How many gatekeepers do we need...?

[sarahb]

Ugh, how many people should there really be in the way of us just being who we are?

There's the SRS surgeon who demands the SOC be followed, which requires being full time for at least 12 months, a letter from the endo prescribing HRT, which requires a letter of recommendation from a therapist, which requires at least 3 months of therapy before handing out. Then, for some reason they require a second letter of recommendation from a different therapist, in a different field of therapy. Then there's just getting to the surgeon, which requires a passport, which requires me to update the name on the passport to match my ID, which requires me to update my birth certificate, which requires me to go to court to change my name legally, which requires me to list the name change decree in a newspaper for 4 weeks and wait...

...all of which costs thousands of dollars in total. Darn, I wish it could be as easy to get SRS as is was to get FFS. For FFS all I needed was money, there was nobody standing in my way, and no stupid rules to follow.

It's bitter-sweet, I have managed to find the means to get SRS done by March, but before I can make the appointment he requires 3 letters of recommendation, 2 from therapists and 1 from the endo who is prescribing HRT (never heard of this stupid rule before!). My therapist has said she will write the letter, but needs me to first get back with an endo so she can reference the endo in the letter. So now I have to wait until December 1st until they have an opening, which means I won't be able to get the letters for probably at least another month! The longer it takes to get the letters, the later I'll have to make the surgery appointment.

It sucks when everything is ready to go, I have confirmation from the therapist that I can get the letters, I have the down payment, but I have to continue to wait for this and that to fulfill the demands set by people who have no clue how hard it is to continue waiting after doing so for far too long already!

I want to scream.


AHHHHHHHHHHHHHHHHHHHHHHHHHHH!!!!!


...ok, I feel a bit better now, but it's still ridiculous what we have to go through.


~Sarah

[Bellaon7]

I feel you. I byassed the little ones when neccissarry(I don't really like consonents this much, but got redenned for ignoring them in the past). Srs solves(many, or most) legal issues point blank. I suspect soc as a buffer against malpractice at it's most innocent. If I have the $ together, I can get through the gates. I don't need to bs a bs'r.You have to know what people want to hear before trying to tell them what they want to hear. Would you turn out the lights & take take a plugged in toaster apart in the dark & go pokein' around in there with a butter knife? Dr's=no problemo, $=I am so screwed!

[deviousxen]

It'd be nice to have gatekeepers in ANY of this world that weren't as equally stupid as the person passing through it...

[Flan]

*hugz*
I hear 'ya (and this from after I got a hrt letter not to long ago, which is amusing for the fact that the clinic I go to rx'ed me meds without a letter making me wonder what the point was, but I digress)

In an ideal world, grs would be treated like any other surgery of non emergency nature where the patient would get a quick test that they have their head screwed on right, have realistic expectations about the outcome, and understand the potential complications. (and of course ability to pay or have it covered by insurance)

Unfortunately, in the world I'm stuck in, there are those who aren't sure of their identity or otherwise aren't looking at genital surgery for the right reasons. (either by confusing gender role and/or expression with identity, or a mental health issue causing delusional thinking)

While I get the need for making sure that people who want genital surgery are sure of identity, and psychologically ready, making the process of surgery and social integration shouldn't have to be an endurance race or a litmus test of being ->-bleeped-<- enough (or at least able to bs it) to get the letters.

While there are those who will get surgery who shouldn't, the current 2 letters system does nothing to address those unable to go through the so called proper channels all the way through transition. There is alot of DIY hormone use out there, and people with no access to either a qualified therapist/psychologist/psychiatrist, or one they can't afford to see regularly.

My *ideal* (requirements for hrt and surgery) would be simply 1 letter of recommendation from a qualified therapist/psychologist/psychiatrist (no rubber stampers) based upon 3 months of sessions to obtain medical services. The rest would be informed consent based on the stable mental health of the patient.

I can only dream until then, and in the mean time do what I can to inform others of the process so they too can do their own version of informed consent.

[K8]

I'm sure you know, Sarah, that this process is laid out in this way for several legitimate reasons.  The gatekeepers of course want some legal protection against suits but probably each of them wants to feel like they are doing the right thing. 

Since SRS is irreversible, everyone involved wants to be sure this is the right thing to do.  How do they know that, if the only way they can find out is for you to tell them?  Well, of course you can tell them anything, hence the problem.

Another element in this, of course, is that changing from one social gender to another is very complex and your body parts are only one small piece of a much larger puzzle.

Changing my name and IDs was pain-free.  It cost money and was a hassle, but otherwise no big deal.  But the medical steps need some assurance this isn't something you just woke up one morning feeling a little off and decided would be fun.

(In the begining I told several people that at first I couldn't decide whether to clean my garage or become a woman, but had finally decided to become a woman.  They all saw the silliness of this.)

But of course you know all this Sarah, don't you?  You just want to complain.  Bitch away, girl.  And good luck with your journey to wholeness.

- Kate

[Asfsd4214]

Changing my name and IDs was pain-free.  It cost money and was a hassle, but otherwise no big deal.  But the medical steps need some assurance this isn't something you just woke up one morning feeling a little off and decided would be fun.

You know, I've heard that argument quite a few times, my doctor even brought it up. But I've been wondering. Has that EVER actually happened?

I know people with other psychological issues have mistakenly undergone transition only to end up with genuine gender dysphoria as a result. But has anyone, anywhere, ever transitioned purely because they thought it would be something interesting to try? I just can't see any mentally competent person, male or female, ever thinking that. And if they're mentally incompetent, then what you're really doing is keeping mentally incompetent people from access to life altering surgery, so why isn't that the example?

I know comments of "we need to protect people who might just decide "i wonder what it's like being the opposite sex"" are for the most part not serious suggestions that are meant to be taken literally. But I've always found it a rather odd way to make the point. Has it EVER actually happened?

I just find it strange because I can't see anyone, for any reason, perusing transition on a whim. Mentally competent or not. But all too often medical professionals seem to seriously propose that they need to protect such people.

Personally, I'm pretty individualist, I don't believe in the massive bureaucracy "protecting people from themselves". I think all it does is function marginally if at all at actually protecting vulnerable people, but all too often hinders people who know what they're doing.

I for one often feel like screaming out to medical professionals "please for the love of god stop trying to save me!"

It doesn't help that I've had a run of bad doctors who feel the need to treat me as a personification of GID rather than an actual person who might in fact already have an educated and informed view of what she wants.

[DamagedChris]

There have actually been cases where people after GRS regret their decision, and a couple have even tried detransition after surgery...I remember hearing about this one MtF that hastily had surgery, decided after the fact he was a he after all, and spent a lot of money more trying to correct the damage he had done to his own body. Then went all gung-ho to the press about how horrible and deluded real transsexuals were and that this shouldn't be a legal procedure.

So in a way, I'm glad that some of the hoops are in place...the RLT/HRT time especially. Because some people might not pass in a way that will allow them to carry on as normal bio-men/women would, and should see the public feedback they will get before the big jump and they get stuck in a situation that is not what they had planned for. And as Kate said, helps weed out the nutters that just jumped out of bed, spun the roulette wheel and said "oh, looks like I should become a woman today".

That said, I wish there were easier treatments and routes available for those that can't afford to keep up therapy + HRT + regular docs visits, etc etc etc.

[jesse]

you would think that the sheer cost of transitioning would prevent people from doing it on a whim really i mean who blows 60000 or more just to expierment so it would seem the rules are to prevent the insane from harming themselfs and legitamate GID people are caught in the web as well
jessica

[taru]

you would think that the sheer cost of transitioning would prevent people from doing it on a whim really i mean who blows 60000 or more just to expierment so it would seem the rules are to prevent the insane from harming themselfs and legitamate GID people are caught in the web as well

But insane people do get referrals. It just slows everyone down and hands money to the medical profession.

[lpfix2009]

*** loves living in Ontario Canada

[jesse]

*** loves living in Ontario Canada

wonder if i can become a canadian lol

[K8]

I think if I was a surgeon, I would want some assurance that I was doing what was needed before performing irreversible surgery that would alter every aspect of someone's life forever.  Since, as a surgeon, I would not be qualified to determine the emotional and psychological needs of the patient, I would want someone else to evaluate the patient for me and give me the go-ahead.

As a patient, I want to make very sure that a) this is what I want, and b) I will be able to live my life successfully in this very different social role before taking a step that will change my life forever and from which I will not be able to return.

- Kate

[Renate]

Don't kid yourself, gatekeeping never ends.
There's always another hoop to jump through.

[jesse]

quite frankly i think and this might sound anti social or crazy that if you go into this on a whim or w/o a care about the results then you get what you deserve
i have yet to meet a transperson who wasnt well educated on whats going on what the effects of hrt is what reasonable expectations can be achieved any loss suit generated by someone who says he shouldnt have been given srs or grs or even ffs because he wasnt really aflicted with gid should be thrown out of court. Just saving the amount of money required for the procedures indicates competant decision and goal setting thinking so im sorry i have to advocate personal responcibility i think they should reduce requirements to a signature on an informed consent form and be done with I.E. you are aware that this surgery is irriversable : answer yes okies you get what you ask for...end of story this is just anouther way for the american society to protect the stupid from themselfs ie dont drink on a bottle of draino ......really you think ...
jessica

[juliekins]

I've got two observations about this. First of all, I have learned that our beloved American legal system is set up to preserve billable hours and fees charged by their fellow lawyers to us stuck in the system. Here in the states, it is difficult to do anything and get a fair trial in front of a judge who is also a lawyer. The analogy extends to SRS and our psychology profession. We have to be in therapy for x number of months to get our HRT letter, which another doctor will charge me for an evaluation as to my health to take meds. During my RLE, I'm still seeing my shrink and checking in from time to time to let him or her know about things. (at over $100/hr) I want my SRS letter, so I'm going to play by the rules. I then have to pay again for my first SRS letter, then schedule time with a second psychiatrist for more evaluation and a letter request costing me hundreds more.

There is a cottage industry involving the care of people with GID that is necessitated by the fact the our medical condition is still listed in the DSM. If you look into the history of us getting put there, it was after the likes of kooks like Dr. Paul McHugh who called us psychotic. He was one of the people who shut down the John's Hopkins hospital program for TG patients. He was also a religious zealot with an agenda. Once these programs shut down, we went to the 'pay for play' gender transition business run by the psychologists and surgeons just looking to cover their butt. I'm not saying that the old gender clinic era was the best, since only 15% of applicants got approved for surgery based on ridiculous standards.

It is amazing to me that I can walk into a plastic surgeon's office and get complete FFS or Breast augmentation without a letter. These are much more visible signs of feminization to the public at large, and in the case of FFS, equally permanent.  Again, I blame this on GID being included in the DSM manual as a psychiatric disorder. I don't think that there should be the gatekeeper function to the degree there is today. For many individuals, the costs are prohibitively expensive and puts GRS out of the reach of too many people. 

[K8]

Maybe I'm stupid.  I am old and still tend to be naïve.  I was in the military for a long time and am used to taking sensible orders and refusing insensible ones.  I follow direction well.  (I had a lover say that to me, but it sounded like a good thing at the time. )

I see the gatekeeping as helpful to me as I struggle through this.  This is not like buying a car or picking up a puppy at the shelter.  This is my life.  I want help along the way.  I want some validation that this is, indeed, something I should be doing.

I've done a lot of crazy things in my life.  There were a few times it would have been helpful to check with someone before I did them.  GRS is a BIG deal.

But each of us is different.  And part of the gatekeeping is a carry-over from days when transition was less socially acceptable and assimilation much more difficult.

For me, I cherish this year between starting RLE and my surgery.  I don't expect to do this again.  I'm having the time of my life.  I will be glad and eager to get the surgery, but I want to savor every moment of the work and anticipation to get there.

But, as always, YMMV.

- Kate

[Laura91]

Well, while it can be annoying I think that it makes sense to have the SOC and therapists in place. It wouldn't be very smart to rubber stamp any and all people that come in requesting HRT and surgery. Even though there a lot of people that are 100% sure of what they want there is always going to a few that have no idea about what they really want (i.e. someone that would transition from MtF and then transition back to where they were before). It's just a fact of life that there are going to be some hoops to jump through in this process and that's just the way that it has to be.

[Keroppi]

You know, I've heard that argument quite a few times, my doctor even brought it up. But I've been wondering. Has that EVER actually happened?

Well, I found this page early on. *shrug*

[K8]

There is a cottage industry involving the care of people with GID that is necessitated by the fact the our medical condition is still listed in the DSM. If you look into the history of us getting put there, it was after the likes of kooks like Dr. Paul McHugh who called us psychotic. He was one of the people who shut down the John's Hopkins hospital program for TG patients. He was also a religious zealot with an agenda. Once these programs shut down, we went to the 'pay for play' gender transition business run by the psychologists and surgeons just looking to cover their butt. I'm not saying that the old gender clinic era was the best, since only 15% of applicants got approved for surgery based on ridiculous standards.

Just a little off-subject here, but I thought the university-based clinics shut down because they were there to do research and at some point stopped being helpful to their patients.  That was my experience with Johns Hopkins.  I'll have to read about Dr. McHugh.

When I went to JH in '96, they couldn't figure out why I was there.  I had a good job and a stable marriage.  I wasn't on drugs or abusing alcohol.  I wasn't in jail or suicidal.  What was my problem?  I was just a normal person with GID.  They weren't interested.

They did a lot of useful work in the beginning, but my impression was that they outlived their usefulness.

And now, back to our regularly scheduled thread...

- Kate

[Sandy]

(In the begining I told several people that at first I couldn't decide whether to clean my garage or become a woman, but had finally decided to become a woman.  They all saw the silliness of this.)

- Kate

{hijack}
I was told that my transition was a stupid excuse to get out of a marriage.  It seemed rather harsh...   
{/hijack}

-Sandy