How many gatekeepers do we need...?

[juliekins]

Thank goodness that this is all behind me! I was able to do it privately, with my own out of pocket money since my insurance would pay nothing. It nearly broke me, but I'm now where I need to be as a woman.

I know two friends whose therapist seem to be using the carrot and stick approach. The therapists are hanging out the hope of getting the HRT letter, but are making them overcome their other personal issues first. In the one case, a friend started smoking again due to the stress of coming out and possibly losing her wife. The therapist wanted her cured of some other childhood stressors first, as well. She can't get her letter until she stops smoking. In the case of my other friend, she has a lifelong eating disorder. Her therapist won't allow the HRT until she overrcomes a 40 year battle.

I understand that stopping self destructive behaviors like smoking, drinking or abusing food are healthy changes. But I have a problem with some of these therapists trating us like children in the process. Did it occur to them that the REASON we do these things is that we are living our lives in the wrong body and gender? Sometimes I get the feeling like it is simply a matter of getting more sessions in at $100+ per hr. or even may be some type of control or power trip. Thoughts? 

[Flan]

Thoughts?

That's one of my gripes about the lack of consistency in taking into account the individual needs of the client, instead of saying "what can (we) do to make you a more happy and healthy person" there is an attitude in some circles of "only if you do x and y, I'll allow z".

While in some ways that can be good if intentionally (trying to) stop something from happening will prevent health side effects, saying "no" for the sake of going by the book is a good way to make desperation and defiance. (in a "they won't stop me when the grey market is on my side" sort of way)

just my 2 cents not counting inflation

[Asfsd4214]

Thank goodness that this is all behind me! I was able to do it privately, with my own out of pocket money since my insurance would pay nothing. It nearly broke me, but I'm now where I need to be as a woman.

I know two friends whose therapist seem to be using the carrot and stick approach. The therapists are hanging out the hope of getting the HRT letter, but are making them overcome their other personal issues first. In the one case, a friend started smoking again due to the stress of coming out and possibly losing her wife. The therapist wanted her cured of some other childhood stressors first, as well. She can't get her letter until she stops smoking. In the case of my other friend, she has a lifelong eating disorder. Her therapist won't allow the HRT until she overrcomes a 40 year battle.

I understand that stopping self destructive behaviors like smoking, drinking or abusing food are healthy changes. But I have a problem with some of these therapists trating us like children in the process. Did it occur to them that the REASON we do these things is that we are living our lives in the wrong body and gender? Sometimes I get the feeling like it is simply a matter of getting more sessions in at $100+ per hr. or even may be some type of control or power trip. Thoughts?

I think, and have thought for a while now, that the medical profession attracts the same sort of people as the education profession, which is to say they attract a type of person who feels a need to have a small corner of the world where they can play god in.

[Naturally Blonde]

Thank goodness that this is all behind me! I was able to do it privately, with my own out of pocket money since my insurance would pay nothing. It nearly broke me, but I'm now where I need to be as a woman.

I know two friends whose therapist seem to be using the carrot and stick approach. The therapists are hanging out the hope of getting the HRT letter, but are making them overcome their other personal issues first. In the one case, a friend started smoking again due to the stress of coming out and possibly losing her wife. The therapist wanted her cured of some other childhood stressors first, as well. She can't get her letter until she stops smoking. In the case of my other friend, she has a lifelong eating disorder. Her therapist won't allow the HRT until she overrcomes a 40 year battle.

I understand that stopping self destructive behaviors like smoking, drinking or abusing food are healthy changes. But I have a problem with some of these therapists trating us like children in the process. Did it occur to them that the REASON we do these things is that we are living our lives in the wrong body and gender? Sometimes I get the feeling like it is simply a matter of getting more sessions in at $100+ per hr. or even may be some type of control or power trip. Thoughts?

The U.K's NHS GIC's also play it with a carrot and stick mentality. I had no underlying problems and according to previous psychistrists had no mental health issues whatsoever. I have never taken drugs, never smoked and I don't drink alchohol. But the NHS still refused HRT but it was very easy for me to get HRT privately.

[tekla]

At least in the States those gatekeepers have nothing to do with protecting the patient, but everything to do with protecting the doctors and hospitals from lawsuits.

[Naturally Blonde]

At least in the States those gatekeepers have nothing to do with protecting the patient, but everything to do with protecting the doctors and hospitals from lawsuits.

In the U.K they only protect themselves and not the patient. If the patient gets so despressed from the refusal of treatment they attempt suicide, the psychiatrists couldn't care less.

[Bellaon7]

But when he said it, he looked into my eyes like he really meant it.
Post Merge: November 18, 2009, 05:21:14 PM

[Naturally Blonde]

But when he said it, he looked into my eyes like he really meant it.
Post Merge: November 18, 2009, 05:21:14 PM

Which relates to?

[sarahb]

Again, more gatekeepers hell bent on making me jump through hoops!!! I just got a call back from the therapist who I was referred to for my second SRS letter today, and she starts saying how I'll need to see her 3-4 times before she'll write a letter!! If she's the same price as my last therapist, that's another $600...for a letter!!! Plus, that's another month and half or two more that I'll have to wait for the surgery!

It's so frustrating being so close to completion, and wanting to just get on with the rest of my life already, but constantly having to continue to shell out hundreds and thousands of dollars for needless "therapy" that I don't need or want. I thought I'd be able to have the surgery done by march or April, but noooooooooo, the therapist is going to make me wait even longer so she can make an extra few hundred or cover her ass for no reason.

I swear, these therapist's are going to drive me insane!!!

~Sarah

[jesse]

hmm next appointment ask her if you can just give her the 600 dollars sign an informed consent sheet and be done with her. lol when she looks at you crazy ask her if she really is looking at you do i even remotely look like a male to you do you think i want to be a male please lol of course shell then try to say you have anger repression issues or some other crap and delay you even more
such is the world of the insane
jessica

[rejennyrated]

I feel for you Sarah. <<<hugs>>>

Wouldn't it be nice if someone could come up with a proper diagnostic test for this which didn't rely on perpetual delays and driving the genuine cases to the edge of suicide (and sometimes beyond it) just to weed out those on the wrong track.

It feels like they are punishing the innocent to weed out the guilty and it makes me mad every time I hear another example.

I know some may disagree but frankly I have thought, since my own treatment decades ago, that the Benjamin rules are barbaric outdated and frankly it's sign of just how poorly medically served we are that in all that time no one has come up with a better treatment and diagnosis protocol.

Come on medical researchers - where are you on this? It's been three decades since I went through and if anything things have got worse!

[Luna!]

To the title question?
As many as it takes to get that lightbulb in there. Oh, and I suppose one more to actually guard the gate.
(Sorry, I couldn't help it...  ^_^)

Seriously though? Ideally, you'd only need one, to keep out the occasional crazies/idiots, and the others would all take their word for it that you're not either of these. But that would require this person to actually know what they're doing, and care about your welfare as opposed to getting paid, which both appear to be quite rare. Potential lawsuits don't help, either.

So many letters. Do they feel no guilt for the forests they're obliterating?..

[Naturally Blonde]

Again, more gatekeepers hell bent on making me jump through hoops!!! I just got a call back from the therapist who I was referred to for my second SRS letter today, and she starts saying how I'll need to see her 3-4 times before she'll write a letter!! If she's the same price as my last therapist, that's another $600...for a letter!!! Plus, that's another month and half or two more that I'll have to wait for the surgery!

It took me nine years to get a SRS referral through the NHS and even then I had to get two referrals independantly. If you think it's hard in the U.S.A try living in the U.K

[Renate]

I believe that there are three kinds of therapists for second letters.

• Those who can do it in a single session, don't know you from  Eve (or Adam) and charge a lot of money.
• Those who can do it in a single session, can vouch for your first therapist personally and charge a medium price.
• Those who "want to get to know you" and require multiple sessions.

When presented with a full set of choices you need a computer spreadsheet to evaluate
all the costs (including travel) to determine which is the cheapest.

[Just Kate]

I feel for you Sarah. <<<hugs>>>

Wouldn't it be nice if someone could come up with a proper diagnostic test for this which didn't rely on perpetual delays and driving the genuine cases to the edge of suicide (and sometimes beyond it) just to weed out those on the wrong track.

It feels like they are punishing the innocent to weed out the guilty and it makes me mad every time I hear another example.

I know some may disagree but frankly I have thought, since my own treatment decades ago, that the Benjamin rules are barbaric outdated and frankly it's sign of just how poorly medically served we are that in all that time no one has come up with a better treatment and diagnosis protocol.

Come on medical researchers - where are you on this? It's been three decades since I went through and if anything things have got worse!

Research is being done, quite a bit of it, but the more is done the more it points toward GID being something other than what it has been popularly defined as for so many years.  This research points more and more toward GID being mental than medical.  Mental problems necessitate mental health solutions which may sometimes include medical intervention.  We are a long way off from this being termed exclusively a medical diagnosis (perhaps though because it rightfully isn't, but more research is needed).  Until then, because consensus cannot be reached, we will continue to need 'gatekeepers.'  The more honest trans people are generally with their therapists, communities, and most importantly themselves, the more likely better treatment processes will arrive, but so many of us feel the need to perpetuate a the image of a prototypical TS to the outside world (when it doesn't totally describe us), that it is no wonder the mental/medical community is suspicious.  My eyes about roll out of my head when I hear the standard trans story considering how many I've met in real life who have admitted otherwise to non-gatekeepers.  I cannot imagine how hard it must be for a gender therapist/psychologist who actually has to wade through all these standard stories and half-truths at the risk of lawsuit.

[rejennyrated]

This research points more and more toward GID being mental than medical. 

We must be reading different research papers then because the last three I have read all point to minute gene faults on certain chromasomes. One was pointing to an epigenetic effect and the other two were faults relating to the way that neural development was moderated by testosterone - in effect they were suggesting it was like a rather specialised variant of androgen insensitivity - which is a medical condition that I have anyway.

From memory one of the researche papers was from Prince Henry Instutute in Australia, one from a UK research group and I can't recall where the other was but I'm pretty sure it was Europe somewhere.

Admittedly the research I'm talking about was only published in 2008/2009 and probably hasn't been fully replicated yet - but I was under the impression, and I have read the actual papers not some news digest, that it was becomming pretty darned clear that in many cases it was indeed medical. I was certainly convinced by what I read anyway.

EDIT:

Just so you don't think I'm making that up I found this example:http://shb-info.org/id37.html

It isn't any of the ones I was thinking about - but it is a similar result.

[juliekins]

Again, more gatekeepers hell bent on making me jump through hoops!!! I just got a call back from the therapist who I was referred to for my second SRS letter today, and she starts saying how I'll need to see her 3-4 times before she'll write a letter!! If she's the same price as my last therapist, that's another $600...for a letter!!! Plus, that's another month and half or two more that I'll have to wait for the surgery!

Sarah, I don't know if you are anywhere near Chicago, but Dr. Randi Ettner, who is a psychiatrist, will see you for an hour and then send you an evaluation letter which should contain your "medical necessity and approved for GRS". If you can't find her phone #, then pm me, and I will see what I can find. I think your appt with her with letter will be in the $250 range. I know it's not what you want to hear, but it may work out for you. Maybe you can Skype or Yahoo video mail her, and do the appt that way?

[tekla]

minute gene faults on certain chromosomes

First of all, because its very important to stress - there are no 'faults' as such in the DNA/RNA assemblage.  In so far as we know, there are only mathematical variations that occur.  "Fault" implies some sort of values-based judgment, where the natural order provides no such assessment.  Nature has no good or bad only a probability of occurrence.

But, back to the quote:  I think in the end everything is going to come down to this, or living world (bacteria, viruses).  The DNA code, if not setting up exact specifications, at least pushes the odds in one way or the other.  In other words, DNA does not make one a TS, but certain DNA configurations make it more (less) likely that the person may well develop in that manner.

In that way, it may become much harder to point to a difference between mental and medical in the future.  It will be much more of a matter between DNA factors or and outside/invasive forces (injury, infection, flu).

I used to tease my Xian students there at the Super Huge State University of Science and Technology about their protests of Darwin being two major scientific advances behind other things that they would like even less.  Those being advanced physics, and DNA.  Now that advanced physics thing, forget about it, they couldn't read Darwin correctly (and Darwin wrote very well) I'm such not going to start handing out Einstein, Planck, and Heisenberg to them.  (Much less Chaos stuff)  But DNA, that's very interesting, because what happens if it turns out that so much of what we think is 'choice' and 'free will' (thereby a 'sin' or a 'not sin') turns out to be pretty much encoded into us? (By god itself, who else in their world view could possibility code DNA?, Matter of fact - currently painting themselves into a corner - the fundys here in the States use DNA as proof of "intelligent design'.) Hummm... 

So what happens when most of this turns out to be - not a birth defect - but a birth variation?  Then what happens when we find out how to control it? (Or at least gain the illusion of control over it).

[rejennyrated]

minute gene faults on certain chromosomes

First of all, because its very important to stress - there are no 'faults' as such in the DNA/RNA assemblage.  In so far as we know, there are only mathematical variations that occur.  "Fault" implies some sort of values-based judgment, where the natural order provides no such assessment.  Nature has no good or bad only a probability of occurrence.

But, back to the quote:  I think in the end everything is going to come down to this, or living world (bacteria, viruses).  The DNA code, if not setting up exact specifications, at least pushes the odds in one way or the other.  In other words, DNA does not make one a TS, but certain DNA configurations make it more (less) likely that the person may well develop in that manner.

In that way, it may become much harder to point to a difference between mental and medical in the future.  It will be much more of a matter between DNA factors or and outside/invasive forces (injury, infection, flu).

I used to tease my Xian students there at the Super Huge State University of Science and Technology about their protests of Darwin being two major scientific advances behind other things that they would like even less.  Those being advanced physics, and DNA.  Now that advanced physics thing, forget about it, they couldn't read Darwin correctly (and Darwin wrote very well) I'm such not going to start handing out Einstein, Planck, and Heisenberg to them.  (Much less Chaos stuff)  But DNA, that's very interesting, because what happens if it turns out that so much of what we think is 'choice' and 'free will' (thereby a 'sin' or a 'not sin') turns out to be pretty much encoded into us? (By god itself, who else in their world view could possibility code DNA?, Matter of fact - currently painting themselves into a corner - the fundys here in the States use DNA as proof of "intelligent design'.) Hummm... 

So what happens when most of this turns out to be - not a birth defect - but a birth variation?  Then what happens when we find out how to control it? (Or at least gain the illusion of control over it).

Ok yes - I'l buy that line of reasoning... I'll also apologise for slightly oversimplifying the argument because you are of course absolutely correct in what you say, a gene variation represents a predisposition and not a certainty.

So yeah - I would agree it is a bit of both - nature AND nurture. Point is, by logical reasoning, if you present with the symptom AND you have the gene variation then it is making the case more easy to prove that you may indeed be suffering from the condition.

Now the point where, of course InterAlia can justifiably come back at me is that just because you have the condition it doesent automatically follow that transition and SRS is the right solution for you!

So it is complex area - but what a medical "test" might allow for is a greater degree of flexibilty of approach - rather than the one size fits all that we seem to have at the moment.

[tekla]

of course InterAlia can justifiably come back at me is that just because you have the condition it doesent automatically follow that transition and SRS is the right solution for you!

It's easy for Interalia to do that, because, largely he is correct in that determination.  I can look at your picture, and you could look at mine, and we'd both know that here are two people with a complete and utter understanding that not only does one size not fit all, it might not even fit most.

What I see here, in the all the people I have known in my life with a variation in not just the degrees of GID or whatever you want to call it - I prefer 'gender variance' but that's just me - but in the texture also.  What has turned out to be the 'right' choice for some, is not the best way for others.