How do you feel about the waiting period for HRT?

[Britney♥Bieber]

I think it should be up to the therapist to write the letter, and I'm pretty sure that's how it works. I started therapy July 12th and since then I've had 8 sessions, and today will be my 9th. (9th woulda been last week but he was on vacation) and I'm pretty sure I'll be getting my letter today. I ask my therapist two weeks ago when I could start hormones and he said whenever I felt ready and I told him I'm ready, I had been ready for a few weeks. So he gave me the info of this doctor at planned parenthood and I have an appointment with her on the 29th!! AHHHHHHHHHHHHH

[long.897]

Arch - you needed the time and you knew that. I need some time - and am taking it right now - and I know that. But there's no reason to think that everyone needs the same amount of time or that the time can only start after the first therapy session. Some people like to work things out with the help of a therapist. Others, though, like to work things out in their own heads before talking to strangers about them. And some of us like to work things out entirely in our own heads, but with the occasional discussion with a professional to make sure that what we're coming up with is practical.

I think people in general know what they need, or can figure it out if their mental health point of contact asks the right questions. And if someone already has it worked out, has done their research, grappled with the implications, come out and explained to their loved ones, all the necessary stuff before even talking to a therapist, then why impose an artificial waiting period?

I just feel like I need to reiterate; there are definitely instances in which a person is mentally ill, and is not in the right state of mind to be making permanent changes to their body or life.  There are certainly situations of schizophrenic patients (mis)identifying as transgender; there are also certainly situations in which people with legitimate personality disorders have wanted to make changes to their bodies that they might regret if given treatment.  If I were a medical professional, I certainly wouldn't let a mentally ill patient say, remove all their teeth; it would be self mutilation.  Transgendered individuals changing their bodies are doing so out of a medical necessity, but done under the duress of mental disorder, the mutilation label absolutely fits. 

[Inkwe Mupkins]

why do we care if someone changes their gender?  Why is there so much wrapped around it all?

A few days ago I thought there should be like a 4 yr life expireince for ppl under 18 before  hormones. But after reading that it clicked. This reminded me of what my endo said "There are some ppl out there that think what were doing here is immoral and what he is doing is wrong". I am his first trans patient he is treating, he has other trans patients but they seem unsure they haven't requested hormones quite yet.

I don't want someone to tell me how I and what I should do to my body. who cares if Sally in georgia is getting estrogen. I understand that a 14yr old kid may not understand the consiquences and neither may there parents, but I guess who cares. If they change there mind after 5yrs of hormones and get breast surgery then that's there deal. What is the difference between a full body lift, breast implants, rhinoplasty compared to HGH and SRS. HGH and SRS are drastically improving the lives of people. I don't think anyone is gonna die from lack of breast implants. For many trans ppl it's either surgery or suicide. Hormones is your first step.

[Cowboi]

Kind of a random note, one person brought up the fact that we need to keep in mind health care providers are legally responsible for us as well. One of the issues with informed consent comes into play with the idea that there COULD be other issues.

For example someone who is mentally ill could easily do informed consent and never once bring up their mental illness, or may not have even been diagnosed. Years go by, person is unhappy with the results for whatever reason, they later get diagnosed with a mental illness. Now who is at fault? Depending upon the mental illness the doctor is. They could have gone through with HRT or SRS based upon the informed consent of someone who has a disorder that prevents them from making life changing decisions in a rational or reasonable way, having never gone through with therapy the doctor may have had zero signs this individual had any illness at all. This patient could then turn around and sue the doctor, while informed consent was obtained it was obtained from someone who may have not been (or simply could claim they weren't in) a clear state of mind.

Not all mental illnesses or emotional issues can be assessed by sitting in a room with someone for 20 minutes explaining a procedure and getting documents signed. I personally know someone who has seen doctors for years and they STILL have to change his diagnosis every few months because he is so good at hiding his issues intentionally and sometimes just unintentionally. He also happens to be trans. This guy states over and over again to any medical professional within reach that he's trans, that he's ready and now he's on hormones. In his personal life he still tells people he isn't sure. He tells mutual friends that I forced him to live as trans when we were a couple, which is very very far from the truth. Story was simple, I had a girlfriend and we got married, one day my wife told me she was trans too, I accepted this and stayed eventually the relationship ended for a mixture of reasons but not due to gender identity. Now he tells people I made him do this because I wouldn't love him if he didn't? Honestly, I loved him more when he was a woman... but that's just because I'm a straight guy lol. Personally I'm not even sure he is trans at all, his huge emotional/mental break began at the same time he chose to come out to me. It was really his mental issues that eventually drove us apart. We were together for a year with no signs of issues before he came out and then started displaying several signs of mental illness including a complete change in personality, family values, the ways he treated people both in his life and strangers... tons of craziness all at once. He is most likely schizophrenic, it runs in his family.

That is just one person. What about the stories of people who went through therapy and still ended up not making the right choice?

I think it's easy for all of us to look at our own experiences and say it should be this way or it should be that way, but the medical system and the legal system does not work that way (at least not in America). Maybe it isn't a matter of looking at people who change their bodies in other ways and saying "Hey we should be allowed to do that too!" Maybe some of them should be required to meet certain standards and guidelines as well to achieve their goal.... maybe they got what they wanted too easily and without anyone questioning why. I'm sure there are plenty of women with boob jobs who did it for reasons like self confidence who could have gotten counseling instead. I'm sure there are a million other examples of people altering their physical appearance that could have been dealt with in a reasonable manner instead of undergoing alteration surgeries that may not be reversible and may not make them happy in the end anyhow.

I think that at least some therapy is necessary, and as someone else mentioned, 3 months is a guideline not an actual requirement... a therapist can choose to not hold you to those standards. Most are aware of that, but they aren't going to admit it, they don't want to be liable for anything you make a wrong choice on because they didn't follow the standards with you as a patient.

[cynthialee]

I made the vow when I got married...'In sickness and health'.

Mental illness is a sickness. I could not leave a mate for becoming mentaly unstable.

[Cowboi]

I made the vow when I got married...'In sickness and health'.

Mental illness is a sickness. I could not leave a mate for becoming mentaly unstable.

You don't really know what all mental instability includes so you can't honestly say that. When you marry a kind gentle person and they turn into a selfish, drug abusing, self hating person who pushes away their entire family and becomes a stranger to you then begins beating the hell out of you on a daily basis including things like throwing TELEVISIONS at you.... well your opinion might change.

By the time I got out I was flat out told by cops and my family to never ever let this person in my life again. For 4 years I tired to be his friend, always coming when he needed me, always giving him a place to stay, ensuring he had food, clothes and a roof over his head. In the end he always went back to the streets, always told me he hated me and didn't need me, threw some punches and ran away. Always letting me sit at home worrying if he was dead or alive. Manipulating every single situation in his own mind to be the victim of it rather than the person who caused it and acting as if this was the mater of fact way that it happened. When we were alone he'd apologize to me, if anyone else was present he'd cry and whine and scream until they believed I was the one who treated him so poorly.

Saying you wouldn't leave someone for being mentally ill is easy to say when you've never dealt with it. When you have a very happy childhood and life then one freaking relationship makes you capable of reading books like "A Child Called IT" and RELATING to the character because your spouse has done a lot of the same things to you.... well you may feel differently then dear.

[long.897]

I think that it's important to help your partner work through the bad points, but if they don't want to help themselves, how can you be expected to do it for them?  If I had a mentally ill partner who was genuinely working to get better I would stand by them, but if they were spiraling out of control and simply didn't care, or liked the volatility and hostility, I can't see myself staying.

[Steph]

On another note...  The medical professionals who are charged with providing for and caring for our mental and physical health have much time and money invested in this thing they do.  Why should they jeopardize that because some starry eyed individual does not have patience.  It's almost typical of todays society, the "Me Now" generation, the "I know what's best for me" crowd, the "Why is my problem not on the top of your list Mr Doctor" bunch, "Screw things up and I'll SUE your arse".  Well folks welcome to the real world, doctors need protection as well cause the rules were put in place to ensure that idiots don't die.  Sheeeesh, frig! Even after transition you're gonna have to wait for things.  I have an 8 month wait just to see my OBGYN, and that's for a regular check up.  Slow down sweeties, good things come to those who wait.

Steph

/Rant off

[Cowboi]

Even after transition you're gonna have to wait for things.  I have an 8 month wait just to see my OBGYN, and that's for a regular check up.  Slow down sweeties, good things come to those who wait.

Seriously! I'm bipolar and at this point by the time my appointment with a new doctor rolls around it will have been over a 3 month wait, and that is for an appointment for a mental disorder that can prevent you from functioning in any sort of reasonable manner at all. If I mess up between now and mid October when I finally get to see someone I could loose my job or worse, so I have to watch myself and so does my partner to ensure that I stay on track until then. It isn't a simple task it's an all day long every single day concern because my meds aren't currently working so the only help I have is myself and the people in my life until I get to the doctor.

You have to wait for everything, you have to pay for everything, and rather we like it or not you even have to pay for and wait for the portions of treatment you just don't care for, desire or feel you need. It isn't always about our protection, sometimes it is about the protection of other's like the doctors and therapists. Their lively hood depends on NOT making a mistake that could cause them to loose their job or license. For me that would be enough of a reason to make everyone follow the letter of the law rather they liked it or not if I were in their shoes.

[Cowboi]

I think that it's important to help your partner work through the bad points, but if they don't want to help themselves, how can you be expected to do it for them?  If I had a mentally ill partner who was genuinely working to get better I would stand by them, but if they were spiraling out of control and simply didn't care, or liked the volatility and hostility, I can't see myself staying.

Thank you, this is the difference in between my situation and many others. My partner didn't want help, it's been 7 years since we first married and he still has never gotten help. When it seems like he is finally going to do it he uses that help for things like being diagnosed with disorders he does not have to get certain prescriptions to use to get high or sell to other people (he has a background in the medical field so he knows how to fake it to get what he wants). There has always been an alternate motive behind his cries for help, never once has he actually made any attempt to better himself or his life.

When I have tried to be his friend and have him in my life to help him he instead screws up everything I have going for me. It is literally to a point where had I not cut him out of my life I would have lost my own family, I gave up many friends when I was with him and only some am I lucky enough to be getting back now years later.

I am willing to stand by my partner but I am not willing to allow them to tear my life apart at the seams over and over again when they are not even willing to work towards getting better. No matter how much you love someone there is always one thing to remember, the first and last love is self love. In the end you are the only person you are guaranteed to have, there is a point where you have to take care of yourself and stop trying to help someone else. I almost lost everyone in my life and lost my home before I let my partner go.... looking back I can honestly say it was not worth it. He was not worth the life that I put on hold and gave up for him.

[cynthialee]

You make some big assumptions about me Cowboi.
I live with a spouse who has issues, I would not even imagine leaving over mental issues. I have been in a relationship that was downright abusive. I never left them though. I was left, I didnt do the leaving. I tried my hardest to make it work.

I stand by what I said.

[Cowboi]

You make some big assumptions about me Cowboi.
I live with a spouse who has issues, I would not even imagine leaving over mental issues. I have been in a relationship that was downright abusive. I never left them though. I was left, I didnt do the leaving. I tried my hardest to make it work.

I stand by what I said.

Then all I can say is that is a sad way to live. Having been there myself I know how hard it can be and after having done it I would personally never choose to stay in that situation again. Either way this thread is not about abusive spouses, the original commentary was unnecessary and has only lead to a useless side conversation where neither of us are going to agree anyhow. So lets agree to disagree, I know you have to be strong to stay but I also know how much it took to get out of the situation, either path takes a strong person assuming that the person is making the choice and doesn't feel stuck. It takes a strong person to actively try to make it work, it takes a strong person to know their own limits and walk away from something that has become unhealthy for them.

[V M]

Not to derail, side track or distract from the thread any further... But I'm dang curious about that cute lil' doggy in your avatar

Is it yours? have you more pic.s? I think there is a pet picture thread

[Cowboi]

I will have to look for the pet pictures thread. That is my little boy Cruiser in the avatar pic, he's an Italian Greyhound. And of course I have TONS of pictures... I am one of those my pet is my child people.

[Mara]

There are a lot of people who absolutely need HRT immediately, and a long mandatory waiting period could kill them.  I understand that there are apparently people here who actually felt like they could wait years and years before starting hormones, but some of us were borderline suicidal by the time we were asking for hormones.

I also think that people who desperately need HRT immediately greatly outnumber people who are confused but somehow able to hide it from therapists.  I understand wanting to make sure a few confused people don't transition when they shouldn't, because they might hurt themselves, but I don't understand taking precautions that would almost certainly cause other people to hurt themselves, which is what a mandatory waiting period does.  Besides, if someone can pretend to need HRT for three months straight, they could probably pretend for a year.

Three months is a bit too long, and I honestly, literally think that any mandatory period longer than that should be treated as a human rights abuse.  Therapists should be able to encourage patients to wait if they don't seem ready, but not require it.

If a confused person goes on HRT and realizes they didn't want it, they can stop the treatment and generally be okay.  (They'll have a deeper voice and facial hair if they were on testosterone, but us trans women manage just fine.  And if they were on estrogen for a short time, there probably won't be any major effects.  Even if they were rendered sterile, it's not that big of a deal, since they don't need fertility to live.)  Whereas if a desperate person is denied HRT and commits suicide, there's no way to reverse it.

[Arch]

There are a lot of people who absolutely need HRT immediately, and a long mandatory waiting period could kill them.  I understand that there are apparently people here who actually felt like they could wait years and years before starting hormones, but some of us were borderline suicidal by the time we were asking for hormones.

Hi, Mara. I'm not sure what you consider "long." Or even what you mean by "immediately." Late in your post, you say that three months is too long; but it's only a recommendation, and therapists don't have to abide by that.

But therapists do have to be responsible, and they have to cover their asses a bit. If a client is borderline suicidal, then the therapist has to weigh priorities--take enough time to properly evaluate the client, but also help the client get through the rough period and not become actually suicidal. If a client is actually suicidal, then that person should probably be hospitalized, not automatically given a letter. I don't think it's a good idea for therapists to write HRT letters for a suicidal person if the therapist hasn't had a good chance to sort out the client's sanity, stability, issues, and needs. And all of that has to be evaluated case by case. While it's true that transsexuality should be largely self-diagnosed, the therapist does need to be convinced that the client knows what he or she wants, is stable enough to decide, and is ready to pursue it.

I think a lot of people forget how powerful hormones are. We tend to think, "We need to save the people who need HRT right away and might commit suicide without it. Hey, if it's wrong for you, you can just stop." What about the unstable people (and I've known a couple) who could be harmed by HRT or who are just as unstable after starting HRT and can't make good, informed choices? Can we honestly say that immediate HRT saves more people than a judicious waiting period and a bit of psychotherapy? Even if we can, is this a responsible policy overall? You talk about desperate people who are denied HRT; isn't that a separate issue? Aren't we talking about desperate people who are being asked to wait for a short period before being approved for HRT?

Perhaps informed consent should be more prevalent than it is. Then it's all on the trans person.

I guess I have several points. If you have access to informed consent, fine, go for it. But if you're going to go the therapy route (even if that's your only choice), then remember that the client isn't the only person who can be affected by the decision to start HRT. I don't think we can assume that HRT won't badly affect certain people, and I have mixed feelings about the argument that it's better for suicidal people to immediately go on HRT (that's what you seem to be saying). I think such people should be hospitalized and properly evaluated if they're that unstable.

I feel that therapists should be responsible to their clients and sensitive to trans people but not unduly jeopardize their own career and livelihood. They should prioritize the client's needs and well-being over their own pocketbook, and they should recognize that three months is only a recommendation and is too long for some clients. And I think (along with you, I think) a lot of therapists just don't do that. But if they don't, they're too cautious, too controlling, too uneducated about trans issues, or too dogmatic about the SOC. Maybe they shouldn't be in practice at all.

[Al James]

I'm at the point where its been 12 months since i first went to see my G.P. I saw a gender specialist three times and have had my first assessment at the gender clinic and will have my 2nd in October. I'm 38 years old- apart from my name i have more or less been living full time since i was 17 when i first realised that there was a word for people like me. Even if you discount me getting pregnant at 19 tonprove to myself that female body equalled female i ve still been virtually full time since i was 20. Yet i come on here and find others who are in different parts of the UK and the rest of the world being given T on their 2nd appointments or after 3 visits to a therapist and while i understand that everyone is different; the fact that a time line for T hasnt even been mentioned to me is really bringing me down. While i'm really pleased for those who are getting it i'm jealous as hell. Theres even a chance i may have to do another 2 yrs RLE before i get T. I think our wishes must be taken into consideration, and this isn't anything against the younger ones; but especiaally us older ones who have had a lifetime of working things out and sorting it all out in our own heads before we go anywhere near the professionals. I know i'm ready for hormones and surgery- someone telling me ive got to wait even longer isnt really what i need

[Samantha_Peterson]

I kinda hate it but I understand why it's there. Can I wait? Maybe for about two more weeks but after that I'm pretty sure I'll go insane if I don't even have my letter...

[Asfsd4214]

I think it's retarded. I don't accept that I should be seen as too mentally incompetent to know what I want, I don't accept the system as it exists today, I don't accept that I should be punished for the mistakes of other, I don't accept the principle of people trying to save me from myself.

Because of that, when doctors screwed me around too much, I self medicated until they realized that their word is not the final one, which was pretty damn fast.

That's how I feel about the waiting period for HRT.

People do way too much trying to protect other people from themselves.

[cynthialee]

People do way too much trying to protect other people from themselves.

I couldnt agree more!