is lightening fast. That makes me feel better after worrying about a 2 month long wait. lol

It's good to know that you're almost done with everything. That must make you giddy!!

Thank you again for the help and advice. I'm forever in your debt.

Lexxi

[Allie Jayne]

Interesting to note that a couple of the posters went to their first therapy session wearing women's clothing but presenting as male. I have to admit that I did the same! It must be a common thought that we have to convince the therapist we are trans, and need something external as evidence. My sessions since have been straight after work, so I was in my work clothes.

Allie

[Lexxi]

Hi Kathy,

Thank you for the advice and the suggestions. I think just to be on the safe side I'll get myself a new pair of jeans and a new blouse too. Oh and I'm going to be sporting a new earring also, because I'm going to go get my right one pierced in the next day or two. I already have the left one done. Now I'll be matching.

I'm also going to take your advice about getting that referral. I already know my GP will give me one because he's the very best doctor in the whole world. I've never told him about what I've been hiding and I'm kind of scared to. But it's going to have to be done eventually, so I'll call him and let the chips fall where they may.

Once again thank you for the advice,

Lexxi

[Lexxi]

Allie maybe the heard the same thing that I did. I think every article I found said that if you weren't presenting as female they would refuse your request for the letter. I'm glad that that appears to be false though. I wonder if some anti-trans group put that misinformation out there to scare people. Or I suppose they could have been older articles. I really don't recall looking at the dates they were published.

[Lexxi]

Well ladies I have to say that I feel much better. With your help, advice and guidance I feel like I can get this done. And according to Steph it's going to be lightening fast too, which I really like. I knew you all wouldn't let me down. 

Lexxi

[LordKAT]

There used to be , and maybe still are, some reputable online therapists. I'm not sure how to find them but maybe someone else knows.

[steph2.0]

Hi Steph,

Thank you for the information! I just looked up the therapist that WPATH recommended. Apparently she's the only one near my vicinity. Her website says she specializes in Life Transitions, which I would think that Transgender issues would certainly qualify. She's Transgender Allied too.

Her website also says she's been a member of WPATH since 2017. Oh and she's a Psychological Associate, MA, LPA. Sadly she must not have her PhD though. But it looks like she specializes in Trans patients so I feel comfortable giving her a try. It makes me feel confident that WPATH recommends her.

I didn't know Trans issues had such long wait times. I'm glad to know though that 2 months is lightening fast. That makes me feel better after worrying about a 2 month long wait. lol

It's good to know that you're almost done with everything. That must make you giddy!!

Thank you again for the help and advice. I'm forever in your debt.

Lexxi

The PhD requirement comes in if you decide some day that you want GCS. Who requires what varies all over the map, but my insurance company requires two letters from therapists, and at least one of them has to have a doctorate. For various reasons, I've worked with four different therapists over the years, and in the end I had to find another who had that special designation before I could move forward.

Giddy? I still fight fear and doubt issues, but that's just my inherent personality asserting itself. A lifetime of pessimism, living in the wrong shell, is a hard habit to overcome. Logically, I know that I've been lucky with the way transition is going, but emotionally I still live in fear of being misgendered, despite it not happening for about a year. I've been belittled by those who are adamant that it shouldn't matter to me, but it does, very much. Despite all that, by the end of this year (fingers crossed) I will have finished all the name and gender change paperwork, had two rounds of FFS, and will have had GCS. "Giddy" might describe how I'll feel then. Right now I only feel nervous anticipation.

As for being in my debt, I'll PM you with my address so you can send the check. [emoji16]


Stephanie