Ways to improve the way Trans. people access medical procedures.

[Sarah]

So here's what I think.

Getting HRT meds and later even surgery should not depend on a Psychologist or Psyciatrist.

My idea:

It should be a certification.

One that anyone could go throught the training to give.

A person who is Trans. could go to thier local PRIDE center and speak to one of the people there who had been certified and trained to give such certification.

They would go through an interview, ask questions, and the certifier would give them what would have formerly been a diagnosis, now a certification.

One could take this certification to thier doctor, who could then use that as a means for prescribing HRT. The Doctors also should be trained in being able to certify.

If one had been on hrt for at least a year and there were no detectable health problems as a result, the doctor should be able to refer for surgery.


That would be my solution.

That way a Psychologist could be trained to give such certification if they wished, but they would not be the only ones. Anybody should be able to give the certification if they went through the proper training for it. Including ones actual doctor.

The Hary Benjamin Whatever stuff should be completely scraped and replaced with a more modern system.

My thoughts.

Sara

Any ideas?

[lady amarant]

My gut-reaction is to agree with you, being an anarchist to my core. I should be free to make my own decisions in life, as long as I accept the responsibility that comes with those decisions. Transition should not even be contingent on a certification, as you propose. I might be making a terrible mistake in transitioning, but it is my mistake to make. I'll sign any waiver to that effect.

I would rather set it up in such a way that health services make a voluntary period of counselling available, not necessarily psychological, but just a forum in which to deal with issues stemming from one's GID. Attendance of this counselling would not in any way affect one's access to treatment, though some doctors might of course decide to require certain minimums (their right to choose under which conditions they will treat a person)

[Sarah]

I agree.
Someone should be able to see a psychologist if they want to
but they should not be required to in order to recieve help from thier professional doctor.

[Patroklos]

There are a number of reasons why I believe that psychiatric evaluation and treatment should be mandatory for transgendered individuals seeking HRT and various forms of "corrective" surgery.

1. Most people who are transgendered experience a large amount of stress, doubt, confusion, denial, depression, and anxiety about their Gender Identity. Talking to a qualified professional (more often than not, in my experience) helps a person to sort out his feelings, more objectively evaluate problems and solutions, and provides support that may not otherwise be available.
2. There are not many but there are those who "fake it" for a myriad of reasons. Some are disillusioned or depressed teenagers who don't know any better. Others are criminals. Many are psychologically unstable.
3. Many of the effects of HRT and most of the effects of surgery are permanent. A person who plans to undergo those types of processes should be fully aware of the permanence, risks, side-effects and make sure that he knows what he's getting into.
4. There are transsexual individuals who completed the whole process and still regretted it, wishing they could undo the effects of surgery and HRT.

If I think of any others, I'll list them later.

[Kate]

I think we're pretty much stuck with what we have, although I'd love to see it standardized a bit more - and draw a clearer line between diagnosis and (optional) psychotherapy.

Doctors can't ethically prescribe hormones unless there's a medical necessity, and surgeons can't ethically perform non-cosmetic surgery unless there's a medical reason to do so. Both require a diagnosis from a medical professional. Waivers or certifications aren't enough... the medical necessity has to be established.

~Kate~

[Sarah]

There are a number of reasons why I believe that psychiatric evaluation and treatment should be mandatory for transgendered individuals seeking HRT and various forms of "corrective" surgery.

1. Most people who are transgendered experience a large amount of stress, doubt, confusion, denial, depression, and anxiety about their Gender Identity. Talking to a qualified professional (more often than not, in my experience) helps a person to sort out his feelings, more objectively evaluate problems and solutions, and provides support that may not otherwise be available.
2. There are not many but there are those who "fake it" for a myriad of reasons. Some are disillusioned or depressed teenagers who don't know any better. Others are criminals. Many are psychologically unstable.
3. Many of the effects of HRT and most of the effects of surgery are permanent. A person who plans to undergo those types of processes should be fully aware of the permanence, risks, side-effects and make sure that he knows what he's getting into.
4. There are transsexual individuals who completed the whole process and still regretted it, wishing they could undo the effects of surgery and HRT.

If I think of any others, I'll list them later.

I don't know if you understood the OP.

I said that the person giving the certification should be "properly trained" including on how to tell the difference of fakes.

At the very least ones own doctor should be able to make the call and not just a Psychologist.

REason being: with regard to your first example, that does not apply to all trans people universally.

As I said, people should be able to see one if they want to, but they schould not be required to.
I know more than one person, myself included, whose only possible need or reason for seeing a gender therapist is to collect a diagnosis.

That's it. I have no puropse for one other than that.

AS such, IT seems an unessicary step theat could be bypassed and gone straight to my doctor for,

It costs a lot of money. and with the current system in the US, requires at least 3 months of of expensve, and for me, useless session for a referral.

The only reason they do it that way is because of the Harry Benjamin stuff.

I wouldn't mind seeing one once and walking out with the paperwork.

And what about those in England? They are pretty much screwed.

Official estimates are 28 years!
Unafficial is less than that, but still, six years wait! then more years without HRT! Then many more still before they can get surgery!

What I'm suggesting is that someone could go to a suffeciently trained competent certifyer who could then go to their doctor and start HRT.

Sara

[lady amarant]

There are a number of reasons why I believe that psychiatric evaluation and treatment should be mandatory for transgendered individuals seeking HRT and various forms of "corrective" surgery.

1. Most people who are transgendered experience a large amount of stress, doubt, confusion, denial, depression, and anxiety about their Gender Identity. Talking to a qualified professional (more often than not, in my experience) helps a person to sort out his feelings, more objectively evaluate problems and solutions, and provides support that may not otherwise be available.
2. There are not many but there are those who "fake it" for a myriad of reasons. Some are disillusioned or depressed teenagers who don't know any better. Others are criminals. Many are psychologically unstable.
3. Many of the effects of HRT and most of the effects of surgery are permanent. A person who plans to undergo those types of processes should be fully aware of the permanence, risks, side-effects and make sure that he knows what he's getting into.
4. There are transsexual individuals who completed the whole process and still regretted it, wishing they could undo the effects of surgery and HRT.

If I think of any others, I'll list them later.

Okay, I see your point, but allow me to raise some counter-arguments.

1. Yeah, we all develop a number of issues around GID, and most assuredly, dealing with those almost certainly leads to a more successful transition. However, dealing with them should be my choice, not be forced upon me by an outside agency. It's crazy anyway, IMO, to deny a person treatment of the root cause of most of those problems on the basis of not dealing with the secondary issues that spring from it.
2. Yeah there are fakers out there, usually people with other issues that present as GID. However, again, if I am sane enough not to have been committed, I'm sane enough to make my own decisions, however ill-advised they are. As to criminals seeking GRS - I think that quite rare, but you'd hardly need a couple of referrals to access treatment - there are plenty of take the money and don't ask questions surgeons out there.
3. I absolutely agree. In the same way that a tattooist or piercings artist would discuss the dangers and side-effects (well mine did, anyway) before proceeding, anybody who is going to prescribe you HRT or perform surgery should make damn-sure you know what you are letting yourself in for. If nothing else, they have to do that for the consent form and waiver you sign to be binding. I'm not saying transition is like getting a tattoo, but what I do mean is that informed or ill-informed, it should still be your decision. The therapist/doctor/whatever's responsibility is to inform you, not to decide for you.
4. Yes, after they went through the entire shebang of counselling, RLE, etc. Going to a psychologist is no guarantee you are making the right decision, but we should be free to make those decisions for ourselves. If they turn around and bite us later, we have nobody to blame but ourselves.

I would concede to saying that PERHAPS a SHORT manditory period of counselling might be in order, but again only to inform me and make me aware of all the aspects of what I'm undertaking. At best two or three sessions of discussing procedures and likely psychological impacts, etc. Having some stranger who knows probably half as much as most of the people on this board to about GID, never mind that that person doesn't know me from a block of wood, decide when and if I can transition is wrong.

[cindybc]

Hi Milo
I agree with what you have posted I was going to more or like post something with similar thoughts. Just wanted to add as well that after two or three years of therapy with a qualified therapist of psychiatrist and two or three years of real life experience should pretty well weed out most of the wannabees or those that were uncertain about the whole thing. I really don't think many of these would make it as far as the surgery but far enough with HRT to affect irreversible changes.

As for myself I can't see myself going back to who I was before, that is more frightening to think about then having to go through the process I took to get to where I am now. After seven years I feel quite comfortable being Cindy.

Cindy

[Kate]

At the very least ones own doctor should be able to make the call and not just a Psychologist.

They can. And some doctors do make that call for themselves.

Although now that I think about it, are therapists qualified to make a *medical* diagnosis anyway? Psychs, yes of course... but is there any real legal "weight" behind a therapist's conclusions?

~Kate~

[NicholeW.]

At the very least ones own doctor should be able to make the call and not just a Psychologist.

They can. And some doctors do make that call for themselves.

Although now that I think about it, are therapists qualified to make a *medical* diagnosis anyway? Psychs, yes of course... but is there any real legal "weight" behind a therapist's conclusions?

~Kate~

Nope, just as psychological diagnoses if they hold licenses to make diagnoses: clinical psychs and LCSWs. Psychiatric nurses and doctors can also make those mental disorder diagnoses. That's it.

No licernsed therapist will make a medical diagnosis.

But the surgeons prefer the cover. That's why there IS an SOC for HBS. It's a liability thing.

They wanna make sure that someone like the guy in Australia we ahve seen the TV clip about is not doing what he did.

So, I really doubt the psych issue is going away for people who don't want it.

N~

[Purple Pimp]

Unless socialist medicine can take a foothold in America, allowing surgery to be paid for through universal healthcare, I think the best thing at the moment is to just treat it as a "customer" situation.  Personally, I prefer the Thai way of doing it, paying lipservice to the SOC, but not demanding a pathologizing "diagnosis."  By treating it as an economic situation only, one only has to pay for the services and legally accept responsibility for the choice beforehand (already a given, since Americans can't sue Thai nationals).  It's not perfect, since it places the onus on the individual to pay for the surgery--which lots of people can't afford--but I still think it's a hell of a lot better than the paternalism in having transsexuality be a medicalized, diagnosed condition.

Lia

[Keira]

I think there is something weird about the whole SRS needs letter, etc.

I can get my whole face reworked for 10h (which are a set of major surgeries
with much potential risks) by just signing something,
so I'm not even recognizeable
to my mother and look a different sex.

And a 2.5 hour lower risk op needs humongo gatekeepers.

Supposedly because the face ops can be reversed... Well, they
may be reversed, but its doubtful you'd look the same and
it would probably cost much more to get back what you've taken
away with much more risk than the original operations.
Rebuilding the nose for example is a much more involved
and risky operations than reducing it.

Would SRS be more accessible if it be easily reversed?
I think not. I think there's something else at play
than just liability here.

I think that men, are just horrified that someone would want
their genitals changed, and classify this person as mentally
unbalanced and such a person per definition needs to
be protected against itself. Its a paternalistic and macho
attitude.

I think the liability issue is just used as cover for
the TS much be crazy for even wanting this so
lets not patronize and participate in their crazyness.
They see us the same way as people who want to
remove a leg, This is absurd because our organ
at the end essentially has the same function as
before except reproduction. Plenty of women or
men don't have or want children so I don't know
why that can be held against us.

[Purple Pimp]

I think that men, are just horrified that someone would want
their genitals changed, and classify this person as mentally
unbalanced and such a person per definition needs to
be protected against itself. Its a paternalistic and macho
attitude.

Exactly.  There's a great article by Gayle Rubin in the early 80's that hints at this.  The more statistically deviant the sexuality/behavior, the more likely the person to be considered nuts/unable to comprehend the consequences of their actions.  She mentions an S/M case where the Sadist was convicted of battery because, in the judges view, no one with functioning mental faculties would consent to flagellating etc.

The current system in place is definitely more about preserving norms and pathologizing the transperson than about helping them, whatever therapists/psychologists may think.

Lia

[lady amarant]

I think that men, are just horrified that someone would want
their genitals changed, and classify this person as mentally
unbalanced and such a person per definition needs to
be protected against itself. Its a paternalistic and macho
attitude.

Exactly. We're so screwed up about sexuality and gender in the West because of our patriarchal system, both religious and political, that anything deviating from safe, secure, familiar is either seen as a sickness or a sin, rather than healthy, natural variation. In my opinion, ANYTHING goes, as long as you are making your own, informed decision, not forcing that decision on another, and not harming another by acting on it.

Sadly, that's not the way most people see the world. Somehow my decision to live my life authentically and quietly is a huge threat. Meanwhile we have a rapist and embezzler most likely to be the next president in South Africa. Go figure...

Sorry all, not my usuall chipper self this morning, so if I sound a bit grouchy... sorry. 

[Schala]

3. Many of the effects of HRT and most of the effects of surgery are permanent. A person who plans to undergo those types of processes should be fully aware of the permanence, risks, side-effects and make sure that he knows what he's getting into.

Many of the effects of HRT are permanent...true, but there are a whole host of other surgeries and drugs that have permanent, sometimes even delibitating effects much worse than the low % side-effects of HRT (well, except death). Anti-psychotic drugs that can make you suicidal, hmm yay?

I agree the person should be fully aware, but that doesn't take 12 sessions or 3 months weekly, to be able to know that...I knew 10x more about GID when I first saw a psychiatrist at the end of 2005...and 100x more when I saw one recently in 2007...yet I still need that diagnosis to change my legal name (well unless I get SRS first, like in Thailand, I bypass the whole letter thing).

[NicholeW.]

I think there is something weird about the whole SRS needs letter, etc.

...
I think the liability issue is just used as cover for
the TS much be crazy for even wanting this so
lets not patronize and participate in their crazyness.
They see us the same way as people who want to
remove a leg, This is absurd because our organ
at the end essentially has the same function as
before except reproduction. Plenty of women or
men don't have or want children so I don't know
why that can be held against us.

My inclination is to completely agree with this. I suspect that is exactly what the fear is, Keira. And that the surgeons who do that work don't want to have nasty things like "How is he, or, in one instance, she any different than Mengele and some of those Nazi-doctors doing horrid experiments on other human beings? "

WPATH by itself is hardly influential and strong enough to make this stick everywhere.

As Lia said, Thailand observes the SOC hardly at all, only enough to make the fuss go away if it should arise. Iran not at all and they do more surgeries than anyone (altho there is a large asterisk there) !

Nichole

[Berliegh]

In the U.K you have to scrap for everything and the psychiatrists here don't comply with the HBSOC anyway, so there seems little point in it's existance even though I think it's a good treatment guide. We have had to fight for HRT and fight even harder for referrals for surgery...

Also the psychiatrists over here don't believe gender dysphoria really exists, so where does that leave us?

[Sarah]

...don't believe gender dysphoria really exists...

WOW.
Sara

[Berliegh]

...don't believe gender dysphoria really exists...

WOW.
Sara

It's true. I can scan one of my letters from Charing Cross GIC to prove it. Also in the letter the psychiatrist said I had delusions of being female....

[Sarah]

...don't believe gender dysphoria really exists...

WOW.
Sara

It's true. I can scan one of my letters from Charing Cross GIC to prove it. Also in the letter the psychiatrist said I had delusions of being female....

I am having trouble recovering from this..
Are you saying that the official policy of the Medical System in the UK is that Transexualism and ->-bleeped-<- is a delusion?