Progression Check

[Kaori]

I would like advice and perhaps clarification on a situation I am currently in, if anyone can offer.

In June of this year my Endocrinologist set up an appointment for me with a Urologist.  I told my therapist about this and he said "Let me know how it goes and what the Urologist recommends."

Everything went smooth with the Urologist.  I set up a date, location and agreed on an incision point with him.

4 days before my scheduled 'orchi', I had my next therapy session.  I explained that the consultation went well and both of my Doctors were fine with it.  And at that point my therapist mood changed to... slight disappointment?  Maybe just uncertainty?  For the last few minutes of our session, I could tell that he was concerned about this surgery being done so soon.

The next day I received 3 phone calls at work.  To spare the details, the day ended with my therapist postponing my 'orchi' for an uncertain amount of time due to his interpretation of the SOC.

I was crushed.  I left work an emotional wreck and went home and cried for hours.  I almost felt betrayed.

I lived.  The next day, I chalked it up to lack of communication.  The next session with my therapist, he explained to me that I had to wait for a year after starting my RLE before he would 'sign off' on me getting my 'orchi' because of the SOC.

Great... so does he have the authority to deny me of this medical service even though docs had offered to go through with it?  I gather that he does, from my experience with it and according to the paperwork and agreement between him and my medical doctor.

And following the SOC guidelines in the strictest sense, I can see (after this episode) that I could be make to wait for RLE not just for SRS but also for 'Orchi.'

My problem with this, is that I have read many instances of people NOT having to wait in this exact way.  SRS, yeah... I have no problem there.  I don't know of any reputable Doctor personally that would schedule one before 12 months of RLE.  But for 'orchi' and mastectomy, it seems that many people have only had to wait 6 months or some other variation, less than required of me by my therapist.

That is my first issue.  The second is that I went to a gender specialist in another city, as a preliminary screening to see my new Endocrinologist (my previous one went to work for the VA so I can not see him as a patient under my insurance, and there are no other local Endocrinologists here that will administer HRT for me).

While talking to this gender specialist (therapist),  when I answered how soon I hoped to have SRS, he stated that my letter of recommendation would have to come from someone qualified like him... as opposed to my current general therapist.  After I told him of my plans to move in about six months, he said then I will probably want to seek the services of, and eventually an SRS letter, from the new gender specialist I see at my new location.

Ugh... so this past year I spent with my 'general therapist' isn't going to count toward either of my recommendation letters?  Or perhaps he would be able to be the "second opinion" letter writer/recommender thingy person?

I hope that all makes sense.

In hind sight, my therapist is very close with the LGBT community and college campus here.  Though he admittedly is not a "gender specialist", he has been a pretty good therapist.  And he's done quite a bit of 'homework' not only with me, but a few other trans people here to help out however he can.  So besides the one day I felt like throwing his office couch pillows and then shooting staples at him (the light, thin kind)... he's been nothing but supportive and positive.

I just want to make sure I'm going at the right pace here, and not being held up by a lack of communication or qualifications, etc.

[lilacwoman]

I'm in exactly the same situation but more stupider...basically the problem is that those guys are crazy about their danglies and can only think you are crazy to want to lose yours.
In my case I was fully 3 years RLE and had to have the left undescended out as it looked to have ashadow round it and could be turning cancerous...I asked to have the right one off at the same time but surgeon refused because the shrink ahd told him not to!
I'm still trying to get soem legal redress over this but no joy beacuse the testicles mafia is against me..
Hang on until the year is out is your only hope.


Post Merge: December 14, 2009, 04:13:03 AM
I know of others who are getting SRS treatmnet funded by VA so why you can't may just be due to some '->-bleeped-<--hater' blocking things.

The shrink is wronga s the letters can come from therapitss anywhere.. Find another one.

[placeholdername]

I'm no expert on the SOC, but it seems your general therapist isn't either.  He's not a gender therapist, and despite his 'doing his homework' I don't think he really understands and I do think it is getting in the way of you getting proper treatment.  I personally can't vouch for what 'proper treatment' is, but what I do recommend is that you see an actual gender therapist who has experience with SRS/related letters and get a better opinion on it.

From what I DO know, you don't have to have all the required therapy time with one therapist, but if you do switch therapists the latter one might require that you seem them for some amount of time (not necessarily the full required time) so that they can get their own sense of your situation, in addition to whatever information they get from your previous therapist.  So no, you shouldn't have to start over, but make sure to ask your prospective new therapist about it before you start.

[Kaori]

Thank you very much for your replies and advice.

And lilacwoman: I'm sorry to hear about your experience with this, I think your situation would be even more frustrating to deal with.  I hope things work out good for you soon!

Looking back over my original post, it seems I edited out an extra paragraph while proof-reading.  My timeline is all amiss.  For clarities sake:

At the time of my previously scheduled 'orchi', I had been seeing my therapist for over 8 months.  I had only been on HRT for close to 2 months.

I understood the SOC as far as SRS, I just didn't think you had to wait the same amount of time for orchi and mastectomy.  And from many stories that I have heard, orchi/mastectomy is given out to some folks in much less time than 12 months of RLE.

With this clarified by my general therapist, I'm cool with waiting for 12 months of RLE.  I just think there was a lack of communication on his part...
I mean, he knew I had an orchi consultation in a couple weeks.  What did he expect, that I would go for the consult and then say "Thank you - I'll see you in a year Mr. Orchi Doc!"

Anyway, I'll take the advice given and continue seeing my new gender specialist.  It sounds like that's the much better route to go.  Thanks again.

[Sandy]

As my therapist put it, who is a gender specialist, the guidelines are just that, "guidelines".  They are not rules.  They can be applied in a flexible manner.

They are a method by which the therapist can judge how the client is adjusting to the issues of transition.  RLE is the most difficult part of transition.  Coming out to friends and family, being socially active and having a legal name change to a gender appropriate name are the most daunting aspects to becoming your target gender.  But they are all reversible.

The point of the WPATH SOC guidelines are generally to allow the client to put off the medically irreversible steps as long as possible to allow them to contemplate and adjust to their new position in society.

If you are already living FT in your chosen gender role and have been for some time, your new therapist may very well agree with you and not require you to spend additional time with them before giving you the go ahead for the orchi.

-Sandy

[Janet_Girl]

Ditto with what Sandy said.



Hugs and Love
Janet

[Naturally Blonde]

I would like advice and perhaps clarification on a situation I am currently in, if anyone can offer.

In June of this year my Endocrinologist set up an appointment for me with a Urologist.  I told my therapist about this and he said "Let me know how it goes and what the Urologist recommends."

Everything went smooth with the Urologist.  I set up a date, location and agreed on an incision point with him.

4 days before my scheduled 'orchi', I had my next therapy session.  I explained that the consultation went well and both of my Doctors were fine with it.  And at that point my therapist mood changed to... slight disappointment?  Maybe just uncertainty?  For the last few minutes of our session, I could tell that he was concerned about this surgery being done so soon.

The next day I received 3 phone calls at work.  To spare the details, the day ended with my therapist postponing my 'orchi' for an uncertain amount of time due to his interpretation of the SOC.

I was crushed.  I left work an emotional wreck and went home and cried for hours.  I almost felt betrayed.

I lived.  The next day, I chalked it up to lack of communication.  The next session with my therapist, he explained to me that I had to wait for a year after starting my RLE before he would 'sign off' on me getting my 'orchi' because of the SOC.

Great... so does he have the authority to deny me of this medical service even though docs had offered to go through with it?  I gather that he does, from my experience with it and according to the paperwork and agreement between him and my medical doctor.

And following the SOC guidelines in the strictest sense, I can see (after this episode) that I could be make to wait for RLE not just for SRS but also for 'Orchi.'

My problem with this, is that I have read many instances of people NOT having to wait in this exact way.  SRS, yeah... I have no problem there.  I don't know of any reputable Doctor personally that would schedule one before 12 months of RLE.  But for 'orchi' and mastectomy, it seems that many people have only had to wait 6 months or some other variation, less than required of me by my therapist.

That is my first issue.  The second is that I went to a gender specialist in another city, as a preliminary screening to see my new Endocrinologist (my previous one went to work for the VA so I can not see him as a patient under my insurance, and there are no other local Endocrinologists here that will administer HRT for me).

While talking to this gender specialist (therapist),  when I answered how soon I hoped to have SRS, he stated that my letter of recommendation would have to come from someone qualified like him... as opposed to my current general therapist.  After I told him of my plans to move in about six months, he said then I will probably want to seek the services of, and eventually an SRS letter, from the new gender specialist I see at my new location.

Ugh... so this past year I spent with my 'general therapist' isn't going to count toward either of my recommendation letters?  Or perhaps he would be able to be the "second opinion" letter writer/recommender thingy person?

I hope that all makes sense.

In hind sight, my therapist is very close with the LGBT community and college campus here.  Though he admittedly is not a "gender specialist", he has been a pretty good therapist.  And he's done quite a bit of 'homework' not only with me, but a few other trans people here to help out however he can.  So besides the one day I felt like throwing his office couch pillows and then shooting staples at him (the light, thin kind)... he's been nothing but supportive and positive.

I just want to make sure I'm going at the right pace here, and not being held up by a lack of communication or qualifications, etc.

Try living in the U.K where you can wait years and years! the timescale here is unbelievable and I had 7 years of RLT before I got a referral, let alone any consideration of surgery.

[Kaori]

Try living in the U.K where you can wait years and years! the timescale here is unbelievable and I had 7 years of RLT before I got a referral, let alone any consideration of surgery.

Oh my, I shall count my blessings then.  I never realized.

@Sandy: I value your input.  Very sound.

[sarahF]

I also agree with Sandy. SOC is not law.the guidelines should be flexible Find the a therapist that will help you
Sarah

[Ms.Behavin]

The 12 month thing has crepted into the mind set of therapists.  The SOC does not set a timeline but leaves it open to interpatation.  I had to wait a year for SRS even though I would have been fine with it asap.  Gee I would have been fine with it when I was 13. 

Sometimes you just have to work within the system.  Though  with spiro it pretty much blocks most of the t anyway. 

Sorry for the disapointment. but your day will come.

Beni

[Alyssa M.]

Try living in the U.K where you can wait years and years! the timescale here is unbelievable and I had 7 years of RLT before I got a referral, let alone any consideration of surgery.

But then, we get to pay for it out of pocket. America is a garden of Eden, a paradise to live in or see; but believe it or not, you won't find it so hot if you ain't got the do re mi.

[LordKAT]

my therapist is gender specialist. 4 months hrt for mastectomy

[Miniar]

You could request that your current therapist write a letter to your new one explaining/detailing your therapy so far, what you've done, and where you've gotten, in an attempt to make sure your new one doesn't start you off back at the beginning, which he/she probably wouldn't anyway if he/she knows how much work you've put in already, but it may solidify that.
just a thought..

[Renate]

You can substantiate one year RLE even if you have not been been with your current therapist a year.
It requires some incontrovertible proof, such as name change (best) or letters from your employer or school.
Saying that you go to the mall sometimes in women's jeans does not qualify.

[Naturally Blonde]

But then, we get to pay for it out of pocket. America is a garden of Eden, a paradise to live in or see; but believe it or not, you won't find it so hot if you ain't got the do re mi.

Unfortunitely, I suppose that's the assumption people have outside the U.K that we get everything on a plate for free?

We pay very high taxes to fund our NHS health service and it is paid for by the tax payer (us). But in my own particular case I have not recieved any NHS treatment. I have already paid out a lot of money for my private treatment including psychiatrists to start on HRT in 2003 and Laser at £200 per session. I have also have had private psychiatrists for my referrals. I am amazed that outsiders to the U.K assume we are all NHS and that the NHS greets people with gender dysphoria with open arms. In fact it's the complete opposite. I was unfortunite to be mislead by my GP at the start of my transition to originally go down the NHS route which was a big mistake and it did consist of time wasters which lead me to seek private treatment in the end.

[Alyssa M.]

I'm confused. Are you saying that you experienced long waits when you got treatment outside the NHS? All the complaints I've heard from the U.K. about long waits have been with regard to the NHS. Did private therapists also drag their feet also?

Also, I wasn't talking about taxes. Or insurance premiums, for that matter, which are really, really high. I was talking only about out-of-pocket expenses, i.e., expenses beyond taxes or premiums. There's no option for most people in the U.S. to get any insurance coverage for transition costs no matter how long they wait, which puts surgury out of the reach entirely for a lot of people.

I'm not trying to get in some argument over who has it worse; I'm just saying there are tradeoffs, and though you say, "Try living in the U.K.," if you lived here you'd likely say, "Try living in the U.S." Either way, it's a hell of a lot better than Uganda.

[sarahF]

Beni I wish we all could have the choice at alot younger age.
As for living in the US or UK You pay through taxes, Mandatory
medical insurance voluntary.
Sarah

[Suzy]

I am still watching the mail for my Progression Check.  Hope it comes soon, I am a little short this month.

Kristi

[LordKAT]

I am still watching the mail for my Progression Check.  Hope it comes soon, I am a little short this month.

Me too.

[cutejanessa]

see I am wondering how I got as far as I have in my transition. I have had never sought therepy nor have I ever gotten any letters to continue forward with my transition. But I have gotten breast implants, started on HRT 6 months ago and have FFS appointments set here in a few months...none of the doctors had asked for any kind of documentation. WTF?