Buy your letter for surgery?

[Princess_Jasmine]

So I am pretty sure that according to the normal standards, you must be one year full time before a psychiatrist will write your letter approving surgery. I was considering going to Dr. Chettawut in Thailand, and when I saw his website it says the following.

"In case you can not provide me any documents supporting your eligibility , you may need to consult with my psychiatric partners for psychological evaluation on a one-time basis here, for which they charge 300 US$."
http://www.chet-plasticsurgery.com/scheduling.html

Does this mean I can go to Thailand and get SRS even if I have not been fulltime a year? I want to have the surgery done before I go off to college and stay in the dorms, but this policy of Dr. Chettawut's sounds a little fishy. Is this something most foreign surgeons do? I want opinions ladies! Thank you

[Jamie-o]

Correct me if I'm wrong, but I believe the issue with having SRS before being on hormones for at least a year, is that the body hasn't finished making all the changes it's going to make, which could affect the final results.  (I know this is the case for breast enhancement, and for FtM's lower surgery.  Not sure about Vaginoplasty.)

[Flan]

Thailand aligned last year with the soc when it comes to the required letters of recommendation although a local assessment is required anyways (on top of continuous hormone use, full time living, ect).

as far as getting the letters(s), it depends on the mental health practitioner, I've had no problems with letters, and chett (when I've been in contact with him last year) was pretty flexible when it came to individual needs (as long as the client was reasonable stable mentally, and that's not saying much).

[bamboo]

although a local assessment is required anyways

you have to present him your originals during the consultation, and pay, that's all.

[Autumn]

It's so rich people with a hair up their ass or a manic streak don't go out and get a vagina.

Also you kind of NEED real life experience to be successful.

And for say, drag queens or transvestites who are going too far... they need some time to realize they are making a mistake (such as the loss of sexual arousal from putting on panties day in and day out and lowered sex drive.)

[rejennyrated]

I don't support the rigid requirement and I never have. It's a bodge to cover up the fact that there is still no proper medical diagnosis method. I think doctors should treat individuals not a set of rules. I also think that there is now starting to be enough medical evidence to develop a proper diagnosis based on genetic testing and brain scanning.

For the record I didn't have two letters and I didn't do a formal supervised RLE.

If you count only the period whilst I was under formal medical supervision my RLE was less than 2 months. I only had one letter too, but I had actually had far more than two years experience living in role. I had also been on hormones for some considerable time. However as that was all done by ME on my own, without any medical support in theory it didn't count... (which is crazy because actually that made it tougher and more like a REAL life test than some silly doctor's game).

The idiots in the clinics in the UK wanted me to come back OFF HRT and have ANOTHER delay whilst they ticked all their boxes, put me back on HRT, jabbered on to me about how the surgery would never make me a real woman and how I'd always be a freak and all that stuff they say to try and put people off. Then I would have to do a formal RLE under their supervision.

At the time I didn't feel like playing their silly little mindgames.

My position was simple, and it remains so to this day. It's my life and it was therefore mine to ruin and make a mistake over if I was going to. So I was adamant that no interfering do gooder was EVER going to be allowed to try and protect me from myself, however mad I might have been. Even today there is one thing which gets right up my nose and that is anyone who is foolish enough to try and "protect me" from my own decisions. The nanny state can simply butt out!

Happily I found a doctor who was prepared to let me break the rules and 30 years later I would do exactly the same thing again. NO doctor or therapist ever gets to sit in judgement on me period.

My justification? Well I have been happy, healthy, well adjusted, stable, employed, and in a long term relationship ever since. I have NO regrets whilst many tens of people who do the formal RLE's and counselling end up far less successful and indeed having regrets. So in my view the whole RLE thing simply does not work effectively.

However having said all that I will agree that sadly until there is some kind of medical test the RLE is probably the best that there is. Bottom line if you "buy your letters" then you have only yourself to blame if it all goes wrong... and please don't go bellyaching and trying to sue someone for not having stopped you. Cos if, like me, you choose to buck the system then you have to be prepared 100% to take responsibility for any consequences good or bad!

[Sarah B]

I'm with Rejennyrated on this.

I grew up knowing that something was different or not quite right and I had the inner sense to keep my mouth shut, full stop period and in hindsight, I made the best decision I have ever made in regards to my personal privacy.

I do not know what would have happened if I had come out like Rejennyrated, Northern Jane, Gothique11 or the other girls that came out and suffered at the hands of the do gooders, that wreaked their life's.  However, I am damn sure that if I did, my life would have suffered big time and I would not be where I am today.

I was lucky in regards to my Doctors and the letters they wrote (extremely brief).  to say that I could have the surgery.  See this post for further details.  I had my surgery in 1991 and I would love to know what my psychiatrists said about me at the time, but that will never be, because those records no longer exist, they have been destroyed.

However, what I find offensive is that nearly Twenty years later, I have to play the F...ing stupid game of I have got GID so that I can get my birth certificate from England.

As I slowly gained the knowledge on my problem.  I realised I have always been a female.  Hence I never had a gender problem.  To go to two psychiatrists so that they can say in a report or letter saying that I have or did have GID to satisfy some condition written down in law that was only created in 2004, is repugnant to me, just so that I can get my birth certificate. 

As Rejennyrated said, its my F...ing life, I will live it how I want to live it and no F...ker is ever going to tell me how I should live it.

My justification also? Well I have been extremely happy, healthy, well adjusted, stable, employed, two long term relationships and miserable sometimes.  This has been my life ever since I had my surgery nearly twenty years ago.  I have Never Ever Had Any Regrets.

My suggestion, minimalist amount of requirements possible and you be prepared to sign a waiver that you understand the full implications of what you are going to do with your life.  So that you cannot come back later and sue anybody and everybody that your life has been F...ed up by the people that gave you, want you wanted in the first place.

I apologise for my profanity, however it was the only way I can convey to you, how I feel about satisfying some condition, that will not affect the way I live my life.  That is not even valid in the first place.

Kind regards to all
Sarah B

[Nigella]

Hi, I am a little concerned about being able to buy some letter giving permission to have GRS and for that matter any letter from any Psychologist giving you permission. Basically if you jump the hoops they put in front of you and you use all the right language and story line (easily got of the net) then you will be given the all clear. All to often I have seen people who have done all the above and had GRS but their lives are less than fulfilling. No integration and no employment follows. They spend their lives alone and on benefits because someone has said its OK to have GRS. 

There has to be a better way. Lives are being ruined.  I know there are successful lives here and around me but there are those who ruin their lives even with letters. This is not for the faint hearted.

Stardust

[FairyGirl]

(such as the loss of sexual arousal from putting on panties day in and day out and lowered sex drive.)

Is that what did it? And here I was blaming the spiro lol

I think the one year requirement is a good idea for most people. I got both my letters at 6 months, but that wasn't because both my therapists weren't very thorough with me, and though I scheduled my surgery at that time I still gave myself 15 months RLE before the actual date.

As much as we knew right from the beginning and it's merely jumping through hoops to us, there are a lot more people for whom the RLE requirement is a good way to make sure this is not only what they want, but that they can deal with the reality of living in another sex role while there is still a choice. That is, this surgery is permanent and irreversible. To me that's kind of the whole point, but to someone who's unsure it can help them to decide if it's going to be right for them or not.

[JennaLee]

Thank you rejennyrated!  I couldn't agree more. 

[tekla]

It's so rich people with a hair up their ass or a manic streak don't go out and get a vagina.

What planet do you live on?  On my planet rich people pretty much can do whatever they want.  I know a guy who turned a private jet around (at a cost of over $50K) to retrieve a coat that cost $2K.  I know that because I was on that jet.  His reason.... "I really like that coat."  That's what rich people can do.

Anyone who makes over $40K a year can pretty much buy that letter.

[K8]

However having said all that I will agree that sadly until there is some kind of medical test the RLE is probably the best that there is. Bottom line if you "buy your letters" then you have only yourself to blame if it all goes wrong... and please don't go bellyaching and trying to sue someone for not having stopped you. Cos if, like me, you choose to buck the system then you have to be prepared 100% to take responsibility for any consequences good or bad!

I agree.  I had surgery 367 days after going full time.  I scheduled it well before I had either letter because I was certain I fit the criteria and could get the letters legitimately.  I got both letters at 9 months RLE because both psychologists agreed I am TS and knew I needed them to meet the schedule.

Because they can't do an MRI or something and say conclusively you are TS, they have the SOC.  There are many reasons someone who isn't TS might present themselves for GRS.  The SOC is an attempt to weed them out before the surgeon performs irreversible surgery.  It is a way to protect all involved.

I have very little contact with the "TS community" other than here on Susan's, yet I have heard of people IRL who were able to circumvent the system and later had a hard time – mostly from unrealistic expectations.

RLE is for the person going through it.  Perhaps not everyone needs it.  (Jenny had it almost from birth even though it wasn't supervised.)  But I think if you skip it or truncate it, you do so at your own peril.  GRS is a HUGE step that will affect every aspect of your life.  Don't take shortcuts.

*Grandma Kate will now sit back in her rocker and sip her schnapps*

- Kate

[FairyGirl]

mmm Kate, got an extra rocker on your porch? sipping a little schnapps sounds good to me

[V M]

While I feel that there should be some sort of guidelines, I also feel that the current system is way too demanding and overdue for a revision

Each person is different and should be able to decide for themselves if this is truly what they wish to do

Having to prove yourself to a bunch of other people over and over is a waste of time and money if your mind is already made up

Poor peoples lives that would benefit from transitioning should be able to obtain financial aid

[Nigella]

Poor peoples lives that would benefit from transitioning should be able to obtain financial aid

I agree, there are a number of people who have turned to prostitution to get the money for their GRS surgery.

Stardust

[gothique11]

I guess I'm lucky 'cause here I didn't needa prove myself to anyone. Yes, there were basic things, like going full-time for at least a year before GRS, but it was more for yourself than to prove to a doctor or a gate keeper. I saw the "gate keeper" only 3 times -- no doubt it would be easy to just dress for that day, and not be full time and lie to the doctor. Very easy, in fact. I never had the doc call my work or double check anything.

Of course, at the time, GRS was funded by our provincial health care and the requirement was 1 years FT and to see the provinces approved doctor during that year to sign the paper work. It wasn't very strict, and it could be easily cheated. Most of it was based on the honor system. If you lied, who were you lieing too? Yourself or the doctor?

(Note: GRS/SRS is no longer covered by our provincial health care system.)

Of course, there were several opinions about that. Some were that it was great, others thought a year wait was too long and they needed SRS asap, even if not full time (ie: if I only had SRS, then I could go full time), and others thought the system was too easy to cheat (some, even got angry and jealous if they saw someone cheat while they were being honest and working hard at transitioning).

No matter what system, or lack of system even, not every one is going to be happy. There are those who want the surgery now, even before attempting to even go out in public as a woman; and there are those who see the time (RLE) as a valuable part of transitioning fo rthemslves.

I guess it comes down to if RLE is a value to the person transitioning or not. If SRS had no rules, no requirement for RLE, no need for letters -- how would that change things?

There are several views on RLE: some see it as a value to themselves and a valuable part of transitioning. Others see RLE as a great wall with gatekeepers to impress. Sometimes, you have to take what you can get and make it valuable. Polish the poop, in a way.

One thing I agree with is funding, or health insurance, to be available to those who wish to have GRS/SRS.

[Nigella]

I guess it comes down to if RLE is a value to the person transitioning or not. If SRS had no rules, no requirement for RLE, no need for letters -- how would that change things?

There are several views on RLE: some see it as a value to themselves and a valuable part of transitioning. Others see RLE as a great wall with gatekeepers to impress. Sometimes, you have to take what you can get and make it valuable. Polish the poop, in a way.

One thing I agree with is funding, or health insurance, to be available to those who wish to have GRS/SRS.

The RLE was invaluable to me and I had to do two years here in the UK to get state funding for my GRS/SRS not the one year. Of course if I had the money I could have had surgery a year ago but I think I may not have been ready. The two years have allowed my female persona, confidence and womanhood to express its self more fully and I am grateful for that time.

Stardust

[Northern Jane]

I am of two minds on the whole 'gatekeeper issue'.

I think it is critically important that people know what they are getting into (by changing their lives) and that means getting beyond the thrill/novelty/excitement of being a girl and getting into the day to day grind - like having a social life, making friends, getting a job, and all the normal routine. Nobody (doctor) with any kind of ethics wants to make a person's life worse. RLE is a way to test the waters without burning bridges.

On the other hand, there are some stubborn, head-strong kids who know exactly which way they have to go and are going that way come hell or high water (names withheld to protect the reckless LOL!  ). For those people, there has to be some discretion. They are going to do what they are going to do and getting in the way is just going to make things worse.

I never did 'full time', as in 24/7 - I lived en femme whenever I could get away from my parent's house for a weekend or a week. I didn't start regular HRT until I was 17 - DIY before that - and only got started as a minor because the doctor knew damned well that I was going to do it anyway! I had one psych evaluation, 1 day, well before SRS became available and that was done in the hope they (my doctors) could find a surgeon to do my SRS (even then it took 2 years before Dr. Biber came on the scene). I know that the strongest 'gate-opener' was simply the fact that I couldn't pass for male and the whole thing had been going on for nearly a decade so it wasn't a whim. Any 'hoops' before SRS would have seen me dead so everything was expedited. (Thank God!)

[K8]

I think it is critically important that people know what they are getting into (by changing their lives) and that means getting beyond the thrill/novelty/excitement of being a girl and getting into the day to day grind - like having a social life, making friends, getting a job, and all the normal routine. Nobody (doctor) with any kind of ethics wants to make a person's life worse. RLE is a way to test the waters without burning bridges.

Exactly.  Yes, there needs to be some leeway for exceptions, but for most RLE is an important time of learning and adjusting.  I never saw my doctor or therapists as gatekeepers but as helpers along the road.  Maybe I'm just lucky (I am) or naïve (I often am).

There are a number of psychiatric disorders and syndromes which may cause someone to ask for surgery but surgery is wrong for that individual – not correcting their problem and in fact adding huge new problems.  Do we just let them hang themselves?  Or an individual may insist on surgery before maturing enough psychologically to handle the social and psychological results.  How responsible for a person's well-being is a doctor, surgeon, mental health professional, or society in general?  How responsible should helping professionals be for not allowing someone to harm themselves?  How can it be determined whether a course of action is beneficial or harmful to them? 

(I don't know about you, but I've made some pretty stupid decisions in my life.  Fortunately, none of them screwed me up too badly.)

If everyone is sane and mature and well-informed and reasonable, no gatekeepers are needed.  But what about the few who aren't?  Society has some interest in not letting people who have problems create more problems for themselves because invariably they then cause problems for society.  It's really part ethics and part pragmatism and needs a thoughtful answer that looks at each individual's needs – a global guideline for most people with allowances for exceptions.

- Kate

PS: Chloe, there is always a rocker and some schnapps waiting for you here.