Therapist Concerns, What should I do? (Warning, possible rant.)

[GorJess]

Before you read this, you should know I'm 18, going on 19 in about 1 month. 

Currently, I've been seeing a gender therapist for the past 5 or 6 months, but I've been seeing therapists all over my state for the past 2.5 years. I'm due. My current therapist, the only true GT, refuses to get my HRT letter until I: Get a job, become more socially active, and "cross live" for 3 months.

Okay, I have no problems with the job business, but the problem is, this incorrect gender role is holding me back, at least on a personal level. I live in tiny area where everybody knows somebody who knows YOU. As a result, I find it downright impossible to work as anyone but who I really am. It will get back to me, my college, and eventually a future employer. I might sound paranoid, but my state is so small that I would be more surprised if this didn't happen than if it did.

For being more social, my concerns are similar: Too many people know each other around here. I'd rather tell a potential friend during transition, rather than now. Yes, if they are real friends, they'd stick with me, however, to the general populace (in a non-dating/relationship context), it looks easier to say that "I had/have a male body, but that's not who I am" as opposed to "I am a girl, despite that fact that I have a bass voice and look like a guy." I plan to get into some local support groups in a couple of weeks after my finals are finished, so hopefully that will help.

On the 3rd issue, cross-living for 3 months: This has me livid. He says this is according to SOC. That's fine, I have zero issues with the SOC. My issues are this: He treats the SOC as laws of the world, and must be enforced. As I said before, his facts, upon self-research are somewhat incorrect: It can be 3 months of RLE, as he said. Or, it can be 3+ months of therapy. I've had 27 months, which is certainly "at least 3." I can NOT pass right now, despite being only 18; I've been cursed with the lowest male voice I have ever heard or seen performed.

I am also concerned with his very frequent talks about sex. He asks what I think about during fantasies. This is also his specialty, he has written a few ED books over the years. Still, I don't care- that's my business and has nothing to do with my gender identity.  He also seems to think that I won't get a job, friends, etc. until after surgery; I have no idea why, I have never said anything of that nature.

My plan is ideally: Start HRT soon (like, this month or next), start my sophomore year as me, and get a job then! I don't see the issue with this, it's pretty much reasonable.

Any ideas for me? Despite having 35+ years in the field, is he a good GT for me?  I admit I need a lot of better work and social skills, but what should I bring up with him during my next session?

[rejennyrated]

I came up against someone like that back when I was 16. Sadly I didn't have the wisdom to deal with it. My advice is this: You basically have two options. You either find another therapist who will be more "flexible" or if that is impossible you tough it out and do the transition and 3 months.

You wont get anywhere arguing with a man who has already started to use the guidelines in defensive manner, so you either comply and prove his fears unfounded or you find another way forward.

I suspect that he is being like this because he knows that you feel that you can't pass - and he is worried that you may be hoping for bigger miracles with the HRT than will actually occur.

The sad fact is that in most cases if you cant pass to some extent without HRT you almost certainly won't without some level of FFS. So from his perspective the worst case scenario would be for you to take HRT and end up unable to pass as either male or female - stuck perpetually in between and therefore unable to get the job you need to afford the surgeries that you would need to succeed. That would be a very dark place to be in.

Bottom line he may feel that it is in your own interest to give you a real reality check. If your pass ability is as poor as you fear it is something to consider. You really don't want to end up unable to gain employment and unable to fund your surgeries, so securing a job and proving that you can hold on to it even when transitioned and at your worst really is the key to having a reliable way forward.

[Ann Onymous]

There are plenty of reputable endos and surgeons who will treat the TS patient who is seen by someone outside of the 'gender mill community.'  Neither of my letters way back when came from providers who had regular experience with transsexuals and I found my endo through the gay and lesbian yellow pages...he had known a few transsexuals but never had one as a patient.  He did not even require a letter from a shrink, being comfortable on his own that I had made an informed decision about moving forward with HRT. 

If you don't feel comfortable with the current provider, then look elsewhere.  It really IS that simple.  And in this day and age, it would be FAR easier to find someone willing to work with you than it was back in my day...

[Ann Onymous]

I am also concerned with his very frequent talks about sex. He asks what I think about during fantasies. This is also his specialty, he has written a few ED books over the years. Still, I don't care- that's my business and has nothing to do with my gender identity. 

sounds like you got stuck with one of the old-school minions that were the bane of my existence in my late teens...one of the idiots that thinks a true transsexual wants to move from the male life and into the role of heterosexual woman.  It was precisely that sort of thinking that cost me almost ten years of my life...

[Bird]

I believe the RLE experience before HRT should not be mandatory.

If you think it is going to be a bad thing for you, then don't do it and find another therapist. If your town is as small as it sounds, being outed so soon could be bad for you.

[Ann Onymous]

Three months RLE before HRT is absolutely absurd, and any trans-friendly therapist would never require that. People always seem to forget that they are the client and the therapist is providing a service. You don't like the service? Find a new therapist. Alternatively, if you can find a friendly doctor, you may be able to bypass therapy entirely.

It is absurd in this day and age, but it was not unheard of in the day of the dinosaurs (relative to treatment of transsexuals).  Unfortunately, not all of those dinosaurs are extinct...

[Bird]

It is interesting how things change from place to place.

I have been seing a psychiatrist for the past 5 months because I had depression major and panic disordersecondary to GID. Anyway, though he agrees I should go on HRT he says he himself can't do a thing about it. I went to two endos and both of them told me they knew nothing of HRT.

They all ofered to send me to services in the country who specialise in TG patients, but it would require traveling and more psychiatric evaluation. WIthout garantees. So the situation was that I would end up either doing a full circle visiting the single two other endos in my city or begin visiting random doctors from other cities.

I ended up settling for a GT I found online who has been helping me with everything, including my meds giving the situation I find myself in. Large TG population aside, Brazil health care system does little for us.

[BunnyBee]

First of all cross-living without the positive cosmetic effects of HRT AND getting a job are practically mutually exclusive.  Maybe you look fine right now or maybe you can find an open-minded employer, but realistically you will have work so much harder to get a job if you don't pass.

From the SoC:

Eligibility Criteria. The administration of hormones is not to be lightly undertaken because of
their medical and social risks. Three criteria exist.
1. Age 18 years;
2. Demonstrable knowledge of what hormones medically can and cannot do and their social
benefits and risks;
3. Either:
a. A documented real-life experience of at least three months prior to the administration
of hormones; or
b. A period of psychotherapy of a duration specified by the mental health professional
after the initial evaluation (usually a minimum of three months).
In selected circumstances, it can be acceptable to provide hormones to patients who have not
fulfilled criterion 3 – for example, to facilitate the provision of monitored therapy using
hormones of known quality, as an alternative to black-market or unsupervised hormone use.

On criterion #3, notice it's OR not AND.  I would bring this up to him or find a new therapist.  This one seems intent on being a "gatekeeper."

Also becoming socially active is much easier when you don't have the dysphoria associated with the wrong mix of hormones crushing your soul.

[Beni76]

It seems Jessica that my psychiatrist and your therapist has a few things in common and sometimes it is good to have a rant to release the anger of some so called experts assumptions, opinions and idealisms.
Mine is also a dinosaur and was asking me what I fantasize about when I play with myself. I said men but, I said I like women too though not to have sex with them and see myself as a bi sexual women. He said that is not possible, you can't do that, it won't work - there will come a time when she wants a penis and you won't be able to provide.

I was also previously in a hetrosexual relationship for nine years and he asked me that if I was able to 'perform'. I was stunned and was thinking really what is the point of this, why do people assume that the way you feel about your gender is all about sex? I guess it is an age old question that has been asked many a time . I did how ever say that I wanted to live as a woman but stay with her and he rattled off again.

He also said that I have to become more social able which I think is a valid point but, I think you also have a point Jen with the wrong mix of hormones can make you feel alienated . I would prefer to find another therapist but, resources are scarce where I am and I don't particulary want to relocate to a big city. I think I am getting somewhere with this psych even though last time I saw him he said HRT for me would be 12 to 15 / 18 months yet which I think is a bit extreme.

[Ann Onymous]

Mine is also a dinosaur and was asking me what I fantasize about when I play with myself.

That was one of the questions that teh first shrink I went to disliked my answer...he could not comprehend that I wanted nothing to do with the skin tag and that I derived no pleasure through it, hence it was not a part of the 'fantasy life.'

I said men but, I said I like women too though not to have sex with them and see myself as a bi sexual women. He said that is not possible, you can't do that, it won't work - there will come a time when she wants a penis and you won't be able to provide.

Oh geez...you got a double dinosaur.  While I don't grasp the whole bi-orientation, those I know who profess to be bi were at least in committed relationships and had toys to use if they really wanted something other than digital or oral penetration.  They could, at least in the context of the relationship, be perfectly content without a penis in the bedroom...