Went to the doctor, don't really know what to think.

[Starscrash]

Around mid-December 2009 I decided to start the steps towards becoming the woman I've always felt like.  I started seeing a therapist, and notified my GP about it.
Some background on me:  I have a high functioning autism spectrum disorder, I'm tall, naturally have a decently feminine build (but with broad shoulders; ack!) and a few other things.  My GP had a karyotype run of my chromosomes, suspecting Klinefelter's syndrome.
I went to see him today, and he informed me that I have a 1 in 25.000 condition called XX male syndrome.  A baby with XX chromosomes develops into an otherwise male body.
I don't really know what to think about this right now, but I felt like I had to share somewhere.  It's just so odd, and I really wonder how this will affect everything; the legal aspects of transition, the coming out, how hormones will affect me, etc. 

[vlmitchell]

Nothing much to think here, I would say. It explains some things but that's nothing to really get too worked up about. We've been hearing theories all over the place for years about how trans is possibly a manifestation of a biological condition. You just happen to be one of the few who have had the karyotype run to know for sure and can confidently say that you're moving toward who you are supposed to be. Personally, I'd be warm and fuzzy all over for days off that one!

[Starscrash]

Despite having the medical documentation to back this up, my first psychiatrist visit today ended with him saying he thinks TG is just a form of OCD, and should be treated with SSRIs.  Blech!

[vlmitchell]

Ummm.... yeah, just go ahead and get a real freaking GID therapist. Sounds like a quack.

[Asfsd4214]

Change psychiatrists. That's even more ridiculous than the autism theory floating around. 

It took me 3 attempts to find a good psychiatrist, it can take a little while.

[Janet_Girl]

I had one shrink that tried the same BS for the same reason.  When I found my gender therapist, he had me diagnosed as TS by the end of the second meeting.

Get a real therapist that know what is really going on.

[Alyssa M.]

Avoid psychiatrists. They are mostly interested in biochemical processes that they can alter, which is great of you are OCD, ADD, schizophrenic, depressed, etc., but not typically sufficient for treating those issues, and completely irrelevant if you're trans. When you have a hammer, everything looks like a nail, and your psychiatrist's hammer comes in pill form from a pharmacy.

To reiterate what others have suggested, if you need to see anyone, it's a therapist, and that usually means a psychologist, someone who can help you with talk therapy and can help you deal with the many difficulties (fear, shame, lack of self-acceptance, etc.) that might affect your ability to discern whether transitioning is indeed the right path for you. And you need to see someone who doesn't have an agenda about anything, either pro or anti.

[Starscrash]

To reiterate what others have suggested, if you need to see anyone, it's a therapist, and that usually means a psychologist, someone who can help you with talk therapy and can help you deal with the many difficulties (fear, shame, lack of self-acceptance, etc.)

I've been seeing a psychologist since mid December, and she referred me to a psychiatrist for depression.  I haven't seen a gender therapist specifically (though I probably will) yet because I think my insurance will stop paying for therapy if they think my depression is caused by transgender issues, and billing from a gender health center would be pretty telling. 

I just felt like sharing the OCD thing because it really just was absurd.  When he first said it I thought I must have misunderstood for a moment, it doesn't even make sense.

[vlmitchell]

Not sure where you are (I'm in the states so that's my context) but most GID therapists are also just regular psychologists with specific degrees and certifications which enable them to sign off on WPATH stuff and know the specific issues related to GID issues. You're probably fine just looking one up and seeing what you can do.

[Starscrash]

Not sure where you are (I'm in the states so that's my context) but most GID therapists are also just regular psychologists with specific degrees and certifications which enable them to sign off on WPATH stuff and know the specific issues related to GID issues. You're probably fine just looking one up and seeing what you can do.

Well to be honest, I don't know how to find a GID therapist, but within 10 miles of me there's a psychology center called the "Gender Program of Central Ohio."  That's probably where I'd start off.  Other than that I really don't know where I'd find a sympathetic psychologist. 

http://www.genderprogram.com/services.html

[vlmitchell]

Simple: go to Andrea James' site and look one up. Or just google GID specialist. You don't *have* to go somewhere as my GID does skype sessions and from what I can tell, you seem to have internet access so things may be easier that you'd think! 

[Alyssa M.]

I've been seeing a psychologist since mid December, and she referred me to a psychiatrist for depression.  I haven't seen a gender therapist specifically (though I probably will) yet because I think my insurance will stop paying for therapy if they think my depression is caused by transgender issues, and billing from a gender health center would be pretty telling. 

I just felt like sharing the OCD thing because it really just was absurd.  When he first said it I thought I must have misunderstood for a moment, it doesn't even make sense.

Gotcha, misunderstood slightly. You might consider checking out the coverage and exclusions on your insurance plan. If they cover therapy in general, it's not that unlikely that they discriminate against one particular diagnosis in the DSM. My health plan specifically excludes SRS or any surgury that could be considered cosmetic that doesn't stem directly from some other treatable condition (e.g., mammoplasty for breast cancer patients who have had mastectomies). But it covers other treatment (e.g., endo visits). It might be worth looking into.

p.s. If you are happy with your current therapist, there's no particular reason, a priori, that you can't use that person as a gender therapist. You might not benefit from the same level of specialization, but if you have a good relationship, it might be worth it to just go with that. Perhaps point your therapist to the WPATH web site or something like that, if you think it's necessary (to get a letter for hrt, for example, should that be needed).

[K8]

It looks to me like you are already getting good advice here, so I'm a little reluctant to butt in.  But in my limited experience a therapist (clinical psychologist, whatever) can help you a lot.  They can't prescribe drugs, but that can be a good thing.  They don't have to be a gender specialist.  As Alyssa said, there are a lot of aspects that aren't specific to being trans - fear, anxiety, guilt, etc. - that a good general psychologist can help you with.  And as you work on those, everything may very well fall into place.

You may have to try several therapists before you find one you are comfortable with.  You need to be able to establish two-way trust with them.

Good luck.

- Kate

[Starscrash]

Gotcha, misunderstood slightly. You might consider checking out the coverage and exclusions on your insurance plan. If they cover therapy in general, it's not that unlikely that they discriminate against one particular diagnosis in the DSM. My health plan specifically excludes SRS or any surgury that could be considered cosmetic that doesn't stem directly from some other treatable condition (e.g., mammoplasty for breast cancer patients who have had mastectomies). But it covers other treatment (e.g., endo visits). It might be worth looking into.

p.s. If you are happy with your current therapist, there's no particular reason, a priori, that you can't use that person as a gender therapist. You might not benefit from the same level of specialization, but if you have a good relationship, it might be worth it to just go with that. Perhaps point your therapist to the WPATH web site or something like that, if you think it's necessary (to get a letter for hrt, for example, should that be needed).

Well under my insurance exclusions, it says something to the effect of "Treatment and surgery related to transgender disorders will not be covered."  I don't know how far that extends, but yeah.  If it's really bad, I may look to see how much coverage student health insurance would offer (I'm currently covered as a dependent under a parent.)
I do need to see a new therapist though I think, my current basically told me that she thinks I'm depressed, and psychotic because of it.

[vlmitchell]

I hate to put things this way but there are ways of dealing with insurance and *ways* of doing so. Most of those who help the transgendered community know the difference and file their claims accordingly. Don't worry so much about that as finding someone who can really see your issues in the correct context.

[aubrey]

I'm not exactly knowledgable on this but if you have proof of XX male syndrome it's pretty much a "valid" (in the eyes of insurance) medical issue and no longer just a TS one so insurance should cover it?

[Janet_Girl]

I'm not exactly knowledgable on this but if you have proof of XX male syndrome it's pretty much a "valid" (in the eyes of insurance) medical issue and no longer just a TS one so insurance should cover it?

Having looked up the definition I would agree that it is a medical condition and not necessarily one that would fall under the DSM.

[Starscrash]

I'm not exactly knowledgable on this but if you have proof of XX male syndrome it's pretty much a "valid" (in the eyes of insurance) medical issue and no longer just a TS one so insurance should cover it?

From a legal standpoint though, it still says "male" on my birth certificate.  They could also argue that bringing my appearance more in line with how I feel I should be would be a cosmetic surgery; they could probably justify that looking male isn't the same as say, having to live with a ruptured appendix. 
I may be overthinking it, but I've read a lot of insurance horror stories online regarding gender dysmorphia.

[shanetastic]

SSRIs. .  heh. . .

Sounds like a dumb therapist to me especially deciding this so quickly. . .

Another dumb person thinking someone is a ->-bleeped-<- and it's causing them severe problems

[Alyssa M.]

Shanetastic -- therapist does not equal psychiatrist in this case.

--

My (student) insurance has the ban on gender-related disorders as well, listed under benefits, but under exclusions it specifically excludes SRS, while stating that hrt and therapy and related care is covered. So it's possibly not as clear-cut as it seems. Insurance companies are all messed up, and I expect the outcome has something to do with the doctor you see and the bureaucrat who files the paperwork.