Standards of Care (SOC)

[Natasha]

Standards of Care (SOC)

http://tarald.wordpress.com/2008/09/12/standards-of-care-soc/
9/12/2008

Until recently, I've believed that if the Norwegian Gender Clinic would just use the Standarsds of Care provided by WPATH, everything would be fine. I've thought that the SOC is ok. In my reading of the SOC I've only marked the parts that the gender clinic doesn't follow.

1)Procedures, not transition, not identity. There's an almost universal assumption that these standards of care are in case a patients decides to "change hir mind" about transitioning. Putting aside of the implications of protecting trans people from themselves for a moment, transition regret is a red herring. No medical procedure can force you to live in a particular gender permanently. If I've been on estrogen for 10 years, have bottom surgery, facial surgery, the works, and decide I want to live as a man again? I start taking T, bind my tits, pack, and it's no big deal. Yeah, it kinda sucks for me, but I'm not really any worse off than a female assigned at birth transsexual man (and, in fact, my situation would be remarkably similar to his).

[tinkerbell]

  Normally, the people that bitch and moan about the HBSOC are those who do not fit the medical criteria for transsexualism anyway.  IOW, they always want to push their own agenda, so there! 

tink

[Natasha]

concured. heh

[Seshatneferw]

And normally the people who defend the HBSOC are those who have transitioned under them. Funny, that.

(And no, I'm not taking a position here. The SOC are not perfect, but neither are they the epitome of all that is evil in the medical profession. Which, by the by, seems to be what the blogger thinks too.)

  Nfr

[Natasha]

Normally, the people that bitch and moan about the HBSOC are those who do not fit the medical criteria for transsexualism anyway.  IOW, they always want to push their own agenda, so there! 

tink

i just want to see what they're going to do in 2012 when the dsm/soc are revised & they're labeled as "fetishists" tsk tsk tsk

[SusanK]

And normally the people who defend the HBSOC are those who have transitioned under them. Funny, that.

I agree. It seems to me that those who approve them are the ones who went through the steps and hoops to get through their transistion and on with their life. I'm not against that, but one's experience isn't everyone's experience.

The SOC's are good general guidelines but they're not universal to encompass everyone who wants to transistion, which is its failure. There needs to be a way to be more flexible with people who are committed but who not necessary need a prescribed procedure or who need to adjust it to improve their transistion.

And as evidence it doesn't work universally, just look at the stories of post-transistion women who have personal and life problems during and after their transision, or find their life, while personally better off in their new gender, find the rest of their life worse off. It's often put off to the individual who didn't fully understand their life situation, but it also raises the question, where did the medical community fail?  The SOC's allows people who are too focused on their gender or blind to reality of a transistion.

And it is the history of the SOC's that show they weren't based on reality or helping the individual so much as it was a compromise among the psychologists to get something done. The one-year RLE is an example of this academic and professional compromise which ignored the individual. The psychologists established it more for self-protection and fear of liability than reality.

The RLE has never been established as scienfitically helpful for the person. It's there to get through, get the letters for GRS/SRS and get on with their life. No one has ever tested if it would be better to allow it early in the transistion once the individual and therapist knows it's the best solution for the individual. The RLE is just the rest of their life.

And yes, I support the SOC but think it's needs more flexibiltiy. But it not and it's applied, apply it evenly which we know it's not. There are some who simply bypassed or shortened steps to get the letters.

[Mister]

I had a transitioned under a liberal view of SOC- my doctors and therapist viewed them as what they are (guidelines) not what most think (rules).  i can't stand SOC because it's so often used as a barrier to transition.  Telling a 5' transman with large breasts and a high voice to RLE for a year in, say, Arkansas?  Bad idea.

I live in SF and transition can be done under SOC, Harm Reduction (you're getting hormones off the street so we might as well give you the legal stuff) and informed consent (hey, you're an adult! you want 'em? you got 'em.)  and while i don't agree that these are the perfect solutions either, they're a hell of a lot better than a rigid interpretation of SOC.

[Keira]

There is so little real science behind the SOC,
its basically a whole lot of arbitrary numbers.

Why 3 months for HRT, why one year of RLE, why not 9 months, or 2 years.

Why is not possible to take HRT, whose effects or mostly reversible for a (MTF)
Why not just really use informed consent in this case? When you ask the doctors,
they've got a flimsy logical construct.

(even significant breasts are removable and sterity has not really been researched,
in fact there's much more proof that people don't become sterile (just less fertile)
after coming off HRT than the other option).

In many of the places where medecine is socialised the standards used often
go way way beyond SOC (much more restrictive). In Quebec you're lucky to
get HRT within a year of starting therapy. 


The only argument we get is people that go through SOC have very little regret.
The problem with that is that by insuring that they've got statistically the highest
chance of getting the real TS, they are SURE to refuse a subtantial number of
real TS. The higher the bar, and the more arbitrary the bar is, the bigger the
chance that they'll overshoot.

All TS are far from being equivalent, far from it, and SOC should acknowledge it.

I know a TS who was a president of a company, in her 40's, a loving family and friends
who had known for years that she wanted to do this. She waited till her children
where older, and then, despite having the finest support network in the world, solid
finances and a job security, she still had to wait the full year after she had met the
therapist. After 6 months, she felt ready,
she went to Thailand and she's 15 years post op now
and the company she had has flourished. Tell me how the SOC is serving this person
well?

[Sheila]

There should be some changes made in the time lines. I feel that people who are transitioning should be on HRT a little longer so the effects of the hormones have more physical features. So you can pass a little better before you start your real life. Now, that I feel is more of a personal feeling as some are more courageous and not afraid of going out. There are some that HRT is not needed to pass very well. I don't feel that there should be any specific time lines. I do feel that at least a year for the real life is necessary as it may need longer. I do know for myself that one month or no time was needed. I knew who I was.

[April221]

I'm not complaining about anything. I'm currently transitioning under the SOC, and generally enjoying myself. I meet the criteria set by the earliest standards, and receiving any requested letters is only a matter of asking for them. My therapist is widely published, and is a Ph.d  specializing in gender dyphoria. My SRS is planned for late 2009 by my request. It has taken so very long for me to have found help, having given up looking in 1970, that I'm just taking my time, without any pressure, and enjoying my RLE. Knowing that I can have the procedure at my convenience takes a lot of pressure off of me, and allows me to really relax and to refine skills and to plan post-op goals.

I'm doing what is right for me. I make no suggestions as to what is best for anyone else. I think that guidelines are needed in order to help clients with informed consent. The underlying attitude of the SOC, what I feel the spirit is, is to help ensure that people truly understand the consequences of their actions, and understand what they wish to do. No one is sitting in judgement. If I say something that my therapist feels is not well reasoned, she will ask me about why I made a statement. She doesn't argue with me.

The RLE may not be needed by someone else. Someone else may be fine with a short period of exploration. I'd like to have a year or so, in part, to get the money together. SRS is such a major, major, procedure, I need to be prepared for it emotionally, and I do not feel ready right now. I need some time. For me, the SOC are not a problem. They're useful guidelines.

[Mister]

There should be some changes made in the time lines. I feel that people who are transitioning should be on HRT a little longer so the effects of the hormones have more physical features. So you can pass a little better before you start your real life. Now, that I feel is more of a personal feeling as some are more courageous and not afraid of going out. There are some that HRT is not needed to pass very well. I don't feel that there should be any specific time lines. I do feel that at least a year for the real life is necessary as it may need longer. I do know for myself that one month or no time was needed. I knew who I was.

I completely disagree with this statement.  Six weeks after starting testosterone my female ID was completely unusable.  There is no way I could've been on hormones any longer and not lived as male.

[Yvonne]

I think the specialists in transsexuality have gone beyond reality to try to categorise who is a transsexual and who isn't, who genuinely suffers from severe gender dysphoria and who doesn't.   There are many peeps that are clearly not transsexual but they've taken over the definition of transsexual the same way they change silky lingerie or choose a new wig.  Transsexuality isn't a gag, it has nothing to do with being dressed in soft, ballerina dresses or "feeling" like a girl.  Transsexuality is a serious medical ailment and very simple to understand. Body-mind incompatibility.  Same thing with post-op GRS, it doesn't mean to remove a single testicle, half of a penis, both testicles, or a quarter of a willie!  Post-op GRS in trans gals is the lack of male genitals, testicles, penis, internal reproductive organs, and the creation of the female vulva & vagina.

Also it's possible that an inappropriate candidate may attempt to transition.  If they learn the right things to say or outright lie to their gender specialist, a non-transsexual might slip through the screening process and obtain mones, letters & GRS.

I'm just bloody tired of peeps trying to conveniently change the diagnosis of transsexuality to their advantage & in that process, I get lumped right there with them & medical coverage's denied for the peeps that genuinely suffer from transsexuality.