is therapy really necessary?

[Anon]

Is a trans person required to have a gender therapist or psychologist diagnose them with GID before they can get HRT and etc?

I'm curious, because I'd rather not spend six months or more talking to someone about my feelings. I don't really need counselling, I want to transition medically. I'm seeing an endo in 3 days for other reasons, but I think I'll explain being FTM and see what he can do anyways.

The only other trans people I've met and heard about went the therapist route, though... Is there anyone here who has started hormones or gotten surgery without seeing one?

[PandaValentine]

It depends on where you live. In some places it isn't required but requested by the doctor to ensure you are sure, or 'stable'.

[Alice.Wonderland]

I know for a fact that Colorado endocrinologists will require a recommendation letter legally.  You are required to spend 3 months in therapy (the same therapist) in order for them to be able to write a letter on your behalf.  I had spent roughly $90 every 2 weeks for 3 months for an hour of therapy each time ($90 * 2 weeks * 3 months = $540 for 6 hours of therapy... Now that I think about it, it's kind of ridiculous and her real rate for patients was $130 but I got a student discount.).  After I got the letter, I stopped seeing her.
I do believe that you cannot get any type of surgery without a letter from a therapist and a letter from your physician (So two letters total as well as living full time as the opposite gender for a full year as well as being on HRT for a year.)  I'm not sure if this applies to top surgery, but it does to bottom surgery.

[JessicaR]

No, but you're cheating yourself if you refuse it.

   There are M.D.s out there who will prescribe HRT with no evidence of therapy but I, personally, would question their integrity.

   Therapy for people with GID is designed to HELP you... A good therapist will first rule out any conditions that might mimic GID (like borderline personality disorder or Aspbergers Syndrome.) Once that's done, a gender therapist will be there for what you need to talk about what you can't talk to anyone else about.
   Almost 6 years into transition (I'm done, really) and I still love my therapy sessions... My therapist wrote the letter to indicate SRS as necessary for me... A good therapist is such an ally... Don't knock it till you try it!

[Tad]

It's a good idea to do some therapy before hand, or some real life experience.. because issues that you might not have thought were issues might arise A. when therapist points them out or B. you discover them during RLE. They are both there as safeguards to weed out the people that thought they were sure about transition (or maybe not sure).. but end up figuring out that maybe full transition is the wrong way to go.

[quinn]

A good therapist will first rule out any conditions that might mimic GID (like borderline personality disorder or Aspbergers Syndrome.)

@JessicaR:
How could borderline personality disorder mimic GID? I'm assuming Asperger's could mimic it, with the issues about fitting in socially or whatever, but isn't borderline the same kind of thing as being bipolar?

[Anon]

Thanks for your responses everyone! they were really informative. I expected there wouldn't be many shortcuts because of the weeding out process, but I'm hopeful.  I live in Canada, by the way.

I guess I also should have mentioned that I dressed in boy's clothes and had short hair for almost all my life, so appearance wasn't an issue...I've been out as trans to family and friends for 3 or 4 years now, but I lived in a really small isolated town without a chance of getting hormones or therapy until recently.

[Liam K]

It's going to depend entirely on your doctor, really.  My doctor required that I have a letter from a mental health professional, but I was able to find a sympathetic counselor, and since I'd already been living full time as male for over two years at that point and didn't really have any issues I needed to work out, I only had to see her once or twice before she wrote the letter, and my doctor was okay with that.  It was more of a formality than anything.  Some doctors will prescribe T based on informed consent, without a letter, and some won't; likewise, some therapists will be flexible and not put you through a required number of sessions, and some are going to be really strict about seeing you for a certain amount of time. 

Also, there are a few surgeons out there who don't require a letter.  I believe Brownstein is one of them, but I might be wrong about that.


EDIT: I just read that you live in Canada.  What I said is true for the US; I have no idea how things work in Canada.  Sorry.

[JessicaR]

@JessicaR:
How could borderline personality disorder mimic GID? I'm assuming Asperger's could mimic it, with the issues about fitting in socially or whatever, but isn't borderline the same kind of thing as being bipolar?

  Some folks who have conditions like these exhibit compulsive behavior, sometimes behaving in ways that are specifically contrary to social norms. An example would be someone with BPD who acts out emotionally by compulsively crossdressing, insisting that he/she is transgender. Many with BPD have issues with self-image and identity. Bipolar disorder is a manic-depressive illness without the identity symptoms that BPD have.
  Some with Aspbergers have issues with their perception of "gender appropriate behavior."(Heh, don't we all!)  For instance, I had a longtime friend with AS who was extremely effeminate.... most people assumed he was Gay upon meeting him but he was quite straight and definitely not trans. I do know that there are lots of aspys who are also trans but there are some with AS that might display trans-like behavior.

[PixieBoy]

Some people with AS are "gender blind". They may mis-gender people without realizing it, or not understanding why a man in tighty-whities is seen as a funny image when shown on TV, while a woman in a bra and panties is seen as a sexy image. They might not understand what's so bad about a woman taking her top off. They might have difficulty recognizing whether a person is a man or a woman.

I occasionally use the wrong pronouns, and I've noticed that my classmates with AS do such as well. It's not malicious, just a slip of the tongue type thing.

[Linus]

Thanks for your responses everyone! they were really informative. I expected there wouldn't be many shortcuts because of the weeding out process, but I'm hopeful.  I live in Canada, by the way.

I guess I also should have mentioned that I dressed in boy's clothes and had short hair for almost all my life, so appearance wasn't an issue...I've been out as trans to family and friends for 3 or 4 years now, but I lived in a really small isolated town without a chance of getting hormones or therapy until recently.

In Canada's case (and I believe this is true across the board in all provinces) you will need therapy before HRT. As others have said, it can be a good thing. Although a Canadian, I live in the US and only got a 30 min diagnosis from a LCSW. I think my age and determination had something to do with it because I knew of others who have been to the same doctor's/LCSW and it was months before they got HRT. I ended up supplementing my own therapy by seeing a therapist for about 3 months after starting.

[JohnAlex]

No, but you're cheating yourself if you refuse it.

   There are M.D.s out there who will prescribe HRT with no evidence of therapy but I, personally, would question their integrity.

   Therapy for people with GID is designed to HELP you... A good therapist will first rule out any conditions that might mimic GID (like borderline personality disorder or Aspbergers Syndrome.) Once that's done, a gender therapist will be there for what you need to talk about what you can't talk to anyone else about.
   Almost 6 years into transition (I'm done, really) and I still love my therapy sessions... My therapist wrote the letter to indicate SRS as necessary for me... A good therapist is such an ally... Don't knock it till you try it!

I disagree that someone who doesn't want therapy is necessarily cheating themselves.  I don't want to get therapy if I can help it.  I just don't think I have a need for it, I don't really have issues that I need help dealing with.  I usually always have someone to talk to when I feel like I need to talk about something.  Or if there is something I don't want to talk about yet, I won't even want to talk to a therapist about it.

It's true I can't really knock it until I try it.  The only therapy I've had was years ago to address issues I didn't even have, so that really was pointless.  I definitely think therapy can really help some people and is great for them.  I'm glad you enjoy therapy so much.  But don't assume that everyone is like you and need it or can always benefit from it.  There are a few people who are fine and don't need the extra help.

Plus, I'm just not going to pay for it if I don't think I'd need it and it's not required.  I'd rather put that money towards surgery.

I don't think I'm the only one here who thinks this.

My doctor required that I have a letter from a mental health professional, but I was able to find a sympathetic counselor, and since I'd already been living full time as male for over two years at that point and didn't really have any issues I needed to work out, I only had to see her once or twice before she wrote the letter, and my doctor was okay with that.

[Robert Scott]

Personally, I wanted to go the non therapy route -- I have a doctor who will prescribe T and a doctor here in the Twin Cities who doesn't require a letter for top surgery.  I also have some obgyn issue so I can get my hystro covered without a letter.

However, my partner insisted on counseling.  So, I have recently started going.  I know I am a man ... I know I am trans...I know I do not want to continue living my life precieved as a female.  I do not have any mental health issues and have never seen a counselor.  But like almost everyone else I have had doubts and questions about transitioning and if I really am trans.  Then yesterday when my therapist said she will write the letter for me for whatever I want - hrt or surgery -- there was something so good about it.  It is so validating to have a person who is trained and worked with other trans folks say - yup, I agree with you!  It really felt rewarding.  That moment and feeling alone has made going to counseling worth it to me.

So, if you can't find a doctor to help you transition without a therapist just know there should be at least a moment or two that make you feel really good about yourself and confident in your decision.  Plus, if any family or friends question your decision you can say - hey I had to see a counselor about it and they diagnosed me.  Which I think takes the fight out of their argument.

[Nygeel]

For many people it is a requirement, for others it's not. Things are a bit easier if you have a letter. Without a letter you have a significantly smaller number of doctors that would treat you. Also, many doctors that perform top surgery require a letter. If you get that all out of the way at the beginning then you don't have to do it later (or wait to get a letter before getting surgery).

[sascraps]

A little off topic, but how do you live as a male full time before any physical transition? As in, when you can't legally claim a male name or apply for a job under a name other than your legal name, and so forth?

I do worry about the recommendation letter part though, since I don't think anyone in my area would ever diagnose someone as truly being the opposite sex. They literally think you're crazy if you're not a religious nut here. 

[Linus]

A little off topic, but how do you live as a male full time before any physical transition? As in, when you can't legally claim a male name or apply for a job under a name other than your legal name, and so forth?

I do worry about the recommendation letter part though, since I don't think anyone in my area would ever diagnose someone as truly being the opposite sex. They literally think you're crazy if you're not a religious nut here. 

Many cities/states/provinces allow you to change your name without a therapist letter. And many workplaces are, if you request it, to adhere to how you prefer to be called and identified. As such, one can live male or female without HRT, surgery and/or therapy. And there are many who pass without HRT already (from what I've seen it's a very "boyish" look).

[sascraps]

As far as I know, my state requires having had surgery to amend your birth certificate. I'm not sure if the same applies to a legal name change.

[Anon]

I can't see why they would make you have surgery just to change your name - there are a lot of non-trans people who legally change their names for various reasons.

Although, I was given a unisex name, so I can't say that I've ever bothered to look into the issue.

[Liam-XXI]

Thanks for your responses everyone! they were really informative. I expected there wouldn't be many shortcuts because of the weeding out process, but I'm hopeful.  I live in Canada, by the way.

I guess I also should have mentioned that I dressed in boy's clothes and had short hair for almost all my life, so appearance wasn't an issue...I've been out as trans to family and friends for 3 or 4 years now, but I lived in a really small isolated town without a chance of getting hormones or therapy until recently.

Hey, You're from up north, eh?

If you're on the east coast; like Ontario, there's the Sherbourne Health Clinic - they can't prescribe you anything if you don't live directly in Toronto, but they do have this handy-dandy package for MD's who are interested in treating Trans Patients!
http://www.sherbourne.on.ca/PDFs/Trans-Protocols.pdf

If you're on the west coast, like BC - this might be helpful for you/a doctor
http://transhealth.vch.ca/resources/careguidelines.html

These are also other Canadian-specific links to resources/information!
http://www.rainbowhealth.ca/english/trans.html

[PandaValentine]

Sherbourne health clinic is not a good option unless you live in Toronto, and serving people in Toronto is their first priority.

If you're from Ontario, it's like I said in my first post, you don't have to have therapy, but then it all depends on your endo. My endocrinologist, Dr. Booth, was very nice, and despite me being out for a year, he wanted me to see the therapist he works along side with for trans people. I only had to attend one session and based on what she thought he okayed me.

Still, it's very likely they are not going to want to feel responsible, if you regret it, which from what I understand rarely happens but they make it seem like it happens all the time!