Getting the letters

[Terra]

I was wondering, what criteria is there for these letters? Like how often do you need to see your doctor, or what kind of doctor is able to write them?

Supposedly these letters are the easy part, but since i'm in this collage town...

I can get the money (in theory) through my student loans. But that still leaves the letters. I might have a lead on how to get the letters, but I wanted to know the criteria.

[lisagurl]

I might have a lead on how to get the letters

Then you are not.

[gothique11]

It depends on which letters you're looking for (HRT, GRS, etc). Your doctors, the system you have there, etc. Most doctors will follow the Harry Bens thingy, or at least use it as a guideline

I'll just quote what it says.

"VII. Requirements for Hormone Therapy for Adults

Reasons for Hormone Therapy. Cross-sex hormonal treatments play an important role in the
anatomical and psychological gender transition process for properly selected adults with gender
identity disorders. Hormones are often medically necessary for successful living in the new
gender. They improve the quality of life and limit psychiatric co-morbidity, which often
accompanies lack of treatment. When physicians administer androgens to biologic females and
estrogens, progesterone, and testosterone-blocking agents to biologic males, patients feel and
appear more like members of their preferred gender.

Eligibility Criteria. The administration of hormones is not to be lightly undertaken because of
their medical and social risks. Three criteria exist.
1. Age 18 years;
2. Demonstrable knowledge of what hormones medically can and cannot do and their social
benefits and risks;
3. Either:
a. A documented real-life experience of at least three months prior to the administration
of hormones; or
b. A period of psychotherapy of a duration specified by the mental health professional
after the initial evaluation (usually a minimum of three months).
In selected circumstances, it can be acceptable to provide hormones to patients who have not
fulfilled criterion 3 – for example, to facilitate the provision of monitored therapy using
hormones of known quality, as an alternative to black-market or unsupervised hormone use.
14
Readiness Criteria. Three criteria exist:
1. The patient has had further consolidation of gender identity during the real-life
experience or psychotherapy;
2. The patient has made some progress in mastering other identified problems leading to
improving or continuing stable mental health (this implies satisfactory control of
problems such as sociopathy, substance abuse, psychosis and suicidality;
3. The patient is likely to take hormones in a responsible manner.
Can Hormones Be Given To Those Who Do Not Want Surgery or a Real-life Experience?
Yes, but after diagnosis and psychotherapy with a qualified mental health professional following
minimal standards listed above. Hormone therapy can provide significant comfort to gender
patients who do not wish to cross live or undergo surgery, or who are unable to do so. In some
patients, hormone therapy alone may provide sufficient symptomatic relief to obviate the need
for cross living or surgery.


XII. Genital Surgery

Eligibility Criteria. These minimum eligibility criteria for various genital surgeries equally
apply to biologic males and females seeking genital surgery. They are:

1. Legal age of majority in the patient's nation;
2. Usually 12 months of continuous hormonal therapy for those without a medical
contraindication (see below, "Can Surgery Be Performed Without Hormones and the
Real-life Experience");
3. 12 months of successful continuous full time real-life experience. Periods of returning to
the original gender may indicate ambivalence about proceeding and generally should not
be used to fulfill this criterion;
4. If required by the mental health professional, regular responsible participation in
psychotherapy throughout the real-life experience at a frequency determined jointly by
the patient and the mental health professional. Psychotherapy per se is not an absolute
eligibility criterion for surgery;
5. Demonstrable knowledge of the cost, required lengths of hospitalizations, likely
complications, and post surgical rehabilitation requirements of various surgical
approaches;
6. Awareness of different competent surgeons.
Readiness Criteria. The readiness criteria include:
1. Demonstrable progress in consolidating one's gender identity;
2. Demonstrable progress in dealing with work, family, and interpersonal issues resulting in
a significantly better state of mental health; this implies satisfactory control of problems
such as sociopathy, substance abuse, psychosis, suicidality, for instance).

Can Surgery Be Provided Without Hormones and the Real-life Experience?

Individuals cannot receive genital surgery without meeting the eligibility criteria. Genital surgery is a
treatment for a diagnosed gender identity disorder, and should undertaken only after careful
evaluation. Genital surgery is not a right that must be granted upon request. The SOC provide for
an individual approach for every patient; but this does not mean that the general guidelines,
which specify treatment consisting of diagnostic evaluation, possible psychotherapy, hormones,
and real-life experience, can be ignored. However, if a person has lived convincingly as a
member of the preferred gender for a long period of time and is assessed to be a psychologically
healthy after a requisite period of psychotherapy, there is no inherent reason that he or she must
take hormones prior to genital surgery.

Conditions under which Surgery May Occur.

Genital surgical treatments for persons with a diagnosis of gender identity disorder are not
merely another set of elective procedures. Typical
elective procedures only involve a private mutually consenting contract between a patient and a
surgeon. Genital surgeries for individuals diagnosed as having GID are to be undertaken only
after a comprehensive evaluation by a qualified mental health professional. Genital surgery may
be performed once written documentation that a comprehensive evaluation has occurred and that
the person has met the eligibility and readiness criteria. By following this procedure, the mental
health professional, the surgeon and the patient share responsibility of the decision to make
irreversible changes to the body."

You can find the full text here: http://www.wpath.org/publications_standards.cfm

--natalie

[Terra]

I might have a lead on how to get the letters

Then you are not.

Not sure what you mean here.

It depends on which letters you're looking for (HRT, GRS, etc). Your doctors, the system you have there, etc. Most doctors will follow the Harry Bens thingy, or at least use it as a guideline

The letters i'm talking about would be the SRS ones. Problem with being in this small Wyoming town, is that while my school consolers are able to help me with life in general they are unable to write any letters. However, since i've been on HRT for some time the school health doctor is prescribing as per my chicago doctor's advice.

Getting the money here is easier then getting the letters for surgery. But I do know I have to be under someone's psychological supervision for a year. The real life test as it is. But I was hoping that it isn't necessarily the gender specialists that I have to see, and that there were other options.

[elena]

I was told by my therapist that I needed to see the Psychiatrist for the GRS letters.  I'm nowhere close to that yet, but that's the route I will have to go when I get closer to total transition.