RLT - Is it a reasonable safe guard or a needless obsticle?

[stephanie_craxford]

I might be wrong about this.  But I thought in Thailand you can get the operation with only a doctor consultation?  They make the call there and then?

Yeah... it means going to Thailand for the op.  But it does make it available without all the hoops if you are truly desperate?

Annie is right although each clinic follows the SOC each has their own list of prerequisites based on the Standards they require their patients to follow before permitting surgery.  I imagine there are chop shops out there that will perform the same service without the patient following the SOC but I believe that you would need to be "Truly desperate" to risk those.  Being "Truly desperate" can lead to acts of desperation, which can lead to mistakes and regret.

Steph

[Terri-Gene]

I think you got it a little confused Erica.  All the decent docs in thailand require the letters from your shrink the same as any doctors in america/canada do.  Same stuff, just a lot cheaper.  Most of them can put you through thier own psychs there though if you lack what you need.

Take it from the not so humble though, if you can't make it through RLT, you will be dead meat if you had SRS and went from there.  Just the simple opinion of one who walks through a lot of stuff most won't come close to.

Personally it's all about as hard to get through as your mood this morning.

Terri

[Kimberly]

Bumping up to my own RLE (or started already? ^*shrug*) I find there are just too damn many layers. RLE tends to help strip some away and make us realize a few things, I think.

The extents that are wanted, however, I think are unnecessary. By and large we are not a dense group.

...
Or are we simply a cash cow?
...

^*chortle* Well, what do you think? ^*wink*

[jan c]

thank you again for a good thread, Stephanie.
I was thinking hard about this very thing. Like Teri Anne, I am a Libertarian about some things (and a complete pinko about others), this being one. Individual is ultimately responsible, ya pays yer money, ya takes yer chances.

What is a Real-Life Test for me? I do not pretend to be other than I am. Because I am an artist, I don't function in any typical way in society anyway. Working and living as a woman? I am, have been all year. I need to prove this to 'the gatekeepers' to complete this journey: this involves some strenuous hoops to be jumped through, which are (understandably, in a completely pragmatic cost-to-benefit ratio for the surgeons and ultimately the society they must function in) in place to protect people from themselves.
Re: these hoops. The changes I am going through, some days I will be perceived the one way, some days this is not possible, clearly male by default - the effects of the 'booster shots' they gave me to ensure that puberty went according to outward genitalia are undeniable. Until I can afford and complete electrolysis for instance, acceptance as strictly female by anyone but the MOST enlightened and sensitive individuals, is a joke. (Despite the existence, and cafe ownership, of Bearded Ladies in SF.)
I am not a Believer. I do not have Faith in doctors, or therapists, or "Professional Help". "Professional" means one thing for certain: they require being paid. Handsomely, in these professions, Drs, Therapists &c. This tends to corrupt any process.
[The person I live with is a Marriage/Family Therapist interning, soon to open his personal practice; he does not 'believe' either. There are Believers in the picture sometimes; this contrast, of an astute person that has the ability to stand back from the 'trade', versus the ones with belief and faith (who tend to be pretty messed-up btw) is quite revealing, and a source of insight for me.]
Now one of the hoops involves supposedly some 12 sessions with the approved level of therapist or shrink before HRT. It is interesting to me that the one I chose (astutely I hope) recommended me to an endo during in-take. To get Medicare (long story) to pay for 'therapy', requires a recommendation by a Doctor, so, rec. to endo for rec. back.... which when I thought about it, was stunning to me. What an opportunity, and I am confident the therapist knew just what she was doing. (I have not seen the endo, I am going through changes at a surprising rate without HRT, and figure to allow this to happen as it is, and when I go to this endo, she will be hard-pressed to deny I need help.)
The complexities of my relationship with the person I live in the house with are very indicative of the problems a woman faces, IN REAL LIFE (see my post in PMS Zone for EG). Now, maybe I should get a gig as a waitress to boot? Sure, maybe so, for my own enlightenment, what is faced by an average woman. As a test, before a Professional? Often as not, someone from an Ivory Tower background with preconceived, prescribed slots my life has always tended not to fit in the first place. Well, whatever part of this process I can subvert, I surely will.
In spite of my very slightly Libertarian positions, I will try to get the Federal Government to pay for as much of this (EG: HRT eventually) as is possible. This will almost certainly mean my compliance at some, at many stages.
ya do what ya gotta do I guess.

[Sarah Louise]

Ok after all this time I voted, not because I could honestly respond one way or the other, but my curoisity got the better of me and I wanted to see how the vote was going.

I voted yes, but I would have rather voted Not Sure.

Sarah

[stephanie_craxford]

Love your post Jan.

Just a small point though...

Now one of the hoops involves supposedly some 12 sessions with the approved level of therapist or shrink before HRT.

No where in the SOC does it state a requirement for the number of therapy sessions.  If you are being told that you will need "X" number of sessions for HRT to be prescribed they you are being milked for sure.

From the SOC:

Psychotherapy is Not an Absolute Requirement for Triadic Therapy.
Not every adult gender patient requires psychotherapy in order to proceed with hormone therapy, the real-life experience, hormones, or surgery. Individual programs vary to the extent that they perceive a need for psychotherapy. When the mental health professional's initial assessment leads to a
recommendation for psychotherapy, the clinician should specify the goals of treatment, and estimate its frequency and duration. There is no required minimum number of psychotherapy sessions prior to hormone therapy, the real-life experience, or surgery, for three reasons:

1) patients differ widely in their abilities to attain similar goals in a specified time;
2) a minimum number of sessions tends to be construed as a hurdle, which discourages the genuine opportunity for personal growth;
3) the mental health professional can be an important support to the patient throughout all phases of gender transition. Individual programs may set eligibility criteria to some minimum number of sessions or months of psychotherapy.

The mental health professional who conducts the initial evaluation need not be the psychotherapist. If members of a gender team do not do psychotherapy, the psychotherapist should be informed that a letter describing the patient's therapy might be requested so the patient can proceed with the next phase of treatment.

Check out this here: Psychotherapy for adults

Steph

[jan c]

that is interesting, Steph, considering the therapist that suggested this to me gave me the rec to the endo at intake, which she had not (will not) been paid for, a freebie (and when she will for actual sessions, will be underpaid, by Medicare, and told me 'don't worry about it we'll work something out', which boyo here (you know the one u said I oughtta pointy-toe his ass), the MFT, says I can take at her word.

Now that I look at the link more closely, thank you for that, my best guess is what she said was a test to gauge my commitment to this (she KNOWS there's no $$$ here, in fact seemed to be willing to take me on as a special case. Got Milk? (well maybe I do) Can you say 'blood from a stone'?), having noted my, ahem, independent tendency and persuasive bent came up with the endo rec as a fast track. Speaking of fast track, the MFT I live with qualifies as a "mental health professional" as of last Friday. hmmm.

[Hazumu]

Interesting question--

I think there needs to be some sort of safeguard, but does it have to be the Real Life Test, exactly as written and adhered to to-the-letter?  I think that too-strict an enforcement of the RLT can turn it into a ritual whose meaning and purpose become lost, and can also be used by misguided gatekeepers to deny as many people as possible the object of thir desire/need.

It's a little like how various groups view the criteria for dispensing welfare/social aid.  That there are people who need the assistance of welfare or some other form of institutional charity is acknowledged by most.  But there are various views on how criteria for reciving aid should be judged. 

At one end are the people who believe that no aid should be given except in the most extreme cases.  After all, if you coddle people by giving them handouts, they will have no motivation to work hard, and will become lazy.  Therefore, you make it as difficult as possible to get aid, so they will have to jump through many hoops to get it.  This will prevent those inclined to laziness and sloth from taking advantage of the system, etc., etc., etc.

At the other end of the system are those that believe that, although there may be those who wrongly take advantage of the system, it's better to allow this to happen rather than to inadvertanty prevent someone who really needs the aid from receiving it and possibly being driven to do something worse to alleviate their situation (such as stealing, or entering an abusive relationship that at least may provide living support, or,ultimately, killing onesself in order to escape the situation.)

My feeling is that a too-strict, ritualized, one-size-fits-all RLT can be as bad as having NO safeguards whatsoever.

But there needs to be something in there -- a checklist or an evaluation or something.

Also, what does it take to satisfy 'living in the gender role"?  Jeans or slacks, nice t-shirts or polo shirts, tenny-runner shoes and little or no jewlery is the de-rigeur 'uniform' for women where I work, with skirts/dresses a rarity.  Do I get penalized on my RLT if I wear less than a pantsuit to work?  And what happens if I'm not ma'amed enough?  I'm being a little rediculous here, but I really have no clue as to where the boundaries are.  And, the devil is in the details.

In a semi-perfect world, I'd have already come out as Karen, without fear that any negative fallout might affect my financial ability to transition (in a perfect world, I'd have been born as Karen...)  However, at work they are implementing a new personnel system that 'allows managers much more flexibility in managing personnel'.  Read between the lines, they're removing the safeguards from managers making capricious, arbitrary, and unchallengeable decisions (I'm already looking for escape hatches...)  And, correct me if I'm wrong about this, but it seems that society in general is a little more accepting of a TS girl if she's post-op than if she's pre-op, all other things being equal.

Finally, I think that starting RLT too soon can do more harm than good.  Didn't a girl used to have to complete a year of RLT before starting HRT?  In fact, RLT becomes easier as HRT feminization progresses.  Thus it seems that RLT before HRT is putting the cart before the horse.

What's the answer?  I think there needs to be some sort of validation process -- a checklist, as it were -- but I don't think that RLT (as I understand it) should be the only route to the summit.

And If you feel I have a wrong impression of what RLT must entail, PLEASE correct me.  I'd rather be 'wrong' and smarter because I've been corrected than 'right' and willfully ignorant.

Karen

[BraydenKid]

Needless Obsticle

[Stephe]

I don't see how SRS or the lack thereof is somehow going to make the RLT any easier. Face it, if you have lived as your birth gender all your life, when you start living as the other gender, what's in your pants isn't going to make ANY difference unless you plan to come out in a nudist colony or spend a LOT of time in public showers. If you can't make it past that point, I can see why they wouldn't want to operate on you. Should RLT be required for HRT? Of course not but for surgery, I def think so. You can call the first year you live as a woman whatever your want but this first year pre or post op isn't going to be easy for anyone.

[janetcgtv]

Reasonable safeguard

It gives one a chance to back out if discriminated against
It tests if you can take it as the world treats you(no discrimination) just discrimination because you will be paid 60 percent of what a man gets
It also tests if you really want to live as a woman before surgery

[TaoRaven]

Isn't "Real Life" the goal anyway?? Why rush things, or force things for some "test"...when you're ready, and feel safe, it should be your choice to go "full time"....you should not be pressured into it.

Not to mention....what if I ended up being a total tom-boy who wore work boots and flannel shirts, and cut my hair short...I don't need some "professional" telling me that I don't fit their mold, and therefore have failed some test.

I AM a woman. I don't need to prove that to anyone. I live as ME, and therefore I live "as a woman". No one will or can tell me how I should live, or how I NEED to live in order to receive the health care I need.

So glad for informed consent.

[Megan Joanne]

I think a real-life test is very important (at least for the SRS because once you go down that road there's no going back - miss your balls and having errections, oh well, too late now), afterall once you head into it and know this is who you are, you're in it for the long haul. Not up for the test, well, then maybe you either just aren't ready yet (need to muster up more courage; I went through my whole teens keeping who I was hidden inside but once I was ready unleashed it all), or are there are other issues (perhaps you aren't transsexual but think you are, but merely enjoy feminine things, playing dress-up for pleasure but not really feeling like a woman inside).

My therapist told me I had to live full time as a woman for 1 year before she'd consider HRT. Okay! Very next day I was out full time and felt very liberated. But then I was already working my way up to that point for several years, a little this a little that. It was a necessary experience. Can't say it all came easy, living as a boy/guy for about 20 years of my life, I had some relearning to do, but for the other gender. Afterall, I was well past the point when behavior came naturally, everything 'male' was drilled into my head, so I had to school myself, train myself pretty much from scratch. I was essentially a little girl within the body of a man, so my early beginnings were very experimental, like I were role-playing and trying to behave like the woman that I would later become. Now, all these years later, it all comes pretty natural, aside from some flaws (remnants of manhood) I pass as a woman in looks (so long as the adam's apple don't give me away), behavior (I'm not super girly, just me), and speech (I still find myself constantly checking this though).

The one thing I don't agree on though is having to see a therapist for any of this, but that's just me, I knew what I wanted, I knew who I was inside. What came of all that therapy (several years of it)? A lot of money down the drain which could have been used for SRS (would've been about halfway there to cover the cost). What'd we talk about? Not a whole hell of a lot really since I wasn't much of a talker, just how certain events of my week went, my home life, work, ect. The whole thing just pissed me off. But, I had to do it, either that or no hormones. I got what I wanted, she got paid, even exchange, I guess. I don't need some damn letter giving me permission, like I'm a child, to do something that has to be done. This is for my well being, not anyone else's, I have to live with it, and have for a long 15 years...I think its about time for that surgery. My mom keeps saying we need to play the lottery, I don't think I could ever get that lucky so don't bother.

[Felix]

The person I was in 2006 would not be friends with the person I am now.

This question is probably a lot different for different people. As an ftm, I never saw a clear line between presenting as a woman and presenting as a man. Or maybe I personally felt a clear line, but nobody else did when they looked at me, so any external measures of whether I was living as my target gender would have been meaningless. There were major barriers to getting hormones, but how I looked and acted was never questioned. Everybody seemed to decide for themselves whether I was a "real" man (or whether I could become one), and a lot of people clearly had their opinions cemented before they met me.

I would likely have been damaged by a requirement to follow some kind of obvious-to-everyone-but-me script about gender before being allowed to medically transition. On the face of it that just looks like cruelty imposed by an in-group on an out-group.

[Jill F]

I think it should merely be a suggestion before SRS.  It's your body, and you should be able to modify it anyway you like.  I personally went full time because I wanted to, not because it was required of me.  I probably will not get the whole shebang installed until I will have been full time for over two years and know damned well what I am getting into.

At least I already have my letter in hand for when I need it.