The ethics of advice on DIY.

[dawn]

That costs about 500 dollars.

It costs me 50 euro, every three months.

[Sarah]

That costs about 500 dollars.

It costs me 50 euro, every three months.

You are in Europe.

[dawn]

You are in the USA.

what kind of game are we playing here ?

seriously though you said "That costs about 500 dollars" , firstly i wonder why you said "about" and didnt give a figure, but more importantly giving that figure may lead others to not check the price for themselves, believing they could never afford it.  And to clarify, 50 euro, thats with no financial aid or the like, thats just the price.

[tekla]

I have to agree with the standards for not addressing this issue.  Kit brings up a huge point about liability.  And that liability could well extend to Susan, this site and even further - the tendency is to sue everyone, and let the court sort it out.  I know I can pretty much win any workplace disagreement about safety with the remark "Hey, let's call the insurance carrier and ask them." 

Anyway you look at it you are dealing with powerful drugs that have long term effects.  And any such medication needs a doctor and labwork. 

[lady amarant]

"Feeling slightly ban-shy, she bravely donned her sword and buckler to enter the fray once more..."


Okay. A bit of background:

I have a friend I chat to fairly often who lives in Mumbai. Transsexual people used to be fairly well regarded as manifestations of Shiva's duality, and they had an important part in the religious life of India because of that. When the English colonised India, they banned all forms of sexual and gender variance, and unfortunately the taboos have stayed even if the English didn't. Today, Hijra are streetwalkers or beggars. Society only even tolerates them because they are nominally scared of Shiva's wrath. Incidentally, few Hijra are ever in a position to access HRT, but do routinely have castration surgery done as soon as they can afford it. Sadly, this is a major obstacle to passing for most hijra.

So my friend doesn't want to be a Hijra, but India pretty-much makes NO provision for transition in the way we know it. Her dream is to save enough money to go to Thailand, but in the meantime she self-medicates in an effort to 'blend'.

I'll come clean. I gave her direct advice on HRT.

Pretty-much everybody else I come across asking for help, I advise to find a therapist, get in touch with their GP, or failing that to at least take some time to read up on the subject properly. I usually link them to  the same studies and reports I used to educate myself in the matter, because here I do feel that we ALL need to know a lot more about the drugs entering our bodies, especially when many endos are still prescribing conjugated oestrogens and the like. I do not however provide direct help unless I am convinced they have no way other way out.

I agree with Kit and Nichole that, in most cases people are looking for short-cuts or simply want to stay off the grid, but there ARE situations where DIY really is the only option.

So my feeling is that, if there is ANY other option but DIY and advice on DIY, then that is the right course. But there are always going to be individual cases that defy the 'right course', and in those circumstances, I can't justify letting somebody potentially hurt themselves if I could have at least made the chance of that a bit less.

That said, DIY information probably SHOULDN'T be freely posted on forums like this, because yes, many people WILL abuse it. But if somebody in genuine need comes to me asking for help, I'm not going to say no.

[NicholeW.]

Unlike some of the commentators I have worked for 6 of the past 7 years with the "young, college-aged, and street-level prostitutes" as a clinician. One year of that was in a LBGT gender-program in Philly that is totally free to the destitute. Totally free. It's also used by rather well-to-do people to legally obtain scripts without going through their insurance.

No, it doesn't have a pharmacy so the hormones aren't free.

The other five years I worked at an inner city mental health center where I worked with a number of gender-variant people, male- and female-bodied.

Their issues: childhood sexual abuse, physical abuse and emotional abuse in their homes of origin, often severe and persistent mental health disorders and a huge variety of personality disorders of which Borderline & Antisocial predominated and in the case of trauma, severe PTSD, and were exacerbated by Bi-polar w/ psychotic features (schizo-affective,) Depressive and Schizophrenia.

This is inner-city northeast corridor. Prostitution, drug-sales and she-male/gay movies were the primary means of support these women and men used. To a person they were 99% also users of street-drugs and were often addicted. They were often 'run' by pimps and those who were not pimped were beaten unmercifully and told to 'get out or die' in no uncertain terms by pimps and/or gangs.

Strangely enough, many would enter treatment for their trauma/abuse issues and drug-use and would continue to make their livings in the sex-trade. When they did so their incidence of 'self-medication' dropped drastically. They used the free clinics, sliding-scale gender therapists and regular pharmacies to obtain scripts and medications. Some, on general welfare, through Medicaid.

When they related the causes for self-medication they often would admit they self-medicated because 1) they were spending their money on drugs, clothes and food 2) ignorance of assistance, 3) ignorance of the FACT that the SOC provides a mandatory prescription-policy for those already on hormones. When they received education as to the facts about industrial-grade silicone injections to body transformation most discontinued its use. They were unaware that prescription hormones would regularly make the sorts of body-changes for them that the silicone was providing.

They were also unaware that the silicone hardens over time and flows until it hardens. Both effects cause severe deformations and increase one's risk of death drastically.

I cannot say what life is like elsewhere but that's what its like here. These kids and young adults did not want to continue harming their bodies. One of the most frequent remarks I have heard over those years has been "Why would I want to do all that just to die before or during the process." That from survivors.

When they came in they would often plead 'unfairness' and the fact they were 'just young and nobody knows what we are going through or cares.' Once they found that some of us did actually care very much and did know what they were going through, in many cases without having lived the life ourselves, they got better. Did better and refused to be victimized unmercifully anymore.

Its all well and good to make suppositions about age and availability. But, good information tends to rout poor information. If people want to become activists and helpers then have at it. Push for free-clinics in your area. Push for parity treatment for mental health with medical health. Donate to organizations that are already doing the work. Get yourself educated about the state of affairs and how you can become a player in a way other than posting on a forum. Volunteer your time after you're educated to an LBGT service organization in your area.

One post, made in violation of a forum rules, or even thirty will not give the assistance provided by your body involved in any one of the above.

Nichole 

[Sarah Louise]

Well said Nicole.




Sarah L.

[Tanya1]

Well it really depends.

If your going to plan on self-medicating AT LEAST educate yourself properly by opening up some medical books on the endocrine system and do some serious research before hand. Find all the side effects and such.

But the problem is that many of the side effects can't be deteremined and usually come up as miscellanous.- I knew of this one woman that said she felt GREAT...what happened after 4 months of feeling "great"?- she went into FULL CARDIAC ARREST and now has to take 4 prescription drugs for LIFE!

Their are many chemicals and substances in the body that are altered by HRT.

I do know of people that have been self-medicating for a long time and have had no health problems BUT usually most people don't understand that HRT takes very good health and caution.

I'm not recommending it but it is possible that you'll come out fine if you excersice, watch your diet, quit smoking, alcohol, and do some tests on your kidney and liver by a doctor. But their is still a risk no matter what and doesn't mean you'll come out fine even if your very healthy.


I defeintly understand why people self-med because of money, living in a country where the system is flawed or because of a lack of resources- but again make sure you are completely aware that you need to keep an eye on your health and that your literally playing "russian roulette" with your body because doctors are the ones who have done not only research about properly adminsitring these meds BUT can do tests on the body to make sure nothing is wrong. And yes- some doctors don't know a lot BUT neither do many of us. It's also not about research and information- you have to have medical equipment to do bloodwork and tests!

- I'm nuetral on Self-Med

[Sarah]

By the way, Dawn, it can be cheaper than that, it depends on the doctor.
But everything is expensive without insurance.
There are some clinics that will do it for a low cost, but most private doctors charge more.

This will be my last post to this thread,
But I wanted to point out,
That I had to take out student loans in order to be able to cover the costs associated with transitioning.
I took it on as debt.
That's not an easy thing to do.

I know others who have to do other means in order to cover their costs.

Things that are not ideal sometimes.

I think we forget sometimes that poverty is a very real issue in this country.

50 dollars means a lot to some people.
Especially, more often than not, people my age or younger.

I'd really like to not have that dismissed.

I would appreciate it.

Sara

[Annwyn]

Ugh.  I self medicate because I don't have the time or cash right now to be travelling halfway across the country just to talk to someone who is goign to make me make the same $300 trip 1-2 times a month for half a year before even letting me get anything out of the damned thing.  Why not simply do it on my own and when I finally do ahve time to see a therapist demonstrate that I'm living WELL as a woman and am LOVING IT?

If I could do it the 'proper' way then I would.  But I'm not even sure if I agree with the system to start with, but I'd still do it because believe it or not, I dislike breaking the rules.

Sara hit the nail on the head with us college kids.

As far as prostitution and such, I'm really mixed up in my opinions of this.  I can honestly say that it doesn't bother me to be used.  In fact I've been a prostitute before, and I've still got 2 clients that I see about once a month who've become very close friends of mine over the course of half a decade.  I believe that a lot of transsexuals get more out of prostition than just cash, they get acceptance of a kind that they can't find elsewhere, even if it is just skin deep sexual obsession with the abnormal, it's still being appreciated in some method.  I spoke with a lawyer in california who's had a lot of experience with TG's, and I was shocked when he said that most transwomen he's ever known have done some street work, even if they didn't need the money, just to do it he said.  If I wanted to do it, I might.  In fact it crosses my mind quite a bit, considering my looks and petiteness.  It's just a dangerous thing though, I'd much rather have a stable well paying job than some cheap thrill of running around on the streets.

Idk why I even went into that mess, I guess I just wanted to let you all know that it's not as rare as it seems, I could actually appreciate being appreciated enough to be able to charge for services for my beauty and sexual appeal.

[Steph]

And it think that is where folks can get them selves in trouble "Living like a woman" doesn't make a person a woman, much the same as taking HRT either prescribed or DIY does not make that person a man or a woman.  There are some out there who can and do fool themselves into believing this and believing that, and see taking HRT as the road to womanhood, it isn't.

The information folks pass to each other on HRT, whether it be advice, dosage, how to obtain black market HRT is strictly between those concerned, and if those same folks feel comfortable enough, and competent enough to be the source of this information, or just playing doctor then more the power to them, go for it, start your own web site, we just can't and won't permit it here.

I may have read every bit of literature in the world on HRT, but that doesn't qualify me to dispense medical advice either professionally, ethically, morally, or legally.

Steph

[Keira]

I think that
- Considering the mess that Ifeel the SOC is;
- The barrier to treatment that the process is that protects
more the doctors than the patient
- The fact that there is very little research on HRT
used in transexual which makes the endo's
as ill informed as anyone.
- That there is a huge community of users that didn't exist in the past that can be used
to share knowledge and warnings
- That even if you DIY, your physician will in most case follow your vitals closely,
which reduces risk
- That there is a lot of empirical evidence born through practice and studies
on women using HRT and collated through the internet that reduce risk further
- That the risks of HRT are oversold considering that tylenols
are far more dangerous (deaths and liver damage a gogo).
- That the new types of HRT drugs have a significantly safer profile than in the past,
have a better understood biological effect and can be monitored more easily.
- That HRT is reversible
- Etc.

To make aiding anyone not much of an ethical problem to me.

But, hey, I'm all for people using marijana and LSD if they do it in their home
(not driving or putting others in danger),
a view not shared by many americans (but more canadians do share this view).

[Annwyn]

Haha, you rock out Keira.

[bethzerosix]

Haha, you rock out Keira.

X2

im not a doctor... but i play one on t.v. and im all for doing things the proper way because SRS is not do it your-self ... believe me..... i've tried....yeeeeeeahhh

[lady amarant]

I just want to reinforce that I DO NOT think places like Susan's and the like should do anything that makes them legally liable, dispensing DIY advice or otherwise. We need open, public spaces for gender variant people to be able to meet and interact safely and EASILY. For those who just don't have access to therapy, peer counselling becomes a VERY important part of their lives. Introducing DIY advice would push places like Susan's out of the "mainstream", which would be a very bad thing. Likewise, GenderDynamix is an activist group back home, and being associated with "shady" practices could destroy all the work they do.

This was purely a question on PERSONAL ethics.

Thanks for all the responses.

[taru]

Knowing what reasonable dosages are is very important even if one is under a doctor's care. Since many doctors don't have a clue and may prescribe dangerous dosages if the patient is not informed.

Blood tests can be useful if something goes wrong, but even among doctors there is considerable difference about this. Here they tend to take many tests before starting HRT and only small tests (without any hormones etc) once a year during HRT.

[Seshatneferw]

And it think that is where folks can get them selves in trouble "Living like a woman" doesn't make a person a woman, much the same as taking HRT either prescribed or DIY does not make that person a man or a woman. 

True. Then again, especially in the last stages the SoC are not really about whether you are a woman but rather about whether you are better off living as one -- because after SRS that's what you'll have to do. In this sense it's understandable that the diagnostic criteria to an extent emphasise the social implications of the condition over the physical aspects.

  Nfr

[DarthKitty]

I think that
- Considering the mess that Ifeel the SOC is;
- The barrier to treatment that the process is that protects
more the doctors than the patient
- The fact that there is very little research on HRT
used in transexual which makes the endo's
as ill informed as anyone.
- That there is a huge community of users that didn't exist in the past that can be used
to share knowledge and warnings
- That even if you DIY, your physician will in most case follow your vitals closely,
which reduces risk
- That there is a lot of empirical evidence born through practice and studies
on women using HRT and collated through the internet that reduce risk further
- That the risks of HRT are oversold considering that tylenols
are far more dangerous (deaths and liver damage a gogo).
- That the new types of HRT drugs have a significantly safer profile than in the past,
have a better understood biological effect and can be monitored more easily.
- That HRT is reversible
- Etc.

To make aiding anyone not much of an ethical problem to me.

I'd like to make it very clear what the SOC states, so people happening upon this thread do not get the wrong impression:

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.

The most important aspect of the entire SOC as it stands today is not about protecting doctors and therapists.  While there are guidelines and recommendations within it about protecting a health care provider's liability in dealing with extreme cases, they are more guidelines that state "if you are ill-equipped to handle a particular patient, you are not required to provide sub-quality care."  Everything else about it is making sure that care is available and open to patients.  As it is, it is still recognized as a living document that is subject to change.

Arming a person with knowledge to head down this long journey we're all on, we are all in agreement that it is about education.  There are no shortcuts on the road to being both of body and mind the correct gender.  Everybody at some point in time is going to have to deal with the ramifications of heading down this road, whether they want to face the facts now or later.  The best thing we can do for all our peers here is arm them the best way we can for the life ahead.

Regardless of anyone's opinion of the SOC, it makes an important read that should be mandatory for anyone considering this course in life.  It outlines so much of what to expect, not only from the therapeutical or medical value of its contents, but also of what life changes need to be made and considered:

https://www.susans.org/wiki/Standards_of_Care_for_Gender_Identity_Disorders
PDF direct link to the official SOC distribution repository http://wpath.org/Documents2/socv6.pdf

That people have a big problem with their local health care systems and individual situations, these are not in debate here.  As Nichole stated above so eloquently, if you want to change the situation for the better, get out there and help the community where you live to get better local support and health care where possible.  Write letters, send emails, attend town meetings, anything contributes to getting things changed.  With a global group like we have here, and with the number of people who want things changed, if we can reach out in our own communities and create waves locally, we can make rivers run. 

-Kit

[NicholeW.]

I second Kit. It becomes too easy for any of us to be critical. Especially when we are using few if any of our abilities to do anything but criticize.

There are way more supporters and friendly endos, therapists and others out here who are ready to help and learn for us to comfortably just sit and complain about the state of affairs.

There's nothing wrong with criticism and suggestions to better care and educative functions. But, to do that effectively if you have complaints then address them with your providers. A job in a pharmacy or with a pharmaceutical company does not an expert make.

But, if in having those employments someone can pass their knowledge along to providers to effect a better way of doing transition, then it seems to me that she or he should do so.

I understand that the words below have become almost a cliche, but cliches become powerful when they are applied to a life or many lives. The fact that they are repeated often doesn't mean they are invalid.

We can change the world, but only if we are willing to enter into dialogue with the world.

Nichole

[dawn]

- The fact that there is very little research on HRT
used in transexual which makes the endo's
as ill informed as anyone.

The more people that do not go into the system, the harder it will be to collect actual facts about wanted and unwanted side affects.

- That there is a huge community of users that didn't exist in the past that can be used
to share knowledge and warnings

Chinese whispers are a less than ideal and accurate way to get your infromation.

- That even if you DIY, your physician will in most case follow your vitals closely,
which reduces risk

In my experience most who self med do not see a physcian regularly, and if they have no reason to believe that your liver function (for example) should be monitored then they usually wont.

- That there is a lot of empirical evidence born through practice and studies
on women using HRT and collated through the internet that reduce risk further

Empirical - """depending upon experience or observation alone, without using scientific method or theory, esp. as in medicine.""

That the risks of HRT are oversold considering that tylenols
are far more dangerous (deaths and liver damage a gogo).

I dont see how the fact that there more be more dangerous drugs available reduces the risks

That HRT is reversible

Alot of the effects of HRT are NOT reversible.

Keira i dont not wish to start a flame, nor do i have anything against you, but you made alot of points that i feel need to be countered.

I think i seen somebody mention that people here dont know what it is like for college kids. Just for the record i am 21, unemployed, and in growing debt. They are temporary problems that i will sort out, i dont see any reason to let my health suffer because of them.